HomeMy WebLinkAbout0018 CHEQUAQUET WAY �4b;`,kt
..i14�e4r..r. 7'+C• •% �„ ..�. P�tf�:4 '}4 1, :�,'.
bl
TAB» '+'. �M n^:' r'� ;t •i:je�-r�y�..5. ''�. s.. $�i:
.• a+ .,]p;.:. e a ,: - w... r,., k .t« .. v..RI\xs.. �.1,vns! . eY�:,.s, l.. .42 r. .. -,Lv-:' 4 +. .y, ....:3 ,zs r. R
..,:, . .... g.._. ,,..,.. Rrf' o,.r,1. l.,e y .;n., stY`-< d .awa. 7r� r ..F. .•�.• :.[i..
VI
;4,
,,.,. r« _rst .. i r:4x...�J -ru.;. t!._ r -. ,.t,..r.. Ayrr�..,i. _'u�. ,1:• .':..
,:[ 'S>•��.�`'' ale �{,�� -
a
#yo-:u� $,. �Y��..., �,•l,� ..:r ti?y: R,'s.. ! .f ,id" 5 S.:*�' �. .� •C �,J,. �j - « h
y.♦ . P e..�r �i,c
f, yrx�. ��, V Fr,, . ... .Y+G+,� qn. L.1- 6 A CF K •F'
+L�X,„•��,[��,,a r•7 :)g 4...'k: �. ^'�r�. .ti•�.6,.• t•r �.� tr .�"'
t' S�`.c?. �'i' ,-,-�. ,!T.x�'. 1.. «, .t ..f.vR.- is�`.° .% >• 'C.1
r.i:'.' .�.fr"-0, 3., u
! ...�t,°+Y.�ahr) .y �.zc. f '2'.� �.,e 5n. ✓.. k }, -d .NET
tr
F'Spj« '� "'. �� •°', b r' °' Ye
r. Bx �a�', Ds � t J � .r . a,, s•� Me � _9 $ °� p o�
a�
� a
rma � � D �•� �pwc `" c r �.. of a °, �� w� ,{ �.
n
C 4
10 a
rk
tI
STe M4' 6
jr
f K
m
a
i
� u
rt.•� E 4 .~z �. a+ 'a �: �+ a '�,�, r. nu. �l c t,� +:.W
e a
-
' r
a
t
c
,
r n w
6 p,f+ �5� �Q p' a tip l- a ua' � p � r 7N: "� d'" � 14�:u W - r• �„
,
c " a, b
S _, .h` h• fir'' ,� a 'ei �., y «u, r
u
V �
c
r
B
N
' u
Town of Barnstable . <��C( D le -ft%,�,W Building
t Post This Card So'That it isVisible From the Street Approved Plans Must be'Retained on Job and'this Card Must be Kept
YABEVSTABLE,
KAS& ` Posted Until'Final"Inspection Has Been-•Made. . yam 1
Where a_Cert cafe offOOccupancy is4Required;such Building shall Not be Occupied until a FinalJnspection has beenjr6cle_ i ei llll 1,
Permit No. B-19-2676 Applicant Name: Robert Rostocka Approvals
Date Issued: 08/20/2019 Current Use: Structure
Permit Type: Building-Insulation-Residential Expiration Date: 02/20/2020 Foundation:
Location: 18 CHEQUAQUET WAY,CENTERVILLE Map/Lott' 191-010 _ Zoning District: RC Sheathing:
Owner on Record: HIBBARD,RYAN SCOTT .. Contractor Name ROBERT A ROSTOCKA Framing: 1
x
4,
Address: 18 CHEQUAQUET WAY Contractor License:_113252 2
51
CENTERVILLE,MA 02632 Est Project Cost: $4,477.00 Chimney:
Description: Insulation&Air Sealing. $ Permit Fee: $85.00
i Insulation:
Project.Review Req: Fee Paid.` $85.00
Date. 8/20/2019 Final:
�" �CLsss(rn Plumbing/Gas
7,
' Rough Plumbing:
_ _' � ' BuildingOfficial
Final Plumbing:
This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance.
All work authorized by this permit shall conform to the approved applcatiorrand thefapproved construction documents for which this permit has been granted. Rough Gas:
All construction,alterations and changes of use of any'building and structures shall be in compliance with the local zoning by-laws and codes.
This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for_public inspection for the entire duration of-the ' Final Gas
work until the completion of the same.
Electrical
The Certificate of Occupancy will not be issued until all applicable signatures.by the Building and Fire`Officials are provided on this;permit.
Minimum of Five Call Inspections Required for All Construction Work: Service:
1.Foundation or Footing
2.Sheathing Inspection Rough:
3.All Fireplaces must be inspected at the throat level before firest flue lining is installed
Final:
4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection
5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough:
6.Insulation
7.Final Inspection before Occupancy Low Voltage Final'
Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health
Work shall not proceed until the Inspector has approved the various stages of construction.
Final:
"Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A).
Building plans are to be available on site Fire Department
All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final:
Town of Barnstable ..-,. Building
t This Card So That it is Visible From the Street-Approved`Plans ' p
Pos Must be Retained on Job and.this Card Must be Kept
MAS&
iPosted Until Final Inspection Has Been Made. . °
034. ♦ I e r 1
Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final,lnspection has been made.
Permit No. B-19-1311 Applicant Name: HIBBARD,RYAN SCOTT Approvals
Date Issued: 04/19/2019 Current Use: Structure
Permit Type: Building-Smoke Detector-fire Alarm Dection Expiration Date: 10/19/2019 Foundation:
System Ma Lot: 191-010 Zoning District: RC Sheathing:
Location: 18 CHEQUAQUET WAY,CENTERVILLE u
Contractor Name:'- Framing: 1
Owner on Record: HIBBARD, RYAN SCOTT Contractor license: 2
Address: 18 CHEQUAQUET WAY Est Proje
y�ct Cost: $0:00 - Chimney:
CENTERVILLE, MA_02632 Permit Fee: $35.00
Description: Adding Smoke Detector-hardwire system on first floor and f Fee Paid:, $35.00
Insulation:
basement ` Date 4/19/2019 Final: J
Project Review Req: FULL UPGRADE OF SMOKE DETECTORS.
` Plumbing/Gas
- Rough Plumbing:
Building Official
This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commencedwithin six months after issuance. Final Plumbing:
All work authorized by this permit shall conform to the approved application and the approved construction documentsfor which this permit has been granted. Rough Gas-
.All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws-and codes.
This permit shall be displayed in a location clearly visible from access street or road'and shall be maintained open for public inspection for the entire duration of the Final Gas:
work until the completion of the same. .'
The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit: Electrical
Minimum of Five Call Inspections Required for All Construction Work: Service:
1.Foundation or Footing y tP
2.Sheathing Inspection Rough:
3.All Fireplaces must be inspected at the throat level before firest flue lining is'installed -
4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Final:
5.Prior to Covering Structural Members(Frame Inspection)
6.Insulation Low Voltage Rough:
7.Final Inspection before Occupancy
Low Voltage Final:
Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations.
Work shall not proceed until the Inspector has approved the various stages of construction. Health
"Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final:
Building plans are to be available on site Fire Department
All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final:
------ ---- ----- -
Application Number:.� ..........................
MAS& Permit Fee.......................................Other Fee........................
0,19.
TotalFee Paid............................................................... ......
TOWN OF BARNSTABLE Pem3it Approval by... A-O/....................OnAtIlby........
BUILDING PERMIT q .Parcel.........OLD.......................
MV.......................................
APPLICATION
Section I — Owner's Information and Project Location
Project Address 14,071J,-401W lAkil Village
I - I
Owners Name k3o
A,
Owners Legal Address we,
Y
City cemeyvilit State Zip Dili
Owners Cell# 50k 340 09V E-mail
F— Section 2 —Use of Structure
Use Group_ F-1 Commercial Structure over 35,000 cubic feet
❑ Commercial Structure under 35,000 cubic feet
Single/Two Family Dwelling
Section 3 — Type of Permit
E] New Construction ❑ Move/Relocate [] Accessory Structure E] Change of use
❑ Demo/(entire structure) El Finish Basement El Family/Amnesty F1 Fire Alarm
Rebuild El Deck Apartment El Sprinkler System
❑ Addition E] Retaining wall F1 Solar
El Renovation El Pool El Insulation
Other—Specify
Section 4 - Work Description
41"e- A"6x 5xSPeA? zan ifest e- 4oVJ
Last wdateZ- 11/15/2018
T
Application Number.....................................................
Section 5—Detail
Cost of Proposed Construction Square Footage of Project
Age of Structure Dig Safe Number
#Of Bedrooms Existing '` 0 Total#Of Bedrooms (proposed)
110 MPH Wind Zone Compliance Method ❑ MA Checklist ❑ WFCM Checklist ❑ Design
Section 6—Project Specifics
El Wiring Oil Tank Storage Smoke Detec
tors
1 ,
❑ Plumbing ❑ Gas ❑ Fire Suppression
❑ Heating System ❑ Masonry Chimney ❑ Add/relocate bedroom
Water Supply ❑ Public ❑ Private
Sewage Disposal ❑ municipal ❑ On Site
� sP P
Historic District ❑ Hyannis Historic District ❑ Old Kings Highway
Debris Disposal Facility: I am using a crane ❑ Yes ❑ No
Section 7—Flood Zone
Flood Zone Designation
Within or adjacent to a wetland,coastal bank? Yes ❑ No ❑
Section 8—Zoning Information
Zoning District Proposed Use Lot Area Sq. Ft.
Total Frontage Percentage of Lot Coverage #of Dwelling Units (on site)
Setbacks Front Yard Required Proposed.
Rear Yard Required Proposed
F
Side Yard Required Proposed
Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No
Last updated. 11/15/2018
Application Number...........................................
Section 9= Construction Supervisor
Name Telephone Number
Address City State Zip
License Number License Type Expiration Date
Contractors Email Cell#
I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780
CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and
documentation required by 780 CMR and the Town of Barnstable.Attach a copy of your license.
Signature Date
Section 10—Home Improvement Contractor
Name Telephone Number
Address City State Zip
Registration Number Expiration Date
I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780
CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and
documentation required by 780 CMR and the Town of Barnstable.Attach a copy of your H.I.C...
Signature Date
Section 11 —Home Owners License Exemption
Home Owners Name: A
"914Z
Telephone Number '50 3"d 3�1 Cell or Work Number
I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780
CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and
documentation re y 0 the ToNp of Barnstable.
G 1gl�
Signature :. Date f!/ 9
APPLICANT SIGNATURE
`Signature / 'Itf Date
L14441z—Pant Name �� /� Telephone Number 5 b
E-mail permit to:
Last updated: 11/15/201 if
Section 12—Department Sign-Offs
Health Department ❑ Zoning Board(if required) ❑
Historic District ❑ Site Plan Review(if required) ❑
Fire Department ❑
Conservation ❑
For commercial work,please take your plans directly to the fire department for approval
Section 13— Owner's Authorization
I
I, , as Owner of the subject property hereby
authorize to act on my behalf, in all
matters relative to work authorized by this building permit application for:
(Address of job)
Signature of Owner date
Print Name
Last updated:11/15/2018
Y DATE C
p f,T ,B cBU1LDINGDEPT. .
C
DEPARTME ST DATE
SvTFt SIGNATURES ARE REQUIRED FOR PERMITTMO
Ile
7
f .
a
�� 06
QX The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations"
600 Washington Street
Boston,MA 02111
www mass.gov/dia j
Workers' Compensation Insurance Affidavit- Builders/Contractors/Electricians/Plumbers
Applicant Information` Please Print Legibly
Name (Business/Organization/Individual): /Jit
Address: chtquaq y-f "o
City/State/Zip: �' �i� aZ 5Zf` Pho116#: .50� 3G0 39 92
Are you an employer?Check the appropriate box: Type of project(required):
1,❑ I am a employer with 4. E] I am,a general contractor and I'
employees(full and/or part-time).* have hired the sub-contractors
6: New construction
2.❑ 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.
working for mein any capacity. employees and have workers'
9. El Building addition
[No workers',comp.insurance comp.insurance.:
required] 5. E]^We are a corporation and its' 10.07Electrical repairs.or additions
3. am a homeowner doing all work officers have exercised their 11(. Plumbing repairs or additions
myself[No workers comp. ri .t.of exemption MGL. P P 12.0 Roofrepairs`.
insurance required,]t c..152,§1(4),and we have no
employees. [No workers' uEl Other .
comp;insurance required.]
*Any applicant that checks box#1 must also fill out the section.below showing their workers'compensation policy.information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
$Contractors that check this box must attached an additional sbeet:showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractor;have employees,they must provide their workers'comp.policy number: .
I am an employer that is providing workers'compensation insurance for my employees. Belo_w is thepolicy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lic.#: - Expiration Date:
Job.Site Address: City/State/Zip:
Attach a copy of the workers'compensation policy declaration page(showing the policy.number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c: 152;can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for ins,rrar,ce.coverage verification.
I do hereby certify under a pains and penal' of perjury that the information provided above is true and correct
Si ature:z" Date: y! l911 .
Phone#: 368 310 ygV
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.CiVrown Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
Information and Instructions .,
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire,
express or implied,oral or written."
An employer is defined as"an individual;partnership,association,corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise,and including.the legal representatives of a deceased employer,or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein;or the occupant of the
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152,§25C(6)also,states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the perforinance of public.work until acceptable evidence of compliance with the insurance
requirements of this chapter have.been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,are not required to carry workers'.compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be retumed 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
Depmllnent 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 4-24-07.
www,mass.govfdia
�'THE> Town of Barnstable *Permit#
Regulatory Services Fees6monthsjromissaedate
t BAMSras[.e, o 1 c
y Mass. g, Richard V.Scali,Director
039. �0
A,ED1�,tp Building Division '► °
Paul Roma,Building Commissioner s
200 Main Street,Hyannis,MA 02601 ®� Fp 3 0
www.town.barnstable.ma.us ��� 20Pe
Office: 508-862-4038 FAQj 08-790-6230
EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY
_ Not Valid without Red X-Press Imprint
Number � � _.. 4
P P ��l 6� T—�"~
Property Address—— C l t? fi WAl C' . r 1„ Ile
ff'Residential Value of Work$ GUU Minimum fee of$35.00 for work under$6000.00
Owner's Name&Address b
��S C.!/i.0(19()(��-�f' GVa�, �`P�t�r�•illF
Contractor's Name Telephone Number
Home Improvement Contractor License#(if applicable) Email:
Construction Supervisor's License#(if applicable)
❑Workman's Compensation Insurance
Check one:
❑ I 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
VRe-side
roof(hurricane nailed)(not stripping. Going over existing layers of roof)
❑ Replacement Windows/doors/sliders.U-Value (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 Home Impro ment Contractors License&Construction Supervisors License.is
re ed.
SIGNA
TURE:
/"
QAWPFILESTORMS\building permit forms\EXPRESS.doc
06/20/16
r
.,
' 27ze Conzrnarmealth of Massachusetts
Departrnerrt�r•f rnda rush iaiAccidads
- Q}f ire of rmwsfigafions. ,
# 600 Washington Street
'.Boston,M4 02111
N%Turk-ers' Campensaf an Insurance Affidavit-.Srlders/CuntraciursMectr cianrJPhmibers
A�lr pHcant Infarmaf nu Please Print f e�'iliv
Name(BZ15rnESSf�F�an�t}II/��erinal}
Address
City/S ate(Zily - Phone w '
Are you an employer?Check the appropriate boar: Type of project(required}:
1.❑ I am a employes with 4 ❑I am a general cmfractor and I 6_ ❑New constKudion
employees(full arldfor part-lime * Dave hired the sub-contmcfors
Remode
2.El I am a sole eto>f or . es fisted au the attached sheet~ 7_ ❑ Sing
Mese sub-contractors have
stop and have no employees $_ Q Demolition
w g far ma in an employees and have ivormrs'
ad�.nb y � 9..❑Building addition
INo wodmm'comp.it swanre comp-insucancel
5--❑ �,�41e area corporation and its 1Q❑Electucal repairs or addifiom
equtred� officers have exercised their 1L Plumbing re airs or additions
3. am a homeoumer doing all wade ❑ 1? P
myself[No workers'gip- refit of eaetupfiog per I4IGL 17.❑Roofrepairs
r�cetra„rerequired i c.152 §IM andwehaveuo
;
employees.[Na vmzken' -❑¢?flier
comp_m u mm required_]
'Amy WKcat$wt chadabos#1 mast also facli the section belaw sltowkg iheawolkEe ca®peasatianporugimo=a9mL
t l ameawners who submit d s atiidaru inffcaGug they are&mg allwc*sad then hire outside contrRaorsnmst sohmit anew affidxe t:mdir�ne rnrFf
ICantnic I is tfist cbecf this box must attached sm addifians2 shad showh3 g the name of die sub-camaxctan sod state whether ar nat those entities bAw
employees.Ifthesobtoatmct,,mh ceempiope%they=nsrpmridethes workm'o=p.polignium3ser_
I am art enipLoyer that is prauiding Warkers'congwisrdion imurance for Esty eirrph4wes $elow is the policy and job site
information,
Insurance Company Name:
Policy 4-or Self-ins-Lic_; ExpirationDade:
Job Site Address CrtylState 22p:
Bch a—copy of fire workers'compensationpolicy declaration page(shoving the policy number and esphmfloa date).
Fail=to secum coverage as required under Section 25A of MC L c.L527 can lead to the imposition of criminal penalties of a
flue up to$1,5OUG andfor mie-y6irimprisonmenk as well as civil penalties. th
e o form of a STOP WORK ORDER and a fie
of up-to$250-00 a day"abainst the i,3olator. Be ad,,ised'that a copy of this statement maybe fxwarded to the Office c&
Investigations ofthe DID for insurmw coverage veriffCafiom_
I do& re.&Y cerhfj,r i t z i r vfFei juiy diattlts mf armatfon prm &i abmre rs true mid carrect
Sisnattrre_
Datp- 91-W1 4
Phone i- 99,9
o9
f1,�eiaL�arils: �T]o irat isrite it7 flies area,tfx 5e CO'illFJlreted 5y tdip artanrn afficiat
City or Town: PermitUcense#
Issuing Authority(c rde one):
L Board of Health 2.BuffTing Department 3.(ityffowa Clerk 4 Electrical Inspector S.Pkm.bmg Inapecter
(.Other
C'omfact Person: Pht► it:
-- --- -- - -- - 6
laformation. and Instmetions
Massach setts General Laws chapter 152 rmpirm all=mpIqy=In provide woik=7 compensation for their empIoyees.
pit t„this sbatotp-,an mnp&ye is defined as`_.everypersonin the sm-vice of another under aay cozract ofbfre,
express or nnphed,oral or ."
An Moyer is de fined as"an inTNiCIUA partnership,association,corporation or other legal entity, or any two or more
of the foregoing engaged is a Joint=tmpase,and including the Iegal representatives of a deceased empIoyer,or the
receiver or trustee of BU individnal,parl[2=ship,association or otherlegal 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 aQofher who empIoys persons to do maintenance,construction or repair woi on such dwelIiug house
or on the gmzmdsror burldm' g app $ereto shall mtbecause of sash employment be deemedto be m employer."
.'MGL chapter 152,§25C(6)also status that"every state or local licensing agency shall withhold ffie issaance ar
renewal of a Been a or permit to operate a buskess or to construct buildings in the commonwealth for any
applicant:who has not produced acceptable evidence of compliance with tb:e in=rance eovaxage requu-ed."
AdditionaIly.MGL chapter 152,§25C(7)states'Neitherthe.commauwealth nor aiy ofifs political subdivisions shall
enter into any contract for the perfmmmm ofpnbho work unfit acceptable evidence of campli.anee with fhe msu�ce..
reTii emus of this chapter have been presented to tho contacting alfhoa� "
Applicants
Please fill oiu t the workers' compensation affidavit completely,by cherlang ffie boxes�apply to your situation and,if
necessary,supply sob-contractors)name(s), addresses)and phonenumber(s) along with their cerfifrcate(s) of
znmi a ce_ LmaitedLiabdity Compamcs(LLC)orL=te:dLiability Partnerships(LLP)withno employees other thaathe
members or partners,ale not requimd to cant'workers'compensation insurance. If an LLC or LLP does hate
employees,apolicy is required. Be advised thattbis affidayrt may be snhmitted to the Department of Indusf ial
Accidents for conformation of ins farce coverage_ -Also$e sure to sign and date-.he affidavit.- The affidavit should
be refnzaed to the city or town that the application for the permit or Iicense is being requested,not the D epemeat of
Inrhnstri 1 Accideats. Should you have any questions regarding the Iaw or if you ate required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-iosvred companies should enter their
s elf-insarnce license number an.the approFdate line.
City or Town Officials
t � _
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space st the bottom
of the affidavit for you to fill out in.the event the Office of7n7estigaiions has to coa act you regarding the applicant_
Please be sure to f Dl in the penni0icense mmbes which will be used as a reference number. In addition,an applicant
that must submi<multiple pe�itlIicense applications in any given year,need.only submit one affidavit indir.�cmrent
policy information Cif necessary)and under'gob Site Address"the applicant should write"aIl locations i a (may or-
town):'A copy of the-affidavit that has been officially sipped or mad ce;d by the city or town maybe provided to the ' '
applicant as-proofthat a valid affidavit is on file for furore pemlifs or licenses- Anew affidavit mast be tilled oi±each
year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial veninn e
(Le. 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 aay questions,
please do not hesifatr to&,-,us a call.
The Depar mf's address,telephone and fax number_
-fie C.ammMWe as *of Massaah2n sett , .
Depa�mt of h idusf dal Accident%
f�ics of �fio�
�Q4 man Sire
B MA Oil11
Tf�-L 4 617' -4900 QEd 4-06 or I977-MASSAFE
Fax 6I7 727;7M
Revised¢24-07 z�as �fdia
P r
Town of Barnstable,.
Regulatory Services
MA Richard V. Scali,Director.
163 ,.
Building Division.
Paul Roma,Building Commissioner
200 Main Street,Hyannis;MA 02601
www.town.barnstable.ma.us
Office: 508-862=403-8----- .... --`-... Fax: 508-790-6230 ---
r
Property Owner Must
, z
Complete and Sign This Section ,-
If Using A Builder
I _ ,as Owner of the subject property
hereby authorize to act on ray 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 Owner Signature of Applicant
Print Name Print Name
Date ,
'
QYORMS:OWNERPERMISSIONPOOLS
Town of Barnstable '
Regulatory Services
oFTiiF ,y Richard V.Scali,Director
Building Division
Paul Roma,Building Commissioner
MASS. �.
1639• 200 Main Street, Hyannis,MA 02601
AlEo Mai www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
C) 3 U�/6 Please Print
DATE: j /'l
JOB LOCATION: � C/I.(ei Ila gut�- WL'�/
number _ _/ treet village
"HOMEOWNER": &Q1 �O f�G1�'/ 6 0 9!70?
nime home phone# work phone#
CURRENT MAILING ADDRESS: Cli,i AiuC�9iv GUGh/ �+5 �"
e&IH.--011e rn)*- sac 3�
city/town state zip code
he 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
The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,
bylaws,rules and regulations.
The undersigned` meowner"certifies gi34 he/she understands the Town of Barnstable Building Department minimum inspection
procecturesAm'd s e will comply with said procedures and requirements.
ign o H eowner
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
this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in
your community.
Q:\A'PFILES\FORMS\building permit forms\EXPRESS.doc
06/20/16
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
4 no',vtj r AR STABLE ele
Map Parcel 0, !� i�•¢ Application v!�� r
Health Division '_r y r r F r` '` Date Issued SA f It 5
Conservation Division Application,Fee
Planning Dept. r§� +� '^ " :.R. Permit Fee
Date Definitive Plan Approved by Planning.Board
Historic - OKH _ Preservation / Hyannis
Project Street Address �� e-A u c r L)c-r c-tW .4 41
Village l/_ W-rZ4✓ f 11-C
Owner /� �.,4.�1 �1 �J�a C, Address J,410 e.
—.Telephone SbOP— 34 o - 3 51 T-Z
Permit Request �-4- �oc,,bJ 1Ld isT�.✓s C�d�rv�.ve ! . Go,� �rr� c /t
a2 w_ SI�E.a ,4 0/,,Il Ti 64) s,4 : 4-oC4-71o,d eve- c,,' d-0
wt �� SIT UN 1Z-X1J7_/n/1r Fou.jbA-r10A) a 1--oo-r A,/ w, e/ Iyyr CJM, SL
A d 171W/ W f S/ N bu,.re Fu-ru rce R 1 Fi�a G-c- e
Square feet: 1 st floor: existing proposed 2MIoor: existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuation#444Q•dd Construction Type
Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units)
Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No
Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other
Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft)
Number of Baths: Full: existing new Half: existing new
Number of Bedrooms: existing _new
Total Room Count (not including baths): existing new First Floor Room Count
Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other
Central Air: ❑Yes ❑ 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
i
APPLICANT INFORMATION
(BUILDER OR HOMEOWNER)
Name ��,�.�/ �', �JG',►'cr Telephone Number ''5-D 3 60
Address /�' C�1 r'4���l ���-� w/s� License #
r CP.yYdi�.✓a�s'rc. Home Improvement Contractor#
Email Worker's Compensation #
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
bPA7 OU
SIGNATURE DATE-*
{ FOR OFFICIAL USE ONLY
APPLICATION#
DATE ISSUED
MAP/PARCEL NO.
ADDRESS VILLAGE
OWNER
Al
DATE OF INSPECTION:
FOUNDATION
FRAME
c
y INSULATION
z
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
;a
GAS: ROUGH FINAL
FINAL BUILDING l�01 h - yfia l
DATE CLOSED OUT
ASSOCIATION PLAN NO.
riwencr7rv�tzWsacttrese=
rA Pw*nentoflndm*iff1Acdd6z&
Office of&mfigadons
- 600 Washington Street
_ Boston,M4 02111
www.massgovliffa
Workers' Compensation Insurance Affda.,vibBwlders/Contractors/Elecfricians/Plmnbei-s
�Applicant Information A PIease Print Legibl,'
�:-Name(BusincsdOrga�m&d;o&4: �'�/�✓ / ,�z�,i
-City/So3fe%Zip: �' -------------------
X d �e%9 Phone#: A-Sb
e you an employer?Check the appropriate bow ; Type of project(require:
1.❑ I am a employer with 4. ❑I am a general contractor and I
* have hired the sub-contractors 6. ❑New construction
employees(firIl and/or part time)_ . .
2.❑ I an a sole proprietor or partner- listed on the attached sheet 7. Q Remodeling
ship and have no employees these sab-cautractors have S. [.-demolition 'r
woriong for me in'aay capacity. employees and have worisers'
[No workers comp,inst� comp.msnranrr.t 9• aa.
5. We are a corporation and its I0.❑Electrical repairs or additions
3: w wI am homeowner doing all work officers have exercised their I I.❑Phmibing repairs or additions
myself [No wo�'comp. right of exemption per MGI. I2.[f Roof repairs
insmmce ]t c.152,§1(4),and we have no
employees-[No workers' 13.[]Other
coup.msor nce reqnfied-]
*Any applicant that checks box#1 must also fill on±the section below showing their worker'compcnsdion policy inh—fion.
t Homeowner who submit this affidavit indicating they arc'doing all wort and thm hie outside contactna most submit ancw affidavit indicating such.
$Coutzarns that check this box mast aftaehed an additional shoot showimgthe name of the sub-conhaemrs and state whether or not those caMics have
employees.If the sub-conlnelnts have emiployecs,they roust pmYide thcr wow'comp..policy mmnbec
I ain an employer thot is pravidi g workers'compensation insurance for my employees. Below is the po&cy and job site.
information '
Insurance Company Name:
Policy#or Self-ins.Lic.# r ExpirationDate:
Job Site Address: cfty/stodzip:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section25A of MGL e.152 can lead to the imposition of crhnind penalties of a.
one up to$1,500.00 and/or one-year imprisomneat;as well as civil penalties in the fur_m of a STOP WORK ORDER and a fine
of vp to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the O$ice of
Investigations of the DIA for iasnraace coverage verification.
I do hereby certify under the aims and penalties ofpm jrny that the information provided above it true and correct-
�S"���� • — ' Date: , /
Phone#
Official use only. Do not write in fhis area to be conpkted by city or town ojkiaL
City or Town: PermitlLicense#
Issuing Authority(circle one):
1.Board of Health 2.BnildmgDepartnnent 3.City/Town Clerk 4,Electr7ical7nspector 5.Plumbinglnspector
6 Other
Contact Person: Phone# ,
r Information and Instructions .
Mxrccarht�s Geheral Laws chapter 15Z requires aII employers to provide workers'compensation fur their employees.
Pursuantto this staiife,an emplayee is defined as".:.every person in the service of another under any contract ofhire,
express or implied,oral or writer."
An emplayer is defined as"an individual,pazinership,ass=iatiwc corporation or other legal entity,or any two or more
of the foregoing engaged in a Joint m&xprise,and inch&ag the legal repmsenudves 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 t3=apartments and who resides therein,or the occapant 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.
" old the issuance or
52 25 also states that'every state or local licensing envy shall withhold MGL chaptPs 1 ,§ C(� �y g� -
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,MGM chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance ofpublic wont until acceptable evidence of compliance with the insura cd.
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers'compensation affidavit completely,by chmldug the boxes that apply to your situation and,if
necessary,supply sub-contractor(s)name(s), address(es)and phone numbers) along with their cmtfcate(s)of
insurance. Limited Liability Companies(I.LC)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,apolicy is required Be advised that this affidavit maybe submitted to the Department of Industrial
Accidents for confirmation of incrTrance coverage. Also be sure to sign and date ithe affidavit The affidavit should
be retuned 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-insrn-ed companies should enter their
self-insurance license number on the appropriate lime.
City or Town Officials
r
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 peimit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple permMicense 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 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 tzi buts 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.
-Thy Commmwedth-of I achusetts
Department of ludu%fzid Accidents
office of j VCSffgatio=
600 Wasbingtan Siz=t
8ostau,MA E1�11�
TeL#61 t-727-4900 cxt 4€16 or I-977-MASSAFE
Fax#617-727-7749
ww Revised 424-07 .maz—goof dia
Town of Barnstable
'Regulatory Services -
��me roryy Richard V.Scab,Director
Building Division
Tom Perry,Building Commissioner
1639- .m� 200 Main Street; Hyannis,MA 02601
CEO" A - www town barnstable.ma.us
1
Office: 568-862-4.038 # . Fax 508-790-6230
HOMEOWNER LICENSE EXEMPTION_
-
roB LOCATrorl /r� C A e v-4 Q c-r i i A. '&t u,d 4�
nombcr village
-HOlE C dd —3`OOE � /
name home phone# work phone#
CURRENT MAILING ADDRESS:
city/town Stitt 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 undersign d"homeowner"certifies that he/she understands the Town ofBarnstable Building Department minimum inspection
procedur d re that he/she will comply with said procedures and requirements.
[Siewfir=of Homeowner J ,, *
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 suchUomeowner 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 Iicensed 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.-\WPFILSMRMS\bufldmg permit forms\EXPRESS.doo
Revised 061313
EVE Town of Barnstable
° Regulatory Services
Richard V.Scali,Director
' 6 �, 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
L ` , as Owner of the subject property
hereby authorize to act on my behalf,
i
in all matters relative to work authorized by this building permit applicatio r.
(Add
re
fences rperforined
re the sponsibility of the applicant. Pools
are not to blized be ore fence is installed and all final
inspections and a epted.
Signature of Owner ignature of Applicant
Print Name P�int Name
Date
Q:F0RMS:0WNFRPERMISSI0NP00IS
! 'y
CX\ , � /ate ♦ .. .,
�sy �
F
u
< GG r t
e
� M
|
| .
|
a [
� � w
�
( . .
-
�
\k ¥ a e� .
. $ C
. • � � C
\
!
z �
a
F
h k,
i
ll��Ik
f .
i
A�FVC'Grci le to Wood Construction in Hide bind Areas:110 ticph EV1nd ZoriC
Massachusetts Checklist for Compliance(78o Cn'(R53oi:2.l.1)' -
Check
CompHan
1.1 SCOPE
Wind Speed(3-sea gust). ................. ............... ...................... 110 mph 7
Wind Exposure Category..........................................
... ....... ............................ ................................................
.................... .B
Wind Exposure Category............ Re
quired equired For Entire Project.....................I..................C
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) ........................................... -<12:12
MeanRoof Height•..................................................... (Fig 2)...................................... ft 5`33'
Building Width,W °
.(Fig 3).......................... .......
ft 5 80'
Building Length, L ................................................. ......(Fig 3).............................................. t�-•ft s 80'
Building Aspect Ratio(L/W) ..............................................(Fig 4).................................................
�__<3:1
Nominal Height of Tallest Opening; ...................................(Fig 4)................................................. 6' 1
:..,.
1.3 FRAMING CONNECTIONS
General compliance with framing connections. .......(Table 2)...............
2.1 FOUNDATION
Foundation Walls meeting requirements of 780 CMR 5404.1
Concrete............................... 'f7
ConcreteMasonry........................._........................................................................................:................ -�
22 ANCHORAGE TO FOUNDATION" v
5/8"Anchor Bolts=imbedded or 5/8'Proprietary Mechanical Anchors as an alternative in concrete only
Bolt S pacing-general.........................................(Table4)......... .�.... 3a in.
-Bolt S pacing from endroint of plate.............................(Fig 5).....................:..............•-L In..:5 6"-12".Bolt Embedment-concrete..........................................(Fig 5 '
Bolt Embedment-masonry
............................................................;......................(Fg 5)...........r....................._.........- T in.a15'
.......... 3"x3'x'Plate Washer..:... (Fig 5). ......................... •-----........-- K ,✓
3.1 FLOORS
Floor•fiaming member spans checked ...............................(per 78b CMR Chapter 55).............................
_.._. /�
Maximum Floor Opening Dimension..................... .....(Fig 6 '
Full Height Wail Studs at Floor Openings less than 2'from Exterior Wall(Fig 6
AOL
Maximum Floor Joist Setbacks ( g ) ......................................
. . .
Supporting Loadbearing Watts or Sheanvall :..............(Fi9 7)...................................................T ft s d
Maximum Cantilevered Floor Joists
Supporting Loadbearing Walis'or Shearwall................(Fig 8).........:................... ... _ft Id
............... .....
FloorBracing at Endwalls.................... .............(Fig9
Floor Sheathing Type ........................................................(per 780 CMR Chapter 55)...................................
Floor Sheathing Thickness ...........................................:....(per 780 CMR Chapter 55).................. fn_ �l
Floor Sheathing Fastening......................... ...... ` .(Table 2).._d nails at in edge 1 in field 'e6/J
4.1 WALLS .
Wall Height
Loadbearing walls. ................... .......................(Fig 10 and Table 5)........................'a, ft <-10, ✓
Non-Loadbeadng walls.... .........................:...........(Fig 10 and Table 5)....:.............. ft'S 20'
Wall Stud Spacing ..................:.......................................(Fig 10 and Table 5)...................-ft"n.<-24'o.c.
Wall Story Offsets ............... ...... ....................(Figs 71(8)............................................. -ft-s d
4.2 EXTERIOR•WALLS'
Wood Studs
Loadbearing Yvallp........:..................................... .(Table.�).. ....................-.2x 4 -37 ft D in:
Non-Loadbearing walls...............................................(Table 5)......... ..................2x`( ft .D in. �✓
Gable End Wall Bracing
Full Heidht Endwall Studs............................................(Fig 10).......... .... `, ........ AY,A.
WSP•Attic Floor Length............................:.................:(Fig 11)_....................................... ft zW/3
Gypsum Ceiling Length(if WSP not used)....................(Fig 11)..._........................ ....,. .......... ft 2:0.9W
and 2 x 4 Continuous Lateral Brace @ 6 ft.o.c...(Fig 11)..............................................................
or 1 x 3 ceiling furring strips @ 16'spacing min.with 2 x 4 blocking @ 4 ft.spacing in end joist or truss bays
2
Double Top Plate
Splice Length . .................:......................................(Fig 13 and Table 6)....................................
Splice Connection(no.of 16d common nails)..............(table 6)....................................
.......................= �j�-
ip-
AN C Gilyde to Wood Construction in Higlr Wind Areas: 11 D fnph Wind Zone
Massachusetts Cheddist for Compliance (780 CiViR53"o1.2.1.1)r
Loadbeanng Wall Connections
Lateral(no.of 16d common nails)................................(Tables 7).....................................................
Non-Loadbearing Wall Connections
Lateral(no.of 16d common nails)................................(Table 8)....................................................... L
Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9)
Header Spans ........................................................(Table 9)...................................Q 11_in.511'SIR Plate Plate Spans .. ..... .... ....................(fable 9).................................Q ft in.511' ac,rf.
Full Height Studs (no.ofstuds)..................................(Table 9).............................................. .... A/4
Non-Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9)
Header Spans...... able g ft_in.51 z iY
SillPlate Spans...........................................................(fable 9).................................._ft_in.5 12'
Full Height Studs(no.of studs)....................................(Table 9).......................................................
Exterior Wall Sheathing to Resist Uplift and Shear Simultanbously4.
Minimum Building Dimension,W
Nominal Height of Tallest Openingz ............................................... ..............................
SheathingType.................•---........ ............(note 4)::.. ................................................ z ✓
Edge Nail Spacing.........................................(Table 10 or note 4 if less).........................�in. v
Field Nail Spacing � able 10 ,L"in.
.. ..
Shear Connection(no.of 16d common nails)(Table 10)..... ............................................. 2
.
Percent Full-Height Sheathing........:..........:...(Table 10)....................................................jW %
5%Additional Sheathing for Wall with Opening>6'8'(Design Concepts).................... �f�Y
Maximum Building Dimension, L
Nominal Height of Tallest Opening2............................................................ ..
.•...__•_.•
Sheathing Type.................:. ...(note 4)..................................................... 1 z
Edge Nail Spacing.........................................(fable 11 or note 4 if less) ... Y— in. ✓
Feld Nail Spacing.....................:.................:..(Table 11).........................................I.......xe in.
Shear Connection(no. of 16d common nails)(Table 11)................................... ............ L
Percent Full-Height Sheathing......:................(fable 11)......................................:.....:......./C0 %
5%Additional Sheathing for Wall with*Opening>6'8"(Design Concepts)....................
Wall Cladding
Ratedfor Wind Speed?..............................................................' ...>....../..............................................._.... '
5.1 (tOOFS.
Roof framing member spans checked?.........................(For Rafters use AWC Span Tool,see BBRS Website)
Roof Overhang ...................................................(Figure 19).............L ft s smaller of 2'-or L13 c/
Truss or Rafter Connections at Loadbearing Walls e
Proprietary Connectors 70'��/ 6J
Uplift................................................(Table 12).............................................U= plf
Lateral .........................................(Table 12)................................---.........L= pif
Shear............................:..................(Table 12)............................................S= ' •Rff- -
Ridge Strap Connections.ff Qar ties not used per page 21... able 13 T= plf
P P 9 R ). .............................
Gable Rake Outlooker.................:........................(Figure 20)............. ft 5 smaller of 2'or L/2 Sri/,s
Truss or Rafter Connections at Non-Loadbearing Walls
Proprietary Connectors
Uplift._..........I....................................(Table 14)...........................................U= lb.
Lateral(no.of 16d common nails)...(Table 14).......................................L= . lb.
Roof Sheathing Type...................................................(per 780 CMR Chapters 58 and 59) "cox
Roof Sheathing Thickness.........................................:.......................................... .!Sj�in.>_7/16"WSP
Roof Sheathing Fastening..........................................(fable 2)..................... ................................kD
Notes:
•1. . This checklist shall be met in its entirety, excluding the specific exception noted in 2,to comply with the requirements of
780 CMR•5301.2.1.1 Item 1. If the checklist is met in its entirety then the following metal straps and hold downs are not
required per the WFCM 110 mph Guide:
a. Steel Straps per Flgure 5
b. 20 Gage Straps per Figure 11
c. Uplift Straps per Figure 14
d. All Straps per Figure 17
e. Comer Stud Hold Downs per Figure 18a and Figure 18b
2. 'Exception:Opening heights of up to 8 it shall be permitted when 5%is added to the percent full-height sheathing
'requirements shown in Tables 10 and 11.
3. The bottom sill plate in exterior walls shall be a minimum 2 in.nominal thickness pressure treated#2-grade.
fi WC Cicide to Wood Coristrirctiori in High Wind Areas: 110 mph I Khd Zone
Massachusetts Checklist for Compliance (790 CIAR 5301.2.1:1)'
4 •
a. From Tables 10 and 11 and location of wall sheathing and Building Aspect Ratio,determine Percent Full-Height
Sheathing and Nail Spacing requirements
b. Wood Structural Panels shall be minimum thickness of 7/16"and be installed as follows:
I. Panels shall be installed with strength axis parallel to studs.
il. All horizontal joints shall occur over and be nailed to framing.
01. On single story construction,panels shall be attached to bottom plates and top member of the double
top 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 at double top plates, band joists,and girders shall be a double row of 8d
staggered at 3 inches on center per figures betow:Vertical and Horizontal Nailing for Panel Attachment
5. Glazing protection:a)new house or horizontal addition—required if project Is 1 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'floo_r
c)replacement ieriridows—needs energy conservation compliance only(chap 93)
6.Wood Frame Construction Manual(WFCM)for 110 MPH,Exposure B maybe obtained from the American Wood Council
(AWC)website.
—�ITNSl3�EREST5DN '
FRA WGUSEadMAL$
'ATh"=
• n 11
19 ,
it it
y
1 tl II D t t 1 ar. 1
t ll 11 H t ,
1' o iti `►N t 1 t :
►�- ii it m' ` r d '� '` •
v z I
FRAMING + ,
1 .1 Irk + sL r 1 C!< t•
AMING MSMBGRS + 1 11
LU I t EoGERiTEJ*AEDMTE t, t
' .IL 9
1 ,
1 ,1 It
• 1 1 p 11. I I F _ I I C
N i i i I `
STRCaCs� P �M
NAI[,SPACk�G WAA PAT Tffw
PAWL EDGE DOUBLE NAIL EDGE SPACING DEML
See Detail on Next Page
Vertical and Horizontal Nailing Detail
far Panel Attachment Vertical and Horizontal Nailing
for Panel Attachment ,
Parcel Detail Page 1 of 3
o� 'FIBlp�
�a�'`-�„�'��,' �3" � ram'- t •
PA MS,
Logged In As: Parcel Detail Tuesday,April 7 2015
Parcel Lookup
Parcel Info
Parcel ID 191-010 ( DeveloLoot LOT 7 I
Location 118 CHEQUAQUET WAY I Pri Frontage 298
ISec Road Sec Frontage L
Village ICENTERVILLE I Fire District C-0-MM
Town sewer exists at this address No I Road Index�0296�
Interactive ti
Map
Owner Info
Owner FHIBBARE, RYAN.SCOTT Co-Owner
Streetl 118 CHEQUAQUET WAY I Street2 I I
City CENTERVILLE I State MA zip 02632 Country
Land Info
Acres 0.35 Use Single Fa MDL-01 I zoning IRS _ Nghbd§ 5
Topography Level I. Road FPaved
Utilities 1 Public Water,Gas,Septic ( Location
Construction Info
Building 1 of 1
Year Roof Ext
Wall Built
1967 I Struct Gable/Hip I Wood Shingle
I
Living 1260 Roof(A�s h/F GIs/Cm AC None
Area Cover r p p TypeInt Bed r
style Ranch I wall 1"rywall I Rooms F3 Bedrooms z
Int Bath
Model I Residential Floor Hardwood Rooms 1 Full-0 Half . 7 41t i
_ OAS'
Grade Avera a Heat Hot Water Total I6 Rooms `
I g ) Type���_�.�___ ( Rooms I __. _) F,t, ,
Heat _t
Stories 1 Story Fue Gas 1 F anon Poured Conc. " I
Gross 3084
Area
Permit History _ - — -------..
http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=13339 4/7/2015
•
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map V Parcel 0 V Application tq
Health Division Date Issued a�
Conservation Division Application F
Planning Dept. Permit Fee 73
Date Definitive Plan Approved by Planning Board k Fs/2-2)13
Historic - OKH _ Preservation/ Hyannis
Project Street Address 18 C e_9 c6 s 41
Village C cN'7-ei2
Owner /2 YA y + 10 Lo Address
Telephone S-0 cP 2-
Permit Request ) V,"e_Yr%out- Ti4_2 a won/ -2 I N-re-Av z �G� w� nN�• /�tNo�
3 7e,z rs e c�'oa►� C l -Se -r odd g 7¢2 -B.e-7,4✓'e a✓^ Zs SX--,f, 23Zd 401.�w
,4va rziocre ?o IAA c/c wail .add 4w.Y•.us "11WDOW iN uew T,0sn•vf w��•.�/
UsiNp i X vy7l.. r /�✓pI, oPcr..vr/
Square feet: 1 st floor: existing /Z 3z-proposed Xtme 2nd floor: existing N/A proposed Total new
Zoning District Flood Plain Groundwater Overlay
. r1c,r OY►�y
Project Valuation oo•U o Construction Type Xs-�d ;j J
Lot Size / Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family Gd" Two Family ❑ Multi-Family (# units)
Age of Existing Structure 1167 Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No
Basement Type: Urfull ❑ Crawl ❑Walkout ❑ Other
Basement Finished Area (sq.ft.) Basement Unfinished Area Rift) iZ.7v
Number of Baths: Full: existing / new 2 Half: existing R €w
Number of Bedrooms: 3 existing _new w ,
ro�vJ c
Total Room Count (not including baths): existing new First Floor R. om Court -w
Lei
Heat Type and Fuel: U4as ❑ Oil ❑ Electric ❑Other
Central Air: ❑Yes S-No Fireplaces: Existing New Existing wood/coal stave: O'Yes 2-No
Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_
Attached garage: �isting ❑ 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 /�,y.�,�/ S ���.r Telephone Number
Address / /7 e- Q 4,C e;7 way License #
Home Improvement Contractor#
Worker's Compensation #
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL-BE TAKEN TO Z5 t7 6%ec0*
SIGNATURE DATE �/ZZ//,
i
FOR OFFICIAL USE ONLY
:,_APPLICATION#
'R f�
DATE ISSUED
MAP/PARCEL NO.
e
ADDRESS VILLAGE
OWNER
i,
i
DATE OF INSPECTION:
Y FRAME Ec Qt�'H` �►� r .t r D 1-br
;,INSULATION- 41,11
FIREPLACE
ELECTRICAL— ROUGH FINAL
PLUMBING: ROUGH FINAL
i/ •
GAS: ROUGH FINAL
FINAL BUILDING-0g�d//i
i
DATE CLOSED OUT
!` ASSOCIATION PLAN NO.
The Commonwealth of Massachusetts
Department of IndustrialAccidents
Office of Investigations r
600 Washington Street
Boston,ALL 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Le gib
Name(Business/Organization/Individual):
Address: lldck 9 Ue 5ey G�
City/State/Zip: 3 Z Phone#: :�50'Z -3 6 d-3 ffz
Are you an employer?Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and I
employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction
2.❑ 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
working for me in any capacity. employees and have workers'
cam insurance.: 9. ❑Building addition
[No workers comp.insurance P•
ed.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions
3. I am a homeowner doing all work officers have exercised their l 1.❑Plumbing repairs or additions
myself [No workers' comp. right of exemption per MGL 12.❑Roof repairs
insurance required.]t c. 152, §1(4),and we have no
employees.[No workers' 13.❑Other
comp.insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. s
$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.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 a allies ofperjury that the information provided above is true and correct.
Signature: - - ` Date: ��3��3
Phone#: .SDI -36U- 3�9Z
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
f
x�
Information and Instructions m_
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(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance.coverage required."
Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. AIso 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
Degaitment of Industrial Accidents
office of Investigations
600 Washington Street
Boston,MA 02111
Tot.#617-727-4900 W 406 or 1-877 MASWE
Re-✓ised 4-24-07 Fax# 617-727-7749
www.mass_gov/dia
1
VIE� Town of Barnstable
Regulatory Services
s -rwer>w Thomas F.Geiler,Director
16 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 EXEMP nON
Please Print
DATE: �113
70BLOCATION: .A--, �/l/✓�� C!N"7c2✓ �IC
number village
"•HOMEOWNER":4�. � W Zia r cl "— 3 o -3 S� Z 6—bp- . ly-Z7 7-d
name ,, home phone# work phone#
CURRENT MAILING ADDRESS: �� C 4L
cityhown 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 Rerformed 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 Bamstable Building Department minimum inspection
proctdiggMd is that he/she will comply with said procedures and requirements.
Signa1rve 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 2.1S) 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.
C:\Users\decoU&X,kppDaffi\LocaRMcrosoft\Wmdows\TempotarylntunetFfles\ContcntOudooMQRE6ZUBN=RESS.doc - -
Revised 053012 _._...
'WEr Town of Barnstable
Regulatory Services
• RaRNCI'IRT�A, f -
MAS& Thomas F.Geiler,Director
1639. �6
1 Building Division
Tom Perry,Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.barnstable.maxs
Office: 508-862-403 8 Fax: 508-790-6230
Property Owner Must
Complete and Sign This Section
If Using A Builder
as Owner of the subject property
hereby authorize to act on rap beb4
in all matters relative to work authorized by this building permit
• i
(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.
Signaature of Owner Signature of Applicant
Print Name . Print Name
Date
QTORM&OWNERPERMISSIONPOOL•S 62012
;I
Z ;
p c°
w. � �' � `-i � I is � ,.�•
�� _) law _�• f! � yr
I C �
I
4
d
Y