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- " - \ TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map Parcel 0 Application #_ s
Health Division ca Date Issued �'2-,0 —f (eye
Conservation Division Application Fee
Planning Dept. Permit Fee
Date Definitive Plan Approved by Planning Board ?' rn / -7 6
;!1_� 0
Historic - OKH _ Preservation/ Hyannis
u'1 eJ
Project Street Address If 40 ij (_ 4 A Ce,.4 f-I V i ho M4
Village C��T F , V �t r
Owner C eS rClL_ f- 0.41249 e f ( Address (51 e t�cze,rT' �n . r��
Telephone cS pt- CU®- Z-7O s-
Permit Request - �ti�e 4y u <�N�°'� A' _k, e•4,t-
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuation a tY Construction Type
Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family Two Family ❑ Multi-Family (4 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: I? existing _new
Total Room Count (not ila,
Type ding baths): existing S new First Floor Room Count
Heat T e and Fuel: � ❑Oil ❑ Electric ❑ Other
/
Central Air: ❑Yes Gd'No Fireplaces: Existing g J New Existing wood/coal stove: ❑Yes 0INo
Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_.
Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other:
Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑
Commercial ❑Yes ❑ No If yes, site plan review#
Current Use Proposed Use
APPLICANT INFORMATION
(BUILDER OR HOMEOWNER)
Name `1 of f P.� t�f l l Telephone Number S_ _0 Z 7A_r X
Address eI�G��J� 'J'�'VC License #
t_i4 � Ae- G kA_ Home Improvement Contractor#
Email _� ( a - I( �o o o✓n Worker's Compensation #
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE DATE
FOR OFFICIAL USE ONLY
APPLICATION #
DATE ISSUED
° MAP/PARCEL NO.
ADDRESS VILLAGE
OWNER
DATE OF INSPECTION:
FOUNDATION
FRAME
INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
FINAL BUILDING
DATE CLOSED OUT
ASSOCIATION PLAN NO.
27m C'ommo nivear h of-Mcaysr,drusetts.
Deparbrfeut afludus&id Accidenys
- f -ce of tigaticnrs
. 600 Washington-greet
Boston,AM 0211
Wcw.keens' Campensafien Immn-ance Affidavit Builder-dCnntrac-torrsMectdciansiPlmmbers
Applicant Inf'arm,atign .�p r Please Print
Ni I f,SncinPccOg C.,
V{I i •
Address: 1. g Al •
City/Statt°j e^ t/ ,/ Phvn5*-t,4r--'
Are you an employer?Check the appropriate bay ' Type f project r
am a general contt d I PP o ro'racor an F ] � =
I_El I am a employer v: I al❑ ❑New ccnstmc6cn
employees(full an�dfor part4ime * 1-Lave]sired the sib caIIfitactozs 6-
2.❑ I am a sole prop:detoi;orpaxtner Tisfed onthe.attached s•1ree . 7- ❑Remodeling
These sub-confractors hake
ship and have nq employees. • $_,❑17emalifion:
w formm in an employees mdhare wodmrs'
�'� Y C3P�t5`- 9. ❑Ruildmg addition
¢ ' comp_insu= comp-insurance#
5_ ❑ We are a•oorparafion.anti ifs 1O.❑Electrical repairs or a,di ions
officers 1L❑Pl airs or additio untbin re ns
3. I am a botneotirn:er doing all work � p
myself[No worrkers'ccatg- right of exemption per MGL U❑ a Lepaim
Ro
fnnu-mcerequired]T' c.152, §1(4k andwefiWeno' /J
employees-[NO workers' 13_ tfier L
co=p-kw=-me mquired_]
•AayapgricmteLatcheciaboxfti most aim ffiaatthesechoabeIows—au=zdie" woae s'compens&donpaIiUmfornm5mL
Homeuwaersarho submit ffiis s±Gd=f mtHr2bng they are doing Ru waax amd thm base outside coutr9cmunmst submit a near amdxzit indieat n9-CbL
fCamizsctnrsrT7'tdaecT�thisboatmsststtacbedmt213dififm sheet showing thenxmeofthesub-camtsdams dshearbether.ornottImseemitieshn�p-
emVIoyees.Ifthesnbtamtad m'hxveemployeas,they workea'comp.po)icynumbrs:
I am arr ettepinl�r flerrt is pratzdit�x��rBeets'con�rtsrdiart iresriraaca�or m�•empTo}�e¢s $elobv isYlte policy ar�td jola sits
inforrlra olL ,
Insurance CompanyNiame:
'Policy 4'or Self ins_11C_,�3 p1E3fIGIIDate:
Job RIP-Address - Crtyl5tafel a:
Attach a.copy of the workers'compensationpolicydeclaration page(showing the policy number and expiration date).
Failure to secure coverage as req*edunder Section 25A of MGL c�157-can lead to the imposition of rdminal penalties of a
flue up to$l,SOD OU andfor one-Dear imprisonment;as w8ll as civil penalties in the;farm of a STOP WORK ORDERand a fine
of up to$250-00 a clap against the violator. Be advised&at a copy of this statement.maybe forwarded to the Office of
Inrestrgatiom of the DIA.for insurance coverage i tion_
yrfa hemby ccrt6 anc7ar the pairs and psr of et rcxy f mtfJts iriforma€i w prarrrTed a bvty!s tram and caarrrect
mature_ Date-
Phone i;�- L����
t1B&fi L use tarry. Do not tsrite in this area,67 be cmnpleta by fxiy artorntt afficzat
City or"Town:: PeTffitIlkeIIse if
Issuing Ruth-or€ig(drde one):
L Board of Health I BuMmg Department 3.CitylTown Qerk 4.Electrical hispector S.Plumbing Inspector
6.Other
Contact Person: FIrtrnt #:
— -- - —- 6
- ormatioxa an' d lastructiORS : . . .. .
Massachnset GeEieml Laws chapter I52 req�Es aIl e�Ioyes to provide�° ='��on for their e�Ioyees_
Pmsaantto this si b,an argrhy�is defined as.":�vetyP�ason m$ie service of another andes any coact ofhoe;
express or implie4.oral or writ[
An ernpkYer is defined as-an in I,p��,asso�on,coxporat101L or other Legal may,or anyeC or mare
of the foregoing engaged.is a Joint ,and iachzdmg the Legal�s of a deceased employer,or the
receiver or trastee of an kdi'vidnal,pa taMShrP,association or other legal entity,emPloymg employers_ However the
owner of a dweIImghowmha�notmore thantlrree aPeme andwho residestherein,or the oc ofthe-
dwelling house of anon who employs persons to da mai ntea nce,consfmr_h on or repair worm on such dwelling hawse
or on the grotmds or T)MIdmg BFPl¢r�ihcmto shallnotbecanse of such emplaymedbe d=nedto be an employer-"
MGL cTispter ISZ,§25C(r7 also sites tlt2t aevm Tsfaia or local lice,,in agLcy shaTI withhold ffie issuance or
renewal of a Ticeuse or permit to opera na
operate a busess or to construct buildings ut the cmmmonwealtTi for any
applicant-mho has notprodaced acceptable evident of compliizt rm With the inscirance coverage require
Additionally.MCQ.chaptra 152,§25dM states'W617thcr the coM.anwealih nor my ofitrs political subdivisions shall
enter info any contract for the.per&m=ce ofpublio worlctmtU acceptable evidence of complian.cewiffi the insmanre..
regtm=eats of this chaptea have lien prr-S=±V d to the MU[17 cting.anffi za f
AgpHcauts
Please fillo:Ct the wolk='compensation affidavit completely,by checl®.g the boxes that apply to your situation and,if
necessary,soPPIy sub,contactor(s)name(s), addres_s(es)andphone numbers) aIongwithiheir certa ems)iher than the
insrn nce. Limited Liability Companies(LLC)or Limited Liability Partacnilips(I I P)v no y .
members or partners,are not rimed to carry worlcm-e comPeusation insmumce• If an LT.0 or LLP does have
�pToy=s,apolicyisregnu� Be advisedtbaftbisaffrdayitmaybesnbmittedtatheDepartmentofTndmsbrial
i confnmation of fiom nce coverage Also be sure tm sign and date-the
adavit. The affidavit should
Acrodemfs for
b e dent d to co city or town that the application for the p®it or license is being requested,not the D epartnimf of
T„Aa S,-j ai A t
- em s ST nnldyou have any gnestioms regardmg tTie law or ifyon are rec ed to obtain a wodCers'
compensafonpoIicy,plrase call the,DepartneaxtatthenmmberlisDdbeI0W. Self-insmedcompamiessliouldeatx.their
s elf-m�ce license member on the appropaate line.
City or Town Officials
t
Please be sate that the affidavit is complete andpril� legilhly. The Depaitmemt has provided a space at the bottom
ofthe affidavit for you to fin out mthe event the Office oflnvesti�m's has to comt-tyontegardmgffie applicant
Please be sure to fllin the peamiVlicensemrnber which wMbe used asarefertuconumber.Tnaddition,am applicant: t
eel o sab=t one affidavit i od�mg c[mrn
mitt m. - Ie ermtlf' tcemse apph:�ioms m any green year,n only
that must sob P
n oli fijf3 =nation if aece&=y)and tinder`mob M A dd—IMe the applicant sho>?ld white"aII locations in ( 5'or
�' be rovided to the
e affidavittbat has bea officially stamped�coaled by t6 city or tova may P
awn . A co of fh
PY
applicant as proofthat a valid affidavit is on file for-5 1 .-pmmits or limmses_ Anew affidavit must be filled out esar�
year.Vdhere a home owneg or citizen is obiaiIImg a license or pff= not relate-A D any b„tin=or commercial vie
(ie_a dog license orpennit to bum Iea:v= said person is NOT regm to complete this affidavit
The Of of Inve5tig2fH=would him to thank you in advance for your cooperation and ffiuddyou have any gacsb.oms,
please do not hesifateto&otm a mIL
The Department s afidress,telephone and faxnumber=
Depadment Gf fidwgdA Accidents
Office a lnvedtafio=
M&Rill
• �4 man
R.evisext 424--D7 m a�a�gf tad. .
AWC Guide to Wood Construction in Sigh WindAreas:110 niph Wind Zorze
Massachusetts Checklist for Compliance(780 CMR 5301.2.1.1)t
Check
Compliance
1.1 SCOPE
WindSpeed(3-sec.gust)..................................................................................................................110 mph
WindExposure Category....................................................... ....... ............. ................................... B
1..2..APPLICABILITY
Number of Stories(a roof which exceeds 8 in 12 slope shall be considered a story) . stories <_2 stories
RoofPitch .........................................................................(Fig 2) ........................................ 512:12
MeanRoof Height ..............................................................(Fig 2).............................................. ft 5 33'
Building Width,W...............................................................(Fig 3)................................................ _ft 5 80'
Building Length,L ..............................................................(Fig 3)................................................. ft <_80,
Building Aspect Ratio(L NV) ...............................................(Fig 4). ............................................. 5 3:1
Nominal Height of Tallest Opening2 ...................................(Fig 4)................................................: 5 6'8"
1.3 FRAMING CONNECTIONS
General compliance with framing connections....................(Table 2). ............................ ....... ...............
2.1 FOUNDATION
Foundation Walls meeting requirements of 780 CMR 5404.1
Concrete.......................................................:............................................................:.........
ConcreteMasonry................................................................... ................................................................
2.2 ANCHORAGE TO FOUNDATION'3
5/8"Anchor Bolts imbedded or 5/8"Proprietary Mechanical Anchors as an altemative in concrete only
Bolt Spacing—general .......:......................... ........(Table 4).................................:............. in.
Bolt Spacing from end/joint of plate ............................(Fig 5)..................................... in.:5 6"—12"
Bolt Embedment—concrete........................................(Fig 5)................................................. in.z 7°
Bolt Embedment—masonry.........::..............................(Fig 5)............................................ in.>_15"
Plate Washer.........................................................:.....(Fig 5)...............................................z Tx 3"x%"
3.1 FLOORS
g
Floor framing member spans checked ...............................(per 780 CMR Chapter 55)....................................
.Maximum Floor Opening Dimension...................................(Fig 6).................................................. ft:5 12'
Full Height Wall Studs at Floor Openings less than 2'from Exterior Wall(Fig 6).......................... .........
Maximum Floor Joist.Setbacks
Supporting Loadbearing Walls or Shearwall.:..............(Fig 7).................................................... ft 5 d
Maximum Cantilevered Floor Joists
Supporting Loadbearing Walls or Shearwall................(Fig 8).............,...........:...:......................_ft 5 d
FloorBracing at EndwAs...................................................(Fig 9)....................................................................
Floor Sheathing Type ........................................................(per 780 CMR Chapter 55)................................
Floor Sheathing Thickness ............
....................................(per 780 CMR Chapter 55).:..............:...... in.
Floor Sheathing Fastening..................................................(Table 2)..._d nails at in edge/ in field
4.1 .WALLS
Wall Height r
Loadbearing walls........................................................(Fig 10 and Table 5)..........................._ft :5 10,
Non-Loadbearing walls................................................(Fig 10 and Table 5)..........................._ft 5 20'
Wall Stud Spacing ........................................................(Fig 10 and Table 5)..................._in.5 24'o.c.
Wall Story Offsets .................(Figs 7&8) _<
4.2 :EXTERIOR WALLS'
Wood Studs
Loadbearing walls..................................... (Table 5) 2x -_ft_in.
Non-Loadbearing walls........................ (Table 5) _ ft in.
_
Gable End Wall Bracing
Full Height Endwall Studs............................................(Fig 10)..........................:.......................................
WSP Attic Floor Length ...(Fig 11)...::.:......:..........: >
Gypsum Ceiling Length(if WSP not used)..................(Fig 11)............................................_ft z 0:9W
and 2 x 4 Continuous Lateral Brace @ 6 ft.o.c... (Fig 11).............................. ...............................
or 1 x 3 ceiling furring strips @ 16"spacing min.with 2 x 4 blocking @ 4 ft.spacing in end joist or truss bays
Double Top Plate
Splice Length ........................................................(Fig 13 and Table 6)....................................._ft
Splice Connection(no.of 16d common nails).............(Table 6).........................................................
AWC Guide to Wood Construction in High Wind Areas:110 mph Wind Zone
Massachusetts Checklist for Compliance(780 CMR 5301.2.1.1)1
Loadbearing Wall Connections
Lateral(no.of 16d common nails)...............................(Tables 7)......................................................
Non-Loadbearing Wall Connections
Lateral(no.of 16d common nails)...............................(Table 8). ....................................................
Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9)
HeaderSpans ........................................................(Table 9).................................._ft_in.s 11'
Sill Plate Spans ........................................................(Table 9)......................... . . _ft_in.511'
Full Height Studs (no.of studs)...................................(Table 9)........................................................
Non-Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9)
HeaderSpans.............................................................(Table 9).................................._ft_in.512'
Sill Plate Spans...........................................................(Table 9).................................._ft_in.512"
..................................
Full Height Studs(no.of studs). .(Table 9).......... .............................I...............
Exterior Wall Sheathing to Resist Uplift and Shear Simultaneously,
Minimum Building Dimension,W
Nominal Height of Tallest Opening2 ..............................................................................._s 6'8"
SheathingType.............................................(note 4)......................................................
Edge Nail Spacing.................................:.......(Table 10 or note 4 if less)....................... in.
Field Nail Spacing.........................................(Table 10)................................................. in.
Shear Connection(no.of 16d common nails)(Table 10)........................................................
Percent Full-Height Sheathing.....................(Table 10). ...... ..........................................
5%Additional Sheathing for Wall with Opening>6'8"(Design Concepts).....................
Maximum Building Dimension,L
Nominal Height of Tallest Opening2 ..............................................................._5 6'8"
SheathingType............. ...............................(note 4)......................................................
Edge Nail Spacing..........................................(Table 11 or note 4 if less)....................... in.
Field Nail Spacing ........................................(Table 11). .... . .................................... in.
Shear Connection(no.of 16d common nails)(Table 11)........................................................
Percent Full-Height Sheathing.......................(Table 11)....................................................._%
5%Additional Sheathing for Wall with Opening>6'8"(Design Concepts).....................
Wall Cladding
Ratedfor Wind Speed?............. ......................................................................................... ..............
5.1 ROOFS -
Roof framing member spans checked?.......................(For Rafters use AWC Span Tool,see BBRS Website)
Roof Overhang ...................................................(Figure 19)............._ft 5 smaller of 2'or U3
Truss or Rafter Connections at Loadbearing Walls
Proprietary Connectors
Uplift................................................(Table 12)............................................U= pif
Lateral.............................................(Table 12).............................................L= pif
Shear..............................................(Table 12)..............................................S= plf
Ridge Strap Connections,if collar ties not used per page 21... (Table 13)...............................T= pif
Gable Rake Outlooker.........................................(Figure 20).............._ft 5 smaller of 2'or U2
Truss or Rafter Connections at Non-Loadbearing Walls
Proprietary Connectors
Uplift................................................(Table 14)..........,.................................U= lb.
Lateral(no.of 16d common nails)...(Table 14).......................................L= lb.
Roof Sheathing Type...................................................(per 780 CMR Chapters 58 and 59) ............
Roof Sheathing Thickness........................................... .............................................. in.z 7/16"WSP
Roof Sheathing Fastening ..........................................(Table 2).........................................................._
Notes:
1. This checklist shall be met in its entirety,excluding the specific exception noted in 2,to comply with the requirements of
780 CMR 5301.2.1.1 Item 1. If the checklist is met in its entirety then the following metal straps and hold downs are not
required per the WFCM 110 mph Guide:
a. Steel Straps per Figure 5
b. 20 Gage Straps per Figure 11
c. Uplift Straps per Figure 14
d. All Straps per Figure 17
e: Comer Stud Hold Downs per Figure 18a and Figure 18b-
2. Exception:Opening heights of up to 8 ft.shall be permitted when 5%is added to the percent full-height sheathing
requirements shown in Tables 10 and 11.
3. The bottom sill plate in exterior walls shall be a minimum 2 in.nominal thickness pressure treated#2-grade.
AWC Guide to Wood Construction in High Wind Areas:110 ynph Wind Zone
Massachusetts Checklist for Compliance (780 CMR5301.2.1.1)t
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.
ii. All horizontal joints shall occur over and be nailed to framing.
iii. 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 below:Vertical and Horizontal Nailing for Panel Attachment
r
_MEN THIS EDGE R EKM ON
FRAMING USE M NA44
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11 11 11 'L r
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NAIESPAGkJ3
PAfiEt
See Detall on Next Page' ~
Vertical and'Horizontal Nailing
for Panel Attachment
AWC Guide to Wood Construction in Sigh Wind Areas:110 mph Wind Zone
Massachusetts Checklist for Compliance(7so CMR 5301.2.1.1)1
ga
► ► ► tr
► 'I I1
I ` W Ir rl
Ba ll I1
1 FRAMING MEMBERS r
1 1 EDGE MFRKAEDIATE ► r I
I � ys•
I S sw ►
r
► r � ' i i
► I
. ► � � �j 3"GAIN. I i
STAGGERED
• NAIL PATTERN � r PANEL
PAWL EDGE DOUBLE NAIL EDGE SPACMG DETAL
Detail
Vertical and Horizontal Nailing
for Panel Attachment
AWC Guide to Wood Construction in High Wind Areas:110 fnph Wind Zone
Massachusetts Checklist for Compliance (7so CMR 5301.2.1.1)1
FAQ*: WFCM Checklist
Question: I understand if a new home is built in a town in a 110 mph wind zone
then the American Forest and Paper Association (AF&PA) Wood Frame
Construction Manual can be used to prescriptively design it. I also understand
that in some cases the home can be framed per the WFCM too mph Guide, if it
meets certain requirements including but not limited to aspect ratio, roof height,
number of stories, and exposure category (B). I have heard that Massachusetts
has a "modified" checklist that can be used instead of the checklist at the end of
the Guide. Is this true and what can you tell me about this "modified" checklist?
Answer: You are correct on the items that'you have noted. MA has modified the
checklist in several important ways. The MA version allows a roof with a pitch up
to and including 8 in 12 to not be "counted" as a story. Further it does not require
steel hold downs and straps in many locations if full height sheathing is used as
defined in the MA checklist. Further, if the building will have furring strips
installed in the ceiling abutting the gable wall then 2 x 4s installed on top of the
ceiling joists are not required. There are other changes as well that were not
noted here. il
The MA version of the checklist was formulated in recognition of the highly
regarded framing methods used in MA for many years and wood framing that has
been used in North Carolina over the past 10 to 1 ears which h p 5 y as performed
well in severe hurricane weather in that state.
*Answers to FAQs are opinions of the BBRS Staff and do not reflect official positions or code interpretations of
the BBRS.
F
1
e
Town of Barnstable
Regulatory Services
p!FIHWE rqy Richard V:Scali,Director -
Building Division
BAMNSrAISM : Paul Roma,Building Commissioner
�e3y. 200 Main Street, Hyannis,MA 02601
�tb www.town.barnstable.ma.us
Office: 508-862-4038 -Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTTON
7 Please Print ,
DATE: / / /1
JOB LOCATION: J7 C } i TfJ'� L9�� C e/b J T l/l �(e-
number street village
-HOMEOWNER-: heS c,�d �A�SA� (4�Gl - -0 c7 7�:q a 7
name home phone# y� work phone#
,CURRENT MARLING ADDRESS: "I lei (n E1 rt (✓�^ 1(I
E/+s 1114-- P,2333
city/town I state zip code
The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow
homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor.
DEFINITION OF HOMEOWNER
Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-
family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one
home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form
acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section
109.1.1)
The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,
bylaws,rules and regulations.
The undersigned`homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection
proc d/ures anndd�requiremen d 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,100.1.1-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 itwould 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:\WPFILES\FORMS\building permit forms\EXPRESS.doc
06/20/16
All
Town of Barnstable
Regulatory Services
r INAM Richard V.Scali,Director.
Building Division.
Panl Roma,Building Commissioner
200 Main Street;Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
S-
Property Owner Must
Complete and Sign This Section
If Using A Builder
. j
I - ,as Owner of the subject property
hereby authorize to act on my beh4
in all matters relative to work authorized by this building pertnit 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 Natne
Date
QYORMS:OWNERPERMISSIONPOOLS
.. .
V. R:-: GE 1N PECTIQN PLAN!
(:THIS,PLAN WAS NOT CREA7E6 FROM AN INS(RUMEN.. SUR�IEY'AND IS .FOR MORTGAGE PURPOSES ONLY
m.CDOUGAII SURVEY-WI4L,N0T ASSUME UABItJTY FOR:ANY OTHER USFj
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NOTESi;
i IT APPEARS THAT:THE BULKHEAD MAY;`
CROSS OVER THE LOT LINE
., , LY REvOb4MEP�JFD
2) AN INSTRUKIENT Sl1RUEY IS 'ilGFi
TO LpCATE THE EXACT LOCATION OF.THE DWELLING
AND CREATE A NEWER RECORDABLE PLAN
CERTIFY THAT THIS MORTGAGE INSPECTION PUW WAS PREPARED IN:ACCORDANCE WITH 250 CMR>SECTION:5.05 OF 1HE MASSAGNUSETTS,RULES Qc-REGULATIONS FOR THE
PRACTICE OF IJWD,SURVEYING THE BUILDING.SHOWN IS ":NOT AFfECTED;BY A SPECIAL FLOOD.;H QARD:AREA AND:DQES,"NOT ..CONFOR►1 TO T}{E::LOCAL,ZONING . :.:
BY LAWS IN EFFECT AT THE...tME QF.CbNSTRUCTION W1TK:'RESPECT.:TO SETBACK REQUIREMENTS,OR:'IS EXEMPT FRAM VIOLATION;ENFORCEMENT Adit UNDER MASSACHUSETTS
GENERAL LAWS CHAPTER 4QA SECTION 7 REFERENCED DEED SUB ACT TO ANA WITH THE;BENEFIT OF ALL RIGHTS RIGHTS Y. EA RESERVATIONS AND
RESTRIb710NS OF RECORD 1F.ANY TH!RE BE AND;INSOFAR AS THE SAME ARE OF LEGAL FORCE AND EFFECT.:
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` ti- 4' TD�1TJ : 8ARN51ABLE (CENTE:RVILLE)'
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• • • THIS SECTIONON DELIVERY .
■ G;Qrnplete items 1;2,and 3.Also complete A. Sig e
item 4 if Restricted Delivery is desired. X ❑Agent
® Print your name and address on the reverse I I ❑Addressee
so that we can return the card to you. B. Received y(pnnte Name) C. bate of Delivery
v Attach this card to the back of the mailpiece, (�i�H��
or on the front if space permits.
D. Istv,
e ifffrent°from item 1? ❑Yes
I. Article Addressed to: �r \
•Ifel�ery a ress below: C7 No
� I
J
�f 3. Service Type
Q�3 Certified WHO ❑Priority Mail Express'"
S. ❑Registered ❑Return Receipt for Merchandise
❑Insured Mail ❑Collect on Delivery
4. Restricted Delivery?(Extra Fee) ❑Yes
2. Article Number, I i I i !t ! a = ,i: 9 i t-'
(Transfer from service/abeQ r "r 7 01{4 *12�U U: UiU Qi1J Q 3 5;8 i t767 3
PS Form 3811,July 2013 Domestic Return Receipt
I
UNITED STATES POSTAL_SERVICE +• � R� #�ist"Z�` ailn ,
Sender: Please print your name, address, and'Li`r�4�� this box*--
�I
I
TOWN OF BARNSTABLE
BUILDING DIVISION
200 MAIN ST. �
HYANNIS, MA 02601
I,
UUTSI Postal Se , iceTM
CERTIFIED MAILTM RECEIPT
(Domestic Mai/rn,'y;,rifa,lnsurance Coverage Provided)
IF,oradeliV—e ,information,-visit our,website:at www.usps.corT
_■
j ¢■
or PO Box No. LA
I
i
i
i
PS Form 380Q,August 2006 See Reverse for,lnstructions
Certified Mail Provides:
o A mailing receipt * F .
n A unique identifier for"your mailpiece- "
0 A record of delivery kept by the Postal Service for two years -
Important Reminders:
o Certified Mail may ONLY be combined with First-Class Maile or Priority Mail(:
o Certified Mail is not available for any class of international mail.
o NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For.
valuables,please consider Insured or Registered Mail.
® For an additional fee,a Return Receipt may be requested to provide proof of
delivery.To obtain Return Receipt service,please complete and attach a Return
Receipt(PS Form 3811)to the article and add applicable postage to cover the
fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for
a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is
required.
e For an additional fee, delivery may be restricted to the addressee ors
addressee's authorized agant.Advise the clerk or mark the mailpiece with the
endorsement'Restricted Delivery°
e If a postmark on the Certified Mail receipt is desired,please present the arti-
cle at the post office for postmarking. If a postmark on the Certified Mail
receipt is not needed,detach and affix label with postage and mail..
IMPORTANT.Save this receipt and present it when making an inquiry.
PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047
F
�p tHE Tp�
o Town of Barnstable
1ARNSPABLE, * Regulatory Services
9 MASS..
039• �� Richard V.� Scali,Director -
Building Division
Thomas Perry,CBO
Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
..Office: 508-862-4038 Fax: 508-790-6230.
Notice of Building Code Violation(s) and Order to Cease, Desist and.
Abate:
Margaret Ann&Chester Hill and all persons having notice of this order,as owner/occupant of the
premises/structure located at 5 Clifton Ln:,Centerville,MA 02632 Map 226 Parcel 104 you are hereby
notified that you are in violation of the Massachusetts State Building Code 780 CMR R105.1 and are
ORDERED this date,September 10,2009 to:
1. CEASE AND DESIST IMMEDIATELY,all functions connected with this violation on or at the above
mentioned premises.
SUMMARY OF VIOLATION:
780 CMR R105.1 Permit Required.
2. COMMENCE immediately,action to abate this violation.
SUMMARY OF ACTION TO ABATE:
Remove the construction installed without the benefit of a building permit.
And,if aggrieved by this notice,and order,to show cause as to why you should not be required to.do so,by
filing an appeal with the State Building Code Appeals Board within forty-five(45)days after the service of
this notice.
If, at the expiration of the time allowed, action to abate this violation has not commenced,further action as
allowed by law may be taken.
By order,
J.fie Lauzon
ocal Inspector ' '
r
Town of Barnstable *Permit
�{. Expires 6 onthsam issue dale
Regulatory Services Fee
MU NSR6E Thomas F.Geiler,Director
A 0 a ESS PERMIT Building Division
APR t ® ZOO$Tom Perry,CBO, Building Commissioner
200 Main Street,.Hyannis,MA 02601
TOWN OF BARNUAK www.town barnstable.ma.us
Office: 508-962-4038 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
Not Valid without Red X--Press Imprint
Map/parcel Number 6 y J'
Property Address 57 C L I OO- A) L C
Residential ValueofWork 5-906 c Minimum fee of$25.00 for work under$6000.00
Owner's Name-&Address C H 25 I k R,
S" C119:7_4 y LA00 P l..i jE ,7- N KAPJ
Contractor's Name 370 A BJ ) yL9A Telephone Number 570?1-38V_77 . 5 `l
Home Improvement Contractor License#(if applicable) D6 (-3L-1
❑Workman's Compensation Insurance
Check one:
�LI am a sole proprietor
❑ I am the Homeowner
❑ I have.Worker's Compensation Insurance
Insurance Company Name
Workman's Comp.Policy#
Copy of Insurance Compliance Certificate must be on:file.
Permit Request(check box)
®.Re-roof(stripping old shingles) All construction debris will be taken to '3A'0A-3;,5T#,$t,c L AtO lb FILL
❑ Re-roof(not stripping. Going over existing layers of roof)
❑ Re-side
❑ Replacement Windows/doors/sliders.U-Value (maximum:35)
*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 Improv ent Contractors License is required.
SIGNATURE:
Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc
Revise020108
Board of Building Regulations and Standards
lugHOME IMPROVEMENT CONTRACTOR
Reg istratig6*1406627 /
Exn raticn=7/24t/2008
17r - T VIM It al
JONATHAN M TYL6%=S-ty
Jonathan TylerI f y
l
67 Cranberry Lane Bo:C80
W Hyannisport, MA 02672 Deputy Administrator
x, r Boalr�o m mg ego atia�is.an tan ar s
` C'onstru"tion Supeiv�so�License' r
L"ns§e: CS, 72579 I
o ' Expi ti_on i/4/2010 Tv 14112
JONATHAN M
2 LYNXHOLM
HYANNIS;MA 02601 ''
Commissioner
A
y t
Town-of Barnstable
anxxsTast.E. •
� Regulatory Services
ABED MPS s Thomas F.Geiler,Director
Building Division
Thomas Perry,CBO
Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us "
Office: 508-862-4038 Fax: 508-790-6230
Property Owner Must
Complete and Sign This Section
If Using A Builder E
r
I, X //Owner-of the subject property,
hereby authorize to act on my behalf,
in all matters relative to work authorized by" building permit application for.
(Address of Job)
b� J" '�(-0k
Signature of er Date ,
Print Name
QAWHILESTORMS\building permit forms\EXPRESS.doc
Revise020108
IKE Town of Barnstable
Regulatory Services
r r
&UNST"L& Thomas F.Geiler,Director
KAM
°6 1639. .0� Building Division
Arm 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 ON
Please Print
DATE:
JOB LOCATION:
number sire village
"HOMEOWNER":
name home phone# work phone#
CURRENT MAILING ADDRESS:
city/ state zip code
The current exemption for"homeo errs"was extended to include owner-occupied dwellings of six units or less and
to allow homeowners to engage dividual for hire who does not possess a license,provided that the owner acts as
suuervisor.
DEFINITION OF HOMEOWNER
Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to
be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A
person who constructs more than one home in a two-year period shall not be considered a homeowner. Such
"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be
responsible for all such work performed under the building permit. (Section 109.1.1),
The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other
applicable codes,bylaws,rules and regulations.
The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department
minimum inspection procedures and requirements and that he/she will comply with said procedures and
requirements.
Signature of Homeowner
Approval of Building Official
Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the
State Building Code Section 127.0 Construction Control
HOMEOWNER'S EXEMPTION
The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions
of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such
work,that such Homeowner shall act as supervisor."
Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,
Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly
when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed
Supervisor. The homeowner acting as Supervisor is ultimately responsible.
To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,
that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by
several towns. You may care t amend and adopt such a form/certification for use in your community.
Q:\WPFILES\FORMS\homeexenipt.DOC.
j •
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations'
a 600 Washington Street
Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information l Please Print Legibly
Name(Business/Organization/Individual): To"q i/7 A (NJ T Y Lle
Address: L YN X Na i. C 7
City/State/Zip: Ate, 06?6Qi Phone.#: SOS- 36y- 795-7
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
6. New construction
employees full and/or art-time .* have hired the sub-contractors ❑
( P ) •
..2.M.I am a sole proprietor or:partner-' listed on the attached sheet. 7...❑Remodeli
ng
ship and have no employees These sub-contractors have g• ❑Demolition
working for me in any capacity. employees and have workers' 9. ❑Building addition
[No workers'comp.insurance comp. insurance.$
required.] 5. ❑ We are a corporation and its 10.0 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
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.
TContractors 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.M 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 ance coverage ication.
I do here certify nde the pa' sand enalt' s of erjury that the information provided above is true and correct
Sijznafore: Date: q y �8
Phone#: <ke — 4 — -7`j`� 7
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#:
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 j oint 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 iri 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. 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 bum leaves etc.)said person is NOT required to complete this affidavit.
The Office of Investigations would like to-thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address,telephone and fax number: r
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 11-22-06
www.mass.gov/dia