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HomeMy WebLinkAbout4022 MAIN STREET r Ii . `, Town of Barnstable Building Department OF SHE Tpi Brian Florence,CBO 15'' °� Building Commissioner • ' AB . Y 200 Main Street,Hyannis,MA 02601 13 Y MA98. 1639• ♦tb www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Approved: Fee: Permit#: �j^ 19 - 1 12 HOME OCCUPATION REGISTRATION Date: b2-) // g Name: AV o r (ram( I-; Ri C h a v / Phone#: 50 ct Address: 2 /'lain ( - Village:avyvntlai U Name of Business: j./jan D,e, mt.... Type of Business: V )! Map/Lot: - J(1)—(M INTENT: It is the intent of this section to allow residents of e Town of Bamstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter,odors,electrical disturbance, heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials, in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There are no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. I,the undersigned,have read/and a ee�withh the above restrictions for my home occupation I am registering. Applicant:/ I Date: V /9 Homeoc.doc Rev. 10/17 Town of Barnstable Building Department Brian Florence, CBO Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Pre-application for Business Certificate Date k.P./ 7 Map (4 Parcel 64 4 Applicant Information Applicants Name I)ap(f X eiona/e rma Applicants Address 4,9,2Lin D 5' mail Address f11'/ 4d I"d /yle. ()OM Telephone Number 4, -7 3 Listed Err Unlisted El Business..Information o c New Business? Oes 0 No Z Business is a registered corporation? Yes No m If yes Name of Corporation Fri C Does business operate under the registered corporate name? Yes mid! z I p I 0 Is the business a sole proprietorship or home occupation? es No Z m Q If yes then a Home Occupation Registration is required—See Building Division Staff � 0 Name of Business Oder ri O U )-7 T—a r m Business Address 1p� �pL/h �� , Cu� YY1 Q e//d � Od-6 � Type of Business --3‘11)//)I1/n6 Bu. ding Commissioner Office Use Only Conditions I VP (Le G r• ' • Building Commissioner ' K • Date 0 Clerk Office Use Only 020 M7S-9E. f 1HE 7 Town of Barnstable *Permit# Expires 6 r issue date /�` 1 'f� `� Regulatory Services Fee g rY 3s---- • i6 Richard V. Scali,Director � DMA'taPRID ---- -- -- ----- - __ _------- #�t� $uilci-ing=Divisran---_ _-_._--:_--_- -_�-- —- .---_ _. _—_-v __ NOV 0 6 2015 Tom Perry,CBO,Building Commissioner ,rj TOWN OF 200 Main Street,Hyannis,MA 02601 PERMIT BA- --u ABLE www.town.barnstable.ma.us Office: 508-862-4038 F guS:-g9100330 EXPRESS PERMIT APPLICATION - RESIDENTIAIO I3yBABN Not Valid without Red X-Press Imprint S TA B L E Map/parcel Number`n�..J� Property Address ` fôz7- Am 110 5-r-i-LcLeT C-um&AkQ i 1 nil Pto 2-6 3-7- [;Residential Value of Work$ t,OOO Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address FAUL- C• (1 c U. P,®• e70)1 1e C.uwoit•AoQu1O /nr), co2437 Contractor's Name O W IJ Telephone Number 5 o' -17 G-2-42✓3 Home Improvement Contractor License#(if applicable) Email: q cho•rctIMi� eJ e Fi at,l COY'\ 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) g Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be Taken to y444.40 litik I OWN-) ❑ Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ 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 Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: FC3-P-IL Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 040215 The Commornvealth of Massachusetts �r 1 partrnent of Industrial Accidents �`' t Office of investigations ---, l _ - _-- 6fit?Washington Street --— — r Boston,31,4. 02111 - wwwmass govfdia Workers' Compensation Insurance Affidavit Builders/Contractors/EIecfricians/Plumbers Applicant Information Please Print Lealy Name(BuSmessfOlganizationfin al); OW L - Address: 4o Zy A 1 k) 5T . CO W1 Vvl,4 t20 1O / AAA,-- D 2 J3) City/State/Zip: Gow►rvtAG1 v kr2, M O Phone ic SO ( - 47 C - 7j Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer pith. 4. ❑I am a general contractor and I 6. ❑Near employees(full andfor part-time).* have hired the sub-contractors 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' [No workers'comp.insurance comp.insurance# 9. ❑Building addition required.] 5. ❑ We area corporation and its 10'❑Electrical repairs or additions 3.34.I am a homeowner doing all work officers have exercised their 11_❑Plumbing repairs or'additions myself o workers' right of exemption per MGL F L.g Roofrepairs insurance required.]i c.152,§1(4),and we have no employees.[No workers' 13.❑Other camp-insurance required.] *Any app!icaot diet checks box N1 must also fill out the section below showing their workers*compensation policy information_ I Homeowners who submit this affidavit indicatng they are wing all work and then hie outside coat actors must submit a new affidavit indicating such. :Contractors that check this Ewa must attached en additional sheet showing the name of the sub-contractors and state whether or not those entities have employees.lithe ontactase have employees,they roust prov-ide-their workers'comp.policy number. I am an employer that is providing workers'cotrtpensation insurance for my employees. Be£ow 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$1,540.00 andfor 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 maybe forwarded to the Office of Investigations of the DIAL for insurance coverage verification_ I do hereby certify under the pains and penalties a perjury that the information provided abova is true and correct Sienature: q, -3 Date: I Phone# So - 774 2-433? Official use only. Do not write in this area,to be completed by city or town official City or Town: PermitlLicense i Issuing Authority(circle one): 1.Board of Health 2.Bui ng 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 In Fuuvide workers'compensation for their employees. ' y Pnzsuaatto this statute,an employee is defined as."_.every Person in the service of another under any contract of hire, expiGss or implied,oral or writ" . An erTIvyer is defined as"an individual,partnership,association,c ojyoration or other legal r,1i if y,or any twu or more of the foregoing engaged in aJoint enterprise,and including the legal lcyLesentatives of a der•-used employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling horse 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 is'building appurtenant thereto shsT1 not becansa of such empl. ••.int be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state nr local licensing a:-,cy shall withhold the issuance or renewal of a license o permit to operate a business or to construct build', gs in the commonwealth for any applicant who has not rodnced acceptable evidence of compThnice -• the insurance.coverage regnired_" AdrlitionaTly,MCGL chapter 152, §25C(7)states" Neither the cemmcmw-.:1■• nor may of its political subdivisions shall enter into any contract fo�the performance ofpublic work mold accep•:.•le evidence of compliance with the insurance.. requirement of finis chapte\have been pLCSr ritPrl to the contracting., r.••ozity_ . Applicants ' Please fill out the workers'comps .:on affidavit completely,b, checking the boxes that apply to your situation and,if necessary,supply sub-confactor(s) .'=.•_e(s), address(es)arid ph,,nenumber(s) along withtheircertifzca±e(s) of in urance. Limited Liability Compani (LLC)or Limited *. " Partnerships(LLP)with no employees other than the members or partners,are not required to e;.. y workers'comp.,. anon insurance. If an LLC or LLP does have employees, a policy is required. Be advise. this affida 1 maybe submitted to the Department of Industrial Accident for confirmation of insurance cove e. Also be ire to sign and date the affidavit The affidavit should . be returned to the city or tovrn that the applirati. for the p-...' or lir—nse is being requested,not the Department of Industrial Accidents. Should you have any questi c -•. ding the law or if you are required to obtain a workers' compensation policy,please call the Department at `,-. her listed below. Self-insured companies should enter their self-inst rance lirpuse number on the appropriate line. City or Town Offiri2Ts / r Please be suit that the affidavit is complete and Filed.legit . The Department has provided a space at the bottom • of the affidavit for you to-F11 out in the event the Office of Inv .gadons h a c to contact you ia.ding the applicant Ken cebe sure to f1in the pernitficensemmmber chwillbe • ed as a reference number. In addition,an applicant that must submit multiple peuuitbIirpnse apply ons in.any given ear,need only submit one affidavit indirating current policy irormaLion(if neceq_zary)and under"Joy Site Address"the- •licant should write"all locations in (city or town)."A copy of the affidavit flu at has been o ciafy stamped or m ed by the city or town may be provided to the - applirant as proofthst a valid affidavit is on five for future permits or lit:• es A new affidavit must be-Filed out each year.Where a home owner or citizen is obtsinmg a.license or permit not ; -•-• to any business or commercial venture (ie. a dog license or permit In bum leaves eq.)said person is NOT -am; • complete this affidavit • The Office of Investigations would ilke to you in advance for your coop- :on and should you have any questions, please do not hecitatP to give us a call • • The Department's address,telephone and.number. . . The Co-raaanweattlr of MPcTirlivetJs .- •• ' _ , , De.parimtnt o Licingtrial A eidents . , ; 1 - • ()Moe of Txtvestigatio= 600 NkTaslikaton.Stmet Bosto 32 MA 02111 -TO.#617 27-49 e.xt 406 or 1- .T-MASSAFE Fax#617-727='74.9 Revised 4-24-07 - Nai vi w rn a C gCg/dIa Town of Barnstable Regulatory Services iciTHE rqt�,` Richard V.Scali,Director Building Division * BARNSfABLE, ' Tom Perry;Building Commissioner Mns.4 71044639. o.`�� 200 Main Street, Hyannis,MA 02601 �''°len www.town.barnstable.ma.us • Office: 508-862-4038 Fax 508-790-6230 HOMEOWNER LICENSE EXEMPTION DATE: `c E &( Please Print JOB LOCATION: 'fO LZ ( A I►J S- -&lc c U'M.Wd d ev.0 number street village "HOMEOWNER": ?AO L G gL A i 50£5- 362 71 ct3 5Ok 7-74.-2-dM name home phone# work phone# CURRENT MAILING ADDRESS: e O' (J a-A (Q coMmAcgol'r gyp. 02637 city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) { The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes; bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often • results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 040215 , a, l * anartsrnsi.E. �, ,.� Town of Barnstable Argo M a _- 'Regulatory Services____._ Richard V.Scali,Director % Building Division Thomas Perry,CBO tBuilding Commissioner ,` , 1 7 ,200 Main Street, Hyannis,MA 02601 y ' 1.4i. v J., r .. y �� a r _a. www.town.barnstable.ma.us Office:''508-862-4038 ` .e t t t =: •• Fax: 508-790-6230 • `) Property Owner st " f Complete and Sign T ,s Section IfUsingAB ' der I, ?AUlu a, , (21 c.A"ml , as 0w et of the subject property hereby authorize 9A uu G . ,Llk l\A to act on my behalf, • in all matters relative to work authorized b, this buildin permit application for: # , (Address of Job) f / / c743;- - '''. -- 62-----‘---- (C2( Signature of Owner // D. e s?/o,UL G • F-1c tote, ,, Print Name 1 If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 040215 ti: i( — tt—tt-t PP i r Town of Barnstable *Permit# Expires 6 months m issue date ass/ Regulatory Services �� i SS P „ .Inv II 9� � Richard V.Scali, Director Dmoo, Building Division OCT 30 2014 Tom Perry,CBO,Building Commissioner TOWN OF BARNSTABLE 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address -io 2-i P\AI 0 5- comm A Q t) i 0 / virlps . 0 7-6'31 O. Residential Value of Work$ 1 000 Minimum fee of$35.00 for work under$6000.00 1l Owner's Name&Address Pill u L. ( • F-V- Ct A 1---0 Contractor's Name Cu.)kJ — Telephone Number 5 O -77L "Z4f3S Home Improvement Contractor License#(if applicable) Email: it 1 t.,\AArS i ( e All .C,„3n„ .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 Re nest(check box) Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to YA_m o OTit lbw)\-) ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows #of doors: I ❑ 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 Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: C0J--.,• -,._ gric=1.---:".4 , • Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 061313 - i1 t• Ck • The Commonwealth of Massachusetts Department of Industrial Accidents = VI s Office of Investigations ' 600 Washington Street A Mil r Boston,MA 02111 ;P,Z www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers , • Applicant Information Please Print Legibly • Name(Business/Organization/Individual): h L)L G D Address: 4oz1.: rAli..) City/State/Zip: G0M MACev Xp dYl is ,6763/Phone#: 5613 79'6`24 3 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 listed on the attached sheet. 7. ❑Remodeling 2.❑ I am a sole proprietor or partner- ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' [No workers' comp.insurance comp. insurance.# 9. El Building addition required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3AI 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' 13.0 Other comp:insurance required.] *Any applicant that checks box 141 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 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$250.00 a day against the violator: Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties perjury that the information provided above is true and correct. Si ature: ��� Date: O 3tS Phone#: 56$ .77‘. "Zt'Z, 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#: Informati s n 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 gaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling h use having not ore than three apartments and who resides therein,or (occupant of the dwelling house of another who employs'm persons to do maintenance,construction or repair .rk on such dwelling house or on the grounds or buill*ig appurtenant thereto shall not because of such employment t e,deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency /all withhold the issuance or renewal of.a license or per "t to operate a business or to construct buildings the commonwealth for any. applicant who has not produc d.acceptable evidence of compliance with tb. I surance coverage required." Additionally,MGL chapter 152, 25C(7)states`"Neither the commonwealth or any of its political subdivisions shall enter into any contract for the pert°• I.ance of public work until acceptable e dence of compliance with the insurance requirements of this chapter have be-n presented to the contracting authori►;." Applicants Please fill out the workers' compensation a`.davit completely,by chi king the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s), .•dress(es)and phone . iber(s)along with their certificate(s)of N` insurance. Limited Liability Companies(LLC)o. Limited Liabili 'artnerships(LLP)with no employees other than the members or partners,are not required to carry wo .ers' compens. on insurance. If an LLC or LLP does have employees,a policy is required. Be advised that thi`affidavit m. be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. • .o be su re to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the pe .t it or license is being requested,not the Department of Industrial Accidents. Should you have any questions reg. ••;g 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 printe egibly.. Th- I epartment has provided a space at the bottom of the affidavit for you to fill out in the event the Offi of Investigati has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as reference number. In addition,an applicant that must submit multiple permit/license applicationgin any given year,n:-d 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 .e city or town may be provided to the applicant as proof that a valid affidavit is on file for`future permits or licenses. ; new affidavit must be filled out each year.Where a home owner or citizen is obtaining a lipense or permit not related t.\afly 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 arid should you have any questions, please do not hesitate to give us a call. ' The Department's address,telephone and fax number: - t 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 4-24-07. www.mass.gov/dia fi4 J l/ifig- 11.41:4:14 IR% * BARN6TABLE, ,r �,0� Town of Barnstable midRegulatory Services Richard Scali,Director Building Division Thomas Perry,CBO /,f , 4 Building Commissioner 200 Main Street, Hyannis,MA 02601.. . .' 1 www.town.barnstable.ma.us _ Office: 508:862-4038 \ y Fax 508-790-6230 Property Owner ust mplete and Sign his Section If Using A uilder I , s Owner of the subject property hereby authorize f/ to act on my behalf, in all matters relative to work authorized by . .. liuilding permit application for: • / - (Address of Job) - '� 1 i \ Signature of Owner / Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. Q:\WPFILES\FORMS\building permit forms\smokecarbondetectors.doc. Revised 050412 I own of Bar t stable Regulatory Services ` �F Richard V.Scali, Director :zss Building Division ;ss vsrnsc.E, *' Tom Perry,Building Commissioner 4." 200 Main Street, Hyannis,MA 02601 Eo I4" www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: 1 C)/SO \� JOB LOCATION: 4o22 f I I,t 5-1-12J 1 cum w4 AQ o r'V number street village ..HOMEOWNER": 904 U L. C� • 62-1CAA 5O b 3 cz -7- [(i So g .7c,:2..53 name home phone# work phone# u CURRENT MAILING ADDRESS: . 0 . �J D- 'q b corn MA.,QUw MA. o2- 7 Olqc, city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to i 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 re uirements. 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. 1 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. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION: . Map 3 3 Parcel 0`f Application# OO Iv 95fo Health Division ,- Date Issued 0 Conservation Division ch . ,. • Application Fee Tax Collector Permit FeeJS Q6 Treasurer air $ _/p- 0>' Planning Dept. .. - Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address 40 9-2- M A I D sT. Village COrf\mAQU\Q Owner P flu l.- • P--1GNASP Address Pao. PboX k,9((:, Cum mtQu101 rfA. O?4.3 1 Telephone (t4) -es 3(2 -"71 93 ) 5'6s, 776- 2-433 _ Permit Request 13U ti,010 G. Qls ur I t c01 ADO IT16P-3 TQ 1STIQC. 1100 S 1\ - a, ��,�, %-�-- 4 \\ .Vekkir\ ti' Square feet: 1 st floor:existing 1304 proposed SI 2nd floor:existing 742- proposed O Total new A'SI Zoning District` r 2-- Flood Plain Groundwater Overlay Project Valuation S©>oo° Construction Type Ln®0 Fit Lot Size 9--,370 l Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family V Two Family ❑ Multi-Family(#units) 1 Age of Existing Structure t.6-1 )'C S 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) 100 Number of Baths: Full:existing 2. new I Half:existing 1 new 0 Number of Bedrooms: existing 3 new Total Room Count(not including baths):existing I-o S new I First Floor Room Count T Heat Type and Fuel: 44 Gas ❑Oil ❑Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing I New d Existing wood/coal stove: ❑Yes ❑No Detached garage existing Cl new sizealk4C Pool:❑existing ❑new size Barniexisting ❑new size lb 2-6 Attached garage:❑existing ❑new size Shed:0 existing CI new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ -Commercial ❑Yes 'No If yes, site plan review# Current Use 5 t k)'idts it- c1 h L Proposed Use S t►.1G(-- FA Mil %1)C196i.`6 BUILD R INFORMATION ,,o a- 776 - f-' Name Ph uL G • 0 4 046M,. 0 Wit Telephone Number 5(2 ` 362_ l9 3 i`,' '.� f Y` Address . o z Z- Al t 0ST . License# r . P CA-)rn .o 63 �' �t r? Home Improvement Contractor# C M. 4 J t 4, �� Q 3`7 Worker's Compensation# — .E si ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 0NSi?-U al 6k -Do GvhS"re 75 L" M6 cI- Ch9C c--ei'D SIGNATURE PC:tA,C .. `,:-. A DATE 1/2-3/0 t , (. FOR OFFICIAL USE ONLY APPLICATION# - DATE ISSUED MAP/PARCEL NO. . r+ ADDRESS VILLAGE I. `' OWNER ' ," DATE OF INSPECTION: FOUNDATION O FRAME / ! •• INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH = FINAL ' / r j ' I GAS: ROUGH FINAL FINAL BUILDING r 1::i DATE CLOSED OUT ' , - ' ASSOCIATION PLAN- NO. 1 t It • The Commonwealth of Massachusetts , _ - Department of Industrial Accidents • E, ►= Office of Investigations • • . Silt • 600 Washington Street 'e)= v Boston,MA 02111 • —. ', www.mass.gov/dia • Workers' Compensation Insurance_Affidavit: Builders/Contractors/Electricians/Plumbers . Applicant Information Please Print Legibly • Name(Business/Organization/Individual): . Pb U 4._ G • _ ` h • • • •Address: Ply 6 011 • I t 6 • . ' . • . • City/State/Zip: C U NI V11 i6 2 v\ O . t'lTh. Phone.#: 56 3 -- -7( 13 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 part-time).* have hired the sub-contractors 2.❑ I am a'sole proprietor or partner- listed on theattached• sheet. 7. ❑Remodeling • • • ' ship and have no employees These sub-contractors have 8. ❑Demolition • working for me in any capacity. employees and have workers' P t. 9 Building addition [No workers' comp.insurance comp.insurance. required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions '3121 I am a homeowner doing all work officers have exercised,their . 11.0 Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12.0Roof repairs • 1 insurance required.]t c. 152, §1(4),and we have no . employees. [Na workers' .13.0 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 en additional sheet showing the name of the sub-contractors and state whether or not those entities have , employees. lithe sub-contactors have employees,they must provide their workers'comp.policy number. • lam an employer that is providing workers'compensation insurance for my employees. Below 1st/se 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 penalties of erjury that the information provided above is true and correct • Sienattuur-e: �- eQ4---A-• _ • � Da ter/710- _ Phone#:•SO? '3 6 2_ - -3'?3 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 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 ins-trance 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 completeand 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 fo 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:. .The Commonwealth of Massachusetts Department of Industrial Accidents . Office of Investigations 600 W ishingtou Street • Boston,MA 02111 • Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 • Revised 11-22-06 www.mass.govidia i • Town.of Barnstable• f".-rt:E,„, .psi'' Regulatory Services . it, Miss Thomas F.Geiler,Director �" i639. ,b� • • Building Division • Tom Perry,Building Commissioner ' ' • • 200 Main Street, Hyannis,MA 02601 . Office: 508.-862-4038 • Fax; 508-790-6230 Permit no. . • Date • ' • AFFIDAVIT • HOME IMPROVEMENT CONTRACTOR LAW • • SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction, alterations,renovation,repair,modernization,conversion, -improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied • building containing at least one but not more than four dwelling units or to structures which are adjacent to • such residence or building be done by registered contractors,with certain exceptions,along with other requirements. 1 • Type of Work: 13 U(I-(�1 N� • ��D 1Tl b 1J - Estimated Cost 50 00 D— A.ddress of Work: 40 7,2- en t i►•) •ST?11 T CO m IYl A&O 1 D 1 m a,- .OZCS • Owner's Name: . C Ao a•. RA ci4 p• 7• 0 Date of Application: 4l7-3(07 . I hereby certify that: . • Registration is not required for the following reason(s): • • DWork excluded by law • ❑Job Under$1,000 • ' ❑Building not owner-occupied' - • Owner.pulling own permit . Notice is hereby given that: • . • OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE . • ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY • I hereby apply for a permit as the agent of the owner: ' Date Contractor Name Registration No. FOR . . 7(011/0-7- eck,..t., d?, V--------" . . Date • . Owner's Name • QffoimshomeaEdav • rave asZin(ensnnaaeco 1 • . . Pseseriptiro Pac&sgd for Owe awl T anus Asai3aatW Baiidinp.31 ated*ilia f �'Re1s MINIMUM • • Glazing Glazing Ceiling wart ' Hoot T Basement • Slab '&ating/Ccol'ur93 . A,renr('A) U-value= R-vaiuer ' R value4 R,Ysluc° Walt . �Ik ads' Equipment M acyr • plc It values R.' uer r • • 5101 to 6300 Resting llrgrrr Darr'12%• `0.4.0 • 38 I3 19 10 6 Normal A MA0.52 30 19 : 19 10. 6 r . 12% 0.50 33 • 13 19 - i0 ' 6 • '•iS lS • T 15% . 036 I 31 • 13 , 25 • .WA • • WA. • LJ 15% 0,46 33 19 ' 19 _ 10 • 6' .Normal Y L 15% 'OM ' 31 13 33 , WA' . 15 AFUE 15b'a O,51 30 • 14 • 19 1a d i5 AFUE ' Normal ,x . IS% 0.32 38 _ 13 2 T NIA _ Al/A y . 18%. 0.4•2 38 • - 19 2 WA NiA' Normal • 13% • 0,4t 38. 13 19 10 ••la90 ARM 12% 0•.50 30 19 19 10 d 5;1 AF17z , 1, ADDRESS OF PROPERTY: 22, t 1SA12A-� 1— ' • , Cut Q,01�l �A .. oWG3`7 • �, gQUARE FOOTAGE OF ALL EXTERIOR WALLS: . 7k TA . 3, SQUARE FOOTAGE OF ALL GLAZING: 8 : `tA ' • 4, °jo GLAZ32,10 AREA•.(##3 DIVIDED BY' 2): i - .% .TD . . • . Sg,LECT PACKAGE(Q..AA-see chart above); • . • voTBi OT I-3ER MORE IN-VOLYED MTHODS OF DETERMItqG ENERGY REQUIREMBiNTS ' ARE AVAILABLE. A .•US FOR THIS INFORMATION, • • i • 7 . BtraLING•LNISPECTORA:PPROYAL: YES:, JNO: • q-l'urts-DoG303a ' • BOISE' Single 11-7/8" AJSTM 20 MSR Joist\1st Floor\D1 BC CALC®9.3 Design Report-US 1 span I No cantilevers 10/12 slope Wednesday,July 11,2007 08:40 Build 057 16"OCS I Repetitive I Glued&nailed construction ' File Name: Paul Richard.BCC Job Name: Richard's Addition Description: 1st Floor\D1 Address: 422 Main St Specifier: be City, State,Zip: Cummaquid, Ma ' Designer: Customer: Paul Richard Company: Shepley Wood Products Code reports: ESR-1144 Misc: 11 � 1v1 , 11v11 1w � 1 „ 1111v1111w111 , 11vv11vw111 r , \ t i/ 4 _. ..� tip.. . l 17-09-12 BO,6-7/8" B1,6-7/8" LL 475 lbs LL 475 lbs DL 119 Ibs DL 119 lbs Total Horizontal Product Length=17-09-12 Load Summary Live Dead Snow Wind Roof Live Tag Description Load Type Ref. Start End 100% 90% 115% 133% 125% OCS 1 Standard Load Unf.Area (psf) Left 00-00-00 17-09-12 40 10 16" Controls Summary Value %Allowable Duration Load Case Span Location Disclosure Pos. Moment 2350 ft-lbs 53.4% 100% 1 1 -Internal Completeness and accuracy of input must End Reaction 556 lbs 40.1% 100% 1 1 -Left be verified by anyone who would rely on Total Load Defl. U673 (0.299") 35.6% . 1 1 output as evidence of suitability for 1 Live Load Defl. L/842(0.239") 57.0% 1 1 particular application.Output here based Max Defl. 0.299" 29.9% 1 1 on building code-accepted design properties and analysis methods. Span/Depth 17.0 n/a 1 Installation of BOISE engineered wood products must be in accordance with %Allow %Allow current Installation Guide and applicable Bearing Supports Dim.(L--x W) Value Support Member Material building codes.To obtain Installation Guide orBO Wall/Plate 6-7/8"x 2-1/2" 594 lbs n/a n/a Unspecified (800)232-0788 k questions,before inplease call B1 Wall/Plate 6-7/8"x 2-1/2" 594 lbs n/a n/a Unspecified installation. BC CALC®, BC FRAMER®,AJST"", Notes ALLJOIST®, BC RIM BOARDTM BCI®, BOISE GLULAMTM SIMPLE FRAMING Design meets Code minimum (L/240)Total load deflection criteria. SYSTEM®,VERSA-LAM®,VERSA-RIM Design meets User specified (L/480) Live load deflection criteria. PLUS®,VERSA-RIM®, Design meets arbitrary(1") Maximum load deflection criteria. VERSA-STRAND®,VERSA-STUD®are Composite El value based on 23/32"thick sheathing glued and nailed to joist. trademarks of Boise Wood Products, L.L.C. Page 1 of 1 BOISE- Double 1-3/4" x 11-7/8" VERSA-LAM® 2.0 3100 SP Floor Beam\1 st Floor\D2 BC CALC®9.3 Design Report-US 1 span I No cantilevers 10/12 slope Wednesday, July 11, 2007 08:40 Build 057 File Name: Paul Richard.BCC Job Name: Richard's Addition Description: 1st Floor\D2 Address: 422 Main St Specifier: be City, State,Zip: Cummaquid, Ma' Designer: Customer: Paul Richard Company: Shepley Wood Products Code reports: ESR-1040 Misc: ai •¢ , y Hm� 'Po,- a , .��"'/v'- il * \ r � 14-00-00 BO,8" 61,8" LL 2520 lbs LL 2520 lbs DL 712 lbs DL 712 lbs Total Horizontal Product Length=14-00-00 Load Summary Live Dead Snow Wind Roof Live Tag Description Load Type Ref. Start End 100% 90% 115% 133% 125% Trib. 1 Standard Load Unf.Area(psf) Left 00-00-00 14-00-00 40 10 09-00-00 Controls Summary Value %Allowable Duration Load Case Span Location Disclosure Pos. Moment 9443 ft-lbs 44.4% 100% 1 1 - Internal Completeness and accuracy of input must End Shear 2467 lbs 31.2% 100% 1 1 -Left be verified by anyone who would rely on Total Load Defl. U539(0.285") 44.5% 1 1 output as evidence of suitability for Live Load Defl. U691 (0.222") 52.1% 1 1 particular application.Output here based Max Defl. 0.285" 28.5% 1 1 on building code-accepted design properties and analysis methods. Span/Depth 12.9 n/a 1 Installation of BOISE engineered wood products must be in accordance with %Allow %Allow current Installation Guide and applicable Bearing Supports Dim.(L x W) Value Support Member Material building codes.To obtain Installation Guide BO Wall/Plate 8"x 3-1/2" 3232 lbs n/a 15.4% Unspecified or asuestionb,pleasecall B1 Wall/Plate 8"x 3-1/2" 3232 lbs n/a 15.4% Unspecified (800)232-0788 beforea installation. BC CALC®,BC FRAMER®,AJSTM', Notes ALLJOIST®, BC RIM BOARDTM' BCI®, BOISE GLULAMTM' SIMPLE FRAMING Design meets Code minimum (U240)Total load deflection criteria. SYSTEM®,VERSA-LAM®,VERSA-RIM Design meets Code minimum (U360) Live load deflection criteria. PLUS®,VERSA-RIM®, Design meets arbitrary(1") Maximum load deflection criteria. VERSA-STRAND®,VERSA-STUD®are trademarks of Boise Wood Products, Connection Diagram L.L.C. rl b r_ 4 • f N l� a minimum=2" c=7-7/8" b minimum=3" d= 12" Member has no side loads. Connectors are: 16d Common Nails 1 Page 1 of 1 BOISE- Single 11-7/8" AJSTM 20 MSR Joist1st Floor\D3 BC CALC®9.3 Design Report-US 1 span I No cantilevers 10/12 slope Wednesday,July 11,2007 08:40 Build 057 16"OCS I Repetitive I Glued&nailed construction File Name: Paul Richard.BCC Job Name: Richard's Addition Description: 1st Floor\D3 Address: 422 Main St Specifier: be City, State,Zip: Cummaquid, Ma' Designer: Customer: Paul Richard Company: Shepley Wood Products Code reports: ESR-1144 Misc: v w 1 1 Fa 9 4 1 V V m l V $ 1 1 1 1 1 V11 V 1 V 1 V 1 1 ® V V , 1 1 V 13-09-12 BO,6-7/8" B 1,6-7/8" LL 368 lbs LL 368 lbs DL 92 lbs DL 92 lbs 1 Total Horizontal Product Length=13-09-12 Load Summary Live Dead Snow Wind Roof Live Tag Description Load Type Ref. Start End 100% 90% 115% 133% 125% OCS 1 Standard Load Unf.Area (psf) Left 00-00-00 13-09-12 40 10 16" Controls Summary Value %Allowable Duration Load Case Span Location Disclosure Pos. Moment 1364 ft-lbs 31.0% 100% 1 1 - Internal Completeness and accuracy of input must End Reaction 422 lbs 30.4% 100% 1 1 -Left be verified by anyone who would rely on Total Load Defl. U1407 (0.109") 17.1% 1 1 output as evidence of suitability for Live Load Defl. U1758 (0.087") 27.3% 1 1 particular application.Output here based Max Defl. 10.9% 1 1 on building code-accepted design Span/Depth 0.109" Na 1 properties and analysis methods. P P Installation of BOISE engineered wood products must be in accordance with 1 %Allow %Allow current Installation Guide and applicable Bearing Supports Dim.(L x W) Value Support Member Material building codes.To obtain Installation Guide orBO Wall/Plate 6-7/8"x 2-1/2" 460 lbs n/a n/a Unspecified (800)232-0788 k questions,before installation.please call B1 Wall/Plate 6-7/8"x 2-1/2" 460 lbs n/a n/a Unspecified BC CALC®, BC FRAMER®,AJSTm, Notes ALLJOIST®,BC RIM BOARDTM' BCI®, BOISE GLULAMT^" SIMPLE FRAMING Design meets Code minimum(U240)Total load deflection criteria. SYSTEM®,VERSA-LAM®,VERSA-RIM Design meets User specified(U480) Live load deflection criteria. PLUS®,VERSA-RIM®, Design meets arbitrary(1") Maximum load deflection criteria. VERSA-STRAND®,VERSA-STUD®are Composite El value based on 23/32"thick sheathing glued and nailed to joist. trademarks of Boise Wood Products, L.L.C. Page 1 of 1 BOISE- Double 1-3/4" x 11-7/8" VERSA-LAM® 2.0 3100 SP Floor Beam\2nd Floor\D4 BC CALC®9.3 Design Report.-US 1 span I No cantilevers 10/12 slope Wednesday,July 11,2007 08:40 Build 057 File Name: Paul Richard.BCC Job Name: Richard's Addition Description: 2nd Floor\D4 • Address: 422 Main St Specifier: be City, State,Zip: Cummaquid, Ma' Designer: Customer: Paul Richard Company: Shepley Wood Products Code reports: ESR-1040 Misc: ± ± ± ± ± ± ± ± ± ± ± ±2 ± ± ± ± ± ± ± 3 P ,.., ,,,, , , -, , , , „fie>,m ia„ Z. ,,,,i`r . .. ,.\ ,, , ;. „ ... .. .,• �.... ., . �caiy a 14-00-00 BO,4" B1 4" LL 840 lbs LL 840 lbs DL 1169 lbs DL 1319 lbs SL 1335 lbs SL 1635 lbs Total Horizontal Product Length=14-00-00 Load Summary Live Dead Snow Wind Roof Live Tag Description Load Type Ref. Start End 100% 90% 115% 133% 125% Trib. 1 Standard Load(ceiling) Unf.Area(psf) Left 00-00-00 14-00-00 20 10 06-00-00 2 Roof Unf.Area(psf) Left 00-00-00 09-00-00 15 30 06-00-00 3 Roof Unf.Area(psf) Left 09-00-00 14-00-00 15 30 09-00-00 Controls Summary Value %Allowable Duration Load Case Span Location Disclosure Pos. Moment 11221 ft-lbs 45.9% 115% 2 1 - Internal Completeness and accuracy of input must End Shear -3005 lbs 33.1% 115% 2 1 -Right be verified by anyone who would rely on Total Load Defl. U429(0.377") 56.0% 2 1 output as evidence of suitability for Live Load Defl. L/659 (0.245") 54.7% 2 1 particular application.Output here based Max Defl. 0.377" 37.7% 2 1 on building code-accepted design properties and analysis methods. Span/Depth 13.6 n/a 1 Installation of BOISE engineered wood products must be in accordance with %Allow %Allow current Installation Guide and applicable Bearing Supports Dim.(L x W) Value Support Member Material building codes.To obtain Installation Guide orBO Wall/Plate 4"x 3-1/2" 3344 lbs n/a 31.8% Unspecified (800)232-0788 k questions,please call B1 Wall/Plate 4"x 3-1/2" 3795 lbs n/a 36.1% Unspecified before installation. BC CALC®,BC FRAMER®,AJSTM, Notes ALLJOIST®, BC RIM BOARDTM' BCI®, BOISE GLULAMT"" SIMPLE FRAMING Design meets Code minimum(L/240)Total load deflection criteria. SYSTEM®,VERSA-LAM®,VERSA-RIM Design meets Code minimum(U360) Live load deflection criteria. PLUS®,VERSA-RIM®, Design meets arbitrary(1") Maximum load deflection criteria. VERSA-STRAND®,VERSA-STUD®are trademarks of Boise Wood Products, Connection Diagram L.L.C. fi-lb d 4 c C / •1 • a minimum=2" c=7-7/8" b minimum=3" d = 12" Member has no side loads. Connectors are: 16d Common Nails Page 1 of 1 BOISE" Double 1-3/4" x 11-7/8" VERSA-LAM® 2.0 3100 SP Floor Beam12nd Floor\D5 BC CALC®9.3 Design Report-US 1 span I No cantilevers 10/12 slope Wednesday,July 11, 2007 08:40 Build 057 File Name: Paul Richard.BCC Job Name: Richard's Addition Description: 2nd Floor\D5 Address: 422 Main St Specifier: be City, State,Zip: Cummaquid, Ma' Designer: Customer: Paul Richard Company: Shepley Wood Products Code reports: ESR-1040 Misc: f 14-00-00 BO,4" B1 4" LL 1260 lbs LL 1260 lbs DL 1657 lbs DL 1657 lbs SL 1890 lbs SL 1890 lbs Total Horizontal Product Length=14-00-00 Load Summary Live Dead Snow Wind Roof Live Tag Description Load Type Ref. Start End 100% 90% 115% 133% 125% Trib. 1 Standard Load(attic) Unf.Area(psf) Left 00-00-00 14-00-00 20 10 09-00-00 2 Roof Unf.Area(psf) ,Left 00-00-00 14-00-00 15 30 09-00-00 Controls Summary Value %Allowable Duration Load Case Span Location Disclosure Pos. Moment 15547 ft-lbs 63.5% 115% 2 1 -Internal Completeness and accuracy of input must End Shear 3898 lbs 42.9% 115% 2 1 -Left be verified by anyone who would rely on Total Load Defl. U311 (0.519") 77.1% 2 1 output as evidence of suitability for Live Load Defl. U475(0.34") 75.8% 2 1 particular application.Output here based Max Defl. 0.519" 51.9% 2 1 on building code-accepted design properties and analysis methods. Span/Depth 13.6 n/a 1 Installation of BOISE engineered wood products must be in accordance with %Allow %Allow current Installation Guide and applicable Bearing Supports Dim.(L x W) Value Support Member Material building codes.To obtain Installation Guide BO Wall/Plate 4"x 3-1/2" 4807 lbs n/a 45.8% Unspecified or ask questions,please call B1 Wall/Plate 4"x 3-1/2" 4807 lbs n/a 45.8% Unspecified (800)232-0788 before installation. BC CALC®,BC FRAMER®,AJSTM, Notes ALLJOIST®, BC RIM BOARDTM, BC1®, BOISE GLULAMTM SIMPLE FRAMING Design meets Code minimum(U240)Total load deflection criteria. SYSTEM®,VERSA-LAM®,VERSA-RIM Design meets Code minimum (L/360) Live load deflection criteria. PLUS®,VERSA-RIM®, Design meets arbitrary(1") Maximum load deflection criteria. VERSA-STRAND®,VERSA-STUD®are trademarks of Boise Wood Products, Connection Diagram L.L.C. fi-I __—d� j�/�\ c /N • • a minimum=2" c=7-7/8" b minimum=3" d= 12" Member has no side loads. Connectors are: 16d Common Nails Page 1 of 1 (E",_,%), r Town of Barnstable Re ulator Services NSTA : Thomas F.Geiler, Director 1639p Building Division rFD MA'I Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION q � Please Print t // DATE: d-3/®`/ JOB LOCATION: 4dOZZ— MAIO 5 S-c—er Cora inAV\0 number a street village Q "HOMEOWNER": C AUL G. �G, -�ALO 50S J,z-`!-7 1 1C�l 3 5-08 776 2-43s name home phone# work phone# p CURRENT MAILING ADDRESS: ` J O.' b l` 9 Cumrnik.Q0117 MA . 0263 city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable.Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and • requ`iirremepn—ts. ` Signature Homeownerof 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 caret amend and adopt such a form/certification for use in your community. Q:forms:homeexempt Town of Barnstable *Permit# Cr-60 g • Expires 6 months from issue date Regulatory Services Fee T;1 UU ®� Thomas F.Geiler,Director • it [ 2op� Building Division Nw �, 3 Tom Perry,CBO, Building Commissioner �S-Tr Main Street,Hyannis,MA 02601 �F gPR www.town.barnstable.ma.us Office: 5o0C� 4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number 3 3 GO it '' Property Address loz2 f1n A11J 5 Teo=e"1: -13 Af4a5-C4u itvt A. of 37 ' Residential Value of Work I® D wuMinimum fee of$25.00 for work under$6000.00 Owner's Name&Address PA .) . G . AO P, o. 001 tq Cur/ m-4010D imp. 02-6 3`7- Contractor's Name WOVv►,4 0idW -- Telephone Number 562 362--71413 Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one; ❑ I am a sole proprietor ig 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 ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side Replacement Windows. U-Value 6� 3 f (maximum.44) *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. Home Improvement Contractors License is required. SIGNATURE: (JU�. � — Q:Forms:expmtrg Revise071405 114G Luinriwri'Yelun Of lrlussucnuserrs Department of Industrial Accidents . o — Office of Investigations 1?1e1 • . 600 Was • hington Street • Boston,MA 02111 1.1-0 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information ' . Please Print Legibly il Name (Business/Org ni7ationandividual): Pa Ol. • G. .?04 A Address: V.o• 0 0 ( G. . 40 rvx-k w sT. c v rvo A ervk)10 ��A -• 0 24 3.7 City/State/Zip: c°.0 mrAial O tO ,11,1A 0)2_63-'• • Phone#: SO8.. 3 2.- 7I.TS ct c.c., cos .776- 3> 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.g Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We area corporation and its • required.] officers have exercised their 10.❑ Electrical repairs or additions 30 I am a homeowner doing all work right of exemption per MGL . 11.0 Plumbing repairs or additions myself[No workers' comp. c. 152,§1(4),and we have no 12.❑ Roof repairs insurance required.]t • employees. [No workers' • comp.insurance required.] 13.0 Other *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 their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: (OJ. A- -.. ( Date:' I ci2Y0 Phone#: P"08 3 6Z--7113(1 ) ( cf-,1.ti,) 5762 776-2k3 . 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 • . ,• t ,_.. 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,,partnerskip,association, corporatio' or other legal entity,or any two or more • of the fdri going engaged in a joint enterprise, and including the legal repres-I •fives of a deceased employer,or the receiver o trustee of an individual,partnership, association or other legal en ty, employing employees. However:the owner of a welling house having not more than three apartments and who resides therein, or.the occupant of the dwelling hou of another who employs persons to do maintenance,cons' ction or repair workbn such dwelling house or on the groan or building appurtenant thereto shall not because of su employment be deemed to be an employer." MGL chapter 152, § 5C(6)also states that"every state or local licen ng agency shall withhold the issuance or renewal of a license o permit to operate a business or to constru buildings in the commonwealth for any applicant who has not roduced acceptable evidence of compli ice with the insurance coverage required." Additionally,MGL chapt r 152, §25C(7)states"Neither the co ..nwealth nor any of its political subdivisions shall enter into any contract for ic performance of public work until a eptable evidence of compliance with the insurance requirements of this chapter h:ve been presented to the contrac u i g authority." . • Applicants • Please fill out the workers' compens:tion affidavit completely by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)n•""=e(s), address(es)and p i one number(s)along with their certificate(s)of insurance. Limited Liability Companies ' LC)or Limited Li.i ility Partnerships(LLP)with no employees other than the members or partners; are not required to c.1 : workers' comp;nation insurance. If an LLC or LLP does have employees,a policy is required. Be advised th this affidavit ,s•y be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be s re to sign and date the affidavit. The affidavit should be returned to the city or town that the application f•.the p u 't or license is being requested, not the Department of Industrial Accidents. Should you have any questions r:!.ar''Ig the law or if you are required to obtain a workers' compensation policy,please call the Department at then „ 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 le_i•ly. The ►y•artment has provided a space at the bottom of the affidavit for you to fill out in the event the Office of i i vestigations ,•s to contact you regarding the applicant Please be sure to fill in the permit/license number which , ' be used as are ence number. In addition, an applicant that must submit multiple permit/license applications in . 1 y given year,need a' submit one affidavit indicating current policy information(if necessary)and under"Job Site • i dress"the applicant sho ' write"all locations in ' (city or town)."A copy of the affidavit that has been officially stamped or marked by the ci or town may be provided to the . applicant as proof that a valid affidavit is on file for. ,tare permits or licenses. A new 1 davit must be filled out each year.Where a home owner or citizen is obtaining a 'tense or permit not related to any b iness or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete affidavit. The Office of Investigations would like to thank you,in advance for your cooperation and show'&you have any questions, please do not hesitate to give us a call. t ' The Department's address,telephone and fax number: The Commonwealth of Massachusetts ' . Department of Industrial.Accidents .• . .. . . . ,, • . . ., Office of hvestigations .. 600 Was' gton Street .' `" Boston,MA 02111. • Tel.#617-727-4900 ext 406 or.1-877-MASSAFE Fax#617-727-7749 Revised 5-26-05 www.mass.gov/dia oFvee4 Town of Barnstable Regulatory Services saR:tsaalk , Thomas F.Geller,Director .44206344. hasBuilding 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 G g-1ck2() ,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: Th T (Address of Job) e I II 2y0r Signature of Owner Date FpuU G' P-4(A I(t9 Print Name Q:FORMS:OWNERPERMISSION , 3 TOWN•OF BARNSTABLE BUILDING PERMIT APPLICATION U f(.4:( Map 336, Parcel ()It Permit# 2 s7 7 s.s- Health Division pa 7 /3/uy ?j f . Date Issued 7 /6 0 Conservation Division Application Fee a o® Tax Collector 0 -�-Rerrq.it,Fee_ oZ -S� 0 0 Treasurer 1 f C 11 0 ImsTA' LED IN COIVIPLIANcE Planning Dept. WITH TITLE 5 ENVIRONMENTTAL CODE AND Date Definitive,Plan Approved by PI nning Board TOWN REGUL 'IONS S '"7 ),w°kcio w Historic-OKH Of/--1)SYn 11151 Preservation/Hyannis Project Street Address 40 2_2- MA 1 5'T(2_ t Village CUYY\ iy1 AC90 0 , r( A. • 0 263 Owner e— 4 N pNGy p..,1atmo Address 1 Telephone 5US 3 G Z-- 31 i s cAsL,l� 568 -77-6. /3` 1 p " c:. t _ C) Permit Request (Z 5 N;1 N‘1.-16 aAg AG 6 k ()Jo fL1�5 l� de J i Ot 6 - �' c.„.) fe-Ls:fi. 5e-Lt (51. 1- Amp _ o - ry u0 . f326O 6/6„ g)e I-2_ c '13 co =: Square feet: 1st floor: existing proposed __ 2nd floor:existing proposed TotaLnew„ Zoning District Flood Plain Groundwater Overlay Project Valuation 1'1000 Construction Type ()Joao Lot Size o 01 tt c P.lam Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. D c O C;4te,gbi. (904444 iit of Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure 8C) e 1.0 yps Historic House: TgYes ❑No On Old King's Highway: 16Yes ❑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 CI new size I I I lo -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 BUILDER INFORMATION Name POOL G - ; k1YLQ 640 ow1JtTelephone Number 568 -30 e 3 Address /67,i_ 01 A 1 v4 Tr . License# rad. Oak 19. 4 Home Improvement Contractor# C o vn e O U 1 pi MA • a 3' Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO W P`Ttt '5 y b r r0 , 011` c0 fi.. c-o Q `Tv rutIt SIGNATURE Poi, �. P-�-A DATE '7 13/o f r �— ' FOR OFFICIAL USE ONLY ti. m f in. • PERMIT NO. . i ,; , DATE ISSUED — • — : MAP/PARCEL NO. - - - F • ADDRESS VILLAGE OWNER _ . 1 ,'.. • . f I • DATE OF INSPECTION:" _ w ! FOUNDATION FRAME ... INSULATION — FIREPLACE ' ELECTRICAL: ROUGH FINAL ' . PLUMBING: ROUGH FINAL - GAS: ROUGH—; FINAL J r FINAL BUILDING - I. . ,- ' DATE CLOSED OUTa ASSOCIATION PLAN NO. g I, r a I ro , r __— ___, The Commonwealth of Massachusetts - ► Department of Industrial •Accidents. • • r xf = t O�lce etIsresd91#U' ' 600 Washington Street • - d y, • Boston,Mass. 02111 . • -" ' Workers' Corn ensation.insurance Affidavit-General Businesses -- 4, P �i'gt;•gt,t4,yi ..•.'w,t'. •'°'+'t'0i. • .reer.a,A,r"^.,w,. .. .. •. ,,.':i.: .•:'X..:Aa*§1 • address: ... • . • state: zip: phone# .. '- work site location(full address/: • • • ❑ I am•a sole proprietor and have no one Business Type: 0 Retail 0 Restaurant/Bar/EatingEstablishment - - . working in any capacity. . ❑Office 0 Sales(ineluding.Real Estate,Autos etc.)' . ❑I am an em to er with •em l�es(full& art time: ❑Other ' • • ' LI4///////%///fil,%%/%/%%%%/%///%/%//%G/%//////%%%%%///%%%%////%/G�/%%/%%%%%% %%%//////////%/%%%%//%/////////%/O�%%//////%%//%/�%%/%%%G%%%//////�O/.1N.4 I am an'employer providing workers' compensation for my employees working on this job. • . :1, • :•:11'q 17s • _. •r. ep'• i•*; 'tat' ••rv. c'` ...1 . r•• t;,t.•:„• :, ' ' •i•' cote}an •name: . • ', :4 ••... •Y .. • t••': ',r - '7 , • . ttf •^ • fib(:•s .i. ': u+' ' s •'t:. ', 1 P} •t• w.. ,•4 r' ' addr •ess: • i f .;, i v. t::, :;<ir . .• . r.., .:t..c .;•• °.• r.w, .•". Pntt.... :i'^r:..+. iJ:t••t •• .irisiirance.ccl£ ::•.• i'•^ .�L:•,,; ::4:Y'i.y Yr:•r.:!:".• 1r <' r . I am a sole proprietor and have hired the independent contractors listed below who have the following workers' ' compensation polices: • • • , I :r: gang' •4 .4• • . 'i; ,'t',' t.',f. •it'd. •a•Y.<�^+••::,.4•aY t •';r. :a •. co'mpan*name r•t • .::.• ' .•i .. y: '-•. • • • address:. 4 L:+ t.• •rY' ,i.a - ,•h :7.$`••"'''.•M4;'a,•i+". '.i a"i' ,tt. ''i. .:.ii .l: .7',••.:t••'• .1, • `:ti.r,i • `i•: 1 • ,,it •'+: ,iZ tr C;.';•';:ir, •'t insura•nce co.: �_�'�� • ' tilt• 'i•. •:• '.• ..1 4 •_r•j ;t.•. •'94.• rt' •!'•;•t't ,41 ;r .{:'' - .I,' •t Ds'••F'i" :�'I;.u:! .4. .'�t.t• • \. •.C: ':i::'it"•, •,;:.0 Y'I.t•' .. .•4. � .. •mil'•, , :'..s:.:f'.�_ .. .. ,trr.'r 4�' •t. address:. • • • .. • .+ '. - , �f..r .vj,.. '!i'I.: t�•!'•'t i'j'r rfiYt: tj. cii:v: •. ,. • .• .• , . _ •• . . • • • . .phone#e 'i ;.4%'i • t!- :.,'Y _ -•i. .:r;.':',;4+:k+ '1. .,- .4.: 73:.:i:4t • :, r'':•4: • il.'; •t :5',:i.a': •t • • ,rti • ,'•r', '°': :9•, • 'i. < i.;,..?•:".':"..;Y � ::. :if ?^'.t'. • •i•...,.3t.d•.; In i114- • Failure to secure coverage as required under Section 25A of MGL 152 can lead to the Imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties In the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a • copy of this statement maybe forwarded to the Office of Investigations of the DIA for coverage verification. . I do hereby ce i under the pains and penalties of perjury that the information provided above is frue and correct. ' . • • Si tune t sip--. - . Date • 71 13161 . Print name Jb 0 L, 9--Ie..k.t k • Phone# �6 � � • ,,=� =`. rr�-+a—. _-- '�': tk_ .,va,s. :-_ _s .,E, r w,-�.;;.-,�,,v.,3•f,l -- r;'1.=� . __�_ _...r :..£-,t i._--,. • 1 official use only do not write in this area to be completed by city or town official . • permit/license# n. cityor town: []Building Department il s _ []Licensing Board �j ❑check if immediate response is required ❑Selectmen's Office - [health Department : contact person: . phone#; ❑Other (revised Sept 2003) _r. .,,_.-; ? =':t-".-r:4=`Y. ._ :1v3.c.. _S=/ '✓.r:• .. _.._,3,..-✓c=_ .....:;;7=�..--._ram---':•'.. - ,:.:L..1 ..x:—.. :L�.:,..P.. . w.l5F.t_ ,,^F.:.�^%L'�-F ,, .-u • • . Information and Instructions. t Massachusetts General aws•chapter 152 section 25.requires all employer' to provide workers' compensation for their. • employees: As quoted fro •the I`law", an employee is.defined as every p son 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, co oration or other legal entity,or any two or mare of - the foregoing engaged in aSjoint.sferprise, and including the legal r-i, esentatives of a deceased,employer, or the receiver or trustee of an individual,partners''',. association or other legal enti , employing employees. 'However the owner of a dwelling house having'not more ..• , three apartments and•who res des therein, or the.occupant of the dwelling house of• another who employs persons to do. •! "tenance, construction or epair work on such dwelling house or on the grounds or building appurtenant thereto shall not b= use of such.emplo ....t.be deemed to be an employer. :. MGL chapter 152 section 25 also'states tha . very state'or lb al licensing agency shall withhold the issuance or'renewal of a license or permit.to operate a business to constru ,buildings in the.commonwealth for any applicant who has not produced acceptable evidence of complian a with the'nsurance coverage required. Additionally,neither the' commonwealth nor.any.of its political subdivisions hall ever into any contract for the performance of public work until ' acceptable evidence of compliance with the insuran - eq i ements of this chapter have been presented to the contracting . authority r/ / / / /// //// , / %a�,,/�� Applicants . Please fill in fhe wmP orkers'compensation affidavit co letely,'by ch- g the box that applies to your situation.,Please e address andphone numbers al ng with a certifi of insurance as all affidavits may be submitted 1 company name, sign� y supply to the Department.of Industrial Accidents•for con tion of insurance co age. Also be sure to sign and date the affidavit. The affidavit should be returned to the ci or town that the applica ,. for the permit or license is being , requested, not the Department of Industrial Accidei Should you have any ques'... regardin 'the"law"or if you are tion policy, lease call the D artment at the '•. .er listed below• a workers. .compensation Department obtain �P required to .. . .. • City or Towns . 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 Officefof 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. The.affidavits:may.be.returned to the Department by mail or FAX,unless other'arrangements have been made.. • .. . ••'. •• • ' : . The Office of Investigations would like fo thank you in advance for you cooperation and should you have any questions, please do not hesitate to give us avail.-• .. : The Department's address,telephone and fax number: , • . • The Commonwealth Of Massachusetts• ' • Department of Industrial Accidents • Office of ievestigatiens • • 600 Washington Street ' . . • ' • Boston,Ma. 02111 fax#: (617)727-7749 . phone#: (617) 727-4900 ext.406 r • Town of Barnstable R. .h. ok"o2 Regulatory Services •qativitza $ . Thomas P.Geller,Director 1659 , Builclirg Division ��rFD MA�k Tom Per ,Butlding Commissioner T r3' • 200 Maio Street, Hyannis,MA 02601 , Fax; 508-790-6230 Office: 508.862.4038 • Permit no._____-. • • . Date • AP 'IDAV` RSUPPLEMENT O ERMIT APPLICATION • de MGL c.142A requires that the"Feconstruction,alterations, of an aadd tiontooany pre�exisQting o�wr�er o,ccupled conversion, . • end removal,demolition,or construction blini1dingding containicig at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other • requirements, ,j I Type of Work (2-s Sik nth 5104 � Estimated.Cost 1�c__ O2 (71A►� • C..k.)MVYOA .0\ 0�GS- Address of Work , Owner's Name; A • , Date of Application: 7 3 I hereby certify that: Re4istration is not required for the following yeas on(s): • • ❑Work excluded by law . ' . []Job'Under$1,000[]Building not owmer-occupied , • .Owner pulling own permit Notice is hereby given that: • OARS PULLING TEEIR OWN P,ERMIT OR Il1�PROYEMENT WORKDO NOT HAVE ' CONTRACTORS FOR APPLICABLE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A, SIGNED UNDER PENALTIES OF PERJURY Thereby apply for apermit as the agent of the ow4er: • Contractor Name RegistrationNo. Date s • ?put, G. (L`aAp OR �.� Owner's Name I :L • ir tte,0 Town of Barnstable ), „ Regulatory Services ,STABLE, :� Thomas F.Geiler,Director �b 69. 1 Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us • Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print �Z( I O 1 DATE: Q JOB LOCATION: '1 o 47--'Z {PA I. l►J 5-t a-�fL�(' CO M M/ \0 j ill A . number street village "HOMEOWNER": f'P UL Q: PA CA-Ai 42 So 367- 7153 568 ?--7-6 -243S name home phone# work phone# CURRENT MAILING ADDRESS: e. Q. I27 d?t `q 6 cum roA.OU\0 .YY1,A. O1V3 7 city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures.and requirements and that he/she will comply with said procedures and requirements. Cn.ti.--A. r Signature of Home 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." 1 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:forms:homeexempt .91 .• s Office(1st floor) Map it .3' Lot 4+ 9/1. Permit# 9p7 L Conservation Office(4th floor) Date Issued 7 - S J9\s/ Board of Health(3rd floor)(8:30-9:30/1:00-2:00) r�� - )'y;:).6"7} Fee „�,, J /$6,,S Engineering Dept. (3rd floor) House#1 :ee(' .J t"f �� THE Planning Dept.(1st floor/School Admin. Bldg.) duo ,�� r ads �" 0 `�" �`14` �� RNRTABLE, : Definitiv ' an Ap i ro ed by Planning Board �19 ;t`�,� � 9 �� TOWN OF.BARNSTABLE 044, ' 4 Building Permit Application ( St. Building 61' Project -et Addr..s -®2.L (Y11 410 STL 3.,"N ` �� Village 13 STAL-t- ( m1IsiCb<)1b'J� . Owner PR,Ut-- 4 04N(-) L. P-1C-14 Address 41,Lz- A►u. 5T . P�!).),nnmrot03, 11m, 02437 Telephone (N) 3,Z_ 7!a3 / 1 4z8 - 3a.0 Permit Request —re) Lir)O 'O04,A,e,e ,-.., ---6 2io1) 1 -L' ' - ST©A A - 5g,oN61.Z ROO nrJ a e 'Jr lea'-, P-0n'- Total 1 Story Area(include 1 story garages&decks) square feet - l 3 l D►'✓,-Q ar Total 2 Story Area(total of 1st&2nd stories) square feet Estimated Project Cost $ �00 5(',L,1 eS Zoning District Flood Plain Water Protection 3139 Lot Size '� (� ✓44-'Z- frl" Grandfathered ? Zoning Board of Appeals Authorization Recorded Current Use 1p��-f') Proposed Use (LASS i n C1I10 L— Construction Type 10 0,00 1 n C Commercial Residential Dwelling Type: Single Family X Two Family Multi-Family Age of Existing Structure IS-0 + y Basement Type: Finished Historic House [�' C q g_cA ( Q Unfinished )< Old King's Highway -* B(R��q 0 �g SiI►�( a 2_,I c t Number of Baths cS1 No.of Bedrooms 1' Total Room Count(not including baths) First Floor Heat Type and Fuel I4z)T 1/5 ATEf- �4 Central Air PO 0 Fireplaces ( I Garage: Detached it, X Other Detached Structures: Pool Attached Barn None Sheds v40�K Other Builder Information Name rPI)U ' k\CO614)"5", OW IN LSYL..., Telephone NumberN 61 )¢Z8 3665- Address 40 Z2 rPti►4 5 IT - ex, .pd x License# C, Ph►n k Co I r7 1 yy o 7G?a 7 Home Improvement Contractor# Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO A mw.S 061c,I-c 69vV3L, cd . 5 DWEC4/ vl10 SIGNATURE EL-. DATE 7/ /'j c' BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) t - FOR OFFICIAL USE ONLY . - PERMIT NO. 9294/ , y Y DATE.ISSUED 7/25/95 _ �; 1 - • t -' / - , • 'ry 1 _ • MAP/PARCEL NO. �'336 - 044' t t _ ADDRESS • 4022 Route 6-A r VILLAGE Barnstable t ; t ` OWNER , t , i • , DATE OF INSPECTION: ' �1 t FOUNDATION ' Y\W t;r FRAME 4. ZN13 .Ob -'1 g r Z1" LAS .. INSULATION ��`0SS D errw.t, - ,-c '9,S U f FIREPLACE f ELECTRICAL: ROUGH FINAL , PLUMBING: ' .ROUGH FINAL - GAS: •..~'-ROUGH FINAL . FINAL BUILDING , ` '. • r DATE CLOSED OUT 9�`2,3 '`� ASSOCIATION PLAN NO. • , , .t 4 Assessor's Oki)(1st F'lbor): 1 � 9 — /)7 7 - Assessor's map and lot number utic*TN E>o g. _ 3c� �� 1`'. : E!c;y, ' 4' ;: '. en.,;1 _ wah(3rd floor): t • wt number . / � % /� 5 ■..ant a s �` ' ' ' E6��IR®i�91�Ef T ,moo �a o. g_ Engineering Department(3rd floor): r t L ®�';ray . `� House number f T'% E UL�T O r Definitive Plan Approved by Planning Board 19 APPLICATIONS PROCESSED 8:30-9:30 A.M:and 1:00-2:00 P.M.only € 1 TOWN OF rBARNSTABLF, ;BUILDING INSPECTO !APPLICATION �9_ FOR PERMIT TO 6 f�,�� �Q(�/'f I . ����� �( TYPE OF, CONSTRUCTION . . 1 s7 2° ig 93 • TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location 1/O D2'Z /2 a./i Street) Ctim rrm a fic,6.d /724 b 2 G 3 rProposed Use bra 5.6 Zoning District Ra. # / Fire District Za`'/J DS 747f. Ce._ Name of Owner Pa-a./�9'. 5'A(a/2 I :cha k-d Address A/0 Z 1'1Ia//I drrccf C mina /? I Name of Builder /)etc. Address Ja/r)C- Name of Architect /7e-1,-- Address i-aM2- Number of Rooms / Foundation 4-5077 6e4 Exterior 'J//7 9 6 Roofing Q4/PA 11.4& Floors Q(] Interior /In eft /S he d Heating /1f4 Plumbing 4V4 Fireplace /171 Approximate Cost 3 &() --' Area 360 S F Diagram of Lot and Building with Dimensions Fee M.• OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. 1 Name 0 X - ')i th a.A.-77( Construction Sipervisor's License MOW- _ 1 a 1 RICHARD, PEUL G. & NANCY el f • , GC. • .I No 36132 Permit For REBUILD BARN ,-A Accessory to Dwelling f Location 4022 Main Street' r - Cummagu i ,!• • • Owner' riyaul & Nancy Richard Type of Construction Frame , i Plot !' • Lot - ' �� • e 1,1 Permit Granted August 30 , i9 93 t - Date of Ins pection: e f/ , • • Frame 19 � - A ' 1. Insulation 19 . F Fireplace `' 19 ,' Date Completed /� 19 - ',":{o.,i2 a,es ?lZl/ _ . `t K i >f Hea •_" t' e ` , :,.» Ate. ,a. , , =.. . K �;.y' Y' . b e a gr �n y Application to .mac~°` " v o,a.r."t % :`�'`� Old King's Highway Regional Historic District CO r �t, e 121. •:•,. IP', . P7.7 1 in the Town of Barnstable for a IIN 2 31993 CERTIFICATE FOR DEMOLITION OR REMOV at 5. ` TOWN OF BARNSTABLE Application is hereby made, in triplicate, for the issuance of a Permit for Demolition or Remo .1 of _141.ADI a srru`ctute or part thereof, under Section 6 of Chapter 470, Acts and Resolves of Massachusetts, 1973, for proposed work as described below and on plans, drawings or photographs accompanying this application. TYPE OR PRINT LEGIBLY DATE =' - �2 J -y 3 ADDRESS OF PROPOSED WORK yU2 2 /2)0 Jr.) Sr?'(' ASSESSORS MAP NO. 3 3 6' (it/ fl'7 OWNER l'/ 'X. (' R./(7/4 fq eO' r1, A/V6' y L., /-) CHAW% sSESSORS LOT NO. Uvy HOME ADDRESS hi0)2-2 MO '/1.) ST /('/)jY7t'YJA4)L.) I/) , ✓)1 TEL. NO. 5O8 - ? - 7/ 9�,3 NAMES AND ADDRESSES OF ABUTTING OWNERS: Include names of adjacent property owners across any public street or way. (Attach additional sheet, if necessary). AGENT OR CONTRACTOR J(--(1• TEL. NO. '57)9 36.: - '7/ 9.3 ADDRESS DESCRIPTION OF PROPOSED WORK: If building is to be removed, give new location. Snap shots showing all views of building must accompany application. (Attach additional sheet, if necessary). 642E )c 7i(2,1q(E e_/< /57-24/G' 3-412/I7. //li e)(/577`I/6 f POTP/`/.ail i tc) i TJ .�e v sTRu ( Tt.)2F OF S .,-1 � c / ZE / � NAG� / ,� /A)>O(._ , Do� �r e00/4_IAJF, :5 i'4/ 6 , E're . Note: If approval is granted for relocation, a separate Certificate of Appropriateness is required for new location if within the Old King's Highway Regional.Historic District. 19111 n n SIGNED�I Ot a-e-/ wner. ontacto .A -/cil L A_-(-) —DV)) `>i I �1 I gent gna:eellowrq e,fpr use. Jbuii iJ Received by H.D.C. The Certificate is h reby adV Date 7( Date ; Time By 41 Approved IMPORTANT: If Certificate is approved, approval is subject to the 10 day appeal period provided in the Act. Disapproved El ,'fl LcT `t N 2 4 s$a -S ri) 113 t.taosi• MOP) St, e f t a I osIo Za 3a46 56' 1001 err 800K 6161 PAGE v7 502% QUITCLAIM DEED We, Ivan S , Daugherty , Jr. and. Norma Daugherty, husband and ,Yife, as tenants by the entirety, both of 4022 Main Street, Cummaquid (Barnstable) , Massachusetts, ' for consideration paid of One Hundred Ninety Thousand ($190, 000. 00) Dollars, grant to Paul G. ichard and Nancy L. Richard, husband and wife, 'as tenants by the entirety, both of 4022 Main Street, Cummaquid, Massachusetts 02637 , with QUITCLAIM COVENANTS that certain parcel of land with buildings thereon situate in Barnstable (Cummaquid) , Barnstable County, Massachusetts, bounded and described as follows: Beginning at a point in the Northerly line of Main Street in said Barnstable (Cummaquid) , and at the Southeasterly corner of land now or formerly of John H. Sullivan; thence running North 9 12 ' East, two hundred sixty-six (266) • _ feet, more or less, to an iron pipe at land now or formerly of Louise A. Wallace Crocker; thence running Easterly by land now or formerly of said Crocker, one hundred thirty-seven and 38/100 (137.38) feet, more or less, to land of Charles N. Libby et ux; thence running South 9° 17 ' West by land of said Libby, two • hundred sixty-six (266) feet, more or less, to a stake in • the Northerly line of said Main Street, which stake is one and 45/100 (1.45) feet distant Easterly from a Massachusetts Highway Bound; . t_hence running Westerly in the Northerly line of said Main Street, one hundred thirty-seven and 38/100 (137 .38) feet, more or less, to the first mentioned bound. Being a portion of the premises as shown on a plan entitled "Plan of Land in Barnstable belonging to Thacher Holway May 4, 1926 D. M. Pratt, C.E. " , which said plan is duly recorded with Barnstable County Registry of Deeds in Plan Book 17, Page 61. There is excepted from this conveyance a strip of land running the length of the Westerly side of the above described parcel, said strip of land measuring seventeen (17) feet in width and containing a way known as Stoney Point Road. Being the same premises conveyed by deed of Kenneth W. Willman and Phyllis C. Willman to us dated April 4, 1985 and recorded with Barnstable Registry of Deeds in Book 4476, Page 298. • BOOK 8161 PAGE 178 WITNESS our hands and seals this /Y day of August, 1992 . Ivan S. Daugherty, Jr. moo_- Norma Daugherty THE COMMONWEALTH OF MASSACHUSETTS Barnstable, ss. August /Y , 1992 Then personally appeared the above named Ivan S. Daugherty, Jr. and Norma Daugherty and acknowledged the foregoing instrument to be their free act and deed, before me, KEN • Peter Van W enen, Notary b14:c •. My commission expires 24 3 1#.,,.�,, e1`• • ' 4_ .fir d * N 0 A Z3 "T� `��1 l r'Q b c L. Lu o a IiLUOIW.0 A ;u i7 92 yo*THETo4 • TOWN OF BARNSTABLE B9,BBSTABLB,I i 9� OMAULY /0 BUILDING INSPECTOR APPLICATION FOR PERMIT TO TYPE OF CONSTRUCTION rG 19f9.7 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the fo owing information: e d) Location 6./d//ff, L-/�i.1 C. t1/�.�t!�:V.:. .l�.f.(C'k� �CiQd�s" XL'S �ef.�� El /9 Proposed Use 5-J0fe 4,4*' ' Zoning District / Fire District Name of Owner rkil.E.S...R."7`h co /M ►. 4 Address /4") Name of Builder .V.'` k!. +4. d 4rx0 4 Address /! Ct 57 lam" 0/en/el L/t-� Name of Architect Address Number of Rooms Foundation Exterior (A.) Roofing //\r��.az T Floors Interior Heating Plumbing Fireplace Approximate Cost S00 a" Difinitive Plan Approved by Planning Board 19 /9,eri9 ell 1 ' Diagram of Lot and Building with Dimensions e�Q 4 Do n /4 S 3 ' ,< 7 ' iv, G �4w Gok m!ve- I`I gar I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. G Name �"'` , , . Coffman, Nrs. Ruth . . 'i No 11 Permit for 400 two dormers . . IA L-16a7-/—K..ot:..'ort. i..,L, Location 11412223::6A -- -4rr4V rroi/21 I . ci....e...,...0....4-4 e......,,,,,-7,...... -_,I e—4:" Cummaquid Owner Mrs. Ruth Coffman $ Type of Construction frame Plot Lot is Permit Granted October 31 19 67 ' Date of Inspection s 19 Date Completed // --2.• 2.--- 19.69. 1 , 1 PERMIT REFUSED 1 . f . 19 i . .., f I Approved .._ _ 19 t . . I - I _ Q I ' .i4 • L \37.3 .SMOKE DET ORS REVIEWED 79:3• RNSTABLE BUILDING DE I � • g - I' I r D TE • 1E .:.. ''. : I I 7 FIRE DEPARTMENT I BOTH SIGNATURES ARE REQUIRED FOR PERAIRTING • • • I Ig,. i •. • • • • . I /,... I I I • -I, • • WI , 4wJ • ° /-B • =I • LL B • • fipORTANT UPGRADE REQUIRED.4 /I r • . ie'o . . . ' • ,; .I: • I • I • .. STATE EI.UILDING CODE REQUIRES THE UPGRADING OF ' / I I ' SMOKE DETECTORS FOR THE ENTIRE DWELLING WHEN: • . . . I ONE OR MORE SLEEPING AREAS ARE ADDED OR CREATED. • • ,r 2 I 4 _ r NOTE: A SEPARATE PERMIT IS REQUIRED FOR THE I K 6' • • ' • INSTALLATION OF SMOKE DETECTORS-THE ELECTRICAL.I 1 • - - • • , I • • T T R , i I PERM! DOES NO SATISFY.THIS EQUIREMENT i • 1 - IV/ C+4f.A /WORILSHOP ------------�- •- • - • •: • . //;/////ii '///!iz//e- , 8 I i _ ,,t 'r. I i7. , I r n1I I ? - - -- —-- _, 1 . . 1 r I O / • 33' �. yj ems` . . . / . N 1 1 IL I PtzoPasD \\ I 2 nn 1 Y pj I p it V) I. . ' • I � �y e • j. � ` p ipa \ .. I I • 3 � I 1 I � • L ' • . I. j I • I r. .. r r NoIZ'i�{ 11 6' O. 17. •30. 1 I. I • • , I I $ e�7J) 50� �� __ —.— — pAUL NA^'�r c1IA •- • '4O22MAIN STR.Cfir _ FLoT • PL_,SIJ GUTAMAQUI R6v SH Q M/� 15�: - 07 . . . • 5 13 7 .PAUL IZ � �.,WNer• u442 • • • IS'-.2"_ f..... 4 a` 00 PL • n O • • N r o \ \ _ / ti\ V L \\ \ \\ \\ .., \.. IDS 1T \\ �\ -• --- .�i • • 18� 04 - X. �i • • o .. i • • • • • • i G . N •0. 3 r •z ` z ;; L y r r r • 761-2" 9'_Zu Zoe_2.1 0.1 91 21'-9.. I6`=ZI1 � -- --_ _ - - 1_2'1 1-' '' S'-4 51-6" 21_9" 31-6° 2'-.1" II'-It" 5'-IDP 4'�" IG'--2." - ( I 1 II_ I I II . Po-RA-..14 MI ® '/ . 4 -„- - I v ( v i 41! 15GtNv V101 R.vly\ . _ 1 I FAMI y R. D I • /10 A # = I 1 1C r I `,i - Lam— In! ti t d I1 I .. _ mil.. i — - 5TE 1 I i Iibetl)' f FBLG Rf 9,-Zy 1O'-16. . �a rii 19�{ R-SnTH ; 3 l'i 1 h 5cv-c-LSn1 PORc�i{. p { "' L I V I tQ C EOM_ to' el 1 j : y � a � 1.►f3Rn�: � g � _ - _O - _O - - rt~ ge'a -4 -' Dal, — _ - r. 1 " " = v b Q Irj • 3�„ �I 5'-a II'-9 - :- ..� — . U • 07 1n • VF = f ` �° a . 0 I II' 2 41- 4 G'- It -6 _ D r _.._... - - - -- 'O STEM o O{ 20'-2" zs'-2" ... by a o . - . . _ �D M I dl _ t LL d Q 9 1 , i 1 I i ry fL Oo FIR-5"T' FL PLAN) 247-O N_ Scat-E% 114" = I'-.a/1 A Ps(UL>�N Ncr 17.4CA-1/kR17) tl • zz M A 11J 5T { - - cu��Y�nA 6ZVIQ km W SEp.514-O7 -� 'DKK•HIJ ex: UL. Rlc.{111Qq 3 �� -- - _ I 1W 0° 4 A—. 'I Y"Trl L � ;f' 3 DRad _ o , viieuies 111— — I • - - = - l t -�BATN" ,i P � i I mr-- 1.41 ...T. *4 ...0 4'-0 . _ C.'-I" _0.10_4:-1-_"_....1.____4'.31''' rt � B - I N 1 `" t .-. 1 � s,a u z . . • Sec.c)N17 Ft_oa1Z. PLAN 54A1-E4 = I I--O II • 'PA .tt.ffiwcy Ri 114Rt7... zz _ �o MAIN $TRL�.T c- fnM ARU1p, Mil REVISED S 1+° U 7 - 7 'ISWWN • 2..10 1 .o 11 /+ 8 Rao �A■ ,� l —4x5 Woob GutT� 711 �Z„� � D,c 17,_ywrooD MARV11) I MARaj 1 r l 22• uvv .iZ. I UDH 28Z2 - vex 2.s in en Ov � Nt iJ 1:t9 5Th GDx Q OOrj MR5LL-)/ 515? . 11'7is• A15 2.o MsR e I G" o;c.. Eo4iW 51u.Sid(_ 1/2`.qu o•�-,c1}ot�go�-T5 4 coIJca.a;c `sL_A& ov i v VAUL NANQy KIc.HARD 4022 MAIN STREtrT f GVMMAau1Q, MA. REi 5F.Dt 7-17-07 07 Dw Y Y 1Zi 7-►b- WW g AUI. 014,2D