HomeMy WebLinkAbout0015 GLEN ROAD /� G�� ��.
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TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map Parcel ZG Application # c?W J S 6 ! 7 U
Health Division Date Issued
Conservation Division Application Fee 50 . D
Planning Dept. T' Permit FeeJy '
Date Definitive Plan Approved by Planning Board
Historic - OKH _ Preservation/ Hyannis
Project Street Address / S 6/e ti Pot
Village
Owner n Sc� �.( Address /S� 61eh
Telephone dS
Permit Request CC Sc s�e� are
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuation ��D Construction Type
Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units)
Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No
Basement Type: Lf 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 0—new
Total Room Count (not including baths): existing new First Floor Room Count
Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other
Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No
Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_
Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other:
Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑
Commercial ❑Yes ❑ No If yes, site plan review #
Current Use Proposed Use
APPLICANT INFORMATION
(BUILDER OR HOMEOWNER)
Name3-f-649416, 'CA I Telephone Number . 7-8 1�ro V
Address I ✓1 s License #
Home Improvement Contractor#
Worker's Compensation #
ALL CONSTRUCTION BRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
d V'1
SIGNATURE DATE
f1(
I
1
v
FOR OFFICIAL USE ONLY
APPLICATION#
DATE ISSUED
MAP/PARCEL NO.
E I
! ADDRESS VILLAGE
OWNER
r DATE OF INSPECTION:
ct iFOUNDATIO,NsaI) ff,4i _rya�2;-i,!t: ,wt,.`kl,,f_
FRAME — — — — — —
-i INSULATION , r
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
}
GAS: ROUGH FINAL
FINAL BUILDING:
DATE CLOSED QUT
ASSOCIATION PLAN NO.
e
the r✓ommonxc th of-Vassachuseffs
Depart#afludmsftial Accidents
- - - , OK We o,f Investigalions
600 #3 ay7riregton&Y-eet
f Bestan,Al 02M
wwminass:gasMia
Workers' Compensation Lis muce. davit:Builders/Contractor MectriclailSlP umbers
AppEca-ut Infarmation i Please PrintLef_ibly
Names Mu6,,ss/Gfpniza(im&dividffi1). f. 1 i.✓� cr+ [
Address: �S C�le 0 0�
CitylStallZip: i1. Phone 47f
Are you an employer?f heck the appropriate box: Type of. o ea r•
4_ I arrC a contractor and i 3� �' � ���'��
1_❑ lam a employer with ❑ f 6_ New constniost
employees(full andlorpartfime)-* have hued the sub-contractors.
2._❑ I am a sole proprietor or partner- listed on the attached sheet. 7_ ❑Remodelmg
strip and have no employers These sob-contractors have g- ❑Demolition
employees and have workers'
- e
working forme many capacity 4_ ❑Budding addition
[No workers' Comp_immnanre comp_tnsuranc&#
5_❑ We area corporation and its 10_❑Electrical repairs or additions
3_ am a homeowner doing all work officers have exercised their 11_.0 Plumbing repairs or additions
myself [No workers'Comp- right of exzemption per MGL 12_[l Roof repairs
invn*ance required]T - c.1.52,§1(4),and we haim no rEt�l �'et lC�1
employ-[No ems• 13_❑father
comp_insurance required.];
*Any sgpliumt$hat sheds boat#1 most also fill out the section below showing ihdr walere compeasatioa poHU inf3rroz inn-
*Homeowners who submit this affidavit hbficatia g dzy are doing all waak and then bun outside contractors un,st submit a new affidn'll meficatin such-
'Contmcrors that check this boot must attached an additional sheet shorting the name off the sub-�and stste whether ocnot those enttes have
e mpluyees. If the sub-contractors hose employees,they must pro-vide thew workers'comp.policy number
I am air employer#fiat is provitUng workers'cam perrsation irmi rancefor azy empFnyem Helatr is the po8cy and job site
informat6q&
Insurance Company Name:
Policy-44,or Self-ins-Uc-;-!f: Expiration Date:
Job Site Address: CitylStatelzip:
Attach acopy of the workers'compensation policy declaration page(slt-owing 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 rrirninal penalties of a
fine up to S 1,500.OQ andlor one-year imprison*as well as ci%il penalties in the form of a STOP WORK ORDER and a fine
of up to"S250.DO a day against the violator_ Be advised that a copy of this statement may be forwarded to the Office of
hn,estigations of the DIA for i Ty- cation
I do i�,0hi ,6e-,fy-render its a3pdpenatlies f rmation provided above is 6ua and correct.
gna Bate:
Phone 9:/
F
ri use onF}. Eta not write in this area,to be completed by Gify�or town af,iciaL
City or Town:. PermitUcense
Issuing Authority(circle one):
1.Board of Health 2.Building Departatent 3.Cit�ff Fown Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone if
6
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees.
Pursuantto this statute,an employee is defined as"...every person in the service of another under any contract of hire,
express or implied, oral or written_"
An employer is defined as"an individual.,partnership,association,corporation or other legal entity, or any two or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer;or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6)also states that"every state or Iocal licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to cousfruct buildings in the commonwealth for auy
applicant who has not produced acceptable evidence of compliance with the insurance.coverage required."'
Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contractors)name(s), address(es)and phone number(s)along with their cerl-ificate(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 Indusrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit_ 'IZre affidavit should
be returned to the city or town that the application for the permit or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant_
Please be sure to fill in the permit/licease 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 tilled out each
year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(Le.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit
The Office of Investigations would Ile 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 hidustrlal Accidents
QfZm of kvesfrgatiaxzs
600 Washington Strut
Boston,MA G2111
Tel.A 617-727--49QO W 406 or 1-$77-DABS E
Revised 4-24-07 Fax#61 ` 27-7-149
www,mas-,gov/dia
ff TVCT Guide to [Yard Cunstrucdbi-i irc Higlr Frind Areas: 110 inph Wind'Zone
Massacltusett Checkli.A for COMPRaace(790 c;�zrzs�ot.?Lr}I
Loadbearing Wall Conner�DnS -
Lat�ral(no.of 16d Comrnon (Tables 7)---__._._._-------- :---..----------•.
Non-L-cadbearing Wag Connections
Lateral(no_of 16d common (Table B)_-..__- -__.__------------.._--
Load Bearing Wall-Openings(record largest opening Sut check all openings for conip[rance to Table 9)
Header Spans -----_------- __-_...`tt_in S 11`
Sill Plate Spans ------Fable 9)---'-------. ft_in._<11`
Full Height Studs (no.of �...(Table 9)--_._...__._----_-.._-------..__
Nan-Load Bearing Wall Openings (record largest opening btrt check all openings for compliance to Table 9)
Header Spans------_..--------------------------------_---------_..(Table9}�_____--------._.__-._ft_in �12`
Sig Plate Spans.-____.______.----�_;_--•-------.----___-.(Table 9)__ __--------------------_ft—in-s 12'
Full Height Studs(no.of surds)._L-------.--._----_--(Table 9)--_-_----_--•----------_-------_- -_---.
Exterior Wall Sheathing to Resist Upfdt and Shear Simulianeousv
Minimum-Bur7ding Dimension,W r
Nominal Height of Tallest Dpeningz ------• --
Sheathing Type-.----- (note 4)---- - ------- ---- ---
-Edge Nail Spacing--------___---_-_-.:--,•._-�(Table 10 OF note 4 if Less)----------.-_-__ in_
Field Nail Spacing (Table 1D)
Shear Connection(no.of 16d common nails)(Table 1D):.....-____-.._------------------------
Percent Full-Height Sheathing--------____----------(Table 1D)------,..---•_------- --------__-_%
5%Additional Sheathing for Wall with Opening>6'E"(Design Concepts)-----------......
Maximum Building Dimension; L
Nominal Height of Tallest Dpening7--__- -------------------------------------------------------------- <_SIB`
Sheathing Type___----.....-- ----------------(note -
Edge Mail Spacing------------------------_-----{Table i 1 or note 4 if less)---.------
Field Nail Spacing-.__.___-._-------------------------(Table 11}-___- _-----_-_-_-__----- in_
Shear Connection(no.of 16d Common nails)(Table 11_)----------,----_------------------------:--•—
Per-cent Full-Height Sheathing-------- (Table l l)------------------------- _-----_%
5%Add"dianal Sheathing for Wall withz'Opening>68"(Design-Concepts)------
Wail Cfadding
Rated;or Wind Speed?-- -- --------- -- - ---- -__- - --__-_ -._.__ ._ '
5.1 RODFS
Roof framing member spans checked?._.________.._-_-.For Rafters use AWC Span Tool,sea B.BRS Websita)
RDof Dvefiang -------------------------------------------------(Figure 19).__.:-____-_ft s smatter of 2'or 113
Truss or Rafter Connecfions at Loadbearing Walls
Proprietary Connectors
Upfdt-• -----:-------------------<--_ (Table 12)------- -- - -----U= pf
Lateral--------------- -- --(Table 12) -- -- ---- ------L= plf
Shear----------------------------------(Table 12)------------•--------------•� •P�- -
Mdge Strap Connections,if collar ties not used per page 21... (Table 13)--._...__---___ = p
----------T- tf
Gable Rake Ouffooker 20) -- -- ft s__.._.............:. _ Fi ire smallei-of 2'or L12 '
-- -----( 9 _
Truss or Ratter Connections at Non-Loadbearing Walls
Proprietary Connectors
Uplift----------..:........ ----.:(Table 14)-_ - ---------U- Ib.
Lateral(no.of 16d mammon nails)__(Table 14)---------------------------------------I_= . lb-
Roof Sheathing Type ____.__.:_____-________________(per 7BD.0 MR Chapters 53 and 59).............
Roof Sheathing Thfdme$s--•-._--.---------
--:---_�_..---.-------_ -__ _—irz?711a,WSP
Roof Sheathing Fastening.__....---:_..-_._--.-__-_._:.-_-.(Table 2)__._.___,.___--.._.___..__..._.._.
dotes: - - --. -
f, : This chackfisf shall be met in its entirety, excluding the specific ex>~epfion noted in 2, to comply with the na-quirements of
7BD CUR53D1.2-1.1 Item 1. If the checld'rst is met in its entirety than the following metal straps and hold downs are:not
req uh ed per the WFCNI 11 D mph Glide:
a. Steel Straps per Fgtre�
6. 2b Cage Straps per Figure 11
r- Uplift Straps per Figure 14
cL All Straps per Figure 17
e_ Comer Stud Hold Downs per Figure IBa and Figure 1Bb.
Exception:Dpening heights of up to 8 ft shall be permified when 5% is added tq the percent full---height sheathing -
requlremerits shown in Tables 10 and 11.
The bottom sM plate in exterior walls shall be a minimum 2 in-nominal thilciaiess pressure tali d#2-giade.
AWC fstride to Wood Cb,7rftw&i9rt ur Hi�h H17nd Areas:J.£Q kzph WFnd Zone'
Massachusetts CheckrNt fir Compliance(780
Est chi
compliance.
1.i .SCOPE
Wind Speed(3-ser.gust)_._._-------- _.._--.--_____:_.__ ____..---------- ---:.._. _�_ __.. 110 mph
Wind Exposure Cafegory 8 '
Wind Exposure Category................Engineering Required For Entire Project.......................................C
12 APPL.ICABILIIY
Number of Smries(a rD-of which exceeds 8 in 12 slape shall be'sansidered a story) stories _<2 stories
Rdaf Fit :h
Mean Roof Height' (Fig 2)_-----_-_•_-_•--__-_-___....-. f <
33
Building Width,W --------_ ------........ 3
(Fig 5a Building Length,L ___�_.------._-_ — _
Building Aspect Ratio(LAq) _--.-=------- - - ---- -(Fig 4) -....... - --- _5 3:1
Nominal Height of Tallest DpeningZ .__. {Fig 4)-.--------�__. .-------_--_-_--- 5 SIB,
1-3 FRAMING CONNECTIDNS
General compliance with framing cflnnections........-_.__-.(Table
2.1 FOIJNDATiON
Foundation Walls meeting requirements of 780 CMR 5404.1
........................................__:..._........------......._..---------•-----.__...._......_......_._._..._....•-•--
corlcrafe Masonry--•--••----_ -- -- ---- - __..------------------------------_ --_•_•-_•_
2-2 ANCHORAGE To FOUNDATIDN',3
5/8`Anchor Boh4rnbedded or 5/8`Proprietary Mechanical-Anchors as an,altemative in concrete only
Bolt Spacing-general................................-..__._:.(Table4).. _ _ --- -- in
Bolt Spacing from endroint of plate---------..-:----_-_...(Fg 5)------ _____----------------------- in._<6'-12'.
Bolt Embedment-concrete-- - -- _ - ----- (Fig 5) ----. in.>_7"
Bolf Embedment-Masonry-.-______________________._-_----(Fig 5)__.=-----:--------.._-: in._>15`
PEate Washer.. -- - __ -- ----_-- - (Fig 5)-- -'-3`x 3`x t/'
3.1 FLODRS
Floor'frarning member spans check�--d :-----_--•_---__-_-_-(per 78D CMR Chapter 55)
Maxfmum F1oorDpening Dimensfori__�--_--•--___..----•(Fig 6)-.---_----_---___--------- - -
Full Height Wall Studs at Floor Dpenings less than 2`from Exterior WaQ(Fig 6)..........................._..............
MtDdrrrurn.Floor Joist Setbacks
Supporting Laadbearing Waifs or 5hearnal(__ (Fig 7) _---_-__-_-- ' ft <d
Maximum Canflevered Floor Joists --
Supporfing Loadbearing Walls or Shearwail.......----(Fig e)------------------------------ -__ ft s d
F1oorBracing at Endwafls-_________________________-- - ---_-__ _(Fig 9}-.__-_---•------------•----------
Floor Sheathing Type '.::------------------_-------;-__--,.___(per 780 CMR-Chapter 55)------
---------------------___--
Floor Sheathing Thickness . ..-------------------------------(per78DCMR�hapf�r55)_-- -•---- in_
FloorSheathing Fastening_-----_:..................__-_---- (Table 2)__d naifs at in edge 1_in field
4.1 WALLS
S
Wall Height
Loadbearing wags.�.__;----------- --.(Fig 10 and Table 5)--------,---•__-•_ft c 1 D'
Non-Loadbeajng wolfs.._------=._----- -_ -�._.(Fig 10 and Table 5)__
----------------
ft's2D'
Wall Stud Spacing _.___------_..__.�._ (Fg 10 and Table 5)_-----:..___-•_fn s 24`o_o
Wall�offsets- -_.----_-------------___.____.(Figs 7 8)�_-_____,----_-__--
—ft sd '
42 EXTFP1 OR'WALLS'
Wood Studs
in.
Non-Loadbearing.walls-----------------------------•_--_--. --.(Table 5}--- --- --------------zx- ft in- '
Gable End Wall Bracing 1 1 - — _
Full Height Etdwalf Studs _._......-(Fig S D) -
WSP-Attic Floor I_engffr_ _---_-�._.._ :_. (Fig 11)_--________,__-_.___•___-_.__ ft�:W/3_
Gypsum Ceiling Length[rf WSP not used)_._ -(Fg 11).____----__--_--_-- _ft>uw
arid 2 X 4 Continuous Lateral Braes @ 6 ft o_o-(Fig 11�_........--_..._-•-..__--_.-.___
br 1 x 3 ceing furring strips I W spacing min.wr$2 X 4 blocking @ 4 f.spacin
laauble Tamp Plate g in end joist Dr truss bays'
_
•Sprica Length ..____.----:----- .-._-(Fig 13 and Table 6)__.___.___-------.---__-_-_It
SplGe Connecfion (no.of 16d r�nunon rrarls)__ ....__.(Table fi}_�__---------------._._ ___
- AiYC Gi de to Wood C-orrrtr'ucdoa in High Mhdflreas_ III mplr Hjxrd Zane
Massachuset k Checklist for Camp lance�r�o cn-T S _j:i)r
4.
a. From Tables•10 and 11 and location of oral!sheathing and Build-mg Aspect Ratio,determine Percent Full-Height
Sheafhing and ball Spacing requirements
b. Wooed Structural Panels shall be minimum thickness of 7116,and be installed as fCIHDws:
1. Panels shall be installed with "strength axis parallel to studs.
I All horizontal joints shall occur over and be nailed to framing.
ui. On single story construction,panels shall be attached to bottom plates and top member of the double
tap plate.
iv. On two story construction,upper panels shall be attached to the top member of the upper double top
plate and to band joist at boftnm of panel_Upper attad rneht of lower panel shall be made to band joist
and lower attachment made to lowest plate at first floor framing.
v Horizontal nail spacing at double top plates,band joists,and girders shall be a double raw of ad
staggered At 3 inches on center per figures below:Vertical and HorimntaPNaifFng far Panel Attachment
5. .Glazing protection:a)new house or horizontal addition—required if project is 1 mile or closer to shore(generally,south of
Rte,28 or north of-Rt-e.6)
b)vertical addition—not required unless there is extensive renovation to the first floor
c)replacement windows—needs energy conservation compliance only(chap 93) -
6.Waod Frame Con&tr CdDn Manual(WFCM)for i 10 MPH,Exposure S may be obtained from the American Wood Council
(AWC)webslta. .
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See Detail on Next Page
Vertical and NoriMnlal HaTng Detail
for Panal Attachment � �1�►d Hotrzontal Na2Cmg
for Panel Atfachment .
� ETti Town of Barnstable
Regulatory Services
BARNSTB
MA S. E$ Richard V.Scali,Director
i639'
a Building Division
Tom Perry,Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-403 8 Fax: 508-790-6230
Property Owner Must
Complete and Sign This'Section
If Using A Builder
I, X-60tAk r151,0 1 , as Owner of the subject property
hereby authorize to act on my behalf,
in all matters relative to work authorized by this building permit application for:
(Address of Job) k
Pool fences and alarms are the responsibility of the applicant. Pools ` t
are not to be filled or utilized before fence is installed and all final
ins tions are rmed and accepted.
e; ignature of Owner Signature of Applicant
344L �
Print Name Print Name
7 t 0()I�
Date
Q:FORMS:O WNF-RPERMISSIOI\TPOOIS
Town of Barnstable
Regulatory Services
�aFTH Ta Richard V.Scali,Director
Building Division
Tom Perry,Building Commissioner
MASS
yQ, 1639- .�� 200 Main Street, Hyannis,MA 02601
pTEOt a www.town.barnstable.ma.us
Office: S08-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
SATE:
71 //� C� Please Print
1 J
JOB LOCATION: 61C k P'Ook—
number street village
-SS�J y Q!�/
''HOWIEOWNEW': !L'l lfo- GO C / —�45" !
n.c ? home ph ee# work phone#
CURRENT MAILING ADDRESS:
city/tovm 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,oa which there-ig,•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
-09.1.1)
fie undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,
bylaws,rules and regulations. _
-'he undersigned"hoineo "certifies that he/she understands the Town of Barnstable Building Department minimum inspection
proc d -e ents an that he/she will comply with said procedures and requirements.
tgnature of Homeo-
E.pproval 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 1091.1-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 Iast 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:\WPFELBS\FORMS\building permit fonns\E)TRESS.doc
Revised 061313
All Documents by Address -Search Results Page 1 of I
Barnstable County Registry of Deeds John F. Meade
Land Records by Property Adr
Property Addr: 15 GLEN
Search Date: *All dates
Town: Barnstable
Document types: Deed
This may not be a complete listing of activity for the address you are searching. We index the address provided to us by
the party recording the document. We have no way of verifying that the address given to us is correct or complete. We
provide address information as a search aid only and it should not be relied upon as an accurate reflection of all activity
for a given property.
<Prevwus .Next_ �Show'PfintzCart . 'il Street Name Only, .Pint Listing;
PROPERTY ADDRESS LIST
Bk-Pg:26663-27 1 If 'I Recorded: 09-11-2012 @ 10:54:06am Inst #: 52426 Chg: Y Vfy: N Sec: N
Pages in document: 2
Grp: 1
Type: Deed Doc$: 165,000.00
Desc: 17 86/127
Town: BARNSTABLE Addr: 15 GLEN RD
Gtor: BORELLA, ANDREW 70HN (AS TR) (Gtor)
Gtor: GLEN ROAD REALTY TRUST (BY TR) (Gtor)
Gtee: KALUKIEWICZ, ROBERT E (&W) (Gtee)
Gtee: KALUKIEWICZ, ELIZABETH A (&H) (Gtee)
Bk-Pg:27609-257 Recorded: 08-09-2013 @ 10:55:19am Inst #: 46482 Chg: N Vfy: N Sec:
N
Pages in document: 2
Grp: 1
Type: Deed Doc$: 1.00
Desc: 17 86/127
Town: BARNSTABLE Addr: 15 GLEN RD
Gtor: KALUKIEWICZ, ROBERT E (&W) (Gtor)
Gtor: KALUKIEWICZ, ELIZABETH A (&H) (Gtor)
Gtee: KALUKIEWICZ, ROBERT E (&0) (Gtee)
Gtee: KALUKIEWICZ, ELIZABETH A (&O) (Gtee)
Gtee: DRISCOLL, BRENDAN 3 (&0) (Gtee)
Gtee: DRISCOLL, CHERI ANN (&O) (Gtee)
No (more) matches found
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https://search.bamstabledeeds.org/ALIS/WW400R.HTM?W9PA... 7/2/2015
t
Town of Barnstable Geographic Information System August 11,2014
9 Y 9
288015
" 288027 949
#63
288029 288028
#77 #69 t
c�
;288023
#53
288026 4�>Y '288016
#15 #12
xq A A.
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288024
' 288025
- 288017
_ #31 #20
a ,
0�Feet
DISCLAIMERS:This map is for planning purposes only. It is not adequate for legal Map:288 Parcel:026
boundary determination or regulatory interpretation. Enlargements beyond a scale of Owner:KALUKIEWICZ,ROBERT E& Total Assessed Value:$227500 Selected Parcel
1" 100'may not meet established map accuracy standards. The parcel lines on this map {
are only graphic representations of Assessor's tax parcels. They are not true property Co-Owner: Acreage:0.21 acres Abutters
boundaries and do not represent accurate relationships to physical features on the map Location:15 GLEN ROAD
such as building locations. Buffer
i
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�J mo0/(16V3
�TME rqy, Town.of Barnstable *Permit#
p� &t Expires 6 mo s from issue dale
Regulatory Services Fee
• saRxsreai K
MASS.
,�$ Richard V.Scali,Director
ArEo►MtA J0 N09&ng Division .
Tom Perry,CBO,Building Commissioner
NOZ L ' ��0�0 Main Street,Hyannis,MA 02601
www.town.bamstable.ma.us
Office: 508-8624 Fax: 508-790-6230
EXPRESS PERMIT AP11CCATION - RESIDENTIAL ONLY
`7 0 /`/ ] f_ Not Valid without Red X-Press Imprint
Map/parcel Number 4, (/6166-
1(/ ,Property Address 1. l /�J c�" `, S
esidential Value of Work$ 6 0,9 Minimum fee of$35.00 for work under$0000.00
Owner's Name&Address / ( v 1
�eA r
Contractor's Name e,o Telephone Number.
Home Improvement Contractor License#(if applicable) Email:
Construction Supervisor's License#(if applicable)
❑Workman's Compensation Insurance
Check one:
❑ I am a sole proprietor
❑ I am the Homeowner
❑ I have Worker's Compensation Insurance
Insurance Company Name
Workman's Comp.Policy#
Copy of Insurance Compliance Certificate must accompany each permit.
Permit Request check box)
e-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to
❑ 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:
❑ 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 I rovement Contractors License&Construction Supervisors License is
SIGNATURE:
Q MPFILES\FORMS\building permit forms\E)PRESS.doc
Revised 061313
Town of Barnstable
Regulatory Services
PN°FjKE r° Richard V.Scali,Director
Building Division
* $nrcxsrnsr.E Tom Perry,Building Commissioner
v� 16 9. �m� 200 Main Street, Hyannis,MA 02601
prfOI a www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
/ 71.20 f / e Please Print
DATE: / C JOB LOCATION: /J 6/et, s
number street Y village
HOMEOWNER,,: lQ. pf". X6 lI 791— VQS-STV
name A home phone# work phone#
CURRENT MAILING ADDRESS: ��°l C G d . U/7 y_9
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. _
jThendersigned"ho er"certifies t he/she understands the Town of Barnstable Building Department minimum inspection
ures em nts e/ e will comply with said procedures andrequirements.
re 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.
t 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 061313
* anxxsr.�ar.E, «
�$ ' Town of Barnstable
'Orin rnt+y a
Regulatory Services
Richard V.Scali,Director
Building Division
Thomas Perry,CBO
Building Commissioner ti
200 Main Street, Hyannis,MA 02601
ti,�, '• www.town.barnstable.ma.us "
Office: 508-862-4038 ,' ' Fax:�508-790-6230
r
Property Owner Must
Complete and Sign This Section
If Using A Builder
I, C i -0 t , as Owner of the subject property
hereby authorize to act on my behalf,
in all matters relative to work authorized by this building permit application for:
(Address of Job)
7171)01
��
Fatu'teOwner Date
444, rl --s C-0
Print Name
If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the
reverse side.
Q:\WPHLESTORMS\building permit forms\EXPRESS.doc
Revised 061313
1'�1�ce�'�ar,�tr�rx�r�c1�v�'?�crssr�el�res
Deparhuent rrf ltu-ustrial Accidents
- 0-&e Off
600 Mayburgtom SMeet
Boston,.MA02—Ul
wmv.rrrasmgov dia
W,orkeers' Compensation lusurauce davit:Bi-iilderslContra:ctorsMectriciansMumbers
AppligqA Information / Please Print,LegiUy
Name l
Address. _37
City/statrIZip: 14. O/Ad Phone g� ;?,'l
_ Are you an employer?Checlrthe apgrogriate hoz: ----`__ _ ---- _- - Typepfproject: r-
1..❑ I am a emp loyer with 4. ❑ I ai n a dal contractor and I 6. 0 New oonsbxtion.
employees(full and/or part-time)* have lamed the sub-contractors.
2_0 I am a sole proprietor or partner- listed on the attached sheet 7-
ship and have no employees These sub-contractors have: g- ❑Dernolifioa
worlfiing for me-in any capacity employeesand have wormers' q_ 0 Building addition
[No Workers,comp:insurance Comp.rtisuranc:e`$
] 5..0 We area corpotatismand its 10-❑Electrical repairs or additions
3_VI am a homeowner doing all worii officers hnm exercised their 1l�PI g repairs or additions
right of eszemption per MGL
Myself. [No Workers'comp- / I Rr}ofrepairs
rnstxa-n�eregnired_]1 c_152,�1(4},andweliBS`ena
employees_[No workers' 13_0 tither
camp-insurance require/-]
*Any applicsnt that cbecks boa-91=ust also fill out the section below showing the waffcee compensstioat Police uffz nadinm-
T mwaevwners who submit this affidavit in&ca g dtey are doing aIT no�c and dten hire ontsidc cozitrscmn omit submit a new affidivit indicating&rick_
tCtmU:Rctors thst rSixk this bar,must sitarhed an additions)sheet showing the name of the sob-cnuft-ickra=d statp whether or not those eatifies have
mpinyees If the sir-contractors have emplbyees,they rmi pmuide their workers'comg.policy number
.1 am arz employer that is pt m ickg workers'coiripenmu on inert mor for my e-mp7vyees. Belau is thegoiicy an.dl:ob site
in,fot��Yan_
liasurance CompanyName:
Policy:w or Self ins Uc-* Expiration Date.
Soh Site Address: Z5— V/ vi Cify,Statel7ig: lCrj/t
Attach a copy of the workers'compensation policy declaration page(showing the Policy nu der And expiration date).
Failure to secure cai erage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal al penalties of a
fine up to S1,5DUM and/or me-yearimprisonment,as well as civil penalties in the,form of a STOP WORK ORDER-and a fine
ofup to$250_00 a day against the violator_ Be advised that a copy of this statement may be forwarded to the Office of
Im estigations of the DIET for instmance coverage venEcation_
Ida hereby c r rid alft s a at the inforraaiianpratddedd aben a is h-Tw and correct
Sianatur�e: Date: l a t
Plwne il:
OREc ai use only. Da not write in this area,to be completed by city or town offrciaL
City or Town: PermiffIcense#
Issuing Antharity(circle one):
1.Board of Health 2.Bulling Department 3.CityHowu.Cleric 4.ETC.ctrical Inspector 15.Plumbing TnLTeCtor
6.Other
Contact Person: Phone t#-
6
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers compensation for their employees.
Pursuantto this statute,an employee is defined as"_..every person in the service of another under any contract of hire,
express or implied, oral or written_"
An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer;or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the -
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an em to yer."
� g aPP ym P 5
s,
MGL chapter 152, §25C(6)also states that"every state or Iocal licensing agencFsball withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in•tbe coznmonw?alth for airy
applicant who,has not produced acceptable evidence of compliance with theginsurauce.coverage required."
Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter bave been presented to the contracting authority."
Applicants
Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certafiicate(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 1
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. 11-e afLdavit.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. Sell insured companies should enter heir
self-insurance license number on the appropriate lime.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out' 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/liamse applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must:be filled out each
year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's a-ddress,telephone and fax number: i
The Commonwm aTth of Mas�sachusc is
Departrneut of Industriat Aocid(�
Office Of v stipt am
600 washes an t
Bas ao 02111
` tL A 617-727-4900 W 4-06 or I-977 IAS 'E
Revised 4-24-07 Fax#61 727-7-149
viww.naass.gavT/dia
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map_ Parcel - Application oo/3D ,0
Health Division Date Issued 31 1 (3
Conservation Division Application Fee
Planning Dept. Permit Feeb3
Date Definitive Plan Approved by Planning Board Old
Historic - OKH _Preservation/ Hyannis
Project Street Address 63/e
Village
AA
Owner ;c G� Address ;s
Telephone-. / �.
..Permit Request G�.1
w
Square feet: 1 st floor: existing ovc proposed `' 2nd floor: existing proposa 'metal rcnw
-r1
Zoning District Flood Plain v Groundwater Overlay Na03
Project Valuatio • 100 Construction Type
Lot Size Grandfathered: ❑Yes 3<o If yes, attach �upportirLg,sdocu�entation.
Dwelling Type: Single Family Two Family ❑ Multi-Family (# units)
Age of Existing Structure /A 77 Historic House: ❑Yes LP16 On Old King's Highway: ❑Yes YNo
Basement Type: & ull ❑ Crawl ❑ Walkout ❑ Other
Basement Finished Area (sq.ft.) Basement Unfinished Area(sq.ft) go a
Number of Baths: Full: existing new Half: existing new
Number of Bedrooms: 3 existing _new
Total Room Count (not including baths): existing new First Floor Room Count
Heat Type and Fuel: C7 GaS ❑ Oil ❑ Electric ❑ Other
Central Air: ❑Yes 5 o Fireplaces: Existing 0,3 New Existing wood/coal stove: ❑Yes ❑ No
Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_
Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other:
Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑
Commercial ❑Yes ❑ No If Y site plan review #
Current Use �C�1 Proposed Use
APPLICANT INFORMATION
(BUILDER OR HOMEOWNER)
Name /e.1 At to Telephone Number
I y
Address � 7 '�G�i _1�l P%X License#
Home Improvement Contractor#
Worker's Compensation #
ALL CONSTRUCTIION,pEBRIS RESULTINg FROM THIS PROJECT WILL BE TAKEN TO
SIIo11 t1P f e.
SIGNATURE DATE S
4 FOR OFFICIAL USE ONLY
APPLICATION#
DATE ISSUED
MAP/PARCEL NO.
t:.
ADDRESS VILLAGE
OWNER
1
t
DATE OF INSPECTION:
i
c _ FOUNDATION
' FRAME
INSULATION
0
.F FIREPLACE
` ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
a
t GAS: ROUGH FINAL
FINAL BUILDING
DATE CLOSED OUT
ASSOCIATION PLAN NO. "
= The Commonwealth of Massachusetts
Department of IndustKalAccidents
Office of Investigadons
600 Washington Street
Boston,M4 gill]
www.massgov/dia
Workers' Compensation Insurance Affidavit: Blinders/Contractors/Electricians/Plmnbers
"A licant Information Please Print Le gib
Name (Business/organizahon/Individual):-,L ' e_a Y
Address: l ,'rG ,A,,-e
fa
City/State/Zip:.. �e,,2041 / v/7 YOZ Phone#: 9/ 9 —fr7 y
Are you an employer? Check the appropriate boa: Type of project(required):
1.0 I am a employer with 4. I am a general contractor and I
employees (fall and/or part-time).
* have hired the sub-contractors 6 ❑New c tion
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. P901temocieling
ship and have no employees These sub-contractors have 8. Demolition_
working for me in any capacity, employees and have workers' 9.. 0 Building addition
[No workers'comp, msmmoe comp.insurance.t
ed] 5. We are a corporation and its E Electrical.repairs or additions
3. I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions
myself. [No workers' comp, right of exemption per MGL 12.❑Roof repairs
ms ce required.]t c. 152, §1(4),and we have no
:. employees. [No workers' 13.7 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 am 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
Lae,up to$1,500.00 and/or one-year imprisonment,-as we"E as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day-against the violatof. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insane coverage verification.
I do hereby.certify under ena1des ojCp e{/ury that the information provided above is true and correct
:Si _ Date:
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: w. Phone#:
Information and .Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. .
Pursuuant'to this statute,an employee is defined as"...every person in the service of another under any contract ofhire,
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,ar 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 Iicensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance.coverage required."
Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter-have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely,by checking-the boxes that apply to your-situation'and,if.
necessary,supply sub-contractor(s)name(s),address(es)and phone n=ber(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 eat r.their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legrbly. The Department has provided a space at the bottom
of the a$davit 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 per=t/license number which will be used as a reference number. In addition,an applicant
multtr le permit/license applications in any given year,need only-submit one affidavit indicating current
that must submit
P . F
policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in. (city or.
towel)."A copy of the-affidavit that has.been officially stamped or marked by the city or town may be provided to thee' . .
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'Hcense or permit not related to any business or commercial venture
.(i.e. a dog license or permit to,burn leaves etc.)said person is NOT required to complete this affidavit
The Office of Investigations would Irke to than you in advance for your cooperation and ihbuuld you have any questions;
please do not hesitate to give us a call.
The Deparmient's address,telephone and fax number:
The Cor monwcalth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA Q2111
Tel.#617-727-4900 ext 406 or 1-977-1vLASSAFE
Fax# 617-727-7749
evised 4-24-07 '
. www.mass.gov/dia - -
THE Tp Town of Barnstable
� �,-
ywP'' yYo� Regulatory Services
f Thomas F. Geiler,Director
ASS. Building Division
QED a Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.maxs
Office: 508-862-4038 Far..508-790-6230
HOMEOWNER LICENSE EXEMPTION
Please Print
ll
ATION: IS Noll �� ' //V�.�� e s
—"'number street village
E75WtR" Ceh �o co
LI 7d l s' a y
name home phone work phone#
II G. DRESS: iC A f!' x
e)17 y;2
— state zip cod
The current exemption far"homeowners"was extended to include owner-occupiedmes of dwell 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
mir,irrnrm inspection edures and requirements and that he/she will comply with said procedures and
ats.
% rg h.of Homeowner
Approval of Building Official
Not: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the
State Buildin Code Section 127.0 Construction ControL
HOMEOWNER'S EXEMPTION
i
The Code states that Any homeowner perfornung work for which a building permit is required shall be exempt from the provisions
of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a persons)for hire to do such
work,that such Homeowner shall act as supervisor."
Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,
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 ofhis/herresponsrbilities,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 j
several towns. You may care t.amend and adopt such a fdrm/certification.for use in your community.
Q_forms:homeexempt
°FTKE . Town of Barnstable
Regulatory Services
+ sAaxsrAsra, * .
names Thomas F.Geiler,Director
sbg9. ♦�
Building Division
Tom Perry,Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town barnstable.maxs
Office: 508-862-403 8 Fax: 508-790-6230
Property Owner Must
Complete and Sign This S ction
If UsWg A Builder
I, s Owner of the subject propetty
Hereby authorize to act on my behalf,
in aIl matters relative to work authorized by this wilding permit
/alhe
ob)
**Pool fences anesponsibility of the applicant. Pools
are not to be filled fence is installed and all final
inspections are pepted.
Signature of Ownet Signature of Applicant
Print N e Print Name
Date
QFORMS:0VINERPERMISSIONPOOLS 6/2012
•:x
• 172" - tar- �,�'
13" 27„ 27„ 39„ 9„ 30" 12„ 12„ -
68 2' 36" 67 z
1 5 ,„
2 2 ./
2 2 „ 3311
„ r
6 7 8 9 loll-, -
ECC 3
24.DISHW 3 4 0-GAS-RANGE 5 `Legend
1 = ICI _ 1: P4836
--- ---- --------------------------------------------------------------------------------------- N
� 2: LS36L
'coo 3: SB27
�a�tiA A�- i 4: DB15
ECC 3f rn 5. F330
19 CO 6: W2730
7: W2730
8: . W0930R
-� 9: W3012
W w W 10: W1230R
>00 11: F330
2„ � = 12:
38 /4RE
13: 3/4REFP24
14: 3/4REFP24
co
• = 15: WC3030L
16: W1830R
17: RW3612
CO 18: B30
N CA 19: P4836
O • �
---------------------
All dimensions_size designations Cape Islands Kitchen This is an original design and must Designed:.5/16%2013
given are subject to verification on Designed by: not be released or copied unless Printed: 5/16/2013
job site and adjustment to fit job Kevin T. Schlosser applicable fee has been paid or job
t conditions. Kevin@capekitchens.com order placed.
C: 1-781-291-6184
15 Glen Road Hyannis MA All Drawing#: 1