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Town of Barnstable "Permit#
y7 , .yam EApire 6 monthsfrnm issue date
Regulatory Services Fee
,»AaIX
NAM� Richard V.Scali,Director.esa
5 C�
Building Division
Tom Perry,CBO,Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.bam stable.ma.us
Office: 508-862-4038 Fax:508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
Not Valid ndthout Red X-Press Imprint
Map/parcel Number
R! .
Property Address zz V,�,..11 �`1 1 1
�esidenlial Value of Work$ JSQ Minimum fee of$35.00 for work under$6000.00 JUN O 8 2016
Owner's Name&Address
AVE
Contractor's Name Telephone Number
Home Improvement Contractor License#(if applicable) Email:
Construction Supervisor's License#(if applicable)
❑Workman'sCompensation Insurance
Check one:
a sole proprietor
�rll am the Homeowner
❑ 1 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 t0��7G �'( - JCrQ^�
❑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 Ho m Improvement Contractors License&Construction Supervisors License is
req fired.
SIGNATURE: An
C:\Users\Decollik\A Data\ I\MicrosoR\Windows\Temporary Internet Files o em.0ullook\2P101 DMEXPRESS.doc
Revised 040215
r
HA&MASS,
`'. ,f Town of Barnstable
Regulatory Services
Richard V.Scali,Director
Building Division
Thomas Perry,CBO
Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
Property Owner Must
Complete and Sign This Section
If Using A Builder
1. as Owner of the subject property
hcrcby authorize to act on my behalf,
in all matters relative to work authorized by this building permit application for:
(Address of Job)
Signature of Owner Date
Print Name
If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the
reverse side.
C:\Users\Dewllik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Oullook'W]0I DHR\EXPRESS.doc
Revised 0,10215
Town of Barnstable
Regulatory Services
d1WM Richard V.Scali,Director
Building Division
8AJV%9u8ts' Tom Perry,Building Commissioner
n\as.
+3s .� 200 Main Street, Hyannis,MA 02601
FOB www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
� '� �I W HOMEOWNER LICENSE EXEMPTION
Please Print
DATE: // �^� cc(( � L, � (
JOB LOCATION-U L. J'r-(j��L�h Dt" � _�l ` a 1 0
number ��77str`�eeetpt ((^� Q village
-HOMEO\VNER'�_rA nn Cam" �J-�D-(006(` 3_7 9
name / I ,., /home phone NN L -yam work phone N
CURRENT MAILING ADDRESS:1 n C.J 10 V L C f I
���LjS rn ills rn� OZ.(fZu S�`
city/town state 'ri- p�wde
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
pro res and requiremen a�d that he/she ill comply with said procedures and requirements.if
Sig o ouner
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.
C:\Users\Demllik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\2PI01 DHR\EXPRESS.dm
Revised o4om
The Commonwealth ofMassadiuselts
- Department of Industrial Accidents
t= D,,Q'ice of Investigations
a 600 Washington Street
` Boston,MA 02111
unt." rrtaszgovIdia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbets
Applicant Information Please Print Legib
Name(Busineesssl]Orgamzericmuladividual): y�� d
Address( U c L�
City/State/Zip: \ phone
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
(full and/or part-i ).s 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-contmetors bave S. ❑Demolition
working for me in any capacity. employees and have workers'
(No workers'comp.insurance comp.insurance./ 9. ❑Building addition
r ed] 5.❑We are a corporation and its 10.❑Electrical repairs or additions
t+'- m a
3.' homeowner doing all work ofTtcers have exercised their I I.❑Plumbing repairs or additions
myself[No workers'comp. right of exemption per MGL 12,$alooftepairs
insurance required.]1 c.152,§1(4),and we have no
employees.[No workers' 13.0 Other
comp.insurance required.]
'Any applicam that checks box ill mtw also fill out the section below showing their wmkm'camper cam policy information.
1 Homeowners who submit this affidnit indicating they are doing all work and then bve outside connectors mast sobntu a new affidavit indicating sucb.
:Contrecco.Poet chant nos btu mast attached an additional sheet showing the name of The sub-contractors and state whether ar not cbose eaooes have
employees.tribe sub-comracttas have employees,they mast provide the workers'comp.policy maaber.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
informmtian.
Insurance Company Name:
Policy#or Setf-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$1500.00 and/or tee-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 DU for inenr mce coverage verification.
I do hereby c ify uIner the pa d d penalties of perfu at the information provided above
—is7trite and starred
Si a a^ Date: a / 60
Phone#: U 6
QBricial 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.Citylrown Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
6
11;02'94 1T :07. pDl/ 1A IlLi
�/ � �1� i
ConunanweaLLL O� Q.'fdQCJt(�ldl.�
600
.�ames.L campbsa
Cornrnisuorer
Workers! Compensation ibst ranoe Af &Wit
1, �/-fN cc1 I26�21 Crams S
with a principal place of business at:
/ cv,41i 7--3F"- S i 9 C14 Zug- y u� .-�)iO li-START-67- iAl4 o e 64
cagrrsea�sw
do hereby certify under the pains and penalties of perjury, d=
an gnployer pravidmg workers' Compensation Coverage for my employees wf
this job. ,
Insurance Company Policy Number
[ am a sole proprietor and have no one worsting for me in any capaaty
0 1 am a sole proprietor, general contractor or homeowner (tilde one) and have hit
Connectors ilsmd below who have the following workers' compensaIIon policies.
Contractor
Insoraaoe Compare Ipariicy
Contractor lastnance Goinpany/Policy
Contractor Laurance Company/policy
() I am a homeowner performing all the work myself.
t tando-st:nd--hu a CM/of dtis s—Ousnent will be fWaarded W tit Mice of lnv"dPdM of dw CIA far COMM vffGMzU n and that
ec a.te z rvG:zd under Section ZSA of MGL 151 can lead W the irnpaaWM of ei t CG1&"A:W9 of a an of up to S I'S
ire:.-s tm�iso :an z well U civil aanaldes in the fom:of s STEP WaRK 4ROER Md a fkte at Sioo.Oo a day aping Rfe-
Sgned this day of � f/G� % • 1 q
1
censee/Pe tree Btu D
UcMsing Board
Selectmen Office
Health Department
T1 e �om na uuea/ a�✓�naaae�u�aelta
Restricted To: 00
DEPARTHENT OF PUBLIC SAFETY
CONSTRUCTION SUPERVISOR LICENSE 00 - None FaUsre to p"sess aourrest
Nassaebasetts State/0/04141
Nuiber•_-., _ Expires:
16 - 19 1 Family Homes of this lleonm '
i Restricted To:'` 00
FJONN,Y RODRIGUES DUPLICATE
E - 151;YHITE BIRCH NAY
`�N'6ARNSTABLE, HA 02668
p _`ti ;�:s }•,t��,�vti �7�` t`'.7�Yr7y,lG4,�1'ai g.xivvA�y''' �� y�.
r. e ��i s�oams�eoMeira�d� ✓uaaaaerEuae(la:
Ra:HOME,IMPROVEMENTr'CONTRACTOR .-
Y' " legistration 105252
�- TrPe `^INDIVIDUAL t �:
' x�`l�EzpI Tat ioo:-�,!17/16/96
John W:Rodrigues 6 Sons'
Y
„John"W."Rodrigues
;G2 `o .� �PO Boz'641 15f: hi#e Birch W
<<: noMlNisTRnroR * Barnstable MA 02668
r' c
1°r.�,`..�--.y—Nub.•.—Lw...�.� MM.:'1-�� .`��.c.L: '..0 k..c..+..`�;t���
i
L ,
The Town of Barnstable
NAM Department of Health Safety and Environmental Services
` BwIding Division
367 Main Street,Hyannis MA 02601
091= 508-790-6227 ftiph
Faic 508 775-33" Btttldtag Comm
For office use only
Permit no
Date
AI3+'IDAV1T
HOME IMPROVEMENT CONTRACtOR LAW
SUPPLEMENT TO PERMrr APPLICATION
MGL c. 142A requires that the-reconstruction,alterations,renovation,VC04 tnod oa,conversion,
improvement, remmal, demolition, or constnictiOn of an addition to any pm-casting owner occupied
building containing at least one but not more than four dwelling units or to sttuctsuzs which ate adJacem
to such residence or building be done by tegistered contractors,with certain cooepdons, along with Other
requirements
Type of work: Cost 062 , o-0
Address of work: 12' 6 c��9 u �/C �Y. 4 4 ` /4,/V,0� 17
Owner.Name: �, Q
Date of Permit Application: llz/q
I hereby certify that:
Registration is not required for the follcming reason(s):
Work exdudod by law
Job under S1,000
Budding not owner-00=0ed
Owner Pulling own permit
Notice is hereby gi<cn that:
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREQSIERED CONTRACTORS
FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS M 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.
du
Date Contractor name Registration No.
OR
Date owner's name
I Assessor's-Office(1st floor) Map_ 160 Lot _ O A1G m Permit# 0
Conservation Office(4th floor) - Date Issued
Board of Health(3rd floor)(8:30-9:30/1:00- 2:00) Fee' �.
Engineering Dept.(3rd floor) House#1
Planning Dept.(1st floor/School Admin. Bldg.) 7
' - • BARNSTABIE
Definitive PI p ved by Planning Board 19 e 9-
to Nu+� i
TOWN OF BARNSTABLE
Building Permit Application '
Project Street Address
Village -1-0,eJ �-
Owner S lL L Address
'Telephone
Permit Request ) /� L� 0f��= lc�/%/� S7' .tJ✓��12
Total 1 Story Area(include 1 story garages&decks) f square feet
Total 2 Story Area(total of 1st&2nd stories) square feet
Estimated Project Cost $ 9 0-0
Zoning District Flood Plain Water Protection
Lot Size Grandfathered ?
Zoning Board of Appeals Authorization Recorded
Current Use Proposed Use
Construction Type
Commercial Residential
Dwelling Type: Single Family Two Family Multi-Family
Age of Existing Structure Basement Type: Finished
Historic House Unfinished
Old King's Highway
Number of Baths No.of Bedrooms
Total Room Count(not including baths) First Floor
Heat Type and Fuel Central Air Fireplaces
Garage: Detached. Other Detached Structures: Pool
Attached Barn
None Sheds
Other
Builder Information
Name 0*/,/ o_) 62_Q bI2 l6420� Telephone Number
Address /,j'/ 6ZW'jy',!5_ S j fiZC/gl &014 `r' License# (;j O , 2-C'J
.lam 1 "A Home Improvement Contractor# _CEO
13 OX 6 e-/ Worker's Compensation# &_ZA
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
/''I At:3/Z S T0.0 1-4 /L. LS
SIGNATURE DATE 7 7 S
BUILDING RMIT DENIED FOR THE FOLLOWING REASON(S)
FOR OFFICIAL USE ONLY
PERMIT NO. 9580
DATE ISSUED August 8, 1995 s
MAP/PARCEL-NO. 100 046 ; z
ADDRESS 62 Starlight Drive VILLAGE Marstons Mills, MA 02648
OWNER William E. & Natalie M. Coleman
DATE OF INSPECTION:
FOUNDATION r ,
FRAME i
INSULATION
x y
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL '
r .
FINAL BUILDING
DATE CLOSED OUT
ASSOCIATION PLAN NO.
%THE
TOWN OF BARNSTABLE
ii
IBARNSTLBLL
NASL- BUILDING INSPECTOR
1639
APPLICATION FOR PERMIT TO .................................
TYPE OF CONSTRUCTION ... .................................................................................................
. ................................................19........
TO THE INSPECTOR OF BUILDIN S:
f
The undersigned hereby applie's or a permit accordingh following f on:
to t�e o owing in ormoti
Location ....... ..................... ......... ..............................................................
Proposed Uselkv. e..4,10'w.-c..... ...
....................................................
ZoningDistrict ........................................................................Fire District ................""***"**"*"**"",**,*****I .. ........................Name of Owne0_. -17zm1e5-�_7._ -Address 6
Nome of ...Address .............................................................
Name of Architect ......................................Address ........................................
Numberof Rooms ....... .......................................................Foundation .../.0..........� ......................
Ual?........................Roofing
Floors .&Onn...b..............................................................Interior ..... ............
.. ...........................................Plumbing
Heating ng ..... ................................................................
'y ..........................Approximate .....
Fireplace ......................................... e, Cost
................................................
Definitive Plan Approved by Planning Board ----------------—-----------
/
Diagram of Lot and Building with Dimensions
SUBJECT TO A P P R 0 V ALI`-6 F PBO'A;R D E'�;L_T U'lj�
SANITARY WAII,
rr
NAGE E* Ep"
TOWN "OF E37MNSMi:a-
13 0 tR 10Fj HEALTH
J
�" OBTAIN Sf
WAGE
INSTALLERS
j_jc1E LL SYST�E M'
PERMIT, AND MSTA
7-7—
X,
e-1-i cz,
661 LO'
6e, -------
I hereby agree to conform to all the Rules and Regulations of the wn of Barnstable regarding the above
construction.
Nam . ... .. .. ........
?(
........ .. ............................................
'Cammett Builders, Inc.
15144 one story
No ................. Permit for ....................................
single family dwelling
...............................................................................
Location t
........Starlight Drive
......................................................
............ ......Marstons Pills..........................s
..............................
.... .....................
Owner ..........Hammett tt Builders,rs, Inc.
........................................................
Type of Construction ........................franB..................
#6o
Plot ............................ Lot ................................
Permit Granted .......... June 19 ........ 72
............ . ... . ..19
Date of Inspection ... .............19
Date Completed ; ...........19
..
Con
PERMIT REFUSED
................................................................ 19
............................................................................... 0 (2
Q C'
................................................................................
...............................................................................
...............................................................................
C) C
Approved ;.............................................. 19
...............................................................................
...............................................................................