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t TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map P 7 Parcel Permit# r '� .
Health Division _o -7 -(0 1 Date Issued
Conservation Division t Ss ®� Fee U i5o
Tax Collector - SEPTIC SYSTEM MUST BE
Treasurer - D INSTALLED IN COMPLIANCE
WITH TITLE 5
Planning Dept. ENVIRONMENTAL CODE AND
TOWN REGULATIONS �
Date Definitive Plan Approved by Planning Board
Historic-OKH Preservation/Hyannis
Project Street Address q ID u E
Village
Owner W A LZER 06,n)G%i l Address &'!3 15b:Weg RI A. U. ns-ruwltc
Telephone c7- � °7s7 6
Permit Requester
0 ZAIZ-0 Allie'44/ISL,00Ie —<:A RA L /)yK
L
Square feet: 1st floor: existing proposed 2nd floor: existing proposed TI new =
Valuation 3 SD0D,D a co
Zoning District Flood Plain Grouun.Later 6ierlayx' -
o
Construction Type IAAxD &,&nrv:
Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting do umentatien. rn
Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units))l
Age of Existing Structure Historic House: ❑Yes 1 f 0 On Old King's Highway: ❑Yes ❑'No
Basement Type: 6Full ❑Crawl ❑Walkout ❑Other
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft)
Number of Baths: Full: existing oZ new r7 Half: existing C:> new
Number of Bedrooms: existing_CR new
Total Room Count(not including baths): existing new_ CD First Floor Room Count 3
Heat Type and Fuel: 21N
as ❑Oil Electric ❑Other
Central Air: ❑Yes o Fireplaces: Existing
g �_ New (D Existing wood/coal stove: O 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❑
U(Commercial ❑Yes No If yes, site plan review#
Current Use &11 Proposed Use
BUILDER INFORMATION
NameP25A- e5D64 t),&bj A RIIILWYTelephone Number —,A'S 2q T
Address , �Dk �, License# q 3 S-s6
aL's�j�7!'V 1 1iLjS� j,a oa i; Home Improvement Contractor# I R % 3 %
Worker's Compensation# `%:C_ I Do 9.-� ME-Q. "
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
D o g Ki LAN
SIGNATURE DATE 3 �a i)a-s
CY
FOR OFFICIAL USE ONLY
1
i •
PERMIT NO.
4 ,
a' DATE ISSUED
s MAP/PARCEL NO.
ADDRESS � VILLAGE !
OWNER ,
DATE OFINSPECTION:
FOUNDATION
FRAME
INSULATION
FIREPLACE ;
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL : ;
GAS: ROUGH FINAL
FINAL BUILDING
DATE CLOSED OUST .
ASSOCIATION PLAN NO.
5
77te Commonwealth of Massachusetts
—•= Department of Industrial Accidents
offer Offim"twx9am
-" 600 Washington Street
. Boston,Mass 02111
wor'I{m' Com pmgatiDn Insurance Affidavii
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location �7 7,1 w t
phony
❑ I am a h=ww=ping wMkmyself
❑ I am a sole groPnetor and bave.no oae wo g in aav
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The Town of Barnstable
Regulatory Services
Thomas F. Geiler, Director
Building Division
Peter F. DiMatteo, 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. 2r^
Type of Work: - M Estimated Cost OPd d
Address of Work: b> IDI.✓ b1 GA
Owner's Name:
Date of Application:
I hereby certify that: .
Registration is not required for the following reason(s):
❑Work 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 er:
J
Date Contractor Name Registration No.
OR
q:forms:Affidav
:rev-122001
j
. ! �.,:•'�'4' �°•jY,;;l �TOO�n�n0httt/ell�.0��/,`� uGead a
:j BOARD OF BUILDING REGULATIONS ;
License: CONSTRUCTION SUPERVISOR t�
ii
t :Numberf_CS\ 043556 i
d� 27 31j P2
Vie•{°:: -t
4itplrsst( 1 002 Tr.no: 4782
i� Restricted To ,`00
4I SCOTTE CROSBY,,.; �'
C 62 CROSBY CIR ,-
l.I OSTERVILLE, MA 026.55 —Administrator.
r•� '
. _ - --- �� ✓1�e wommca►euiea� o�✓�iwaac�auaelk:
Board of Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR
Registraftn::131378 ,
Expiration:"07/13/2002
Type. ..
PEACOCK&CROSBY BUILDERS,
SCOTT CROSBY
1112 MAIN STREET UNIT 7
Y� OSTERVILLE,MA 02655 Administrator
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