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Town of Barnstable *Permit
ds ` 1°�'` ' ► Regulatory Services wee 6monthsfromissuedate
snnNareB[.E.
Muss. � L 18 2017 Richard V.Scali,Director
-jjARn' F Building Division
y I AB�[Paul Roma,Building Commissioner -
C 200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma us
Office: 508-8624038 - Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
��ll ,dyot/['( w out Red X--Press Imprint
Map/parcel Number )2., V
Property Address do?o Wes aj nj C(-rCk C
PyResidential Value of Work$ °� Minimum fee of$35.00 for work under$6000.00
Owner's Name&Address
� I
Contractor's Name �Q- ��1 I e y Telephone Number_ (o 6) ?
Home Improvement Contractor License#(if applicable)Q y 10 Email: IUS3uj AQ1�s r� �r�.o.�� C o M
Construction Supervisor's License#(if applicable) S— r'O 7 L(Y-7
❑Workman's Compensation Insurance
Check one:
[C�I am a sole proprietor
❑ I am the Homeowner
❑ I have Worker's Compensation Insurance
Insurance Company Name
Workman's Comp.Policy#
Copy of Insurance Compliance Certificate must accompany each permit.
Permit Request(check box)
❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to
❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof)
a Re-side
❑ Replacement Windows/doorsMiders.U-Value (maximum.32)#of windows
#of doors:
*Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
***Note: Property Owner must sign Property Owner Letter of Permission.
A copy of the),Home Improvement Contractors License&Construction Supervisors License is
re uir d.
SIGNATURE: ��
QAWPFILESTORMSUilding permit formsEXPRESS.doc
61/25/17
/ 27zz t oTllwo7rweahh of MasSCfCtllrS!&
Depvhffent Qf1alf=&at Acddt'7zY
' VV6��YY0SS//0((�WaS,�ilifi ton niW3��Ir'eett
Botstona AM 02111
' }t�vi-ttma�gr�pfi�ut .
Warlmrs' Campens3flan Insurance Affidavit BOder-s!(;aniractersMect cians/Pluinhers
A.pplicamt Infhamptian Please Print E.e�Iy
Na=(Bvsmessnot " _ ,/jql4,,&,l ���►
Address: ixe
Citytstatel 6�-6)3a
Are you an employer?.Checkthe appropriate ba= ' Type of project(regmiLed):
L❑ I am a employer with 4. ❑I am a general conEmctor and I 6. New construction:
AnDloyees(fish andfor part dime * have hired the sub-contzactors
2.&f I am a sale grvpxietmr or partner- listi-d oat$e attached sheet:. y. ❑wo g
�ese sub-cadractors hale
ship and liave iw employees 8.,0 Demalitioa
a
world fnr�in any capacity: �lI es and have woAmrs' 9. ❑Building addition •
[No sv a&.rs' camp.insurance comp-km=cf-$
regxired] 5_ ❑ We are a corporafiou and i s 10 ElMe dca repairs ar adfr
officers exercised their
3_El am a bomeovm�er dniag all vrorlc 1 L Q Plnmbingrepaiis ar sdditions
myself- o ems' right of exemgfion per MGL
coop- c_152, §1(4k and we have no 13 Roof
employees_(NOworkem' 13.❑Other
comp_i =cz mquired ns _]
`AYaPFficr�azaccbecls box#lmastdmMo ttheseci=beEmshuvdn&Irwa2ea'comp—otinaparkyinamns6an_
ffnmedarn4rstrhd sab�i tlris l ag they axe+�m'eiF W�and t5ea hire astride canTmctarsamct.sdbmit a new affidazyt indiesti"smell
rContnda6$u[diedrthisbat must rftr-hed=addifianal shad sbnorimgd%enmmeofthesafi-ca mxndstaearhelhezarnottbdseentidmbzm
emplayees.If the sub-c�Lace emplayeas,they pmvide their warkrs'comp.paliU n=bm
lam arm ernpIapar that is pra din,markers'campmsa lian fi=rartca f or my enrp,eim fferow is tTwpaticy and job sda
information.
Insurance Company Name:
'Policy ll'or Self--ire 11c_,4". F�pizatiaaDafe:
Job Site Address: Cityf5tateJTp:
Attach a copy of the workers'coampensationpolieydeclaration page(shoving the policy number and expiration date).
Far'lnre to secure coverage as requiredvader Section 25A of MCH r-152 tan lead to the iimpositim of criminal penalties of a
fine up to$1,500 OU andfor one-year imprison as w6ll as tail penalties,in the harm of a STOP WORK ORDERand afore
of up to$250-00 a day against the violator. Be advised that a copy of this statement,tisay be farwarded to the Office of
Imuestigatiow ofthe DIi,for insurancz coverage ve ifrca3ion-
1 tt0 Frerzby sr ttt Ifthffe.s afpediuy thatthe ircfarmaiimr prorirbed above i s bus and[:affect
Simatum- — ' Date-
P3mae i 5 - 60 ^ 61 3 a .
O,�rcicd rr mrI}. I7a not trrita irr flm�axes,fa be calupfetad by city artoirn x,jrciat
City or Town: Per>mtfLicense#
Issuing Anther€ty(curie one):
L Board of Health T Builifing Deparfinent 3.CitylTown Clerk 4.Electrical linpector S.Phzmbing Inspector
6.Oth-er
Contact Person: Phont=#:
-Information
and Instrue ions r
Macr�r- Getmg Laws auapter M reqaares all eropIoy='to Pmvnde waEke&=nPMS3fnn fur weir eorPIo�
p=a=-m this ,an w'PL*=is defned as.¢—MmyPeason.m.$f a service of azoffier.mdw auy matrad ofhfir, f
expir-M or h33PH 'oral or veritt=af
Air Mayer is defiaed as-an i a&vidual,pm-EncrEp,assoc�icm,cmpar�ton or other Iegal may,or any o or more .
of file foregoing is a3��B,andmclnding the legal=F==Wivw of a deceased employer,or 13�0
re dv=or fxvstees of an nodividM1l,per,sasociafion or otherlegal eniiiy,employing eraployees- However the .
owne<r of a dwelling
house baying not more thaw three apartneufs andwho resides�,or the occupant of the-
dw zk g house of another who employs pesons to do maw ce, .,o- m Aim or repair voir on such dwelling horse:
or on the grounds or building m-Tt
therefn sbaIlnotbecanse of such employmeartbe deemedto be an employer"
MM chapter 152,§25C(6)also states that'every stf nr local licensing agency shaII withhold$e im-aance or
renewal of a liceiuse or permit operate a business or to construct btu7dings in the commonwealth for any
applicantwho has notprodtaced acceptable evidence of compliance With the insurance.coverage required:
Ad tionaIly,Mal.meter 152,§25CC7)states-Neither the connnmweaM nor a'ny ofits political subdivisions shall
enter into any contract for the puree ofpubho vac uatl acceptable evidence of eamphm=wbh&e b"ormce.-
fer have Been eaatrd to fie�„ c6�.afhoiity.7
• rex�s oftbis� 1�
AppIicaats •, .
Please fll oiot $ze worms'compeasafon affidavit completely, u
by chg the boxes that apply to yotu:sifnaiion and,if
n ,sopPly salr-Contxactor(s)name(s), addresses)and Phone rromber•(s)along with thcir cMtEaca±r(s)°of titan the
insraance. L�dLiabMfy Companies(LLC)or Lmzi�dLiabr7itp Pat(n�h=Fs(LLp)wrHino e�Ioyees
members or partners,are not mgaired to carry warms' comPensalion msmmnoe. If an LLC or LLP does have
employaes,apolicyisregairei Be advisedtfidthisaffida-vitmaybesnlmitbedtothe Department ofrndvstrial
Accidents for con�mati�of insru�ce coverage: Also Be sure to sign and date the affidavit. The affidavit should
b e•reb=ed to!he,-city or town that the applicafioa for the pence or 1ic=a,is being rmxlues( no t the D eparbned of
TTd ctr i al�4 c ;lm, �dyou�any gnestLons regarding the IaW or ifyon ate req¢ired to obtain a eats'
comp ensatio policy,please call the Dep arfineof at fhe n=bea listed below Se ured lf-ins ec�anies should en,'r r their
self-insurance license nmmber on the appiopnzte lie.
City or Town Officials .
Please b e sore that the aTmdavif is eomilete and primed legibly. The Department has provided a space of the botfzaa
of the affi&-&for you to f M out in the event the Office oflnvestigaiions has to coafect you g the applicant.
Please be,svretofillmthepeam�cessemmbaWh'chwillbe used asaref==cernmbcr Tn addition,anapplicant
that must sabmit n:a'b#)le peOnWliceose applitsfions m aay given yam-,need only submit one affidavit=&cafng cn¢ent
policy information(if nxessaz3')and wader"Tob Site�._ddrese the applic•�should wrde`°aU locatbw n (citY or
town)„A copy of theaffitdavitthathas been officially s a roped madaed bytiie nc ar fawn mayprovided to the '
applicant as proof the a valid affidoit is on file for frdm e'permits or pteenses Anew affidav mustbe filled oiut cart
t
year.'Where a home owner or citizen is obtaining a Iiceuse or peUit not related to any business or commercial v=t=B .
to bumleaves etc.)said is NOT complete fhis affidavit
a dog license orpeamit
The Office ofjuvcsfigslions wonldlBM to thank you in advance for your coopma ion,and should you have any questions,
please do notbtsifato to givens a call
The De par[mers ad&mss,telephone and fax sYmmber_
-
.
f�tce�� `ktia�
RAM&oil 11
Ta 4 617- -4 m t 4-06 or 1477 MASSAFF
Fax 617 727 7M
Kevised424-07 -
j
i
` ,per Urie rpomvnaa�uueall/o��iwe�craelyd.i
-\` Office of Consumer Affairs&Business Regulation
HOME IMPROVEMENT CONTRACTO'R
e
lug
Registration:.`',- ,1^7,9410
Y s
Expirations--`-==7.28/2018 Individual
�-,TEEN
NATHAN BAILEY ,.::j'=_=-c°;,.,4' °•
NATHAN BAILEY
:• ,—_:-
ti 5 JONES RD —
MARSTONS MILLS,MA 0648 Undersecretary
I
I
Massachus�O --DePartmentof p
_ Board of Buildin Public Safety
g Regulations and Standards
=� Construction Supervisor
License: CS-107447
NATHAN
5 JONES RO pE a'
Matstons Mills Ala 026'8
Commissioner Expiration
08/30/2017
i
Town of Barnstable e
Regulatory Services
K Richard V.Scali,Director.
i
►��' Building Division,
Paul Roma,Bailding Commissioner
200 Main Street,Hyannis,MA 02601
www.town.barnstable.maxs
Office: 508-862-4038 Fax: 508-790-6230
Property Owner Must
Complete and Sign This Section
If Using A Builder
as Owner of the subject property,
hereby authorize / "' � to act on my behalf
in all matters relative to work authorized by this building peunit application for.
L
(Address of Job)
**Pool fences and alarms are the responsibility of the applicant Pools
are not to be filled or utilized before fence is installed and all final
inspections are perfomaed and accepted.
U
S" a of Own e o Applicant
Q14A*
rint!Na=4�'
. Print Name .
a
Q:FORMS:OWNERPERMISSIONPOOIS
e
Town of Barnstable
Regulatory Services
clot �iy,Y Richard V.Scali,Director
Building Division
t M Paul Roma,Building Commissioner
639. �� 200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-403 8 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
DATE:
7Z19/f(7 Please Print
a � ,pq c r �
JOB LOCATION: �V'J t�A�Lxj(y� r 4 L`\�1 Cz OU�u< oe
number street p village
"HOMEOWNER": 1 'c�b f r� 77 y -a O r 7 g Q
name home phone# work phone#
CURRENT MAILING ADDRESS:
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
this issue is a form currently used-by several towns. You may care to amend and adopt such a form/certification for use in
your community.
Q:\WPFILES\FORMS\building permit forms\EJCPRESS.doc
06/20/16
�* TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
t
Ma 011 0'. ! Parcel /a�16110'ot/ (ter ✓o)
p Permit# ? 4'S9
Health Division a1sD ��—v3 Date Issued (e l'Z'3/o y
Conservation Division IS 6 G Application Fee
Tax Collector /v _p tF��
30, 00
�� � �� SEPT���Y
9
Treasurer INSTALLED IN COMPLIANCE
WITH TITLE 5
Planning Dept. ENVIRONMENTAL CODE AND
Date Definitive Plan Approved by Planning Board TOWN REGULATIONS
Historic-OKH Preservation/Hyannis
Project Street Address
Village C!fk`ll
Owner _ D !` � �D�/�Ct 11�J a//h Address
Telephone 6 0
t
Permit Request ��C�C 1 �; �(�l (o
C'9
Square feet: 1 st floor: existing 11160 proposed 2nd floor: existing — proposed ToWnew sr. 7
Zoning District Flood Plain Groundwater Overlay --
Project Valuation d ®' Construction Type
Lot Size 16-,190 F 5 9 FT Grandfathered: 9Yes ❑No If yes, attach supporting d cumentation. .
Dwelling Type: Single Family 2r Two Family ❑ Multi-Family(#units)
Age of Existing Structure Historic House: ❑Yes Flo On Old King's Highly: ❑Yes r/YNo
Basement Type: gull ❑Crawl EANalkout ❑Other
Basement Finished Area(sq.ft.) IeQ !�W Basement Unfinished Area(sq.ft)
Number of Baths: Full: existing v2 new Half: existing new
Number of Bedrooms: existings new
" Total Room Count(not including baths): existing ;_ new First Floor Room Count �5_
Heat Type and Fuel: B-Gas ❑Oil ❑ Electric ❑Other
Central Air: ❑Yes ®'No Fireplaces: Existing `New Existing wood/coal stove: ❑Yes ❑ No
Detached garage:zexisting
ing ❑new size — Pool:1t1 existing ❑new size �- Barn:❑existing ❑new size —
Attached garage: ❑new size '— Shed:lexistin ❑new sizeg g g lax 1 Other:
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial ❑Yes I/No If yes,site plan review#
Current Use Jw C Proposed Use
BUILDER INFORMATION 419 8� (27 7 .
Name 60 b ���.� �l ^�d�' Telephone Number � ��'
Address 4q0-M!e 0 LIJ h License#
Home Improvement Contractor#
Worker's Compensation# 1
ALL CONSTRUCTION DEBRIS R LTING FR_ HIS PROJECT WILL BE TAKEN TO yl3GL�/�Sra✓le �-a �'cL
r
SIGNATURE DATE
FOR OFFICIAL USE ONLY
PERMIT NO.
DATE ISSUED
MAP/PARCEL NO.
'- ADDRESS VILLAGE
OWNER,
DATE OF INSPECTION:
FOUNDATION
'4 FRAME
4
INSULATION
FIREPLACE
F ELECTRICAL: ROUGH FINAL
f= its
PLUMBING: RQU!GH FINAL
n S
s GAS: RCS}dQ FINAL _
E, l,,,, 4-N- S 15- F 0
4- FINAL BUILDING � ,
: Oi0
m
>< a ru®
Q
1 , DATE CLOSED OUT d N
TTe
C'
ASSOCIATION PLAN NO.
F .
v
e
��FtHE rq�� Town of Barnstable
°;^ Regulatory Services
BAHNSrABLE, ' Thomas F.Geiler,Director
MAM
9�ple 039. a``� 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.
Type of Work: Estimated Cost
Address of Work:
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 r
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 actor - ame Registration No.
e Owner Name
Q:fbmwhomeaffidav
The Commonwealth of Massachusetts
Department of Industrial Accidents
600 Washington Street
Boston,Mass. 02111
Workers' Compensation.•Insurance Affidavit-General Businesses
name:
address: .
city state: zip: phone#
work site location(full address):
❑ I am.a sole proprietor and have no one Business Type: ❑ Retail❑ RestaurantBai/Eating Establishment
working in any capacity. ❑ Office❑ Sales (including Real Estate,Autos etc.)
❑I am an employer with em to ees(full& art time). ❑Other
[5 I am an employer providing workers' compensation for my employees working on this job..
comUany.name,
address.
efty
I am a sole proprietor and have hired the independent contractors listed below who have the following workers'
compensation polices:
Icompany name:: `. '.<. .: .. •.. . .. ... .. • ::a:; '':
ad dress: �:
city: throne-
,
insurance co. "'
COm 8nV name :. .,
p
address:. ..
. ..,. ;..
..::: .......: .•
Tu
t.
tn suranc_G:so.
Failure to secure coverage as required under Section 25A of MGL 152 can lead to the g q nnposttion 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 R
copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification.
I do hereby certify under the pains andp_eenalties of perjury that the information provided above is true and correct
Signature !1 D 6 �'^� fT'! e Date
Print name Phone#
Official use only do not write in this area to be completed by city or town official
` city or town: permit/license# ❑Building Department +
❑Licensing Board
❑check if immediate response is required ❑Selectmen's Office
❑Health Department .
contact person: phone#; ❑Other
(revised Sept 2003)
Information and Instructions
Massachusetts General Laws ch�pter 152 section 25 requires all employers provide workers' compensation for their.
employees. As quoted from the `law", 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,eniployer, 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.eiriploys.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 bean employer...
MGL chapter 152 section 25 also states thatevery 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, neither the
cormnonwealth 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 in the workers' compensation affidavit completely,by checking the box that applies to your situation..Please
supply company name, address and phone numbers along with a certificate of insurance as all affidavits 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.
i
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
I 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. The.affidavits maybe.returned to
the Department by mail or FAX.unless other arrangements have been made.
The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions,
please do not hesitate to give us a call.
I The Department's address,telephone and fax number: .
The Commonwealth Of Massachusetts
Department.of Industrial Accidents
BMW of Iesesugmens
600 Washington Street
Boston, Ma. 02111
fax#: (617) 727-7749
phone #: (617) 7274900 ext:406
Town of Barnstable
o� Reguiatory Services
9i �$ Thomas F.Geiler,Director
s6.79 a, Building D l I si0n
Tom Perry, Building Commissioner
200 Main Street, Hyannis,MA 02601 .
www.town.b arnstable.ma,us
Fax: 508-790-6230
Office: 508-862-4038
Property Owner Must
Complete and Sign This Section
If Using A Builder
as Owner of the subject property
I, d
K9411 q. 1014 S tr -'to act on my behalf,
herebyauthorize /Tv��►�°'
in all matters relative to work authorized by this building permit application f or:
(Address of Job)
ate
Si e o Owner .
print Name
r,.cnQMC�CIWNERPbRMISSION
12"
2x ail
4X4 st 4x Post
CV) Balasters 4x4 Post
5" apart
I L
--- - 2x8 !2' ____....
6x10 6x10
!013 _
4x6 post 4x6 post
12"Tubes 12"Tubes 12"Tubes
4
4"
11
Robert Kahelin
220 Westwind Circle
Osterville Ma
Existing House
Existing deck-
New Deck
UP n65)
New Deck
R
POO)
Robert Kahelin
220 Westwind Circle_
Osteville MA
Town of Barnstable
o� Regulatory Services
Thomas F.Geiler,
anartsTnars. + ,Director
T Mass.
1679. .E Building Division
• eft)Mp't A
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
f j Please Print
DATE: �/ /S ozr/ q
JOB LOCATION: )tXD
number street village
"HOMEOWNER': n
name home phone# work phone#
CURRENT MAILING ADDRESS: 220 W eS 11%e h dt/- 4-i e
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.
toad e!!n,r
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
iseveral towns. You may care t amend and adopt such a form/certification for use in your community.
Q:forms:homeexempt
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
4
Map Parcel7& 4 Permit# �(v 8
Health Division O3rr4fl ate Issued 'f 2 _q-
Conservation Division �.w 6� r ;'`^ Application Fee
Tax Collector Permit Feed
Treasurer — ----- __ _
Y^
Planning Dept.
Date Definitive Plan Approved by Planning Board
Historic-OKH Preservation/Hyannis
Project Street Address as 6 RAO-0 A)/46 (-. 0ezle-
Village OS fei'diIle,
Owner i�4 � f PAn1JG ?4�'4plf,0 11401 Address D Mtf-f f//?,Of
Telephone _53 Y'— -�s3 9-D
Permit Request ������� or AffDY,4 6101,-4'.0 /-;;JOZ — d t we_ ASS X aS 1
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuation /?GU- Construction Type
Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
.ti
Dwelling Type: Single Family Two Family ❑ Multi-Family(#units)
Age of Existing Structure / L/2S Historic House: ❑Yes O No On Old King's Highway: ❑Yes t5!fNo
Basement Type: 0 Full ❑Crawl ❑Walkout ❑Other
D-o
Basement Finished Area(sq.ft.) Av. Basement Unfinished Area(sq.ft) ' s�
Number of Baths: Full: existing 49, new Half: existing new
Number of Bedrooms: existing_] new
Total Room Count(not including baths): existing S new First Floor Room Count
Heat Type and Fuel: ZGas ❑Oil ❑ Electric ❑Other
Central Air: ❑Yes &No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No
Detached garage:❑existing El new size Pool.❑existing (-new size X Barn:❑existing ❑new size
1#-bme �j rt7ko
Attached garage:2"existing ❑new size Shed:❑existing ❑new size Other:
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial ❑Yes U/No If yes, site plan review#
Current Use O\ 166'., e.P Proposed Use STdeoee
tV" ��� BUILDER INFORMATION�F—
ame Telephone Number "
Address 3 7 License# J3 Q�3 7k
o 141, Home Improvement Contractor#
Worker's Compensation#
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 1%/0 ✓Q-7
i r SO 77,N<
SIGNATURE DATE
t�
j FOR OFFICIAL USE ONLY
PERMIT NO.
i DATE ISSUED �K
MAP/PARCEL NO. a
ADDRESS VILLAGE
y
OWNER
DATE OF INSPECTION:
t
f FOUNDATION 11®a
FRAME
:J INSULATION
_.r
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
FINAL BUILDING
DATE CLOSED OUT
ASSOCIATION PLAN NO.
. f
"-=— The Commonwealth of Massachusetts
(;1'6 Department of Industrial Accidents
wee#fMM"VPVM
600 Washington Street
Boston,Mass. 02111
Workers' Com�ensation Insurance Affidavit-General Businesses
•,,.;
name'
address: 3 D !J�PS f IM1Ne
,it, state: zip: t7aYASS phone# Sd d' 4/2 o—s J o
work site location(full address): 15-478-e—
❑ I am a sole proprietor and have no one Business Type: ❑Retail❑Restaurant/Bar/Eating Establishment
working in any capacity. ❑Office❑ Sales(including Real Estate,Autos etc.)
❑I am an em loyer with em loyees(full&part time). ❑Other
LJ I am an employer providing workers'compensation for my employees worldng on this job.
company name: `
address:' ..:.
i'
city 4. phone#:-
In suran ci.cb: io.
offlz
I am a sole proprietor and have hired the independent contractors listed below who have the following workers'
compensation polices:
d�J
colllAenV name: ��`
' f- ,.
eStv: eo�o `aa7d 9 `::.. phone# afaa.`_ -�a.j..
f
N. C
insurance co. �rl!/9 %<�.... ..••. : `:F%�l'IAG/ olic" #
company name:.,;'::
address
phone# .. . .
iri'sursace�eo. -r ;°. :•.: . >olicv�#.:' .
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 may be forwarded t the ff of Investigations of the DIA for coverage verification.
I do hereby certify under pai ties rjury that the information provided above is true and correct
Signature / Date y
Print name �• ���/h ✓ Phone#
�e-
r
rl use only do not write in this area to be completed by city or town official
yr town: permit/license# ❑Building Department
[]Licensing Board
❑check if immediate response is required ❑Selectmen's Office i
[]Health Department
contact person: phone#; ❑Other
(tweed Sept 20M)
v C'
r
Information and Instructions
Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their
employees. As quoted from the"law", 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 section 25 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,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 in the workers' compensation affidavit completely,by checking the box that applies to your situation..Please
supply company name,address and phone numbers along with a certificate of insurance as all affidavits 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 pernvt 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'
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 Office of Investigations has to contact you regarding the applicant. Please
be sure to fill in the per•nrit/license number which will b�e 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 lice to thank you in advance for you 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
Once of Inaesdgwons
600 Washington Street
Boston,Ma. 02111
fax#: (617)727-7749
phone#: (617) 727-4900 ext.406
oF�HEr Town of Barnstable
Regulatory Services
B ABI,E, Z Thomas F.Geiler,Director
9pp s639• �,�� 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
dj
building containing at least one but not more than four dwelling units or to structures which are oft agent to
such residence or building be done by registered contractors,with certain exceptions,along with oher
requirements.
lee)/ �Vlastirnated Cost
Type of Work'
Address of Work: aa0
Owner's Name: �(J Z 4 ��
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
i
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 C ntrac r Name Registration No.
D ate weer' , me
I '
Town of Barnstable
CF SHE 1p�
Regulatory Services -
snxxslear.>;, ; Thomas F.Geiler,Director
6 9. .0 Building Division
ArED �a 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
DATE: ✓ /d L /
JOB LOCATION: as 6 ae,5/ (d/)Jl 01�CLz
number street village
,IOMEOWNER".
name home phone# work phone#
CURRENT MAILING ADDRESS: 1,P 5_
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
_ 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
-- lie;amine=or=tvi+o-farrulydwelling:attacl ed�or:defached-structures accessory to such use and/or-farm stiuctures;:A-..
person who-constructs more than one home in a two-year period shall not be considered a homeowner. Such
_`chomeo- "a hall.submit.to_the Building Official on a form acceptable to the Building'Otfcial,that,he/she shall be
- ---
-responsible, or 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 omeowner"certifies that he/she understands the Town of Barnstable Building Department
_ ...._.minimum inspe .proce d quirements.and that he/she will comply with said procedures and _�._ R,�._...... -_ n. ....
requirements.
Signatur o omeowner _ _.._... ._.._
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. .
HOMEO WNER'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.
0•fnrmc•hnmeexeirmt
/H CERT/FY 7X 7H/S LOT/S NOT GOCr4 TER /N. ..:vciM FG 000 HA
„Zif/Pp ZSFe
"AS ShrOYYN ON'THE FEOERA.(. FL DOP INSURANCE RATE AG4P FOR THE T W
oA'�UN/rY PANED. Nlo"-S 4wo i ovisaEFFECTIYE ca4TE I
Roa R,T E1,$4YAIONP, R.,t,.S PATE
NOTE: NORTH ARROW NOT TO BE Oy
4115EG FOR SOLAR PURPpS�' ,
stir
ti
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N
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Z-07753 ,CDT�S ,COTS i Y
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TM/S PLOT P4AAt IVAS NOT AIAPE FR0,4! • 4P#4f 44//IW 40CW TION -P.kAN
AN /NSTii�UMENT SURvEYA/1/P /5 FOR TM,�
USE OF THE BANK G?/V,LY. UNDER NO 407-,74 MESTGI�ND. CI,QC,L,E
C/RCl/MSTANCES ARE OFFSETS TO BE 6AL 2/VSTAaLE 11114
USEP FOR FENCES, WA444, liCKES,
- ErC. OWNER BY: t�E�c%/I.-5 �5r�.� �,0,SP �.
�ZN OF 41%g0 .4*fof4O# ENGINEERING. INC.
for ROB ERT 60 EAST FALMOLIM HIGHWAY*
N EAST F
RAYM D ALMOUM MA. OZS3b
I ON ,
?, No.21583
0 SCA4of' GATE:
��fs 9FC1 STEP�QJ`� 1"_. c�U,L 27, /98S or
LA s �,IWNAVY,= ,4PPP. BY: PA,.4N Na
o L.• y,
4t / HEiPEBY CERT/F THA.T TH/,5 OIYE.G,t,/NB /S LOCA MP ON THE GOT A3 S
TO THE rowN Of' 6 ,Z►ONING REG414AT/ON3, REIGARO/NG
W zINe%? ,4N0 .GOT 4INEg AT THE T/ME /T w,,49 CON9TiPUCTEO. ,
� t •
fOBERTE.
Qi
A o � �
8
10
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•
ofTME�� TOWN OF BARNSTABLE Permit No. ......28554 .
BUILDING DEPARTMENT
TOWN OFFICE BUILDING Cash
$
HYANNIS,MASS.02601 Bond ................
CERTIFICATE OF USE AND OCCUPANCY
Issued to Dennis Star Construction
Address
lot #54 220 West Wind Circle. O-2tP.-vi11P
USE GROUP FIRE GRADING OCCUPANCY LOAD
THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL
' SIGNED BY THE BUILDING. INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN
REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE
BUILDING CODE.
?6rgTn1).e...,... ......... 19.... 6......... ... ....................
Buildingqnspector
°•. TOWN OF BARNSTABLE
BUILDING DEPARTMENT
i ssaaSrAIM TOWN OFFICE BUILDING
rut
ab 1639' �� HYANNIS, MASS. 02601
MEMO TO Town Clerk
FROM: Building Department
DATE:
An Occupancy -Permit has been issued for the. building authorized by
BuildingPermit #.......... . J.�N . ........ .......... ......................................................................................................................
issued to ✓ ?y '_.. k .. 1% `1h........................................ ...._...........................
_
Please release the performance bond.
r
>I
))t C; f•. J. .f:' iti r�.,\:�'Y.`'�1�},::•MhP}Y1{�L1S'T i
Z
_ D•
PINK:i'=DEPi F4E CDPY!WHITE=FIELD:COPY.%,YELLOW-APPLICANT+
r °`
BUILDING.:':
•TOWN OF BARNSTABLE,�'MASSACHUSETTS t
•'VALIDATION
j`A612:'1-11-21:
:PER I
October �17; 85 N •",28554
DATE 19. PERMIT NO.
dpero .Theoharidis S. armoutF- 0 6.681
;1-: APPLICANT •' ADDRESS
f.'...:!.. ...,.. (N0.) ' . ' .(STREET)' ..ICONT.R'S LICENSE)
NUMBER OF
PERMIT:''T0 '` Build:.:DWelling (::_1 1 STORY Single Family.:-Dwelling
:DWe'1'lin�' DWELLING'UNITS
1 (TYPE OF IMPROVEMENT) •. .NO. (PROPOSED USE)' '
Lot 54. 220 -West: .Wind Circle, Osterv.ille '.•. ZONING . RC
AT(LOCATION ". DISTRICT•
(NO.)' (STREET) -
AND
(CROSS STREET)...' (CROSS STREET).•',
. . ....:;:�,..:;4.,.... LOT. .
.::SUBDI..VISION: 'LOT BLOCK SIZE
BUILDING iS TO BE FT. WIDE BY FT.•LOAG BY FT. IN HEIGHT ANQSHALL'CONFORM..IN CONSTRUCTION
TO TYPE ( USE GROUP BASEMENT:WALLS-OR FOUNDATION'
.(TYPE)
aEM�at(s
Sewage'#.84-903 .
Bond.
AREA OR YY PERMIT
VOLUME :•159y. sQ r f t. ;` '• ESTIMATED COST'' 35,900.-00• FEE 71 .7t5
- .•;:::'•.` "(CUBIC/SQUARE FEET)-':" - 1
( Dennis Star Construct"ion
OWNER ' ;t�•.
9UILDING.DEPT '
THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR-SIDEWALK OR ANY PART THEREOF. EITHER TEMPORARILY OR
PERMANENTLY. ENCROACHMENTS ON PUBLIC'PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE AP-
PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED
FROM THE:DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS
OF ANY APPLICABLE SUBDIVISION RESTRICTIONS.
MINIMUM`OF .THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE
INSPECTIONS REQUIRED K:f CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR
ALL.CONSTRUCTION WORKi ELECTRICAL, PLUMBING AND
1. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS.
2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL
•FINALMEMB I SSE TI TO LATHE FINAL INSPECTION HAS BEEN MADE. �'.9. FINAL ItVS'rECTIO��, BEFORE '
-OCCUPANCY.-' POST THIS CARD SO IT IS VISIBLE FROM STREET
BUILDING SPECTION APPROVALS PLUM ING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS . '
2 2 /Y ^� 2
3 Owl HEATING INSPECTING APPROVALS REFRIGERATION INSPECTION APPROVALS '
..... ........
INEE ING
1
OTHER 2 HOARD .OF HEALTH
/ 11-42
HZfEgf CRT/FY U, 7H/S LOT/S NO,T LOCATED /N ~.:vr_eAG FL 000 HAI4 RP,-l�QNE
;4"AS SNOWN ON THE FERERAL FLOOD INSURANCE RATE AG4P FOR THE 7!.WN OF `
OMMUN/TY P ma, NO.a.S xo/-ov/S;6EFFECTIYE A4TE/a ! 6.
�B RT E. YMONo, R.4,.S PATE
NOTE. NORTH ARROW NOT TO BE 0~
- !/SEG FOR SOLAR PURPASE$,
y
� a y
Z-OT 53 ,CD7 .5,4 ,COTS z (4
o° may
000
17.75 � X
l
/8. 9 8 y �
9.z /Q.G1�N 97D c� 171 nl O �I
?D•30 Q
Co
o f'
f ,
�r
T,HI%5 PLOT PLAN WAS NOT MADE fR6W AWE441" 4WATiON _AUN
AN /NsmilmENr SURVEY ANO /.S FOR
USE OF THE BANK aVLY. UNDER NO 'LOT,�`f WE5TGVIAID
CIRCUMSTANCES ARE OFFSETS TO BE BAINSTAG'L,E
USER FOR FENCES, WALLS, HEpGES,
Erc. O/YNEO BY: QzV4//S Slwe (2,c�)5T Co.
11 OF Bfq�.��yC *4R#PO)Y ENGINEERING INC.
ROBERT - dO =Aar Fi41.MOUTH H/GmwAY
E.
RAYMOND EAST FA4.MO4lrH, MA. O.Z5%96
�o N6.215830 �o SCALE= AA Ti,.': SHEET
9FGfsTtiP J``' ,"_�' cJO/— 27, /98S
L ,OR.IWN BY: CNECKEOBY APPR BY: PLAN Na
S,L•H• :.
r
d qv
Ass.e'u map and lot number ..... SEPTIC SYSTER
INSTALLED I1� C NI' U Q�oF Toy`
THE
S4age Permit number ........... •••• WITH TITLE 5
ENVIRONMENTAL CODS Ati�'� s B��a L$.
House number ....................c ...`.am...................... s
TOWN REGULATIONS °°moo 039,
war
TOWN: OF B-ARNSTABLE
BUILDING INSPECTOR
r
APPLICATION FOR PERMIT TO .............. .. .. :.......................................................................
•i �
TYPE OF CONSTRUCTION .......... .e:,....�.
.............../.. L1-`.1,� .......19.��1�
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location ...... .. ...D......./..........d....! ..........'.W...1� c ....(......1 I. '.0.........../... .. ..c: ..,�>... i..'.....��..,�.T�i�1�✓I LLB
ProposedUse .................. ..:41' 4 a...................................................................................................
ZoningDistrict ...................<..1.................................................Fire District ..............................................................................
Name of Owner ..�.. .� Address ............ .........
Name of Builder ...`.tJ..(... ...-rh�5. ll �0/•Jgddress ..............If:....�y1 .�� .........
Nameof Architect ..................................................................Address ....................................................................................
Number of Rooms .... .. .. .... ..1.Vi...��1 ,�•h.1'. Foundation .....I..Vr.�. ..: Q� & C7,E........
Exterior ... V..1/... ....../., L11..f.��.Roofing .....fi.d.fAffikI.........s.l.J.......4 ..4.-��i.;f..........
Floors .............'. �..i ..l'.. ..f ..............................:.Interior �J.. .y ...........................
Heating ..... .......Plumbing ............X...../.s.?..! ................................
Fireplace ...................Q... .a............................................Approximate. Cost ...............� s";Vvov...... .
Definitive Plan Approved by Planning Board ------------------------------19________. Area ......L. ...............
Diagram of Lot and Building with Dimensions Fee /� ��
....... ......................................
SUBJECT TO APPROVAL OF BOARD OF HEALTH
26
0
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
iconstruction.
Name
Construction Supervisor's License .... .,�: ..�..��..
f
DENNIS STAR CONSTRUCTION
4
. 2-8 .
5 4.... Permit for ................
1 ........
Single,..Fami..l..y Dwelling....................220 West Wind Circle
Location ..... ..............................................
...................Os terville.....................................
Owner ....Dennis Star Construction
...... ..................................................
Type of Construction .....Frame..........................
. ................................................................................
Plot ............................. Lot ................................
Oc
Permit Granted ...............t ob6.r...1.7.........19 85
Date of Inspection ....................................19
dr Date Completed A.........19
..r
q
Assessors map p and .lot number ���..��....�f..'..!. c THE rn`
F
Snrage"` ermit number ........8`-1.....���..3..:............. ....... t,
House .number ........: .��.. . ?.'1....................: =pB b 9\��
TOWN. OF BARNS-TABLE
BUILDING -INSPECTOR
APPLICATION FOR PERMIT TO.
TYPE OF CONSTRUCTION . ........ ,� �g'l/ ... a`l '/'1'11 i>i!. ..... /.J.? !./,./•a, - 1/, !%/•,/....
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location .... ., .. /... .......f ... ...........lL�.G-.'�.. ...�/1/.:.�., ......... ��..-. �..., ..... .a.T F12✓!GL
Proposed Use ... -C....................................................................
.................:
..............
'Zoning District .....................................Fire District
Name of Qwner✓.. .�'� �.: ...�f.T . . �� fiAddress .......
..........
v
Name of `'Builders .q '11.!...�!..'.0....T� f1! / ddress ............... .t... ,.
Name of. Architect
..................................................................Address ....................................................................................
v v_
Number of. Rooms � ........ p , W , oundation ............................... .. ...... ..... . .......
Exterior ....V . . 'S.Roofing ...... ,J. ..0#11,iO7......S.i.�G.�.� �.:........
Floors .............(�.:. ,. ..4+.. ..� -?.................................Interior .............0...9,y....... .L.G
Heating `::Nf�.T:: i:r .......:RFumbing ............ ...... r�.T 6 ... '.
Fireplace' ...................� N. --............................................APProximate Cost ... . . �..•••.••....
\
Definitive Plan Approved by'Planning Board -----------------------------19_______ . Area ......zl:�! 4. ...................
Diagram of Lot and Building with Dimensions f Fee 7J
SUBJECT TO APPROVAL OF BOARD OF HEALTH
J
1
26
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to alyhe Rules and Regulations of the Town of Barnstable regarding the above
construction.
Construction Supervisor's License 4. 1..(0.. ..� /
• .f...
DENNIS STAR CONSTRUC ON A=121-11-21
Permit for ..............
inoe F.amily ....
.......... .... ...... ........ ..)2,Ff�j,,�ing.....................
Location ......2,2Q..W.e.s.t..W.i.nd...C.i.Kcl-e
Osterville
.......................................................... ....................
Owner ,Dennis Star Construction
.................................................................
Type of Construction ...FK-Mq............................
................................................................................
Plot ............................ Lot .............................
1----
Permit Granted .......October 1,7.......................I .19 85
Date of Inspection .......;.............................19
Date Completed ......................................19
/��
UPDATE PERMIT RECORDS : ADD CHANGE DELETE PRINT FEES HELP END
CHANGE RECORDS IN PERMIT TABLE
PENTAMATION-------------L--------------------------------------------- 09/23/04
PERMIT NO. 78965
PARCEL ID 121 011 022 230 WEST WIND CIRCLE
PERMIT TYPE BADDD BUILDING PERMIT ADD DECK
DESCRIPTION 16 ' X 20 ' DECK
STATUS C COMPLETED
APPLICATION DATE 08/31/2004 DATE ISSUED 08/31/2004
EXPIRATION DATE DATE COMPLETED
MASTER PERMIT• VARIANCE
VALUATION 7500 . 00 BOND 0 . 00
CONSTRUCTION TYPE 434 GROUP TYPE 1
CONTRACTORS 017167 ANGELO KALDIS
ARCHITECTS/
ENGINEERS/OTHERS
ENTER Y IF ALL ARE CORRECT OR N TO REENTER
LEAVE BLANK FOR NON-PROPERTY RELATED PERMIT. CTRL-I FOR HELP.
i
YC
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
I ,
Map Parcel t, . Permit#
a•
• (J" .,t R t�: �
Health Division - � (r) �� $ `Datgfsaued
Tom—
Conservation Division v 4. 10 PH Epp gion Fee
Tax Collector Permit Fee C-51).
Treasurer D SIUr
Planning Dept. UJOUSYSM
Date Definitive Plan Approved by Planning Board tN=T0.LJ0R=R0=
g��.
Historic-OKH Preservation/Hyannis -tbV J-.F_ C.
Project Street Address ;Q,30 tags f"r7 y 611 rC.le,
Village D V ,///le- /w--•
Owner /` ,OU yaas Address a 3o tdes-�Ul nd Cl r61e— 6sT
Telephone q 71ffLiLED 1?g
Permit Request
i Id ���) clerk f (0 X8 pj-en U,-e �.t�Oei
W `Trek '' oeejb
v
Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuation Construction Type
Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation.
Dwelling Type: Single Family Two Family ❑ Multi-Family(#units)
Age of Existing Struucture l q y Historic House: ❑Yes YN0 . On Old King's Highway: ❑Yes ❑No
Basement Type: ,Xull ❑Crawl Aalkout ❑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: 2/Gas ❑Oil ❑ Electric ❑Other
Central Air: ❑Yes -EfNo Fireplaces: Existing 1 New Existing wood/coal stove: ❑Yes 9160
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#
CurrenfUse -- �- Proposed Use 7
BUILDER INFORMATION ��
Name 10/ (7"
� �/ -S Telephone Number 3a 3C/ F7
Address 3 11 �SG� ( '✓�-� License# �ry
Home Improvement Contractor#
Worker's Compensation# /�n
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO _00 SI1Z, dQ rD't 5
SIGNATURE An &lr�: DATE �� ' �D -O
FOR OFFICIAL USE ONLY
+r,
PERMIT NO. u<
DATE ISSUED
MAP/PARCEL NO.
G
' p
ADDRESS _ E VILLAGE f
OWNER
DATE OF INSPECTION:
6:
FOUNDATION
FRAME
INSULATION
FIREPLACE
ELECTRICAL: ROUGH �j FINAL
PLUMBING: ROUGH FINAL r:
GAS: ROUGH FINAL ;
FINAL BUILDING
DATE CLOSED OUT
ASSOCIATION PLAN NO.
:t
The Commonwealth of Massachusetts
„ - Department of Industrial Accidents*
' z OA9'68 af�srhrsd(�atlaJ� .
660'Washington Street
-Y 1 Boston,Mass. 02111.
workers' Com ensation.Insurance Affidavit-General Businesses
• '+:�"t° .::e�steo.• . :.T+�c,-eaF „"^p,`,a.
•1 n Gf 01 Y
eddress.'
V/IIX� state: zi O��J� hone#
• � �30' ��
_, �:+e irtt sti01,(fall address): to
❑ I am.a sole proprietor and have no one Business'Iype, ❑Retail❑Rest
worn oaurantBai Bating Establishment
working in any capacity. ❑.Office[] Sales(ineludingReal Estate, Autos etc.)'
❑I am an ern
to er with eta to ees(full& art time
El Oth
er
I am an. �loyer providing vtorkers' comuensation for my employees working on this job.:
:,, ..}•.:.i!tsl,:I:S? -, 'i••:�'• .,5: :; r:l'3.'.�•' c —,rt'-�i:•,:`l: •.r7,1'.'+':
clim'an'•liame• i S'. :wl: `.r., J r i. '1 _ ''t:,'•'i;i,:: };: 'rr
• •1. - �'a �,'• ',.t?tt•ff:,.. .'p' i�•;,:.f::.^,i• •. ��i•1:: _ i:•'•n t.,,'4 :j ..
ed'dressi t.t.. y: 1:..,., Y' '''� ?::S 't'i; �1.'.:�•,
'1.H•i .�;. ''n' ''1,:4..t '•t,: +i:J,1•.,�,ay�'4: t:,'.,il,la%�5:':k:.. o11C,'.{r t L •4
frisiira>i
ce.cos
❑ I am sole proprietor and have hired the independent contractors listed below who have tie following workers'
a
.compensation polices: : .. ' •�:;
OIIII an IISITr
:•r. ''' e.'' t.^!..; ? . . •:i' •P.ti:+:11 :.' :{ o.
1.
C �t.� ,•.i.^. {.r, �;:': •,•;_:, .,' 'rh..e,, y.�:1,•: 'I r' '
ILI
address:.
•:'t*:a'i i ti::; s.A�. �;);.'. ;'i '. rr• ;.rrl•;',' :i ;r'` :t,
Cl . ._:;ly;ti. i,.• .,�-.;s11.:.. :,.`.t,�.+,.',i:t:::�:Z��M:;•,+:• •'r;. •;S'••' ,
idsurance'co.
,,;• •.;('^' •L v: � •"� 'L .J 1, ..t 1':. .G'••
coin an. ria.121e:
address: '
CJ, •;,_ •.i,i•t.•t :'4� i.1J •r' >:3..?.�;a i .l.� ,.�„y ;.a. ,� -t.;�. .<,-S ••J:'' 'r
ins`tirsace�'so:•�i��'i ':'�'_:' .:::; ''�:.�.:;.:::•,:•. . •-:� ..• .. ., .. •. ., . . . . .. . . ;, .. ,.
-allure 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,jJnpr{sonment 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 IL
copy of this statement may be forwarded to the Office of Investigations of the DIA,for coverage verification.
I do hereby certify under th pains d pen ties of perjury that the information provided above is true and correct.
ate
Date 0-06a-D
Si�atvre
( (� Phone#
Print name `
official use only do not write in this area to be completed by city or town official
permitllicense# ❑Building Department
city or town: ❑Licensing Board
ediate res once is required ❑Selectmen's Office
❑•checkiflmm p ❑HealthDepartmeni
phone#; ❑Other
contact person:
_
(revised Sept 2003)
Information and Instructions.
viassachiisetts General Laws chf pter�152 section 25.requires all employers to provide workers' compensation fof their.
loyees: As quoted from the law', an employee is.defined as every person rn the service'of another under any contract
m lie oral or written.
)f hire; express or map dd; '
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 enferpris e, and including the legal representatives of a deceas ed,unployer, or the receiver or
association or other legal entity, employing employees. 'However the owi:ter of a
trustee of an individual, partnership,..
dwelling house having'not'inore than three apartments and-who resides therein, or the.occupant of the dwelling house bf
another who employs Pis to do.maintenatice, consii action or repair work on such dwelling house or on the grounds or
build g appurtenant thereto shall not because of such.eaployment.be deemed to be:an employer....
MGL chapter 152 section 25 also'states that•every state'or local licensing agency shall withhold the issuance or renewal
of a license or pernut 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,neither the
any.of its political subdivisions shall enter into any contract for the performance of public work until
commonwealth nor.a compliance with the insurance requirements of this chapter have been presented to the contracting .
acceptable evidence
authority.
Applicants ,
Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation.:Please
supply company narne, address and phone numbers along with a certificate of insurance as all affidavits may be submitted
to the Deparment of Industrial Accidents-for confirmation of insurance coverage. A.lso'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 D ep artment of Industrial Accidents'. Should you have any questions regazdiri the'"law" or if you aze
required to obtain a;workers'•compensationpolicy,please call the Department at the number-listed..below.
City or Towns .
Please be sure that the affidavit is complete andprinted legibly. 'The Deparment 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 perrrntlhcens.e number.which w�71 be used as a reference number. The.affidavits may.be:returned to...
the Dep artment bj. o .':FAX unless other:arrangements have been made.
The Office of Investig
ations would file to thank you in advance for-you 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
8fflce of ImsHl UNS
600 Washington Street
Boston,Ma. 02111
fax#: (617)727-7749
phone#: (617) 727-4900 ext:406
i
oY ,E To'a. of Barnstable
• , ' °� Re&latory.S eria
aver. Thomas F.Geller,Director
s619, k1�� Building DIVision
l6D MA'S '
• Tom Perry,Building Commissioner
200 Mama Street, Hyannis,MA 02601 ,
Office: 508-862-4038 Fax: 508-790-6230
• Permit no.
Data '
AFMAVIT
• XrOME IMPROVEMENT CONTRACTOR LAW
SUPPLEMENT TO PERMIT APPLICATION
mm 0.142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion,
•improvement,xemoval,demolition,or can stru ction of an additionto any pre-existing owner-occupied
bta'Iding containing at least one buff not more than four dwelling units or to structures which are adj'cent to
•. such residence or building be done by registered contractors,with certain exceptions,along with other
requirements, I '
• Type of Work: Estimated Cost
• - Address of Work:
Owner's
Date of Application: V�'��' • ' .
I hereby certify that:
Reotration is not requixed for the following reason(s):
[]Work excluded bylaw
❑Job Under$1,000 '
[]Building not owner-occupied
[]Owner pulling own permit ,
Notice is hereby 91Yen that:
• OVMRS PULLING TE EIR OWN PERMIT OR DEALING WITH UNREGISTERED
CONTRACTORS FOR AYPLICAB„LE HOME MIPROYEMENT WORK 1)0 NOT HAYS
ACCESS TO THE ARBITRATION PRO GRAM OR GUARANTY FUND UNDER MGL c.142A,
SIGNED MMBR?BNALTMS OF PERMRY
Ibereby apply foi&permit as the agent of the owner:
Date Contractor Name Re4isErztioar(o.
OR
Owner's Name
OFIKE r Town of Barnstable
Regulatory Services
BAMSCABM .' Thomas F.Geiler,Director
MAS&
Building Division
CFO MA't
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
DATE: - o
JOB LOCATION4 30 6 - / )/o
numbe street (�v-il7la e // J
"HOMEOWNER": W1 U V/t)e/j ! / T 7 0 S_" ` 7
name home phone## work phooneep#
CURRENT MAILING ADDRESS:
G�r vey
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
re m
gnature oTWmeowner
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:forms:homeexempt
/HEREBY CEPT/F�; THAT r►�S LOT/S NOT �(.00ATER /N f no, � ,&-A1.0'OO YAZARP ZONE
"AS SHOWN ON THE FEDERAL FL000 INSURANCE RATE #fAP FOR THE TOWN OF
,.` COMMUN/Ty PANE(, NO. _ EFFECT/YE
RoBERT E. RAYMOND, .T i4 E NOTE: NORTH ARROW NOT'TO
BE USEP FOR SO,GAR PURPOSES. > y
r
• O � y
16O.O0 bb
y
• 1.1�T �3 i r � •
1950cx s F
hoc
a �, y � e
6
loo.00 � (A
n
�c1 EST
c Co o
rs �
�
THIS PLOT PLAN WAS NOT MAPS FROM FOUNDATION 1,OCATION PLAN
AN /NSmIIMENT .SURV46Y.4NP /S FOR THE �--�T �3
!/SE OF THE BANK ONZ Y UNDER -NO \4/2ST VJ t a.I 0. G k 2CUE.
C/RCUM.STANCES ARE OFFSETS roar. _
USEP FOR FENCES, W,441.S, HEPG4Cl5 5TA,—tt e=
Fro. OWNER BY...
.4MOj'Y ENGINEERING INC.
60 EA.ST rAkAIOUTH HIGHWAY
Ron��z
E. T
FALmouTH MA. O.U36
o EAS
RAYN11M .
N0.2-15<:J SCALE: t PATE: SHEET:
9� °c 30 -ate 112
t� 1
PRAJVN BY: CHeompBY APPP. BY: PI AN NO.
1,006
7774w;: . ..........
y •
The Town of Barnstable
��ss e
Departm Services
ent of Health Safety and EiMronmental
' Building Division
367 Main Street,Hyannis,MA 02601
:e: 508.862-4038
508-790-6230
PLANT REVIEW
Owner: ®it�PG.t�i Map/Parcel:_ - t7 l I 6'L2
Project Address: �0 ?-S� W J' `�� Builder: kod A iS
i
The following items were noted on reviewing:
`
,ye �l�IN�e®�WCr 0A6y 24k ov) ^ CoA ✓
D U rks PM n;
• S'P���' �f�/a�� �13o1oy .
Reviewed by:
Date: ' e 3®A6
i
w CLI-I
to
t
1
.-
t
� t
6
+1 ova
A Y �C wJ
Angelo Kaldis
3 Bittersweet Lane
Harwich, Massachusetts 02645
508-432-3984
Contractor License#017167
Customer, Chrissoula Kouvaris
1 Stouter Circle
Andover, Ma 01801.
Property: 230 West Wind Circle
Oster-ville,MA 02655
Contract:
Application of all necessary permits.
• Construction of 16 x 20 deck according to specifications provided
Total Cost of Materials and Labor.....................................................$ 7,200.00
Contract price of Seven Thousand Two Hundred Dollars ($7,200.00)to be paid.in full at
completion of said,contract.
We, the undersigned agree to the above terms and conditions.
Chrissoula ouvaris,Owner Date Angelo is, Contractor
i
Results Page 1 of 1
Home Improvement Contractor Look Up
Enter Search terms separated by spaces. Search terms can be Town/City,Name, or License number
Select Search type: r AND r OR
Search Results
Reg. No. Applicant 11 Street City jgiR Zip Name Title Expira
3 KALDIS
122982 ANGELO'S BITTERSWEET HARWICH MA 02645 ANGELO CONTRACTOR 11/14/:
LANE
Total of
1
Records
matched.
Back to Home Page
BBRS Privacy Statement
00
http://db.state.ma.usibbrs/hic.pl 8/31/2004
Results Page 1 of 1
Licensed Contractor Look Up
Select the search method: License
Maximum number of matches: 25 F-
Enter Search terms separated by spaces. 17167
r1Select Search type: r AND G OR F5�rc-
Search Results
City/Town Name Lic.Type Lic. # Restriction Expiration Street State Zip
KALDIS, 3
HARWICH ANGELO CS 17167 00 O1/03/2006 BITTERSWEET MA 02645
LN
Total of 1
Records
matched.
Back to Home Page
BBRS Privacy Statement
http://db.state.ma.us/bbrs/contract.pl 8/31/2004
/HEREBY CERTIFY THAT rr1S LOT/S NOT 1.0CATEO /N FEAR(. F,0000 HAZAR0 ZO%VE y
"AS SHOWN ON THE FEDERAL F1000O INSURANCE RATE MAP FOR THE TOWN OF
COMMUN/TY PANES. NO. EFFECT/YE GATE
i
AOBERT E. RAYMONO, ALA5 DATE NOTE: NORTH ARROW NOT'TO
BE USED FOR 804AR PURPOSES. � y
0
ioo.00. bb
a
' yay
'n .
Qi
o
2 1p d' 0
62,49
s Fou► IDAM o
• \
too.o0
' n
!� D . y >
4 rn �
rR S PLOT PLAN WAS NOT MADE FROM FOUNDATION 1000ATION PLAN
AN INSTRUMENT SURVEY ANO IS FOR THE `C) �3
USE OF THE BANK ONE,Y. UNDER NO W[STlv-f 4J o G l 2GLT----
CIRCUMSTANCES ARE OFFSETS TO BE
USED FOR FENCES, WAkk%5, HEMES,
Erc: MINER BY:
F TH Of
.44ffR0W ENGINEERING INC.
N`' ', 60 EAST FALMOUTH HIGHWAY
ROG�H'f �: EAST Fw.MOUTH, MA. O?536
E.
RAY lvI O NI'D
` No.2,15Z.:, SCA�(.E: i DATE? SHEET
� �i,. •>• '•,•. �� 3p 'ECG I �9 1
OR.4M'N BY. cworEOBY APPR BY: PkAN NO.
r-.-�,•iv--------�..,.-------.---�.�- gyp•^ eis+-smr•� -�n+.e+r^--TMwRs.v �
TOWN OF BARNSTABLE Permit No. .3U.?4
BUILDING DEPARTMENT
TOWN OFFICE BUILDING Cash /
,iur • �•�/
HYANNIS,MASS.02601 Bond .....
CERTIFICATE OF USE AND OCCUPANCY
Issued to Theo Construction Co.
Address Lot #53, 230 West Wind Circle
Osterville, Massachusetts
USE GROUP FIRE GRADING OCCUPANCY LOAD
THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL
SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN
REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE
BUILDING CODE.
,Harsh 15, 19 88
......... ........ �...............
Build ng Inspector
��. _n �?. .. " !.� � T ��," „'F ^ ,�; .,„1' �,,r 'k ..tom .n ,. •_ .1:: ,"
TOWN OF BARNSTABLE
BUILDING DEPARTMENT
�Afla7T i TOWN OFFICE BUILDING
� rua
HYANNIS, MASS. 02601
MEMO TO: Town Clerk
FROM: Building Department
i
DATE: 2--4 O
An Occupancy Permit has been issued for the building authorized by
If
BuildingPermit $k. ... ........ .........................................................................................._.................�... ...... _.
issued .to .. ..............................._................................ ........................................._.. _................_..........._........___
Please release the performance bond.
PINK- DEPT. FILE COPY/WHITE- FIELD COPY/YELLOW-APPLICANT COPY Z 0
BUILDING04
TOWN OF BARNSTABLE, MASSACHUSETTS PEIZM11-
VALIDATION
A=121-11-22
I)ecemr,•tr 23 85 tel `�
DATE 19 PERM T NO I4 u 2�'794..,
APPLICANT Spero Theoharidis �outh 7 Emou"E'Fi UI56'8'1 '
ADDRESS
(NO.) - (STREET) (CONTR'S LICENSE)
PERMIT TO Build dwelling (_)1 STORY Single family dwelling NUMBER OF 'l .
' (TYPE OF IMPROVEMENT) N0. (PROPOSED USE) DWELLING.UNITS '
AT.(LOCATION) lot " #53 230 West Wind Ci.i.cle, Ostervi'lle. ZONING
(NO.) (STREET) DISTRICT
BETWEEN AND
(CROSS STREET) (CROSS STREET) "
SUBDIVISION LOT
LOT BLOCK SIZE
BUILDING IS TO BE FT. WIDE By FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
REMARKS: — &i #IX 1(2WCpe )/84-787
/'
bond. .
VOLUMEAREA OR 1584 sq. ft. 32,000 PERMIT 71.50
. (CUBIC/SQUARE FEET) ' ESTIMATED COST $ FEE
OWNER Theo Construction Co.
ADDRESS, South 3'rmout 1, FIABUILDING DEPT. `I
BY
THIS P'5RMn -i.Urvv E'i S"nv'rtivn5 �v'v�.C'�ir�' Nrvi"5'I Rtt T, ALLtT UK
® PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING'CO!)E� Mu�I•'"oYc
PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED
FROM THE'DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS
OF ANY APPLICABLE SUBDIVISION RESTRICTIONS.
MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED-.ON JOB AND THIS WHERE APPLICABLE SEPARATE
INSPECTIONS REQUIRED FOR CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FORALL CONSTRUCTION WORK: ELECTRICAL, PLUMBING AND
I. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS.
2. PRIOR TO COVERING STRUCTURAL OUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL
MINAL IN (RE INSPECTION
TO LATHE FINAL INSPECTION HAS BEEN MADE.
3. FINAL INSPECTION BEFORE
OCCUPANCY.
POST THIS CAR® SO— IT IS, VISIBLE FROM STREET
BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS .
�vu --
2 2T p�
3 r¢AS HEATING INSPEC ING APPROVALS REFRIGERATION INSPECTION APPROVALS
ENGINEERING
D'.HER 2 y„�,r�ti 2 BOARrb OF HEALTH
WORK Sna.LL NOT PROCEED UNTIL THE PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION iNSPECTIONS INDICATED ON THIS CAR( I:INSPECTOR HAS APPROVED THE VA RI
WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE CAN BE ARRANGED FOR BY TELEPHONE
STAGES OF CONSTRUCTION. OR WRITTEN NOTIFICATION.
PERMIT IS ISSUED AS NOTED ABOVE.
As'sessor's map and.lot number ...../ ..-./ aZ.... g`' THE
b U P `
Sewage•..Permit number `.....U-..........7.............• .���
Z BABBSTABLE, i
` House number .. .!, ............................... .. t 900 t6 9.
�o war a'
TOWN OF BA'' NSTABLE
BUILDING INSPECTOR
1 i
APPLICATION FOR PERMIT TO raw. 0"16.
TYPE OF CONSTRUCTION ........... m-,e ........................................................
................7.... ..... ........
r TO THE INSPECTOR OF BUILDINGS: t
The undersigned hereby applies for a permit according to the following information:
' q
Location .....;JC/r .....,J••.3......... .....
ProposedUse ..........1�/..Yt'.. ��/ ...........................................................................................................................
ZoningDistrict .......................r.r... ...........................Fire District ..................C.. .................................................
Name of Owner ....7� L�� �r.�..l�f://..✓.. ...�F�1/YI Address ................ .... ..........
'L
Name of Builder ....... �ill�.....,rC� ` ��uJ, ddress _...............d•.... /.7 ..�AT...............
Nameof Architect- ..................................................................Address ....................................................................................
Number of Rooms cJ 6.6.pa..41k.f I—T Foundation ...../"69. 1.9.E C.Or..AXA! .4••:W4�•T•••�••
'Exterior ......... Roofing ......ILDYQ,fJ 4.7.....:.J. l .6.6/,.. ........
Floors G .. .. ...........................Interior ......... jlY .1 ' .............
Heating ..... ..r..11i�/ .T �...�J. :."- -- ...:.....Plumbing .:........:�..... .7/T. ................:................
Fireplace .................10-41.67............................................Approximate. Cost ...........` �'d.�..0�.�.......................
Definitive Plan Approved by Planning Board -----------------_---.- Area ....A '..........
19_____-- .
Diagram of Lot and Building with Dimensions Fee ........r,... .....................
SUBJECT TO APPROVAL OF BOARD OF HEALTHd N�
r
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.
Name .. :G�.....���� r . .. LL�
Construction Supervisor's License Q
THEO CONSTRUCTION CO.
No .... Permit for ..One, Story.............
Single Family Dwelling ,
...........................................................................
Lot 53, 230 West Wind Circle.,
Location ................................................................
Osterville
...............................................................................
Owner .............Me.9...C.Q.0 5t N.V.c,t i.Q.rk..Q P.........
Frame
Type of Construction ..........................................
. .................................................................................
Plot ........................... Lot ................................
Permit Granted ......D.e.cemb..e.r...2.3..........1-9 85
.. . . ...... . .. . . .
Date of'Inspection ....................................19
Date C pleted . .........19
�:My tires C �,� • ;. ..-i::. 8:`' �.:. ,-;. r {� ,f,�.. c.: - �. T 4 ti
Assessor s map._and lot'' number t...;.......... ............................ uFT E t0�N
Sewage Permit number
� .^! BAHB9T4DLE.
House number .................. :,....,....%.,....... 90 M6
O 1 39•
r 0 MAj A,
TOWN 'OF ,. BARNSTABLE
P n
BUILDING INSPECTOR
APPLICATION FOR PERMIT TO ......
TYPE OF CONSTRUCTION ........... f! :%9 ..... ! ..-�J..... ......:......................... f.
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location .... /. ...... ......... !? .r...� !!./ ..... .(�G.t .....:�f.. f + 1�`/.1. ....
n �
ProposedUse ..........l.l..l.✓.l��l,l..f/?/.Z-1)......................................................................................................... .
ZoningDistrict ............................. ............................Fire District .................. .....v...........................................
Name of Owner ... ...611.2>!!lAddress � ........
Name of Builder .......!� r ��..... y"r1'l /,/�LfAddress .................?...'.. . 1 f �. •//.. .... .......
Nameof Architect ..................................................................Address .................................................
Number of Rooms ...Foundation ..... / /,/ ...... .. �A!. �.. 7 ..
Exterior L',r— .411A61, 7-jr.Roofing ......,�� �� ,`���l..T.......�/ /(/.. ' . ........
Floors 7 .....Interior .......... .. ,.. ......!A!<:.r�.�. �:.�.....:.....................
Heating t ( :.r..l!1 =. . ..R. .,........ ..Plumbing ..:.. :�....:�!^T..?��..................:.........:..:.
Fireplace ..............,.......... ..........:...............................................Approximate. Cost ..:.............a......:................................................
Definitive Plan Approved by Planning Board -------------------_-----------19-------- Area .....'. ....+.......:..............
Diagram of Lot and Building with Dimensions Fee
� SUBJECT TO APPROVAL OF .BOARD OF HEALTH
1r
J �
1
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.
Name .. ! ?l f l `�- .. f?• �s.�t�l-�
Construction Supervisor's License .._.. .F�. .. .
THEO CONSTRUCTION CO. A=121-11-22
,28794 One Story
No ................. Permit for ....................................
Single Family. Dwelling
...............................................................................
Location Lot 53, 230 West Wind Circle................................................................
Osterville
.........................;.....................................................
Owner
Theo Construction Co.
........ ,
. .........................................................
Type of Construction .....Frame
.....................................
................................................................................
Plot ............ Lot .................................
December 23, .85
Permit Granted ...................... ..................19
Date of Inspection ....................................19
Date Completed .......................................19
U it
��� 1111617
i
/H4e�E. , CERTIFY TV, 79/S LOT 5 NOWT LOCATED /N. -.:vcRAL FLOOP HAZARP
"AS SAY wN ON THE F£PERAL FLOOD INSURANCE RATE ,4G4PB FOR THE r F
�T OMMUN/ry PANEL. NO.�S�o�s EFFECT/YE RITE/0 / 6
•+ i
YMONO, /P.k.S P E
NOTE. NORTH ARRON/NOT TO BE -4
USED FOR SOLAR PURPOSES.
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TiN/J P�►OT P�.A S .
AN 1wsmUMENr .SURVEY ANP /S FOR THE ,
F THE BANK ONLY. UNDER NO WESTAIIND C1.426L.,E
l/SE O
CIRCUMSTANCES ARE OFFSETS TO BE BAL9NSTA MA• `
USED FOR FENCES, WA4k%li NEpGES, F
ErO. ONNEP BY:
��a1,1U OF Mg3sq�y A*ftfO)V ENGINEERING. INC. _. .
(00 EAST FALNOLIM HIGHWAY 1
cm E.ROBE G�� EAST FA�i.MOUTH MA. OZ536 3
N .
RAYMOND SNEET� I
No.21583 0 �SCA�GE% PATE
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