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Town of Barnstab re , . *Permit#
C Tres 6 months from issue date
Regulatory Services Fee ems, --
� s
MASS.I E Richard V.Scali,Director
Building Division
Paul Roma,Building Commissioner ��I ® ] ZQi7
200 Main Street,Hyannis,MA 02601 '
www.town.bamstable.ma.us -_
Office: 508-862-4038 9 ������ LE
�� ° I�Oj �O
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
Not Valid without Red X-Press Lnprint
Map/parcel Number , 2 / eo 5
Property Address 295 O A)��LP�N!o ST.
❑Residential Value of Work$ S,000,G ^Minimum fee of$35.00 for work under$6000.00
Owner's Name&Address r GF(c7 Cr.`mil Ue nC�
Contractor's Name �A(C6(0 C61") Telephone Number'
Home Improvement Contractor License#(if applicable) Email:
Construction Supervisor's License#(if applicable)
❑Workman's Compensation Insurance
Check one:
❑ I am a sole proprietor
I am the Homeowner
❑ I have Worker's Compensation Insurance
Insurance Company Name
Workman's Comp.Policy#
Copy of Insurance Compliance Certificate must accompany each permit.
Permit Request(check box)
Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to )l-n
❑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:
'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
***Note: Property Owner must sign Property Owner Letter of Permission.
A copy of the Home Improvement Contractors License&Construction Supervisors License is
required.
SIGNATURE: ,
Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc
01/25/17 L
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Workers' CumpensaflanImmn-mceAf Edav&Buflder-JC+o-ntractors/Mecfricians/Phmibers
Appikam# Please Brmf fetY
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Are you an employer?Cfieckthe appropriate b= ' Type of project(required).--
r
L❑ I am a em 1 with 4 ❑I am a general confractor•=d I '=
P barel ireddthe M-b-conkractom 6- ❑New construction
employees(fish andfor part fime)-
2.0 I am a sale propitetas orpartuer listed onthe,attached sheet.. 7 ElRemodeing
shs p and have no employees Mme sub�-cadractors have 9..❑Demolition
,w dnv form in any caparitg employees andbare wodmss' 9. ❑S,uildmg addition
[NO vupdobw comp.ins anr5 Comp-i1sl anmi .
recZuired 5_ ❑ We are a vmporafiflu and its M ElFte#dcal repairs,or additions
3 ] I am a bemeov ner doing ali work afficets have exercised� 110 Flumbingrepaiis or additions.
my set o wadme A*of emm3prfiou per MGL� - c §I �}, andwebaveno 1..-❑y Rflofrepairs .
fimu =e regE red]t .152, (4h
employees-[No workers' 1311 other
;Amy WRcmitCat c7ndcsbos#1 ma>t also fiIla�the sec�oaheTmr �eaum�cea'c�peasatiaapo iafarms`no�
�ffamevsvaesswbo snb�3 iris ia�c�d�v_y arf$aing agv�a�s�dtbea]�autideroatm�amst suHmitanewsffid�t iadicabn;sac'b.
fCa�cfpatbstchecYidtFsboxmostx=r1, dsaaddiGanal shed sLo=mg&m=necflmesat-caatrzc#o-ssndstg9awhedmarnatftsee2itieshn9-_
emp9oyees.7fthesaH-caatradaesha�ee�gIopers,tbey�stpmu�dz#h�ir Rorke�'r�mP•pa3.i�a��lsrs
lain are empfaper Seat;isprcauiidii;g workers'compenisaf4art Reloav is Ae policy and job sate
informaom
Tn�tance Cnuipanyl�lame: .
Policy 4 or Self-iag uc.4k - �piiatiouDafe:
Job lifeAddae= Cify/StafelT"_
Attach a.copy of the workers'coampensationpaUcy-declaration page(showing the policy,number and expiration date).
Fadare to serum coverage as requiredundes Section 25A of MG1 r-152 cm lead to the imiposifion of criminal penalties of a
fine up to$l,SOU OG andfor one-year imprisonment as well as civil penalties is the farm of a STOP WORK ORDER and a Ease;
of up to$25100 a day against the violator. Be adtdsed drat a copy*of this statement.snaybe forwarded to the Office of
liivestiga#ians of the DIA fof i�uranciff covesage��xfrcatioa
Ida leery m Afy cruder"pains andpamMes F cry tfud Sin ihfarmatzvu prm i£rd above is bars aisd arrrect
a Date- 7
Phone
ik-
0JEdd asp mil}. Do uat trite in thb rhea,to be cmnpfetdd by city artann o iciaL
City or Town: PertzitUcense:9
Inning Autirarit)*(circleone):
1.Board of Health 1$mT�Department 3.CitylToim Clerk 4.13edrical hnpmtor S.Plambing Fnspecter
(.Other
Contact Person: Phone#:
--- 6
Information a)a* d Instructiox's '
Masmch=e G-<� Laws chi 152 rmffa=all='PIOY=to>rOV111e W01IM& =M±inn far fbei r oEDPIoy�
P==M3ttO an enplapee is defined M. M=:ypeason in.ffie service of anof m mder any mLtcart ofliirr, �a
Mpress Or iroplie4'oral or wrhm."
Au_employer is defeat as`eau.3ndrvlcln ,partner,assoclatuA corporation.or other legal�Y,or zMY tWO or mare
of fhe foregoing in a3� .andmclndmg Legal represeniayes of a deceased empIayer,or the
r=eiv=or trustee of an mffvidaA per,amocfaf um or other Iega1 entity,eurploying emPIOY=5- However the
owner of a dweIImghowmhz:vingnatmor tfiaafhree apadmeuts andwho residesf ,arthe ocrag�off3ie-
dweIlmghouse of another who emplays persons to do mafi tffiaa ce,caa*ucan.or repair wo$C an such dwelling house
or onn,the grotmds or bnrldmg appu�
fherefo ffiOnOtbmanse Ofsvch=PIoymeutbe tee edfn be an employs.'°
MGL ffiapter 152,§25C(6 also States that aeverp stem ar Local Tcetxrmg agency shall withhold the issuance or
reuewal of a Fcen r-or permitto operate a lausitess or in construct bm dbags iu the coxnmor�ealfh for any
applicant�ho has notprodna d acceptable evidence of cdmpTiance wn the iIIsntanc�coverage requxrech"
Ad�ionaIIy,MC,r�•pts 152,§25C(7)states 7Ncither flie nor�y ofits poIiiical snbcfivisians shall
enter into any contrast for foie pm T=ance Ofpu)hr wmk�acceptable evidence of compiianmw&L the hlmnmr6._
rec�eme�s offizis chapfeshavelieenpreser�din the cOniracting:ar�•horzty.,, -
AgPHcanfis
Please fill out the wo&='compeusaiion affidavit completely, u by chg ldie boxes fib apply to pour situation anc�if
ne..sa:q Ply sob-mnixadm(s)nam(--(s), addresses)andphonennmber(s)aIongwifittli==tficate(s)of
. insurance. LimitedLiabiIrty COmpames(LLG�orL�it�LiabiIitpPartneasbips(LI,p)u�ino employees other thanih.e
members or pm new are not to curry worjcersr_comps safion i as ante. If an LLC or 112 does hav e
employees,apolicy is regairecL Be advisedthattius affidayif maybe miffed to the Department of Industrial
Accidents far confmmation of insm-c a coverage. Also ba sore to sign and dafe the affidavit. The affidavit shOvld
beret amed to$e city or town that the application fbr the permit or license is being regnestA not the D ePa Ini mf of
Badastrial Accidents- gMyDU have any q=tons regarding tiie Law or if you are rcq=ced to obtain a wont='
compensationpolicy,pleasecaathr,Departmentattiiennmberlis�bcl0w Self-m�caapaniesshonIdenter.1heir
self-n,suranm Ii=me,number an file appmgiiafe Ime
City or Town Of Facials
t Please be sore that the affidavit is canny letm and prig ed IegRly. The D epa=bmnt has provided a spa the _
bah
of the affichi for you tO fill out in the event the Office Oflnyesthgatrms has to contact youreg-ardmg apP
Please be sure to fillmthe pexmnWIicease number which will be used as are&rmce=onber. In addi ion,an applicznt
that must sabmit multiple penniVH=ose applbati=in any given.yew,need only solMit one affidavit indicating=cut
policy, infomat on.[if necessary)and under, `lob site Ad&c&*tie applicant should write-aU locations in (may or
town)-"A copy of tho aff davitthat has been officially stamped Or maked by the ci y Or town maybe provided tO ffiz '
applicant as proofthat a valid affidavit is On file for fotm 'pemzts or Hc:euses. Anent afhdavJ.!,nn t be filled oiot each
year.Where a home owner or citizen is obtaining a licensor or pe onit not related to any business or commercial yftb=
(ie_a dog license orpemitto bmnleavrs etc.)saidpersan is NOT xEganDdtn complete this affidavit:
The Office of Ines gaiinrs wOuUhjD__tD thank you inadvance for your cooperation and shouldyou.have nay quesfiOns,
please do nothesifate to&D M a cal
Ike.Depp artmamf's aAdres%tnlephane and fax nlnnber:
T f:a I*of Massachnse� ,
�r}flad�ialAo�.�nts • .
TeiL 4 61 f—TV-49W Qxt 406 w 1971MAW44FE
Fax#617` 27'749
P.evised 4--24--0 7 1 �c
t
Town of Barnstable
Regulatory Services,
`" of Richard V.Scali,Director
Building Division
KAM t Paul Roma,Building Commissioner
e ►��� 200 Main Street, Hyannis,MA 02601
www.town.barastable.ma.us
Of6ce: .508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE:
JOB LOCATION: mw 1) 57 Nl nv�I-S �11
number street village
"HOMEOWNER": M a resJo -T, n u )) q
name home phone# work phone#
CURRENT MAILING ADDRESS: P-0 dc g I3
{�ynn�s Mfl 02,601
ity/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 uermit. (Section
109.1.1)
The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,
bylaws,rules and regulations.
4 '
The and ed"homeowner"certifies that he/she understands the Town of Bamstable Building Department minimum inspection
procedur s li requirements and that he/she will comply with said procedures and requirements.
Signature o Homeowner L�'
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. n
Q:\wPFILES\FORMS\building permit focros\EVRESS.doc
06/20/16 } .� }
Town of Barnstable 46_
„ Regulatory Services
' Richard V. Scab,Director.
L639- �� Building DIvision,
Paul Roma,Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.barnstable.maxs
Office: 508-862-403 8 Fax: 508-790-6230
Property Owner Must
Complete and Sign This Section
If Using A Builder
I, NA l/f C-,d o- T, G5!21 t6�V- ,as Owner of the subject property
hereby authorize Hcif Cs�o -r. CE;'q oc to act on my behalf,
in all matters relative to work authorized by this building permit application for:
T
� 29.� ag►��,A�vu 5
(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 performed and accepted.
S*na a of Owner Signature of Applicant
Print Name Print Name
p
Date
QFORMS:0WN.ERPERMISSI0NP00IS
Parcel Detail Page 1 of 3
Logged In As: Parcel Detail Wednesday,June 7 2017
Parcel Lookup
Parcel Info
Parcel ID 271-091I Developer Lot SLOT 6 �
Location 299 OAKLAND ROADI Pri Frontage 172 -
Sec Road I Sec Frontage
Village Hyannis I Fire District HYANNIS l
Town sewer exists at this address NO �I Road Index 1115I
Asbuilt Septic Scan:
Interactive Map 1
271091_1
Owner Info
Owner DEUTSCHE BANK NATI cO %CERQUEIRA, MARCE —
owner
streets F130 BRIST0L AVE�street2 F -. 1
city HYANNIS l state MA =zip 02601 "J country I,
Land Info
.........................................--............................................................................................................................................................:......................................................................................................................................................................-....................-.................................
Acres 0.37 � I use .Single Fam MDL-01�.I Zoning RB I Nghbd 10104 I
Topography Level — --1 Road Paved 1
UtilitiesPublic Water,Gas,Septicl Location l` l
Construction Info
Building 1 of 1
Year Roof Struct 1961 w Vinyl Siding
Living 1372 Roof s� h/F GIs/Cm AC None
Area Cover p p Type
Style Ranch walk DryWall� Rooms 4 Bedrooms
Model Residential Flo r EHardwood Rooms 2 Full-O Half
Grade verage Type Hot Water _ l Rooms 9 Rooms
stories l Stoun
ory Fuel Gas F atl n Poured Conc.
Gross 2 J
Area 12
r Permit History
Issue Date Purpose Permit# Amount Insp Date Comments
2/1/1994 Addition B36507 $13,500 1/15/1995 12:00:00 AM HY ADDIT'
Visit Historyr
Date Who Purpose
htt ://iss 12/intranet/ ro data/ParcelDetail.as x?ID=20472
P Q p p p 6/7/2017
Assessor's office(1st Floor): i- SEPTIC MTEM MUST BE
Assessor's map and lot number / ' �. 1T INSTALLED IN COMPLIANCE o<<NE to
a S�- WITH TITLE 5
Conservation(4th Floor):
Board of Health(3rd floor): r ENVIRONMENTAL CODE AN
Sewage Permit number r (� ` �> TOWN REGULATIONS t DARIST�DLL
Engineering Department(3rd floor): , �° 1639'
House number �o yrY
Definitive Plan Approved by Planning Board i ? 19
APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only'
j TOWN . OF BARNSTABLE
ti 'BUILDING INSPECTOR
APPLICATION FOR PERMIT TO )
TYPE OF CONSTRUCTION
19
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location g9
Proposed Use .S I Ng le.
Zoning District /` G Fire District / (ilf3'f0'�'liLs
Name of Owner 1C' �� 2 Addres 4 "
Name of Builder Address l J/
Number of Rooms Foundation Le- Oe �
`lve
Exterior /4`r r Roofing 14 "4a/74
Floors �/L Interior CJ`�Gyl3'f/
Heating Q,I.G. Plumbing ,L _1""4
Fireplace 40 Approximate Cost
f l
Area 1
Ile-
Diagram of Lot and Building with Dimensions Fee �5 —
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.
r
Name �`�'// 42
Construction Si ipervisor's License
LANGFIELD, DAVID & JANET
y
-7 a-
36507 BUILD/Addition ,
No Permit For -
single Family Dwelling
Location . 299 Oakland Road
Hyannis ' 4
Owner
David & Janet Langfield
Type of Construction Frame , -
Plot Lot f
Permit Granted February 25'; 19 94
Date of Inspection:
Frame
Insulation ij v! a� 19 !
r
Fireplace i 19
Ie CLeted `f r r 19—' ,
M '
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IMAGES FROM POOR
QUALITY ORIGINALS)
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DATA
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TOWN OF BARNSTABLE
BUILDING DEPARTMENT
HOMEOWNER LICENSE EXEMPTION
Please print
DATE
JOB LOCATION p�
Nu�m/ber-� Street Address Section Of Town
"HOMEOWNER"
Name Home Phone Work Phone
PRESENT MAILING ADDRESS99
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 such 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 to six 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, by-laws, rules and
regulations.
The undersigned "homeowner" certifies that he/she understands the Town of
Barnstable Building Department minimum inspection procedures and
requirements
HOMEOWNER'S SIGNATURE . 0
APPROVAL OF BUILDING-OFFICIAL
Note: Three family dwellings 35,000 cubbo feet, or larger, will be
required to comply with State Building , ode Section 127.0, Construction
HOME OWNER'S EXEMP1tION
The code states that: "Any Home Owner performing work for which a buildin
permit is required shall be exempt from the provisions of this section g
(Section 109.1.1 - Licensing of Construction Supervisors); provided that if
Home Owner engages a person(s) for hire to do such work, that. such Home
Owner shall act as supervisor."
Many Home Owners who, 'use this exemption are unaware that they are assuming
the responsibilities of a supervisor (see Appendix Q
for Licensing Construction Supervisors, Section 2.15� Rules and Regulations
awareness often results in serious problems, j •. This lack of
Owner hires unlicensed persons. P � particularly when the Home
against the unlicensed erson as it would with this caseour licen licensed supervisorr.Board cannot The
Home Owner acting as supervisor is; ultimately responsible.
To' ensure that the Home Owner is fully aware of his/her responsibilities,
many communities require, as part of the permit application, that the Home
Owner 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 to amend and adopt such a form/certification for use in your
community.