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Engineering Dept. (3rd floor) Map -4/S Parcel 073 Permit# <9 8
House#T; Date Is`suueed
Board of Health(3rd floor)(8:15 -39:30/1:00-4:30) - Fee
Conservation Office(4th floor)(8:30- 9:30/1:00-,2:00)
Planning Dept.(1st floor/School Admin. Bldg.) THE rq
Definitive Plan Approved by Planning Board Y 19
TOWN OF-BARNSTABLE;
Building Permit Application
Project Street Address
Village Zo
Owner Address ® &Z_ //036 ,
Telephone -
Permit Request _ t
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First Floor square feet Second Floor square feet
Construction Type
Estimated Project Cost $
Zoning District Flood Plain Water Protection
Lot Size Grandfathered ❑Yes ❑No
Dwelling Type: Single Family Two Family ❑ Multi-Family(#units)
Age of Existing Structure Historic House ❑Yes ❑No On Old King's Highway ❑Yes ❑No
Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft)
Number of Baths: Full: Existing New Half: Existing New
No.of Bedrooms: Existing New
Total Room Count(not including baths): Existing New First Floor Room Count
,Meat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other
.Central Air ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No
Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size)
❑Attached(size) ❑Barn(size)
❑None ❑Shed(size)
❑Other(size)
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial ❑Yes ❑No If yes, site plan review#
Current Use Proposed Use
t°O®dl�2 k #ilrkOel, Builder Information
Name &W-- Skme 66 1C=T1G, nle-_ Telephone Number
Address License#
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Home Improvement Contractor#
Worker's Compensation#
NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS
PROPOSED STRUCTURES ON THE LOT.
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO L �
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SIGNATURE —DATE
BUILDING PERMIT DENIED FOR THE OLLOWING REASON(S)
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FOR OFFICIAL USE ONLY
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PERMIT NO. �'
DATE ISSUED
MAP/PARCEL NO.
ADDRESS ` i VILLAGE".
OWNER - ; ` # „• ; `� _ - � K � _
DATE OF INSPECTION: _ } _ - •' ` ' i '
s
FOUNDATION-
FRAME
INSULATION
FIREPLACE
a 1 r ti
ELECTRICAL: ROUGH FINAL ; -
PLUMBING: ROUGH FINAL -
GAS: ROUGH FINAL
FINAL BUILDING -
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DATE CLOSED OUT t
ASSOCIATION PLAN NO. i i
The Town ®f Barnstable
9 g� Department of 11e:1Ith Safety and Environmental Services
Bu lding Division
367 Main St c:;Hyannis MA O2601
R.aiph C
Of ce: 503-790-621-7 BuiIdizz
Fax: 508-790-62-1 0
For afce'use only
Permit no.
Date AFFIDAVIT
HOME IMP1gOVEi'MENT CONTRACTOR LAW
SUPPLEMENT TO PERMIT APPLICATION '
MG;, c. 142A requires that the w=constructton, alterarionz, renovation, repair, modernizrti
conversion, improvement, removal, demolition, or construction of an addition to any pre-ex'm�
owner occupied building containing at least one but not more than four dwelling units or
structures which are adjacent to such residence or building be done by registered contractors, w
certain exceptions.along with other requirements
Type of tiVorlt: - Est. Cost
Address of Work:
Owner's Name
Dace of Permit .application: 3 '�
I hereby certify that:
Registration is not required for the following re=on(s):
Work exriuded by taw
Job under 51,000.
Building not owner-occupied
Owner pulling awn permit
Notice is herzby given that: OWN PERMIT OR DEALING WITH UNREGM-1=
O W NEMS PULLING THE1R
O
CONTRACTORS FOR APPLICABLERO GRAM OR HOME �JR�FUND UNDER MGNT WORK DO NO 14ZA �
ACCESS TO THE ARBITRATION P
SIGNED UNDER PENALTIES OF PEF—My
I hercbv apply for a permit as the agent of the owner.
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C�azrsczor Naine g trtioa�Y
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DepartInelly of ludilsrrral Acc dents
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Bosion. Muss. U3111
Workers' Compensation lnsurancr ARduvit
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rill /l -5 -a nhtlnt•B �QJ�y[Po' /�3�
I am a homeowner periormin_ all work myself.
I am-a sole proprietor and have no one working in any capacity
I am an empiover providing workers' compensation for my empiovees workine on this job.
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i am a tole pronric•or. general contractor. or homcoti�ner(circle acre/ and have hires the contrsc:ors fisted beio%% a
the 'biloNvin= workers' compensation polices:
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,1ltzch additionai sheet if neee_iary -_ �.��...� "--
F:ulurc to 5ccure curer Cc as requircu u ucr tceuon_`A of ►1G:. 153 an fcau to the tmpostuon of eriminai penalties of a lint uP to SI-—uu
unc cars' imprisonment a> %%Cil :u cil ii pcnaitics in the form of a STOP'WORK ORDER and a fine of 5100.00 a dad against me. 1 undersnnt
cam of thi.% smiciocist ma% Uc furlrardcu to the Orrice of lnvcstiesttons of the Du for coverage verification.
I do iterchl• teat urit'er rile prrilrs a11d pe1;ahies of perjurt•that the information provided above is true and correct.
c ._...... Date
Phone 9 7�-77Lo3
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atTiciai use unh• do nut write in this area to be ct)MPieteti by tiny or town oRciai
i` permit/liccnsc 9 r--Uuildine Department
cit%- ar tni%n: QLicensing Huard
I G'itjeiettmen•s Uf[icc
;peel; if immediate resrunsc is rcyuircd ClUalth Ucpartmcat
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HOME±IMPROVEMENT CONTRACTORS ;a �S� tiT1UN
F_ oard '�f Build' nq Regulations ar;�1 :�-„<iard
One Ashburton Place Room :t30� •
,Boston Massachusetts 02 iG3 r. u
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HOME IMPROVEMENT CONTRACTOR.
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Reg�strati'on 108918 Expiration 08�zT/Gc ,
Type - INDIVIDUAL _
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PO BOX 211/ 55' LTSA:LN.: a '
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