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4 Town of Barns,#able *Permit
Tres 6 months from issue date
Regulatory Servicesa ee
BARN&riBmJUL Y v?j' 0
rsnas Richard V.Scali,Directyo0 {' 2016
s ., '
Building Divlsi0�/I�A/OF
Paul Roma,Building Commissioner . j e
200 Main Street,Hyannis,MA 02601 _
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
EXPRESS PERNUT APPLICATION - RESIDENTIAL ONLY
Not Valid without Red X-Press Imprint
Map/parcel Number
Property Address /rL v_ ��4 c___h�i� /"c�%�2-. � 'L c:�../c`y�✓ '��t': ��� z ;2
E Residential Value of Work$ 5 ee` Minimum fee of$35.00 for work under$6000.00
Owner's Name&Address iry' C!
Contractor's Name 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
❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof)
Re-side
Replacement Windows/doors/sliders.-U-Value (maximum.32)#of windows
#of doors:
❑ Smoke/Carbon-Monoxide detectors 4 floor plans marked with red S and inspections required.
Separate Electrical&Fire Permits required.
*Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
***Note: Property Owner must sign Property Owner Letter of Permission.
A copy of the Home Improvement Contractors License&Construction Supervisors License is
required:
SIGNATURE:,
Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc
06/20/16 r
DepartrF azt of radustrial Acciderrt4
600 wasfi%q rt s reef
Boston,MA 02111
1PFPI-xviasmgOvIdia
Wkir ers' Compensation Insurance Affidavit:%LIderslContmctGrsXlectrwmns/Phmhers,
Ariplcant Infan nating Please Prat F.e llly
Nam
City/Sta- l € ZL
Are you an employer?Checkthe appropriate box: Type of project(required):
L❑ I am a employers with 4 ❑I am a general contractor and I 6_ ❑New construction
employees(fu11 andlorpart-timer*, have hired the mb•-contrachars
2.❑ I am a sole etas listed on tine attached sheet. 7_ ❑Remodeling
Fml?u or1 Dnese stab-contractors have
slip and have no employees. $_ E]Demolition
wodang forme in any sty_ employ andhave.warmrs' 9_.0 Building addition.
[No warmers'comp.ium,t•a,,,-e comp-n,sax`nl 10-El Electrical repairs or a,d&tious
r 1 - S. We are a cotpomfioa and ifs
3.W 1 am a Homeowner doing all work officers have wised their 1L❑Phmzbing repairs or additions
mys-elf[No wo&mm'gip- age of ememption
per we have L L_0 Roofregairs
insurance required.]y c.� ,§1(4
Ia avos' �-®father S/`�>�� :l�rsyc/f
empcone.insurance required-] 00 r c,7
'AapWffcznt&Acbedm box iRl—st also IMora the secd=beTa klnu deirwakeecomppQmfimpn5eginfm=sfim
�ameoara4ss t4hD snbanit shiS of da they use dm�sll Wa dG sad the hire oatsi3e coafnactnrs�at salfmit a new afih1z&mdirff'4" sarlL
ICnaizactossjff=rheclrthisbDXmastarmedsna difif111 shed szw!=gthenameof the sib-conscWmsadstatevhed <arnatthoseentitiesham
employees.IftbP zd tagtmct la-emplayea%dWn nstpmxide*W trorlse&=xp.palm mmilsez
lam art mrrippmr that isprat�itiir�g tvrrrkers'canrpertstrftorr utsura>3ce f er my enrplaj�ee� 8etaov is i�lre prrlicy arad jab site
inftrrmatian. •
Inktrance Company Dame:
Poficy;Al-or Self-ins-Lim Expiraf oaDate:
Job Eta Address: cifylStafelr=:.
Aftach a copy of the workers'coanpensation.policy declaration page(showing the policy number and expiration date)
Fair to secure coverage as required under Secion 25A of MGL c�1572 can lead tin the imposition of crirnhmkl penalties of a
fine up to$L,54U OD asdror one=year imprisonment,as well as rivil penalties is tine fates of a STOP WORK ORDER and a fine
of up to$250_00 a day against tfre violator. Be adidsed t3taf a copy of this sh Mwient may be forwarded to the Office of
lwvvestigafions of the DIA for instwanci--coverage,vet cation_
f*horgiy co*fp under th-apafns andpsmahEks afpEr kq thatthe iinforr unffo tpem-idud abm'd is bw and carrect
Sismature
Mtge A- 72/-- S.7'7U
t);gTciat am agy, Do not writm in fh€s arma,to be campieted by cup artoorn V'fficiat
Cky or Town: Perndff.&use;9
I A uf1m ity(tdlyde one):
L Board of Health 1 BuRding Department 3.QtpTown Clerk 4.Electrical Inspector S.Phrmbbg Inspector.
6.other
C,orttact Person Phone#-
-- — 6
formation and 11as-Luc-ions
hfaaecar-]it?scft C '7 b=-9 LEW Gbfptel M Ieq=es all=plq=to XDVIde WMIM&COmPeQSIt=on fM-f e==Ploy= ,
P==,-a tto this Statute`,an erIP&YW is defined a&' waxy person in the service of another nad=any contact ofhae,
express or iinplied,oral or Vzftk n_"
An e V&ym-is dln med as-an m3i4i3ual,ParfnersT ,asso®iian;coiporaiion or other legal may,or airy two or me
of the foregoing=gaged in a Joint a tcrprise,and inclaffmg the legal Fegreserdati vas of a deceased employer,or the
receiver or trastes of an mdividaal,per,association or ofherlegal entity,employing employees. HOWever the
owner of a.dweIImghouse,haviognotmore than three apartments and Who resides therem,or the occupant ofthe -
dwaMag house of ano$ier Who employs persons to do co,cnnstru on or repair wow on such dwelling house
or on the grounds or bm7.dmg appm-fnn ant tii=to shall notbeca use of mch emplapm ent be deemed to be an employer."
MGL chapter 152,§25CC6)also states at"everysfafe or local licenskg agencyshallwithhold the ZSS¢ance or
th
renewal of a lccense or permit to operate a business or to contract buildings in the Commonwealth for=Y
applicantvvho has notproduced acceptable evidence of eompr=mwitlx the n,-mra_nce.coveragerequh:e
Addi ionaIly,MGL chapter M,§25CC7)stags-Neithm the nor;�Oy ofits political snbdrnisions shall
ear mto any contract for the,performance,ofp Lhc work unfit acceptable evidemce of compliance;with.8Le insurance..
ems of this chapter have been presented in the:oe—w ting anthozity.-"
Applica Its
Please fill out the Wonisrrs'compensation affidavit completely,by g e boxes tinat apply to your situation an(�if .
necessary,supply sub-cantxactar{s)name(s), addressCes)and Phone mmber(s) along with their cet(ifrcat*) of
fi=rance. UMi Liability Companies CLLC)or Limitcd Liability'Pmtamsbips 9-LP)wifhno earployees otizet thm the'
members or pare are not reepm:ed to cant'workers'compensation iUSurE oe. If an.LLC or LLP does have
employees,apolicy is required. Be advised that this affidayitmaybe snbmhtedto the Department of Industrial
Accidents for conEm ation of insurance coverage. Also be sure to sign and data ithe of davit The affidavit shoal
be retnmed to!he city or town that the application for the permit or license is berg regaestA not the Deepartmmd of
LnAnstad Accidents. Should you have any questions regar'dm.g the law or if you ai e rued to obtain a woiio='
c anpe nsationpoliey,please call the Depart eof atthennimmberlistndbeIoW. Self-msvredeompanies should eatrrtheir
self-insurance;license mmmber on the appropriate line.
City or Town OfddaIs
Please be sure that the a$davit is complete and pried legibly. The Department has provided a space at the bottc=
of the affidavit for you to fM out in.the event the Office oflavestigatians has to contactyoureganimgthe applicant_
Please be sure to f M in the permitlficense number which will be used as a ref=ace number: Ik-addition,an applicant
that mast submit multiple p applitstions i a a:Ly given year,n eeti only submit one affidavit mdicaimg c=eut
policy i3�tion Cifnwzssary)and under'rJ b Site fi_dtiess"the applicant should writ--"all locations in (may or
town)_'A copy of the•affidavit that has been officially stimped or Mm3r-d by the city or town maybe provided to the
applicant as proofthat a valid affidavit is on file for f m permits or licenses A new affidavitmust be filled oit each
year.Where a home owner or citizen is obtaining a license or permit not reilated fe any bush=s or commercial v6at=
Cie.a dog license or pexmrt to bum leaves etc said person is NOT regrind to compIeto tins affidavit
The Office oflnyestig��wouldliketo ii>ankyonim advance foryour cooperation and shovldyouhave any questions,
please do not hesitate to give us a call.
The DcTarfineres address,telePb=and fax number:
. I�ega�n�cif Ac�d�nt�
Tf,-L 4 617- -49W=ft 406 ox I-W M SSAF
Fax 617`27 7M
xevised4-24-07 . fig
Town of Barnstable ✓
Regulatory Services
Richard V. Scab,Director.16"3 "
►� Building Division. i
Paul Roma,Building 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
I , as ear of the subject property a
hereby authorize to act on my behalf
in all matters relative to work authorized by ding permit application for.
(Address o ob)
'**Pool fences and alarms are th responsibility o e applicant Pools
are not to be filled or utilize before fence is ins d and all final
inspections are performed d accepted. ,
Signature-of Owner Signature of Applicant
Print Name r Print Name
Date
Q:FORMS:OWNERPERMISSIONPOOIS
Town of Barnstable
Regulatory Services
dF Richard V.Scali,Director
Building Division
'�. Paul Roma,Building Commissioner
MASS
16,39. 6 200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
/ Please Print
�i�1�[DATE:" 4 -10 46
JOB LOCATION/:
number street village
"HOMEOWNER":
name home phone# work phone#
CURRENT MAILING ADDRESS: SaJ,, `G—g c�c�
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 Rules&Regulations for Licensing.Construction Supervisors,Section 2.1 This lack of awareness-often
( PP Q+ � g P � �
results in serious problems, articular) when-the homeowner hires unlicensed persons. In this case our Board cannot
P +P Y
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 formslEXPRESS.doc
06/20/16
Cod �D
Town of Barnstable
Approved O Regulatory Services
Fee v Thomas F.Geiler,Director
Building Division
Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
Office: 508-862-4038 Fax: 508-790-6230
Home Occupation Registration
Date: cJeC• 3 204) 2
Name: /,Jd,���rl� �'e�S Co Phone#: �'�
�J� f/p d illag e 0 -ei a%`l e-
Address:/ t"'/7 e'_bIle a c� V
Name of Business:/`&'Ca 71- 74 16 0
� �o� _
Type of Business: -�i S'u vim ti�. �' Map/Lot:
INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation
within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the
activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual
alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal
residential volumes; and no increase in air or groundwater pollution.
After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the
following conditions:
• The activity is carried on by the permanent resident of a single family residential dwelling unit,located
within that dwelling unit.
• Such use occupies no more than 400 square feet of space.
• There are no external alterations to the dwelling which are not customary in residential buildings,and
there is no outside evidence of such use.
. LNo traffic will be generated in excess of normal residential volumes.
The use does not involve the production of offensive noise,vibration, smoke,dust or other particular
matter,odors,electrical disturbance,heat,glare,humidity or other objectionable effects.
There is no storage or use of toxic or hazardous materials, or flammable or explosive materials,in excess
of normal household quantities.
Any need for parking generated by such use shall be met on the same lot containing the Customary Home
Occupation, and not within the required front yard.
There is no exterior storage or display of materials or equipment.
There is no commercial vehicles related to the Customary Home Occupation,other than one van or one
pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to
exceed 4 tires,parked on the same lot.containing the Customary Home Occupation.
No sign shall be displayed indicating the Customary Home Occupation.
If the Customary Home Occupation is listed or advertised as a business,the street address shall not be
included.
No person shall be employed in the Customary Home Occupation who is not a permanent resident of the
dwelling unit.
I,the undersigned,have read and agree with the above restrictions for my home occupation I am registering:
Applicant:
Date: . 3"do
S.T,-,Ann
J
/A, ssessor's, map and lotrnumber .��.."Qq. ..... DO FTHET
Sewage P it number w Q
WITH C TITLE E LE j BA"STABLE, i
House number y NAB&
.................................................................... ENVIRONMENTa` In C�� °o,,� 639•a�am
0 MAI
TOWN OF �BARNSTABLE
BUILDING INSPECTOR
APPLICATION FOR PERMIT TO .i......a. ) vs.T.R.U.ar....R.....P.�K. ..........................................................
TYPEOF CONSTRUCTION ...........W.Q P..(>.:...:.....................................................................................................
........... ............19 ,.�
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies fora permit according to the following information:
Location ........ /.- ......R.. JVA .......00. 7r...........!C/ Tc1:.vmtL.�..................................................
... ................ .
ProposedUse .............................................................................................................................................................................
Zoning District ..................t� .. .. .......................:.......Fire District .............. 't.. ..............................................
134)?134gA- '
Name of Owner .....Ray....82 .C-o 1 .........................Address ...-5 1 ....i...�.... ......O.Y.O.Vf.................................
Name of Builder ..Pp!y.ALD �(ZC5.GOT...............Address .....................................................................................
Nameof Architect ..................................................................Address ....................................................................................
Numberof Rooms ..................................................................Foundation .....................................:.........................................
Exierior ....................................................................................Roofing ....................................................................................
Floors ......................................................................................Interior ....................................................................................
Heating ..................................................................................Plumbing ..................................................................................
8a
Fireplace ..................................................................................Approximate. Cost ........�Q0..... ..................
Definitive Plan Approved by Planning Board ---------------_________________19________. Area ..... ................
�................
Diagram of Lot and Building with Dimensions Fee _.._..
SUBJECT TO APPROVAL OF BOARD OF HEALTH
I
IL '�
�CPnc
0
T'RNK
f �
I
PORCH I
i f
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... .... ... .....
Construction Supervisor's License .................................
t PRESCOTT, BARBARA & ROY
A
�. M1
No 27704. Permit for ......Build Deck
Single Family Dwelling
Location 165 Annable Point Road r
....................................................... ... ...
Centerville '
. ......................................................................0........ r
Owner Barbara & Roy Prescott
............................
Type of Construction Frame - -�
.......................................... �f
t �ij t •�
................................................................................
Plot,............................ Lot ................................ �,• •
Permit Granted ril 5
Date of Inspection .............................'. 19
Date Completed ................... t
� w 3
A
. 1.
\
// -�` o... c�r�
Assessor's map and lot number ......................f-�..... 'T.......... r�� %7HE
Sewage Permit number ........................-.:.................
....<..........,
Z 33A" dDLE, i
Housenumber ......................................................................... y MU&
�p 1639• 9�
TOWN OF BARNSTABLE
BUILDING INSPECTOR
`APPLICATION FOR-PERMIT TO ........0 ,�?fill �'.Gtar..... ......s:?
TYPE OF CONSTRUCTION .........:VVQP.P............................................................:............................I..................
w� ...........� . '. .Ile, ..... ............19s�?�?.
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit,raccording to the following information:
r
Location ........1.6 5......A N�tI A R G�......P0IAI7.....!`.`T:...........C•'..E• tUTt ��.!.. ................. ........ ...................
ProposedUse ............................................::...................................................................................................................................
ZoningDistrict ..............._.. .......�....... ............Fire District ............... , .{................................................
Name of Owner ....�� .`tr.. �k' . 'a .. ...Address ......,. .
Name of Builder ...PU,1t1.��O � k E5CC7 Address .....:....:..........:.
............ .... .............................................................
Nameof .Architect ................................................:.................Address ....................................................................................
Numberof Rooms ...................................................................Foundation ...:..........................................................................
•' ..Roofing
Floorsi a...........................................
Heating .......................................................:..........................Plumbing .:............................................................;...................
Fireplace ..................................................................................Approximate Cost ........ 0
Definitive Plan Approved by Planning Board ________________________________19________. Area .............:............................
Diagram of Lot and Building with Dimensions ° Fee f
SUBJECT TO APPROVAL OF BOARD OF HEALTH
I I
I &A k A( � I
q-
I
� r t
i I
i ?
i F-0RCH I
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.
! v
Construction Supervisor's License ..................................
E
PRESCOTT, BARBARA & ROY A=211-004-000
27704
No Permit for $uad..Ask.
............Single. Family...? !�� � 5."....:............
Location ......16 ... nnabjp,..PQj yjt..l 019d.........
....................... .................I.............
Owner ........ arbara.. RA�.. 1SGM.........
Type of Construction .k'. aMe.............................
................................................................................
Plot ............................ Lot
Permit Granted A ,
...........pr11.......5............... 19 85
Date of Inspection ....................................19
Date Completed ......................................19
/ r
/ r
Assessor's map and lot number '/`
T E
Sewage Permit number ..�cr.� .. /.ct :......:....:.. MUST B''.�`" . o�
SEPTIC SYSTEM Y
. INSTALLED ,IN. CO
PLIA
Z H9SH9TADLE, i
se number .........................................:...... NAG
. WITH ARTICLE I! STATE 'oQ 39
SANITARY CODE AND TUW ° 0Mix
HT® WN OF B AD N LL a�
BUILDING ' INSPECTOR
APPLICATION FOR PERMIT TO ..:.................... .
a ................................................................................................
TYPEOF CONSTRUCTION ............................................::.................................. ....................................:..............
..... .................19........
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for permit according to the/following information:
Location .. ��S�, i�.�cc ��.../..to/..�. ..J`. ,...`.5�.?�......cl.t.. ..............................................................
�e ✓Z tL C .Proposed Use .........................f..�................ .............................................:........................................:............... .....
Zoning District ...... ...1....`................................................Fire District 4 Fri es cs 1/ ..-..�j �c'.u�.l../�
...... .. .......................
Name of Owner f.C. d't.1<4&��4.17:.. s.G /./....Address/�.,5 /.'f!7 .P!�//��!j„l„�!.,............................0 IC
Name of Builder ..............C........lf?.....:.... ............................Address .s .
/ems s,
Name of Architect .....................✓.Yt?.�f ............................Address ...............::...................../...............................................
Number of Rooms ..................................................................Foundation .......��.'??..4� ..T-
.................................................
Exierior .....<J.dla. ....'"...5.�?.!�?�c/,1.................................Roofing .........GC..S,��/Z s,./. ............................................
Floors .....CA.!12..C/5�e-.Xlc..................................................Interior :......! .6'.4... ........................:...................................:
Heating ..............
......... e............................................Plumbing ............... .................:............................
' -
Fireplace ....................�.!2.. . .............................................Approximate Cost ...................: .........,........... ..
Definitive Plan Approved by Planning Board -_-_----__-_ ��. s,
------- -- 19 ----. Area ............................
10
Diagram of Lot and Building with Dimensions Fee L�— ....
SUBJECT TO APPROVAL OF BOARD OF HEALTH
3
1
.� do'e'V00 ed [-22
c
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction..
�j
Name
Prescott, Barbara A.
No ....?,,Dri�7 Permit for .....garage.....
...............................................................................
Location ...........165 Annable Point Road - y
....................................................
Centerville
...............................................................................
Barbara A, Prescott
Owner ..................................................................
frame
Type of Construction -
......... . . ............................................................
Plot ............................ Lot .................................
Permit Granted October 3 7 * '
.. 19......... $:.............
Date of Inspection ......19 '
Date Completed �' •..�,�
.......19
PERMIT REFUSED -
.... .......................................................... 19 r ;
................................ :.................................. f F
....... .............................................
.......................... .............. ...........:................... 4
................................. ..........................................
Y
Approved ..... 19 '