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Town of Barnstable r ue,-4-
Building Department Services
Brian Florence CBO
seaxs ABM • Building Commissioner
�6 & 200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
PERNIITit B'— ..0 47 I FEE: $35.00 .
SHED REGISTRATION
RESIDENTIAL ONLY
200 square feet or less
i 3 a 1 ' G2
Location of shed(address)I Village
Property owner's name .> Telephone number
2— J��f L� 1 Z�
Mq? 17
Size of Shed Map/Parcel#
E-Mail U'e LG,4, /I
_ ZO
4ignre�Z
Date
Hyannis Main Street Waterfront Historic District?
Old King's Highway Historic District Commission jurisdiction?
You must file with Old Ving's Highway
Conservation Commission(signature is required) _ AIM
Sign off hours for Conservation 8:00-9:30&3:304:30
PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE
ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION
FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS.
THIS FORM MUST BE ACCOMPANIED BY A .
PLOT PLAN
Q-forms-shedreg
REV:08/6/17
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102.10
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5 yt; yg� C9/OH FND
R.30. 0,0.
�,.A O. 7j . cA 034 SF
EEngiiieering Dept. (3rd floor) Map Parcel / Permit# � 54
House# 0 Date Iss ed' '7 R ,9 �o
Board of Health(3rd floor)(8:15 -9:30/1:00-4:30) / ee o�a�
1
'Conservation Office(4th floor)(8:30-9:30/1:00-2:00) "] 3 0
Plannin
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y lanning Boar 19 '
BARNSTABLE,
6y9• �e
TOWN OF BARNSTABLE
Building P it Application
00
Village ff
Owner 471 Address
Telephon /
Permit Request -2 .
First Floor square feet Second Floor square feet
Construction Type
✓ Estimated Project Cost $ G 4 a o
Zoning District Flood Plain Water Protection
Lot Size Grandfathered ❑Yes ❑No
Dwelling Type: Single Family O" Two Family ❑ Multi-Family(#units)
Age of Existing Structu � Historic House ❑Yes [�No On Old King's Highway ❑Yes ZNo
Basement Type: Full ❑Crawl ❑Walkout ❑Other
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft)
Number of Baths: Full: Existing -3 New Half: Existing - New
No.of Bedrooms: Existing New
Total Room Count(noXas
ding baths): Existing_ New First Floor Room Count
Heat Type and Fu l: ❑Oil ❑Electric ❑Other
Central Air �d YeS ❑No Fireplaces: Existing New Existing wood/coal stove ❑Yes o
Garage: �etached(size) Other Detached Structures: . ool(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
Builder Information
Name ( ( «. w C Y v v Telephone Number ! 50,E Gf f 7�_
Address 1.3 0 ,l 5 4e,, ,r- License#
J0 2-L;3 P 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
SIGNATURE ` t DATE r , /'� ✓�
BUILDING PERMIT DENIED FOR THE EOLLOWING REASON(S) , r
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The Town of Barnstable
• eJAXrrsrAB14 •
��� Department of Health Safety and Environmental Services
rE1 9- Building Division
367 Main Street,Hyannis MA 02601
Office: 508-790-6227 Ralph Crossen
Fax: 508-790-6230 Building Commissioner
For office use only
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 requir ments.
4J ..
Type of Work: Est.CostAddress of Wotk: 3Ot�Z
Owner's Name
Date of Permit pplication:
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 MOROVEMENT 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 Contractor Name Registration No.
;OR I
Date Owner's N' e
n
The Commonwealth ofAfassachusetts
Department of IndustrialAccidents
• � -•_ _= 0/J�iCeo//I1Yesdy'gll�ns
600 Washington Street
a�% f Boston.Mass 02111
Workers'Compensation insurance Affidavit
a8me:
61 hr 0
UL
l am a homeowner performiti8 all work thyself. 2/ 22
I am a sole proprietor and have no one working to any capacity
❑ I am npyrowkenpnaan fOr,tny employees working on this job.
-------------
insura ce
• olio #
0 i am a sole proprietor,genera)contractor,or homeowner(eln;le one)and have hired the contractors listed below who have
the following workers' compensation polices:
Rho
insuranceimam
c ,
mop
Failure to secure coverage as required under Scctioo ZSA Of HG1.152 can lead to the imposition ofcriminal penalties 01T ftue up to 51,500.00 andlor
nac years'impripottmenl as welt as civil prnattitt itt tl)e form nfa STOP V4'ORK ORDER and a tine or5loo.o0 a day against the. 1 understand that a
cotry of this statcmeni stay be fot v►arded to the()t5a of JavcstiAatioaa of the D1A fnr coverage verification.
l do hetehv eFirjy, under the pains an ennlries ofF-jtary that 111e i famwilion provided above is_trae and evffm.
Signxturc ate A16
Print nomc 1 �u ✓I 0 4_, U e d /
nfticiut use oniv do not write la this area to to completed by city or town oificiel
city or town: perini111iccmc# Building Department
i7 check if immediate response is required C31.ieensing Board
pSclectmen's Olrtce
Contact person: QHcatth Aeparlmcnt
pbaae+y; __nOther
(reviace Iron PW
r
''- TOWN OF BARNSTABLE
BUILDING DEPARTMENT
HOMEOWNER LICENSE EXEMPTION
Please print.
DATE
JOB LOCATION
Number Str t address Section of town
"HOMEOWNER"
Name Home phone Work phone
PRESENT MAILING ADDRESS
41t�ytown���§tate ��'
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 in-
dividual for hire who does not possess a license, provided that the owner
acts as supervisor.
DEFINITION OF HOMEOWNER:
Person (sj who owns a parcel of land on which he/she resides or intends to re-
side, 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 Stat
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
and that he/she will comply said procedures and requirements.
HOMEOWNER'S SIGNATURE
APPROVAL OF BUILDING OFFICIA2,
Note: Three family dwellings 35, 000 cubic feet, or larger, will be required
to comply with State Building Code Section 127. 0, Construction Control.
HOME OWNER'S EXEMPTION
The code state that: "Any Home Owner performingwork 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
Home Owner engages a person (s) for hire to do such work, that such Home Owner
shall act as supervisor. "
Man Home Owners who Y use this exemption are unaware that they are assuming
the responsibilities of a supervisor (see Appendix Q, Rules and Regulations
for . licensing Construction Supervisors, Section 2. 15) . This lack of awarenes
often results in serious problems, particularly when the Home Owner hires
unlicensed persons. In this case our Board cannot proceed against the
inlicensed person as it would with licensed Supervisor. The Home �bwner actin
as supervisor is ultimately responsible.
To ensure that the Home Owner is fully aware of his/her responsibilities, man
communities require, as part of the permit application, that th6 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.
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Assessor's map and lot number ......le? ... ..
Sewage Permit number ..........................................................
yoFTHETo�° TOWN OF BARNSTABLE
i MAUSTLELE, i
y q BUILDING INSPECTOR
'Fp pY a•
APPLICATION FOR PERMIT TO � s `�f:� ...... ref�17...... C?U`.r.................................:..
TYPE OF .CONSTRUCTION ... ..............................................:......................................................
................... .. .. 19... �
TO. THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies fora permit according to the following information:
Location .......omz..e.........
.fib?/ 1 �....................
ProposedUse ....................................................................................................................................:..............
ZoningDistrict ........................................................................Fire District ....(...........................................................................
Name of Owner ��. !��.��.... %..—e.7.. .................Address .... . )./� . '��..................................................
Name of Builder Address 1 ��.�c�,! : /N�..:�A�:...... r........
�/.�®�rr��
Name of Architect ................Address '
.................................................. ....................................................................................
Numberof Rooms ..................................................................Foundation ..............................................................................
Exterior ....................................................................................Roofing ....................................................................................
Floors ......................................................................................Interior ....................................................................................
Heating ..................................................................................Plumbing ..................i ...........................................
Fireplace ........._........................................................................Approximate Costrf � ......................................................
p �•
Definitive Plan Approved by Planning Board ________________________________19________ . Area ..........................................
Diagram of Lot and Building with Dimensions Fee ..............................................
SUBJECT TO APPROVAL OF BOARD OF HEALTH
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Name .. �l.G.:. .....................................
/
Kott, Dana
l /
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** �
No —. Permit for ..... .. '
..�—�AQ1.............................................................. .
'
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Location ..........
/
�w���JJ<��]�� �
-------- ---------- �
Owner ...........Dgua..�Q.t.t___________.
'
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Type of Construction ..... ..Qgx}l---.
--------.—.----------------. �
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Plot ---------' Lot ----------' ' |
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Permit Granted — 25 75
�����— /
Dote of Inspection -.d.
Dote Completed �� �_� l�
' '�~'r—'�— ----- �
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PERMIT REFUSED
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-----_--------------.. 19 /
------------'—~------------
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Approved ................................................ 19 \
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C;pa3LIa r u:m e 0
POOLS `
Wakefield, Massachusetts 01880
l� (617) 246-0064
SPECIFICATIONS
I SET BACKS SIZE,/?) x DEPTH_, TO `-
FRONT SIDE SHAPE? PERIMETER
REAR ; BLDGS. , TILE /�' COLOR
ELEVATION FILTER A J�,f' HP ZA
OWNER TO DETERMINE HEATER
APPROXIMATE ELEVATION SEPARATION TANK
AS NOTED OR ESTABLISHED /
f' ON EXCAVATION DAY' BACKWASH
'J MAIN DRAIN W/HYDROSTATICERELIEF VALVE
/ GRADING 2-. SKIMMERS RETURNS
AFTER GUNITING / LIGHT SHELL LIGHT
AS SPECIFIED LADDER . . HRtitDRA+I
9 ,' RECESSED STEPS GRAB RAILS
iv l t `� ROPE & FLOAT'
* FILL OR STONE BOARD SLIDE
S BROUGHT TO JOB SPA —�-
` BY ADDENDUM STUB OUT
PUMPS DECK WORK
R NUMBER USED CANTILEVER FORM
RENTED FROM - COPiNG STONE —
OTHER ACCESS WATER ELECTRICITY
CONSTRUCTION NOTES �
TT LOCATE FILTER EQUIPMENT
2- SKIMMER & RETURNS �� � CCIMMERCIAL SPECIFICATIONS
r- - EQUALIZERS CHLORINATOR
R Y
DEPTH MARKERS SHEPHERD'S CROOK.
i MAIN DRAIN VALVES
TURNOVER CAPACITY gals
fI G '-�'--!
T1. Electrical, gas and fence work by others POOL AREA TO BE �eneral (Votes
f FENCED, PER COUNTY1 ?. Heater venting by others
OR CITY OFIC�INANCE, 3. Up to eight h� ur pool excavation allowance.
GATES TO BE SELF CLOSING AND SELF d. Additional Work by addendum only
LATCHING- ; SALESMAN DATE DRAWN CHECKED
BY OWNER DRAWN BY BY
4
_ NAME - ,4�; �;
—�-
I C I TY( "
. STATE ZIP CODE
�� ---� RES. PHONE-71-
BUS. - -
F PEiMIT # INSPECTOR__ JOB ##
OWNER : 1 /8" 1 ' DIRECTIONS
WET DOWN CONCRETE SHELL A LEAST TWICE
I DAILY FOR 14 DAYS
DO NOT TUPN ON POOL_ LIGHT WHEN POOL
s IS EMPTY.
DO NO USE P iBBER HOSE WHEN FILLING
POOL AS IT I.L MARK PLASTER' I-'I