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TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map 92� Parcel Application# &), L)c
Health Division Date Issued
Conservation Division Application Fee
Tax Collector Permit Fee"
Treasurer oK Vdo&-
Planning Dept. '
Date Definitive Plan Approved by Planning Board
Historic-OKH Preservation/Hyannis
Project Street Address
Village C�_ J .�' ✓i f
Owner :Irgs: : c.,wi Address
Telephone
Permit Request t'`P
Square feet: 1 st floor:existing proposed 2nd floor:existing proposed, Total new
J
Zoning District Flood Plain Groundwater Overlay
Project Valuaf n Construction Type
S `Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation.
Dwelling Type: Single Family 14 Two Family ❑ Multi-Family(#units)
3 Age of Existing Structure Historic House: ❑Yes A[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
Number of Bedrooms: existing new
Total Room Count(not including baths):existing new First Floor Room Count
Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other
Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coat,stove: O,Yes _ ❑No
t
Detpched 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. _O_No _If yes,..site..plan.review#
Current Use Proposed Use
BUILDER INFORMATION
Name ``\�� � Telephone Number 'c d y) 4 -7-3-7
Address4vF, License# O
• ,fr.r Home Improvement Contractor# % 3 S'
Worker's Compensation# mil/
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE DATE
t
i FOR OFFICIAL USE ONLY
j
APPLICATION#
DATE ISSUED
MAP PARCEL NO.
ADDRESS VILLAGE
OWNER
t
F
DATE OF INSPECTION:
FOUNDATION ���>
FRAME
INSULATION
i
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
FINAL BUILDING (*5-1IS/o rdk
DATE CLOSED OUT
ASSOCIATION PLAN NO.
4
The Commonwealth of Massachusetts
Department of Industrial Accidents
Offcce of Investigations -
600 Washington Street
Boston,MA 02111'
www.mass.gov/dia '
Workers}Compensation Insurance davit: Builders/Contractors/Eleetricians/Plumbers
Applicant Information Please Print Le ibl
Name(]3usiness/Organization/Individual): . �nc CA'v`�'"
• -Address:---,. �c�,• rtJ • c�S'
City/State/Zip: Phone.#:
Are you an employer?Check the appropriate box: :Type of project(required):,
I.❑ I am a employer with 4. ❑ I am a general contractor and I
: have hired the sub-contractors 6. ❑New construction .
•employees(full and/or part-time).* 7, Remodeling
2�am a'sole proprietor or partner- listed on the-attached sheet. ❑ g
These sub-contractors have g, ❑Demolition
ship and have no employees
employees and have workers'
working for me in any capacity. 9. Building addition
• $'
[No workers comp.insurance comp.insurance. 10.❑]Electrical repairs or additions
required.] 5. ❑ We are a corporation and its
3.❑ I am a homeowner doing all work . officers have exercised their 11.❑Plumbing repairs or additions '
myself.[No workers'comp. right 6f exemption per MGL 12,❑Roof repairs
insurance.required.]t C. 152, §1(4), and we have no 13.❑ Other f+,/L
employees, [No workers
comp,insurance required.]
*Any applicant thatchecks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners.who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. .
Contractors that check this box must attached an additional:sheet showing the name of the Sub-contractors and state whether ornot those entities have
employees, If the sub-contractors have employees,they must provide their workers'comp.pofidy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is.the policy and job site'
information.
Insurance Company Name:'
Policy#or Self-ins.Lic.#: Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers' compensation policy declaration page'(showing the policy number and expiration date).
Failure.to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK,ORDER and a.fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of
Investi ations of e I)IA for insuraiwe coverage verification,
I do hereby c rti un r the pain n Pena 'es of perjury that the information provided above is true and correct.
Si afore ,' Date:
Phone#: 156 6
Official use only. 'Do not write in this area;to be completed by.c.. &town official
City or Town: ' ' .Permit/License# '
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector.
6. Other
s
Pho
ne
one#:
Contact Person:
F
oFTHE Tom, Town of Barnstable
-Regulatory Services
San AHM
MASS.. Thomas F.Geiler,Director
i63�ATf1619. & Building Division.
Tom Perry, Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
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 permit application for:
(Address of JobZ /"Z&4�2 K
Signature f Owner Date
&� . mod P—
Print Name
If Property Owner is applying for permit please complete the Homeowners License
Exemption Form on the reverse side. 16
flF(1RM.C•f1WNRRPF.RM1SSTnN . - '
Town of Barnstable
�Op THE Ii
Regulatory Services
w BARNSTABLE, Thomas F.Geiler,Director
9 MASS. g
1639 p,0 Building Division
TFD MAC
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:
JOB LOCATION:
number street village
"HOMEOWNER":
name home phone# work phone#
CURRENT MAILING ADDRESS:
city/town state zip code
The current exemption for"homeowners"was extended to include owner-occupied dwelling 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.
t
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,I,I -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 Bc 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.
i
r
DECK SPECIFICATIONS
Gombar
58 Katherine Rd.
Centerville, MA
All pressure treated wood, #2 or better frame. Premium decking and
railing .
• Footings, 10"x48 concrete piers.
• Girt, 2- 2x8 built up box beam.
• Posts, 4x4
• Joists, 2x8--16" o.c.
• Joist header, 2x8, with Azec (p.v.c.) ledger and flashing at
houes.
• Decking, Premium 5/46 planks, full round head.nailed.
• Stairs, 2x12 stringer custom fit to net 36" between posts.
• Railings, 44 posts, 2x4 rails, 2x2 baluster, 5/46 rail cap over
the post.
• All hardware to be corrosian resistant, ACQ compatible.*
T T r'IIrHL IrVIVIf ONEN T S FOA CAN 1'ILCVER DECK
5/4 X 6 RAIL CAP
I pp I I V- 1
M 2 X 2 0ALAST`R 6 0.C.
HOUSE � ' qq � � � �— 4X4 POST
— — . —- 514 X F DECKING
` HANGER � r� G!RTFR I-tEAnEC].�.
�.nu WITH i t SPACER ` (�jN13£ T
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Bruce Gombar 910-938-0648 P.1
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MORTGAGE IIVSP'EC T101V .PLA.N
APPLICANT: GOMBAR TOWN-. CENTMALLE
MAN ROAD
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FLOOD PANEL: 250001 0008 D FLOOD ZONE: "C" D.ATE MAP REMSEO: 07/02/1992
1 NER®T aMTIrY TMAr%as MomAGE MVEMON"HAS OEEN MWAREO ra: DATE: 12/19/07 SCALE: 1' = 30'
NAVY MERAL CREDIT UNION DEED ;kV CRT 60346 PLAN REF: LC 30469A
mE UrATTON OF THE QWQA rO MADAN DOES WIT TALL Wf7NIN A SPECIAL FUM HAZARD ML
PER TAPED MSP£CRON THE DWEWNG APPEARS TD r0WORN TD TNC LOCAL 20WI:BYLAW IN VRcT 7NE smcrUM o(CIVM ON TN15&WMACE ONVECTUN"ARE'LOCAIED OY TAPE Wft
At 7w me 07r CpiS)H emw IMTN RETPECr r0 NOROMTAL DILOO M SfWCN REQUMN&TS ONLY.MO 11,151RUME M SWYEY WAS PIEAFORMED 40 LOCA71ONS SMW ARF APPRO MA1E
dR IS 9MPT FROM WaAlION 0WORc 000 ACTOW UNM 49A CENnAL LAMS 04AP?E0 AGA AN I0951RWA ENT S WWV 3 NECCESART FOR PKE=SE DEMUNATION OF MOMG LOCATION
SECTION 7.RETt7AETICE DEED SUBJECT TO AND VOR INC WMEnT OF ALL Wp475.ROM OF WAY, AM DUD,A00tolt lF ANY E]OST.DWER WAY AMM PROPERTY UMM YANKEE Lb0
AS S5AAµEE ARE OF LMA'WDFm=AND MCT.RECORD,i ANY THERE SNAl1,Be AND INSOFAR or 7wiS 00Io OR PURPOSES 01)0 NAT ME N DATCACE INSPE UAW nA CEOeI.NE9UUMG P1tON ANY uSE
TELEPHONE: 505—428-0055 YANKEE LAND -)UR VE'Y COMPANY, INC
FAX: 508-420-5553 40 Industry Rood, Morsto.ns Mills, MA 02648
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Board of Building Ri�ulatilons and.`Standards
HOME iMPROVEME+NT CONTRACJ.
TOR
Registrattan 132454
Ezpirafion 2009 Tr# 12036 y
c Ty 060
;CHARLES HOLMAN !.A`-it
! hCFARLES HOLMANt-
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9 sMAY LANE "�'a5`
S.YARMOUTH,MA 02664 Administrator ,
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't and of Building Regulations and Standards
-construction Supervisor License -
License:. .CS- 60653 ;
$lkhdate)3/20h964
lEzpiration 3f20'l2009 Ar#�12768
s t Restriction 1 G
7CHARLESOLMNr ;,MA 02664 � Commissioner
RESIDENTIAL PROPERTY
MAP NO.\ LOT NO. x y � -
•-�- FIRE DISTRICT SUMMARY
�srREEr' 4 58-Katherine,Road. � !C-77 C terytl.le 3 LAND s ..,
22$ �+5 .: -4-- - -1 BLDGS. a i..:
OWNER
TOTAL 3 0
LAND
RECORD OF TRANSFER DATE BK PG I.R.S. REMARKS: D.L. #4
BLDGS.
'd G. . . 3()935
TOTAL
LAND
III f BLDGS.
Moriarty, Marion E' L 10-26-73 Ctf. 603 - 485 �� � � TOTAL
33,900 LAND
;' BLDGS.
TOTAL
LAND
' ✓ � BLDGS.
9 TOTAL
LAND
BLDGS.
TOTAL
LAND
BLDGS.
TOTAL
LAND
INTERIOR INSPECTED: j l i /C= T BLDGS.
DATE: -�7; ; %- ;, ,✓ :, Cr0) TOTAL
LAND
ACREAGE COMPUTATIONS rn BLDGS.
AK�ND TYPE # OF ACRES PRICE TOTAL DEPR. VALUE TOTAL
HOUS T r�9 7tl ,�t p �— s U LAND
CLEARED FRONT BLDGS.
REAR
TOTAL
WOODS&SPROUT FRONT LAND
REAR -
BLDGS.
WASTE FRONT TOTAL
REAR
' LAND
BLDGS.
O1 _
TOTAL
LAND
e� BLDGS.
LOT COMPUTATIONS 0,
LAID FACTORS TOTAL
FRONT DEPTH STREET PRICE DEPTH% FRONT FT. PRICE TOTAL DEPR. COR. INF. VALUE HILLY TOWN SEWER LAND
l0 d ROUGH TOWN WATER BLDGS.
HIGH GRAVEL RD. ELAND
LOW DIRT RD.
ne.Wells Fin. Bsmt.Area Bath Room / / Base V „� .� .�/ LAND COST 1
one.Blk.W'lla Bsmt,Rec.Room St. Shower Bath Bsmt. BLDG. COST
one.Slab Bsmt.Garage St. Shower Ext. Wally PURCH. DATEPURCH. PRICE.
rick Walls Attie FI.&Stairs Toilet Room Roof
RENT
tone Walls Fin.Attic Two Fixt. Bath
/ ..
jars INTERIOR FINISH Lavatory Extra Floors
smt. F 1' 2 1 3 Sink
V. % 1/4 Plaster Water Clo. Extra Attie
EXTERIOR WALLS Knotty Pine Water Only
ouble Siding Plywood No Plumbing Bsmt.Fin.
Ingle Siding Plasterboard Int. Fin.
/N Shingles TILING l ,`'L
nc.Blk. G F P Bath Ff. Heat
ace Brk.On Int.Layout Bath &Wains. Auto Ht.Unit
Veneer Int.Cond. Bath FI. &Walls Fireplace
om.Brk.On HEATING Toilet Rm. Fl. plumbing
olid Com.Brk. Hot Air Toilet Rm.FI. &Wain4.
Steam Toilet Rm.FI. &Walls Tiling
lanket Ins: Hot Water St.Shower / / ~
oof Ins. Air Cond. Tub Area Total 1 33v �0 f O
Floor Furn. f L /tr
ROOFING COMPUTATIONS
sph. Shingle Pipeless Furn. S.F.
ood Shingle No Heat S.F.
sbs.Shingle Oil Burner �� S. F.
late Coal Stoker S F
Ile Gas L�
S.F'
ROOF TYPE Electric OUTBUILDINGS
able Flat S.F. 1 2 3 4 5. 6 7 8 9 10 11213141516 7 8 ,9 10 MEASURED
ip Mansard FIREPLACES S.F. Pier Found. Floor -
ambrel Fireplace Stack / Wall Found. 0.H.Door
LISTED
FLO RS Fireplace % Sgle.Sdg. Roll Roofing
/fir^
onc. LIGHTING Dble.Sdg. Shingle Roof
arth No Elect. DATE
ine
Shingle Walls Plumbing
ardwood ROOMS Cement Blk: Electric /
sph.Tile Bsmt. lsts/'/J TOTAL `� y��! Brick Int. Finish D
Ingle 2nd 3rd FACTOR
REPLACEMENT
OCCUPANCY CONSTRUCTION SIZE AREA CLASS AGE REMOD. COND. REPL. VAL. Phy.Dep. PHYS. VALUE Funct.Dep. ACTUAL VAL.
v-- R 303� 3a � 3yS �za3sa
2
3
4 J
5
6
7
, B
9
10
TOTAL
Py�FTHEtp�1TOWN OF BARNSTABLE
•
BARNSTAII
NO3 AGIL
9.
0 MAY BUILDING INSPECTOR
APPLICATIONFOR PERMIT TO ............. ......a.-a—%........................................................................................
. ... .......
TYPE OF CONSTRUCTION .......... ............................................. .. .............................................
...........19
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according tote Ilowing orma ion.
....... ... .
Location ........J.el ..
ProposedUse ... ..... ...... .......... ................................................................................................................................
Zoning District .............7. Fire District .................. ...............
Name of Own ........ ...................Address .. . .......... ............... ...
,Name of Builder ........... . .. ...................I............................Address .............. ....... .................... .....................................
Name of Architect
........ .............................Address ............ .......................................
......
Numberof Rooms ...........6........ ....:.....................................Foundation ..... .................... ..................................................
Exterior ....... .. .. ........... .................................Roofing ........... . . .. .. ..........................................................
Floors
. .................... .............;....................Interior . ... .. .. .. ... ..... ............................................
Heating ... ........................................Plumbing ........... .........................................................
Fireplace .............0---z.. ..: k
...............................................Approximatt- Cost .........
.............................................
Difinitive Plan Approved by Planning Board ------------------------------19 s-r—
Diagram of Lot and Building with Dimensions
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I hereby agree to conform to all the Rules and Regulations o he To n of Barnstable regarding the above
construction.
Name .....
Doherty,Corp.
VFC 31 19 �
14122 one story
No ................. Permit for ....................................
single family dwelling garage
......................................................... .................
�0 therine Road
Locatiof�.............................................................
i
Centerville
........................................................
Owner Doh.erty. ...Corp. . ..
..... . ...... . . .... .
.
Type of Construction frame
................................................................................
Plot ............................ Lot ................................
Permit Granted august 5 71
Date of Inspection ... .. r ........19 i I
Date Completed .....lzsY j .f.....19
1
s D
PERMIT REFUSED
................................................................ 19 I
...............................................................................
............................................................................... !
9
Approved ................................................ 19
...............................................................................
.. ................ .........................................................
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