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131� /Vt)15'
r Town of Barnstable *Permit#
Expires 6 monthsfrom issue date
Regulatory Services . Fee 35.) ,
snxrtsrnBt
039. Richard V.Scali,Director
Building Division
Tom Perry,CBO,Building'Comt�i'i n rES, S PERMIT
200 Main Street,Hyannis,MA 2�01
www.town.barnstable.ma.us JUL O d q
Office: 508-862-4038 k„ 'Fax: 08=790-6230
EXPRESS PERMIT APPLICATION - RESiD 1 'T'YfOl�'LLt
Not Valid without Red X-Press Imprint
Map/parcel Number r f, 0 6 rt
Property Address �d L4 �` 1?0A..d, /// `.,yor5,7
t,
U Residential Value of Work$. d Minimum fee of$35.00 for work under$6000.00
Owner's Name&Address S G /4L_ � � Iff
:t
Contractor's Name 1� m t # � 4 Telephone Numb er
Home Improvement Contractor License#(if applicable Email:_Email:- jWP1
Construction Supervisor's License#.(if applicable) to
®Workman's Compensation Insurance ,
Check one:
.I am a sole proprietor
❑ I am the Homeowner
❑ I have Worker's Compensation Insurance `
Insurance Company Name Ar
Workman's Comp.Policy# `�`�`' `'•`��U ���l a'� ��5 y
Copy of Insurance Compliance Certificate must accompany each.permit.
Permit Re est(check box)`
Re-roof(hurricane nailed)(stripping'old shingles) All construction debris will be taken to T_o4 ' f
❑Re-roof(hurricane nailed)(riot 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,Le:Historic;Conservation,etc. _.
***Note: Property Owner must sign Property Owner Letter of Permission.
A copy of the Home Improvement Contractors License.&Construction Supervisors Licenseis
aired.
SIGNATURE: D ----Y
Q:\WPFILES\FORM building pe it forms\EXPRESS.d,,
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Revised 040215 ,
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Off2e fin-cgoing m1gaged m-a joint Vie+and t ICgBl rCPr=mtdI?m of a decrased cmployq or fhe
receives or t=tee of an i javi dmal,gadnembig,amnmat n or oth m legal extity,emplaymg emPloyexs_ RoweVrr f m
ogtner of a d�eIFmgbonse hay>ggnotm ee age and who resides therein,or Iht ocrngant of the
aWnRing house of another Who EM.pIoys peasons to do qo nst ncdaa or repair wozk on such dweHing house
or on&I,-gm=ds or buff ing Eppmt ma:mtffiexctD sha n not because of such m3ployment be deed to be an employer."
ILL r r IS2, §25C(Q also stains that¢every,sib or Io{aI hiCeuSbag ag=cy shRU WW hold fhe i=znce or
renewal of a:ficense or permit to operate a bnsiae=or to mnsfi act broad ngs in the commonwealth for any
appftcaat'yFIao hag not pLvduced acceptable VVkIMCe of coiapbaace Wifia the T IMri M coverage requn-- _
Q r E6L,,aTlyr,MCA cicapt=152,§25CM staffs-14eifhm-fie commonwealth nor any of its polifical subdzyisions shall
into MY for&C perf==ce of pnbfio Workunt"acceptable evidence of COInPlIMCe Y,rith the ins�ance
re gLa=eds of thus chapb t have been pr =d:md to fhz cordradi antb ority.'
Appl"icaa;
Please fill out the vas'cdurpensa{ion affidavit complettjy,by chimldng tim boxes fhat apply to your sitnztion and,if
necessazy, supply sub-cont=fDr(s)nsme(s),addresses)MdphOne-Trn =(s)along with then ces65c ate(s).of
;,,corance_ I:imitea Llabimy Compamts(LLC)or T=ItndLiabE*Parfne�shigs(LIP)wiihno employees othLer the
members or , arfn��,are nntreq Ed �y 'campensoiion incrn�tCe If an LLC or LLP does hate
employees;a policy is rerjoiz Be advised that this aihdav>tmay be submified ib the Department of Indugtiial
Accidents for confirmation ofin=Rnce Coveaage. Also hie stare to sign and date the affidavit. The affidavit should
be rrt=cd to the city or town that fhe application.for the permit or hicrmse is being requested,not the Department of
InchnStrial'Accidanfs. Should you have any gmEs}T( reg-&-ding the law or if you are mgnired to obtain a�*orkers'
co�ensalion policy,please call the Departmcot at the number hrtrd below. Self-iBsmzd compsnie s should enter their
self-m •nce license mmiBer on the agpmpiain line
City or Town Officials
Please be sure�the affidavit is complete andp 11y Tlic Departrniat her provided a syare atffie brsta
o f the affidavit f=you fn fiIl out is the event tlm Of nice❑ i has to coma ct.yon regarding&c applicant '
Please be sure to fi l.in fhe permb.;r-aaSa ibex v -ji71 be used as areference umber. Iu add_,rion,an applicant
that must submit nmItiple p®it/H=mm applications is any given year,need only submit one al$davit indicafog r-mTmt
Policy ii6b=mEdon(if necessary)and under Tub Sim A:ddressa the applicant should writ$Gall locations io. (city or
town).-A copy of the affidavit flat has been officially stamped or marked by thle city or town may be provided in the
applicant as proof that a valid affidavit is on file for fdm permits or licm'se& knew affidavit must be iiIlcd.Dt±each
year_Where a home owner or citi=is obtaining a license or permit notreIated tn-any business or commercial Ye atom
(Le.a dog H=me or p=it to bum leaves etc.)said peson is NOT reed to complete this affidavit
theOfficeofla e!4�would Emtof=kyoumadvancefuryourcooperationandsbouldyQuhave any.questions,
please dD not hesitBte D give as a cell"
Me Depadme;ofs add trIephone and faxmmmbes_
v?I-,RIth oflf�u
Qfh&d� A is
B MAG21II
TeLA 617-727-4 w±4.66 Qr 1477h SAFE
R=4 6I7-72'-' 49�
Revised.4-24-177
-
o�,
• sARNSTAEM
1659. Town of Barnstable
Regulatory Services
-Richard V.Scali,Director
Building Division
Thomas Perry,CBO
Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 5.08-796-6230
Property Owner Must
Complete and Sign This Section
If Using A Builder
c
s
I, Sha�-O"17)adak at'd 6W'Oil ,¢ , as wner,of the subject prop 0
hereby authorize to act on my behalf,
in all matters relative to work authorized by this building permit application for:
F
J �-iA- d 2-4 3 Z r
(Address of Job)
Zia sartil . .1-5
Signature of Owner D
5� PA) MDN�}h�Ail/
CAL
Print Name
If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the. .
reverse side.
QAWPFILES\FORMS\building permit forms\EXPRESS.doc
Revised 040215
Town of Barnstable
Regulatory Services k
oFT rorfp Richard V.Scali,Director
Building Division
BMWSTABLE. Tom Perry,Building Commissioner
MASS.
1639. ��� 200 Main Street, Hyannis,MA 02601
�En a www.town.liarnstable.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 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 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
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.
Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc
Revised 040215
�assact�'�seuy OePart—, nt of Public Safety
Board of Bu i-ingI Regulabors and Standard
Cnriitruction$lperrisor .
License: CS-104107
,..
CARLOS FI FIG[TYRO$
20 CAPTAIN N01fES RD; - G4
SOUTH YARMOYTTS11iy
J,•�.-- � '� " �ti��� Expiration
08/2512015
Commissioner
Unrestricted--Buildings of any use group which
contain less than 35,000 cubic feet(991m3)of
enclosed's`pace.
Failure to possess a current edition of the'Massachusetts
State Building Code is cause for revocation of this license.
For DPS Licensing information visit
: www.Mass.Gov/DPS
?��Lie �Porr��aoncoecr�C�o� aa�ac�cweII.
-Office of Consumer Affairs&Business Regulation License or registration valid for individul use only
ME IMPROVEMENT CONTRACTOR before the expiration date. If found return t:
egistration: 537g2 Type: i Office of Consumer Affairs and Business Regulation i
10 Park Plaza-Suite 5170
xpiration: _1a8)20T7=_== DBA IBoston,MA 02116
C&F REMODELING::!== `
I
CARLOS FIGUEIROq 4 '
20 CAPTAIN NOYES RD
S.YARMOUTH,MA 02604 Undersecretary I `� _ Not valid without signature
• 1 ;
I
Docket No. Commonwealth of Massachusetts
LETTERS OF AUTHORITY FOR The Trial Court
PERSONAL REPRESENTATIVE BA15PO359EA Probate and Family Court
Barnstable Probate and Family Court
Estate of:
3195 Main Street
Anne M O'Malley
PO Box 346
Barnstable, MA 02630
Date of Death: 01/31/2015 (508)375-6710
To:
Sharon O Monahan and
114 West Broadway Carol A Cushing
Gettysburg, PA 17325 6 Pickwick Road
Marblehead, MA 01945
You have been appointed and qualified as Personal Representative in ❑ Supervised QX Unsupervised
administration of this estate on March 18, 2015
- ae •
These letters are proof of your authority to act pursuant to G.L. c. 19013, except for the following restrictions if any:
not applicable
The Personal Representative was appointed before March 31, 2012 as Executor or Administrator of the estate.
(Do Not Write Below This Line-For Court Use Only)
CERTIFICATION
I certify that it appears by the records of this Court that sald appointment remains in full force and effect. IN TESTIMONY
WHEREOF I have hereunto set my hand and affixed the seal of said Court.
Date March 19,2015 ,
Anastasia W Perrino, Register of Probate
MPC 751 (3/31/12)
e
l
Assessor's office(1 st Floor): .
Assessor's map and lot numb i �/ �P• / �o�'r"E Toy
Conservation(4th Floor): �r' �+ Z���*`�y SEPTIC SYSTEM o:
Board of Health(3rd flo r ""a orj: �f INSTALLED IN C
Sewage Permit numbe
9 � WITH TIT ,b
Engineering Department(3rd floor): /� � ENVIRONMENTAL
House number IQ
Definitive Plan Approved by Planning Board t 19 TOWN REC,t41UM
APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:60 P.M.only
TOWY2 OF BARNSTABLE
BUILDING } INSPECTOR
APPLICATION FOR PERMIT TO l IC4
f TYPE OF CONSTRUCTION tGCG
TO THE INSPECTOR OF BUILDINGS:
The undersigned herebyapplies for a permit according to the following information:
r Location 9O
Proposed Use
Zoning District Fire District
Name of Owner / �/i Address'�Ot ®� �Tr/ G7/�/ vC. L, �����f7
� 1 y�3•y3G ��q�
Name of Builder Address
Name of Architect Address
Number of Rooms Foundation
Exterior Roofing
Floors Interior
Heating Plumbing
Fireplace Approximate Cost 02-so_o a-o
' Area
1
Diagram of Lot and Building with Dimensions Fee
r
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 �G"� L
Construction Supervisor's License
O 'DIIALLEY, ANN M.
7_.
No 36452 Permit For REPLACE DECK.
Single Family Dwelling
Location:. '98 Long Beach Road
Centerville
Owner. Ann M. O 'Malley
p
Type of Construction Frame
Plot Lot '
Permit Granted % January 25 , 19 94
Date of Inspection:
Frame 19
x Insulation.' 19
Fireplace 19—
Date Completed 19
ge
vwr fa3
z k- iL
M
c=MT6w .,.E N
EXIST. FLOATS
ROREPT A.
EBB
ERAMAN C
No. 1U405 �k
FLOOD
V i v p ` ►� ,,o
%VTERI1/LLE IFIVER -�o
GE�1Te 2dK_t_o /tA(2.1302
/NCO /N U.S.G.S. 0 1000 _ 2000
HYANNIS QUAD. 1:25,000
I
EXIST.' 2-5.7x8' FLOATS
EXIST. 5.5'x8' FLOAT W/ 2— P`P� PILES
W/ 2— PIPE PILES EXIST. 3 x11.5' RAMP EXIST. 8'x12'
FLOAT W/
EXIST. 3'x14' RAMP/1 ELW -0.5 PIPE PILES
3.0'x4.5' /p. EXIST. 3'x12'
PLATFORM RAMP
p E . 5.7. SEEN ls1. p6
oo STONE & CONC MHW a� 6 EXIST.
STONE
WALL N N AND
9
12'x24' AL CONC.
DECK WALL
C.B. FND EL. 7.0 .5 "`
0
LOT 5 6 N SALT
DOM IN K & JU GAUTRAU EXIST. g MARSH
103 L NG BE ROAD HSE b.
EXIST.
CEN VILLE, M 02632 6 GAR.
3.5'x20.3'
FEr N C E WALKWAY
EXIST. EL. 6.8
GAR. LOT 7
�'t f LOT 6 FENCE JOAN E. MURPHY
ANN M. O'MALLEY 21 ANNE DRIVE
PEABODY, MA
01960 PLAN
0' 10' 20' 30'
LONG BEACH ROAD
SCALE: 1"=30'
PLAN ACCOMPANYING PETITION OF
ANN M. O'MALLEY
TO MAINTAIN EXIST. STONEWALL, DECK, AUG. 24, 1992 SHEET 1 OF 2
PLATFORM, RAMP, FLOATS & PILES BRAMAN ENGINEERING COMPANY, LTD
CENTFRk&ZF RlkER CIVIL ENGINEERS AND SURVEYORS
CENTERVILLE, BARNSTABLE, MA 258 MAIN ST., BUZZARDS BAY, MA
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TOWN OF BARNSTABLE
BUILDING DEPARTMENT
HOMEOWNER LICENSE EXEMPTION
Please print.
DATE Z24
JOB LOCATION Gez 01er/ ll Ile-
Number 4treet//Address Section Of Town
"HOMEOWNER"
Name Home'Phone Work Phone
PRESENT MAILING ADDRESS
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
APPROVAL OF BUILDING OFFICIAL
I
Note: Three family dwellings 35,000 cubic feet, or larger, will be
required to comply with State Building Code Section 127.0, Construction
4
• `cti
HOME OWNER'S EXEMPTION
The code states that: "Any Home Owner 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'
Home Owner engages a person(s) for hire to do such work
Owner shall act. as supervisor." . t hat such Home
Many Home Owners who use this exemption are unaware that they are assumin
the responsibilities of a supervisor (see Appendix Q g
for Licensing Construction Supervisors, Section 2.15) .. Thisalackeoflations
awareness often results in serious rob
Owner hires unlicensed persons. Inp this ecase pour1Boa dlcannot when the Home
against the unlicensed person as it would with proceed
licensed
Home Owner acting as supervisor is u.ltimately :responsibleupervisor. The
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.
r.., I