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I � � •, j'f` ,} •i t 11 a!1 t i '}} 1' i , i ' �' `•1'i'fin 1 �. i�' .� �f :,i,i7' � � 1 •� {{ I L. 4 F� t t , { �• t , r , r ; : { , #� {{ �.� � 1`� �,1 ,,11t1 ��tt .t,� .�� � tltL � I �I'� + 9 ; �k{•> �'�,t P; 1 � i {�'st! t r 1' :][� 1 k, r.t t• ,'.7' `.}' � J i f "� J I i 1 :�. a `l >< � 1' ''1{��t' i<� ,5�jtu 7 �1�'ft: ,a r 1 � 1 t�- ;� "; �( �it + } ;�' � i iEi jj}fff �."t'�� �� �j}j]�; 1}f 1 .J.. ai s�. �:• i ,�.i "1, .. {i{ , ;i }j+=" 7` f.�.l:.�:N1.,.' �,r1 � � s 1, 't 'i c •1 i i" I ,F{j�'i t `P �i � `'j i. ,, ,i, .I ..ry' Ij dp .t �y"J'•ri• 'i, ,1 t } ,i i t s, `. 1 � I col ,•. ,t. f>t ,' ,' 3 i l ' 1 1 1, qq �J } r y'I i 1' f^. f.i r i� r a.1, i •P. i t ,i a t• t, t^ f :4' tt a 1 t tjtF ,1'.I' 1} t! Ii 1 1 � � �., � IAll r 1.+ TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application # C�01/6 Q o_) Health Division Date Issued 3 l Conservation Division Application Fee Planning Dept. Permit Fee ?J Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address'j Z V I-U►A 6f1F T Village Owner e 1Bcvt 6��y� Address �a��C Telephone Permit-Req-uest=3 i �e L i t a D-YL r .SZ Xi �0� 1A) V1 cr p i o a ct►va 1 !'r--acl ree)i'A a L. Ce I n9 C( rP o T C asp Lk y'i�na cCrect Square feet: 1 st floor: existing /02yproposed 0 2nd floor: existing 23 2 proposed 192_ Total new '19 oleo Zoning District Flood Plain Groundwater Overlay Pr-ojee Valuation-�sda" Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. 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 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 e; Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove': ❑Yes ❑ No Detached garage: ❑ existing ❑ new size Pool: ❑ existing ❑ new size _ Barn: ❑ existing 0 newri size_ z I�� Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # =y-- Current Use- Proposed Use - - APPLICANT INFORMATION (BUILDER OR HOMEO_W_ NE.__ R ,Names :J cTelephone-Numbe-��� Address-0-1-1 - 1 o, e r'T Mill Ul License # Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE - FDATE--= _t FOR OFFICIAL USE ONLY APPLICATION# i DATE ISSUED !? MAP/PARCEL NO. �4 ! ADDRESS VILLAGE OWNER y , x DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL s PLUMBING: ROUGH FINAL GAS: ROUGH FINAL ` FINAL BUILDING Z3/1 r DATE CLOSED OUT , . - m ASSOCIATION PLAN NO. t .,_ • 2 � The Commonwealth of Massachusetts Department of Industrial Accidents ' Office of investigations 600 Washington Street, r/ Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: guilders/Contractors/Electricians/Plumbers Applicant Information Please Print Le�_TiblY _ - �Nflille=(B'usiness(Organization/Tndividual): J®�r�ns� 6 /�L� P_�5 �Addres=s 20 �CItyLS,tate/Z-ip ,.-�,, ewl�'et�V'IIIC_ MAx. 'Phone #:$ J°��F-.4 LF =CYz4F7 Are you an employer?Check the appropriate box: ; L 4. I am a general contractor and IF�E] oject(required): 1.❑ I am a employer with construction employees(full and/or,part-time).* have hired the sub-contractors . 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. odeling These sub-contractors haveship and have no employees,. � 8. E]Demolition working for me in any capacity. employees and have workers' o workers'comp. insurance comp. insurance. # 9. ❑ Building addition required.] 5. 0 We area corporation and its I0:❑ Electrical repairs or additions 4;_3, I am a homeowner doing all work officers have exercised their 1 I.[Plumbing repairs or additions myself. [No workers' comp." : right,of exemption per NIGL 12.❑ Roof repairs insurance required.] t c..152, §1(4),and we have no employees. [No workers'. 13.❑-0ther comp. insurance required.] *Any applicant that checks 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. XContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that isprovidurg workers'compensation insurance for my employees., Below is thepolicy andjob site information Insurance Company Name: z Policy#or Self-ins: Lid;#: Expiration Date: Job Site Address: City/State/Zip: •Attach a copy of the work&rs':comp.ensa6&n 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 may be forwarded to'the Office of Investigations of•the DIA for insurance coverage yerification. I do hereby certify under t pains'and pe ties of perjury that-fire information provided above is true and correct. Sig_ature: r-�-•-Date:---..d ell ' . �P-honey#:---�— 1'��" `TIC+: ", �°`7 � • -Official use only. Do not write in this area, to be c6mpleted by'city or town offciaL ;, Y City,or Town: Permit/License Issuing Authority(circle one); 1. Board of Health 2. Building Department 3. City/Town Clerk 4"Electrical lnspectar S.`Plumbing Inspector' x - 6.Other- ' Contact Person; ; Phone At Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer,.or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein; or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be .deemed to be an employer.' MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuanceior renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until a ceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractors)name(s),.address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies(LLC) or Limited Liability Partnerships(LLP) with no employees other-than the members or partners, are not required to Carly workers' compensation insurance. If an LLC or LLP does have. employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation.of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the'pemut or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit da it for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. e sure to 611 mi the ermit/licewe number which will be used as a reference number. In addition,an applicant Please b p that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current Policy information(if-decessary) and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a.home owner or citizen is obtaining a license or permit not related to any business or commercial venture a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, Please do'not hesitate to give us a call. The Department's address,telephone and fax number: ' The Commonwealth`of Massachusetts o Department of Industrial Accidents 0 Office of Investigations 600 Washington Street Boston, MA 02111 Teh.#.617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 4-24-07 www.mass.gov/dia THE Town of Barngta4te� Op r}-y Regulatory Services Thomas F. Geiler,lDirector - MA-q& Building Division pig a 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: JQB`LOCATION: z© Lfd lrrrl AeT'T /"1 l UVI L�i�`V Q I(41P. number street Q,+ village - 1 e� g- •'HOMEOWNER"lil�lfwl ,, e� l f�Ll�R�Y�t�c� •�DC�-'y2. .1�1 ✓�a� ! 6,i 7 name P home phone# -1 pone# CURRENT MAfL(NGADORESS: Z,D 4.(,Zy �'� ., / "l'f ` r Ce-y1 I e-RV j le M-A. o z402- 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.aparcel 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 lie responsible-for all such work performed under the buildina'pemut. (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 witlrsaid procedures,and req ire /�per/Fits. gnature 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 `, nyhoineowoer 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 pcnon(s)for hire to do such wtxk,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of supervisor(see Appendix Q, Rules&'Regulations for Licensing Construction Supervisors,Section.2.15) This lack. 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 uhimately 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 helshe 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/ecrtification for use in your community. Q:forms:homtexempt 1X. �P4 20 r` • HARNST.ISI.E, � . Y� 1 ,�� Town of Barnstable Regulatory Services Thomas F. Geiler,Director Building Division Thomas Perry, C Building Commiss oner 200 Main Street, Hyanni ,MA 02601 = www.town.barnst ble.ma.us Office: 508-962-4039 Fax: 50,8,-790-6230 Property caner Must Complete an Sign This Section If Us' g A Builder 1, as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized b this building ermit application for: (Addre s of Job) 10 Signature of Owner Date Print Na-mc If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on th`e�' . reverse side. C'\Users\decollik\AppData\Locaf\Microsoft\Windows\Temporary Int>met Files%Content.oudook\DDV97AAZ\EXPRESS.doe Revised 072110 `Y ..�� ,h,``•-.s EAST VI Evil i qv ' r; y 2 X re S i � tg"j' �.. ,. .._.:.,,_.... . _..:.. .,.............. T& :' r:• I, 1 � i i j ' ! � e . f ' ==—•y-+®w.a,-- ,�� w.�,ew,v-wA,.+wx:...,.. � a .e.. y y, e«xu .�.c,n j . - '�+:a nrov AtY.n"^rfit"^9i`!'S'T18 l3Y1J sL .- ..x..ace<wessr.+n...c�.reattams�c�.xsnrne�n,tt'+sru:.w:.,: ':•:•�" "•••"qy+ I Q; rr 1� fl' ,5 r � _ 6,L _ �3c) S.P.D. U Sf- l OCDC) G4,L. . . 7 � F�iT - oc�c, GnL �. c. r%{ uSE I 0 FAT -�► �cP7 �Grf-rc"(t ToT� L- ^425 .PD. '� t 3W E+.PD. 9y a 1 f^6 Y TOP �NU s t00.O EL LOA. if'Poe I o� tuv. �► sup <r,e 4 P -Box gG.4 Sc�rtc Io' 95 ew, Tar/K GAL• 96.4 � L ;,. : A ram,r e� .. • WASHED .. ►�!r� WAITER1- 4/c3i77 Tt Ct=t; �=.`r Tt !Ar Ti��_ �avKD�T1ON SUcru►J ", P� ��►�E . . . . L- a T --i. AWLS ;�'T"try Mc_1..1Ty Or 7 µC --- '•LEA k.[:�Jit:L ` . �� ,�. i C'.,l/U GC- CA.rf Fbi ==r—•j' t�i_G l 5 IZ-�:.�L L1�1.•1 PJ '_l%�'�.i:.'.`_ U ry 't 2J "'C- aZ r . •Q i r • _ 10 a A t` KfA%e e' f. Q E Zx� ��G 4... �. 5 5 9 1 S 'd • 1 'pay A`r� �r• ,i 1 � \ � � O i7 cn 1 •.. _.: _r A... co v h T 0 o� / N _ : * TOWN OF B,ARNSTABLE BUILDING PERMIT APPLICATION Map Parcel (ir Permit# 7 f 2 2 Health Division -;)-Yg Ch lam. Date Issued " 2--0 3 Conservation Division S I Application Fee Tax Collector Permit Fee Treasurer U ' SEPTIC SYSTEM MUST SE Planning Dept. )XISTALLED IN COMPLIANCE Date Definitive Plan Approved by Planning Board VWTH TITLE 5 ENVId�0NMENTAL CODE'ANE' Historic-0 KH Preservation/Hyannis TC VWI REGi1U.INNS Project Street Address Village 7P d' �,ri l �� Owner ae LA--f \f ea-LA 'TL&y-4 b 'S c�v\ Address Telephone S�9 2F-Permit Request ,,r r 4 4\o O M .1cW,Y_1' "2� Square feet: 1st floor:existing proposed 2nd floor: existing proposed Total new__L_1_5::6 Zoning District Flood Plain Groundwater Overlay Project Valuation e(567D Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family 12r Two Family ❑ Multi-Family(#units) Age of Existing Structured S Historic House: ❑Yes Ud No On Old King's Highway: ❑Yes U'No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other ,ZIA 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/coal stove: ❑Yes ❑No Detached 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 ❑No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION ame l� - Telephone Number- Address 2-0 Lc m 6o r-( M L t� ^:A1 License# ` Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO — rn J SIGNATURE DATE 2- f r FOR OFFICIAL USE ONLY t - r � y - w 4 PERMIT NO. DATE ISSUED ; 4 MAP/PARCEL•NO. ADDRESS VILLAGE OWNER - DATE OF INSPECTION: t FOUNDATION r FRAME t INSULATION FIREPLACE ` i ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH. ` FINAL , GAS: ROUGH' FINAL FINAL BUILDING t DATE CLOSED OUT ASSOCIATION PLkN)NO. t i w RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings,Additions_ $50.00 Alterations/Renovations $25.00 Building Permit Amendment $25.00 FEE vALUE WORKSHEET NEW LIVING SPACE Co square feet x$961sq.foot �v x.003 1= • '� plus from below(if applicable) ALTERATIONSIRENOVATIONS OF EXISTING SPACE square feet x$64/sq.foot= x.0031= plus from below(if applicable) ACCESSORY STRUCTURE'>120 sq.f� � >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf-1000 sf 75.00 >1000 sf-1500 sf 100.00 >1500 sf-Same as new building permit: x.0031= square feet x$961sq.foot= , r STAND ALONE PERMITS Open Porch x$30.00= (number) Deck _x$30.00= - (number) Fireplace/Chimney. _x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) , Permit Fee projcost The Commonwealth of Massachusetts Department Of Industrial Accidents ,� — Office of/ayasti affs _ t 600 Washington Street Boston,Mass. 02111 Workers' Com ensation Insurance Affidavit name: � p D location: 2 © L. lM ! t ci P�vt7-' f` ( � 7 hone# s�J7 q2 �C( I am a homeowner performing all work myself. ❑ I am a sole netor and have no one working in ca achON workers co ensation for my employees em 1 rovldin mP................:.::.:.::..:::{.;:ti.::.::.:.:_::::::.;:.r:..::......,...................:...................-............. .tom .............. :::....::...:....:......::- ,:.... ..,... 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I do hereby certify under the airs and penalties of perjury that the information provided above is tarp and correct Signature �—� Date 2-0 � �� Print name '* official use only do not write in this area to be completed by city or town oMdal city or town: permittlicense# ❑Betiding Department ❑Licensing Board once is required ❑ en Selectm 's office . ❑checkif immediate reap q ❑Health Department contact person: phone#; ❑Other, 4rAsed 9195 PIA) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An employer is defined as an individual,partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,Partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a Icense or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neitherthe commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance as all affidavits maybe submitted to the Depa rtment of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and �:. date the affidavit The affidavit should be retumed to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. i City or Towns Please be sure that the affidavit is complete and printed Legibly. The Department has provided a space at the bottom of the Office of Investigations has to contact you regarding the applicant. Please e Offi _ fill out in the event the -- _ ' for you to _ ... affidavit y .. ' 'sense number which will be used as a reference number. The affidavits may be ret rhR io be sure to fill in the permitllt _ the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone #: (617) 727-4900 ext. 406, 409 or 375 5 pFtHETow Town of Barnstable ti Regulatory Services �B g Thomas F.Geiler,Director �A 1639. ♦0 rfD MA'S° Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 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 requirements. Type of Work: ALA&Lr,u.r-�,✓� Estimated Cost rc Address of Work: O Owner's Name: G1M ! (�LOyd�l Date of Application: Z (' 73 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 IMPROVEMENT 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 ����iC7y✓l �cT/\ Date Owner's Name QArms:homeaffidav Town of Barnstable Regulatory Services Thomas F.Geiler,Director MAW 9q, 019. �.� Building Division AlEO � Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION �j Please Print DATE: G Z a, o .� n_1 JOB LOCATION: s�G Z.e2 ►M b e IT r 1� I�C� Ce-u7e r y i 1 P number street village , "HOMEOWNER': ;j 0 Lp K �_q`f ? name home p one# work phone# CURRENT MAILING ADDRESS: �t1-�.rilA 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 individuaffor 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.XSection 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 requiremen c_r Si lure 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:forms:homeexempt (12l' GGk -?L-f D E I',- x 6 e•���s L6"o� GLS � - axc( ST�ns i6 0�, r� . as , tr _ O Z-Z /V zz z z OC ro v `! S t q�.� v v� ��e�'' V tie v 13 r of T P`pF THE Tp The Town of Barnstable - Ny p ' BARNSTABLE. Department of Health Safety and Environmental Services T MASS. a 0 pTf039 0MF�1, wilding Division 367 Main Street,Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 PLAN REVIEW Owner: 1 � 13 Map/Parcel: /.(0 d Project Address2Q L -1171 Ly'4 N�1� � �� Builder: 0 W yA C.-y The following items were noted on reviewing: vY 2 ivy s��. l L C� �,� —I—> Q s - �' 0 � I l Q i 4 , I n 1 Reviewed by: C) Date: /�"_� U 3 q:building:forms:review I L`-( - -3, ZO CU A/l L1G ->AiZG�.� C�RI +-lU�SC tea t�.� >~1�.,� = i t o � 3 t 33 0 4•P�p. . �E�'1-i G Tom•*-i IC = 3�Y 1�i C �Jo 4��j;6.P D. Q USA lC>C7CU I`�Isa✓oA� �lT �sE loco y.—� �Cl�� y V t T -� • � 15 �ra.P.�. ToT,AI_ .425 G.P.L7. - -r oTA t_ t t_..,( F t d 4lJ 330 6..PD. � Ef.'GDLIaTIC?LJ �'l�TE I� 'LMIQ' olz L. oo, .r WILUAhiC. z N v E 26 ' ToY F.,o ELq- FG : it tr �v�:; i '�� q s va I oao INv. .� 4'Poe � lw. G.aar. 96.7 9s luv. 1 -box 9�.4 S�rlc lo, ,' 1000 46,E t T-AnlK .., Gnu. INV. 9G.a 9C 2. I_%ac a 'A �T Wlru �` WA41<D STONE, 89 Cs=C�TiF= 1a L-D Lc,'T- PL /its LoCATIo�� Cr-- VkLt-E N� ASS A-- O ►Jo ScALic- CA1_Y' - Ne`WATE2 fly.=�0 =T� 4/es /77 I Gt>t,TtF �� TIJAT- Ti4c-- Pt-. 4at-,1 �•.�i_1-�_G'.�t�iL'C Attie LT k (O Vl/�J C'�{— IIB/�IC►�S S-f/� C'S L L P L A N4, / 4Zi=GfS [Z i=C> ;uZv�Yu�'_ 'T'l�l-, I7t_/i►� 1'; JUT l'.A•;C'C� Ut .i �FJ Li5"�EG'v'��_Li= c� M�LSy, �IJ�, I"�'._%,�✓�l-_�-� , �.�,..�/l'_`•, y 1�1i_: �.:Ft-J��i_��� lil•ILWt.-l� of Town of Barnstable *Permit# M 60. LVIrea 6 months from issue date NAM Regulatory Services Fee , s639. �e� Thomas F.,�Geiler,Director '°rEDa Building iII Division Tom Perry, Building Commissioner R 7``M T 200 Main Street, Hyannis,MA 02601 O C T 2 2 2004 Office: 508-862-4038 Fax: 508-790-6230 TOWN OF BARNSTABLE EXPRESS PERK APPLICATION - RESEDENi TIAL ONLY Not Valid without Red X Press Imprint 4ap/parcel Number 6 0 C' 'roperty Address '70 L U W4 b2d� r G/ OPat72 r U'l ! I� Residential Value of Work Minimum fee of-$25.00 for work under$6000.00 hvner's Name&Address w 2-o 4 0m br7 M-C C2U47WIvi1 e- -ontractor's Name Telephone Number Some Improvement Contractor License#(if applicable) construction Supervisor's License#(if applicable) -lWorkman's Compensation Insurance Check one: �S WI am a sole proprietor am the Homeowner ❑ I have Worker's Compensation Insurance :assurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate'must be on file. Permit Request(check box) dRe-roof(stripping old shingles) All construction debris will be taken to PIA " ❑Re-roof(not stripping. Going over (� existing layers of roof) [1I�Re-side ❑ Replacement Windows. U-Value (maximum.44) *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. Ho Improvement ntractors License is required. Signature Q:Fomrs:exprrrtrg Revisc063004 o�TME r The Town of Barnstable do Department of Health, Safety and Environmental Services 9 M M�; Building Division �pr%6 5�a,0 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph M.Crossen Fax: 508-790-6230 Building Commissioner �r Home Occupation Registration Date: 2- I - �.. AVzo-A e�pssd`I eS Name'~) �101� ✓1. ON�( f/�- -'=, - Phone# 42- =`700 -z Address: ® U.tvi:�®-i(`.T - "d`�c �7�ag,� � Type of Business: A o i0 alp,-vKa r keT IF,1 V� 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 carved 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. • No 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 C Homeoe.doc a _tee., �„��'"` • TOWN OF BARNSTABL9 " 2131`l e Permit No. Building Inspector. ua�rrau i Cash ___-- ''o e,o OCCUPANCY .,.PERMIT Bond "No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a. Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to John T-, Thompson Address, ' 1.37 Lumbert Mill Rd., Centervi, le lot #71 20 Lw.bert Mill Road. Centerville Wiring Inspector %, _ Inspection date �1J rs Plumbing IhspFct � � Inspection date Gas Inspector rl Inspection date f- Engineering Department %"e- C- � Inspection date f e) THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS. Building Inspector f � L� V:AmtL.4 - 3 T:515ED QnDcaM �.1d C�-+AfL'13Gl,;.t.� URA ESL � L`.at�..�•! P'I_v� = 1 to � 3 = 3'3U �.P•b• j 1r -i c 49 ra 6.P tom. 43 usue- t oC)C� E.Q.L._. } y PiT TO-CA t,. 'v cS16KI - 425 � {,. flGDIQTIC?tJ �'D"I"t ���tt.! 'Z�4ttu 02 1 �7{j. AI '� !� ✓ W OF ALAC. n } y • �� 14 YE F • TAT _A'r f ToP V-40 a,Qo.o ELF , .... ...,.., 4' P�v� ... � i PPe iNV, g7a .�! 1 voo iuv. '�; sins 1W. 9s f `Box 94.4' St�r+c iNV. P T'A�!K ;' lc>ao 9�,8 taw iuv. . Gn.�. 94.a 9L�L I-MAC 14 A p,T W P'ru q. W ASHlL'p C_rt2Tltw1C-.D {-:)LC:)r -L ,�►� tErR/�v�L�.�, MASS. Pi's T�-±Ar • Ti4c-- T70uJAAT10Q '5"c,,.uQ {I -1C.t:tt7t.l t ���1Pt_+lS vt/ t"rN Tt.t� �t btk t.i�.tE: :•t:_'ril.l.Ct:� VIYC;sxci:ME. T 'TOWW G[= l3A2N5TA%-Z'—a �'l._AN B;e,.3OVA PG t'7 UA`I'ti ICE d 5 2� 'lq � '�z c�t s rr=; �v �►�� 5 U✓�V�Y c��:�-z 1 Q OTi v t,4 A&.l Av rr+��V v� L_LL- c� �trC•�5;, i{JSI 7•.J.'./l t�_t..� ;' ✓�:1t=•1>~i.�� i��t_.: 0'f ji Te! J, Ltii t.. At'7 t�'t�t rA,t-.j 1 t `aC' �',t tJ�.i � T`�, i��rl'i�►�M�►,1C- 1..C�..f. t_It.ii�;a r--•,--___ _ .. ZF'`C TNa►�p��..C'� / af,— i Asseftr's map and lot nu /.. .�� .. ..9.9......... ® ot, ��r' �� d ` THE Sewage Permit number .... .............�.9.............................. Be ' SEPTIC SYSTEM MUST Z HAWST"LE, i House number .40 ... INSTALLED IN COMPLIANCE 9 rasa WITH ARTICLE II STATE . 1639. 0� TOWN TOWN OF BAR NATTIciftE �r BUILDING INSPECTOR ` APPLICATION FOR PERMIT TO TYPE OF CONSTRUCTION ................... ......................... ................ ........,9.7.. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a per it accordi g to the followi�informafioLocation ...�6':...........�....r�.. .. .... . ..... ..� . .....�4�1,............ .. ..................................................... ProposedUse ...........R . .. .... . .....� ........... ....................................................... ........................... Zoning District ............................................Fire District ...........�"E:.Q.................... ............................. Name of Owner ... .VL.....1.:......IF..i!1�1!+'} ..S'i}?%�....Address ..« �. . . �..d�it�V'....��?4................... Name of Builder .....................t2.. e...........................Address Name of Architect ............:....... .G�!!�.P........................Address R �'.......... .. ........................................... Number of Rooms ..................... ..................................Foundation .....eon/4..... ...................... � Exlerior .7r1:4.... .... ..."................ ��,. ."..... .. oofing ............: ...... ..... ..... ............. Floors ... ...... ............ .....................Interior ... .".. . ..... . ..... Heating �. .. ... ...............Plumbing ............... ... =....`�!i:.J..rl................................... Fireplace ..:...............................................................................Approximate Cost..�Q�QO . Definitive Plan Approved by Planning Board -------------------_-----------19________- Area /d 0....... ...................... .. ................... O© Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH Ir r I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name `...... .. ... .. . . ........... ^ Thompson, Jm}oz T. ^ . .` . . . � ' 11317 two �6 ---.--. Permit for ----...�����---'' i7 ' single family ...........—~^:—`_'.----'=--^'_^---' ^ ' 20 Luzbert Mill Road Location ---..-----------------. U. Centerville ---------------.----------- Jolon ]C Owner --------.�..�����]��..------. trzooe Type of Construction .......................................... � ................ _-------~----------. /- �7 Plot �� " ' --------- ----------' Permit G,onha6 ........kl4y.24------.lg 79 Date of Inspection ------------lg -- �J ' Do+a Completed --- lV ^ - ~ PERMIT . . ' �����B� .� Z., 7. '---.�.�—r:.,-.�.---------.. lV -. - `- , '� r` ............................................ �-----'' ....... �� ................... - . *.. . .--m--..—.---...—... ............... . ��. ','r .'-----.. lg _'-- ---------' ' . . ` -----.-------.--~..-----..~.—. . ----~—^^----^'^'' . —_ _ Assessor's map and lot number .... ............................... Sewage Permit number ......................... .............................. . 33ARNSTLBLE, House number. ................. ........... MAS& 039- 'TOWN OF BARNSTABLE BUILDING INSPECTOR .............. APPLICATION FOR PERMIT TO ............................................1—�. ........... . .............................. TYPE OF CONSTRUCTION .................................... ------- . . ....................................................................................... ............................ ................... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the followininformation: t:11V) :t4- ............ , Location ...I ........... ......0.......................k..................................................... I.,.......... .Proposed Use ........... .......... Zoning District ........................... .............................Fire District ............ .................................." Name of Owner ...... .1.4tt..0I1 ....Address J. .... .................... Name of Builder .....................5 '7-::::;, ...........................Address .................................................................................... Name of Architect ...................... .......................Address ..................... ........... Number—of Rooms ......................-5. .......................................Foundation ...... ...... 7:t. I-/(., 11�4, - - — �,�-t.............................. Exterior ................ ............. Exiei ..... .. 44,Roofing .................... V .... Interior .. . ....... A.. . ......Floor ............... Heating ..............Plumbing ....................... ....... .. ............................ ----------- Fireplace ..................................................................................Approximate Cost Definitive Plan Approved by Planning Board ________________----------------19--------- Area . . d ............... .. ......... 0— Diagram of Lot and Building with Dimensions Fee .31.............................. 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 ......... ... ............. Thompson, John.'T. A=168-99 21317 permit for two story No ............... .............. ............. single famil dwelli . .............................X............... .................. Location 20 Lumbert Mill Road ............................................................... Centervill ........................................... ........................... John T. Th .son r Owner ..................... .. ......................... Type of Construction frame ................................, ........................................... + Plot ............................ of ...........#:................. + Permit Granted .......... Y 9................19 79 + Date of Inspection ....................................19 Date Completed ... ..................................19 P RMIT REFUSED ................ 19 ......................... . .......................... ...... �............... .................................................... ......................:........................................................ Approved ................................................ 19 ............................................................................... , . SEPTIC SYSTEM UST Assessors and lot number....•................................� INSTALLED IN COMPLIANCE of THE TO WITH TITLE 5 �►, Sewage Per'mit: number ................................... ... - 9 IdVIROHt7ENTAL CODE AND ' House number TOWN REGULATIONS Z BAUSTAnLE, r 9�4 M039. 0 NOR TOWN OF. BARNSTABLE . .BUILDING INSPECTOR APPLICATION FOR PERMIT TO ....•7.)( ......... ..... . ..... v1K)e.7,�•t TYPE OF CONSTRUCTION t, .......... .....6. ... ............19,11`'. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ............ ��.....4- U..r/1!1... �'. ....... .I./ .....Y d.. ........ C.ATET.V .l.l:e........................................... ProposedUse ................... .V..... �t^��1........ !3D..✓ ...............................................................................I......................... Zoning District ....................................................Fire District ............... Name of Owner ...1.lU .P1.. .... .f 1.G.Wt. >�® .......Address .a..�^.Uwi l0ef.l...... !.��.......��.................... Name of Builder ..........L... .7Qwt y .S,f1...`{..5'. .......Address ........................a / ....................................:......... Nameof Architect ...................................................................Address .................................................................................... Number of Rooms ........ ........................................Foundation .............. ............................................... Exterior ...........................4N.,O..v.... .........................................Roofing .............. ......................................... Floors .Interior .............� ..............................v�., . .. ........................................ .. Heating ..................................................................................Plumbing ...................................... . Fireplace ...................... ...............................................Approximate. Cost .................................................................... Definitive Plan Approved by Planning Board -------------------_-----------19________ . Area :.. . . ............. Diagram of Lot and Building with' Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH fV o < m. (,At , �� �(9 d/ 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. J.. .. �`Name ..... .......�`....... .......... ....................... Construction Supervisor's License ... .......... THOMPSON, JOHN T. No .... Permit for ... ............ .................. lation ...... U11AWAd.............. ....................... ................................ A Owner .......... ..................... Type of Construction ..........FX.ame..................... ............................................................................... Plot ............................ Lot ................................. -August 27, 85 Permit-Granted ..�.....................................19 Date of Inspection .................................19 Dater Completed A ........ ............... 19 > M M 0 _ - - � ^Aoae000/, m � '? «/9��J� Sewage ��nn'��«u'noe' ----..-.-----..�..�-.�� *<�_�/ - | House -----------------------'` ' ^ ftful MAGIL 1639* ' ����� �� � � � �� � � � � � TOWN�� |� ��]�� BARN STABLE �� ���� ���� ` BUILDING � NN N N | N �� INSPECTOR ���� �� �� | - �� NNNN_N0N �� �� N ��������N� � NN �� | . =� == � ���~ � �� �� " °=m~� �=�~ � �� �� z�' ~/�� / 1 -7�_ ^�� �kPPL1CATU��0� FOR PERMIT TO . . --..-�/8���D- -. . .���. wv TYPE OF CONSTRUCTION ---------.---------.--.------._.'-----,....^.-^--... � �a �x�--..�,*�.. ......l9J��T [/ ' TO THE INSPECTOR OF BUILDINGS: , � � The undersigned hereby applies for o permit according to the following information: J � Location ---.. ..... ...L`e^z.......�� '---`-.. ...... ` Proposed Use --- diry--.. ey?.-...------------------_-.--.--------- Zoning, District ..1�1=,�-----.--------`---_..RneD��icf ---. ����/ ................. ,----. � V�*i»�rL Name of Owner .-0c �� .- -- �A66reo - .---.�-.. ,.. . .^.. /--�J-^l/.>........ ............ � ! Nome of 8.i|6e, -.-f' .�A_-.A66,e^ --'---. "��~��/��----..---_-------. | Nome of Architect ----------------------Addres ---------..-------------..---.� Number of Rooms -.------' .......................................... ................ ............................................... -J Exie,ior --------'�!�a�.��.........................................Roofing .................... ........................................ � / / � F|=zrs yikY�� 1 . . . . - ----� |n�,�r ----/��- /��.��- ----------' ' --� -� ' - - � '� -- --------� '` -T----. . . Heating -------',---- . -----.-----_--..---------_.-_ � Fireplace ...................................................... ...........................Approximate Cost ----- --,.^_,,____,.. ~^ DefnhiveP|on Approved by Planning Board l -------- Area -------------- Diagram of Lot and Building with Dimensions ` Fee ------.---.----' | SUBJE[T TO APPROVAL OF BOARD 'OF HEALTH . | ^ \ � el C . � \ / x` - - | ~ . ` ^0/)'~ <u_^ ^ �� vl ` ~~ ` OCCUPANCY PERMITS REQUIRED FOR NEW DVVE0NGS\, ' . � | hereby agree to conform to all the Rules and Regulations of the Town of 8ornxhz6le regarding the above construction. /� ` No -^-.~ U ��.�---..,-.»"�^ / �r ~ ' ^ Construction� Supervisor's License -/7 _-.. ` THOMPSON, JOHN T. A=168-99 No ....28356 Permit for .....Rui.Ld..Additioxn Single..F.a.milY...Pwclaing...................... LAotio'n .... ..Mill..Road................ k ............C.entery ....... ..... ..............i...j)_(� ............................. Owner .....Jo ..T. T.hn . ..... .... .... Awnp 5.Qxx....................... Type of Construction .....Fx.ame.......................... ................................................................................ Plot ............................ Lot ................................ August 27, Permit Granted .......................... .............19 85 Date of Inspection ....................................19 Date Completed ......................................19 #-DIP