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C) 5
w TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Ma o cl Parcel J TOVI'Hl D Elpr �f ST LE
p C Permit#
Health Division , 7, �r ��,"' l`E .3 j:� l l; Date Issued
1 1 ,
.,
Conservation Divisionz/ � ��e t3 Fee65��'1
Tax Collector - -
'I'1 I SEPTIC SYSTEM MUST BE
Treasurer WTA=N COMIAt1NCE
Planning Dept. KITH TiTt,E S
Date Definitive Plan Approved by Planning Board CMMAL CODE AND
TOWN REGULATIONS
Historic-OKH Preservation/Hyannis
Project Street Address 5 a. 0")f) 1 E u
Village C c-
Owner to��(� 1� �t�C Address
Telephone '� Cl 's
Permit Request
Square feet: 1st floor: existing proposed .7 y \\2nd floor: existing proposed Total new
Valuation a 1120 Zoning District r�ll � � Flood Plain Groundwater Overlay
Construction Type Woo
Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation.
Dwelling Type: Single Famil\yu Two Family ❑ Multi-Family(#units)
Age of Existing Structures= Historic House: ❑Yes O No On Old Kings Highway: ❑Yes ❑ No
50
Basement Type: /Full N Crawl ❑Walkout d 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 G new First Floor Room Count _
Heat Type and Fuel: �1 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:0 existing ❑new size Shed:❑existing ❑new size jZo
Other:
OtPX '
Zoning Board of Appeals Authorization. ❑ Appeal# Recorded❑
Commercial ❑Yes ❑ No If yes, site plan review#
Current Use Proposed Use
BUILDER INFORMATION
C �
Name 6 Gv d% G Telephone Number J�� G
(-A ress �o� P719PL .. &1 . License#
Home Improvement Contractor#
Worker's Compensation#
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE DATE
` FOR OFFICIAL USE ONLY
PERMIT NO.
DATE ISSUED
} MAP/PARCEL NO. -
x -
L
x
ADDRESS _ VILLAGE
t OWNER 2
R .
DATE OF INSPECTION:
FOUNDATION
FRAME
INSULATION 1� Z� `/ CS> ya► �
FIREPLACE
03
ELECTRICAL: ROUGH. 0- FINAL
PLUMBING: ROUG1� ' aye FINAL -
m
GAS: ROUGH 0- 3� FINAL
FINAL BUILDING
z. DATE CLOSED OUT
ASSOCIATION PLAN NO.
5
a` 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 C
1
square feet x$96/sq.foot= x.0031 �->
,
plus from below(if applicable)
ALTERATIONS/RENOVATIONS OF EXISTING SPACE
square feet x$64/sq.foot= x.0031=
plus from a olb w(if applicable)
ACCESSORY STRUCTURE>120 sq.
>120 sf-500 sf
>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:
square feet x$96/sq.foot= x.0031=
STAND ALONE PERMITS ,
Open Porch x$30.00=
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 Fees 7
projcost .
The Commonwealth of Massachusetts
S -- - Department of Industrial Accidents
Myte 010YCSMSONS
600 Washington Street
1 Boston,Mass. 02111
Workers' Coen ensation Insurance Affidavit
Irif
IN
If
3.tne
)cation:.
itv ohone#
I am a homeowner performing all work myself.
T
I am a sole rc netor and have no one working in ca achy
I am an em'1 er providing workers' compensation for my employees working on this job.
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{.....
1
I WE
am a sole proprietor, general contractor, r homeowner 'rle one) and have hired the contractors listed below who
have
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�j
Faftue to secure coverage as regWnd under.Section 25A of MGL 152 can lead to the Imposition of erlmimal penalties of a fine up to 51 00.00 and/or
one yeah'tmprisonmmi as well as dvil penalties in the form of a STOP.WORK ORDER and a fine of 5100.00 a day against me. I understu d that a
copy of this statemeni may be forwarded to the Office of Investigations of the DIA for coverage verifieation.
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct
f
sigaatute Q c c-� 4`� — Date n
Print name Phone#1
ONE
oflldal use only do not writs in this area to be completed by city or town offidal
city or town- permit/license# [3Mding Department
❑Licensing Board
❑checkif immediate response is regmdmd ❑Selectmen's Office
C3Hea1th Department
contact person: phone#; ❑Other
Onned 9195 PIA)
i
qe
The Town of Barnstable .
Regulatory Services
Thomas F. Geiler, Director
Building Division
Peter F. DiMatteo, 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: _ ��d� JZr-,. Estimated Cost—
Address of Work: �)a wl'r-\ 7 L-L A, Je
Owner's Name:
Date of Application:
I hereby certify that: y
Registration is not required for the following reason(s):
OWork excluded by law
Job Under$1,000
OBuilding not owner-occupied
6wner pulling own permit
Notice is hereby given that:
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED
CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE
ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A.
SIGNED UNDER PENALTIES OF PERJURY
I hereby apply for a permit as the agent of the owner:
Date Contractor Name Registration No.
OR
q:forms:Affidav
:rev-122001
r
66 27 '95 -4 i :: i�Ff 9 CT iiI LL P_ TO P I ZZUT I P•.'.01
_ LOT 6
loo
� w
' LO 9 i - (cgLc�
6A
5. 0..
gip''
ZONE "RD-1" Th1s MORTGAGE INSPECTION Plan 11 or FLOOD ZUN� „C„
�� Use 0 I
� REP
�L4 /. _` ----- KEGISTRY OWNER, �i�,l �' �B ° ,FL--
�BY CERTIFY TO - --- -- ' PLAN P.EF:. 2d�13� _SCALE: _ n'— ���•
THE BUTLDING a4t� OF jia YAN K., E SURVEY
V ON THIS FLAN' IS LOCATED ON THE GROUND AS PALtii -CQNSt:I,'rANTS
�I AND THAT ITS POSITION DOES _ CONFORM
;E ZONING LAW SET$ACK MCQUIREMENTS OF THE cs ME-AtTMEW 40B (cvITE 1)
OF g� --------------AND THAT � No.�G�G Q INDUSTRk ROAD
LIE WITHIN THE SPECIAL FLOOD .HAZARD � � Eo RARMNS::Mt�iS, t�A• �o2eae
AS SHOWN ON THE H.U.D. MAP DATED_Z/_Z�__ ,Iyo ��STc TEL; `428 S. MA. 1
liniftr— �1 � 50001 OflIB .42D-5553
THIS AN NOT MADE FRO AN INST M�,NT
gCb� — SURVEY NOT TO SE USED FOR urMe-rO Vrr 181r�fJ :F
The Town of Barnstable
Regulatory Services
Thomas F. Geiler, Director
Building Division
Thomas Perry, Building Commissioner
200 Main Street,Hyannis MA 02601
Office:, 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
` Please Print
DATE: c,�yN_�J V. n� C
JOB LOCATION: L q J
number \ \ street ) village
"HOMEOWNER":
name c home phone# work phone#
CURRENT MAILING ADDRESS: J� �{� L qw E_
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:FORMS:EXEMPTN
I.
�G9Z�g
The Town of Barnstable
Department of Health Safety and Environmental Services
Mpy Building Division
367 Main Street,Hyannis,MA 02601
18-8624038
18-790-6230
PLAN REVIEW
1wner: . a�cAr Map/Parcel: �.Z-7 Ojr
-ojectAddress: s2, p)_Pjjj4L Builder: OWy416E
'he following items were noted on reviewing: `
cs�. b .J z'II i A.e. CMK 3(00q,3,-1a
eviewed by:
Lte: d L 1&A'63
Assessor's Office(1st floor) Map �Q Parcel l a �d
Conservation Office(4th floor)(8:30-9:30/1:00-2:00) 1 V . 4a-te IssuedeW
Board of Health(3rd floor)(8:15 9:30/'1:00-4:45) / i P .$ "? ( n
Engineering Dept:(3rd floor) House# 6{` ��;
iAa
NSUB
annmg Board 19 t ; "'3
TOWN OF BARNSTABLE' -- f
Building Permit Application
. ProjecTAddre;s
Villagy \ Q i
'Owner Address
,Telephone
Permit Request a o K 1
� A-)C
First Floor O square feet
square feet
Estimated Project Cost $
Zoning District U — / Flood Plain Water Protection
Cot Size Grandfathered ?
Zoning Board of Appeals Authorization Recorded
Current Use Proposed Use
Construction Type
Commercial Residential
Dwelling Type: Single Family Two Family Multi-Family
Age of Existing Structure Basement Type: Finished
Historic House Unfinished
Old King's Highway
Number of Baths No.of Bedrooms
Total Room Count(not including baths) First Floor
Heat Type and Fuel Central Air Fireplaces
Garage: Detached Other Detached Structures: Pool
Attached Barn
None Sheds
Other
Builder Information
Name Telephone Numbe
Address License#
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 DATE
BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S)
FOR OFFICIAL USE ONLY
PERMIT NO.
C:
DATE ISSUED , =
MAP/PARCEL NO.
9
ADDRESS i VILLAGE ,
OWNER
y
DATE OF INSPECTION:
FOUNDATION
FRAME ® r j
INSULATION
FIREPLACE
ELECTRICAL- ROUGH FINAL i
PLUMBING -.:. ROUGH FINAL - 'f
GAS: y ROUGH FINAL _
FINAL BUILDING
y
DATE CLOSED OUT 9� •� , f
ASSOCIATION PLAN-NO. } '
t
'HPU =_�_ f°if ii'li if li i TO F' 1- - - - - PIZZUTI ,01
LOT 6
8'
LOT
5A nit
5' o - -_--_--____- 6•�
HSE
j4. 85 (PLAN)
f?F'S 20NE• "RD-1" T1iis MORTC Ac C INSPECTION 111an iq For ^LODD 2UN6: C„
' L -, alI
r k Usr. Onl
DEED REfi: lL4, /�Q, _ "- --- i�!✓GISTt�Y OWNER; h��YNty
DA _d?L�2L�z---- --- ---- PLAN REF, 21�13 �_�'_��trT,Bd,_X�l'�'g_ -
i_EAaEEY CERTIFY TO ---_ ------•- ----
SCALE:
—__TIIAT 1HZ SUtt,pING QF �+ YANKEE SURVEY
3ROWN ON rjj[S KAN IS—LOCATED ON THE GROUND AS a�b� '�4�
:HOWN AND THAT ITS POSITION DOES CONFORM PALM CONSULTANTS
M THE ZONING LAW SETBACK RZQUIREMENTS OF THE t pq �;;a' �. 40D (SUITE 1)
GOWN OF aAe-VS.�48�----------- THpZ .
}•• __AND TI'.AT �� No. a?� �a�4� INDUS�'?��' ROA1�
:T DOES_i T _ LIE WITHIN THE SPECIAL FLOOD .HAZARD � MARSTONS. Mf1 LS, MA. ;02648
kREA AS SHOWN ON THE H.U.D. MAP DATED—�?f �,rs�o�Ecrsr.��°�� TEL' 428—O0;i5
7a — el � 50001 0016 a� ta�� ' 4.28-5553
W' ------- S'JRVPY NOT TO �E USED FOR rr%,c7'3 rTc IHI�tB iF'
_ THIS AN NOT MAD . FROM AN I\STRU
rc.
TOTAL P,01
• TOWN OF BARNSTABLE
BUILDING DEPARTMENT
HOMEOWNER LICENSE EXEMPTION
Please print. . ..
DATE
,/ JOB LOCATION
- Number Street address Section of town
/"HOMEOWNER
" ' r- �-
Name Home phone Work phone-
RESENT MAILING ADDRESS � 1�
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 in-
dividual for hire who does not possess a license, provided that the owner
acts as supervisor
DEFINITION OF HOMEOWNER:
Persons) 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 ith said procedures and requirements.
HOMEOWNER'S SIGNATURE -= --
APPROVAL OF BUILDING OFFICIAL
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 performing work for which a "Lilding
permit is required shall be exempt from the provisions of this section
(Section 109. 1. 1 - Licensing of Construction Supervisors) ; provided that .if
O
Home Owner engages a person (s)
for hire to do such work, that such Home wner
shall act as supervisor. "
Many Home Owners who 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 "Owner 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 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.
y -
. 'MAPLE AVE.
N 12-012'00uE 90,00
i
8
N
14 0' ' \
g
s1o���Qou w Z�r.53' m
j
sor's map and lot number .. .'.:...:. .:..I:..:,; s Q� �C �0-�3- •
4. .. f•
r
- � SEPTIC SYSTEM MUST BE
` INSTALLED IN COMPLIANCE
&�Permft number .....��l�:�y �.d.
.• i
"' '' /" ...............
"="" { WITH ARTICLE II STATE
SANITARY CO TOWN
7NETQ�� 'K TOW OF BAR 1S1TI
y� i B�H9TOIiE�. • a= � .
` "AS9 � �lt BU,,IL�DI,N.G INSPECTOR
.°' A*PLICAT169 FOR:PERMIT ,TO .:......: ./.1 ....T�J:..... ,0.,0W,4.. ..: ................................ .... .
13, TAPE OF CONSTRUCTION ... :................ .....................:...
a ' ? ••••••••` •....................
TO THE INSPECTOR OF. BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location .........�.. .....A" (,r LL=......5. ....:........1: . An4.:. ::.... . .........:................................
ProposedUse ............0 0.0d8.. .........................................................................
Zoning District .......Fire District .........:
Name of Owner .lY. ....Cd� ��� ,,......Address ....... .°.......
Name of Builder hIu:/.40. C...A1,C !`:.R..A.Al...........Address .(I�/�'`I ftl ../t&P..��,,....t'����". IT���.
Nameof Architect ..................................................................Address ....................................................................................
Numberof Rooms ..................................................................Foundation ..............................................................................
Exierior ....................................................................................Roofing ....................................................................................
Floors ......................................................................................Interior ....................................................................................
Heating ..................................................................................Plumbing ..................................................................................
Fireplace ...............Approximate Cost . off'
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.
NamelK��!(� �a?/L _%... ..........
bells Kenneth
aq
ermit for Kennet1r.0......be.1.1
.... Build Dormer
..... . .....................
Location............ C.ente.r.vi 1.1.e.
.. ........ . ...... . ..
.........................................................:.....................
Owner .........Kenneth..qV
. p!?!�..........
................ ............
uction Frame
Type of Constr .........................................
y
..................... .......
Plot ............................ Lot .........
Oct 3 77
Permit Granted ..........
Date of Inspection L77 0
............&19
Da4 Completed ....19
PERMIT REFUSED
......................... ............................... ...... 19 <
..........................................................................
.........................
....................... ................................
................... ...............................................
Approved ................................................ 19
.................................... ...... ..........................
. ................................... ...................... ...................
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ADDITION' ((
FRONT ELEVATION REAR ELEVATION �•E`
SCALE: 1/4" 1'-O' SCALE: 1/4" 1'-0'
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O LEDGER BOARDS ATTACHED TO EXISTING llF
SWEATWM W/PLC ADWESIVE AND J
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QALV. METAL OMGERS TYP. U — -
--- - �EXISTING� U
W W
SW PLTM'OD SWEATWING/1/2''MWM?4 UNDERLAY
RUBBER MWISRANE/FLOATING P.T. DECK/IL -7 DCISTIN6 _---_- --- 1JJ
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FOUNDATION LEFT ELEVATION
SCALE: I/4" � 1'-O"
-M: 0316
DRAWN BY: KW
DATE: 6/25/03
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JOB: 0316
DRAWN BY, KW
DATE: 6/25/03