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Regulatory Services Fee
9 1M" S, `ee'� Thomas F.Geiler,Direstor Ut
�ATf� Building Division �
Peter F.DIMatteo, Building Commissioner
367 Maier Street. Hyanzzis,MA 0260lw .
Office: 508-562-43 8
Fax: SOS-790-6230
EMPRESS PERINTIT APPLICATION - RESIDENTIAL ONLY
Not Valid without F."X-Puss lmprW
tap:parcel N. =ber 0
roperry Address t A Le
esidenria
Value ofwork `t 49
l
iwner's,N,=C&;ddress
:ontractor's Name
��! �. Telephone Number
Ipme improvement Ccnnacror license 4(if applicable) e�+
construction Supervisoi s License-(if applicable)
'S Cotn#ieasatien Insurance op��C 02
Check one: R 1515
blr=a sole proprietor MP
❑ I.am the iiomcon'er OF
❑ I have Nod='s Comaensation Insurance �00
asurance Company Name
Vorlanan's Comp.Policy.
)ermit Requcst(check box)
Re-roof(smppinz old shingies) +
❑Re-roof(not stripping Going over Cdsting layers ofroofl
Q Re-side-
❑ Replacement jt indo,%vs. U Value
Q Other(specif)
emp
li==with etha town dertn
pateat regulations.i.e.Historic.Conser�'ation.e:e.
*\VhcRM4uired: Issuaace of permit doa not ex t
Sienamrc
Q.Forms:exomrrs:ra-4)70601
The Town of Barnstable
9MASS �0$ Department of Health Safety and Environmental Services
t659.Eo r9" Building Division
367 Main Street,Hyannis MA 02601
Office: 508-862-4038 Ralph C—rossen
Fax: 508-790-6230 Building Commissioner
SHED REGISTRATION
�6ZiK)c.- Hlgc k)eA �Z
Location of shed(address)
�a 50 - `—7
Property owner's name Telephone number
�Sx r-2-
Size of Shed Map/Parcel#
Sign a t, I Date
Hyannis-Main Street Waterfront Historic District?
----6kHCng'rHighway Historic District Commission jurisdiction?
conservation Commission(signature required)
THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN
Q-forms-shedreg
I • .gar � �C` �i , � ,� � �
• . .%'„lam I � .I ► �_ ,J � i
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3roFKM lines shown on this PIM
elre e.
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Assessor's map and lot number ....1.................................... ' �j�./"G� '' �J� 7- 77
SEPTIC SYSTEM MIDST BE
INSTALLED IN COMPLIANCE
ag i Sewe=iPermit number '
�..; .. . .....7....,�.....:.......... WITH ARTICLE II STATE
t e
SANITARY CODE AND tbWN
I THETA f1 - TOWN OF BARNS �' ��'
i BASB 9TAIII;E, • �-.�.
h o pYa•�� = ' : BUILDIN-G } INSPECTOR
Ci iri ;7 .
C9 APPLICATION FOR .PERMIT TO .. ..s. ........................
TYPE OF CONSTRUCTION ..' +'' '' '-'"." r
i + . ..... ................1+9,.. ..
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a per it according to the.f IlWwgor ion:
Location ........... ..................... ....... ....... :. U.C �.t� ........ .................. . ................ ----�
ProposedUse ............0..........................................................:...:..........................................................................
r -
Zoning District ............ ... . ........... Fire District .........
Name of Owner .1........ .........................................................Address
............(!-2c..... ......�-A. ................................
Nameof Builder Address...........................G................................. ................. ...............................................................
Nameof Architect ..................................................................Address ....................................................................................
Numberof Rooms ..................................................................Foundation ..... ....................................................................
Exierior ....... .. ............... /. ..............................................Roofing ........... ......................................................................
� �
Interior ...... ..Floors ............:.................................................. .�� ..........................................................
,mac
Heating ...... r....(.(..4. ..............................................Plumbing �(�......
Fireplace ............ ..... ............................:....Approximate Cost..........' v
i................................. .....
Definitive Plan Approved by Planning Board -------------------_-----------19________ Area /Q� S
... ......... ... .. .........
Diagram of Lot and Building with Dimensions Fee Y6 ...........
SUBJECT TO APPROVAL OF BOARD OF HEALTH
40
l �
I hereby agree to conform to all the Rules and Regulations of the Town.of Barnstable re rding the above
construction.
Name .............................. .... ........................................
. Small.. Alan E... ` ~ .
' ��-
~^
^ ' ^�
N.^ r�5l1
one story o �:... Permit f6} .................................... .
_I_- ,
le family domm��^
.—.—.~---..'^`.—.—.—.------.-----
` =
i�nce' Blackley Road'
^"^.=. --^--.----.------..'---.-
CmzlesviIlm� _
` ---..—_---.----~—.—'--------.— .
-
Alan E. Small
K�vvnar ' °
` . '—.-----,--~--------.—, -
frame '
' Type of Construction ---
----. —.----..
� . .
_—..:.—~--.-~-..,--~...---------
-
'
Plot ..................... . Lo� ��0� '
. . —.. ----------..
.
' August 17 - 77
. Permit Gronte6"—. ---]P
~ . '
Date of | ----19
^
" Dote Completed '../ v--�--]g
.
i PERM0[^liEFUSED
( .
� � 19
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Approved
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