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¢ oFTNe r Town of Barnstable *Permitog/,50 .S�J
Expires 6 mo hs frolm issue ate
Regulatory Services Fee I
* anaxsTABM
9� 1MASS. Richard V.Scali,Director
prED MA't A
Building Division
Tom Perry,CBO,Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.bamstable.ma.us
Office: 508-862-4038' Fax: 508-790-6230
EXPRESS PERM PLICATIQN - RESIDENTIAL ONLY
Map/parcel Number
qqLavE' Not Valid without Red X-Press Imprint
Property Address .21:x - A .a,ae') C10Lr5-Orj l d ° --ejgj1&+/d4e-
Residential Value of Work$ j(.20 Minimum fee of$35.00 for work under$6000.00
Owner's Name&Address (j1!J )698-
Contractor's Name a A-, nskrr�-c Telephone Number �J'�D� Sg-5-1 Sy
Home Improvement Contractor License#(if applicable) fZZO GS— Email:
PRESSConstruction Supervisor's License#(if applicable) - _C$—d 7-7 5-0 to a
❑Workman's Compensation Insurance MAR 2 7 2015-
Check one:
❑ I am a Sole proprietor TOWN OF BARNSTABLE
❑ I am the Homeowner
�I have Worker's Compensation Insurance
Insurance Company Name D✓A/0 -'rns A41-e-rlc, �A/�IJ� ) C_1�4�t�c�0 c.KP60 4?-te 3q.
Workman's Comp.Policy# Z 14 0
Copy of Insurance Compliance Certificate must accompany each permit.
-
Permit Requ st(check box)
Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to 45 U d 1^n2
❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof)
❑ Re-side
❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#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,i.e.Historic,Conservation,etc.
***Note: x Property Owner must sign Property Owner Letter of Permission.
A copy of the Home Improvement Contractors License&Construction Supervisors License is
required.'
SIGNATURE:
Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc
Revised 061313
OFZHE rpm
�P ti
* anxxsz BLE,
�$ MASS.: ,0� 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: 508-790-6230
Property Owner Must
Complete and Sign This Section
If Using A Builder
as Owner of the subject property
hereby authorize i1�' /� - !7 A'l1�i�lfl to act on ray behalf,
in all matters relative to work authorized by this building permit application for:
(Address of Job)
Signature of Owner Date
Print Name
If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the
reverse side.
Q:\WPFILES\FORMS\building permit forms EXPRESS.doC
Revised 061313
I
Town of Barnstable
Regulatory Services
P�oFSHe roty,� Richard V.Scali,Director
°-^ Building Division
BARNSTABLE, " Tom Perry,Building Commissioner
9 MASS,
1639• 200 Main Street, Hyannis,MA 02601
ArFD �s www.town.barnstable.ma.us
r
Office: 508-862-403 8 Fax: 508-790-623 0
v
HOMEOWNER LICENSE EXEMPTION
DATE:
Please Print
-�';�•—��
JOB LOCATION: 7 &,&,,c e 1 (2 ,— d/vj Ld nel?4-4-dl���,
number / street village
••HOMEOWNER": 6 i ! K"e /EPE) -7 71—J V63 /'a t[ —V.3919
name 0orme phone'# work ph ne#
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.doe
Revised 061313
05"
Assessor's map' and lot inumber te. S STC
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,number ...... ............. .. ..... ..........
Sewage Permit .... ..... '- •• 1� I
013 TOWN OF . BARNSTABEE
�f^ Z •BJHBSTADLE,,. ,. � � � j a .
""` BUILDING ' INSPECTOR
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�E YPY h• r ';: � -
c .... ........... ............................
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APPLICATION•-FOR PERMIT TO .......................... .... ..:.. ..
TYPE OF CONSTRUCTION ...... .............................
DGD................. ................................... ................
„ I 1 :.................... l.s........19. .
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for anpermit according to the following information:
Location Lt�T '1 gG/l�Po (.F��SoN li/�
ProposedUse .................... .................................. ............................................................ . .............................................
Zoning District ....., 1........... ..........I......... ...Fire District ....`..... ..........................................:.:Name of Owner ... 1. .. .:..
....t..... . ................Address ... ... .....�C.R.c.h.�.�....1:.�.
��. �:.:�.�/./
Name of Builder ........>.�4 .Address...................................... ..�,. ......................................:...............
Nameof Architect .............d...............................................Address .................................................:..................................
Numberof Rooms ..............r(..................................................Foundation ..........:...................................................................
Exterior ....................................................................................Roofing ....................................................................................
_ r
Floors ......Interior•. ...................................................
Heating ..................................................................................Plumbing ............ .................
Fireplace ................................................. .............................Approximate Cost .....1.......v...................................................
(; �
Definitive Plan Approved by Planning Board ________________________________19________. Area .x...6.......�.....�.....
Diagram of Lot and Building with Dimensions
Fee .. ........................ ...........
SUBJECT TO APPROVAL OF BOARD OF HEALTH
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0136CHEI, C04SON z_,9
I hereby a ree to conform to all the Rules and Regulations of the Town of Barns ble regarding the above
construction.
Namei ....
Richard A. Seronick 190 205
No.1829 ,•,, -Permit for .-.Add3t.i..an--4-Deck•)
. ..... ..,.^.�'-.�......... . ......................................... • ..
Location 2.2..Rack,e
Centervill ...........................
I • ......................
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Owner ......... ...............
Type of Construction ......Aqood....:.....................
...................`................................ ...................
Plot ...................... Lot ................................
• 1
Permit Granted Aril
Date of Inspection
Date Completed ,1 ......19 _
`PERMIT`REFUSED
............... ........................................ 19
................... .......... ............................. `z
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h.: • • Ill
........................._.. ................................................. F
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Approved ............................................ 19
............................................................................... . -
Ass r's map and lot number ....�.:.1 ................ .....
rSEPTIC SYST fl OUST BE
j_ [INSTALLED IN. A10CE
Sewage Permit ,number .........X�.............. WITH ARTICLE 11 STATIC
S�1R1T Y CO 1
Prof -NETo�y _., TOWN OF BARNS
.....I
i E9SH9TSDLE, i F
MASS.
BUILDING INSPECTOR
APPLICATION FOR PERMIT TO .k �: /. .... ................................. ................................................
TYPE OF CONSTRUCTION ............. ...................... ..... .... ........................... ............ .
......... .. . ........19..2/k--"
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following, information:
Location ........ .... ............................................................
ProposedUse .... .... .. .. ..............................................................................................
Cj
ZoningDistrict ........................................... ..........................Fire District ..............................................................................
Name of Owner... ............Address ......
� c
Name of Builder .P ..... .............................Address ........................................................
Nameof Architect ..................................................................Address ....................................................................................
Number of Roos ....... .......�.......................................Foundation ........G��:�� .........................................
........ .. .
Exterior .. ... ................ .....................:..................................Roofing .:...:
......................................................................Interior .�f.. lr�Floors �,..... ..... :...............................
.......... ....
r
Heating .... .............................................................Plumbing ........ `.. .................................................
Fireplace ;/Y .rannWing
........................................Approximate Cost ........�4-,/...............................................
Definitive Plan Approved by Board ________________________________19________, Area .....l..oK.. c. ......�r. ...
Diagram of Lot and Building with Dimensions Fee / / n�
SUBJECT TO APPROVAL OF BOARD OF HEALTH
l�
I hereby agree to conform to all the Rules and Regulations of the Town of B7.1
e rega ding the above
construction. ...... .............. '
�
'8 all, Alan E.
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.......... . ......................... .
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Owner�- .___.�lao_8�_8m��ll/________.
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^ Type, .........fram�-------'
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. Plot ------'`-_ �� ___.#47___`__
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May 9 75 '
Permit Granted ........................................lV
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Date of | -------19 '
Date Completed
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PERMIT REFUSED
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