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QF1HE Tp Town of Barnstable *Permit#
P� r r ti Expires 6 months from issue date
` p 2008, Regulatory_ Services Fee
57ABLE, •.
��Arfo39- , ���� Thomas F. Geiler, Director (l`](L(lG�
A
Building Division
Tom Perry, CBO, Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.barhstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY
Not Valid without Red X-Press Imprint
Map/parcel Number _ �C)�
Property Address _ ���� �
f Residential Value of Work b.: C � Minimum fee of$25.00 for work under$6000.00
Owner's Name �:.Address •& ,GQ, (�
Contractor's Name nn Telephone Number
I lome Improver-entContractor License#(if applicable)__
Construction Supervisor's License# (if applicable)
❑Workman's Compensation Insurance
Check cne:
1 am a,sole proprietor
❑ I'am.the Homeowner
❑ I have Worker's'Compensation.Insurance
Insurance Company-Name
Workman's Comp. Policy#
Copy of Insurance Compliance Certificate must be on tile.
Permit Request(check box)-
X Re-roof(stripping old shingles)All construction debris will be taken to G-rilr-d -4ay WQ. t�
❑ Re-roof(not stripping. Going over existing layers of roof)
❑ Re-side
❑ Replacement Windows/doors/sliders: U-Value i(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.
A copy of the Home Improvement Contractors License is required.
S1c,NATUar::
Q:'WNFII..F.S`- ORMS'huilding permit torms\EXPRESS.doc
Revised 100608
R
IHEr � Town of Barnstable
Regulatory Services
• awarrsresc E
y g, Thomas F. Geiler,Director
i639 ��
Building Division
Tom Perry,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
r, f nc►Q XO (2.j2�rC_e, F't , as Owner of the subject property '
hereby authorize GAS eA S Lo%W�, to act on my behalf,
in all matters relative to work authorized by this building permit application for
e&
(Address of Job)
Signa of Owne nate
C 04 a__
Print NV me
If Property Owner is applying for permit please complete the
Homeowners License Exemption Form on the reverse side.
n-rnv e.rc•ncIMMV ocv'Alt rccInv
y�P�oF�H�E r��T
Town of Barnstable
Regulatory Services
SAMSTABL.E Thomas F.Geiler,Directo
MAISM
t639. '.�� Building Division
'OrFn raa'�" .
Tom Perry,Building Commissilner
200 Main Street; Hyannis,MA 02601
vc'ww.town.barnstable.ma.us
d
Office: 508-862-4038 f Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
Please Print j
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 extend to inc/de owner-occupied dwellings of six units or less-and
to allow homeowners to engage an individual for hire o do s not possess a license,provided that the owner acts as
supervisor.
DEFINITION O OMEOWNER
Person(s)who owns a parcel of land on which he/she resid or intends to reside,on which there is, or is intended to
be, a one or two-family dwelling,attached or detached s es accessory to such use and/or farm structures. A
person who constructs more than one home in a two-year erio shall not be considered a homeowner. Such
"-homeowner"shall submit to the Building Official on a rm acc table to the Building Official,that he/she shall be
responsible for all such work perfor=d under the bail R permit. Section 109.1.1)
The undersigned"homeowner"assumes responsibili for.compliance 'th the State Building Code and other
applicable codes,bylaws,rules and regulations.
The undersigned.."homeowner"certifiesthat he/sh understands the Town o . arnstable.Building Department
minimum inspection procedures and requiremen and that he/she will comply with said procedures and
requirements.
Signature of Homeowner
Approval of Building Official
Note: Three-family dwellings retaining 35,000 cubic feet or larger will be req ed to comply with the
State Building Code Section 127.0 Co traction Control.
HOMEOWNER'S EXEMPTION
The Code states that; "Any,ho owner performing work for which a building permit is required shall.besexempt 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 supeMsor(see Appendix Q,
Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in senous.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
I M Assessor's map and lot number
oZ 3
....................................
......... i. �Qi THE
' Tp�♦
Sewage Permit number .. .., ....... ............... e�P
/ �.�..
Z EARNSTAXI, i
House number �� � :.. 9� MAB6
............................. p 1639. e00
O YPY a\
TOWN OF BARNSTABLE
BUILDING INSPECTOR
Sm. ..APPLICATION FOR PERMIT TO ...C�C� ��K.l��l r�.. .
r� ....... .......................................
TYPE OF CONSTRUCTION /. �{.
/ ,
..................1�...Q` ........19........
TO THE INSPECTOR OF BUILDINGS: 1
The undersigned hereby applies for a perm/it according to/the, following einrmation:Location .. . ./...........00........�!:.l.idq/.....4-�. I— �.�1..��.f��/S•I.I.�J .............................
e-7— r
ProposedUse ..... ... /.f...... .............................................................................................................
Zoning District .... . ....... ............................. ...Fire District
Name of Owner .... lf' z'1... C. i�.... �.i� ....Address ?.:.Cr.... ...1..
Nameof Builder .................. .................................Address ....................................................................................
Nameof Architect .............................................._....................Address ........................................ ...........................................
Number of Rooms ..... ..................................... ................Foundation ..... .�rS.�(� ..... .... ✓Lim .
Exterior ..... /5.P3%ofing f.S.G.l� ...............
Floors 4!.f°. .. r... .. !� .. ...................Interior ...... .. e.��. ..�� ...............................
-- ,[� Imo.,
Heating .....F..... ../..L........ ....����. .................Plumbing ......a....!-�^.. ... ..........................................
Fireplace r--
p �.OK.......� ........................................Approximate. Cost ....... ..�.C?..U.................................
Definitive Plan Approved by Planning Board _________3/-<� r '
-------19 ��. Area .. ... ......... ..........
Diagram of Lot and Building with Dimensions Fee /� .
i
SUBJECT TO APPROVAL OF BOARD OF HEALTH
C4
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the Rules and Regulations of the Town /ofBrnstable regarding the above
construction.
Name .... .. .... 0
Construction Supervisor's License ........
-197,EENBRIER CORP.
Ij No Permit for ...........Story.........................
Single family Dwelling
.................................................................
ILot 25, 86 Whidah Way Location Centerville
......................................................I............
Owner
Greenbrier Corp.
.....................: Frame..........'......
JN
Type,of Construction ..........................................
................................................................................
Plot ............................. Lot ................ ..........
Permit Granted ... ......f9 85
Date of Inspection .......................... 19
Ij Date Completed ............199*
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Of CERTIFIED CERTIFIED PLOT PLAN
38ERT `yam L.� T D,� Al w/1
ELDR DGE s
'NO. 1936Z o IN
k x 7 'r t }. 1.(+ Y +1.,p.{:+ d h 9 c 4'•�L`.LW�n-� V
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'f SCALE$ P .40 DATE 's ca',.s".
CERTIFY THAT T E4 Al
T: E RED SHOWN ON THIS PLAN IS LOCATED
sa
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. .,....�.�. ON , THE GROUND AS INDICATED AND
ft� JOOViLs A,
.,CONFORMS TO THE ZONIN®. LAWS. -
x, Y t E8�G1l�EER > UR� ORu° >Y' :; OF QARN�TSGLE b1A�8
},zc /� `¢,t�' . . .
T 12 AAA NY1�'>r R;E E T=u `,` , 1' T? ,.- ���
` . IiY�1:NlolS� If �IS . a' 1 , T;, pi�t :!,q, : fiE RE®. LAND SURVEYOR
s'rM-:,fir �_.,� .. .._ .. '�. +..i^4;:""f•i"� J _... .. j'Ff:r} s -:;yntT`s'as. vA� _.a.;� .`„�:�..a,.,,�' .,,, L5u'+"� .x
•> TOWN OF..BARNSTABLE- Permit No. -_--- `_�776
. . .
- - ----------
b �.
}a�n� `;: Building.,Inspector cash
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amn -- —
OCCUPANCY'�PERMIT Bond -----_----x---
_�
Issued to Greenbrier Corp. Address
lot #25 86 Whidah Way`";Centerville ..-
Wiring Inspector �!j i Inspection date �a
Plumbing Inspector, Inspection date
Gas Inspector dfl`Q F + 7 1 Inspection date %e
/nit f7itm.r
En ineerin Department— �; � �!'`.1 -�- Inspection dateyelF
Board of Health �TM yyV��j �� �yy„�-I � Inspection date / ��t,
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 AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE
BUILDING CODE:
.........................................-* .......... 19 s .........�r......�._.... � �
...........�_. _
Building Inspector
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