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Town of Barnstable 4- ermit#
F'Pires 6 months&om issue date
Regulatory Services Fee
ammirmiLL : Thomas F.Geiler,Director
MASS. .
�a�� Building Division ,. b
Tom Perry,CBO, Building Commissioner
- 200 Main Street,Hyannis,MA 02601
www.town.bamstable.ma.us �i (O/�/ IVJ1rr
Office: 508-862-4038 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
Not Valid without Red X-Press Imprint
Map/parcel Number /^ V
Property Address 7 i 1 I$� �Q ��. {�Q i ( 1.C'n+e,r 1/1
Residential Value of Work 0 Minimum fee of$25.00 formork under$6000.00
Owner's Name&Address L LS" A S
0 (o N 6L 0 a.IC. i C?n�Krvi II e
Contractor's Name I•L• I4 IT0I Ud L C(�(JSI(C'ocT I D Telephone Number a 9 - -5`77(j3
Ho e Improvement Contractor License#(if applicable) 15�5
Workman's Compensation Insurance
Check one:
F/]
a sole proprietor -PSS PER IT
the Homeowner
e Worker's Comp sation Insurance S E P Q 2008
Insurance Company Name
Workman'sCom P Policy# +Z7-3b ARNSTA
Copy of Insurance Compliance Certificate must be on file.
Permit Request(check box)
g'Re-roof(stripping old shingles) All construction debris will be taken to
❑Re-roof(not stripping. Going over existing layers of roof)
❑ Re-side
❑ Replacement Windows/doors/sliders.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.
A.copy of the Home Improvement Contractors License is required.
SIGNATURE:
Q Torms:buildingpermits/express
Revised U3107
4
MAM A� Town of Barnstable
k Regulatory Services
Thomas F.Geiler,Director
Building Division
Tom 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 roect subject bl property,
hereby authorize IqD"'*PCAC,06
to act on my behalf,
in all matters relative to work authorized by this building permit application for.
7/2�
(Address of Job)'
Signature of Owner
Date ,
Print Name
Q:Fonm:expmtrg
ReviN071405 +
r, Engineering Dept. (3rd floor) Map / Parcel G'�{ � Permit# / 3
r House# Date Issued
_,,�oard of Health(3rd floor)(8:15 9:30/1:00-4:30) ` , e/ �, FF: q O
conservation Office(4th floor)(8:30- 9:30/ 1:00-2:00) irlC-P5� 4
-01-17"pNvea vy Planning 19
• �� A�ARNST49LE.
> AMASS.-,, P
TOWN OF BARNSTABLE
Building Permit Application
f i it
Project Street Address
Village
Owner 1�11��: Address
Q �.^
" Telephone •
Permit Request .
First Floor o I S square feet Second Floor square feet
Construction Type
Estimated Project Cost $ a�-C�, D 0
Zoning District Flood Plain Water Protection
Lot Size a Grandfathered ❑Yes XNo
Dwelling Type: Single Family J Two Family ❑ Multi-Family(#units)
Age of Existing Structure AO U9,S Historic House ❑Yes Po On Old King's Highway ❑Yes iNo
Basement Type: `Full ❑Crawl ❑Walkout ❑Other
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) ( S
Number of Baths: Full: ExistingNew Half: Existing
New
� g
No. of Bedrooms: Existing New
Total Room Count(not including baths): Existing New First Floor Room Count
Heat Type and Fuel: *as ❑Oil ❑Electric ❑Other
Central Air ❑Yes 0 Fireplaces: Existing INew Existing wood/coal stove ❑Yes XNO
Garage: ❑Detached((size) Other Detached Structures: ❑Pool(size)
*Attached(size) LABarn(size)
❑None ❑Shed(size)
❑Other(size)
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial ❑Yes 1No If yes, site plan review#
Current Use 1Q j Q (� Proposed Use
/ Builder Information
Name Telephone Number
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• 4DATE CP
BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) -
r
r FOR OFFICIAL USE ONLY
PERMIT NO. (�f- 1 �'•
b:
DATE ISSUED
MAP/PARCEL NO. -
? A
ADDRESS VILLAGE-� ,•' �- i -�
r OWNER
DATE OF INSPECTION:
FOUNDATION
FRAME
INSULATION R`7
FIREPLACE :
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
FINAL BUILDING
DATE CLOSED OUT r
ASSOCIATION PLAN NO.
'1
• TOWN OF BARNSTABLE
• BUILDING DEPARTMENT
HOMEOWNER LICENSE EXEMPTION
Please print.
DATE -
JOB. LOCATION ® W I �✓ ` I IC
Number Street address r Section of _town
"HOMEOWNER" S
� TeSM -S p ,
Name ome pho ork phone
PRESENT MAILING ADDRESS .SY�9 �� bo
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:
Person(s)- 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 comp y with s id proced res and equ'rementS.
1.
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 O M 'S EXEMPTION
The e- de state that: "A Home Owner rforming ork for which a building
permit ' s required shall b exempt from a pro isions of this section
(Section 109. 1. 1 - Licensin of Construct' S pervisors) ;.., provided that if
Home Ow engages a persons for hire to d such work,. 'that 'such,Home Owner
shall act s supervisor. "
Many Home `0 ers who ruse this t exem ion., e, unawa ythat they are assuming
the resp`onsi 'pities. o'f a supervisor (s a Appendix Rules and Regulations
for licensing onstruction Supervisor Section 2. 15 This lack of awarenes
often results i serious problems, rti ularly when t e Home Owner hires
unlicensed perso In this case ur, Boa tcannot, proc ' d' against the
inlicensed,;person it would-w' h licensed. u ervisor.
as supervisor is ul 'matel y r ponsible p he Home Owner actin
. _
To ensure that the Hom er is' fully�aware
`of his/her resp sibilities man
communities require, art of the permit applica� on, that a Home Owner
certify that he/she- unde stands the responsibilities of a supe isor. On the
last page of this issue is a form currently used by se oral town You may
care to amend and adopt such a form/certification for use, in your community.
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THE tO�y TOWN OF BARNSTABLE
BABHSTADLS, i
"6
p ppY 9 BUILDING INSPECTOR
'E a•
APPLICATION FOR PERMIT TO
TYPE OF CONSTRUCTION
!PNl.............................., '............ ........................
5 ...................19 .y°1.
TO THE INSPECTOR OF BUILDINGS:
The°undersigned hereby applies-for a permit according to the following information:
Location ..r.�i..Q. ...a.. . ��.4`.�..N1.f�`�Sr...............
ProposedUse .....i0.W.�..'.1'...)&a..................................................................................................................................
Zoning District ... .....::(/ /sl`r�cT — ..........Fire District
Name of Owner ., �./VI ..�. TO-171 AII .........Address ..r�....8 .......................................
Name of Builder /�
.. ....f . 3U.1/.4:...............Address ....................................................................................
Nameof Architect .....,r .O..!V .............................................Address ............................................................................
Number of Rooms yer... rr
............................................Foundation .... ...........
ExteriorY�........Roofing ..........................
0 h' F L 0 D lR S C; r
Floors -... - .. .................Interior ....ZA......
...W.f . ........................................
__Heating__ :� �. ...,....Q. ... 5......... ...::....................Plumbing .....C. ?. "...... � ...:'r..... .....
y..
Fireplace ...... ..............................................................Approximate Cost ... ... �.. .�.Q ..�?
.....................
� -7-'%fe j_
Difinitive Plan Approved by Planning Board --------------------------------19-------- , f
Diagram of Lot and Building with Dimensions
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I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
• r
Nam .. .11?
OY7
Johnston, Elmer L.
�95... Permit for one story
single, family.dwell ng-garag,Q,....
. p.T(' ST/pP
Location�.�1 , d..White,.4ak...TxA l...................
...........................Centerv„, ,�.. ....:.......................
t
Owner ................Elmer.,L,,,,JQhnstgn,,,,,,,,,,,,,, s
Type of Construction ..........frame..................... -
................................................................................ u
t
Plot ............................ Lot ...........#24...............
Permit Granted ......December 9,.....:.....19 69 I
Date of Inspection 19 70.
Date Completed ......................................19
I
PERMIT REFUSED,
....... 19 j
...............................................................................
............ .: y
............................................................................... I
............................................................................... t�
Approved
...............................................................................
...............................................................................