HomeMy WebLinkAbout0294 POPONESSETT ROAD Ac�
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TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
y Old
Map Parcel U Application # r 6
Health Division Date Issued rl
Conservation Division Application Fee
Planning Dept. Permit Fee aD
Date Definitive Plan Approved by Planning Board 0 d4l �-
Historic - OKH _ Preservation/ Hyannis P P-1 trsz
Project Street Address Fepo�SSeTT Roo.
Village
Owner 13,4f)?Rr &pe/' Address IS Lc
cas't'ef
Telephone 6'/7 16-no 0 979
Permit Request
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuation 3000.00 Construction Type rNoa(10
Lot Size Grandfathered: ❑Yes YC If yes, attach supporting documentation.
Dwelling Type: Single Family Two Family ❑ Multi-Family units)
Age of Existing Structure Historic House: ❑Yes l-No On Old King's Highway: ❑Yes Ulo
Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑Other
Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft)
Number of Baths: Full: existing_ new Half: existing new
Number of Bedrooms: °d` existing ' new
Total Room Count (not including baths): existing new First Floor Room Count
Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other -.a
�=,_
Central Air: ❑Yes OrNo Fireplaces: Existing New Existing wood/co-fJ stove: 0 Yes ') ISO
Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ ex stl' g ❑ ne tv s-_
CD
Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: '
Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ vd w
� m
Commercial ❑Yes I No If yes, site plan review#
Current Use Proposed Use
APPLICANT INFORMATION
(BUILDER OR HOMEOWNER)
Name P zxe4lol �a/� Telephone Number
Address f3Pi/% LA/1/P License # C S- /03y�9
Home Improvement Contractor#
Email EZ&AW 4T ey V,If Cc/l Worker's Compensation #
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 2Y&f2
SIGNATURE DATE
I
t
r
FOR OFFICIAL USE ONLY
APPLICATION #
DATE ISSUED
MAP/PARCEL NO.
ADDRESS VILLAGE
OWNER
DATE OF INSPECTION:
" FOUNDATION
FRAME
INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL
A
PLUMBING: ROUGH. FINAL
GAS: ROUGH FINAL
FINAL BUILDING
DATE CLOSED OUT
{ T..ASSOCIATION PLAN NO.
27ze Comntorriveakh of Massachusetts
Deparanewt ofrnihafJ'ial Acciderds
- - Of we OfI'Mfffig,af gm t
600 Washington Street
Bastoln,, MA 02111
}4'nw ruse govldia
i
Workers' Campensatian Insurance Affidavit.Bu ldersiCantractuirsJEIe,ctricians/P'Iu nbers
ApUlicant Inf6rmatian Please hint Legibly
Name 03usiwMf0Dr9aniMdGnflndivi&a1): PAW zArAlal /1" -- -
Address: yi9/�Plrt� L/I/YP
City/ tatel : 04 f Phone i
Are you an employer?Check the appropriate box.: ' Type of project(required):
1-❑ I am a employer uith 4. ❑I am a general contractor and I 6. ❑New constr tion
44 loyees(full andfor part-time).* have hired the sub-coa t actors
2.LJ I am a sole proprietor arpartaw- listed an the attached sleet. ?- ❑ o ff
ship and have no employees. These sub-cadrac#ors have 8.,❑Demolition
worldng, for me in any capacity_ employees and have wodcers' g. ❑Building addition
[No w-- rkers' comp,insurance, comp.inenranml
required-] 5- ❑ We are a corporation and its 14.❑Electrical repairs ax additions
3.❑ I am a homeowner doing all work officers have exercised their 11-❑Plumbing repairs or additions
m),sel€[No workers'gip- right of exemption per MGL : 121-1 Foofrepaim
insurance require&]T c.152,§1(41 and we have no, r
employees.[No worms' ;13-❑other RAzW
comp-insurance required_]
•AzEyappticmtdmtcheckshas9l also fill out the secdm below sbuwing their wortserecompensstion policy informaiim.
I Homeowners who submit ibis af5da l imdicmmg they are doing all wad and den hire outside contractors mass submit anew a$rdaest ind;rat ag such-
=Contractors It=check this bmc must attached an additional sheet showing the mime of the sub-contrwAo¢s and state whether or not those eofrties have
employees.Ifthesubtaatractorshace employees,theymmstgmvide their workers'comp.policy number.
I am an erltplopr that is prorddinig it�orkers'coitWmsatfaii iusrirauce for airy*¢nrplbywes Below is the policy and job site
friformatiort, t
Insurance Company Mine:
Policy,or Self-ins.Lic. g: E•pirat as Date:
Job Sits:Address: City/Statdzip:
Attach a copy of the workers'compensation<policy declaration page(showing the policy number.and expiration date).
Failure to secure coverage as required under Section 25A of MGL t. 152 can lead to the imposition of criminal penalties of a
fine up to$1,50aOD and.For one-yearimpnsonmmA as well as civil pen.akies.im the farm of a STOP WORK ORDERand a flare '
of up to$250-00 a day against the violator- Be adt+ised.that a copy of this statement maybe forwarded to the Office of
Irrvestigations of the DIA few insurance coverage verification-
.I do hereby CaWfy Rtdcrthe ins aardpenai'tfes-of pedWy thatthe fnformatimrpt viiiW aboiv is true acid correct
Si�ature: Date: -19t'lq
Phone
Official use oai£y: Do not write in this area,to be aruipl<eted by tat} ortown odreiaL
City or Town.: PermitlLkense#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.CitylTown Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
- -- --- - ---- - - - 6
-information and Instructions
hfaccachma is Geam-d Laws chapter 152 requires all employers to provide workers'compensation for their employees.
pursuant-to this statute,an.elnrployrz is defined as""_.evmTy person in the service of another under any contract of hire,
express or implied,oral or written_"
,An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the .
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than tb�apartments and who resides therein,or the occapant of the -
dwelling house of anodaer who employs persons t D do maim m c%contraction or repair.work on such dwelling house
or on the grounds or budding appurtenant therein shall not because of such employment be deemed to be an employer."
MCrL chapter 152,§25C(6)also states that"every stain or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance.coverage required."
Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter mto any contract for the perform"ame ofpublic work until acceptable evidence of compliance with the ins ce.
requirements of this chapter have been presented to the contracting aufhority." :
Applicants
Please fill out the woikers'compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contractor(s)name(s), address(es)and phone nomber(s) along with their certificate(s)of
;nc=nce. LinnitEd Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,are not mgamed to carry workers'compensation inn-ance. If an LLC or LLP does have
employees, a policy is required 13e advised that this affidavit maybe submitted to the Department of Industrial
Accidents for confrrmation of iis=ce coverage_ Also be sure to sign and date the affidavit The affidavit should
be retomed to the city or town that the application for the permit or license is being requested.,not the Department of
lodustrialAccidents. Should you have any questions regarding the law or if you are regr ed to obtain a workers'
compensation policy,please call the Department at the nunnber listed below. Self-insured companies should enter their
self-his r-a„ce license number an the appropriate line.
City or Town Officials
Please be sire that the affidavit is complete and primed legibly. The Department has provided a space at the bottom
of the affidavit for you to fM out in the event the Office,of Investigations has to contact you regarding the applicant
Please be sine to f ER in the peroaWlicense number which will be used as a reference nomber. In.addition, an applicant
that must submit multiple pennitllicense applitEdons in a3y given year,need only submit one affidavit iodic, current
policy information Cif necessary)and under"Job Site Address"the applicant should write"aIl locations in (crLy ar
town)-"A copy of the"affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for fJ=permits or licenses A new affidavit must be(died oit each
year.Where a home owner or citizen is obtaining a Icense or permit not related to any business or commercial venilse
(i.e. a dog license or permit to bum leaves etc.)said person is NOT requined to complete this affidavit
The Of of Investigations would lake to thank you is advunce for your cooperation and should you have any q �ons,
please do not hesitate to'give us a caI
The I?epmt ent's address,telephone and fax number_
The CammmWealttr of Massac„hus-ttfs ,
Dtpadment of li idugtial Aw9enta
�itee rxf�tve�g�tio�
�Q4 T�ashin�an�
Bastou.,MA G� I I I
` fI 4 617 727-4900 Qxt 406 or 1-9 MASSAF
Fax#617-727 7M
Revised 4-244 7 m �gQ�fcha
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. .. . .
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. ` .
A WC Guide lm'Womd Construction imHigh Wind Areas. Iy0mph. ZoneMassachusetts `
Chec0fi0t for Co ce(70CMR 5301.2.1'1)" �
check '
I SCOPE � . ` ' , . ' `~.p=n=
Wind ' `
11V '
YWndE�ooum{a�go�___-'__------__�'--'�.-_---_- ' mph
� __-
1.2 APPLICABILITY
Number ofStories
Roof Pitch ----
�
Mean Roof ----
Building VVkdth,VV __. ___.
Building Length,L �_
| Bunmmgmspe�maoo �l �-- S 3� ---'
| Nom�a|He�hxofT�|autOpwninQ^ --------_---__(Fig' 4)................................................. ---
� . ----- ----
1'3 FRAMING CONNECTIONS
General compliance with framing connections....................(Table 2)..........
............................................ .......
'
� 2.1 FOUNDATION
Foundation Walls meeting requirements of780CMR54041
Concrete.
ConcreteMasonry....................................................................________�______,____.__,__.
� �
� 2.2 ANCHORAGE
� TOFOWNDA8ON`-3
5/8^Anchor Bob imbedded m5/8'Proprietary Mechanical Anchors osonalternative in.concrete �
. 8p�
. Bolt Spacing ° .
^ B�E�e��-�m�o___.____--- --
Bolt Embedment-masonry......................................... ................................. ....- ---- ' �
Plate Washer...............................................................(FiQ5)..__--_----_.-_'--.�3-x:3rzV4' ---�
---- .
3.1 FLOORS ' ' ' .
R �ooran�ngmambaropanuohooked
Maximum Floor Opening Dimension................................... ............................. ft 512'orU2or ! '----
� Full Height Wall Studs at Floor Openings less thon2'hnm ExteriorWall(Fig 6).................. ................
__ ---
Maximum Floor Joist Setbacks
Supporting Loadbearing Wails u,3hoanwaU................Fig7>_-_...-_--_'-c---'-` ft Id
Maximum Cantilevered Floor Joists
.
or
'.or�~_-_' ~ -_-� _-_'_--.
Floor
Floor Sheathing /momeao-__-'-'--_'___.--_--_ ._--_.. ' in.
'
�uorshoa�mgFmsu��g---_--_--_------.(Tab�2)- 'dn��at � in edge ----
. .
4.1 WALLS
Wall Height
and .........................__'ft :51.0
~",Loa"""a"g,~^=.---_'--'---_---_--� and Table u)_--__'--- ft �27
WallStud Spacing -_-_--_�_-.--__--_ �dTa�e5V-_-_--' ��2��� ---
~oomoryunya� -_-_--_-.__...................(Figs 7&8).............._-.-...-._-_--____ft �� --_
� . �
4'2 EXTERIOR WALLS'
Wood Studs ^ �
Loodboohng walls........................................ ..............(Table 5)..............................2x ft in.
.~°,^"=,"e", �/ao�q_-__-���--.2)�__ nin.
Gable End Wall Bracing
� Full Height Endwall Studs�
` nn,rao�:m, Length - 11 ---- '
Gypsum cemngu�gmmvvop n� (F� 11 _--............... ,�aO.9VV ----
2x4 Continuous Lahera Brace @GfLo.c...(Fig 11)............................................................ ---' �
| � Double Top Plate
/ Splice Length ........ ---_-......
_'-_-_<F� 13 and Tub��q-_-'-_._-''_.-- ft
O�x�Conneo§on(no o[18d common na�)..............(Table o)...................-...'---�.....................___ ---- .
�
'
` � -
AWC Guide to Wood Construction in Nigh Irnd Areas:110 mph Wind Zone
Massachusetts Checklist for Compliance(7s0 CIMR 5301.2.1.1)1
Loadbearing Wall Connections
Lateral(no.of endnailed 16d common nails)..._.........jable 7)............................
..........................
Non-Loadbeadng Wall Connections —'
Lateral(no.ofendnaffed 16d common nails)...............(Table 8)........................................................
Load Bearing Wall Openings(record largest opening but check aff openings for compliance to Table 9)
HeaderSpans ........................................................(Table 9)...............................:.._ft_in.s 11'
SillPlate Spans ......_....................................-._.......(fable 9)...._..........................._ft_in.511'
Full Height Studs (no.of studs)...................................(Table 9)........................................................
Non-Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9)
HeaderSpans.............................................................(fable 9)................................._ft_In.51T
Sill Plate Spans................................
......................
.... able 9 _ft_in.512'
(T )..................................
Full Height Studs(no.of studs)....................................(fable 9)............................ ..........................
Exterior Wall Sheathing to Resist Uplift and Shear Simultaneously"
Minimum Building Dimension,W
Nominal Height of Tallest Openingz ..................................................................... .....
SheathingT .""
Type................_............................(note")......................................................
Edge Nall Spacing.........................................(fable 10 or note 4 if less)........................ in.
Field Nail Spacing..........................................(Table 10)................................................. in.
Shear Connection(no.-of 16d common nails)(Table 10)........................................................
Percent Full-Height Sheathing......................(Table 10)...................................................._%
5%Additional Sheathing for Wail with Opening>6'8'(Design Concepts).....................
Maximum Building Dimension,L
Nominal Height of Tallest OpeningZ.........................................................................
Sheathing Type................................_.......__.(note 4)..........................
Edge Nall Spacing....................__.................(Table 11 or note 4 if less)........................ In.
Field Nag Spacing..........................................(Table 11)................................ in. _
Shear Connection(no.of 16d common nails)(fable 11).................................................
Percent Full-Height Sheathing.......................(Table 11)..............................
5%Additional Sheathing for Wall with Opening>6'8'(Design Concepts).....................
Wall Cladding
Ratedfor Wind Speed?............._................................................ ...............................................................
5.1 ROOFS
Roof framing member spans checked?.......................(For Rafters use AWC Span Tool,see BBRS Website) _
Roof Overhang .................................................. (Figure 19)........... _ft 5 smaller of 2'or L/3
Truss or Rafter Connections at Loadbearing Walls
Proprietary Connectors
Uplift................................................(Table 12)............................................U= pif
Lateral................................ ..(Table 12)............................................. = Of
If
Shear..........................................._..(Table 12)............................................S= . plf
Ridge Strap Connections,If collar ties not used per page 21..... able 13 - pi
Gable Rake Outlooker...........:.............. . (T }.............................T= f
..............(Figure 20) ft s smaller Truss or Rafter Connections at Non-Loadbearing Walls of 2'or L2 —
Proprietary Connectors
Uplift...............................................(Table 14)..................................... .....U= lb.
Lateral(no.of 16d common!nails)...(Table 14)................................ ......1= lb.
Roof Sheathing Type.................:...:.............................(per 780 CMR Chapters 58 and 59)..................
RoofSheathing Thidmess................................_......................................................._in.a 7/16'WSP —
Roof Sheathing Fastening...........................................(Table 2)........._...................................._.........
Notes: —
1. This checklist must be met in its entirety,excluding the specific exception noted in 2,to comply with the requirements of
780 CMR 5301.21.1 item 1.if the checklist Is met in its entirety then the following metal straps and hold downs are not
required per the WFCM 110 mph Guide:
a. Steel Straps per Figure 5
b. 20 Gage Straps per Figure 11
c. Uplift Straps per Figure 14
d. All Straps per Figure 17
e. Comer Stud Hold Downs per Figure 18a
2. Exception:Opening heights of up to 8 it shall be permitted when 5%is added to the percent full-height sheathing
requirements shown in Tables 10 and 11.
3. The bottom sill plate In exterior walls shall be a minimum 2.in.nominal thickness.pressure treated#2-grade.
1
'4 WC Guide to Wood Construction in High Wind Areas: 110 mph Wind Zone
Massachusetts Checklist for Compliance(780CMR5301.2.1.l)'
4.
a. From Table 10 and location of wall sheathing and Building Aspect Ratio,determine Percent Full-Height
Sheathing requirements
b. Wood Structural Panels shall be minimum thicimess of 7/16'and be installed as follows:
i. Panels shall be installed with strength axis parallel to studs.
I All horizontal joints shall occur over and be nailed to framing.
MI. On single story construction,panels shall be attached to bottom plates and top member of the double
top plate.
iv. On two story construction,upper panels shall be attached to the top member of the upper double top
plate and to band joist at bottom of panel.Upper attachment of lower panel shall be made to band joist
and lower attachment made to lowest plate at first floor framing.
v. Horizontal nail spacing at double top plates,band joists,and girders shall be a double row of 8d .
staggered at 3 inches on center per the Figure, Vertical and Horizontal Nairng for Panel Attachment
AWC Guide to Wood Construction in High Wind Areas:110 mph Wind Zone
Massachusetts Checklist for Compliance(790 CMR 5301.2.1.1)'
-VWgM THIS EDGE REM ON
FFbUdM IWsd NAtS
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+ 11 11 +
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See D&Wl on Next Page
Vertical and Horizontal Nailing
for Panel Attachment
Town of Barnstable
Regulatory Services
MAMRichard V.Scab,Director.
Building Division.
Paul Roma,Balding Commissioner
200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 509-862-4038 Fax: 508-790-6230
Property Owner Must -
Complete and Sign This Section
If Using A Builder
4 /
l .
as Owner of the subject property F
hereby authorize // z9 /�6�l� to act on my behalf,
in all matters relative to work authorized by this building permit application for.
(Address of Job)
**Pool fences and alarm are the responsibility of the applicant Pools
are not to be filled or utilized before fence is installed and all final
inspections are performed and accepted.
R
+
Signature of Owner S' tore o pplicant
Print Name Print Nar6e
r .
2016
Date
QYORMS:OWI�RPIItMI ONPOOLS
I,`
Town of Barnstable
Regulatory Services j
J
Richard V.Scali,Director
Building Division
MASS. . ' Paul Roma,Building Commissioner
"9. ��� 200 Main Street, Hyannis,MA 02601
www.town.barnstabie.ma.us
Office: 508-862-403 8 Fax: 50&790-6230
HOMEOWNER LICENSE EXEIYIPTION
Please Print
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 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 P two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form
Y g
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 EXEN11MON
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
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.
Q:IWPFILES\FORMSIbuilding permit formslE3TRESS.doc
0620116
Massachusetts Department of Public Safety
Board of Building Regulations and Standards
Licenser CS-103429
Construction Supervisor
E.i::S
PAUL Z ROMA
'r.
P.O.BOX 142 f 5
COTUIT MA 02635 v
r—j,nK Expiration:
Commissioner 09/30/2017 '
_ •',%�e- �r'afriurorru.ecc�f�nfG�jrr..ur/ti<:;r(t�.
41 Office of Consumer Affairs&Business Regulation
—HOME IMPROVEMENT CONTRACTOR
egistraiion: 147262., Type: ,
hEx iraUon .-_6/23/2017 Individual ,
P.ZACHARY ROMA
PAUL ROMA
29 BAY BERRY LANE
COTUIT,MA 02635 Undersecretary
r '9i
i • - r ay,S����- -
.i?:4,;�•�:•••c-_"La's ,,�'._' �;2•i. ,.L
v
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
a ^
Map n 19 Parcel 0(o D Permit# ���� (COO
Health Division 0 60 j% Date Issued 0P-o(S. - P.
Conservation Division --�� j a Z ' �,
Fee
Tax Collector
Treasurer1C(�e, 11 - 2(,1- OZ SEPTIC SYSTEM p�►UST BE f
INSTALLED IN COMPLIANCE
Planning Dept. VWTH TITLE$
Date Definitive Plari Approved by Planning Board ENVIRONDENTAL CODE AWTOMI REGUUTIONS
Historic-OKH Preservation/Hyannis
Project Street Address a 94 10poo n e-ase t cad_
Village C0+61 l-
Owner (A h iam t 6arbar,L__-Roner Address 15 Lane- a al 4
Telephone
.Permit Request 'Rernode. e_il'A �S' wolI _gh1nAks cwa replace 1uL h°c�S�inG�s • �n,o�eccnA reo�
4wo C, kf, or•doors• �d emo op and reel Gnerhano *1 rn� haarras� �rno ye �d PenlCice hri cPnPn+
.�ylkhea CL
Square feet: 1 st floor: existing N�R proposed 2nd floor: existing m proposed Total new
Valuation Zoning District Flood Plain Groundwater Overlay
Construction Type
Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family Two Family Cl Multi-Family(#units)
Age of Existing Structure So lard Historic House: ❑Yes O No On Old King's Highway: ❑Yes ❑No
Basement Type: ❑ Full dcrawl ❑Walkout ❑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 new First Floor Room Count
Heat Type and Fuel: ❑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 �a
I
Attached garage:❑existing ❑new size Shed:❑existing ❑new, size Other: 4%
} '
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ ~Z
Commercial ❑Yes ❑No If yes,site plan review#
Current Use Proposed Use
BUILDER INFORMATION
- Name Telephone Number _ ,fin - 7Z>43,?V
Address (11 S)nkhorn Pv1n1' License#' 6/4-70�),
Mak_wP. At a 6,)- - Home Improvement Contractor# 16610
Worker's Compensation#
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO P1 na oSamC�L2 w�
SIGNATURE �-r 1� DATE //, zo
FOR OFFICIAL USE ONLY
i -t - - ,• -
PERMIT NO. "
DATE ISSUED i
MAP/PARCEUNO.
ADDRESS, VILLAGE
OWNER
DATE OF INSPECTION:
FOUNDATION
4
FRAME
INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL
S"� is •_ -
PLUMBING: ROUGHi FINAL
GAS: ROUGH 7"' t FINAL" ry`
FINAL BUILDING
I
DATE CLOSED OUT
ASSOCIATION PLAN NO. �''
OF
• The Town of Barnstable .
Ruvsze UL
MASS A�O� Regulatory Services
Thomas F. Geiler, Director
Building Division
Elbert Ulshoeffer, Building Commissioner
367 Main Street,Hyannis MA 02601
Office: 508-862-4038 Fax: 508-790-6230
Permit no.
Date
AFFIDAVIT
HOME IMPROVEMENT CONTRACTOR LAW
SUPPLEMENT TO PERMIT APPLICA11ON
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: 1�e_ � r �� "r l t�/ /�G� Estimated Cost
Address of Work:
Owner's Name: '�
Date of Application: �i D
I hereby certify that:
Registration is not required for the following reason(s):
❑Work excluded by law
FlJob Under$1,000
[]Building not owner-occupied
[]Owner 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
Date Owner's Name
q:forms:Affidav
•°� �.�_.__ The Commonwealth of Massachusetts
Department of Industrial Accidents
- ,, ~- _� . 0lflca ollmresll�atlo�s
_ — 600 Washington Street
_ Boston,Mass. 02111
Workers' Com em sation Insurance Affidavit
name: J ryl.Zs
�C 3�hone# I
❑ I am a homeowner performing all work myself t
I am a sole -tor and bane no one inn°a
am oyerP g ' tion for my
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BOARD of BUtL@IN6 REGULAI IONS
I = Ltc�se GO`MS•'FRUCTIOhk�I�PERUtSfJR '�
Niui ber CS':_ 0,14162
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MASHREE, 'MR 0264� ' gtlmfnRstrraYor
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Board of Building Regutatous and Standards
HOME Impik,/EMENT CONTRAdt,09
Regstrrartgn- �6
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-� ual
JAM S P.FfTZGf ( � U r
Ja'ts Fitzrald '
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Mas�pee,-fii1i�02�J A,�miit�strator 'M �' i
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RESIDENTIAL BUILDING PERMIT FEES
APPLICATION FEE
New Buildings,Additions $50.
Alterations/Renovations 25:00 -
Building Permit Amendment
FEE VALUE WORKSHEET
NEW LIVING SPACE
square feet x$96/sq.foot= x .0031=
plus from below(if applicable)
ALTERATIONS/RENOVATIONS OF EXISTING SPACE rj-
�"
square feet x$64/sq.foot= �a x.0031=
plus from below(if applicable) c
ACCESSORY STRUCTURE>120 sq.ft.
>120 sf-500 sf $35.00
>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=
(number)
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 Fee
t,( L
TON 6F BARNSTABLEM16 Y
pit 3: -5
3
Level �/�►�
p ro dVYA9144
TOWN OF BARNSTABLE
I I, I N
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