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TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map 2 J Parcel / Application #
Health Division Date Issued
Conservation Division Application Fee
Planning Dept. Permit Fee - a�
Date Definitive Plan Approved by Planning Board
Historic - OKH _ Preservation / Hyannis
Project Street Address a G I/ e 1:1) `✓�—
Village C e ✓ o l 1 �--
Owner Y11 A Y-H 4Vle- 4- Address c5'a�+ -e--
or
Telephone J '7, a '7
P rmit Request AJew &1b V-� , 'f �- Rio�'t - pti a o W o®c� ✓e,��: �C..`��
Permit �
F ,o y Gt ,J CoC!an T--�f•% L c�vl�'is� a d✓, Al e I—
Square feet: 1 st floor: existing o lYproposed 0 2nd floor: existing 0 proposed ® Total new -S4-1—V-'—
Zoning District Flood Plain Groundwater Overlay
Project Valuation _56 Construction Type 1,J®®a? ✓�-°^''�-
Lot Size 3 4 ``7 17�' Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family I" Two Family '❑ Multi-Family (# units)
Age of Existing Structure .3 0 y� Historic House: ❑Yes WC, On Old King's Highway: ❑Yes 2lo
C9'Basement Type: Full ❑ Crawl ❑Walkout ❑ Other
Basement Finished Area (sq.ft.) ® Basement Unfinished Area(sq.ft) L/ 3 9
Number of Baths: Full: existing 1-. new [3 Half: existing / new
Number of Bedrooms: existing _6new
Total Room Count (not including baths): existing new 0 First Floor Room Count
Heat Type and Fuel: L111"Gloas ❑ Oil I ❑ Electric ❑ Other
Central Air: Mg/Yes ❑ No Fireplaces: Existing i New Existing wood/coal stove: ❑Yes U!rNo
Detached garage xisting ❑ new size—Pool: ❑ existing ❑ new size — Barn: ❑ existing ❑ new size_
Attached garage: existing ❑ new size _Shed: ❑ existing ❑ new size _ Other:
Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑
Commercial ❑Yes YNeo If yes, site plan review#
Current Use TIA-il le [)Wed YS Proposed Use 1
w
APPLICANT INFORMATION
BUILDER OR HOMEOWNER
Name e i Telephone Number
Address 3 %"L f" s License # 0 y
a O JA, 4 `,/ A Home Improvement Contractor# / 71
Worker's Compensation # 6 6(0 6 6o 7.Z,O'V7A-E'/i
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
Jv_�000 15 C'.0'r. 4-
SIGNATURE DATE 1-0 7 �--
s
FOR OFFICIAL USE ONLY
APPLICATION#
r DATE ISSUED '
MAP/PARCEL NO.
ADDRESS VILLAGE
OWNER
DATE OF INSPECTION: ,
s
FOUNDATION
't FRAME _
INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL
{
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
FINAL BUILDING
c
DATE CLOSED OUT
'� ASSOCIATION PLAN NO.
`TME Ta,, Town o' f'Barnstable
Regulatory Services t
&UMSTABLE Thomas F.Geiler,Director ;
Mass.
9`b i65
9• •�� Buildin Division''Oren rrw'�° g
Tom Perry,Building Commissioner
200 Main Street,Hyannis,MA 02601 .
www.town barnstable.ma.us ,
Officer 508-862-4038
t Fax: 508-79076230
4 Pro e `Owner-Must `
,P rtY
E
Complete.and.Sign This Section.r
... 'w. : If USinL,ABuilder I _
I, /1/1 c.cis cz re tl1' N 13 as Owner of the subject property
a ,
hereby authorize. -� w,�.S" A vvl `ate to act on my behalf;
in all matters relative to work authorized by this,building permit application for.
(Address of Job)
Signature Owner D e'
Q, V f Q,V2,
Print Ny
If:Pro e Owrie`r is applying. for pem-it,please. complete the
T,
Homeowners.License Exemption'Form on the reverse side. "
SION
Q:FORMS;O VJNERPERMIS
�oFt T Town of Barnstable
P o Regulatory Services
snxrrsUBLF. : Thomas F.Geiler,Director
9Q, 39.
A.�� Building Division
� ArFD MA't
Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
Please Print
.Z
DATE: o f
JOB LOCATION: / J a� e., � :P f .a e.t/I e+/✓.' 1
number street village
"HOMEOWNER": /vl A r c.r-C ' /� o�A
name home phone# (o j''7 4;Z ®3or phone#
CURRENT MAILING ADDRESS: 3 S a C e w, ✓.J
city/town/o-year
state zip code
The current exemption for"homeo ers"wed t include owner-occupied dwellings of six units or less and
to allow homeowners to engage an' vidua w o does not possess a license,provided.that the owner acts as
supervisor.
DOF HOMEOWNER
Person(s)who owns a parcel of land on whicresides or intends to reside, on which there is, or is intended to
be, a one or two-family dwelling,attach d od structures accessory to such use and/or farm structures. A
person who constructs more than one ho a iyear period shall not be considered a homeowner. Such
"homeowner"shall submit to the Buildin O a form acceptable to the Building Official,that he/she shall beres onsible for all such work erformed unildin ermit. (Section 109.1.1)
,Y M
t i r • 4 r `
The undersigned"homeowner"assumes r sp nsibility for.compliance with the State Building Code and other
applicable codes,bylaws,rules and re atio.
The undersigned"homeowner"ce es that he/ e understands the Town of Barnstable Building Department
minimum inspection procedures requirement and that he/she will comply with said procedures and
requirements.
Signature of Homeowner ,
Approval of Building Official
Note: Three- ' y dwellings containing 35,000 cu is feet or larger will be required to comply with the
State Building Code ection 127.0 Construction Control. .
HOMEOWNER'S E TION
The Code sta. s that: "Any homeowner performing work for which a ilding permit is required shall be exempt from the provisions
of this section(Section 1 9.1.1-Licensing of construction Supervisors);provided th if the homeowner engages a person(s)for hire to do such
work,that such Homeo er shall act as supervisor."
Many home ers who use this exemption are unaware that they are assuming responsibilities of a supervisor(see Appendix Q,
Rules&Regulations or 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:forms:homeexempt
I '
Town Of Barnstable *Permit#
Expires 6 months from issue date
Regulatory Services _ Fee
_ r BARNSTABLE.
y MASS. g Thomas F.,Geiler,Director1639.
ATED MP't�
6 E I Building Division
RESSTom Perry, CBO,,Building Commissioner
D E C. 10 2009 200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 5br8 NQF BARNSTABLE Fax: 508-790-6230
EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY 1
Not Valid-without Red X-Press Imprint
Map/parcel Number
Property Address Ll r ei C ce wt 1 ,,.-V e
Residential Value of Work 0 C3 U • Minimum fee of$25.00 for work under$6000.00
Owner's Name&Address 111'� «�
Contractor's Name !ti WIC ' `�`�`� Telephone Number � '
Home Improvement Contractor License#(if applicable) T
Construction Supervisor's License#(if applicable) L`
❑Workman's Compensation Insurance
bhe k one:
I am a sole proprietor
❑ I am the Homeowner
[2'I have Worker's Compensation Insurance
Insurance Company Name -7,1"its jI_ fii'4
Workman'.s Comp.Policy# U 13 0 72
Copy of Insurance Compliance Certificate must accompany each permit.
Permit Request(check box)
❑ Re-roof(stripping old shingles) All construction debris will be taken to
❑Re-roof(not stripping: Going over existing layers of roof)
dRe-s'ide
#of doors
❑ Replacement Windows/doors/sliders.U-Value- (maximum .44)#df windows
*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&Construction Supervisors License is
required.
SIGNATURE:
Q:\WPFILES\FO \building permit forms EXPRESS.doc
Revised 0908.09..
n
THE Toh Town of Barnstable
Regulatory Services
BARNSPABLE, ' Thomas F. Geiler,Director
f�06. Building Division
Tom Perry,Building Commissioner
200 Maui 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
I, &121 , as Owner of the subject property
hereby a thorize to act on my behalf,
in all matters relative to work authorized by this building permit application for.
(Address of Job)
gn e of r D e
Print Mme
If Property Owner is applying for permit please complete the
Homeowners License Exemption Form on the reverse side.
Town of Barnstable
OF THE Tp�
o Regulatory Services
aaENsrwsi.E Thomas F.Geller,Director
Mass.
9�a 163g. a`�� Building Division
TFD MI�'1
Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508`790-6230
HOMEOWNER LICENSE EXEMPTION
Please Print
}
DATE:
JOB LOCATION:
NADDRF-SS.:
street village
"HOMEOWNER":
home phone# work one#
CURRENT MAILI
city/tow state zip code
The current exemption for"homeowners"was tended to include owner-occu-pied ellin s of six units or less and
to allow homeowners to engage an individual for 're who does not possess a licens ,provided that the owner acts as
supervisor.
DEFINITIO OF HOMEOWNER
Person(s)who owns a parcel of land on which he/she re 'des or intends to reside on which there is,or is intended to.
be, a one or two-family dwelling, attached or detached s tures accessory to s ch use and/or farm structures. A
person who constructs more than one home in a two-year pe 'od shall not be c nsidered a homeowner. Such
"homeowner"shall submit to the Building Official on a form a ceptable to Building Official,that he/she shall be
responsible for all such work performed under the buildin erm' . (Sectio 109.1.1)
The undersigned"homeowner"assumes responsibility for compliant w' the State Building Code and other
applicable codes,bylaws,rules and regulations.
The undersigned"homeowner"certifies that he/she understands e Town Barnstable Building Department
minimum inspection procedures and requirements and that be e will comp with said procedures and
requirements. d
Signature of Homeowner
Approva/bomeowne:rs
ding Official
: Three- dwellings containing 35,000 cubic feet or larger will be requir d to comply with the
State B Code Se on 127.0 Construction Control.
HOMEOWNER'S EXEMPTION
ode st s that: "Any homeowner performing work for which a building permit is required shall be xempt from the provisions
of this sect 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a p on(s)for hire to do such
work,thmeowner shall act as supervisor."
homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,
Rules& ons for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly
when thener hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed
Supervishomeowner 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 helshe 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:\WPFILFS\FORi\4S\bomeexempt.DOC
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€ S7REET ADDRM 1143'SA DMW
ASSESSORS-MAP 229 PARCEL_'105.
7ONN OF BARNSTABLE.ZONING
OWNER: MARGARET ABRAMS-
DEED REF: °BK. 20192 PG. 26
BY_LAW PLAN RE'f:: PL. BiC 198 P 47 LOT 4
ZONE : RD- 1
"REM .FRONT - 30' I M?7)FY THAT TO 7HE BEST OF MY PROFS IOIVAL
E = f0' KNOKED(� %NFFORMA77ON AND BELEF` 7HE DN�ELLING`
REAR = 10' SFIONN HEREON CONFOR US 70 7HEf HORYZUNTAL SETBACKS
OF THE ZONING 'BY—CAW FOUR THE 717WN OF BARNSTABLE
g
PROPERTY LMS SHONN HEREON
WERE COMPILED FROM AVAILABLE
PLANS OF RECORD AND";VERIRIED
ON •7NE GROUND.
PLOT PLAN
7HE DNELUNG DEPICTED ON,,MIS SHOWING PROPOSED ADDITION
PLAN WAS LOCA7ED ON 7HE WOUND. IN
BY (%RVE'Y ON SEPT.,Z 2011 AND
ENSTS AS SHOMV AS OF.7HE DA7F. BARNSTABLE, MASS.
OF LOCH 770N SCALE:' 1"=40' SEPT.. 8, 2011
THIS'PLAN IS FOR PLOT PLAN TERRY A. WARNER, P L.&
PUI4P0SES ONLY. 22 LONG ROAD
HARMN. MA. 02645
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