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Town of Barnstable Permit: C �
Regulatory Services
D
il G
Thomas F
of
ate: cZ l �S 113
7He T°ts, F. eer, Director
do � Building Division ee:. . 3.�
Tom Perry,�Building Commissioner
i839' ��� 200 Main Street, Hyannis, MA 02601
'gpD MPy�
www.to wn.barnst a ble.ma,us _
Office: 508-862-4038
TOWN OF BARN,STA..BLE Fax: sos-�9o-6230
Q ID FUEL STOVE PERIYIIT
Owner. Phone: '�
�, -��`- 0
Install at: ` k e �Rd
Village:✓ ��'u/ L(� MIA
Map/Parcel: 70 Date:
Sto�ew
e
A. Used B. Type: Radiant/ irculat'
C. Manufacturer: \Ae®,,Y � Lab. No. $ `
D. Model No.' nip� CA
Chimney ..
A. New Existin ff existing, please note date o \ o
. last clean r u:..f anin' �- ,
B. Flue.Size � �Ja�-vim �tZ.-c`�1�
C. Are other appliances attached to Flue? ,.,
D. Pre-fab Type and M ufacturer u Z �
E. Masonry.: - � eg'Unlined '.
Hearth can
A. Materials: C'k
B. Sub Floor Construction: O+�C�t e�-�Z� rn
Installer
Name:— �� Address: F
Phone:
Location of Installation:
H.I.0 Registration#
Construction Supervisor#
OR check—Homeowner Installing, no license required.
APPLICANTS SIGNATURE
APPROVED BY: �.
Please make checks Payable to the Town o Barnstable
- *This constitutes an.offrcial stove permit after inspection,photographed, and approved b the .
- - Building inspector. Y '
i
i
T'he Com,?iioxwearth.oflYlassachusetts ,
Department oflndustriaZAccidenfs
Office ofh'cvestiaQations
- ' d 600 W ash ington,Street
` Bosun,MA 02111'
' wwv.mass.gov/dia
Workers}Compensation Insurance Affidavit: Builders/Contractors/Electridans/Plumbers
A licaut laformation Please Print I,e 1
Name(Business/organizalion/lndividnal):
Address:4tAIA d (,(( _n
`City/State/Zip: (J(1 ��(�( L NPhoneW. /
'Are you an employer? Check the appropriate.box: :Type of proj7edred):.
1.❑ I mn a employer with 4. ❑ I am a gemeral contractor and I ti, []New c .er aployees (full and/or parttime).* have hired the su-contractors2.❑ I am a'sole proprietor or partner- listed on the'attached sheet 7. 0 Remoship and have no.employees These sub-contractors have
8. ❑Demolivozldng for me m any capacity. employees and have wviicers' 9, Buildm[No workers' comp. incnrancr comp. insurance.$' ❑quired] • We are a corporation and its 10.[]Electrior additions'3. 6 am a homeowner do all•work. officers have exercised their• 11.❑Phmbior additions
myself [No workers'comp, right df exemption per MGL
insurance required.]t ' � c. 152, §1(4), and we have no 12,0 Roof repairs
employees. [No workers' 13.❑Other -
comp,insurance regdired.]
*Any applicant that checks box#1 must also fill out the section below showing then workars'compensation policy in�.
t T3omeowners•who submit this affidavit indicating they are doing an work and then hire outside contractors must submit anew afdavit indiratinggsuch,
tCantractors that check this box must attached an additional sheet showing the name of the yub-contractors si d state whether ornotthose entities have
emplayees. If the sub-contractors have employees,they must provide then-workers'camp.policy number. ,
I arri an employer that is providing Wrkers'compensation insurance for my employees Bela olicy and job site'
information.
Insurance CompanyNa�ne:
Policy#or Self-ins.Lic.;r: Expiation Date:
lob Site Address: City/Statemp:
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 c, 152 can lead to the imposition of criminal penalties of a
fine tip to$1,500.00 and/or one-year hnpns on nm� as well as civil penalties in the forest of a•STOP WORg;ORDER and a fine
of up to$250.'00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the-Office of•
Imvestigatims of the DIA for inn mnce coverage verification. '
I'do hereby c rh;jy lender thepaiW-,and enaltses ofperjuTy that the information p o xded above is ue and correct.
Official-Use Only. Do not write in this aTeq to be completed by city m town a ci¢L
city or Town: �ermit/License#
' Issuing Authority(circle one):
�-OFTHE Tqw Town of Barnstable
Regulatory Services
awarrsras[E Thomas F.Geiler,Director
MASS9^ 1 ,e$ - -
'°rfnl9'tA 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
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE:
JOB LOCATION: ;q&kh P`L4 C'r
number 7}� street `/h r�village
..HOMEOWNER": x 5 0� k2® I �/ � J I1" J
name home �l�
hone#
p work phone#
CURRENT MAILING ADDRESS:
Atrn 6A/t mas5 nb
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,.0
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
I
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:forms:homeexempt
j4.
s
THE Town of Barnstable
Regulatory Services
Thomas F.Geiler,Director
iOTEn19.ra`m 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
•
1
Property Owner Must
Complete and Sign This Section
If Using A Builder '
f
L o�—d— 6111)U-4 , as-Owner of the subject property
hereby authorize act on my behalf,
in all matters relative to work.authorized by this building permit.
(Address of Job)
**Pool fences and alarms 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.
Signature of Owner Signature of Applicant
Print Name Print Name
Date
Q:FORM&OWNERPERMISSIONPOOLS 62012
Town of Barnstable *Permit#A 93
�, 9• Expires 6 months front\issue date
STABLE, '
Regulatory Services Fee9A
v� 1639. ,e$ Thomas F.Geiler,Director
AIFo �a Building Division Did
Tom Perry, Building Commissioner
200 Main Street, Hyannis,MA 02601
Office: 508-862-4038
Fax: 508-790-6230E RESS PERMIT APPLICATION - RESIDENINIB11tv C00 PERMIT
Not ValldwithoutRedX-Press Imprint JUN 6 2003
Map/parcel Number I r7ni rnLL—
T �� ARNST�BLE
Property Address
Residential Value of Work
Owner's Name&Address
Contractor's Name - �— Telephone Number
Home Improvement Contractor License#(if applicable)
Construction Supervisor's License#(if applicable)
❑Workman's Compensation Insurance
Check one:.
❑ I am a sole proprietor
D/I am the Homeowner
❑ I have Worker's Compensation Insurance
Insurance Company Name
Workman's Comp.Policy#
Permit Request(check box)
Re-roof(stripping old shingles)
❑Re-roof(not stripping. Going over existing layers of roof)
ED/Replacement Windows. U-Value (maximum.44)
Other(specify)
*Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
I
Signature
Q:Forms:expmtrg
The Town of Barnstable
Regulatory Services
Thomas F. Geiler, Director
Building Division
Tom Perry,Building Commissioner
200 Main Street,Hyannis MA 02601
Office: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE: J
JOB LOCATION:
nu er '4 b5t
village 1 .
n work phone#
CURRENT MAMWG 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.
DEMITION OF HOMEOWNER
Persons)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 12emut.
(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 B arnstable Building
Department minimum inspec 'on procedures and requirements and that he/she will comply with said
pro es and req ' eme
f
L45afore o Homeown
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.
Tn—eiirP thor the hnmenwner is fully aware of his/her responsibilities,many communities require;as part of the permit - .
Assessor's.map and lot number ............................................ QyOF THE toy
b i P Sewage Permit number � .. row Ky�
g ,.. .�,..... . .. .�.......................... Z 13AHB9TaDLE, i
House number ... ��. .. .............................................. 90 Hasa
039.
ON a\
TOWN . OF BARNSTABLE
BUILDING INSPECTOR
n APPLICATION FOR PERMIT TO .............��(�`............:....V.u�.C:.... ����ti.n alp..............................
.............. ..... .......
TYPE OF OF CONSTRUCTION .................. � �.........� .QVY1.e..—
...............................................................
. �...�..................19.4��1`
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information-
Location ..........�r C) ........ �.......... ,,A Vj (�.C'..: ........:R.g)6: -'.............�n� ".......
G
ProposedUse ............... ..............� :........................ ... ...0............................................................................................
Zoning District ......1� '. S..l. .,..!1. ..�. .......i........Fire District .........
......
................. S
Name of Owner ......�Ck, F'.:n.... ......`?.M.k ........Address ................ ac n 5�.��_.6- .......................
Nameof Builder' ... Gm .....? !.:....S6.. ..........Address ....................................................................................
Nameof Architect ..................................................................Address ....................................................................................
Number of Rooms ............` .................................................Foundation ............ ..1�'1et/,,,,1,-C �.........QfM(A-
Exterior ... .5...... ....4 ...��..\.�.................................Roofing ................. 1y7 k��.Sl:. ....................................
............... .
Floorsl l t, �- .........1.. !.A ^......................Interior ............................a �.. .............................
Heating _ ....Plumbing -- -
.....................�- `............ ...............................................
Fireplace ........ .............................................................Approximate Cost .................A�?O0 .............................
Definitive Plan Approved by Planning Board -------------------_-----------19________. Area ..........................................
Diagram of Lot and Building with Dimensions Fee
SUBJECT TO APPROVAL OF BOARD OF HEALTH
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the Rules and Regulations, of the Town of Barnstable regarding the above
construction.
Name ......N.a1imgm !.... `.... .S.Y.'....................
U
SMITH, JAMES K. A=170-121
Nor 23990 permit for 1� Story
............... .....�.............................
Single Family Dwelling
..::.......................................... .....................
Lot #221 -4Skunknet Rd
Location ................................................................
Centerville
...............................................................................
Owner ..James K. Smith
...............................................................
Type of Construction ..Frame
........................................
i
.................... ............................ ....................... f
Plot ....... ............ Lot ........
April 27 82
Permit Granted ........................ ...............19
Date of Inspection ... i
Date Completed .. ..................................19
Assessor s.ma and lot 4 5 number
p R � /,
THE
•. � TIC SYSTEM .�P•. �o
Sewage Permit number .. .- .:� 'ts, a T.. ................ .. ETA -,
IN C0MPL
• AEgSTAXE, i
.House number ...�j�J Jam.. ...................: �r �111'IT9� TITLE :o M6 a
,
VIRON
f EIV 39• �0 �
Iwli°ENTAL CODE S °°�0 NAr a'
TOWN OF ARNSTMI,D'�` TIONSA
BUILDING I SPECTO j
APPLICATION FOR PERMIT.TO ........ �: ::'`..�U L .. .....: `�. �.n.:. ...................:...:.....
TYPE OF CONSTRUCTION �-
................................................
TO THE INSPECTOR OF BUILDINGS.
The undersigned hereby applies for a permit according• to, the following information:
Location ........... .......�-�:� ........... ................... ....... .��C^� :...... .......
Proposed Use .......... `�..� �... ��............ �. .. . ........ .. ..........................................
Zoning District ......\.\e. .?.a 1�A.. .................Fire District ......... ...... ...............................� C _
Name of Owner ......��. F ..... .:...J.M..� ........Address ................�f'� c J v .........................
{
Name of Builder' .....��G m '� !v. .! M.!' Address ...................................................... r
Name of Architect ...:....::.......:. :.Address ..........
Number of Rooms .........:......................................... ..... Foundation t.............�-�.� ...
Exterior ... ..-'...... .... .��.�. A Roofing ... „ ,.� a .4 .Y�! ......:..................:...:.....
e +. .
Floors ........W. ....... ..:...:.:4 >1,C ... Interior ............................. ..:........... t
Heating .............!.4 '............. ............................Plumbing ...................................�C
Fireplace ......:.� �....:..:................:.. ......................:.::.......Approximate Cost :........:...... ...:. .....
................. .. .. j
Definitive Plan Approved by Planning.Board _______________________ -----19_______ Area _.....C1./
Diagram of Lot and Building with Dimensions Fee ..........—
SUBJECT TO APPROVAL OF BOARD OF HEALTH
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Name :C� 2... '..... ! .Y`�. !..........................
` SMITH, JAMES K.
23990 1 2 Story
No ; Permit for
i
Single Family Dwelling..........:..........................................Lot 22 t................unknet Rd � s �
Location ............................................................... f
Centerville
Owner ...James ..K ...Smith.....:........:.....:.....
Type of,Construction ........ .................. t
�q ............................................................... ................
Plot ........................... Lot ................................ ;
April 27, 82
{
Permit Granted P19
Date of Inspection .0/AN-' . .. 4.1,9 =
.
Date Completed ..... ;/ 219
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TOWN OF BARNSTABLE _____----------
``, •e Permit No. --
Building Inspector
ymf7UL Cash -------------
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OCCUPANCY PERMIT Bond ----____
"No building nor structure shall be erected, and no land, building or structure shall be
used for a new, different, changed, or enlarged use without a Building Permit therefor
first having been obtained from the Building Inspector. No building shall be occupied until a
certificate of occupancy has been issued by the Building Inspector."
Issued to Address
Wiring Inspector Inspection date
Plumbing Inspector Inspection date
Gas Inspector Inspection date
Engineering Department Inspection date
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.
......................................................1 19...... .................................................. ...........P........................_...._._........_
BuildingInspector
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