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` TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
v �Map Parcel p M Permit#
Health DivisionC �� s � C�`� Date Issued
Conservation Division i 3r Fee c»i
a Tax Collector
Treasurer ,r_,,� -9
Planning Dept.
Date Definitive Plan Approved by Planning Board
Historic-OKH Preservation/Hyannis
Project Street Address ;- 4 n B Q �y La n E�.
Village""�&w-n�-ta�7 '�
Owner IRoUt + k eAth etc &J Address ��� 5 L-�
Telephone 3 � — A-
Permit Request / X 4 / C Ca
screet7pnt-c—k ,
Square feet: 1st floor:existing proposed 2nd floor:existing proposed Total new
Estimated Project Cost.�'iUo Zoning District Flood Plain Groundwater Overlay
Construction Type
Lot Size o - a cx f- Grandfathered: ❑Yes ❑No If yes,attach supporting documentation.
Dwelling Type: Single Family" Two Family ❑ Multi-Family(#units)
Age of Existing Structure OPP, Z�3 VtS Historic House: ❑Yes *No On Old King's Highway: ❑Yes gNo
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: existing new
Total Room Count(not including baths): existing new o First Floor Room Count
Heat Type and Fuel: Gas ❑Oil ❑ Electric ❑Other
Central Air: ❑Yes �410 Fireplaces: Existing �_ New Existing wood/coal stove: ❑Yes ANo
Detached garage:❑existing ❑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 IdNo If yes,site plan review#
Current Use e-c Proposed Use C:
BUILDER INFORMATION
Name Telephone Number
Address License#
Home Improvement Contractor#
Worker's Compensation#
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE DATE `f ��
4
r '
FOR OFFICIAL USE ONLY - a
s "PERMIT NO.
y DATE ISSUED
MAP/PARCEL NO. "
ADDRESS " } VILLAGE -
DATE OF INSPECTIO :
FOUNDATION
FRAME
INSULATION £'
,w.
y
� FIREPLACE
x ELECTRICAL:` ROUGH FINAL
,r PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
FILIAL BUILDING t
DATE-CLOSED OUT
ASSOCIATION PLAN NO.
e
' a
{
P98`�' NOTE:MA E:not all symbols will appear on a,map
6,6
'241 :. GOLF COURSE FAIRWAY
M ....298\ .� r 1 EDGE OF DECIDUOUS TREES
\ //v - / L._ _... ./ EDGE OF BRUSH
l
Rj v # 1 I ORCHARD OR NURSERY
\ EDGE OF CONIFEROUS TREES
/ / \ MARSH AREA
\ EDGE OF WATER
DIRT ROAD
2--DRIVEWAY
PARKING LOT
PAVED ROAD
i — — DRAINAGE DITCH
PAT RAIL
- ' H T
/ ....... ......- PARCEL LINE
MAPmApIio---MAP#
- 5V ' 21-* —PARCEL NUMBER
a1e60 E HOUSE NUMBER
_..... p FOOT CONTOUR LINE
e. o
/ 240/ J `; --L{d — 10 FOOT CONTOUR LINE
v 4.9 SPOT ELEVATION
:• ,... _.... •; _>... STONE WAIL
FENCE
RETAINING WALL
RAIL ROAD TRACK
STONE JETTY
voa
QQ /
MAP /V/ SPOIMMI�G DECK
J ,
--1
BUILDING/STRUCTURE
135 V r°°€°c DOCK/PIER/IETTY
I E1
` HYDRANT
" ' v e VALVE O MANHOLE
--------------------3
lJ 0 POST 0`r FLAGPOLE
T O W N O F B A R N S T A B L E G E O G R A P H I C 1 N F O R M A T 1 O N S Y S T E M S U N I T v SIGN a STORMORAIN
N PRINTED SCALE:IN FEET *NOTE: This map is an enlargement of a Fp,,00pe,,t,
The parcel lines are only graphic representations DATA SOURCES: Planimetrics(man-made features)were interpreted from 1995 aerial photographs by The lames
j s =" M-�:..,.:.. : I"=100'scale map and may NOT meet boundaries. They me not hue locations,and W.Sewall Company.Topography and vegetation were interpreted from 1989 aerial photographs by GEOD o UTILITY POLE 4 TOWER
d e...
0 2 S 50 National Map Acrumry Standards at this rosent actual relationships to physimlobjects Corporation. Planimetrics,topography,and vegetation were topped to met Notiantl Map Aconacy Standardsi„ nl i•,n„ni I° IIIFI' I':pn.i liar..•:,::::dinii„I�nnu I mPl L...... ,!t..::.�,LI 4... :: i
The Town of Barnstable
MAE& Department of Health Safety and Environmental Services
1°rEo 59 Building Division
367 Main Street,Hyannis MA 02601
Office: 508-862-4038 Ralph Crossen
Fax: 508-790-6230 Building Commissioner
Permit no.
r
Date
AFFIDAVIT
HOME IMPROVEMENT CONTRACTOR LAW
SUPPLEMENT TO PERMIT APPLICATION
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: Estimated Cost
Address of Work: vo AIZAS:� 2"Az�
Owner's Name:
Date of Application:
I hereby certify that:
Registration is not required for the following reason(s):
❑Work excluded by law
❑Job 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.
•. �� R
c
Date ame
glorms:Affidav
Uma8' 367 Main Street,Hyannis MA 02601
• EOlrIP��
Office: 503-862-4033 Ralph Crossen
Fax: 508-790-6230 Building Commiss
HOMEONVMM UMSE F.7CEMMON
Please Print
DATE
JOB LOCATION: O
��+ tt,�� number J /� /� ///1 � /{ village
"HOM1:01 NW. I UlJ 1�.t�A p 1 lO OC v I
name home phone># work phone s
CURRES T MAILING ADDRESS:
citylto" state sip code
The current exemption for was extended to include overt. ied dwellings of six units
or less and to allow homeown=to engage an individuai for hire who does not possess a license,
that the owner acts as sne�sor.
DEFII�II'riON OF80MEOWNER
Persons)who owns a parcel of land on which htlshe resides or intends to reside,on which there is,or is
intended to be,a one or two-family dwelling,attached or detached saucturea 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 an a form acceptable to the
BuildingOffcial,that
(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
Slgtuun:r 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 Q(EINPnoN
71he Code states that: ,Any homeowner performing wortk forwhich a building permit is required shall be exempt from
the provisions ofthis session(Section 109.1.1-accusing of construction Supervisors);ptuvided that ifthe homeowner engages a
persons)for hirer to do such vo*.that such Homeowner shalt act as supervisor."
Many houstowners who use this etempdon air uwwarr that they tut:assuming the responsibilities of a supervisor(see
Appendix Q.Rules&Regulation for L lc=,ng Construction Supervisors.Section 2.15) This lack of awareness often results in
serious problem particularly when the homeowner hires unlicensed person. In this case.our'Board cannot proceed against the
unlicensed person as itwouid with a licensed Supervisor. The hotnemme:acting as Supervisor is ultir atdy responsible.
To cam that the homeowner is fully aware of his/her responsibilities.mauY communities requ=as pan 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 cars to amend and adopt such a formlcer ification for use in your community.
Q:FOR111S.E.YEMF7N
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THE
TOWN OF BARNSTABLE
11BAWS ABLE,
NAM
039. BUILDING INSPECTOR
am
APPLICATION FOR PERMIT TO ....041444.,1 -4 F4��
.................................... .........................
Ir-7
TYPE OF CONSTRUCTION ...... ....... ..............................................................................
................................................19.7
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the fallowing—.In.formation:
Location L�j
.................................................... ....................................................................................................
ProposedUse .............. ............ .......................................................................................................................
Zoning District ....... .......................................................Fire District ... .......................................
Guy J
Nameof Owner .......... .........................................7.... ess ... . ........... ..62 .�.. ....=..................................
Nameof Builder ....................................................................Address ....................................................................................
Nameof Architect ..................................................................Address ...............................................................................
Number of Rooms .6.......... 0"l.S.).............Foundation 1*11*1*11-141��......................................................
Exterior .. ........ .......................... Roofing .......or .... . ................................................................
Floors O.e. �..Z-i4.1-8�................Interior .... ..........................................................................
Heating 71— -- X
<74L5. ...................... .....................Plumbing t -,'
.........................;1.....................
Fireplace ...... ...................................................................Approximate Cost ... .....................
Definitive Plan Approved by Planning Board
---------19
Diagram of Lot and Building with Dimensions
SUBJECT TO APPROVAL OF BOARD OF HEALTH
1C)OO 94-L serVe—
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I hereby agree to conform to all the Rules and Regulations of the Town of Barnstdble regarding the above
construction.
d1X
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Name ....... ........ ... ..........................................
Royal Acres Realty Trust
1()000 one story
No, Permit for ......................................
single-family dwelling
... .... ...
. .5. . .L. . ........6..............
Location ................................................................
Barnstable
............ .............................. ............................
Royal Acres Realty:.Trust
Owner .........o�.......................................................
Type of Construction frame
..................................0........
.............................. ...... •
........
..G f,
Plot ...................... of ................................
e if
Permit Granted 4%':rPh--19.................19 73
Date of Inspection .......0.............. ......0.......19
Date Completed ...... .... ........... .0............19
#40 C'
PERMIT REFUSED
....................... ....................... 19
. ......................................!........................................ �71
................................................................................
...............................................................................
.................. ...........................................................
Approved ................................................ 19
................................. .............................................
........... ................ ..................................................
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