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TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map Parcel Applica ion #
Health Division Date Issued � Lt Z
Conservation Division Application Fee
Planning Dept. Permit Fee
Date Definitive Plan Approved by Planning Board p D 1Z41g'iz
Historic - OKH _ Preservation / Hyannis
Project Street Address f3ytkiif U
Village 5 LF—
Owner Address
Telephone mod$ ' Z " 0 03
Permit Request ahm_ 1 l7D12 or -udJ1 ' 6 " t
L_�& .A Jwx
a54,p ' �� Z -�
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new
Zoning District Flood Plain /Gr__oundwater Overlay
Project Valuation 000. Orb Construction Type 1W/4�6� R___
Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family `d Two Family ❑ Multi-Family (# units)
Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No
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 First Floor Room Count
Heat Type and Fuel: ❑ Gas ❑Oil ❑ Electric ❑ Other C?
^� ';g
Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood%coal stove:]Ye ❑ No
Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑e fisting ❑.n9w -size_
Attached garage: ❑existing ❑ new size _Shed: ❑ existing ❑ new size _ Other:
Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑
Commercial ❑Yes a- o If yes, site plan review#
Current Use Proposed Use
APPLICANT INFORMATION
(BUILDER OR HOMEOWNER)
:fie � �� e 6t ' t«//i Telephone Number
Address �, .� /i/� License
Home Improvement Contractor#
Worker's Compensation(
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
Dl�7 2L-,Z,1Z
SIGNATURE DATE �� �r�' 7 i
FOR OFFICIAL USE ONLY fx -
APPLICATION#
r,
DATE ISSUED
MAP/PARCEL NO.
E ADDRESS VILLAGE _
OWNER
t DATE OF INSPECTION:
FOUNDATION
FRAME
INSULATION
;I FIREPLACE
ELECTRICAL: ROUGH FINAL :..
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL -
' FINAL BUILDING -
t DATE CLOSED OUT Y
I -
h ASSOCIATION PLAN NO. '
r
A
OWNER AUTHORIZATION FORM
I, ne Je—2--ctt-d ,
(Owner's Name)
owner of the property located at
q
r`
(Property Address)
(Property Address)
b authorize CDJ �-here y uthontot QO \j ,
(Subcontra )
an authorized subcontractor for RISE Engineering,to act on mybehalf to obtain a building
permit and to perform work on my property.
er's Signal We
Date
A A
CAPE 86iff 1,
NS U LAj(jgcNt p 2: 3'
R-e-P]El N n
IIySp OI SSA MSSSS Spp AT tOAAI SySP[NOSp
sans
uurnys iesulabD»oQem�uS�s
1-800-69�f���RN
Town of Barnstable
Regulatory Services
Building Division
200 Main St
Hyannis, A 02601
Date: --,)/7//3
Dear Building Inspector
Please accept this Affidavit as documentation that Cape Cod Insulation, Inc. performed &
completed the insulation and weatherization work at the property listed below. Cape Cod
Insulation did this in accordance to the specifications listed on the building permit
application. All work has been inspected by a certified Building Performance Institute
(BPI) inspector. All work preformed meets or exceeds Federal & State Requirements,
Property Owner Property Address Village ,
Insulation Installed: Fiberglass Cellulose R-Value Restricted Unrestricted
Ceilings ( ) (x ) ( y2) O (X )
Slopes ( ) ( ) ( ) ( ) ( )
Floors ( ) ( �C) ( ZL )
Walls ( ) ( ) ( ) ( ) ( )
Sincerely
l�-
He yWsidysident
Cape c.