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TOWN OF BARNSTABLE BUILDING.PERMIT APPLICATION ,
Map Parcel Application # 7
Health Division Date Issued
Conservation Division Application Fee to
Planning Dept. Permit FeeS�
Date Definitive Plan Approved by Planning Board
Historic - OKH _ Preservation/ Hyannis
Project Street Address /�9 C�ti n-{w a Cl
Village
Owner cJ as n. kir`d i G vw) Address 1 tau VV_l C°aU6 Qram.
Telephone 9111(� y
Permit Request �In'sk-v\ �Y� _ m�J o,�. �. t�9/ tZl,a�— ��n
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuation Construction Type
Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family 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
Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No
Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing O new size_
Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: = =-
1
Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ - '
Commercial ❑Yes ❑ No If yes, site plan review #
Current Use Proposed Use
APPLICANT INFORMATION
(BUILDER.OR HOMEOWNER), _
Name L M H /3 �?S-�y c i rv, 6 ,rox,40 Telephone Number 0 g- 33(Q ^aSSCp
Address 3a s P2=4 4 License#('� OJ 1'I S
CL Home Improvement Contractor# q(x q0
Email M4rill, - 0 r v Worker's Compensation # Lac 3/ S 4,D 103 j'a D i
ALL CO ST71ONB IS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
i
SIGNATU E S DATE I 9
FOR OFFICIAL USE ONLY-
. -
`APPLICATION #
DATE ISSUED
MAP/ PARCEL NO.
ADDRESS VILLAGE
OWNER
DATE OF INSPECTION:
FOUNDATION a
FRAME
"1
p•
INSULATION
FIREPLACE .'
ELECTRICAL: ROUGH FINAL
T
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
FINAL BUILDING
DATE CLOSED OUT
t
ASSOCIATION PLAN NO.
r
Permit Authorization ''��
mass save Form
PARYCMTWG
Site ID: S00050118969 Customer: JOAN K WILLIAMS
I, JOAN K WILLIAMS ,owner of the property located at:
(Owner's Name,printed)
119 Country Club Dr CUMMAQUID
IProperty Street Address) (city)
hereby authorize the Mass Save ome Energy Services Program assigned Participating Contractor listed
below to act on my behalf an tain a building permit to perform insulation and/or weatherization
work on my property. ,
Owner's Signature:
Date:
FOR CSG OFFICE USE ONLY
Conservation Services Group has assigned the following Mass Save Home Energy Services Participating
Contractor to the above referenced project:
Parti ' tin ntractor Date
Os'O
Conservation Services Group • 50 Washington Street,Suite 3000 • Westborough,MA 01581 • 1800-080.7472
For Office Use Only
Rev.10201S
om: n rid Johnson Fax:(608)536-0751 0: Fax: (508'790-6230 Pa a of2 111130r2017 9:08 AM
MIMI
L H Construction Group, W
32 Fie.rce Street
Br.:o.ckton,MA 0.2.3.02
D..::5 0.8-:32.6-25 a 6
F:508-53E-0751
Email: Ingrid.Jobnson@Iive.com
Noveinb:e.r 29,2017
P:m erty Owner:
loan.K Williams
1:19 .O.untryClub Dr...
C.ui' rhaoui.d, MA.02637
Contract*201.5112:4_ASEAL 3
�x
Contractor! CD
Ingrid Jahns6h --W :�_
32 Pierce Street
Brockton, MA'02342 '
'0 a
Lic#10599$ �-
HIC;197640 tom= m
RE: Permit.413 6194 Job Completion=Weatherization
Dear B.uilding.Commissio.ner
WB ar..e writing this j:etter (ith regards to the w.e.atheriz.ation proect; Permit 81629�4,which:has been
co.m.pCeted:in accordance with the:state mgulations and guidelines.The date of completion of-this
project was on;M.aref .9` ,2016.— If you should need any additional information,we can be reached at
5Q$*32672
Sin . rely,
Ingri s n
D�
LMH Construction Group, LLC
Town of Barnstable *Permit# l��w ZZ
Expires 6 mo s from issue date
Regulatory Services Fee nn
t BARMN zasc e - P
Richard V.Scali,Director
A
t ;,� Building Division
Wwal Perry,CBO,Building Commissioner
AUG Q 6 205 200 Main Street,Hyannis,MA 02601 ,
www.town.bamstable.ma.us
office:T50Wk- 6ARNSTABLE Fax: 508-790-6230 ,
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
Not Valid without Red X-Press Imprint
Map/parcel Number Ct�'J�
Property Address Zzz ` �'�i� � 't{� �� ✓_% ��
❑Residential Value of Work$ 66;o , g6minimum fee of$35.00 for work under$6000.00
Owner's Name&Address qg7/'/ e ee_.� °� I�+,, A.S
IF
Contractor's Name � Telephone Number
Home Improvement Contractor License#(if applicable)��/. Email:
Construction Supervisor's License#(if applicable)
❑Workman's Compensation Insurance
Check one:
❑ I am a sole proprietor
❑ I am the Homeowner
I have Worker's Compensation Insurance
Insurance Company Name 7"/C � Tza/L
Workman's Comp.Policy# j® � S�
Copy of Insurance Compliance Certificate must accompany each permit.
Permit Req est(check box)
Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to 636t)
❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof)
:S-Re-side
❑ Replacement Windows/doors/sliders.U-Value 0, (maximum.32)#of windows
#of doors:
❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required.
Separate Electrical&Fire Permits required.
*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\FORMS\building permit forms\EXPRESS.doc
Revised 040215
iy
• swnxsrwsL.E.
MASS,16.39.
Town of Barnstable
PIED Mt►'��
Regulatory Services
Richard V.ScaIi,Director
Building Division
Thomas Perry,CBO
Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-40-38 Fax: 508-790-6230
Property Owner Must
Complete and.Sign This Section.
If Using A Builder
I, �'1 erG� V ��� � S , as Owner of the subject property
hereby authorize to act on my behalf,
in all matters relative to work authorized by this building permit application for:
1�9 CGY��Ifi'S�CQ c�r��
(Address of Job)
di
Signature of Owner Date
Print Name
If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the
reverse side.
Q:\WHHILESTORMS\building permit forms\MTRESS.doc
Revised 040215
III
Town of Barnstable _.
Regulatory Services
oFjKWE rOiyy Richard V. Scali,Director
Building Division
BAMSTABLE Tom Perry;Building Commissioner
nsA.gs.
1639. � 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:
number street village
"HOMEOWNER":
name home phone# work phone# .
CURRENT MAILING ADDRESS:
city/town state zip code
The current exemption for"homeowners"was exten d to include owner-occ ied dwellings of six units or less and to allow
homeowners to engage an individual for hire who doe not possess a license, rovided that the owner acts as su ervisor.
DE ION OF HOME R
Person(s)who owns a parcel of land on which he/she res'des or intends to r side,on which there is,or is intended to be,a one or two-
family dwelling,attached or detached structures accesso to such use an or farm structures.'A person who constructs more than one
home in a two-year period shall not be considered a homeo er. Such" omeowner"shall submit to the Building Official on a form
acceptable to the Building Official,that he/she shall be resp ible for such work performed under the buildin ermit. (Section
109.1.1)
The undersigned"homeowner"assumes responsibility for comp 'an a with the State Building Code and other applicable codes,
bylaws,rules and regulations.
The undersigned"homeowner"certifies that he/she understands a own of Barnstable Building Department minimum inspection
procedures and requirements and that he/she will comply with id p cedures and requirements.
Signature of Homeowner
Approval of Building Official
Note: Three-family dwellings containing 35 00 cubic feet or large will be required to comply with the State Building Code
Section 127.0 Construction Control.
HOMEOWNER'S EXEMPTIO
The Code states that: "Any homeown r performing work for which building permit is required shall be exempt
from the provisions of this section(Section 10 .1.1 Licensing of construction Stupervisors); provided that if the homeowner
engages a person(s)for hire to do such wor that such Homeowner shall act as \on
"
Many homeowners who use this emption are unaware that they are ase responsibilities of a supervisor
(see Appendix Q,Rules &Regulations r Licensing Construction Supervisors,S5) This lack of awareness often
results in serious problems,particular when the homeowner hires unlicensed p this case,our Board cannot
proceed against the unlicensed perso as it would with a licensed Supervisor. Thner acting as Supervisor is
ultimately responsible. : .To ensure that the home er is fully aware of his/her responsibilities, munities require,as part of the
permit application,that the ho eowner 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:\WPFILES\FORMS\building permit forms\E31PRESS.doc
Revised 040215
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map Parcel D3 Application #
Health Division Date Issued <
Conservation Division Application Fee
Planning Dept. Permit Fee
Date Definitive Plan Approved by Planning Board
Historic - OKH _ Preservation/ Hyannis
Project Street Address 179 �vy� % �`� D✓z v e
4 fie ` ✓t'Village 4
Owner Address
Telephone A 2— —A 4P
Permit Request keefo . AO g
Square feet: 1 st floor: existing*W proposed f'gZ9 2nd floor: existing 940 proposed Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuation 13� Construction Type
Lot Size 0 46? Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family FP Two Family ❑ Multi-Family (# units)
Age of Existing Structure Historic House: ❑Yes 'lo On Old King's Highway: ❑Yes (JMo
Basement Type: )�Tull ❑ Crawl ❑Walkout ❑ Other :1 E?
Basement Finished Area (sq.ft.) Basement Unfinished Area (sgft)
Number of Baths: Full: existing 2— new Z Half: existing nevv,
Number of Bedrooms: existing -new
Total Room Count (not including baths): existing new —----- First Floor Room Count w_
Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other
w
Central Air: Wes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No
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 (U No If yes, site plan review#
Current Use Proposed Use
APPLICANT INFORMATION
(BUILDER OR HOMEOWNER)
Name /�4C�M � l�j Telephone Number �00 ' 696 -6S 6
Address Yr/L�. J License # tic: 7
ggt4>6o Home Improvement Contractor#
Worker's Compensation #
ALL CONSTRUCTION DEBRIS RES TING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE DATE
r
t
d FOR OFFICIAL USE ONLY
i {
' APPLICATION#
`j
DATE ISSUED ,
MAP/PARCEL NO.
'i
' ADDRESS VILLAGE
OWNER
DATE OF INSPECTION:
FOUNDATION
FRAME
ti
INSULATION
z
FIREPLACE
r
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
` GAS: ROUGH FINAL
FINAL BUILDING
DATE CLOSED OUT
ASSOCIATION PLAN NO.
i
-
�P do
e fi�ANLTl of�r i
Ml CC
Town. of Bar-nstable
rEo�►�
Regulatory Services
Thomas F. Geiler,Director
Building Division
,Thomas Perry, C30
Building Commissioner
200 Main Street, Hyannis,MA 0260.1
WPFW.town.b arnstable.ma.uS
Office: 508-862-403 8
Fax: 508-790-6230.
Property Owner Must
Complete and Sign This Section
If Using A Builder
Iv , as 0*ner,of the subjec e
rty
hereby authorize UC. l✓ o act on my behalf,
in all matters relative to work authorized by this b ' ding permit application for.
(Ad ess of Job)
O� O
*Sliao f OLvner ate -
Print Naive
if Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the
reverse side.
{
C;lUscrs\dccollik\AppDEUU-ocaAMicrosofilVdindowslTcmporary Inicrnct FilcslContcnt.ovtlooklDDV87AAZIEXPRE,SS,doc
Revised 0721 10
Town of BarngtaWa -
, �` Regulatory Services
= a,si;ttsrAac.E.
Thomas F. Geiler, Director
MASK
6�a,� Building Division
Tom Perry, Building Commissioner
200 Main Street, Hyannis, MA 02601
www.t6wn.barnyta-ble-ma.us
Officc: 508-862-4038 Fax: 509-790-6230
HOMEOWNER LICENSE EXEMPTION
Please Print
~ DATE:
JOB LOCATION:
number street village
"HOMEOWNER":
name home phone# work phone#
CURRENT MAILING ADDRESS:
city/tAwo ' state zip endc
The cun-ent exemption for"bomeowners"was extended to include owner-occupied dwetlings 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'i homeowner."Such
"homeowner"shall sty r it`o the.B Idin 0 ci lemon a form acceptable to the Building Official, that he/she shall be
responsible for all suc�� �Dep t "`° r'uldine permit (Section 109.I.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 Bamstable Building Department
mitumtun inspection procedures and requirements and that he/she will comply wiElrsaid procedures and
requirements. 3
Signature of Homeowner
Approval of Building Official w
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.
HOMED WNER'3 EXEMPTION
T'be Code states that "Any hbgreowner performing work for which a building permit is required shall be cxearpt from the provisions N,
of this section(Section )09.1.1-Liccnsing•of construction Supervisors);provided that if the harneowner engages a persorl(s)for hire to do fucb "
work, that such Homeowner shall act as supervisor."
Many homeowners who use this exetnption'am unaware that they arc assuming the responsibilities of a supervisor(see Appendix Q,.
Rules&Regulations for Liccpsing Construction Supervisors,Section 2-15) This lack ofawateness often results in serious-probacros,particularly
when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the uriliccnsed parson as it would with a licensed
Supervisor. The homeowner acting as Supervisor is ultimately rrsponsibie.
To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,
rhat the homeowner certify that hdshe understands ncc msponsibilitics of a supervisor. On the last page of this issue is a form errrrcndy used by
several towns. You may cart t amend and adopt such a fomJecrtifieation for use in your community.
Q:forms:homeexrmpt
f
FRANK KORINKO D/B/A
YOUR HOME RESTORATION ` 119-COUNTRY CLUB RD- `
55 POND VIEW AVENUE 17
WEST YARMOUTH, MA 02673 CUMMAQUID, MA
508-778-1211
Shipment #: 1
15326 5 CASH 41258065 06/30/11 999 41221415 07/08/11
1 0 1 EA 2/8X6/8 RH TS296 SGL BORE 208.947 208.95*
4-9/16 JB STD SILL NO CASING
;DOOR
PO # 4196626 VEND # 3333-HUT-T Qty 1 Expected : 07/07/11
1 0 1 EA Fuel Service Charge 7.000 7.00
Attached to all Del. Slips
FUEL
-1 0 -1 EA CASH DISCOUNT 10.448 -10.45*
DISC
DO NOT LEAVE INVOICES AT DELIVERY SITE!!!
THE INVOICE TOTAL OF 217.91 HAS BEEN REDUCED BY THE FOLLOWING PAYMENTS:
DESCRIPTION REFERENCE AUTH CODE DATE AMOUNT
VISA 1431671 00 07/08/11 217.91
September 26, 2011. 14:40:1 OT:549 7 / 2 205.50
*************** BEST WAY 0.00
* INVOICE
*************** PAGE 1 OF 1 6.250% 12.41
0.00
Signature:
South Dennis **PER PRICE BREAK** Change: 0
'
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TOWN OF BARIPI STABLE
`M SEP 29 Aii fi0n: 29 A
� IVII 10
. R
Y
I
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map 50 Parcel 639 Permit# (J �
Health Division lr__ - Date Issued C/
Conservation Division = Fee �tS
Tax Collector
Treasurer
Planning Dept.
Date Definitive Plan Approved by Planning Board
Historic OK `= ��i f Preservation/Hyannis
Project Street Address 6 q
Village af5 �`C2_ `
Owner (DA Z (10,r1 e S3OW, Address PU, �d k. �� 3 ,
Telephone J
k.
Permit Request <SQ O 3 �e
9
a t
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new
Valuation .4 Ltd $� . Zoning District Flood Plain Groundwater Overlay
Lo
Construction Type
Lot Size Grandfathered: ❑Yes ieI o If yes, attach supporting documentation.
Dwelling Type: Single Family Two Family 0 Multi-Family(#units)
Age of Existing Structure Historic House: ❑Yes Oho On Old King's Highway: ales ❑ No
Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft)
j 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
i
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
Attached garage:❑existing ❑new size Shed: ❑existing ❑new size Other:
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial ❑Yes W,110 If yes, site plan review#
Current Use Proposed Use
BUILDER INFORMATION
Name 0Telephone Number
—oZ8 —q Sl
Address % License#
C677-[xL — fVli/4 0 Home Improvement Contractor# 1667 LO
J
Worker's Compensation# AP9 9&1O�
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATUREdd&.2 JZ PAoJ,.Z0_
e DATE
"
FOR OFFICIAL USE ONLY
�PE3'tMIT NO.
DATE ISSUED ^ `.
MAP/PARCEL'NO. � .
ADDRESS VILLAGE°
OWNER
T
DATE OF INSPECTION:
FOUNDATION
FRAME F
INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL l
PLUMBING: ROUGH FINAL -s
GAS: ROUGH FINAL - -
FINAL BUILDING
7-1
DATE CLOSED OUT
ASSOCIATION PLAN NO. -. E
Y ,
° The Town of Barnstable
9 Department of Health Safety and Environmental Services
i659. �0
'°rigs r Building Division
367 Main Street,Hyannis MA 02601
Office: 508-862-4038 Ralph Crossen
Fax: 508-790-6230 Building Commissioner
Permit no.
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. OD
Type of Work: �Pl� i 1 � Estimated Cost
Address of Work: ! It �� � T `-- - �—'��
Owner's Name: ��A z, :4✓I f J6y A
'i Date of Application:
s �
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.
-7
Date Co tractor Name Registration No.
OR
Date Owner's Name
q:forms:Affidav
=- TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
�-2 l/
Map 3 50 Parcel Q 3 q Permit# T Z9
Health Division Date Issued
Conservation Division Fee 4 - too
Tax Collector m7n
c
Treasurer ar v
Planning Dept. '.
Date Definitive Plan Approved by Planning Board
Historic-OKH Preservation/Hyannis t
Project Street Address Co C t 3L.t1jr,
Village
.Owner (>U z 96 yA 9 Address ' 2b BUX 3 3 , ANA3r to o.)6 3-i
Telephone ��" �3
Permit Request 6K17- 1�`IJyCr 5lDIkiCV (�-e-XIST 0LA ajebSTjg PemOye�)
Square feet: 1 st floor:existing - proposed ' 2nd floor: existing proposed . Total new
Estimated Project Cost f 0°V) Zoning District Flood Plain Groundwater Overlay
Construction Type
Lot Size Grandfathered: ❑Yes. U"No If yes,attach supporting documentation.
Dwelling Type: Single Family Two Family ❑ Multi-Family(#units)
Age of Existing Structure Historic House: ❑Yes Flo On Old King's Highway: ales ❑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
Central Air: O Yes ❑No Fireplaces: Existing New Existing wood/coal stove: °❑Yes ❑No
Detached garage:❑existing Cl 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 IBlo If yes, site plan review#
Current Use Proposed Use
BUILDER INFORMATION
Name aiA.Z7-/ dell 05��T" Telephone Number
Address 1645,5, 7&,J7Jaw yC License# . S `7a 7 9
C�j` �,� h 14 y � Home Improvement Contractor# /G o 7 qo
Worker's Compensation# 4)C 5 &26 6 V
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE DATE
FOR OFFICIAL USE':ONLY
t PERMIT NO. xI } .} - • _ r 3'
DATE ISSUED17
_ - - -� •t- ,
MAP/PARCEL NO.
ADDRESS; �: 4 ,=';VILLAGE ' _ '• ,
21
DATE OF INSPECTION f , ' '_., t ,, • �- r •
:. .... } i M { • /41 , ' - .. -~ , � . ��.., f I` fir"
FOUNDATION
FRAME
INSULATION ,. __ • -s
FIREPLACE
ELECTRICAL: ROUGH FINAL -
• i ...t� j • _ b w 1 e K _
PLUMBING: ROUGH s FINAL
GAS: ROUGH FINAL. ✓.:'1 -' - . h'
FINAL BUILDING..
41
DATE CLOSED OUT
ASSOCIATION PLAN NO{ +! t "'
_ Y _
The Town of Barnstable
9 mom Department of Health Safety and Environmental Services
t"9. Building Division
Eo rug'
367 Main Street,Hyannis MA 02601
Ralph Crossen
Office: 508-790-6717 Building Commissioner
Fax: 508-790-6230
For office use only
Permit no. ,
Date AFFIDAVIT
HOME IMPROVEMENT CONTRACTOR LAW
SUPPLEMENT TO PERMIT APPLICATION
MGL c. 14"A 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 thanbe done by ordwelling
contractors,tsr to
structures which are adjacent to such residence or buildingregistered
certain exceptions,along with other requirements. y�
rr— �1A6 L �/�) 6— Est. Cost ' 9 ( �D•off
Type of Work: ��-e � �
.� p0a
Address of Work: C�
Owner's Name 3ugateVilij
Date of Permit Application: &
I hereby certify that:
Registration is not required for the following reason(s):
Work excluded by law
i
Job under S1,000.
Building not owner-occupied
Owner pulling own permit
Notice is hereby given that:
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED
K DO NT HAVE
CONTRACTORS FOR APPLICABLE HOME IMPROVEMED UONIDER MGLO 142A
ACCESS TO THE ARBITRATION PROGZAh1 OR GUARANTY
SIGNED UNDER PENALTIES OF PERJURY
I hereby apply for a permit as the agent of the owner: D O ry
9 ZO Registration No.
Date Contractor Name
OR
n.,mers Name
v -
1 TOWN OF BARNSTABLE Permit No.
I ,uW ! Building Inspector cash
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 .r Inspection date
Plumbing Inspector Inspection date
Gus 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.
19 _ .._ ..
Building Inspector
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A�.essor's map and lot number ............................................
��i THE
Sewage Permit number
� SEP°TIC SYSTEM MUST BE �
........................................................ INSTALLED IN COMPLIANCE' �°� ♦�
WITHARTICLE II STATE ! BABa9TADLE,
House number RY CEDE AIVD TIJ4 r rasa �
.................... ....................... ......................./ SANIT oo t63q. 60
REGI.€IATSGNS. n war a•
TOWN OF ' RAR.NSTABU
BUILDING INSPECTOR
APPLICATIONFOR PERMIT TO ..................................................:....................:.....................................................
. J , ,� ,
TYPE OF CONSTRUCTION l!�
.�.2.,t:...............19.`..
TO THE INSPECTOR OF BUILDINGS:..
The undersigned hereby applies for a permit according to the foll wing information 4
Location ...:......................... ..... ................ ......;...................................................... .........................../ ......................
Proposed Use ..........v./l jj,..Z. ......... !! .(.('/y.........................................
ZoningDistrict ........................................................................Fire District .............................................5................................
Name of Owner ..�r' .-l T/�'1.... ..Q ( ...� US ddress ....�1 y.... ....�U �.5...
Name of Builder _ .......................................................
... 2.���.��..0..`.y.....�.�.....���.L.,.:-.Address .........:�.��.
Name of Architect .. C .... T� ... 5 lilrAddress ..........!..!.....o. ..... . ....�...r�.ti.... !4...................
Number of Rooms ............)� ...............................................Foundation ..... ..........................................
Exterior .......5"A ./ y.....f^F,�...............................................Roofing ... 5 ....!9.1 U ..................................
Floors. ..........................................Interior .......... !! ��. �'T 1
�._. ......J-�. /_l.
Heating ...AIr„-:1-�....�..........!..... .......................Plumbing ....../.....1..:�4.1.../!/.-/k-3........................................
Fireplace .......1 .!.1/.L%..........................................................Approximate Cost .........1.. ...
Definitive Plan Approved by Planning Board --------------------------------19________. Area /r � ... ......:..........
O
Diagram of Lot and Building with Dimensions Fee J.............................................
SUBJECT TO APPROVAL OF BOARD OF HEALTH
0 1�
1 5h V
I hereby agree to conform to all the Rules and Regulations.of VT1.o.wnfBarnstable regarding the bove
construction. Name ................ ....... ........................
Wen-Kim .Realty Trust
I `o 20820. Permit for ,..,,,,1.1./2 story
y
single family dwelling
........................................................
Location .......119 Country Club Drive
.............................................
Barnstable
...............................................................................
Owner ....... Wen-Kim Realty Trust...........................................................
Type of Construction ............f..rame............................ �
_...............................................................................
Plot ............................ Lot ...........#21...............
Permit Granted ........November..1.5••••-:.19 78
Date of Inspection ......19 ;
Date Completed . . 1
t
.PERMIT REFUSED
................................................................ 19 a
... .... ................4. ................. ... s
1 t
v
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.... ..`.............................�
... ................ � ........
Approved ................................................ 19
....................................................... C
I
.................... .......................................................... 5
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