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92015 e�YNNII Town of Barnstable *Permit#
T Regulatory Services > eres s romissue
•
snaxsznsie, kiVSTABLE
MAS& Richard V.Scali,Director
Building Division
Tom Perry,CBO,Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.bamstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
��n q Not Valid without Red X-Press Imprint
Map/parcel Number,- 5/ 0 U V
Property Address �JG
Residential Value of Work$ ��tC Minimum fee of$35.00 for work under$6000.00
Owner's Name&Address / h
Contractor's Name 4/y� � y�-L�i Telephone Number
Home Improvement Contractor License#(if applicable) h Z a 41 Email: -56G
Construction Supervisor's License#(if applicable) C S 6 3 410
❑Workman's Compensation Insurance
Check one:
❑ I am a sole proprietor
❑ I am the Homeowner
I have Worker's Compensation Insurance
Insurance Company Name
Workman's Comp.Policy# W o0 501 O 7 2,o/5
Copy of Insurance Compliance Certificate must accompany each permit.
Permit Request(check box)
❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to
❑ e-roof(hurricane nailed)(not stripping. Going over existing layers of roof)
❑ Re-side
Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows !
#of doors: AO(
❑ 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: F
Q:\WPFILESTORMS\building permit forms\EXPRESS.doc
Revised 040215
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RAIMSTABM
MMSM ,.� Town of Barnstable
ArFD�p
Regulatory Services
Richard V.Scali,Director
Building Division
Thomas Perry,CBO
Building Commissioner
200 Main 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
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:
(Address of Job)
9
Signature of Owner Date
X4�le le ,2 k'e(� -�2
Print Name
If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the
reverse side.
Q:\WPFILESTORMS\building permit forms\EXPRESS.doc
Revised 0402B
Town of Barnstable
Regulatory Services ,; 4
°fTKME r° Richard V.Scali,Director
Building Division
sAxrvsrasr E Tom Perry;Building Commissioner
A1639. ��� 200 Main Street, Hyannis,MA 02601
l �
ED
� www.town.barnstable.ma.us
Office: 508-862-403 8 Fax: 508-790-6230
y
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE:
JOB LOCATION:
nu r street village
"HOMEOWNER":
name home phone# work phone# .
CURRENT MAILING ADDRESS:
city state zip code
The current exemption for"homeowners" as extended to include owner-occupied dwellinJowner
six units or less and to allow
homeowners to engage an individual for hire o does not possess a license, rovided that acts as su ep rvisor.
DEFINITION OF HOMEOWNER
Person(s)who owns a parcel of land on which he/s resides or intends to reside,o/berformed
here is,or is intended to be, a one or two-
family dwelling,attached or detached structures acces ry to such use and/or farm . A person who constructs more than one
home in a two-year period shall not be considered a horn wner. Such"homeowneubmit to the Building Official on a form
acceptable to the Building Official,that he/she shall be res ible for all such wor under the buildin ermit. (Section
109.1.1)
The undersigned"homeowner"assumes responsibility for compliance th th State Building Code and other applicable codes,
bylaws,rules and regulations. 4 ;�
The undersigned"homeowner"certifies that he/she understands the To of B table Building Department minimum inspection
procedures and requirements and that he/she will comply with said pr edures and r uirements.
Signature of Homeowner
A 1 '
Approval of Building Official
Note: Three-family dwellings containing 3 ,000 cubic feet or larger will be required to comply with 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 empt
from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the home caner
engages a person(s)for hire to do such ork,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 communoy.
Q:\WPFILES\FORMS\building permit formsEXPRESS.doc
Revised 040215
r
"I �I
oFT► T Town of Barnstable *Permit#
Expires 6 nronthsJrou7 issue date
sT�6 Regulatory Services Fee
BARNib gym$ Thomas F. Geiler, Director
�pTFD MA't�
Building Division
Tom Perry, CBO, Building.Commissioner l
200 Main Street, Hyannis, MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
Not Valid without Red X-Press Imprint
Map/parcel Number
Property Address r6`l E6�n�!-1-U
ff-R-esidential Value of Work b b Minimum fee of$25.00 for work under$6000.00
Owner's Name&Address
�n e
Contractor's Name \y t Azov__ ,t Telephone Number
Home Improvement Contractor License (if applicable) l L�
Construction Supervisor's License#(if applicable) qc6(1�Lf
orkman's Compensation Insurance ®PRESS PERMIT
Check one:
❑ I am a sole proprietor SEP m 8 Z009
❑ Ia the Homeowner
I have Worker's Compensation Insurance TOWN OF BARNSTABLF
Insurance Company Name A ),,-, VYVA PY I
Workman's Comp. Policy ( 5
Copy of Insurance Compliance Certificate must be on file.
Permit Request(check box)
❑fie-roof(stripping old shingles) All construction debris will be taken to �. 5
❑ Re-roof(not stripping. Going over existing layers of roof)
❑ Re-side
❑ Replacement Windows. U-Value (maximum .44)
*Where required: Issuance of thi4dooes pt co li nce with other town department regulations,i.e.Historic,Conservation,etc.'Note: Pro rty o ty Owner Letter of Permission.
o License & Construct Supervisors License is required.
SIGNATURE:
Q:\WPFILES\FORMS\Express\EXPRESSPERM IT.DOC
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over and ObWe Said proposaL
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ACCEPTANCE OF PROPOSAL
Jhe.
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Assessor's office (1st floor)' e //
3/ 4 � 0�THEt0
Assessors map and lot number ....................................... �a �Q.. �o
Board of Health Ord floor): SEPTIC SY
��1,� ATE Sewage PL'r'm)t number lW....1....... � FAIST�ALLED `
IN C
Engineering Department (3rd floor): i -
•, n i6
Hoy se number .................:.........! ...L �..Cf...,. .. .L... N
ITH TITL 3 .0
VIR®NMENTA C(3 YP
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A LICATIONS PROCESSED 8:30-9:30 A.M. and 1:00.2:00 •P.M. only TOWN REGULATICKK*�'
TOWN OF BARNSTABL. E
BUILDING INS'PECTO-11
APPLICATION FOR PERMIT TO ....... ......................... .....
TYPE OF,CONSTRUCTION ............ .........
........................�....... ............19
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
C-40
Location m ............................... ... ........:...............................................................
f ✓...` .... .... f
ProposedUse .... .. .................... ...... ........................... .. ..............................................
ZoningDistrict ................10f. .. .....................................Fire District ............................................ .................... ....
A' &..V.Address
Name of Owner.... .. .... . .. ...............
Nameof Builder .................................. . .............................Address ....................................... ..........................................
....Address C�
Name of Architect .............................................................. .................................................................................,..
Number of Rooms ....................�f .........................................Foundation ........................4F/
..................... ... .
Exlerior ......4� ..................Roofing ............................. ........................ .............................
Floors ..................... ......................................................Interior .........
C%.6CJ
Heating ...................... ..........................................................Plumbing .......................4!:::;:;........................... ..........................
Fireplace p .....................f.........................................................Approximate Cost ............./..�J.P.. ........................... . ......
Definitive Plan Approved by Planning Board __-_ ---------------1 Area .....1..../..�.. �``:.....:.......
Diagram of Lot and Building with Dimensions Fe
SUBJECT TO APPROVAL OF BOARD OF HEALTH
1
6AX �Lq
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the Rules and Regulations of the Town of Barns able rding the abov
construction. a
Name ......... ...... ...... .......
Construction Supery is License ..........�.. ..y ..... ...
ULAS, LARRY D.
f - -
29351 On Story
No ........ Permit for
,r
Sin lea Family Dwelling
Loeation .•..,,'.Lot,#9, 159 Flint Roek Road t
Barnstable '
Owner ......Larry'D. Nickulas _
_ ........ .Frame.......... ..... • ...... �` f.
Type of Construction -�
.................................".............................................. .. r
Plot r...................:........ Lot c r-
I x:fit. _ ,."'� �, • '
Permit Granted ............May.'.16'.............19' 86
Date of Inspection ... ...........19 s a r
Date Completed ..�,.:.......... ...........`..19.
�� r
of E� TOWN OF BARNSTABLE Permit No. ..29 l
BUILDING DEPARTMENT
SAM I TOWN OFFICE BUILDING Cash
60
°�oriY HYANNIS,MASS.02601 Bond
x. i7..
CERTIFICATE OF USE AND OCCUPANCY
Issued to Larry D. Nickulas
Address Lot #9, - 159 Flint Rock Road
Barnstable, Massachusetts
USE GROUP FIRE GRADING OCCUPANCY LOAD
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 AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE
BUILDING CODE.
.. 19... ?.. .... .� .... ............
Building Inspector
r
•j::i.$74�i.' :ray'' .:..+4:.k. .'ALL'.".rt-s[,W.sM.P i+�+Y�wY,pa4 w wvYYw
BUILDING
TOWtd OF BARNSTABLE, MASSACHUSETTS PERMIT
A-316-80-001
JOB WEATHER CARD
� a 16 86 s `�,� 29351
DATE 19 PERMIT NO.
APPLICANT Owner ADDRESS 002265
(NO.) (STREET) (CONTR'S LICENSE)
PERMIT TO Build dwelling (� STORY iiy.j. lt' .Family C1,JLll i:1F! NUMBER OF
DWELNG UNITS 1
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
lot 1?9 159 Flint jOCk 1C1<jcj, Ba.rnst :(u1a ZONING , , 1
AT (LOCATION) DISTRICT
(NO.) (STREET)
BETWEEN AND
(CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
dd (TYPE) "
" JCYAlLi}jN. 7f ti}7-�4.)i>
f REMARKS:
i
i
AREA OR ! 918 UQ. 1 C. 90,00o 'PERMIT 66.50 I
VOLUME ESTIMATED COST $ FEE
(CUBIC/SQUARE FEET)
Larry D. Nickulas
OWNER 1 BUILDING DEPT. l (�1n 1. , i c. ct,/.'.1 1 :i;IOL ", t"tt ..F::•' - ;;!,: �.
ADDRESS BY i
THIS PERMIT CONVEYS NOb RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF. EITHER TEMPORARILY OR
PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE AP
PROVED BY.THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED I
FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS
OF. ANY APPLICABLE SUBDIVISION RESTRICTIONS.
i
MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE
INSPECTIONS REQUIRED FOR CARD KEPT POSTED UNTIL FINAI.INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR
ALL CONSTRUCTION WORK: ELECTRICAL, PLUMBING AND
I..FOUNDATIONS OR FOOTINGS. MADE. WHERE 'A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS.'
2.-PRIOR TO COVERING STRUCTURAL QUIRED.SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL y '
MEMBERS(READY TO LATH). FINAL INSPECTION HAS BEEN MADE.
'! 3. FINAL INSPECTION BEFORE
OCCUPANCY.
POST THIS CARD SO IT IS VISIBLE FROM STREET
BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS
i
d j
3 HEAT)NG !NSPECTING APPROVALS .•RE I I ALS
l
o T H 2 C _ _— _— 2 _
Z 3 A
• ' �'
___7,00
WCRK SMALL NCT PROCEED UNT:L THE PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION, INSPECTIONS INDICATED ON THIS CARD i•
NSPECTOR 1A5 APPROVED THE VAR -,US ( WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE CAN BE ARRANGED FOR BY TELEPHONE
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