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TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Y'
Mapr ��� Parcel ? _ Permit#
Health Division Date Issued 2�
Conservation Division Fee �ZS
Tax CollectorlC7g/01 U`'
Treasurer 0 X-PRESS PERMIT
Planning Dept. F E B 0 8 2001 K V
Date Definitive Plan Approved by Planning Board 1 �,,
TOWN OF BARNSTABLE
Historic.OKH 44WY�7 v Preservation/Hyannis
:Project Street Address 2 y �1111"AS>^'2 C_ t
Village `Sf110NS44161 l e JA C.? `�o
Owner .LNG'/c/_� C UL/J'/� L y Address (A,44/„
Telephone S -+ — '��?/5�2,
Permit Request /' x0 o/-
Square feet: 1st floor: existing proposed 2nd floor:existing proposed Total new
Valuati4 7, G 4-4 Zoning District Flood Plain Groundwater Overlay
Construction Type
Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation.
Dwelling Type: Single Family Two Family 0 Multi-Family(#units)
Age of Existing Structure Historic House: 0 Yes O 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 0 No
Detached garage:0 existing Q new size Pool:0 existing 0 new size Barn:0 existing 0 new size
G�
Attached garage:0 existing ❑new size Shed:0 existing 0 new size Other:
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
z
Commercial ❑Yes I(No If yes,site plan review#
Current Use Proposed Use
BUILDER INFORMATION
Name�fN/���J - d l/�/"? y Telephone Number a - 3 0A Z
Address_ ;/ .�r'r'i4 f/� f� C r License# 0
Home Improvement Contractor# /0
Worker's Compensation#
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 0EM
SIGNATURE �.- f DATE4ZZZ4 � t
iF + �,�-
Barnstable
: . . ; The Town of B _ _
• e�xr►srnsc.e.
1659. Regulatory Services
Thomas F. Geiler, Director
Building Division
Ralph Crossen, Building Commissioner
367 Main Street,Hyannis MA 02601
Office: 508-862-4038 Fax: 508-790-6230
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 thanfour 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: /e
/^ /�� v Estimated Cost
Address of Work:�� � S'ly C �' �i�F✓/l?�C?Z_Cr '14.4 G Z 6-2
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Owner's Name:
Date of Application: Z i�
I hereby certify that:
Registration is not required for the following reason(s):
[]Work excluded by law
OJob 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.
OR
Date Owner's Name
q:forms:Affidav