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rA Application numbe ......... Iaj
Fee .........�....:1..4.4431.... ................
sue :
Building Inspectors Initials........... .... ..................
DateIssued..................................... ..........................
i -64D-1..........
Map/Parcel..... ..
TOWN OF BARNSTABLE
EXPEDITED PERMIT APPLICATION:
ROOF/SIDINGAVINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION
PROPERTY INFORMATION
Address of Project: ai 0 d r_> ate All/// 62�
NUMBER STREET VILLAGE_
Owner's Phone Number 'lo • t
Email Address: Cell Phone Number
Project cost$ `l�� Check one Residential V Commercial
b(
OWNER'S AUTHORIZATION
As owner of the above property I hereby authorize ,.�.,.�,� G�,'�l®
to make application for a building_permit in accordance with 780 CMR
Owner Signature: r2wllz Date:
TYPE OF WORK
Siding ❑ Windows (no header change)# ❑ Insulation/Weatherization
❑ Doors(no header change)# Commercial Doors require an inspector's review
❑ Roof(not applying more than 1 layer of shingles)
Construction Debris will be going to
CONTRACTOR'S INFORMATION
Contractor's name /GhaT;!4 �A �d
Home Improvement Contractors Registration(if applicable)# / (attach copy)
Construction Supervisor's License# 6-�2 ;h. ? S 1 C-- (attach copy)
Email of Contractor�����j f�`�"��� ;�_�-�-,o„ , Geri numberb��3 Y Z
ALL PROPERTIES THAT HAVE STRUCTURES OVER 751�EARS OLD OR/F THE SUBJECT PROPERTY/S IN
APPLICATION.NUMBER............................................................ {
*For Tents Only*
Date Tent(s)will be erected Removed on number of tents total
Does the tent have sides?Yes No (If yes please attach floor plan with exits marked)
Dimensions of each Tent X X X
Additional tent dimensions can be attached on a separate piece of paper.
Purpose of Event
Check one: this event is a: for profit non-profit event
Check one: Food served Yes No
Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s)of each tent
Fuel source being used LP tank 20 lbs. or> Yes No ,if yes, a gas permit is required.
.Natural GasIYes 4> ` No ,ifIyes, a gas peri iit is.required. j
If food is being served at.your event please obtain a Health Department approval between the hours
of 8:00am-9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval
.f
*WOOD/COAL/PELLET STOVES
Manufacturer# Model/I.D.
Fuel Type Testing Lab
Offsets from combustibles: front back left side right side
HOMEOWNER'S LICENSE EXEMPTION
Homeowner's Name:
Telephone Number Cell or Work number
I understand my responsibilities under the rules and regulations for Licensed Construction
Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand
the construction inspection procedures,specific inspections and documentation required by 780
CMR and the Town of Barnstable.
Signature Date
APPLICANT'S SIGNATURE
Signature Date
f < All permit applications are'subject to a building off cial's appr oval prior to issuance.
10% BUILDING DEP-T Application Number............ .........
%63 APR26 2018 Permit Fee...... 07-�7. .............Other Fee......,.,................
To I WN OF BA RNS7-AF3LE Total Fee Paid.............................. ........ .................... .....
TOWN OF BARNSTABLE Permit Approval'by., ................... Slls�� g
BUILDING PERMIT
Map., ..........I., ...... ....Parcel........... .......................
APPLICATION
Section-l'- Owner's InformationahOd Prdiectlocation�'
Project Address -.1m.............
Owners Name
lOwners Legal Address
;City 00114 S*4 State //424 Zip 40�
lOwners Cell# E-mail bA
/�,'V1),oAx;I)s CA, e9mle-
LSection 2— Use of Structure
Vse Group Commercial Structure over 35,000 cubic feet
❑ Commercial Structure under 35,000 cubic feet
Single I Two Family Dwelling
Section 3 —Type of Permit
New Construction ❑ Move/Relocate Fj Accessory Structure ❑ Change of use
Demo/(entire structure.) ❑ Finish Basement ❑ Family/Amnesty D Fire Alarm
Rebuild 0 Deck Apartment ❑ Sprinkler System
Addition Retaining wall Solar
Renovation Pool ❑ Insulation
ther—Speci 6,0,-7-Z�" '�
Section 4 - Work Description
Ar dgobm 'PAALIIA�ft�s
6/QW A—/_,11, LOUL X Ah e- 4 2 dA A
VA,4 &ARJ�k_
far ,,,:
V V
Last updated:3/15/2018
Application Number—.................................................
Section 5—Detail
Cost of Proposed Construction, (. Square Footage of Project
Age of Structure Dig Safe Number
#Of Bedrooms Existing Total#Of Bedrooms(proposed)
110 MPH Wind Zone Compliance Method ❑ MA Checklist ❑ WFCM Checklist ❑ Design
Section 6—Project Specifics
[� Wiring ❑ Oil Tank Storage Smoke Detectors
[] Plumbing ❑ Gas (] Fire Suppression
❑ Heating System ❑ Masonry Chimney ❑Add/relocate bedroom
Water Supply ❑ Public ❑ Private
Sewage Disposal ❑ Municipal ❑ On Site
Historic District ❑ Hyannis Historic District (-� Old Kings Highway
Debris Disposal Facility: I am using a crane ❑ Yes ❑ No
Section 7—Flood Zone
Flood Zone Designation
Within or adjacent to a wetland, coastal bank? Yes ❑ No ❑
Section 8—Zoning Information
Zoning District Proposed Use Lot Area Sq. Ft.
Total Frontage Percentage of Lot Coverage #of Dwelling Units (on site)
Setbacks Front Yard Required Proposed
Rear Yard. Required Proposed
Side Yard Required Proposed
Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No
Last updated:3/15/2018
Application Number...........................................
Section 9— Construction Supervisor
Name Telephone Number_j7f J5-y-Y'ZY'()
Address S� City Ve/` _State_��Zip eb?zig
License Number 165 0((-�, L y _—�Expiration Date V /_
Contractors Email Cell #
I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780
CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and
documentation requir 780 C . the o of Barnstable. Attach a copy of your license.
Signature Dater' C
Section 10—Home Improvement Contractor
NamAOer aJiUe� 1A)94,k Za fi Sri;jAc_ Telephone Number, ?-�Pv��f�
Address c� Lal!:l Ye. City lye,— State� Zip 6�7oZ/
Registration Number —Expiration Date
I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780
CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and
documentation required b 780 CMR and t Town of Barnstable. Attach a copy of your H.I.C...
Signature (7 Date
Section 11 —Home Owners License Exemption
Home Owners Name:
Telephone Number Cell or Work Number
I understand my responsibilities under the rules and regulations for licensed Construction Supervisor in accordance with 780
CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and
documentation required by 780 CMR and the Town of Barnstable.
Signature Date
A.PPL T SIGNATURE
Signature Date
Print Name d I p�— Telephone Number
E-mail permit to:Ter �L1A)&_M e_r-i ZZ4_A07l.@ Q
Last updated:3/15/2018
Section 12 —Department Sign-Offs
Health Department 0 Zoning Board(if required)
Historic District F Site Plan Review(if required)
Fire Department ®'
Conservation
For commercial work,please take your plans directly to the fire department,for appro vat
Section 1.3 -- Owner's Authorization
S , as Owner of the subject property hereby
authorize 7-' to act on my behalf, in all
matters relative to w6k authorized by this building permit application for:
(Address of job)
Signature of Owner date
Print Name
bast updated:3115I2018
of INE r Town of Barnstable
Regulatory Services
nAtty*sraBir, Richard V. Scali,Director
9 MASS.�p 1639. ,�w� Building Division
Paul Roma
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
I, JENNIFER PHILLIPS , as Owner of the subject property
hereby authorize /i/ferWLA Vt-k�kWV-i'2 to act on my behalf,
in all matters relative to work authorized by this building permit application for:
100 Indian Hill Road Cummaquid, MA 02637
(Address of Job)
Signature of Owner Date
Print Name
If Property Owner is applying for permit,please complete the Homeowners License Exemption Form.
C:\Users\decollik\AppData\Local\Microsoft\Windows\INetCache\Content.Outlook\L7U69LF2\EXPRESS(2).doc
01/25/17
ALTERNATIVE
WEATHERIZATION
' 34heDate
o
Town of Barnstable to
200 Main St.
Hyannis,MA 02601
Re: Permit 4 �—
The Insulation work at
has been completed In accor ce with:780CMR.
Agency work performed fo
::ftegeriis'•
rmothy Cabral;
President
CSL-105454
58 DICKINSON STREET i PALL RIVER,MA 02721 ( (508)567-" ) ALTERNATNEWEATHEREATIONOGMAILCOM
Town of Barnstable Building
�PoTeesedhUsPoW ais iiC'teard oThat itc�wsVisinble. From,ahle St„r,.,eet ,�Au" roved�Plan. s�M ust be Re,tair retl on Job a,nd tphis CardtMust.be=Ke t ,Ga
Permit
Permit No. B-17-1633 Applicant Name: Stephen Dickinson Approvals
Date Issued: 05/31/2017 Current Use: Structure
Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 11/30/2017 Foundation:
Location: 100 INDIAN HILL ROAD,BARNSTABLE Map/Lot: 318-029� Zoning District: RF-1 Sheathing:
Owner on Record: PHILLIPS,JENNIFER M �`3 3 Contractor Na nee STEPHEN T DICKINSON Framing: 1
Address: 97 DEERFIELD AVENUE ' Contractor en CS-081843 2
WESTWOOD,MA 02090 �
fst Project Cost: $2,316.00 Chimney:
Description: Replace 1 sliding door ermit Fee: $35.00
Insulation:
Project Review Req: Replace 1 sliding door Fee Paid; $35.00
pFinal:
hate 5/31/2017
Plumbing/Gas
Rough Plumbing:
Wouilding Official Final Plumbing:
This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within ti`6months afterlssuance.
t Rough Gas:
All work authorized by this permit shall conform to the approved applicatiRapthe approved construction documents for which this permit has been granted.
All construction,alterations and changes of use of any building and st uctures hs all be in compliance with the local zoning by laws and codes. Final Gas:
This permit shall be displayed in a location clearly visible from access street or oad and shall be maintained open for publicinspectio for the entire duration of the
work until the completion of the same. IT
Electrical
s r
The Certificate of Occupancy will not be issued until all applicable signatures by�the Buildingand Fire Officials are provided on this permit. Service:
Minimum of Five Call Inspections Required for All Construction Work: lk
1.Foundation or Footing Rough:
2.Sheathing Inspection
3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final:
4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection
5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough:
6.Insulation
7.Final Inspection before Occupancy Low Voltage.Fina1:
Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health
Work shall not proceed until the Inspector has approved the various stages of construction. Final:
"Persons contracting with unregistered contractors do not have access to the guaranty fund"(as set forth in MGL c.142A). Fire Department
Building plans are to be available on site Final:
All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT
i Town of Barnstable
�R cE�I�PT
200 Main Street, Hyannis MA 02601 508-862-4038
Application for Building Permit
Application No: TB-17-1633 Date Recieved: 5/25/2017
Job Location: 100 INDIAN HILL ROAD,BARNSTABLE
Permit For: Building-Siding/Windows/Roof/Doors
Contractor's Name: STEPHEN T DICKINSON State Lic. No: CS-081843
Address: MERRIMAC, MA 01860 Applicant Phone: (508) 676-6820
(Home)Owner's Name: PHILLIPS,JENNIFER M Phone: (401)484-3766�
(Home)Owner's Address: 97 DEERFIELD AVENUE, WESTWOOD,MA 02090 1=4
Work Description: Replace 1 sliding door vim,
trs
c_
Total Value Of Work To Be Performed: $2,316:00
Structure Size: 0.00 0.00 0.00
Width Depth Total Area
I hereby swear and attest that I will require proof of workers'compensation insurance for every contractor,subcontractor,or other worker before
he/she engages in work on the above property in accordance with the Workers' Compensation Act(Chapter 568).
1 understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by
filing a waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage unless he files his intent to
accept coverage.
I hereby certify that I am the owner of the property which is the subject of this application or the authorized agent of the property owner and have
been authorized to make this application. .1 understand that when a permit is issued,it is a permit to proceed and grants no right to violate the
Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and
specifications. All information contained within is true and accurate to the best of my knowledge and belief.
All permits approved are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24
hours in advance.
Signed: Stephen Dickinson 5/25/2017 (508)676-6820
Applicant Date Telephone No.
Estimated Construction Costs/Permit Fees
Total Project Cost: $2,316.00 Date Paid Amount Paid Check#or CC# Pay Type
Total Permit Fee: $35.00 5/25/2017 $35.00 XXXX-XXXX-XXXX- Credit Card
7597
...........:......................................................................................................................
..
Total Permit Fee Paid: $35.00
Q �
Assessor's ma and lot. number .... .� :. U..:.:. '
SEPTIC'SYSTEM MUST BE
-� f 0- K INSTALLED IN COMPLIANCE
Sewage-,Perniit nurrrber ..................Jar....! ..........,.................
WITH ARTICLE II STATE
SANITARY CODE*AND TOWN
�Q�pGTHE
rO��O TOWN... OF 'BARNA��LE
Z BAENSTODLE, i t
Q pY OUILLNG INSPECTOR
`'.. APPLICATION FOR PERMIT T ... ly// .... ....� ................ ...dV•.. ...............
TYPE OF CONSTRUCTION ............ ... �.4. p1J.......... 4 ....`.....................
G ( ..................................... ........19........
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereb es for "rmit according to the following information:
.....lu Q
....�1 Location
. . ........................... .. ........
Proposed Use ...... ........ .........................................................................................:..............................................
a:J.4?4!►.1�... . .
ZoningDistrict ..... .. ....................................................Fire District .........................................
Name of Owner . .G�.. . ...... .......................Address:4�•.1�J.P ...� a� .��: .r ., ..............
It
Nameof Builder ..........:....... ... .!!!..................................:.....Address ....................................................................................
Nameof Architect ...................................................................Address ....................................................................................
Numberof Rooms ......... .....................................................Foundation .. ..........................................................
Exterior .. ... . .... ....... ..... • ...................................................Roofing .... . ...aft
.............................................................
..................................................................Interior ...,........~..... ??`..... ......................................................
Floors '�'"y
Heating .... ...................................................Plumbing ..........
..4P... ....................................:......... ..........................
Fireplace .............1:...................................................................Approximate Cost ................/.../.................. .. ...
Definitive Plan Approved by Planning Board ________________________________19________. Area .......�18.l. ...............
Diagram of Lot and Building with Dimensions Fee
SUBJECT'TO APPROVAL OF BOARD OF HEALTH
COM
lS
I
hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Name (l9ld...... ...............................
Murphy, Edward J.
No ...,18850 Permit for ... 1..1/2...story
single...family dwelling
Location�k.....Indian Hill Road.................... 1
ICCl47/... .....•.................................
Owner ,...........Edward J. Murphy.................. -
..
Type'of Construction frame......................... -
................................................................................
Plot ............................ Lot ................................ ,
December 1. 76
Permit Granted :.:. 19
� /o
Date of Inspection ... ..1 W� .......
'Date Completed ..l..................................19
PERMIT REFUSED
'14 r
.................... 19
... n ......r.............................................................. .�- ti. 't•,� r �.. 1 _ ��..
.......................'....................................................... '�---
............................y `
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t
Approved ..........:..................................... 19_
...............................................................................
...............................................................................
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