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�oFTHE roi Town of Barnstable *Permit#
y�P ti� Expires 6 months rom' ue d e
Regulatory Services Fee
BA1 MASS. I E,
v� 9: ' Thomas F. Geiler, Director f1MA
Building Division
Tom Perry, CBO, Building Commissioner
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 _ I-T L �`�h 4
U<esidential Value ofWork.S16TV Minimum fee of$25.00 for work under$6000.00
Owner's Name & Address �/ Telephone Number J ICJ i0,4 l! YQ
Contractor's Name {��1 ������ p
I lome Improvement Contractor License#(if applicable) �
Construction Supervisor's License#(if applicable)
❑Workman's Compensation Insurance
Ch ck one:
FI am sole proprietor gar
-PRESS E I
❑ t I am the Homeowner
❑ I have Worker's Compensation Insurance 200�
APR 2
Insurance Company Name
-F®WN
Workman's Comp. Policy #
Copy of Insurance.Compliance Certificate must be on file.
Permit Request (check box) -
❑ Re-roof(stripping old shingles) All construction debris will be taken to
❑ Re-roof(not stripping. Going over existing layers of roof)
V/Re-side
❑ Replacement Windows/doors/sliders. U-Value (maximum .44)
*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 is required.
SIGNATURE:
Q.`WI'1-ll.lN&ORM3\buil ing p mii forms\EXP 4ES.doc
Revised 100608
Ta�ti Town of Barnstable
o�
Regulatory Services
ILAIINSTABLE-
MAIM $ Thomas F.Gefler,Director
16 Building Division
Tom Perry,Building Commissioner ,
200 Maui Street,Hyannis,MA 02601
www.town-barnstable.rna.us
Office: 508-862-403 8 Fax: 508-790-6230
Property OwnerMust
Complete and Sign This Section
If Using A Builder
L ��ef���jr9 �li ,as Owner of the subject property
hereby authorize /7✓I —4GR v to act on my behalf,
in all matters relative to work authorized by this building permit application for.
/ -0
.(Address of job)
Signature of Owner Date
Print Name
If Property Owner is applying for permit please complete the
Homeowners License Exemption Form on the reverse side.
•, ? TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map �3 Parcel ® f (� �` Permit# �
Health Division Date Issued V�
Conservation Division = ' Fee��_ l�
Tax Collector • . a�Z7
1
Treasurer v E
Planning Dept.
Date Definitive Plan Approved by Planning Board ,
Historic-OKH reservation/Hyannis }
Project Street Address Z7 y
Village 6tlL 504A-14,16-
.Owner Aegs
Telephone
Permit Request /G Ajo
S-E-vw,J Cr-�.cQ 12�r�i
�.O 17'i •
Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new
Estimated Project Cost .-U O Zoning District Flood Plain Groundwater Overlay
Construction Type
Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation.
Dwelling Type: Single Family Id 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 0 new size Barn:O existing ❑new size
Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other:
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial ❑Yes ❑No If yes,site plan review#
Current Use Proposed Use
BUILDER INFORMATION
ERASER1,CONSTRUCTION Name Telephone Number
Address ('_01111T 544 �t* �a� License#
i R) 428-2292 Home Improvement Contractor#
Worker's Compensation# zx) IL117al ,
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Ccit
SIGNATURE DATE " Cry
FOR OFFICIAL•USE ONLY - >
t 3PERMIT NO.
DATE ISSUED
MAP/PARCEL NO.
�� .�'- i • ti .•:� ..'�.a^. • •.ter• r
- ADDRESS VILLAGE
OWNER
Lj
DATE OF INSPECTION:
FOUNDATION
FRAME
' INSULATION e � -. • {" `` � . •- � � j R.
FIREPLACE
tr
ELECTRICAL: ROUGH FINAL`r
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
FINAL BUILDING r F
DATE CLOSED,OUT
ASSOCIATION PLAN NO:
fi
The- Town of Barnstable
mms Department of Health Safety and Environmental Services
Building Division
367 Main Street,Hyannis MA 02601
4
Office: 508-862-4038 f Ralph Crossen
Fax: 508-790-6230 Building Commissioner
Permit no. ' Y`
1 ix 'It
Date
# a=: _ •{,= • AFFIDAVIT
HOME DWROVEMENT CONTRACTOR LAW
"t-,1UPPLEMENT TO PERMIT APPLICATION
MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion,
# f'..i SY: xi
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.
Type of Work: Re R,0 -F I V1 Estimated Cost
• p
Address of Work: z'V'2� ?A— ' < �G16, L�
Owner's Name: i I` .�, c Gc�i 41666
Date ofApplicationtG�-
f h �
I hereby certify that:
r
Registration is not required for the following reason(s):
f -
• Work excluded by law
C]Job Under$1,000
Building not owner-occupied
Owner pulling own permit
Notice is hereby glven that:
OWNERS,PULLING111EIR OWN PERMIT OR DEALING WITH UNREGISTERED
CONTRACTORS'FOR`APPLICABLE=HOME IMPROVEMENT WORK DO NOT HAVE
ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A.
SIGNED UNDER PENALTIES OF PERJURY
I hereby apply fora permit as the ag owner:
11�
Date Contracto Name Registration No.
OR
Date Owner's Name
q-1orms:Affidav
THE FOLLOWING
IS/ARE THE BEST
IMAGES FROM POOR
QUALITY ORIGINALS)
I M ^C&L
DATA
TOWN OF BARNSTABLE permit No. 2e 394 a -
Building Inspector: '-
. sAU3TAU Cash
OCCUPANCY PERMIT Bond
No building nor structure shall be erected, and no land, building or structure shall be
used for a new, different, changed, 'or enlarged use without a Building Permit-'.therefor
first having been obtained from the Building Inspector. No building shall be occupied until a
certificate of occupancy has been issued by the, Building Inspector."
..,Issued.to George U a Warren Address
11M Yndian Trail- (4pnprvamiid
Wiring Inspector / Inspection date
Plumbing Insp�egtor �' ..�- - Inspection date
v R
Gas Inspector Inspection date
1
Engineering Department r iM Inspection date
THIS PERMIT WILL NOT BE VALID; AND THE BUILDING SHALL NOT 'BE OCCUPIED UNTIL
SIGNED BY ,THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN
REQUIREMENTS.
.......... 1922 .
.
%� Building Inspector
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a DISTANCE AS CERTIFIED C— �f� ° ��! ! /��Qr7"
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�' '�� �� �rl"� CLAN ,
I WEREBY CERTIFY TWAT THE$UILDING '
aHgddN QN THIS PLANAS LOCATED ON THE <z, a jj \ y c—
aRQUtvFDAS'SH01141NHEREON&THA -_I:T -y22S �,\ ,d""`:;5 ,.r LOCUS �/�!✓f itd �rQ/L
Q1VEq;fiM,TO THE ZQNIN.G BY,LA�9S OF THE
rgwN r � �o ARNIC
1JH
EN2 CONSTRUCTED-` DATEI -,
o kU2 ' �'' REF: C"G
PREPARED FOR: �aL��3C
CIVIL ENGINEERS ,�I �.
h t LAND SURVEYORS _ _ _ i
t .�_ :ry- C. ' •R / i�l,''} . 0
SCALE t Gt_
g A Yarmouth.&Orleans MA . �— DATE .'
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' Assessor's map and lot number oQ �.�.......��........� �y....: THE
s j � ��► SEPTIC SYSTEM MUS '
Sewage Permit number � o
... .. ..... .............................. INSTALLED MI COMP
l ;< EAUSTADLE. i
House number .................. ,t'��....................................... MTN TITLE b 9 Mpea
f
ENVIRONMENTAL � 9�
CODE 6 •39 39a`
mxf
TOWN OF BA�.NSTT " '°�TI`'
SUBJECT TO APPROVAL O
BUILDING INSPECTOR F
SUBJECT
CONSERVATION
COMMISSION
APPLICATION FOR PERMIT TO �!4.... '
..........• . ........... � ... ... ...d� .�r�.
tq Go
TYPE OF CONSTRUCTION ..........(V..I!!?I��r�.............................................................).q.1�1.14„)......G � ..
................................................19........
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies
for a°permit acconrcling to the following information:
Location4 f;1!1. k��.6JA".. + ktido.tKlff .......................................................:...................................................
Proposed Use .. .-P�R!k...o!* � .!'!1,.1.��'I�.. .N'1'..�...................................................
Zoning District . ..........1.�.. .. .�.....................................Fire District .... ........
Name of Owner GWY ' .'jM..U tW. , m ...................Address Ols1 a olc Yet* J a 2.s 37
Nameof Builder ................................................Address ....................................................................................
Nameof Architect .� '1 �...............................................Address ....................................................................................
Number of Rooms .40.u.,r.0) eXd...K!.CaV-4:�4 oundation Co�
Exterior ) ..V 4-LSWWiW4 (�.Roofing !'�. .. .i .
Floorsk". S4 ! 1 � .Inerior ........:.... . ................................ ...........................................................................
Heating + `. .(e� 1.�l.A�.�! ! Plumbin �. 17N.Si .....................
ov
Fireplace Q:d '' 0, .. f.!!Vk ..........Approximate Cost ,. ...........................................
.....
Definitive Plan Approved by Planning Board -------------------_-----------19________. Area ..... .......... .........................
Diagram of Lot and Building with Dimensions Fee ..... ...........
SUBJECT TO APPROVAL OF BOARD OF HEALTH
P
9r-
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Name . ....
Y.
r
Warren, George U.
22384 1 1/2 story
No ................. Permit for ....................................
mingle family dwelling
......................................................................
140 Indian Trail
Location ................................................................
OL�t"V� �C , _ +.
..................................................
Owner ...............George..U....Wa.rren....................... ...... .... .... ........
st
T Cotruction .............f.r.ame...................
-011 . . ......
YP-
6 Folf
.................................................................
.......................... Lot ................................
tl�ermit Granted ..............jv.jy 80
Date of Inspection ....................................19
Date Co ple d .................... 19 0,2,
PERMIT REFUSED
.... .QM.. ...... ..................................... 19
......... ........... .... . ..........................
....... .. .... . .... ........ ... .. .. ... ......
... . ........ . ...........
0
............ .. ....................................
V
10
Apobvil .........................k....................... 19
........................................................... ...................
.. ...............................................................................