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. ineering Debit. (3oor) Map L Parcel "/ Permit# l l
House#-- ,,2'7/S 76 . Date Issued Z" 1 Z 7
Board of Health(3r• � oor)(8:15 -9:30/1:00-4:30) � - - Fee e,..1,.. ,
:30-9:30/1:00=2:00) e
min. Bldg.) ' /THE
},`�.�.� ;�:_ •. . :oard 19 • ass,. v
._.. BARNSTABLE.
MASS �/
t S s6�q• ♦ II ll v
�- 61 .ti�E::: 4 0 / v
-, DZ TOWN OF BARNSTABLE t� ��
Building Permit Application t�T 1 p I(i
Project Street Address 7/, )e?- 4/� ' �1
Village fj , '
Owner '�/6- 60�dEk) Address /S� X42
Telephone 34d- /7?
Permit Request £- Z)Y 9-/Z 5J4 0_, &0,,627) - s/tyi,A,e.f-'
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First Floor ,SV-L: square feet Second Floor er square feet
' Construction Type � - .29- f�-i2, S) Rig�-- '
Estimated Project Cost $ /6 l-r-2)
Zoning District Flood Plain Water Protection
-Lot Size j.,,47j7_6 Grandfathered ❑Yes ❑No
Dwelling Type: Single Family 21 Two Family ❑ Multi-Family(#units)
Age of Existing Structure /. -c) Historic House ❑Yes ❑No On Old King's Highway ['Yes ❑No
Basement Type: Li Full Brawl ❑Walkout ❑Other
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft)
Number of Baths: Full: Existing l New Half: Existing New
No.of Bedrooms: Existing .2 New
y Total Room Count(not including baths): Existing , New First Floor Room Count
Heat Type and Fuel: ❑Gas ArOil ❑Electric ❑Other
Central Air Li Yes .0 No Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No
Garage: Li Detached(size) Other Detached Structures: ❑Pool(size)
Li Attached(size) ❑Barn(size)
..None . Shed(size) 17 Ai/jj-
Li Other(size)
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial ❑Yes Li No If yes, site plan review# -
Current Use Proposed Use
/�• Builder Information
Name ../;-'
j —�," //� �z Telephone Number / 2 41--
AddressL J�2p'- "i�/i �P� An , License# o�
i/l A 'i S ," ,� 7/ Home Improvement Contractor# /aZl Q
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Worker's Compensation# Alc 77,A 57_5-2_.-,
NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS
PROPOSED STRUCTURES ON THE LOT.
ALL CONSTRUCTION DEBRIS RESULTING FROM TH S PROJECT WILL BE TAKEN TO
SIGNATURE DATE V ,4 ' pi- 7 -
BUILDING PERMIT DENIED F THE FOLLOWING REASON(S)
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FOR OFFICIAL USE ONLY
PERMIT NO. i. It ,' L— tr ,
DATE ISSUED •
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_ . MAP/PARCEL NO. ,
P #, riT 4+
i ADDRESS f VILLAGE t 1
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OWNER t
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DATE OF INSPECTION: t • , ••, 3 `
FOUNDATION
FRAME r ' -• . '
INSULATION ,
FIREPLACE -
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ELECTRICAL: . ROUGH FINAL +
PLUMBING: ROUGH FINAL i
GAS: , ROUGH FINAL — '
1 ,
FINAL BUILDING v^/ —�sir— , _ i
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-1 1
DATE CLOSED OUT .
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—'ASSOCIATION PLAN NO. _
1
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i, . The Town of Barnstable
1.
"SS. Department of Health Safety and Environmental Services
`4°r i Mi 86 : Building Division
�� g
367 Main Street,Hyannis MA 0260I
Office: 508-790-6227 Ralph Crossen i
Fax: 508-790-6230 • Building Commis:
.
For office use only
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.
ff
Type of Work: / Est.Cost / - (JZ37-)
571
Address of Work: �7 / r V
-I__L___4- / leia,-_ I
Owner's Nameeb-4-'2-0L'''--
Date of Permit Application: /a __o? - 97
I hereby certify that:
Registration is not required for the following reason(s):
•
Work excluded by law
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
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 th •
�-4�
. tor
Registration
Co - Name No.
I �,.'..:'•,,,,-- -.-._--
r -1
r<.•§EF:rii.t,.--tii.IV-Mit5'• :::' 5.7- 7-e__:.-- /if‘/-i v./A Y ' le°(-1 7-6- C'9 ' \\.
't y ice:, ry r1 / 1�1�"03 J .�.,,. ; / 3�-� \ 1 '
`' I /fir! . . :
-41
I / V :
BK. /ZZi /�. 377
se. //o z f '. 56,5 I I ; •. -,t.
c.C. •-i7o f:. /7
3.C. CGo A . 4S I/ I 0 ,
8,e. .S.�¢ X: -3 Lo , NI
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1 % 2,044/
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z certify that this property is a��
located in Flood Hazard Zone C (out- ��� ����(� �� ,
year flood) as identified ,1 �n1 /` -`' C1
side the 50O . y I
i by the Department of Housing and Urban I De.�ei op ,lent (HUB) . CERTIFIED 'PLOT PLAN
,,i a..a, /J,q.SS
Date JAB Z, /44 N,;/,, '� \ LOCATION8 NSTf>B �,. '7 . ..
``,6 '�' 1_�:1{;,r,n\ .% 7 11"'20' DATE T.9 ,. �
,, SCALE
�✓G Gq,�r� . .
, ,:�. ; PLAN REFERENCE} (3E7 , .. .. •
Reg.v,Z�.nd-.,Surveyor yi~,2/B6"I� /� 1? D
•�K• • /7 // • •s8
QK 3 3 '8.` R'. ZBz.
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y titlen_ ;rarce company
• ��S we DwEu/�/.•
I Certify to its vi l 1 CERTIFY THAT THE .
hat there are no visible encroachments ICERTI ON THIS P AN IS LOCATED ON THE GROW:
i except a E shown and that this �g SHOWN HEREON AND THAT IT Lvi�IFORidS TO Th
•
easements y immediate SETBACK RE•DUIREME"ITS OF THE TOWN OF
Plan vis on. ed under my . .eee/v,: ',"?/7«. . v1HE.�, Ccr:STRUCT,
supervi sior.. • .- ;r, _,., 'c`''�
3 - ,y PP
f.,
e90Il4O1 S0'7
cfr"E Town of Barnstable Permit#
Expires 6 ihs from issu date
Regulatory Services Fee r,
BARNSTABLE, •
MASS. Richard V.Scali,Interim Director
06 9.
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
J'
yot Valid without Red X-Press Imprint
Map/parcel Number U
Property Address 2 7/5 Ind f' _S/7
J /
i;.fJ i c.79 Sir
kesidential Value of Work$ %240, 0 0
p
Minimum fee of$35.00 for work under$6000.00
Owner's Name&Address C. A J (0 1)i l cf ,SC 6 k C SQ
a-.715' /al/m ST>se T i AZ/2 S%9V? i0J9
Contractor's Name )(p ily)i c'j A e-I S'!.Telephone Number 50 F 30 - 'cNi„
Home Improvement Contractor License#(if applicable)i4/ /5.7"MC
p
Construction Supervisor's License#(if applicable) C
Workman's Compensation Insurance MAR 2 7 2014
Ches. -one:
am a sole proprietor
I am the Homeowner TOWN OF BARNSTABLE
I have Worker's Compensation Insurance
Insurance Company Name Al.//011 w C_ GC/PII 9 . Vl/U4(/ L 057/E9,7 ( !
Workman's Comp.Policy#
Copy of Insurance Compliance Certificate must accompany each permit.
Permit Req t(check box)
Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to L//r(//5) * f(= L.,¢#.06
Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof)
Re-side
Replacement Windows/doors/sliders.U-Value maximum.35)#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 pe u. orms\EXPRE§ doc
Revised 061313 r aid9-i.ae 11
CoOtigti
Town of Barnstable4fReulatoServices
xsrws Thomas F.Geiler,Director
i6 • 39 ivisionp Building D
Tom Perry,Building Commissioner
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:
numbe
street village
HOMEOWNER”:work phone#name home phone#
CURRENT MAILING ADDRESS:_
ci own ' state zip code
The current exemption for"homeowners was exte ded to include owner-occ .•ied dwellings of six units or less and to allow
homeowners to engage an individual for hi who do s not possess a license,,.rovided that the owner acts as supervisor.
D' FINITION OF HOME s R
Person(s)who owns a parcel of land on which ': she resides or intends to •eside,on which there is,or is intended to be,a one or two-
family dwelling,attached or detached structures a esso\y to such use am-/or farm structures. A person who constructs more than one
home in a two-year period shall not be considered a'•mc wner. Such omeowner"shall submit to the Building Official on a form
acceptable to the Building Official,that he/she shall be -s .onsible fo•all such work performed under the building permit. (Section
109.1.1)
1
The undersigned"homeowner"assumes responsibility for corn':• ce with the State Building Code and other applicable codes,
bylaws,rules and regulations.
The undersigned"homeowner"certifies that he/she unders . ds the `;•wn of Barnstable Building Department minimum inspection
procedures and requirements and that he/she will comply th said pro edures and requirements.
Signature of Homeowner
Approval of Building Official
Note: Three-family dwellings contai ' g 35,000 cubic feet or larger will be,yired to comply with the State Building Code
Section 127.0 Construction Control.
HOMEOWNER'S EXEMPTION
The Code states that: "Any ho' eowner performing work for which a building permit is required shall be exempt
from the provisions of this section(Se. 'on 109.1.1-Licensing of construction Superviofs);provided that if the homeowner
engages a person(s)for hire to do s h work,that such Homeowner shall act as supervisor."
Many homeowners who use this exemption are unaware that they are assuming theearesponsibilities of a supervisor
see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15)\\is lack of awareness often
results in serious problems,particularly when the homeowner hires unlicensed persons. In thase,our Board cannot
proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner a g as Supervisor is
ultimately responsible.To ensure that the homeowner is fully aware of his/her responsibilities,many communities r quire,as part of the
permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last pageofthisissueisaformcurrentlyusedbyseveraltowns. You may caret amend and adopt such a form/certification for use in
your community.
C:\Users\decolla\AppData\Local\MicrosomWindows\Temporary Internet Files\ContentOutlook\QRE6ZUBN\EXPRESS.doc
Revised 053012
1
ti.l
0F1HE 1V Town of Barnstable
te ,.
r Regulatory Services
t
ASS. Thomas F.Geiler,DirectorMass.
bAr A Building Division
Tom Perry,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, & ee/E - SCa rT 43EAR2SE as Owner of the subject property
hereby authorize iri 9SS@7 to act on my behalf,
in all matters relative to work authorized by this building permit
a7/6— i uurri Et. 2ar71tir /e.
Address of Job)
Pool fences and alarms are the responsibility of the applicant. Pools
are not to be filled or utilized before fence is installed and all final
inspections are performed and accepted.
a °e of er Signature of Applicant
Print Name Print Name
Dat
Q:FORMS:OWNERPERMISSIONPOOLS 62012