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Town of Barnstable *Permit# / 7- ?-3
Regulatory SE�ues 6 months from issue date
_. , Fee ��
.MST.
SIP
MAS& Richard V.Scali,Director 1639. ]
Building �}}'��s��}}onMAR 1 3 2oii
Paul Roma,Building C83ifkiso�-gg�r�:° �Q
200 Main Street,Hyannis,MA�26(�ARI f
www.town.barnstable.ma.us ��14 `�
Office: 508-862-4038 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
Not Valid without Red X-Press Imprint
Map/parcel Number r - 1 y�/� /�
Property Address cJ Ai l�//�l e-�.� , 6,tus4bl� . /!ll� Q a a U
Residential Value of Work$ %o Minimum fee'of$35.00 for work under$6000.00
Owner's Name&Address
Contractor's Name w i A S_S P Tr Telephone Number__
Home'Improvement Contractor License#(if applicable)W J5rj 706 Email:
Construction Supervisor's License#(if applicable) _ 9y
❑Workman's Compensation Insurance
Check one:
211',am a sole proprietor
❑ I am the Homeowner
❑ I have Worker's Compensation Insurance dd
Insurance Company Name homL
Workman's Comp.Policy#
Copy of Insurance Compliance Certificate must accompany each permit.
Permit Requ t(check box)
❑i Re-roof(hurricape nailed)(stripping old shingles) All construction debris will be taken to 6fikli—L�z
� n❑ Re-roof hu ne ailed)(not stripping. Going over existing layers of roof)
❑ Re-side
❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#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: t,,i✓1 �(
Q:\WPFILES\FORMS\building permit forms\EXPR_ESS.doc
06/20/16
�"E Town of Barnstable
Regulatory Services
` sKAM . ~ Richard V. Scab,Director
&63q.
Nua 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 6 6A,4s -SG'r1-' , as Owner of the subject property
hereby authorize /arm LR'a ase-H to act on my behalf
in all matters relative to work authorized by this building permit application for:
(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. '
ignature-of Owner Signature of Applicant
Print Name Print Name
Date
QTORMS:OWNERPERMISSIONPOOLS
' I
Town of Barnstable
e�
1
Regulatory Services •)
�t Richard V.Scali,Director
Building Division r
EARMAu. = Paul Roma,Building Commissioner
MAM
��� 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:
number street village
"HOMEOWNER":
name , home phone# work hone#
CURRENT MAILING ADDRESS:
city/town state zp code
The current exemption for"homeowners"was exte ed to include owner-occu ied dwel ' s of six units or less and to allow
homeowners to engage an individual for hire who do not possess a license,provided th t the owner acts as su ervisor.
D ON OF HOMEOWNER
Person(s)who owns a parcel of land on which he/she re 'des or intends to reside,on w 'ch there is,or is intended to be,a one or two-
family dwelling,attached or detached structures accesso o such use and/or farm s ctures. A person who constructs more than one
home in a two-year period shall not be considered a homeo er. Such"homeowne 'shall submit to the Building Official on a form
acceptable to the Building Official,that he/she shall be res o ible for all such wo Derformed under the building ermit. (Section
109.1.1)
The undersigned"homeowner"assumes responsibility for compli ce with th State Building Code and other applicable codes,
bylaws,rules and regulations.
The undersigned"homeowner"certifies that he/she understands the T f Barnstable Building Department minimum inspection
procedures and requirements and that he/she will comply with said proc ores and requirements.
Signature of Homeowner
Approval of Building Official
Note: Three-family dwellings containing 35,000 cu c feet or larger will be re ed to comply with the State Building Code
Section 127.0 Construction Control.
HO WNEWS EXEMPTION
The Code states that: "Any homeowner pe orming work for which a building�'Rermit is required shall be exempt
from the provisions of this section(Section 109.1.1 Licensing of construction Supervisor�)'; provided that if the homeowner
engages a person(s) for hire to do such work,th such Homeowner shall-act as supervisor.
Many homeowners who use this ex ption are unaware that they are assuming the re s,Ronsibilities of a supervisor
(see Appendix Q,Rules&Regulations fo icensing Construction Supervisors,Section 2.15) This lack of awareness often
results in serious problems,particularl hen the homeowner hires unlicensed persons. In this cas_I_our Board cannot
proceed against the unlicensed pers 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
this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in
your community.
Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc
06/20/16
ng neering Dept. (3rd floor) Map Parcel _ it# a 7 (o
House# �,j�j Date Issued
Board of Health(3rd floor)(8:15 - 9:30/1:00-4:30) �� '� � Fee do
Conservation Office (4th floor)(8:30- 9:30/1:00-2:00)
Planning Dept. (1st floor/School Admin. Bldg.) �p�yC$YS �,NE►b,
Definitive Plan Approved by Planning Board 19
TOWN OF BARNSI iPMAi F° 'NO
Building Permit Application '1VS
Project Street Address
Village /3d T9fSC-G�
Owner 001ti- Address
Telephone
. Permit Request '461� /1"y'?6K-- 0s seiC:O '4
First Floor square feet Second Floor square feet
Construction Type F-,W,,A76?
Estimated Project Cost $
Zoning District Flood Plain Water Protection
Lot Size Grandfathered ❑Yes ❑No
Dwelling Type: Single Family ® 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
No.of Bedrooms: Existing 3 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
Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size)
❑Attached(size) ❑Barn(size)
❑None ❑Shed(size)
❑Other(size)
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial Yes No If es site plan review#
❑ ❑ y
li
Current Use - , s Lk l Proposed Use �t�Q
Builder Information
4 Name J��,V,40 e, , 4-k2 64_ Telephone Number
cy Address OQ Gear Z-0/,3 License# 6 d�_N
C?" s® Home Improvement Contractor# /0,(6 / 5
Worker's Compensation#
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 THIS PROJECT WILL BE TAKEN TO
SIGNATURE DATE 3
BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S)
' r
FOR OFFICIAL USE ONLY
I �
PERMIT NO. - •
DATE ISSUED
MAP/PARCEL NO.
ADDRESS VILLAGE
OWNER
h
DATE OF INSPECTION:
FOUNDATION
FRAME K /9l ye
INSULATION /���?
FIREPLACE
ELECTRICAL33�RO .I ,.: FINAL
PLUMBING: lbMI <" FINAL '
GAS: FINAL
FINAL BUILDIlW(J:- 3A.,
Q , ,
DATE CLOSED O -�
ASSOCIATION PLAN NO.
The Town o: . f Barnstable
• wexsrnat� •
9� �m�' Department of Health Safety and Environmental Services
Building Division
367 Main Street,Hyannis MA 02601
Office: 508-790-6227 Ralph Crossen
Fax: 508-790-6230 Building Commissioner
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.
Type of Work:"I'm Est.Cost Ow-0. ci1J
Address of Work:
Owner's Name &)AY,
Date of Permit Application:
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 the owner:
Date Contractor Name Registration No.
OR
Date Owner's Name
/ v
3
Engineering Dept. (3rd floor) Map Parcel Permit# "� '#
House# S Date Issued
Board of Health(3rd floor)(8:15 -9:30/1:00-4:30) Fee'
Conservation Office(4th floor)(8:30-9:30/1:00-2:00) C1
Planning Dept. (1st floor/School Admin.Bldg.)
c�6r
DeApproved by Planning Board 19 gib , 1
�,, ,BARN$TABLE.
0?p
TOWN OF BARNSTABLE
Building,Permit A placation
ddress Z �f S �j�/� 5 r /f Gdr
Owner UM ('50e&l-> Address Z 75> -57�
Telephone 51
Permit Request ro f t Z-z- ��� •-- Sold C
101
•First Floor 2 square feet Second Floor square feet
Construction Type 4jaeo �
Estimated Project Cost $ 74V,Gof4C?
Zoning District l Flood Plain Water Protection
Lot Size Grandfathered ❑Yes ❑No
Dwelling Type: Single Family ❑ 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
No.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
Garage: o,6etached(size) 7- `(e K t-"*— Other Detached Structures: ❑Pool(size)
❑Attached(size) ❑Barn(size)
❑None ❑Shed(size)
❑Other(size)
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial ❑Yes ❑No If yes, site plan review#
Current Use Proposed Use
Builder Information
.Name el
``061;-OF4(�lJ Telephone Number
Address PQ- 43� &3 License# e!$ 83
e Home Improvement Contractor#
Worker's Compensation#
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 THIS PROJECT WILL BE TAKEN TO
SIGNATURE DATE
BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S)
FOR OFFICIAL USE ONLY -
PERMIT NO.
DATE ISSUED �� • :..� �. - _ �, r f . ,
MAP/PARCEL NO. - r q '� • - • ,
v _ f
ADDRESS VILLAGE , F
OWNER
DATE OF INSPECTION:
FOUNDATION
FRAME
• INSULATION
FIREPLACE + r y
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL -
GAS: ROUGH FINAL
FINAL BUILDING
DATE CLOSED OUT
ASSOCIATION PLAN NO.
. I
�"E
The Town of Barnstable
HAMss.
�g De artment of Health Safety and Environmental Services
6,jg. P Building Division
367 Main Street,Hyannis MA 02601
Ralph Crossen
Office: 508-790-6227 Building Commissioner
Fax: 508-790-6230, e
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 a or building more than four be done by registered dwelling
contra tors with
reside
nce structures which are adjacent to such g
certain exceptions,along with other requirements.
Est.Cost Z 2,
Type of Work:
Address of Work•
Owner's Name
Date of Permit Application:
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 APP
LICABLE 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.
Registration No.
Date Contractor Name
OR
t ILL I CENSUS TRACT# 123
CLIENT: DEED BOOK 2848 PAGE 33
OWNER: JOM WMARY ALICE RYAN PLAN BOOK PAGE LOT
APPLICANT; WILLIAM BREPM AMESSORS PLAN PLOT
MORTGAGE INSPECTION PLAN
OF LAND LOCATED AT
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