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Town of Barnstable �i�t#csa�
10 Expire
' - Regulatory Services Fees 6mont from issue date
sARNSTABLE, '
•
x�ss i639, NI Thomas F. Geiler,Director
AjFDt p't6
Building Division
Tom Perry, CBO, Building Commissioner
200 Main Street, Hyannis, MA 02601
www.town.bamstable.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__3_5La_9_L
Property Address L
`Residential Value of Work 3, 000, 1 Minimum fee of$35.00 for work under S6000.00
Owner's Name &Address L"ohtnJ �
/-?6 6,41- Cif Petj' cjij )0 A
Contractor's Name Gsue-;a=A/,, �/i�
1�
Telephone Number 7'</,y,1./././_e.l'.75'
Home Improvement Contractor License#(if applicable) /42ICL/j.
Construction Supervisor's License#(if applicable) l 29 5 ,.PRE
❑Workman s Compensation Insurance MAY
'10 t,
• Check one: , RNST'°'$�'
1 am a sole proprietor TO
❑ I am the Homeowner
❑ I have Worker's Compensation Insurance
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Insurance Company Name
Workman's Comp. Policy#
Copy of Insurance Compliance Certificate must accompany each permit. •
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)
k Re-side (ekc,,,,f c1-,41-1--O✓to la S tk Vv c_
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#of doors
❑ Replacement Windows/doors/sliders. U-Value (maximum .44)#of windows
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*Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
***N•.dte: ' Property Owner must sign Property Owner Letter of Permission:
A copy of the Home Improvement Contractors License & Construction Supervisors License is
required.
SIGNATURE:
Q:\WPFILESIFORMSIbuilding permit formslEXPRESS.doc
of:HE r Town of Barnstable
Regulatory Services •
s,tsxsrAs[.�
Thomas F. Geller,Director
�$Eo Buildin'g Division
Tom Perry, Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-403 8 Fax: 508-790-623 0
Property Owner Mus t
Complete and Sign This Section
If Using A Builder
T, J o A L� �-'� , as Owner of the subject property
hereby authorize Eu Q/f Ji, /y C 4/(6 /4 to act on my behalf,
in all m2tters relative to work authorized by this building permit application for:
93C ei/4,11,17/)1'.fr/ /4 /, 2‘?"4-)
(Address ofjot)
•
5-%- /J
or._tore of ner Date
er(
611:141(1
Pro' Name
• If Property Owner is applying for permit please complete, the
Homeowners License Exemption Foini on the reverse side.
r\
Town of Barnstable
ofY> •
y .wss;. '�\ Regulatory Services .
aAarlsn scn. • Thomas F. Geiler, Director
•
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• Building Division
bS
P 165¢rEO '�{• } Tom Perry, Building Commissione •
-• 200 Maia.Street,_Ayannia,MA 026?1
WITTY.tip wn_barnstab1e.ma_ .
Office: 508-862-4038 Fax: 508-790-6230 '
HOMEOWNER LICENSE 4 ' ON
Please Print
DATE: •
•
JOB LOCATION:
.\ . . .
number street village
"HOMEOWNER":
name home p .nc# work phone# .
CURRENT MAILING ADDRESS: •
.ty/town state rip code
The current exemption for"homeown , "was extendei to include owner-occupied dwellings of six units or less and
to allow homeowners to engage an in.• dual for hir.who does not possess a license,provided that the owner acts as
supervisor. -
• D t r ON OF HOMEOWNER ,
Persons)who owns a parcel of land on w• h lid..e resides or intends to reside, on which.there is, or is intended to'
be, a one pr two-family dwelling, attached o der hed structures accessory to such use and/or farm structures. A
person who constructs more than One home in • o-year period shall not be considered a homeowner. Such
'homeowner"shall submit to the Building Of r-'al on a form acceptable to the Building Official, that he/she shall be
responsible for all such work performed under•. building permit. (Section 109.1.1)
The undersigned "homeowner"assumes resp.nsibih' for compliance with the State Building Code and other
applicable codes, bylaws,rules and rcgulati q. . •
The undersigned"homeowner"certifies ..',he/she u nders:nds the Town of Barnstable Building Department
minimum inspection procedures and re. •:-ments and that h. she will comply with said procedures and
requirements. - .
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Signature of Homeowner /
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Approval of Buflding,Officia.l
Note: Three-family dwellings containing 35,000 cubic feet or large will be required to comply with the
State Building Code Section 127.0 Co I truction Control. .
HOMEOWNER'S EXEMPTION
be exc t from the rovisions
a building smut is rc� ircd shall p
The Code stairs that: "Any homeowner perfot„y��g work for whichg p iT�P
l person(s)s
of this scction.(Scctian 1 D9.7.1 -Licensing of construction Supervisors);provided tha[if the homco�vn•� engages a p ()for hire to do such
work,that such Home-Owner shall act as supervisor."
lv1any homeowners who use this exemption arc unaware that they arc assuming the responsnbih'.'cs of a supervisor(sec Appendix Q,
•
Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly
when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with i licensed
Supervisor. The homeowner acting u Superrisor is u)timately 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 hdshe understands the responsibilities of a Supervisor. On the last page of this issue is a•form currently used by
several towns. You may care t amend and adopt such e form/certification for use in your community. •
- - TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION.
Map- 3 5 1 • Parcel D if/ ' Permit# : (a 66
Health Division 77-7 Z �41/ �lg7 z ' Date Issued 5 ( 4 9 9
Conservation Division �..� o\ q-ci _ Fee �6 Y
Tax Collector , tic12 G s
Treasurer 4�•� � SEPTIC SYSTE UST-C
INSTALLED IN COMPLIANCE
Planning Dept. Iri/ITH TITLE 5
Date Definitive Plan Approved by Planning Board ENVIRONMENTAL CODE AND
TOWN N REGULATIONS
Historic-OKH Preservation/Hyannis ,
Project Street Address L•-1 6 G 'Midi) 4'1 ,
Village G'vniinQ/v,�� ..
bwner To/7 n , , Gaz,f1/5 Address P0.&,x 23) G01,47 r66 '02677
Telephone Tog _.3z-6 6' 7 �/
Permit Request /'rPoor elect . airi",0b /6 x to
Square feet: 1 st floor: existing /0/0 proposed /6 d 2nd floor:existing 7 4 e proposed '' Total new /&0
Estimated Project Cost 300ame Zoning District Flood Plain Groundwater Overlay
Construction Type 'U ad-F' n
Lot Size 3,3 go Grandfathered: ❑Yes ❑No .If yes, attach supporting documentation.
Dwelling Type: Single Family Ge Two Family ❑ Multi-Family(#units)
Age of Existing Structure g6)yrj Historic House: 0 Yes D No On Old King's Highway: 3 Yes ❑No
Basement Type: ❑Full ❑Crawl ❑Walkout "Other I5-P5-Fa1/ R s� 1s e/12 al/
Basement Finished Area(sq.ft.) U' Basement Unfinished Area(sq.ft) 2 Z5
Number of Baths: Full: existing 2- new Half:existing new
. Number of Bedrooms: existing ,� new
Total Room Count(not including baths): existing f new i First Floor Room Count
Heat Type and Fuel: ❑Gas a Oil ❑ Electric ❑Other
Central Air: ❑Yes l o Fireplaces: Existing 0 / New Existing wood/coal stove: ❑Yes EiNo
Detached garage:❑existing ❑new size — Pool:❑existing 0 new size --' Barn:❑existing ❑new size
Attached garage:❑existing ❑new size -- Shed:lErexisting ❑new size 6 Other:
Zoning Board of Appeals Authorization ❑ Appeal# ,Recorded❑
Commercial ❑Yes ❑No If yes,site plan review#
Current Use R4-5`i1n 1 / Proposed Use . l'es/dam 41
-.a
BUILDER INFORMATION
Name Tire %vi/�iiei - ���r-�. Tv f9 Telephone Number 5-69• zf-30✓a
Address 95 4,9 v,e// L h License# .5 00 88'6
Ma. t,45'/i?//4 /4'J 02‘�( Home Improvement Contractor# /09680
Worker's Compensation#
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Nap/7 1 fi I lam- l- ,Z '//
SIGNATURE , //ii'///,r2� DATE _ 9- /6--f7 .
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FOR OFFICIAL USE ONLY -- --1"--• c�. .
1• , c - i ' ,
PERMIT_NO. • ' - - -
DATE ISSUED — •
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MAP/PARCEL NO. r
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ADDRESS , . .5 I a IIf • = VILLAGE - a
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OWNER ` •
DATE OF INSPECTION: - ' ~ , . . .' a
FOUNDATION r - r , - c e
a + $
FRAME ., ,
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INSULATION 4
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*FIREPLACE • _•. a
ELECTRICAL: ROUGH FINAL a •
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PLUMBING: ROUGI- , FINAL . - '^a
GAS: ROUGHS P FINAL - '
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FINAL BUILDING• - l� G - 1 r
tv ''=' — -
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DATE CLOSED_ OUT : a', rr r f @ x 1 • � ,
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ASSOCIATION PLAN NO. I-- 4
''• i' Sf1 i 4
t a J{
Lat us - residence
e1Ot vise
liN4141- 11111.11111.1111.11111111
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