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oFt► r Town of Barnstable '*Permit#
Expire 6 nr l'sfrom issue date
Regulatory Services Fe
. RKRN5rABLE, Thomas F. Geiler, Director
v MASS. $
4, 039• Building Division ® 'L
'rfo Mai
Tom Perry; CBO, Building Commissioner
200 Main Street, Hyannis, MA 02601
www.town.bamstable.ma.us
Office: 508-862-4038 Fax: 5087790-6230
EXPRESS PERMIT APPLICATION . - RESIDENTIAL ONLY
To � Not Valid withoutRet/-Press lmprint
Map/parcel Number
Property Address._4��6�1 � e
d_<eesideiitial Value of Work Minima n fee of$25.00 for work under$6000,00
Owner's Name &Address 4K;AIZ L-
3 Li __1) f
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Contractor's Namelb - Telephone Number t7 ����32 Vq
Home Improvement Contractor License#(if applicable)
Elw�orkman's Compensation Insurance
Check one:
❑ a sole proprietor -PRES PERMIT
�
ElI am the Homeowner
❑ I have Worker's Compensation Insurance - SEP 3 2008
Insurance Company Name C7 12A
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)
❑ Re- a •� �9cJN L1 oo 5�l C5
Replacement Windows/doors/sliders. U-Value (maximum..44) 1
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*Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,CoigaarvatioW,-etc.
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***Note: Property Owner must sign Property Owner Letter of Permission.
A copy of the Plome Improvement Contractors License is required.
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SIGNATURE:
QAWPFILESIFORLVISIbuilding permit forms\E PR SS.doc
Rrvist020108
Town of Barjastable
Regulatory Services
• :wzrasrwsLF
v uwss �+ Thomas F. Geiler,Director.
E1 u•- - Building 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 Must
Complete and Sign This Section
ff Using A Builder
as Owner of the subject ro e
M �+ J P p rty
hereby authorize A u UE N CoIUS�• to act on my behalf,
in all matters relative to work authorized by this building pemut application for:
31/ Mbki ory &)AS C�M�r� ��� '� 1?9 4 0Q.637
(Addtess of Job)
Signature of Owner Date
d<A Q L S o 8LP 6 LP-
Pant Name
If Property Owner is applying for permit please complete the Homeowners License
Exemption Form on th'e reverse side.
Town of Barnstable rr
N�op 7HE
Regulatory Services
r rt Thomas F.Gezler,Director X.. -
i gARNSi'ABLt+; '
M" Building Tivision
i639-
Tom Perry,Building CorraTjissioner
200 Main Street; Hyannis, MA 02601
www.town.barnstable-ma.us
S08-862-4038 Fax: 508-790-6230
BohlEOWNER LICENSE EXF-MP770N
Please Print
DATE:
JOB LOCATION: t
number Street village
"HOMEOWNER": 1
"name. home phone# work phone#
CURRENT MAILING ADDRESS:
city%town state zip code
The current exemption for"homeowner"was extended to include weer-occu ied dwellin` s'of six i�nitsror less and
to allow homeowners to engage a—n vidual for hue who does n t possess a license provided that the owner acts as
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supervisor.
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DEFD1g1T10N OF BO OWNER
Per who owns a parcel of land on'which ht/she resides,� intends to reside, on which there is, or is intended to
be, a one or two-family dwelliug, attached�kdetacbed strut es accessory to such use and/or faun structures. A
person who constructs more than one home a two-year pe 'od shall not be considered a homeowner. Such
homeowner"shall submit-to the Building O ial on a fo �acceptable,to the Building official*that he/she shall be
-es onszble for all such work perfbr=d under buildin ermit. (Section 109.1.1) '
[be undersigned"homeowner" assumes responsibi ty f r compliance with the State Building Code and other
applicable codes, bylaws,rules and regulations.
.be undersigned "homeowner"certifies that be/sbe u de stands the Town of Barnstable Building Department
ni,imurn inspection procedures and requirements:aid tha be/she will comply with'said procedures and _ t
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equirements. I
ignaturc of Homeowner
/
t
pproval of Building Official
Note: Three-family dwellings coma' g 35,000 cubic feet or I er will be required to comply with the
ate Building Code Section 127.0 Construction Control.
HOMEOWNER'S EXEMT-110N
The Code states that "Any homeowner p/omung work for which a building permit Tcquircd shall be exempt from the provisions
this section (Section 109.13 -Licensing of cumtryction Supcyisors);provided that if the hom cr engages a persons)for hire to do such
A,that such Homeowner shall aci as supernscr.
Many homcownas who uscthis exemption arc unaware that they arc assuming the Tesponsi ']ides of a supervisor(sec Appendix Q,
Its&Regulations for Licensing Construction Supervisors,Scction 2.15) This lack of awareness often its in serious problems,particularly
as it would hdth a licensed
cn Lhc homeowner hires unlicensed persons. In this ease,our Board eannol proceed against the unlicen d person
7crvisor. The homeowner acting as Supuvisor is.ultimately responsible.
To cnsuTe that the homeowner is fully a"of his/her responsibilities,many communities rcqurre, part of the permit application,
:the homeowner certify that hc/she understands the responsibilities of a Supervisor. On the last page of this t c is a form currently used by
oral towns. You may care t amend and adopt such a form/certification for use in your Community."
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Assessor's map and lot number . SEPTIC SYSTEM MUST BE
INSTALLED 1"d CO"-311-A-NCE
2 WITH
Sewage Permit number ............ ................................... A TiC4_E II ST�,rE
SANITARY CODE AND TOWN
REGU Py�fTHE Tp�y TOWN O BAR' Ib t LDL1J
BARNSTABLE, i
nuv��e� DUILDING INSPECTOR
APPLICATION FOR PERMIT TO ... T�N..... .....�f...............®....fY............................................
TYPE OF CONSTRUCTION .............5./.IU10........ (./. ......`�JJ.1 ��.................................
.......... .............. .............19........
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
GGf lry9�it�! , e .......�..V
Location ................................�. ...e!f.I.10......l�P�.�I A............................ 1 ,..
Proposed Use ....... ofv. .. Q.. ...........-r.. ./v .l ..........d�✓��'/��/AL> .
........................
7i✓7 ......
R 4):S'
ZoningDistrict ... .. . ...-...... ............ .:....Fire District ......:. je........... ........... �. ..........................
Name of Owner ..... ./ :F• �� .. J.'.. J / �;2!tAddress .....�!5 .L! ......c E!.. �!/ ...® ...../...�.....
Name of Builder / 1�-�7I.N �.. t!1�s--T/ .....Address �t�� /� !! ? /�1°�tc�/Gfi� _
Nameof Architect ..................................................................Address ....................................................................................
Number of Rooms ..�.....: .... � �� :............Foundation za ! ?....... 1 .... ..
Exterior .. ......f?IDA W..(.--p...:(....���1n.�u!t�......Roofing .......����<.�`"...... :�/.U��'
Floors Q � ........................................: .Interior sd4�G i [ Ge .
................ .................... ............... .......... .......... ...................................
Heating ..... 5...............tf ?.?` .. .............Plumbing ........z....... ..........
.�r'��..� .... .��/f
Fireplace ........ G` G�l�'� ...................... ................Approximate Cost ......... � ��0. oo<n
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Definitive Plan Approved by Planning Board -------------------_-----------19________. Area ........ .............�.o.........e. ...
Diagram of Lot and Building with Dimensions
Fee ........................ '. ........
SUBJECT TO APPROVAL OF BOARD OF HEALTH
Toi-�L Le gg H'� C�t��S t W-e 0�2nnewSiesy
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I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
o� y
Name ...... ... E .
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Curtin, Martin J. �
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I6049 one
----- story, .
— '' ' ~^^' '~
........................... ^
Location ............................ L—.�— ----' T-�'.Brnstable
single -family -^_~�
-------'�����............------------
Owner ---Maztizz..J�_Cuz"bin_______
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frame ^ �
Type of Construction ...........................................
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---.----------.------------.
Plot ............................ Lot ................................
Januar
23 7�
Permit Granted --.�����.�...'�---'lP ' ' '
-
Do,c or Inspection /z
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, ' .'
uo,e Completed
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PERMIT REFUSED
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_._____________.,_.,,_,_.____._..
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Approved ................................................. lA
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