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I
of r Town of Barnstable
Fires 6 months fr iss a date
* Regulatory Services Fee _ J
iaaxsrasr�,
9 MASS � Thomas F.Geiler,Director
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 '22�3 OlA 3�0.1\ Lcu`C _Ra(P S_ a y�-
0 Residential Value of Work Minimum fee of$35.00 for worse under$6000.00
Owner's Name&Address ClOct Cope
contractor's Name Telephone Number
Tome Improvement Contractor License#(if applicable)
a IT
:onstruction Supervisor's License#(if applicable) �.RSS
]Workman's Compensation Insurance APR 09 2012
Check one:
❑ I am a sole proprietor
[�I am the Homeowner
p OF BARNS-r BLE
❑ I have Worker's Compensation Insurance
isurahce Company Name
orkman's Camp. Policy#
opy of Insurance Compliance Certificate must accompany each permit. — --- -
snit 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-side -1Ufk0c
#of doors
❑ Replacement Windows/doors/sliders. U-Value (maximum.44)#of windows
*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
16-NA TURE:
W lq�
PF=\F0RMS16m7dine vcrrait.formsTDORESS.doc
1
°V Town of Barnstable
v�THE�ti
Regulatory Services
3MMST"M * Thomas F.Geiler,Director
y MA99.
�'0re1639. � 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
HOMEOWNER LICENSE EXEMPTION
Please Print
JOB LOCATION: Zc�3 m_a 3 c k�, ks d �a� `q
number t street (� village"HOMEOWNER": ek'n CA CC))c, y��"`3�I' ''11
name home phone# work phone#
CURRENT MAILING ADDRESS:.
city/town
�, state zip code
The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and
to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as
supervisor.
DEFINITION OF HOMEOWNER
Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is, or is intended to
be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A
person who constructs more than one home in a two-year period shall not lie considered a homeowner. Such
"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be
responsible for all such work performed under the building_permit (Section 109.1.1)
The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other
applicable codes,bylaws,rules and regulations.
The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department
um' 4,gction procedures and requirements and that he/she will comply with said procedures and
5-g.7-t,-,ne��o§f_Hlomeowner
m
i
Approval of Building Official
Note: Three-family dwellings containing 35,000 cubic feet 41rger will be required to comply with the
State Building Code Section 127.0 Construction Control.
HOMEOWNER'S EXEMPTION
The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions
of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such
work,that such Homeowner shall act as supervisor."
Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see 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 a licensed
Supervisor. The homeowner acting as Supervisor is ultimately responsible. i
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 of this issue is a form currently used by
several towns. You may care t amend and adopt such a form/certification for use in your community.
Q:forms:homeexempt
oF7 Town of Barnstable
- -._ -
Regulatory Services
n�txsres�, f
m+ms Thomas F.Geiler,Director
.,63� ,m�
Fo Building Division
Tom Perry,Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4WIS . _..--Fax:--508-790-6230-------_ ------
Property Owner Must -
Complete and.Sign This S coon
If UsiniLy A Builde
as Owner of the subject property
hereby authorize to act on my behal�
in all matters relative to work authorized by building permit
(Addres of Job)
**Pool fences and alarms re the responsibility of the applicant. Pools
are not to be filled before nce is installed and pools are not to be
utilized until all final ins ctions are performed and accepted.
Signature of Owner Signature of Applicant
d>
Print Name Print Name
Date
Q:FORM&OWNERPERMMSIONPOOLS
Town of Barnstable *Permit# ^
Expires 6 months a iss a
Regulatory Services Fee---- =L
BAHNSPABLE, Thomas F.Geiler,Director
it ��A i6;9• ��� Building Division 11K/
rEa�,t a
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 ^]��
Property Address Q��
Residential Value of Work �� 0 a� Minimum fee of$25.00 for work under $6000.00
Owner's Name&Address COX
Contractor's Name f 0W&4 (,dr- IRKOM9,6&11/L�, S Telephone Number
Home Improvement Contractor License#(if applicable) 145-5-P-
❑Workman's Compensation Insurance
Check one:
❑ I am a sole proprietor
❑ I am the Homeowner -PRE PERMIT
❑ I have Workers
' Compensation Insurance
Insurance Company Name N.Q009
Workman's Comp. Policy# TOWN OF BARNSTABLE
Copy of Insurance Compliance Certificate must be on file.
Permit Request(check box)
Re-roof(stripping old shin les) All constru Lion debris will be taken to R17a 6t- /YVIX5 _�
r
❑Re-roof(not stripping. Going over existing layers of roof)
❑ 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:
QAWPFILESTORMS\building permit forms\EXPRESS.doc
Revise020108
.r .
sTti Town of Barnstable
RegulatoryRegulatory Services
sAxNUM Thomas F.Geiler,Director
19. 16 Building Division
Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.tna.us
Office: 508-862-4038 Fax: 508-790-6230
Property Owner Must
Complete and Sign This Section
If Using ABuilder
I, 91.17A COX , as Owner of the subject property
hereby authorize /��j10I� _ t Y/2 to act on my behalf,
in all matters relative to work authorized by this building permit application for: ^e 66 r-7
(Address of Job)
kk o9
Signature of Owner Jate
Print Name
If Property Owner is applying for permit please complete the
Homeowners License Exemption Form on the reverse side.
Q:FORMS:O WNERPERMISSION
0
�f
Town of Barnstable
% Regulatory Services
awRxsrwaM . Thomas F.Geiler,Director
rKwss.
p�'PrEn A�O� Building Division
�. Tom Perry,Building Commissioner
�. www.town.barnstable.ma.us
1
t
Office: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE:
JOB LOCATION:
number ° street village
"HOMEOWNER":
name home phone# work phone#
CURRENT MAILING ADDRESS:
city)ttown state zip code
The current exemption for"homeowners"was extended to includ owner-occupied dwellings of six units or less and
to allow homeowners to engage an indivi ual foi hire who does of possess a license,provided that the owner acts as
supervisor. +
EFINMON OF H7 OWNER
Person(s)who owns a parcel of land on whi he/she res ides fr intends to reside,on which there is, or is intended to
be, a one or two-family dwelling, attached or\atwo-year
jed strut es accessory to such use and/or farm structures. A
person who constructs more than one home in p 'od shall not be considered a homeowner. Such
"homeowner"shall submit to the Building Ofo4 a fo acceptable to the Building Official,that he/she shall be
res onsible for all such work erformed undeuil Dermit. (Section 109.1.1)
The undersigned"homeowner"assumes responsibili for compliance with the State Building Code and other
applicable codes,bylaws,rules and regulations.
The undersigned."homeowner"certifies that-he/she upd,r4tands the.Town of Barnstable,Building Department
minimum inspection procedures and requirements a�d th t he/she will comply with said procedures and
requirements. !
/6
Signature of Homeowner J/
Approval of Building Official `
f
Note: Three-family dwellings containing 35,000 cubic fe or larger will be required to comply with the
State Building Code Section 127.0 Construction Control.
HOMEOWNER'S EXEMP N
The Code states that: "Any homeowner performing work for which a buildi permit is required shall be exempt from the provisions
of this section(Section 109.1.1 -Licensing of constructj'on Supervisors);provided that if a homeowner engages a persons)for hire to do such
work,that such Homeowner shall act as supervisor.'
Many homeowners who use this exemption are unaware that they arc assuming responsibilities of a supervisor(see Appendix Q.
Rules&Regulations for Licensing Construction Supervisors,Section,2.15) This lack of aw ess often results in serious problems,particularly
when the homeowner hires unlicensed persons. In thin case,our Board cannot proceed against unlicensed person 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 communiti s require,as part of the permit application,
that the homeowner certify that he/she understands tNe 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°a fonn/certifr cation.for use in your community.
Q:forms:homeexempt
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0�S�7NG
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CERTIFIED PLOT PLAN
LOCATION . f3 !ST��LG' MA:
SCALE . �."��?p DATE �G .
PLAN REFERENCE
pr
�/? . EDcn°.Sou r . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1 CERTIFY THAT THE .���.. . . . . . .. v.D!`tT?. . . .
/ C.'S7 "�`Q � 't SHOWN ON THIS PLAN IS LOCATED ON THE GROUND
AS SHOWN HEREON AND THAT IT CONFORMS TO THE
SETBACK REQUIREMENTS OF THE TOWN OF
WHEN CONSTRUCTED.
I
DATE
BG-�/1A�fi.✓ �NL�3- /�L-��7T/oN� f
REGISTERED LAND SURVEY R
Assesstsr s office(1 st.Fbor):
Assessor's map and lot oo number ; 2 77— D z 3 S�� I � ' `��% In; �� p{TMc Tp
INSTALLED IN COMPUAN
Conservation MTH MTLE 5 °
Board of Health(3rd floor): ENVIROwNIENT41,COS • esi�rant •
Sewage Permit number •
mug
Engineering Department(3rd floor): ' . .1 `.SINS 'o 'e�q.
House:number,
Definitive Plan Approved by Planning Board 19
APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2-00 P.M.only
TOWN OF BARNSTABLE
3 BUILDING INSPECTOR
APPLICATION FOR PERMIT TO t �ll����-�'G� ��Gj� G US' 6'�"51-6 Cam`
TYPE OF CONSTRUCTION19
r
i
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location [/G Ave
Proposed Use �!t!L 2:-Czs9
Zoning District ` ' G Fire District
-._." Name of Owner 13 G 611 Address
Name of Builder L7 ��6� Cam✓- w Address
Name of Architect Address
Number of Rooms 6� Foundation �dy.�L� c��"t'CILCTTGs
Exterior �Lflr�r C `r Roofing ` / T
V Floors LTV G�aori 'f CG Interior
Heating` ILI Plumbing
Fireplace I�L�L� Approximate Cost
Area
Diagram of Lot and Building with Dimensions Fee
®,�c'04
1,4
1I
l
t
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regardingthe above construction.
Name
Construction Supervisor's License o S^ 3 T
JONES, 4EN T
,N6 34779 Permit For BLD. DWELLING & GARAGE
Single Family Dwelling
Location 283 Old Jail ' s Lane
Barnstable
Owner. Ben Jones
Type of Construction Frame
Plot Lot
Permit Granted January 7 , 19 92
Date of Inspection -19
Date Completed `= 19
r
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c�ea� 'Y'---' •�+...r�^ ,�",�T'ff''f, � � �+.' .i.+`.if.]�,y.. yp..�.'' 1"^"4fv' �"'t'�r�"^��'�` 1��f+6r't.V�'.�w `x4i- b ^""^ems IL r"j„'""ti�'FY.7.'.'� i,'�.,
�it "'^� � \ �+�i3.J" +—rf�" � F1'r � i �"'► �i,d —v ...,:7r1� 1C7.%1 Syp.
,ATM[>o TOWN OF BARNSTABLE 34779
. , Permit No.................
I BUILDING DEPARTMENT Cash $50.00
TOWN OFFICE BUILDING """"""""wa`b79 `
HYANNIS,MASS.02601 Bond ................
CERTIFICATE OF USE AND OCCUPANCY
Issued to ben Jones
Address 283 Old Jail Lane, Barnstable
USE GROUP FIRE GRADING OCCUPANCY LOAD
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 AND.IN ACCORDANCE WITH SECTION,119.0 OF THE.MASSACHUSETTS STATE
BUILDING CODE.
May 21 92 ��jJp� (• C�. .
1:9.................
Budding Inspector
THE FOLLOWING
IS/ARE THE BEST
IMAGES FROM POOR
QUALITY ORIGINALS)
I M ^C&L
DATA
S
TOW'QLOF BARNS�I'ABLE, MASSACHUSETTS BUK� NG. : P R r
DATE J +i Ui':f:'' / , 19 �•� PERMIT NO. N9 `/4779
yy ,. ' ''.0 p,CIN. t , #015834
APPLICANT �'ICI4%i.il�C'1 4Y. �i�x.fl. �'j�7<•,Li.?.lei]. ADDRESS is �.U; Yi?1"fl:���'"2i ')li_
IN0.) (STREET) (CONTR'S LICENSE,
PERMIT TO build 1�1'J: 11:_i(:� &(i r".:` " ) 1`:e li.% .; NUMBER OF
( * �_J` STORY`' r If CJ1iJ':_'1L1i1C; DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
ZONING
i AT (LOCATION) - _�yII3 U1.C.Z •�:a _I �' _ ti) 1t�.;1:1:_. .:I.�).. DISTRICT RG
(NO.) (STREET)
I
BETWEEN AND '
1 (CROSS STREET) (CROSS'.STREET).
LOT
SUBDIVISION` LOT BLOCK SIZE
BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTI
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
.. _- (.TYPE) ..
Z�li�ci4 S(_:wt qud 91-556
REMARKS:
howara W. Woollaid 50.00>
VOLUME 1499 5C3.. tt o $ 90 "QUO. UO ...: PERMIT $ 1 S (JU
ESTIMATED COST �D / FEE j
(CUBIC/SQUARE FEET`) - - -
OWNER
k3t':Si: .7v1"iUi
ADDRESS }� 0. / Cummaquld BUILDING DEPT.BY /'j;,.
/'J.',
i y .
.THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF. EITHER TEMPORARILY
01PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE; MUST BE A
. ,PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL,AS DEPTH AND LOCATION OF.PUBLIC.,SEW.'ERS MAY.,.B_E.-0BTAINE
7ROM'THE DEPARTMENT OF PUBLIC WORKS: THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIOI
OF ANY APPLICABLE SUBDIVISION RESTRICTIONS.
MINIMUM OF THREE CALL -APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE
INSPECTIONS REQUIRED FOR UNTIL FINAL INSPECTION HAS BEEN
ALL CONSTRUCTION WORK: CARD KEPT POSTED UN PERMITS ARE REQUIRED FOR
_ELE.C.TRICAL PLUMB,ING-.�_A_N.D.:-
1. FOUNDATIONS_OR_F.00T4NOS. MADE. WHERE- A--CERTIFICATE'OF OCCUP'A'NCY--;S'RE- MECHANICAYINSTALLATIONS.
2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL
MEMBERS(READY TO FINAL INSPECTION HAS BEEN MADE.
3. FINAL INSPECTION BEEFORFOREE '
OCCUPANCY.
POST THIS CARD SO IT IS VISIBLE FROM STREET
BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS. ELECTRICAL INSPECTION APPROVALS
APPROVED � ,� 2 �9
WN OF BARNSTAB
..BUILDI G INS CTO
3' HEATING INSPECTION APPROVALS ENGI EERIN DEPARTMENT
If
4
' }OTHER
SITE PLAN REVIEW APPROVAL
i
WORK SHALL NOT PROCEED UNTIL THE INSPEC- PERMIT W!LL BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS INDICATED ON THIS CARD CAN
TOR HAS APPROVED THE VARIODUS STAGES OF I WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE
CONSTRUCTION. PERMIT IS ISSUED AS NOTED ABOVE. ARRANGED FOR BY TELEPHONE OR WRITT
NOTIFICATION.
I
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