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Commonwealth of Massachusetts
Sheet Metal Permit
Map _Parcel
Date: 0 O Permit
Estimated Job Cost: $ 1000. 0(� Permit Fee: $ lP ( ►
Plans Submitted: YES NO Plans Reviewed: YES NO .
Business License# Applicant License# 'SIM
Business Information: Property Owner/Job Location Information:
Name: _H i !- R�`i P Name:
G _ V
Street: l�15 . �� Qn0t7 i� {d �j Street: APM ��
City/Town: ITf_n City/Town:
Telephone: �_ I I Telephone; �C 8 SO
Photo I.D. required/Copy of Photo I.D. attached: YES VINO
Staff Initial
J-1 /M-1-unrestricted license
J-2/M-2-restricted to dwellings 3-stories or less and commercial up to 10,000 sq. ft. / stories Mess'
Residential: 1-2 family VL Multi-family Condo/Townhouses Othei
Commercial: Office Retail Industrial Educational
Fire Dept. Approval Institut oval Other
Square Footage:_under 10,000 sq. ft.- - over 10,000 sq. ft. Number of Stories" �
in
Sheet metalwork to be completed: New Work: Renovation:
HVAC Metal Watershed'Roofing Kitchen Exhaust System
Metal Chimney/Vents Air Balancing
Provide detailed description of work to be done:
Iv i 1 f if+ 'PC R,�n tCOJI'1►otN► j ke
I �
yj �'
I �
3URANCE COVERAGE: ,
ave a current liability insurance policy or its equivalent which meets the requirements of M.G.L.Ch. 112 Yes❑ No ❑ `
-ou have checked yg&, indicate the type of coverage by checking the appropriate box below:
lability insurance policy ❑ Other type of indemnity ❑ Bond ❑
JNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 112 of the !
ssachusetts General Laws, and that my signature on this permit application waives this requirement.
- Check One Only
Owner ❑ Agent ❑
Signature of Owner or Owner's Agent
checking this box[3,I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and
urate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be
ompliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws.
Duct inspection required prior to insulation installation: YES NO
Progress Inspections
Date Comments
Final Inspection
Date ,- Comments
II
Type of License:
❑ Master
❑ Master-Restricted
I
Town ❑Journe erson
yp Signature of Licensee
nit#
❑Joumeyperson-Restricted License Number: 11
Check at www.mass.gov/dgl
i
lector Signature of Permit Approval
Town of Barnstable
Regulatory
Services .
1639. Thomas F.Geiler,Director
Building Division
Tom Perry,Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.ns
Office: 508-862-4038 '
Fax: 508-790-6230
Property Owner Must
Complete and Sign This Section
If= A Builder
' ,,as Owner of the subject property
hereby,authorize- /!'' 67410
to act on my,behalf,
in all matters relative to work authorized by this building permit
(Address of Job)
**Pool fences and alarms are the responsibility of the applicant.
are not-to be filled before fence is installed and pools are not to be Pools
utilized until all final inspections are performed and accepted.
Signs e Owner S e f Applicant
of r � �4� Joao Mato110
Print Name Print Name
Date
Q:F0RMS:0WNE3pERMSST0NP00LS
oFtKE
Town Barnstable
Regulat ry Services
aARNSUBILE, Thomas F. eiler,Director
�
69 '� BuRdin Division
A�D 3��R1
Tom Perry,Build g Commissioner
200 Main Street, annis,MA 02601
www.town.ba nstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICE SE EXEMPTION
Please int
DATE:
JOB LOCATION:
number street
. village
"HOMEOWNER":
name home pho # work phone#
CURRENT MAILING ADDRESS:
city/town state zip code
The current exemption for"homeowners"was extended to inc de er-occupied dwellings of six units or less and
to allow homeowners to engage an individual for hire who d s not ssess a lice 'e'p ns rovided that the owner
r acts as
supervisor.
DEFINITION 0 HOMEO R
Person(s)who owns a parcel of land on which he/she resi es or intends o reside, on which there is, or is intended to
be, a one or two-family dwelling, attached or detached s ctures access to such use and/or farm structures. A
person who constructs more than one home in a two-ye period shall not a considered a homeowner. Such
"homeowner"shall submit to.•the.Building-0fficiabon form acceptable t the Building Offieial,that he/she shall be
res onsible for all such work erformed under the b din ermit. (Sectio 109.1.1)
The undersigned"homeowner"assumes responsi •ty for compliance with e State Building Code and other
applicable codes,bylaws,rules and regulations.
The undersigned"homeowner"certifies that /she understands the Town of table Building Department
minimum inspection procedures and require ents and that he/she will comply th said procedures and
requirements.
Signature of Homeowner
Approval of Building Official "A
Note: Three-family dwellings containing 35,000 cubic feet or larger will be re uired 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 sh 11 be exempt from the provisions
of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner enga s 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 assumingthe responsibilities of a sue 'p supervisor(see Appendix Q,
Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results
li serious problems,particularly
p 'p y
when the ho
meowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed 1 •
Supervisor. The homeowner acting as Supervisor is ultimately responsible.
To ensure that the homeowner is full aware of his/her y 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
Y r Town of Barnstable *Permit n z15?18
]Expires 6 mo from issue date
�T Regulatory Services Fee
BARNMBLE
9 MA83 Thomas F.Geiler,Director to
1639. �0
prfD MA't�
Building Division
Tom Perry,CBO, Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma us
Office: 508-862-403 8 Fax: 508-790-623 0
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
. �� ! Not Valid without Red X-Press Imprint
Map/parcel N U umber ti /� (�
Property Address 1 SS S /G�DL,PlV� PO k11 J P(AZ tv S� A� �6
g Residential Value of Work 7 9 Pft,0 O Minimum fee of$35.00 for work under$6000.00
Owner's Name&Address �a.U Cy�i cc:) .n �c cwo i S S Sn( , . Paj J+ 2D
1l N_zt_Pr�5A_r,�Cc, Ara
Contractor's Name CAIIM�b S `� t�-Pf Telephone Number p y 3 3 7�SyL
Home Improvement Contractor License#(if applicable)
Construction Supervisor's License#(if applicable) I 0 0
[�JWorkman's Compensation Insurance ����SS PERMIT
Check one:
❑ I am a sole proprietor
❑ I am the Homeowner S EP 2 O 2012
I have Worker's Compensation Insurance
Insurance Company Name 6-cAL( „TOWN ,,F BAR R STABLE
Workman's Comp.Policy# \kJ C_ `�0—�C) , GQOCT a >Cl
.Copy of Insurance Compliance Certificate must accompany each permit
Permit Request(check box)
[� Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to
❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof)
Re-side
#of doors 2-
Replacement Windows/doors/sliders.U-Value ,U. i�,�tc�fc�. (maximum.35)#of windows 6
❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. .
Separate EIectrical&Fire Permits regnired.
*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.
copy of the Home Improvement Contractors License&Construction Supervisors License is
ired:
SIGNATURE:
QAWPFMESTORMS t formsT)TRESS.doc
Revised 053012
d �f
RAWSTABLIL
KAM
Town of Barnstable
Regulatory Services
Thomas F.Geiler,Director
Building Division
Thomas Perry,CBO
Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
Property ProP a Owner Must
Complete and Sign This Section
If Using A Builder
1, Gne l ip!!!I [ A✓t"A ba p ,as Owner of the subject property
` e
hereb authorize 1-04 *E� a t y con my behalf,
r oS � A'uet , C ,. ��rr�
in all matters relative to work authorized by this building permit application for:
/ems �'a f ,v, Posh RzoS oQrnsk1 i /�e,
(Address of Job)
1Q -,(Z
Signature Vwner 01 Date
6y 06!11 (_ova} 2 A� Lo
Print Name
If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the
reverse side.
C:1UsenWecolliklAppOatalLocallMicrosoftlWindowsiTemporary lntemet Files Content,OutlookiDDV87AAZtiEXPRESS.doe
Revised 072110
I
sor's Office(1st floor) Map Parcel TO Q Permit#
Conservation Office(4th floor)(830- 9.30/1:00-2:00) N14, L-ac,-16 Date Issued 7 SO
Board of Health(3rd floor)(8:15 -9:30/1:00-4:45) Fee 0�5-0 /6,
Engineering Dept. (3rd floor) House# i�
y,
Planni (1st floor/School Admin. Bldg.)
BARNSTABLE. °
De 'nitive Plan roved by Planning Board 19 ,E6 A.
.�
PP
TOWN OF BARNSTABLERmcANTMusTOBTAINASEWER
. ; CONNECTION PERMIT FROM THE
Building Permit Application' ENGINEERING DIMON PRIOR TO
CONSPRUCTIOIZ
roject HreetAd ess 155 Salten Point Road A,
e nstable
Owner Suzanne Reid t Address 155 Salten Point Rd,, Barnstable
n 508-362-4532 -
Telephone
Permit Request Remodel existing house . Add" sunroom 'and screened porch.
First Floor A `5-°a 7`" square feet
Second Floor NA square feet
Estimated Project Cost $ ' 68 ,000 .00
Zoning District R F 1 Flood Plain E l e v° 12 Water Protection No
Lot Size 1 .95 Acres Grandfathered ? No
Zoning Board of Appeals Authorization No Recorded
Current Use Residential Proposed Use Residential
i
Construction Type Wood/Masonry
Commercial Residential Yes
Dwelling Type: Single Family Yes Two Family Multi-Family
Age of Existing Structure 30 yrs . Basement Type: Finished
Historic House No Unfinished yes
Old King's Highway Yes — Approved
Number of Baths NA No.of Bedrooms NA
Total Room Count(not including baths) NA First Floor NA
Heat Type and Fuel NA Central Air NA Fireplaces NA
Garage: Detached Other Detached Structures: Pool
Attached Barn
None Sheds
Other
Builder Information
Name E .J . Ja xt imer Telephone Number 508-778-4911
Address 48 Rosary Ln , Hyannis , MA 02601 License# 003251
Home Improvement Contractor# 110 6 0 9
Worker's Compensation# 312—2 04 2 3 9—0 2 3
NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS
PROPOSED STRUCTURES ON THE LOT.
ALL CONSTRUCTION DEBRI RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE DATE_ I lqlq
BUILDING PERMIT 14ED FOR THE FOLLOWING REASON(S)
• r �
.� FOR OFFICIAL USE ONLY
PERMIT NO.
DATE ISSUED
MAP/PARCEL NO. ,
f
ADDRESS VILL GE �..�
OWNER '
DATE OF INSPECTION:
FOUNDATION
FRAME-
INSULATION , l �✓"� _ '
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL y
co
GAS: ROUGH ,ki FINAL t
FINAL BUILDING
MMA
DATE CLOSED OUT -
i .. 611 , _ 3
ASSOCIATION PLAN NO.
The Town' od Barnstable
. .
Kum
1eP Department of Health Safety and Environmental Services
Building Division
367 Main Stnzk Hyannis MA 0=1
Off= 508-790-6227 Ralph Cttr
&= 508 775-33" Btnldnng CAmmL
For office use only
Permit no.
Date � � ��
AFFIDAVIT
HOME mWROVEMENT CONTRACTOR LAW
S ppuMENT TO PERMIT AFFUCATION
MGL c. 142A requires that the"reconstruction,alterations,renovation,npak,modernization,oonvetsiM
impravement,.remcm- , demolition. or construction of an-addition to any PVC-existing owner oeaP'ed
building containing at least one but not more than four dwelling units or to====which==*ent
to such residence or building be done by registered eonu2=M with certain C=;dons,along with other
tzqui�aents.
Type of Work: f Y� Est Cost C�? DC
Address of Work: `5 5 � 11 P n ��l� PC)) 1- 'ram o r� -
Oaner.Name: !SO2-&f)r-
Date of Permit Application: k 1,44 1%
I hereby certify that:
Registration is not required for the following rason(s):
Work crAd tded by law
Job under SI,000
Building not oamc-ooeapied
Ow=plhngownp=mt
Notice is hereby ghren that:
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGI3'I CONTRACTORS
FOR APPLICABLE HOME UAMOVEmaM WORK DO NOT HAVE .ACCESS TO THE
ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A
SIGNED UNDER PENALTIES OF PEFJURY
I hereby apply for a permit as the agent of the owner.
Da& Contractor name Registration N
OR
T
P E'A S H l GH WA TER
e.o (PER PL 8K 90 PG 79)
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HAZARD 20,','E L/NE 3„ .
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NOTES :
I. PROPERTY LINES W=RF CO+NP,LED FROM A
PLAN RECO?DED !N PLA,Y 900K 90 PAGE 79
NOT FROM AN ON THE SUP, Y.
2. a=NcH MARK USED: .R.R _ K- 1.7 COL _
ELEv. - II. 17 N.G. V.D. � � l\V UC - L_ � i ND '
J. BES--.H MARK INFORMATION FROM C(;AWA,OU.D
SURVEY. INC.
�^. ! P� L /! �4
4. TOPOGRA.'H,C✓DETA i L I NFORm1 T I oN 03 TA I NED F !"!� ! V �`� �~ ,�: �=► t Fm..
9Y ELFCTRONiC SURVEY M=THODS.
PRE-F'ARE-D F'OR
5. PROP' • Y SHOWY IS IN FLOOD HAZARD ZONES
' f
AS ((EL-! AND C. AS SHOWN ON NAP 25000! r-
0003 D YD DATED ULY ?. I992. �J LJ ?C—t / l ! Y r� \
SCAL E- : ! - 30 MARCH 26 . / 993
REVISED DEC. 1. 1994 3
REvISED DEC. 19. 1994 ;
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