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0361 SANDY NECK ROAD
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TOWN Perry,CBO, Building Commissioner N OF F3ARNS7 $�� 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-8624038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Map/parcel Number .-573 5, U 0,7' Not Valid without Red X-Press Imprint / / Property Address 3(P t �1166 /l)66lc ❑Residential Value of Work `r 2 500 Minimum fee:of$35.00 for work under$6000.00 Owner's Name&Address GLryI � r(P0 2 Aeu ,� 1a'v loA � Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) - Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor 2'I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) [�Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to Ge/K,Q ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side #of doors ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\QRE6ZUBN\EXPRESS.doc Revised 053012 r� .P � t. •1 , ofBtable Regulator y Services t neRwcr�nryr, Thomas'F.Geiler,'Director ` 16 jq. BuRdiA9,Divlision Tom"Perry,$alibiing Commissioner 200.Main Street,.Hyannis,.MA 02601 www town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE:_ 'r / l /// �..."`"""� • JOB OCATO �Nnu mbrCer_-,,�,.�,.,�----`,..,,.�;.a, ����� ..'�/-1/=��C/�--'._ _ ��/`fl_S:.O�(,�J� • street "HOMEOwNEW name r� r home phone p CURRENT MAILING ADDRESS: L city/toFrrr 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 individ-mal for hire who does not possess a license,provided that the owner acts as supervisor. DEFWTTION 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 accessary to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be 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 uncer 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 se/she understands the Town of Barnstable Building Department minanilm inspection procedures and requirements and that he/she will comply with said procedures and requirements. Si Signature of Homeowner - Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HO•i MOWNER'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 ifthe 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 Supervisor,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. To ensure that the homeowner is fully aware of}is/ber 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 forrr/cerlification-for use in your community. Q:forms:homeexempt t 1 .g'T.•Y A'nj L>�L. K 9 ,i' 2 .a �, i.{ t c 'F9°I kid 5 �';. f (�:. �. ,P' a s. F� �A .'.., q r' A;iF "3-:tY I .p 4N w.?[ y[,1�•" ,ti,,'� .L° ^` / idEft r¢t§� „ tot 'tVk t{;:.T_ nt PAk. f 'r' 1"k P K ,.l•y, r K,:l �''�F P A • k':i ;�(4�j F:�: t( 11 J fiai� a,Me1.,�1 i�bq7R 1, Msn.+ "'"*4 � � „w ....k 8 -j �,—N•f.,f;:-tid�.p M� �i��.:• I, I j'jE' ._�$,o�,,yw ks'My:P ea .rr' `�f 1*:f !" , �1 r 3 ka ,'ew 'ifFa ± ktvR" 'f' a.. yr}5 _ BLi .._ `t �./ ' tP, Town� of rnsta ,f, a f a. t R`' e ate 0 'Se F �I. rY rvices . Tho mas F':Geiler,Director k Bw1din .gi.`Division ... Tom1Pe�rr9,BuiTdimg Commissioner 200 MamStreeti Hyanius,MA 0260.1 svw.w iowriba'nm'able.ma.ns office: 508-862-4038 Fax; 5. 790-6230 .Property Owner Must Complete and Sign This Secti If Using A.Builder ,as Owner of the subject property hereby authorize to act on my behalf, in all rnn relative to work authorized b his building ermif- (Ad ess of job) **Pool fences and s are the responsibility of the applicant. Pools are not-to be filled•be re fence is'installed and pools are not to be utilized until all fin inspections are performed and accepted. Signature of Signature of Applicant PEat Nam Print.Name D QF0KIY2.0WNMERh0SI0IV00LS Map Parcel 902 Permit# Q� Conservation Office(4th floor)(8:30- 9:30/1:00_2:00) - Date Issued oard of Health(3rd floor)(8:15 -9:30/1:00-4:45) - Feeyy z: OrIJTICSYSTE `Engineering Dept.(3rd floor) House# per �3 INSTA UST S PLI�, is �) �111VIRE d 19 TOto,co" `. TIC'' CSC WN OF BARNSTABLE Building Permit Application Prol ct eet ddres Village Owner LU e-1 k�k0 Q. (J 1&I Address 120CjCy Vf"Oy r Y"6100 L&-*WV Telephone ® 5-09- — 34 2 — #J6 f_3 -Permit Request +0 gTjZ I P + egftl � f 2Q LiL ' ROOF . 15-,-YVe t I-�� P Z A-c e L-J it rE- ti (L.5 41- - W 14J.DdU'5 F EPLA-CE 3 20 E-,b 5/ LLS rwi0-U 4)0 40) — First Floor 3V 6 square feet Second Floor square feet Estimated Project Cost $ nc>o Zoning District Flood Plain Water Protection Lot Size Grandfathered ? Zoning Board of Appeals Authorization Recorded -Current Use Co A!% (% Proposed Use e�-U M A4h-7 Construction Type \,A Commercial Residential Dwelling Type: Single Family Two Family Multi-Family Age of Existing Structure d 1f/L 5 Basement Type: Finished Ilj0A/� /r !" Historic House Unfinished V Old King's Highway --- Number of Baths '`- No.of Bedrooms Total Room Count(not including baths) 3 First Floor Heat Type and Fuel p L Central Air Fireplaces Garage: Detached Other Detached Structures: Pool 1 t1 Attached Barn i None Sheds Other o ate_ Builder Information Name C S L Telephone Number 7 SS'l _F16 Address 2—( License# yqp— �lLC 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) f a , - �_ FOR OFFICIAL USE ONLY x`. . .Y • �. j " r • Jim _ , ' ' . PERMIT NO. , D E ISSUED R - MP/PARCEL,NO. ADDRESS ! VILLAGE OWNER �• �' i t 3 DATE OF F INSPECTION: FOUNDATION I ti' ! r,• } FRAME INSULATION _ FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: = r .a: ROUGH FINALir FINAL BUILDIN lK , + DATE CLOSED,OUT , ASSOCIATION^PLAN NO. ! � r 4 ' j 1 ' i • � r 1 i 1 { 1 I I f � • : The Town of Barnstable . es -� S Department of Health Safety and Environmental Serv><c �e Building Divis.on 367 Main Street,Hyannis MA 02601 Raiph Ctosset: Off= SOS 790-6227 '^ A Bugg Cc= Fay_- 508-775 33" U Mt v For office use only ' Permit no. AFFIDAVIT HOME MWROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION i n mode zadon,conversion, MGL c. 142A requires that the"mconstrucZan,altaatzoas;renovation, owneroccupi imprava senncnt.. 0%-4 demolition. or consaua tion ion of an addi to =Y Ptc' which an ad}acezzt dwe;liag units or to sora�ues bniIding Ong at one but not more than four o�, along with other to such residence or building be done by rc&at d tamtract =with certain�ti rc4uir=cWL 12�,� .�.�(,�(..�� Type of Work: Zy,-c- .(o� ✓- Address of work. Owuer.Naznc L2I Date of Permit Application: 6 I hereby certify that: Registration is not required for the foIIowing rcmn(s): Work coduded by law Job under S1,000 Building not owner-oc=Mied 0wher puffing own pamit Notice is hereby gh=that: CONTRACTORS OWNERS pULLING M EIR OWN PERMIT OR PP DEALING NH GHAVE S TO TIC FOR APPLICABLE HOME D PROVE ENT 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. SILL f)c-ND l F NEEAL X` 3 ReO=tioa No. D e Con name OR '