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rWYMIP
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iS art. M , 'Y:D1
r Town of Barnstable U b
Expires 6 mon
. Regulatory Services Fee Iromiss to
11.4aNST.4314 •
� Thomas F. Geiler,Director 1
Building Division
Tom Perry,CBO, Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.bamstabld.ma.us
Office: 508-862-4038 Fax: 508-790-6230
EXPRESS PERNHT APPLICATION - RESIDENTIAL ONLY
Not Valid without Red X-Press Imprint f�
Map/parcel Number 15 L4 011
S l
Property Address 130 ✓/Ill} 110CAJ �r, t
Residential Value of Work (�7, Minimum fee of$35.00 for work under$6000.00
Owner's Name&Address. V1
?30 s6mlo(", 06ki1 f
Contractor's Name Telephone Number
Home Improvement Contractor License#(if applicable)
Construction Supervisor's License#(if applicable)
❑Workman's Compensation Insurance SS PERMIT
VI
one:
m a sole proprietor
.LIY r
P P . :
m the Homeowner
❑ I have Worker's Compensation Insurance VVN OF BARNSTABLE
Insurance Company Name
Workman's Comp. Policy#
Copy of Insurance Compliance Certificate must accompany each permit.
Permit Request(check box)
e-roof(stripping old shingles) All construction debris will be taken to u
❑Re-roof(not stripping. Going over existing layers of roof)
❑ Re-side
❑ Replacement Windows/doors/sliders. U-Value #of doors
(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 Ownef must sign Property Owner Letter of Permission.
A copy of the Home Improvement Contractors License&Construction Supervisors License is
re d.
SIGNATURE:
i�
2AWPFILESTORMSIbuilding permit formsT SS.doc ?
devised 070110
Town of Barnstable
P` THE
Regulatory Services
3 Thomas F. Geiler,Director
gb, 16.19- .b� Building Division
rfa `
Tom Perry,Building Commissioner
200 Mairi•Strcct, Hyannis,MA 02601
RWv.town-b arnstab le_ma.us
Office_ 508-8624038 Fax: 508-790-6230
HOMEOWNER LICEldSE EXEMPTION
Please Print
f
JOB IACA770N v Odv
number street village
NOMEowNER': � �� J)6 ha y So- 9 3/25-cVF
a
name Q home phone# work phone#
CUR:RFNf MAILfNG it-DDRFSS:
city/town states ap code ,
The current cx=option for"homeowners"was extended to include owner-occupied dwelling 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.
DEFVfMON OF BOrYiEOVV7%TR
Par-son(s)who owns a parcel of land on which he/she resides or intends to reside, on which.thcre 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 constrgcts more than one home in a two-year period shall not be considered a bomtsowncr. Such
"homeowner"shall submit to the Building Official on sT fog acceptable to the Building Official, that he/she shall be
responsible for all such work performed.under the building peimit (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 tmdcrsigncd"homeowner"ccrtifics that.hc/she.understands the Town of Barnstable Building Depar-b=t
rMTnrr+n.n inspaction procedures and rcqufi nnzats and that he/she will comply with said procedures and
rcquir -
lr� o Ho'mcmvnall
Approval of Burlding•Official
Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with tha
State Building Code Section 127.0 Construction Control.
$0NzowNER,8 F.Jtzmmbx
The Code states that Any bomcowner perfmming worTc for which a building permit is rcquirr d shall be cxcmpt hem the provisions
of this scction.(Section 7 D9.1.1-ljcrosiirg of construction Superyisors);provided that if the homeowoa eagages a pason(s)for biro to do such
warYti that s�uCch Homrawnall act sha as supervisor,•
Many homeowners who use this crampoon arc unawars that they are assuming the responstbiHties of a supervisor(sec Appendix Q,
Rules&Rcguladans for Licctuing Cmstruction Supervism-s,Section 2.15) This lack of awm==bAm results in serious probleras,particularly
when the homeowocr hires unlicensed persons. in this ease,our Board cannot proceed against the unlicensed person as it would with}licensed
Supervisor. The hmveowner acting as Supervisor is ultimately responnble
To masvra that the bon=wncr is My¢wart ofhis/hciasponsibilitia,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 i formlrxrtification for use m your conummity.
ti
oFTti Town of Barn-stable
o
Regulatory Services
s. MASS $ Thomas F. Geiler,Director `
Building Division
Tom Perry,Euildiag Commissioner
200 Main Street,Hyamais,MA 02601
www.town.b arnstab le.ma.us
Office: 508-862-403 8 Fax: 508-790-6230
r
Property bier Mus t
Complete and Sign'Y is Section
If Using A Builder : 4
as Owner of the subject,prope-tty
hereby atrthorize to act ou my behalf,
i.n A matters relative to wprk a o by the building permit application for.
(Address o ob)
f 1
Signature of Owner
Date
Print Name
If Property Owner is applying forpermitplease complete. the
Homeowners License Exemption Form on :the reverse side.
9 ?
Assessor's Office 0st floor) Map ,S"/ Lot Permit# 20 /1
Conservation Office 4th floor —1 3 •S Date Issued ti
Board of Health Ord floor •_:/ , vim TIC S'YSTEM ST BE
Engineering Dept. (Ord floor) House# *-0 INSTALLED IN "ROE
6 WITH
Planning Dept. (1st floor/School Admin.Bldg.):.'' ®NIE
Definitive Plan Approved by Planning Board 4 Q1 19 TOWN RE
A licatio r e ed 8:30-9:30 a.m.& 1:00-2:00 .m: ��e—'o� o✓4'L N lo+- �Q P�
TOWN `OF BARNSTABLE
Build ng Permit Application
-� ���Project Street Address
Villaee (/C CC.l �7 .� // Fire District
Owner �d K G /-� l C K ci�w J Address 4 i-0
Tele one
Permit Request:
Zonin District Flood Plain Water Protection
Lot Size 4 o C - Grandfathered
Zoning Board of Appeals Authorization Recorded
Current Use Proposed Use
Construction Type 6 CS
Eaistine Information
Dwelling Type: Single Family Two family Multi-family
Age of structure Basement type
Historic House Finished
Old King's Highway Unfinished
Number of Baths No.of Bedrooms
Total Room Count(not including baths) First Floor
Heat Type and Fuel Central Air Fireplaces
Garage: Detached Other Detached Structures: Pool
Attached Barn
None Sheds
Other
Builder Information
Name i G1.. GJj X-4 y ir I Telephone number
-� -7
Address 'G��S � 1f-S a i�-il m � License#
,�c • [� Z fo C 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. i
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
Pro'ec 0
Fee
SIGNATURE DATE
BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S)
BPERM T
FOR OFFICE USE ONLY
7/17/95 9019
254 019
ADDRESS 78 Shallow Pond Drive VII.LAGE Barnstable
Donald W. Nickulas
OWNER
DATE OF INSPECTION: 1
FOUNDATION
FRANE
00'
INSULATION
FIREPLACE f l _� /� t ,'4 a`' .
ELECTRICAL: ROUGH.- iFINAL
PLUMBING: ROUGH FINAL
GAS: - ROUGH t�- ` - FINAL
FINAL BUILDING:
J
DATE cLoSEa•OU'T:
. r•. t S
ASSOCIATE`PLAN NO:
-
f TOWN OF BARNSTABLE,
CERTIFICATE``] OCCUPANCY
PARCEL ID 254 019 GEOBASE ID 16590
I
ADDRESS 80 SHALLOW POND DRIVE PHONE
Barnstable ZIP -
LOT 18 BLOCK LOT SIZE
DBA DEVELOPMENT DISTRICT BA I
PERMIT 10655 DESCRIPTION SINGLE FAMILY DWELLING
PERMIT TYPE BC00 TITLE CERTIFICATE OF OCMpidffient of Health, Safety
CONTRACTORS: and Environmental Services
ARCHITECTS:
TOTAL FEES:
BOND $.00 _.. � �►�
CONSTRUCTION COSTS . $.00
753 MISC. NOT CODED ELSEt HERE 1 PRIVATE P.It grAELF ;
MAS& �►
D 39. A�0
OWNER NICKULAS, DONALD W
ADDRESS P 0 BOX 507
i
W BARNSTABLE MA
BUILDING DIVISION
DATE ISSUED 09/29/1995 EXPIRATION DATE BY ! -
'I DIVISION APPROVALS FOR
CERTIFICATE OF-OCCUPANCY
TO BE SIGNED.BY EACH DIVISION HEAD UPON COMPLETION
BUILDING:A� DATE:
'COMMENTS: '
PLUMBING:' DATE:
'A COMMENTS:`
t ELECTRICAL: r DATE:
COMMENTS:
GAS: DATE:
COMMENTS:
CONSERVATION: DATE:
COMMENTS:
OKH: DATE:
COMMENTS:
HISTORIC: DATE:
COMMENTS:
FIRE DEPT.: DATE:
COMMENTS:.
OTHER: DATE:
COMMENTS:
TURN THIS IN TO THE BUILDING COMMISSIONER AFTER ALL SIGN-OFFS ARE'
COMPLETED.A CERTIFICATE OF OCCUPANCY WILL BE ISSUED AT THAT TIMEr
THE FOLLOWING
IS/ARE THE BEST
IMAGES FROM POOR
QUALITY ORIGINALS)
I M ^C&L
DATA
BUILDING PERMIT
CEG Ib 2�54-_'()1 9 GE014ASP, D 113590
SHALLOW POND LRIVE �,l
ADDRESS 78-, PHONE.
ZIP`
Barfibtable
SIZE I:
LOT' ff i !,BLOC
DEVELOPMENT DfST1iI4T BA
019 I DESCRIPTIOM NEWT SIP
GLE !FAMILY DWELLING
E'w!
P g I T Wki' PUILDH I t,L* R, RR.S/COt M PERMIT
alth,�,Sdety
Departineird Hie
Co10. RACTOR% plqKUTAs BYIL ING CO:'
and Environmental Services
ARCHITECIS ,
F;
2 5.00
TOtA 0-98S- , $ 2 1i I 3 ,
BON
00- Q
cm T4UC ION COSTS'. 00.oo�
P
PINGLf3 10' VA'TE J FAMJ �Ej DETA HI�D 1
BARNgrABLI&
MAS&
10KULAS:, 'DONALD w
N 'N 041. ER
ADDRESS P 0 BOXI!,;,507
Ji
t
V BARNStABLF MA 0 ILDI IVI�I M
�"
DATE ISSUED 07/17/1995 EXPIRATION DATA BY f %
-THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF,EITHER TEMPORARILY OR PERMANENTLY.EN-
dkQACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR
ALLEY-GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS
PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS.
MINIMUM OF FOUR CALL INSPECTIONS REQUIRED APPROVED PLANS MUST BE RETAINED ON JOB AND
FOR ALL CONSTRUCTION WORK: WHERE APPLICABLE, SEPARATE
1.FOUNDATIONS OR FOOTINGS THIS CARD KEPT POSTED UNTIL FINAL INSPECTION PERMITS ARE REQUIRED FOR
2.PRIOR TO COVERING STRUCTURAL MEMBERS HAS BEEN MADE.WHERE A CERTIFICATE OF OCCLI- ELECTRICAL,PLUMBING AND MECH-
(READY TO LATH). PANCY IS REQUIRED,SUCH BUILDING SHALL NOT BE ANICAL INSTALLATIONS.
3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE.
4.FINAL INSPECTION BEFORE OCCUPANCY.
POST THIS CARD SO IT IS VISIBLE FROM STREET
BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS
o
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2 2-,5-, 2 1p-Ag.pow"
nis 44YA9*0=z�lwa
RARM 8 9_2 7-5 5, A �W .
3 1 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT
2 2-7 5 S BOARD O E H
Q_
OTHEF Xr:;Z
4C)l
AAPR6VED ')
TOWN.;-OPS RNSTAB P 4*WORK SHALL NTTT?TOCE NT)t A
0 -Gas-'
THE INSPECTOR HAS APPF�, vEwuD THE
1�7
VARIOUS STAGES OF CONSTRUE- a '�40 8 1 i�
Plum irelpipector '.
TION. t f Plumbing
._APPROVED
W OF. BARNSTAE
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o N RC RATE .
e fl CAST LEACHING PITS
, . r e P E .
T WITH e
P ECAST SEPTIC TANK •
R � �i9RRY
o o . E I
• tit T
a x WITNESSED BYI _
s' .s o o/v� del i T t� I
} T E I LET D 7 . ,� NO.. SIZE.
CAS IN PLAG N AN �- I
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P�9,E'/t/v�-���� BOARD D F HEALTH ,
I BD 0
T P TIT` E
I � - OUTLET S ER L V
6 2 � _ _ I
sTo n/� D A STo�� DATE :
3 G
DDO � •
/ GALLONS OF STONEI
i SIZE . � ,
4 Pervious /o ti - 4G I
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I , PROFILE LCOFPROPOSED5 �!/1.GESYS , EM
O
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T-9 E�.4R/VS �
L ,
TOWN OF _�.. REGULATIONS AND ,
� SYSTEM DESIGNED BY THE _
i
D1SP0SAl OF SEWAGE
SCALE 1/4 0
I STATE TITLE U FQR SUBSURFACE
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� B SCHEDULE 4 P.V.C . SEWER ' PIPE
1 . All PIPES SNAIL E SCH L r7
x
P / PER FOOT EXCEPT F0
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_ 2. ALL PIPES SHALL BE SLOPED � 4 E o, •, ,
x
J
BE EVEl I
! F T T OF THE DIB 'WHICH ,SHALL l + P-�
� 'THE -,FIRST 2 EE 0U
,G
, 1 I O t - I
3 b I 3 ,
R B GAL/ DAY
a
1 , 3, DESIGN FLOW ,.� .BEDROOMS AT 110 GALDAY PE R .
6
0 95
I SEPTIC TANK SIZE X G`AL �4
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�aoo G D I P S ,
� USE — GAL., W/� GARBA E S 0 Al
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' LEACHING STEM . USE � .� A x �-F , ��� �,� N I
I KIN SYSTEM :
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Z x x x EPa i
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EFFECTIVE AREA . SIDE
z 1
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OTAL FLOW
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REFERENCE PLANS . � aq I
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D B Y ,
- -- APPROVE s�
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BOARD of HEALTH
DATESEWACE �
N
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PROPERTY OWNER ,
�I//C/ccIGfIS 6,61iG1�//i/G CO> OF
flfic"N T'J f'G E /'
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INCORPORATED
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DOYlE ENGINEERING ASSOCIATES,
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Falmouth,uth A
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`Box 595 53D Thomas ,
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