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TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Maps Parcel Application # -o
Health Division Date Issued
Conservation Division Application Fee
Planning Dept. Permit Fee
Date Definitive Plan Approved by Planning Board
Historic - OKH _ Preservation/Hyannis
Project Street Address 9l SM&t `L4� &6 t0,,36
Village
Owner 10A A,J!d Address
Telephone '"
Permit Request,_� rl
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new
.Zoning District ,q� Flood Plain Groundwater Overlay
Project Valuation`s S Construction Type ® a
Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
CD
Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units)
Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway.-cU YeL U No
Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other
Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ftl W
Number of Baths: Full: existing new Half: existing new
Number of Bedrooms: existing _new
Total Room Count (not including bath.,,): existing new First Floor Room Count
Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other
Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No
Detached garage: ❑existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_
.Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other:
Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑
Commercial ❑Yes ❑ No If yes, site plan review#
Current Use Proposed Use
I�9cuD-36/
APPLICANT INFORMATION
(BUILDER OR HOMEOWNER) �p
Name Telephone Number C1 7g
Address License# (7
�I a no U- �—�''{� � Home Improvement Contractor#
Worker's Compensation #
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO IuCkl. Ql.
SIGNATURE DATE I S /
FOR OFFICIAL USE ONLY
APPLICATION#
DATE ISSUED
MAP/PARCEL NO.
ADDRESS ' VILLAGE
OWNER
'E
DATE OF INSPECTION:
r
FOUNDATION
4 FRAME
INSULATION
a
i FIREPLACE
F
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
FINAL BUILDING ~
DATE CLOSED OUT
ASSOCIATION PLAN NO.
OWNER AUTHORIZATION FORM
(OWNERS NAME)
Owner of the property located at:
(PROPERTY ADDRESS)
Jd
(PROPERTY ADDRESS) s
Hereby authorize
�L C
(SUBCONTRACTOR)
An authorized subcontractor for RISE engineering,toact on my behalf to obtain a buidin
Perform work on my property. g perm
it and to
Owner's signature
---------------
Date
oF�rOy,
Town of Barnstable *Permit#
14 ,y Q Expires 6,M frn e
U0 Ir Regulatory Services Fee
9$ ieg9 ��� Richard V.Scali,Director
�Eo �0. N - 5 2014
Building Division .
Tom Perry,CBO,Building Commissioner
TOWN OF 13ARN`TABLE200 Main Street,Hyannis,MA 02601
www.town.bamstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
EXPRESS PEST APPLICATION - RESIDENTIAL ONLY
\ /,�� Not Valid without Red X-Press Imprint
Map/parcel Number �1 V
Property Address �q�$g - dS t]' L,,� ►. Aem CiTj.-w�- e
Residential Value of Work$ 1 Minimum fee of$35.00 for work under$6000.00
Owner's Name&Address
yr7 S%l,,jsa` Lt-,. 2A(L L
Contractor's Name Z o'sax �&fsl_L Telephone Number 51o!i —75162—a377 77
Home Improvement Contractor License#(if applicable) Email: Zj I--I e 9— cZ
Construction Supervisor's License#(if applicable) !� 4
❑Workman's Compensation Insurance
Check one:
❑ I am a sole proprietor
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
❑ 13.c roof(hurricane nailed)(not stripping. Going over existing layers of roof)
Re-side
❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows
#of doors:
❑ 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:
Q:\WPFILESTORMS\building permit forms\EXPRESS.doc
Revised 061313
Town of Barnstable
Regulatory Services
P�o4t Tpiyti Richard V.Scali,Director
Building Division '
sniuvsrnacE Tom Perry,Building Commissioner
MUSS.
9� 039. � 200 Main Street, Hyannis,MA 02601
�rfD �A www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE: �
JOB LOCATION: 11f �V � 9062 /°�2�14VA O,
�nuum ( `� streetvillage
HOMEOWNER": �/i'�r 0- A r S� 614 l/ ��� ��G A 3!:7?
name - ( — home p onh e# work phone#
CURRENT MAILING ADDRESS: D .L/y 4 X_ I"
1-04 A 0.)5 Q`Ly M-4 lqyz��n
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 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 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 minimum inspection
procp 7
s and r quire ents and that he/she will comply with said procedures and requirements.
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 Constniction 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 personas 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 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:\WPFILES\FORMS\building permit forms\EXPRESS.doc
Revised 061313
ti
anxxsrwscs. +
9$ ' ,�� Town of Barnstable
'OTEn Nu•'�a
Regulatory Services
Richard V. Scali,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 Owner Must
Complete and Sign This S tion
�Jf Using A Build
I, Owner the subject property
hereby authorize t ct on my behalf,
in all matters relative to work authorized by s building permit application for:
(Addres of Job)
Signature of Owner Date
Print Name
If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the
reverse side.
Q:\WHILESTORMS\building permit formsTYPRESS.doc
Revised 061313