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�T Town of Barnstable *Pe 1
Jl q8t
Regulatory Services EF
aMWs BL&
MASH& Richard V.Scali,Director
s63¢ ♦�
Building Division
Paul Roma,Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
EXPRESS PERAHT APPLICATION - RESIDENTIAL ONLY
/%Z Not Valid without Red X Press Imprint
Map/parcel NumbeA3' w V t
Property Address S ` 14 IA L c y- 1-1® ea)
❑Residential Value of Work$— 5-0 0 Minimum fee of$35.00 for work under$6000.06
Owner's Name&Address L /N D 4 H
3 s TA L0,1 1� D
Contractor's Name MARK M U L z—/I\( Telephone Number
Home Improvement Contractor License#(if applicable) / 7,,? / Email: ]]ttM UGZ->ti/ Rcw F/lJC ®6M A /4, 097
Construction Supervisor's License#(if applicable) /p 0 7 6
❑Workman's Compensation Insurance JUN O 8 2017
Check one:
❑ I am a sole proprietor To"I
�'� p
❑ I am the Homeowner S TA®L E
[-I have Worker's Compensation Insurance
Insurance Company Name U C
Workman's Comp.Policy# Q 7 f4 73
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)
2-Re-side
❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows
#of doors:
*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
�J ,required.
SIGNATURE:
QAWPFILESTORMSUilding permit forms\EXPRESS.doc
O1/25/17
i r N n�Cf
Town of Barnstable
Regulatory Services
Richard V. S=14 Director.
►`� Building Division.
Paul Roma,Building Commissioner
200 Main Street,Hyannis,MA 02601
wwwAown.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
Property Owner Must
Complete and Sign This Section
If Usin-a A Builder
4 I as Owner of the subjectproperty� l
hereby authorize G�/��V �'V ` C�!l dU to act on my behalf
in all matters relative to work authorized by this building permit application for.
(Addres of Job)
**Pool fences and alarms are the responsibility of the applicant Pools
are not to be filled or utilized before fence is installed and all final
ins ctions are perfo d and accepted.
Signature of Owner Signature of Applicant
C
Print Name Print Name
Date
QFORMS:OWNERPERMISSIONPOOLS
Town of Barnstable
Regulatory Services
p@ �Y Richard V.Scali,Director
ti
Building Division
s MASS. e, = Paul Roma,Building Commissioner
��m� 00 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
HOME LICENSE EXEMPTIO
Please Print
DATE:
JOB LOCATION: '
number street / village
"HOMEOWNER":
name home phone work phone#
CURRENT MAILING ADDRESS:
city/town zip code
The current exemption for"homeowners"was extended to include wner-occuDied dwellina of six units or less and to allow
homeowners to engage an individual for hire who does not possess a lice e,provided that the owner acts as supervisor.
DEFINITION OF HOMEOWNER
Person(s)who owns a parcel of land on which he/she resides or inten reside,on which there is,or is'int6nded to be,a one or two-
family dwelling,attached or detached structures accessory to such use d/or farm structures. A person who constructs more than one
home in a two-year period shall not be considered a homeowner. Su `homeowner"shall submit to the Building Official on a form
acceptable to the Building Official,that he/she shall be responsible or such work Rerformed under the building gMLL (Section
109.1.1)
The undersigned"homeowner"assumes responsibility for co m 'ance with a State Building Code and other applicable codes,
bylaws,rules and regulations.
The undersigned"homeowner"certifies that he/she unde ds the Town of le Building Department minimum inspection
procedures and requirements and that he/she will comply th said procedures d requirements.
Signature of Homeowner
Approval of Building Official
Note: Three-family dwellings containin 35,000 cubic feet or larger will be re ed to comply with the State Building Code
Section 127.0 Construction Control.
HOMEOWNER'S EXEMPTION m
The Code states that: "Any home caner performing work for which a building ermit is required shall be exempt
from the provisions of this section(Secti 109.1.1-Licensing of construction Superviso );provided that if the homeowner
engages a person(s)for hire to do such ork,that such Homeowner shall act as superviso "
Many homeowners who use is exemption are unaware that they are assuming the esponsibilities of a supervisor
(see Appendix Q,Rules&Regula ' ns for Licensing Construction Supervisors,Section 2.15) his lack of awareness often
results in serious problems,pa ' ularly when the homeowner hires unlicensed persons. In th' case,our Board cannot
proceed against the unlicenso person as it would with a licensed Supervisor. The homeowner a ling as Supervisor-is
ultimately responsible.
To ensure that the homeowner is fully aware of his/her responsibilities,many communities equire,as part of the
permit application,that the homeowner certify that he/she understands the responsibilities of a Supe or. On the last page
this issue is a form currently used by several towns. You may care to amend and adopt such a'form c ification for use in
your community.
Q:\WPFILES\FORMS\building permit forms\EXPRESS.doe
06/20/16
TOWN OF BAR;NSTABLE BUILDING PERMIT APPLICATION,
Map Parcel Application #
Health Division Date Issued 49�� ! 17
Conservation Division Application F ilj�
Planning Dept. Permit Fee
Date Definitive Plan Approved by Planning Board
Historic - OKH _ Preservation/ Hyannis �iyisr�lG —
Project Street Address 3-5 1 c_
Village
Owner -eri' Address
Telephone 9( 2--US
Permit Request
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new
Zoning District �1 Flood Plain Groundwater Overlay
Project V�ation 00 Construction Type
Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family Two Family ❑ Multi-Family (# units)
Age of Existing Structu e Historic House: ❑Yes o On Old King's Highway: YYes ❑ No
Basement Type: Full Xcrawl ❑Walkout ❑ Other
Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) {l
Number of Baths: Full: existing new Half: existing new'
Number of Bedrooms: existing Sew
Total Room Count (not including baths): existing new First Floor Room Co t
Heat Type and Fuel: ❑ Gas it ❑ 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: O.existing L1,:hew ize_
Attached garage: existing ❑ new size _Shed: ❑existing ❑ new size _ Other -,
Zoning Board of Appeals Authorization ❑ Appeal # �ARecorded ❑
Commercial ❑ N If yes, s' plan r view# ,
w
Current Us Proposed Use rn
APPLICANT INFORMATION
(BUILDER OR HOMEOWNER)
Name W.tL.LtP► m o Telephone Number 509 _ V,2F- 06V-
Address 6 U-mc-a' i, 0 1 FZQ 5Lt-C License # C 5 P A - 06 q;tL1 5
Home Improvement Contractor# l?G717 �va-a- 13
Email U)J FQ&3 d A I M - C Om
Worker's Compensation #.
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
j
SIGNATURE DATE I
FOR OFFICIAL USE ONLY
P
APPLICATION #
DATE ISSUED
MAP/ PARCEL NO.
ADDRESS VILLAGE
OWNER
DATE OF INSPECTION:
FOUNDATION
FRAME
INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL
-PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
r _
FINAL BUILDING
4
DATE CLOSED OUT
ASSOCIATION PLAN NO.
Town of Barnstable '
Regulatory Services
MAM ` Richard V.Scali,Director.
►`� Building Division
Paul Roma,Building Commissioner
200 Main street,Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 509-862-4038 Fax: 508-790-6230
Property Owner Must
Complete and Sign This Section
If'Usinm A Builder
I ,as Owner of the subject property
hereby authorize 1 t-Z t (a M F OEMIV to act on my behalf,
a
in all matters relative to work authorized by this building permit application for.
35 ILLv Ho., &wu8 i AB LE
(Address of Job) '
**Pool fences and alarms are the responsibility of the applicant Pools
are not to be filled or utilized before fence is installed and all final .
inspe ns Tar ;perTfed and accepted.
Signature'4 Owner Signature of Applicant
2iy
Print Name Print Name
Date
Q.:FORMS:OWNERPERMISSIONPOOLS
Town of Barnstable
Regulatory Services
off Richard V.Sca14 Director
Building Division
r Paul Ro ma,Building Commissioner
MASS.
s6.7 .� 200 Main Street, Hyannis,H MA 02601
www.town.barnstable.ma.us
Office: 509-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
DAT E: Please Print
JOB LOCATION:
number street age
"HOMEOWNER :
name home phone# work phone#
CURRENT MAILING ADDRESS:
Y zip code
Tile-rurnat exemption for"homeowners"was extended to inchide o er-occu ied dwellings of six units or less and
to allow ho owners to engage an individual for hire who does possess a license,provided that the owner acts
as supervisor.
DEFINI/resi
MEOWNER
Person(s)who owns a arcel of land on which he/ intends to reside,on which there is,or is intended to
be,a one or two-family elling,attached or detaes accessory to such use and/or farm structures. A
person who constructs more an one home in a twd shall not be'considered a homeowner. Such
"homeowner"shall submit to Building Officiacceptable to the Building Ofcial,that he/she shall be
res onsible for all such work a ed under themit. (Section 109.1.1) 4
The undersigned"homeowner"assume esp ibility for compliance with the State Building Code and other
applicable codes,bylaws,aPP Y ,rules and re
The undersigned"homeowner"certifie he a understands the Town of Barnstable Building Department
minimum inspection procedures and r quirements d that he/she will comply with said procedures and
requirements.
Signature of Homeowner
Approval of Building Official
Note: Three- y dwellings containing 35,000 cubic feet or er will be required to comply with the
State Building Code ction 127.0 Construction Control.
HOMEOWNER'S EXEMPTION
The C e states that: "Any homeowner performing work for which building permit is required .
shall be ezem from the.provisions of this section(Section 109.1.1-Licensing o onstruction Supervisors);
provided th if the homeowner engages a person(s)for hire to do such work,that ch Homeowner shall act
as supervysor."
Many homeowners who use this exemption are unaware that they are assuming a responsibilities of
a supervisor(see Appendix Q,Rules&Regulations for Licensing Construction Supervisors, ection 2.15)
This lack of awareness often results in serious problems,particularly when the homeowner h es unlicensed
persons. In this case,our Board cannot proceed against the unlicensed person as it would with licensed
Supervisor. The homeowner acting as Supervisor is ultimately responsible.
To ensure that the homeowner is fully aware of his/her responsibilities,many communiti require,
as part of the permit application,that the homeowner certify that he/she understands the responsibi'ties of a
Supervisor. On the last page of this issue is a form currently used by several towns. You may care to amend
and adopt such a form/certification for use in your community.
35
00 „
0
Clcjq
OCJ
�E/lU!/E �xi s Tint CAI ST �.�J� /Do
Q
V
A
Commonwealth of Massachusetts
Sheet Metal Permit
Ma43 Parcel 095
Date: 4 / Permit# 4
Estimated Job Cost: $ D 0 Permit Fee: $ y�
Plans Submitted: YES NO Plans Reviewed: YES NO
Business License# /_3 9,0/ Applicant License# /398/
Business Information: Property Owner/Job Location Information:
Name: ZA41 6a) Name: G;W- - S
Street: LfhlaI Street: 3s- 7�Y
City/Town: �S,Q, �/l! _ City/Town: , ` - Ar+
Telephone: r (:3' Telephone: ^1�a ^G39D
Photo I.D. required/Copy of Photo I.D. attached: YES f NO
Staff Initial
-1/M-1-unrestricted license o ) ,
J-2/M-2-restricted to dwellings 3-stories or less and commercial up to40%svf,%/2-stories or less
Residential: 1-2 family Multi-family Condo/�Ttq o t-s -ERNS d�DL }
Commercial: Office Retail Industrial �1 Educational
Fire Dept.Approval Institutional_ Other
Square Footage: under 10,000 sq. ft. ,over 10,000 sq. ft. Number of Stories:
Sheet metal work to be completed: New Work: Renovation:
-HVAC - V Metal Watershed Roofing Kitchen Exhaust System
Metal Chimney/Vents Air Balancing
Provide detailed description of work to be done:
i
Sv G v 'a
i
���� 9UZ4 J �aA44 A&
i
INSURANCE COVERAGE:
I have a current liability insurance policy or its equivalentwhich meets the requirements of M.G.L. Ch. 112 Yes 20eNo ❑ -
If you have checked yp&, indicate the type of coverage by checking the appropriate box below: `
A liability insurance policy ❑ Other type of indemnity ❑ -Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 112 of the
Massachusetts General Laws,and that my signature on this permit application waives this requirement
Check One Only
AA /,4-X—/n
Owner Agent ❑
Signature of Owner or Owner's Agent
By checking this box[],I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and
accurate to the best of my knowledge and that all'stieet metal work and installations performed undeFthe permit issued for this application will be
in compliance 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 Continents
I
Type of License:
By ❑ Master•. _. .
Title
❑ Master-Restricted: .& ,
City/Town
Permit#
❑Journeyperson
Signature of Licensee
❑Journeyperson-Restricted
Fee$ License Number:
Check at.www.mass. ovIdol
Email
Inspector Signature of Permit Approval
' Town of Barnstable
' Regulatory Services
" MASM Thomas F.Gefler,Duvetor
Building Division•
Tom Parry,Bu Rding:CommiWouer
200'M tm.Slredt,Hyannis,MA 02601.
www.town.bamstable:ma.u,s
Office: 508-8624038 Fag: 5:08-79M230
Property Owlier Must
Complete and.Sign This Section.
If Using A Builder
I ,as Owner of the sulbjectptopetty
hereb-y autharitie to act.on alp behalf,
in-all-mattm..rdative.to woxk.authoiized by taus buddingpe=i
3f' X1,��,� ,
-(Address of Jab)
**Pool fences and alarms are the responsibility of the applicant. Pools
are not to be filled before fence is installed and pools are not to be
Utilized.Until all fnal inspections are performed and accepted.
Qrmtme of Owner Signature-af pplicant
Print Name 'Print Name
Date
O:F0RMS:0RRNERPER2M9I.0M 0L:S
Nov. 20. 2007•- 8:32AM Aa�fe�•-No._2875• P. 1/1
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Town of Barnstable *Permit# ,;�0070`-(
Expires 6 months from issue ddayatte\e
P Regulatory Services Fee d!5:
f it it Thomas F.Geier,Director
Building Division
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 1 o`n 1 3 n
Prope Address,� � �� (� S� J Ix � b z�0 C)
Residential Value of Work J` 7�. 60 Minimum fee of$25.00 for work under$6000.00
Owner's Name&Address \
o
Contractor's Name ! G�"I Telephone Number6w) 3-rd- V �/
Home Improvement Contractor License#(if applicable) 1 1//1lio
Construction Supervisor's License#(if applicable)
❑Workman's Compensation Insurance
Chec X-PRESS PERMIT
I am a sole proprietor
❑ I am the Homeowner J U L 1 7 2007
❑ I have Worker's Compensation Insurance
Insurance Company Name TOWN OF BARNSTABLE
Workman's Comp.Policy#
Copy of Insurance Compliance Certificate must be on file.
Permit Request(check box)
❑ Re-roof(stripping old shingles) All construction debris will be taken to
❑Re- of(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 t epgtment 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:
Q:Fonns:expmtrg "`v
Re,vise061306
r
114E��� 'Town of Barnstable.
Regulatory Services
` $ Thomas F.Geller,Director
Building Division
Tom Perry, Building Commissioner
200 Main Street, Hyannis,MA 02601
w%'w.town.b arnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
Property Owner Must
Complete and Sign This Section
If Using ABuilder
as Owner of the subject property
hereby authorize 2G'. C-V— to act on my behalf,
in all matters relative to.work authorized bythis building permit application for: .
I > C -
(AddreA of Job)
of Owner Date
Pnnt� I,1,� -19
�. Name
QFORMS:O'W E ERMISSION
Building epartment
Comp laint/Inqui y Report "
1 x �., - --
Daw._ 1 V Rec'd by: C !L_/-�-/�.o Assessor's No.:
Complaint Name: L I n d Q , &0(1
Location
Address: q0 rknnrl)
M/P
Originator Name• �0 C/-5
Street:
Wage:. State: Zip:_
Telephone:D/C
Complaint
Description:
+f�A s
Inquiry 0 old uj An d-o 5 cl-n
Description:
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For Office Use Only
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Engineering Dept. (3rd floor) Map Parcel Permit# ,9 15_6
w House# Date Issued -z-
} 11 ld I El Fee �.
1
THE
19 ' ' ��
BARNSTABU. `
lED j9.
TOWN OF BARNSTABLE
Buildin Permit Application
Project Street Address ,
Village e
Owner 1 Address
Telephone
Permit Request
First Floor square feet Second Floor square feet
Construction Type
Estimated Project Cost $ '
Zoning District Flood Plain Water Protection
Lot Size Grandfathered ❑Yes ❑No
Dwelling Type: Single Family �al Two Family ❑ Multi-Family(#units)
Age of Existing Structure u Historic House ❑Yes ❑No On Old King's Highway ❑Yes ❑No
Basement Type: Vull ❑Cra 1 ❑Walkout ❑Other
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft)
Number of Baths: Full: Existing New Half: Existing New
No. of Bedrooms: Existing New
Total Room Count(not including baths): Existing New First Floor Room Count
Heat Type and Fuel: ❑Gas �6il ❑Electric ❑Other
Central Air ❑Yes ❑No Fireplaces: Existing / New Existing wood/coal stove ❑Yes 31NO
( Q Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) .
❑Attached(size) ❑Barn(size)
❑None ❑Shed(size)
❑Other(size)
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial ❑Yes ❑No If yes, site plan review#
Current Use Proposed Use
Builder Information
Name Telephone Number .22 W %'�P?— C9
Address , License#
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
I
SIGNATURE DATE
.,&BUILDI x PERM DENIED FOR THE FOLLO G REASON(S)
A
FOR OFFICIAL USE ONLY
ti 7
PtRMIT ISO.
DATFt ISSGJED; f
MAP y PARCED 01, '
ADDRESS' i ! VILLAGE a
OWNER
i
DATE OF INSPECTION: ►
FOUNDATION
FRAME I
INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL !
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
f
FINAL BUILDING
DATE CLOSED OUT
ASSOCIATION PLAN NO.
=- iI ' �'
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oFVE t The Town of Barnstable
Department of Health Safety and Environmental Services
&MW9TABU ' Building Division
MAM
9 1639• .�� 367 Main Street,Hyannis MA 02601
��rED MA'I A
Office: 508-790-6227 Ralph Crossen,
Fax: 508-790-6230 Building Commissioner
Building Permit Procedure for Residential Additions
1. Plot plan or mortgage survey required for zoning compliance.
2. Old King's Highway Historic District Commission approval required prior to
construction/demolition for any properties located in the Historic District (north of the
Mid Cape Highway).
3. One set of plans, reduced to 8.5" x I or 8.5"x 14" is required.. Plans must include a
cross section and a framing schedule as well as proposed insulation. Note: The
applicant must also submit a set of plans to the appropriate fire department for
review.
4. Approval from the following departments must be obtained:
Engineering Department (3rd floor Town Hall)
Health Department (3rd'floor Town Hall- 8:30 - 9:30 a.m./1:00 - 4:30 p.m.)
Conservation Department (4th floor Town Hall) (8:30 - 9:30 a.m./1:00 - 2:00 p.m.)
5. If the cost of the addition exceeds 50% of the assessed value of the house the Fire
Department requires a smoke detector sign-off and the Building Division requires a
certified (as built) foundation plan. The Building Commissioner will make this
determination.
Insurance Affidavit form must be submitted for an
6. Workers Compensation Ins Y workers
hired. In the event the homeowner takes out the permit, subcontractors hired must supply
this..
7. Home Improvement Contractor Affidavit must be submitted.
8. Copies of the following licenses are required: Construction Supervisors License &
Home Improvement Specialist's License
9. Homeowner License Exemption Form must be submitted if homeowner is acting as
general contractor or builder for the project.
10. Fee must be paid prior to issuance of permit.
Note: No wall is to be covered before wiring, plumbing and frame inspections.
PERMIT
Rev 2122/96
tME
The Town of Barnstable
• sanivsTnsM •
9� Department of Health Safety and Environmental Services
ATEDNIo'�A Building Division
367 Main Street,Hyannis MA 02601
Office: 508-790-6227 Ralph Crossen
Fax: 508-790-6230 Building Commissioner
For office use only
Permit/no. `
Date ` � � '�
AFFIDAVIT
HOME IMPROVEMENT CONTRACTOR LAW
SUPPLEMENT TO PERMIT APPLICATION
MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization,
conversion, improvement, removal, demolition, or construction of an addition to any pre-existing
owner occupied building containing at least one but not more than four dwelling units or to
structures which are adjacent to such residence or building be done by registered contractors, with
certain exceptions,along with other requirements.
Type of Work: Est.Cost /Y —
Address of Work:
Owner's Name
Date of Permit Application:
I hereby certify that:
Registration is not required for the following reason(s):
Work excluded by law
Job under$1,000.
Building not owner-occupied
Owner pulling own permit
Notice is hereby given that:
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED
CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE
ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A
SIGNED UNDER PENALTIES OF PERJURY
I hereby apply for a permit as the agent of he owner:
Iql
at ontracto ame Registration No.
OR
Date Owner's Name
Engineering Dept.(3rd floor) Map 3Z6 Parcel 623 Permitft
' House# Date Issued
Fee 5
BARNSTABLE.
MASS16s9-
TOWN OF BARNSTABLE
Building Permit Application ,/
Project Street Address j
Village S4--y-}O —c
Owner M rt.S S h -CMG. Address
Telephone
Permit Request
i
I
First Floor square feet Second Floor square feet
Construction Type
Estimated Project Cost $
Zoning District Flood Plain Water Protection
Lot Size Grandfathered ❑Yes ❑No
Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units)
Age of Existing Structure Historic House ❑Yes ❑No On Old King's Highway ❑Yes ❑No
Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft)
Number of Baths: Full: Existing New Half: Existing New
No.of Bedrooms: Existing New
Total Room Count(not including baths): 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
Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size)
❑Attached(size) ❑Barn(size)
❑None ❑Shed(size)
❑Other(size)
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial ❑Yes ❑No If yes, site plan review#
Current Use Proposed Use
Builder Information
Name t dw �'--,-c c,. Telephone Number
Address / TT4�Gt�rn-� Z License#
Home Improvement Contractor#
Worker's Compensation# 6xAf
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 TAKEN TO
SIGNATURE DATE �7�5
BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S)
-- oFVE ram,
ti
The Town of Barnstable
• EARNszABLE. •
9� NAS& ,m� Department of Health Safety and Environmental Services
ArFD Mpg" Building Division
367 Main Street,Hyannis MA 02601
Office: 508-790-6227 Ralph Crossen
Fax: 508-790-6230 Building Commissioner
For office use only
Permit no.
Date
AFFIDAVIT
HOME IMPROVEMENT CONTRACTOR LAW
SUPPLEMENT TO PERMIT APPLICATION
MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization,
conversion, improvement, removal, demolition, or construction of an addition to any pre-existing
owner occupied building containing at least one but not more than four dwelling units or to
structures which are adjacent to such residence or building be done by registered contractors, with
certain exceptions,along with other requirements.
Type of Work: / /� 2 Est.Cost
Address of Work: %iq- l
Owner's Name
Date of Permit Application:
I hereby certify that:
Registration is not required for the following reason(s):
Work excluded by law
Job under$1,000.
Building not owner-occupied
Owner pulling own permit
Notice is hereby given that:
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED
CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE
ACCESS TO THE 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:
-71&A 6
I)fite Contractor Name Registration No.
OR
Date Owner's Name
1 � :. �i
��d'� t
Fsor's map and lot number ... .. .. ..................... .. .... . T"C SyST
r MUeIVI ' B
INSTALLED IN • ST
�
�a. G� _ 7 3
wITH ARTICL C PPLIANCE
+� Se"vvbge4 Permit number .. ..................................................... SAN,ITA `I STATE
CODE A 4
;EC;�,�Lia x JoAt AND i OWIV
�Qy ?"ET°�; TOWN OF BARNSTABLE
Z 89&BSTADLE, i r
°
"6 BUILDING INSPECTOR
0 MP.1
APPLICATION FOR PERMIT,TO .:.... .....Y'!... ... ...................................................
' TYPE OF CONSTRUCTION y�l�,........1.... ....,;..,r. ::....................... I� L�.................................................
............................. ...............19.. .
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Locatio ..�/ ............. `.. ! . .......... ................. ... ..................................................................................
ProposedUse ............................................................................................... ..........................................................................
ZoningDistrict ........................................................................Fire District ..............................................................................
Name of Owner Vi � .....................Address ' . GP ,�. �J -. 7"
.................t........... ............................. ..................
Name of Builder .. .. ..... .. �.. .,�................Address ............. .................................................
Name of Architect ...., 44.... : ........ " .Al .......Address ............... + ,)5!! ......................
Numberof Rooms ...... ,6......................................:................Foundation ......87. ....................................:.................
Exlerior ...... ..V..ft- ............................................................Roofing .......... .....................:................................
Floors ......................................................................................Interior ... ......av!;�4.......................................
Heating ....� A.. .w......-n�.0.. .......................................Plumbing ..................................................................................
Fireplace ....... ar.f.eh.......................................................Approximate Cost ..........
Definitive Plan Approved by Planning Board ________________________________19________ . Area ......�1..............S. ....:.......
7,
Diagram of Lot and Building with Dimensions ......'......��
Fee .............
SUBJECT TO APPROVAL OF BOARD OF HEALTH
3,6 - 9.3 .- C Alb nay + ,
I hereby agree to conform to all the Rules and Regulations'of the Town of Barnstable regarding the above
construction.
� O� 4 ...................................
Name ..... ....................:....... ........
Rikilly, John N.
...q8' 21.,Permit for ..one s.t.ory................ .. . ......
..A.lwe f imi ly &we I Ling
• ............................................
Lbcation'Z...... ......H ,Ro-id'
. o........................................
.......................AgMtable
............................................
Owner ........... ........................
Type of Construction ........frame
e.........................
................................................................................
#107
Plot ............................ Lot ................................
-Permit Granted ......December 23.........1�6
-4......................
•
Date of Ins pectiom-t,/
.....T
........ . .. .. ......19
Date Completed ...........19
PERMIT REFUSED
................................................................. 19
.................. ............................................... ...........
...............................................................................
.......................... ......................................... ...........
...............................................................................
Approved ................................................. 19
.............................................................................
................. ........................................................
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