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2 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map352— Parcel dGs°gig.` ,. R ppISTABLF 'Application #0-26 5 —
Health Division ,. Date Issued Poe-
-12"l
Conservation Division Application Fee
Planning Dept. Permit Fee
Date Definitive Plan Approved by Planning Board �TO r
Historic - OKH _ Preservation/ H annis
\/a,n c,Lze_.
Project Street Address 1 Z. KA
Village
Owner C f t N r, 1--0 V(/ Address 17 d \ l
i
Telephone y 13 ti 3 2 om4& �,_( L O L GO
Permit Request 1'e INAC3 ({y��ift� (n�� `VO r(tJCs�( -� `l wq w
Square feet: 1 st floor: existing 142 proposed 2nd floor: existing proposed Total new
Zoning District Flocd Plain Groundwater Overlay
Project Valuatio�ZDO Construction Type Gg
Lot Size Art Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family 0' Two Family ❑ Multi-Family (# units)
Age of Existing Structure --1!7 IS1 _ Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No
Basement Type: ❑ Full ❑ Crawl ❑ Walkout *Other NaAl�
Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft)
Number of Baths: Full: existing_ new Half: existing new
Number of Bedrooms: 3 existing _new
Total Room Count (not including baths): existing �_new First Floor Room Count
Heat Type and Fuel: ❑ Gas ❑ Oil AElectric ❑ 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 504SNn L\I ykC.&[)6 K( *o►1A C Proposed Use S-AuYI �
APPLICANT INFORMATION
(BUILDER OR HOMEOWNER) �l
Name O.tA c ,\ 41 63 - Z 3 2 3
Telephone Number _ r��(� )
Address License # to
0 4 60 Z Home Improvement Contractor#
Email - 1 e_0101 A avU&,Q 1 C 6 KA Worker's Compensation # We V d i-Z` 3-7U c
1�4ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO)fQC M 0 U+ hIA
SIGNATURE �1I✓ DATE —J7 /s�
V
FOR OFFICIAL USE ONLY
APPLICATION#
DATE ISSUED
,NAP/PARCEL NO.
` ADDRESS VILLAGE
OWNER
r
DATE OF INSPECTION:
FOUNDATION
FRAME
INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
FINAL BUILDING
DATE CLOSED OUT
ASSOCIATION PLAN NO.
' OCT. Y
>,•, stable
Town of B H}ghwaY
old Clnogmnittee
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�F11HE Tpy, Town of Barnstable Permit#
Expir ^ months fr issue date
f Regulatory Services Fee
f =; S P � 0�
1639. Richard V.Scali,Director
Building Division .
TOWN OF BARNSTAR m 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 I rint
Map/parcel Number 0o f _ ��- /Y-71
Property Address '
Residential Value of Work$ G'a'D. Minimum fee of$35.00 for work under$6000.00
Owner's Name&Address
'9 roCy- u),Ca 40 �a .� s Gzc�-e /,spa.! f �Uf
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Contractor's Name l n Q A i-( J fit.Yl A60 S fP(j''F- (C, Telephone Number b to7
Home Improvement Contractor License#(if applicable) Email:
Construction Supervisor's License#(if applicable)
❑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
❑Re-roof(hurricane nailed)(riot stripping. Going over existing layers of roof)
❑ Re-side ,3a
❑ Replacement Windows/doors/sliders.U-Value (maximum.4}#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: 3 75-6 S (i
Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc
Revised 061313
inn
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IMETay Town of Barnstable
Regulatory Services
BAFtNSi"LFL +
r Muss. ; �, ... Richard V.Scali,Director
'' a i,►oy" Building DiVision
Tom.Perry,Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.barnstabie.ma xs
Office: 5.08-862-4038 Fax: 508-790-6230
Property Owner Must
Complete and Sign. This Section
If_ Using A Builder
as Owner of the subject property
Tau orize
7�i�1 y iS/V�o,�iPS to act on.zx�y behalf,
in all matters relative xo work authorized bythis building permit application for.
AA ,Dr Z&X /(o�� co r7i9-< iF
(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
.inspections are performed and accepted.
S 1. tore of Owner `Signature of A plicant
Print Larne Prim Name
4 y , ' .. ..
Date
Q:F0RMS:0WNERPERMISS oNPooLS
s
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V`+�
�"`• e� r
A T T '�3T{CN:
T S ` KE4[�Ert CT RS REVIEWED MASSACHUS�*, LAe-v .REQUI ES
{ CARBON Mn7 "�: uL DETECTORS IN
$A TA ALL REES10P.; ,;`-.'_ DMELLING .
LDI EPT ATE ;
IN AnrIT;�,.;.; . .' T FiE FIRE ALARM
I INSPEM'iC. N, THE iNSTALLATIO OF
FIRED PAR ENT DAT `---- - CO nE'L'-%;ORS, iN ACCORDA CE
BOTH S/GNATURESAREREQU/REDfDRPERMITING �" l. 1 b27 Ci�;R 31.00 WILL BE,
_ .
"'" VERIFIEt7 PRIOR TO SIGNING THE
BUILDING P
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yoFTMETory TOWN OF BARNSTAB]L]E
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BAMT"LE, i MM
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APPLICATION FOR PERMIT TO ........
...................................................................................................
TYPE OF CONSTRUCTION 7'Cr�,t/� ..........................................................................................
................................... 19 —
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby •pplies for a permit according to the following informatio
Location .............................. ......................................�"�-4-
- ........ ............... .................................................
ProposedUse ............................................L% L. ..............................................................:...........................................
/
Zoning District .................. °� ,......._I/ ...............................Fire District ......... s.........................................
Name of Owner ..........Address ............................... ,:....................:...............
Name of Builder .......................................
... .....6/U ... ?.!?. C.A�cldress .c�L6u-L�
.....................:................. ...........................................
Nameof Architect ..........................................................:.......Address ....................................................................................
Number of Roo ............(. `.`..........................................Foundation ...../, &.
1 .......................................................
Exierior ........................ ...........................................................Roofing ............. ...........................................
Floors ..............f„'✓fL'.......:.................................................Interior .............. tce'2 ...............................................
Heating ............. ............................. :....................................Plumbing ................................ ................................................
Fireplace .................... .............................................................Approximate Cost .....................................................................
Difinitive Plan Approved by Planning Board ________________________________19________. d' S,
Diagram of Lot and Building with Dimensions
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I hereby agree to conform to all the Rules and Regulations of the T f Barnstable regarding the above
construction.
Name ...
..........................................?.............. ...................
Baxter, Wl]]LlaooO° '
�
No IDI8O-----.. Pamnit for —--oom
—Pto.ry.---..
--�f..!���.�����y..��������-------- .
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Location -- .Rmad________^_
...................... .—.��-r�����~�.L�.. '
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Owner -- .S�..Baxdmm�_______
'
Type of Construction .....................frame...........
`
Plot f§.
^�* /
o±c�xar 2I �� '
Permit Granted ---D----------.lP �~
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Date of Inspection —. .*c----lV4J `
Dote Completed ------------..lg
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-----.--.------------- 19
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---------'----'—^^^—^^''^^'--^^^^'
Approved ---------------- lQ
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