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0010 BRAMBLEBUSH DRIVE
,....-_ ,�r���6 s�� � r h i i.s_ .. �i... r-. i ..'. _ �; .i :� a .. - .. Z }: i a '2 j 1� � � y. 'tn :_3 •�'�o/a� _� d� ,� ;� :' _ i 4 ff !. r 4.,t �� 1 0 z ' `f f �. �'` ,� ��.: .. _..._....-_ .. _-�._ �... f .._.-._ .��,i y ,r z i r� i3 5 , l j,v tocbc- f a p (9 4 Fa `9 fz 7 f' a r g 3. fif 4�y 3lo ,—/o z t , t� F < �w `fit a € t - - M—la r � m ' rv3 w i its ®r r Ar l�4 Y I 4 cy r. � ' g e M1 qy# y S �av v fist �. Y �$ r ��r8r # fie T, r , t � i >• P 6 n „ �t 1/1V0.1� ►q-�x _ -en=� t 1 - - zGz - z� 3 7 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map It Parcel In -;Applicatidh #" Health,Division -'Date Issue Conservation Division Fee Planning'Dept: Permit Fee Date Definitive.Plan Approved by Planning Board Historic 7 OKH Preservation Hyannis Project Street Address ve Village Owner Address Telephone Z30 S(e=) mo 6z(go3v Permit Request <S—EZIC,15n i-100c/rc Dw Square feet: 1 st floor: existing proposed -2nd floor: existing proposed� Total hew Zoning District Flood Plain Groundwater Overlay Project Valuation?-00%2DO Construction Typewal) L&t Size Grandfathered: Ll Yes Q No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family Ll Multi-Family (# units) Age of Existing Structure Historic House: Ll Yes U No On Old King's Highway: U Yes Q No Basement Type: Q Full U Crawl U Walkout 0 Other Basement Finished Area(sq.ft.). I CC Basement Unfinished Area (sq.ft) Number of Baths: Full: existing: new Half: existing new Number of Bedrooms: 7F3 existing new Total Room Count (not including baths): existing new First Floor Room Counter Heat Type and Fuel: 0 Gas L3 Oil Q Electric U Other >I No Fireplaces: Existing New Existing wood' al stov6?- Ll Y-� Central Air: U Yes ,%s U No Detached garage: U existing Q new size—Pool: Q existing Q new size Barn: Q ex ting M newer;size_ Attached garage?existing U new size —Shed: U existing Q new size Other: Zoning Board of Appeals Authorization U Appeal # Recorded U Commercial U Yes No If yes, site plan review# Current Use � 041 �Ilq Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) NamSO , )�MeA11 b Telephone Number Address Nia am ��. 3 License #--T� - - 0-S Dq 9 Uy F0 - &J 1-7 1 Home Improvement Contractor# Ne,,,, n� �. ,P-( . m, 0 Worker's Compensation #W a-&qto- 9b�-&2- ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO)hj�g A A SIGNATURE DATE U FOR OFFICIAL USE ONLY ~APPLICATION# DATE ISSUED MAP/PARCEL N0. -'.ADDRESS VILLAGE - OWNER ` ' rDATE OF INSPECTION: FOUNDATION ' FRAME Cow ` INSULATION FIREPLACE - ,E ELECTRICAL: ROUGH FINAL ;PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. r 1 • i The Commonwealth of Massachusetts Department of Industrial Accidents ' Office of Investigations ' 600 Washington Street Boston,MA 02111 -• www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual)C-� P�LI�:Jle�l! t � /1 L^S �v Address:lo& I l l rl l n ST- u lit 3 (Poi City/State/Zip:l t't0V1 I_ I M R 626T Phone#: Jvg�'1 S - (mc Are you an employer?Check the appropriate box: Type of project(required): I)KI I am a employer with t:� 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the subcontractors 6. New construction listed on the attached sheet. 7. Remodeling 2.❑ I am a sole proprietor or partner- ship and have no employees These sub-contractors have g, ❑ Demolition workingfor me in an capacity. employees and have workers' Y P h'� 9. ❑ Building addition [No workers' comp. insurance comp.insurance.$ required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 13. 1 Other comp.insurance required.] a Hb 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. .Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for any employees. Below is the policy and job site information. Insurance Company Name: �U Policy#or Self-ins. Lic.#: IN� �� ' �C© Z Expiration Date: Ca �� Job Site Address: 1()U I I f'S I.E6us n De . City/State/Zip:&Jut Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby rti under pains and penalties of perjury that the information provided above is true and correct. - 01 Si nature: Date: 5 Phone#: �tq' Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: lit. _ eJri!ilFfi(ii•. ..1� •.,; 1 �n,!i i91(YII'E:1 ,:77•li'-.FN.;^ �I n, •1• - �� ' .,r, n•a I,'•� °r;p" a,�:,.L�.'1, .1:.•.-:.:, DATE(MMUDDIYYi 9 [[qq gg�p�ppHRI�(��(L���i �'Yl �,, �;�� w '-:.:; a:::.'r'•� �; Ii 6^1 V M' TM i1`hIL;ALWr.7:� �' ': � 'A;�-�1�Ay1� ''' 1 1�• 11 /r 14,�..,:1'i:,.;.�. I,• = L'� dJ' 1- I � : r.,_ J•?;1 r,'� = 8�Z5/2009 ��vvar....,1:•.�.••:..:'--'•-->_.:-.:,:.,-��;T.�!,Il:l:.:....::.r-•n�..,�. ifn'k:-..M.4�IG:4:.I..1:4 e,l—.J..J.=s•:__� :f•1.�. ,ul.�;!in9'..r,.: �y: OR60UCER J THIS CERTIFICATE'15 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE GERMANI INSURANCE AGENCY HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 908 MAIN STREET ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. OSTERVILLE, MA 02655 ._ . ... COMPANIES AFFORDING COVERAGE COMPANY A SAFETY INSURANCE INSURED COMPANY SCOTT PEACOCK BUILDING&REMODELING B AIG AMERICAN HOME ASSURANCE CO. PO BOX 171 4STERVILLE, MA 02656 � c C COMPANY D - r'�Y''.y_:•. :>.�.•:;n;. ,1 r,•I {I!, 'iLMI?' 'In r.t '•ITS. ''rl�• :.�,•1"!' 'r...:.6 - -•.1'• .I.a:' ul'1 tP r'Zi. ':I ':?i�•.::i• _ Lr' �7. tt,-rrf;..1,- I :•��. r_y_ _-LI.s'•: >:�," _l�:r__.'rhl. °I':n� .L• ��:�.-ten..r.r, ..1�'• r`,. h.'_�'17ID11_.._YIJJ n,r.�iil•1; :.,•`.-.�..�. ....r�.,,`'Iil:�'L...�a:i11:......._...._ .J.._�,'�_.�.�-:�:�,�1_:.I.�v:<:�,:w_:..�c.:::.in�u:ry,l,,,,..,.Ji,l�,:r..36!ud:.':,•7•,..�,,,::nE..,.�..�._.,9�......._...IL....L.,.�I.fi:fe`; THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTWITHSTANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED B Y THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _ ... CO TYPE:OF INSURANCE I POLICY EFFECTNE POLICY EXPIRATION LTR POLICY NUMBER DATE(MMIDDIYY) DATE(MMIDDIYY) , LIMITS GENERAL LIABILITY T� 'GENERAL AGGREGATE E 2,000,000 A COMMERCIAL GENERAL LIABILITY I CPODUO1152 07/05/08 07/05/09 I -' '-•-- _' "'- .. . . PRODUCTS-COMPIOPAGO E I CLAIMS MADE L—I OCCUR PERSONAL&ADV INJURY f E OWNER'S&CONTRACTOR'S PROT EACH OCCURRENCE 16 1,000,000 _ - - - - FIRE DAMAGE (Any one(Ve)—'— MED EXP (Anyone person) 16 AUTOMOBILE LIABILITY I COMBINED SINGLE LIMIT I f ANY AUTOLIMIT ALL OWNED AUTOS ' BODILY INJURY � E SCHEDULED AUTOS (Par peroon) J HIRED AUTOS I BODILY INJURY i E NON-OWNED AUTOS (Per oWdenl) PROPERTY DAMAGE :E GARAGE LIABIUTY I AUTO ONLY-EA ACCIDENT ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT 6 --- i i AGGREGATE E i EXCESS LIABILITY I EACH OCCURRENCE - ! 6^-- - — UMBRELLA FORM ! AGGREGATE I E OTHER THAN UMBRELLA FORM i 6 T- WC STAW Ol}6 B I WORXER'9 COMPENSATION AND ;WC 696-76-62 06l22108 OBI22/09 TORT QUITE_ .. .• Era EMPLOYERS'LIABILITY EL EACH ACCIDENT 6 1 QO 000 '- !THE FROPiUETOW r= INCL EL DISEASE-POLICY LIMIT E 500,000 I PAATNCRWEXECVTIVE _...._... 'OFFICERBARE i EXCL' EL DISEASE-EA EMPLOYEE S 100,000 OTHER DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESISPECIAL ITEMS COVER PROPERTIES AT:MARCEL R.POYANT 269.274,282 BARNSTABLE RD.HYANNIS,MA 02601; 1620-72 FALMOUTH RD.CENTERVILLE,MA 02 ; PLAZ TWENTY-EIGHT NOMINEE TRUST, 181-195 FALMOUTH RD.HYANNIS,MA 02601;CENTERVILLE SHOPPING CENTER I NOMINEE TRUST, 1676-1698 FALMOUTH RD.CENTERVILLE, MA 02632;20-30 OPECHEE RD.CENTERVILLE,MA 02832 i.l!_t '1 is 1? J 1 ti: 1 v a: +;::•: :r,='v. r, :: 'r pY�T .?iO�EfZ:r=''�'' bl'=iva1' r.°;ce_�Ig.r _1•�r::h I. :�'' Y `�{'• `'i I• -� .�y� J=!'.',':';. - ;'9'.:E..16�•„_ —�,� .�. ,�-.Y.1�.........�.........,.1.-.la'J,I_Iry�f..�n.1 1::1.�..!_.Li:vu__1=�a'��i!I'11J c.7 i, �'n :•L:�1.� '1,.2! M;iLi�, _ �.1.. ..1.' _�•, ,III.':=1Y:.. Ir,..h C r....rS:.''r' � ( =�''C-•!I -:1�7: ��� .� _Lr�'�._{.7i '. 1 .�, _ SHOULD ANYOF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE ATTN.: SALLY EXPIRATION DATA THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO NAIL DAYS WRITMN NOTICE TO THE CERTIFICATE MOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICEABI SHALL IMPOSE NO OBLIGATION OR TOWN OF BAFtiVSTABLE OF ANY KIND UPON THE GQMeANY, ITS AGENTS OR REPRESENTATWA, FAX#: 508-790-6230 AUTHOWP R EP�rATN��� '., , li C'�$:111:, '}!Ii{!lip �I."'�_:' :aI� ir.'d a '7!y' '''I x v •- - .... -,:- .,:',�.1 I:.,! •I!1?M.,.:}::..r..;;,'!>� ��I-!:n�.^_qR?:r:r+�h Ik,ttl:;:,;i;:J.r.b:,!:_i:!;,,.ti:4a,:;n�-aur^ ' . . .. -' �: ' W- r!:ihr!! O i License: CONSTRUCTION SUPERVISOR _T Number: CS 094500 Birthdate: 07/22/1962 Expires:07/22/2010 Tr.no: 94500 Restricted: 00 JAMES S PEACOCK PO. JY.171 OSTEVILLE, MA 02632. Commissioner i I `C-\ Board of Building Regulations and Standards - HOME IMPROVEMENT CONTRACTOR i = I Registry on:,,151853 Ez.piration-Z17/2010 Tr# 271501 =-nType:°—P_-nvlate Corporation SCOTT PEACOCKBUIILDING%REMODELING INC JAMES PEACOCKr, � 1:J ` 1046 MAIN STREET S,UITE'7 w�: Administrator OSTERVILLE,MA 02655' { I . .P�ofVE�° Town of Barnstable Regulatory Services '9BA RAW. Thomas F. Geiler,Director q'prEn 9. p`0 Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 • a Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must i Complete and Sign This Section If Using A Builder fI i I, '/'Gd-GC �Gk n. r►tiww , as Owner of the subject property hereby authorizs( m�L.t-c/ ' FIA i e�'M •I r)c o act on my behalf, in all matters relative to work authorized by this building permit application for: i1 (Address of Job) Signature of Owner Date 1��Gt,GI`�G�� f'Z��✓rYt.�r� li Print Name Q:FORM&OWNERPERMISSION is elf" C c rYii --� f ;: ..•� a _ ._Ms:?41tr Y"w n7'wc,� Cl-.I"T"i:� r•►+�R �� �- •iPa-� y`pF AI Town of Barnstable - BARNSTABLE : Regulatory Services .e MASS. Building Division` f prFO.MPS a. -� 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Inspection Correction Notice Type of Inspection ,� iC yu 1 Location /O Permit Number 1- Co?,o -Owner Builder L77�Gc��� One notice to remain on job site, one notice on file in Building Department. The following items need correcting: IUU6 a FARE R�4TL�A F /K . ,V� 2 k[mac. 0 rl-A bun G C. — t/c10lers — P �/r& DT6,E• cw5�. l�l� ,D ?big Toc7 .r Please call: 508-862-4.99&for re-inspection 1 (� �/z , _Inspected by ,C '! q� Date ��/ y`oF iME Tp�,� Town of Barnstable _ 4 Regulatory Services ' + BARMAT,q. E. MASS. g. t679• �0 Building Division ATEp�y e, 200 Main Street, Hyannis, MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Inspection Correction Notice Type of Inspection Location 10 At#-m ogC ne a",-- f Permit Number Owner Builder One notice to remain on job,site, one notice on file in Building Department. The following items need correcting: ; CO/UGj2t---7E . G Q (l J �E Gu,rze- rflo p.= iI U a ":�-ti/) or- &!/L — Ga-)c &Sj° a Please call: 508-862_ for re-inspection. Inspected by/2 Date 7 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel'_- ''Application # Health Division -'Date ISSL jed 311:co Conservation Division Application Fee Planning,Dept. ."Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation Hyannis Project Street Addre:ss 4') Village Owner Address VO An A4 Telephone :!5�'�d Yl: Permit Request _Za�tkhyi a- /Z -A Yq, J-4&�ay,�yu .did) I ijwxy i J tie—J o MA, AZ441, /1) 5) Ae -,4 -70 5- 410-1 Square feet: 1 st floor: existing proposed 2nd floor: existing propose:d _-- Total new Z6ning D.istrict Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: L3 Yes 0 No ' If'yes, attach supporting documentation. Dwelling Type: Single Family (21 Two Family Q Multi-Family (# units) Age of Existing Structure Historic House: Ll Yes L1 No On Old King's Highway: L3 Yes 0 No Basement Type: El Full Ll Crawl 0 Walkout L1 Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: Z existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: L3 Gas Ll Oil CrElectric U Other Central Air: L1 Yes El No Fireplaces: Existing New Existing wo&d/coal stove: J_Yes Ll No Detached garage: L1 existing L1 new size Pool: Ll existing Ll new size Barn: L�'-;__',,1xisting(7'L' 1 ndW' size Attached garage: Ll existing L11.new size —Shed: Ll existing Q new size Other: Zoning Board of Appeals Authorization Ll Appeal # Recorded Ll Commercial Q Yes L] No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) N6 — Telephone Number Address 51 License # D57ZV Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATUR DATE FOR OFFICIAL USE ONLY , PLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE DATE OF INSPECTION: }FOUNDATION } • m FRAME , INSULATION r FIREPLACE ELECTRICAL: ROUGH FINAL ' ' -PLUMBING: ROUGH FINAL :GAS: ROUGH 'FINAL FINAL BUILDING l/L DATE CLOSED OUT _ i F l' ASSOCIATION PLAN NO. ` f F i f J The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations- ' 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information A / / Please Print Le ibl Name(Business/Organization/Individual): %� !�!Ge: C Address: City/State/Zip: Z1 hone.#: ������—d 3 Are-,you an employer?Check the appropriate box: Type of project(required): 1.E 1 yoam a employer with ry ' 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or'partner- listed on the'attached sheet. 7.. ❑ Remodeling ship and have no employees These sub-contractors have g.-❑ Demolition workingfor me in an capacity. employees and have workers' Y P tY• $ 9. ❑ Building addition [No workers'.comp.-insurance comp.insurance. '10. Electrical repairs or additions required.] 5. ❑ We are a corporation and its ❑ P 3.❑ I am a homeowner doing all work officers have exercised their I L E]Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.)t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp.insurance required-] "Any applicant.that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating They are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContr-actors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: v� Policy#or Self-ins.Lic.#: Z - y Expiration Date: Job Site Address:_ J0 �Cp�/lt !/�� ��r. City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the'imposition of criminal penalties of a 'fine tip to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day.against_the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby ertify der the, a'ns Pena ies ofper•u hat the information provided above is true and correct - zz Si afore: ( Date: ,w� ��/ Phone#: Official use only. Do not write in this area,tb be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer,or the receiver or ffi stee of an individual,partnership,association or other legal entity,employing employees: However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states'Neither the commonwealth nor any of its political subdivisions shall . enter into any contract for,the performance of public work until acceptable evidence of compliance with the insurancerequirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractors)name(s),addresses)andphone number(s)along with their certificate(s)of insurance. Limited Liability Companies or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions'regarding the law or if you are required to obtain a workers' compensation policy,please-call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials .Please be sure that the affidavit is complete*and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. as Plee be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy*information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town).".A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license of permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone-and fax number: The e6mmonwealth of Massachusetts Department of lndustW Accidents Off>ree of IaVestigatkns• 600 washington'Street Boston,MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727470 Revised 11-22-06 s' www.mass.gay/dia GTE r�arrvnan..uea/��i o�✓�aaoac�iuoet� Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registron: 106386 Board of Building Regulations and Standards Ezpitation-7/23/2010 Tr# 271199 One Ashburton Place Run 1301 Boston,Ma.02108 f Type:Private Corporation �= Al ERICAN MOB*ILE=HOMES_INC FRANCIS WARDIII I a 51 MOORE RD ` E.WEYMOUTH,MA 02189'4� ! _ Administrator Not valid without signature 107 baoeguliiboGs an an,ar s w .Constru tion Suppery pr Lic4", ense I " =rJg 57291 �., Birtltdate= 9/17/1963 2009 Tr# 2882 `t1M1JZes i ctign:=00: i FRANCIS V WARD II- 51 MOORE RD WEYMOUTH,MA 0218 y"°\°o- Coitinissiorier i t AMERICAN MOBIL HOMES INC. 51 Moore Road Weymouth,MA 02189 4H (781)331-0333 1-800-232-9991 PROPOSAL Fax(781)335-0707 Date f G L) Name. ��t C-k- �-Am IV,G M c 4,1 Est. delivery date Address /O ���,n,t American Mobile Homes,Inc.hereby propose to furnish the materials and perform the labor necessary for the completion of installing_�»y i3 /2- leased mobile home containing: Refrigerator,stove,dining set, living room set,curtains,bedding 1st ,2nd_:W,;�„ —,washer' and dryer,air-cenditimring- porary Plumbing installation to mobile home pplying for building penmit'for mobile home. Ef Temporary.Electric installation to mobile home "Remove necessary trees,tree limbs or shrubbery 0 Temporary LP gas installation to mobile home ❑ Remove any necessary fencing . ❑ Other: Any resulting damage to said property as a result of the installation,removal and existence,of mobile home and its its utility connections shall not be the responsibility of American Mobile Homes,Inc.,specifically driveway,fence, stonewall,septic system,trees,lawn or any other type of landscape items and/or: ..-American Mobile Homes,Inc.;is not responsible for the re-installation of any of these items. Costs: `The monthly rental of the mobile home_1� mos. The delivery and pick up.charge of J� � D - Air conditioning Pet fees 20D other .There will.be additional charges for utility connections,permits,fees,site preparation. There.will be a profit and overhead charge of J 0& 10 for all subcontractors,and fees paid out. Any applicable sales tax.A 5d/o canying cost will be billed and payable on all invoices not paid within 45days of billing. =--'A$1,000.00 se�ty deposit is due on delivery of mobile home.I/we agree to sign a lease for the mobile home rental at delivery. Projected job cost: d1//,1��) .i.ilC CLc d.c�:S �,�yU i�7a► 1�:-�iiA4ti Payment Method : O Belled directly to insurance company with a signed assignment of payment. ❑ Other: Any alteration or deviation from above specifications involving extra costs, will become an extra charge over and above the estimate. All agreements Respectfully submitted -� -_ contingent upon strikes,accidents or delays beyond our control. ACCEPTANCE OF PROPOSAL The above prices,specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. If insurance company is not willing to honor assignment of payment,I/we understand I/we will be responsible for full payment of all services. NOTICE OF RIGHTS TO CANCELLATION You may cancel this agreement if it has been signed by a party thereto at a place other than an address of the Seller,which may be his main office or branch thereof,provided you notify the Seller in writing at his main office or branch by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the third business day following the signing agreement. See attached notice of cancellation form for an explanation of this right. Signature `' Date r Signature altK- 03/06/2009 14:31 FAX 781 331 6507 DUNCAN MACRELLAR INSURAN �I001 CORD ,,, CERTIFICATE OF LIABILITY INSURANCE DATEIMM/DD/YYM 0a/05/09 .PRODUCER ERTIFIUTE IS I MA OF WF Duncan MacKellar Iaa.Agcy., Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 835 Broad Street ,ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. E. Weymouth, MA 02189 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA' SCOTTSDALE INSURANCE CO American Nobile Homes, Inc. INsuRERB Nat IIn Sire Ina Co of PittElburgh,PA 51 Moore Road INBURPRQ Arbella Protection E.Weymouth, MA.02189 INSUM 01. INSURER I_ COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSRO TYPE OF INSURANCE POLICY NUMBER U EMMDf E POLICY EXPIRATION DATE IMMIDD/WI DATE MMIOD LDMTS A GENERALLIAeanY BCS0019023 02/04/2009 02/04/2010 EACH OCCURRENCE a 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES(Es oewronee) e CLAIMS MADE Fx]OCCUR MPL EXP(Any one Person) 8 PERBONAL a ADV INJURY e GENERAL AGGREGATE 51,000,000 GENPL AGGREGATE LIMIT APPLIES PFJZ PRODUCTS-COMPIOPAGO e POLICY JEC7 LOG AUTOMOBILE LIABILITY 23904400000 02/26/09 02/26/10 COMBINED SINGLE LIMIT ANY AUTO (Eoeaddara) S1,000,000 ALL OWNED AUTOS BODILY INJURY e G x BCHEDULEDAuros (Per parson) HIRED AUTOS BODILY INJURY = NON4 MEDAUTOS (Foraeddsn0 PROPERTY DAMAGE 3 (Par acaldern) GAUGELIAOILITY 363.74400000 01/01/2009 01/01/2010 AUTO ONLY-PAACCIDFNT s C ANY AUTO OTHERTHAN EAA X CC scheduled Autoe AUTO AGC 31,000,000 EXCE80IUMBRELLA LIABILITY EACH OCCURRENCE S OCCUR CLAIMS MADE AOGREOATE 9 S DEDUCTIBLE s RETENTION S S WORKERS COMPENSATION AND WC399-62-49 08/12/2008 08/12/2009 x "UbTAIU. Ulm TORYLIMITB ER- B EMPLOVERB LWBILITY E.L.EACH ACCIDENT a 100,000 ANY PROPMETOR/PARTNER/EJECUTNE OFFICER/MEMBER EXCLUDED? G.L.DISEASE-EA FIPLOYEE a100,000 It yes,desedbe under SPECVL vROVIBIONa below E.L.DISEASE-POLICY UMIT 8 500,000. OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSION$ADDED BY ENCORBEMENT I SPECIAL PROVISIONS Rental of Mobile Homes CERMFIGATE HOLDER CANCELLATION TC;V= of Barnstable OHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE 8WIRATION 200 Main St DATII THUXBOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN Barnetable,NA 02601 NOTICE TO THE CNTIRC:ATE HOLDER NAMED-TO THE LEFT, BUT FAILURE TO DO 90 SHALL IMPOSE NO OSLIOATION OR LLASIUTY OF ANY KIND UPON THE INSURER, ITS AGENTS OR ENTATN60, Attn: Bldg. Dept. ATIVE an Nac>I;e11ar no. Agcy.Inc. ACORD Z6(Z 07 ACORD CORPORATIMJ Assessor's map and 1Ot number ........... P. O.iC• 2•�•�. ///� G/8;Z F?NE T Sewage Permit number ...... �a l a ``Q o Z BA"5 ABLE. i Horse number .................. ..........................._..... .............. o 9O "AM. AFC YAY{r�9 TORN OF BARNSTABLE BUILDING INSPECTOR APPLICATIONFOR PERMIT TO ......... .!.;.-...........................................................................:........... TYPE OF CONSTRUCTION L KP.e•.....Fr'•A.M.� ........ �.�5��P.. .. ...... .......•..................................................................... ...........19$.a. �J TO THE;!INSPECTOR OF BUILDINGS: - ..- .- .-...-.. .. :�,.. ..a r... -• - �. � .- . ... .The;:undI r'sig ed hereby applies for a permit according to the following information: Locatiom �l.e?' >.` ............ .......... r•I•v e.........C�UT�.!..'.......................... ................................... •i ProposedUse .... ......................:.................................................................................................................... Zoning District r Fire District ....C4T.� T ..1�,�d.................. ram........................ 5►q �NST2VC?/Oa1 /PA� f-hw� ........5• 2r,Qu -Name of Owner �,P,�r��.s.............�'.....�.............................Address ...�..�.....��................:................� !9 Nameof Builder ...6.P..f:k.e.......................................................Address .................................................................................... j Nameof Architect .....fil�....................................................Address .................................................................................... Number of Rooms ......... ..............................................:.......Foundation ...qpnqcre *e .............................................................. Exterior .��.'cQPR.....C,.A.,ru9. ..................................................Roofing ...Ry.h&,�7 :...... .................................... P Interior ..S.�.P�r 2ac�f Floors ti u�o..n,.�Q.......................... Heating Plumbing ......::1,, h�.>.. i t .5.........: ram.......u?........... .!!. .......:: ......... t FireplaceN�' ...... Approximate Cost ..... :............. .................................................. J.......................•...........•.......... .•.•. l /3e2 :�, Definitive Plan Approved by Planning Board SPa ___n�!_________19_�_3_ . Area !............. . ............. Diagram of Lot and Building with Dimensions Fee ........�........................ SUBJECT TO APPROVAL OF BOARD OF HEALTH `a IV l �v OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ..... '! ........................ Construction Supervisor's License Q/� �fff�............. DENNfS 'STA /NSTRUCTION k=40-92 9A 2467��i � One Story No ............. Perm"t for .................................... Single Family Dwelling ............................................................................... Lot #24, 10 Bramblebush, B.r. Location ................................................................. Cotuit ............................................................................... Dennis Star Construction Owner .................................................................. Frame Type of Construction .......................................... . ................................................................................ Plot ............................ Lot ................................ December 29, 82 Permit Granted ................................ .......19 Date of Inspection ....................................119 Date Completed .......................................19 I . C, L TOWN OF BARNSTABUE 24678 Permit No. --46 - } Building Inspector '{ surnan Cash .-----------__---- � ru4 "• 1 X OCCUPANCY PERMIT Bond --_-------___-_-- Issued to DE3T ais Star Coast nr-- On Address Trot- 94, In Pr;:mb1 ah,:ch i"h-i xra_ Wiring Inspector . /� Inspection date Plumbing inspector,;, ` _ �"f ` Inspection date Gas Inspector r� � ,/ 't �i Inspection date 72 �3T P4 X Engineering Department �•.���j Inspection date `,T v k Board of Health Inspection date J?,e47 THIS PERMIT WILL NOT BE VALID,,AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. ................................................................................. _........ 1Z Build `Insp .. ector Assessor's-map and lot number ............1..........qa......... ' pFTHEtp� Sewage 'Permit number ...... f/ Z BAEBSTABLE. i Hduse number ....... �.:� .................................................... 90� M6 9. 0� a MA 6, TOWN OF BARNSTABLE BUILDING ' INSPECTOR APPLICATION FOR PERMIT TO ... 1.................................................................................... TYPE OF-CONSTRUCTION ...�'.P91 ....Ft 4.wl 9........ ...................................................... n�A.U.Q. .kQc......l. ...........19$ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ...1>aT....... .`FC.N.!!.13.�e.4.�. ...........V�.� �. ........C�? " .............. .... ......................................................................... ProposedUse .... ........................................................................................................................................... Zoning District ;Fire District .......o.. T"� T .... ......................................... Name of Owner ......S+A ...... �?.^?3.?...... h'...Address .. ...` ..... !�f!?......a � ��• S• 2�►o y7�. a �. .. a........................y. ........... Nameof Builder ... .H.P].e....................................................Address .................................................................................... Nameof Architect ......4J .....................................................Address .......... ........... :............................................................ P61jr e- 7 Number of Rooms .......... ...........Foundation ...: .............................................. Exierior .�4.INR S ti ...Roofing /fir, Floors ...P ...W.A.A.d............................................................Interior ...J9.4,ecrt p��-k....................................................... r. ..Heating ...:::::... ...........................................Plumbing ....... ..................................:............. Fireplace ...(2.WC....................................................................Approximate. Cost ......(?.. ................................ �... ,5 1 3 .� Definitive Plan Approved by Planning Board ____e�.,T____�___________19.7___ . Area .................sO........ ...'... Diagram of Lot and Building with Dimensions, Fee I SUBJECT TO APPROVAL OF -BOARD OF HEALTH vG, . OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ....................... Construction Supervisor's License �,1 �,,�� ............. DENNIS STAR CONSTRUCTION S 24679 0 e Story No ................. Permit for .................................... Single Family Dwellin .................................................................g............ Location ..Lot....#.2.4.........1.0...B.ramble.bu.sh Drive A .. .. .......... . .. .... .... Cotuit ............................................................................... Owner Dennis ta r Con.s t.r.uc.t.i.o.n.. .... .. .... .. . .. .. Type of`Construction ...Frame.......................... ................................................................................ Plot ............................ Lot ................................ �9 ,- Permit Granted .......Dece, mber ........................ .........19 82 Date of Inspection ....................................1.9 Date Completed .... . .............19 1 bo.00 � z40625 .d ± f n M L J ry 1 1,3.�i9MaZ_45AG aIrIl DR; • r PLAN SHOWING FOUNDATION LOCATION aw� L . o �✓ GOTUIT, MASSACHUSE TTS Qa� OWNED 8Y DL-AIAIiS SrWAZ CaV,.S'TQ• C0 Z w ��m� ca• yR.�i�bs�T/�/.MASS• O Z o Nz a 0 w � SCALE : 98z -0 " = 40 DATE a7EG. /9 l 3 Y Z w, zw NORMAN GROSSMAN----- ' REGISTERED LAND SURVEYOR z G w MOOS Fes ,,`` vi 'w : f .* I HEREBY CERTIFY THAT THIS FOUNDATION IS LOCATED P`1N OF Mqs `^2 V4 ON THE LOT AS SHOWN AND CONFORMS TO THE TOWN �.�`� sq�. i a w w vi OF BARNSTQBLE ZONING REGULATIONS REGARDING ;'o reaSMA G� z� z ". SETBACKS FROM STREET LINES AND LOT LINES . i� GROS'PA1Ai y � W <` Na 1B}75q 1 a 0 a �. 2.0 p�! NORMAN 6ROSSMAN R.L.S. OA �s� Assessor's offioe (1st floor): / Assessor's map and lot number ........0. az- yOFTNET0 Board of Health (3rd floor): fO�Q v 1 � Sewage Permit number .................. ...... .....:::......:: i Baaa9TSBLE, Engineering Department (3rd floor): —7 � °o, NAM t639• House number .........................:...... .,.1 -.................. 'Fa YAY a�6 APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00 2:00 P.M. only TOWN OF BAR.N.STABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ....�L R��G. r........�..er`?!iv..� .................................................................. TYPE OF' CONSTRUCTION ............. <?.D....... ...fa-yi..CA.!T...................................................................... n. ..................... ... .. .5....19...Kh TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: 1 Location ....�0t......7 7.2..... `7".WDQp .�� �1.......�COT!// %.../.. ..... �. ................. ........................................ ProposedUse . t%rS,� .°Y.�L„'. .. ...................................................................:.........t................................................... Zoning District ..... i ...,.Fire District ... T. ...........T........... ........ ...... f doa S 2�4SS ,F 2 Avg, Name of Owner f/fc 2/ t��. ..!:.......�. .�L.v.L/...........Address .....li)./ .5..�.u.).0e")4.,?....!`A0i.5:......0 9"0 S G 4 .................... Nameof Builder ..................S. f-,?. .............................Address. .................................................................................... Nameof Architect ................ ... ..(n...r...........................Address .................................................................................... Number of Rooms .................%5.............................................Foundation fS �Ou2�:1� .....Co�UC 2 tr 7:r ...................... .... Exterior ... .,`:?.r..r'.':r;�.21`)...�..��f. fa.2..��.�yr!UGI .S..Roofing ...........� �(, .ffl . ......... ................ Floors ........f. ti.f,!Q P.. ....................................................Interior ....�'.��CJ.�..../.��< �.(�D....././�'�Fl �.`�/...�1............ Heating .. .e�}. 8..... r. .5..Plumbing .......... ��....�` �7:' .5 ....................................... �...................:.Fireplace ........r/...i..... :............:...... ...Approximate Cost . Definitive Plan Approved by Planning Board ____�/< 19_ Area Diagram of Lot and Building with Dimensions Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH �4. w � i 6 \ OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. .�..................................... Construction Supervisor's License CARROLL, HERBERT A=025-056 No 30024. Permit for .....1. ...Story.............. Single family Dwelling .......................................................................... Location ....Lot...#7.......7.7..D.o.gwo.o.d..Lan.e......... .. .. . ...... . .. ...... . cotuit ........................................................... Owner ......Herbert...Car..r..o.11........................... ...... .... Type of Construction ..Frame............................. ...................................................................... ........ Plot ............................ Lot ................................ Permit Granted ..... October 10.;........�19 86 ......................... . Date of Inspection ....................................19 Date Completed ......................................19 Ly 7o o�txero• TOWN OF BARNSTABLE Permit No. .....30024.... BUILDING DEPARTMENT 164.00 Cash TOWN OFFICE BUILDING HYANNIS,MASS.02601 Bond / CERTIFICATE OF USE AND OCCUPANCY Issued to HERBERT CARROLL Address lot #7 77 Dogwood Lane, Cotuit USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. August2 ........., 19...8?.......... i...................................... Building Inspector TOWN CfF BARNSTABLE, MASSACHUSETTS DATE 19—.:—_.. f�Ekt.'I" CJO�.�_"� yr _ APPLICANT ADDRESS (NO.) (STRLET) '(f ONTR'S"LICENSE)- ' PERMIT TO (_) STORY _OWEL,i,'G -0i fS (TYPE OF IMPROVEMENT) NO. (PROPOSED USE) AT (LOCATION) Q ZONING (NO.) ,(STREET) ISTRICT BETWEEN AND (CROSS STREET) (CROSS STREET) LOT SUBDIVISION LOT •BLOCK SIZE BUILDING IS TO BE FT. WIDE BY FT.°LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTR�1 TION• k � ' TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION n (TYP�Ef � r REMARKS: AREA OR PERWT t VOLUME ESTIMATED COST 1 "` FEE. . ` (CUBIC/SQUARE FEET) ° OWNERADDRESS BUILDING DEPT;.-,,) BY h THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF. EITHER TEMPORARILY OR PERMANENTLY. ENCROACHMENTS ON PUBLIC. PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BR)ILDING CODE, MUST BE AP- PROVED 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 THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE INSPECTIONS REQUIRED FOR CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR ALL CONSTRUCTION WORK: ELECTRICAL, PLUMBING AND I. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTA.LLATIONS.) 2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL MINAL INSPECTION TI TO LATHE FINAL INSPECTION HAS BEEN MADE. 3-FINAL INSPECTION BEFORE OCCUPANCY. POST THIS CARD SO IT IS VISIBLE FROM STREET ILDING INSflE ON APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS Iv I � 0 / �� I 2 2 04 3 ]fTrHEATING INSPECT) N AP ROVALS ENGINEERING DEPARTMENT 1 F-2- OTHER 2 BOARD OF HEALTH i T� V • •c- c f Wa/VL�. WORK SHALL NOT PROCEED UNTIL THE INSPEC- PERMIT W!L L BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS INDICATED ON THIS CARD CAN Bf`' TOR HASP APPROVED THE VARIODUS STAGES OF WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE ARRANGED FOR BY TELEPHONE,OR WRITTEN CONSTRUCTION. PERMIT IS ISSUED AS NOTED ABOVE. •. NOTIFICATION. ROAD • �Ztib a, ti - LDT 7IV 18 w e 1 N N_ 1� •�U 0�0_ f p A - A C:> N o v ,q e¢ JAP04 / L CHRIrTaPC-WbA4�2c�� PLO;r PLAN No.31305� TOWAI BA2N5TABLF- sZ� Zsosl,/ �3s w SS,�� ER49f �T 4ARRO�L. t_ SUl � V ` .SCALE : / /At= &o , DATE ' . 912318(0 RE,4' : I HEREBY CERTIFY THAT THE ABOVE FOvMPArldWIS LOCATED ON THE GROUND AS Sll0NN,THAT IT CONFORMED TO THE TOWN ' S, ZONING SETBACK REGULATIONS AT THE TIME IT WAS CONSTRUCTED AND THAT THIS MORTGAGE INSPECTION WAS PERFORMED IN ACCORDANCE WITH T�iE TECHNICAL STANDARDS FOR MORTGAGE LOAN INSPECTIONS AS ADOPTED BY THE MAS SACHUSETTS ASSOCIATION OF LAND SURVEYOR AND CIVIL ENGI EERS,INCORP6RATED. 71115 LOT/S is/oT IAA 7WF OP COSTA R. L.S . DATE g12�` 1421- CAPeF s�Rvery lol,,OVL TA,t/ T 72 FAST AA MO 711 t/Yw 2�,A-AZ/VlQlvrf�, /yA, BE Assessor's offioe-'(1st floor): ' ' C UST FTNET o as'- �'.s�6� SEPTIC S Assessor's map and lot number INSTALLED 91 COMP�„IAN °•, ............................................ Board of Health (3rd floor): // W s d� ° Sewage Permit number ......V..........................1.......... ....•.... \ • �Sd9TADL6, i Engineering Department Ord floor): #�� �JS^ ENVIRONMENTAL.CODE House number ............................... :. . . TOWN REGULATIONS o�pra�e� APPLICATIONS PROCESSED 8:30-9:30 *A.M. 'and 1:00-2:00 P.M. only TOWN OF R. NSTABLE BUILDING ` INSPECTOR APPLICATION FOR PERMIT TO .... ../ TYPE OF CONSTRUCTION ............... ..or:D......ri�. n..rvx��, ..................:.................................................. ...................... ...-.. . ....19... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ....•f0tF..... ..............�...7.2.....i9ba-.-.GQoap......1,1.qw.[ roorvi-r.).......... ProposedUse ...... ��.�J�.12.�Z.fU.Orr ............................................................................................................................... ZoningDistrict ........................................................................Fire, District .. C--.. ?....f...c�..t...�........................................... "' S�2f}-s S " A v'- Name of Owner H-If9-13!PA—I........�. .�L..O.J.. .............Address .....wls�.i..W.P.C.� M1�I.SS........�2�5-6........ Name of Builder .................�..l�..M. .............................Address ....... .................................:.......................................... . Nameof Architect .................S..J,9..(.YL..(z_........................Address .................................................................................... Number of Rooms Y r �n . ...........................................:....Foundation ... ..... 2 ................. Exterior ....C� Raafing ...........���/'� ��� ..5! �( G. ................. i Floors ........P!. .�t1C� ?.. ..............................................r.....Interior ....J j1UA...13-4fi.&4?...����. �..�/rc�......... � ....��.S...Plumbing ..........�../ � , Y � . Fireplace ......... ..............................................................Approximate Cost .......0. /..mod d......�..y..'.................. Definitive Plan Approved by Planning Board _1�� •�L_"_'�--_19�Zk Area ems::I ................................ls3 ...... pD Diagram of Lot and Building with Dimensions Fee i ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH /4�0, 0, • �O n,.,/7" 1 OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name*. . . . . ..... .. .. ................................. e Construction Supervisor's license .v.".!.�D!................. I CARROLL,. HERBERT No ..300 4..... Permit for ...U.AtQ-Ky................ 6 ........ .................. Location .... Lane .................. ................... ............................................... Owner .... ...Car.r.o.11.............................. ...... . . .... Type of Construction ............................ ............................................................................... Plot ............................ Lot ................................ October 10.........19 86 Permit Granted ................................ Date of Inspection ......... ...19 Date Completed 19.... ..... . Zvi f7l