HomeMy WebLinkAbout0021 CAP'N ISIAH'S ROAD C opr
,
• Town of Barnstable *Permit# D V 4 2 � .
Expires 6 months om issue date
Regulatory Services Feed
, e Thomas F.Geiler,Director
° '"r Building Division
MAY Tom Perry,CBO, Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-400MV � �` LE
EXPRESS PERMIT APPLICATION Fax: 508-790-6230
Not Valid without Red x--Press imprint
RESIDENTIAL ONLY
lap/parcel Number_�� 067
roperty Address & 1-9 J` _,s
.Residential Value of Work ®�® Minimum fee of$25.00 for work under$6000.00
wner's Name&Address
ntractor's Nam- e^
Telephone Number
me Improvement Contractor License#(if applicable) 5-5 6
nstruction Supervisor's License#(if applicable)
orkman's Compensation Insurance
Chec3{one:
❑ I am a sole proprietor
❑ I am the Homeowner
❑ I have Worker's Compensation Insurance
fiance Company Name
kman's Comp.Policy#
y of Insurance Compliance Certificate must be on file.
't Request(check box)
Re-roof(stripping old shingles) All construction debris will be taken to
❑Re-roof(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 town department regulations,i.e.Historic,Conservation,etc.
***Note: Property Owner must sign Property Owner Letter of Permission.
opy o he Ho ovement Contractors License is required.
ATURE:
s:expmtrg
61306
Board of Building Regulations and Standards
One Ashburton Place - Room 1301
Boston. Massachusetts 02108
Home Improvement'Contractor Registration
Registration: 112536
Type: DBA
Expiration: 3/23/2009 Tr# 127920
FRASER CONSTRUCTION CO.
DEAN FRASER
P.O. BOX 1845
COTUIT, MA 02635
Update Address and return card.Mark reason for change.
DPS-CA1 Co 50M-05/0&PCa490 ❑ Address ❑ Renewal Employment ❑ Lost Card
—— -- - - -----------
-
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:
5 Registration: Board of Building Regulations and Standards
1 12536 Expiration: 3/ One Ashburton Place Rm 130123/2009 Tr# 127920 Boston,Ma.02108
Type: DBPr�
FRASER CONSTRUCTION CO./
DEAN FRASER `
4556 RT 28
COTUIT,MA 02635 Administrator Not valid without signature
r
2007 12:27PM No, 2484 P. 3
Any deviation or alteration from above specification will be executed upon written orders
and will become an extra charge over and above the estimate. All agreements
contingent upon strikes, accidents or delays are beyond our control. Owner should
carry fire, tornado and other necessary insurance upon the above work,. We, if not
accepted within thirty days may withdraw this proposal.
FRASER CONSTRUCTION: Carries Workman's Compensation and PubHe Liability
Insurance on the above work.
DATE OF ACCEPTANCE: 6/
v _
HC- eowner Fraser Construction
Referral for landscaping:
EHE Irrigation - Construction Landscaping
Emerson Soares 508-367-0909
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
a
600 Washington Street .
Boston,MA 02111'
m4.mass.govldia '
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Organizalion/Individual): . ►� ��'
Address: ' k• IS` .
City/State/Zip: ►'�` V11 > Phone.#: .509 —C/�
Are you an employer?-Check the appropriate box: :Type of pioject(required);,
1; I am a employer with 4. ❑ I am a general contractor and I
employees(full and/or part-time).*• have hired the stab-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
'working for me in any capacity. employees and have workers' 9, ❑Building addition .
[No workers' comp,insurance comp,insurance.$'
required.] 5. ❑ We area corporation and its 10.❑•Electrical repairs or additions
officers have exercised their ,
'3.❑ I am a homeowner doing all-work . 11.❑Plumbing repairs or additions '
myself.[No workers' comb, right of exemption per MGL 12,❑Roof repairs
insurance.required.]t c. 152, §1(4),and we have no
employees, [Na workers' 13.0 Other
comp,insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation paHoy information.
t Homeowners,who submit this affidavit indicating they are doing all work and then hire outside contractors mutt submit anew affidavit indicating such.
;Contractors that check this box must attached sn additionaI sheet showing the name of the sub-contractors and state whether arnot those entities have
employees. If the sub-contractors have employees,theymust provide then workers'comp.policy number.
I a»i an employer.that is providing workers'compensation insurance for my employees. Below is.the policy and job site'
information.
Insurance Company Name:_ ffa_�Q-
Policy#or Self-ins.Lic,#: -7 0 y X 6 / 17 Expiration Date: 10 6-7
Sob Site Address: a l e'er-�.� 15•�� 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 ofMGL 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$250.00 a day against thq violator, Be advised that a copy of this statement may be forwarded to the.Office of•
Investigations of the bIA for insurame coverage verification
I do hereby,ce t ins-an n ti perjury that the information provided above is true an'd correct.
Si tune: Date;
Phone# SY�`3 •.Y a �'�� �- '
Official use only. Do not write in this area,tb be completed by c.4 or town official
City or Town: ' Yermit/License#
Issuing Authority(circle one)
.1•Board of Health 2,Building Department 3, City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6. Other
ContlLct Person: Phone#:
f
_i7�yoGR.
i r No. 1586 P, 2
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PRODUCE$ TDI1S CULTIFICATE JS lSSUEb.43 A bLLTTER OF INBORMaTlON ONLY
AND COMrXR&NO CA LD THIS
T)VYCATR DOES N TTAME D,EXTgyp OR ALTBR 7'!!>i ERA
WISE&QUINN INSURANCE AGENCY AFFORDED BY TH9 PoLlCra$"LOW, OV GE
449 PMASANT ST
ERaCKTON,MA 02301
COMPANMS AFFORbINO COVER CV,
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vRBEFNIS4UEDTOTftLINSURED.Y �py0 'RORTyRpOUCYPSRIOb ''l
CBRTIRIG4TE MAY BE J9SUBD CIR MAy OA CONDITION OF ANY CONTRgC7 OR OT!ffiR DOCLJbr&NT W17A R AND CONDITIONS OP SUCRPOLlCffiS ))VSI!!tANCB AxROJtDBD BY THI3 POIICDJS D1 9C RJBBD ylgggp�IS SUBJECT TO ALL TO wPRC!!THIS
LEIS SFIDVIN MAY HAYS B$�j REDUCED BY PAID TH2
CLAIMS: TERMS,EXCLUMONS
CO TYPE OP 1NSUAANCE POUCYNUMBPR
LTA POLICY 'POLICY
EFPWTJVE bATE RMRATlON DATE LlMIT9
GANERALUADILITY (MMIDWY YVYY)
COOS EWAL GB!J1 M LIABILITY MMULA
TB 3
CLAISIaMADB OCOA S-ODWIOPAOO. S
OWNU'S&MMACTOks PROT. ➢EMONAL 4c AD'V,INJURY
EACH OCC �� S
AVTOMOEILELlABff.ITYI DANAOB(Ae90ne S
MBD.ExPaNa per,,, S .
ANYAUto COM9LS16DSDIOIPLP S
ALL OWNED AUTOS
,
90HCbUL@DAUfp9 BODL'YDdY(p� $
WM AUTOS (pe PmEn)
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AOOMEOATS
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A WORKER'S COMPBNSAT(ON 57AT(1t08Y LDRP9
AND WOLJB-794X6191 EMPLO 09/26;06 / EACRA SIGJ,OOo
L 'S LIABIY TI y 09/26.07 DISEAS>~PO CYLA>iT E500,o00
OTM
D
. OY6B SlOri,000
DES ON Oh O!&RATIp TIONS/{+I)IIICLES/SPECIAL 7TBAl9
ITS RMACES ANY P CD D?ICAT6 OCD
T C6DTlSttaTDgOIp AFnCPDVG•WOIQ;kBSCOMTCO
CERT 14C9Q�,HOLD
RRABERtoNSTRU&YON 9uo AaOVBn>0.q.
EXPIRATAM DATE TBSREOD,TlBB 1661JWG CW CAFCHLLEa NE�rpRE�
PO NOX 1845 nd�f �'o� tNDRAvoB
COT', sa,K WRMEN NO'II'"To M C)LWMCATB ROLDBR NAb1SD �bIA1L 10
1 02635 BUTFAII.=TOWJL9UCRNOPICE9BIAL1:WpOSENOOBLYOATIOxT aLEFT'
L};AB1Lrpy OR ANY IOJV9b LTOx THE C0bVANY;ITS A MTS CM
AL REPRS9E.\TATNu
y�v'aan�xrxuva
f'+'• ®ACUItb•CORTION 18S1'0
gl� lo� 8PIIAJ O
-• - TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map O� U Parcel LN Permit#
Health Division �1—•33? � 7I Date Issued -7
Conservation Division, /n� Application Fee
Tax Collector Permit Fee �3c 0
Treasurer
Dept. SEPTIC SYSTEM MUST BE
Planning P INSTALLED IN COMPLIANCE
Date Definitive Plan Approved by Planning Board WITH TITLE 5
ENVIRONMENTAL CODE AND
Historic-OKH Preservation/Hyannis TOWN REGULATIONS -
Project Street Address
Village13 n L y
Owner NCI Sl f� Address � 6wQu C. (, �P'Q.( I nohaA . M0-61762,
Telephone sgj
Permit Request Sion
r
Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new.',
Zoning District Flood Plain Groundwater Overlay
Project Valuation Construction Type
I W rn
Lot Size 6 0)D Grandfathered: ❑Yes ❑No If yes, attach supporting d cumentation.
Dwelling Type: Single Familyy 4Z Two Family ❑ Multi-Family(#units)
Age of Existing Structure 90 f' 4- Historic House: ❑Yes Rlgo On Old King's Highway: ❑Yes JO�o .
LJ
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
Number 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
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
BUILDER INFORMATION 22nn, n P�
Name 0 f' V) inc Telephone Number � I'�!'�
Address V . - F License#S , No A In tcN,
Q. Home Improvement Contractor# I`I,,� a3-3
Worker's Compensation# C UG�
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
Li
SIGNATURE DATE
r
FOR OFFICIAL USE ONLY
r5 �
)PERMIT NO.
DATE ISSUED
. / t
-' - MAP/PARCEL NO.
' ADDRESS' VILLAGE
OWNER
1
r
It DATE OF INSPECTION:
FOUNDATION 16it0
I
FRAME
5
INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL _
PLUMBING: ROUGILN S FINAL _
GAS: ROUGHS _� FINAL
FINAL BUILDING �' t°f �� '0 ' tu'
j b
f, I � Mr
DATE CLOSED OUT- h d ni
to
ASSOCIATION PLAN NO.
.c
nk\
- The Commonwealth of Massachusetts '
1T : b Department of Industrial Accidents
T 600 Washington Street
Boston,Mass. 02111
Workers' Co m ensation Insurance Affidavit-General Businesses
name
address: ^ �
city �. state: lill-MWhone# -
work site location full address):
❑ I am a sole proprietor and have no one 13usiness Type: ❑Retail❑Restaurant/Bar/Eating Establishment
orking in any capacity. ❑Office❑Sales(including Real Estate,Autos etc.)
u am an employer'
m to er with em loyees full& art time). ❑Other
am an employer providing v/prk ' compensation for my employees working on this job.
hone#• .'U '� „�vQ(
I am a sole proprietor and have hir the independent contractors listed below who have the following workers'
compensation polices:
comp name
addressi
city' nlioiie - —
insurance co.
compariV name• 4 ••� � -
address
city.. ..r .. '•:. , . ,::. _ .: .. • . .. .. _ • -
vhone#'i
insurance eo. ::
FeUure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or
one years'imprisonment as well as civilpenalties in the form of s STOP WORK ORDER and a fine of$100.00 a day against me. I understand that p
copy of this statement maybe forwarded to the Office of Investigations of the DlAfor coverage verification
I do hereby certify under the s d penalties of perjury that the information provided above is true an correct
Signature Date �S'/W 16`
Print name �: Phone# L"J�'1 OQCk--Dp .
a� official use only do not write in this area to be completed by city or town official
city or town: permlt/licenve# ❑Building Department
Licensing Board
❑check if immediate response is required []Selectmen's Office I
❑Health Department
contact person: phone#; ❑Other
(revered Sept 20M)
F -
Information and Instructions
Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their
employees. As quoted from the"law", an employee is defined as every person in the service of another under any contract
of hire, express or implied, oral or written —A
'
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
trustee 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 section 25 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,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 insurance requirements of this chapter have been presented to the contracting
authority.
Applicants
Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation Please
supply company name, address and phone numbers along with a certificate of insurance as all affidavits 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.
City or Towns
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. Please
be sure to fill in the permit/license number which will b�e used as a reference number. The affidavits may be returned to
the Department by mail or FAX unless other arrangements have been made.
The Office of Investigations would lice to thank you in advance for you 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 Commonwealth Of Massachusetts
Department of Industrial Accidents
Botts of Imsdgaflons
600 Washington Street
Boston,Ma. 02111
fax#: (617)727-7749
phone#: (617) 7274900 ext.406
i
IV.HOME IMPROVEMENT CONTRACTOR REGISTRATION COMPLIANCE LANGUAGE
A. All home improvement contractors and subcontractors shall be registered. Inquiries
concerning a contractor or subcontractor relating to a registration should be directed to:
Director,Home Improvement Contractor Registration
One Ashburton Place,Room 1301
Boston,MA 02108
B. The owner may have three-day cancellation rights under MGL c.93, §48;MGL c. 140D, §10,
or MGL c.255D, §14,as may be applicable.
C. All warranties and the owner's rights under the provisions of 780 CMR R6 and MGL c. 142A
D. In the event that the Owner does not pay the contractor per this contract,the property is
subject to a mechanic's lien.
E. No contract shall contain an acceleration clause under which any part or all of the balance not
yet due may be declared due and payable because the holder deems himself to be insecure.
However,where the contractor deems himself to be insecure he may require as a prerequisite
to continuing said work that the balance of funds due under the contract,which are in the
possession of the owner,shall be placed in a joint escrow account requiring the signatures of
the home improvement contractor and owner for withdrawal.
F. No work shall begin prior to the signing of the contract and transmittal to the owner a copy
of such contract.
I guarantee that all our workmanship and materials will be of high quality. Additionally,we are
[licensed,registered,and fully insured.
Our signatures indicate that we have read,we understand,and we accept all provisions of this agreement.
Do not sight this contract if there are any blank spaces.
Vov,���Date
Owner
Mrs. Sally tein
Contractor Date
George Davis, President
George Davis Builders,Inc.
i
Page 4 of 4
Lic.#056130
Reg.4 107333
:"��i bwaa.vsva;rarzr �./�.aae��aek2
- .. Roard:of'RaildiegRegnlations and Standards
HOME IMPROVORENT'CONTRACTOR
Registratton 107333
Ezpiratl'o'.n.; 7/31/2006
_Type: Pn�vate Corporation
GEORGE DAVIS BUILDERS,JN!C:.
George Davis
9-NEW VENTUR'E'llbR`,'ONIT7'
So:'Dennis,MA 02660 ~� �✓ "
Administrator
,�.P, -�0�79/HEIYy,III��^•r� n/' ���.C7Af(XA,�71A.Of3I.Ga
BO'ARD'l0F,BUILDIN REGULATIONS
-. ..:.
Licenfise: GO.NSTvRU:GT�ION SUPERVISOR
�• �� O'S6�T30
Nuinbera�
p BIR9332?0
0 ! 112n� Tr.no:
i
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11 Rest'cted:j 0
R.Ja`Y....
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GI- RG F 9AV
9 NE
VENTURE i ! 1
�S DENNIS, MA .0'2660 '.' Commi'ssioner
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Fib 0 MIA 30439 CANS C'1 137
PAt1L!.I:A. 13�dZAB�TH 41S 1F� Y FA Y INVESTMEN_T.T R PLANFq
67
APPLICANT!SAME ASSE.MRS PLAN 39 PLORTGAGE INSPEC 'T10N IPI, �i N 0
DATED AT
21 CAP'N ISIAH ROAD
BARNSTA°BLE,MASSACHUSETTS
SCALE: I April 10, 2003
/V�° Td Sc4•t2.
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6 r•
Naw
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LOST' 48 LoT 5o
1�7°91;: l.T G-7
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4.a C .•271 • W IF'-
IHH CERTIFY TO: CANNING A KIRRANF, L.L.P., WELLS FARGO HOW MORTGAGE, INC., AND as TTIL
SURANCF COMPANY,THAT THERE ARE NO VISIBLE ENCROACHMENTS OR EASENM4TS EXCEPTA
OWN AND THAT THIS PLAN WAS PREPARED TINDER MY INOVIPDIATE SUPERVISION.
THE LOCATION OF TIME DWEL°I.ING AS SHOWN HEREON
IS IN CONeLLkNC1E WrM THE LOCAL APPLICABLE OF
ZONING BY-LAWS WITH RESPECT TO HORIZONTAL
DW-NSIONALREQUIREMENTS.
TM DWELLING SHOWN HERE DOES NOT FALL WMUN
Af
A SPECIAL FLOOD HAZARD ZONE AS DELINEATED ON A J{'s(1 �� -•`**°
• ' N Vim_.
MAP OF COM[vIUWW, #25W0I.0018D DATED 7/2/92 BY THE
F.I.A.
! � Kenneth I. Ferreil�
E�ioaelrll�9 III.
f F.O. B�ooc 1903
f New 13tidf0cd.IAA,02741-
1903
30e-992-0020 Fm: 992-3374
BNERAL NOTES:(])The deolxesim o m*eban-e m on the kub of ev Wgwledde,ittfirtgedoet,isd belief ee>�t�telt ata alaeegs�plat plson
eteAe to Alo antnlel eked d as�e d eywaed laid e*wym pasttoia{fm?Amend luetta. (1)Da Wrothm m mtle to tha mbove Hared Am ody M of ft does.
31 This Ow ww not xWe for reoombg ptt�po %r uw in pteprrie�deed desor�tioge ae ibr eaostsreatlaee. (�)VaifBoefiotu of piaynty lath d{memaooe,building rEste,
,or lot ow ftm6 n eny be eeeasipii"0oly by+Ise WMAI a bleertl®iet array.
0�1
oF,Ht To,,, Town of Barnstable *Permit# Y a
� y .
Expires 6 months front issue date
RANii�UB E, : Regulatory Services Fee rV,
MASS.
c�A 4t —
039. Thomas F. Geiler,Director
lfDMAtA Building Division E�� ���p�
Tom Perry, Building Comnrissioner IWIT
200 Main Street, Hyaruvs,MA 02601 OCT 0l 2002
Office: 508-862-4038
Fax: 508-790-6230 roWN OF B4j� ,V A�
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY SLE
Not Valid ivithottt Red X-Press/ntprint
dap/parcel Number O Q(v
'ropetty Address / Ca /7�i
/esidential Value of Work �,31pp
)wner's Name&Address /
;onhactor's Name�� j�Zi ADy�l�_ " ��(�t)J/��1/1 Q n'�' Telephone Number
tome Improvement Contractor License#(if applicable) !Co JYo
:onstruction Supervisor's License#(if applicable) 'Ct5 OJr7 03�
orkman's Compensation Insurance
Check one:
❑ I am a sole proprietor
❑ I am the Homeowner
have Worker's Compensation Insurance
nsurance Company Name /I bizy J CLl GC_
Vorkman's Comp.Policy# C i7 LlfCC ? )�
'ermit Request(check box)
❑ Re-roof(stripping old shingles) J
❑Re-roof(not stripping. Going over existing layers of roof)
/❑ Re-side
✓ eplacement Windows. U-Value t 50 (maximum.44)
❑ Other(specify)
*Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
>ignature
�:Forms:expmtrg
tevised121901
Assessor's.rriap, and lot number ........ ...........................,..<.
Sewage Permit number .. ..3..�'...........................`.......
OF HE
�o TOWN OF ,,
VM�TLE 6
"AS` BUILDING 0%S
900 i639, \00�
APPLICATION FOR PERMIT TO ..../J.........................................................................................
TYPE OF CONSTRUCTION f1.aF '.' ... ................
................... .................2 .......19.���.
TO THE INSPECTOR OF BUILDINGS: w ��
The undersigned hereby
oapplies
�for a permit according to the following information: _
Location ..... a. ./..........` � ; � G .. �...... !/............C
ProposedUse .............:.f.�f..YI ....................................................................................................................,.........................
ZoningDistrict .........................:..............................................Fire District ...........1.. 1.v/. .........:....................................
Name of Owner ... Ste,{/�ro�rJs1>'i.
/� a ....`.//���..t[t..r ................... Address .......... ..... /�',�+
Name of BuilderA�t A......1 .� /��-.........Address � ����� 1� / �✓:.. � '��f
Nameof Architect ...........................................:......................Address ....................................................................................
Number of Rooms ......... ...................................................Foundation ..... ® ` ......................................
......
�f
Exterior .....`-....
.f�./.................................Roofing ........ Fl. ...............................................
��jj
Floors C�,//,�y) / .Interior .......PA,V 4449 ...............................................
Heating ......d./..li...... // /................. ............I...........................Plumbing .....�`...��`�...............................................
.... ....... .. . ..
Fireplace ..............f.� ........................................................Approximate Cost ....... ...............................:........ .
Definitive Plan Approved by Planning`Board _____________________._______19__ . Area .. ....s
30 Diagram of Lot and Building with Dimensions Fee
°
.............................................
SUBJECT TO APPROVAL OF BOARD OF HEALjH �/��
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Name ......: ... �/... . ...... .....................
SELIGOWSKI, LOUIS & -HELENA
/0
No ....'f'Permit for ...One e...Story. . ...................... ..... .. .. .... .....
Single Family Dwelling
...................................................................... ...
Lot #49 21 Capt. Isiah' s Road
Location ................................................................
cotuit
...............................................................................
Owner .,Louis...&...Helena...Sel.igo.w.s.k.i
.. ....... ..
Type of Construction ..Frame
................................
................................................................................
Plot ............................ Lot ................................
-Permit Granted .......!T ..............i............19
Date of Inspection ....................19
Date Comple ed ... ...........19
M
IV Z;
E:P ITZ#EOUSED
......................Wit ........................ 19
... .... ............
..................... ....... . . ............. ........
.................... r............ .......................... ....
.ft ................................ .. .......
.................
rO
Approved ................................................ 19
...............................................
............ ................ ................................................C.
Assessor's map and lot number .............................................
Sewage Permit number ....:..:........ =..................................
` y�i TM E TOIL
TOWN OF BARNSTABLE }
1i BARNSTA13LL i
"6 BUILDING INSPECTOR
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APPLICATIONFOR PERMIT TO ..................... ...».... ... .........................................................................................
I TYPE OF CONSTRUCTION ................................................:.............................................................
..................................... .........19........
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location ..... ..... : ........................................................!!.... ........ ....... ...:>.... ......:.. i G................................................
ProposedUse .............................................................................................................................................................................
Zoning District Fire District ...........................................................!
..........!......
Name of Owner /'� �'' �� l Address , ���� <
f
Name of Builder,` �i/��,...../! i�f �;'/�f / ..........Address ..�!.:........
. ......... ............ ... ..........................................
Nameof Architect ..................................................................Address ....................................................................................
Numberof Rooms ..................................................................Foundation ...........:: ..1.:.:............ ............................
Exteriora.......................................................................Roofing ........ ......,..................................................................
Floors ...........................:............................................................Interior .......! .�? .�...... ..............................................
q
Heating .............. ....: ::.............................................Plumbing ...........:.............r. ...:.:...............................................
Fireplace ........................................................Approximate Cost o
Definitive Plan Approved by Planning Board -----------_-------------------
Diagram of Lot and Building with Dimensions Fee .............................................
SUBJECT TO APPROVAL OF BOARD OF HEALTH
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Name ..............
.... ......... ......... .... ......... .............................
f SELIGOWSKI, LOUIS & HELENA At-!!�67
l 3�- 6�
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No 3210 Permit for ...One Stort'.........
Sin le Famil D�ellin
�.....................X.....................g..............
Lot...#4 9 21 Cap :�... ; .�,c�h.'.S Rd.Location .....................
Cotuit
Owner ....Louis & Helena S.l.i.90ws.ki
Type of Construction .... Al..........................
1 .
y
Plot ............................ Lot' ................................
a
Permit Granted .......JUAQ.. 7.................19 81
1
Date of Inspection ......... ......................19
Date Completed ........................................19
1
PERMIT REFUSED '
19.
j ..................................................... ........................
j ..
'> .... ..............� `.....................
S �•i,G .....d.. . . .[0.. ...............
1
! ...............................................................................
r
tApproved .............:.................................. 19
...............................................................................
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...............................................................................
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•""' TOWN OF BARNSTABLE �U
Permit No. �.,__
I Vwn.a Building Inspector Cash -- —
� rua
Bond
• OCCUPANCY PERMIT --�
"No building-iior structure shall be erected, and no.land, building or structure shall be
used for a new, _different, changed, ,or enlarged use without a Building Permit therefor
first having been obtained from the Building Inspector. No building shall be occupied until a
certificate of occupancy has been issued by the Building Inspector."
Issued toIaiis & Helena Sellgamjid Address
lot #49 21 Capt,.. Isiab`� Road, C.atuit 'V "
Wiring Inspector f ��r"'"'" Inspection date
iw.._.
Plumbing Easpector� �. Inspection date L
Gas Inspector ! �t� / P - . Inspection date
X Engineering Department-, �Y � !�--4�MsPection dater` '
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.
._.........._........._, 19 ............................. ......
�• Building Inspector -
ol
iadl L'-r t`Low _ 110 -4 3 = 330 G•P•D i5iA HS
150 % •
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TOTAL '�E-S160 = d25 G.t?D. logo ��t✓
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6/29/05 Expsanded Deck George Davis Builders, Inc.
Mrs. Sally Vetstein Unit 7; 9 New Venture Road
South Dennis, MA 02675
21 Capt. Isaih's Road, Cotuit (508) 394-0832
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6/29/05 Expsanded Deck George Davis Builders, Inc.
Mrs. Sally Vetstein Unit 7; 9 New Venture Road
South Dennis, MA 02675
21 Capt. Isaih's Road, Cotuit (508) 394-0832