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MASSACHUSETTS UNIFORM AP�
(Print or Type) Mal'
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Building Location
New ❑ Renovation ❑
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-39
SUB-BSMT.
BASEMENT
1ST FLOOR
2ND FLOG
3RD FLOG
4TH FLOOR
5TH FLOOR
6TH FLOOR
7T
PERMIT PAYMENT RECEIPT
'TOWN OF BARNSTABLE
BUILDING DEPARTMENT
200 MAIN STREET
HYANNIS, MA 02601
DATE: 09/25/14
TIME: 09:49
-----------------TOTALS------------------
PERMIT $ PAID 35.00
AMT TENDERED: 35.00
CHANGEPLIED: 35.00
APPLICATION NUMBER: 201406497
PAYMENT METH: CHECK
PAYMENT REF: 2408
1 S
Town of BarnstablePermit:
Regulatory Services ate:��25 ll
oF1ME rq� Richard V. Scali,Interim Director
Fee: t
• ` Building Division L S
` BAmgrABLF, ` Tom Perry, Building Commissioner
ncass
200 Main Street, Hyannis,MA 02601
RFD MA'S A
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
TOWN OF BARNSTABLE
SOLID FUEL STOVE PERMIT
Owner: ) ��IIP ��cg. Phone:
Install at: h vvL'61 KVillage:
Map/Parcel: Date:
Stove
A. New/ se
B. Type: Radiant/Circulating
C. Manufacturer: KIp W CA S�lk Lab.No.
D. Model No.:
Chimney, 1 7 o
A. New(E:x�iDstin (If existing,please note date of last cleaning) I
B. Flue Si 41
C. Are other appliances attached to Flue? b '
D. Pre-fab Type and Manufacturer
E. Masonry: me nlined
Hearth / =nCn
A. Materials: &I Gam'(
B. Sub Floor Construction: CD
Installer
Name: f-e-Address: 6PU C b)c ;9-o'P,
Phone
Loca0if of nstallation:
H.I.0 Registration# a
Construction Supervisor#__J�e 6
OR check__Homeowner Installing, no license re red
LICENSED INSTALLERS SIGNA U
APPLICANTS SIGNATURE:
APPROVED BY: /L 9 2 I l
Please make checks payable to the Town of Barnstable
*This constitutes an official stove permit after inspection,photographed, and approved by the
Building Inspector
Q:forms:stove
Rev 11/4/13
� d .
V
Office of Consumer Affairs and Bu iness Regulation
10 Park Plaza- Suite 5170
` Boston,Massachusetts 02116
Home Improvement Contractor Registration
Registration: 161642
Type: DBA
Expiration: 11112MO14 Trd 2336N
CHIMNEY CARE
SCOTT SMITH
P.O. BOX 202
MARSTONS MILLS, MA 02632
Update Address and return card.Mark reason for change.
Address Renewal Employment C Lost Card
sCA 1 G 2oM-OSn I
ns mer Affairs
s ReguladoWe License or registration valid for individul use only
y� 'Office of Consumer Affelrs&Bosldess RegolaHoo �
R aa
ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
glatratlon: 161642 Type: Office of Consumer Affairs and Business Regulation
Oration: 11/1212014 DBA 10 Park Plaza-Suite 5170
Boston,MA 02116
CHIM EY CARE
SCOTT SMITH
7 CAPTAIN LUMBERT LN g
CENTERVILLE,MA 02632 �—
Uaderseeretary Not valid without signature
Massachusetts -Department of Public Safety
Board of Building.Regulations and Standards
C on%truction Supen i%or Spcci:Ilt%
License: CSSL-105026
SCOTT B SM]TE1 '
7 CAPTAIN LUMB
Centerville MA 02M t
Expiration
Commissioner 0f1112FMS
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�'ME t° Town of Barnstable
Regulatory Services
searrsrwsrs M�43S. Richard V.Scali�Director
1039-
.� �
�'OTEDMAI&`0 Building Division
Tom Perry,Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
Property Owner Must
Complete and Sign This Section
If Using A Builder
I as Owner of the subject property
> J P P rty
hereby authorize e 1( �.i�� to act on my behalf,
in all natters relative to work authorized by this building permit application for.
6�
(Address of Job) 1
""'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.
J
Signature of Owner Signature of Applicant
Print Name Print Name
Date
Q:FORMS:O W NERP ERMIS S IONP O OIS
Town of Barnstable
Regulatory Services
��ztie rotyy Richard V.Scali,Director
Q Building Division
2ARNSTABLZ ' Tom Perry,Building Commissioner
mAss. r „
1639- ,�� 200 Main Street, Hyannis,MA 02601 ,
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE:
JOB LOCATION:
number street village
"HOMEOWNER":
name home phone# work phone#
CURRENT MAILING ADDRESS:
city/town state zip code
The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow
homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor.
DEFEIaTION OF HOMEOWNER
Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be, a one or two-
family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one
home in a two-year period shall not be considered a homeowner. ,Such"homeowner" shall submit to the Building Official on a form
acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit (Section
109.1.1)
The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,
bylaws,rules and regulations. _
The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection
procedures and requirements and that he/she will comply with said procedures and requirements.
Signature of Homeowner
Approval of Building Official
Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code
Section 127.0 Construction Control
HOMEOWNER'S EXEMPTION
The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt
from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner
engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor."
Many homeowners who use this exemption are unaware that they are,assuming the responsibilities of a supervisor
(see Appendix Q,Rules &Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often
results in serious problems, particularly when the homeowner hires unlicensed persons. In this case,our Board cannot
proceed against the unlicensed person as it would with a licensed Supervisor_ The homeowner acting as Supervisor is
ultimately responsible.
To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the
permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page
of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in
I.your community.
Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc
Revised 061313
i
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111 .
�J www mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please
//Print Legibly
Name (Business/Oiganization/Individual): %
Address: L C� � L��--��� f -
City/State/Zip: C e Ac �t�. c r��"c�a-6 3),Phone#: �-
Are you an employer?Check the appropriate boa: Type of project(required):
1.® I am a employer with '2 4. ❑ I am a general contractor and I 6 ❑New construction
employees(full and/or part-time).' have hired the sub-contractors
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 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 d.uire re t c. 152,§1(4),and we have no
required.]
employees. [No workers' 13.�Other l�n n of �v,�u-f � l�
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.
tContractors 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 my employees. Below is the policy and job site
information.
Insurance Company Name: [ —
Policy#or Self-ins.Lic.#: /�b✓G �O a I a O � o �I Expiration Date: o '
Job Site Address: t 1 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 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 cerd under the pains and penalties of perjury that the information provided above is true and correct
Si afore: Date: � Zl fc 3
Phone#: L� `fob �9 6
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#:
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY
INFORMATION PAGE
A.I.M. Mutual Insurance Company
54 Third Avenue, Burlington,Massachusetts 01803-0970
`' (800)876-2765 NCCI NO 26158
POLICY NO. I AWC-400-7024208-2014A
PRIOR NO. AWC-400-7024208-2013A
ITEM
1. The Insured: Scott Smith
DBA: Chimney Care of Cape Cod
Mailing address: P 0 Box 202 FEIN:"="7764
Marston Mills,MA 02648
Legal Entity Type: Sole Proprietor
Other workplaces not shown above: See Location
2. The policy period is from 04/27/2014 to 04/27/2015 12:01 a.m.standard time at the insureds mailing address.
3. A. Workers Compensation Insurance:Part One of the policy applies to the Workers Compensation Law of the
states listed here: MA
B. Employers'Liabllity Insurance:Part Two of the policy applies to work in each state fisted in item 3.A.
The limits of liability under Part Two are: Bodily Injury by Accident $ 500,000 each accident
Bodily Injury by Disease $ 500,000 policy limit
Bodily Injury by Disease $ 500,000 each employee
C. Other States Insurance: Coverage Replaced by Endorsement WC 20 03 06 A
D. This Policy Includes these Endorsements and Schedules: SEE SCHEDULE
4. The premium for this policy will be determined by our Manuals of Rules,Classifications,Rates and Rating Plan.
All Information required below is subject to verification and change by audit.
Classification Premium Basis Rates
Code Estimated Per$100 Estimated
No. Total Annual Of Annual
Remuneration Remuneration Premium
INTRA 904123
INTER SEE CLASS CODE SCHEDU
Minimum Premium $550 Total Estimated Annual Premium $1,579
GOV GOV Deposit Premium $1,619
,STATE CLASS
MA 9014 MA Assessment Chg.
$1,179.00 x 3.4000% $40
This policy,including all endorsements,is hereby countersigned by 04/01/2014
numortM signature Date
Service Office: Twinbrook Insurance Brokerage
54 Third Avenue 400 A Franklin Street
Burlington MA 01803 Braintree,MA 02184
WC 00 00 01 A(7-11)
Includes copyrlgMed material of the National Council on compensation Insurance,
used with Its permission.
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
A Q►
Map 64 Parcel oo - Permit#
/Health Division �� �Ls�� �" /% ��� Date Issued
/Conservation Division P4 Fee
ZTax Collecto A A i I �e
ZTreasur
SEPTIC SYSTEM MUST BE
Planning Dept. INSTALLED IN
WITH TITLE 5
Date Definitive Plan Approved by Planning Board ENVIRONMENTAL CODE AND
Historic-.OKH Preservation/Hyannis TOWN REOULATQONS
Project Street Address �J� � 9L C �U i� e— \'
Village ,0 4"&" lj9 ; S �7�
Owner e_liad Address
Telephone 2_�'
.Permit Request E61 - AIAOtL�' JL,%- &a ; SL
7 n d
kd-
Square feet: 1 st floor: existing proposed 2nd floor:existing proposed Total new
Estimated Project Cost LU Zoning District Flood Plain Groundwater Overlay
Construction Type
Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation.
Dwelling Type: Single Family Two Family ❑ Multi-Family(#units)
Age of Existing Structure k Historic House: O Yes 41go On Old King's Highway: ❑Yes �(No
Basement Type: �ull ❑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 Al Oil ❑ Electric ❑Other
Central Air: O Yes 90 Fireplaces: Existing New r Existing wood/coal stove: ' Yes El
Detached,garage:❑existing ❑new size Pool:❑existing 9 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
Name O w iv-e— Telephone Number
Address License#
Home Improvement Contractor#
Worker's Compensation#
ALL CONSTRUCTION DEBRIS RESULTING F M THIS PROJECT WILL BE TAKEN TO
SIGN AT DATE
1
�'=R FOR OFFICIAL USE ONLY
PERMIT NO. V(�
DATE ISSUED
MAP/PARCEL NO.
ADDRESS - � VILLAGE
OWNER
DATE OF INSPECTION.: .
FOUNDATION
FRAME
INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH. - FINAL
GAS: ROUGH FINAL
FINAL BUILDING 0 =� � 1�
DATE CLOSED OUT
ASSOCIATION PLAN NO. t '
Yr.,.-/�..-�'�.r.^NYw vrnvti.-�.w.r. ... _ � � —..e � - .. r • _. _.. ,.y��.`l 4..-^r..^�•..v�.^`Y"..r. .fLt1.^^'ai.�Y`..,•,(
tME The Town of Barnstable
BARME. Department of Health Safety andEnvironmental Services
qq-
Building Division -�-
367 Main Street, Hyannis,MA 02601
Office: 508-790-6227 Ralph Crossen
Fax: 508-790-6230 Building Commissioner
Inspection Correction Notice
Type of Inspection �(� 0 I �� dG A
YP P
ILocation S � A _4A-1 Permit Number
Owner Builder
One notice-to remain on jobsite, one notice on file in Building Department.
The following items need correcting: '
f.
f
V
vm 0
i
Please call: 508-862-4038 for re-inspection.
Inspected by
Date -7 1( '�i (� b o()
ti
=
BUILDING PERMIT N0. Dni
ASSESSORS PARCEL ISO.
CONTINUATION Or ROAD BOND
The unde=sigaed' oc,-ne=/ctntractor hereby agree to aaiZtain t:ie=: road bard i s
fore until the foilc �=_ work itens are cc=letad to the sat=sfaction of the
E =nee_-:s *Section of tYe Denarrent of.Public wor'_tis:
c/ loan and seed shoulders as soon as
weather pe—:ts: - - -
of ter (e_-:7,1zin) C
j _. .. —
_-...- --
S__:;- , ( :,i;c ;CC:;� (print --name ) - -- -- - - -- --- -
----— ——- - 7-7- 1-7-7 - -
v
YM > TOWN OF BARNSTABLE 36645
PermitNo. ......:.........
` BUILDING DEPARTMENT
TOWN OFFICE BUILDING Cash
X
HYANNIS.MASS.02601 Bond ................
CERTIFICATE OF USE AND OCCUPANCY
Issued to Igusan & Michael Lanahan
Address 49 Shammas Lane, Martftihn.Q Mi, 1 15
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. i
.:........... qr
ildingi nspector
mliall"ll"llix IF
r BARNSTABLE, MASSACHUSETTS
��` L-pr , 1 .f c r 19 • 94 PE MI "`NO l�Y
_ - DATE ,
t`Z. �1C}.C.`.' p, (I� 'L31JX 1 3 i Buzzard !,a 36645
/J
• !:P%iiANT �'-�...Lii3T ADDRESS
(N0.) r (STREET) (CONTR'S LICENSE)
�L?'iCi��'. .f`:.:Y(ij.J.�•� :-+�'!�•ii�.SjiNUMBER OF
PERMIT TO L'Ui�_l1 Dwelling (=) STORY 'DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE) •� f`
49 si,.amurnas Lane, �`lar stClii.`-�i III j.I.I ZONING i.-CY'' L l;
AT (LOCATION) (,STREET) � �
r t',
i
BETWEEN T;, I 9r: AND
(CROSS STREET _ } ilCR 055 STREET) !�i
LOT ,..:.. �• r7.i
S S,fY SUBDIVISION } a LOT BLOCK' SIZE t« �
' S t ( FT IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
BUILDING IS TO BE 'FT. WIDE B�FT LONG 8Y
» " USE GROUPBASEMENT WALLS OR FOUNDATION
TO TYPE: )
(.TYPE
>. 13 a
Secaaye '
f REMARKS: �-
s,l,
AREA OR `„t' :Z 84.�:s ESTIMATED COST 40,y000 -L ;�",FEEMIT.
- 4 (CUBIC/SQUARE FEET). .
+owN a sus ri' & wlich�el= D ahan -
BUILDING DEPT•.
ADDRESS a' 8 '�Timbei ' 'W&a ', Sandwich BY /
i
r9•;� A.
�S'v
�
-
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 PERMITS PAREC REQUIRED PLIABLE A SEPARATE
INSPECTIONS REQUIRED FOR CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN ELECTRICAL, PLUMBING AND
ALL CONSTRUCTION WORK:
1. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS.
2. PRIOR TO COVERING STRUCTURALIQUIRED,SUCH BUILDING SHALLNOTBE OCCUPIED UNTIL
MEMBERS(READY TO LATH). FINAL INSPECTION HAS BEEN MADE.
3.FINAL INSPECTION BEFOR
1 OCCUPANCY-
O H CARD SO IT IS VISIBLE FROM STREET
li UILDING PECTI PLUMBING INSPECTION APPROVALS E ICAL INSPECTION APPROVALS
" p l6.. L �
HEATING INSPECTION APPROVALS EENGINEERINGDEP TM�ENT
3 �
1 y
O — —
2 OARD OF HEALT
O ER SITE PLAN REVIEW APPROVAL
WORK SHALL NOT PROCEED UNTIL THE INSPEC- PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS INDICATED ON THIS CARD CAN
I WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE ARRANGED FOR BY TELEPHONE OR WRM-,
TOR HAS APPROVED THE VARIODUS STAGES OF
CONSTRUCTION. WORK
IS ISSUED AS NOTED ABOVE. . NOTIFICATION.
BUILDT Ii P MET NO. -3 6 a ` Dn__
ASSESSORS"PARCEL NO.
CONTINUATION OF ROAD BOND
The unaersigaed' ocrae:/c=n..1actar hereby- a-_e_ to aa_..ta_n.'.t:ie road bond it
forts until the foLowi=- wort ite=s a=a" co=leted to the sat-;sfact_on oz is
E c-nee .5.'Sec__on of tYe Denar=ent'°ar .Psniic wow�s:1 .. __�
04,
c/ loa7- and seed saoulde_s as soon as
weatae: Pe=:ts: _ -
• .� other (e-7 =) C1�
—.(Print -name,z
) -. -- --= ---- --
r
AL:_ _�:Y
•z.
a'�y ••: TOWN OF BARNSTABLE
BUILDING DEPARTMENT
= sassSTAsr TOWN OFFICE BUILDING
� rua
°b +aJ9• �� HYANNIS, MASS. 02601
MEMO TO: Town Clerk
FROM: Building Department e94 '
DATE:
An Occupancy Permit has been//issued for the building authorized by
Building Permit $k........... lo,`t i ........ . ...... ..............._.......... ..................._..................
.. .......___
issued to ... :�;�(,(.�'� /YC�-...� ..................... .........._.. .................. ..........
Please release the performance bond.
LOT 16
236' 5p�p0'
176. 32
,26 E
0
l`�l LOT 14
o
LOT 15
CD
28.0'
� o
O � �
7.5'5'
Qej
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LOT 7
FLOOD ZONE "c"_ FO UNDA TION CERTIFICATION RES ZONE. "RF"___
TO WN.MARSTONS MILLS SCALE.-1' 60 PL.REF.38973F ELEV NIA
I CERTIFY THAT THE ABOVE YANKEE SURVEY CONSULTANTS
FOUNDATION IS LOCATED ON of M P. 0. BOX 265
THE GROUND AS SHOWN, AND PA � UNIT 5, 40B INDUSTRY ROAD
IT'S POSITION ��_____ �a:., ;
MARSTONS .MILLS, MASS. 02648
CONFORM TO THE ZONING LAW . NO. o TEL: 428—0055
SETBACK REQUIREMENTS OF �� 9fiSTER�� �� FAX 420—5553
BA_R_N_STABL_E C�
`�s/ONq� LA�oS
C JOB 50372FND
PA UL A. MERITHEW DATE. 4121194 NUMBER______
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COMMONWEALTH DEPARTMENT OF PUBLIC SAFETY _
y , ) Far')uff to poreee•a Out"
r' OF ONE ASHBORTON PLACE )! Alydaaahnsens Jtata B�IId1D0
MASSACHUSETTS R' BOSTON,MA 02108 j. C&N 140 oana•/ai fNooauoo
EXPIRATION DATE c_�'=�/(_r:?:/�. ,�=��; I_i•I CAUTION
r ASTIR. _;I_IF'EF;V I:_,f-1f:
I -�� ^ ;` EFFECTIVE DATE LIC-NO. is FOR PROTECTION AGAINST
RESTRICTIONS �d �� v .�I,
THEFT, PUT RIGHT THUMB
`'.
(-)'>../_�i/1 9Li.^-, 011.44 y(-) if PRINT IN APPROPRIATE
g: BOX ON LICENSE.
I I W I L.E_I AM R D I GI-.'::EY BLASTING OPERATORS
_ = d]: i i].:_:-54—:-5--6, F'(�) E(OX ].�r/;.:=:
— m; MUST INCLUDE PHOTO.
PHOTO(BLASTING OPR ONLY) FEE: .I B U Z Z A R D,-: DAY MA (_)2 J
ii I
.L o o a (_)() I NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY
HEIGHT: t STAMPED-OR-SIGNATURE OF THE COMMISSIONER j
DOB: f. I
THIS DOCUMENT MUST BE I
CARRIED ON THE PERSON OF I SIGNATURE OF UCENS II« SIGN NAME IN FULL ABOVE SIGNATURE LINE
THE HOLDER WHEN EN-
OTHERS-RIGHT THUMB PRINT GAGEDINTHISCCCUPATION. •1 NER
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assessor's office(1st Floor): y _ DO �° �r�+� � L i ��US-°LD-- THE
Asses3or's map and lot num ��i"� ALLE®I�C P"A �'"P�o`Conservation(4th Floor '•�•��
Board of Health(3rd flo WITH TITLE r!� s� �� r �a,5
Sewage Permit number NAS
Engineering Department(3rd floor): - r • a�..'aM j ° i6�q
House number 2
o y�Y
Definitive Plan Approved 6yAanni6g&drd 19 4
APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only
TOWN OF BARNSTABLE
BUILDING INSPECTOR
APPLICATION FOR PERMIT TO cli9worn Hlcf�-,5
TYPE OF CONSTRUCTION
�v 1 19 _
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location Li 6 Lor 'SH 4 MM � L
Proposed Use 1 1..f ✓! JOK1114=9 1Z—�
Zoning District Fire District ""'" !'/,1q-
Name of Owner '5�AAVJ A &^AtAMftt 1_ eiBiMAJAddress f1 Ti ngl&*x t✓tAq,,, nl,q��/►�A/1
Name of Builder W KA JAY✓1 ID39A<" Address ACV 14Q-3 ill Z-LdnA4r') dzLi-t
Name of Architect �i�'Y �— Address
Number of Rooms IfL Foundation PI" r!.[�nP�.v►�6
Exterior G - � � 7 - %�-S' Roofing
Floors—VlLt4z hJ0' CW Interior 13'z. 1F 1,43 e asdirwsr
Heating l' � (AA � - Plumbing
Fireplace "7 :Q FWL Approximate Cost
Area ' `�
Diagram of Lot and Building with Dimensions Fee
-4 .
13
r
is
a
208.3`i
�61�
, �-
KIP
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable r eW abov c str 'on.
Name
Construction Si ipervisor's License OLN L/-
LANAFtAN, SUSAN & MICHAEL
No 36645 Permit For TWO STORY
Single Family Dwelling
i
Location Lot #15 , 49 Shammas Lane
Marstons Mills
Owner •.Susan & Michael Lanahan r _
Type of Construction Frame _
Plot %" Lot '
Permit Granted Apr i 1 22
, t 19 94 -
. --
Date of Inspection:
Frame 19
Insulation 19—
Fireplace 19
Date Completed of 19 r
t
1
• f
f
The Town of Barnstable
• aAatvgresrE. •
'� • Department of Health Safety and Environmental Services
ArFprr►A+'' Building Division -
367,Main Street,Hyannis MA 02601
Office: 508-8624038 Ralph Crossen
Fax: 508-790-6230 Building Commissioner
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: f ove- ir Estimated Cost
Address of Work: jl(AS
Owner's Name:, C /116.1
t
Date of Application: E- /
I hereby certify that:
Registration is not required for the following reason(s):
Work excluded by law
Job Under$1,000
wilding not owner-occupied
Mvwner 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:
Date Contractor Name Registratio NoV 77�V
to Owner's Name
q:forms:Affidav
_ `'--.. The Commonwealth of Massachusetts
?i =j Department of Industrial Accidents
.:Z
, -_..
T_�R Office ol/nyestigations
--ate r
600 Washington Street
't�� �''� Boston Mass. 02111
Workers' Compensation Insurance davit
Icsnr�mrnratlp rrz ��/%%%
name: n
location: k
citya-t"S S g _ phone
❑ I am a homeowner performing all work mvself.
❑ I am a sole pronrietor and have no one tivorkin in anv capacity
❑ I am an employer providing workers' compensation for my employees working on this job.
comnnnv name:
address: :..,...;..:.:;::::.... ..
city: phone#-
insurance co. nlicv#
❑ I am a sole proprietor, general contractor, homeowner cle one)and have hired the contractors listed below who
have
the follo«ing N,.•orkers' compensation polices:
company name:
�2'j-w. L4 C5AL//fr,/-
L
/� :::..
...:.::..:.::::::...... .:.... .::.
address: �.. � OY S-� _ ::. ::....: •::::..;:.::.:.
�?/3 4 0�l� L� r:l phone .':...
insornnce cn. oitev# /�r;/r '::>::;:::;''':<:: s;;:::;::
...... iii/.i011111171111111,11111 ' //%//;
comnanv name: :.::...
address:
cith- ... phone
itunrancc
# /%%%%%%%
Failure to secure coverage is required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a flue up to 51.500.00 and
one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of 5100.00 a day against me. I understand that a
copy of this statement may be forwarded to the OMce of In gations o e DIA for coverage verification.
I do hereby certify under the pains an4penalfi o rjury [he information provided above is true and correct
-
� - G
Print name S i4 t� �1� ��_�_a`, ,.� Phone
otIIcial use only do not write in this area to be completed by city or town otllcial
dry or town: permitNcense# ❑BuildiDDepartment
.QLicen
❑ check if immediate response is required ❑Select
❑Healt
contact person: phone#; ❑Other
([evuea 9,95 P1A1
Information and Instructions
Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for theii
employees. As quoted from the "law", an employee is defined as every person in the service of another under any comer
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 or-
the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receive.
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 renew&:
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,neitherthe .
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
I authority.
Applicants
I
Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and
supplying company names, 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.
• y
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 be used as a reference number. The affidavits may be returned io
the Department by mail or FAX unless other arrangements have been made.
The Office of Investigations would like 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 J
Department of Industrial Accidents
Office of Inuesduations
600 Washington Street
Boston; Ma. 02111
fax#: (617) 727-7749
phone #: (617) 7274900 exL 406, 409 or 375
t.
E '
The Town of Barnstable
E ° Department of Health Safety and Environmental Services
Building Division
yBAMr+z�IZ 367 Main Street,Hyannis MA 02601
i639. �0
ArED AAA't A
Office: 508-862-4038 Ralph Crossen
Fax: 508-790-6230 Building Commissioner
HOMEOWNER LICENSE EXEMPTION
n Please Print
DATE:= �
JOB LOCATION: v ,j &C
n6iler street village
t
"HOMEOWNER": �% Ck 4/ O
name home phone# f ikork phone#
CURRENT MAILING ADDRESS: t-�—�'/ � �� aT »/2
city/town —' state zip co e
The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less
and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner
acts as supervisor.
DEFINITION OF HOMEOWNER
Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to
be,a one or two-family dwelling,attached or detached structures accessory to such use and/or faun structures. A
person who constructs more than one home in a two-year period shall not be considered a homeowner. Such
"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be
responsible for all such work performed under the building en rmit (Section 109.1.1)
The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other
applicable codes,bylaws,rules and regulations.
The undersigned"homeown 'certifies tlia e/s understands the Town of Barnstable Building Department
min �in..s ec_tion proce re a d.requ' eme and that he/she will comply with said procedures and
re e if ie -s
Si re of Home ner� � --•----
Approval of Building Official
Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the
State Building Code Section 127.0 Construction Control.
HOMEOWNER'S EXEMPTION
The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the
provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for
hire to do such work,that such Homeowner shall act as supervisor."
Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,
Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,
particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would
with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible.
To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,
that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used
by several towns. You may care to amend and adopt such a form/certification for use in your community.
Q:FORMS:EXEMPT
I ` V
LOT 16
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LOT 7
FLOOD ZONE "c"_ FOUNDATION CERTIFICATION RES ZONE.' "RF"___
TO WN.MARSTONS MILLS SCALE.•1"=60 PL.REF•38973F ELEV NIA
I CERTIFY THAT THE ABOVE YANKEE SURVEY CONSULTANTS
FOUNDATION IS LOCATED ON iN O M P. 0. BOX 265
THE GROUND AS SHOWN, AND PAULcye� UNIT 5, 40B INDUSTRY ROAD
IT'S POSITIONS----- y MARSTONS .MILLS, MASS. 02648
CONFORM TO THE ZONING LAW .
SETBACK REQUIREMENTS OF o 140.32098 c TEL: 428—0055 EW
BAR_NSTABLE' ►STER�S� FAx 4,20-5553
— yAl IANa
__—c�� ____-- 14
JOB 50372FND
PA UL A. MERITHEW DATE. 4121194
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Space Age g Pool Niter
A TOTALLY NON.cORixosm wrRATION SYSTEM
The new Sea Isle swimming pool filter system
is the key to a dean sparkling pool,day alter
day.Modern engineering concepts set a new
standard of performance In home pool filtra-
tion,offering features previously found only in
commercial systems.
•Pernumerd media sand fiber
•Over 2,000 gallons per hour capackY
0 National Sanitation Foundation Testing Laboratory approved
•Fliberglau reinforced tanhr•-wmPlCt*rorroslon reslsant
•Easy to clean strainer pot for maximurn pump protection
•Fingertip control,b position could-port valve
t •Faker and 3/4 h.p.motor And pump assembled on non-corraslve
base
The Sea Isle Water Purification System cleans pools fast; removes even
the most minute particles the Rfst time through.Filter and pump work
together In perfect b&vKe.
60 39'96 S,CCd 60OVSSr'skV 9Gb00bbLT9 08:71 666T./81/90
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��yoTTHE> STOBE PERMIT #
TOWN OF BARNSTABLE Date:
'oo,,�ornY►�� MASSACHUSETTS Fee: —
Solid Fuel Stove Permit
. .DATE OF APPLICATIO ....................................................................:........ FIRE DEPT, ISSUING PERMIT ............................................................
NAME (owner) .......... � ( ) M¢
��..... ................:.... . ........!n,.......................... NAME Installer
V� -
ADDRESS t" a..&4 ... ADDRESS �aS �i + ,1 �S . ` `►c.
� �STOVE TYPE .........fir!�1....................... --:........................................`r''�.—v- CHIMNEY NEW EXISTING........................ ........................
Manufacturer M�•..... .:....................................................... CHIMNEY: Masonry ................:...:................:...:...............................................:...
....
.......................tAr�.*
\�� f
Mass. Approval CHIMNEY: Metal 1e-?k'!"!1...... `..... f� ��� 'I
.................... .......... .........�................
This is to certify that the above installer has permission. to install a solid fuel burning. appliance at the listed
address in accordance with an application on file with the ..........:......................................................................................... Fire Department,
and subject to the provisions of the Commonwealth of Massachusetts State Building Code and regulations made
under the authority thereof.
I
IssuedBy: .............................................................................. .........................Title ... Date
Permit to install expires 60 days after issue date
n ...................Stove ................. ..1 QU�.. :�..T. ....... 1. .Q.mil....�......................... :.:.....:`......................................:.......:............................................:..
StoveClearance /G} " ...........................N........ ........................................ .................... ........ ..............
Floor .......... ...........1.:10" .5............0.f.S............e.............Y42t..5..n. ............R, ...0 ........:.........R?.. .,..................:............................................................................
Smoke Pipe .....................(P. .................:...........:............:.................
.....................................................................................................................................................................................................
SmokePipe Clearance ................ ..�/............................................................:......................................................................................................................................................................
Chimney 2i:......................:......:..............
...........:.............:.:.............:...............................................................................................................................................................
SmokeDetector ........................................:....................................................................................................................................:....................................................................................................
The undersigned hereby certifies that the installation of solid fuel burning.stove and equipment made under au-
thority of permit dated...........................:........................... has been made in accordance with provisions of the Commonwealth
of Massachusetts State Building Code now currently in effect and pertaining thereto ...............................................:........................
Installer
1
INSTALLATION APPROVED . ... ��/...1.. ..... By:..�, .... �a.. ...::.... ... -.............................. Title: .... ......... Q'
date
WHITE: FIRE DEPARTMENT — CANARY: BUILDING INSPECTOR — PINK:.APPLICANT
i N6
i i / , /
/ 236 37' / 6
10 yYIDR IDRfVE#AY Q) .
/ I
4� a ate s
176.32' 4�
LOT 14 PROJECT LOCATION
49 SHAMMAS LANE
_ BARNSTABLE, MA.
°j0 / / / __- 2 3 reserve
�' 8 =_ area G
1 nj� o�C�'Gj - / 12 �tqt' NK Or MAsf APPLICANT
JOHN tiN off` PAUL q�yG MIKE LANAHAN
LANDERS CAULEY �, ff A. ' 18 TIMBER WAY
d1st. CIVIL ��Pts� H SAND WICHMA 02563
box � No.35101 g, No. THE � ,
� l / / / -
LOT 15/ / 1500 al si 'a��a ��® ° YANKEE SURVEY CONSULTANTS
54,OOOfsf l / �`� �q taP c _% 1� ac
t 1n�1 UNIT 5, 40B INDUSTRY ROAD
/ �, P. 0. BOX 265
263. 79 -
MARSTONS MILLS, MA. 02648
TEL. 428—0055, FAX 420—5553
LOT 7
LOT 8 NO TES. SCALE 1"=40' DATE 09-21—93
TOWN WATER IS AVAILABLE IREV- 01-12—94 [REV-
FIELD BOOK; .23
LAND COURT• PLAN 38973F
ASSESSORS NO.: 48—6 JOB NO. 50372 SHEET 1 OF 1.
FLOOD HAZARD ZONE. C
_45. 0_PROPOSED
TOP OF FOUNDATION
20' MIN.
10' min CONCRETE CO VERS 2"LA YER OF
44.3 PROPOSED
42. 0E EXISTING /4. 0 EXISTING
CONCRETE CO VERS WAS YED STONE
45. 0E
' 4" CAST IRON 12"i4fAX i i /
OR SCHEDULE 40 4" SCHEDULE 40 PVC
P. V.C. PIPE DIST
' S=0.02, D=25 BOX M N.
BOX
FLOW LINE S—O. 02 D=8' - S=O. 02, D=15' PRECAST
INVERT 42_38 1MIN. 19 LIT CORNG
EL.= _
c
INVERT f 2' PbW o EQUIVALENT
INVERT EL.= 41.63 LEVEL q c o
EL.= 41.88 0• : 6, :: oc
INVER INVERT INVER 0. _ < 34 - /2"
OTE1H S
1500 EL.= 41.30
. _ oc
cSEPTIC TANK 0
35. 0
LEACH PIT
ffi. . . 3' B' 3'
PROFILE OF 12'DIAM. -
SEWAGE DISPOSAL SYSTEM
NOT TO SCALE BOTTOM OF TEST HOLE OR USGS PROBABLE WATER TABLE EL= 36.5_
ALL ELEVATIONS ARE ASSIGNED
i SOIL LOG ��� OF
WITNESSED BY: JOHN JACOBI JOHN
LANDERS CAULEY
P# 6290 U CIVIL
No.35101
GENERAL NOTES PERCOLATION RATE _2_ MIN./ INCH FMISTER�����`Q
1. THIS PLAN IS FOR CONSTRUCTION OF A SEWERAGE DISPOSAL SYSTEM. S�WVAL
2. PLAN REFERENCE LC 38973E LOT 15, BARN. REG. DEEDS. DATE 02-03-1986 DATE — —
3. THIS PLAN IS FOR INSTALLATION/ REPAIR OF SEPTIC SYSTEM TEST HOLE 1 TEST HOLE 2
AND NOT TO BE USED FOR SURVEYING OR ZONING PURPOSES. EL. = 48.5 EL. = DESIGN DA TA.-
4. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P.
TITLE 5 AND THE TOWN OF BARNSTABLE RULES AND REGULATIONS
FOR THE SUBSURFACE DISPOSAL OF SEWAGE. 48 NUMBER OF BEDROOMS FOUR
5 ALL COVER TO SANITARY UNITS SHALL BE BROUGHT TO WITHIN TOP & SUB
12" OF FINISHED GRADE. SOIL GARBAGE DISPOSAL NONE
6. EXISTING AND FINAL GRADES SHALL REMAIN ESSENTIALLY THE
SAME, UNLESS NOTED BY FINAL CONTOURS. TOTAL ESTIMATED FLOW 440 GPD
7. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE110__GAL/BR./DA Y x _4-- BR.)
OF WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER
OR WITHIN 10' OF DRIVES OR PARKING AREAS. H-20 LOADING MET. SAND SEPTIC TANK CAPACITY _1250 _
SHALL BE USED UNDER OR WITHIN 10' OF DRIVES OR PARKING.
UNLESS NOTED. LEACHING AREA REQUIREMENTS
8. ANY MASONRY UNITS USED TO BRING COVERS TO GRADE SHALL
BE MORTARED IN PLACE. 36. 5 SIDEWALL AREA 188.5 GAL IS F.
9. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH BOTTOM AREA 78.5 GAL/S/F
DEEDED OR ZONING REGULATIONS. OWNER/APPLICANT IS TO LEACHING CAPACITY (BOTTOM & SIDEWALL) 549 GAL.
OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY.
10. THE EXCA VA TOR�CONTRACTOR SHALL VERIFY THE LOCATION OF ALL UNDERGRO UND ( 3.14 X 5 X 12 X 2. 5 J f ( 3.14 X 5 2 X 1. 0
UTILITIES PRIOR TO ANY EXCAVATION THE WATERGATE WAS NOT FOUND, THE GENERAL RESERVE LEACHING CAPACITY 549 _ GAL.
CONTRACTOR SHALL VERIFY LOCATION WITH WATER DEPARTMENT.
CAPACITY PER LEACHING PIT JOB NUMBER___50372______
OU S MA= Sl_-4`�E = 2000;
FT NVNIMUN FR' TAGE = 15'
56C
MUIV AREt: 43
V, R�,_E L 4
N
7 67-5 r^_RES AREA OF L CiTS __2 2 2 2 Sij - ----i I -
-.REEA OF R: '- 3; ,208 S- FT 7i;6 ACRES
39
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TOWN OF SARNS7ABLE Z
3LC I 3q.;
LOT 7 1 LOT 8 0
28
BLI;EBERRY ACRES Li
NOMINEE TRUST �1:
LC. 38973E) CTF. I06313 10 399
L T 9
0 S,_tt_Ll 09
i.050 ACRE 0 q
VAN
QUIGLE'y 5 98339
JOSEPH A- Lr
o D CTF. 9882 I 2>897-30 CTF
Le- 389,
DH PV ca (jpfjD) z
0 i5 T='!9.96
, / i - Ts 39.99 1
-54 0.20 R: 36 88
20,61 76
3
R z 4C.71 ' 54. 97 9=2
0.10 21 00 A= 63.22
89.43 216.22
Az i47.63 050 35
BRB FND $3
2CE4. 32
IDH IN CS (FIV,-) AI _H iN CF, (FND)
PUBLIC .......
RACE LAIN E
61-
e
A.-) 30 SUBDIVISION PLAN OF I__,� ND I BARNSTABLE MASS .
sc 4 e,& L_ FCALE OF ONF HUNDRED FEET TO AN INCH /00DWARD E . KELLEY , Rr--": . AN SLRVEYOR CUMMAQUID , Nphass ,
AUGUST 187 119816
BE-1 NG A SUBDIVISION OF LOT 6 `J �� y�
I CERTIFY THAT THIS PLAN W,",S MADE lN
D
ACCORDANCE WITH THE BARNSTABI E Pi ANNING SHOWN ON LAND COURT PLAN 38973
BOARD INSTRUCTIONS AND THAT THE PERMANENT
POINTS SHOWN ON THE PLAT ARE !N EXISTENCE
ON THE GROUND .
AUGUST IS, 1986 1 CERTIFY THAT THIS -OCTJAL SURVEY 'A'A'S MADE ON THE I CLERK OF THE
GROUND IN ACCORDANCE WITH THE L4ND COURT INSTRUCTIONS T(Yvk N, OF BARNST-' HEREBY CERTIFY
REG. LAND SURVEYOR OF 197! BETWEEN JULY ; , !982 AND A LJ G!t.-ST 18, 1986 . T!-.'j TH'E NOTICE Oz- Ac>PROVAL OF Th!`
PLAN BY THE B4RNST,^,BLE PLANNING
DATE APPROVED . AUGUST 18 , 1986 H'AS BEEN RECEIVED AND RECOi-
7 BORL�
LAND SURVEYOR AT THIS OFFICE AND NO NOTICE OF APB.
DATE C'SNED WAS RECEIVED DURING THE ITWEN
NEXT AFTER SUCH RECEI P
-p
;' 77 OF SAID NCTICE .
8
DATE
dA
_7� r
CT
EBARNST.ABLE PLANNING B0)` P__, SARNSTABLE TOWN CLERK
BLU,EBERRY ACRES Et TRUST TR! PET!