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HomeMy WebLinkAbout0012 TIFFANY ROSE LANE I 0 _ , . �,� C Town of Barnstable *Permit# Expires 6 m nI'hs f om i date Regulatory Services Fee r r BARNSTABLE. MASS'9 Thomas F.Geiler,Director� 1639• SEED.MA'I A Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 50&862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid.without Red X-Press Imprint Map/parcel Number ?1 � W U Property Address iff Residential Value of Work �i Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address �/Gi11.t11zA//� �� Contractor's Name. (f4�� Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) X gp UHT 9workinan's Compensation Insurance N0V 1 Check one: ❑ I am a sole proprietor ❑ I am the Homeowner TOWN Q� �;A! !�STA � ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) UeRe-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side #of doors ❑ Replacement Windows/doors/sliders.U-Value (maximum .44)#of windows *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License.is,. required. SIGNATURE: Q:\WPFILES\FORMS\building permit forms\EXPRES .Z. Revised 090809 r The Commonwealth of Massachusetts Department of Industrial Accidents ` Office of Investigations I' 600 Washington Street c � Y Boston, MA 02111 wwm n:ass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information ,p Please Print Legibly Name (Business/Organization/Individual): Address: Zrt� City/State/Zip: &C/yam. ef tz Phone #: Are you an employer? Check the appropriate box: Type of project(required): 1.❑ 1 am a employer with 3 4. ❑ I am a general contractor and 1 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 workingfor me in an capacity. employees and have workers' Y P h'• 9. ❑ Building addition [No workers' comp. insurance comp.insurance.1 required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.ElI am a homeowner doing all work officers have exercised their 1 . lambing repairs or additions myself [No workers' comp. right of exemption per MGL 11/0 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. =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 my employees. Below is the policy andjob site information. _ Insurance Company Name: 4411 /IJZ 71; — 0 Policy#or Self-ins.Lic.#:_� /C/i�i �!r� Expiration Date: Job Site Address:Z, , -r✓.��y��`�sa'Cl /-l dwate/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 certify under thepains andpenalties ofperjury that the information provided above is true and correct, Q Si ature: Date: Phone#: — z 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#: 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 trustee of an individual, parinership, 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 insurance requirements 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-contractor(s) name(s), address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)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. Please 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 or 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 Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax # 617-727-7749 www.mass.gov/dia 1 I SHE T� Town of Barnstable Regulatory Services 9 BAMSrABLF.MAS& 8; Thomas F. Geiler,Director ��FDNIAI�`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 as Owner of the subject property hereby authorize �?///n (�,� to act on my behalf, in all matters relative to work authorized by this building permit application for. ?, OFF � iy , ,��5�1 (Address of Job) Signature of UWVr Dafe Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FORM&OWNERFERMISSION Town of Barnstable OF'IME Tp� o Regulatory Services BARxslesr E Thomas F.Geiler,Director MASS. 94, i6.19. ,�� Building Division ATED MA{a Tom Perry,Building Commissioner 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 st9te 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. 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 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 be/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 your community. Q:\WPFILES\FORM S\homeexempLDOC iWxssachusetts- Department of Public Safch- '��� Board of Building Rc�•„ Lyl �ulutions and Standards % Construction Supervisor License License: CS 63537 Restricted to: 00 DAVID R COX PO BOX 401 S YARMOUTH, MA 02664 f Expiration: 10/15/2011 l,. (`unmiissiuncr Tr#: 5822 _I lie&.vrca —ld a�./�aaaacl«�a`etla " 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: Board of Building Regulations and Standards i - Registratr_on:, 100497 I' One Ashburton Place Rm 1301 .. E1 xpiiration;=g/18/2010. Tr# 268012 Boston,Ma.02108 �- -�.� i Type___P_r,vate Corporation ; N-2 i �- DAVID COX,INC.. 1 David Cox ,19 LAVENDER LN Not valid without s' nature W.YARMOUTH,MA 02673 Administrator n From:Kathy Geddis FaxID:Northwood Insurance Page 2 of 2 Date:11/12/2009 09:59 AM Page:2 of 2 ' I CERTIFICATE OF LIABILITY INSURANCE OP ID KG [7 DATE(MM/ODMW) d.� DAVID-2 11/12/09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Northwood Ins. Agency, Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 540 Main Street,. Suite 9 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Hyannis MA 02601 Phone: 508-771-1632 Fax:508-393-2955 INSURERS AFFORDING COVERAGE NAIL INSURED INSURER A: Travelers Insurance Co. INSURER 8: Travelers Insurance company David COX, Inc. INSURERC: P. 0. BOX 401 INSURER D. S Yarmouth MA 02664 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REOUIREMENT,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 NSRC TYPE OF INSURANCE POLICY NUMBER DATE(MM/DD/YYYY) DATE(MM/DD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1000000 A - COMMERCIAL GENERAL LIABILITY I-680-1481M796—COF-0903/14/09 03/14/10 PREMISES(Eaoccurence) $ 300000 CLAIMS MADE X�OCCUR MED EXP(Any one person) $ 5000 X Business Owners PERSONAL&ADV INJURY $ 1000000 GENERAL AGGREGATE $ 2000000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2000000 POLICY PEa LOC CSL 2000000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) ' GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ EAUTO ONLY. AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION ' AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER B ANY PROPRIETOR/PARTNER/EXECUTIVE El 07/15/09 07/15/10 E.L.EACH ACCIDENT $ 100000 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 10 0 0 0 0 It yes,describe,under SPECIAL PROVISIONS below E L.DISEASE-POLICY LIMIT $ 5 0 0 0 0 0 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE'HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION TOWNBAR DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 1.0 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL TOWN OF BARNSTABLE IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR BUILDING DEPT R 367 MAIN STREET REPRESENTATIVES. HYANNIS MA 02601 AUTHORIZ REPRESE TATIVE ACORD 25(2009/01) ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD OW .Assessor's off ioe (ld floor): `� �3./..`.00s%(J/� �oF rNc>o� Assessor's map and lot number .. Q ... Board of Health (3rd floor): Sewage Permit number ?^....t.�{. ....v�..p ....:.`.... i Basa9TenLE, Engineering Department (3rd• floor): :N 'oo 039, e0� House number s, ..............s .............. ,........ ............................ �Fp YP�d\ 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 ...........� C�{4v � ���./� ............ ... �,.. .................... TYPE OF CONSTRUCTION �i� )(�l/.�........ 1�-�M ................................ ..................... ........................................................... .........--••--.--.... ..............19....W.... TO THE INSPECTOR OF BUILDINGS: 1 The undersigned hereby applies for a permit according to the following ;information: Location ...., ...r� ...`Ir....,. 1 D.. 1 ...v�l.s�; .A!):J.......(✓I ,, ll /� / /� Proposed Use .......�.�N..t�( , ,... .S M 1�/ ....... Zoning District ............Fire District ......... Name of Owner ..... (C�........a4ge.Address ............ rJ.:. 'J./�X .�IQ Nameof Builder ....: M ...........................................Address .............. . .. ................................................... Nameof Architect ..................................................................Address .................................................................................... Number of Rooms � � � .. ExIerlo. .....-....................,..... ..............�....................................Roofing ............... .................................................. Floors ...v1.• iCam..........Interior .............-5-6 cle ............................... Heating ....... q.......:64-S...........................Plumbing ..........:.rL ....�.. ?4 ................................... ....... Fireplace ...........................................................Approximate Cost ....'+.......:... -...00 6.i............. ............... Definitive Plan Approved by Planning Board _____`�! __�7;__ 19_ Area .' . .......... Diagram of Lot and Building with Dimensions Fee ...P�....................... �� SUBJECT TO APPROVAL OF' BOARD OF HEALTH V�� , 34X i Z( wte Zealj�l / _8a�_-:z /r i 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. /� J 1 Name ...... 1,/1 v��Q�f r Construction Supervisor's license ..........,.�.!..../........... Greenbrier Corp. Y 1q 01-_ 004 03� � No ....30587. . ... Pe'rmit for .......1 1�.2...st-o.r.y..... single family dwelling ........................................................................... Location ..............1.2..Tiffany. . . ...ROs.e...Lane. ......... .. .. . . ........ ...... . ...... . Marstons Mills ..................... Owner ...............G..r..e..e..n...bI.r..ier Corp................... Type of Construction .................fraM................ ............................................................................... 4a Plot ............................. Lot ......... ................. Permit Granted .............March 30..........19 87 .................. Date of Inspection ....................................19 Date Completed ......................................19 i I of TOWN OF BARNSTABLE Permit No. ....30 7..... BUILDING DEPARTMENT { Cash "8MA } TOWN OFFICE BUILDING ,63 �O urk HYANNIS,MASS.02601 Bond .......X....... CERTIFICATE OF USE AND OCCUPANCY Issued to GREENBRTER CORP. Address lot #25 12 Tiffany Rose Lane, Marstons Mills 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. .luly 9 87 19................. ........`,. ........... Building Inspector TOWN OF BARNSTABLE BUILDING DEPARTMENT »ST TOWN OFFICE BUILDING ' rua '639• � HYANNIS, MASS. 02601 I 0 rAY MEMO TO: Town Clerk FROM: Building Department DATE: An Occupancy Permit has. been issued for the building authorized :by BuildingPermit $k:... ._.........._.. _� ..._ _..................:... _...._ .. _.... ........_ _W...... ».._.. »».»_»_ issued to .....� 2%t���� . .. ...........,-............. _.._........................... IPlease release the performance bond. r TOWN OF BARNSTABLE, MASSACHUSETTS ;GIJILDING N. IT 0=031-005 . 0121 �� ? 0 31 606 DATE i•larch 30 19 67 PERMIT • � APPLICANT Greenorier 'Usurp. ADDRESS P. . ox CErlt. r`J1 0- • ; 001391 IND.)5 (STREET) % (CONTR'S LICENSE) PERMIT TO Bu'ilu Dwelling ( 17 ) STORY .y.i itl j e F'akidly L well).?'1�EBERN OF G UNITS (TYPE OF IMPROVEMENT) NO. (PROPOSED USE) LAa �25, 11 ` i.1- tan..• Ross: \larst:ons :'ii i ZONING AT (LOCATION) DISTRICT--- (NO.) (STREET) 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 CONSTRUCTION TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION (TYPE) REMARKS: - g 2 U ' �=tle its VOLUME c�31.? :;Ci. iL. 45, 000* 0") PERMIT ESTIMATED COST $ FEE (CUBIC/SQUARE FEET) ' Gr-eeri,ario' r Crrr�. OWNER .. 1 U. Box L C i1t `:{ J LJ c: BUILDING DEPT. ADDRESS BY __ Y'.�I! I• �Tt/ �� 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 BUILDING 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 INSTALLATIONS. z. PRIOR TO COVERING STRUCTURAL OUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL MINAL INSPECTION TI TO BEFORE FINAL INSPECTION HAS BEEN MADE. 3. FINAL INSPECTION BEFORE ' OCCUPANCY. POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 1 � 2 ,U, 21 � �ry`. Z i•. 3 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT J t OTHER BOARD 8 Sul l''A7 WORK SHALL NOT PROCEED UNTIL THE INSPEC- P E RM I T 'WILL BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS INDICATED ON THIS CARD CAN BE TOR HAS APPROVED THE VARIODUS.STAGES OF WORK IS NOT STARTED WITHIN SI: MONTHS OF DATE THE ARRANGED FOR BY TELEPHONE OR WRITTEN CONSTRUCTIO1, I: PERMIT iS ISSUED'AJ,1J19jED ABOVE, NOTIFICATION. I • y \ itt 1 r- /1Z 7s i LoT 2S F J m 21�¢(,��SF . Lo-7-- 2 o 1 23. 4 3t � . M a 5,3 0 0 ti CERTIFY THAT. THE • FDU�r/D,9-7/D SHOWN ON THIS PLAN IS Of �qS LOCATED ON THE GROUND AS INDICATED WILCO)( 9 31341 p o . Nq; DATE REGISTERED LAND SURVEYOR y LEVY a ELDREDGE ASSOCIATES,INC. CLIENT R21- . 2-CERTIFIED PLOT PLAN .Y ENGINEERS - LANDSCAPE ARCHITECTS JOB NO.1oR2 PLANNERS-LAND SURVEYORS DR. BY:-4,,4,lq, - IN 889 WEST MAIN STREET CHKD. BY,_ ,L��}R�c/ST"�E3L CENTER I LLE., MA. 02632 SHE ET2_OF„L_ SCALE t - O' DATE 2• 8 J a l l E i Lo T 257 E 1 I m 2 li 4(c N G� 26 2 3.4 ° 5.3 3t � - o 0 r s �r 41 34.0 N O �4 N I CERTIFY TH T THE FOU�DA-7/D� SHOWN ON THIS PLAN IS ����H OF 2P gsf9� LOCATED ON THE GROUND z ti AS INDICATED � BIN WILCOX ' 0,313 - f, DATE REGISTERED LAND SURVEYOR a' LEVY a ELDREDGE ASSOCIATES,INC. CLIENT i_q 9-CERTIFIED PLOT PLAN ENGINEERS — LANDSCAPE ARCHITECTS JOB NO f°_ L�T`2TiftilS� �ys�� N� PLANNERS— LAND SURVEYORS OR. BY, IN 889 WEST MAIN STREET CHKD. BYE, J y; CENTER I LLE, MA. 02632 SHE ET—LOF—L SCALE '�- GATE s p °41 Asse%sor's.offioe (1st floor): �`3�' d 93J..•.aP :Pj/ SEPTIC SYSTEM MUST B TMEtO` °Assesso�"s map• and lot numbe ............ '" ... . ONSTALLED IN C®MPLIAN, Board of Health (3rd floor):Sewage Permit number ........85.7^...t.L{. .... .s................... . WITH TITLE 5 Z BAHII9TLBLE, Engineering Department (3rd floor): :='24�I (�y�MENTAL �';P1�Pn moo rbs}9. •�' House number ......................................1 ?............................ Tf 0`111"M RI�G�,.", oho SAY a� APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only TOWN OF BARNSTABLE . BUILDING INSPECTOR l APPLICATION FOR PERMIT TO .............��S/. 4V. L......... UGr1 .........:. ...................... TYPE OF CONSTRUCTION .....................1,0062)1........F1 ..me................................'....................:...... •......................... . ..� .......19. TO THE INSPECTOR OF BUILDINGS: The .undersigned hereby applies for permit according to the following information: inform'^a/t�ion:7 Location .. . .. .V: ' /✓- r ! A ,.✓�,�, ... .YA4-9` / � An / q Proposed Use ....... .�j6.T��. ......... !!'.L�.S���...................................................................................................... ° Zoning ,District .............. ... . ...................... ...........................Fire District ......f' ,'�4`°.>- -V.,v� ....M.J,. 's t /' / ��p �p �y K. Name of Owner ....4.GA .....�(�-6 ddress V l/�:...Jt0......1:. i Name of Builder ..Address S -t�'I ........................................ �..� ..M.. . ................................................ Nameof Architect ..................................................................Address ..............................................................:..................... Number. of Rooms ....(r/...........................................................Foundation ....... 4lalz— ........ 11:!.1 1�� J ��.. . .. .. . .... Exterior W.. .'.6 srJ 5.... ..4:-.y!•.0.5.........Roofing ..............T�.7 rl.:a•�r� v . .................. r Floors ..........Interior ............ &.15-Irv.0 . ...........................:... Heating . ( BB....6: ...........................Plumbing ?i ................................... Fireplace ............ ...........................................................Approximate Cost .. .j..GIQo.k Definitive Plan Approved by Planning Board -" =�7------19-Q__fa . Area ...... .LZ... .................. • I Diagram of Lot and Building with Dimensions ` Fee ................. ... ....................... SUBJECT TO APPROVAL OF BOARD OF HEALTH 34'x G l2� I X f Z� OCCUPANCY PERMITS REQUIRED FOR 'NEW DWELLINGS I hereby agree to conform to all the Rules and Reguldtions of the Town of Barnstable regarding the above construction. � � L. Name ......... . m ............ Construction Supervisor's License .. ......... ./..��........ Greenbrier Corp. 30587 Permit for ......LV.LstP.0...... .........qing,�q�jqlnilv dwelling ................. Location ............12...Tiffany Rose Lane ..........Y.............................. ...........................649�tms�..Mlil.ls...................... Owner ..............Q);.4?-.enb.r.i.e.r...C.qr.p...... Type of Construction ............ 9.4.1 ................... ............................................................................... Plot ......... Lot ....... ................... Permit Granted ...........V ...3.4...........19 87 Date of Inspection ...................................419 Date Completed 19