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HomeMy WebLinkAbout0140 WHITE MOSS DRIVE /f� lzY�r/e /rf�ss d< ci.. YOU WISH TO OPEN A BUSINESS? P For Your Information: Business certificates(cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) You must first:obtain the necessary signatures on this form at. 200 Main St., Hyannis. Take the completed fonTi to they Town Clerk's Office, 1 st FI., :367 Main St., Hyannis, MA 02001 (Town Hall) and get the Business Certificate that is required by law. � f �.: DATE: I/8 /y Fill in please: 'ts. UP,t'.. Z,001 � `��_ APPLICANT'S YOUR NAME/S: 'Tf-PH�b�1 �• ��NG �1s «3 Na US NESS YOUR HOME ADDRESS: yo N/T,E bss !u v� fir,,. �o�y 73-7 00-77 �� �t J��;' r �• �=��'f L" ,4rcS-roa s iU-S 02(vL1 S TELEPHONE # Home Telephone Number NAME OF CORPORATION: NAME OF NEW BUSINESS 3TF-VE- W 10& ` Lu k4(31 PJC Afjqn►- C, TYPE OF BUSINESS �1 l"Y) 1 trl { )V15 IS THIS A HOME OCCUPATION? YES ✓ NO �— ADDRESS OF BUSINESS ///T� Hoss.�54—iI6 nrs /Nrzcs /LfiQ- MAP/PARCEL NUMBER 03) " ©� SOS (Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - [corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COVhann R'S O ICE This individ m#o m of a y rmit req irements that pertain to this type of business. MUST COMPLY WITH HOMEOCCUPATION RULES AND REGULATIONS. FAILURE TO ign ie COMPLY MAY RESULT IN FINES. M EN S 2. BOARD OF LTH This individual ha b i forme er �. gpirem hat pertain to this type of business. Authorized Sig, ture* MUST OMPLY WITH ALL COMMENTS: nAnrcr"ni 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has b inf r e of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: Town of Barnstable Regulatory Services Richard V. Scali,Interim Director MST" E, ; Building Division 1 ��� Tom Perry,Building Commissioner Eo 't 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Approved: Fee: Permit#: ' 0 O� HOME OCCUPATION REGISTRA ON i Date:_ Name: 3T-EPH Enl Et4W s Phone WS016/ 737 -00 7 7 Address:_HO IV1117,C A/loss ,y Village: / illXs?nNs JL-1,le-LS Name of Business: * cD7_F V E ,Ew/N G ?Lu jy&,J& + /�Ch7-,iu6- Type of Business: 62-0ikf67111,5 � /4-c'1477 V&- Map/Lot: 03 f- 00 y INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes; and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter, odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There are no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation:' • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. I,the undersigned,have read and agree with the above restrictions for my home occupation I am registering. Applicant: Date: y Homeoc.doc Rev.103113 Town of Barnstable *Permit#OZI�C� I • � F.Wir Regulatory Services Fe t""m Thomas F.Geiler,Director Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.batnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number 0 00 Property Address 7 y D 0 � 3 f Pi I., S �1^l V au�S�bYIS t j(� MA0 Z6 Y k Residential Value of Work$ g'St)O Minimum fee of$35.00 for work under$6000.00 tp Owner's Name&Address �-rQ_1� ��S IA Q 110 cvH4-&- Mnss r6/e ,Mw-s}vns�W/Is . MA- 62-6y r Contractor's Name ,�C sj i l L,c ro c c. Telephone Number 501 21 a—!J j Home Improvement Contractor License#(if applicable) 9 c R� -7 Email:TijlkrAUM ICJ 1.e"Oea• e QM Construction Supervisor's License#(if applicable) 10 4 211 ❑Workman's Compensation Insurance CI)eck one: I am a sole proprietor I am the Homeowner ❑ I have Worker's Compensation Insurance OCT 1 ' 101,E Insurance Company Name Workman's Comp.Policy# OwN 0FaAQAj Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to A'" )I 5pb5J ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) Re-side Replacement Windows/doors/sliders.U-Value 3 0 (maximum.35)#of windows r 3 #of doors: �— ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. 'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: C:\Users\decollik\AppD callticrosoffiWindowffempond Internet Files\Content.Outlook\8R76BDVA\EXPRESS.doc Revised 061313 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' 600 Washington Street Boston,MA 02111 ivwn:niass.gmldia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organirationllndividaal): Ta S�4 �1LAA- l c.� n Address: 2I A p4CU�-s IAa.0 City/State/Zip: t M ® OI Phone#- SO 8 - ail a- 9/a o� Are you an employer"CWeck the appropriate box: T of project r 4. I am a general contractor and I 3'Pe P ] (required): 1.❑ I am a employer with � g 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. [A Remodeling ship and have no employees These sob-contractors have 8. ❑Demolition working for me in any capacity. employees and have wodmrs' 9. ❑Building addition (No workers'comp.insurance comp.insurance. required- 5. ❑ We are a corporation and its ME]Electrical repairs or additions ] officers have exercised their 11. Plumbing repairs or additions 3.❑ I am a homeowner doing all work ❑ 1; ep sel£ o workers' right.of exemption per MGL my � �P- 12.❑Roof repairs insurance required.]Y c. 152,§1(4),and we have no employees.[No workers' 13.0 Other comp.insurance required.] •Any applicant that checks box#1 mast also fill out the section below showing their wo¢kets'compensation policy information. I Homeowners who submit this affidatit indicating they are doing all wort and then hue outside contractors mast submit a new affidavit indicating,such. lContractors that check this box must attached an additional sheet showing the tame of the sub-coup tots and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I ant an employer that is providing workers'conipetisatiarr insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self--ins.Lie.#: Expiration Date: Job Site Address: q "� l V a rv.S City/State/Zip: KS-Ipm U!I Uk 6 2�tjl 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 S1,500.00 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 adtrised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby ce fy under thepains and penalties of peduty that the information provided aboue is true and correct Signature: Date: Phone#: 50<6 c7a I Official use only. Do not write in this area,to be completed by city or town o icia[ City or Town: Permit/License# Issuing Authority(circle.one): 1.Board of Health 2.Building Department 3.CitylTown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: • .�atvsr�. • MASS Town of Barnstable Regulatory Services Thomas F.Geiler,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-8624038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, cJ l P� �W�N , as Owner of the subject property I �q hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: .140 W 16A -A o.6s Air. (Address of Job) 3o �3 Signatur er Date SrEPHigi J- Cw".ky—� Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Users\decollik\AppData\Local\MicrosoMWindows\Temporary Intemet Files\Content.Outlook\8R76BDVA\EXPRESS.doc Revised 061313 • t y lboa1 Il (if 3i ii4i11', !ulat4ff1)S .111i �1i7.l1f�kltP� tars SuperV ,or License Im 7 a JOSEPH BURGUM off r 213.PITCHELRS WAY HYANNIS MA'02601 11/2J2gj4 r� 104847� ce'ololslumeK � +1 `/ .' beense or registration valid for individul use only fibers cress ".; before the expiration date. If found returnHOME IMPROVEN{ENTICGAftjtjCfOR Office of Consumer Affairs and Business Regula~.ion URM Registration: 458277 f rB IoTark Plaza-Suite 5170 Expir2tionBo"ston MA 011 16' HOME IMFR QVEN LN*T-4 J( ,G�PH BURGUMi=:..,-• :. DDD 21 r TCHERS 1/VAYq g, sA of V�alid without sign re:­ Unde Town -of Barnstable *Permit# aQ IQ 6 O� Espires 6 months from issue date + a Regulatory Services Fee a a MACg Thomas F. Geiler Director 9�p�1659.ar "��� X-PRESS PERMIT Building Division Tom Perry, CBO, Building Commissioner OCT 2 2012 200 Main Street,Hyannis,MA 02601 ' www.town-barnstable.ma.us Office: 508-862-4038 TOWN OF BAMMM EXPRESS PEEMITT APPLICATION - .RESIDENTIAL ONLY Nat Vaud without Red X-Press Imprint Map/parcel Number f D?l l 00 q Q Q — L-0-(-- 13 Property Address I`Io dyNi TE /l7oss [�.� /%X5'7®NS'./lrGcS� � O-26 Ye residential Value of Work tO Qt70 • QD Minimum fee of$35:00 for work under$6000.00 Owner's'Name&Address 57-r,#01+rc.dJ 3). Elul AS G J A44 Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: L❑ am a sole proprietor am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp. Policy# Copy of Insurance Compliance Certificate must accompany each permit ' Permit Re est(check box) Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to AA A A Asp 0��, ❑Re-roof(hurricane nailed)(not stripping. Going over mdstmg-layers of roof) ❑ Re-side . #of doors ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. . Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt campliance 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 i required. SIGNATURE• e� Q:IWPFII.E TO farmsTXMESS.doc i The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations d 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeZibly Name(Business/Organization/Individual):,STEPtFcN Address: /yo ldllyr,E 1%,55 City/State/Zip: srvNs /cc �'f 1)26 f',F Phone.#: �So�, 73'7 -.00 7 Are you an employer? Check the appropriate box: Type of project(required):. 1.❑ I am a e to er with 4. [Jr I am a general contractor and I � Y 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 tY• $ . 9. El Building addition comp.insurance. [No workers' comp.insurance required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.E] oof repairs insurance required.]t c. 152, §1(4),and we have no o� a pol C'£rl�N employees. [No workers' 13. Other le 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 subcontractors 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.#: Expiration Date: Job Site Address: 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 certify under the pains and penalties of perjury that the information provided above is true and correct. Si afore: . Date: B 2 /—' Phone#: (J OR) 737 ^ Cb 77 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): .L Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: p 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,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." f 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 burn 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 dq_not hesitate to give us a call.. The Department's address,telephone-and fax number: The Qornmonwealth of Massachusetts Department of Industrial Accidents Of-flee of Investigations 600 Washington Street Boston, MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASS.AFE Fax#617-727-7749 Revised 11-22-06 www.mass.gov/dia i The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): . 1, P'Gi km Address: 913 P i fcd-e-rs lnl c�a City/State/Zip: wr n i S "A 6ZLOL Phone.#: a s Are you an employer? Check the appropriate box: Type of project(required);_ 4. I am a general contractor and I 1.❑ I am a employer with ❑ 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. ❑ l Remodeing ( _ ship and have no employees These sub-contractors have g. ❑ Demolition working for me in an i employees and have workers' Y ca ac P tY t. 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 regquired.]t c. 152, §1(4),and we have no employees. [No workers' 13.[ Other .610 F t.'p—,p I A cl- 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 boxmust 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.#: Expiration Date: Job Site Address:_1 40 Wh i luo55 Dr-. City/State/Zip: AAAr54D v15 _Ali Sl Mk 026Ll 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 the pains and penalties of perjury that the information provided above is true and correct signature: I Date: D L Phone#: U "2%a— / Official use only. Do not write in this area, tb be completed by.city or town official City or Town: Permit/License# Issuing Authority(circle one): A.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions F. 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,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the 'dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C()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 compliarce vdth.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-contiactor(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 Departrufmt of ladustrial Accidents Off ee of.Zuvestaggat-ans , 60.0 Washington Street Boston, MA 02111 Tel. #617-727-49f10 ext 406 or 1-977-MASSAFE Revised 11-22-06 Fax#617-727-7749 www.rnas,,,,gov/dia i Town of Barnstable Regulatory Services B"NST,BLE, : Thomas F.Geiler,Director tans. 16 y� .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 HOMEOWNER LICENSE EXEMPTION Please Print DATE: 1012%4 /a JOB LOCATION:_ I Yo �H/TE / �O SS f�� &k5-7-01VS /V/c t s number street village "•HOMEOWNER": V7-9 PH E/y T). G14,1J6 (50-6) 737 00 77. name /�/ ,�hoome phone# work phone# CURRENT MAILING ADDRESS: I yo �H /%OS S D,Z 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. 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 he/she will comply with said procedures and requirements. lgna meowner 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 4„ 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/certifi cab on for use in your community. Q:forms:homeexempt r' °pTHE Tqy, Town of Barnstable ti r Regulatory Services r • •. BARNSTABLE, y WAss. �+, Thomas F.Geiler,Director '�Eo►��'' 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;- c�TJ�.P/��1� �• Cw N6 , as Owner of the subject l property hereby authorize to act on my behalf, in all matters relative to work authorized,by this building permit. //V�Ls�Ns /ccS (Address of Job) **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. ature of Owner S- tur. of Applicant c5-)eP//AI5N E0,A16 To Print Name Print Name J. /D Z /2- Date Q:FORM&OWNERPERMISSIONPOOLS 6/2012 Town of Barnstable p1ME 1py�O Regulatory Services y . Thomas F.Geiler,Director aARNSTASM 9 MASS. . Building Division 1639. p�FD MA'1 Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 ov PERMIT# q9 FEE: $ SHED REGISTRATION 120 square feet or less ��d l�hi�°I'�(�ss �� ►��ars�sns V�tlll� Location of shed(address) Village. Jc�nn IMc1� �- l ftrP��• Property owner's name Telephone number i !U-Xl2 (> 31 - Cwq - oo, Size of Shed Map/Parcel# 5D Signature Date t Hyannis Main Street Waterfront Historic District? 11.E Old King's Highway Historic District Commission jurisdiction? Ll Conservation Commission(signature required) PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN Q-forms-shedreg REV:121901 �0T.i3.. - 23,334 �S.F r4 / 30 y t A/lo s S .7�OVE �L CERTIFY THAT THE SHOWN ON THIS PLAN IS f LOCATED ON THE GROUND ��� ROBI AS INDICATE® 1LC0 of F.3134 DATE REGISTERED. LAND SURVEYOR `- ELDREDGE ASSOCIATES,INC. CLIENT��eEE_......_ C� ���� LOTPLAN ENGINEERS - LANDSCAPE ARCHITECTS JOB N0. /o�_ _ I�OTY✓H1T'E /"lOSS �/��u Eye' PLANNERS— LAND 'SURVEYORS DR, BY o � c IN 889 WE7 MAIN STREET CHKD. BY,, 434aN57-95LE,�,q y CENTERVILLE• MA. 02632 SHEET ..L--".CW / Crnl vs :90' nAPC. -7 1 ae.: FRIEDLINE& CARTER ADJUSTMENT, INC. 436 Main Street, P. 0. Box 338 Hyaniiis, Massachusetts 02601 Tel. (508) 771-3232 FAX (508) 790-2344 TO: —f-)wilding Commissioner or Inspector of Buildings ( ) Board of Health or Board of Selectmen ( ) Fire Department TOWN OF Barnstable TOWN HALL Hyannis, MA RE: Insured: McDONALD, John/CORONELLA, There i Property Address: 140 White Moss Drive Marstons Mills, MA Policy Number: H09917174 Type of Loss: Fire Date of Loss: 7/9/2003 File#: 97095 Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or cause Mass. General Laws, Chapter 143, Section 6 to be applicable. If any notice under MGL, Ch. 139, Sec. 3B is appropriate, please direct it to the attention of this writer and include a reference to the captioned insured, location, policy number, date of loss and file number. On this date, I caused copies of this notice to be sent to the persons named above at the addresses indicated above by First Class Mail. R. M. NEGUS Adjuster 8/12/2003 TOWN OF BARNSTABLE Permit No.3.0.9 .... BUILDING DEPARTMENT {I D°e; I TOWN OFFICE BUILDING Cash '�Or1,V HYANNIS,MASS.02601 Bond p I CERTIFICATE OF USE AND OCCUPANCY Issued to Greenbrier Corp. Address Lot 413, 140 White Moss Drive Marstons Mills, Mass, USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. Scptentber 30, 19 8.......... .` -,.... Building Inspector o'�y ••'. TOWN OF BARNSTABLE BUILDING DEPARTMENT BARruaU TOWN OFFICE BUILDING HYANNIS, MASS. 02601 MEMO TO: Town Clerk FROM: Buil 'ng Department DATE: i An Occupancy Permit, has been issued,,for the building authorized by Building Permit #.................. .......... ......................... ..................................................... ......_......_ .......». ...w issuedto ....... ...................._... - ,,.. ........................................................................ _. ._ ....._._. ..._. _.._ Please release the performance bond. 1 OWN OF BARNSTABLE, MASSACHUSETT$�. 1J9, „-.� 4ry I+y� L� tl'�,. , y j.- r r-•, `,< 4 Iv 1 l�'} ) � S.t�f/ r� ><� rry'� `t:a�`��•lF.,� f '� yif• 1 !}jj�'yr�,t r /� r• ! `.�.} s. �tf: �r l•,a t a'4 w'law.`• 5�r 1 L 1. �,(� �n.•>. s�LAat 3(�.. .'DATE'" '1 r m 1,8 Y.. �P� '�OM rk� 4 APPLICANT + AD SS x,T: ti� T1 AR ' .;�•,' •- •� - (NO ) (STRE�T1,•'frl'x' ' 'a +'� .tin ' ICONTR ! II CLNSLI. ,- y r;. +, . . ;. ..: ,NUMBER- OR � tn' ,i r.. ? Y I. }�, �' rt�•A•. ERMLTyTO.' '" L�11 STORY+ WELI��NGyUN�ITSy sS n :. ;,�:}�,I�;S, }•T. � .. ( [1,:"{ { lY•�: � Q. } <`,1 ',,1.V'1a1N � W,. teT'(1• C: FET;V *nr! M ry..aWb`ON) iv zit) Q '' ® ����B�i?i AND (CR03l•lT.REET) - - • `',` 10331.ST R[Eti;I i"N k,.. -. .., . .. .... ... r r y. . .�, ..:. � t 1. a LL "y�". t.'�Y�Y"'^,'F�'i"Q'•'i"yr..+,MM1'V� +�y.ry.�•1�.•yy+1�o •�r.ut`7 ��` 'ti SUBDIVISIOM LOT BL l ... _� t4 ,r. r• r-rr �I. yF� �4 1 yf xl+ • -BUILDING I$ TO BE T /WIDE BY FT. LONG BY f FT��N E4GNj�ND SNP[uL�Gr F0�3tAi ONSjt uttTlf�Ny � ft ' - ...c e '; Id f/ J r C✓fl jLi 14 If Gi.7)/s'' S$ '� i.��� �.,a ��^2 '' f 3 ,,PTO TYPE USE GROUP BASEMENT WAL45 +- F.;7�, ..s •., }. r 4-cp°J H <`,a .sG w +.�,aJ f•.+a.t•,s tTt{[ ..3tir�`x•��i .. �' 1. > \) � ty ry x!a x�7^�'�y�1 Jam; r`' ./l I .�'•� ed. �RGMARKS k 11 ya X•. ".r.,..- _ .j. ♦ �.•YR-A8' +ry a!`�} i 41!1 } h (lA r,t 1, T } .�' • Z )F l tY xt. IiJ/N 1/ tBA..�,•/�}t i �1 t ,1,�; AREA j. 'OR.. t VOLUME ESTIMATED COST ,1 OIC/30 DARE FEET).. . .. ..... •.ti.-: ri- +•:' J ♦ vr, w''!t+�-'rt. iF'k` rY'; ti" W-Y rp+t w.. � � t. t?: ^x,yy,��. It OWNER Q3T�T=�r—•46r •`. f ' t,� tr 5 1r ,K}a yi I+ �+•� �,�� : I j } py}r BUILDING QF}PTiT .1 rx s •" .e.¢tL �: G u. s t• ;n rr c s +fix: t s Y r A }'; ADDRES *+" , t��. r_" n ' 4 +j' I j}r �.,�,y° ��L -,i�4xru riyt 1, rrJ{•r 1ti r i� � i�Jyu N�t�� . {,Dr ai L y •x.. .. .. \I -M r 174rw rI.t��j 7jMc\•i�! G,N S,Sl1t�°fr' ;j r•�r'�am � f" `°4`"� t ��. 11•; t Y i. a,1 IiUkQ hF6 91r1a�111A" yl t'y£r� J "f �I}r +: :'i .:t• }.; 1.•,. .M , s J .y , ti .rl: i': r.��,+!!, 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: T ELECTRICAL, PLUMBING AND 1. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS' RE- MECHANICAL INSTALLATIONS. ` 2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL MEMBERSIREADY TO LATH). 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 3 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT I OTHER Z D�. A2 `�J BOARD' r, �L9 . V PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION ' WORK SHALL NOT PROCEED UNTIL THE INSPEC- INSPECTIONS INDICATED ON THIS CARD CAN BE TOR HAS APPROVED THE VARIODUS STAGES OF WORK IS NOT STARTED WITHIN SIX MONTH5 OF DATE THE ARRANGED FOR BY TELEPHONER WRITTEN - CONSTRUCTION PERMIT IS ISSUED AS NOTED ABOVE. NOTIFICATION. s 4, x: `•S �Or /3 � Z 3,339 = S.F ?YS n _ M 4 1 J� x 33 3� '71 r „c1 w 14;fir I CERTIFY THAT THE SHOWN ON THIS PLAN IS Nw of a�Asr :;.. LOCATED ON THE GROUND ��' Rosl aG c TAS INDICATED ILCO ' 0 0.3134 DATE TREGISTERED LAND S RVEYOR 4 LEVY a ELDREDGE ASSOCIATES,INC. CLIENT CERTIFIED PLOTPLAN ENGINEERS - LANDSCAPE ARCHITECTS JOB NO. 1.._31 �oT l3 - y/Hlr� /joss u s PLANNERS- LAND SURVEYORS DR. BY bc IN 889 WEST MAIN STREET CHILD. BY,� 1 "J: «6 CENTER I LLE, MA. 02632 SHE ET..I OF." SCALE, /'' = 9 0' DATE I.?//3 J 1B 7 59F_AKOv 7' s ` J 6V / N / O1 . O Av �23 3.4 �Vt f930O� ! O!L 1000 �` C.�rr / 4,;r � t ju I 7:6- ' t LEGEND ; EXISTING SPOT ELEVATION 06 PROPOSED SPOT ELEVATION N OF/yq EXISTING CONTOUR ---0- -- �°�' of qRss� ! fi PROPOSED,CONTOUR 0 P A L �Ln o�� ROSIN NOTE: THE LOCATION OF ANY UNDERGROUND W. SEWERAGE,WELLS, OR OTHER UTILITIES SHOWN ON 12'v Y�' I . THIS PLAN IS APPROXIMATE ONLY AS DETERMINED p No.10050�0 Q i3S1 �j I a. FROM RECORDS AND/OR VERBAL INFORMATION. 90 F�ls�E� ® �'F THE CONTRACTOR IS RESPONSIBLE FOR THE �FSsroN E ss�o���{aps°Q VERIFICATION OF THE EXISTING LOCATIONS IN THE FIELD. ' RwIN I .......R..._....5_.._ .A :: Y. ND SSURVE 41 LEVY & ELDREDGE ASSOCIATES,INC. CLIENER m.0 PLOT ' PLAN 4 ;ENGINEERS— LANDSCAPE ARCHITECTS JOB NO./C� =� PLANNERS — LAND SURVEYORS oR. BY, �L ,�/ --"• / ; N.Od 889 WEST MAIN STREET - CHKD.8Y (A ,__ iP/i�5BGE' CENTERVILLE, MA. 02632 , SHEETL„OF Z SCALE' 'JpATE�.V, ,.Nr tiF 7 NOTE /F EiTNER TN,ESEPTIC TANK DR^ a a-;, * ,.;,. .., 20 FT. M/N. LEAC/,IIA!<s P/T AJlE HAN •, fa•^�'7, 'MjK .:t piq. GRAOEr�A 24"OIAAl E7,Ze CONC.FET.= CGVER } scHEouLe 4 SNAL[ BE B AauG.I T TO 61rA Z> C,4 N EXTRA ' CONCRETE PKC. P/PE J�tEAVy C�'1 ST/4POIV CO�/ER .S/�A4L QC USED .; 03,.6 M/N. P/TCH - COYE/tS B 0,''ER FT /1=/IV ,DR/VEN/.4 Y 2 M/N. CO/VCRFTE - _ Cy�.4oE Co✓ER CLEAN .SALVO LIQtl/D LEVEL :• �• S(IyfpUL+ie44 2 1 AYER :.. , . _ f yCf /PE _ G/�L. 0 •o N o - 41/1/.PlTC/1 o t• • • • • •• t p o40 %4"PE/'�P7: SEPTIC TANK D/sT, o , a • • • • • • • • e • WASHED S7i�NE • t B • • • t• • 0 O • t • • pEPTj/ • I • • • v WASNED STaXE a. c e • • • • • t • t p ,�„ PRECAST SEEPAGE 1Ae'N�P97 44EYAVONS a ►p e • • •, • • • t e o P8 OR EQU/V, /NyERT AT BU/LOING �g.0 FT. 6 FT D/AM. WILE? .SEPTIC T.4NK 98`� FT, SEE TABULATION 0074 ET SEPTIC TANK 98 AFT. IMLEr DISTRIBUT/ON BOX 9z'3 GROUND W�iTER T.4eLE Ot1TLETD/STRIB117lON BOX 9 2 a 'FT SECT/O/V OF /APLET.LEACHING /9-/7- UFT. SPI�AGE O/SPQSA L SYSTEM TABULA?! LEACH//VG F'/T D,FS/Cs/V CRITERIA SCALE : %s" _ /=o' D/MENS/ON A frT. D/•`'LENS/ON $�FT. IVvhf6ER OF BEDROOMS -3 D/MENS/ON C 4 FT. Cao4ROAGED/SPOSAt_ L/,Vlr D SO//— LOG Ta7AG EST/M.aTEn Fto*v 33 0 G,44./DAT SOIL. TEST SOIt TEST*2 .SOIL TEST ,vuMBER OF LE.4cH/NG RIrS—L _ f`ELE V. 99- d r-EtrY.�•O DATE OF SOIL TEST S/DEl.�ACH/NG PERP/T 1�"/ SQ, PT. -/ ro f 01-31 TO/::�So/L RESULTS HlITNESSEO dY 7% MCIS"A� OoT70M LEACH/NG PER P/T�SQ FT. -So 0S�14- r PrRCOLAWO" RA7,=Af Al1NV/NCH TOTAL LEACHING AREA �SQ FT iZ FEVCOL.4T/ON RA7-,=j*2 •EA — M/N.�INCH RBSERYELCY1A&AREA T.SQ. F ;: ``may 5U6so/L 3 r- /o T/L L • �` sr S/�s�l p oy 0o P AAU L L ° T Dy4i Ves LEVYco - � -Q No.10050 .S4.,1 P o O 0 F �e LEVY & ELDREDGE ASSOCIATES. INC. r �/57 ���' • 8�,O L 889 WEST MAIN STREET CENTERVILLE,MASSACHUSETTS 02632 N �0 GROUND ;4/14TER E/VC0ZIM7E�eEo FCA/,Fit/?- Em 3P EP_.0, 7 :Q6-[3GROUN4 Y►/�TER ATB /1/D. J032 SlfEET OF '� i , Assessor's offioe (1st floor): Assessor's map and lot number ... .. C_� of THE To Board of Health (3rd floor): , -FIC SYSTEM MUST P4!7 Sewage Permit number ............ ^.. .. .............:.... G�g TAL.LE® IN COMiPL I AUC • UN STALLED BARNSTABLE Engineering Department (3rd:floor): {.ram WITH TITLE 5 + MAS& House number ....................................... /ice/!) 0e, 639 9 ��.ENVIRONMENTAL C®®E A y 'Ep ypY a` APPLICATIONS PROCESSED 8:30:9:30 3A.M. and 1h:00`2:00 P.M. only-' TOWN REGULATIONS TOWN `OF BARNSTABLE ` BUILDING INSPECTOR APPLICATION FOR .PERMIT TO ......... :C��� . ,�iN�>!,(•1.t� TYPE OF CONSTRUCTION ...................t!lJ... .... ............. ............:................................................... '. •.1114---....19. TO THE INSPECTOR OF BUILDINGS: The undersigned�hereby applies -for/a permit according to the following information: Location ......... 11"�... .3 ..,�t��f'J. �.... USS.... 1..1�Q. !v/ �.....(n/..5 l�I Proposed Use ...... ...... . ...................................................................................!.!. . X.�:i� ............................ /� / us Zoning District ........................................................................Fire District ..... ..kl..l.1 .................... Name of Owner .......Address ....� c..�,�d ...�� ...1'Q�. �� �1.� �... Name of Builder ......Q�). ............................................Address ..... .�. ...................................................... Nameof Architect ........ ..........................................................Address ................................:.................... .............................. Number of Rooms .......42......................................................Foundation ... Q ..... ���r�r�X. ...:............... Exterior .!!���4:.� fn�./. ��......v.V/.. ....Roofing .......... � .!./. 1.:1.i1........ ��� ..... Floors .......t'../. ./.. .......1_ f...P ............................Interior ...........hle.:, :J..O.. .. ........... Heating ...r-04........� ......r �iC.7............................Plumbing ......... ... . 1.?�.............................................. Ad , Fireplace ......... A Approximate Cost Definitive Plan Approved b Planning Board _ _._ p� ` PP Y 9 `-J 19 D Area .q- z Diagram of Lot and Building with Dimensions Fee / '.. ..... /'� SUBJECT TO APPROVAL OF BOARD OF HEALTH f OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ,/ , Q- Gll.!!fC iS /1!1..... 4... . . ......... . Construction Supervisor's License ......:(J.0<..3..1..-7..... GREENBRIER CORP. No ... Permit for ..... ............ Single Family..P��i�ing.......... .............. ................ .. ..... Location :..Lot #13, 140 White Moss Dr. ....................................................... Marstons Mills ............................................................................... Owner .....Greenbrier...C.or .................... .. .... .. .... .. . .. .. .. .... Type of Construction ...Frame............................. .. .. .............. ............................................................... Plot ................A............ Lot ................................ Permit Granted......J.Uly. ...13................19 87 Dcite of Inspection ....................................19 QQ Date Complet9d ... .........1'9 Assessor's wffine (lst floor): Assessor's mop and lot number '. -� � ' --~~- " J/ ' | � 8oard.uf Health (3rd floor): �p��,,I �� � ! Sewage Permit number --_'. --_- Engineering �� floor)-' ' � House number ........... -_��-_ APPLICATIONS PROCESSED 8:30'9:30 A.M. and 1'00-2'00 P.M. only ` ������7�J �� �� �� � �� �J�� �� � �� �� �� . . � � � |� �� ������ � � �� �� ^ �� NN N N �� �N INSPECTOR , �� �� �� �� , �� NNN0-00@ �� N� N �� ���� �.N� N �� �� ` _- _ - ---- - -- ~- - -- -~ ~ ~~ .~ ~ ~~ ~~ , - ��PPKUC�kTIx��� FOR PERMIT TO --'/ .......... /.(././l __________.___. c� TYPE OF CONSTRUCTION ...................�!���{!f�---J�l��I�����---------------------. ~-'-7 / /. .�'�- ����--lA���/ . - TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for o permit according following information: / L �� /�� �\� ~ Ja °� ���//4 � ^»� Location ---�����L��O-'-~�.'»���l[l��.-i�1!!����-� 1���;^�1�J�'L.2/,��!=`-.��<]!.!.''=��-�y!k7�---- Proposed Use -'- ____^^ _______________________________' Zoning District --i24`---------------------'Fi,e District -lL��/��/�� ........................ Name of Owner -./-/-/%�� / /-�'/� /, �/~"�'-� 6ms� -� ' "5�~/ s�'� '. ^~»/1 -----' -' -------�lY-� - `---� °'----' � ---'-----'� ` ' ' | Nome of Builder -' ��M:e......................................... -' --------__-______ ...... Nome of Architect �---------------------'Addnss ----------------.---_________ ' Number of Rooms ....... / ......................................................Foundation -~/�\"^ /�' ................... Ex/e,io, -�.^��!����- Roofing .......... ._____..10 ...... Floors K !/l ��/� // ' �*e'in' ' � � ^-��nz�� �/ �(��� ---� '`'7-�r--'---�--_---------' ' �.---_''------------------' | Heating ^1 ............................Plumbing --' g- ............................................ � Fireplace - -----------------------.Appruximooe Cost .......... �________,_ �� Definitive Plan Approved by Planning Board --- l9'',+'= ' Area Lot -------------- /r/ �� . Diagram of � and Building with Dimensions � Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH ~'"� � �� ~ xr- ` /Y x ` � ! ' - OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS ' / hereby agree to conform to all the Rules and Regulations of the Town of 8o,nmo6|e regarding the above construction. � Nome ..... ....... ' . Construction Supervisor's License ......��Z/=���,�'`/...... ` GREENBRIER COR,V. - - 0 3 I c)0 No . 30.7..8. Permit for ... 1 b Stor ............2. ..........�' Single Family..Dwe11.�,Ag........ Location ...Lot....#Ia..... 4.Q..Wlhjt ..,,Mp5.5 Dr. Marstons...D.? .l s........................ Owner ..Greenbrier...Corp ...................... i Type of Construction ..Fr??sly........................... Plot ............................ Lot ................................ Permit Granted July 1.3! ........19 8 7 Date of Inspection ....................................19 Date Completed ......................................19 a