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Town of Barnstable *Permit 0076 -7�o
�� PERMIT Expires 6 months from issue date .
X-P ' ' Regulatory Services Fee A-;�
AUG 2 3 2007 Thomas F.Geiler,Director
Building Division 0
TOWN OF BARNSTABLnm Perry,CBO, Building Commissioner � �D
200 Main Street,Hyannis,MA 02601
www.town.bamstable.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 U90 Pic)CT-�,O,
Property Address r�
r r m�
Residential Value of Work -002.0 00,-- Minimum fee of$25.00 for work under$6000.00
Owner's Name&Address �6LL) t6L �— . M l �dt' /va r LlJ/n d S b)
� ksh i re-Trai s 60'B . ma l/`�1 a�d�-QSs
S C%� - pr—O I e-C.� Telephone Number,
Contractor's Name
Home Improvement Contractor License#(if applicable) n
Construction Supervisor's License#(if applicable)
❑Workman's Compensation Insurance
Check one:
I am a sole proprietor
I am the Homeowner
❑ I have Worker's Compensation Insurance '/
r Id5SGL�Vl US FArU" _pl
Insurance Company Name d,/1
Workman's Comp.Policy#
Copy of Insurance Compliance Certificate must be on file.
Permit Request(check box) /
[ -Re-roof(stripping old shingles) All construction debris will be taken to rz-n tv r-1 y cl U S
❑ Re-roof(not stripping. Going over existing layers of roof)
❑ Re-side
❑ Replacement Windows/doors/sliders. U-Value (maximum.44)
*Where required: issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
'Note: Property Owner must sign Property Owner Letter of Permission.
CAAccopy of the Home Improvemeentt Contractors License is required.
SIGNATURE: `✓ �:�c�-� v` . `" '�
Q:Forms:expmtrg
Revise061306
The Commonwealth of Massachusetts
Department of IndustrialAccidents
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 Le 'bl
Name(Business/Organization/Individual): . Q.LJ L -(1 v l r'
Address: 5,6
City/State/Zip: W ��fns. /�l� Phone.#: s6 3 G C;L
Are you an employer? Check the appropriate box: -Type of project(required):.
1.❑ I am a employer with 4. I am a general contractor and I
employees(full and/or part;time).* have hired the steb-contractors 6. ❑New construction .
2.❑ I am a•sole proprietor or partner- listed on the'attached sheet. 7. ❑Remodeling
ship and have no employees These sub-contractors have g• Demolition
working for me in any capacity. employees and have workers' 9. 0 Building addition
[No workers' comp. insurance comp.insurance.#'
required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
3I am a homeowner doing all work officers have exercised their l 1.E3 Plumbing repairs or additions
Y myself [No workers' comp. right of exemption per MGL 12.❑Roof repairs
insurance required.] t c. 152, §1(4), and we have no
employees. [No workers' . •13.❑ Other
comp. insurance required.] .
'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowner;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 Bove employees,they must providh their workers'comp.policy number.
Iam an employer that is providing workers'compensation insurance for my employees Below isthe policy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lic.M 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 c inn 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 DU for insurance coverage verification.
Ido hereby certify under the pain s•gnn�dpenalties ofperjury that the information provided above is true and correct;
Sienature: .C�4_ / ' I Date: 0
Phone#:
Official use only. Do not write in this area,'tb be completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town CIerk 4.Electrical Inspector 5.Plumbing Inspector
6. Other
Contact Person: Phone#:
�oF,THE Tgk, Town of Barnstable
Regulatory Services
BAMSTABM S Thomas F. Geiler,Director
MASS.
i639• .�� Building Division
rE0 tiAP't 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
�j DATE: Please Print
O c�7/0
-/ a� '�7�'
JOB LOCATION: b O /�S�(/�-� / /�C�/
number street p t, village
/��
"HOMEOWNER": �Q U L r"l///(/al SO 0 c a - !a 7
name � ) home phone# work phone#
CURRENT MAILING ADDRESS: ! " o r—A w i' n
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�equirements and that he/she will comply with said procedures and
regts.
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 ofconstruction Supervisors);provided that ifthe 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/cerlification for use in your community.
L
p�TN[}0 TOWN OF BARNSTABLE 34622
� Permit No. .
BUILDING DEPARTMENT
t •.aarr I �,S 1 ;0 0
.... TOWN OFFICE BUILDING Cash
639.
HYANNIS.MASS.02601 Bond
CERTIFICATE OF USE AND OCCUPANCY
Issued to Tom & Paula Millar
Address Lot #2 2, 5 Northwinds Lane
West Barnstable, 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.
May18, .... 19......92. ..... .......... .. .. ........ . . .. . ....... .........
B"glin �to ;
fin. ?��,F'r:?e{•x�.-,9�?' e'�';Wl��!?�;'�,:r,..
,�. TOWN OF BARN STABLE 3,4622
•, . Permlt No.:
I BUILDING DEPARTMENT
TOWN OFFICE BUILDING Cash ,O AQ,Q.Q 0
<► •,o.
HYANNIS.MASS.02601 Bond
i
CERTIFICATE OF USE AND QCCUPANCY
i q '
Issued to Tom & Paula Millar
Address Lot #22; 5 Northwinds Lane
West Barnstable, Mass .
USE GROUP FIRE GRADING
.00CUPANCY LOAD
THIS PERMIT,_WILL:NOT BE 'VALID,.'AND"THE BUILD NG;SHALL: 1VOT-.BE O.•CCUPIED UNTIL SIGNED BY .THE BUII DING INSPECTOR UPON SATI ACTORY'�COMPLIANCE WITH."TOWN': .•
r
REQUIREMENTS AND IN ACCORDANCE WITH SECTIOIS jig.
O.OF.THE MASSACHUSETTS STATE:BUILDING CODE.
May..18!......... 19.:...9.G...
A�E
. .. :...
guiIding Inspe o
.- ;.....-...._....ram. ..y,...� _.i:..._a _.._.__.�__...._... � ..
l
6
BUILDING COF BAR N O ER5 OFFICE
PAYABLE TO: DATE -
ACCT.#• 8`O/ �/r70 00</0
L & L Construction VENDOR#
5 Tilson Road
Rochester, MA 02770 ANT '
PO# N
APPROVED BY
4J71
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Y
R^Y tl
Yam. "•'7r ,� i�',. VA�_'e.T Ya �,".,�Y�Y�:. -�.: y.
• I�, � �,. n ; .>;yr +w1��.;a .. r.e r. �„ �. 'n^'o7,.,��,.r-P�•
TOWN OF BARNSTABLE, MASSACHUSETTS- But
A 109-13-2 •
. a DATE October 31 (g 91 PERMIT NO. N0 1, 462
APPLICANT.Lorin Motta. Sr. ADDRESS5 Tilson- Rd, Rochester - #021264
'y] �7 (NO.) (STREET) (CONTR'•S LICENSE)
{PERMIT TO� uild Dwelling OF
I[ (�_) STORY Single Farm 1A Dwelling pypELLIRNG UNITS
}• (TYPE OF IMPROVEMENT N0. �PROPOSEO USE) '
ZONING .
AT (LOCATION) Lot #22, 5 Northwinds Lane. w Barnst-�hl a RF
(NO.) (STREET) DISTRICT—
j; r
4• BETWEEN' AND
(CROSS STREET) CROSS STREET) ,
SUBDIVISION LOT t BLOCK LOTSIZE
'98UILDING IS TO BE FT, WIDE BY FT. LONG BY } I FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCT)(
B
TO TYPE USE GROUP BASEMENtt WALLS OR FOUNDATION
` (TYPE)
k REMARKS: Sewage #91-335 }
L & L Constructi,n ($1000',00)
5 Tilson Road Rochester, Ma.
It AREA OR 6 �'T
VOLUME 1640 �'1• - ESTIMATE�COST 125,000.00 MIT $ 147150
(CUBIC/SO UARE RE ET) FEE
owatR Tom :& Paula Plillar .
BUILDING DEPT.-Weymouth,ADDRESS •'440 Front` Street, . ntouth, A11� �
.. -% BY �....
F � s
...., M CS` �?rHH D E P A R- :......:-. 1
r RTMENT OF PUBLIC WORKS THE ISSUANCE OFFTHIS•P" ERMI D ES NOT:REL:.1E ASE THE APPLICANT FROM THE CON D,I�T�10
OF ANY APPLICABLE SUBDIVISION RESTRICTIONS.
MINIMUM OF THREE CALL •APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE
INSPECTIONS REQUIRED FOR
ALL CONSTRUCTION WORK: CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR
1?. FOUNDATIaNS OR FOOTINGS. ELECTRICAL, PLUMBING AND
MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE• MECHANICAL INSTALLATIONS.
2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL
I MINAL INSPECTION
TI TO LATHI.
E 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
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OTHER SITE PLAN R(Vq APPROVAL
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yh
WORK HAL OT PROCEED UNTIL THE INSPEC- PERMIT 'W!LL BECOME NULL AND VOID IF CONSTRUCTION
TOR HA PROVED THE INSPECTIONS INDICATED ON THIS CARD CAN
VARIODUS STAGES OF WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE CONSTRUCTION. PERMIT IS ISSUED AS NOTED ABOVE, ARRANGED FOR BY TELEPHONE OR WRITTI
NOTIFICATION.
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Form "A-1"
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rr OLD KING'S HIGHWAY HISTORIC DISTRICT
.Alt
Spec Sheet
`.; Foundation Type
a Siding Type 411 Ce-
;.a Chimney Type ��/ Color
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Color _
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t' -W# ��Lc�v J ��6��1`e /�`'(j Size 9 C 2
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Trim Color U d
/cue w"� C s
"i Doors W'ocf Color Cv
Shutters
Gutters
L.
Deck lre. l✓ve
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Garage Doors 60 vJ� Color
Pl?? ` o
Notes: Fill out com 1 t y, including measurements and materiahs/colors to be used.
Three copies of this form are required for submittal of an application,
R E C E I v E Dlong with three copies each of the plot plan, landscape plan and elevation E
plans, when applicable. . j
MAY *� 8 1991 Plot plan .need not be "Certified", but should show all structures on the lot .
to scale.
OLD KING'S HIGHWAY
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O NOTE CHANGES
TOWN OF BARNSTABLE
Building Inspection Department
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Form "A-1"
OLD KING'S HIGHWAY HISTORIC DISTRICT
Spec SYieet
Foundation Type �r�✓i e (` �rt�t _ _
Siding Type �,�-r C'_ C� C� �L�i' ho a r T ��I
.. Chimney Type G�/ C-� Color
Roof Material ( �. `� �� Color /V
Pitch / Z=
Windows 14�j�ll J Size �C
Trim Color Xe de wa tz Ccl
Doors A,)os OC Color b =e
Shutters
Gutters .�e
Deck
Garage Doors J uI Color
Notes: Fill out completely, including measurements and materials/colors to be used.
Three copies of this form are required for submittal of an application,
' V E d along with three copies each of the plot plan, landscape plan and elevation
R E C E plans,, when applicable. .
1 "Plot plan need not be "Certified", but should show all structures on the lot
MAY 1991 to scale.
ODD KING'S HIGFMAY APPROV5-
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� SHEET I o f= Z SHE�'TS
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P� �/ g ' CERTIFIED PLOT PLAN
LOCATION WEST B,q�iV-sTfli3G
A SCALE . . /�r_�..... DATE
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PLAN REFERENCE
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No. 26�('0 � I CERTIFY THAT THE C�Sni✓6..
✓ �uNDATIOv
qr p 0nz4 SIIOWN ON THIS PLAN IS LOCATED ON THE GROUND
`rsc fCl$ � / AS SHOWN HEREON AND THAT IT CONFORMS T
0 T H E
SETBACK REQUIREMENTS OF THE TOWN OF
.WHEN CONSTRUCTED.
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DATEGi.�
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DEPARTMENT OF PUBLIC SAFETY.
COMMONWEALTH 9"
br OF _ 1010 COMMONWEALTH AVE
r r '• ";- ! ` BOSTON,MASS.02215 �. .,• - .I .
rMASSACHUSETTS
ENCLOSE CHECK OR MONEY ORDER
L-ICENSE
EXPIRATION DATE l,9, � . - CONSTR. SUPERVISOR
FOR REQUIRED FEE,,. : ,
06/30/1993 ' MADE PAYABLE TO
RESTRICTIONS 6 .EFFECTIVE DATE LIC-NO. 6
NONE' "coMMlssION LIC SAFETY"
LORIN MOTTA. _ (D MOT SEND CASH).
:5 TILSON 'RO
- ROCHESTER NIA 02770 PLEASE NOTE- FEE INCREASE
i
PHOTO Ieusrwc oPR ONLY) FEE: �
z! 100.00 E17FECTIVE ' QSP'?;° 1989
• ��
HEIGHT: NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY
� `• STAMPED-OR-SIGNATURE OF THE COMMISSIONER
C
��/�;�,•' • �� S D NOT DETACH LICENSE STUB
Y
.. THIS DOCUMENT MUST BE SIGN NAME IN FULL-ABOVE SIGNATURE LINE
- CARRIED THE PERSON OF SIGNATURE OF LICENSEE
THE HOLDER WHEN ENGAG•
kO.TMfi ED IN THIS OCCUPATION, ,,/ -- ;,: //_ COMMISSIONER ,•\
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TOP OF FOUNDATION
e CONCRETE COVER
CONCRETE COVERS
z.bl , a 4"CAST IRON 12"MAX. 12"MAX. T
OR SCHEDULE 40 4"SCHEDULE 40 PVC.(ONLY)P.V.C. PIPE PIPE - MIN. LEACH
PITCH 1/4"PER.FT. PITCH I/4'PER.FT. pITTINVERI aGEL•/3 3•/c.. \—INVERTINVERT o .SEPTIC TANK i3 g DIST. 138.41 j .INVERT EL•'' ' BOX EL .EL./3�• GAL. INVERT INVERT 6 va ' I/2 63 /3 .8o e: o �:EL.. 7.... w 20 __ J 1� _� Z-131_80
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PROFI LE OF GROUND WATER TABLE
SEWAGE DISPOSAL SYSTEM
NO SCALE
SOIL LOG WITNESSED BY :
DATE �1p?!� 3O.�y�7� TIME��=?�. �`? ��� L � '',����5. BOARD OF HEALTH
TEST HOLE I TEST HOLE 2 ENGINEER
ELEV. . ! /.80. . ELEV. .. .. . . . . . .
waoow,9-�
DESIGN DATA
36. NUMBER OF BEDROOMS 3
T(*(AL ESTIMATED FLOW . . 330 . GALLONS/DAY
BOTTOM LEACH I NG AREA SO.FT. /PIT/C,,D D.
N te-
Z> /88.S 4 Z
SIDE LEACHING AREA . . . . . SQ.FT./ PIT 7/,1 �
GARBAGE DISPOSAL (50% AREA INCREASE)
TOTAL LEACHING AREA SQ.FT
PERCOLATION RATE MIN/INCH
LEACHING AREA PER PERCOLATION RATE �'` .-B¢3SQ.FT/CpD
.... . .WATER ENCOUNTERED
NUMBER OF LEACHING PITS
APPROVED . . . . . . . . . . . BOARD OF HEALTH
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
DATE . . . . . . . . . . . . . . . . . . . . . . .
AGENT OR INSPECTOR
OF F,!q�� � tH OF Mqs c
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7J1; `FPS CrgTE��vi��1 /STEP
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Application to
O�pPN'1 t ENNStE pJ�HS cg^
Y Old Kings Highway Regional Historic District Committee
in the Town of Barnstable for a
CERTIFICATE OF APPROPRIATENESS
Application is hereby made, in triplicate, for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470,
Acts and Resolves of Massachusetts, 1973, for proposed work as described below and on plans, drawings or photographs
accompanying this application for:
CHECK CATEGORIES THAT APPLY:
1. Exterior Building Construction: New Building ❑ Addition. - ❑ Alteration
Indicate type of building: [�] House Garage ❑ Commercial ❑ Other
2. Exterior Painting: ❑
3. Signs or Billboards: ❑ New sign ❑ Existing sign ❑ Repainting existing sign
4. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Other
(Please read other side for explanation and requirements).
TYPE OR PRINT LEGIBLY DATE
ADDRESS OF PROPOSED WORK L L 22 60_' 5 tVA- (J ASSESSORS MAP NO.
I LLi'►'-OWNER � �� ►�' 4- P�-S% � ASSESSORS LOT NO. Z_3 - 2—
HOME ADDRESS o r '� `� �� `4 TEL. NO.
FULL NAMES AND ADDRESSES OF ABUTTING OWNERS. Include name of adjacent property owners across any public
street or way. (Attach additional sheet if necessary).
e
�� G C t Ji I f �. CE y� S
AGENT OR CONTRACTOR „I�� ���i TEL. NO.
ADDRESS I/ ` C/
DETAILED DESCRIPTION OF PROPOSED WORK: Give all particulars of work to be done (see No. 8, other side), including
materials to be used, if specifications do not accompany plans. In the case of signs, give locations of existing signs and proposed
locations of new signs. (Attach additional sheet,, if necessary). /
C�✓cSl tG 12144 j 3J2 e CJ
Signed
Owner-Contractor-Agent
Space below line for Committee use.
Received by H.D.C.
It® G
t E_ Q �P�et erfica i hereby _ � Dat/
THY l 819911
OLD NG'S HIGHWAY—
Approved IMPORTANT: If Certificate is approved, approval is subject to the 10 day appeal period
provided in the Act.
Disapproved ❑
f A P P R O
A is office(1st,Floor): 1 ^� _�.� Q '
Asses�r's map4nd iot number _ 3 / G•-�/SEA;t` arnstabhe Conserva on
Board of Health (3rd`floor): -' INST
Sewage Permit number R -
Engineering Department(3rd floor): taros
ENV914®NIViER9 '
CODE AND �p,�16}9.A,
House number
Definitive Plan Approved by Planning Board �s ! P/i4p I9 19 1V6IN RE�du�.AT'®N o r�r
,APPLICATIONS PROCESSED 8:30-9:30 A.M.`and 1:00-2:00 P.M.only
TOWN :, OF' ; BARNSTABLE
BUILDING INSPICTOR
APPLnWATION FOR PERMIT TO
! i
TYPE OF CONSTRUCTION /, ek .7
19
TO THE INSPCTOR OF BUILDINGS:
The undersig ed hereby applies for a permit according to the following information:
Location D - ` z" klq j: 1(A � �. �'°L 1,-Q— 6), 2 A (/U�
Proposed Use
Zoning District Z Fire District
Name of Owner t? r� "`� �-1 yam- Address lao fir", J yMDA• /,ywds
Name of Builder Address
Loi-tn 1f`notta
S2. T•TOSon Rat. Rnc N.SUr ►mess oa 1-)0
Name of Architect Address
Number of Rooms Foundation
Exterior CL� �� �' Roofing �_
ff
Floors Interior 6k `
Heating 95- Plumbing 4e --V 'C,
Fireplace ''' O"'CGG� Approximate Cost �r�[ I Jr a co �-
Area /� 4
Diagram of Lot and Building with Dimensions 4�� Cee
6104
dv
i
OCCUPANCY PERMITS REOUIRED FOR NEW DWELLINGS -
I hereby agree to con.for Ito
7{ all the�Rules and Regulations of the Town of Barnstable regarding the above construction.
` '� . � I
U`"} Nam.
oa �.
n
Constr c n Supervisor's License
MW
MILLAR, TOM &`PAULA 1
NO! 34622' Permit For BUILD DWELLING
Single Family Dwellin
+# Location Lot #22
n West Barnstable
Owner To &` Paula Millar
Type off Construction Wood Frame
•�' Plot Lot � •� � i k --} `- �'~ ' I � � •, s. s t
Permit Granted; October) 8 �19 91 `r
.� Date of Inspection
Date Comprted -.19
IT I
17
40
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1
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