Loading...
HomeMy WebLinkAbout0200 HIGH STREET o o •� �L w I OXf01 NO.152113 ORA MADE W USA ESSEM Iq i i �I y Town of Barnstable `fie mL� of T►te r� 1 Expires n1on! front sr dale Regulatory Services Fee + BARNS-TABLE, i v� sb3S. `gym Thomas F. Geiler, Director HIED MPS A V C`C-P-Mi4rco f.&a-►�M,<KK Building Division Tom Perry, CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.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 Property Address _ g2U` b �l�rf sl > ft'r U �� Residential Value of Wort. 1 OL-) Minimum fee of$'25.00 for work under S6000.00 Owner's Name & Address Eck C:'ontractor's Name �ry V�/L=�7 Telephone Number I Ionic Improvement Contractor License# (if applicable) 7 Construction Supervisor's License# (if applicable) O / ❑Workman's Compensation Insurance Chet amna sole proprietor pP ESS PERMIT ❑ I am the Homeowner ,JUL 17 Z000 ❑ 1•have Worker's Compensation Insurance Insurance Company Name TOWN OF BARNSTABLE 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 mmowrif ❑ 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. A copy of the Home Improvement Contractors License is required. SICN'ATURE- i.'\\I'I II.I:SiI ORM5\huilding permit forms\EXPRESS.doc Revised 100608 L zr. 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 'VQ V' jj Please Print Les=iblY Name (Business/Organization/individual): =.—{�6�J Address: City/State/Zip: Phone,-#: �O! : (t Are you an employer?'Check the appropriate box- Type of project(required): 1.❑ I am a employer with 4. old`�a general contractor and I 6. ❑New constriction employees(full and/or part-time),* have hired the stab-contractors 2: listed on the attached sheet 7. .0 Remodeling Q I am a sole proprietor or partfter-' ' ship and have no employees These sub-contractors have g, 'Q Demolition working for me in any capacity. employees and have workers'comp. Building addition [No workers'-compAnsurance °O�' msurance'# 5 10.❑Electrical repairs or additions . 0 We are a corporation and its required] ' 3.❑ I am a homeowner doing all work officers have exercised their I LE]Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required_]t c. 152, §1(4),and we have no employees.[No workers' comp.insurance required] •Any applicant that checks box#1 must also fill out the section below showing their workers'compmsation policy infomjation. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such tConhactors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have c rq)loyccs. If the sub-contractors have employees,they must pravidt 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.Lie.#: Expiration Date: Job Site Address: 6'lj V-, City/State/Zip:W,$AIST T��f0&S Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure io secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine tip to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a•STOP WORK ORDER and a fine of up to$250.00 a day against 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 ce nder the pains-and penal 'es ofperjury that the information provided aboy is true and correct. Si e: Date: to 0 r Phone# (Jyr ` b e Official use only. Do not write in this area,tb be completed by city or town offuiaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone 4: Information and Ins tr-uctions 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-engagedm atom en rpr�isee a inclu3ingtlie leg represenfatilr�6f- iieczasettzmpitryerorthe-=__..._ : - - -- receiver or tiustee 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(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 in-sunance 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),addresses)and.phone number(s) along with their certificate(s) of inrance. Limited Liability Companies.(LLC)or Limited Liability Partnerships(LLP)with no employees other than th na e members or partners,are not required to carry workers' compensation insurance. If an LLC or UP 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 nurr}ber 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 permittlicense 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 permifs 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 fo any business or commercial venture (i.e.a dog license orrm peit to bum leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would hike 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 MassachuseM Department of Industrial Accidents Office of Iavestigationts 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext'406 or 1-877-MASSAFE Fax# 617-727-7749 IZe'vised 11-22-06 www.mass_gov0a WORKERS' COMPENSATION AND, EMPLOYERS LIABILITY INSURANCE POLICY Information Page WC 00 00_o1 Atlantic Charter Insurance Company VDAC NCCI Co. No.:29211 Policy Number: WCV00730203 1. INSURED: Prior Policy Number: WCV00730202 Tyndall Roofing, LLC Producer: 30 Jillian's Way Fredericks Insurance Agency, Marston Mills, MA 02648 Federal ID Number:204616445 Inc. Risk ID Number: 1046 Main Street Osterville, MA 02655 Business Type: Limited Liability SIC:9999 NONCLASSIFIABLE ESTABLISHMENTS Other Named Insured: Other Work Places: See WCE107 2. POLICY PERIOD: The Policy Period Is From: 7/11/2009 To 7/11/2010 12:01 A.M. Standard Time at The Insured Mailing Address 3. COVERAGES: A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: MA B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in item 3A. The limits of our liability under Part Two are: Bodily Injury by Accident $ 100,000 each accident Bodily Injury by Disease $ 500,000 policy limit Bodily Injury by Disease $ 100,000 each employee C. Other States Insured: Part Three of the policy applies to the states, if any, listed here: COVERAGE REPLACED BY ENDORSEMENT WC 20 03 06A All states except Monopolistic State Fund States D. This policy includes these endorsements and schedules: See WCE105 4. COVERAGES: The premium for this policy will be determined by our Manual of Rules, Classifications, Rates & Rating Plans. All information required below is subject to verification and change by audit. Code Premium Basis Total Rate Per Estimated Classifications No -Estimated Annual. $100 of Annual Remuneration Remuneration Premium See WC 00 00 01 Minimum Premium: Deposit Premium: $500 $1,284 Interim Adjustment: Annually Servicing Office: Total Estimated Premium $1,217 25 New Chardon Street Surcharge(s). 67 Boston, MA 02114-4721 Total Premium and Surch rge(s) $1,284 46�Issue Date 06/22/2009 Countersigned By: Date 1�1N 2 20 9 Copyright 1987 National Council on Compensation Insurance Form: 100m J `-3 t �zrti Town of Barn-stable Regulatory Services swaxsz,�:ram, v � $, Thomas F. Geiler,Director 65 9- A Building Division Tom Perry,Building Commissioner 200 Main Street, Hyanais,MA 02601 www.town.barnstable.ma.us Office: 508-862403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign.Tbis Section if Using ABuilder I, �:Y(j t+66 Z?T A-m L0(J ,as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this badiag permit application for. .(Address of Job) - ko Signature of Owner ate G oGl� Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. COPY . -�omr�rco,uuea��i a�.,�aclu�aeQa '�-\ Board o(H'zing Reg ►ations and Standards i HG„IE IMPROV01ENT CO:4TRA.CTOR License or registration valid for individul use only Registra tion: before the expiration.da;a. If found return to: Expiration - _ 119766 Board of Building Regulations and Standard; _.8/28/2009 Tr# 132550 One Ashburton Place Rm 1301 Type DSA Boston,Ma.02108 WEBB CRAFT DESIGNy DAVID WEBB 17 ACADEMY LN FA!.MOUTH,MA 02540 Admiulctrator Not valid without signature ibjuscacy tq.tiett `D R ns tr4�t�o, `' Rc:,U; ��tt of e&ri O ctea tO Op S QsiBg suAer isa"�s..tgV S S.t/t,tt. 1�VjO ty License � 41)(1 rr/s �V • Fqq oq pT M� 02540 ' Expiration. Try. S��9/2p10 I =-� COMMONWEALTH DEPARTMENT OF PUBLIC SAFETY _ OF D ONE ASHBORTON PLACE MASSACHUSETTS ;'BOSTON,MA 02108 LICENSE EXPIRATION DATE °CONSTR. SUPERVISOR 04/13/1996 j EFFECTIVE DATE LIC-NO. RESTRICTIONS E _ 06/30/1993 004650 0 t o 0 °`.EARL E BROWN 5 zt9 POND VIEW DR SS R 021-48-5273 �I'CENTERVILLE MA 02632 z m I PHOTO BLASTING OPR ONLY) If 00.00 0•00 I t NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY HEIGHT: i STAMPED-OR-SIGNATURE OF THE COMMISSIONER DOB: 041i3/1S8 M w� THIS DOCUMENT MUST BE CARRIEDON THE PERSON OF I i SIGNATURE OF LICENSEE THE HOLDER WHEN TION. EN- OTHERS-RIGHT THUMB PRINT GAGED INTHISOCCUPAON. I LONER l ` e �e Lammeanaea�l�i.a�� u3e/l1 HOME IMPROVEMENT CONTRACTOR Registration 114200 I ;1 Type - INDIVIDUAL (� Expiration 08/12/95 EARL E BROWN JR EARL E. BROWN 9 POND VIEW DR ADMINISTRATOR CENTERVILLE MA 02632 Application to / Old Kos Highway Regional Historic District ComnlitteA 8 in the Town of Barnstable for a CERTIFICATE OF APPROPRIATENESS Application is hereby made, iri 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 CATEGORI_V THAT APPLY: 1. Exterior Building Construction: ❑ New Building MrAddition ❑ Alteration Indicate type of building: L7 House ❑ Garage ❑ Commercial ❑ Other 2. Exterior Pail-ting: ❑ 3. Signs or Bi+Iboards: ❑ New sign ❑ Existing sign ❑ Repainting existing 4. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Other (Please read other side for explanation and requirements). p. TYPE OR PRINT LEGIBLY DATE ADDRESS OF PROPOSED WORK !.✓elT BayhJla d/e. , /`7,4 ASSESSORS MAP NO. /J y OWNER s,�A h /'?us+, L aG/l ASSESSORS LOT NO. HOME ADDRESS _,2 Of/ /-//�z T/YeC4 [.✓� TEL. NO. J42 - 70'401 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- 7'rR i'-/:/ ad V /11/,:2 S fT v,✓V. 6/c- 6eal- ce /tirJ L✓.'hte,1.7 ,- 1110' 24-i4J7- [,✓ od2 AGENT OR CONTRACTOR TEL. NO. ADDRESS 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). /'7A./je✓ , eW,-oo—, 6e-.011 Of fl c p/`-eG�I� P.Y�✓�%�5_ /�� /'oof a Goy-���`�'y� `✓ A h ties/ 7wa ,��vuofavC Ge% q/ ho1� 7�mC.GS 9rm�.�.ol�. )''hiJ o1�X d 7 ' /`7. eh f he— e-,I•///,by 2 ate! 1e oaA w f ti h e_ ,pa er r aef C�r�o A X,6 1Vle L'6 eel,, ,hs/4�), le e— J U 6,01 /%d h o�� m00%j:��, �✓/�-V Si 9� /`I a/�Bv lfe�vaa� gned wD ® � er Contractor-AgentSpace below line for Committee use. k Received by H.D W u r ; f I ° q he if• ate is hereby _ Date I I r Tim 1 1QQA �-cv- 01NN O LD lNG'S HIGHWAY L-Tap Yproved ❑ IMPORTANT: If Certificate is approved,approval is subject to the 1.0 day appeal period provided in the At. Disapproved ❑ f ADDITIONAL INFORMATION FOR MAKING AND FILING AN APPLICATION FOR A CERTIFICATE OF APPROPRIATENESS The four categories for which a Certificate of Appropriateness is required are: (application for demolition or removal is a separate form). 1. EXTERIOR BUILDING CONSTRUCTION (new or existing buildings): An application is required for any exterior of a building to be erected or altered including windows, doors, siding, roof, light etc., that will be visible from any public street, way or public place. The following scale drawings are required in duplicate with application: plot plan (if addition — show existing buildings in outline), floor plan and elevations. Also required are snap shots of existing buildings, where additions or alterations are to be made. No plot plan is required for addition or alteration which does not touch the ground. 2. EXTERIOR PAINTING: An application is required for any, portion of a building, structure or sign to be painted that is visible from a public street, way or public place. Color samples must be attached to these applications. An application is not required when repainting existing colors, changing to white, or using colors approved by the Town Historic District Committee. 3. SIGNS OR BILLBOARDS: An application is required for any sign or billboard to be erected within the District, with the following exceptions: a. Existing signs or billboards on November 27, 1974 shall have until November 27, 1977 to secure an approved Certificate of Appropriateness. b. Temporary signs for use in connection with any official celebration or parade or any charitable drive as long as they are rerr.:)ved within three days of the event. Certain other temporary signs that the Committee feels does not detract from the Act may be allowed with the prior permission of the Committee. c. Real Estate signs of not more than 3 square feet in area advertising the sale or rental of the premises on which they are erected or displayed. d. A single sign of not more than 1 square foot in area showing the name, occupation or address of the occupant of the premises on which they are erected or displayed in a residential zone. 4. STRUCTURE: An application is required to build or alter any structure within the District which is defined by the Act as a combination of materials other than a building, sign or billboard,.but including stone walls, flagpoles, hedges, gates, fences, etc. GENERAL REQUIREMENTS 5. Work on projects requiring approval shall not be started until the Certificate of Appropriateness has been filed with the Town Clerk by the Committee. Approval is subject to the 10 day appeal period provided in the Act. 6. No changes shall be made from the original approved specifications without advance approval of the Commission or% an amended application filed with the Committee. 7. A separate application must be filed with each project requiring a Certificate of Appropriateness. 8. Under heading of "Detailed Description of Proposed Work" give detailed data on such architectural features as: foundation, chimney, siding, roofing, roof pitch, sash and doors, window and door frames, trim, gutters —leaders, roofing and paint color. 9. Unless application is complete and legible and all material required is supplied,application will not-be accepted or acted upon. Copies of the Act establishing the Regional Historic District may be obtained at the Town Hall. k f _,. ..... _. _ .._ ....,.. ... OLD KING'S HIGHWAY HISTORIC DISTRICT S P E C S H E E T FOUNDATION S I D I NG TYPE G O//2 1'�iti ti lnl COLOR CHIMNEY TYPE COLOR ROOF MATERIAL A ti A a _ / COLOR PITCH f�h�C vJ o� Lv �, o,••� . WINDOWS SIZE �o✓ w,h�% .� JizEf. TRIM COLOR WAlle DOORS COLOR SHUTTERS A �e GUTTERS L,/ A ,le-, DECK Ll-Yl GARAGE DOORS COLOR Notes : Fill out completely, including measurements and nn materials/colors to be used. � 1f11 � Three copies of this form are required for submittal ?' V with three copies each of of an application, along P the plot plan, landscape plan and elevation plans , when applicable. "Plot plan need not be "Certified" , but should show all structures on the lot to scale. .� As ip I y • N W m • 23-1 H 1•I SAC 0 23't l.OSAG • o �► O I 'O , !.OZ AG a #, � �It a y � �l AL .. ljO' pYfj�• 15 '� r The ToWT1 Of 1321-11!4213IC ..r=� I ) 'I):illlllt'!ii i I ::� ii \:.ii•;� :;!Ii I Il\'ll'tlllllll'lltal �t`t'\'Itt'� Building DIvIS1011 367 Main Suect,Hyannis MA 02601 Office: 508 79M227 mph men Fax: 508 775-3344 Building Commissioner For office use only Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPT F.MFNTTn PF.RMTT APPT TPA"niq MGL c. I42A requires that the"reconstruction,alterations,renovation,repair,modernization,oonv!ersion, improvement, removal, demolition, or constructionof an addition to any pre-existing owner ooaipied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirments- i Type of Work.- -40( X I` ✓. Est.Cost �13 o 000 . Address of Work: an n Omer Name: Q O 64 14Q M Date of Peanut Application: /G S-9 I hereby-certify that: Registration is not required for the following rcason(s); Work excluded bv-laa• Job under S I,OW Building not owner-occupied Owner pulling oKn permit Notice is hcrcbv gi,,-cn that: OWNTERS PULLING THEIR O«T'PEP.I.TT OR DEALTING%�TTH UNREGISTER.ED CON- RACTORS FOR APPLICABLE HONE IWRO\r1�?\rT \t,ORK DO NOT HAVE ACCESS TO TIE ARBITRATION PROGRAM OR GUAR jM,FUND U'DER MGL c. 142A SIGNED UDDER PENALTIES OF PERJURY I hcrcb\ appl\-for a permit as the cEcnt cf the y � Datc Contractor name Registration No. OR Date Owwncr's name CO MMONTWEALTH OF MASSACHUSETTS �_ `• D T I't.7: '�: O`'TND LISTRIAl-ACCI DENTS James WORIL'ERS' COMTFNSATION INSURANCE AFFIDAVIT (liccnscdpermincc) with a principal place of business/residaicr at: (Gry/Statc0p) J do hereby certify, under the pains and penalcics of perjury;that: j] 1 am an emplover providing the following workers'compensation coverage for my employees working on this job. le, lei e-rS 1 I T— (31 —�-� lnsurancc Company Policy Numbcr 1 am a sole proprietor and have no one working for mc. ( J I am a sole proprietor, general contraaor or homcowncr (circle onc) and have hired the contractors listed below who have the following workers' compensation insurznec policies: Nanic of Contractor Insurance Company/Policy Numbcr Namc of Contraaor lnsurzncc Company/Policy Numbcr Namc of Contraaor lnsurancc Company/Policy Numbcr 1 D 1 am z homcowncr performing all the wort:myself. NOTE-• Ple:se b< :-•:.e:h:t while horreo-=ers k�o eroloy persons to co rnaintenaaec,construction or repair wort:on z dwcllir.�cf not more thaw three units in N,'Ich the! orycc-:cr:lso resiCcs or on the groua6 appurtcnaat thcrctO arc not tcocrJ) eonsidcrcC to be erployers r:.^4 cr the C✓ora•ers' Corrvczs:tion Ae.(GL C. 152,sect. 1(5)). application by a boraeowner for a lleenSe or perr-..it r :v evidence the lcEal s =t1 s of:n crnploycr at�cr t5c C or)crs'Cornpcazatioa Act. 1 under:t;:c th:t a copy of i�:se:terner:t wiL be fo:�•rdcc to the Dcc::trnent of Industrial Aeodenu-Ofiiee of Insuraner for.coverare vcrifie:ion a.,d that f:ilurc to .ccL:c eovcrzgc :.s rccci:cc t:ndcr Scctio:25A of 1,/,GL 152 e=n lead to the imposition ofSyimin pcnJt'cs ccr-11, of: Lnc Of up to S 15G0.GG Z.d/c r ir.p: cr.nc-:cf Up:e enc ye.: :-.d e'J Pper.:j uCs in Ltie form of: Stop r✓ork Order and fine of S)GG.C'G, d:y: a r.:. 'Mc. Signed thiS day of . 19 Icensce/Per ittee Licensor/Permiiior i 1 RmPrJT tz -..--NF4 'S y WIriW1vS T 4rYl `raT i� I LJ r I ( 6�? o�T./pHG•O -1v pF3WgirJ MCI POP . GW 4•i LW AW Aw.De68R I.� pw- E� ww� i I I I: II II AV. 3 �L."�J HY/WI.P 1 V t I i l I~ 41P r 41 IR_ ` HPW Nr*, WINv9w ..-,,,I. A ® .►y � � 8 I /e etc � r I F, ti t. , :.AWW W#j -�— :• L.—..— '---- ----- -- -- P'-'- ------ -- - --._ 1u�+14 lcw74+CryHa raw14 I th - r .T --.. -Yfi•Fi�1'�f0 'SDP OF U11Mr�6( M• � 17 71 - _- -_ LIU - CNN r� ME" �Ty notJ ui ---cOrrf wa,wrl+r 1x� Fa`.r.1P R-APan _ 1 lrfe Fy1R6 —:::. —T�• l - -raw 6w — zY- s V1 40, &-Za 92 (�I(R{-1'r GiIt�G � qy L6� �I�JE EI�E•/f�lorl ;i i t n'ice 1st floor MaD Lot 441 c�, Permit# �o c. n ffice 14th floor �d� � - Date Issued 10 -7 Board of Health Ord floor Engineering Dept. j3rd floor House# ��Bi> t<�®�`�'d1a� ` �► Planning Dept. 1st floor/School Admin.Bldg.): a3�, ,yd[pA�BIl, Definitive Plan Approved by Planning Board 19 4S'�i��f�� �' 9. (Applications processed 8:30-9:30 a.m. &*1:00-2:00 p.m.) TOWN OF BARNSTABLE Building Permit Application Proiect Street Address 06 ` Village LJ, (�_� y�S�-e,��l p Fire District /. . (hvner /,g Address S 4 m -e Telephone Permit ReQuest: ��� � �,c,�v : Z� gAv00'-n e 7 , - © z d Ley,d16 2 E Zoning District Flood Plain Water Protection Lot Size . Grandfathered Zoning Board of Appeals Authorization Recorded Current Use /L f c Cl Me Proposed Use ;e-te r C 4 . Construction Type L4 Eaistin2 Information Dwelling Type: Single Family Two family Multi-family Age of structure Basement tie h e- r r �P Historic House Finished 6 r-S Old Kin s ighway yz'S Unfinished Number of Baths / No. of Bedrooms Total Room Count(not including baths) a�� First Floor Heat Type and Fuel /'c-ecA ,c) O. Central Air Fireplaces f Garage: Detached Other Detached Structures: Pool Attached 4,. Barn I , None Sheds Other Builder Information Name )z o. r-)^ R ro j^ Telephone number Address 2Lncl i e uJ License# A ce--,7 fe Y V; 1 t /7�I 1 r., Home Improvement Contractor# O D Worker's Com nsation # W C C I R NEW CONSTRUCTION 0R ADDITIONS REQUIRE A SITE PLAN (AS BUILT) SHOWING EXISTING, AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Proiect Cost 00 SIGNATURE DATE BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) BPERM T LOCK, JOHN (/^n FOR OFFICE USE ONLY y L �t SS 200 HIGH STREET, WEST-,BARNSTABLE VILLAGE OWNER JOHN MAMLOCK DATE OF INSPECTION: FOUNDATION _ _y INSULATION - FIREPLACE ` ELECTRICAL: ROUGH FINAL r PLUMBING:.'3 ROUGH FINAL GAS: � RQUGH FINAL FINAL BUILDINGS ell 9 4 ! 4 DATE CLOSED OUT: ASSOCIATE PLAN NO. . i