HomeMy WebLinkAbout0023 HILLIARD'S HAYWAY OXliDW NO. 152 1/3 ORA
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Town of Barnstable Building
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Post This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept
xes4. �b� Posted Until Final Inspection Has Been Made. Permit
. 3w 6 Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made.
Permit No. B-20-2374 Applicant Name: James Diede Approvals
Date Issued: 09/03/2020 Current Use: Structure
Permit Type: Building-Sheet Metal-Residential Expiration Date: 03/03/2021 Foundation:
Location: 23 HILLIARD'S HAYWAY,WEST BARNSTABLE Map/Lot: 136-049 Zoning District: RF Sheathing:
Owner on Record: BIRDSEY,ASHLEIGH L Contractor Name: JAMES M DIEDE Framing: 1
Address: PO BOX 1093 Contractor License: 101 2
S. ORLEANS, MA 02662 Est. Project Cost: $20,000.00 Chimney:
Description: install 2 new hydro air air handlers with all new ductwork one in Permit Fee: $85.00
attic one in basement all new ductwork Insulation:
Fee Paid: $85.00
Project Review Req: Date: 9/3/2020 Final:
Plumbing/Gas
fficial Rough Plumbing:
This permit shall be deemed abandoned and invalid unless the work authorized by this permii is commenced within six months after issuan Final Plumbing:
All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted.
All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. Rough Gas:
This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the
Final Gas:
work until the completion of the same.
The Certificate of Occupancy will not be issued until all applicable signatures by the Building-and-Fire-Officials a re-provided on this permit. Electrical
Minimum of Five Call Inspections Required for All Construction Work:
1.Foundation or Footing Service:
2.Sheathing Inspection
3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Rough:
4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Final:
5.Prior to Covering Structural Members(Frame Inspection)
6.Insulation
7.Final Inspection before Occupancy Low Voltage Rough:
Low Voltage Final:
Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations.
Work shall not proceed until the Inspector has approved the various stages of construction. Health
"Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final:
vit- Building plans are to be available on site Fire Department
"I;—. All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final:
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YOU WISH TO OPEN A BUSINESS?
For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you
must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis.
Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get.the Business Certificate that is
required by law.
DATE: _
Fill in please:
.� APPLICANT'S YOUR NAME/S: /Cf/i9�/� (p
BUSINESS YOUR HOME ADDRESS: i ✓c
14
p 2
E. TELEPHONE # Home Telephone Number
NAME OF CORPORATION: KIJ T PK Al T i Al—
NAME OF NEW.BUSINESS TYPE OF BUSINESS
IS THIS A HOME OCCUPATION? YES NO
ADDRESS OF BUSINESS6alxn +e MAP/PARCEL NUMBER _ " l (Assessing)
When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of
Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth
-Rd. & Main Street) .to make sure you have the appropriate permits and licenses required to legally operate your business in this town. -
1. BUILDING COM SIO ER'S OFF CE
This individu I h's e n.infor e of p mit re uirements that pertain to this type of business MUST COMPLY WITH HOME OCCUPATIC
RULES AND REGULATIONS. FAILURE TO
Au or' d ignat COMPLY MAY RESULT-IN FINES.
MMENT
C 1
2. BOARD OF 4ALTH
This individual has,been informed of the permit requirements that pertain to this type of business,
Authorized Signature
COMMENTS:
3. CONSUMER AFFAIRS (LICENSING AUTHORITY)
This individual has been informed of.the licensing requirements that pertain to this type of business.
Authorized Signature*
COMMENTS:
Town of Barnstable
aF
Regulatory Services
Richard V. Scali,Interim Director
,,,RM.,,BLF� ; Building Division
`0$ Tom Perry,Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
Approved:
Fee:
Permit#: 60
HOME OCCUPATION REGISTRATION
Date:_
Name:_ 14?l C
[[H��"/�/'04.) f2l+��1 D Phone#:_ S/0� 3�7 �9° l
Address_�� �T'/�l a�� l7�fij "� Village: U gh p—/J
Name of Business: Q f / 4-%,4J F f,,r&
Type of Business:_ �� �/V /� �— Map/Lot: — 649
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 extenor 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 ad and agree with the above restrictions for my home occupation I am registe
Applicant: Date• r
Homeoc.doc Rev.103113
O,TMf Ip
TOWN OF BARNSTABLE 2• 0'
Permit No. .
BUILDING DEPARTMENT
TOWN OFFICE BUILDING Cash
67 V•
�,�T+♦ HYANNIS.MASS.02601 Bond
CERTIFICATE OF USE AND OCCUPANCY
Issued to Mr. & Mrs. Frank Jannelli
Address lot #34 23 Hilliards Hayway, West Barnstable
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.
September 28 94
19................. ..................
Buildin .Inspector ;
:PINK:-OEPT: FILE COPY WHITE-FIE` LO'COPY .
Z
— / t YELLOW-.:APPLICANT COPY z_
BUILDINGAas
' TOWN OF BARNSTABLE, MASSACHUSETTS PERMIT
VALIDATION
y=136-049
t Aug
ust t 11
' DATE'..' g 19 1. 86 PERMIT:NO. L-�i a .•�`iJ��•�'.
APPLICANT Richard L. Willis ADDRESS 18- Megansett Drive, P1 outh, IMA 042462 I'
j
(NO.) (STREET) � -(CONY R'S LICENSE)
Build dwelling 1 Single family dwellin NUMBER of
PERMIT,TO— g ( ) STORY r
(TYPE OF IMt-ROVEMENT) N0. (PROPOSED USE) DWELLING UNITS_ �-
lot #34 23 Hilliards Haywav,:West Barnstable ZONING: :
AT..(LOCATION) 0ISTRICT R
' (NO.) - (STREET)
BETWEEN AND
.(CROSS STREET) (CROSS STREET) '
�;: .... LOT
'SUBDIVISION LOT BLOCK SIZE
I BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN.HEIGHT AND SHALL CONFORM IN-CONSTRUCTION
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
REMARKS: Sewage #86-88
•Yam,..
f,. AREA OR PER
BOND
VOLUME 24.50 sq. ft. ESTIMATED COST $ 165,000 FEEMIT
• (CUBIC/SQUARE FEET) ^
OWNER —B9�}�}}p �Le� �sl, � - Mr. & Mrs. Frank Jannelli
i BUILDING DEPT. lh ;0��
•- . 'ADDRESS BY
M:NIMUM OF THREE CALL -- �
INSPECTIONS REOUIREO FOR �APFROVE'CT"YL'A'NJ-ML151 tlt HET AINEU ON' JOB ANU I MIDREQUIRED
...e
CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE RE MBIN G FOR
ALL CONSTRUCTION WORK: ELECTRICAL, PLUMBING AND
FGU7tC,%7;CNS OR eOOT,NGS. MADE. WHERE A. CERTIFICATE OF CCCUPANCY :S RE- '•7EC;i AD'I CAL In:ST AL LAY: S.
z. PRIOR TO COVERING STRUCTURAL QUIREO,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL
MEMBERS(REAOY TO LATH), FINAL INSPECTION HAS BEEN MADE.
3. F!NAL INSPECTION BEFORE
OCCUPANCY.
POST THIS. CARD SO IT IS VISIBLE FROM STREET
BUILDING INSPECTION APPROVALS PLUMBING INSPECTION
APPROVALS ELECTRICAL INSPECTION APPROVALS
2 2 2
HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT
OTHER Z BOARD OF HEALTH
T M '
�ZK A.LL NOT PROCEED UNTIL THE INSPEC- 1 .1ERM,IT 'N!LL BECOmE ;MULL AND VOIDIF CONSTRUCTION INSPECTIONS INDICATED ON THIS CARD CAN BE
TOR HAS APPROVED THE VARIOULIS STAGES OF WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE ARRANGED FOR BY TELEPHONE OR WRITTEN
CONSTRUCTION. I PERMIT iS ISSUED AS NOTED ABOVE. NOTIFICATION.
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JOSF,PH, D. DAL,UZ TELEPHONE: 775.1120
Building Committiontr, EXT. 107
TOWN OF BARNSTABLE
BUILDING INSPECTOR
TOWN OFFICE BUILDING
HYANNIS, MASS. 02601
May 10, 1988
Mr. William J. Driscoll
1 Pheasant Run
Norwell, MA 02061
RE: Farnstab e Building Permit #29767
Lot #34 . 23 Hilliards Hayway, West Barnstable A=136-049
Dear Mr. Driscoll:
Please contact this office immediately re your incomplete dwelling
located at 23 Hilliards Hayway, West Barnstable.
P ce,
Qosep D. D.aLuz
V Building Commissioner
JDD/gr
JO✓F.PH D. DaLuz TELBPHONEt 775.1120
Building Commissioner
EXT. 107
TOWN OF BARNSTABLE
.' BUILDING INSPECTOR
TOWN OFFICE BUILDING
HYANNIS, MASS. 0.2601
May 10, 1988
Mr. William J. Driscoll
1 Pheasant Run
Norwell,. MA 02061
RE: Barnstable Building Permit #29767
Lot #34 23 Hilliards Hayway, West Barnstable A=136-049
Dear Mr. Driscoll:
Please contact this office immediately re your incomplete dwelling
located at 23 Hlliards Hayway, West Barnstable.
P ce,
osep D. DaLuz
Building Commissioner
JDD/gr
BooK3844 FAA 024 1t-Y-1 � r
We, LUCILLE A. NOWICKI and DAVID E. NOWICKI , Husband and' Wife , as
tenants by the entirety, both
of Yarmouth (port) , Barnstable County, Massachusetts,
being munarrled, for consideration paid $ 2 0 , 0 0 0. 0 0
grant to DAVID W. ALLEN and DONALD G. CURRIER, as tenants in common,
of 66 Ploughed Neck Road, East Sandwich, Barnstable County, MA with quitclaim ruttruants
thelandin West Barnstable, Barnstable County, Massachusetts, bounded and
described as follows:
(Description and encumbrances, if any)
BEGINNING at a point on the Southerly sideline of Hilliard' s
Hayway, a private way as shown on a plan hereinafter
mentioned at the intersection of Lots 34 and 35;
THENCE N 870 36 ' 30" E by the sideline of Hilliard' s Hayway
as shown on said plan, One Hundred sixty and 00/100
(160 . 00) feet to a point;
THENCE S 20 23 ' 30" E by Lot 33 , as shown .on said plan, Two
Hundred Twenty and 00/100 (220 . 00) , -feet to a point;
THENCE ' S 870 36 ' 30" W by the Great Marshes; as shown -on said
plan, One Hundred sixty and 00/100 (1,60 . 00) feet to a
point;
THENCE N 20 23 ' 30" W by Lot 35, as shown on said 1?lan, Two cv
Hundred Twenty and 00/100 (220.. 00) .2feet to the original
point of beginning.
Being shown as LOT 34 containing an area of 35 ,200 square feet, more or
less, on a plan entitled "Subdivision Plan of Land in West Barnstable,
Mass. and East Sandwich, Mass. designed for Point Hill Realty Trust,
Petitioners by Crowell & Taylor Corp. Yarmouthport, Mass. Scale: 1" _
100 ' , July 1971 . " said plan being duly recorded in Barnstable County
Registry of Deeds in Plan Book 249 , Page 107 .
The above-described premises are conveyed subject to. and with the benefit
of -all rights, rights-of-way, easements, appurtenances, reservations and
restrictions of record and especially as set forth iri a deed from Robert
W. Bridges, as sole Trustee of ,the Point Hill Realty Trust under Declara-
tion- of Trust, dated February 1 , 1971, and recorded i_n Barnstable County
Registry of Deeds in Book 1512 , Page 33, and amended: in Barnstable County
Registry of Deeds Book 1570 , Page 123. / Said Deed to us was recorded in
Barnstable County Registry of Deeds in Book . 1829 , -Pa:ge 263 .
hand and seal this................... 9
�.ihtPss. .....our..... s s Z ../...........day of.......August,..... . ......................1 83 .
................................................... ........................... 1jC'I�I,�"1)-
.... '11:
................................................................................. `4'..DAVID.:E.:...I OWICKI,. .SelYer. ...........
i .................................................................................. .................................................................................
U 1M (6MWn0=rn1t4 of 1285m4tts m
.BARNS. 'A .......ss. .........Augus.t....................7.�.;ry....................19 83 .
Then personally appeared the above named.....LUC.ILLE...A„...N.OWI—C91...and...DAV-1, )..,E.....N0W1CKI
................................................................:........................................................................................................................
and acknowledged the foregoing instrument to be....their„free act and deed, before me,
_ Notary Public—Justice of the Peace
1 _ . My Commission Expires :
.� ..1. : y Conumssion-expires................... ........................ 19...1...
AUG 26 83
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May 3 , 1988
Re : Lot 34 Hilliard' s Hayway
Point Hill , W. Barnstable
Owner: William Driscoll
Dear Mr . Martin,
Pursuant to our conversation of 4/28/88, the undersigned abutters
hereby request the Department of Building Inspectors to contact Mr .
Driscoll insisting that completion of dwelling begin immediately
since no construction has been forthcoming in an 18 month period,
which, as I understand, is in direct violation of the building
code .
Also, as discussed, please contact the E.P.A. and the Board of
Health describing the extremely unsightly condition of the lot,
including the. accumulation of waste , discarded materials , and
possible erosion, since the lot has been devoid of landscaping for
three years . Finally, the "attractive nuisance" aspect could pose
a potential legal problem not only for the owner but, conceivably,
the town of Barnstable as well .
Please contact us at your earliest convenience if additional infor-
mation is necessary. We appreciate your attention to this problem.
Sincerely,
lQ
raig Chamberlain
V? illiard' s Road C l
W. Barnstable 362-4757
Lowe 1 E. Brower
148 Point Hill Road
W. Barnstable 362-5258
William Doherty
124 Point Hill Road
W. Barnstable . 362-9236
Asfpsor's4ffice (1st floor): �9�P `
p,� � � THE T
Assessor's ma orid loi n'bmber .... 36..... O O.I.K..1......
SEPTIC SYSTW,1 UST
Board of Health (3rd floor): I INSTALLED IN COMPLIAN
Sewage Permit number .:.. .....l.!4:........ =
WITH TITLE 5 9e NAB LEA
Engineering Department (3rd floor): , 163q. 00
�n ENVIRONMENTAL CODE A
House number. .........................., ...................:.:.........:...;. o�aYa
APPLICATIONS PROCESSED 8:3V9:30 A.M. and 1:00-2:00 P.M. only. TOWN (REGULATIONS
TOWN_ OF - BARNSTABLE
BUILDING INSPECTOR
APPLICATION FOR PERMIT TO ................. .............D..........:....t.... v..........0 ! ' '..................................
TYPE OF CONSTRUCTION ......... ® .D...../...::! ......... LG,//1..�................................
I,
....9-4............
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location ..../`-. ..........�...
.........
/ //9�,>5....... `. 1....:.:1�`..... �/�/l ..f ��..
Proposed Use .................... ...................5I.J.I Q1.. ' f/`f.)Yl L t .............................
Zoning District ..... ...................................................Fire District ...... .......���e.�m.Dat................................
Name of Owner ../3PN..4�.J! ... 1��.� ..T/�... dclress _1J .1112= 141Sx.. .T..t9.J.rC'...... �5
.......�/.n, 5
� v 7-/-IL
Name of Builder RP !VIA.R.P...47.......A f4.4..Si........Address
Name of Architect .............Address L/`�A�.�r....1.rnl�.S.�.
Number of Rooms ..........( ..)...........................................Foundation ... 9D....C�'�����
Exterior ..CAH BO.ARD...........................................Roofing ............f• .'.. .>..........4U��.L7.... .........................
Floors 0® ......... ......C /� ��..(...............Interior ............... lagz�� � L ......
. - ......Plumbin Z /Z /¢THS
Heating ...... � g
11
,Fireplace ............�z.l.......................I...................... Approximate Cost ........... .(P—D�J...U.d.0................. ..............
I j7/
definitive Plan Approved by Planning Board Area �...........
"Diagram of Lot and building with Dimensions Fee ............ ............. Z
SUBJECT TO PROVAL OF BOARD OF HEALTH 2 /vQ
1
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I e � 0
\70,k,
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Name ....�.'. . .. . .. .......� ! / .............
Construction Supervisor's License A� .`. ' <o .........
tVY-�- �
29 1j Story
eNlo! ................ Permit for ....................................
Single Family Dwelling
..........................................................................
Location ..... ......Z3..Atlji.q.Kds...H.a.vwav
West Barnstable
......................................................................I........
Owner ....Bondik Realty Trust
........................... ..................................
Type of Construction ...Frame.............................
................................................................................
Plot ............................ Lot ................................
Permit Grante ........A-.utDu.s.t...1..I, ..19 86
Date a .. . .............. . ......1
99
Date Completed ........ . .. ... .... . .............10
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i--tr 40:3 %.;0
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TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
d �A C/
' Map i Z f', Parcel Permit# b 7
Health Division `I'�BL Date Issued
Conservation Division —�r�l Is 3 Application Fee
Tax Collector Permit Fee -
Treasurer tilt ik!fSt r,
Planning Dept.
Date Definitive Plan Approved by Planning Board EXISTING SEPTIC SYSTEM
Historic-OKH Preservation/Hyannis LIMITED TO_�'S OF BEDROOMS
Project Street Address *Z 5lov 1
Village gnww
Owner Address 4d 7-3 A"111--,-d1S �w
Telephone ?3 3
Permit Request J&0� W ;N
Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
N11*Project Valuation OI° Construction Type
Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation.
Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units)
Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑ No
d
Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft)
Number of Baths: Full: existing new Half: existing new
Number of Bedrooms: existing new
Total Room Count(not including baths): existing new First Floor Room Count
Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other
Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No
Detached garage:❑existing ❑new size Pool: ❑existing ❑new size Barn:❑existing ❑new size
Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other:
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial ❑Yes ❑No If yes,site plan review#
Current Use . Proposed Use
BUILDER INFORMATION
Name _ _ sS Telephone Number -/ZO— vi 3 S�
Address 7 License#
Home Improvement Contractor# 13 Yyy 3
Worker's Compensation# -W( .r— 3 ]S —,3y0 S yZDiy
ALL CONSTRUCTION DEBRI R LILTING FROM THIS PROJECT WILL BETAKEN TO
� Al
I
SIGNATURE DATE
FOR OFFICIAL USE ONLY
o
PERMIT NO.
3` DATE ISSUED
MAP/PARCEL NO.
ADDRESS V ILLAGE ,
OWNER
DATE OF INSPECTION: !
FOUNDATION
FRAME
INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL i
' PLUMBING: ROUGH. FINAL
GAS: ROUGH FINAL
FINAL BUILDING
DAT&CLOSED OUT
ASSOCIATION PLAN NO.
r
t
The Commonwealth of Massachusetts
Q — Department of Industrial Accidents
j 600 Yl`ashin;ton Street
Boston,Mass. 02111
Workers' Com ensation Insurance Affidavit General Businesses / /
^t4Yt .
ame•
address:
state: C( uy: U�l0 vhona#
city
work site location rhll address
[] I am a sole proprietor and have no one Business Type: Retail❑Restaurant/Bar/Eating Establishment
working le any capacity. ❑OfJce[]Sales(including Real Estate,Antos etc,)
I am an em to er with etn ] es full& or,time. ❑Other14
/ /� �%%%
// /// /////%//ill ri//%// %/S%c��m��5////n/f/I�/y%//gip//Y// working on this job.
I am an employer providing-work
�: .,.;'r..• ' }';r%'`�;;�.• •1' Jar ; .•. '-'�•r•
co'm an name:
•.•• .a _'iC ij• '•.4. •A,,•i•.5::tj:�t^.:�.' ..Y js.. .�.r 'r""'''1.' �' '
bone#•'
City: r y,
I am a sole proprietor and have hired the independent contractors listed below who have the following workers' .
coIDpensat on polices:
oddressd %
"r "1 �"' ` rr r h
et �S. :i.f:rt:,
�:•4j•t: ...'',,' '•Y+•,1.•`'•)•'r't•''". .ii.,r•.7r`: :•... ,�' •,•' I cv,# •'•�'"J' ••Y'1'•i
insitrenceco • • i.i../:% ///� D/ /// /l/// / /// ///// // ;•
NOUN OXWO OR W4
COtn^Hn.•pant@ t': _-y:i - •.r: ,'r .. - . .
address:
t, hone#� ' ''' .%`'' ''-
impositionOWNp to Sl OO.O0 and/or.
Failure to secure coverage as required under S�in �form STOP'R+ORI{O ER aad s fine ofi$10 00 eday against ' fund erstaud.that @
one years'imprisonment es well as ctvilp
copy of this statement may be forerarded to the Office of Investigations of the'DIAfor coverage verification.
I do hereby ce ify under the pains and penalties of pert ury that the Inform ation provided above is true and correeG
Date
Signature
phone#
Print name _
. •. of3iei2]we aaly`
do not write in this area to be completed by city or town official
permit/Ileense� [)Building Department
' city or town: Qliceasing Board❑Selectmen's.Office
❑cheek if immediate response is required ❑$ealthDepartment ,
pboneR; ❑Other
contaetperson
,s
(revbedSCyL2 3) Q ^
. ._._ ._...--...... . � __...►,.... - ...:. .._.._.+.......r �..�....._-......ate... _. .�.._....�....r...w�.�.. � ..,.� ..-•.� �-__ _.._..�_-«.._._
i
i
Information and Instructions-
Massachusetts General Laws chapter�152 section 25 requires an employers to provide workers' compensation for their
employees. As quoted from the"law", 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 defused as an individual,PP�artnershi 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 section 25 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,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.
.,.n�..iiaiiiadi/��i��////l�r//�/Y��////U/%�////%�//%�����/.yiY/////��/////j�������/a��������1////.CSC%�,eti%���i.���i,�L.%/////ii%y�i%%/.y��j�/�/��%����/.//'//i%%��/ ••.....
Applicants
Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation Please
supply company name, address and phone numbers along with a certificate of insurance as all affidavits may be submitted
to the Departraent of rndustrial Accidents for confirmation of insurance coverage. .Also be sure to sign and date the
d to the city or town that the application for the permit or license is being
affidavit. The affidavit should be returne
requested, not the Department of Industrial Accidents. Should you have any questions regarding the-"law"or if you are
required to obtain a workers' cornpensationpolicy,please call the Deparment at the number listedbelow.
City or Towns
Pleasebe sure.that the affidavit is complete and printed legibly. The Departrnent bas provided a space at the bottom of tine .
affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please
er which wdl Ve used as a reference number. The affidavits maybe returned to
be sure to fill in the perrrnt/license numb
the Department by mail or FAX unless other arrarigernents havebeen made.
The Office of Investigations would hlce to thank y'au in.advance for you cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address,telephone and fax number
The Commonwealth Of Massachusetts
Department of Industrial Accidents
no of IavesfiM UOns
600 Washington Street
' Boston,Ma 02111
fax#: (617)727-7749
phone#: (617)727-4900 ext.406
tr+e Town of Barnstable
F try .
N
Regulatory Services
! BARNSrABLE, Thomas F.Geiler,Director
9�A 039. p10� Building Division
FFD MA'S
Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
Office: 508-862-4038 Fax: 508-790-6230
Permit no.
Date
AFFIDAVIT
HOME IMPROVEMENT CONTRACTOR LAW
SUPPLEMENT TO PERMIT APPLICATION
MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion,
improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied
building containing at least one but not more than four dwelling units or to structures.which are adjacent to
such residence or building be done by registered contractors,with certain exceptions, along with other
requirements.
Type of Work Estimated Cost
/�) Ai ln c Zzi Address of Work:.-, �1�1/.l Val�1Y ��7 b �
Z-
Owner's Name:
Date of Application: l, 5 A a
I hereby certify that:
Registration is not required for the following reason(s):
❑Work excluded by law
❑Job Under$1,000
❑Building not owner-occupied
[]Owner pulling own permit
Notice is hereby given that:
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED
CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE
ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDERMGL c.142A.
SIGNED UNDER PENALTIES OF PERJURY
I hereby-apply for a permit as the agent of the owner:
Date Contractor Name Registration No.
OR \
Date Owner' am
Qlorms:homeaffidav
RESIDENTIAL BUILDING PERMIT FEES
APPLICATION FEE .:
New Buildings $100.00
Residential Addition $50.00
Alterations/Renovations $50.00 f' �C o 0 lj
Building Permit Amendment $25.00
FEE VALUE WORKSHEET
NEW LIVING SPACE
square feet x$96/sq.foot= x.0041=
plus from below(if applicable)
ALTERATIONS/RENOVATIONS OF EXISTING SPACE
square feet x$64/sq.foot= 0 / 3, x.0041=
plus from below(if applicable)
GARAGES(attached&detached)
square feet x$32/sq.ft.= x.0041=
ACCESSORY STRUCTURE>120.sq.ft.
>120 sf-500 sf $35.00
>500 sf-750 sf 50.00
>750 sf- 1000 sf 75.00
>1000 sf- 1500 sf 100.00
>1500 sf-Same as new building permit:
square feet x$96/sq.foot= x.0041=
STAND ALONE PERNUTS
Open Porch x$30.00=
. (number)
Deck x$30.00=
(number)
Fireplace/Chimney x$25.00=
(number)
Inground Swimming Pool $60.00
Above Ground Swimming Pool $25.00
Relocation/Moving $150.00
(plus above if applicable) !,
Permit Fee O S
Projcost
Rev:063004
S&Y
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z,
*t.K' 4�1iae 4 2 IiCAX'`kr lip
..•aid 1 rNN1r'i. .^Nc.Y+s`�K
. � d r' �:� +, C✓�ie go7nmzaiuueaal�i .. ��•.s ��;` ��
%gul'attons and Standairl� �
fit® MPROV NT CONTRACTOR d i*
tte tca>on_t
ri
M1� C n 1 , 9/2005 •
3 iability Corporation .
ENT ERPPJSES
irk
�� k
KERTH. GUF_MORE�,�' e!r
28 Ci6BQEfV
WiP6t6iSTQ�FS l4lILL5�lV)i4 02648 ' _
;.:... Administrator. ,.
1
y,;c 9 r
Town of Barnstable
_ Regulatory Services
A` Building Division
Tom Perry, BuRdiag Commissioner
200min Sfttt iiyam L%MA 02MI
Office: 50&862-40 8 Fax: 508 790-MO
Property Owner Must
Complete and Sign This Section
If Using A Builder
I, /0�i�'Y 8�'�/ �/ y as Owner of the subject Property
hereby authorize CCL�to act on my behalf,
in aIl matters relatme to work authorized by this budding permit apphcation for
(Address of Job)
t
Sigru ure of Own V Date
A&J'a L
Print Dame
Q7XMkMS:0WMMPERMMSMN
Application to
®1b Ring'# 3�tfgbb p Regional 3�Iotorit Ootritt Committee
In the Town of Barnstable ID
E
SEP 2 3 2004
CERTIFICATE OF APPROPRIATENESS
�n�,,i+!Qr BA t�STf',X_E
Application is hereby made,with four complete sets, 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: -' n
1. Exterior building construction: ❑ New ❑ Addition Alteration
uildi House ❑ Garage ❑ Commercial 0 Other iV 47Vf "
Indicate type of b 9 �
2. Exterior Painting:
3. Signs or Billboards. ❑ New Sign ❑ Existing Sign ❑ Repainting Existing Sign r— `P
4. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Other M 0
TYPE OR PRINT LEGIBLY: DATE !' .Z 3 •G /
ADDRESS OF PROPOSED WORK X Z-S 9.-114w.-I. /�^'I^�'lT ASSESSOR'S MAP NO._ J '3 (P
OWNER_C���.-r /�r��� B��`�/svc/ _ _ ASSESSOR'S LOT NO. gi2Vilf �I
HOME ADDRESS /✓fit L E P H 0 N E N0.&og .?&2E40 Y
PULL NAMES AND ADDRESSES OF ABUTTING OWNERS, including those of adjacent property owners across Thy
Public.street or way. (Attach additional sheet if necessary.) C'
r—
M
AGENT OR CONTRACTOR ��%/ �i �(�i! i _�A2•'scS�46491JONE NO. !� 36 2 -O Co S(
ADDRESS 70. BOX /'] ce,h fcrv,//c
DESCRIPTION OF PROPOSED WORK: Give particulars of work to be done, including materials to be used. Please
include locations of proposed signs. /
7Z,"o vc-
e- . Av
Signed
Owner-Contractor-Agent.
For Committee Use Only
This Certificate is hereby Date /(Ilm��/
' Lroved/pp ied
Committee Members' Sign
r
Town of Barnstable
` Old King's Highway Historic District Committee
SPEC SHEET
FOUNDATION
SIDING TYPE _____ COLOR
i
COLOR
CHIMNEY TYPE
i F--^'rr-
-15D
7 e
ROOF MATERIAL � COLOR
SEP 2 3 2004 ?
a Ilc 5
PITCH 1i fill
I„ HISS r'
r�
3 � �z x yo -
WINDOWS yfti�/ A"//1 07V COLOR W4, Y(-4— SIZE 7 Z
i
TRIM COLOR W� —
i
DOORS COLORS
SHUTTERS - COLORS
GUTTERS COLORS
DECKS MATERIALS
GARAGE DOORS COLORS '
SKYLIGHTS SIZE COLORS
SIGNS COLORS
FENCE COLOR .
NOTES: Pill out completely, including measurements and materials/colors to be used. Four copies of this
form are required for submittal of an application, along with Four copies of the plot plan, landscape
plan and elevation plans, when applicable.
RDF.CSHT
-
{
a
S E P 2 2004
_ .......
...... T N OF BARNSTABLE
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HISTORIC PRESERVATION
J. Ive
`� _ �.hT. rat v 11.:-0�►S _. . .... .. . -
EX
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-
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west- 8�,..�rs�.�d/_t_ . . - ....... ......�. .... .. . .... _. .
oFtt�,at,
Town of Barnstable
"o Regulatory Services
BAMSTABLS. : Thomas F.Geiler,Director
MASS,
039• ,0� Building Division
AtFo �a Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
` Please Print
DATE:
JOB LOCATION: .! /// S C/_2 r�
number/ stre village
"HOMEOWNER": �` Z 7
name ome phone# work phone#
CURRENT MAILING ADDRESS:
city/town state zip code
The current exemption for"homeowners"was extended to include owner-occoied 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.
,/-/""�,/, A
Si ature of Homeo
Approval of Building Official
Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the
State Building Code Section 127.0 Construction Control. .
HOMEOWNER'S EXEMPTION
The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions
of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such
work,that such Homeowner shall act as supervisor."
Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,
Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly
when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed
Supervisor. The homeowner acting as Supervisor is ultimately responsible.
To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,
that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by
several towns. You may care t amend and adopt such a form/certification for use in your community.
Q:forms:homeexempt
f
P Town of Barnstable *Permit# ODCd10P
Expires 6 monlhs from issue date
]regulatory Services Fee
Thomas F.Geiler;Director
Building Division U
Tom Perry,CBO, Building Commissioner /
P� DNS g
N�F 8P 200 Main Street,Hyannis,MA 02601 �
www.townbarnstable.ma.us
OeN 508-862-4038 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
Not Valid without Red X-Press Imprint
Map/parcel Number 1 3Ca 0 /
Property Address CO Nt llIArdS HQy Y esi &rN S4-a-Ve,
ov
[Residential Value of Work Cot 010W- Minimum fee of$25.00 for work under$6000.00
Owner's Name&'Address tk/%s�er A (QS/
Contractor's Namelldmv Telephone Number-6-0 P OOY/7
Home Improvement Contractor License#(if applicable)
Construction Supervisor's License#(if applicable)
2w/orkman's Compensation Insurance
Check one:
❑ I am a sole proprietor
21 am the Homeowner
❑ I have Worker's Compensation Insurance
Insurance Company Name _CQ/A&M Q-r Ce ,1 NS j ,j Le A/VA4 01 1
Workman's Comp.Policy# W C. a 7 9 t!S°(v 9
Copy of Insurance Compliance Certificate must be on file.
Permit Request(check box)
[!rRe-roof(stripping old shingles) All construction debris will be taken to WU-( .,lU✓�g k
❑Re-roof(not stripping. Going over existing layers of roof)
❑ Re-side
❑ Replacement Windows. 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.
H - e Improvement Contractors License is required.
SIGNATURE:
Q:Forms:expmtrg
Revise071405
e ommonwea oiwia—ssactrusens
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,NIA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plaalnbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): (Qcc r-s CONS}v oN Q0.��t}iaq
Address: J rA.' f w i (a If
City/State/Zip: DgNpcs AAa 09660 Phone#:-,SO Y- 3`l y- 711
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 6
El New construction
employees(full and/or part-time). f have hired the sub-cofactors
2.❑ I am a sole proprietor or partner- listed on the attached sheet 1 7. ❑ Remodeling
ship and have no employees These sub-contractors have 8. ❑ Demolition
working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition
[No workers' comp. insurance 5. ❑ We are a corporation and its
quired.] officers have exercised their 10.❑ Electrical repairs or additions
r
3. I an;a homeowner doiWg all work right of exemption per MGL 11.❑ Plumbing repairs or additions
myself. (No workers' comp. c. 152, §1(4),and we have no 12.❑ oof repairs
insurance required.] t . employees. [No workers' 13. Other NP.t� 2Da�
comp.insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy infomiation:
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 cbeck this box must attached an additional sheet showing the name of the sub-contractors and their workers'cornp.policy information.
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. #: u)C, a'7 9 14 Expiration Date: O^z
Job Site Address: d9 M11liaxlS HaYway City/State/Zip: Wes} Ow u%�l , Ak— 0a66?
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 un er th pains andpenalties ofperjury that the information provided above is true and correcr.
Si. afore: Date: -FZ-9
Phone#: 0-"
%Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/License#
Issuing Authority (circle one):
1.Board of Health 2.Building Depai tmeut 3.City/Town Clerk a.Electrical inspector 5. Plumbing Inspector jl
6. Other
Contact Person: Phone#:
3
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their emplcqees.�_ Y
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(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
regi-drements 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-contractors)name(s),address(es)and phone number(s)along with their certificate(s) of
insurance. Limited Liability Companies q—LC)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 thata 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 do not hesitate to give us a call.
The Department's address, telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE
Fax + 617-727-7749
Revised 5-26-05
wwtiv.mass.gov/cia
*1Mf>, TOWN OF BARNSTABLE 29767
� Permit No. ...... .........
BUILDING DEPARTMENT
I ""'r I TOWN OFFICE BUILDING Cash
aw•
HYANNIS.MASS.02601 Bond ................
CERTIFICATE OF USE AND OCCUPANCY
Issued to Mr. & Mrs. Frank Jannelli
Address lot #34 23 Hilliards Hayway, West Barnstable
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.
September 28 94 LG �e%:.•
J
.. .... P.. . .. ... ...... . ..... 19................. ..............`.............................
BuildinVinspector ;
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