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HomeMy WebLinkAbout0028 HOLWAY DRIVE o e a e rsaWs.erErr.:.:�W�v.�,ca.:siea���-:.�an�.y.a'.c.:a.n.�.t.,,.y -- UPC 12543 ` No.5. R.� HASTINGS, UN r PINE I Town of Barnstable *Permit ° Expires 6 urontds frous issue date Regulatory Services Fee * BARNSTABLE, " v "'ASS' $ Thomas F. Geiler,Director � �D� � � � s�.r�.��. � 5.6 � Building Division //�� Tom Perry,CBO, Building CommissionaSC 2 200 Main Street, Hyannis,M1A 260 1' ���� www.town.bamstable.ma.usf��' i, Office: 508-862-4038 L'` Fax�508-790-6230 EXPRESS PERMIT APPLICATION' - RESIDENTIAL ONLY -7 Not Valid without Red X--Press Imprint Map/parcel Number j Property Address 'Residential Value of Work Minimum fee of$35.00 for work under$6000.00 ' Owner's Name&Address S 0_� Contractor's Namez 1`� �'�� 5 ��=vt -�t/L� Telephone Number `) c-) Home Improvement Contractor License#(if applicable) I 1 Construction Supervisor's License#(if applicable) 0 1 J C j 4!tWorkman's Compensation Insurance Check one: ❑ I.'am a sole proprietor ❑ I am the Homeowner have Worker's Compensation Insurance Insurance Company Name _ _(f Workman's Comp. Policy# � 15 t 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 ❑ Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side '`� #of doors Replacement Windows/doors/sliders.U-Value s 3 V (maximum.35)#of window... *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 ,,,.-r quired. SIGNATURE: C:\Useis\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\DDV87AAZ\EXPRESS.doc Revised 072110 r of E Town of Barnstable. _, Regulatory Services BAMSTASM Thomas F.Geller,Director A,�.- Building Division - ----..---- Tom.Perry--Building Commissioner 200 Main Street Hyannis, MA 02601 www.town.bamstable •ma.us Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using ABuilder I. Marilyn Calderwood , as Owner of the subject property hereby authorize E. B. Norris & Son Inc to act on my behalf, in all matters relative to work authorized bythis building permit application for: . 28 Holway Drive, W. Barn.stable, MA (Address of o Signature 6f Owner Date I i r Massachusetts Department of Public Safety ! Board of Building Regulations and Standards Vv License: CS-015851 '-"°"> Construction Supervisor CRAIG N ASHWORTH* t K 138 OST W BARNSTA6LE�- '. OSTERVILLE MA 026 :5 k Expiration: Commissioner 09128/2017 �9?� �d�����Z�2•GI��CY/G�fL rZ• CMG��;1�J•C2'�Cl'Z�GG;1 Pi Office of Consumer Affairs and B siness Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 102014 Type: Private Corporation Expiration: 6/30/2018 Tr# 288022 ERNEST B. NORRIS & SON INC Craig Ashworth 138 Osterville W. Barnstable rd. =- Osterville, MA 02655 -- Update Address and return card.Mark reason for change. Address Renewal Employment Lost Card sCA 1 0 2OM-05/11 nur.crnr/rue 'B'/,,,,..//(n-/riJ:;lation License or registration valid for individual use only �� Office of Consumer r�ffalrs�c Bus�Ffless l�egulat�on g y HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: '102014 Type: Office of Consumer Affairs and Business Regulation q _ Expiration:. 6%30/2018 Private Corporation 10 Park Piaza-Suite 5170 Boston,MA 02116 ERN T B. NOR RIS&'S:C4*1'KC 1.:.. Craig Ashworth - 138 0slervifle W. Barnstable rd` Osterville, MA 02655 Undersecretary 44Not validwithout signat re . t �`}tO 'a»rrrarrrraail�z' a,�'1�C'��t�aoftlP�eg ,Delrr""ti a�"xrzus�rr� sp���� ro BOOM UA 02111 Workers' COMPOSA00a bMUCO A dviho �ra��:����►�,�xt«a�a � ���,�lgl�1������ I49' xta(i a el�rq nr dnattndivlckw4l)g U3 Norris&Mtn No. �Ids'�s�t 138 c7,9tol�rille�V', � etab�a 1�oad . � � Osterville,Nth Q2&� alone 165 Ara you 44 amplaytar?Check the appropl#sto bow Tea u>���t�t{r�uir�d); amploy►ar w►tth—a. I Um a smog amc wtor ad 1 mplQy"a w and/or pp�* hava hired to m64odt wo% d, a Now Cow ma ift X am a sofa gmpciotor or part a, Wod'aa tha at abed-Obw 7, M Remd i O SNP ad havo ma O plargug. The,"Imb-Conhftil ham 8� �1�amoild+aa n 6dchag ibr rno to ony capacity, atdp10yam AM bAIVIDI ►or ' LNQ watt='Qomp,wattuaa cam,itmmo%t p+ i 1dt uw�kd z�gairad:] g, ( We a corpondm a2d W 214waal rapes or au m 3.[] 1 am a affiam myt MOMIM dI& 1 pl ct� k�dx dddaSi®rte myself.C1a WO&M°aaMp, ri t ipeu vda gar ML 6�, +a�lspa WOaean;cm ra trail t a� 1JZ 11(4),end,wo ha,vo do ; M a h�sm ar ra= a a�pl�yaas,�Q w Qom' Z�:Q btf►q "cA tty F arm t1 t,yE�aYr�t bait{�i fntuaa a1aQ�1 aug tie W4=MOW aliwa� �i�t v+q 'S4u a�Ilay i�ia�ttaM 1 ', kank9tYypaa►tm tuhm aul lVt tb3a aP�tdivl�farltaattaa t�r era dcain��f4 vcar6x { cn t► ap�ld�apigfruat m-AXNAAOU9 A low 04AVII pnQlgui�i�uncle 00asftiovt thd duh IW box mut arlmbad apt� a!slur vhp �du u m of�a q�q t��I RA d� ka �ax RpR tQsa Wa elms 1t�Vd aea�siayOIa„ l�'EJ�a dab aa�cetaata�a lavalayraer�,Ihaq antnp rAabr yreryfcata°4�snt,pel{ag atlatlt�� an an Etrrsploy�rO'aart INP'avi#?1,+rwgrt �aarm�asa�esoMgre bWl&rrq�re�br m,�+c�nptir�atsa� l��tow!<C�Oap�rft'sy�,ta- i-Ol stYm rf!7t`YaA1 k��at�a�►�ar�a� °SL11 e MAO A+¢cpyr off'i'hd Warhara compeos og palms doaiuMon page(showu9ds the parlay nlamherr=mdk*a date. � Oq*cd=du$coft2SA ofMOL a 152 oaa l«ad to so i as 40m off' DOS."of a �►a ttp t��t,�rX3.00�d/a�apaMye�r' �Qttma�,as w�1A tR,�aivtt p�ai�aa isa#ho��raP a�"COP��'t��Si~'C��1�y1,add a�a , of uP r Q.Q#a +'�+g C tt�trial r. 13a advised dmt a copy d this Ontamett maybe femordw to go OTNO gf J�aveseptfoml of tho AlA fbr insmiaca l eta hell?0 dr Af prom 1 vp , priWdsd aba'# a Ord aarrara, 6f}A���-1155 1 . W'' .wwvswwa,w,n ¢7 r�r ' o orr(t. Do not 110a In dh mmd7 dd he cgrrrptotad by ORY a,r&M&Offlel" CEty►'or"g"a' 9 11valfis A khor ty teirele acre); 1,Hoed a(004th 1.lauomam DgOert*mnt4 &CRIMma Crane da zjgo�Haaj>i�a aecto� ,PttG atxt Ix+apm 6, f I • Client#:646400 2NORRISEB ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 08/24/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder In lieu of such endorse ment(s)., PRODUCER COMMA Dowling 8 O' Neil Insurance Ag FAX nrCDNN Ext;508 775.1620 A/c Ne; 5087781218 973 lyannough Rd,PO Box 1990 E-MAIL DORESS• Hyannis, MA 02601 INSURERS AFFORDING COVERAGE NAICA 508 775-1620 INSURER A:Employers Mutual Casualty Comps INSURED INSURER B: E.B.Norris&Son,Inc. 138 Osterville-West Barnstable Road INSURER C: Osterville,MA 02655 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, LT RR TYPE OF INSURANCE ADD SUB POLICY EFF POLICY EXP S WVD POLICY NUMBER M/DON MM/DDIYYY LIMITS A GENERAL LIABILITY 5D46954 05/03/2016 05/03/2017 pEACMH OEC7CURRENCE $1,000 000 X COMMERGAL GENERAL LIABILITY PREMISES Ea occu ence $1 OO OOO CLAIMS MADE a OCCUR MED EXP one arson) $5,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000 000 GENL AGGREGATE LIMIT APPLIES PER. PRODUCTS-COMP/OPAGG s2,000,000 POLICY P CT LOC $ AUTOMOBILE LIABILITY COMBINED LI SINGLE MIT Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per $ AUTOS AUTOS { ) NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ $ UMBRELLA LIAR HOCCUR EACH OCCURRENCE $ EXCESS GAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ A WORKERS COMPENSATION AND EMPLOYERS'LIABILITY 5H46954 05/03/2016 05103/201 X AND STATU- OTH- ANY PROPRIETOR/PARTNERIEXECUTIVE Y I N E.L.EACH ACCIDENT $500 OOO OFFICERIMEMBEREXCLUDED9 FN NIA (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $500 OOO If yes,describe under DESCRIPTION OF OPERATIONS below. E.L.DISEASE-POLICY LIMIT $500 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived, or extended the coverage provided by the policy provisions. CERTIFICATE HOLDER CANCELLATION Town of Barnstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE mow- ©1988.2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S175842/M175841 LS1 I . u°o3313 Town of Barnstable *Permit -� aa3 Expires 6 months Om issue date ° S PERMIT Regulatory Services Fee 2 • snaxsrZLFr v�pr A�$ 2�15 Thomas F.Geiler,Director 1659. Building Division 0 Tom Perry,CBO, Building Commissioner TOWN OF BARNSTABLE 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERNUT APPLICATION - RESIDENTUL ONLY rJ� 0-2v Not Valid without Red X-Press Imprint � Map/parcel Number �`� ° Property.Address a o L W q. �L `I•� &Pt jLa.LSTR 01 Cog_ El-Residential Value of Work a 0 S J Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address M A 2 j,.J N Contractor's Name ADT, LLC Telephone Number 410 University Avenue Home Improvement Contractor License#(if appftt Construction Supervisor's License#(if applicable) C—nl-- ❑workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner [2,I have Worker's Compensation Insurance Insurance Company Name �- �C.Ik �1 M E iL Q GA a-i a w�-/�e.bG (!-a Workman's Comp.Policy# W C Sa 9 S Y 9 g 0 -- 101, Ils-, 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 ❑Re-roof(hurricane nailed)(not stripping. Going over existing 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 compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A_co.py of-the Home Improvement Contr rs License&Construction Supervisors License is require d/ SIGNATURE: Q:\WPFl1M\FORMS\building permit it oe Revised 053012 t ' r - , �.,r 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: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section if UT I as Owner of the subject property hereby authorize A 61 to act on my behalf, in all matters relative to work authorized by this building permit application for. (A ess of Job) Signature of Owner Date print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on,the reverse side. Q:IWPFILESIFORMSIbudding Permit fomulEXpRESS.doe • Dmrieivi A7A7 1 f) - The Commonwealth of Massachusetts Department oflndustrial Accidents Office of Investigations ' 600 Washington Street Boston, MA 02111 5� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organizati��ndi idull, v �..LL Address: 410 University Avenue Westwood, MA Q BYp ! City/State/Zip: Phone #: Are you an employer? Check the appropriate box: Type of project(required): 1.E&I am a employer with_ S� 4. ❑ I am a general contractor and I 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. 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 required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing 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.❑ Roof repairs insurance required.] t employees. [No workers' 13.® Other_Ai.r,t�.►,� 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 hue 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 their workers'comp.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: -..U-IL-T-C'µ A rn j�-ul4� 't t�s�-�A.R+.b c is Go w►Q� Policy#or Self-ins.Lic. #: V`�G 5 0�5� 9% O ff. irati at 1°�! t 1.5 Job Site Address: g8 HoLvJ6}, Pn /l,• City/State/Zip: W, RAn­S[.t_v (-t"/3(. 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�*;uander the pains penal ' perjury that the information provided above is true and correct Signatur . Date: i o ►l!q' - Phone#: Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1. Board,of Health 2.Building Department 3. City/Town Clerk 4. Electrical Inspector 5.Plumbing InspectoJa.. 6. Other Contact Person: Phone#: CERTIFICATE OF LIABILITY INSURANCE °09/0504°""`' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE-A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsemengs). PRODUCER CONTACT Marsh USA Inc. NAME: PHONE FAX 1560 Sawgrass Corporate Pkwy,Suite 300 a.Ell, ('C.No): _ Sunrise,FL 33323 E-MAIL _ - ADDRESS: INSURERS AFFORDING COVERAGE ti —NA1C 9 048953-ADT-GAW-13-14 INSURER A:Zurich American Insurance Company 16535 INSURED ADT,LLC INSURERS:American Zurich Insurance Company 40142 ADT Security Services INSURER C: 1501 YamatO Rd. INSURER D: Boca Raton,FL 33431 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: ATL-003287232-03 REVISION NUMBER:0 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED-NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE-INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, _ EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. �INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR JMa - POLICY NUMBER MM/DD MM/DD/YYYY LIMITS A GENERAL LIABILITY GLO 5095899 02 10/012014 10/01/2015 EACH OCCURRENCE $ 2,000,000 X COMMERCIAL GENERAL LIABILITY PREM SES Ea occurrence) $ 1,000,000 CLAIMS-MADE M OCCUR MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 4,000,000 X POLICY PRO- LOC $ B AUTOMOBILE LIABILITY BAP 5095900 02 10/01/2014 10/012015 COMBINED SINGLE LIMIT(Ea accident) $ 110001000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS. HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA I U>.B OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ B WORKERS COMPENSATION WC 5095897 02(ADS) 10/012014 10/01/2015 X I WC STATU- OTH- AND EMPLOYERS'LIABILITY A Y/N WC 5095898 02 ( )MA,WI 10101/2014 10/012015 2,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED7 NIA (Mandatory ih NH) E.L.DISEASE-EA EMPLOYE $ 2,000,000 If yes,describe under 2,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION ADT LLC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Attn:TOM LEE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 410 UNIVERSITY AVENUE ACCORDANCE WITH THE POLICY PROVISIONS. WESTWOOD,MA 02090 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukhedee -3"Lu+.s .a to►fie ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD ti• i • a'v,i:,.COMMON.WE'AL�7H.OF:.M<;;::<:. .....::.::. .:::: ASSACH.U$ .. I�� .. `E.l"E CTR h.C:I•:A•N:S •"_ • .... ?fSSUSE . ; GN Commonwealth of MassachusettsTH AS i 1` a 9> RAG I S �R'ED SYSTEM C`ONTR"A:CTOR.. " �`� I Department rtment of Public Safety tieetrril�•systet,s-5-License License: SS-001779 `LC DBA ADT."S`E'CUR I TY 4.1'0 UN Thomas J I.ee - •,. MEAS` W I 410 University.Ave U I• — _ t` :.. , Westwood M�02090 ":WtE S>TWO O.D ; MA ; Expiration: Commissioner F 05/16/2016 1 THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) I A I m / � L DATA `...v,..... ' n w.V. •u....♦ ...,Ww. ..�.•....{•M1r'Yw,.+,.l�:w'i- rl .. . ^1'a ..yPY• M e�y^.�rrr. t y.f..u. .. •. E .7 .. 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',r• � r i' k - '•Lr�+,' r '• _ .a r * �:«•.w�.�•i �- •r;•.c ra ~ Y vo ;�-,e,9.� IOU, i•-7,At '._ t ' - ` L * r-•y r w . y}1*'�'!.� ��y' �i ; i ce`. ;±•'""'-""' "'• --y }�.. ` � . '- s.,I -( ����•�_�. �.,+.. _ � .. .k,'i.�r .'k�.-:'+�fir.;+, � ? � �( .. _ ......_....� _,...__ ...�: ,�. ..._..., rat •�Z.M4� `=.1_ y'.L' •' - f •r.. 1•�,' .,f r- .:��i�� _ �f� • � _�'���� •_x, � .. � �••L..'},f •. �f���� __ _ K, , I .� /'� �• �f-srY� I �� ���� �. � . � >� .� � • .� r • � u � t����.. t �r • • M,• i ,`. • 1� i _ � 7 � � • � � 1. � ri, r � . • � • ':i e r Y : � TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 13G Parcel f o f� Application # � V Health Division Date Issued J Conservation Division �/1�- Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board O Historic - OKH _ Preservation / Hyannis Project Street Address olC> o S uoe Village e5V e15 Owner e b� ab l GJ)"�' tO Address Telephone 5O� Z ' / C - �U���5 Sou Permit Request Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type 1Sc� SQ Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure 3 f;s Historic House: ❑Yes 4-No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl 511-Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq:ft)' ti_ _ Number of Baths: Full: existing e2 new Half: existing news Number of Bedrooms: 3 existing--mew - F co Total Room Count (not including baths): existing new First Floor Room Count ` Heat Type and Fuel: ❑ Gas 64Oil ❑ Electric ❑Other Central Air: ❑Yes 6&No Fireplaces: Existing New �� Existing wood/coal stove: ❑Yes to Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: 9ioxisting ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # ` 4 Current Use ELS Proposed Use �� a APPLICANT INFORMATION (BUILDER OR HOMEOWNER) c� Name J ����S � . O-C, Telephone Number 5-OS Zg `1/6 S Address DzJ� P r3�r�S��� A c S 6S� rr c,� License # Home Improvement Contractor# �Z� ( I Email�i�R�- c�c��L CC) 2� y-,oCS(S . C''`'�Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO D SIGNATURE DATE Zro i I ' FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME aFR�I oK �lalxeA., INSULATION gfAt FIREPLACE T ELECTRICAL: ROUGH FINAL ' PLUMBING: ROUGH FINAL + ' GAS: ROUGH- FINAL ' .FINAL BUILDING DATE CLOSED OUT i ASSOCIATION PLAN NO.-- r 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 Legib[y Name (Business/Orpnizadon/Individual): E �Wc I Address: 3 Q - C5 �e �c = �4" �i� oG-c� F[JI te/Zi Phone #: n employer?Check the appropriate box: a employer with 2D 4. ❑ I am a general contractor and I Type of project(required): oyees(full and/or part-time).; have hired the sub-contractors 6.,[�New construction a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling and have no employees These sub-contractors have g. ❑bemolition ing for me in any capacity. employees and have workers' orkers' comp. insurance comp. insurance.t 9. ❑ Building addition red:] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL insurance required.] t c. 152, §1(4),and we have no 12.❑ Roof repairs 3a.❑ I am a homeowner acting as a employees. [No workers' 13.❑Other general contractor(refer to#4) comp. insurance required.) Any applicant the checks box#1 must also fill out the section below showing their workers'compensatio$policy information Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractats that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'com p.policy number. I am an employer that is providing workers compensation insurance for my employees. information. Below is the policy anti job site Insurance Company Name: Policy#or Self-ins. Lic.#: C �, ( z l Z Ln Expiration Date: Job Site Address �--',v 1"t�� ��«`"�/ �5 'i /State/Zi _ AA 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 fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a TOP WORK ORDER and a of 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 cert! under enalttes of erjury that the information provided above is true and correct 0.f3cial 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): I.Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: ... Client#: 646400 2NORRISEB DATE(MM/DD/YYYY) ACOROT� CERTIFICATE OF LIABILITY INSURANCE 05/27/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CJERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Dowling&O'Neil PHONE 508 775-1620 FAX Insurance Agency E M I�° E"t: ac,No): 5087781218 973 lyannough Rd., PO Box 1990 ADDRESS: Hyannis, MA 02601 INSURER(S)AFFORDING COVERAGE NAIC If INSURER A:Acadia Insurance INSURED INSURER B: E. B. Norris&Son., Inc. 138 Osterville-West Barnstable Road INSURER C: Osterville, MA 02655 INSURER D: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUB POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MMIDD YYY MM/DD/Y A GENERAL LIABILITY CPA005234525 05/03/2014 05/03/2015 EACH OCCURRENCE $1 000 000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occuence $250 000 CLAIMS-MADE 51 OCCUR MED EXP(Any one person) $5 000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $2,000,000 POLICY PRO LOC $ JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ A WORKERS COMPENSATION WCA021246417 05/03/2014 05/03/2015 X 1TWoC STATU- ERH- AND EMPLOYERS'LIABILITY IOT ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED? � N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE s500,000 If yes,describe under - DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) Insurance coverage is limited to the terms,conditions,exclusions, other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived, or extended the coverage provided by the policy provisions. CERTIFICATE HOLDER CANCELLATION Town of Barnstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis, MA 02601 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD ttC1,%nQ15IM1 inq'IA I C1 1. .: Massachusetts -Department of Public Safety - �- Board of Building Regulations and Standards . Construction Supen•isor License: CS-015.851 t CRAIG N ASHWOkTH 138 OST W BARNSTABI'E' OSTERVILLE AfA 0 655 r. - =fi Expiration Commissioner 09/28/2015 "1 i 1L' Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Can.actor Registration Registration: 102014 _ Type: Private Corporation z t s Expiration: 6/30/2016 Trt/ 252322 ERNEST B. NORRIS & SON INC M I.i Craig Ashworth a ^ + 138 Osterville W. Barnstable rd. W Osterville, MA 02655 Ir Update Address and return card.Mark reason for change. E Address Renewal ❑ Employment Lost Card SCA 1 Co 20M-05/11 License or registration valid for individul use only Office of Consumer Affairs&Business Regulation ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: re,,gistration: EMENTA2014 Type: Office of Consumer Affairs and Business Regulation Private Corporation10 Park Plaza-Suite 5170 iration:�613.Q/201;6 Boston,MA 02116 ERNEST B. NORRIS&=S.ON ING=- t Craig Ashworth ice-- 138 Osterville W.Barnsta6 d Osterville,MA 02655 Undersecretary Not valid without signature t8. °F E1�. Town of Barnstable. Regulatory Services B'ARNSTAS' S& = Thomas F.Geller,Director . 'p x. ..... Building Division ......... --.-. Tom.Perry--Building Commissioner 200 Main Street Hyannis,MA 02601 . www.town.barnstable •.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using ABuilder ly Marilyn Calderwood , as Owner of the subject property hereby authorize E. B. Norris & Son Inc. to act on my behalf, in all matters relative to work authorized by this building permit application for: . 28 Holway Drive, W. Barnstable, MA (Address of o g �U Signature f Owner Date 5 Town of Barnstable Old King's Highway Historic District Committee 200 Main Street,Hyannis,Massachusetts 02601 (508) 8624787 Fax(508)862-4784 CERTMCATE OF EXEMPTION Application is hereby made,.with four(4)complete sets,for the issuance of a Certificate of Excmpdon under section 6 and 7 of Chapter 470,Ads and Resolves of Massachusetts,1973,as amended,for proposed work as desanW below and on plans,drawings,or photographs accompanyi ng P application: Date U . Address of Proposed work, Assessoes.Map and lot# L' . House# Street D� CSL' Village: GC/• .1 ' This application is,for an exemption of the proposed construction on the grounds that work: /0-Will not be visible from any way or public place ❑- Is within a category declared exempt by the Old Kings Highway Regional Historic District Commission ❑ Other Description�of Proposed Work: �t3 ` -tSe- ��'e• �� t,J����-�S I'e v�CX9- Agent or contractor(please print): !&LN5t S Tel.no. Z S Address \ Owner(please print): w� t s1o�J Tel no.07 f Owners mailing address: j t K Signed,Owner/Contractor/Agent c• t'S X �I For Committee Use Only This Certificate is hereby Approved/Denied Date: Committee Members Signatures: g)PROVED AUG 21 2014 Town of Bar ghway ble Old Committee Any conditions of approval• .. G IDoaiaw�ts axd SettingaldecoIIfklLocal SettingaiTempo�y Internet FtiertOLB7lO1CHTsxemption Farm 07.doc . x a. t .'- �yv � a °.. `• .. `" - � � - _ ; �fi ly's�C v tt' d ` r t.rl t• ♦ ,�5�..� UK{ ° h )a low.. f is - . 2.� J Y t S �i ES s .y _� r'.t``^.:-'S4 'taw v Li f 41 F r :. t k St ,•� �; r Y }. t< i ' C 3 .,. a '. 7 t ° yy '�: N pl-!.f ••iY-•r�..�wl,}�y�k.�- ' '��;4�a J �, •� Y• ,NWT �r' W"'�y�J�- J-. 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'7� '�,����".�i►-r-tr` yy c_ n �oFr►u rots Town of Barnstable *Permit# ti Re Expires•6 marlhs fro ue dnre m 'gulatory Services Fee H,ARV52"LE, ' y pASS. _ i6yo- ��� Thomas F.� Geiler, Director�rF1 tsp.`f A �/i Building Division � ����� :����� D Tom Perry, CBO, Building Commissioner A �+ 200 Main Street, Hyannis, MA 02601 OCT — 7 2010 www.town.barnstable.Ma.t.rs Office: 508-862-4.038 TOWN OF %RM$T7Aa�E0 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Yniid rPithoul RedX-Press Imprint Map/parcel Number RPro erty Address�� gpL.vt4� 0 2 v LE'S` '✓��-,eiv esidential Value of Work >[ l� ���n,�,.� Minimum fee of$35,00 for work under$6000.U0 Owner's Name & Address- M i L m�j Contractors Narne_ X f( -I A-m No LL( KJ Telephone Number ,ZK t9 galo Home Improvement Contractor License f{(if applicable)_ � � Construction Supervisor's License#(if applicable) 4= 17 - ❑Workman's Compensation Insurance Check one: E�tl am a sole proprietor ❑ I am the homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name 'I�b W LI OF 11 ( W ff GP—ArG9/ A,1uTU AL I MS U aigPV(f) Workman's Comp.Policy i-I TL1 Copy of Insurance Compliance Certificate must accompany each permit, Permit Request (check box) ❑ Re-roof(hurricane nailed) (stripping old shingles) A.II construction debris will be taken to ❑ Re=roof(hurricane nailed) (not stripping. Going over existing layers of r•000 �e-side #of doors ❑ Replacement Windows/doors/sliders. U-Value (maximum .35)#of windows *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e. Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License & Construction Supervisors License is .required. [ ZG IWPI-ILESIP0RMS1bui.lding permit forins\EXPRCSS.doc :vised 072110 The Canunoirwea.11h of-Massachusetts Department ofIndits1rialAccidenis Office of-Invesfig alions 6 600 Wash-inglonStreet Bosion, 4 02111 ivivmniass.govIdia Ilefurkej-s' Compensation Insui-Auce Affida-vit: B nil ders/Co ntr-a ctai-s/Elechi cia n s/Plumb ers Applicant Information Please Print LeeiblN Nan3.e (Bttsiness/OrgaL zaboji/1-ndividLial): W_111( *vL. Any UL'0 Address: IZII� JA)INOWST .C'tV/Sta-te/zi ip jAWN. m* b;Li, 0* I _ Phone #: '::3-0 8-744-- --?o ;I_Z) Are you an employer?Clieck the ZlYpTopriate box.: Type of project(required): I I arn a employer with 4. E] I am a general contractor and 1 6- E]New construction employees.(fuJ]and/or part-time). have--hired the sub-coutractors I I.am a sole proprietor orpiirtnef- listed on the attached sheet- 7. B<emodeltng slit and have no employees' These mb-contractors have 8- EJ.Demolition working for mein any capacity. employees and have.workers' .9. [].Buildin addition [No workers' comp.insurance comp-insurance-.1 g required.] 5. ❑ We are a coi- 10.El Electrical repairs or-additions poration and.its 3.El 'I arm a.homeowner doing ail work afficexs have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL I 12.EI'Roof repairs insurance required.] c- 152, §1(4),and.we have no employees. workers' 110-other comp.insurince required.] OAny Pupplicimrthst checks box#l.must also fill out the section beloA,shooing theivvvoylcers'compeusH.tionpaiicy jnfionwilan- I llonieovmers who submit this affidavit indicating they nre-doing all wwk and then hire oirtsiae-contmclors nitiv submit aisew offidavit indicating such_ t Coubmcfars that cbeck thi5bcc(mirst sitached an sdditionAsteei showing the-maine of the sub-contmczi5 and stureirbeth-er or not those entities-have employees. Ifthe sub--contcactors:hsN,e e3nixioyLes,they.anist provide their workers'comp.policy number. I alit an eyiplo:yer that is prof workers'contpezurafion hisnearice for UVenfployies. Belolvis bile policy and job site ill forntad,011. Insurance Company Name: Policy#or Self-ins.Lic. Expiration Date: Job Site Address: city/statezpl- Attacla a copy of the workers' comppitsittioii.policy die.claration page(&Noiiing the policy number and expiration,date). Failure to secure covexage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalfies of a fine up to S1,500.00 and/or one-year imprisann ent,as well.as ci,41 penalties in the form of a STOP'WORK 1ORDER and a fine of up to$250.00 a day against the violator. Be advised that a cop),of this statement may be fommi-ded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby ce.rtifyijjtd,-r the pants aijdpeiialfi'as qfpeditty that the iitforttiatio.-i.iprmid;Fdaboire'E'S trus and correct 11 ow MUU_,-Ao0' Dote: /6 — Signature: M_ Phone M J�,6—?44-- -7e) 16 Official itsevfdy. Do not tirite in this area,to bs completed by ci�t or town official City or Toiirn: Permit/License# Iss uing Au th ori ty(circle one): 1.Board of Health 2.Building Department 3. Citvffoiim Clerk 4, Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone M. # ttnaxenun.$ t . Town of Barnstable fp Mp't t. Regulatory Services Thomas F.Geller,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 0260) www.town.barnsta ble.ma.us Office: 508-862.4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize to act on my behalf, in all maths relative to work authotixcd by this building permit application for. (Address of Job) Signature of Owner Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. Q:\WPFIL&MAMSIbuilding permit formsWXPRESS doa Revkrri 072110 I Office of Consumer Affairs&.Business Regulation License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registrations, :164831 Office of Consumer Affairs and Business Regulation Expiration: =�A-7 9/2011 Tr# 290710 10 Park Plaza-Suite 5170 9T E'7= ', on MA 02116 -= Bost ypei����lndividual le WILLIAM D. MULLI i ,_NJR ==-a WILLIAM MULLIN' 325 WILLOW WEST BARNSTABLE�AAA=02668 Undersecretary Not valid without�sj2 i iVlossachusettx- Deportment of PubliC Sof"et Board of•Buildin,, Rcaulations and Standards Construction Supervisor License License: CS 4173 Restricted to: 00 WILLIAM D MULLIN JR 325 WILLOW ST L W BARNSTABLE, MA 02668 Expiration: 3/14/2012 ('ummissiuncr Tr#: 17843 THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) im A DATA �. ,. ,,«... .�: .i 4 .� jr i t o TOWN OF B.A.RNSTA I-" Permit No. 1 , Building Im-pector Cash al0• f gal OCCUPANCY PERMrr Bond -----------------1 Issued to Address Wiring Inspector Inspection date Plumbing Inspector Inspection date Gas Inspector Inspection date Engineering Department Inspection date Board of Health Inspection date 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. 19_ . .......: :f �.... ................................................... Building inspector Assessors map and lot number, ...../ ......... ........�..: o - ?H E Sewage Permit number .81�:..�2a.?. t ................. EM MU............1 INSTALLED IN COMP • AME, i House number ............................................................. WITH TITLE 5 r6 9. \0� ENVIRONMENTAL COO a' TOWN OF BARNSTk ULATI®Ns ).JECT TO APPROVAL OF �ARNSTABLE CONSERVATION, BUILDING INSPECTOR COMMISSION APPLICATION FOR PERMIT TO ... U.� . ................ :.5 ..............I. .+.( ..r.......................... 1 TYPEOF CONSTRUCTION ...... ,rl,,, U .... ... ............. ...............:.................................................................. `1.-....� ...............19.4/.. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for/a permit according to the following information: /� Location ......4Q.. .... ....... '^'. ..... ....J...: t.... ! 2 ? .'.d...1 ........................:..... ,olkProposed Use .... ��- �"..... w:. ......... :..... . .............................................................................................................................. . Zoning District ........................................................................Fire District ..... .r... ,e4�ww , ................................... Name of Owner ... •`.:1- © ..... �.�.. '...............Address ....tol ...PPi...�7.20.d ,,6-- ... ..P'7� 14 Name of Builder' .!"1!" a...:0.�41� 1k�.?... .n^.................Address .. �. :.....176Qr?!!�..l.�.IV► �! /�. a... ....... / h : >✓ -6Q w �,ox. -�.�..., ..0.4.........01�--�� Akc Name of Architect C? .....1�..........�VGE.N........./.... .......Address Number of Rooms ..... ........................................................Foundation I' b � Exterior .... ..................................................................Roofing .....0.49.0................................................................. Floors W ND..... .........................................Interior .......t�Q0. .... ... � S Y4�.:..f�................... Heating �?...0� ..........................Plumbing ..::......... :..:....:............. Fireplace .........3.....................................................................Approximate Cost ............ ..,�. �.J................................ Definitive Plan Approved by Planning Board -----------____---- -----------19_______. Area .......................................... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH 10241 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 c.........:................ ... ..... LARSON, MILTON No Permit for ..,Build Build One & 1/2 Story ................. ........................... Single Family Dwelling ............................................................................... Location .....Lot...#.16......2.8...H.o.1.w.ay....Dr... ' West Barnstable ............................................................................... Owner Milton Larson ...Milton Frame Type- of Construction .......................................... ................................................................................ Plot ............................ Lot ................................ Permit Granted ....November....2-5........19 81 .... .. .... .. Date of Inspection?/244-4. ....................19 Date Com5ple7ted 19 ...... ........ A Z40�1�1 C rA 111131,11 Assessor's map and lot number .... ........................ ... �K- TH THE 46 S4wage Permit number ...................................... 31AR1194ABLE, • - 4"r f�66se number .........2................................................................ V 1639- TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ........................ ................................;*....................I....... ................................. t TYPEOF CONSTRUCTION .... j......................................................................................................................... ..... ................. .................19........ .. . TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: .........................................;........ Location .... ...... ....................... .......... ............................................ ProposedUse .................................................................................................................................................................. Zoning District .................... ...................................................Fire District ....�J..,........-. ........................................................... yh Name of Owner ...... ............................ ...... ........................ .... ..........Address ... ............ ... 7-, ............... .Name of Builder': ............ ............. .......Address .. ................... Name of Architect' ........Address !1�............. Numberof Rooms ..................................................................Foundation ............. ............................... ................... Exterior ........... Roofing .... ............................................................................ ...................................................................... Floors .......................4......... ..............................................Interior ............ . ....... ........................ ............................. Heating ...................................................................................Plumbing .................................................................................. Fireplace .......... ..............................I........................................Approximate Cost ........ ........................................ Definitive Plan Approved by Planning Board ----------------------------- Area .......................................... Diagram of Lot and Building with Dimensions Fee .............in.............................. SUBJECT TO APPROVAL OF BOARD OF HEALTH 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,".....,........................................................................... 1 r � r LARSON, MILTON A=1�-31 No3651$... Perm�t for30ne & 1/2 Story . Siric�le FamilX Dwelling............ Location 16.:...2$...Holway,...Dr.-..:... West Barnstable' ............................................................................... Owner ..Milton Larson .................. - Frame Type of Construction .......................................... ....I.................................. Plot ...................�......Lot ........:....................... Permit Granted .....November 25,............................. ....:19 81 Date of Inspection .......... ........................19 . Date Completed ........................................19 ` r / F .f L nN �M• �r t �i 3 sF Dt11 i .1101 CA ..jam.'• �� . gg-�. �I -��� --------. ----._----- -------- I' h s-f. /\fA o 25 r•�/STAG^ �: Gb V4, cTa�.— I 1lq76 tyj=', -71110- PI o� �-