HomeMy WebLinkAbout0249 PERCIVAL DRIVE oxforer NO.152113 ORA
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sessor's Office(1st floor) Map f Q Lot 001 • b0 eP rmit# AM
Conservation Office(4th floor) Date Issued
Board of Health(3rd floor)(8:30-9:30/1:00-2:00)9 - " '0 F , 5'd .Lit
SMS
Engineering Dept. (3rd floor) House#1 /J(, r y,e4 y/b
Planning Dept.(1st floor/School Admin. Bldg.) 'Ram ��4$01, RNSTA L.E.
Definitive Plan Approved b Planning Board 19 go e' � , � q%9.
)_0 �- 2 �l�S �' ?2- •P .. , �s�+his �►
TOW OF BARNSTABLE
Building Permit Application
Project Street Address e� p�. t t/ L ,� r+:• ,
Village we= �l
Owner��y( ���( Address. `CZJ
Telephone 1! , .'i Oa 6 r9
Permit eq s j
Total 1 Story Area(include 1 story garages&decks) / square feet
Total 2 Story Area(total of 1st&2nd stories) E 'square feet
Estimated Project Cost $ Q -T->
Zoning District FN Flood Plain Water Protection
Lot Size 3 S a, 0 b Grandfathered ?
Zoning Board of Appeals Authorization Recorded
Current Use Proposed Use
Construction Type G6 9 �r A M Q
Commercial Residential (/
Dwelling Type: Single Family Two Family Multi-Family
Age of Existing Structure ,ram lC Basement Type: Finished
Historic House Unfinished Ja U Y'p k (_Gh('\,n�
Old King's Highway L/
Number of Baths No. of Bedrooms
Total Room Count(not including baths) First Floor
Heat Type and Fuel zry '(�Wit"1-to&ntral Air Fireplaces
Garage: Detached, Other Detached Structures: Pool
Attached Barn
None Sheds
Other
Builder Information
Name C. Telephone Number
Address P-o r j M License# 0 /7 7 9 d
Cc) �� � WI �'1 c�}. Home Improvement Contractor#
(egs
Worker's ompensa ion# o k_Ct3 k'952 -7 9
NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS
PROPOSED STRUCTURES ON THE LOT.
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
T� vt C . DATE
SIGNATURE
BUILDING PER T N D FOR THE OLLOWING REASONS)
i,
FOR OFFICIAL USE ONLY
F
PERMIT NO. L_� d
DATE ISSUED July 24, 1995
r
MAP/PARCEL NO. 110 001 001 R
ADDRESS 239 Percival Drive VILLAGE West Barnstable, MA 02668
OWNER Tartan, Inc. a ;
DATE OF INSPECTION:
FOUNDATI9N ;
FRAME r
INSULATION `
Sec 0 Q� h►"`O w,� ;0 0
FIREPLACE �'��. 1 1� �
ELECTRICAL: ROUGH FINAL
PLUMBING:.` ROUGH FINAL
GAS: , ROUGH FINAL
FINAL BUILDING
DATE CLOSED OUT
ASSOCIATION PLAN NO.
d
`oFTHE T The Town of Barnstable
BAR.A-'NSTABLE. ' Department of Health Safety and Environmental Services
039.
°rFo,r,A•° Building Division
367 Main Street,Hyannis, MA 02601
Office: 508-790-6227 ! Ralph Crossen
Fax: 508-790-6230 Building Commissioner
In1!spection Corr'e tion Notice �
t
i Type of Inspection _
Location 2-�o /v •l.V Permit Number r
6
4 Owner Cl 1'`` ! { U Builder
One notice to remain on jobsite, one notice on file in Building Department.
The following items need correcting:
5—h4
c? 0 ra LV�
Please call: 50�8---7�90-6227 for reeinspection.
Inspected by
Date ' Z � �� y
The Town of Barnstable
O,e
• BARNSTABLE.
nd Environmental Services
Y MASS. g. Department of Health Safety a
o►r,A 039.
Building Division
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367 Main Street,Hyannis, MA 02601 i
Office: 508-790-6227 Ralph Crossen
Fax: 508-790-6230 Building Commissioner
Inspection Correction Notice
Type of Inspection
P
� ' n 1
Location � q f t,y Permit Number
Owner Builder
One notice to remain on jobsite, one notice on file in Building Department.
The following items need correcting:
a-t 0(^)O ?- �c
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sup- � �L � �_a 1� � e-j-
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P r fz -,Jr)
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Please call: 508-790-6227 for reeinspection.
Inspected by i.� �,•c.
Date
i
07/15/1996 05:11 5088805522 TONV RAPOSO RIVCO PAGE 01
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DATE: r7 j 1 S j`1 -
PAX #: dot-7 qa- G-�-3 o
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07/15/1996 05:11 5088805522 TONY RAPOSO RIVCO PACE 02
RIVCO -- PGZZI ID :352:55 JUL 15'96 1.5:25 No .017 P .01
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TOWN OF BARNSTABLE ,
°"ter BUILDING PERMIT
PARCEL ID 110 001 601 GEOBASE ID .y36836 i-
ADDRESS 239. PERCIVAL DRIVE ' PHONE
W. Barnstable ZIP
LOT 20 BLOCK. LOT SIZE
DBA - _ -DEVELOPMENT > DISTRICT WB
PERMIT 6801 DESCRIPTION 'PUILD HOUSE WI144 ATTACHED GARAGE .,:
PERMIT TYPE BUILD TITLE NEW RES/COMM BL PERM T ?}
j department of Health,Safety
CONTRACTORS: TARTAN, INC.
and Environmental Services
ARCHITECTS: { _
TOTAL FEES:,'
BOND :ti $.00
CONSTRUCTICN COSTS $100,000.00
101 SINGLE FAM HOME DETACHED 1 ,' PRIVATE , 039.
MASIL
OWNER TARTAN. :INC I
ADDRESS ;P 0 BOX 1198 _ ?s = S
. W CHATHAM _BUILD SI 2•a _ s
DATE ISSUED 08/08/1994 EXPIRATION DATE BY
THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY.EN-
CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR
ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS
PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS.
MINIMUM OF FOUR CALL INSPECTIONS REQUIRED APPROVED PLANS MUST BE RETAINED ON JOB AND
FOR ALL CONSTRUCTION WORK: THIS CARD KEPT POSTED UNTIL FINAL INSPECTION WHERE APPLICABLE, SEPARATE
1.FOUNDATIONS OR FOOTINGS PERMITS ARE REQUIRED FOR
2.PRIOR TO COVERING STRUCTURAL MEMBERS HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU- ELECTRICAL,PLUMBING AND MECH-
(READY TO LATH), PANCY IS REQUIRED,SUCH BUILDING SHALL NOT BE ANICAL INSTALLATION::.
3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE.
4.FINAL INSPECTION BEFORE OCCUPANCY.
POST THIS CARD SO IT IS VISIBLE
BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS
1 1 1
2 2 2
3 1 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT
2 BOARD OF HEALTH
OTHER: SITE PLAN REVIEW APPROVAL
WORK SHALL NOT PROCEED UNTIL PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED.ON THIS
THE INSPECTOR HAS APPROVED THE STRUCTION WORK IS NOT STARTED WITHIN SIX CARD CAN BE ARRANGED FOR BY
VARIOUS STAGES OF CONSTRUC- MONTHS OF DATE THE PERMIT IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICA-
TION. NOTED ABOVE. TION. 508-790-6227
M•a � Application to
9 5 j
2 4,
Old Kings Highway Regional Historic District Committee
in the Town of Barnstable for a
CERTIFICATE OF APPROPRIATENESS
Application is hereby made, iri triplicate, for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470,
Acts and Resolves.of Massachusetts, 1973, for proposed work as described below and on plans, drawings or photographs
accompanying this application for:
CHECK CATEGORIES THAT APPLY:
1. Exterior Building Construction: ❑ New Building EDAddition ❑ Alteration
Indicate type of building: ❑ House ❑ Garage ❑ Commercial ❑ Other
Z Exterior Painting: ❑
3. Signs or Billboards: ❑ New sign ❑ Existing sign ❑ Repainting existing sign
4. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Other
(Please read other side for explanation and requirements).
TYPE OR PRINT LEGIBLY DATE
ADDRESS OF PROPOSED WORK a a E?e^1'-C(v2 L Py , ASSESSORS MAP-NO. ��d
OWNER 1�,;T4 -�V-KC ASSESSORS LOT NO. - f
HOME ADDRESS �a �� X / �7 14-I ►1 &V11-1 Ii�O ,a9l TEL. NO. f;312 s—�y0•�"�
FULL NAMES AND ADDRESSES OF ABUTTING OWNERS. Include name of adjacent property owners across any public
street or way. (Attach additional sheet if necessary). p
7 ,, w•aq�KsT,,b /v el 66�
�-r�-� IV,+Thnll A_f Sh4-YoW p No��' �60 rcJ�a6.
ct Gec e� .I-• a h 9s (le rc, vcg L O r. 4� • 1367:�S7rf6 fie. 0 J. Cc
l.�t `ASS Ric ,&yT-x p•9.90c rno a30 viva
H0 d 1 n% < CC .rf c. S/ S chi O v G/. De n N C .Ind O a 6 70
AGENT OR CONTRACTOR S e S O c. V1,P y TEL. NO.
ADDRESS
DETAILED DESCRIPTION OF PROPOSED WORK: . Give all particulars of work to be done(see No. 8,other side), including
materials to be used, if specifications do not accompany plans. In the case of signs, give locations of existing signs and proposed
locations of new signs.
II (Attach additional sheet, if necessary).
�'�w, .�(.( O D• ire.i4�-- o-� � a ►-Y, -�
D 4 i,-TA r-) _API
Signed
Owner-Contractor-Agent
Space below line for Committee use.
Received bv H.D.C.
D
Cert• ' to is hereb DateTZJ J ��
me.0 N 2 9 1g95 - C
B
KIN 'S IGHWAY
pproved IMPORTANT: If Certificate is approved,approval is subject to the 10 day appeal period
provided in the Act.
Disapproved ❑
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TOWN OF BARNSTABLE
CERTIFICATE OF OCCUPANCY
PARCEL ID 110 001 001 GEOBASE ID 36836
ADDRESS 249 PERCIVAL DRIVE PHONE
W. Barnstable ZIP -
LOT 20 BLOCK j LOT SIZE
DBA DEVELOPMENT DISTRICT WB
PERMIT 16804 DESCRIPTION SINGLE FAMILY DWELLING (PMT.#6801)
PERMIT TYPE BC00 TITLE CERTIFICATE OF OCCUPANCY
CONTRACTORS: Department of Health, Safety
ARCHITECTS: and Environmental Services
TOTAL FEES:
BOND $.00 Oki
CONSTRUCTION COSTS $.00
k 756 CERTIFICATE OF ,OCCUPANCY
'` * BARN31'ABLE, s
i MASS.
OWNER TARTAN, INC
ADDRESS P 0 B�X 1198
FD
W CHATHAM MA BUIL , G DIV IOC
BY a
DATE ISSUED 07/25/1996 EXPIRATION DATE
�+ ♦ BU L I.JDIfir; PERK,T A
r
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r cef, -,-r. -.
Ul�h C;iP,U'F?L0p id'.0
. 01 !�_., tY�:�rT.L1_ 1=,IJIr�ti f��cia :. WITH.
n_ u't�•i. `i' ). . _ _.
.„. a \En;Cn1•i is;..BU I LD i'i PEF%MI'I'
Department of Health, Safet3
i; t d f'='a+„rv"� : TAT�'�ace , '.```~. and Environmental Services
AR
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i'.�C:�hJ s:i_l:_� ..0 .I.}l}li _G0
{:.L . .N'•..i.1, i r i i .1► •
P_t I!_'1'
+ RARNSTABLE, ;
MASS.
;IV F � I1 a
1 r ( t BUJILDINGISMSI097)
ti_vF
) I'IZA DATE BY /�' .�i�� ./1. /�.✓
... - e
THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY.EN-
CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR
ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS
PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS.
MINIMUM OF FOUR CALL INSPECTIONS REQUIRED
FOR ALL CONSTRUCTION WORK: APPROVED PLANS MUST BE RETAINED ON JOB AND WHERE APPLICABLE, SEPARATE
1.FOUNDATIONS OR FOOTINGS THIS CARD KEPT POSTED UNTIL FINAL INSPECTION PERMITS ARE REQUIRED FOR
2. PRIOR TO COVERING STRUCTURAL MEMBERS HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU- ELECTRICAL,PLUMBING AND MECH-
(READY TO LATH). PANCY IS REQUIRED,SUCH BUILDING SHALL NOT BE ANICAL INSTALLATIONo.
3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE.
4.FINAL INSPECTION BEFORE OCCUPANCY.
VISIBLEPOST THIS CARD SO IT IS
BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS . ELECTRICAL INSPECTION APPROVALS
1 �-1V11 T dl-&Il
s
Fv
3 1 HEATING INSPECTION ROVALS ENS
- �'� L� 7 I g c
s 9� - d
OTHER:4Ja F SITE N REVIEW APPROVAL
! Y'ORK-CHALL NOT PROCEED UNTIL PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDiCATED ON THIS
•,'HE!r!SPEC i OR HAS APPROVEDTHE STRUCTION WORK IS NOT STARTED WITHIN SIX CARD CAN BE ARRANGED FOR BY
VAPIOUS ST;.:;ES OF CONSTRUC- MONTHS OF DATE THE PERMIT IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICAj
j T ON, NOTED ABOVE. TION. 508-790-6227
Assessor's office(1 bor): JD �/
0
Assessor's map of n f ! C ITI� �f�g tYl/d o�TM[
Conservatiomj ` i!N P!�6ALLE®IM C®
board of He 3rd flo O
r. WITH T'IT'LE t ssa,SrAncc
Sewafige Pe umbe I:NVII3®i�PJ7R�T'AL. riva
Engineering,,Department(3rd floor): (�
House number ,. `' ��7 ���-1/r� Tots I�9 f"FGULAT'I®
Definitive Plan Approved by Planning Board ZC- [v-r Lo .-ec«a1 l��g
APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2-00 P.M.only
, TOWN, OF BNRNSTABLE
- HOLDING INSPECTOR
APPLICATION FOR PERMIT TO 'C_fM:S�lr�ee� �jh9 � -�a•�i(� . �UUS2 Wi V
L} 4
TYPE OF,CONSTRUCTION )�
4G I` � Qom$ Qy 19
TO THE INSPECTOR OF BUILDINGS: '
The undersigned hereby applies for a permit acco1d�ing to the following information: 11 /
Location 0 ?e r6 V►g-L
Proposed Use yer i
Zoning District Fire District w C ,4Y n
r
Name of Owner I tq Y C_• Address I-V.B bX �L l.t)• cv1 wj M 6- &(of9
Name of Builder �A�l "y�N �✓h G - Address
yyf� Srniw6errY /41tL t3 ..
Name of Architect Shl'lrwl 4hMe- �T1AhSn, Address Ce h(tyV,'((e, ►M\n 0k63 A
Number of Rooms b Foundation POU YeA C T11, C YP-
r Exterior!•&Y do ✓DgyA C + Sk I h S eS Roofing y+S Ph(3 V)5 je �
_h.
Floors af'K. + GJA(( (n 10A(f CA Interior S/1eZt,-0Ckec 0A)(y a�}r'1 IIIWtS
Heating_�►�S _�Ir�C WfA- hnAJ2'V' Plumbing 0 41) 1
Fireplace c'm Q, Approximate Cost I 66
Area
Diagram of Lot and Building with Dimensions Fee
'1
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.
�.,r`t"►4 v1 w
Name
Construction Supervisor's License _ 0 I-7 7
�1
No • Permit For
Location
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Owner �.�
r
Type of Construction ale
Plot 140 Lot
Permit Granted 19
Date of Inspection 19
Date Completed _
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111,02/94 17:02 $6177277122 DEPT IND ACCID ZOO
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600 Waehin#on.. t,n t
0211 f
James J.Campbell &� �
n, aluaaE � -
Commissioner
Workers' Compensation llltsurance Affidavit
I, h4v C
with a principal place of business at:
«,5tawzlp,
do hereby certify under the pains and penalties of perjury, that:
() l am an employer providing workers' compensation coverage for my employees working on
this job.
��u �
Insurance Company Policy Number
() i am a sole proprietor and have no one working for me in any capacity.
() I am a sole proprietor, general contractor or homeowner (circle one) and have lured the
contractors listed below who have the following workers' compensation policies:
Contractor Insurance Company/Policy Humber
Contractor Insurance Company/Policy Number
Contractor Insurance Company/Policy Number
{) I am a homeowner performing all the work myself.
1 u�cer_tarC:`at copy of this statement will be forv:arded to time Office of Investigations of the OTA for eo%Trage verification and that failure to secure
ccverage=ree:ired under Secdon 25A of MGL 152 can lead to the Imposition of criminal penalties consisdne of a fine of up to s 1,500.00 and/or or..,
years' imprLca-rent as well as civil penalties in the for of a STOP WORK ORDER and a fine of S 100.0o a day against me.
Signed this y of
Licensee/Permittee Building Department
Licensing Board
Selettmens Office
Health Department
TO VERIFY COVERAGE INFORMATION CALL: 617-727-4900 X403, 404, 405, 409, 375
Tr)T,T\T nr RAR\T(ZTART R RTTTT T)T\TC PT:RMTT #
__-----"-".ter-g'•'
;� Failure toposs te '
l DEPARTMENT OF PUBLIC SAFETY r. zScous tatSta t ese by
COMMONWEALTH 1. ONE ASMBORTON PLACE i ; �•
r OF.-- BOSTON,MA 02108 CAUTION
MASSACHUSETTS LICENSE
`
SE
CONSTR. SUPERVISOR FOR PROTECTION AGAINST
EXPIRATION DATE I EFFECTIVE DATE LIC-NO. THEFT, PUT RIGHT THUMB
PRINT IN APPROPRIATE
12/26/1995 07790 ` BOX ON LICENSE.
RESTRICTIONS 0 6/3 0/19 9-�
NONE RUB ERT SON t BLASTING OPERATORS
E J A M ES A UST INCLUDE PHOTO.
AT
TLEBORO MA 02703
--
1 �
TING OPR ONLY) FEE •O^ NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY
PHOTO(OCAS 1'O O V T OF THE COMMISSIONER
STAMPED•OR-SIGN
HEIGHT:
IGENSEE '4 .•+.�F7 I C, w.�{%J
IGN
THIS DOCUMENT MUST BE
CARRIEDON THE PERSON OF COMMISSIONER
THE HOLDER WHEN EN'
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{�
CUPATION
cRS-RIGHT THUMB PRINT GAGEDINTHISOC
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DATE: G"117 9i c -ti'r ,6,4 X7;E.2es iVyE /it/C.
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Richmond Gray-
HC-9a Alexandria Beige
HC-77
Application to
d' c��-let♦,r►��`�6�►. .
Old King's Highway Regional Historic District Committee
in the Town of Barnstable for a
CERTIFICATE OF APPROPRIATENESS
Application is hereby made, id triplicate, for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470,
Acts and Resolves of Massachusetts, 1973, for proposed work as described below and on plans, drawings or photographs
accompanying this application for:
HECK CATEGORIES THAT APPLY:
1. Exterior Building Construction: New Buildin ❑ Addition ❑ Alteration F
Indicate type of building: House ' Garage D Commercial ❑ Other
2. Exterior Painting: ❑
3. Signs or Billboards: ❑ New sign ❑ Existing sign ❑ Repainting existing sign
4. Structure: ❑ Fence ❑ Wall, ❑ Flagpole ❑ Other
(Please read other side for explanation and requirements).
TYPE OR PRINT LEGIBLY DATE Y—� 3 Cr
ADDRESS OF PROPOSED WORK )4T #)6 1 el-cIvt4L i�7 ASSESSORS MAP NO. 4/ 0
OWNER (14 v l t,h L�c ��,,.f{ ASSESSORS LOT NO.
HOME ADDRESS P 0• t��� x ,'i 5! w. rtiA hpgd::1 0�,66� TEL. NO. �-9S�S — �657
FULL NAMES AND ADDRESSES OF ABUTTING OWNERS. Include name of adjacent property owners across any public
street or way. (Attach additional sheet if necessary).
1-bT 7 T14,70f h J.m e . l' O. R c x /l 9� OLJ o47- ►�r.� isi e4- o -r
j30 4lo 01-46
J��- �/ ��L, n lN► 1�Pl-v 7YS, P. a . �6 �C h6 e63 44 c RO-0 M 4. 0-1
AGENT OR CONTRACTOR S~Rf'''1e .45 Q n e V TEL. NO.
ADDRESS
DETAILED DESCRIPTION OF PROPOSED WORK: Give all particulars of work to be done(see No. 8,other side), including
materials to be used, if specifications do not accompany plans. In the case of signs, give locations of existing signs and proposed
locations of new signs. (Attach additional sheet, if necessary).
. Signed p '
Owner- tractor-Agent
Space below line for Committee use.
Received by H:D.C.
Date The i ' ate is h r y DiNe t
-Ilk
Ti me
By
Approved, IMPORTANT: If Certificate is approved,.approval is subject to the 10 day appeal period
provided..n-the Act.
OLD KING'S HIGHWAY HISTORIC DISTRICT
Spec S1Zee1-
t
Foundation Type Foy Ye (:� 6-'1 cYe l Q_
I Siding Type rfpP�OA rci i� �f �c vn�
Chimney Type
b 11 CK Color �e
Roof Material �T Color
Pitch C1
ey
P/ i r3
g h x 6� /8
Windows K'Te e-, c4s01+1e.IT Size
Trim Color
T2� J e2 Color �IQxr�n cfy�� E
Doors N" I yl Sk 14
Shutters da C1 pf3 1✓1 P ,P XAVl 1 r4 1
Gutters
t-u 11 , �L r( �✓h i h
Deck )0' X I (Ye S S� �ye ►4 re
Garage Doors 1�6c?� / 0 �/�'�' 2 k� Color lC Y
Noes: Fill out completely. including measurements and materials/colors to be u.
Three copies of this form' are required for su�mittal of an application,
along with three copies each of the plot plan. landscape plan and elevat
plans, when applicable.
'Plot plan need not be "Certified but should show all structures on the
to trcald.
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to �.
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PETER
SULLIVAN
No.29733 "
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OAXTER