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NO. 152 1/3 ORA
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ofIxE,Ok Town of Barnstable *Permit#
j, Expires 6 nionthsfronr issue date
Regulatory Services Fee yam. /
+
+ BARNSTABLE, i
v MAC g' Thomas F. Geiler,Director
i63q. Aim X-PRESS PERK
lFD MA't
Building Division
Tom Perry,CBO, Building Commissioner MAY - 3 2010
200 Main Street,Hyannis,MA 02601
www.town.bamstable.ma.us TOWN OF BARNSTAI.
Office: 508-862-403-8 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
Not Valid without Red X-Press Imprint
Map/parcel Number
Property'Address (0,_s—
L1/Residential Value of Work ef Z:2,62Minimum fee of$25.00 for work under$6000.00
Owner's Name&Address /�W6 z'X 42-IV 6r�6
Contractor's Name-J Telephone.Number f
Home Improvement Contractor License#(if applicable)
Construction Supervisor's License#(if applicable)
❑Workman's Compensation Insurance
Check one:
❑ I am a sole proprietor
❑ I am the Homeowner .
V1 have Worker's Compensation Insurance
Insurance Company Name
Workman's Comp.Policy# 1 � 7
Copy of Insurance Compliance Certificate must accompany each permit.
Permit Request(check box)
vRR Re-`rr�000'f�'(stri ing old shin les)All nstruction debris will be taken to
❑ Re-roof(not stripping. Going over - existing layers of roof)
❑ Re-side
#of doors
❑ Replacement Windows/doors/sliders.U-Value (maximum .4.4)#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
re 'red.
SIGNATURE: /
F
��. The Commonwealth oflYlassachusetts
Department of Industrial Accidents
Office of Investigations
d00 Washington Street
Boston, MA 02111
wwm mass.gov/din
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual):—=�//�r �(�J
Address:
City/State/Zip: Phone M
Are youan employer? Check the appropriate box: Type of project(required):
1.V l am a employer with 4. I am a general contractor and I 6 0 New.constnlction
employees(full and/or part-time),* have hired the sub-contractors
2.❑ I am a sole proprietor or partner- listed on the attached sheet.. 7, Remodeling
ship and have no employees These sub-contractors have g. Demolition
working for mein any capacity. employees and have workers' 9. ❑ Building addition
[No workers' comp. insurance comp. insurance.)
required.] 5. We are a corporation and its ]0.❑Electrical repairs or addition
3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or addition
myself [No workers' comp. right of exemption per MGL 12.eRoof repairs
insurance required.] t c. 152, §1(4),and we have no
employees. [No workers' 13.❑ Other
comp, insurance required.]
"Any applicant that checks box fll 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 hire outside contractors must submit a new affidavit indicating such.
tContractors 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'comp.policy number.
f 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.#: Expiration Date: 4
Job Site Address:, :;�t9t Ij��/l/� � � City/State/Zip:�� ,�,ijJs�/ i��,11�
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 fin'
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 der the pains and pe Ities o erjury that the information provided above is trice and correct.
Sijznature: Date: G lii
Phone#
Official itse 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 ofllealth 2.Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire,
express or implied, oral or written."
An employer is defined as"an individual,partnership, association, corporation or other legal entity, or any two or more
of the foregoing 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, constriction 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 conunonwealth nor-any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insrUance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if
necessary,supply sub-contractors)name(s), addresses)and phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies (LLC)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 that a 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-MASS.AFE
Fax # 617-727-7749
Revised 4-24-07 www.mass.gov/dia
i
�YHF rod Town of ]Barnstable
BAR
s Regulatory Services
� ' $' Thomas F. Geiler,Director
D
ED 39. Building Division
Q µA't A
Tom Perry,Building Commissioner
200 Main Street,Hyannis, MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 5087790-6230
Property Owner Must
Complete and Sign This Section
If Using A Builder
L , as Owner of the subject property
hereby authorize to act on my behalf,
in all matters relative to work authorized 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.
L•
Town of Barnstable
Regulatory Services
BA.RNsTABce Thomas F.Geiler,Director
MASS. Building Division
v� i tip 9• ��� '
PIED ' 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: , village
number street
"HOMEOWNER": work hone tl
name home phone 4 p
CURRENT MAILING ADDRESS:
city/town state zip code
The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and
hire who does not possess a license,provided that the owner acts as
to allow homeowners to engage an individual for
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 be/she understands the Town of Barnstable Building Department
minimum inspection procedures and requirements and that he/she will comply with said procedures and
requirements.
Signature of Homeowner
Approval of Building Official
Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the
State Building Code Section 127.0 Construction Control.
'HOMEOWNER'S EXEMPTION
The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions
of this section(Section 109.1.l -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to dp such
work,that such Homeowner shall act as supervisor."
ware that they are assuming the responsibilities of a supervisor(see Appendix Q,
Many homeowners who use this exemption are una .
Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness of'en.results in serious problems,particularly
when.lhe 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 caret amend and adopt such a form/certification for u mmunity.
se in your co
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Northwoocl IUS. Agency, Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
540 MAi:l Stzeilt, Suite 9 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Hyannis NX 02601
Phone:506-7'71-1632 F&X:SOS-393-2955 I INSURERS AFFORDING COVERAGE �NA1C9
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p N OP OPH. ,LC•CA !WP-ICLEs i FCLUSION6 ADDED BY Gf,00RS&V,2K-/SPECIAL PAVASIONS
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE AEOVE DESCRIBED POLICIES BE CANCELLED BEFORE Tre EXPIRATION
TOWNBAR DATE:THEREOF,THE ISTUR40 INSURER MALL ENDEAVCR TO MAIL 10 DAYS WRITTEN
I NOTICE To THE CEAMMATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO 90 SHALL
IMP03E NO OaUG.ATION OR LIABILITY OF AP1Y KIND UPON TIDE ti'SURER.RS A:SNTS OR
TOWN OF BAMSTABLE REPRESEIdrATIVES.
367 MAIN STRIKET AUTHORL=RIPRESEIIrTATNT
HYANNIS MA 02601 �
ACORD 25(2009/01) O 1988-2009 ACORD CORPORATION. Ali rights reserved,
The ACORD name and logo are registered MWkS Of ACORD
,f� fie Ui oorunwozeue� a�,/�aaaczclucaelta .; ••,
-\ Board of Building Regulations and Standards I License or registration valid for individul use only
HOME IMPROVEMENT CONTRACTOR I before the expiration date. If found return to:
i Registration:, 100497 1 Board of Building Regulations and Standards
j Expiration: 6/.18/2010 Tr# 268012 One Ashburton Place Rm 1301
Boston,Ma.02108 I
E Type: Private Corporation
DAVID COX,INC VI
David Cox
19 LAVENDER LN
i W.YARMOUTH,MA 02673 Administrator - Not valid without si4fnaturc V
'�- IVI&Ssachusetts-
g,Regtmcnt of Public Satct�
Boar'd of Building Rctiulations and Standards
• Construction Supe visor License
License: CS 63537
Restricted to: 00 -
DAVID R COX
PO BOX 401
S YARMOUTH, MA 02664
u Mill isiuner Expiration:•10/15/201,
Tr#: 5822
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Town of Barnstable
OFTNE 1pk, Regulatory Services
O
Thomas F.Geiler,Director
• BARNSTABLE,ASS.MASS• ' Building Division
y �
i639. �0
jD�Eo Mp(p Tom Perry Building Commissioner
200 Main Street, Hyannis,MA 02601
Office: 508-862-4038 Fax: 508-790-6230
COMPLAINVINQUIRY REPORT
Date: ec'd by:
Complaint Name: Map/Parcel
Location
Address:
Originator Name: r exj f�l, r
Street: C�� I/ 36S Jam.
Village: GCJ ate• " Zip: Jab 11�71Z?
7
Telephone: v �(o 2--
Com P 1 'nt Description: _ ��D �O
P
e0 can
e VA
F R OFF CE USE ONLY
Inspector' Action/Comments. Date: Inspector:
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Additional Info.Attached
Q:forms:complaint
FRIEDLINE& CARTER ADJUSTMENT, INC.
436 Main Street, P. 0. Box 338
Hyannis, Massachusetts 02601
Tel. (508) 771-3232
FAX (508) 790-2344
TO:" J-.)-Building Commissioner or Inspector of Buildings
( ) Board of Health or Board of Selectmen
( }Fire Department
TOWN OF BARNSTABLE
TOWN HALL
HYANNIS, MA
RE: Insured: WALLACE, Lesley
Property Address: 11250-IF?
.
3os Tfne ,
W. Barnstable, MA
Policy Number: HP108756
Type of Loss: Lightning
Date of Loss: 5/28/2004
File#: 99790
Claim has been made involving loss, damage or destruction of the above captioned
property, which may either exceed $1,000.00 or cause Mass. General Laws, Chapter 143,
Section 6 to be applicable. If any notice under MGL, Ch. 139, Sec. 313 is appropriate,
please direct it to the attention of this writer and include a reference to the captioned
insured, location, policy number, date of loss and file number.
On this date, I caused copies of this notice to be sent to the persons named above at the
addresses indicated above by First Class Mail.
i
G. D. BRIDGE
Adjuster
7/16/2004
Assessors offioe (lst floor): QFTHE>o
Assessors map and lot number ...................................... .....
Board of Health (3rd floor):
Sewage Permit number ....�.-..V o.7 f�.....?-�......:.............. Z BAHII94ADLE, i
rasa
Engineering Department (3rd floor): --6 o rFj- S,,
Housenumber .................................................. ...................... amo
APPLICATIONS PROCESSED 8:30=9:30 A.M. and 1:00-•2:00`P.M.` only
I
TOWN OF BARNSTABLE
BUILDING INSPECTOR
APPLICATION FOR PERMIT TO ...CON57�2(/CT
....... . .................................
9` TYPE OF CONSTRUCTION
TO•THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location ... a..............AiitlF...... r.........Lt/....�3fl�nit/57fI�L�E �,U�2.KE�. l�D
....................................................................................
S/.�
ProposedUse ......�..................��.f":...................................................................................................................................
Zoning District ..............Fire District , 15192Ns7- LZ
.......................................... .. ...........................�g................................
Name of Owner ...k944 /,E.......4).fi44/1. ............Address .'JC� k....SL Gj/. 6/9Qti57A/96E
........................................
Q
Name of Builder ...1511 Y5 1DE �4n 6 CQr......Address ..... G /J dX /5 CANT E�✓/LLF
n........................:.......................... ....................................................................
Name of Architect .../,:...� /9,445.!)F,4_1 ......................Address .........C�TU.a7......................................................
Number of Rooms O ..Foundation ':UAeC,O........C��CR T�................................................
Exlerior ..C. � Cl�/Q�...*....5 11./41.6LFs.............Roofing .... L.......................................................
Floors .4!K.,..C'.eVPk.7...t 1//�t/YL .Interior ... /!V�...... `....( yf'SUi1/J
................................................. ...................................................
v'��� ,�(, 71Y
- rieafing�.,:.... .....: .. ....... . ..-...Plumbing .. :....:..... /..1
p ..........
Fireplace �Qy�/� /�.......L C'Ce ...g...� /C�........Approximate Cost ...... .Q�,. .......................................
�//� -7X
Definitive Plan Approved by Planning Board ----------- --------------19-------- . Area ..........................................
Diagram of Lot and Building with Dimensions Fee
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 ....�/! Gtit�!.. .......::.. " °'`�......................
Construction Supervisor's License
WALLACE,- LESLIE
32505 Two Story
N ................. Permit for ....................................
Single Family Dwelling
..................................... ..........5
Location ...Lot #2, S �— �- z--R-o ad
.............................................................
West Barnstable
...............................................................................
Owner Leslie Wallace
.................................................................
Type of Construction .....FXAMe.........................
...............................................................................
Plot ............................ Lot ................................
-
Permit Granted ..December....15
.... f.......19 IB GO
.. .. .... .. .... ..
Date of Inspection ....................................19
Date Completed ...................
.....................19
V
TOWN OF BARNSTABLE Permit. No. ...32505
BUILDING DEPARTMENT
4 141n TOWN OFFICE BUILDING Cash
�Yl 7
610•
9'>reu+ HYANNIS,MASS.02601 Bond /
CERTIFICATE OF USE AND OCCUPANCY
Issued to Leslie Wallace
Address Lot #2, 530 Parker Road
West Barnstable, Mass.
USE GROUP FIRE GRADING OCCUPANCY LOAD
THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL
SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN
REQUIREMENTS AND.IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE
BUILDING CODE.
April4........... 19....89.........
Building Spector
i
i
TOWN OF BARNSTABLE
BUILDING DEPARTMENT
t 2ANNIT TOWN OFFICE BUILDING
NU&
HYANNIS, MASS. 02601
i
MEMO TO: Town Clerk
FROM: Building Department
DATE:
f +� f-
An Occupancy Permit has been issued for the building authorized by
Building Permit , ......5. �.. ...D .............................................................._.....
..............................�.......
...........
.... _.....___
��
issuedto ..... .. ............................................................................... _... .............................._
Please release the performance bond.
• I
i
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TOWN OF BARNSTABLE, MASSACHUSETTS BUILDING PERMIT
DATE 19 PERMIT NO. 3 +e
APPLICANT !:S: -4:• ADDRESS +
•(NO.) (STREET) ICONTR'S LICENSE(
' PERMIT TO :-TLi=..L(1 114.•. .. 1+ (_) STORY -„ !: '•• + :-.I 'r r NUMI.II:if 01"
(TYPE OF IMPROVEMENT) NO. DWELLING UNITS
(PROPOSED USE1
AT (LOCATION) - - r - ,I 1 . ZONING
+,(NO.) (STREET) DISTRICT
BETWEEN AND
(CROSS STREET) (CROSS STREET)
SUBDIVISION LOT BLOCK SOT
IZE
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: '•" ""'?+
AREA OR
VOLUME '- .. ... •I r: v ESTIMATED COST $ ;i.' :�j i) PERMIT '?li i
_ -
(CUBIC/SQUARE FEET) FEE
OWNER
ADDRESS 'J" "'� • '�•:: BUILDING DEPT. ^�'f �.•l •
BY
► PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PU
THIS PERMIT CONVEYS NO-RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THERF-OF, EITHER TEMPORARILY OR
PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER TE BUILDING CODE, MUST BE AP-
PROVED
BLIC 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 THREE CALL APPROVED PLANS MUST BE RE
INSPECTIONS REQUIRED FOR TAINED ON JOB AND THIS WHERE APPLICABLE SEPARAT/E
ALL CONSTRUCTION WORK: CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE 'REQUIRED FOR
I. -FOUNDATIONS OR FOOTINGS. ELECTRICAL, PL,UMBIATIONS.
NG AND
MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE MECHANICAL INSTALL
2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL
MEMBERS(REAOY TO LATH).
3. FINAL INSPECTION BEFORE FINAL INSPECTION HAS BEEN MADE.
OCCUPANCY.
POST THIS CARD SO IT IS VISI13LE FROM STREET
BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS
I � —
Qc� ,
HEATING INSPECTION APPROVALS ENGINE5RING DEPARTMENT
i w L T
OTHER
BOARD OF HEALTH
I
WORK SHALL NOT PROCEED UNTIL THE INSPEC- PERMIT 'N!LL BECOME NULL AND VOID IF CONSTRUCTION
TOR HAS APPROVED THE VARIODUS STAGES OF WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE INSPECTIONS I N
NDICATED ON THIS CARD CAN
CONSTRUCTION. PERMIT- ARRANGED FOR BY TELEPHONE OR WRITTEN
LS ISSUED E D A3 NOTED E D ABOVE.V E, NOTIFICATION.
OF --
STlZE�T
�50.00•
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JOe 0 88-340
CERTIFIED PLDT PLAN
PREPARED FOR:
LOCATION. PINE STREET. W . BARN .
SCALE: I "=60 ' DATE. 12/8/88
REFERENCE.
-2 PB .454 PG 82 BAYSIDE BUILDING CO .
I HEREBY CERTIFY THAT THE BUILDING
SHOWN ON THIS PLAN IS LOCATED ON THE
GROUND AS SHOWN HEREON.
OF
A
down cape engineering, . inc . J0 N �s
WELW€E
CIVIL ENGINEERS o `^
LAND SURVEYORS
ROUTE "6A-•• YARMOUTH MA `DATE py S VEYOR
Assessor's offioe (1st floor): ���� �%TNE
Assessor's map"and lot number ....................................... ...'�.. C ��i� M��� ��
Board of Health (3rd floor):. � `:.` ''"�' +' • ,�����;,
Sewage Permit number E- _... .-..�g..7..�,. ..... .........f� `�. 'EASd�9e?ADLE.
Engineering Department (3rd floor): 30 rc�S �' �� 3Q.' ra®® p��+ �06
5 fwiN ��M�
House number ........................................ .....:. .......:... ... .. W
APPLICATIONS PROCESSED 8:30-9:30 °A.M. and 1:00-2:00 P.M. only
TOWN OF BARNSTABLE
APPROVED &UILDING ' INSPECTOR
� Barnstable Conservation Commis
....F.�1n?ic.y.........�.... ......
igaed Date
TYPE OF CONSTRUCTION ........C(J ?.Ql)°.....)=41A.Mh ....................................................................................
/�d V............l9
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location ... ..............&fz`...... 1.......... .... ?t....... ....... ......IUD.,.....................
ProposedUse ..... `'!/ ��................................................................................................................7...................
' ` .....................................Fire District ....4 �. 17"�/�Le�
Zoning District ................................... ......... ......................................
Name of Owner ...494U� .......VAUA. .............Address 456 k...5- CI ram. 13 4V/IJST�7�
p !
Name of Builder .. .YSODE 13.oO6o........CQ:......Address ...�`��X.....5. �AJ�Ei..1/ILL�
Name of Architect ... :... %7 /.. ........................Address ........01 TU/........................................................
Number of Rooms ........... .............:.....................................Foundation %JKJ£�°...... U
-
.......................
Exierior /N6LF—S.............Roofing ....4VIIAL7........................................................
Floors Q! / . ..C/..!.ieP �`....�..1I//i�•Y�........................Interior ...��!V ..... '....G`�YPSUAY/..............................
/� 1
Heating �.L:..F/�1 ...... � ... f/.1..(!t!./glC....Plumbing . ��,��� ..........�.�z �i�7r St
p J Fireplace �!1/1 /�t / �c�... ..40.e!/ .e........Approximate Cost ...... DD ...............................
. .....................................
�// X- . ^
Definitive Plan Approved by Planning Board _____�V__/_-______._______19________ . A a c9F.
Diagram of Lot and Building with Dimensions Fee .. .. !... ......................
SUBJECT TO APPROVAL OF BOARD OF HEALTHL�
t
s •
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to oil the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Construction Supervisor's License ....... .......0....F.S...
WALLACE, LESLIE
32505. Permit W 0 0 F'Y.........
No ................ for
Sin5 i 1 .. Dwell. ... ..............
......... .....Y ..... ..
Location 530 P.alker Road
........... ....................
West Bar
..p5tablel
..................................... ...........;I....................
Owner .....Leslie l-
1., a�ce
..................Wa......................
Type of Construction Frame .,j.........
................. .......
................................................ ...... ....................
Plot .... ....................... Lot ................................
December /15 . 88
Permit Granted ...................................., 19
Date of Inspection -919
Me Completed .......................... 19
Erg