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HomeMy WebLinkAbout0123 CANTERBURY CIRCLE oa 3 ����z-�� T���-e.� - - - --- -_- -- _� _ _--- -- i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Q4 / Parcel o� Application Health Division Date Issued 7L17 r Conservation Division Application Fee 01 Planning Dept. Permit Feab Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street`Address C/r�l Village Owner Address Telephone Permit Request a- Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting docum.,station. Dwelling Type: Single Family Lj/ Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King'`6: ighway:w 0 Ye_, ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other - ' Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) "1 Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION - (BUILDER OR HOMEOWNER) - - - - M Name Telephone Number Mike McCarthy Address PO Box 52 License # West Dennis, Cell (508) 280-6964 Home Improvement Contractor# { CSL-5S633HIC-169393 Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Vv. SIGNATURE DATE I s Ir?- ~ FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL r PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. - °° e ��� S•eces srin,�?cre� � ••Richard'V.Sc:�ii,�ireeior Town. of Barnstable Tom perrp,�3tuYding;Cummiissfoner 200 Mtin Street;Hyannis,-MA 02601 wi t6wn.narnstabie_ma.us Off a: 508-862-4039 Far.: 5o8-790-62.30 Ptoper-ty. Ovvner Must CoiWkte aud $*n,TIus Section I.f Ui --B deer -as Qmner of propM-y . herebyautl did= ,v( Y+ s c ' to act on m-Aelia3f, in Z matters relative to vmrk zuthonl by this building pe�application for. 23 C A^i-car K r v C'i' V( l& I- arvml''S f 0216) ^'= 601 fences and aka= are the respons l ii 6 . le.a p cafit. 1'.oals Mt no�tt o be:OIed-or.utilized bef ore once�s Asa A!! acid all f t impeCtim ,are performed aFid accepted., n , gnatzire of Owner 'Signature of:Applica,nt Pziat.Name Print Name � . I Date Q:FORM S,.0W FMffSS1010.001-S � a� Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-058633 MICHAEL J MCC)kR "° PO BOX 52 , W DENNIS MA 02671 Z- �,.,�11 Expiration Commissioner 04/10/2016 ��-/ Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 169393 N Type: Individual Expiratio /2017 Tr# 264961 MICHAEL MCCARTHY MICHAEL MCCARTHY P.O. BOX 52 - —— WEST DENNIS, MA 02670 Update Aandard.Mark reason for change. 20M-OS/11 Address Renewal L-* Employment Lost Card _ - I f r The Commonwealth of Massachusetts Department of Industrial.Acchlents I Congress Street,Suite 100 Boston,A1A 02114-2017 www.mass.govAlla Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Phinibers. TO BE FILED WITH TILE Pl'RMTTING AUTHORITY. ApOicant information lease Print Legibly Naive (Business/Organization/Individual): Mike C a y —�-R ON52 Address: West Dennis, MA 02670 e2810:69164 City/State/Zip: ('4L-r-8W#: HIC-169393 A71'.m an employer?Check the appropriate box: Type of project(required): 1. a employer with 4� employees(full and/or part-time).+ , 7. ❑New construction 2.❑1 am a sole proprietor or partnership and have no employees working for me in tt, Remodeling any capacity.(No workers'comp.insurance required.) 3.E]i am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9• ❑Demolition 4.❑t am a homeowner and will be hiring contractors to conduct all work on my property. I will .10E]Building addition ensure that all contractors either have workers'compensation insurance or are sole I L n Electrical repairs or additions proprietors with no employees. 5.❑I am a general contractor and 1 have hired the sub-contractors listed on the attached sheet. 12.[:]Plumbing repairs or additions These sub-contractors have employees and have workers'comp.insumnce.l 13.❑Roof repairs 6.❑We are a corporation and its officers have exercised their right of exemption per MCL c. 14.dOlher 152,§i(4),and we have no employees.(No workers'comp.-insurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy informalion. 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 2n 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. I am an employer that is providing)Porkers'cotnpetisation insurance for my employees. Below is the policy and job site Information. insurance Company Name: AT/ ' Mi,I Policy#or Self-ins.Lie. Daly Expiration Date: ).,l l— )IN— Job Site Address: C.� �f� City/State/Zip: Attach a copy of the workers'compensation polic declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. i do hereby certify tin U al s and pities rjury that the:information provided above is trite and correct Si nature: Date: Phone#: F,sfsuine cial use only. Do not write in tlds area,to be completed by city or town official. or Town: Permit/License# Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Cleric 4.Electrical Inspector 5.Plumbing inspector 6.Other Contact Person: Phone#: fY WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMA99UPAGE A.I.M. Mutual Insurance Company 54 Third Avenue, Burlington, Massachusetts 01803-0970 (800)876-2765 NCCI NO 26158 POLICY NO. VWC-100-6017656-2014B PRIOR NO. VWC-100-6017656-2014A ITEM 1. The Insured: Michael McCarthy Construction Inc DBA: Mailing address: P 0 Box 52 FEIN:**-***3862 West Dennis,MA 02670 Legal Entity Type: Corporation Other workplaces not shown above: See Location: 2. The policy period is from 12/15/2014 to 12/15/2015 12:01 a.m.standard time at the insured's mailing address. 3. A. Workers Compensation Insurance:Part One of the policy applies to the Workers Compensation Law of the states listed here: MA B. Employers'Liability Insurance: Part Two of the policy applies to work in each state listed in item 3.A. The limits of liability under Part Two are: Bodily Injury by Accident $ 500,000,each accident Bodily Injury by Disease $ 500,000 policy limit Bodily Injury by Disease $ 500,000 each employee C. Other States Insurance: Coverage Replaced by Endorsement WC 20 03 06 B D. This Policy includes these Endorsements and Schedules: SEE SCHEDULE 4. The premium for this policy will be determined by our Manuals of Rules,Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Classifications Premium Basis Rates Code Estimated Per$100 Estimated No. Total Annual Of Annual Remuneration Remuneration Premium INTRA 0712979 INTER SEE CLASS CODE SCHEDU E Minimum Premium $550 Total Estimated Annual Premium $29,332 GOV GOV Deposit Premium $7,748 STATE CLASS MA 5479 State Assessments/Surcharges $28,601.00 x 5.8000% ' $1,659 This policy,including all endorsements,is hereby countersigned by 12l15/2014 Authorized Signature Date Service Office: Bryden&Sullivan Ins Agcy of Dennis Inc 54 Third Avenue PO Box 1497 1 Burlington MA 01803 So Dennis, MA 02660 / WC 00 00 01 A(7-11) l Includes copyrighted material of the National Council on Compensation Insurance, \ used with its nermissinn. aG X PFIESS Pfft Barnstable *Permit# - !1• M F-v'- nths from us a date MAY �.3�2®1Regulatory Services Fe BAMSTABIX KAS& Thomas F.Geiler,Director TED MA't NS7PA ding Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERAUT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint 2� 1 Map/parcel Number �q Property.Address % �3 r P Residential Value of Work Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Contractor's Name �i���;� ���( Telephone Numbers Home Improvement Contractor License#(if applicable)` 1 pC2?/5?2 Construction Supervisor's License#(if applicable) eWorkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Us e%e!���z Y221 Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) eRe-roof(hurricane.nailed)(stripping old shingles) All construction debris will be taken to 1/ "10,,11*Dz-27/V ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) VRe-side #of doors . ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is /re 'red. SIGNATURE: sue._ Nlassachusetts- Department of Puhlic SafCO Board of Building Regulations and Standards Construction Supervisor License License: CS 63537 , "A AP DAVID R COX }r . PO BOX 401 S YARMOUTH, MA 02664 Expiration: 10/15/2013 ; Tr#: 4314 t'ummissiuner - - - - --- ✓lee -Pomv�no�uuea� o�✓�/�aooac�ucarl�d �'I — ---------.---_----._---..------- Office of Consumer Affairs&B siness Regulation License or registration valid for individul use only . HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration 1,00497 Type ? Office of Consumer Affairs and Business Regulation Expiration_ 3[25%2014 Private Corporatio 10 Park Plaza-Suite 5170 DA D COX,.INC t '„ Boston,MA 02116 David Cox k }$ 19 LAVENDER LN W.YARMOUTH, MA 02673 Undersecretary Not valid without signatur I The Commonwealth h of assachuseds aronent of lndusbgnl Accide r Office of lnvesligafions 600 Washington Street Boston,MA (12I11 wnwv mass.govldia Workers, Compensation Insurance Affidavit: Bmlders/Contractors/Electric anslPlumbers AAp hcant Infacmation ? Please Print Legi Name(Budxss/Org timgn&vidua0: Ad-dress: ,rll/ 'r�l�,c�U�, Z A2 Cityf5tatp: �� Phone # Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with % 4. ❑ I wn a gmexal contractor and 1 6- ❑Ne'w c ction `employees(full an&0r par#trine).* have hired the sub-contfactms ,�, 2.❑ I am a sole proprietor or partner . Iisted ore 1-he attached sheet dLl �g ship and have no employees 1h�sub-contractors have g- ❑Demolition. working fAr'inP 11r any capacshl- employees and have v�lcers' 9.- ❑Building addition [No wGda:s'comp.;nsulunre comp-kwMancr-1 .] 5_ ❑ We area corporation and its 10•❑Electrical repairs or additions required 3_❑ I am a hosrkeou�doing.all work right have exercised 1 LE]Plumbing repairs or additions myself [No workers'comp. right of e2uesuptiflr,per lafGL 1 ❑Rflof repairs insurance required.]g c.152,§1(4),and we have no employees-(No workers' 13.❑Daher comp.insurance required.] *Any applicant that chedks box K must also 5llow th,e section below sbawmg their wmims'compensation policy mformati� Hammowners who submit this affidavit indicking they am doing aQ vvA and then hue autside contractors mass submit a new affidavit indicating sorb. tCautradnrs that check this box m=attached xa additional sheet showing the name of the su�o-s s and state whether or not those entities bxv2 eaVlayem ifthe snlrcontmaors have employees,d-f=ntp Mde their W-k-V—p.policymnaber- I aln an emploj er tliat isprvt ixiing worirers'contrlxrrisrrtiora iris rance far rrny ewph4rerm Below is thepoRcy*rued jab sAff information. lwurance Company Name: Policy#or.Self ins_Lic. Expiration Date _ Job Site Address: CitrstateMp: Attach a capy of the workers'compensation policy dedaratioan page(showing the policy number and expiration date). Failure to secure coverage as required unties Section.25A of MGL c- 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 an&or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a.fine of up to$250-QO a day against the violator. Be advised dent a copy of this statement may be forwarded to the Office of Investigation of the DIAL for inn=nce coverage verific tion- do hereby certrj(y under t#.epai�3,nss a nd�penabiss rrfs /J uty that the infontudi+an prm;ided above is trees aced correct Date- on f� Phe#: ©ffidal sass runty. Do not mite in this arerc,la be can'Fieted by c4 or tmwj official City or Town: PermitUcense# i Issuing Authority(circle one): 1.Board.of Health 2.Budding Department 3.City/Town Cleric &Electrical Inspector 5.Plumbing Impector :. 6.Other i . a of Tt+E rosy . * HARNSTABLF, + Town of Barnstable ATfD��s . Regulatory Services Thomas F.Geiler,'Director, Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.ba rnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, �//l��l�l!/��l/ O�,g���)/JaJJ� as Owner of the subject property hereby authorize Zi &Z,12 to act on my behalf, in all matters relative to work autho ':e by this building permit application for: (Address of Job) S' afore f caner Print Name If Property Owner is applying for permit, please.complete the Homeowners License Exemption Form on;the reverse side. i i 1 :IWPFILESTORMSIbuildin ennit formslEXPRESS.doc Town of Barnstable . Regulatory Services * y E BARNSTABLE, ' Thomas F. Geiler, Director MASS. `�� rF9 n3+a Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601. www.town.ba rnsta ble.ma.us OOffice:,e 508-862-4038 _ Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: w_ } JOB LOCATION: number street village "HOMEOWNER": c a name home phone# work phone# 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 to allow homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Per who owns,aparcel 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. (Seci'ion 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, ,^ bylaws, rules and regulations. A • r , The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department_minimum inspection procedures and,requirements and that he/she will comply with said procedures and requirements. 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 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible.. To ensure that the homeowner is fully aware of m his/her responsibilities, any communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. DAVID-2 OP 10: KU DATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 04126/2013 TfllS 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. It SLIBROGATION 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 endorsements . cDNTACY PRODUCER Phone:508-771-1632_!LAME: Northwood Ins.Agency,Inc. PHONE Fax:5Q8-393-2955 AIc No.Ext) 540 Main Street,Suite 9 EMAIL Hyannis,MA 02601 ---_------ ....._....------- ..... _...: ....... .._._.. ._......,. ._.... --- -ENSURER+�S)_AFFORDINGCOVERAGE INSURER A_Travelers Insurance Company _. -- INSURED David Cox,Inc. INSURERS:ProBresslve Casualty Ins_Co P.O. Box 401 INSURER C: S Yarmouth,MAQ2664 INSURERD: __._._,...._...-. _.......... .........._.._._...__.......-- INSURERE:__---:__.—_...._--'--........._......_._._....._.._..-... _.._---...................".4_..........._......_-.._-- 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 CTHER 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 REQUCED BY PAID CLAIMS. — -- ---.. AD-i7 SUa POLICY 0 F • POLICY EkP -- fig'LSRI. _.__.- TYPE OF INSURANCE I POLICY NUMBER MMiDDJYYYY i MM/DO YYY OMITS QENERAL LIABILITY EACH OCCURRENCE IS 1,000,000 DAfitAr, TOI NTEO A COMMERCIAL GENERAL LAABiUTY 6801481M796, 03/14/2013;03114/2014 PREMIS cccurrence)..,, $_.. 300,00Q _..._.__, , I I MED EXP(Any one person) I$ 51000 j CLAIMS-MADE XJ OCCUR - - "" -" f 'PERSONAL&ADVINJURY $ 1, X 'Business Owners 000 000 --ii i I ,GENERALAGGREGA'^E _._.... ..$- i G_EN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COtAP/O?AGG t$ r000 _— ._. ..---- It -- $ POLICY I PE T I LOC i COMBINED SNGLE LIMIT t-7 AUTOMOBILEIJASILXrY ( {Eeaccide�lL_... .. ...__._g ....._.._..----._-_.. B l ANY AUTO 05717783-5 104M912013 l 0411912©14 BODILY INJURY(Per._... r poon). S_. 250,000 1--1 ALL OWNED �_ AUTOS X 'AUTOS SCHEDULED i - I BODILY INJURY(Per accident) S 500,Oba I ` PROPERTY DMIAGE g 100,0OC I -- NON-OWNED I I ! i {Per ecadenp._...... .--_-. X HIRED AUTOS _X 1 AUTOS ` I UMBRELLA LIAB OCCUR i I I EACH OCCURRENCE S — —4 I AGGREGATE .EXCESS -- ...._ i {._.. CE_._.._...._ OED I RETENTIO $ WORKERSCOIMPENSA'nON WCSTAI'U• OTH- AND EMPLOYERS'LW91LlTw Y!N I �— 00( A ANY PROPRIETORMARTNERIEXECUTIVE I-- n. SKUB91OXT42212 07h6/2012 07116/2013 E.L.Ea_CHACCIDENT _ 5 100.- 1_...1 .. ... OFFiCERIMEMSER EXCLUDED' N!A I E L,DISEASE EA EMPLOYEC S` -� 100,0OI (Mandatory In NH) j It yyes,describe under E,L.DIS"EASE POLICY LIMIT S 600,001 DEBCRIPTION OF OPERATIONS bebw DESCRIPTION OF OPERATIONS t LOCATIONS I VEHICLES (Attach ACORD 107,Additional Remarks Schedule,it more space is required) CERTIFICATE HOLDER CANCELLATION TOWNBAR SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS• 230 Main Street Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE tp 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD e THE TOWN OF BARNSTABLE i . 89flH3 LE, MASL 1639- a M BUILDING INSPECTOR APPLICATION FOR PERMIT TO V t 4 . ....... TYPE OF CONSTRUCTION ...... ............. ................ ................................................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the followiQq, information: ............... . .. ... Location ..14 ProposedUse .. ........ ...... .............................................................................................................................. Zoning District ....P'.........A...I............. strict ........................ .....................Fire Di Name of Ow,!ner .. ...... ..... ... ....... .. .... .... :.................Address ... ......... . .......... ..... Id Name of Builder ... ... . ................. ..............................Address ............... ................................ 4 9eo Of W-4-1;�_c t ......... ........................................... ..................................................Address ............ . . —1 Number of Rooms ...4.......t......... .................Foundation .../....0. ...ro. .......:...::........a..:.:...........C ... . ....... ............... Exierior ..... A............... .....................Roofing .... .. .... .... ....... Floors �.' ............................................................Interior ...... J� ­ .... . Heating ... .......'; ...................Plumbing 111U? :.......1000 24 Ir"o,"J . ........ Fireplace ............... ...................................................................Approximatp Cost .............;ti................................................. Difinitive Plan Approved by Planning Board --------------------------------19-------- - Diagram of Lot and Building with Dimensions 7 J` Ld Ea V) 01� :r 03 2-6 -V < Lo LLI u,) u') < Zz CX o LL-p < Z_ I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name . . .... .............. ............. ......................................... Lawrence, Irving M. 1 Y. No ..12877.... Permit for .....one s nor............. single family dwelling (possible l8-) ............................................................................... Canterbury,Cirihle Locati on ............................................................... ..........................HYanni s ...... Owner Irvi.ng..M.....Latirren. . ce................... .... .. . ........ . ...... Type of Construction frame I ................................................................................ Plot ............................ Lot ..............z ............. Permit Granted ...Feb?"uarY..1..7........ 19 70 � .. .. .. Date of Inspection ... ......19 710 Date Completed ......................................19 9 PERMIT REFUSED { t ................................................................ 19 ; i ............................................................................... ................................................................................ ............................................................................... ............................................................................... Approved ................................................. 19 ............................................................................... ...............................................................................