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HomeMy WebLinkAbout0077 SAINT JOHN STREET �� _C l I TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map^_`� Parcel k Permit# 4 1 Health Division ��A .� � ' �JG Date Issued Z Conservation Division 141� Pik—, Fee %.yj` l Tax Collector. Treasurer J SEPTIC SYSTEM MUST ' INSTALLED IN COMPLIANCE WITH TITLE 5 ENVIRONMENTAL CODE A Historic-OKH Preservation/Hyannis TOWN REG49LA1'I®N.S Project Street dress 77 S t. John Rd. Village $ MA Owner Mr_ & Mrs w; 1 1 ; am M(-T. Address 77 St- John Rd. ua x�stah]_e Telephone Permit Request Remove 8 ft.living room window and replace. with new 8 ft window ' Remove 2 windows in bedroom and replace with 2 new windows Strip roof and reshingle entire. roof. Remove sidewall shingles and replace with new sidewall shingles. Squarefeetplsin�Oor existngnt step prop sect °peri2n� loor a°sting front proposed Total new Estimated Project Cost 14,01 DO.0 Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Q Two Family 0 Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes 0 No Basement Type: ❑Full ❑Crawl 0 Walkout 0 Other ^'4--Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half:.existing new Number of Bedrooms:. existing new,1 Total Room Count(not including baths):existing new First Floor Room Count 4 T Heat Type and Fuel: ❑Gas• ❑Oil ❑ Electric' ❑Other Central Air: O Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes O No Detached garage:0 existing ❑new size- Pool:0 existing 0 new size Barn:0 existing ❑new size Attached garage:0 existing `O new size Shed:0 existing ❑new size Other: Zoning Board of Appeals Authorization• 0 Appeal# Recorded O Commercial 0 Yes 0 No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name 6}13llo—Realty Trurt Telephone Number 771 -6840 Address 6 51 Main St. License# o 1 S 672 West Yarmouth, MA 02673 Home Improvement Contractor# 106134 Worker's Compensation# 1519 00 070147 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO J60nIA SIGNATURE DATE ��/ �� FOR OFFICIAL USE ONLY PERMIT NO. s r DATE ISSUED MAP/PARCEL NO. 4 ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION f ' FRAME INSULATION i ? FIREPLACE ` ELECTRICAL: ROUGH = - r 3 FINAL r PLUMBING: ROUGH `A s» % FINAL GAS: ROUGH,N) FINAL .-> _s. � y�} FINAL BUILDING t _ DATE CLOSED O~UT ASSOCIATION PLAN NO. , 1 °*SHE A . . °: The Town of Barnstable • BARNSTARIM • 9� '& �0�' Department of Health Safety and Environmental Services iOrFo " Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner For office use only Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors, with certain exceptions.,along with other requirements. Type of Work: home improvement Est. Cost $1 4, Ann _ n n Address of Work:-7 7 St. John Rd. Barnstable Owner's Name Mr. & Mrs. William McLien Date of Permit Application: 6/0 2/9 9 1 hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under$1,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: 6-2-99 Giulio Realty Trust Giulio Mariani Trustee 018672 Date 8//I f Contractor Name � Registration No. OR Date Owner's Name I. e ` `� ..;a..- _-_-_----� The Commonwealth of Massachusetts --— ~ - Department of Industrial Accidents ' #me*of/aYeSMOS ions 600 Washington Street - - '` Boston,Mass. 02111 1 - Workers' Com ensation Insurance Affidavit �� 71TTi! name: location city phone# ❑ I am a homeowner performing all work myself /❑///////%%%%/%///%/%/�% %%%%/%/O/%%%//%%%%%�%%//%%//%%/%%/%%%%%%%%/ /////%/%/% 0 ❑ I am an employer providing workers' compensation for my employees.working on this job. ..:i>:.;:.;;:.;:.;:.;:.::.::;.;::;:.;:.:..i.;:.;;:.::.:>:.;:.:;.:;:.;:;.:; comnany: : . ::;:.;:z:::.;:;::<>:>t:.Jt.rz.'l-r.., :..l3.taa.#.... <:>. a-tic4- ...:X. :..... >':>::;:::;'::::::;::;.:;.:;..;::.;....... . . ;;:;::......:::;:.:: :.;::;:::;.:::.:::.:::.;:..;... :: address. _. ._ .. .. .... h one . ;_ a # . fIA i3 1 >::;;.:'..::.;.::::.:'.:;::..:;:.;'.;::i:..::.:;;:.;: ;.�,.::. W. :>` .O.M[%'<>[!•C[1[r `i:` i�a::a'' [ .2� i > i '`:>`<'i'i?'> �< <'is'`;';;3i%' '' < �[? > a r ;::;;::.;:..;::..:::.. ...........;'.;:.;:::.;::.;:;:..........:..::.;;:.:;;: olicy.#:...... .;:. .: ,........ 19,11,❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have -. - .-.- .,, .�. .. . -. , _....n.._ the following workers' compensation polices:• - . . .- comaanvname........ :..::.. :::..:.::::. .:::........ . .: .:.:::.:::. . i. ad resss 2<;' G yt{Y' ? y ti i r `c '; t s s >2 2 'Y' <'%$t} t <2 2 t 2 ? >2[ % % 'i? ::::::::::::.......::............... ..........::::::::::::::.:::::.:...:.............:........ .......::::::::•.... :::•:::--.—.......:.:::::::::::::::.�:::::::.�:.�::.�::::::::::•:::.......... ..... :._: ::•:::.:............. i ::..:::: city:;: :;::;:: __. _ ::::..::..:: ::a;.:,,;:i :................ .......::::::::::. ::::::::::::::: :4:fiii::3:3'5:3:•i::•:3al::' .............:................: ......... ...... ::.:.:::::.::::w:•;i4}?i sij:•:ii•:fi:3:iL:•i ii3:iii3:i3:3:3ii}...i i.:j 4 i>}i:tfiii:- ...........:::::.:::::::::v:. .::.�.�::.:�.:::::.�.�::::::::•:.�.�:::.;::................. ::•:::::.�:::::::::. .f wx:. '.... . ::!iiY..::: iiii-.:i.ii:•::i•::•::•::.:•:•ii::•i:•ii::•......i?:-.::....:..:—.:::::......::::......"...::::::::::n;:.;::;;;..::::::::::::;:. insz,ranceca.... _........ o lk.._... //'r///////////, «Sr > < <?« ?>><' y>> < `s' >>;>;'•`?' >'`• <;< > `>� >> : '�< ': > ><> >> ;> z<ter::;::«:::><>s :.::: ...... ::•.::,........:::..:............:. :..................:.:.....:... 'CaIDDaR 'Tanis:':::; ::%?:.:::;;:;: %: ::: ;:%>.?::::::::.:.:: :.: :. ::::i::i:::::>:;:: address «:::>'<::>::<:;: -.tv- .1-::��,*.:.:X..:... =.... ....-1- 22M ::`'bane .. n ::. ........ ..................... ..................................................-....-.......... <: ::::::::::::::::............,......,.......................,.............::.,::.:::::.:::..::::::.::::::r:::v:;:::::..::.;...... ..........................::::...................................::::::::.::.::....::::...,...::::::::::..:::::-:.. :._:::.;:::<::>::>:<::::<::::-1.1.::::::: in�nrance.ce`:::...:....;.:. :.:...; 1-1 ::..:.....:. .....<:.:::, oli ik....... .. ..... �/% Failure to secure coverage a,required mmder Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to S1,500.00 and/or one years'imprisonment as well as dv8 penalties in the form of a STOP WORK ORDER and a Ste of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification I do hereby certify wider the pains and penalties of perjury that the information provided above is true.and correct r Signature r q r y Date Z&/& _ _ Print name Giulio Mariani Phone# 771 —6840 official use only do not write in this area to be completed by city or town official city or town: permit/license# Building ❑Licens ❑checkif immediate response is requited ❑Select . • [)Healt contact person: phone#, __ ❑Other (aried 9/95 PJA) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law",an employee is defined as every person in the service of another under any contract of hire,express or implied,oral or written. An employer is defined as an individual,partnership,association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity,.employing employees. However the owner of a . - dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neitherthe commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and supplying company names,address and phone numbers along with a certificate of*insurance as all affidavits 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. City or Towns 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 p—ii" icense numbex which will be used as a reference number. The affdavits may be relkn6a o the Department by mail or FAX unless other arrangements have been made. _ The Office of Investigations would lace to thank you in advance for you cooperation and should you have any questions- please do not hesitate to give us a call. The Department's address,telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents Office of InvestlgatlODs 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 7274900 exL 406, 409 or 375 cam_. i ... y 1 .V L '/ I` oo*THE T04 Assessor's map and lot number .......................:.0............... �,�� Sewage Permit number ....4ulc� 4 House number rsnce,J ......................................................................... N 09 VMffll TITLE 6 o rnr a. TOWN OF . BARNS , ,1, ^«ODE AND GULATIONS BUILDING INSPECTOR APPLICATION FOR PERMIT TO WVL �' /`��'................................................... :......y........... ........ ............ TYPE OF CONSTRUCTION .........-,26. ,.41..... /JI��. ......::......CLC/�Gi ................................................... ... ' ..............1 j... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit((a''cc rding t he following information: Location / ! �(. 1J"ff� V� '/ JL/N/J...........................................:........... .............................:.... ...................... .................................. . Proposed Use AA//�!!�../...........�0/L. Y.....':It Y... 7......... ..............�`................................................................... Zoning District ................ 3�.................................:.................Fire District YGi N/f ...... .......................................... ...Ad/dress .............�/... Name of Owner kL.�4:4.����:�...�....:J.Y.�C�........0 Nome of Builder (!:..........Address .................................................................................... Nameof Architect ..........................:......................................Address ................ . ................................................... Numberof Rooms............../...........................,......................Foundation ..........U!E'Fr(..................................................... �r QQ s nJGL� ..........Roofin �S...f... T......... Exterior ...........�...Q...c:...ZJ! ...........::..,..................... g .........�.Q..r� �� ..................................... Floors ............../...!..'�:E5 ......................................................Interior .....:....A.lvi£L....................................................... Healingdo 7' 6)A 7 Cr Ald�j r AIJ4C./J .........�............... ......Plumbing ....................... 000 J pp /VvN£ Fireplace .................... .....................................,...............Approximate Cost ..........�1/........................:.....:....................... --------19--------• Area 5�^^ Definitive Plan Approved by Planning Board ------------------. � ,,, Jd'1 Diagram of Lot and Building with`Dimensions, Fee c�.� .................:.......................... SUBJECT TO APPROVAL OF BOARD OF HEALTH 1- r ISII o� 4 . I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .............. ..�:............C.: .. DATE(MMDDYY)OR T� C Y INSURANCECSR HS GNGCO-1 02/19/99 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Drake,Swan & Crocker Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Agency, Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 14 Lot's Hollow Rd. ,PO Box 429 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Orleans MA 02653-0429 Phone: 508-255-3212 INSURERS AFFORDING COVERAGE INSURED INSURER A: American Economy Ins. Co. GNG Construction Inc INSURER B: American States Insurance Co. &�Giulio Realty Trust wsuRERc: 651 Main Street INSURER0: W Yarmouth MA 02673 INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TWSR LTR TYPE OF INSURANCE POLICY NUMBER_ DATE MM/DD DATE MM/DD O LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 500,000 A X COMMERCIAL GENERAL LIABILITY 02CC32642680 01/02/99 �01/02/00 FIRE DAMAGE(Anyone fire) $ 100,000 CLAIMS MADE F OCCUR MED IXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 500,000 GENERAL AGGREGATE $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,000 000 R O- POLICY JPECT LOC r. AUTOMOBILE LIABILITY _L COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY $(Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) .c PROPERTY DAMAGE $ . • (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE ? $, RETENTION $ $ ^ WORKERS COMPENSATION AND TORY LIMITS ER B EMPLOYERS'LIABILITY 01WC85779810 01/01/99 01/01/00 E.L.EACH ACCIDENT . $ 100000 E.L.DISEASE-EA EMPLOYE $ 100000 OTHER E.L.DISEASE-POLICY LIMIT $ 500000 .� " - ;� - __ DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIO_NS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS s Contractor- Job Site- Polaroid Site, 192 Mansfield Ave. , Norton, MA- Purchase order #733505-0694110 ` CERTIFICATE HOLDER N_ ADDITIONAL INSURED;INSURER LETTER: CANCELLATION BARNST1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL Town of Barnstable ATTN: Building Inspector 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE ' 367 Main Street LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF Hyannis MA 02 601 ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. ACORD 25 S(7/97) " ACORD CORPORATION 1988 J • " /Le T�arrvnaancueaGG/( L�a,i'GCW:JCLC/(UJCL(J DEPARTMENT OF PUBLIC SAFETY CONSTRUCTION SUPERVISOR LICENSE Nusber: Expires: Restricted To: DO GIULIO MARIANI jp?r4%CE0AR ST IALTHAM, MA 02154 HOME IMPROVEMENT CONTRACTOR Registration 106134 ' Type - TRUST Expiration 07/22/00 GUILIO REALTY TRUST GUILIO MARIANI fegQXedar St. I am MA 02154 ADMINISTRATOR ilalth I z � I < o0 r-, o I - m I r to I a ol Z � tol T a C r © m _____.,.-ram. �� ___ _ ?.__-._------__—._�_ .___- ---. ___..___._ _.�- O-�r ---- -• - ao ro ( ~ - m H Assessor's map and lot number > Sr ,L00� ........... ...... `.... � ........,. _ E c ro Sewage Permit nJL umber .....//,AAA /).✓i' r,y „ Z BAHBSTABLE, i House number ................................................... _.. r rnea moo,1639_ \00 MPY a" 4:{ TOWN OF BARNSTA.BLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO .. ..•........I ....................................A�"........................................................... 611VII�6- TYPE OF CONSTRUCTION �6V C&Y,1&Y . //Lj ................................................I TQ THE,IN OF BUILDINGS: The undersigned hereby applies for a permit according to .the following information: Location ..:. ( ..... . . � . ........ � f .. ................................... Proposed Use .... .. •,................................ Zoning District ..........em.................................:.::...:..........Fire District ........Yi Name of Owner kLul.q.1.1-1 .... ...�.4/ �r.././.0 ddress ......... 'g!�'1 ............................................................... Nameof Builder M. �....e... .../N,........Address .................................................................................... Nameof Architect ..................................................................Address .............. ................................................................... Number of Rooms ..................................................................Foundation ...... vcl r'b .....!�........................................................... Exierior ...............................? ...... .......................................Roofing ....................... ,, /c Floors / /L.,C•........................................................Interior ..........!„��......L:...................................................... Heating �/�.7....�)/� 7'F/C...................................Plumbing ......./O6A)c �f'iC�,vr .. ........��.... ........................... 000 Op Fireplace ��£ ..................................Approximate Cost ....A;�2 „ Definitive Plan Approved by Planning Board -------------------_-----------19_______. Area .........:....,......::..i................... Diagram of Lot and Building with Dimensions Fee �^'b U ............................... _ 1 -, SUBJECT TO APPROVAL OF BOARD OF HEALTH , i ? yl I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. G� C ......................... Name . ....... .McClain, William Joice A=291-28=2/1-28 - L�j �_Oor �!�..�ini r�,��qM.Ak . ......q.. No ... .... Permit for ......�4.. . ..and garage to..dw!�.1.1.in ......... .......... ................................... dwelling......... . ....P, Location ............7.7... . .............. . ......... ............................NyAnni.s.................................... Owner ... William & Joice McClain....... Type of Construction ........frame...................... ............................................................................... Plot ............................ Lot ................................ Permit Granted .......Peptember 6.................................19 79 Date of Inspection .............................;...19 Date Completed .1....................................19 PERMIT REFUSED � . .f. .. .......................... I A .................... ... ...... .... .. ... .... .. .. .......... ........ ............................ . ........ ................. ....... .. ..... .... .. .... .... ......fr, .... ................ ....................... . ..... ......C. ....•............................... Approved .... ........................................... 19 ............................................................................... ............................................................................... Assessor's ma aru! lot. Humbert . 1 Ql �,(,id!J�' D :p Q.....Q.. .. o.. ...� O N �O�TNf � fD o Seyvagec Perr►1it:an�mbei ... +411 £Ir"O :N d { ....a......,�^... a : . n T 3I y 'A 14f�t w jiA! N Q tic tx ¢M i 5 YP MA 000 JA-143M Roy Ms rvc, CODE f 3 U@ATIOfV� o,.s���° � N. p U I LIM ICI 3-P00,C0H. m ARPLICATIOy FOR PERA 111T T. ..... ,TY0E O* CONSTRUCTIO ,. ... T /11I'C. �. Q... 0 L.;//V ................ g?.................. i TO THE INSPECTOR OF BUILDINGS: ihe net h r y e tes��cr t� pets ar`��a C rc�iiiy ��r � ii'o/wing in ormotiv�� Location !.. . (.... �/.!� !�.... " /, ... .. /CJN/�.... ` ... Proposed Use .............. 11'!!�/vti ,`` ;D0 .. .. ........................................... Zoning District ........ .. .Irr .... .� .......`.........Fire District ., f..f,Yll/Uti/f................................. l' l t, C Address Name of Owner X�!:./L�-.���.�...1.�:...`�L��C�'l � !9-/�/.� ' ........................................ Name of Builder �.Y.l� �/�M.f...:.c....C4�91.Y.... * ..Address ..... `.. ..............:............................................ Nameof Architect ..................................................................Address .............:.. ............ ........................................ Number of Rooms............... Foundation QUA'�........................�}.....I.............. Exterior ..... ............ ...... Roofing, .......1.!.... .� A/ Floors ............../..:.!.'L. .....................................,.................Interior ........................................................................... Heating: W/7 %; C...... Plumbing ......... .°. .£ ... Fireplace ......... ���.�` fT!d.GE'a ........:..::.:....:.:..Approximate Cost' c?!� �? .�........,......... ... Definitive Plan Approved by Planning Board -----------_..___-----------19......_ Area +Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH ' e S5 01 on 1 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the obov construction. _ Name .. .. .... ...........C. 079�� �v/ Q Assessor's map and lot number ...................... . ��e 9 yDi THE TOIL v Sewage Permit number ....zuc�,f...�, � �� (�G € �� ro�Q ♦� TABLE, i House number ..................... � OMAy�' VVi'M MLE 6 TOWN OF iBARNSP41"VTAL CODE AND. GUI S M1 BUILDING INSPECTOR 1 APPLICATIONf?,�7 `.. %/V f/V .1..:. �.:1.,..,, � �;e��` FOR PERMIT TO ..... ... ............�.......... ....... ... ............ TYPE OF CONSTRUCTION .. � �L/ & Ce-Z I- " ..........511�649............. ...............J...... �.................... .............................................. % TO THE INSPECTOR OF BUILDINGS: The undersigned hereby ap ies for a permit acc rding t he following information: 77 � �� Location ���� � ProposedUse ...............6.J� ............ ...... ....". ��.... ................................................................. ��l.V. Zoning District ..........��...............:............................. ..,.. ..Fire District ...r!f1:......,. Name of Owner•"C,lq ...�.-.-�lol. / / �.. Address .........�! ..... ......................................................... Name of Builder !`tO. .... M �� .......Address .Name of Architect ..................................................................Address ................. ................................................................. Numberof Rooms ............./..................................................Foundation ... ........................................................... 0 S �/!u GL� �N Exterior ..... ....................... . . ...............................................Roofing ............... ....... . .��.............................................. Floors / 4.S,.......................................................Interior .......... i�'V.. ............ i Heating .......................................Plumbing ....................... .......................o ............................. IFireplace ....................................................................:.............Approximate Cost ............./...................................................... Definitive Plan Approved by Planning Board ________________________________19________. Area ....... .. ... ..,... . .... . Diagram of Lot and Building with Dimensions Fee ............... _ «`TJ.�. ............................. . . ........... SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name..... . .......... .:.. .. .......G.... .................?......