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HomeMy WebLinkAbout0117 STRAIGHTWAY r �ypyh�rrzy 111JI) Town of Barnstable APermit Expires 6 months from issue date Regulatory Services Fee • 13w13r4sr�.c. • ��J .V MASS. 10$ Richard V.Scali,Interim Director Building Division 4 Tom Perry,CBO,Building Commissioner AA,, 20.0 Main Street,Hyannis;MA 0 4p/// /VOYO ' www.town.bamstable.ma.us ��j Office: 508-8624038 �iy�/ Fax: 508-790-6230 EXPRESS mmu APPLICATION - RESIDENTIAL ]Vol Valid without.Red X-Press Imprint Map/parcel Number -Pro a�Y AKd` ess P , (Residential Value of Work$ L Minimum fee of$3500 for work under$6000.00 Owner's Name&Address A A l l Contractor's Name? : OTIA—ut- HomeW,U/I(X� Telephone Number 401-WY Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) 66 �� ;�Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance JJn /� Insurance Company Name I��J 04TIV '41 - J PJD N Workman's Comp.Policy# 1k) (p O� 5 Copy of Insurance Compliance Certificate must accompany each p ermit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side Replacement Windows/doors/sliders.U=Value (maximum 35)#of win s #of do ❑ 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: ope wner must sign Property Owner Letter of Permission. o y the Home Improvement Contractors License&Construction Supervisors License is it SIGNATURE: Q:IWPFILESWORMSIbuiidingpeY� f 1EXPRESS.d c Revised 061313 �!7/z"4-3 99 . . Pg3 � 51o14 �O. " 262249PCIALSERVICEG6IE4 IN 0CE U0 - w' Store 2612 HYANNIS Phonet (508):778.8948 .' fi5INDEPENDENCE DRIVE. Salesperson:RHP4LE •, HYANNIS,MA`0260.1 Reviewer VXG1123. nan+e'; phwo MEDIE,RC?S HORT. NS1A REPRN4T " i08S T17 STRAIGHTWAY .... .. rhonal b 7, HYANNIS .. _. .. . . �oncose+oio„ exterior door install:; MR sw�u za . cau xir _201:?r10'20 08:6W- MA. `02601; BAE W TABLE: INe:reserve he:dght to fiord tt►e4uanhties;of;'merchandiso CUSTCIMERPICICUP``#1 } F z MERCHANDISE AN SERVICE ii SUMMARY Sota;�tiagtome �r REF# W10: SKU# 0000�51'5-664. Customer.Picku /Wiil Cait. . SO 'MERCHANDISE TO.BE PICKED:UP: S/(3 FEATHER.RIVER REF:#;S09 ESTIMATED ARRIVAL DATE• 11102/2017. 14309: _ . . DOOR M ti: , QTY UM _., DESCRIPT1bN. , a :`. =`PI TAX. ' H EXTENSION.: 50909 OQ00-10t=2;•0 i'00 EA NA/,STANDARD ENTRY,DOORS ENTRY DOOR:63 5 X 8`/ENTtY A' $3,277 02' $3277 t}2 DOOR63 5 X.81;.626STANDARD ENTRY'DOORS #1 SCHEDULED PICKUP DATEt WiU l e 1666 uled:u ort errival'aail S1O'Merchentlise •WNW 277.02 tp- USTOMER PICKUP ':'REF'#W 90 INSTALLER DELIVERY #1 F :REF#a01. p. STOCK,MERCHANDISE TO:BE DELIVERED:: `SKUr'. ,. °G1TY UM .:. ION ;`PI TAX ,PRICE EACH EXTEN310N R03 . .. i Oat 361.-475:,. 1:00 ..EA 1/2 X 4-1/2 '72 VM47 DLE/ AL Y $26.76` .820.76 R04 0000-:702=678 ,, 1:00 EA' 1 X8.-16FT PRIM t3 D/. :A Y 29.85 R05;. 0000 458-056 24:00 LF 11/16 X3• 4A4 CASING%: 3 Bit . A Y 0.97 $23.28?. R06 0000=822=204 J 1 00 RL 6 , DOOR SEALING TAPE/ A P X48". OLN .3SF:/: Y $14.i5 $14.1580749 . 1Q UR16R07` = L' : • * • $93i52 _..... ,... :•,•CONTINU6 MAN ED.ON,NEXT. PAGE"' WILL-CALLWACH P FOR.WOLL MALL Wil!-Cali Items ;n the store for:7 dpys only (MERCHANDISE RICK-UP Check yourcwrentjorder,atafus online at ;PROCEED TO WILL CALL.OR SERVICE DESK AREA vvvrenhomedepqt:com/order§tatus, (Prq.:Custorners,Pr; To The;Pro.D_esk),,. n ca es;i ern mar. •own. Page 1 of i'4 .Nb KNI -55249 customer Copy SPECIAL SERVIGES`CUSfQMER INVOICE- Con4inued tame: ME-bIERQS Page 5 of'14. No. H2612-65249 INSTALLATION #2. (Cont(nued) L. #IO2 ''CU,STQMER IS RESPONSIBLE FOR PAYMENT OF THE PERMIT ONCE. IN FULL.,NO REFUNDS ON,PERMIT.FEES AFTER 72 HAS.OF PAYMENT.. THE PERMIT IS PAID FOR,.WORK CN,THE if PEFtM ASSEMBLY BEGINS' , IMMEDIATELY,CANCELLATIONS W.ITNIN 72 HRS WILL.BE REFUNDED EN®dF INSTALL. rF �ry►.y. pp�e ®fie �,e SERVICES TOTAL CHARGES .OF ALL-MERCHANDISE & SERVICES • -s - ® $4 272 55 06. 110'ld(PI): SALES TAX $210'M A 90 DAYS DEFAULT POLICY:; T®�'A!. t4,483:21 6AI_AkibE 66 0:00 'The Home Depof reserves the HON'tdAinrt/deny returns. Please see the retum Policy sign in stores for details.' END'OF ORDER iNo:.H2612.55249 ' Customer's Signatu . a ir- - Date ae _ Page 5 011`4 ; ; Ism H26 Z- 5240 Custorrler Copy r rt. a i PAUL MDOWNINGtxpirztlon- Commissioner 19 e e y 71 e Commonwealth of Massachusetts e.� Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 Boston 7�qA,� 1 r ^� y ,lYBl`jL 0Gd l 4�601/ www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/fndividual): �,.11.- Address: — City/State/Zip: � ;�,s ;f;r� ALA y>3o — Phone#: z- Are you an employer?Check the appropriate box: Type of project(required): l.❑ I atn a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.[ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling shipand have no employees These sub-contractors have 8. ❑ Demolition Working for me in any capacity. employees and have workers' insurance 9- ❑ Building addition comp. [No workers' comp. insurance P- required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL insurance required.]t c. 152, §1(4),and we have no 12.❑ Roof repairs employees. [No workers' 13.0 Other _ comp. insurance required.] *Any applicant that checks box#1 must also till 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 anew affidavit indicating such_ . zContractors 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. I am an emploher 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: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required tinder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. ' I do hereby certi y under the pains and penalties of erjury that the information provided above is true and correct: �7Sir►ature: `` 1 Date:'._ Phone#: Official use only. Do not write in this area, to be completed by city or town official Cite or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other 'Contact Person: Phone#: re The Commonwealth of Massachusetts Department of Industrial Accidents d 1 Congress Street, Suite 100 0 Boston,MA 02114-2017 - www.mass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers- TO BE FILED WITH THE PERNUTTING AUTHORITY. Applicant Information Please Print Legibly Flame (Business/Organization/Individual): The A-(or'le j j �-f—�-� rme_ , Address: Cl 0 g ]2)p4,,n I p K City/State/Zip: Sk f-p-w c Jour)( Ma GISLASPbonek (S03) 9 q 2- (pet4 Z Are you an employer?Check the appropriate box: Type of project(required): 1.dl am a employer with pit employees(full and/or part-time)." 7. ❑New construction 2.r_�I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 3.�I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 1 El Demolition 0 Building addition 4.❑]am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole I If Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5. I am a general contractor and I have hired the sub.contractors listed on the.attached sheet. ❑ 13.❑Roof re airs These sub-contractors have employees and have workers'comp.insurance.- 6.❑We are a corporation and it officers have exercised their right of exemption per MGL c. 14. Other €J� 52,§1(4),and we have no employees.[No workers'comp.insurance required.) qn 'Any applicant that checks box gl must also fill out the section below showing their workers'compensation,policy mfonVation. t Homeowners who submit this affidavit indicating they are doing all work and then hire oufside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and 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 isproviding workers'compensation insurance for my employees. Below is the policy and job site information. _ Insurance Company Name: &6ziinela l LIr1 j_Ora _L46 5r S(��l e o• — Policy#or Self-ins.Lic.#: X VC 6 gig 3 1 14 S Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaratio page(sbowing the policy num er and eg iration 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 opy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verificati I do hereby certi funlieltheivains and Pena rjury that the information provided ab e ' true and correct 1z. Si afore: Date: ' 1 t ��7 Phone#: �8 — L 9 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Healtb 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: JJL C 111- .i'Cin t.) t� - Office of Consumer Hffairs and Business Regulation 10 Park Plaza - Suite 517 Boston, Massachusetts 02116 Home Improvement Contractor Registration Ty *pe: Supplerne Care Registration: 1 1271785 Expiration: 04122,201 c HOME DEPOT,USA INC 2455 FACES FERRY RC C-11 HSC ATLANTA,GA 30332 Update Address and return card. Mark reason for change- Address r Renewal C Employment ❑ Lost Card _ office a Consumer Affairs 8 Business Regulation Reoistrafion valid for individual use only - HOME IMPROVEMENT CONTRACTDR before the expiration date" If found return to: TYPE:SUDDlement Card Office of Consumer Affairs and Business Regulation �- Reties o-n Exdiratioc. ,G Park Plaza-Suite E170 12785 Boston,MA 02116 `46mE DEP07 JSA INC r ANDREW SWEET . �' d. Ithou Signature 2455 PACES FERRY RD C-1I HSC ATL AN TA GA. 3033E Undersecretary =777DO' YYY) acoR CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). CONTACT PRODUCER NAME: FA MARSH USA,INC. PHONE A1C No TWO ALLIANCE CENTER EMAIL 3560 LENOX ROAD,SUITE 2400 ADDRESS* ATLANTA,GA 30326 INSURERS AFFORDING COVERAGE NAIC 0 INSURER A:Old Republic Insurance Co 24147 100492-HomeD-GAW•17.18 42757 INSURED INSURER B:Agri General Insurance Company. THE HOME DEPOT,INC. New Hampshire Ins Co I23841 HOME DEPOT U.S.A.,INC. INSURER C 2455 PACES FERRY ROAD INSURER D: BUILDING C-20 INSURER E: ATLANTA,GA 30339 INSURER F COVERAGES CERTIFICATE NUMBER: ATL-003746387-14 REVISION NUMBER:2 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR i I POLICY EFF POLICY EXP LIMITS TYPE OF INSURANCE POLICY NUMBER MMIDO MMIDDIYYYY Tflr AL GENERAL LIABILITY MDAMAGE TO R D WZY 910022 o31o1no17 . o31o1n01e EACH OCCURRENCE S 9,000,000 PREMISES ISES Ea bceurrsnce 5 i'000.0M S-MADE X .OCCUR EXCLUDED LIMITS OF POLICY XS MED EXP(Any one person) S OF SIR:V M PER OCC rPERSONAL&ADV INJURY s 9,000,000 1 GENERAL AGGREGATE S 9.000.000 ATE LIMIT APPLIES PER: 1 i PROOUC pMp�OP AGG S 9,000,000 PRO- Lx S ;EDT I 71017 03101n018 COMBIN D SIN LE LIMITSA I AUTOMOBILE LIABILITY MWTB„10021Ea accident BODILY INJURY(Per person) S LANA ANY ` �SCHEDULED SELF INSURED AUTO PHY DMG BODILY INJURY(Per accident) SNON-CAUTOSNNED fPerr aw�denTY*t TY MAGE( AUTOS S B OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE AGGREGATE S DEO I RETENTIONS pER OTH- Is 8 I WORKERS COMPENSATION F C491123"(TN) 03101/2017 0310112018 X 1 STA TE ER CAND EMPLOYERS'LIABILITY Y/N 023102423(AK,NH,NJ,VT) 0310112017 03101n018 E,L.EACH ACCIDENT ; 1.000.000 ANY PROPRIETOR/PARTNER/EXECUTIVE N NIA 0310112017 0310112018 I1.000,000 OFFICERIMEMBER EXCLUDED? 023102424(WI) E.L.DISEASE-EA EMPLOYER S(Mandatory In NH) 1,000,000 Ityesdescribe under inued on Additional Page E L DISEASE-POLICY LIMIT S DESCRIPTION OF OPERA below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Addltlonal Remarks Schedule,may be attached If more space is required) EVIDENCE OF INSURANCE CERTIFICATE HOLDER CANCELLATION HOME DEPOT USA,INC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 2455 PACES FERRY ROAD THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ATLANTA,GA 30339 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. ManashiMukherjee I @ 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 100492 LOC#: -Atlanta Ace ADDITIONAL REMARKS SCHEDULE Page 2 of 3 NAMED INSURED AGENCY HOME DEPOT U.S.A.,INC. MARSH USA,INC. DI81A THE HOME DEPOT 2455 PACES FERRY ROAD POLICY NUMBER BUILDING C-20 ATLANTA,GA 30339 CARRIER NAIL CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance Workers Compensation Continued: _ -- --Gamer trufemnity Insurance C"ompany d11Q0r��menCa Policy Number.WLR C49112294(ALAR FL,ID,IA,KS,KY,LA,MS,MO,NE,NM,ND,OK,SC,SD,WV,WY) Effective Date:03/0112017 Expiration Date:03/0112018 (EL)Limit$1,000,000 Cartier:New Hampshire Insurance Company Poky Number.WC 023102422(DC,DE,HI,IN,MD,MN,MT,NY,RI) Effective Date:03101 017 Expiration Date:03/0112018 (EL)Limit SI,0D0,000 Carrier.ACE American Insurance Company Policy Number.WCU C49112282(OSI)(AZ,CA,ILNC,OR,VA,WA) Effective Date:0310112017 Expiration Date:0 310112 01 8 (EL)Limit S1,000,000 SIR:S1,000,000 SIR for the states of AZ,CA IL,NC,OR,VA,WA Cartier:National Union Fire Insurance Company Policy Number.XWC 6583144(OSI)(CO,CT,GA,ME,MI,NV,OH,PA,UT) Effective Date:03101017 Expiration Date:0 3101/2 01 8 (EL)Limit:$1,000.000 $1,000,000 SIR for the states of CO,ME,NV,MI,OH,PA,UT S750,000 SIR for the state of GA S350,000 SIR for the state of CT Carver National Union Fire Insurance Company Policy Number.XWC 6583145(OSI)(MA) Effective Date:03101/2017 Expiration Data:03101r1018 (EL)Limit S1,000,000 SIR S5W,0D0 TX Employers XS Indemnity: Camerlilinlos Union Insurance Company Policy Number.TNS C46613202(TX) Effective Date:03/01/2017 Expiration Date:03f0112018 (EL)Limit S10,000,000 SIR:S1,000,0M ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD -�- Assessk map nd` .of number .��.Q. �.1��..:./.. . rIAYG. 11 Sewage Permit number r,� ...._.......G.... ...... .... .... /Di2 d 6[C-"rS °FT"ET° TOWN OF BARNSTABLE B9HB$TABLE, 9� "6 BUIIDI�HG INSPECTOR �amPYa�9 r. APPLICATION-'FOR- PERMIT TO ...!�u/c.17. l .D/T/H�................:.. ... .... .... .... TYPE OF CONSTRUCTION .....1!"..IAR..... . ..........y ...... ................................................................. ........................... rJ�%..........19 ...F. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .............. ........................................................................................................ F...!e.L.'...1✓.c.��Lc.!. . ....Proposed Use ... ZoningDistrict ......... .......................................................Fire District kx..s!............................................................... ��!G�sc� 'o6/Ros r�� SrRjr_KltliA �!/ � Name of Owner ........... .......... .........................Address . .... ........ ... .................... .......... .................. Name of Builder A6-e-.IO.F/ st o. ..Address �i�v� G"gwe S . Nameof Architect ..................................................................Address .................................................................................... Number of Rooms Rdon4s ���QA6- ....................Foundation .4. !`'l !� ................................................... ................. ......... Exterior ...41�/G..... .7yf.4�OP.i'.��. ......................................Roofing ... P�,00!9C ..................................................:.... Floors ...... .�.�� `x".f��:R� .......................................Interior ..���r�l;./'�0G�.................................................. ........... Heating ...PAl ..............................................................Plumbing .. f3T/5r Fireplace .....................................................Approximate Cost .... �j. ®O G Definitive Plan Approved by Planning Board -----------_____:_-----------19________. Area .7;?! .... ....................... Diagram of Lot and Building -with Dimensions p I l,' Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH u r 'CCo2v • 1 10 > r I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Q � Name .. ✓G � ..��� ......................... Medeiros, Angelo `..17279 3�1 to single No ................. Permit for .......�/................ ..........family dwelling.................................... . ...... . . .. ........... ... .. Locations .......... Hy jell.�nn.i.s....................................... V e-, Owner ....A.ng.l.e.o...Me.d.e.iros......................... . . ...... Type of, Construction frame V .......................................... r Iles;) Plot ............. ................ Lot ....................— ............ i -.Permit Grantee! .......Auguat..21...,2.. .....19 74 C, Date,of Inspection ............. 1'0 7-r �r • 7• e omit � Aw Date Completed ......... ... W .19 to .01 �70 -PERMIT REFUSED e .............. .... 19 Iflee* ......... ......;................................................................... el .1 0 t Of, ................................................................................ ................................................................ ? too, ............................................................. "oe Approved ................................................ 19 ............................................................................... v I. ............................................................................... Assess ''s map and lot number ;.r..` ' �: :!......... �jA f< - 7q Sewage Permit number ......................................�N l�.. w € At 3 - /s- %TNEr TOWN OF BARN Sr I 9ASISTADLE, i "b D NPY 1.1.11PING INSPECTOR ' APPLICATION FOR PERMIT TO ... `'. v... 1��/ 7�. . .................................................................................................... TYPE OF CONSTRUCTION ......r✓�n 4AE...................................................................... ................................ ............................ .............19 .. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Locationy.............. ly�ti>L/S........................................................................... Proposed Use ...c'.t .(."....0 u-�t'L r 'L- .......................................................................................................................................................... Zoning District ......... *�.......................................................Fire District �`..Y..���..'................................................................ �lL� c a co�/Ro s ll 7 ) Ric�t��.r�,o Name of Owner Address ...............T........................................... .................. Name of Builder «- Address .................................................... ......................... .. Nameof Architect ..................................................................Address .................................................................................... Number of Rooms .......... Foundation .C....F....I.....t.�...`............................................................ Exterior / .....r /1�,,-,L................5.......................................Roofing ... S1�f�/9L.��..................................................... Ud � f�/QDv�✓eU.12..............................Interior ..�Nr'! y- Floors ................. .................................................................... ...... ...... l lkel. ....................................Plumbin ...`-�... , l:N •+ f Heating � g..:...:................................... ................................................................ Fireplace "t?..................................................................Approximate Cost .... 0, as G ` ......................................................... Definitive Plan Approved by Planning Board ________________________________19________. Area ��.�..... .. ..�° Diagram of Lot and Building with Dimensions P' • L Fee ....... ......... SUBJECT TO APPROVAL OF BOARD OF HEALTH ' r. w M : t �0 /G ° f I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding'the above ` construction. Name JiG, .......................... ' T Medeiros, Angelo 8_ / F17279 add to single ,--No ................. Permit for .................................... � mily dwelling Location I 11.Straightway.................................. Hyannis ............................................................................... Angelo Medeiros Owner .................................................................. frame Type of Construction .......................................... ................................................................................ Plot ............................ Lot ................................ Permit Granted ........August 21 19 74 r Date of Inspection ....................:...............19 Date Completed ......................................19 PERMIT REFUSED ................................................................ 19 ............................................................................... ................................................................................ ............................................................................... ............................................................................... Approved ................................................ 19 ............................................................................... ...............................................................................