HomeMy WebLinkAbout0004 SUDBURY LANE � � � � tig
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t
73
Town of Barnstable Permit#
Expires 6 mor the fr a rssue
Regulatory Services Fee
�xivsr�si.E,
Thomas F.Geiler,Director
Building Division
Tom Perry,CBO, Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.bamstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
EXPRESS PERNIIT APPLICATION - RESIDENTIAL ONLY
^ ---Not Valid without Red X-Press Imprint
Map/parcel Number 1 �l
Property Address- --T�5 U—QZL)k'' L_N t4ri1 ill 1 cs :
❑Residential VA1ue of Work$---&®30 Minimum fee of$35.00 for work under$6000.00
�� -�-1 U4 �c HI _6 QZ� A-G-AWAM MA- olodl
Contractor's Name Telephone Number
Home Improvement Contractor License#(if applicable) Email:
Construction Supervisor's License#(if applicable) p Rha ll-r
❑Workman's Compensation Insurance AUG 6 2013
CC c__ k_`�
❑ I am a sole proprietor
ErI am the Homeowner
❑ I.have Worker's Compensation Insurance TOWN OF BARNS` ABLE
Insurance Company Name
Workman's Comp.Policy#
Copy of Insurance Compliance Certificate must accompany each permit.
}
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 & S r Tb
❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows
#of doors:
❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required.
Separate Electrical&Fire Permits required.
"Where required: Issuance of this pemut 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
�required.
Q:\WPFILES\FORMS\building permit formsMPRESS.doc
Revised 060513
7Ae CommrompeaM ofMassachusefts
Deparhaent orf fadrrs&W Accidents
OKwe of-IMV3 igations
600 Washington Street
Boston,MA lJ2111
www.mas&govldia
Workers' Compensation Insurance davit:Builders/Contractors/Electricians(Plumbers
Applicant Information Please Print Legibly
I�Tame(E i om/Indivitlual): IAA f�,A 0.r� �. L+f�F?fzC Orr
__ . _-- /
�iZ',E- H-t LLB fib, A 614t04/n M
of 1
�C rstatrjzip: M - - alloo Phone-Ik- -5,50 o
Aire you an employer?Check the appropriate be= T of project r
4. I ants contractor and I 3'Pe �����
L❑ I am a employer with ❑ g� 6. ❑New
employees{full and/or part-time.}.* - have hired the sub-contraciom
2_❑ I am a sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling
ship and have no employees Them sub-contractors have g- ❑Demolition.
to and have workers'
working forme in any�c�5`- �P � 9_ ❑Building addition
[No wooers' comp.insurance Comp.MsurdIIt e i
5. ❑ We are a corporation and its 10.❑Electrical repairs or additions
r 3_�I a— a honiemm-er doing all work officers bare exercised their 11-0 Plumbing repairs or additions
�`• ..---- f[No workers'amp- rift of exemption per MGL 12..❑hoof repairs
insurance regnirEd,]I c-152,§l(4} and we have na-
employees-[No workers' 13.❑OTher
comp.insma x e reTired:I
*Any appliaut that checks boa#1 toms'also fill oat the section below sha :&M v odcere oampensatioa policy M&matron.
Hnmeown ers who submit this affidavit iuNcatmg they an doing://neck sad then bare oatside comtEmMrs tomst sabmir a new aifidwk mdics— sucb-
tractors that check tbds boat must attacked m additional sheet showing the name of the MIF-a&2cbm and state Whether arnot those entities have
employees. Ifthe sob-cmtmctan base employees,they must provide their workers'comp.policy number.
I am art employer that is proWAY tg workers'compexsdian inn4r ace far arty angdroyees. Belaty is dte policy and job site
infortttation.
Insurance Company Name:
Policy#or Self-ins.Lie.9: Expiration Date:
Job Site Address: City/Statelzip:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Faure to secure coverage as regairedunder Section 25A o€MGL r 152 can lead to the imposition ofcriminal 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
cf up to$250-00 a day against the violator- Be advised that a copy of this statement maybe forwarded to the Office of
Imrestigations of the DIA for instuance coverage vtrifit°ation.
I do hereby certify render thepruns aad pen aNes ofperjury thatthe information prodded above is tree and correct
Siauatme . _ _ - ' U4th0A' Date: �=I DTI- -
.
O, use only. Do not wriin in this area,to be campieted by city or town o,ASciaL
City or Town: PermitUcense#
Issuing Authority(darcle one).:
I L Board of Health 2.Building Department 3.Citp Town Cleric 4.Electrical Inspector S.Plumbing Inspector
6.Other
Contact Person: Phone#:
6
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." I
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 aparhnents 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, §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"Neith6r the commonwealth Inor any of its political subdivisions shall
enter into any contract for the performance ofpublic work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority;"
Applicants 4
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),address(es)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 toverage. .AIso 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/liceme number which will be used as a reference number. In addition,an applicant
that must submit multiple pennitllicease 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.i 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 Massachusat -,
Departmmt of Industdal Accident ,
Office of kvestigatfans ` r
600 Washington Street i.
Boston,Imo.02111 i
ToL A. 617-727-4M W 406 or I4 hiASSAFE
Fax#617-727-7749
Revised 4-24-07
www.mss-gov/dia
a
Town of Barnstable
• fAR118fA13Ia. • Regulatory Services
M
"9•-��� Thomas F.Geiler,Director
Building Division
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: C5 l
JOB LOCATION: 44 S U-D 6 V R_V 14 I S
number street -1'n village
..HOMEOWNER':
name home phone# work phone#
CURRENT MAILING ADDRESS: I LD--9 C�.14� `L c fl:j L_L5
cityhown 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
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
tog.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 he/she understands the Town of Barnstable Building Department minimum bspection
procedures and requirements and that he/she will comply with said procedures and requirements.
Ognature,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.
f C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\8R76BDVA\EXPRESS.doc
Revised 061313
v Town of Barnstable *Permit#
ao�'�
Expires 6 months from issue date
Regulatory Services Fee
Thomas F.Geiler,Director
�A �S.TPv-f- Building Division10' ld-�16
y -\A O� Tom Perry,CBO, Building Commissioner.
200 Main Street,Hyannis,Na 02601 O
www.town.barnstable,ma.us 1
Office: 508-862-4038 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
Not Valid without Red X Press Imprint
z� �" -
Cap/parcel Number LAI. f
tJ . tJ e
roperty Address P '
Residential Value of Work dU M 'mum fee of$25.00 for work and $6000.00
iwner's Name&Address otyjl�-a(/� ('Aar-r-6+
:ontractor's Name 14-CJA Telephone Number yl3 3 y7-7 7C/T
[ome Improvement Contractor License#(if applicable)
]Workman's Compensation Insurance
Check one: -
❑ I am a sole proprietor
❑ I am the Homeowner
❑ I have Worker's Compensation Insurance
2urance CompanyName
Vorkman's Comp.Policy#
:opy of Insurance Compliance Certificate must be on file.
'ermit Request(check box)
�i Re-roof(stripping old shingles) All construction debris will be taken to }
❑Re-roof(not stripping. Going over existing layers of roof)
❑ Re-side
❑ Replacement Windows/doors/sliders. U-Value (maximum.44)
"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 Horn Improvement Contractors License is required.
iIGNATURE:
!:Forms:expmtrg
.evise061306
Town:of Barnstable
Regulatory Services
f
Thomas F. Geller,Director .
ZAV4 '
9� %6
j •�� Building Division
pFFD MA � '
TomPerry, Building Commissioner
200 Main Street, Hyannis,NIA 02601
Fax: 508-790-6230
Office: 508-862-403 8
Property Owner Must
Complete and*Sign.This Section
If.Using ..A.Builder
as Owner of the subject pxoperty
riz
hereby authoe s5�>c"D�1� /J e2Lll�
to act on my behalf,
matters relative to work authorized by'this building peitnit application fox:
- .
(Address of Job)
Signature of Owner Date
print Name
. t
Q:FORMS:OW:VERPERMISSIOI4
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BBRS Privacy Statement
r
*r
4 -
http://db.state.ma.us/bbrsihic.pl 1/22/2007
The Commonwealth of Massachusetts .
Department of Industrial Accidents
Office of Investigations
Y
' d 600 Washington Street ,
Boston,MA 02111,
vwOmmass.gov/dia '
Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
A licant Information Please Print Legibly
Name(Business/Organiiation/Individual):
•Address:
City/State/Zip: C�yL` �C1�L l�r. 1Mu 3Z Phone.#: 50- 9—
Are you an employer? Check the appropriate box: ype of project(required)i,
L❑ I am a employer with 4. ❑ I am a general contractor and I :T 6. ❑New construction .
,._ : loyees{full and/or part-time).* • have hired the stab-contractors
2. I am a'sole.piroprietor or partner- listed on lhe'attached sheet. 7. ❑Remodeling
ship and have no employees These sub-contractors have g, ❑Demolition
working for me in any capacity. _ employees and have workers'
9. ❑Building addition .
[No workers' comp,insurance comp,insurance t'
required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions
officers have exercised their 3.❑ I am a homeowner doing all work I L❑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,❑Roofrepairs
employees, [No workers' 13:❑Other
comp,insurance required.]
*Any applicant that checks box#1 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.
:Contractors that check this box must attached an additional sheet showing the name of the gub-contractors and state whether ornot those entities have
employees. Ifthe sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer.Mat 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 declarafion page'(showing the policy number and expiration date).
Failure,to secure coverage m required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine tip 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 maybe forwarded to the.Office of
Investigations of the DIA for insurance coverage verification
I do hereby certify der th pains and p [ties of perjury that the information provided above is Prue an'd correct.
Si afore: Data: / 2 Z l `7 _
Phone#:
Official use only. Do not write in this area,to be completed by city or town offrctaL
City or Town: ' Termit[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#:
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,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, §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." .
Additionany,MGL ehapter:.152, §25C(7)states"Nejther the commonwealth nor any of its political subdivisions shall
enter into any contract for.the performance of public�work until acceptable evidenca Gf•compl6in a vyithtlie insurance
requirements of this chapter have been presented'to the contracting authority.'t
Applicants
Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contiactor(s)name(s),address(es)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 n=ber 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 afl davit 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 fo any business or commercial venture
(i.e. a dog license or permit to bum 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:.
Th4 CommonwWth Of Ma ch=,US
art cifA A.ects
Q .ce orf I»veAt pt olls
Boston,.NU 02111 •
TO. 617-727-4 ext 406 or l- MAS.SAFF
Fax##:617-727-7749
Revised 11-22;06 www.m g6v/dia
71
ssessor's map and lot number :...... .................
CF THE
Sewage Permit number .......g. :...�.7.,C1........................
Z DAHBSTADLE,sa i
House number .......................... �`�.. .........:....................... ro ra �
1639. \00
E M a'
TOWN OF BARNSTABLE
BUILDING INSPECTOR
APPLICATION FOR PERMIT TO ....FaM ll..v.we.11InP ......................................
TYPE OF CONSTRUCTION WOOd...F�;dTC12........................................................................:..................................
........1..�7... ... .................19��.
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies fjo-r_a permit according to the following information:
Location "......z 7...... ........................... V...... .............................................
ProposedUse ...................................................................................................................................................I.........................
Zoning District R.B. H Mis.
........................................................................Fire District ....�.....................................................................
Name of OwnerCapriCOrri Realty `gust „Address 755...Falmouth Roads Hyannis................
Name of Builder Franco Real Estate Dev. CoAddress 765,, Falmouth Road Hyannis
Inc...
Nameof Architect ..................................................................Address ....................................................................................
Numberof Rooms ...S.lx.......................................................Foundation .P.9.?...................................................................
Exterior C1aPboard and�Or SYlln�le8 _,,,.Roofing asphalt shingles
.............. ............ .......................................................................
Floors carpet ................................................Interior sheet rock
Heating Gas...-...F a W A.r............... ...Plumbing WO . ................................................
Fireplace ............Approximate Cost .....t4o. .o.Qn.a n.....................................
'Definitive Plan Approved by Planning Board ________________________________19________. Area ..J.0 ...t—A........
Diagram of Lot and Building with Dimensions Fee .............................................
` SUBJECT TO APPROVAL OF BOARD OF HEALTH
a
'A
i
f
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Name
i
r Cunioor� l�yalb/ Iz7��t
' ~_-
;,7 /-5
`^ ___
i
� . '
___.� .... . l} ______..
L6cohon ..........A. .Iaae_______. `
`
�
' ......................... 19----.�--------..
� .
Ovvner '----.. ����.I�yal��.Iroa�_
Type of ---..fzzoe___^___.o �
� . /
'
'
----------'---------------'
,
�Plot ���
---------. ��'----'x�"�---. —
' \
[
' |
.Permit Granted --.��February�� � —22--- 82
lg '
/
Date of Inspection ....................................
Date 6 Como|e�e ~ lV
. .�-----.------
. =
PERMIT REFUSED
`
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----------.—. ------. 19
� ���� .
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. -----�. - . --.------------ `
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,
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TOWN OF BARNSTABLE Permit No. --------``t
Building Inspector `
1 sain..a Cash ___---
•o
OCCUPANCY PERMIT Bond ' ---—: _*01
No building nor structure shall be erected, and no land, building or structure shall be
used for a new, different, changed, or enlarged use without a Building Permit' therefor
first having been obtained from the Building Inspector. No building shall be occupied until a
certificate of occupancy'-has been-issued by the Building Inspector."
Issued to rx`lj3Y 1Ct�I Cl � `� ''rus Address 765 Falmouth Road, Hym-mis
Lo,: 495 4 Stidbuyt mania, Elyamis
Wiring Inspector Inspection date
Plumbing Inspector f Inspection date
�''�t ., Inspection date �-1 Gas Inspector
Engineering Department , ' — y,,��<� Inspection date 7 --
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.
�-
f. .._....... .. _., 19 Building/Inspector
C
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vql
0 a4 i
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lo,000 %. F L~ �" 0 i
WiArH t oo ' '� coa 5 v'
`29874 0
20' F,5 F3• 4�STE��p�
su
T Poun//�A7ivn/ CERTIFIED PLOT PLAN
l,o.' 1130VE ,P.oA- 07- 2$-- S"vp6L)/zy L� rvE s
IN t
J„�ARIV5 Tff 13L4—:"
SCALE: / -3v DATE: l'1?1S2_ I
LDREDGE ENGINEERING CO.,IN F/mwao I CERTIFY THAT THE �vyNDfl7�y
CLIENT 4& SHOWN .ON THIS PLAN IS LOCATED
EGISTERED REGISTERED
CIVIL LAND " JOB: N0. ON THE GROUND AS INDICATED AND
I }� CONFORMS TO THE ZONING LAWS j
ENGINEER SURVEYOR DR BY ;
OF a�9�NsT�t3�E , M S.
712 MAIN.ST
�lYANNIS MASS. 0108 .42
E'T_1, 0F :/ SURVEYOR
SHE
DATE _ E LAND S
s�ssor's map and lot number ...
Sewage Permit number ....... ........................ SEPTIC SYSTEM M"63w`
C13MPL
INSTAL ICI I S
House number ............................ ............:........................ ro s LE.
WITH TITLE 5 o i63q. 0m'
t7C�c FNViRONMENKLATIONS
L CODE �I�AN a�
r ,
TOWN OF BARNS�'AvB
r
BUILDING INSPECTOR
APPLICATION FOR PERMIT TO ..Fad}.U.y...1).W.Q -.1.3,U9............................:.
TYPE OF CONSTRUCTION Wood..Frame. ..........�J........................................ . ............:......................:......
Z4.
4fi
TO THE INSPECTOR OF BUILDINGS: I
The undersigned hereby applies for
,a` permit according to the following information:
Location '�..L T......`�..V.��..N!T�......1�..�n.!')��y....� .��.a .............................................................
ProposedUse .............................................................................................................................................................................
Zoning District R.B. H annis
........................................................................Fire District ....Y.................................:.......................................
Name of Owner Capricorn Realty' T-rust Address '�6 j Falmouth Road, Hyannis
............. .....
Name of Builder Franco Real Estate Dev. C Address 765 Falmouth Road,,.••Hyannis
Inc.
Nameof Architect ..................................................................Address ....................................................................................
Number of Rooms SIX .....................................................Foundation .P...c.
Exterior clapboard and�or Shingle.S•.•.•.•.•.•.••••,•Roofing ..Asphalt shingles
............ ... ................
Floors ...,carp.!.t..................................................................Interior sheet rock
....................................................................................
HeatingGas••,-•••F.TIIi.A.
.............................................................Plumbing :tWO...-...C.QpjJQx:..................................................
Fireplace ...RQXle...................................p ..................................Apprgximate Cost ... !�:Q.,.�Q.O...Q.O.. ..............................
Definitive Plan Approved by Planning Board ________________________________19_______. Area ...10.56..sq.....ft..........
Diagram of Lot and Building with Dimensions Fee �^
SUBJECT TO APPROVAL OF BOARD OF HEALTH
*NN\
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Name .. ... .
Capric6rn Realty Trust
��ermit for .y
P�itS. .... 38�2- one stor
........ ......................... .....
single farnil dwellipg.................
..................... ............... ...
4 Sudbury
Locatioh ............................Sudbury..Lane.......................
.........................HXannis......................................
Owner .....Capr...i..co..r..n... Realty y..T.r..u..s..t...t...........
Type of Construction .............f ......-4�ame
...................
.................................................. ..............................
Plot ................. ........... Lot ...................
February 22.....19 82
Permit Granted ....... ............................
Date of Inspection .....................................19
Date Completed .............. ..19
07
PERMIT REFUSED
..............................! I............................. 19
...............................................................................
..................................................................... .........
..........................................................................
...............................................................................
Approved ................................................. 19
...............................................................................
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