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MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Print or Type)
TOWN OF BARNSTABLE Date CD 19 91S
Hyannis, Massachusetts Permit 1 j 7 7
Building Owner's
AT: Location � Name -:�-pa nh2
s _ Type of Occupancy: Res*ide-nc e
New Renovation ❑ Replacement D
GPlans Submitted Yes ❑ No ❑
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BASEMENT
1ST FLOOR
2ND FLOOR
SRO FLOOR
ITN FLOOR
STN FLOOR
aTN FLOOR
TTN FLOOR
STN FLOOR
(Print or Type)
Installing Company Name Colonial Gas Co. Check one: Certificate
Ej
Corp:
Address 127 White's Path ❑partnership
South Yarmouth, MA 02664 ❑Firm/Company__
Business Telephone 508/394-9851 Name of Licensed p1!±mbees or C_efitter
F. L. Putnam, Jr. h 2157
I hnbr oerttfr dot all.(tla deaile sad larsrwtien I have aI "led for wand)In above appllntiee en Use had aDesna to"Na or op
koowledp and ftl IN plsmbbq work and NwSaUom prfommed soda hrmtl awed(or thla appUntfea aril bo ln esapYaa vrM►all pttlMrl
wo.falose o!the Waaehna is Sate Gas Colo swd Oupter 113 or the 00iral Lows.
1 have informed the owner or his agent that 1 do not have liability
Insurance including completed operations coverage.
Signature of Owner/Agent
1 have a current liability insurance policy to Include completed operations
coverage. Yes
By TYPE LICENS .
Plumber
Title Gasfitter Signatyre of Licensed
City/Town: Master PlMr or Gasfitter
APPROVED (OFFICE usE ONLY) Journeyman License Number
BELOW FOR OFFICE USE ONLY
/FINAL INSPECTION SKETCHES PROGRESS INSPECTION
FEE
N0.
APPLICATION FOR PERMIT TO DO GASFITTING
NAME 3 TYPE OF BUILDING
LOCATION OF.BUILDING
3 S ,l�) V
PLUMBER OR GASFITTER
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PERMIT GRANTED
.I DATE is
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GAS INSPECTOR
Assessor's office(1st Floor):
Assessor's map and lot number �,�7V / rJ �� of TM Ir to
Conservation 7 -9-7 SEPTIC SYSTEM MUST BE
INStALLED IN COMPLIANCE
Board of Heap(3rd fbor): � ,� -` { >taa�sr�nt
Sewage Permit number �/ Vt� WITH TITLE 5
, f �''j
Engineering Department(3rd floor): �� '"{ ENVIRONMENTAL CODE ARID' Q N r°o �6�q.``od�
House number « TOWN �� �'a_P �
Definitive Plan Approved by Planning Board 19
APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2-00 P.M.only
TOWN OF BARNSTABLE
BUILDING INSPECTOR
APPLICATION FOR PERMIT TO C 0,OS 7&�t�f� C;)
TYPE OF CONSTRUCTIONQ(� �� ,► 1� +(J •�C3E3 '�-r�
19
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location --/ bi • �-0 j (S 10
Proposed Use Cam.
Zoning District Fire District 11X4A,1AJ1S
Name of Owner t17�Y)'lIDS LI'VI�S Address 3 OJ71�31(j;�,q
Name of Builder �I UL I ITtP-8QQ DO Address 0, P,
Name of Architect Address Number of Rooms CDFoundation 16 f r;IAJD (.,_/t
HIV Ll2ci-6 )F4$+r�i`tL
Exterior � ` 6irNy� S)D lads Roofing TI J� - J' � —7
Floors _4i)PX50 (.fJr�� �— "&IPL4P RAZE Interior
Heating 'y Plumbing
Fireplace Iy Approximate Cost
Area �`1 g
Diagram of Lot and Building with Dimensions Fee
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OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the Rules and Regulations of the Town of Barnst a regardi g the above construction.
Name
Construction Supervisor's License _ j'
HOLMES, THOMAS
No TU397 Permit For BLD. (2) Car Garage
r
Accessory to Dwelling r
t Location ' r• 3 8 Woodbury Lane
,Hyannis -
Owner _-Thomas Holmes
Type of`Construction Frame '
Lot = 4
December 20` 93
-Permit Granted 19- 1 t
Date of Inspection
?4. I _ �; �. t CT c
Cr
Date'Completed 19 ' •r j11
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`\111
COMMONWEALTH DEPARTMENT OF PUBLIC SAFETY
OF ONE ASHBORTON PLACE
I MASSACHUSETTS BOSTON,MA 02108
�.J —
EXPIRATION DATE
EFFECTIVE DATE LIC-NO.
RESTRICTIONS,
O C
1 PHOTO(BLASTIII(tONLY) FEE:.
. NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY
• �, STAMPED-OR-SIGNATURE OF THE COMMISSIONER
HEIGHT.
I'
THIS DOCUMENT MUST BE SIGNATURE OF LICENSEE ;
CAR RIEDONTHEPERSONOF I ..
P MMISSfONER
THE HOLDER WHEN EN- f
' BPRINT GAGEDINTHISOCCUPATION.
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HOME IMPROVEMENT'CONTRACTOR �-
a Registration 109374 '4
PRIVATE,:CORPORATION
EXPiTAtion 09111/94
PINE HARBOR WOOD PRODUCTS
,� " JAMES'D. HCGRATH
120 GREAT WESTERN RD., P.O:'B
ADMINISTRATOR S; DENNIS MA.02641
r
i�F.T,MRc:T��rT OF IN ACCIDENTS
ACCIDEN S
m Ga ^nae i30 STQN M!,ASSACHUSEX-TS 02I11
0 RS.V ,O t1`Y�S5�S' iT10 N,-INS U RA.N CF A FI DteNrl'T' ur
'.e
(li rcnscc/permictcc)
with a principal place of business/residcnccat:
7
(GrylStatclZip)
d6 hcrcby ccrzifj; under the pains and penalties of perjury, that:
m 2n crnploycr pro�idinj he fofllowing workers"compcnszoon coYciagc f®r mycmp4 yccs -otS ink on ti�is
InsurnCc,Carnpan f Policy-Numbcr
I am+a,solc. prropr;atorand have: s',a one working for ri-sc.
(� I arri a sold proprietor,gcr:cr d co saaaor or hor:c.o mrscr (citric onr-) grad I'aavc hirr..d the conerarcors list.cd below ,
who i:ave the following wctkcrs' corn rnsation insumpcz policies:
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tiamc of anlrsaEornsuraecrnpaar�►fd�c�1€tvrrbcr
Namc erfContrac-car _ Insurance Company/Policy Nurnbcr
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} - -�----`-----�`--- lrlscuarr Ceam lI'ole �c�rsz'scr �✓ �� .
' ?tame ofContr2a.o—, _a.. piny cy , r
n Il am'-2 homcs wm� r performing all the work trayscIL
}'QT : Picasc be &%,wc tbat wbilc boraco-ocn wbo employ perwos to-do raaioteca8u,coastructioo or repair work on a x'
tf-,d(ing or rs,,t mare tb;A Shret.uciu in°which the bonaettwncr:also rcridcs or oa the Ltcauods appuruzzatttlicicto arc Dot geacr`.U)'P
considered Yo crnplo�:ycrs under the o&—ers'CorJpcD,anon Act'(GL C. 152,sect. 1$5)).applicatioo.by a bor�eowaer for x:;icensc
••• rj
or prr ; it may r,.idcocc `tat q.J- xcsrus of 3n cwpio}-cr uodcr ist:Workers° Ccrr�prn:itioa/octIA
! t;18ersunC titat A COP)'at trjf st to rent w`i a forl'•ardcd to rt,c rJcpa :ncnt or iradustrW Accidcnu'Orr,ts orinssrince for covcrxTc
Nerifseation and.hat f vlurc to 3tcuac covcrtac a rccjtaired unZcr Sec-eion?54 of M.GL)52 tan kad tp cbe impoistson 01-f4irmaaa$s l" ut'
consitrlrw taf s line of tip to 515oo.00:w 'dor imprisonm«tt of tap to one ye u aj'id civil penalties in the form cf a Stop Vork Ordcr grid a
fine orS100.00 a da,gainst mc.
12
S �ncd this day Of — - -- .
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