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Town of Barnstable *Permit# o�?Zf1, 06P /
Expires 6 months from issue date
i Regulatory Services Fee
* & Thomas F.Geiler,Director j 33
�A1
Building Division
Tom Perry,CBO, Building Commissioner
200 Main Street,:Hyannis,MA 02601
www.town barmtable.ma us
Office: 508-8624038 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
f O Not Valid without Red X-Press Imprint
Map/parcel Number "/ ',,"}
Property Address �o UC ma
2"Residential Value of Work$ �4`D'o• Minimum fee of$35.00 for work under$6000.00
Owner's Name&Address S Z)--_cL
z6 Cen
Contractor's Name Telephone Number::, �7
Home Improvement Contractor License#(if applicable) Email:
Construction Supervisor's License#(if applicable)
❑Workman's Compensation Insurance HESS PERMIT
Check one: SEP — 6 ZQ1
❑ I am a sole proprietor
tQ I am the Homeowner
❑ I have Worker's Compensation Insurance
SOWN OF E3ARNSTABLE
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
`Replacement Windows/doors/sliders.U-Value m 30 (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 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
required.
SIGNATURE:
QAWPFILFS\F0RMS1building permit formsUT S.doc
Revised 060513
The Comttrar stealth of Massachusef s
Departinent oflndwsftial Accidents
. ..... Office oflnvestigations
s 600 Washington Street
Boston,MA 021II
wnrPv.mas&gosY'dia
Workers' Compensation Insurance Affidavit:Builders/Conti-actorsfE ectricianslPlumbers
Applicant Information Please Print Legibly
Name Munin�min rfion/l&vid ao: MA/,/ a
Address: -Z, z,
city/stat&Zip: Cen�v�10-- M�-� o �7 d Z 7
Are you an employer?Check the appropriate box; Type of project:(req uired�=
1.❑ I am a employer with 4. ❑ I am a general contractor and 1 6. ❑New constructma
employees(full and/orpart4ime).* have hired the sub-conttactvis
2_❑ I am a sole proprietor or partner- listed on the attached sheet; y- ❑Remodeling
ship and have no employees These sub-contractors have g_ ❑Demolition.
working for me in anycapacity. employees and have workers'
t 9_ ❑Building addition
o workers' comp.insurance comp-insurance
_[required.]
5- ❑ We area corporation and its 10_.❑Electrical repairs or additions
3_V I am a homeowner doing all work officers have exercised their l I-❑Plumbing repairs or additions
€ o workers' right.of exemption per MGL 12-. Roof myself [N �P- ❑ repairs
insurance required,]3 c.152,§1(4),and we have,no
employees-[No workers' 13.❑Other
comp_insurance required.]
*Any appUcaat that checks box#1 most also fill out the sectioa below showing their worker'compensation policy anfbrmztiam
T Homeowners who submit this affidavit m cstiug they are doing all wok and then hire outside contractors mast submit a racy affrdarit indicating such_
/Contractors that check this box mast attached as additional sheet showing the name of the wk-caaft2ctm and state vrhether or not those enmities have .
employees. Ifthe subcontractors have employees,they must provide their warkess'comp.policy member.
lam an employer that is prmiding workers'congwnsation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy 4 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 requiredunder 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 imlrisonment,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 cDpy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification-
Id Iaereby c tW render the panes andpenalfies ofpetjuty that the information prinideed above is fare and correct
Si tmeL��
Date:
Oj f ci.al use only. Do not write in this area,to be completed by city or town oficiat
City or Town: Pera dtfLicense#
Issuing Authority(circle one):
1.Board of HeaIth 2.Binding Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: _ Phone#:
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."
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 IocaI 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"Neither the 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 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 certificates) 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 retumed 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/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 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. 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 Massachusetts
Depaitmeut of Industrial Accidents
Office of InyestigatiGns
600 Washington Street
Boston,MA 02111
Tol.#617-727-4900 ext 406 or 1-977 MASSAFE
Revised 4-24-07
Fax#617-727-7749
w .mass_govfdia
OFTHE T Town of Barnstable
Regulatory Services
MARN9 &4&& � Thomas F. Geiler,Director
Eo;A;i 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
Property Owner Must
Complete and Sign This Section ;
If Using A Builder
as Owner of the subject property
hereby authorize to act on my behalf,
in all matters relative to work authorized by this buildin ermit
(Address of Job)
*Pool fences and alarms are the responsibility of the-apphcan Pools
are not to be filled or utilized before fence is installed and all final
inspections are performed and accepted.
Signature of Owner Signature of Applicant
Print Name Print Name
Date
Q:FORM&OWNERPERMISSIONPOOLS 62012
r
e
Asti Town of Barnstable
Regulatory Services
swx U E
DUBS-
Thomas F.Geiler,Director
es.. $
OIE1 jg. 61 0 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: -"SP — /3
JOB LOCATION: G Vu c7/7 /1.
number street village
"HOMEOWNER": U (J� D
name ��LL•�home phone# work phone#
CURRENT MAILING ADDRESS:_ Lit� / D_)V1_1
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 OFHOMEOWNER
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
109.1.1)
The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,
bylaws,rules and regulations.
The un ersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection
pro es uirements and that he/she will comply with said procedures and requirements.
Signature'oflioineowner
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 his/her responsibilities,many 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.
C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\ContentOu[look\QRE6ZUBN\EXPRFSS.doc
Revised 053012
fr
Q�THE>o TOWN OF BARNSTABLE
� Permit No....3r761.8......
BUILDING DEPARTMENT
aeaan I TOWN OFFICE BUILDING Cash .................
■a..
°hour�� HYANNIS,MASS.02601 Bond .......x........ .
CERTIFICATE OF USE AND OCCUPANCY
Issued to BAYSIDE BUILDING'COMPANY
Address lot #8A 26 Alberti Way, Centerville
USE GROUP FIRE GRADING OCCUPANCY LOAD
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 AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE
BUILDING CODE.
Au ust 27 87 ���
g................... 19......8 ........ ..... .......................
Building Inspector
r t
- 3 -. � f4 ��j: ', .?.'-. ,...� .,,�,:, � ,r�s. k �c H t L�'tis`+r.`�i, ' 'y �• �i � ,'.fr..� „ ,y, :-, .r�. ..
y
TOWN OF BARNSTABLE
�� Aw
BUILDING DEPARTMENT
t D�� TOWN OFFICE BUILDING
MNL
HYANNIS, MASS. 02601
0 qY r
LY
MEMO TO: Town Clerk
FROM: Building Department
DATE:
t
-An Occupancy Permit has been issued for the building authorized by
BuildingPermit #$.. _d ... ...... ............................................................................_...._..................................:
issued .to ................. ?dz� .C�a,Z-edr ................................... . . ..: ...__
I
Please release the performance bond.
THE FOLLOWING
IS/ARE THE BEST
IMAGES FROM POOR
QUALITY ORIGINALS)
M A�C(, I
DATA
TOWN OF BARNSTABLE, MASSACHUSETTS ;/ BUILDING , '{�
` • 19
A?SPLICANT h i3' .t.l 9: .. DATE j PERMIT
ADDRESS -r ::)� C.C'•iterVli-k.c: Yf:)�/3
' (NO ) `, (STREET) - (CONT R'S UCENSE<'1�
I PERMIT TO STORY > j:✓ i .1.1� J ,.NcC�i -ttif;NUMBER OF
(TYPE OF,IMPROVEMENT). NO. (PROPOSED USE) •'DWELLING UNITS
AT (LOCATION) ift� t .ai_' r �. t ,.._'a`-:1`-t ZONING
(NO.) (sTR.EET) DISTRICT
BE EN AND
(CROSS STREE'i) (CROSS STREET)
t�I
SUBDIVISION LOT BLOCK SIZE
BUILDING. IS TO BE FT,. WIDE BY FT. LONG BY FT, IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
REMARKS:
a
AREA OR ..:u'US - .. - .
VOLUME ESTIMATED COST $ ( 0 PERMIT
(CUBIC/SQUARE FEET) FEE
OWNER
ADDRESS 1 ° '�"' J ! 1 •:::i t. BUILDING DEPT.
BY X. K
THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR
PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE -BUILDING CODE, MUST BE AP-
PROVED BY THE JURISDICTION. STREET OR _ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED
FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS I
OF ANY APPLICABLE SUBDIVISION RESTRICTIONS.
MINIMUM OF THREE CALL INSPECTIONS REQUIRED FOR APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE .
ALL CONSTRUCTION WORK: CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQ,U.IRED FORELECTRICAL, PLMBI
`
1. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- Iv1ECHANICAL l STALLATIONS.D
2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL �M
MINA INSPECTION
TO LATHE FINAL INSPECTION HAS BEEN MADE.
3. FINAL INSPECTION BEFORE -
OCCUPANCY.
PO T THIS CARD SO IT IS VISIBLE FROM STREET
B LDING INSPEC N APPROVALS PLUMBING INSPECTION APPROVALS
ELECTRICAL INSPECTION APPROVALS
I 1
z _ I
2
Ad
� O
HEATING SPECTION APPROVALS ENGINEERING DEPARTMENT
1
OTHER 2 U G IA S BOAR
WORK SHALL NOT PROCEED UNTIL THE INSPEC- PERMIT WILL BECOME NULL AND VOID.IF CONSTRUCTION •
a TOR HAS APPROVED THE VARIODUS STAGES OF WORK. IS NOT STARTED WITHIN SIX MONTHS OF DATE'THE INSPECTIONS INDICATED ON THIS CARD CAN BE
CONSTRUCTION. . •� ARRANGED FOR BY TELEPHONE OR WRITTEN
PERMIT IS ISSUED AS NOTED ABOVE.
o NOTIFICATION.
s
�.� . LOT 11 A
Mc Loug14t,1nf �.
Zo. NI v o F s rEPHEti1 a
— 0'8Ri E�Nj
- , 39°-
LOT C?A
22, �9ofi s,�: � 4-
2pj"
0 'Ci,eieyd
v
�LIS E�,_-r
Val A� r
I I CERTIFY THAT THE
SHOWN ON THIS PLAN IS `1,A of
LOCATED ON THE GROUND
AS INDICATED ��� ROSIN f
WILC :f
TER.E�
LA%13 Q c
DATE REGISTERED LANDS EYOFt
LEVY a ELDREDGE ASSOCIATES,INC. CLIENT % CERTIFIED PLOTPLAN
ENGINEERS - LANDSCAPE ARCHITECTS JOB NO. /_ ZD3^�
PLANNERS— LAND SURVEYORS
DR. BY I N
889 WEST MAIN STREET CHKD.BYI� I B R.�IJs 4 .,M� ;
CENTE41 LLE, MA. 02632 SHE ET-L O,F�.,,_ SCALE, - 72 DATE` 9
4"
IM
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J �0 82.
L4,
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12 9So b iV�F S Tr`PN�/.1
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LoT IA o' Bev ems!
�ZB,ERi1
WAY
LEGEND
EXISTING SPOT ELEVATION 0 �
PROPOSED SPOT ELEVATION- DARID P. �� OF }
MAIANO r�: ;
EXISTING CONTOUR ---0- -- � w CIVIC 'I �,�� 1
PROPOSED CONTOUR 0 N'bA1115RO
NOTE: THE LOCATION OF ANY UNDERGROUND cis-r
SEWERAGE,WELLS, OR OTHER UTILITIES SHOWN ON �F a Q
THIS PLAN IS APPROXIMATE ONLY AS DETERMINED
FROM RECORDS AND/OR VERBAL INFORMATION.
THE CONTRACTOR IS RESPONSIBLE FOR THE Ar gawp' `
VERIFICATION-OF THE EXISTING LOCATIONS IN
THE FIELD.
I.
RE 1 N IN
�R
E �.DREDGE As �TEs, n�c� . CLIENT l e. . . r 0
ENGINEERS — LANDSCAPE AR:CKITECTS JQB. NO., 4 A �
1
,Lo7"e�rf� - G
;PLANNERS — LAND SURVEYORS DR,BY=
J
8$9 WEST f1N STREET - CMKD By:,��,;,,.,,
� x= o
CENTERVt:4..1.E, lVl . S.?26 - DATE .2 67
-
�O FT 1411v.. NOTE /F E/TNER -We TANK DR
- LEi4ci//N0 PIT ARE, MORE TNAN /2"BELOI• .-
�� /� 4'pi.9. rRAOE, A 24'O/AMET.EL' CoNC.IPE7'� CO�'E.
ScHEOULE¢O SIVALL BLS BROUGJyT TO GRAv.E.�fiN:,FXTRA
"� GONCitCTE P V.C. P/PE h+EAV y CA 57- /RO/Y O o!/ER Sf��I L L DE USED
MN I . PITCH
•;�� 9S O CODERS � � /F/N GR/VElVA y
s,` �8 PEiQ FT
2 9L Min/. COW 4=&L-7
i- G of CO✓ER CLEAN SAA/�
L/Ql//O LEVEL - ' •• �. y�
J"pIA.
S(X�qt.S• - 2*LAYFR
.Awe. J�/PE v o o w.P ®o Gam'
MIN.Jv/TC/'I GAL. . • � • • • • o • •• r A. o4®
SEPTIC TANK DIS
6 X • • s • • • • • • • • • • • . WA SXFD STt?NE
o • o or $ m o oo • • .°°� y
r; ,� a a ° • •EFFECT/Vg • • • 3�4 - f' �2
`` • a ► • • DEPTw • • • • ° v e w.93//ED STONE
' r O • • • • • • •• 1 p o •
4 _ /S/x2•5 = 377, _Tgpz> o d�e4 • • • • • . • o o�p PRECA S T SEEPAGE
//3 x /• O O 1*so! • • • •. • • • • • ` m o PI7 OR EQU/V,
INYPJ�'T �"L ENA770NS e o At C , :7 3. 0
1.
/NYAERT AT OVILD//VG, d`UU 'FT 14
/*VZ&F .SLEPT/C TAN F K 8 T 1� FT: D/AM• *1 C CSEE 7TiBULATJQN>
VL17 :ET SEPTIC TANK _FT.
/AdLET DISTR/BUT/ON 80X 8r1• 2-0 FT. SECT/O/V OF GROLWO W,47.ER TAOLE -•
�QNYLETPISTR/®UT/ON®OX 96, OO F7
INLET LEACK/NG PIT .2. 06 fT. .SffyVA046 P SPOSA L SKS716M
1.EAcH//VG P/T ���IJLA'T/�M
DESISM CRITERIA sc.+�E : %s" m /=O" 0/.•9.ENDIMEIVS
' `N�O9dER OF®EAi�OpI+lS �..—_ D/HENS/®N C�FT. .
aA q&4GED/SPO.SAL UNIT OIVE SDI L LOG
-rO7A4 ArS'T/MATED FLO*V 3,36 GAL./PAY DSO/L 7,657- */ SOIL 7ES7_41*2 /
NUMAZA-OF LEACNlNa P/TS / I•f`EZ e.f� /•O -A-4A-Y, OATE OF SOJL TEST
S/XELEACH/IVG PER P/T /�� ,SY•! PT. _2, �q, c RESULTS h/IT/VESSED BY
.T o
, Co�G �
' LagM - Lc.F My'
®OT'TOM 4,04CN/NG PER P/T1LL._SQ. FT. oeRC04AT/ON MATE At `2 AIJAVINCH
SU SO/4
TOTAL LEACHING AREA JT47. FT. - Nc�rur� PEN COLA 77ON RA7^E/k2
RE3ERt�ELF.4CflINGA 'EA =_� SQ. FT.
�p ���'i _°a;•'9 r .4 - 131 �` iJ _ %.E.�T'"/ DAVID P
tt l:9 / /� ,p
s MA ivil LO T .<A "HL,6z? %
C{ViL �Imo' V ME'L�l ur�-� SAr�ID
t No 31115 ® f �,q qVC L
1O0`ef ' LEVY & ELDREDGE ASSOCIATES. INC.
Fss�c. 889 WEST MAIN STREET CENTERVILLE,MASSACHUSETTS 02632
CVO cr �TOUNP ;-VA7Z•R ENCOIJ/YTL�REO 'CA,/ENT c f/S/L7C DATE
C3 GJtouvo w-4TE. - AT ELEv
JQB NO. L2D 3 $HA--7 O2 ' 2
r
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f
w 71
"Assessor'.s offioq-(lst floor): �a91 �(p oFTNETo
Assessor's map oqd lot number ......................:..................... 3EPTIC SYSTEM MUST BE
Board of Healfh (3rd floor): J_ GTALLED IN COMPLIANCE �'�° ♦�
Sewage' Permit number .:......�-:3 -... ..................&...... WITH TITLE 5 i DAMSTODLE,
` ASIL
Engineering Department (3rd floor): y A� � -MVIRONMENTAL CODE At' 5 'oo M6}9.
I House number f' ............................ . a•
APPLICATIONS ,PROCESSED 8:30-9:30 -A.M. and 1:00-2:00 P.M. only.
TOWN REGULATIONS gay
TOWN OF ,BARNSTABLE
BUILDING INSPECTOR
APPLICATION FOR PERMIT TO .N�3"TR UC T 5/�/ L.� min�/ tf O Piz
l ............ G..................''l".. ............................
..... ..... ...... ..
TYPE OF CONSTRUCTION .......( .00 b R!9 N'1 ....................
..............................................................
......-•.................•---���°........19.k7_
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the fall wing information:
Location ......L .0.T........ .......... Lf°. ER.!1........L !9�,1...: ��EI�D/LL. ...........................................
. �..
Proposed Use /e�..%C7�it/L'
........... ...............................................
Zoning District ..........Fire District q.._a............................ ......................
Name of Owner ... ! Y,$/...9.....8.LDIG........C!`J. .........Address ..... ...... C'Div 1�I�Lt
...............d.: .........
Name of Builder . S £ Address 5���
..................................................
.(�..... �............:......... ............CvTY J T
Name of Architect .........:....'1��...�� ' ... .....Address
Number of Rooms ..................4.............................................Foundation .... ........�lV�'�����—.......:
Exterior. ..... ... 51��!��R�-4.......:............Roofing ....f: -5.#t4!f;0........:...............................................
Floors C09/e r. ...... .................................Interior - ...�1/V .....5......V� . ?. w......
. . ........................
C
Heating f4? ..... /...... ................ ..... ..... ............Plumbing .. .........:.W ......1 .............................r .....
Fireplace CvNcRE7 ...,BLX&...... CiRlG1Z.................Approximate Cost jad.. .
................
Definitive.Plan Approved by Planning Board __�' l� 19_ . Area �?o.�c�a....
Diagram of Lot and Building with Dimensions
Fees/... C,--'.a... .. ........ ........
SUBJECT, TO APPROVAL OF BOARD OF HEALTH ¢,,
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Name �✓
..... ...................................
Construction Supervisor's License ...... S.V....................
'BAYSIDE BUILDING CO.
v
r
.r N. ....3 0 618 Perenit for ....Twe Story
S�na.I FaMi.�V Dweil_,ng
..... .....4........
4cation ...Lot 8A, 26 A�_be ti Way
.......................................... �.
Centervi.Lie
Owner ..Ba side BU i ldi-na Co. ' {
..............................✓...................... i r
Type of Construction r rame
..................................... .F
.........................................................................
Plot ............................ Lot ................................
Permit Granted ...........................'..............19
Date of Irispection .........7. .... .......19? r
Date Completed ...........�..�.��- ` .........19,P
In