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HomeMy WebLinkAbout0061 ANSEL HOWLAND ROAD q ° 0 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map �� Parcel; [ = Application # 6 �6 1 Health'Division Date Issued 5 �d Conservation Division Application Fee Planning Dept. Permit Fee CD� Date Definitive;Plan Approved by Planning Board /7h� Historic - OKH — Preservation/ Hyannis Project Street Address Village Q ` , Y Owner�6 'C', Address Telephone Permit Request 1--AA, Square feet: 1 st floor: existing l proposed 2nd floor: existing © proposed�('Total new Zoning District, Flood Plain Groundwater Overlay Project Valuation 00.00 Construction Type �$- Lot Sizes c>00 Grandfathered: AYes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family �A_ Two Family ❑ Multi-Family(# units) Age of Existing Structure ' e Historic House: ❑Yes 51 No On Old King's Highway: ❑Yes ❑ No Basement Type: 4Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new C) Half: existing new GS Number of Bedrooms: f3 existing 6 new Total Room Count (not including baths): existing Co new_6 First Floor Room Count Heat Type and Fuel: t.Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes . *No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new 4e_ CD Attached garage: -existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes *No. If yes site plan review# Current Use S M� dK"e­Proposed Use d. G a APPLICANT INFORMATION (BUILDER OR HOMEOWNER) - Name \0Telephone Number T1 Address License # �' e��5( `'Z JKHome Improvement Contractor# d - Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO OA5Q41 rl lc SIGNATURE DATEo A 6 FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. Y (r j .. ADDRESS VILLAGE OWNER ' DATE OF INSPECTION: I FOUNDATION FRAME INSULATION A FIREPLACE !y ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING 7 2.311 L DATE CLOSED OUT, ASSOCIATION PLAN NO. The COrrzrrcorcweu�trc of>�Iassac�SusettS Deparfrrteni oflrcdus�ria[Accidents Office of litvestiga2ions 600 Flashineon Street Bosto)i, AL4 02111 wwW,inass.gov/dia Workers' Comperesanon Zn,,arance Af ida,vit; Builders/Contractors/�Iectricians/�'Iunlbers A Iscant Information Please Print Le�� ti on/Lndi vi du al Name (BusincssJOrganiza )= (� � Phone.#; City/State/Zip: as env��\`e J '` oe]L�3�- kre your an employer? Check the appropriate box; Type of project(required): 1.[ 1 am a cmploycr with 4. ❑ 1 am a general contractor and 1 6. ❑.9m construction employees (full and/or partamc) * have hired the sub-contractors 7; Rcmodcliag 2.❑ 1 am a colt-proprietor or partner- listed on t1]c attached sheet ❑ Thes ship and have uo employees e sub-contractors have g, ❑ DcmohtOn' employees and have workers' 9 ❑ Building addition working for mein any capacity, , camp. insurance. [No workers' co�.•insurancc 10]-Electrical repairs or add iffl required j 5, [] We are a corporation and its officers have exercised their 11_❑Plt=bing repairs or addition 3,❑TT am a homcowncr doing all work t o£exem flan er lv1GL, myself, [No workers' co.rop. p 12.❑ Roofrcpairs incnnrncc required]t c, IS2, §1(4), and we havo no I3] O.thcr trgploycc9. [No workers' comp;insura.ncc rcquired_I �' policy intvrrtmtio *Any applicant that chcckc box fll must also fill out the section below showing their workcr conipcnsa flan n t HornowntrC who subroit this a$davit indicating tbcy arc doing all work and than biro outside contractors must submit i new affidavit indicating such. c XConlracton flat check this box must atlathcd an additional shcotshoveing the name of the sub-conk ctnrs and sLtic�vhcthcr ar not those tntitics havo cmployccg. irthc sub-conlraetorr hive employees,they must providr their workers'comp.policy number, Darn art ampfoyer lit rd is prcvtdirrgworkers' compensa Lon insurance for rrsy employees: Before is the policy and job life urformadort F Insurance Company Name: :� � �t1` \% �LIA Policy# or Self-ins, Lic. Job Sitc A-ddress: 4, 'r Meui\ City/Statc/Zip: Attach a cope of the workers' compensation policy declaration pap (showing the policy number and expiratto Failure to secure coverage as required under Section 25A of MGL c, 152 can Icad to'the.imposition of rrimir al penalties of a fine tip.to 31,500,00 and/or onc-ycar imprisonment, as well as civil penaltics in the form of a STOP WORK ORDER and A fir of up to S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Ot�ce of Investigations of the b7A for insurance covcra c vtrif cation. 1''do hereby ce rider the p s• r pe es ofperjury that the irrforttta on provided ctbav true and correct Daft:. Q Si afore: Phone #: Offulal use only. Do not write in this area, to be completed by city or town officfal City or Town: Permit/License# Xsstring Authority (circle one): 1. Board of.Health 2, Building Department 3, City/Town Clerk 4. Electrical Inspector S, Plumbing lnspector 6. 0 th e r •uctlons cneral Laws chapter 152 requires all employers to provide workers' comp ndcr a for contract ooflhiio' Massachusetts G crson in the scrvicc of anoth Pursuant to this stahttc .an employee is dcfi.ned as "..,e.Yery p express or implied, oral or written- „ ociatio corporation or other legal entity, or any two or more An ampLoyer is defined as "an individual part ,d including ads n rP of the foregoing engaged in a joint cntLrprisc, and including the legal representatives of a dye�Io ec�s IHow vcrhtbc rocciYer or tTuste0 of an individual, partnership, association or other legal entity, employing rnp y owner of a dwelling house loving not more than three apaziments and who resides theroin, or the occupant cl rho intcnancc, construction or repair work on such dwcll.ing hen dwelling house of another who cn�ploys persons to do raa cr. or on the grounds or building appur(t:nant thereto shall not because of such employment be deemed to be an emp oy MGL cha to 152, §25C(� also states that"cYeiy strafe or local licensing ncy nthe cornmonwt�lthsfor any r P rege�PYal of a fi.cense or permit to operate a business or to construct buildings a licant who has not produced acceptable eYldcnce of compliance va th n e ns o is politi al m-Lgc b v lions shall PP Additionally,MGL.ohapter 152, §25C(7)states Neither the corumonwblo Y enter-into any contract for,the performance of public work until acccptablo evidence of cornpti�eC�dth the in urance requirements of this chapter have been presented to the contracting authority. Applicants• the boxes that.apply to your situation and, i# . Please tzl.l out tho workers' comp atio(a, adds ss(c ) and phon nirtcly, by umbcKs) along with their ccrti5c�tc(s) of ncccssary, supply sub-contractor`s name s with no raployces othrr insurance, Limited Liability Companies(LLC) or Limited Liability Paztn san ps (I an LLq at L P does havcc than the members or partners, arc notxcqurred to carry workers compc�ahon zns of employees, a policy is required. fie advised that this affidav5uma re{0�is"b ZU nd datt thclaffida t.nt e�dayitlshould Accidents foz confirmation of iusurancc coverage. Also b bo returned to the city ar town that the application for.the portrait ox liconsc is t1ir law or if o ingc rquwred rstc to obtain aewoAccs' of Industrial Accidents. Should you have anancA t the uur�bcglistcd below. Self-iasured companies should enter their compensationpolicy,plcasc call the J�cp sclf-ipsuran(�o liccnsc number on the a ropriatc lino. City or ToWP Ot1lclnls c. Please be sure that the affidavit is complete and printed lcgiby. li oDas hmo contact y udz guding theapph t of tho affidavit for you to fill out in the event the Of5co Of Invcsttcr. in g Please be suxe to fill in the permit/liccnse numbez which will be useday ncccl oral csubmitonF a Edarvit indicating curxcnt that must submit multiple pczmit/1?cense applications in any green y Y policy information(if pecessary) and under"Job Site Address" rho applicalrt should write"all locations r town may r tided to the or tDy,n).17 A cbpy of the afFdayit that has been officially�tanzped�y�nccnsC s�A novvr city oaffidavi must be filled out each applicant as proofth.at a valid affidavit is on file for fu p year.Whero a horse owner or citizen is obtaining a hccnsc or permit not related fo any business or cozorncrcial venture (Le, a dog Jacense ox'peririit to burn leaves etc.) said persop is NOT rcquircd to complete this affidav�f Tho OfEcc of Investigations would like to thank you in advance for your cooperation and should you kayo any questions, please do not hcsitato to give us a call Tbc Department's address, tcicphone-and fax number: Tb5 COmmonwt-,4th 0f M&s-,dG1 ,tL P'P' s D,-Ru n Dt of iadi st al Accidrrnts QfRxce of Rtyesti.gatl.ans 600 'Was2-Ui40n Stt-eet Boston, MA 02111 Tel; # 617-727-490.0 ext*406 Qr 1-V7-NMASSAFE Fax# 617-727-7749 Rcviscd 11-22-06 y�w� .mass..goY/difl �oFrHEr� ` 'own of Barnstable Reguzatory Services xwx�+szxn Thomas F, Ge-Her, Director. p MAS& t67� -o g Buildin Division pre n�'��` Tom Perry, building Commissioner 200 Main Street, Hyannis, MA 02601 w�vw.to�vn.ba'rnsta ble.ma.us Office: 508-862-403 8 Fax: 508-790-623 Pr.o erty Ownep Must Complete and. Sign. This Section ff usuag A Builder- as Owzaer of the subject property hereby authorize %-Z�aav to act on.my behalf, in of matters relative to work authotized by this building permit appucatiotl for: a� (Addtess of Job) Si a re of caner Da e Print Name If Property Owner is applying for permit please complete the Homeowners hicetise Exempdotl Porrri on th'e reverse side. Town of B ax astable Of JHE ro�y� Regula><ox'Y Services Thomas F. Geiler, Director t HARNs'rAsr r, MASS. -sue � Building Division ,a7P. pJFo Mp�n Tom Perry,Building Commissioner 200 Main Street, Hyannis, MA 02601 K,wly,tovm.b2rnstable.rn2,us Fax; 508-790-6230- Qffice; 508-862-4038 HOA2EOWNER LICENSE EX.EAIPTf ON Plense Print DATE: JOH'LOCATION: street village number "I-IOMHOWNER": home phone# work phone# name CURRENT MAILING ADDRESS: state zip coda city/town current exem lion for"homeowners"was extended to include owner-occupied dW fez d of six.un or less ts The P ed that thezowner act nd to allow homeowners to engage an individual for hire who does-not possess a license, ��\ supervisor. DEr,)MT1 IOIq/OB HOA4E01'Tr'ER e eside, on which tliera is, or is intended to' to ds to r 'des OC lIl n . , she rest el . Person(s) who owns a parcel of land on which h� such uso be, a one or two-family dwelling) attached or detached structures cces not be sory oconsideredaa homeowner. Such A person who constructs more than one home ui a iwo y p "homeowner" shall subnut.to theuildingloffzcial on.a form acceptable to the Building Official, that he/she shall be res onsible for all such work erformed under thofbuildm errriC (Section l09.1,1) ith the State Building Code and other The undersigned "homeowner" assumes responsibility for compliance w applicable codes, bylaws, rules.and regulations. The undersigned "bomeovnler" certifies that he/she understands the To mot saible d procedure and minimum inspection proceduresand,requirements and that he/she tivzll comply y requirements; ✓" t ------------ signature of Homeowner Approval of Building Official Note; Three-family dwellings containing 35,000 cubic feet or larger will be required;o complth the State Building.Code Section 127,0 Construction Control. HOMEOWNER'S) XJ;MPTION exempt The Code states that: Any h mof eonstr crfor ctiDn ing work for );phovhded thlah f the homeong permit is wner engages a pers n(s)f fo hire orom i�c rdofsu h of this section(Section 109,J,1 Lu g work, thal such Homeowner shall act as supervisor." a�icularl Many homeowners who ConsWetio Supervisors,section aware 2.15)they This la k of a assuming warnsooftenlresultsf in serioussproblemsppendix ,y Rules &'Regulalions for Licensing annot proceed against the unlicensed person as it would Nth►license, when the homeowner hires unlicensed persons, In this cast,our Board c Supervisor. The homeowner acting as Supervisor is ultimatciy responsible. art of the crmil application, unities rcquiy-c, To ensure that the homeown ndersiaods the rs ponshblhticCF s ofsa Slupcm or i tics, you the 1 s'Page of this aisssue is a form currently used by that the homeowner certify that hdsh f­/rcriificalion for use to your community. From:Kathy Geddis FaXID:Northwood Insurance Page 3 of 3 Date:9/23t2009 11:37 AM Page:3 of 3 9/4/2C09 11:00:02 AM PST (GMT-8) FROM: insurancevisions.com-TO: 15083932955 Page: 3 of 3 .ACCIRO CERTIFICATE OF LIABILITY INSURANCE 7 (MMIDDIYYYY)E �-" 9/4/2609 PRODUCER NORTHWOOD ESHBAUGH INS AGCY INC THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 540 MAIN STREET SUITE 9 ONLY AND CONFERS NO RIGHTS 'UPON THE CERTIFICATE HYANNIS, MA 02601 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. (508)540-1223 INSURERS AFFORDING COVERAGE NAIC# INSURED DEAN F STANLEY BUILDING CONTRACTOR INC INSURERA; LIBERTY MUTUAL 359 CAPT LIJAHS ROAD INSURERB: CENTERVILLE MA 02632 INSURERC: INSURER D: 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. INSR DD'L POLICY EFFECTIVE POLICY EXPIRATION TYPE OF INSURANCE POLICY NUMBER LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTffff- PREMISES Ea occurrence $ CLAIMS MADE DOCCUR MED EXP(Any one arson) $ PERSONAL$ADV INJURY $ GENERAL AGGREGATE $ GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS•COMPIOPAGG $ POLICY 71 PRO- LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ee accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY NON-OWNED AUTOS / (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY. .__._ -. ' AGG $ EXCESS/UMBRELLA LIABILITY - - - EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ . $ DEDUCTIBLE $ RETENTION $ $ 'A WORKERS COMPENSATION WC1-31S-374314-019 8/31/2009 8/31i2010 wCSTATU- OTH• AND EMPLOYERS'LIABILITY Y I fJ ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100000 (MandatoryOFFICER/M in ER EXCLUDED? ❑Y 1 OOOOO It in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under SPECIAL PROVISIONS babw E.L.DISEASE•POLICY LIMIT $ 500000 OTHER DESCRIPTION OF OPERATIONS 1 LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS The workers"compensation policy provides coverage only for the state of MA as noted in section 3A of the policy. CERTIFICATE HOLDER CANCELLATION SHOULD ANYOFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION TOWN OF YARMOUTH DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 7 DAYS WRITTEN 507 BUCK ISLAND RD NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL WEST YARMOUTH MA 02673 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR - REPRESENTATIVES. RIZ" _ _ AUTHOED REPRESENTATIVE x i . -tcn�nt \�sach "\ R�«ula,sorsCt erse } W l of y1< gu\1d guper� �� goy\`�anstruGt\On ��. en5e 1 es ed to R tr Y e . L i �EANANL\JAHO 632 12 CPpT LE,1.11A 11tgI20 11 CEN`ERV\L Expiration 12334 '.',,44, t Board of Buildi� i g Regulations and Sta�� HOME IMPROVEMENT CONTRACTOR License or registration valid for individul use only 5 I Registration: before the expiration date. If found return to: e - 132149 Exp�r n Board of Building Regulations and Standards a-1/2812010 One Ashburton Place Rm 1301 ¢ .._ Tr# 278086. K j N tTY.Pez Individual 'Boston,Ma.02108 n ,. DEAN F. STANLEY s i DEAN STANLEY';� 359 CAPT. LIJAH RD k�;! CENTERVILLE,,MA i Administrator -` �� ii �Il Not valid without si _ gna ur " � ,I, R _ No GARBAGE 6e�NDEGZ � +�`� ' -�. Ap Ito x 3 = 3306-PC, SEPT\G TP►JK 33ox15�"/• =�45G.Po ,I #g 1 usl= t000 GAL. Y m v5E ►000 ot5Po5At_ PtT � •`72 � " S DGv�IALL A2Ga► = 150 SY, Q- 150 0 , BGTTOM AREA= ,� . 5 F. _ ARr.O. PrtaP. �j0 PIT j -ToTA t- �ESt6N = .425 G.P D -TOTAL 'PA►W'? F%-C>V4 - 330 G.Po PE2GoLA'TIo4 RATE s 1"Itj 2MIN !3+ ; Foa F,4 T'l o,.J 3 Fool '`�N of 4f�s9 �o ALA °y 01 22 I RWHARO N A. w: t o � c� BARTER �, 3? DONE `��' 1 ( `OBI Nc�.2=�48 Q �� No.25 , ►JS E� t't @1ST��{O� 4�v stfe+f� r A� H 5$ TOP FNo=SRC SL);Yo , DtST. GAL. �$g 1 INSBvX scoTtG �oa� tNY 56•G. -r�,Nk BoN� Go.4.•. &aAv5L LEAG41` V. INV. PIT 5;2 SS 4 • - :I bJt-1'N WASNG D 67vN6 TtFIGO Pt-oT P1_AN - PRoFIL� /► �.10.SCALE SGAL.E I IL �ATrc 1 ERT1FY THAT THE TOUPLAT100 SuOwN NE.R.EO W GOMPL`�5 WITH"THE �,t cEL►N t✓ I, I° AWP S6TeACX R.6QuIR.rcM NT'� DF'YN CEtJTEh.VIu-�� I-�161-�1.1�+JD� To w N or- 'F A1Z lJ STABLG A N V 1 �P I•�T i; �► nnn PLAID �L, RIC.. d3 Q� �G7 1 a! (3o x - c 1�{ o 0 o 6c zone CA-e -LA<B4;-& IP- ~ „o•'”` TOWN OF BARNSTABLE Permit No. _ �F `� ' • , VAUSTM I Building Inspector' > Cash ` �e o 8 t °.a� OCCUPANCY PERMIT`' ,Bond __ ' f /�/. ' 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 Alan ll Address lot #17 61 Ansel Howland Road, Centerville f} Wiring Inspector .4 Inspection date Plumbing mspelpr. Inspection date Gas Inspector ' inspection date X Engineering Departmental/"�✓C C / ~ -�" Inspection date_o - ) 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. Building Inspector 61NGLL- FAMIL%? - '� BEORQoM WO GARBAGE 621W0612. , DA►L.�( FLOW z 110 A 3 = 33oG.P17 SEPTIC, TAwIK = 330x15�>% -2 ,495G.RQ. y5E- I000 GAL. o15Po5A►- PIT V5E laoo GAL. 5%VSWALL Al2.GIs 15o S.F. X a-. ; r 37 5 G.P 4 50TT0M AREA= .. �JO S.F X 1• 5 O G.P PIT -ToTA1- �E51GN * .4.25 G-P0 V -TOTA%- pA 1 LY j PE2CO .ATIOu RATE] 1"IN 2MIN 0PLE55 $ +r� l3- : 0Ar/ow4 I�HOFM R10HARD �� ALAN S I, A. W. i IjAXTER H JONL 0 M.. 25 ,�►.IS EL l'ir /L�N �� 4��@1STfrp` c str , .�� rG TOP FWD=G1 ?6ST �-Cr3d• r�.� .y/.y NoL� 11-t4-gl �Fb �'`�'^"' ^ i El.= 51 {NV• S40.0 L + 1oot� INS• . SJ95oIL DtST. INS. >aFAPT1G $ 6bX S6'G TAN bC �o0o INY• BoIJ� Gat_. &aAvbL L.EAC14 PI-r INV. INV. _ wITW S'�2 sS d• I , 1��3�g•I�i - - - _._, : rb .__ is WASNGD f' /� 6TvN6• s CERTIFIED Pt.oT PLAN ' pROFILr= ;i t;L= -L o 4 q-T 10 N Ce4j-Tb-zv! S 12 No� SGALE SC E I IL� �p.TE g- 1-82 I j o VV 4T FJz. �-- P>_A N RE F E 2EtJ G1� { CERTIFY TNA-r -THE 1"oVNDATIOO 5"OWN NE,R6o w GOMPL%% 5 1r11TN-T HS S l oELIN E AWP SE116AGK R.6QOIR-EME�dT� oFTµ6- -toV4N OF AND Il�, Orr LOGp►TEP -WITN11�! N'6 G ooD LAIN �� $IL, DAT>r,LL_ 13AXTEiZ.e a•{YE INC.. K-EG 1ST 1cQ6rV't-A►J D,5 u MY Tu15 Pt_o.�t I a NaT 5A5CzD old AN �STIc2VtLt� • µASS. s IuS-t-R.uM6N"c" 5u2vG-'( �-rHE oF�'SETs Suc�1�� i ^CO G -c'-MI►�C Lc�r L t►J��� APP�,IGAwr o-t D - v Ch D T N c � �t.�►J L `�M A u. � �.. f Lses"Ar's map and lot_number .. ./ .. ? ©, 3 �fTHEVI Tp�` Sewage -Permit number ........9 ' „�.......................� ..: .. / /►� %�L3�L Py o D STLU. ...... e r ADd E • House number ............ . ... .....................Y........., SEP IC s�`STEM MUD �� 6 s � ;NSTA e YPY a' N OF. BX L �� LIAN I 11 l� S �1 AST LE 5 DUIL�D1INSPECTOR: ro 4 APPLICATION, FOR PERMIT TO .;..... ........ t TYPE OF CONSTRUCTION ........... .. ................ .... .......... .... .................. ..... ... ........� . .. .....19. ..�' TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following inform tion: Location ...... ... :................. .... ................ ...... ............. ........................... Proposed Use ... . .. ... ............................................................ ................. ................ ............ .. .. . ........... .. .. ..... ..... ZoningDistrict .. . ......... ....................................Fire District ..... ..... ..................................................... Nameof Owner .......... .. . Address .................................................................................... Name of Builder' ...... ......................................................... . Address ....... ......... .......... .... AName of Architect ........ ......................................................... s .. Number of Roo s ..............I................... , ......... ......Foundation .... .. .......................... Exterior ~ .... .....................:... Roofing .:..... .. ..... ............... , ................ I Floors .......! ....°..................... ....................Interior .............. ... ............I................ Heating ..... ............................,........................................Plumbing,...... ......... ......................................... '. Fireplace . ..... . ....... ......:............;..........................Approximate Cost .......4.. ...1-:0.1 �'` ................... Definitive Plan'Approved .b Planning Board -----------_____,_.--------- Area ... .? Y�. .............. Diagram of Lot and Building with .Dimensions Fees_ ..... .......................... SUBJECT TO APPROVAL OF BOARD OF HEALTH a'A),O OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS hereby agree to conform to all the Rules and Regulations of-the Town.of Barnstable r arding.the above construction. Nam .. ................ ....................................... 4.- �� SMALL, ALAN E. r. No ..2 4s�9 3 . Permit f One Story Single Family Dwelling ...... ..... .......................................... .......... Location Lot #17 61 Ansel Howland •Rd' ......... ; . Centerville J ......... ................. ............... Alan E Sma 1 Owner f ` t .............. . s : . Type of Construction Frame... _ 60 , 4 ....... ...Y.............................. .... Plot ... .... Lot ..... ............. • , a '--Sept. 23, 82 ; • Permit Granted ........................................19 r Date of,Inspection ..............f.......................19 a� 'Date Completed L � .......... ......19� • � { �� 'TAT - ,1 /1 Klifp ors -�::" �!"' .:2:'.w° `• t" �t