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Town of Barnstable *Permit# 2 o
Expires 6 months from issue date
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Regulatory Services Fee 2 �� . o D
Y Thomas F.Geiler,Director
lEo j+ Building Division
Tom Perry, Building Commissioner
200 Main Street, Hyannis,MA 02601
Office: 508-862-4038
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Fax: 508-790-6230
EXPRESS PERNIIT APPLICATION - RESIDENTIAL OF1 Y. C U U5
Not Valid without Red X-Press Imprint
���®`� TOWN OF BARNSTc S—
Map/parcel Number (0
Prop Address �� L`�'� :r q��``i
Residential Value of Work
Owner's Name&Address
Contractor's Name %- �211Lr ? Telephone Number 2G
Home Improvement Contractor License#(if applicable)
I
Construction Supervisor's License#(if applicable) '
orkman's Compensation Insurance
Check one:
❑ I am a sole proprietor
❑ I am the Homeowner
❑ 'I have Worker's Compensation Insurance
Insurance Company
workam's Comp.Policy
Permit Request(check box)
[]'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. U-Value . (maximum.44)
*where required: Issuance of this permit does not exempt compliance with other town department regulations,Le.Historic,Conservation,etc.
***Note: Property Owner must sign Property Owner Letter of Permission.
Hqme Improvement Contractors License is required.
Signature_67,*,11
Q:Forms:expmtrg
', Revise053003
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Licrom or rqiwsei..raw for WUNWWW un W*
bcfae t►t tx*stiaa d te. effmad.dw to:
Beard of BuMft RigabOm and standards
one Adamersw 1'faca Rw 1341
gam,i1sa.021M ,;
Net Yaw wttbest Signature
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uard a!siaitdhg RqwYdlam aw SLadardb
mOYE a#PRO'VEMEttT CONTRACTOR i
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RaNtatrntlon: 128083
ExpbWjon: E13/M
7vpe: $uppismeM Cab
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fJ MK AUDETTE
3200 COSS GALLERtA PKWY f$Z0
X.TAN TA GA 30339
wdaaalstrau�
Town of Barnstable
fiery Sakes
DuUdingDivisioa
Tom Fern, 59114tag cw 1sS(0mee
2I0 Maim seat, wykwis,NIA 021601
office, SM-142-40M beat: S06 ?9C-6Z30
PropeM Owner Must
Complete and Sign TW& Section
If Using A builder
at Owner of the subject property
u act on arxy bcaatf,
ltezeb} au�oe
,n all,m'actctt mattivee to w*tk aut�mtis 4 by t-Inds buadial great appLcatioa for:
(�ddznse of job)
rA era a eaf�. es Dam
ptiyc Nam
Q.1°Q�N'L 09Y'P7iAa'1 :dSInPt
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The Commonwealth of Massachusetts
0. Department of Industrial Accidents !li
Office of Investigations �!
-_ 1,
Al -& ... I'h 15
' ;'. 600 Wasltingtotr�treet, i Floor !,I
Boston, Hass. 02111 ; I
'-� Workers' Compensation Insurance Affidavit: Building/Plumbing/Electrical Contractors
Applicant information: Please PRINT lembiv
name: /r w_le
address:
city 4iLQiZ state: e0041Vzi : ol�n7 one h
work site location full addressl:
it[J [ am a homeowner performing all work myself. Project Tvpe:. New Construction []Remodel li
❑ I am a sole proprietor and have no one workine in any capacity. ❑ Buildine .kddiriun
I am an emplover providing workers' compensation for my emplovees working on this j
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company name:
ll:
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address Q7 j'
city: '�!/�fy1 /� 3� hone a:
mow} y'�� /��n/I `i{k
insurance cn. / 1/IW � �_ policy is /t/i1fi c 5_1
II,
❑ 1 am a sole proprietor•seneral contractor,or homeowner(circle one)and have hired the contractors listed below who have +'
-the following workers' compensation polices: ;'l3
cnmpanv name: V
ti,i
address: ;Is
ys
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city phnne#• It3
insurance co. policy#
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company name: hR
address: i+
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city_ t
hone#:
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insurance cn. DOIICV#
Attach additional sheet If necessary j
Failure to secure coverage as required under Section 25A of N1CL 152 can lead to the imposition of criminal penalties of a fine up to St•500.00 and/or
one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. l understand that a
copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. '
I do hereby certify�under the ins and ena/lies oIPerIurY that the information provided above is true and correct
Signature Date �^�-37
f
Print ri Phone#
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official use only do not write in this area to be completed by city or town official
city or town ermidlicense#
P ❑Building Department
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❑Licensing Board
0..-6eela:/:m...od:a.e.eepoo.e ie rey...ed - �Seleeemen's Office I�
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contact person: phone#; (]Health Department Ilfi
❑Other ![
I rc.�acd Sc01.20031 III!
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Assessor's office(1st Floor):
Assessor's map and lot number " 't
/+,, � ; aaffi�"•H®®�h� �`''1�o-�g(��u�'9poc�lp�i�91��p��'®Fv!�0�TN(l�`
Conservation , IN�7T�Cm��'®I`" ��MPf.IA Y .�`w
Board of Health(3rd floor):
Sewage Permit number 2 WITH TITLE 5 I7LDL6 :
VAONMENTAL CO® oo�eso
Engineering Department(3rd floor): 22 _� TOWN REGtUL�TI®N
House number J
Definitive Plan'Approved by Planning Board 19 w
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 f,
TYPE OF CONSTRUCTION
►�.e. lb 19 9cp--
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit ccording to the following information:
Location el � ("bi e
Proposed Use
Zoning District P4�S 1 G��r l �Jt Fire District
Name of Owner 3 7 SAC OM/Address 31 G
Name of Builder_l 1 L ct Iw U/7/'� Address 1 J01 of L( t- Cho
G
Name of Architect Offs �z Address P-h 19-rL&» 1al
Number of Rooms Foundation
Exteriors �pd�� n Roofing G
Floors Interior
Heating AozaJ- 0' of wo Plumbing J r3
Fireplace Approximate Cost
Area
Diagram of Lot and Building with Dimensions Fee
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 (.a 1)d QQ ff1 eA
Construction Supervisor's License OIL
SHERMAN, ALTON B. & MARGARET
No 35709 permit For Build Addi-I.ion
'i Single Family Dwelling
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Location- -314 Bay Lane
_Centerville
Owner Alton B. & Margaret Sherman
Type of Construction Frame
Plot Lot
Permit Granted March 19 , 19 93
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.Date of Inspection /Z3`a 19
Date Completed 19�.
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DEPARTMENT OF PUBLIC SAFETY S
=� COMMONWEALTH 9 _
OF 1010 COMMONWEALTH AVE. y
I BOSTON,MASS.02215
,. MASSACHUSETTS ENCLOSE CHECK OR MONEY ORDER
L.I C LN SE FOR REQUIRED FEE, '
EXPIRATION DATE C O V S T R. 3 U P E R V I S 0 R
0 6/3 0/199 3 r L ''" EFFECTIVE DATE LIC-NO. o yAj�ETYABLE TO
RESTRICTIONS 5 "COMMISSIONER OF PUBLIC SAFETY"
J NONE 006/30/ 1991 030692" 0
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�m WILLIAM E DUNN m Oo�hc7Je►v CASH).
DOLGER CT-
CHARLTON MA 01507 P I E A 5 E FI§E lhCREASE
PHOTO 1BLASTING OPP ONLY) FEE: • •
100. 00 EFFECTIVE FEB. 1, 1989 s
iI HEIGHT: NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY
'I STAMPED OR SIGNATURE OF THE COMMISSIONER
THE PERSON OF
THE HOLDER WHEN ENOAG-
O- I.
OTHERS RIGHT THUMB PRINT ED IN THIS OCCUPATION. /��,7 COMMISSIONER ,
200M-2-87-81429
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o._o1 ' RESTRICTIONS '
Z 01 OTHER 18 HIGH-PRESSURE AND LOW PRESSURE 35 FRONT END LOADER
02 SPECIAL LIMITED 19 HIGH-PRESSURE AND ROTARY 38 CATCH BASIN,SEWER CLEANING M$.CHINE
N 03 AUTOMATIC PUSH BUTTON 20 LOW-PRESSURE AND ROTARY
►J n T :( 04 FREIGHT 37 SIGN
TENSION LIFTS
,A■ 11 06 HAT 21 ASSISTANT
38 SKIN HANGER '
Z ( ✓ .84� N m •;i 08 SCOTCH 22 QUARRY 30 LOCOMOTIVE,SELF PROPEL
23 TUNNEL 40 POLICE BOMB SQUAD
A m- 07 VFT,VT 22 MARINE (UNDER WATER) 21 TRENCH -
O A 08 STRAIGHT 25 RESEARCH AND DEVELOPMENT
(il `-OB COIL 28 BLACK POWDER ONLY 42 PORTABLE(COMPANY)
:9) - 10 RANGE 27 SEISMOGRAPHIC 43 ENGINEERED(COMPANY) .
m 0 y 11 POT 28 ELECTRIC 44 PRE-ENGINEERED(COMPANY) '
O 12 HIGH-PRESSURE 28 CRANES 45 HY DROSTATIC(COMPANY)
i 13 LOW-PRESSURE 30 SHOVELS 46 PORTABLE(INDIVIDUAL)
m C 14 ROTARY 31 8ACKHOES 47 ENGINEERED(INDIVIDUAL)
Z Z 0 POWER(LIGHT.OIL) - 32 DRAG LINES 48 PRE-ENGINEERED(INDIVIDUAL)
--' o �� 18 POWER(HEAVY OIL) 33 CLAM SHELL 49 HY DROSTATIC(INDIVIDUAL) -
17 RANGE AND POT 31 CABLEWAY 50
Z r �j 51
Z
NO. STREET !y
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CITY OR TOWN STATE ZIPCODE
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m CD n �' PRINT CHANGE OF ADDRESS AND NOTIFY THE
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COMMISSIONER OF PUBLIC SAFETY IN WRITING..
V 70=
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THE FOLLOWING
IS/ARE THE BEST
IMAGES FROM POOR
QUALITY ORIGINALS)
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DATA
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DEPARTMENT OF PUBUC SAFETY '
COMMONWEALTH 1010 COMMONWEALTH AVE.
OF BOSTON,MASS.02215
MASSACHUSETTS ENCLOSE CHECK OR MONEY ORDER
I ,
L I ti EN SE FOR REQUIRED FEE, '
EXPIRATION DATE CONSTR. 'UPER�/ � ��R
I '? r"rl -MADE;PAYABLE TO
c.
0 6/:3(�,�199 3 � EFFECTIVE GATE LIC-NO.
". RESTRICTIONS o / 3 / 1 3 l 5 9 "COMMISSIONER OF PUBLIC SAFETY"
tv0NE c i !
0,0'.00T SEND CASH).
m WILLIAM E DUNN m
DOLGFR CT
CHARLTON MA n15C7 Pi EASE N.CTE
— FEE INCREASE 1
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:PHOTO(BLASTING OPR ONLY) FEE: ,
`I El f EC TI VE f EB, 1,. 1989
100. Q0
II NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIA'.LY �
' HEIGHT: STAMPED -OR-SIGNATURE OF THE
COMMISSIONER 1
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LtrOT DETACH LICENSE STUB
"v SIGN NAME IN FULL-ABOVE SIGNATURE LINE I
THIS DOCUMENT MUST BE SIGNATURE OF LICENSEE
CARRIED ON THE PERSON OF _
THE HOLDER WHEN ENGAG- COMMISSIONER-
' OTHERS-RIGHT THUMB PRINT ED IN THIS OCCUPATION �y _ Y'�-'e -
20OM-2-87-81429
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