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HomeMy WebLinkAbout0022 BAYBERRY LANE dK i�o t I III�,Z 4l� it K it lq� I -,k - WI '4 %ttf it i't T;i'i':It","k, 70 W N 1�4 it .1'i 14 1 t, k vo oi A- t4, '4�4�0 i"I 0 �4 V,, f"I, " t . v;o/ Jf j-f, 4 ItIIiItt ... ... .... 1tittittitIttit41 a, r�\ FTHEo, � Town of Barnstable *Permit# Expires nths from issue date Regulatory Services Fee . snxrrSDI ar'1 Ve �� 9 Y'YY �, )k,l 16 m Richard V.Scali,Director , AST . 39• A� � _ TOWN-.Tfo � ��� fBLE 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 PERMIT APPLICATION - RESIDENTIAL ONLY 1 /)�� Not Valid without Red X-Press Imprint Map/parcel Number r/` 1� �n Property Address_ 2 & ry - /"l a 63,x ❑ Residential Value of Work$ 'I r Q G G.-O 0 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address - � �Z �o�r�'eu-s /� -► z4o�djG3z Contractor's Name Telephone Number 7 6 62rs- Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor Kj am the Homeowner ❑ I have Worker's Compensation Insurance 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 betaken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of r of),' ❑ Re-side [9�Replacement Windows/doors/sliders.U-Value (maximum.3n#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 compliancemith 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 re uired. SIGNATURE: �� Q:\WPFILES\FORMS\building permit fonns\EXPRESS.doc - -Revised 061313 L . i _ The CoTjimoii!ivealthofMassachtisetts Deparrtinent of 1rndrrstria1 Accid { laffir-e Of In WAe gaitions 600 Was'hiragtorr"Street B,ostvn,, t ZI1 wavtt•.mamgov/dira %Nlurkel<s' Compensation Insuran. Affidavit:BuiIderJConti-actar-, I ai ns/P beis Applicant Information. J Please Print Legibly Name(Bum-newUrganizadontFndiiidual): Address: 0.Y � � r r y � ;iy �. City/State/Zip: C� f e r-v 't ;e ,/ /, Phone# Are your an employer?Check the apptopriate bow T of project r rice 4- I am a general contractor and I J p a ( d : I.❑ I am a employer with, ❑ 6, ❑New canstaaictian employees(full andror part:-time).* have hifed the sub-contractors 2_❑ I am a sole proprietor or-partner- listed on the attached sheet. 7. ❑Remodeling slop and have no employees These sub-contractors have g- ❑Demolition working fcT mein Pa ca any capacity- employees and.have waiters'� 9_ ❑Building addition. [No workers'comp.insurance comp_insurance I required_] 5. ❑ We are a corporation and its W.El Electrical repairs or additions 3.� I am a homeowner doing all work ofcers have exercised their 11_❑Plumbing repairs Of additions myself[No tivorkers-comp right of exemption per NfGL 12-0 Roofrepairs. insurance required..]^ c.1.52, §1(4),and we have no employees_[No workers' l _❑Other comp_insurance required_] 'Any appfitant that checksbox--1 aLsofill our thesectionbeloiv-shaacingtheir ers�compensation policyinformation_ i Homeowners who submit this:-affidnit indicating they are doing all Arctic and dea hire antside contractors merst subr it a new afiidxvit indicating such. lC'ontractors that check This box must attached an additional sheet shmving the name of the sub-contracim and state wheth,,ornot those eaeties have employees.I€the Mbl ,Ontraciors have smplbyees,they mist arnvide their warkew romp.policy number. lam, an employer fJ[rrt is pros4dirrg workers'cosarpensrrf%ort irrsrarrurce for rrry enrpPol ees ffeloivisthepo8C yemdjobske inforrrra om Insurance Company Name.- Policy r or Self-ins,Lin--4_ Expiration Date: Job Site Address: Gitvlstatefzip- Attach a copy of the workers'compensation policy declaration page(shoming the policy number and eapn-ation date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition.ofcri-in I penalties of a flue up to S 1,500.00 and'or one-year ivapr tmm�enl;as well as cizal penalties in the fair.of a STOP WORK ORDER and a Vie. of up to$250.00 a day against the violator. Be advised that a copy of this statement saucy be.f orded to the Office cf Im-estigations of the DLA.for insurance coverage verification_ I do hereby cgrfiftr ender theixrins& +lances o.f pequ.rt'thatthe irrforrrrnfian prof ded above is true and correct Sie ature- I}ate: L(— l L 1 Phone 3 a 9 ( ` F,S 4fficial use o:nfp. Do,not ivrite-in this area,to be completed by ciV or fot.vii ofciaL Cut}"of Tom : Permit£License 9 Issuing Anthmity(cu-cle one): 1.Board of Health ?.Building Department 3.Cit3fZown.Berk 4.Electrical Inspector s.Plumbing Inspector 6.Other. Contact Person: Phone#r y , f Town of Barnstable ` Regulatory Services ' Richard V.Scali,Director Building Division * BMWSTABLE, Tom Perry,Building Commissioner 9 MASS. 1639• 200 Main Street, Hyannis,MA 02601 ArED NIPS p www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: 7 JOB LOCATION: �sZ number n ' stree village "HOMEOWNER": l "� y` C-/(�J/hvS•,�, "�O 7 �G —G G S name home phone# work phone# CURRENT MAILING ADDRESS:_ 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 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 109.1.1)- 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 inspection proc dures d requir Tents and that he/she will comply with said procedures and requirements. Signature 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 z, 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.IS)!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. Q:\WPFILES\FORMS\building permit fonns\EXPRESS.doc Revised 061313 1 } P�OETHE t�ti * + * BARNSTABLE, "�. � Town of Barnstable ATfD Mptl A Regulatory Services Richard V. Scali,Director Building Division Thomas Perry,CBO 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 �� y' to act on my behalf, iin all matters relative to work authorized by this building permit application for: (Ad ess of Job) J Signature of Owner Date ./q a r /e C 0 Y e +^ Frint Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. Q:\WHILESTORMS\building permit forms\EXPRESS.doc Revised 061313 Town of Barnstable *Permit# 60 0 0�9 �pFS tpyy Expires 6 months from issue date P p� J • Regulatory Services Fee a 9 Thomas F.Geller,Director �/�/ A �e39• IN -b lfo►�+ Building Division 911� Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY Not Valid without Red%Press Imprint Map/parcel Number r q O ie Property Address NEQ,4 _ Value of Work 19 i <13y 5.• 0 0 esidential Owner's Name&Address c � p V.Q .�" Telephone Number 5 d g 7 7 J -1� 7 Contractor's Name Jv��� � `� mPR lvro Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ®PRESS PERMIT ❑Workman's Compensation Insurance Check one: S E P 2 5 2007 ❑ I am a sole proprietor [] I am the Homeowner r, _ F ,, STIAM F.- P-rhave Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy rl �c� 4 � �ol �oorl ;Y Permit Request(check box) ff."Re-roof(stripping old shingles) All construction debris will be taken to RrnoV �i_Z ❑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,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. Hone ement Co tr ct rs License is required. Signature Q:Forms:expmtrg PERMIT,PAttENT'RECEIPT TOWN OF BARNSTABLE . BUILDING DEPARTMENT 200 MAIN STREET HYANNIS, MA 02601 DATE: 09/25/07 TIME: 12:19 -----------------TOTALS----------------- .f PERMIT I PAID 28.27 AMT TENDERED: 28.27 CHANGEPLIED: 28.00 APPLICATION NUMBER: 200706049 PAYMENT METH: CHECK PAYMENT REF: 8146 ' - a n f.�ta ,ta��ae.n.%ft4At4SaewU•..p�4F�r....wa.kl�•p+t4ll",a..gl,y,�r ts.yF ny Town of Barnstable Regulatory Services i a uurSTU LL Thomas F,Geiler,Director e 039. . m Building Division _ Tom Ferry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508 790-6230 Property Owner Must Complete and Sign This Section. If Using A Builder Y Rat �oeN►'ot ��L iZm�._ ..,.:,-.......:..;as..0net.of the.subjectptopetty .........__ .: hereby authotiz e N - to.act 0n xny..behalf,. in all matters xelative to work authoixzed by this building.permit-application%fox: (Address�ofb) �- Signature of Owner Date Print Name f g HOMEOWNER: DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES I authorize Sprinkle Home Improvement to act on my behalf in all matters relative to the work to be performed on this job (i.e. permits, applications etc.) if necessary. 0 t �1 ' Ginn, Kpenig Brad Sprinkle Dat Date The Commonwealth of Massachusetts Departmentpf Industrial Accidents Office of Investigations > 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contr �tors/Electricians/Plumbers Applicant Information Please Print Leidbly Name (Business/Or ganization'Individual)' .PAY, Address: 19ot I�U��t1e ��AY_1\ R5� Phone#• 5b -TZ -- City/State/Zip: Agran employer?.Check the-appropriate box: Type of project(required): 1. am a employer with_� 4 El I am a general contractor and I 6 �Zodeling- listed.on construction employees full and/or art-time .* have hired the sub-contractors( p ) the attached sheet t 2.❑ I am a sole.proprietor or partner- Demolition ship and have no employees These.sub-contractors have $ ❑ working forme in any capacity. workers' comp.insurance. 9, [] Building addition (No workers' comp..insurance 5• We area corporation.and its 10. Electrical repairs or additions officers have exercised their required.] right of ex tion cr MGL. 11.0 Plumbing repairs or additions 3.❑ I am a homeowner doing all work P p myself. (No workers comp. c. 1529§l°(4),and we have no 12.❑ Roof repairs insurance required.]t . employees.(No workers' 13.❑ Other comp.insurance required.], Any applicant that checks box#1 must a]so fill out the section below showing their workers'compensation policy information:`• ' t Homeowners who mAmitiks affidavit indicating they an doing all work and then hire outside contractors must submit a newC�d�t indicating such tContt=tors that check this box must attached an additional sheet showing the name of the sub-contractors end their workers policy infom-m ion. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: CAA n5 Ukl P1CO Policy#or Self-ins,Lis#: "I cA q Jc 12,00 ExpirationDate: 5 113`0 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 required under.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 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 c der the pains and penal perjury thfit the information provided above is true and correct: Signstare: Date: Phone#' 69-- ZZS lT7 0 OrIcial use only. Do not write in this area,to be completed by city.or town 0040L City or Town: Permit/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#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensationy employees.contra f hire, Pursuant to this statute, an employee is defined as"...every person in the service of another express or implied,oral or written." An employer is defined as"an individual,partnership, association,corporation or ot}er 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 the receiver or trustee of an individual,partnership,association or other legal entity,einp yingemployees. owner of a dwelling house having not moOC ant of the re than three apartments an�who ureus n Q u' or the cup wo k on such dwelling house dwelling house of another who employs persons to do maintenance, 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 requi ed."r 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 19 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.certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the t requited to c workers' compensation insurance. If an LLC or LLP does have members orpartners;'are no eq carry of Industrial t this affidavit may be submitted to the Department policy is required. Bedvised that Y employees,a cY mil. should P The affidavit tion of insurance coverage. Also be sure to sign and date the affidavit Accidents.for confirms 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' compensationpolicy,please call the Department at the number listed below. Self-insured companies should enter their se lf-insurance ce license number on_the appropriate Jine. 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 permittlicense 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. Anew 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 abd 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 . Department of Industrial.Accidents Office of Investigations 600�Washington Sheet, Boston,MA 02111 E 6 r 1-8 77-MASSAF t 40 0 ` -4900 ex Tel. #617 727 Fax#617-727-7749 Revised 5-261!05 wwwmass.gov/dia air,lb.celeJr�t 1 41FirI�JilI"i 1 IU I UhiL NU.545 P.C CERTIFICATE OF III YJ I��` + ISSUE DATE M 0511612007 ' rRoDvc�R - - - • TIN41 CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONI.Y AND [iryden&Sullivan Iris Agency CONIFERS NO RK71in UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE Inc DOLI19 NOT AMEND,EXTEND OR kLXER THE COVE'RACE AFFORDED PY THE POL CIES BELOW, 66 Pahnouth Rood ..�,�.._.�...,., _ Hyannii,MA 02601 COMPANIES AFFORDING COVEFAGI; INSURED --� Sprinkle Holme Improvement Inc 199 Barnstable Road COI ,PANY A A.I.Ivf, Mutual Insurance Co Hyannis, MA 02601 LB ER I i COVERAGES T IS IS TO CERTIFY THAT T148 POLICIES OF INSURANCE LISTM)BELOW HAVE 81-IFN ISSUED TO')'FIII INSURED NAMED ABOVE IrL THE POLICY PERIOD INDICATED,NOTWITHSTANDING ANY REQUIREMENT,TE�!r1op,CONDITION Or ANY CONTRACT OR OTHER DOCUNIFNT WITH RUSPRCT TO WHICH T"IS CF.RTIFICATL MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THF,POLICILS DESCRIBED II'ER8IN IS SUBJECT TO ALLTHE TEMMMS,RXCI.USIONS AND CONDITIONS OP SUCH POL!CIES.LTMTTS SHOWN MAY HAVE B►?EN REDUCED BY PAID CLAIMS. C'8 TYPNOTINSURANCB POLICJ{YRRFCCTIYE P0wC•V9XPIRATION LIMIYS 4Ta C'OktCl'NUt•70CR DATOImWoOryY) OATf iMm1UUfYY) _"M1 OCNRRAL LIADILITY 4LNF,RAt.AGCROGATIj ,F ^ I 1 _ aRODUCTS COMPIOP AUO, ;RC IS =COMMJIALOENERAL LrA9iLrrY ,. PL'RSONA{.Sc qDY.INJURY r ©M CLAIM$MAOC E]OCCUR CZJ OWNFiRlS�CONTRACTOR'S PROT. I f!AC•H UCCURRUNCD j FIRO 0)AMAt;k — MFu.nXPBNSBInw n�r�M) 5 - AUTOMODILB UARILITY ..__ COtaDINeD WNGi•B S �IM1T AUO ymrr MJIIRY '•` -. ALLNY OA"UT ED ALrfOS , 9SCIICOUIM AUTO$ MR Fa>an) I R(RPD AUTOS I NON•U"FD AMOS tlU111LV TNJ{JRY GAkAULLIAJII{rry I (PcracCiAcpq i MONURTY DAMAGE tXCP,S9 T,IADIUTY i PACH 0C:-..URRBNCC I UMDRDLLA MRM A00REOATU T� } UTHERTHAN UMYRF;LkA FORM RICERSCOMPPNSATIONAND S'1ATUTORYL!Mi1'S Q'1'li!IR LMPLOYERS LIABILITY ,--• X NF PROPRIETOW A pmNLit%%FxR(.imvB f` F IiACH ACOTDFN'I' 500,000 OPPICIens ARCS: / rNCL �G(c( 700494301200? OS! 3/2'07 05113/200$ llI5(ASI3••POLICY I1MIT $ 500,000 LnISFaSE•EAO,{ 500,000 COMMENTS/DESCRIPTION OF OPERATIONS OR I.00ATIONw; EMPIIJY" I f CFPYI'II+IVATE HOL01 R CA!?C'�l,I A TIOY SHOULD NY OP THE ABOYI!DC.4CNIBGD PQLJCII;S BP C'ANL'NLLPD 3EJ�ORI.s 7IiH HXPIRATION UA'rB I"HERJIOF{THE ISSUING('OMPANY WIL4 UNDEAVOR TO MAIL Q WRITTEN F THE V To NULDLR IlIA1MED TO THE LEF>T,13UT FAILURE TO MAIL$=-j NOTICE SHALL IMP0,NO OBLIUA'fON TP JR LIABILITY OFANY RIND UPON THE COMPANY,ITS AQL+NT5 OR R5PR6$HNTP 51?S, I r nIITHO ZED 1UPRPSF.NTATIVE I i , 4/�� �cvrn�YYt��zcrr��� o�v��crrJ6r.� a _= Board of Building Regulations and Standards _- I HOME IMPROVEMENT CONTRACTOR = Registration 10.3757 Ex iratiori p 7/9%2008 Type P i:v to Corporation r r..._._.., p SPRINKLE HOME IMP INC. Brad Sprinkle 199 Barnstable Rd. Hyannis, MA 02601 Deputy Administrator r l�2f? �O'Yl'G%7L41Gfl.P.CIGC�L 4�« �GCY:YJ(Gf�"LGGQPE� BOARD OF BUILDING REGULATIONS .. ��� License C:ON:STRUCTION'SUPER•VLSO.R: _- Number: CS 006643 i _ s,1 Birthdate 10/08/1955 Expires 10/08/2007 Tr.. no: 6638 0 _ ;ConstruCtion CS, j Restricted :00 BRAD K SPRINKLE 190 LOTHROPS LANE'.. W BARNSTABLE, MA `02668 --/--j—�� Commi sioner TOWN OF BARNSTABLE � BAHHSTABLS, i O pya` BUILDING INSPECTOR P �� �� APPLICATION FOR PERMIT TO ......�/�.�.........Q..................��......... .Y.....7cot?!.1....:........................................... TYPE OF CONSTRUCTION ............. ....... 7................................... ................................................ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ZZ ��22 ���&XV/-LSE ..............................."`.yJ..........y.........:�N............................................................................................................. ProposedUse .........../!c ....................................................................................................................................... ZoningDistrict ......................................................................Fire District ................�......................�..�........................... Name of Owner ..xer-112 A UL................Address 2-2 >6.* . .1.1.���y......................................... ............. Nameof Builder ....................................................................Address .................................................................................... Nameof Architect ...........................�W...........................Address .................................................................................... Number of Rooms ..................................................................Foundation .............................................................................. P p/ Exterior ..................�v�D`!............��?. .<�y?.. ........................Roofing ........... ✓ /............................ �..... .. . .... ............. .. .. Floors !.����./...��/.. �........................................Interior .......: i/GfI00G .. �/.�?�1......................... Heating .............................................................................Plumbing / .... ................................................. Fireplace ................./.do..:......................................................Approximate Cost .................................................................... ® `o Difinitive Plan Approved by Planning Board ---------------_---------------19________ . .(/T //7 Diagram of Lot and Building with Dimensionse I' �J l� c-9 _ q° PaKc►�- �' 6 v pVIC // =Irll- - f the Town f Barnstablei I hereby agree to conform to all the Rules and Regulations o o r rd ng the above construction. Name ....... �(��if..k: �"!.. .G. / :................................. Proulx, Arthur P. 10149 add to single No ................. Permit for .................................... family dwelling C 10a -79'-71J ............................................................................... 22 Bayberry Lane .O V Location ..................................................:.......... f Centerville* i ...................�thur P. Proulx........................ Owner .................................................................. Type of Construction frame ...�G..............5 ................................................ . 3 Q S"�/ j Plot ..... Lot .... .................. �-y ' f Permit Granted 7.gctober $ 19 fi5 r / -/ Date of InspectiQQn�� ...../.........��...................194 7 0 A/4-1' ; Date Completed ......................................19 f PERMIT REFUSED ................................................................ 19 i ............................................................................... ................................................................................ ............................................................................... 1 Approved ................................................ 19 ............................................................................... .................... ......................................................... { i