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HomeMy WebLinkAbout0011 BEECH LEAF ISLAND ROAD II e ch clr a 1 c r. y TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Y Map .. ` `� Parcel ®13 Application # O/ ` ® l C `f Health Division .a Date Issued Conservation Division Application Fee S Planning Dept. Permit Fee _C C Date Definitive Plan Approved by Planning Board A 3 �. Historic - OKH _ Preservation/Hyannis Project Street Address -CAN U%F �D Village CENTGROUE NA Owner `►\ R) \,r\e&� LSD and FNA lrL C, Address 1 See e_ V,,ea� --iSl ctrA , C.e_rr}..erv01e_ MIN Off,c.Q3a Telephone t N� 1�aO © ).OL`..Q Permit Request ' E.W)DC-L &Xl6nW_G- sArit :rn-t:7e(; / on IN 4 Square feet: 1 st floor: existing LAPQ�-proposed D 2nd floor: existing BDO proposed Total new C_ 'Zoning District Flood Plain `Groundwater Overlay 'Project Valuation r4LvPi .M Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes 4 No On Old King's Highway: ❑Yes �10 No Basement Type: )o Full ❑ Crawl X1 Walkout ❑ Other Basement Finished Area (sq.ft.) Q Basement Unfinished Area(sq.ft) Number of Baths: Full: existing a. newa te -C. Half: existing I new O Number of Bedrooms: 3 existing .0 new Total Room Count (not including bathe): existing . iT new First Floorfoom Colt Heat Type and Fuel: ❑ Gas Oil ❑ Electric ❑ Other :j ,CD� Central Air: �Yes ❑ No Fireplaces: Existing_ New _(� Existing woo /coal s�e: Yes JAI No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: existing❑ r9w) size_ Attached garage:X existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: w rn Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use ,,� L Proposed Use 54H Cr. APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name a,annq S i1 v 1a Telephone Number 'J OB - 14 a.0 - O as Cv Address I Q'i Lk(A M cam'%� S-�'r eZ� License# G-S 9�a (fie C)a&,E6 Home Improvement Contractor# 4ar� br-d 0 r0,e )r tA-e_r_ -Mns - MR Worker's Compensation # LoO,)lo00%5V 3\01(-20;a ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATU DATE a,a.1'►3 1 'i FOR OFFICIAL USE ONLY APPLICATION# 4 , DATE ISSUED MAP/PARCEL NO. 4z `t ADDRESS VILLAGE OWNER DATE OF INSPECTION: f !' FOUNDATION - } FRAME f INSULATION FIREPLACE t ELECTRICAL: ROUGH FINAL a >; PLUMBING: ROUGH FINAL GAS: ROUGH FINAL !, FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. ..� The Commonwealth of Massachusetts DepartmeiztoflndustrialAccidents Office.of Investigations 600 Washington Street. } Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le.1blY Name(Bysmess/Organization/Individual):' �k o vi -N S.►1y im �_LG. •Address: �ol�b� '('tl,��s1 �..1�Y'P e� . : " " •. - . City/State/Zip: PhoneA 5 a� IA�0 c� Are you an employer?Check the appropriate bow - Type of project'(regnired):. 1.'® I am a employer with 4. ,0 I am a general contractor and I 6. ❑New construction . employees(full and/or part time).* have hired the sub-contractors ,2.0 I am a•sole proprietor or partner- listed on the'attached sheet:: 7. ®Remodeling ship and have no employees These sub-contractors have " 8. Demolition working forme m** ca aci employees and have workers' Y P t3' $• --9. ❑Building addition [NO wOrkelS' Comp.inrranr_e comp martrance. required-] 5. 0"We area.oiporatiou'and its 10.❑El,ctdcal>;epaii s or additions officers have exercised heir 11. Plumb' airs or additions.. 3.0 I am a homeowner doing all-work ❑ repairs _myself [No workers' comp. - right of exemption per MGL - 12.0 Roof repairs insurance required.]t c. 152, §1(4),and we have no - employees.[No workers' 13.❑Other ' comp,insurance required_] *Any applicant that checks box#1 must also fill out the section below.showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 1(Contractors that check this box must attached an additional sheet showing the name of flee sub-cont wtois and state whether or not those.entities have employe,cs. If the sub-contractors have employees,they must provide their workers'comp.policy number. 7 am an employer that is providing workers compensation insurance for my employees Below is the policy and job site information." 4, Insurance Company Name: KQIf�-�OrA UnAe't-Ior T—AS Policy#or Self-ins.tic.#: (0 S(y G V laz-a 1 Z), Expiration Date: 4— Job Site Address: I k 2)et n k6.I"' Ca load City/stawap: &V Mt MR 0D.Ge A Attach a copy of the workers' compensation policy declaration page'(showing the policy number and expiration date). ' Failure.to secure coverage as re,quired under Section 25A of MGL e. 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 tine of up to$250.00 a day against the"violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification I do-hereby certify under th 'ns-and penalties-ofperjury that the information provided above is true and correct: Si ti3r . r Date: Phone## _15 M IA36 O_aa to Offccial use only. Do not write in this area,p be completed by city or.town officiaL City or Town: Permit/License#° Issuing Authority(circle one): A, Board of Health 2.Buildi-ng Department 3.City/Town:Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Pegson: - Phone#: . ; ,a►co v CERTIFICATE F LIABILITY DATE(MM/DD'YYYY) O A ILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 'THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE.ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Kathyilvia NAME: y The Fair Insurance Agency Inc. PHONE , (508)775-3131 Fax A/C No:(508)790-1677 619 .Main Street E-MAIL kath @thefaira enc com ADDRESS: y g y P.O.. BOX 430 INSURERS AFFORDING COVERAGE NAIC# Centerville MA 02632 INSURERA:Seneca Insurance Co INSURED INSURER B:Hartford Underwriters Ins.-AR 80411 Silvia & Silvia LLC INSURERC: P.O. BOX 430 INSURER D 1284 Main Street INSURERE: Osterville MA 02655 INSURERF: COVERAGES CERTIFICATE NUMBER:CL12122800404 REVISION NUMBER: THIS IS TO CERTIFY THAT 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $ 50,000 A CLAIMS-MADE OCCUR SGL3000362 /1/2012 8/1/2013 MED EXP(Any one person) $ 5,000 PERSONAL&ADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENTAGGREG ATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ 2,000,000 r_X1 POLICY JFQTPRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ $ WORKERS COMPENSATION I WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ . 500,000 OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) 6S60UB5831076212 /1/2012 /1/2013 E.L.DISEASE-EA EMPLOYE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) it Beech Leaf Island Road, Centerville. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of Barnstable .. Main Street Hyannis, MA 02601 AUTHORIZED REPRESENTATIVE Kathy Silvia/FAIKSI ` �✓' d ACORD 25(2010/06) ©1988-2010 ACORD CORPORATION. All rights reserved. INIsn25 rgmnnsi m Thn Ar-rion nnmo nnel lnnn ern ronia#arnrl mmAlre of Arnpin ' v - Massachusetts- Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License •License: CS 16932 RONALD,J S I LV I A f *f; 44 ICE'VALLEY RD j OSTERV1:1,ILLEVA 02�117655 F� _ i �- — �� Expiration: 11/18/2013 Commissioner Tr#: 7138 Office of CCoonsu�rAff�gusidess�latio •License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: ,101627 Type: i Office of Consumer Affairs and Business Regulation xpiration- __.8/2W/20t4_ Private Corporatir ..t: 10 Park Plaza-Suite 5170 1 r -.�, Boston,MA 02116 SILVIA&SILVIA ASSOC -,ES�NG' .Ronald Silvia •��.4", ,��,,' 1284 A MAIN ST. OSTERVILLE,MA Undersecretary Not alid without signature i �+E rti Town of Barnstable Regulatory Services t Thomas F.Geiler,Director MASR 0 9. Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 vmw.town.barnstable.ma.us Office: 508-862-4038 ; Fax: 508-790-6230 Property Owner Must g Complete and Sign This .Section p . If Using A Builder p A p as Owner.of the subject roe p riY lect hereby authorize OV1 A� S► la to act on my behalf, in all matters relative to work authorized by this building permit 11 -6-eP.Ch Vv&aC-.TES\&\r)A Cm4d-V Lt Nl(A (Address of Job) **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signature of Owner SignatYre of Applicant Print Name Print Name _Date Q:FORMS:OWNERPERMISSIONPOOLS 620I2 sHWE T : Town. of Barnstable _ ti . Regulatory Services saaxsz LEgi Thomas F.Geiler' Director Mass. `g a 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: JOB LOCATION: number street. village "HOMEOWNER": 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 em-lit. (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 procedures and requirements 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 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. Q:forms:homeexempt The Commonwealth of Massachusetts William Francis Galvin -... Page 1 of 3 .A The Commonwealth of Massachusetts �71William Francis Galvin f Secretary of the Commonwealth, Corporations Division w t One Ashburton Place, 17th floor Boston, MA 02108-1512 Telephone: (617) 727-9640 11 BEECH LEAF ISLAND ROAD, LLC Summary Screen Help.with this form "Request a Geitiflcate"" The exact name of the Domestic Limited Liability Company (LLC): 11 BEECH LEAF ISLAND ROAD, LLC Entity Type: Domestic Limited Liability Company (LLC) Identification Number: 001038156 Date of Organization in Massachusetts: 10/14/2010 The location of its principal office: No. and Street: 11 BEECH LEAF ISLAND RD. City or Town: CENTERVILLE State: MA Zip: 02632 Country: USA If the business entity is organized wholly to do business outside Massachusetts, the location of that office: No. and Street: City or Town: State: Zip: Country: The name and address of the Resident Agent: Name: MARY E. COAKLEY No. and Street: 11 BEECH LEAF ISLAND RD. City or Town: CENTERVILLE State: MA Zip: 02632 Country: USA The name and business address of each manager: Title Individual Name Address (no PO Box) First, Middle, Last, Suffix Address, City or Town, State, Zip Code MANAGER MARY E. COAKLEY 11 BEECH LEAF ISLAND RD. CENTERVILLE, MA 02632 USA http:Hcorp.sec.state.ma.us/corp/corpsearch/CorpSearchSummary.... 2/26/2013 I The Commonwealth of Massachusetts William Francis Galvin -... Page 2 of 3 The name and business address of the person in addition to the manager, who is authorized to execute documents to be filed with the Corporations Division. Title Individual Name Address (no PO Box) First, Middle, Last, Suffix Address, City or Town, State, Zip Code SOC SIGNATORY MARY E COAKLEY 11 BEECH LEAF ISLAND RD. CENTERVILLE, MA 02632 USA SOC SIGNATORY SARA W. CONDON ONE FINANCIAL CENTER BOSTON, MA 02111 USA The name and business address of the person(s) authorized to execute, acknowledge, deliver and record any recordable instrument purporting to affect an interest in real property Title Individual Name Address (no PO Box) First, Middle, Last, Suffix Address, City or Town, State, Zip Code REAL PROPERTY MARY E. COAKLEY 11 BEECH LEAF ISLAND RD.. CENTERVILLE, MA 02632 USA REAL PROPERTY SARA W CONDON ONE FINANCIAL CENTER BOSTON, MA 02111 Consent Manufacturer — Confidential _ Does Not Require Data Annual Report .. Resident For Profit Merger Allowed Partnership Agent — Select a type of filing from below to view this business entity filings: ALL FILINGS I Annual Report Annual Report-Professional Articles of Entity Conversion Certificate of Amendment ViewrFilin s FE,"�° New Search Comments ©2001 - 2013 Commonwealth of Massachusetts http://corp.sec.state.ma.us/corp/corpsearch/CorpSearchSummary.... 2/26/2013 The Commonwealth of Massachusetts William Francis Galvin -... Page 3 of 3 All Rights Reserved Help t http://corp.sec.state.ma.us/corp/corpsearch/CorpS earchSummary.... 2/26/2013 SWC/d August 26,2010 40511.001 DURABLE POWER OF ATTORNEY I, MARY E. COAKLEY, of Jupiter Island, Martin County, Florida, hereby make, constitute and appoint my daughter, ELLEN C. KINLIN, to act as my true and lawful attorney- in-fact (my "Agent") for me and in my name and place and stead, hereby g revokin all Durable Powers of Attorney previously made by me. SUCCESSOR AGENTS; If my Agent hereinabove named shall for any reason cease to serve as Agent hereunder, I hereby constitute and appoint my daughter, BARBARA C. JAY, to serve as my Agent in such Agent's stead. POWERS,AUTHORITIES AND DISCRETIONS: My Agent shall have and may exercise at any time or times the following powers, authorities,and discretions: 1. To open one or more accounts in my name at any bank, brokerage firm or similar r institution,including new accounts which are for my benefit but for which title may be in another name or names; to close any account (whether or not such account was opened pursuant to this Paragraph) in my name or for my benefit; to establish an Individual Retirement Account or any retirement or benefit plan; 2. To endorse my name on all checks, drafts or other instruments in writing,payable to my order, and to collect the same or to deposit the same in my accounts in any and all banks in which I may have such accounts; 3. To sell and convey all stocks,bonds or other securities standing in my name or otherwise and for that purpose to sign, execute and deliver all assignments and other instruments in writing necessary to transfer said stocks, bonds and other securities to the purchaser or collateral assignee thereof, 4. To sell,transfer, convey,mortgage,lease or otherwise dispose of or encumber,upon such terms and at such price as my said Agent may deem expedient, any real estate or personal property riow or hereafter belonging to me or any part thereof or interest therein; `� DURABLE POWER OF ATTORNEY FOR MARY E.COAKLEY Page I of 7 5. To make, execute, acknowledge, deliver or receive good and sufficient deeds,mortgages, leases and other instruments and papers of the same or different nature necessary or proper to complete execution of the powers herein granted; 6. To pay any and all bills, accounts, claims and demands now or hereafter payable by me including without limiting the generality of the foregoing, the *power to settle or compromise any such bills,accounts,claims and demands; 7. To receive, endorse and collect the proceeds of checks payable to my order drawn on the Treasurer of the United States; 8. To conduct or participate in any lawful business in my name;to execute partnership,trust and other business agreements and amendments thereto; to incorporate, reorganize, merge, recapitalize, sell, liquidate, or dissolve any business; to enter into and carry out the provisions of any agreement for the purchase, sale or exchange of any business interest, whether of a corporation, partnership, joint venture or other entity, upon such terms and conditions, and with such representations, warranties and indemnities, as my attorney in fact deems appropriate; to exercise voting rights with respect to stock, either in person or by proxy,and to exercise stock options and other rights; 9. To hold, demand, receive and collect any and all securities, investments and sums of money due,owing,payable,belonging or coming to me in any way; 10. To sell, manage, invest and reinvest any or all of my property as my said Agent shall .-/ deem expedient, changing investments according to my said Agent's judgment; 11. To sign and deliver checks, drafts or other orders for the payment of money (including checks, drafts or orders drawn to or for the account of my said Agent personally) upon any bank or banks or any other places in which I now or hereafter have deposits; 12. To borrow money in my name; 13. 'To renounce and disclaim any interest otherwise passing to me by-testate or intestate succession or by inter vivos transfer; . 14. To exercise any and' all of my rights under any one or more insurance and annuity policies including but not limited to the right to elect options and change beneficiaries,to borrow upon, collect from and to surrender the policies for their cash value; but my said Agent shall not in any event be authorized to exercise for me any power over any life or accidental death insurance policy on the life of such Agent in which I may have an interest;. 15. To exercise any and all of my rights under any Individual Retirement Account or any 'retirement, health, life insurance, welfare or other benefit plan in which I participate or have an interest, including but not limited to (a)directing and making withdrawals of some or all of the plan or account balance or benefit payments on my behalf, and (b)designating or changing the existing beneficiary designation; DURABLE POWER OF ATTORNEY FOR MARY E.COAKLEY Page 2 of 7 16. To commence, prosecute, discontinue, defend, settle or compromise all actions or other legal proceedings touching my property or any part thereof, or touching any matter in which I or my property may be concerned, and to employ counsel and execute and deliver releases or other instruments in connection therewith; 17. To have full and free access to any safe deposit box, vault, storage room or any other place where any of my property is or shall be or to which I shall have the right of access; to open or enter any such safe deposit box,vault, storage room or such other place and to deposit therein or remove therefrom articles or property; to surrender any such box or terminate the lease of any such vault, storage room or such other place; to exchange any such box for any other safe deposit box; to enter into any agreement of lease for a safe deposit box, vault,storage room or such other place in my name; meaning hereby to give my Agent such control of any such box, vault, storage room or such other place, and the contents thereof, as I now or hereafter have; 18. To execute federal, state or local tax returns (including but not limited to income, gift and intangible tax returns) or any other required tax-filings in my name,to execute any forms (including any special power of attorney which may be required by any tax authority) which may be required in connection with administrative or judicial proceedings in connection with any such tax returns, and to act in my name during any such administrative or judicial proceedings; 19. To make gifts to any one or more of my issue of whatever degree (including any one or more of my said Agents who is an issue of mine) or any one or more persons related to me or to any of my issue by blood or marriage in any amount,to make qualified transfers on behalf of any of them as defined in Section 2503(e)-of the Internal Revenue Code,and to make gifts to charity in amounts not exceeding such gifts made by me in the last preceding calendar year; 20. To sign, execute, acknowledge and deliver any deed or other instrument of transfer or conveyance covering personal property or real estate wherever situated to the then Trustee or Trustees (and their successors in trust) under any revocable trust created by me; 21. To the extent permitted under state law, to execute one or more Wills and/or Codicils or Trusts, revocable or irrevocable, of which I am the Donor, and to sign, execute, acknowledge and deliver any deed or other instrument of transfer or conveyance covering personal property or real estate wherever situated to the then Trustee or Trustees (arid their successors in trust)of such Trusts;and 22. To resign any fiduciary office of which I am serving, including but not limited to the office of trustee of any revocable trust created by me, and to decline any such fiduciary office. The term "issue" is intended to include only persons who are lawful blood descendants, persons who, prior to reaching age 18, have been adopted according to law, and persons who DURABLE POWER OF ATTORNEY FOR MARY E.COAKLEY Page 3 of 7 have been born of a couple who openly lived together as husband and wife after the performance of a marriage ceremony between them. GENERAL AUTHORIZATION: My said Agent may in general do all other acts and deeds, matters and things whatsoever in or about my estate, property (real or personal) and affairs which I might, or could do if personally present,hereby giving and granting unto my said Agent full power and authority to do and perform all and every act and thing whatsoever, requisite and necessary to be done with my property as fully to all intents and purposes as I might or could do if personally present. In no event shall my Agent be held personally liable for any exercise of the powers herein contained except in the case of gross misconduct or fraud. DELEGATION OF POWERS:COMPENSATION: My said Agent is authorized to delegate any powers hereunder to any investment counsel, custodians, brokers, accountants, attorneys, or any other agents, and to revoke any such delegation. My Agent may pay to himself,or to any agent to which he has delegated his powers, reasonable compensation for services rendered hereunder from any property owned by me or to which I am now or may hereafter become entitled. My Agent may deal with himself or with any concern in which he may be interested as freely and effectively as though dealing with a �—' stranger. I hereby ratify and confirm all that my said Agent shall do or cause to be done by virtue hereof. PHYSICIAN/PATIENT WAIVER: My said Agent is hereby specifically authorized to waive my right to have any communications between me and my physician kept in confidence. I intend for my Agent to be treated as I would be with respect to my rights regarding the use and disclosure of my individually identifiable health information or other medical records. This release authority applies to any and all information governed by the Health Insurance Portability and Accountability Act of 1996 ("HIPAA"), 42 U.S.C. 1320d, and the regulations promulgated thereunder. The authority given to my Agent herein shall supersede any prior agreement that I may have made with my health-care providers to restrict access to or disclosure of my individually identifiable health information. GOOD FAITH RELIANCE: For all purposes hereof, any act taken by my Agent and every instrument executed by my Agent, or any person who, according to the provisions hereof, is represented to be my Agent, DURABLE POWER OF ATTORNEY FOR MARY E.COAKLEY Page 4 of 7 shall be conclusive evidence in favor of every person relying thereon that at the time of such reliance this Power of Attorney was in full force and effect and that my Agent was duly authorized and empowered to execute said instrument. An affidavit executed by my Agent,as to any fact affecting this Power of Attorney,shall be conclusive thereof. RESIGNATION: Any Agent of mine serving hereunder may resign at any time by a writing signed by said Agent and attached hereto, written notice of which shall be given to me, any Co-Agent serving hereunder, and anyone herein named as successor Agent. If any resigning Agent shall have in his or her possession any original Durable Power of Attorney signed by me, such Agent shall return such original Power to me or, in the event of my incapacity, to any successor Agent named herein. TERMINATION OF AGENT'S AUTHORITY: The power of any Agent acting hereunder shall terminate upon delivery to such Agent of a written instrument of revocation of this power signed by me. Any Agent acting hereunder may resign by written instrument without intervention of court, and such resignation shall take effect upon delivery of such instrument to me. DURABLE POWER: This Durable Power of Attorney shall not be affected by my subsequent incapacity except as provided in Section 709.08,Florida Statutes,or lapse of time. Any provisions hereof which may prove unenforceable under any law shall not affect the validity of any other provision hereof. Any photocopy of this Durable Power of Attorney shall have the same force and effect as the original. DURABLE POWER OF ATTORNEY FOR MARY E.COAKLEY Page 5 of 7 IN WITNESS WHEREOF, I do hereby declare that I sign and execute this instrument as my Durable Power of Attorney,that I sign it willingly in the presence of each of the undersigned witnesses, and that execute it as my free and voluntary act for the purposes herein expressed this day of : 2010. MARY COAKLEY (Witness) Name: Address: )`a,�jhn (Witness) Name: Address: �Dy� bV)i_c.z,e o 4w DURABLE POWER OF ATTORNEY FOR MARY E.COAKLEY Page 6 of 7 STATE/COMMONWEALTH OF � ) COUNTY OF ss: On the day of k'a�" r , in the year 2010,before me, the undersigned, personally appeared MARY E. COAKLEY, personally known to me or proved to me on the basis of a driver's license or other satisfactory evidence to be the individual whose name is subscribed to the within instrument and acknowledged before me that she executed the same as her free act and deed in her capacity therein stated, that by her signature on the instrument, the individual, or the person upon behalf of which the individual acted, executed the instrument for the purposes therein contained, and that such individual made such appearance before the undersigned in 11 k i N Pb NIFER M P Notary Public: COMMONYV VN OF MAST T7s My Cornmftbn 800 October 28 4958335v.1 DURABLE POWER 0F ATTORNEY FOR MARY E.COAKLEY Page 7 of 7 ENC �- - i - zoo U UK O - - - I - - - RET WMam `-° tom`' Y •. ,..r°A i�F�"�����' . rn a --- - g ----- - — .._:.. ----- I OETME T Town of Barnstable *permit# ,�DC�� 7 y�� 0 Fxpires 6 months from issue date - ~ 's Re ulato Services -- Fee H B , g r3r AWIT Thomas F. Geiler,Director, 10 f2f,/Q7 BwI g '°rFDMAta din Division _ T 2 5 2007 Tom Perry, Building Commissioner �y 200 Main Street, Hyannis,MA 02601 , TOWN OF BAt� V LE Office: 50 8-8 62-403 STAB Fax: 508-790-6230 EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY Not Yalid without Red X-Press Imprint Map/parcel Number w D �- Property Address ❑Residential Value of Work Owner's Name&Address am Tele hone Number i `T � C Contractor's Name r p Home Improvement Contractor License#(if applicable) 70r::Is Supervisor's License#(if applicable) . 43 Compensation Insurance Check one: ` ❑ I am sole proprietor ❑ I the Homeowner have Worker's Compensation Insurance Insurance Company Name ' Workman's Comp.Policy# � PermitReque (checkbox) Re-roof(stripping old shingles) All construction debris will be taken tam(Il 0 -� r.�r u�SfatG� ❑Re-roof(not stripping. Going over existing layers,of r000 ❑ Re-side ❑ Replacement Windows. U-Value (maximum.44) ❑. Other(specify) *Where required: issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. Signature Q:Fomu:expmtrg R.evised121901 10-12-2007 14:03 FEI 508SM9123 PAGE2 t✓bi l l IbVV i Vl`VV 1 it YVV(! WALWW I VW'ff.VVWV _ {1 a Town of Bamtable { Regulatory Services �, T'�amw 8.Oa11Nr�Dlcaemr Building Dividon Tojn���� �r/wa, g met' Q{9ow 50 462 40 8 AM 305-790.6230 Property Owner Must -- _ Complete and Sign This Section _._.. _ .•.. If Using A Bufldit — — - - — n- ,as Omar of the p1meet properiq busby autboAze ` to act on my behalf, in all rniattw totadrs to WO&nthoiized by ti}tis building permit epplioa{don for;. (Udms of Job) 1 His Print Name ..•+.•fw r..nwnmfp.staem7. (�S{'tlli{bb•�/Wiw00{PORir�YiOi�i� . 09-11-2007 12:58 FEI 5BB8889123 PpaM 08/08/2007 10:54 FAX 5084283069 GERNANI INSURANCE g001 R n t• .0 v ,4 n I,i �� w. • �r''�'�� DATE(IAMIDDIYY)- odii, .. ..., a• .,ate,. . . 1!f ..!. '..+Ci..�n. .u:.. PRODUCER THIS CERTIFICATE 13 ISSUED A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE GERMANI INSURANCE AGENCY HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR $08 MAIN STREET ALTER THE Q0VrFF ED TH P LI OSTERVILLE,MA 02655 •,-_ COMPANIES AFFORDING COVERAGE _ cOM A SAFETY INSURANCE tooMPANY SCOTT E.CROSBY BUILDER,INC. g A(Q-AMERICAN INTERNACIONAL GROUP 1112 MAIN ST.UNIT 7 OSTERVILLE,MA 0265E COMPANY c COMPANY D H I;,:i'S: "h r ,. p .I ir' oa }1.1.'� M! A 1;.s;�I,•I:.., Shcr 5 3i f ' Ill i Le��d'lNa6 L't.'�i:'b.I.I,1L,ih_I} �,LL:h'�t�dCay,�ti!��Wf'�.7t�n.=t1>,'�rK,.•a.,>ti.:",�,,,.�{:radl!iD:l"iil;Li:7,;}'I!iu�Ql a' 's.a1 t:.�l,.iw;l.w•.,+.....�. A.M . ilu. THIS 13 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVEDEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED B Y THE POLICIES DESCRIBED HEREIN 13 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. DO TYPE OF INSURANCE POLICY NUMBER POLICY EFFEOTTYE POLICY EXFMTNM LWITS LTRI DATEIMMmDm) DATE(MVIDDI ) GENERALLIAMUTY QENERALAQGREGATTi 0 2,000 000 A )( COMMERCIAL GENERAL LIABILITY CP00001163 07/03107 07105/08 PRODUCTS-COMP/OP AOG c JCLAIMS MADE U OCCUR PERSONAL A AOV INJURY s OWNER'S A CONTRACTOR'S PROT EACH OCCURRENCE s_ 1000,000 FIRE DAMAGE(Any am firm ^i MEDEXP wwfxl I mm) II. AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT 8 ALL OWNED AUTOS BODILY INJURY 8 SCHEDULED AUTOS (Par pww) HIRED AUTOS BODILY NON-OWNEDAUTOS IPeracl INJURY i •..... ... _ PROPERTY DAMAGE' y C-ARAC�6.LIABSdTY AUTO ONLY-EA ACCIDENT S ANY AUTD OTHER THAN AUTO ONLY AGGREGATE S EXCESS LU481U7Y EACH OCCURRENCE S UMBRELLA FORM AGGREGATE OTHER THAN UMBRELLA FORM f _WAOTlh B P S RAND WC 687 7"8 06/22107 06/22/08 EL EACH ACCIDENT c 100 000 TMfi � INCL EL DISEASE-POLICY LIMrT $ 800 OOO PARiIERGIDMOUTWH •- oF[CM AA6: EXCL EL DISEASE-EA EMPLOYEE S 100,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONSIVENICLE=Pi!M4L ITEMS Y ga ...,�.,�,._ .�o. ,. w 'wuN,' d�.f�` {!• I11:i'w .`ii wawf - SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BB CANCELLED BBFORE TH6 EXPIRATION DATE THUMP, TM ISS04 COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN 010710E TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT PAIW RE TO MAR.SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIAZU Y ITS AGENITS Oft REPRUIENTATIVES, AUTHOP"REPRESENTATIVJ I 4 i!�•`.I a i � 'N kj i .N+. A ,,11' G�': li'Y U 1�'�� 'kq I , •4�r.!h „I� �+l �` �%^ ����I� ✓fze'C�oonineo�aurea�i a�✓�aaaac�icael�a i" i � ` \ y.f" oard of BuildtngsRegulattons an�drStandard`s r ry isor w onstructio Supe L41 icense Llcefi3e CS 4�3556 i '+ r B9qrsdate 3/1i962, p raft f 2/ 8f/2008 Tr# 6886 A SCOTI�E CROSB �R 62xCROSBY CIR ;., ;, o��£- $OSTER�U�IL` E'"M�A�0265� i Commissioner p� Tee, �\ Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Board of Building Regulations and Standards , Registration. 15tg82 One Ashburton Place Run 1301. Expiration 7/,l;3/2008 Boston,Ma.02108 j.4 Type PnyaterCorporation. SCOTT E CROSBY BUIEO INC SCOTT CROSBY Y ryt 1112 MAIN ST UNIT#7T ` �Q- -` '�"�5 s✓OSTERVILLE,MA 02655'�_r' Deputy Administrator Not valid without signatur j i Town of Barnstable, • • DA 9rA M ` �� Regulatory Services Thomas F.Geiler,Director Building Division Tom Perry,CBO Building Commissioner 4 200 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 J I ,as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signature of Owner Date Print Name Q:Forms:expmtrg Revise071405 The Commonwealth of Massachusetts T Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers AvyUcant Information Please Print Legibly Name(Business/Organization/Individual): I �. Address: I !Z Ma cm G f ff Inc 4�jl -7 1J City/State/Zip: i° f U1 JLZ ,S-_Phone Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with [I0 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. [],Demolition workingfor me in an capacity. employees and have workers' � y p Ty comp.insurance.t 9. ❑Building addition [No workers comp.insurance p• required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself [No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no employees.[No workers' 13.0 Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: !All, �7��" +��I " [� D Expiration Date: (P ,� a 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 may be forwarded.to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi nder the pains and penaldes of perjury that the information provided above is true and correct Signature: Date: Phone#: . 6%-40 " CIO 6 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/,Lkense# ` 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 M Assessor's map and lot number ...../Z..7:`.....7.`.3............ THE pi Tp SEPTIC SYSTEM MUST BE Sewage Permit number ............... ........................................ d� s INSTALLED IN COMPLIANCE • Z BJBH9T4DLE, i House number Ij - -TS WITH TITLE 5 = MAB6 ................... .... ... . ..................... ENVIRONMENTAL CODE AND °'°�o„ 9 TOWN OF PAW"' ` ` � BUILDING INSPECTOR APPLICATION FOR PERMIT TO .S.I.IV C. , �- M TYPE OF CONSTRUCTION ............l.P,I..C1....�O.............. ................................................... .71....`.............................19....� TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location h1 E ....... CIF......7s.��� 0 ffO.>P.4...... ...C'G!r!�C!cmU/�� ......................................... ProposedUse ,�L�' � '....:�. °.1... ...................................................................................................I......................... Zoning District .................. ....................................Fire District SOLI. :.:4:.!..!.s...................................... ........ 7 Gi. Name of Owner �:.........................: G:........Address 1C.....� � '� �................' � C Name of Builder .//sib �i/d/!�..... �''. ........Address .................................................................................... ......... ...... r L Nameof Architect ..................................................................Address ........�........................................................................... Number of Rooms .......... ....................................................Foundation ....., ONE! ?. �.............................. Exierior ..........................................Roofing S�`J...?..�... '3 . . ..'.L./.......r.................................................. Floors ..... '���'��.f<?/ .P'�...............................................Interior .. L✓...�r�.f.` .:��.G.:..`............................................. Heating ..... .............Plumbing ..../� L Fireplace ................................................ 1..............Approximate. Cost .../ t�> .D.f70..:.`' .......... ............ Definitive Plan Approved by Planning Board ______ ce-L'_ .........19 . Area / l... .... ....................... Diagram of Lot and Building with Dimensions * Fee ................ ............................ 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 .... ........ B-PlACH LEAF ISLAND, INC. No Permit for ...A.32—StOXY............... . ...........5 ingift.....EqTUY..Pwell#lp.................. " W1LI2211 f949.h..Lg.qf...Island Rd.LaCatian ....... ..I . ..... . ... ..............Q?A.t.P..r'Y;UlA................................... Owner .........B,PAOJL4PAf...Island, Inc.•...... Type of Constructi6ri .......Frame ................................... ................................................................................ Plo,t ............................. Lot Z.........:.................. Permit Granted ...........j!4!Y.. ..........19 86 Date of Inspection ................ .........ig Date Complqted ...... .... .......19$7 0 A*$ A WV. PINK- DEPT. FILE COPY/WHITE- FIELD COPY I YELLOW-APPLICANT COPY I?° f. BUILDING- I' TOWS OF BARNSTABLE, MASSACHUSETTS PERMIT VALIDATION A=187-73 DATE iti i + ? 19 S6 PERMIT NO. I'r �`_&961 2 APPLICANT G j I V 7?. t TT 1 '1 s ADDRESS Fl1 Q a i-•. O='1 (NO.) (STREET) •� ) �t �.y_�}"�" (CONT R'S LICENSE) U PERMIT TO ,il.%c� I I i nv NUMBER OF 7•--(_ ) -.t r•,1 I DWELLING UNITS 4 (TYPE OF IMPROVEME STORY NT) NO. �� (PROPOSED SE) T 1 ZONING AT (LOCATION) lot- #1 'I1 F„�.>hil P.t : .+._,l .,.r..' '•r•i�l� '� • / DISTRICT On (NO.) (STREET) - s BETWEEN • ` AND `tt (CROSS STREET) (CROSS STREET) I. ( SUBDIVISION LOT LOT BLOCK SIZE f' BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTIOi TO TYPE USE GROUP. _BASEMENT WALLS OR FOUNDATION (TYPE) I' REMARKS: is r 4 AREA OR LC)i.iL' VOLUME _ 11��'� 11i4 '. PERMIT $ p 4 ``o �� I� ESTIMATED COST $ '• S('; (ti1:4 FEE I. (CUBIC/SQUARE FEET) OWNER - I�Af`11 ^{ 'fcl.S'rl 7 ADDRESS h i Q I`%•t i" ti Y ('s n BUILDING DEPT. e 1,. 1:'V 11 LLB '.JL BY I+ FOUNDATIONS OR FOOTINGS. FrFUF��t7lXtC`C.T`IS' `2-EcTT7i^v'rC'.c'i'-fr4sl:�i'C�q�-ri71v5-.---- 2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL FINALMEMB INSPECTION TI TO LATHE FINAL INSPECTION HAS BEEN MADE. 3. FINAL INSPECTION BEFORE OCCUPANCY. , POST THIS CAR® SO IT IS VISIBLE FROM STREET BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS Z 2 Z �J / / v✓1 3 -- � HEATING iVSPECTiNG APPROVALS REFRIGERATION INSPECTION APPROVALS 1 Imo' -- - 12 I • `�- =^A L'_ r•iCT. ,a OCE�D :iNT L "i+E PERMIT 'W!LL BEJOW14ULL AND�VOID IF CONSTRUCTION iNSFECT;CNS iNDICA�D ON THIS CARD .NSPECT�R -1AS ;,P-R0VEO -HE •,- cUS WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE CA?! BE ARRANGED FOR 9Y TELEPHONE ' cTAGES JF .CONS?'?i:C'.i�N. I OR WPITTcN NOTIFiCA710N. PERMIT IS ISSUED AS MOTED'ABOVE. a, , �'�y�••: TOWN OF BARNSTABLE _ BUILDING DEPARTMENT _ BsaiaTAU TOWN OFFICE BUILDING g' i6J9• � HYANNIS, MASS. 02601 ►- MEMO TO: Town Clerk FROM: Building Department DATE: o� 3 <d ` r� ' An Occupancy Permit has been issued for the building authorized by BuildingPermit $ .... f.... .......................... ..................................................................................................................._..... issued toG�"......./,, Ae L sY/y../G .: ��v�..... ..../T... / ��Ze, Please release the performance bond. c o�TKErp• TOWN OF BARNSTABLE Permit No. .:.29612..... BUILDING DEPARTMENT B°81AO I TOWN OFFICE BUILDING Cash HYANNIS,MASS.02601 Bond 2 CERTIFICATE OF USE AND OCCUPANCY Issued to BEECH LEAF ISLAND, INC. Address lot #12 11 Beech Leaf Island Road, 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. ' r'r 9 September 18 1 87 .Y ,.,���r/ ................. f Builddinin g Inspector i 0-rha Assessor's map and lot number ........ �% V .�, �.... . � ........... Bpi THE . ......... . .sewage Permit number 25` r BABNSTABLE, i House number ........... .!.!....r ^J•�...................................... 900 ,"6& 0A �e '£a MPY Ar TOWN OF BARNSTABLE BUILDING INSPECTOR ` APPLICATION FOR PERMIT TO ........ ..../...N...��.,��`........... /. .............................................................. TYPE OF CONSTRUCTION ............� �C>cr.C�.............Cd!.:!'�/l�c. D 7/;................................................... 1........ ........................19;f TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: /oZ .s�c/�....... c�9 Location .. .......... .................................................................................................. ProposedUse ,.S'/tiG Z ....... .............................................................................................................................. Zoning District l i P/` 1 Fire District ..!.�.5� (� ........................................................................ .. ..................................................... ,� GiL Name of Owner,TfEcH..I-E� . !s/.?,,.o..... !?� 2.........Address. 6/9 /��1.0 ...... E ` ' .......... ......................... ......... .......................... Name of Builder /../Lim .1ri/d/9.... !'`.�--'..........Address ........................................................ Nameof Architect ..................................................................Address ................................................................................... Number of Rooms ..........9....................................................Foundation �..4.s�. ...... ...... !��c.,_ 7E ...... . ................................... r Exterior .1 ./,e3cG�....:l�e',.x^�.< ..........................................Roofing . .................................................................. � 1l Floors 7/�✓2/i 1�(/(r.Q ...............................................Interior � �� .�?O G ............................... ...................................................................................... t Gri,�� �e /.............Plumbing .. f.?.r�:.....��' Heating T/...�:E.�?....��................ �...................... Fireplace .......�........................ .......................... . Approximate Cost ...,../...... 2. 0n(. ......r' `'............ 1 Definitive Plan Approved by Planning Board --------1 Area ;. ................. Diagram of Lot and Building with Dimensions Fee 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 . .. -3 f........ BEACH LEAF ISLAND, INC. A=187-73 No ..29612.... Permit for ,1 Story........ ........ Single Family Dwelling g Y g Location Lot #12, 11 Beach Leaf Island Road Centerville Owner Beach Leaf Island, Inc. Type of Construction Frame ............................................e................................. Plot ............................ Lot ................................ I Permit Granted ..........T.uly...a ..................19 86 Date of Inspection ....................................19 Date Completed 19 . � a a ��cy �•M 7a.p or' c�,vc. ,8ouv� < EL.cV //. 9 J Lad X 72—= ,Q pt Igo 57 ro V ,N 99 u� g4.o 8 \� 0 m ` • cQ 3q• q ,c 3 %ni N •O CPSqjl n 9 •,.� moo,� co U FivIP � g Q o � N V\ a L o 7- le j 0 C.13, CND TOWN OF BARNSTABLE ZONING -,,�``�� of MArdq' �� BY-LAWS DATED FEBRUARY 1985 PAUL tip\ s R' ZONE: RD- 1 RYLL No. 32448 oe; SETBACKS FRONT = 30' ►.�.�,� SIDE = 10' REAR = 10' PROPERTY LINES SHOWN HEREON WERE COMPILED FROM PLANS OF RECORD AND DO NOT REPRESENT PROJECT NO. 3-1461-00 AN ACTUAL SURVEY ON THE GROUND. --- - THE STRUCTURE DEPICTED ON THIS PLAN WAS LOCATED PLOT PLAN ON THE GROUND BY SURVEY ON JUNE 25 1986 in 1 AND EXISTS AS SHOWN AS OF THE DATE OF LOCATION. BARNSTABLE MASS . THIS PLAN IS FOR PLOT PLAN PURPOSES ONLY AND SCALE: 1" = 20' JUNE 26 1986 SHOULD NOT BE USED FOR ANY OTHER PURPOSE. ---- — -- x BSC / CAPE COD SURVEY CONSULTANTS j f 3261 MAIN STREET DAtE PRO ESMIONAL LAND SOEYOR BARNSTABLE VILLAGE, MA. 02630 (617) 362-8133 �