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0035 CAP'N CROSBY ROAD
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M , - - n Post 'wl's rd So that it.is Visible From the Stree Plan t=Apptoved s Vlust be Reted on lob e and his Card Must b Kept Posted Until Final Inspection Has B en Made ' H • „ � Where a Certificate of Occupancy�sRequired,such Buildrng shall Not be�Oceupied until a Final Inspect�o'n has been made '` el illl Permit NO. B-20-191 Applicant Name: THOMASJ LEE Approvals Date Issued: 02/03/2020 Current Use: Structure Permit Type: Building-Smoke Detector-Fire Alarm Dection Expiration Date: ` 08/03/2020 Foundation: System Map/Lot: 194-030 Zoning,District: RC Sheathing: Location: 35 CAP'NCROSBY ROAD,CENTERVILLE ContractorName ,„ HOMASJ LEE Framing: 1 Y a e Owner on Record: GOODE, MICHAEL W ContractoraLicense 172 2 Address: 35CAP'N CROSBY ROAD i Est Project Cost: $ 1,200.00 Chimney: CENTERVILLE, MA 02632 Permit'Fee: $35.00 d Description: install fire system at home Insulation: Fee Paid:l $35.00 Project Review Re SUPPLEMENTAL SYSTEM ONLY Date 2/3/2020 Final Plumbing/Gas . Rough Plumbing: _.. � �Building Official, - � Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. All work authorized by this permit shall conform to the approved application and the'approved construction documep'for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the Final Gas: work until the completion of the same. + Electrical The Certificate of Occupancy will not be issued until all applicable signatures;by the=Building and Fire Officials provided on.this,p rmit. Minimum of Five Call Inspections Required for All Construction Work:P Service: 1.Foundation or Footing 2.Sheathing Inspection u y Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed priorto Frame Inspection Final: 5.Priorto Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation . 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT 5 i eil1 S-, I TQWN OF BARNSTABLE BUILDING PERMIT APPLICATION A Map (l Parcel U li pp cation # � .,alth Div'ision Date Issued Conservation Division T Application-Fee PlanningDept. .. �,�.j�.n,j�'� p ,. Permit•Fee �s•°� ` SCANNED Date Defi I itive Plan Approved by Planning Board 9d�'�1 21�.'1�120 •� . • Historic -'OKH Pr�servation/ gniusr ���n ,ice_ -FEB 0 3 2010 j Project Street Address 3 S C*i {i n 61-4 C fl 5 % I Village Owner_ Address,.' Telephone 04- 4 U !2�0 4 Permit Request oJ,s�f►w �5 I', om C . Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood,.Plain Groundwater Overlay= ` ,project Valuation !�o Con!struction Type • Y Lot Size- ,, Grandfathered: _Ll Yes ❑ No If yes; attach supporting documentation. I . Dwelling Type: Single Family Two Family',, ❑• , Multi-Family(#-units) Age of Existing Structure ii '. Historic House: '0 Yes 1 No On Old King's Highway: ❑Yes 0 No. Basement Type: ❑full ❑ Crawl i : ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area(sq.ft) Number 61f Baths: Full: existing i new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths)::existing new First Floor Room Count Heat Type and Fuel: Ll Gas ❑Oil U Electric ❑ Other Central Air: ❑Yes ❑ No 'Fireplaces: Existing _ New Existing wood/coal stove:' d Yes ❑ No I Detached garage: ❑ existing ® new size—Pool: ❑existing ❑ new size _ Barn: ❑ existing, ❑ new. size__ Attached garage: ❑ existing ® new size _Shed: ❑ existing U new size._ Other: Zoning Board of Appeals Authorization, ❑ Appeal # Recorded ❑ commercial ❑Yes ❑ No Ifyes,.site plan review# Current Use lL�_:tspi �"L Proposed Use sEc�_� 'Ifg "two C�titN APPLICANT INFORMATION T { (BUILDER OR HOMEOWNER) Name T-0 vV. L-Lf- r+�c 1 LI.L _ Telephone Number -2$i-� q g1---:m3 :Address MI6 P1. Si 111An I°Lvdr° License# I a G- F `. `Home Imp* rovement Contractor Email 1< n+ HAw Workers Compensation # YY1 WC, 314 3 1�1 I g ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TOhiA { SBGINe `�U�E 'SEC Al"l't'.(A s '''"`s w, IL DATE. ; 13-01 i l 12.0 I I 47.0' Kitchen Bath 12.0 Family Room Dining area Living Room it I 24 0' i 4.01 I Bedroom 15.o' SCANNED 12-0' l� Fo FEB 0 3 2010 I 32.0' F-E-TECT ORS REVIEWS 1 1st Floor Front '. LiOEPI. AT _.. it n i f'f?-ldiJfl`L ?F?R¢.c:t-',;0 -TING I I I ! Bath j I ' Bedroom B droom-- � .24.0' D i I 1 � I EAVES EAVES i 32.0' 2nd Floor (x .75 story) i 1 CIDf i r / j 13.0' �''� d Zc� 3 I 12.0 47.0' i , j Kitchen Bath 12.0 Family Room Dining area � living Room i , 24.01 , 4•00 I Bedroom �I 15.0' I 12.01 i �; Foye i 32.01 to 1st Floor Front r UILn SIG nFpT. i u c:ftUi,�c 1 FPP; NG i Bath Bedroom r om 24.01 1 I ' I EAVES EAVES i i 32.0' 2nd Floor (x •75 story) N\'_ on f- co �� SCrncn -�- Life Safety Installation - Narrative Report RESIDENCE ADDRESS:35 Cap'n Crosby Rd Centerville,MA 02632 INSTALLATION COMPANY:ADT Security 245 Winter Street Waltham MA Contact: James Leonard—Manager(339) 223-5162 BUILDING DESCRIPTION l A single-family structure with_2_levels of living space, excluding the basement. There are a total of_2_bedrooms which are located on the following floors;_0_bedrooms on the first floor and 2 bedrooms on the second floor FIRE PROTECTION SYSTEMS TO BE INSTALLED ADT,with the approval of the building owner, intends on becoming the monitoring company of record. The Life Safety System will be wired/wireless and the devices to be installed will included: (10) wired combination Smoke/Carbon Monoxide Detectors* (6) wired Smoke Detectors* (3) wired Carbon Monoxide Detectors* and(4) wired 135 Heat Detectors*. The wired/wireless devices have a photoelectric design that will enunciate smoke and all devices are interconnected with built-in sirens/speakers. The panel (Command / Safewatch*)includes a 2- way 128Bit encrypted design. *The product specifications sheets for the Life Safety Devices are included with this narrative submission SEQUENCE OF OPERATION The fire alarm control panel will signal two types of alarms. Supervisory alarms will be silent (tone at the panel). Another signal will be sent via wireless signal (Cell Guard)to the ADT Customer Monitoring Center. ADT will, upon receipt of a supervisory signal, notify the call list on file and dispatch the appropriate safety personal. Fire alarms, if activated either manually or automatically will sound audible devices(the system when triggered will notify all floors) along with sending a signal to ADT's Monitoring Center.ADT upon receiving the fire signal, immediately contact the customer then per NFPA 72 (2013) after receiving confirmation of the alarm or getting no response from the premises, ADT will then contact the COMM Fire Dept. DEVICE TESTING CRITERIA ADT will perform a complete system pre-test prior to scheduling and arranging the final test with an inspector from the COMM Fire Department. ADT will have technicians and all necessary equipment available. Upon successful completion of the acceptance test,ADT will furnish the inspector with all documentation that has not already been supplied. Carter, Jeff From: Carter,Jeff Sent: Tuesday,January 28, 2020 9:53 AM To: 'kbradshaw@adt.com' Subject: Permit/Application:TB-20-191 at 35 CAP'N CROSBY ROAD, CENTERVILLE for Building - Smoke Detector - Fire Alarm Dection System Good morning, Please be aware that we are currently reviewing your building permit application for 35 Captain Crosby, Centerville. At this time we have to deny your request until additional information is provided. Please provide the following: 1) R314.3 and R3153-provide floor plans that show all smoke and co alarms in code compliant locations. And, if aggrieved by this notice and order;to show cause as to why you should not be required abate the violation in this notice,you may file a Notice of Appeal specifying the grounds thereof with the State Building Code Appeals Board within forty-five (45) days of this notice in accordance with MGL 143 c. 100 and 780 CMR: . Respectfully, Jeff Carter Localinspector Building Department Town of Barnstable 200 Main Street Hyannis, MA 02601 - - - - - - _ - - - ----u 508 862-4035 1 The C0HMA0MVXdth CIN Off y�Apo,�'�I9n,,ws-a,gton ¢ one' 600 :dos, ,%AM 0 111 Workerg Coaunpe nsaVion Insurance Affidavit: BnfldareCmtractors/EIleetrncian Ilumbers Applicant Infonnaidon Please Print L—gabfly Name(Husixress�C�rganiZatiom/Cttdi�icbldl)- A27- Address: City/state/zip: ,0-4 Pdkl-rl Phone#: 7V-1 Vol e A re yin P ?Chock u➢a,e t 1@ P >te ka e o Type oif p roject(requnihrel): 1.FkM am a employe r with ❑ I am a general contra c for and I New co nstru ction employees(full ar0orpart-time)* have hired the sub-contractors 2.❑ 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 for me in anycapacity. e mplopes and have workers' coin insurance.l 9. 0 Building addition [No urorkers'comp.insurance p• required] 5. We area corporationandits 10.❑Electrical repairs oradditions 3.El officers have exercised their I am a home owner doing all work 11.❑Plumbing repairs or additions myself. [No viorlters'comp. right of exemption per,IVOL 121-1 Roof repairs insurance required.] fi c.152, 1(4),and we have no employees. [No workers' 13.�Oiher Aza,r,gk2 comp.insurance required] ,k&L Vpli aitthu chedubox#inwstakofMoutthesectimtbelnw orvatgil fr«n¢kers'coa ns�tiampolicy fomr�tic�zt. t Homeownerswlw subndt1w affidavits di d3ngth yae doingtUwm}s sndthmhne outsde commascto¢s ssts it anew affidauitg,idic tmg such. I Uavru=ntchtdkedsboxn=atie,chedmaddd=1skeetslwwmgthe=xcfth sub-ca¢dicta¢ mdst*dewh1herorrattlwseeraieshwe emphres. I the mb-cordmd=have employees,tl-nyn=pmvide tLeir workers'comp.polkyramber. I am an emptoyer that is providing workers compensation insurance for my employees. Belotp is the policy and jab site irnformation. Insurance CornpanyName:_ epx Policy##orSeif-ins.Lic.##:_ —7 ZZ4 Expiration Dad Job Site Address: ,35 'e.Prf4? �^°S ^� ft V^0 CitylStatetZip: fl, 'rv4rw" .�['k.iL<a L'�I!j�� u� �!k.'i�faD1�E��.r:�'c�m�apn4:�l.�.ii1�7J111tj1C�rnlF�:+�ti](k:t'�etiia lfl!Lin�t7!iu!+�!�I�S��ii�'i�`Plllj�lilt€�NQI;��Ti['� lli(p➢�lllT7�L�]�h!��':iSTD1!1i+lll�`]_!fU7IIl v�allL�.� 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 andlor 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 copyof this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do he !certify nun e am's enalties of perjury that the inaformation provided above is true and correct S• nature: / Date: Phone M 7�'/ �e 7 � 7 7 F i cial use on4�. Do snot write in this area,to be completer by cily or tolva official. Chy or Towxu lPeYvn>�t1lLiicear��e# . Issuing Aidhorfty(c ri clb one)- ll°Board oi'Heal>flfn 2.BunM` I(D ar art 3° C° )town C errk 4°lEkctr call ector S.]Epl�nnun>fV° g esctor . � � is 6° Offier Cord act Person: Phone M i .........._ . _ .- .._. ... DATE(MM1DDlY W) CERTIRCATE OF LIABILITY NSURANdE 09/25/2019 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 it an ADDITIONAL INSURED,the policy,(es)must have ADDITIONAL INSURED provisions or be endorsed'. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy, certa.'in 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 'CONTA'CT Marsh USA Inc. NAME: PHONE FAX 1i560 Sawgrass Corporate Pkwy,Suite 300 are.No: Sunrise FL 33323 E-MAIL Attn:FtLauderdale.Certs@marsh:com ADDRESS: INSURER S AFFORDING COVERAGE NAICPI CN10991+8288 ADT-GAW-19 20 INsuRER A Old Re utilicansurance Go :24.147 INSURED ADT LLC INSURER B:. ADT Security Services INSURER_C: 2.45 Winter Street Suite 200 INsuRER.D Waltham,.MA 02451 '.INSURER.E .?INSURER F t COVERAGES CERTIFICATE.NUMBER, ATL 004803800 0;9. REVISION NUMBER: 3 THIS I:S TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE PO:LIGY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER 11Y.OQUMENT WITH RESPECT TO VmlCt H THIS CERTIFICATE.MAY BE ISS.UE-D OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE:POLICIES:DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS O:F.SUCH PO:L-ICIES.LIMITS SHOWN MAY HAVE'BEEN REDUCED BY PAID CLAIMS. INSR= ADDL SUBR POLICY EFF :POLICY'EXP VTR lY_:PEOFINSURANCE - POLICY-NUMBER MMfDDl1'YYY MM/DDNYYY1. LIMITS A _.. X .coMCLAiMs-MaDEERaLLIQCCu MWZY3143189� 1D/0'1%2019 10/01/2020 EAcrloecuRRENc€ $ 20D'0;000' DAMA E REN 1,000;000; PREMISES Ea•occunence I$ X SIR$500 000 MED EXP(Any pnp,person..). X PrcifaglonabLlabIncluded PERSOLFALaADV;INJURY $ 2,000,000: GEN_'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 10THER: POLICY❑JEC LOC 4,000,000 PRODUCTS COMP/pP AGG E$ A AUTOMOBILE UABILITY MWTB 31431:919 9,0/01%2019 1f0/Ol/2020 COMBINED SINGLE"LIMIT Ea;accident $ 1,00000,0 X ANY AUTO 80PILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) S HIRED NON OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLA LIAB OCCUR EACH gCCURRENCE S EXCESS L•IAB CLAIMS-MADE: AGGREGATE DED RETENTION$ O S ., A wORkERS GoMPENSATION :MWC 31431'71:9 /"T ' 1'0/0172020 X RER OTH- AND EMPLOYERVLIABILITY STATUTE . ER b00;000 AN1 PC01 PIEI OF7PARTNLF';IEXFCUTIVE �)Y/;N` I�/A - - C L EAOH ACCIpLIJT 5 OFFICEt3R4EP46ERFXCLUDED? --- (Mandatory In-NH) E L DISEASE EA EMPLOYEE.$ 2,000,000' If yes,descnba under 2,000 000 DESCRIPTION OF OPERATIONS below E.L.DISEASE POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS I-VEHICLES(ACORD 1:01:,Additional-Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANC,EL.L.ATLON ADT LLC dba ADT Security: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 245 Winter Street,Second Floor THE, EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Waltham,MA 02451 ACCORDANCE WITH THE POLICY PROVISIONS. r AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjee O 1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Fold,Then Detach Along All Perforations wog :: .. MA ELECTRICIANS B S -S dlCS<1�6 E FOLLOl9�ING CI�Ef�SE :- '» f REC.dS IRED SVSEN:COLh1fRACTOR' cc a .I.PPAS J LEE ADS LLC_DB-A ADT.SECURITV 31 CAPJtV-A.PD WALPOLE,MA 0208i:-';2O4E?'` 172 C;'"> >`';: <>i'6%131/2022 ::<_:.:. ;:>>> 640581 I - v I Commonwealth of Massachusetts Division of Professional Licensure Sec u ri"`j/sfe�'k-,>S-Lice n s e ,i SS-001779 '', zpires: 05/16/2020 li 5. THO.MAS J LSE^+;'' Employed by: . ADT SECURITY Commissioner � -�, � �w� �� Shea, Sally From: Shea, Sally Sent: Tuesday,January 21, 2020 4:22 PM To: 'Bradshaw, Kevin M' Subject: RE: Goode job 101816930- Mike Goode Attachments: Pro perty-Owner-authorizes-contractor--.pdf Hi Kevin, This is not what I am looking for. The owner is not the applicant on this permit. ADT is so we need the property owner granting permission to ADT to perform the work. Please have the owner complete this form and send to us. Thank you. Sally Shea Town of Barnstable Assistant Zoning Admin/ Lead Permit Tech. 508-862-4031 From: Bradshaw, Kevin M [ma i Ito:kbradshaw('Oadt.coml Sent: Tuesday, January 21, 2020 2:48 PM. To: Shea, Sally Cc: Murray, William Subject: FW: Goode-job 101816930- Mike Goode Hi Sally, Please see signed form Thank You, Kevin M. Bradshaw Permit Coordinator 245 Winter Street 2nd Floor Waltham, MA 02451 (o) 781.497-2773 From: Bradshaw, Kevin M Sent:Tuesday,January 21, 2020 2:39 PM To: Murray, William.<wmmurray@adt.com> Subject: FW: Goode-job 101816930- Mike Goode Kevin M. Bradshaw Permit Coordinator 245 Winter Street 2nd Floor Waltham, MA 02451 (o) 781-497-2773 From: wyman49@verizon.net<wyman49@verizon.net> Sent: Saturday,January 18, 2020 8:28 AM To: Bradshaw, Kevin M <I<bradshaw@adt.com> 1 . Town of Barnstable F Building Department Services • '" r Brian Florence,CBO Bwlding Commissioner 200 Main Street,Hyannis;MA 02601 www.town.barnstable.ma.ns Office: 508-8624038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I^ �-� f` ,as Owner of the subject property hereby authorize Vl C 4, 7 to act on my Ln. p-is all matters relative to work authorized by this building permit application for. ) -*� a w (Address of Job) f © **Pool fences and alarms are the responsibility of the applicant Poo are not to be filled or utilized before fence is installed and all inspections are performed and accepted. Signature of Owner Signa of App ' &CC Wcz Print Name - Print e Da Q:FORhO.OWNERPEILMSIONPOOLS Rev:08tI&17 Town of Barnstable Building Department Services E Brian Florence,CBO Building Commissioner = 200 Main Street, Hyannis,MA 02601 KM www.town.barnstable.ma.us Office 508-862-4038 Fax: 508-790-6230 HOMEOWNERUCEM N' Please Print DATE: JOB LOCATION. number strat village "HOrQI�.OwNSR": us= home pbow# work phom# CURRENT MAILdN(3 DRESS: chyAum• sta0e zip-code The current exemptio for"homeowners"was extended to in gwner-occupied dweg�of six units or less and to allow homeowners to engag an individual for hire who does not ssess a license,pr1ded that the owner acts as supervisor. FD ON OFHONMOWNER Person(s)who owns a 1 of land on which he/shor intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached detwhed structu evsto such use and/or farm structures. A person who cant acts more than one home in a two-year period notbeconsidered awner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building cial,that elshe shallble for all ork ed under the bm1 ' (Section 109.1.1) The undersigned"homeowner" s rev ility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner" es he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and brat el a will comply with said procedures and requirements. Signahuo of Homeowner Appmval of Building OHicud Notc: Three-family d ellings 5,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction C L MBAWNWS EXEMPTION The Code states t: "Any homeowner pe rming work for which a building permit is required shall be exempt from the provisions of section(Section 109.1.1-Li ink of construction Supervisors);provided that if the homeowner engages a person(s)f hire to do such work,that such eowner shall act as supervisor." Many homeowners who use this exemption are unaw that they are timing the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Constractio upervisors Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires 'ce persons. In thisr case,our Board cannot proceed against the unlicensed person as it would with a licensed Supe a homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is folly aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that helshe understands the responsibilities of a Supervisor. On the last page this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Q:\WPFR EMRMSIbuil ft permit bonnsWIPRESS.doc 09/16/17 Fife Safety Installation - Narrative Report RESIDENCE ADDRESS:35 Cap'n Crosby Rd Centerville,MA 02632 INSTALLATION COMPANY:ADT Security 245 Winter Street Waltham NM Contact: James Leonard—Manager(339) 223-5162 BUILDING DESCRIPTION A single-family structure with_2—levels of living space, excluding the basement: There are a total of 2 bedrooms which are located on the following floors;_0—bedrooms on the first floor and 2 bedrooms on the second floor FIRE PROTECTION SYSTEMS TO BE INSTALLED ADT,with the approval of the building owner, intends on becoming the monitoring company of. record. The Life Safety System will be wired/wireless and the devices to be installed will included: (10) wired combination Smoke/Carbon Monoxide Detectors* (6) wired Smoke Detectors* (3) wired Carbon Monoxide Detectors* and(4) wired 135 Heat Detectors*. The wired/wireless devices have a photoelectric design that will enunciate smoke and all devices are interconnected with built-in sirens/speakers. The panel(Command / Safewatch*)includes a 2- way 12813it encrypted design. *The product specifications sheets for the Life-Safety Devices are included with this narrative submission SEQUENCE OF OPERATION The fire alarm control panel will signal two types of alarms. Supervisory alarms will be silent (tone at the panel). Another signal will be sent via wireless signal (Cell Guard)to the ADT Customer Monitoring Center. ADT will, upon receipt of a supervisory signal, notify the call list on file and dispatch the appropriate safety personal. Fire alarms, if activated either manually or automatically will sound audible devices (the system when triggered will notify all floors) along with sending a signal to ADT's Monitoring Center. ADT upon receiving the fire signal, immediately contact the customer then per NFPA 72 (2013) after receiving confirmation of the alarm or getting no response from the premises, ADT will then contact the rr COMM Fire Dept. DEVICE TESTING CRITERIA ADT will perform a complete system pre-test prior to scheduling and arranging the final test Ali an inspector from the COMM Fire Department. ADT will have technicians and all necessary equipment available. Upon successful completion of the acceptance test,ADT will furnish the inspector with•all-documentation that has not already been supplied. s Patti•'.�44fiwf+ 4 .p •l�1.y Rnra;.. Rpr�lnq l,�r• alb OE6 itt eIN d,no Porlit¢ l''0!C[i -. tuyor I 1. tsi iloot° Prom �j "Oedroo• ileoroo. { D EAVES EAVES { $nd floor La , 9S itbry> t i 600 effn Set Boston M4 02111 ` orkere CompmsationInmuunceAffidavit Eh lldars CC mtracturs/lElectmiciann ium bens Applicant hnfonnaidon Please PrinnL ll, ila_l Name(BusiriessK)xgwLizaiiaaffiadividual): A .Address: City/state/zip: Awnrl Phone#: aO; e0l7-.2 7 Are you-am employer?Check the Vprapriaibobox: Type ofprject(required): 1.�I am a employer with 4• ❑I am a general contrac toy and I6. e eo nstruction employees(full andiorput-time)* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub-contractors have 8. Demolition ,Arorking formeinanycapacitT e mployee s and have worke rs' comp.insurance.l 9. []Building addition [No workers'comp.insurance p• . required] 5. We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am home owner doing all work officers have exercised their 11.❑Plumbing repairsor additions myself. [No vmrkers'comp. right of exemption per NOL 12.❑Roof repairs insurance re quire d.] fi c.152,§1(4),and we have no employees. [No workers' 13. Other comp.insurance requited] 'Auygplic: 1haducksbox#1 mist akof3uoutthe sectimlbelaw�hawhgtlhs«u¢3sers'coar�nsatie¢tpolicy�f o�+;n*+ t Ho�ownerswi�o svbrnittliis affidasrnindicadntgtYvryrsse doingallwmlt andtY�nh�mgside eordraet�oasmeuts�.mvt ar�rwaffl3zviiitti,dic:du7g such tCormactcox+sthatchecktk&boxm3staPtando.addE=Islyetslwwingthenamof tie svb-ceraic=mdstyvri�t4ver xrottlwseer�t>t sltisue emphyees. ffthe sub•caunctarsh2n empl yees,thaym-wLpxnvide flues waaisers'ca=p.policyranzber. .. . ..... I am are employer that is providing workers cornpMa tion insurance far my employees. �eIow is the policy artd jab site . informa Lion. Insurance CompanyName:_ Policy##orSelfins.Lie.#: -2,Z 40 Expiration Date:/a Zz Job Site Address: 35 GgfTwGJ C-Mf Cityt5tatelZip: cat.►�t'n. 9��� A 11-h,a.c:o y Qiii ilj�,e.'hlmrlfjaril CiQS 3��;Ak L l TcU� Poll v deb la!l alti4➢Lqage 4{shm'bi li'�le polky Tw �h e and O sr]Lt�';itl`Lon fiii,1e . Failure to secure coverage as required under Section 25A of IuIGL c. 152 can lead to the impo t.tion of crirrdnal penalties of a fine up to$1,500.00 anchor 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 c opyof this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do ker certjy un �e airs enalkes of perjury that the information provided above is true and eorreet S, Mature: Date: - ®/ Al Phone##: f�e 7 ` -2 7 7 P t isaad use on ,. Do_..... f _ , __.._. .._......._._........_.____..._.._,._.._..._....�._._.._.—_—.---._.�._-.,...._.u_____.__-__..._._..: not write in this area to be com p1��,d by c or town offiz al City or Tower )��aaii�trJLiice�e# I Issuing Authority(circleo e)- 1.Board of Health 2.Buffiiing Dep artment 3e GiiylTewiru Clah 44.]Ekc tdcal limp edDr 5.Phmnfiiiug Ins?ector tno Gaer Contart Person- Pho ne#a DATE(MMIDD/YYYY) 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 tfie certificate holder is an ADDITIONAL INSURED:;the pol ey,(es:)must have ADDITIONAL INSURED proiiss ons or 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(ob PRODUCER CONTACT Marsh USA Inc. NnME: PHONE FAX 1660 Sawgrass Corporate Pkwy,Suite 300 A/C.No: Sunrise FL 33323 E-MAIL Attn:FtLauderdale.Certs@marsh:com ADDRESS: INSURER S kFFQRDING COVERAGE NAIL CN109418288 ADT-GAW-19-20 IN uRERA:Qld Re-ublic-Insurance Co ;24:147 INSURED ADT LLC INSURER B:. ADT Security Services ;INSURER_C: 245 Winter Street,Suite200 (NsuI;ER"D: Waltham,MA 02451 INSURER E: ANSURERF;. COVERAGES CERTIFICATE N,UMBER;, ATL 004803800 09. REVISION NUMBER:3 THIS IS TO CERTIFY THAT THE POt�CIES OF INSURANCE LISTED BEL-OV11 HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTfMTHSTANDING ANY REQUIREMENT,TERM-'OR CONDITION OF ANY CONTRACT 0'R OTHIER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE.MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDEp BY THE:POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLU5I.ONS AND CONDITIONS O:F.5UCH PQ:L-ICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INS ft= - ADpL SUER POLICY EFF ' 'P..OLICYiEXP ' iUTR TYPEOFINSURANCE. POLICYNUAIBER MM/DDIYYYY...MMIDD ' LRAITS __.. A X .COMMEItCIALCENER$LLIABILITY MWZY31OIMO 1D/0`1%2019 1010,Q020 EACHQCCURRENCE $ 2060;000' DAMAGE ENTE CLAIMS=MADE F OCCUR PREMISES Ea occu Fence ;S 1000000; X SIR$500,000 MED EXP Rrly.oneperson). S 10;bQ0 i X PtofesSional,Liab lhdyded PERSONA.AA VINJURY $ 2090,000' GEN'L AGGREGATE LIMIT APPLIES PER: GENERALA.QI3 ATE $ 4000;000 JCT PRODUTSCOMF1pP AGGPOLICY❑E . 4,000,000IOTHER: $ MWTB314019`19 1010'172019 10/01/2020 $ t;000;00:0 A AUTCIMOBILE'LIABILITY COMBINED SINGLE'LIMIT Ea;accidebt X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON OWNEp 'PROPERTY'DAMAGE S AUTOS ONLY AUTOS ONLY Per aca nt' $ UMBRELLALIAB OCCUR EACH OCCURRENCE, S ' EXCESS L-IA,B CLAIMS-MADE AGGREGATE $ BED RETENTION$ $ A WORKERS COMPENSATION :MWC 31431719 17'1 ; 10101/2020 - X PER OTH- AND EMPLOYERS'LIABILITY STATUTE . ER Yt:N 000;000 ANtP&OPP!E(OR7PARTt4EP/E`/,ECUI!VE CL �ACIIACCID[N"( S OFFICE RIME MBEREXCLUDED% It NIA - (Manditory in•NH) E t DISEASE EA EMPLOYEE.$ 2,000;000, If yyes,describe under 2,000000 DESCRIPTION,OF.OPERATIONS below E L.DISEASE POLICY LIMIT E DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attach"od-If more space is tequired) CERTIFICATE HOLDER CANCELLATION ADT LLC dba ADT Security SHOULD ANY OF THE ABOVE DESCRIBEp POLICIES BE CANCELLED BEFORE 245 Winter Street,Second Floor THE EXPIRATION DATE THEREOF, .NOTICE WILL BE DELIVERED IN Waltham,MA 02451 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjee wtin�1e e ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD Fold,Then Detach Along All Perforations LTc100 F c���s ���c'SETT T .. Dltvs o a ,;IOl �O� L .; SSu9ES.THE-FOLLOWNG[BCnSE - EC.a a F RED SVS EfUd CO,I TRACTOR' HOMAS J LEE DTLLC-DBA-AD SECUR9TV 31 CAP�11fA.'F:D WALPOLE, MA 0203'P�w'» 172 C f<;:>. <".'0713�1202ti :;:<:>:;<:`` 640581 Commonwealth of Massachusetts Division of Professional Licensure Secur ,, toms&jS:-License SS-001779 '�zpires: 05/16/2020 i -.. THQt4AS J LEE i, e Employed by: . it ADT SECURITY Commissioner t Etterr TOWn Of]Barnstable *Permit?yt/-, 1 Expires 6 months f m i ue e °� Regulatory Services Fee BARNSPABLE, Thomas F. Geiler,Director MASS, / Building-]Division ak 12211.2 Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barristable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY r 1 TNot Valid without Red X-Press Imprint Map/parcel Number 1 V Property Address J� L/-. E !n _ry '1 �2v�, �.. 00.N Residential Value of Work Cll> C� Minimum fee-of$25.00 for work under$6000.00 Owner's Name&Address. �l :, -�� cacf::,oy- c2A Cam,2g Q I L .N ev c,av 3 D- Contractor's Name ►1� t--f Telephone Number Home Improvement.Contractor License#(if applicable) V t I �� ❑Workman's Compensation Insurance Check one: -PRESS PERMIT [A<am a sole proprietor_ ❑ I.am the Homeowner DEC I 20C18 ai have Worker's Compensation Insurance Insurance Company Name 56C,fVM_6 �z :s -0�,s TOW N OF BARN.STABLE Workman's Comp. Policy# ��,� �-P)o UUN Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof-(stripping old shingles) All construction debris will be taken to' ❑ Re-roof(not stripping. Going over ex istJayers of roof) n Re Replacement Windo s/doors/sli ers. U-Value (maximum.44). *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner.Letter of Permission: t , i A copy of the.Home Improvement Contractors License is required. ?, '.._'� SIGNATURE: L � Q:\WPFiLESTO ')S\building permit forms\EXPRESS.doc Revise020108 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name(Business/Organization/Individual): Address: �1 `E'� tlfr �o2r2 City/State/Zip: O_Cxi o�k Phone.#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction , .2.[ am a sole proprietor or partner.' listed on the attached sheet. 7. .©.kemodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers 9. ❑Building addition [No workers'comp.insurance comp.insurance.$ required.] 5. ❑ We are a corporation-and its 10.❑Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions 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.❑OtherR �F comp.insurance required.] •Any applicant.that checks box#1 must also fill out the section below showing their workers'compensation policy information. .;Any who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. xContractors 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-contactors 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: K!:—�,S6C( Nrc3 &Mclo Policy#or Self-ins.Lic.M (gQ0 Q)C Expiration Date: CA Job Site Address: 39 OAD I KJ L°kc6q /. 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 tip 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 her%ycertify under the pains and penalties ofperjury that the information provided above is true and correctSi attir Date: 3 da Phone Official use only. Do not write in this area,to be completed by city or town offcciaL .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 Insttuctions t Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more --ofthe gomg-engage T m -forem-ajot-enterprise at3d-=mc.Iu-duig-=tl e-1"egarrepresenmfve�-cf--deceased=em I-ayer,_ar_-the receiver or trustee of an individual,partnership, association or other legal entity,employing employees. However the owner of a dwelling house having not.more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or 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 required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall . enter into any contract for.the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractor(s)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 members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be 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' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete'and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple 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. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related io any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to.thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone-and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 11-22-06 www rnass.gov/dia 'l 4 c� tra�ti Town of Barnstable Regulatory Services RARNSURM .P MAas. $, Thomas F.Geiler,Director 1639- ♦Q' - '�EnMp.ta Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must , Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize �04t'j. Q • �ly N+� to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of job) Signature of Owner nate ��ls�e L `✓ �o� . Pnnt.Na ne If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. r Q:F0KMS:0 WNERPERMISSION Town of Barnstable Regulatory Services awxxsznsre Thomas F.Geiler,Director MAss. Et A,�� Building Division Tom Perry,Building Commissioner www.town.barnstabIe.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 faun 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 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 an 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 +tom, f �� -�� ��� a�✓G��� ! Board of Building$egulations and Standards > HOME IMPROVEMENT CONTRACTOR — Regist,`4011.'N 101149 f Expiration 6/25/2010 Tr# 267680 t 1 �p Hype IndiFvidual '. JOHN P. DUNN x !' John Dunn 80 MARiE'ANN TERR x CENTERVILLE, MA 02632` Adi'hinistrator mg gu atiorfs and dart d a M Constrdction Suporvisor'-,License License: CS 14007 . \' by Expiration f 5/25/2010 Tr# 23257 i"IRS rICtlOn 00 JOHNP DUNN 'ify `'F BOX 924/80 MARIE,ANN CENTERV1LLf,MA 02632.'i�� • Commissigoer License or registration valid for individul!-use-only before the expiration date. If found return to: ;Board of Building Regulations and Standards i One Ashburton P1Ace Rm 1301 i Boston,Ma.02108 1 j Not valid.without signature t ' 00-35,000 cf enclosed space IA Masonry only 1G 1 2'Famil y Homes Failure to posstess a Current edition of the. ltilassachusetts State Building Code is cause for-revocation of this license. � . i Ij ID . Assessor's map and lot number .......... ...®.. SEPTIC SYSTEM MUST BE >re / �f'; R►F� 1�1 COMPLIANCE Sewage Permit number ......... .1... ..:............................. i f ,n �IwE STATE iENCE �A7E rRy CO3De un ALEN Z 33ARNSTAZLL i ►'F pb 9. BUILDING INSPECT 9U Mot p" APPLICATION FOR PERMIT TO ........................................................................................ ........... TYPE OF CONSTRUCTION �' �°� . ......... 7.or—,.oe ............. ................................................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the followin information- .............. Q Location .............lr..P.2�.............:... ......:........... .............. .......:: ..........a... ...:... ....................... .. . t Proposed Use ......4. ............................................................. ...................................a :.....:....:......................... ..... ..... Zoning District ........Fire District 16AN.- OX-4 ................................................................ .✓.............. ....... ...... . .................................... P P ` t . Name of Owner C. � "" ........................Address .. 4 /" ° s Nameof Builder ....................................................................Address .................................................. ............................... Nameof Architect ........../.......................................................Address .................................................................................... Numberof Rooms ............`P.....................................................Foundation ....... ....................... Exterior ..:... -, .... :.. .. °`.4...................Roofing .................. .................................:.............................. r6 L�6 Interior ..........fig Heating .........dn ........................................Plumbing ....... ...1. °:....... ........................................... Fireplace .........../.....................:...........................................Approximate Cost ............. '. Definitive Plan Approved by Planning Board ________________________________19________. .Area ....................... .....�... Diagram of Lot and Building with Dimensions Fee ............. ...................... SUBJECT TO APPROVAL OF BOARD OF HEALTH 1 ra hereby agree to conform to I e Rules and Regulations of the Town f Barnstable reg ding the above construction. l l,a Nam .. .. .. .................................... Stanley, C. F. ` ` 76789 I I-/2 storyNo --^- Parmh for ' -^--^-------'' single -' - ' - C�oolnr'I�xad Loco�5n`�--���.........-....°'....,--------. Centerville -'-------''-^---------------- C. F. Stanley Ovvner ............................... frame � Type of Construction -------------- ' � ---,...-.---.----------------., ^ " - �n pk� z� �� "� ~ .. -------.. ----------' � Permit Granted ........December..12.__.lg 73 Date of Inspection .. � ~ ` � /y� �Y � Dote Completed ���������g y-./:+-+. . � / � � PERMIT REFUSED ' l9 ^ ' -----~---------------. '~ x��_ , _~~^ ' �m -- .--~-..�«..�..�,/�--.�~.-..---------.. . � ^ ` ---^---'~~~----^'`-^------'--- l . ) � - .^..---.-----.~.-.----..-..----. + � \ ^----------~------'-'-----'-^ � Approved ................................................ lV � '--------------------_----_. � -------------------...---~... ^ ' �