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'' _.— '•"�'-, ��Ste_ IL- I -- I TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Ma f�� l -7w Parcel A lication #� p pp Health Division Date Issued 10 Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board 0 /012-413 Historic - OKH _ Preservation / Hyannis Project Street Address / d' L/ s Woad Village �— Owner&,,b f `J�'C 4m elc Address qV 6&17A01 1d/111 h I/G//7/J/� Telephone SOy - 3 (0 Permit Request.�J_U/6u J/ &9 Yh&U 7AC'1Y 0/4' &ZOellL , ih, kll 76,6el o/afJ, _bloael r /A-) JI/k Square feet: 1 st floor: existingA02—proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation , Construction Type �(,r�rl� , Lot Size a 3 Y GC Le-S Grandfathered: ❑Yes ❑ No If yes, attach supporting documatation. Dwelling Type: Single Family Lam' TWO Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑-Ido On Old King" ,,ighway:�I Yes❑-No Basement Type: &1�ull ❑ Crawl ❑Walkout ❑ Other ? Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) 7Z. Number of Baths: Full: existing_ new Half: existing nev Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: 0 Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes Flo Fireplaces: Existing f New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning,Board of Appeals Authorization Autthhorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑HVo If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name A / ;`l ato f�l�/���'� Telephone Number 3 Of- 779 0/ Address / G A 192/'4 r.ch License #_ L a, o5� /,-t) &6!YAM 0 Home Improvement Contractor# Worker's Compensation �3 01..Z0 0 7 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN To 7&,eW/z� P_cA_ Z)r .2 -7`j SIGNATURE DATE /0�9�/3 —� i FOR OFFICIAL USE ONLY APPLICATION# ` DATE ISSUED MAP/PARCEL NO. t ADDRESS VILLAGE I. r OWNER DATE OF INSPECTION: L rFOUNDATI.OI\It ,;;ire-`<4 ` FRAME — y. --INSULATION, ;�. a�_:�F FIREPLACE ELECTRICAL: ROUGH FINAL a I , PLUMBING: ROUGH FINAL '4 GAS: ROUGH FINAL — z FINAL BUILDING ' DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investiqations 1 Congress Street, Suite 100 Boston,MA 02114-2017 s�m ' www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Prmt Legibly Name (Business/organization/Individual): Tupper Construction Co. Inc. Address: 79B Mid Tech Drive City/State/Zip:West Yarmouth, MA 02673 Phone #:(508)778-0111 Are you an employer? Check the appropriate box: [2. .Q I am a employer with 4. [ 1 I am a general contractor and I Type of project(required): employees (full and/or part-time).* have hired the sub-contractors 6 ❑New construction ❑ I am a sole proprietor or partner- listed on the attached sheet. 7. (J Remodeling ship and have no employees These sub-contractors have working for me in any capacity. employees and have workers' g' Demolition [No workers' comp.insurance comp. insurance.t 9. ❑ Building addition 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 insurance required.] t c. 152, §1(4),and we have no 12 Roof repairs employees. [No workers' 13.[] Other comp.insurance required.] "Any applicant that checks box#]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: AEIC Policy#or Self-ins. Lic. #: WCC 5005593012007 10/3/14 Expiration Date: Job Site Address: City/State/Zip: 12 h ����-�� 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 certify under the pains and penalties of perjury that the information provided above is true and correct. Si ature: Date: Phone#: — O D 7[0ffkia1'Tu0se only. Do not write in this area,to be completed by city or town official. n: Permit/License# Issuing uthority(circle one): 1.Board of Health 2.Building Department 3.City/T own Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person:- Phone#- A CORQM CERTIFICATE OF LIABILITY INSURANCE =DATEWDDA-YYY)/2013 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 NAMEC Lora Lowe Southeastern Insurance Agency, Inc. PHONE 439 State Rd. Arc No Ext: (508)997-6061 1 FAX No,{508)990-2731 E MAIL P.O. Box 79398 ADDRESS: PRODUCER N. Dartmouth, MA 02747 CUSTOMER to#: INSURED INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: Arbella Protection Insurance Tupper Construction Co LLC � INsuRERB: AEIC 27 Roberta Drive INSURERC: CNA Surety West Yarmouth, MA 02673 INSURERD: INSURER E: COVERAGES INSURER F CERTIFICATE NUMBER: 2013/14 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO T I INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM CONDITION HE NSURED NAMED ABOVE FOR THE POLICY PERIOD CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MA CE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, INSR Y HAVE BEEN REDUCED BY PAID CLAIMS. ADDL SUB LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MOMIDD GENERAL LIABILITY EFF MOM/LIDD EXP LIMITS 8500008743 11/01/2012 11101/2013 EACH OCCURRENCE g X COMMERCIAL GENERAL LIABILITY ED 1,000,00( CLAIMS-MADE FRI OCCUR PREMISES We occurrence) S 100,00( A MED EXP(Any one person) $ 5,00( PERSONAL R ADV INJURY S 1,QOQ,OO GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00( r ECT LOC PRODUCTS-COMP/OP AGG $ 2,OOO,OO ILITY $ 5666240000 12/O1/2012 12/01/2013 COMBINED SINGLE LIMIT(Ea accident) $ 1,000,00UTOS BODILY INJURY(Per person) $ AAUTOS BODILY INJURY(Per accident) $ X HIREDAUTOS PROPERTY DAMAGE - X NON-OWNED AUTOS (Per accident) $ INC S UMBRELLA LIAB X�OCCUR $ 460005836 03/01/2013 11/01/2013 EACH OCCURRENCE $ 1,000,00 A EXCESS LIAB IMS•MADE DEDUCTIBLE AGGREGATE $ 1,000,00 RETENTION $ S vwvAND EMRS COMPENSArI IT WCCSOOSS9301200 10/03/2013 10/03/2014 X $ AND EMPLOYERS'LIABILITY YIN WC STATU- OTH- ANY PROPRIETOR/PARTNER/EXECUTIVE RICHARD TUPPER I TORY LIMITS X ER B OFFICER/MEMBEREXCLUDED? N!A E.L.EACH ACCIDENT S 1,000,00 I(Mandatory in NH) INCLUDED FOR WC COVERAGE If yes,describe under E-L.DISEASE-EA EMPLOYEE $ 1,000,00(q,RIPTIONSC OF OPERATIONS below or theft o money & Or E.LDISEASE-POLICY LIMIT S 1,000 00erty. 7106881 02/28/2012 02/28/2013 Limit of $10,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule B more space is required) 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. "For Information Purposes Only" Tupper Construction Co LLC AUTHORIZEDREPRESENTATIVE 27 Roberta Drive W Yarmouth, MA 02673 Lora Lowe ACORD 25 2009/09 ©1988-2009 ACORD CORPORATION. All rights reserved. ( , ) The ACORD name and logo are registered marks of ACORD r r i3DliPeidilV�s fa�l�Ef"S2Hi�Di iiDr D�D,y`"it`f i t�i�, FD�`�:' . t ' massatahuS tts -Department of Publ ic Safety 197 F16mtes%w.suits 110 Board of i3uiiding Reaitlatians and.StpdArds M81W NY 12M (M274-127 �!�n t'rurti„n Sulrcra.ia,rr �ww.ti.c�rr License CS-069058 RICHARD'S TUPPER 79 B MID-TECH DR WEST VARMOUTH MA 02473 s BPI t?40 Expjration ` ts€t RMRSE slut FOR etst6MIM AND EMPATiptt 4 12/31/2014 r ®®„�., °` Uff�e of Consumer Rffaizs 8c�uviness Regulation People Hetpmg People Build a 5afer`Wor1d'h' HOME IMPROVEMENT CONTRACTOR` tti RNARiiA! Registration: 9 845 Type: C011€C4IENCIP, y �, �'Expiration: 0/2 14 fntt,vcdual MEAiIBER - _ k x iIiCNARO TUPPER: Richard Tupper 3 Tu er,Construcfton RICK AR TUPPE . pp. 29 Roberta drive Building Safety Profess,onal z W-YARMOUTH.AAA 02613, i:riciersecretary' Member# 8158119 ,Exp,4130120141 s F, OWNER AUTHORIZATION FORM (Owner's Name) owner of the roperty located at (Property A dress) L M 0 (Property Address hereby authorize. I01 ne C=1 4! 2(Subcontra r) an authorize subcontractor for RISE Engineering,to act on my behalf to obtain a.building permit and to perform work on my property. Owner's Signature q Date i • 09/11/2013 WED 10: 12. [TX/RX 110 93031 0003 Town of Barnstable *Permit# ,2 Expires Lmonthsfirom iss a date �A regulatory Services Fee PRESS PERMI �I'�homas F.Geiler,Director f I,�Building Division ? 1?J JUL 17 zo Tom Perry,CBO, Building Commissioner r; 9AFOWAMEO Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint L Map/parcel Number M f A: , Property Address i� C-F � L 1 Cam vKC3�_ Plic� . m Vesidential Value of Work _7000 Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address " �/�,FQ [G� �•� Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ ;4m a sole proprietor p1 am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) U Ke-roof(stripping old shingles) All construction debris will be taken to 6z0 ❑Re-roof(not stripping. Going over existing layers of roof) '_'TdqK1CX,lam/rho, ❑ Re-side (Replacement Windows/doors/sliders. U-Value 3 (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. A copy f the Home I�Zeet Contractors License is required. SIGNATURE: Q:Forms:expmtrg Revise061306 r �\ t ne i.ommunweacrn uJ tvluaaucnu�eu� Department of Industrial Accidents Office of Investigations 600 Washington Street ` Boston, M4 02111 M ° ' www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): c Address: City/State/Zip: Ct ivy LCE VlH Phone #: 5� '�� 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 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet $ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp.insurance. g• ❑ Building addition [No workers' comp. insurance 5• ❑ We are a corporation and its officers have exercised their 10.❑ Electrical repairs or additions required.] I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs o� additions myself.[No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' 13.[1 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 ;Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy information. 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. #: Expiration Date: 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 certify and the pal an enalties of perjury that the information provided above is true and correct. Si ature: Date: -ZdCo Phone#: Official use only. Do not write in this area,to be completed by city or town official. 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 j Contact Person: Phone#:. Information. and Instructions 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 of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or 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 permit/license 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 to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to thank you in advance for your cooperation 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 # 61 7-727-7749 Revised 5-26-05 wrw-w.m2ss.gov/aia h-s 6P4 TLJ P F E ut� ol+ �� CONSTRUCTION1 CO.e r 796 MID-TECH DRIVE,WEST YARMOUTH,MA 02673 07 PHONE: 508-778-0111 FAX: 508-778-5010 a r. VVVM.TUPPERCO.COM OIV _11Z10 Date: j Town of Barnstable Thomas Perry CBO 200 Main Street Hyannis, Ma 02601 (508) 790-6230 fax Re: Insulation Permits Dear Mr. Perry This affidavit is to certify that all work completed for permit application Issued on i .24 /3 has been inspected by a certified Building Performance Institute (BPI) inspector. All work performed meets or exceeds (Federal and State requirements. r ` Si ely, �� C is ar Tupper License 9 CS-69058 �rNl ' f s• • . '# ' " 1 � x 4 - 4r .�•� ► . 4F �a 7 -A ,` r J A ■ The ;Town of Barnstableg4/�60 Department of Health, Safety and Environmental Services I Building Division 367 Main Strew,Hyannis MA 02601 Office: 508 790-6227 Ralph MCrossen Fax: 508 790-6230 Building Commissioner Home Occupation Regis=fion Dam '�_ Name: e-i-r,e 1 Phone!#: Address' `� C 6� LI ���hf c n Verge: �e�L U k l`e Type of Business: MaPA= k c�I afrE lT. R is the intent of this section to allow the residents of the Town of Banstable to'operate a home oc upation within single funtly dwellings,subject to the provisions of Section 4-IA of the Zoum aadmance,provided that the activity shalt not be discexable fiem ou tside the dwelling: there shall be no increasein noose or odor;no visual ahteration to the premises which would suggest anything otber than a residential use;no increase in traffic above normal residential vduntes;and no lactase in air sir gtoumdwarerpoSttdon. After registration with the Budding hMector,a cu taa>aty ham ooc=don sball be permitted as of right subject to the following oonditioax . • The activity is carried an by the permanent resiidmt of a single fatmly residential,dwelling unit,located within that dwa ft uuiL • Such use occupies no more than 400 sgme feet of space. • There are no exit iaal alterations to the dwdftwbkh are not cmtontasy is residential buildings,and these is no outside evidence of such:use. • No traffic will be generated in excess of normal r es de dd voht==- • The use does not involve the production of offemive noose,vibration.smoke dust of other partictilar mattes,odors,electrical disttabance,hm glare,humidity or other objectionable effects. • There is no storage or we of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quuttities. • Any need for puking gmerated by such use shalt be met an the same lot aontainin the Customary Home Occupation,and not within the requaed fr=yard. • These is no extmiar storage or display of materials or egmpmc= • There is no mntmerciat vehicles related to the Custonary Hama Oaarpaticm other than one van or one pi&rp auc3c not to exceed sine ton capacz%and ow Waller:rot to exceed 20 feet in length and not to exceed 4 tires,packed an the same lot oonrai®gthe CMomary Ron:0ocuupation. • No sign shalt be displayed indicumg the Cwtuour Hoo=Occupation. • If the Customary Hone Occupation is listed or advertised as a business,the street address shag not be e hichuded. • No person shall be employed in the Custo®ary Ha=Occupation who is not a permanent resident of the dwedinguair. 1,the undersigned.have read and agree with the above remtsi=for my home occupation I am registering:, APPffrmw oa -Date:,= Homcocdoc i TO ALL NEW BUSINESS OWNERS Fill In please: YOUR NAME: APPLICANT'S BUSINESS YOUR HOME ADDRESS: ckk^s O-p e ru' O z6 3 2- TELEPHONE Telephone Number (Home) �2 1 - Gvdo �;.. NAME OF NEW BUSINESS '�,ez� \��s e s TYPE OF BUSINESS es o IS THIS A HOME OCCUPATION? ADDRESS OF BU SINESS �lrb ���� ��` s Ce �t Pr MAP/PARCEL NUMBER 2 When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you.may need. Once you have obtained the required signatures, listed below, you may apply for a business certificate at the Town Clerks Office (Ist floor-Town Hall). 'g 1. GO TO BUILDING INSPECTOR'S OFFICE (4TH FLOOR TOWN HALL) This individual h s een informed of any permit requirements that pertain to this type of business. Authori ed Si nature COMMENTS: �- �'� S S `t 2. GO TO BOARD OF HEALTH (3RD FLOOR TOWN HALL) This Individual has been informed of the permit requirements that pertain to this type of business. Auth'&iz9d Signature COMMENTS: 3. GO TO CONSUMER AFFAIRS (LICENSING AUTHORITY) - (3RD FLOOR SCHOOL ADMI ISTRATION BUILDING) This individual has been informed of the licensing requirements that pertain to this type of business. j Authorized Signature COMMENTS: st ainin the required signatures you must return to the Town Clerk's Office to obtain Your in business certifi does not glve•you After obtg �_:. � .,.,...�► A 1,��cinPs� �Artof;►-atP nNl_Y REGISTERS Y(li iR i�^^�F in the town (which you most do b Y _ . Assessor's map and lot number 19 J SEPTiC SYSTE IN8TALLED I M MUS7` gE �D INIT COM 'Sew"egg.Permit number ............... H N PLI n .................................. �A�@ITiM ICLE 11 SrgT.ENC� COD �. ~{ INE TOWN OF , BARNPV T NU TOwl11 r� 0 ° "6 BUILDING INSPECTOR F APPLICATIONS FOR PERMIT TO ��(� ..................................................... F= ;i TYPE OF CONSTRUCTION ...... ... . ..................................................... ............................... . ...:..............7.....I TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according t the following information: Location ........ ...C .......C /... <�T .................................................................................... . .. ProposedUse .....--�.�.12���1-' ....................................................................:................................. ......................... Zoning District ........................Fire District ..... .erg Name of Owner .'..... �403-4--<jq'Address Nameof Builder .. ...... -r..................................Address ................ .......... ....................................................... Name of Architect ....... � .�............................Address ....... ... .............tom � loll, Number of Rooms .......... ..................Foundation ,,p Exieri .........., ............Roofing ........ .......... �........... Floors .;095 ,.-Ie....t.....................................................Interior ...... . . . .......... ....... Y.f ,........................ Heating a�y .................Plumbing ....... c ,��, .......... C,....................... Fireplace ........ ..................Approximate Cost ..... ,1�0� Definitive Plan Approved by Planning Board ________________________________19________. Area b.. ..c?,t....:Sf :...:...:...... Diagram of Lot and Building with Dimensions Fee ........4............................... SUBJECT TO APPROVAL OF BOARD OF HEALTH l e t t hereby agree to conform to all the Rules and Regulations of the Town of Bar table regardin a o construction. 6 . Name . .........z-�................. �-a. .......................... 'I rellegen-Ferrone i f No".48761... Permit for ......1. 1�2. story.'.... • sRP Le family dwelling j......G..��in.... .p.Q�..� 1 C ad i Location ............ ............. ..................................... ! f f Centerville ,. Owner •Tellejgen-Ferrone r frame � • . Type.of Construction ........................................ . ........... ................................................................. r !1 f+ Plot ....................... Lot ....... 28A .......... I October 26 76 { Permit Granted Date of Inspection ...� . � Date Complete .. . - "p �� . . .. �...............:19 P , � r PERMIT REFUSED �f i`....................................... 19 j•r - rli - /j r r• ............................................................................. / ........ ............ ............................................. e� f ........................................................................:...... ............................................................................... r t Approved ................................................ 19 x r • • ............................................................................... ............................................................................... Assessor's map and lot number ......... ..... .............. Se;vac*•,Permit number ................. .................................. T. i QOF?NET��♦ TOWN OF BARNSTABLE i 0 STODLE, • BUILDING INSPECTOR f r APPLICATION'-FOR TPERMIT TO ....• �' G......... ........................................................................................... �., TYPE OF CONSTRUCTION '`."...!�'� w TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to>the following information- -Location ,%,?'� r- ,•� . i,��r ' ...✓�....`..............................................: -Location ........:........ .........,.......,................�.............,.....�... ..................................... Proposed Use ....../'.;llr�'/ -�r ............................................................................................................. .......... ........................... Zoning District ...................Fire District ............................ ........... Nameof Owner ................ ............................................... Address .................................................................................... Name- of Builder ..................... .............................................Address ............................ ................................................... Name of Architect ........ .............Address ...... /��� ................�,.............:............. ,:.. .................................... Number of Rooms...................................................Foundation %'," "r,/ ........................................................ Exterior,....?.....,.-....,..................r,.................:..... ...Roofing .........:_........................... ......,. Floors .........................................Interior .... Heating � ........ 'yam Plumbing ! orr'r�.-a ,f1 � - .................................................... Fireplace ..................Approximate Cost ar ...... !��� ..............................'�.......... , Definitive Plan Approved by Planning Bod ________________________________19________. Area ..........,...,_,`................. .......... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding—the ab construction. \ Name ..... ...................................... ---- - -- --T-- Tellegen-Ferrone A=192=176 17 0 • No .......8.......... Permit for ....l..1/2..stork, .. ..... . ......... ...... single family dwelling . ................................................................................ Location ...................ja.h..Ro.a.d..................... .. .. .... . .. ......................C.e.nte.r.vi.l.l.e.le..... ............................... Owner en-Ferr ............ ............... one Type of Construction ........fram.e........................ .:... ... ._.........j ........ 1#!28A Plot. ......................... .. Lot. ..... ...... . Octobir 26 76 Permit Granted ....................-....................19 Date of Inspection .............. ....................19 Date Completed ................I......./)....19 PERMIT REFUSED ........................................................... 19 .0 . ... ........ 4. ............. . ............. ............................................................................... .................................................... .......................... 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