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0271 CAP'N LIJAH'S ROAD
ACTIVE J Application numb Fee :3.. ® ' Building Inspectors Initials.. W..... R AUG 2 2 2018 Date Issued........... :.......... . ...........123�1 ............... rOI&IN 011 HFik�(16 (ABLa Map/Parcel.............!.` .... ...........�............... TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: off.p p-J "i oj- Qcla� b t I NUMBER STREET VILLAGE Owner's Name: LiSA Do Wt Phone Number S a4 Email Address: Cell Phone Number Project cost$ ��, Check one Residential ✓: Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR Owner Signature: Dater TYPE OF WORK Siding E3 Windows (no header change)# Insulation/Weatherization Q Doors (no header change) # - Commercial Doors require an inspector's review Roof(not applying more than i layer of shingles) Construction Debris will be going to CONTRACTOR'S INFORMATION . Contractor's name AAA AYE /s+ Home Improvement Contractors Registration(if applicable) # _/ ,�� (attach copy) Construction Supervisor's License# f' '/� (attach copy) ff'' Email of Contractor w-tS4 r rol ! `Phone number 5y 16 ALL PROPERTIES THAT HAVE STRUCTUR S OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE PERMIT CAN BE ISSUED. APPLICATION NUMBER............................................................ *For Tents Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Purpose of Event Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent If food is being served at your event please obtain a Health Department approval between the hours of 8:00am -9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval. *WOOD/COAL/PELLET STOVE&* Manufacturer# Model/I.D'. Fuel Type Testing Lab Offsets from combustibles: front back left side right side } HOMEOWNER'S LICENSE EXEMPTION ' Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities tinder the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures, specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLICANT'S SIGNATURE Signature Date All permit applic Itions are subject to a building official's approval prior to issuance.4 I , DATE(MprDOl M) ACCO CERTIFICATE 4F LIABILITY INSURANCE 05r231201$FREPRESENTATWE CERT{FICATE 15 ISSUED AS A MATTER OF INFORMATION AMENDYEXTEND OR ALTERRTHE.COVERAGE AFFORDED BY THE POLE ES IFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY W: THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERS), AUTHORIZED OR PRODUCER,AND THE CERTIFICATE HOLDER, rOVISiO is or be endorsed. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the a policy, must have ADDITIONAL INSURED p N$UgROGATiON IS WAIVED,subject to the terms and conditions of the policy,certain policies may requite an endorsement. A statement on. Ea tificate does not confer fights to the certificate holder In lieu of such endorsement(s). PRODUCER NAME cT Donna Ostrowski FAX N :508 957-2781 lvia Insurance Agency,LLC PHONE 508 957-2125 Om Street E"ems_ •mark marks lviainsurance.COV lle,MA 02632 NAM c _ INSUR@R(SIAFFORDING COVERAGE iNSURER�A:Fa1Tn FariTS1y f''aSUaity inSUranCe µ^�� ��'),,.;� , HOMO improvements LLC INSURER c 177 INSURER D; ille,MA 02632 INSURER E: _. INSUREa F COVERAGES CERTIFICATE NUMBER; .. REVISION NUMBER: ES F, THIS IS TO CERTIFY THAT THE POLICIR£QUIREMERN7 TERM OR CONDf7ONVOFSURANCE AFFORDED ANY CONTRACTT OR OTHER DOCUMENT WITH RESPECT TO WHiCHTIH 5 INDICATED. NOTWITHSTANDING ANYBy THE CERTIFICATE MAY BE ISSUED O SUCH PEU lC N,THE IN SHOWN MAY HAVE BEEW EOUCEDICIES CLAIMS- EXCLUSIONS HEREIN IS SUBJECT TO ALL THE TERMS; EXCLUSIONS AND CONDITIONS POLLCY EFF i POLICY EXP UmTS XdfiR TYPE OF INSURANCE A L S POLICY NUMBER Mwo It 1,000,000 I1X1416 6/012018 5 112019 EACH OCCURRENCE i_$._.. A X COMMERCIALGENERALLIABILITY 200 L $ 10.1000 PR ISES a a ua� �.�$.} CLAINJS-MADE rxn'OCCUR MEpEXP An one son S 5.000 PERSONAL 8 ADV INJURY 8 i. 2,000,000 1 GENERAL AGGREGATE $ CEN'L AGGREGATE LIMIT APPLIES PER: � } PRODUCTS AG -COMPIOP G $ 2,000,000 X `POLICY i��jCT t __ LOC I $ ITTHER: � � COMBi. O i LEL g AUTOMOBILE LIABILITY BODILY INJURY{Per person) $ ANY AUTO t I BODILY INJURY(Per accident) $ i OWfNED SCHEDULED � tt-- PROPEAJvlAOE S HIITOSONLY ANC-M,NED j HIRED !1 ( $ AUTOS ONLY AUTOS ONLY # �. EACH OCCURRENCE $ UMBRELLA LIAR i OCCUR AGGREGATE i EXCESS UAa i CWMS•MADE S j t ED R TENTION 20011N8053 5/01/2018 5/01/2019 iER A WOR%ERSCOmPeNBATtoN E.L.EACH AC� C'MXT^ $_ i,000,OOQ AND EMPLOYERS'LIABILITY Y i N j ANYPROPRIETORIPARTNEP"ECUTNIE N A i E.L.DISEASE•EA EMPLOYE i 5 �1000,�0 , OFICERIMEMSEREXCLUI)ED? Y } 1,000,000 (Mandatory in NHf DISEASE t OUCY UPNT S U as,describe under j0 RIPTION OF OPERATIONS bell t DESCRIPTION OF OPERATIONS I LOCATIONS I VENtCLES(ACORD lot,AddtNonal Remarks Sthadule,may be attached if more apace is required) Carpentry insurance coverage is limited to the terms,conditions,exciusiQo bert limitations ha policy paOvdisiOns.rsements. Nothing contained in the certificate of insurance shall be deemed to have altered,Waived or extended the coverage provided CANCELLATION CERTIFICATE HOLDER SHOULD ANY QF THE ABOVE DESCR38ED POLICIES BE CANCELLED sEFORE THE EXPIRATION DATE THEREOF, NOTICE WiLL BE.DELIVERED iN ACCORDANCE WITH THE POLICY PROVISIONS. Troy Thomas 499 Nottingham'Drive Centerville,MA 02632 AUTHORIZEDREPRESENTATIYEi i t Q 1988-2015 ACORD CORPORATION. All tights reserved. ACORD 26(2016/03) The ACORD name and logo are registered marks of ACORD f Cornmonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards t r Specialty Constructic:�t°S�'� ' ' Fplres 04113l2020 CSSL-099913 TROY ATHOtwo MAS CENTERVILLE MA ,4� * Commissioner /72. Office of Consumer Affairs&Business Regulation Registration valid for individual use only HOME IMPROVEMENT CONTRACTOR TYPECorooradon before the expiration date. If found return to: ` Rfigstratibn,: gal Office of Consumer Affairs and Business Regulation 185422 I Ml08/2020• One Ashburton Place-Suite 1301 TROY THOMAS HOTiMpFt()1MENTS,INC. Boston,MA 02108 TROY THOMAS 40 NOTTINGHAM OEl,- ;." Not d without signature CENTERVILLE,MA 02ti32 " UndersecreWy The Commonwealth of Massachusetts Department of Industrial Accidents k Office of Investigations 600 Washington Street Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Wow.! Please Print Legibly Name(Business/Organization/Individual): ���.>' - Wow.0 Address: VA City/State/Zip: V1/k. Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1. I am a employer with 6 _ 4. 1 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. 7.e�Remodeling 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. 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. Other comp.insurance required.] •Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. f 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 state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. g Insurance Company Name: OK m r I L"t/ ar .--d Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address:_ fs ►>� a<a •d•� . �� City/State/Zip: i 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. Signature: Date: - / Phone# U `2 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 Contact Person: Phone#: Thomas Home Improvements Proposes to perform the following work: Location of proposed work: Mr. & Mrs. McDowell 271 Capnlijahs Road Centerville, MA 02632 Date on which construction should begin: September 2018 The homeowner hereby acknowledges and agrees that the scheduling dates are approximate and that such delays that cannot be avoided by the contractor shall not be considered as a violation of this contract. The contractor agrees that when such delays become known to the contractor,the contractor will advise the homeowner as soon as possible. The homeowner hereby acknowledges that in certain remodeling work,the demolition process may reveal defects in the existing structure which must be repaired, creating additional work which may need to be carried out in order to complete the work described in this contract. In such case the homeowner agrees that the duration of the work and the schedule date of completion may differ, and that such variation is not to be considered a violation of this contract. Cost for labor and materials under this contract: Proposal to install SBC white cedar siding shingles on cheek lines as discussed would be $990.00 per section Proposal to install new window sill on garage&AZEK PVC trim on upper bedroom window would be $300.00 As discussed Harvey tribute new construction windows $995.00 per opening HOME IMPROVEMENTS 4 PH. 508.328.1635 Exterior Remodeling Experts BBB, Web: www.thomashomeimprovements..net Fully Licensed &Insured R.O.: Box 177 Construction:Supervisor U6#99913 Centerville,:MA 02632 II f Thank You for Giving Us the Opportunity to Help You Improve Your Project In the event that while stripping the siding we find rot that needs to be replaced,the homeowner then has to agree and authorize any replacement or restoration. Then in addition to the above contract price,the homeowner agrees to compensate the contractor for any repairs or restoration at the hourly rate of$75.00 for a carpenter and$55.00 for a carpenter's laborer, plus the cost of materials. -Siding to be stripped and cleaned of all old siding&debris -Home to be papered with Typar house wrap -SBC Grade A white cedar shingles to be used in the installation -Harvey Tribute windows to include new trim interior&exterior -All shingle installation to be in accordance to validate manufactures warranty as discussed -10 Yard dump trailer will be needed on site; and will be removed at completion of the job -Contractor will be responsible for all building permits needed at the property NOTICE REQUIRED BY LAW With the agreement of the contract$500.00 of estimate is due. Further payments under this contract are as follows: 1/2 of the estimate due at the start; and remainder due at completion of the job. Balance of all materials and labor shall be payable in full upon completion of work described in this contract. Payment as agreed upon shall be made when due. Any payments which are delayed shall be subject to a finance charge of 1.5% per month. The contractor warranties the work completed under this contract for a period of one year from the date of completion. During the stated warranty period the contractor shall be responsible for the service of the repair or adjustment, but the contractor shall not be responsible for the normal maintenance, repair due to abuse, misuse, and or normal wear and tear,which shall be the responsibility of the homeowner. All warranties for the materials supplied by the contractor shall be passed directly to the homeowner. The homeowner may be required to register or mail in such warranty card or evidence of ownership in order to activate such warranties. Homeowner failure shall not create any responsibility for the contractor under the warranty provisions;the choice of repair of replacement shall be at the discretion of the contractor. The homeowner acknowledges that the form, content, and notices contained in this contract are intended to comply with the applicable portions of the Mass. General Law Chapter 142A, and regulations promulgated there under. In the event of any instance of non-compliance,only such portion shall be invalid and the remainder of this contract shall be in full force effect. In addition,any such portion not in compliance shall be read and interpreted so as to have its intended meaning to the maximum extent allowed under such law and regulation. Signed as a sealed instrument on this date: Date: Homeowner ® Contracto r'� Ilke A4,11 �sJiy116 0 oFTHE Town of Barn stable' *Perrru�# �03 QY ti Lrpires 6 nionthsfront issue date * uaxs-rnai.a. oil. . vices Fee Regulatory Ser 6 9 1�$ Thomas F. Geiler,Director prFD MA't A Building Division Tom Perry,CBO, Building Commissioner, 200 Main Street,Hyannis,MA 02601 www,town.b erns t ab l e.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint ' Map/parcel Numbero Trope dre Adss I ,e e� t 5 e� , :Ae - Residential Value of Work .— Minimum fee of 25.00 for work under$6000.00 . Owner's Name&Address L' r e' Contractor's Name#/es . Aoi/v Telephone Number `-�// 7V0 Home Improvement Contractor License#(if applicable) 7nsction Supervisor's License#(if applicable) 6. O 4- a kman's Compensation Insurance N Y 4• Check one: 2U j ❑ I am a sole proprietor ON OC ❑ m the Homeowner f, �T I have Worker's Compensation'Insurance Insurance t� ,,/ .n e Company Name + �/JG Workman's Comp.Policy# 9 Copy of Insurance Compliance Certificate must,accompany each permit. f Permit Request(check box) . ❑ Re-roof(stripping old shingles):All"construction debris will be taken to ❑`Re-roof(not stripping. Going over existing layers-of roof) Re-side / #of doors + � Replacement-Windows/doors/sliders.-U-Value G, _).S (maximum .44)#of windows. Where required .ISsuance of this permit does not exempt' * compliance with other town department regu]aGons,i.e:Historic;Conservation,etc. ***Note:". Property Owner must sign Propero Owner Letter of Permission.-,':..` A copy of the Home Improvement Contractors License&Construction'Supervisors License is required. SIGNATURE. / " •-v- d-2 - Q:\WPFILES\FORMS\building permit forms\EXPRESS.dOd Zi The Commonwealth of Massachusetts Department of Industrial Accidents w Office of Investigations 600 Washington Street Boston, MA 02111 ''w Jey www.mass.gov/dia s Workers' Compensation Insurance A' ffidavit: guilders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name(Business/Organizatio ndividual): ®0/0 We Address: Cit /State/Zip r �, �-- / Phone#: � �� Y 7V Are yo an employer?Chec the appropriate box: Type of project(required): 1.Ef I am a employer with 4. 1 e a general contractor and I 6. ❑New construction employees(full and/or part-time).:* have hired the sub-contractors. 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. remodeling ship and have no employees These sub-contractors have g• Demolition working for me in any capacity. employees and have workers' comp..insurance.$ 9• �Building addition workers comp.insurance. 10.❑Electrical repairs or additions required.] 5. � We are a corporation and its 3.❑ I am a homeowner doing all work officers have exercised their 1 LEI 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.❑ Other comp.insurance required.] *Any applicant that checks box#1 must also fill information.' ll out the section below showing their workers'compensation policy infoation: 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 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. �r Insurance Company an Name: ,�1. J4/ / UV Policy#or Self-ins.Lic.M Expiration Date: Q Al Job Site Address: n� City/State/zip:f�2 /411 ' .G �� Attach a copy of the workers' corfipensation 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains-andpenalties ofperjury that the information provided above is true and correct. Date: . o Phone# Official use only. Do not write in this area, to be completed by city or town officiaL City or Town: Permit/License# Issuing Authority.(circle one): 1.Board of Health Z.BuiIding Department 3. City/Town Clerk 4. Electrical Inspector S. Plumbing Inspector 6. Other Contact Person: Phone#: ey moo' " for UE Oil NS e, !w£"w'�'F" Sifrdr50O}t # '3 'sV� t:"R�.+x° n Man y ftd - W-G mock MAT 45 •_���:*,a �. i �'�' `� L.Ct{ 1 ICItrH l C tJt" LIHL IL1,1 .Y:, IIV UtWIVE.►C OP ID Jv MOONA-1 05/07/10 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF 11 INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Hunter Insurance, Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 389 Old River Road, P.O. Box 1 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Manville RI 02838-0001 Phone:401-769-9500 Fax:401-769-9502 INSURERS AFFORDING COVERAGE' NAIL INSURED Moon Associates Inc. INSURER A:DBA Gutter Helmet national Grange Insurance Co 1478$ DBA Renewal byy Andersen of RI INSURER B' Beacon Mutual Insurance Co. DBA Gutter Helmet Roofing INSURER C: DBA Moon Works 1137 Park East Drive INSURE Woonsocket Woonsocket RI 02895 INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS: LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE(MMtDOIT YYY) DAl E tMM/DDY EFFECTIVE POLIC I/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1000000 A X COMMERCIAL GENERAL LIABILITY MPS26619 09/16/09 09/16/10 PREMISES(Eaoacuranca) $500000 CLAIMS MADE_ ®OCCUR MED EXP(Any one person) $10000 PERSONAL&ADV INJURY $ 1000000 GENERAL AGGREGATE $2000000' GEN,AGGREGATE LIMIT APPLIES PER:RI PRODUCTS-COhAP/OPAGG $2000000 POLICY ECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT B1S26619 os/16lo9 . 05/16/10 $ 1000000 A X AtdY AUTO (EB accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS '(Per accident) PROPERTY DAMAGE $. (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO `. EA ACC $ OTHER THAN _,...........m..�..—_, ..,; AUTO ONLY: RUG $ EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE $ 1000000 A XOCCUR CLAIMSMADE CUS26619 09/16/09 09/16/10 AGGREGATE $ DEDUCTIBLE $ �$ RETENTION $10000 $ _ WORKERS COMPENSATION I AND EMPLOYERS'LIABILITY X TORY LIMITS I EP, B ANY PROPRIETORIPAP,TNER,'EXECUTIVE 2 8 S 8 6 10 �1 1'�a 9 111 n f 1�1 E.L.EACH ACCIDENT $5�}�1(1 O 0 OFFICERtMEMBER EXCLUDED? El _. (Mandatory inNH) E,L.DISEASE-EAEMPLOYEE $500000 If yes,describe under SPECIAL PROVISIONS belogva EL.DISEASE-POLICY LIMIT $500000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION RENEWAL DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Renewal By Anderson REPRESENTATIVES. 1137 Park East Drive Woonsocket RI 02$95 r=IVE 070'7. ACORD 25(2009101) 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD a 71 CA PT. 4; JAMS (LJ a_►sA g l>tr) ahtc. /9w CEry Iazvi)/C-1 MA Customer Name. &A-i 1.� r7 t D Ott A L y Year Built: Renewal Address; Z ,T t .oar eM Ld JAIL A.), Customer 10#: Renewal ody Andersen of Rhode!eland ■■V��bb�... ` Q Sales Agreement City State,Zip: C Qj ZW yii t r' /1d7 &U 21. Order Number.' 11 7 Park East Drive by` n &mm � � piton-Home: 5`A P i�2� - 3 Si _ Woonsocket,RI 02895 Nr1MaoYr REPLACEMENT an Ankrru+Canptq y - - i�1Yne-Work; ,6,f._�1_1 L_ 12 f p e: Of Date: ��7`/ �-��=---�-�+f� a8 �-- --�- liuuse#RI-30839 RI- 12259 MA- OC A I. Email: J 7->t. OA 119535 CT-562725 UNITS GRILLES RR 1yJ 7,9 oil ! CerRoom tat tlon 1 a � t g 3� u� Sil fPRIGES ' oils' $It a a teaj1 1 . t ; 8 it a tl. it p u! V 8 trH wy 3 Co hrw A� s I n 1 tent, ,�n Sub Total tey.n 14-il ell eotCjwilts9rFxp�trsea 7y/ p101108aEi All�,r it.e(i o 11 Jap a d 1.lifMlr}In IM 4rom l y the U p r a tinted In Ilm nemm�Tim ( nth Wr .Ror Repair,PmnwAen.ae} �8yM611t ME�i�d ry� M .d axl nmrbt vpWl h.r.111 da�a stun Ir oe xu plwY 1 IeM1 t:uaumur and Ra+LLwal 1 ,MAcrncn Mp cr» B' . a > („ 'Y tf nWi pnw,Jarl(wow. Sub Tots)Esser.hpwl pt ion n!Notes 8 Pr S ® C►wdt WC0v0('n APPk- Sub totalus.armi 9 75 flats 1 n.lceem 2wkt�presmearive Symaeurc Credit Card customer t 1.1 Y,w arc habq aatMtti tv)tt>fumi,h as w nJ ma aml d ens ruyu tall ro eomplrre ehh #'AS' b f-t r819. 10 WOW Q LOf ttr,d? Mile.CrOdlts Or Enp9MiS 6 3 S g exrccnnnr fur which •wuknppnnl rRrcca n.ppq ttu emennn ratrd'm thir gpcenxar and aeaydey{m the menu h.rtd: .t'laentillg - See Reverse Side for Terms and Conditions of Sale.You,the buyer,may cancel to r:01L hey FyTydd this traneactlon at arty tithe riot to rnldnight of the thirdbualness day after the date of this transaetion.�lease see attached o cancellation for an 3 S.v sales tax d+ee it"only vqslanation-_',,'ofl,this rig /� Taal MIKcIlarrcour Crodim or Expe,uea Acrepunl�J.L_ �% (aM overle . coal tomLw arAt/mpam udwnn n d e) Work Pbmrk Crft / AdOaaW fMdar,Dint RuarlMd em (. ttromr n Slgtawt: ` (ptee rsdrdesotimrppyr} Special Ord.Notes Total Amount of Agreement �: (f J Heto oast scam Dom Accq%W Brplkw tnhr Goon 54 1Gim.1 Ixy Menoxur-$g"Alwe _ N9�7 A('$►J traposit Required �..�!'3 eprWltyadrdow. M�gqpWMrgsLMota reneaal4rMdreep afn yWd.ebntalilion RetWWW�pw►dea+ontnttad MdnpYrieq letum S",�,g/ N ZI�D /.s0 BalBa[e0"anComple"n •gyp we�tar wrAta mq ensnot de dwl�y are �gtebewt lttpMrotdatry �+er �S 4 d0' - , OrnMdelbeptutl.WM Mda yl window 1M�i7d kBuoverWtf�pimrollatm wo wq pa�Mt*t le 1 Vtice irtcludea tabor,matntab,inarallatan. Wt1W adese car«Inptertaewude aootarwtalea rdduraeyarardroreeel 1e.1anr�pAwal. rcn+oval,andd apinf nxlusto ed. rpeo' ymnd ebaw, an Mtsplbd- noted Maee d�lmorttenhratlm OeEdtvdf 0e - Costemrr Custoww Cusmmdr the a�maro�i.derxleurnewwnr6wixd WA(le-RtntrwBbyMdrtset. Vdlau-dstatlatlan iMdt-xomroame liVn V • Inleab: SJ/"V/) Inrtiab: s � �9 GpT 7 /e"W e D d/D fT. �s'i0E �.isE..� dr fog ,sfAGEO. /.�O.i1 sasoi✓�siov •' i O S/7 AI,eES t O n _ �AFCK � Ll e h 2 sro�✓ \ .+aov:E sePt+C O ' 13 C�9i�i�/ L/✓�i5/ :S •e0.90 MAP EEFE.eE.I/EE �►.�.ec%SlABLE fO.B �//.4.eLES f. .tlA.�/LE1✓ 0.41E0 A!/6!/,sT 2/, /�7,� k SU.P✓EY.9T evevsr.�ate�- J :• •� .. �/!}r�- y'.'(j�. .lit {/��r`3'° j. .s�T� `ea. V • � ..22, � - ,fir►��, .�# 'SOUTH YAFk�qu-rfl, f t ,,,: A• ;� •! .. � ��,��fit �. Q • ` ,+its�.i+`�i'�bs�'���T►k��'�%� � 'r CERTIi' D. = PLOD` OLAiV' LOCAtION f t y am: Wl SCALE . " DATE .. '. 4 PLAN REFERENCE .44 T' ' - ". •♦�� ,�"NN'9^^4rr��'T�'f'.'°�C�!"f"'..^!' } ��\fin+i���4 � f f��+j, SHOWN-0IV H'WPLAW I$ E_.ACAUD 0K Tt#�`':OHOUND�� ` As SM9 N Ht�tEAN ANSI �r+A�`IT ts�e"v�r�s ro TH��r F ` < w CON9YRUCTED `x ivy +� � •i N' ,E` -s T'f mot" wE�.a f -f TOP OF FOUNDATION CONCRETE ^COVER.•.. CONCRETE COVERS e o 4' CAST IRON 12°MAX. PIPE (OR 4 - 12 MAX "ORANGEBURG(OR'EQUIV) -.. EOUIV.) - MIN.,` PIPE-. MIN, 4' L`EACN PITCH 1/4"PER,FT: PITCH i/4 PER.FT: ^' PIT PRECAST- �INV •LEACHING c :PIT OR EL:¢F`7i54 INV 'IN R ° a o SEPTIC TANK DIST." ' EQUIV lF� ° w: . o I N E EL. ./.,'�.'_ BOX EL4 />_ EL :(• GAL: INVFa�f�;T EL. .a'�D IN RT I i/2 IL WASHED, • STONE. � WDIA T DI PROFI LE OF GRO UND, WATER. TABLE,,. . '.•<' /. SEWAGE DISPOSAL SYSTEM NO SCALE LOG:, WITNESSE BY DATE :/.�TO .. TIME. MJ!7�. �`n!`'"''. . .BOARD OF.HEALTH TEST HOLE I TEST HOLE 2 C•� : ENGINEER ELEV. . . . ELEV. .. . o DESIGN- DATA ! - e? 24;t NUMBER OF BEDROOMS 3. . . . . . TOTAL ESTIMATED FLOW ., �. . GALLONS/DAY g,� BOTTOM. LEACHING• AREA �CJ�•�5�. SQ.FT. /PIT 84 SIDE LEACHING AREA . .�88•.` . m�•� ^ S0.FT./ PIT GARBAGE DISPOSAL .�� '. .(50% AREA INCREASE) IcJ t11�' . SA�uD ' TOTAL LEACHING 'AR/EA SQ.FT PERCOLATION RATE"G- T � . MIN/INCH LEACH I.NG AREA_ PER'PERCOLATION RATE=4P. SQ.FT. q'P..WATER ENCOUNTERED NUMBER OF' LEACHING.' PITS . ter APPROVED B / BOARD OF'HEALTHu low- DATE '.AGENT OR `INSPECTOR � ° LS = i� 0f� GiRT� .! �H DF M'ssq Grp✓ Y�^ c Mo GA//7 /STEP�O�'�� , FSS�ONALE�6\ PETITIONER TOWN OF BARNSTABLE Permit No. _Z__-__________-_-__-._- { �mn� Building Inspector Cash �A YPYa sO'r0 YPY�' OCCUPANCY PERMIT Bond _____________-___ "No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to C-. 5tanlev Address Wiring Inspector Inspection date Plumbing Inspector Inspection date Gas Inspector Inspection date Engineering Department Inspection date 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. ...................................................... 19......__ ....................................... .... ..................._.. ......__......._._._ Building Inspector r Town of Barnstable _ Regulatory Services 9'"M "��'EMAMg,* Thomas F.Geiler,Director �A .i63q ♦0 rE1639 & Building Division Ralph Crossen,Building Commissioner 367 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 SHED REGISTRATION Location of shed(address) Village �7- dy9—zeI- 5�5�5��8-284�Sf Property owner's name Telephone number F , .r Size of Shed Map/Parcel# Si nature Date / Hyannis Main Street Waterfront Historic District? Old King's Highway Historic District Commission jurisdiction? Conservation Commission(signature required) E , lD000 S APD >I oo Fieo/►'� W�eTL�N D 45 SkeTcti pd a�v PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION ��7�oa��S MI FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN zo v ® � Q-forms-shedreg STANDARD LEGEND i NOTE:not all symbols wiU appear on a mop (02:� GOLF COURSE FAIRWAY { cv-- EDGE OF DECIDUOUS TREES MAP ���3 � EDGE OF BRUSH 1�►�� C— ORCHARD OR NURSERY v—v-v-v EDGE OF CONIFEROUS TREES t t MARSH AREA —-•-— EDGE Of WATER DIRT ROAD DRIVEWAY --PARKING LOT PAVED ROAD ------- DRAINAGE DITCH ————— PATH/TRAIL PARCEL LINE ** MAP 193 r NAPilo -—MAP# 21 .---PARCEL NUMBER i cuo E HOUSE NUMBER \� 135 R LINE \ O 2 FOOT CONTOUR �\ # 271 —ie 10 FOOT CONTOUR UNE Elevation based on NGVD29 4.9 SPOT ELEVATION �? STONEWALL -X—X- FENCE a a RETAININGWALL RAIL ROAD TRACK STONE JETTY P SWIMMING POOL 1� PORCH/DECK 193 0 BUILDING/STRUCTURE =rs- DOCK/PIER HYDRANT # 51 6 VALVE @ MANHOLE o Mg 0P° HAG POLE T O W N O P B A R N S T A B L E A E O O R A P N I C I N P O R M A T I O N S Y S T E M S U N I T a, SIGN ® STORM DRAIN r PMD SM IN FEET *NOTE:TbIs map is on enlargement of e **NOTE:The pare d Bees are only gmpric representations DATA SOURCES:Planimetrics(man-arode feahrres)were Interpreted from 1995 aeKial photographs by The lanres o UTUIY POLE pTOWER 1°=100 soda mop and may NOT meet of properly baundades.They are nottme kdoM and W.Sewl Company.Topography and vegddo were Interpreted from 1989 aerial photagr phs by 6EOO w e �- _ - 20 40 National Acamry d may N at meet of not represent actual relationships to phood oblub Corporation.Planimeft to hy,and vegeMton were mapped to meet National Map Amoory Standards ¢ UGHT POLE o ELECTRIC BOX `� 1 INCH FEET* enlarged""'" on the map, at a scale of 1°=100'.Panel Ines were ftlfized from 2000 Tares of B-m Wble Assessors tmr maps. 1Bam\sitemapS\Pub1ic\fn193.dgn Aug. 07,2000 11:20:30 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map /93 Parcel 13,57 Permit# Health Division Date Issued Conservation Divisi n o 70 Fee25: Tax Collecto QlAv n (� Z SEPTIC SYSTEM MAST BE Treasurer INSTALLEUIN CbMPLIA14C-P PhC1111 ling Bed__ WITH TITLE 5- ENVIRONMENTAL CODE X rd 'TOWN REGULAT°04)JS t Project Street Address Zz L 9-,-FK Village Owner �lu i1J �/�AGE'/ Address Z/,T���S Telephone Permit Request 4/` - r .7 .5;M 6a,�Aem'la' /,2 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Valuation EOU Zoning District Flood Plain Groundwater Overlay 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 )1/d5 Historic House: ❑Yes B- o On Old King's Highway: Cl Yes ❑No i Basement Type: l}Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing 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: ❑Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing 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 ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name �y ��, � �,� �7Ge% Telephone Number Address „9 l License# C°G- Z, Home Improvement Contractor# _. Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE' DATE . lU� i �a• a FOR OFFICIAL USE ONLY L e t PERMIT NO. DATE ISSUED f1 MAP/PARCEL±NO.' ADDRESS VILLAGE } OWNER DATE OF INSPECTION:—, r r FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH-. V �_- FINAL PLUMBING: ROUGH' ' FINAL r GAS: ROUGH_;, ':� FINAL f FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. , t ' I i i The Commonwealth of Massachusetts Department of Industrial Accidents ,� =-: �: , �_._ • Office of/nsestigations _ 600 Washington Street Boston,Mass. 02111 Workers' coin ensation Insurance Affidavit name location a2 l /��?P%✓ ,//e�'i�hls RJ� city �7"✓Z /Ll//1 G� /�% �a?�� phone#SC1X'-Zy ? I am a homeowner performing all work myself. I am a sole r rietor and have no one wgl in any capacity er rovidin workers' co ensation for my employees working on this job. : .. ❑ I am an employ .;:p g mP coin sn name.. _ address: hone#. ; Ins an-- am a sole proprietor, general contractor, o ' cle one)and have hired the contractors listed below who workers' compensation olices: # .:..the following wo..:. .., ........... mP P , tom an :name.. address < ..::..:::.....:.........::::::::.::. ::;:.;. ...:...: ti >:... c anv:name. ::. U. .. ,. ,. ,,..: one: ct . .. ..:..:. ..:....;:::...:. n�nrantt~co >. Failure to secure coverage as required under Section 25A of MGL 152 can had to the imposition of criminal penalties of a nne up to s1,S00.00 and/or one years,imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification I do hereby certify under the pains and penalties of peijury that the information provided above is true and correct Signature Date � 9 ' ®� _W4ej� Print name -re Phone official use only do not write in this area to be completed by city or town official city or town permit/license# ❑Building Department []Licensing Board nse is re uired ❑Selectmen's Office ❑checkifimmediaterespo q ❑Health Department phone#; - ❑Other contact person: (revised 9/95 P1A) Information and Instructions 'F Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their " eve person in the service of another under any contract employees. As quoted from the"law", an employee� defined as every 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 ajonrt 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 section 25 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,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 in the workers' compensation affidavit completely,by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance as all affidavits may be submitted to,the Department of It 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. City or Towns 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 pi number which will be used as a reference number. The affidavits may be retu mid to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations wouldlike to thank you in advance for you 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 Invesugatloas 600 Washington Street Boston, Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 OF THE rp� ti The Town of Barnstable * BARNSPABU& • 9 MASS, Regulatory Services 4i'°rE0;arA Thomas F. Geiler, Director Building Division Peter F. DiMatteo, Building Commissioner 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION i MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion,. improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: Estimated Cost Address of Work: Z!/ -Z.5'.19:�veL Z d 6?i 19?d Owner's Name: Date of Application: t' I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law &ob Under$1,000 []Building not owner-occupied ®Owner.pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Registration No. Date Contractor Name Re g OR `7—z Off/ lG�o4?�!7 "o�7LG� Date Owner's Name q:forms:Affidav:rev-070601 f F THE The Town of Barnstable * &UMSrnBLE, ��� Regulatory Services rED nt►'t" Thomas F. Geiler, Director Building Division Peter F. DiMatteo, Building Commissioner 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: 7,2 O- / y JOB LOCATION: .�' // Cr/��/� ZZ/ 71 ;71t l �1_ 7;; e!/(GLE' number street village "HOMEOWNER": name home phone# o elk 1,11011 CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of HomevOrner 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:EXEMPTN 1 i i c ri s>ir✓c«sce [�/-RYAS/fiY6 2xgX /2 P.T, /2 a O. e- - � 1 o c\l �. ` � -x/s7li✓G t 4'co.�F a� �n/OieK y X 4 Pa`sTs �YFPL.4�CE L`'X/ST/JY J?�1575. �dIT.�V I�T. —4X� f SrS c�?c(S r�i✓6 29g z2� 7-2 0-200/ b -asses is ma and lot number ...... ../f ..... /`3'S ,P SEPTIC SYSTEM MUST BE _ INSTALLED W COMPLIANCE Sewage Permit number .................T.11................................... NTH TITLE 5 (L�S� °2 T Ct7�, �Qy�F THE rO�o /� T W N OF BARN",TWE �4 . BARNSTABLE, i ON Ar, BUILDING INSPECTOR Al �, APPLICATION FOR PERMIT TO ....../..!'`..0................ ...�...........................................(............................. /- � TYPE OF CONSTRUCTION .............. 'li'D OY. . /Y-e.j..................................................................... ASS :...'Z ............. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information- Location ......../.!l.� .... ..�Z9...... ./ ... Q ../ ! ..`...Ct �1`v1��(�......................... ProposedUse ........... .............................................................................................................................................. ZoningDistrict /�°�....�............................ ..........................................Fire District ................ . ............ ...........................°....... Name of Owner .......... Address /<v7 CAB e2 �.. ` Nameof Builder ..............10 .�.................................Address .................... .` ry`2 ......................................... Nameof Architect ........./4/�`�- .......................................Address ..................................................................................... Number of Rooms ............... `` ..............................................Foundation ...... ................................ ............. Exterior ....... ....Sr.:..U. 01 Roofing ........... � ... ....C..!./........................................ .V. . ... ......................Floors ...................................................... ....................Interior .......... ... .....Heating v�:".`.0...............................................Plumbing .........'...�`..`:".�................................................ fly`'�....................................................A Approximate Cost tJ O� DO D: Fireplace pp......................... /-� Definitive Plan Approved by Planning Board -----------_-------------------19________ . Area �. .................. ........... Diagram of Lot and Building with Dimensions Fee ..... 4,)-.5................. SUBJECT TO APPROVAL OF BOARD OF HEALTH /7� I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regar 'ng the above construction. Name . .,......�!. ........ .�:�..................... a STANLEY, C. F. 'r No 2 2 5. 7 Permit for ....One...1,/2...Story Sin.le FamilyDwelling........... •..II'1 Ldtation ...Lot,,,#4,9.. .Ulz n. ij.ah' s Road .................. ... ........... ................ Owner ....C....... StAnIQ . ........................ Type of Construction .....Fr=P......................... ................................................................................ Plot ............................ Lot ................................ Permit Granted ....S r eptembe 2.5.t..19 80 Date of Inspection ......... ..... ...................19 Date Completed . /..�.. ��J...........19 i y. J Q. PERMIT REFUSED ................................................................ 19 rv.. .....:� ...................................................... .... . ................................................... .;r......................................................... .31. 0 rC, . .. ........................................................ AppS[o,ed ................................................ 19 ............................................................................... � .� Assessor's Lpr and ',lot number ..'.."� / ......... ....... u Sewage Permit number ................../.<o..:......:......................... ` CF TO USe �/THE TOWN OF BARNSTABLE Z BABB$TOIiLE, i "b 9 BUILDING INSPECTOR Op�a M Or• APPLICATION FOR PERMIT TOU/ BPS L" l TYPE OF CONSTRUCTION �/.©d `�* !....� ........ ,` ........ ....... ....................................`.�� ........... j o/ '5- v co .... .................................... ........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following 'information- Location .. ..�!�.�..+�......��"�..��......�-r�'r�'•G f..�Gt;�, lL.. �COt t��f(f'�'� �-.................................. ProposedUse ..........:/vc:.�::..-.'......................................�.......................... . ........................................,......................... + Zoning District ...............Fire District ... --?: '.. ......................... ........�....................�.................................. ..............................:. -Name of Owner ......-�.................... ;f... ....Address t_.a 7� ....................................' Name of Builder ................:Address ....... .1 ................................ ............................ y... ......................................... Name of Architect ........../f/trij• .......................................Address .................................................................................... ..... ......... Number of Rooms �..............................................Foundation ........I...... ..... .... .... �/ / ��!� Z.,� Roofing , tea, � Exterior ........:...........................�........................................... Floors .,ti G tG�, LU Gt- ....................Interior ..........Y��', ...... .......................................................... Heating C. r . r......................................................Plumbing Fireplace f .........Approximate Cost �� "p ` ......................................................................... .................................................................... Definitive Plan Approved by Planning Board --------------------------------19-------- . Area .........�.S. ...4........ Diagram of Lot and Building with Dimensions Fee q �'.................... ........a.5................. SUBJECT TO APPROVAL OF BOARD OF HEALTH 1/ t, . I 17 47 157 ` 1 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. ' ... ....................Name ....................................... .. .... . .. � � I ;r V.. STANLEY, C. F.22537/ /No .............. .. Permit for .One 1 2 St, Single. Family Dwelling Location Lot #49 .271..Captain..Lijah°s Rd. .. ........ ................... ........... Centerville ` ............................................................................... Owner . C. F. Stanley. .......... .. ............................... Type of Construction Frame ......................................... .!.................................. Plot ........ .......... Lot .................. 6!�p��ember 25 80 Permit Granted ......................49 Date of Inspection .......... .........................19 Date Completed .....�............................19 PERMIT REFUSED ........................ .... .. 19 .. .... ... ....y t- 1. ....... ....... . .. ...... ....... ............... ......................... ............. ...................................... ............................................................................... Approved ................................................ 19 ............................................................................... ...............................................................................