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HomeMy WebLinkAbout0073 DOLAR DAVIS ROAD g v � � . NIL o h a e o q n e t -" r Town of Barnstable *Permit# � �7 1 `� ,' F na Expires 6 montirs from issue date qq Regulatory Services Fee Thomas F.Geiler,Director BARNSTAD�� Building DivisionQr Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY I ^� Not Valid without Red X-Press Imprint Map/parcel Number 1 Property Address l \ l a i Residential Value of Work 11Q,Q(] Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address \j,)a 04- f)r A 4,��)!,M,/ Ce0k Contractor's Name Telephone Number �b� y at 6 off) Cc Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I the Homeowner ­I have Worker's Compensation Insurance Insurance Company Name A 1 Workman's Comp.Policy# C —7 ft�( 0 wa, I �� a 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 C Abe a ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders. 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.mug sign r erty Owner Letter of Permission. A copy o the Horrf Imp v nt Contractors License is required. SIGNATURE: Q:Forms:expmtrg Revise061306 f NOTICE NOTICE TO v TO EMPLOYEES EMPLOYEES The Commonwealth of Massachusetts DEPARTMENT OF INDUSTRIAL ACCIDENTS 600 Washington Street,Boston,.Massachusetts 02111 61 7-727-4900 As required by Massachusetts General Law,Chapter 152, Sections 21,22 & 30, this will give you notice that 1(we)have provided for payment to our injured employees under the above mentioned chapter by insuring with: ASSOCIATED INDUSTRIES OF MASSACHUSETTS MUTUAL INSURANCE COMPANY NAME OF INSURANCE COMPANY 54 THIRD AVENUE, P.Q.BOX 4070 BURLINGTON MA 01803-0970 ADDRESS OF INSURANCE COMPANY AWC 7016215012007 01/10/2007 - 01110/2008 POLICY NUMBER EFFECTIVE DATES P 0 Box 494 Leonard Insurance Agency Inc Oster Alle,MA 02655 (508)428-6921 NAME OF INSURANCE AGENT ADDRESS PHONE Mark Herbst 35 Peep Toad Road Centerville,MA 02632 EMPLOYER ADDRESS 01/04n007 EMPLOYER'S WORKERS COMPENSATION OFFICER(IF ANY) DATE MEDICAL THE-AMMEn The above named insurer is required in cases of personal injuries arising out of and in the course of employment to furnish adequate and reasonable hospital and medical services in accordance with the provisions of the Workers Compensation Act. A copy of the First Report of Injury must be given to the injured employee. The employee may select his or her own physician. The reasonable cost of the services provided by the treating physician will be paid by the insurer,if the treatment is necessary and reasonably connected to the work related injury. In cases requiring hospital attention,employees are hereby notified that the insurer has arranged for such attention at the NEAREST AND BEST MEDICAL FACILITY NAME OF HOSPITAL ADDRESS j To` BE P ®ST'ED BY EMPLOYER +�F���� - ,r.-:.'at '�. .�,�t �:si• y m p°��" '�P'e� �a'�� r yt�'^ � `�# s ,, ,�a., s'�•� �,r ^.��n 4r Yixcrw �wr sr "w ti P Y ' A 4�' e� _._, �:s .�,���, 1 svt.,'8:.�'�t �'" a����t,:. ` i�x 'x51.".p�`�a �:•:�r.�,3 �'�iA an .� �•,�,�Y�+„� �yx F+ w .'xr 4"�` � c•�34�Yq � � q L �+v .� ,y ��+x, ,, .i,r-s .�s� �ia� f z ,ic.f 5C��•u.ara` r � 46 w �Yt �� ` sa w. ltVARK HERBS T , z r 5 Peen Toad Rd. 3 - Centerville NIA 02632 (508) 420-6216 Cell phone 774-238-2910, 38 I A }' PROPOSAL SUBMITTED TO: WORK PERFORMED:AT: Y k a� Wagmar Nassery SAME " y3 73 Dollar Davis RoadZy; T • Centerville MA 02632 t t5 i 508-771-2576 We herby propose to furnish the materials and perform the labor necessary for the Completion of the following; }Y. New Roof.- On fi=ont f ?� Remove 11 er o existin shin les �' � '. Install ice &water shield at edge Install 151b. felt aper E Install certainteed shingle-of choice r : f Storm nail all shingles r All debris cleaned daily Certainteed XT 25yr. algae resistant shingles $2025 00( Certainteed Woodscape 30yr. algae resistant 2250 00( ) *Please check&initial choice above Thank You Price includes material labor &dump fees All material i _s guaranteed rt, a anteed to b e as specifi ed, and above .��-.g p , ove work to performed m accordance with specifications submitted for above, and completed in a substantial ` r workmanlike manner for the sum of, as specified above &verified w/your initials r , # Dollars( )with payments as follows;full amount due.upon completion * Any alteration(s) from above involving extra costs will be added under written �Pf agreement, and becom an ztr c arge over and above signed.estimate/agreement r7 s RESPECTFUL STIE n Signature 03-17=07 A CEPTANCE OF PROPOSAL The above prices specification & conditions are satisfactory,we herby accept ` You are author'ze to do the wo and pay a ill be as specified above. ' .. Signatures) z tj Date: This proposal may be withdrawn by said company if not accepted witlein 30 days 's ( � C h FiKA � s a >r�✓+ r .��• s�, r J -. 7.r� � '�t # � �t.�.�� r-,r�„ ��i n s t VM y b? uYb xa kaQt � a� {rkr;awe fix Yy - �"�'tf ',{t {rtX ��"�� r� �� �' +� .,A._•�+. �" ^�° f -.y .�a+1 is '' K:A t < . � - r �a - s ' ?,--APO ¢,.,,'..{ - ri`4r `�' ; sr-'h. th,* s.° y�T�P.3` t �s ,x1�'vyk''"^ ; '. +y iS `s k,r g'p'�n v,• a'-q r4�r�'Ac4 ':s j y The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' d 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plu>mbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): \�-A �)\/--.— `��� Address City/State/Zip: Phone.#: Are you an employer?Check the appropriate bog: -Type of project(required):, 1.[�I am a employer with -3 4. 0 I am a general contractor and I 6. ❑New construction employees (full and/or part-time).* have hired the stab-contractors 2.El 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' 9 Building addition [No workers' comp,insurance comp.insurance.$ required.] 5. We are a corporation and its 10.0 Electrical repairs or additions � ' .3.❑ I am a homeowner doing all work officers have exercised their ME]Plumbing repairs or additions ' myself. [No workers' comp. right of exemption per MGL 12Z Roof repairs insurance required.]t c. 152, §1(4),and we have no 13.❑ Other employees, [No workers' 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 anew.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. n Insurance Company Name: MA 0.10 Policy#or Self-ins.Lie.#: �� �— 1 lc� '�, M" 9LbD7 Expiration Date: Job Site Address: \�� �J�J�S City/State/Zip: ���'��� vy\ 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 DU for insurance coverage verifi lion. I do hereby certify and the p rns•and p ultie of jury that the information provided above is true and correct. Si afore: Date: Phone# rOfficial only. Do not write in this area, to be completed by city or town official.n: 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#: r ' 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 re,ceiver_.oLtruatee-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-contiactor(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 thatmust 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 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 4o 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 question-S.- - please do not hesitate to give us a call. The Department's address,telephone-and fax number; The Cammoawiv alth of Massachusetts Depar4nmt of kdustrial Aeci€lents Office Qf InvestigatiQRS 60G Washington Street Boston,MA 0.2111 Tel. 617-727-4900 ext 406 ar 1-877-MASSAFE Fax#617-727-7749 Revised 11-22-06 www.mass.gov/dia -•.A 3i °FTME rqy, Town of Barnstable Regulatory Services x " saRK Thomas F.Geiler,Director 039. Mass.SS. rEo,,,pra Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 50.8-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, , as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for:✓ (Address of Job) Signature of Owner Date Print Name Q:FORMS:O W N ERP ERM IS S ION ✓lie ��all/ o��/�aaoac�ivaeC'a ) Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR_ before the expiration date. If found return to: Registratibn .1:26480 Board of Building Regulations and Standards x yQ08 One Ashburton Place Rm 1301 Boston,Ma.02108 M 1ypg (flal.Idual MARK HERBST MARK HER BST t I e 35 PEEP TOAD RD.ti` .y ,r C � � j CENTERVILLE;MA 02632 - P.eputy Administrator Not valid withoAlt nature . . 47 Assessor's map and.lot number. .........................:............................ Sewage Permit number. d DA"STADLE, i House number : r6 a r................................... �O 39• 9 �' •rt ��MPY a` TOWN OF BARNSTABLE t BUILDING INSPECTOR APPLICATION FOR PERMIT TO .... ...........1 .........C........ ? " :`1.............................:........................... TYPE OF CONSTRUCTION ....................... ..`J �c - ............................................................................................... ............... ....:!:.5.......19�� . TO THE INSPECTOR OF BUILDINGS: The undersigned ereb/y applies for a per v according to the following information: Location ........ j........ .-........f,-, ^ ........ 0 � '.� . ................. ......: ProposedUse P ..:� .................................................................................................... Zoning District ...................&.14............................................Fire District ............C:.:.."b ........................................................ Name of Owner ............... Address ��.'..r ......... •, c - . tea 19'—d '�' Name of Builder .... '..: ".....' ?......... Address Name of Architect .... ....... ...........Address ....,...�.� .0 ...........�lt{i v�ri �u oZ �.............. Number of Rooms �............................................Foundation .........! : { ::......f::N:�_i .e:. ............. 1 G q r Exlerior ............ J���,�, e ...... .................................................Roofing ..............................................:.........:.::........................ ` Floors IY�`'�.���7.0 ................................ r; .................... ..Interior ..................................f......................... Heating . ................... '' ..................:r... ...... .........i........Plumbing ........`. ...✓L .................................... l� r Fireplace 710% ........................:.................Approximate Cost ................... .,c.�• .C-9 CD............ .......... Definitive Plan Approved by Planning Board ________________________________19________. Area .......�-1...........r l�......... Diagram of Lot and Building with Dimensions Fee .............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Bo stable regarding the above construction. Name . .1.... . .,,.. ... ................... ......... Construction Supervisor's Su ervisor's License �,7....,....l..,. ...... \ t S L S TRUST A=144-2,f9 171 - .277 No .... Permit for ...11...S t or.y............... ...........qing-be FAMi 1Y..Dve lUng.................... Location ....LQ.t.1.12......7.a..Dolar-Ravis...Road ................... .................................... Owner ........... $....JX.uat............................. Type of Construction ...........Frame.......................... . ................................................................................ Plot ............................ Lot ................................ Permit Granted .......June...3....................19 86 Date of Inspection ....................................19 Date Completed ......................................19 A 7 rrr-..�,.,t::��.�1'.',. F :.. i.,ti., - '`- - .,P. .. r r�. "-'-'�`':..:-i, .�•:�' ..w'tr+• e.�_r, 'i.. - ., r ,. e,.r: .. -• w I a t o�T�ero. TOWN OF BARNSTABLE 29449 � Permit No. ....... ........ BUILDING DEPARTMENT HB;a TOWN OFFICE BUILDING Cash °'Pcuv HYANNIS,MASS.02601 Bond .......X.. �1.0 CERTIFICATE OF USE AND OCCUPANCY Issued to' S L S Trust Address lot #12 73 Dolar Ravis Road, Centerville USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. September 18 19 86 Building Inspector r , TOWN OF BARNSTABLE • BUILDING DEPARTMENT = rAR1°T TOWN OFFICE BUILDING • riu� �g i6J9• HYANNIS, MASS. 02601 � �o cur�• MEMO TO: Town Clerk FROM: Building Department DATE: .r. �4E l�.p`�a d. • An Occupancy Permit has been issued for the building authorized by BuildingPermit $k.......... /• '7„�................................................................................................................................................ issuedto ....��.g ................................................................................................................................................._._....... _._„. .. Please release the performance bond. +��"�."• �"�t�'�+'"i�r�•"•�'� �a4 �"'�.#���+s '�. r��,'•'� �.' ,i�S°"���FFts3'�a• . sa�C.•. r �;` �" � - I L 0 N 0. ". 'TOWN OF BARNSTABLE, MASSACHUSETTS { S k A 171-229 PERMIT . 4 JOB WEAT ER .CARD DATE : .Tune 3� 9 PERM.IT'NO:' r o 2 9 ' r I Y.eve1 Sollows Dev,. Re below APPLICANT ADDRESS (NO.) (STREET) (CONTR'S LICENSE).-• PERMIT-TO Build Dwelling ( 1� .STORY /Sirigle T'Amily UWClling DWELLIN OF G UNITS Ef (TYPE OF IMPROVEMENT) N0. - '(PROPOSED USE) {S': ! 'AT (LOCATION) Lot #12, 73 Dolan Davis Road, Ce"C.ervilie ZONING hr _ DISTRICT (NO.) - (STREET) BETWEEN AND (CROSS STREET) (CROSS STREET)LOT SUBDIVISION LOT BLOCK SIZE' { I BUILDING IS TO BE. ' FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND,SHALL CONFORM IN CONSTRUCTION ' TO TYPE USE GROUP �y(' BASEaIENT WALLS OR FOUNDATION - k '� •. s .(TYPE) Sasaags #85-1013 ; REMARKS:", t,. ! v x r :` Bond AREA}OR ' $"12 `a" ft. x; a. .. ! VOLUME ESTIMATED COST $ 50*000.00 PERMIT 54.75 (CUBIC/SQUARE FEET) I. 's 1. S Trust ; �� C •� OWNER �• . BUILDING DEPt: � I ADDRESS, By _ ! •� THIS PERMIT'CONVEYS'NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY *PART T EREOF.•EITHER TEMPOR RILY OR ' PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE AP-; PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED: FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS; OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. i ,MINIMUM OF THREE CALL JAPPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE INSPECTIONS REQUIRED FOR PERMITS ARE .REQUIRED FOR ALL CONSTRUCTION WORK: CARD KEPT POSTED UNTIL�FINAL INSPECTION HAS BEEN r•� _ ELECTRICAL, PLUMBING AND g"A. FOUNDATIONS OR FOOTINGS. r MADE. ,WHERE A CERTIFICATE OF.00CUPANCY IS RE- MECHANICAL INSTALLATIONS. . b 1'.PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL -ct°'MEMBERS(READY TO LATH). 8 ';FINAL INSPECTION BEFORE FINAL INSPECTION HAS BEEN MADE, 0 1OCCUPANCY..: . Y 1 POST THIS CARD SO IT IS VISIBLE FROM STREET �, t i ,i• 4uBUILDING INSPECTION APPROVALS -PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS s_ ::`.. . 2 s r 3. HEATING !NSPECTING APPROVALS I V.ALS ?! •.., 1 1AMI j ICA I - O HER- � Lp _7j J. WORK SnALL NCT PROCE':O UNTIL THE PERMIT WILL BECOME NULLAND VOID IF CONSTRUCTION INSPECTIONS INDICATED ON THIS CARD NSP�lCTOR 4AS APPROVED THE VARICUS WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE CAN BE ARRANGED FOR BY TELEPHONE II r1D WDITTQIJ AI r1TIC Ir`ATIl1.1 -r r DOL-AR DAV l S V�OAD 123:25 i CONG. LaT o FouHOAnoN o -LO'T 1-5 CU - ¢i � =LOT I'L IS,IS6 Sq.F'T. i I = Lo-r I S = —Lo-r I L I JOB # 85-420 CERTIFIED PLOT FLAN PREPARED FOP. LOCA7110N. LOT-12 ©OLAR DAVIS RD CVILLE SCALE 1 "=40 ' DATE. 06/02/66 REFERENCE: PB 403 PG 27 LEBEL-SOLLOWS I HEREBY CERTIFY THAT THE% BUILDING SHOWN. ON THIS PLAN IS LOCATED ON THE . __ --� GROUND AS SHOWN HEREON P�Z� OF 44Ir ARNE H. down cape engineering OJAIA -o #26348 aQ CIVIL ENGINEERS LAND SURVEYORS Z �9�� 'psi 4A gJ POLITE 6A YAPMOUTH MA DATE RE N SURVEYOR p . T../..7.�..':. _? ��y SEPTIC SYSTEM ilk E Assessor's ma and lot number r STALLE® IN CO Sewage Permit number U. o� g .............................................. WITH TIT \/ �ONMENT�A r I , Housenumber ........................:........7.,3..........:.................::..... 'F�MAV tr� TOWN OF ,BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO: ...............d eLxl.....;../...... . .......................................................... TYPE OF CONSTRUCTION ............:........... C9..©D�...................t ................................................................ ' ................0.1;7�E..... s.......19. TO THE INSPECTOR OF BUILDINGS: The undersigned ereby applies for a per . according to the following information: Location .......... /....1..�......... .1l.... .. .. ... ......................................................... f Fig' ProposedUse .................. '` ? :.11..cy1. ............................................................................................................................... Zoning District ....................[ ...........................................Fire District .............C.. .................................. Name of Owner ......... .� ..............Address ....../'v (% .fi e- /-3 Z- ,,((I�,,�rM ram✓ ............................................:..7............. ......... Name of Builder .....�-RJ-..`°.AP%—P.:5....b ...............Address &-���j............. .................................................. Name of Architect ..... 5?g:;—A-.!OQ..........V .� ..........Address �................................. ..................... .......................... Number of Rooms ...................5.......................................Foundation ......... ..........Ada!1 ...........tre. ............ Exterior .............� 1..��?-�1.................................................Roofing ........................�'�. .r............................................... Floors 6l......Q.O` Interior <v _ _ ._ • . Heating ..................G!�.. .....................Plumbing ���-/C /C- Z lQ ..................Approximate host `�� 0,�U Fireplace J..®1. ................................. / ........... ... ..................................... ..................... q1� �� Definitive Plan Approved by Planning Board ___ _ __ ____ ______1&__. Area ..... Diagram of Lot and Building with Dimension ��� Fee . �. ... SUBJECT TO APPROVAL OF BOARD OF HEALTH �< I OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Ba stable regarding the above construction. Nam ............................................. Construction Supervisor's License . ... .. ../ S L S TRUST ry No ... Permit for ...S.t 0..................... Sing,�,�Jj4!�ily.....Dwelling .................. ....................... Location ,,,Lot t...#.1.2 7.3..D.o.lar.....Davis. . ...Road . .. .. . ...... ...... . . ... Centerville Owner ......S..L...S.....Trust.................................. Type of Construction ......Frame.......................... ................................ P16t ............................ Lot ................................ �.A'Permit.Granted ...... ...................19 86 . .....1 i Date of Inspection ...71... Date, Completed ....... ..........19