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HomeMy WebLinkAbout0154 KNOTTY PINE LANE ..- � � � .`- �� i 'Y.. � �r tea , � U..� _g F. .. h � �i � � ': � r li ��'.� .r ..... '., a ar v i ... .. .:� _� u i � r � � � 1. .� �..- � �1. { J _ r � ;. ., ,. '. .' ^ � v � �.� �� �. 11C— .. _ r of Barnstable *Permit# ° ACT 22 ? ervices ExpeQ 6 date 0,? . Regulatory S_ r BAB ME MA Thomas.F.Geiler,Director OPIW Building Division Tom erry,CBO, Building Commissioner 200 Main Street;Hyannis,MA 02601 www.town.barnstable.maus Office: 508-862 4038 Fax: 508-790-62.30, EXPRESS PERNUT APPLICATION RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number . v. Property_Address gesidential Value of Work Z� b / Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address % G fv L S 4 �; c Telephone Number i Contractors Name T f JCr i"'� J eP Home Improvement Contractor License#(if applicable) 1 ,� 9 3. Construction Supervisor's License#(if applicable). LA VWorkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner [�r I have Worker's Compensation Insurance Insurance Company Name �> r d•t;z Workman's Comp.Policy# 1jj C 3 `2`l L/C> Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) 4 Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to r- ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side of doors ❑ Replacement Windows/doors/sliders.U-Value maximum.35 #of windows , Smoke/Carbon Monoxide detectors 4 floor.plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *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 opy o : =ement Contractors License&Construction Supervisors License is e uir SIGNATURE. 6:1wPFtESIFORMSIbuildingpermitforms\EXPRESS doc r AC"" CERTIFICATE OF LIABILITY INSURANCE DATE(MMOQYVYt) �- 5/15/2012 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 temis 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 FRANK L HORGAN INS AGENCY INC CONTACT NAME; 44 B A R N S TA B L E ROAD PHONE(A/C.No Ext: 508 775-583 FAX acLNol: ($08)775-6688 HYANNIS, MA 02601 EaMAIL ADDRESS- INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: LIBERTY MUTUAL INSURANCE TAPE & ISLANDS CONSTRUCTION COMPANY INC ED INSURERS. -- PO BOX 210 - INSURERC: CENTERVILLE MA 02632 INSURERD: INSURER E: INSURER F: -- COVERAGES CERTIFICATE NUMBER: 13095795 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIOW AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAII AR _ -- ---AU13L-SOB P INggRj TYPE OF IF6URANCE POLICY NUMBER N(ttVOLV IYIUNOD YY UUM GENERAL LIA131UI Y EACH OW(FLRENCE $ tX_Iv1MER['LALGENERALUA131UTY _oaxrrelroel—$ -- __JIMSMADE CX7C;I1R MEDEXP(Arry one person) $ -- -- PERSONAL&ADV IPllURY $ _ _GBJERALACCRE_CATE $ GENL AC(,REC'a_AT_E UMIT APPLIES PER: PRODUCES-CCWRCP ACC $ _— -.__ POLICY _ P ? --- LOC $ AUTOMOBILE UABIU IV a'"„ tril $ ANY Al frO BODILY INJURY(%perscn) $ - - A LO ED AA�UED BODILYINJURY(Per wdcl rt) $ - -- NONCMMED acd rti $ ---- HREDALITC1i ` AIJT0S _ $ UMBRELLA LIAB OCCUR EACH OCCURfr=NCE $ -- EXCESS LIAB (-.LAIMS MADE ACr.RE('.AIE $ DED (-_I RETENTION$ $ —. $ A WORKERS COMPENSATION WC5-31 S-377540-012 5/7/2012 5/7/2013 / TORT LMTS AND EMPLOYERS UA6IUTY V/N ANY PRC)PRlTC)WPARTNEWEXECLIV[ NI E.L EACH ACCI------._-_.----.--------_---_.—, (M3ndatory in EL DISEASE-EA EMPLOYE $ —110000(? II ,deSl71LY.LB dPJ DEtirRlrrrTCN nF OPF.RAMONS IAmv E.L.DISEASE-POLICY UMff $ 50000() I DESCRIPTION OF ERAT1om/LOCATIONS/VOiCLIS(Attach ACORD 101,Additional P...ks SchedLde,If more space is requlreq Workers compensation insurance coverage applies only to the workers compensation laws of the state of MA. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TOWN OF BARNSTABLE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200 MAIN STREET ACCORDANCE WITH THE POLICY PROVISIONS. HYANNIS MA 02601 L ALRHORRED REPRESEMAT VE L Qc .1 CCU C Jeff Eldridge v UUU Cc�1968-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD ,1pnJ)' ,u 511b/2012 >t:5B:0y AM Pala 1 of 1 ?l as .:erCifi.:aCc �:.ucel. 5,:�1 si.q,crsrtlr_s ALL previously issued cCPtifiLntes. .......... License.orregisfration•valid.for .mdividulus e only before the ex:piratro,n.dke If found return tiro: Office:of Consumer Affairs and Business Re ulatiod 10 Park Plaza.--Suite 5170 g1 :I Boston,MA 02116 r' al thout srgriature i ._ Massachusetts- Dcpurtmcnfof Public Safe Board of Building Regulations apd.Standariis Construction Supervisor License License:;CS 74660. JOSHUAX KOURI ' PO BOX 210 t CENTERVILLE. MA 02632 s Expiration: 2/t2/2013 '('',mm i-i,-or .Tilt• 1g1�ns ✓1LC VGY�i7/IYJ,OILI!/�(L/L'�—� / �,�,���i���724Aa9%1tCL6CGC6 Office of Consumer Affairs&Business Regulation I V­* HOME IMPROVEMENT CONTRACTOR Re istration 9 165936 Type: Expiration 4/9/2014 Private Corporation CAPE&ISLAND C'0NSTRWGTIOM CO INC. JOSHUA KOURI ) } 55 ELM AVE; HYANNIS, MA 02601 ;, ' �: Undersecretary r • iVlassachusetts- Department of Public SafetN Board of Buildinlly RelIrulations and Standards Construction Supervisor License License: CS 74660 _- JOSHUA X KOURI PO BOX 210 , 'CENTERVILLE, MA02632 ' Expiration: 2/12/2013 Trft• i9m('nnvniccinnrr r, - - xa Date Sep 29 2012 ape & Islands Construction Co Po Box 210 Centerville Ma. 02632 Terms 508.775.7663 r . Ship via Ship Date 3 &7 A i ? farMwl Vick Lejava (508)775-3886 154 Knotty Pine Centerville MA. 02632 United States CERTAINTEED Certainteed Shingle Roof 5,890.00 Strip existing shingles from roof. - Secure any loose sheathing. Install Hicks brand vented_aluminum drip edge. Install Wip brand Ice&Water Shield to all eves, rakes, valleys and all protrusions. ' Install Surround brand Synthetic Felt Underlayment. Install Certainteed Quick Start starter shingles to all rakes&eves. Install Certainteed LIFETIME architectural shingles. Storm nail all shingles, (State building code requires 4 nails, we use 6) Re-flash all vent pipes with new boots. Install Rigid Vent II ridge venting: Remove and dispose of all job related waste. leave your property looking like we were never there! Provide all manufactures warranties and 15 year labor warranty, it's the longest in the business. Please note our wind warranty is also the best And longest available ANYWHERE! Total(0) $5,890 00 S gnaiure Payments $0,00 Balance 0 Page 1 I The Corr mon'wealth of Massadiusetis , Deparhnent of Indus at Acciden&. Office. of Investigations 6M Mashing r,41M Stmet. Brstai M4 42111. .: wnrw mars&gm1ditr Workers' Compensatit�n.Insurance A;'ffidav t: Btiu�ders/C�ntraetorsfE�eetric ansiPl�mbers Applicant Information Pease Print Legibl Name(Bosinew1'Oiganization1idividaal): .91. � bi e ' Address: 9 City/State/Zip: .e14 �/�l Phone# `�� - - G ✓� . c 3 .G Are. au an employer?Cheek the appropriate box: Type of project(required): 4. .I am a ctantractor and I 1. � am a employer with ❑ � . 6_ .❑Ptew construction ., employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed an the attached sheet: Z- ❑.Remodeling ship and hat*e no employees These.sub-contractors have $_ ❑Demolition w for me in a employees and have w+oalcers' orking any��Y•, 9: ❑Building addition [l 0 worlCer3' comp.tnaattanre comp_ins�um3c'.. required-] woc•] 5. ❑ We.are a corporation and its 10.❑Fectrical repairs or additions 3.❑ i.am a homeowner doing all wo& - e�cm have exercised their 11.❑Plumbing repairs or additions nrys eSt [No workers,camp. right of cxemptiah per 1wiGL 12.❑:Roof repairs insurance required.]r c. 152, §1(4),and we have no employees.[No workers' 1.3,❑{)then comp.imoonm required.] *Aay apphcaat that checks box#1:must also fill out the section belowshowing then workers'ca npeusation policy Mfonmitinb Hameowam who submit this affidavit indicating they an doing all wral and then hue aut &con=wrs must submit a new affidavit indicating such FContractors that check this box mast attached an additional sheet showing the name of the saw-contractm and state wbethu air not those entities have emp3nyees. If the sub-watt ams;have employee they mast:provide their workers'comp.policy number. I awn an ernphpyer that is providing workers'col pensa on haurance for my employee& B�eloty is thepoHcy=d ob sfte in ormatioan. L Insurance Company Name: . � r � Policy 4 or.Self iris.Lic.#: �'�i�t 69 > / Y' t., Expifstion Date: 1 VV l/ zz Job Site Add ess: �l ' l —.7 S�'/r� l — city/Stzwzq) l�l(11�G Attach a copy of the workers'compensation policy declaration page(showing th,e: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 farm of a STOP WORT.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 a cor verifimficn- ldohembycetW,Wy as th nand ffiss o.fpe ury that Me in ormaden previ&d ai ow is Gros rand correct Si Date: �- 3 Phone#: Ile 0jokial use oalty:.Do not arrite in this area,to be coaupT.astad by city or toms o�4ciat City or Town: PermitUcense# Issuing Authority(cirde one): L,Board.of Health 2.Buitding Departlnent. 3.City/Town Cleric 4.Electrical Inspector 5.Plumbing Inspector Contact Person: Phone#� G OpTFkEF own of Barnstable *Permit & Expires 6 inonths from issue date Regulatory Services lee RARNSTABL, times Thomas F. Geiler, Director 'ATfoh+pY°` ]Building Division , o Tom Perry, CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address /�J Y1l C2rl�1 PIA1 7- 4,W,;; /er ;17A Residential Value of Work -F�r/� Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address -✓1G f l�l =� � Contractor's Name �� � Telephone Number SZ� `1/3 .. �Y-U Home Improvement Contractor License#(if applicable) /S9 -7/ 3 Construction Supervisor's License#(if applicable) L C '�,l �' ❑Workmen's Compensation Insurance � PERMIT Check one: PRESS P ' I am a sole proprietor ❑ I am the Homeowner JUL 16 2009 ❑ I have Worker's Compensation Insurance TOWN OF BARNS I ABLE Insurance Company Name ' Workman's Comp. Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All.construction debris will be taken to ❑ Re-roof(not stripping. Going over exis4g layers of roof) Re-side ❑ Replacement Windows. U-Value (maximum .44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Ffistoric,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. Home Improvement Contractors License& Construct Supervisors License is required. SIGNATURE: Q:\WPFILES\FORMS\Express\EXPRESS PERMIT.DOC Revise060409 The Commonwealth of Massachusetts "Department of Industrial Accidents Office of Investigations + d 600 Washington Street Boston, MA 02111 www.mass.gov/dia 'davit: Builders/Contractors/Electricians/Plumbers Workers' Compensation Insurance Af Applicant Information Please Print Legibly Name(Business/Organization/Individual): �ifU Address: ��� L�D/��L ��,?� flle � � City/State/Zip:6wxe�- / IV71 622&—'Phone.#: Are you an employer? Check the appropriate bog: Type of project(required): 1.❑ I am a employer with 4. I am a general contractor and I 6. ❑New construction e ces PY (m to full and/or part-tim.e).* have hired the sub-contractors 2. I am a sole proprietor or partner listed on the attached sheet. 7.. 0 Remodeling ship and have no employees These sub-contractors have g. '0 Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp.insurance comp. insurance.t required.] 5. 0 We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I I.❑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. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. xContraactors 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. M1I 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 Eo secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine tip to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the MIA for insurance coverage verification I do hereby certify under the pains and penalties ofperjury that the information provided above is true and correct Siznature• Date: Phone# Official use.only. Do not write in this area,to be completed by city or town officiaG City or Town: Per lit/License# Issuing Authority(circle one): L Board of health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: Information and. Instructions . Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. ...every p" erson in the service of another under any contract of hire, Pursuant to this statute,an employee is defined as 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 periori ance of public work until acceptable evidence of compliance %rith the insures ce requirements of this chapter have been presented to the contracting authority.' Applicants PIease fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contcactor(s)narne(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" I.he 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 bum leaves etc.)said person is NOT required to complete this affidavit. The Office of In 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 Departinent's address,telephone-and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext-406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 11-22-06 www.mass.gov/dia u� . Sr 'Town of Barn-stable Regulatory Services 9�uxrr B�s �` Thomas F. Ge'tler,Director o A61 Building Division m Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder T, ©iCIL. L-'04j94 r/4 , as Owner of the subject property ��N o� to act on my behalf, hereby authorize in all matters relative to work authorized by this building permit application for: / y lZiya� /� f L � �t rz�urdle- .(Address of job) -Al"0 9 Signature of r Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side.. THE Town of Barnstable 1p��� Regulatory Services Thomas F. Geiler,Director BABNsiABLE Building Division PrED A Tom Perry,Building Commissioner 200 Mairi=Street-Hyannis;NfA 02601 _. _..... vt wvv.town.b arnstable-ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER': name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINMON 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 tinder the building permit. (Section 109.L 1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,Hiles 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. Signati=of Homcov:ner 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 lo9:1.1 -Licensing of construction Supervisors);provided that if the homeowner.engagcs a person(s)for hire to do such work,that such Homeowner shall ad as supervisor." Many homcownm who use this exemption are unaware that they are assurning 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 we,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 responn'bilitics,many communities require,as part of the permit application, that the homeowner certify thkt hdshc understands the rcspo='bilidcs of a Supervisor. On the last page of this issue is a form currently used by several towns. You may caret amend and adopt such a fonnlccrtif,cation.for use in your community. Board of Building Regulatio s and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: A - Board of Building Regulations and Standards i Registration 152773 Ex iration! One Ashburton Place Rm 1301 p_ 9/28/2010 Tr# 275598 —i Boston,Ma.02108 ,i Type =DBA J GROUP DANIEL WOOD�''�;��-�` 38 EVELYN CIRCE;� CENTERVILLE,MA 02632 "P Administrator Not valid without signature j t -- -- 077 i Bohr fl u° Ing g%u aiion an tan ar s Corfstruction Supervisor License � License CS. =62822 f. \ ` `>Expiration 3/28/2010' Tr# 22125 t estnc 111, 1 G 38,EVELYN CIR i CENTERVILLE M = c 'A 02632 Commissioner f r C_4 Qy�*THE T��♦ TOWN OF BARNSTABLE • BARNSTA3LL - i "°9 a a'. BUILDING INSPECTOR waY APPLICATION FOR PERMIT TO .... ....... ... .. . , :. .... ✓ ..... ' !b` .............. .......... .. . TYPE OF CONSTRUCTION x .. 19.. /. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information; ^ Locationklo..'F.J.3.......... t �... ?� ... .......... �. ...... .................................................. ProposedUse ... . .... .. ...... .y<<�4...... . ........................................................................ ... ............................... . Zoning District ..... x...................................................Fire District ...1 : : �.L . .......`..... Name of Owner lets' �!�kt.s�:..�� �!.� ;yg.... .. ........Address ` W Nameof Builder .....................................................................Address .................................................................................... Nameof Architect ..................................................................Address .................................................................................... a Number of Rooms Foundation ....ff Exterior ✓ . . .. � :,.. !a:F . .� .............Roofing Floors ....................................................................Interior ......:?—.... .................11-4.................................................... Heating (/.�. �4� / ... ..............Plumbing ....../...� .5..�. .9C`.J.......... ................................. f ..���• `...7....... Fireplace ...!' �..............................................................................Approximate Cost ............,�........................... ............................ Difinitive Plan Approved by Planning Board ________________________________19________. E / �- Diagram of Lot and Building with Dimensions 160 , �^�G FOR ' ,. FTHOD ®ISPOBf`�� THE PROPOSED SUPPLY, GE r. SANITARY CATER. I;PRV >"v �AINAGE IS . E `E 7hl B, AND DR PC �� l�W OF BARN, BOARD OF HEp,LTN 'INSTALLER MIUS OBTAIN SEWA A LICr_NSED INSTALL SY TEM4 PERMIT, AND IttY I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding t e a ove construction. � Name,,�� . .G���.... . .�%k�.. .�....... Dao `° William E. Jr. -- ' DEC !L1971 ' � . No - ... Permit for .-. --single family dwelli � ( ' ................ .................. ................ -...................... / Location -. .P.iom..Lane.______.. , / Centerville ' --------..-.-'--.------------ 'C]vvnar ---. .E�.. ...Jr ' -----' - .---- -- >Type of Construction -'---'']�r�g��----- . ' ' . -~-~~^^^-^-'--------------'--'' ' � . Plot ' Lot � ' ' | _ [ p ^ { � Permit Granted ..... .7................... g7I | .. { / Dote of Inspection ..................................... � ( � . � `�� Date Completed ---.,p..-.��.��.���-l� ' � �� . PERMIT REFUSED ` .-..--.---.--....-.------... 19 � 6 ! � o - -.-_--.---.'_-...~....-..-'...~.--. . � � -..~--.'-..-.--....-~....-_--'--`.,' .. , � | ^.,---...,-.-.------.-^.-~..-.._---. ' _.--.---_.--..--.----.--..-..--.. . ' | �Approved ~_.�_____________. lA . . . -------.------.--~.~....-....-~- | ' | , -------'.--~.------.--..-.--..., -. ^ �� �