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0002 LAKEWOOD DRIVE
v Cd P< i ( Z_ lV—lei Town of Barnstable *Permit �� G Expires 6 months from issue date Regulatory Services Fee * aAMSTABLE. 19. �� Richard V.Scali,Director ; I r w PR ' (lf Building Division Tom Perry,CBO,Building Commissi � t' 200 Main Street,Hyannisl0�601 3 ?oc www.town.barnstable.ma:us'� 4 U Office: 508-862-4038 'rA Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number ' woD d PC/ l/* 0.2�.3 Property Address � �/ XResidential Value of Work$ ��i (�7 .1 U� Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address S S on r� ac_ Z,o � Contractor's Name F(Sf�(�.� �T� Telephone Number J *- 36 —;?w Home Improvement Contractor License#(if applicable) I D Email: /&'o Construction Supervisor's License#(if applicable)_ �J' 00971Y . WWorkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner ® I have Worker's Compensation Insurance Insurance Company Name /ism M Q2 Workman's Comp.Policy# Cu CC J70J - Y J!V 0 1p Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ` ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) JZ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. ' Separate Electrical&Fire Permits required. "Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is q fired. SIGNATURE: I C:\Users\Decollik\AppData\Local\Microsoft\Windows\temporary Intemet F/es\Content.Outlook\2PIOlDHR\EXPRESS.doc Revised 040215 Authorization. Form: IZ 5 - - as owner of the subject property, hereby authorize f3aker & Associates to-act on my behalf, in all matters relative to work authorized by this building permit application for.: Address of property: 2 Lakewood Drive Centerville, MA ;Signature of owner: Print Name:- - x Date: TWU Uoe*rise. CS-009714 a #yea€;frayssar fie - RICHARD P GARNEAt#,d � u PO Box 476 WEST SARNSTOLE. A p 68 ��irtas��t: 04?0412018 16��wt4namt I Office of Consumer Affairs a d }3ilsiness Regulation ` j A 10 park Plaza - Suite 5170 Boston, 'Ma$sachusetts 02116 Homelmp rovement Contractor Registration Registration: 162600 a Type' Supplement Card y i Expiration: 3/26/2017 KER & ASSOCIATES INC. w s _.. .._ ...__ . ...._... BA RICHARD GARNEAU P.O. BOX 923 _ _ CENTERVI'LLE, MA 0.2632 _ ___._ .. ...__....__.._..._ ..... _ _ __ _ ,. Update Address and return card Mark reason for change. [J Address Renewal EI Employment j j Lost Card $CA t £i 24M 0.5711 's/�� �r+rtar�ucazrcerr�l�r�L"l�t�rra•3�rc�rr.�rlfi "�. , ice of Consumer Affairs&Business Regulation License or registration valid for individul use only before the expiration date. If found return to: E IMPROVEMENT CONTRACTOR office of Consumer Affairs and Business Regulation egistration 162600 Type: 10 Park Plaza-Suite 5170 iratiao "3t26617; Supplement C. Boston,MA 02116 13AKER&ASSOCIATES INC- RICHARD GARNEAU 521 SHOOTFLYING HILL RD CENTERVILLE,MA 02632 tludersecretary Not valid without signatur Client#: 9742 2BAKERAS ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 4/2012016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE"-DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:if the certifcate holder Is an ADDITIONAL INSURED,the poiicy(les)must be endorsed.i# iUE3ROGATiON IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER Dowling&O'Neil Insurance Ag Pwa►Eae PAS( (ArG M� xt 508 775 1620��___ w SA+ ,,.No 5087181218 973 tyannough Rd,PO Box 1990 E»MAIL ) ...--- Myannis, MA 02601 508 775- 824 INSURER,J$)AFFORDING COVERAGE w NAIL N .__ . INSURER A:National Grange Mutual insuranc INSURED INSURERS Associated Employers insurance Baker&Assoclates lnc, � . .A INSURER C P O Box923 Centerville,MA 02632-0071 INSURER o INSURER E: _ E ..�.............. INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE INSURED NAMED ABOVE. FOR THE POLICY PER10o INDICATED, NOTWITHSTANDING ANY REQUIREMENT TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT 4Vi°rH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN I5 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ....ADAL€9UBH;�.,.,,..,.. ,..=jiOL�Y�PF POI.iC E�.l'..�,xR__i..._.. �,...,_.... LTR TYPE OF INSURANCE POLICY NUMBER 4MOL lYYYY MMIDOIYYYY LIMITS " A GENERAL LIABILITY MPJ7223M 4111912016 04/19/2017 EACH OCCURRENCE. 1$1 444 4flfl ii � 0 X COMMERCIAL GENERAL L IAelUTYENTED _ � ,fin � 5a00Q{}t}4, .. CIAIMS»MApELA j OCCUR E ?MED EI�P IAy€ne par«�rtr 1L»„��}Q4 PERSONAL&aDV INJURY $110041000 GENERAL AGGREGATE 2,444,fl40 GFN L AGGRPOATE LIMIT APPLIES PER: PRODUCTS-COMPIOP 2 OOO,flOfl P m,,1 pC2licv IE L LOC A AUTOMOBILE LIABILITY " fiOMF31iEp StNkF LIMIt ANY AUTO _ BODILY INJURY(Pe person) $ ALL AUTOS OWNED AUTOSULCO BODILY INJURY(Per ntd dan a AUTOS NON OWNED PROPERTY DAMAGE HIRED AUTOS Per Ac E $ ,,.._ d,w.-.I« .....mod,,......... _ �.....®... E ....... UMBRELLA LIARH_�;UAIMS-MADEOCCUR EACH OCiURR EKE EXCESS LIAB AGGREOAT£,� LtE_ Bum ION$,.. B wQRI(ERscoMPEN$aTioN WGC5005flfl24542016A 412312fl16 44t23T201TX WCwTATU pTH AND EMPLOYERS'LIABILITY N I TOP TA I ..ER 'ANYPROPRIETORtPARTNER/EXECUTIYEY I ...... w µ". OFFiCERWEMBER EX LURED? N r A e,:L j ACH Ac4;IL N „s5Q0,{lflfl (Mandatary In NH), E1,DISEASE EA EMPLOYE $5{}QLfl{�� i#yee describe Under , DESCR1t�TiON ,OF OPERATIONS A4Lrw,. _...,._»,... I _._ _..,.u... .,_...., POtCY..MT a$500 000 L TlSE E ._..a I 1 DESCRIPTION OF OPERATIONS t LOCATIONS i VEHICLES(Attach ACORD 101.Additional Remarks Schedule,It more space Is retlulred) Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements, Nothing contained In the certificate of Insurance shall be deemed to have altered,waived,or extended the coverage provided by the policy provisions, CERTIFICATE HOLDER CANCELLATION . SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ' ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED REPRESENTATIVE Q 1988-2010 ACORD CORPORATION,All rights reserved, ACORD 25(2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD #S16870611101180703 CBD The E'rltlrmoJtw@a7lth of`tNassaa:httsem Department of1ndustrlal.sfcc#aent Office of Invesdgadons, 600 Washington Street } Boston,JVA 02111 ►vww,mass govldlu Workers' Compensation insurance AMdavit: Builders/Contractors/EJectirfcianalPtutaber A__ s a `a nt b NazIIr+(8usintssJormizadontIndvichiiii) Address: C /strz; : 0.26, Phone#. Ar you att ett:pioyer?Check the appropriate boar: !. I am a employer with 4. ❑ I am a general contractor and I Type of project(required): eanployees(bolt and/or part-time).* have hired the stab�contractoas 6. Q New;construction 2.Q 1 am a sole proprietor or partner- listed oa the attached sheet. 7. 0 Rauh deling ship and have no employees "Chase sub vontrachtors have working for ono in any capacity. employees and have workers' S. 0 Demolition (No workers'comp. inaurarace comp. insurance.t 9. Q Building addition 3.❑ require&j S. 0 We an a corporation and its 10.[]Electrical repair$or additions I am,a homeowner doing all work officers have exercised their myself, t I,0 Plumbing repairs or additions (N+a workers'comp. right of exemption Pam`MCIL i U.13insurance required.,)t c. 152. 01(4),and we have no 12.[]]Roof'�repairs I am a homeowner acting as at employees,(No workers' 13.❑Adaej, general contractor(refer to M4) comp.insurance j 'Any VPlicsat t M c—hecb boa qt=0�till out the section below AowWX tbelr w co »t WOMWWt� subadt this sffids ixuti * �od ey E iconm►tm that cbwk M bolt tnwt amwbed aat Wdwow sbeea sbo�win the dten biro outside rootrsactttm out subatit a *alritdavit indicating such. =Ployom If the sutroontrNOM have � of the a �&W swte whyor thaw mtitto have � �they tst provide tbeix wotkete'co>sap.policy munber. t t am an ansp&+yar,that is providing►wrrhwrs'ca 1n tsra>rsa n, mpertarattan tnsaarwwo fer my"Woy"„ Rekw 1s the l P1►and jodt.sire Insurance Company Name f� Policy N or Self-ins.L c.* Expiration Date. Job Site Addmu: � 1D0 d �N 'V\Q Atth Cityrstatelzip: V / 026 3�. ac acopy of the workers'compensation paUcy declarat1013 page(showingthe Fa ow*to secure eovera a asei ration of atetd espiratioa date). S required under Section 2sA of MGC.c. 1SZ can lead to the imposition ofcrirnin4l penalties of a fine up to$1,500.00 and/or one-year impr�sonmenk as well a s civil penalties is this farm of a SfiC1P WQRiC alpenalties ORDER and a one of up b$250.{?0 a day against the violator. tie advised that a copy of this statement may be forwarded ttsvestipaons of the DIA for insurance coverage veriBcatioar. to the Office of I do htamwe car andor a pa and anatttee of peals+ r A41 At to feotrtlonr prauataGnat about is mart and co+rnct i o rut rase on* no not t to tldat. u►reat,to be canspletrd by clay ar tatvalt City or Town, Permit/Liceuse d tssulug Authority(€ircle sere): I.Board oC Health L Building Department 3.City/Tavt'o Clerk 4» 6»Other Etertrfcai tuspector S.plumbing Inspector Contact Persow Phone b: i �Ta+E rp Town .of Barnstable *Permit 59/ Expires 6 mo � r m s issue dyle Regulatory Services Fee (J MASS. i^ rt��+�`a..: a Q r] Thomas F.Geiler,Director p i639• r ' QED UAA� - Building Division 0 1 � LUU� � 0 • Tom Perry,CBO, Building Commissioner -'OWN OF g/. RNSTABLE 200 Main Street,Hyannis,MA 02601. www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RES.IDENTIAL ONLY . Not Valid without Red X-Press Imprint Map/parcel Number z.1 2.6 2 3 GcLT Property Address ? LG,��� rzzy� 1 _ (�r1 er U;Ile n1�9 0 Residential Value of Work 61 9crti Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address SGr")c(''6 Contractor's Name & , a - � a-Telephone Number ` 27c r 7 p � Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner Q I have Worker's Compensation Insurance t Insurance Company Name, Workmen's Comp.Policy# 730 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 Y{/'Illy'>� ❑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 must sign Property Owner Letter of Permission. A copy of the Hame,Improvement Contractors License is required. SIGNATURE: - C:\Users\decolliklAppData\Local\Microsoft\Windows\Temporary intemet Files\Content.Outlook\MY7NB4IL\FXPRF,SS.doc Revised100608 ACORD CERTIFICATE OF LIABILITY INSURANCE TIN " 103/04/2008 PRODUCE - - - THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION SCHLEGEL INSURANCE ONLY AND CONFERS . NO RIGHTS UPON THE CERTIFICATE 34 MAIN ST HOLDER. THIS CERTIFICATE . DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. WEST. YARMOUTH, 'MA 02673 INSURERS AFFORDING COVERAGE NAIC# INSURED Timothy Keating Dba Keating Construction INSURER A: COLONY INSURANCE 54 Lower Brook Rd INSURER B: CNA INSURANCE INSURER C: INSURER D: - South Yarmouth, MA 02664 INSURER E: COVERAGES THE POLICES 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. NSR AWL LIILBT9 POLICY EFFECTIVE POLICY EXPIRATION LTR PNSRO .TYPE OF INSURANCE POLICY NUMBER DATE(MMIDGNY) DATE(MIWDO^/Y) - - A GENERAL LIABILITY GL3326876 03/06/2008 03/06/2009 EACH OCCURRENCE $1,000,000 $ COMMERCIAL GENERAL LIABILITY - - PREMISES(Ea occurence) $100,000. CLAIMS MADE x❑OCCUR MED EXP(Any one person) s5,000 . PERSONAL S ADV INJURY. $1,000,000- GENERAL AGGREGATE "- s2,000,000 ..- GEN'LAGGREGATELIMITAPPLIESPER: PRODUCTS-COMP/OP AGG s2,000,000 POLICY JECT LOC AUTOMOBILEUASILITY _ COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) - ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS - (Per person) HIRED AUTOS - - " 8001LY INJURY $ NON-OWNED AUTOS (Per ecciderl) _. PROPERTY DAMAGE $ . (Per wedded) . GARAGE LIABILITY AUTO ONLY-EA ACCIDENT = - ANY AUTO - - OTHER THAN EA ACC i . AUTO ONLY: AGG $ ... EXCESSAMABREUA LIABILITY _ EACH OCCURRENCE $ - .,.)9CCUR a CLAIMS MADE - - AGGREGATE M . DEDUCTIBLE - S RETENTION S - $ WORKERS COMPENSATION AND - - x TORY LIMITS- .ER - - H OTH- 811PLOYFR4uABILI1r 7305A-6-07 03/09/2006 03/09/2009 E.L.EACH ACCIDENT f ZOO 000 ANY PROPRIETORMARTNER/EXECUTIVE - r OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 100,000 If Yes.describe under YES SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER DE=VFnON OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADD®BY ENDORSEMENT/SPECIAL PROVISIONS THE WORKERS COMPENSATION POLICY DOES NOT PROVIDE WOKERS COMPENSATION INSURANCE FOR TIMOTHY KEATING CERTIFICATE HOLDER CANCELLATION SHOULD .ANY-OF THE ABOVE DESCRIBED) POLICIES,BE CANCELLED;BEFORE_ THE EXPIRATOIE. DATE THEREOF, THE ISSUING INSURER LULL ENDEAVOR TO MAIL 21 GAYS WRITTEN . NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT-FAILURE TO DO SIT SHALL . - IMPOSE NO OBLIGATION OR LIABILITY OF ANY IN7 THE INSURER, ITS AGENTS OR " REPRESENTATIVES. . AUTHORIZED REPR TIVE ACORD 25(2001I08). ©ACORD CORPORATION 1988 r only � ►stCabo ;te 1t t� d Stanaar �:.�- ��'�,- �cose,oCreg►rnt►onaa,at►o►is?°: .,.�- f�a� 1,►etoretbe eating-Rego rn�g01 1��f„�-pp to°�arJs '1�., b oaYd°f Bu-.ton Ytaee R 1 L K�E!►1at�O�S a 1 O RPGTOR Ooe A�� a CN: .Bosto ._ 6°aL d of.,:.. OVEtv�ENS g31 PR 26 . 6 c HpN16\M n 143p53 f t1E Y r 9►St►at►o ` 6jVe 1a1412010 tbout s►gnat ReExPVat lv° �a1►d`�► �. . -s i G CGNgS G r ��Ilws N m KIP -ANY'K�Pj1NK�RD'��.�� -Aa - 54 p e-\R 9 '` I1 »achusitts D�puitmcnt of Publi-�c'S t}'ct� aRM- Boarcf of Building Regulatii�ns and Standards S Construction Supervisor Specialty License License:,CS SL 99351 Restricted to: RF TIMOTHY KEATING 54 LOWER BROOK ROAD SOUTH YARMOUTH, MA 02664 -�� Expiration:.5/11/2012 (Lmmissi.Iner Tr#: 99351 The Commonwealth of Massachusetts Department of Industrial Accidents - Office of Investigations ' 600 Washington Street ti Boston,MA 02111 www mass.gov/dia _ Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information / Please Print Legibly Name(Business/Organization/Individual): Address: S% Lzuer City/State/Zip: SovA Phone#: Sv� 7d� �2D7 Are you an employer?Check the appropriate box: Type of project(required): 1.0 I am a employer with 1 4. ❑ 1 am a general contractor and I employees(full and/or part-time). have hired the sub-contractors 6. New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ®Remodeling_ shipand have no employees These sub-contractors have i 8. ❑ Demolition working for me in any capacity. employees and have workers' insurance. 9. ❑Building addition comp.[No workers'comp. insurance p• 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 ` Roof repairs insurance required.].t c.152, §1(4),and we have no 12.❑ 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. #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. Insurance Company Name: 641-4 Policy#or Self-ins:Lic.#: 7 305',4— -p 7 Expiration Date: Job Site Address: 64 tiF, e§a,? City/State/Zip:, ��-J,P7Ae rn4 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 MOL 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 ofperjury that the information provided above is true and correct Si afore: Date: 16,104a? Phone#: BCD i 7 6 6-_27dr 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#: oF� 4 ♦�}� 1 9. Town of Barnstable Regulatory Services Thomas F.Geiler,Director Building Division Thomas Perry,CBO 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 �-h ,as Owner of the subject property hereby authorize l /M too `f- l T to act on my behalf, in all matters relative to work authorized by this building permit application for: Z 1-4 h-e wwA UQ C?,14' erdi 1p T/4 (Address of Job) u D Signature of Owner 15ate Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Intemet Files\Content.Outlook\MY7NB4IL\EXPRESS.doc Revised 100608 t - -------- - - ---- . - - 11130106 L Town of Barnstable *Permit v�q Expires 6 mont r m issue date Regulatory Services Fee Thas F.Geiler,Director ms ' uilding Division 2,Rm Perry,CBO, Building Commissioner NpV 2 200 Main Street,Hyannis,MA 02601 ffice: 508-862-�UhN OF BARNSTAB 'town.barnstable.ma.us Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red A--Press Imprint /parcel Number erty Address 2 /i� L•�Gv �/ C-P�1�PriA f/C dZO esidential Value of Work V Minimum fee of$25.00 for work under$6000.00 is Name&Address actor's Name k epc 4o y Qjs- r x� Telephone Number Sy t17 Improvement Contractor License#(if applicable)3D5 7 '-si-iperrse-# ff—applicable) orkman's Compensation Insurance Check one: ❑ I am a sole proprietor I am the Homeowner I have Worker's Compensation Insurance ce Company Name. :f4l-4 n's Comp.Policy# 7-7 0 of Insurance Compliance Certificate must be on file. 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 ❑ 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 must sign Property Owner Letter of Permission. A co y of the ome Improvement Contractors License is required. TURF: expmtrg 1306 r uo:lar rRL IG T0:150025$5107 P.1 ACORD �` CERTIFICATE OF UABILITY INSURANCE105/02/2006 Pttl . cs ONLY no COMM NO MGM tmw IM CENM",,m NMJML WM r RAle IDOM HOr *AM% EXTEND OR *L.TM TM COMWM Aimmm W TM Pm=n eEIJm. 34 1471m 8!'g"- MW MMMM, M 02673 BOMERS/IfFolown c0ve"GE NAM:! US lbe�ttAq se*C!A Wa'!1!>DG CON829me Zm Same 2615 Main St s � B=u tab3s, Wk '02630 •owa►s COMERA6ES THE FOLCES OF S MURARGE U BTED OMM HAVE BEEN f39UED 70 7NB MIRED MWED ABOVE FOR THE PMMV PE W MOICATED. NVWf WANDM ANY ROMMEMEM. TERM OR COMMON OF Aar CONTRACT OR ORIER 00CUMBIT WAN RESPECT TO WIOCN TM CERTIFICATE MAY BE ISSUED OR MAY PER AIK THE RIBURANCE AFFORDED BY THE POLICIES DESCRIBED NERRr 6 SUBMW TO ALL THE 7ERMS. EXC.LUBICNS AND CONOAIONS OF SUCH Pam. AGGRESM M MSHOWNMAYNAVEBM BYPAVCLWAS. L70 TMtsPl�YRINIY •oUoltt�w� =W Lm iJ1sA CM31MLMWV CPP0705789 03/06/2006 03/06/2007 EAmOMAROM s1,000 000 J► R M•fMERRILQl3BIALL-M91Tr rRunuR�e�a Mmo _ 050,000 OLOMU E �acun owvw ftr pmwo s 5,000 reno►sXs.wswar $1,000,000 ca"AADDAL6ATF s2,000,000 661LADB�EfUBELtIiAVPUESP6t FrAxmCTB-coroPsoO 82,000,000 water � LOC . AURlrswsttttatTr aaasP®s•AttsAswr a ANv ATw �,od•ts0 AuarNeoAttTao twoLr eltuTr a acraaumAutw �'••a•mtl M�sc,rtnls sa�tr twttmi wtwwtw,�was esr.�+s�a s �.■tsru•wmr AViDafar-EAACCOEIA • AmptilO a1iFA 7NV1 tAA4C • AuwoeLr•. ,GD s ooeEee•wettSlAttATitrr EApfOCQSORE s : s oEDtc7tILE • NEW" a s 8 •Y•ISQwCmmmo mom 73053L39—"3 03/09/06 03/09/07 ZAWAILUT A1M Of ELEaaIAoaDENr a 100,000 a Etaaaoutl EL99MM•EASMOIEE a 200,000 ru.=� eA ewnw-Powvumrr is 300,000 eretot {E101FOR NaP1pR►NOCR10iAI7®R7afEaCLTIS01fa1f00�5116O01�BRt7�Oq FIOYBOI� TIM 1MXM 28 ZXMMW T P09 COVERA= MMM MM WaRMS CQIIMEMWZCN POQ= COUNWATE NOLOW CAMCMIATION lMR9W iom ZMROVEIGM Mc. WMD AW .OF TM MM ONCIM POLMM a CMMUAM MR= tME QvWW 12 CO29l= 8T VXM lrtwaF 7ME own t awm vu. atwaDs to wL 21 Duo M•sTlef � ttultx to P.O. 80R 2476 e m GERM M tlo m"Mm To TM usr, mm reuse To no so aw" AGM OR OiltdJlDTB, 18l 02653 ■Neat No astllA at uvmm of No UPON To PWLW� to >?X 508-225—M07 N ZL O ` pyt p. c OG -A N �.,>.0 o as ISO w Z y � o a .1 - v - s 4 Department of Industrial Accidents Office of Investigations 600 Washington Street " Boston, MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers kpplicant Information Please Print Legibly dame ustness/Or atuzation/Individual ' wdress' S Loul&- �Vd Q �ity/State/Zip: . rAc.,)-ft�i1?/ 02 y Phone # re you an employer? Check the appropriate box:. ? .< Type of pro�ecf(required): I am a employer 4. ❑ I am a general contractor and 1 � Yer with�= 6. ❑ New construction. .. employees (full and/or part-time).* have hired the sub-contractors ❑ I am a sole proprietor or par tier- listed on the attached sheet 1 7• ❑ Remodeling ship and have no employees These sub-contractors.have` 8. ❑ Demolition . workingfor me in an capacity. workers' comp. insurance. - Y P tY• • 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its - officers have exercised their : '1-0.❑ Electncal'repairs,or additions required.] - ❑ I am a homeowner doing all work right of exemption per MGL 1.1.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12:❑ Roof repairs insurance required.] t employees. [No workers' 13:❑ Other comp. insurance required.] ryapplicant that checks box#1 must also fill out the section below showing their workers'compensation policy information::: :)meowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ntractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. w an employer that is providing workers compensation insurance for my employees. Below is the policy and job site ®rmation. r urance Company Name: C IV^i [icy#or Self-ins.Lic. #: 7 305 4 3 4-0,? Expiration Date D Z P_Site-Address: 2 L,�/✓ec,_Z� di City/State/Zip: / (���2 e — z !ach a copy of the workers' compensation,policy declaration page(showing the policy number and expiration date)., _ lure to.secure coverage as required under.Section 25A of MGL c. 152 can lead to,.the.imposition of.criminal penalties of a. ' e up ito$1,500•.00 and/or one-year irnprisomiient, as well as civil penalties in the form of a STOP WORK ORDER and a fine ap to$250.00.a.day against the-violator.-Be advised that a copy-of this•statement maybe forwarded-to.the Of#ice Of 'estigations of the DIA for insurance coverage verification. - 9.hereby certify and r the pains and penalties of perjury that the information provided above is true and correct. ature: _ Dater /l Z Z D )neM wk2� 26o — 270? 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#: 1 Information and Instructions [assachusetts General Laws chapter.152 requires all employers to provide workers' compensation for their employees. , ursuant to this,statute, an employee is defined as"...every person in the service of another under any contract of hire, Tress or implied,oral or written." m employer is defined as "an individual;partnership, association, corporation or other legal entity,or any two or more f the foregoing engaged in a joint enterprise,.and including the legal representatives of a deceased employer,or the ;ceiver or trustee of an individual;partnership, association or other legal entity, employing employees. However the wner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the welling house of another who employs persons.to do maintenance, construction or repair work-on such dwelling house r on the grounds or building aPP urtenant thereto shall not because of such employment be deemed to be an-employer." 4GL chapter 152, §25C(6)also states'that"every state or local licensing agency shall withhold the issuance or enewal of a license or permitto.,operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable.evidence9f.compliance with the insurance coverage required." 25C 7 states"Neither the commonwealth nor any of its political subdivisions shall- additionally,MGL chapter 152, § ( ) :rater into any contract for the performance of public work until acceptable evidence of compliance with the insurance equirements of this chapter have been presented to the contracting authority. applicants 'lease fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if tecessary, supply sub-contractors)name(s), address(es).and phone number(s)along with their certificate(s) of -. nsurance., Limited Liability Companies(LLC)or Limited.Liability Partnerships(LLP)with no employees other than the nembers or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have -mployees,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 ation for the permit or license is being requested, not the Department of be returned to the city or town that the applic [ndustrial 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 pemiit/license number which will be used as a reference number. In addition, an applicant lications in any given year,need only-submit one affidavit indicating current that must submit multiple permit/license app. policy information(if necessary)and-under"Job Site Address"the applicant should write"all locations in (city or tow n)."A copy of the affidavit officially that has been ocially stamped or marked-by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future:permits or licenses._ A new.affidavit must be filled out each . year.Where a home owner or citizen is obtaining a license or permit-not related to any_business or commercial venture (i.e. a dog license or permit to burn leaves_etc.)said person is NOT required to complete this affidavit . The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. - Me Department's address,telephone and fax number: _The Commonwealth of Massachusetts Department of Industrial.Accidents Office of Investigations 600 Washington Street Boston, MA 02111.. Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 :wised 5-26-05 www.mass.gov/dia °Ft � ti Town of Barnstable Regulatory Services + BAMMBM MASS. Thomas F.Geiler,Director 039. I. Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 t Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder 1, J�n��� , as Owner of the subject property hereby authorize_ io<-fi�,f 4� r fi to act on my behalf, in all matters relative to work authorized by this building permit application for: 2 Ll,/ec-,tA)z c�- C'% k-ti`4r, ✓�/�D 2 G32 (Address of Job) �—� It J/x lob Signature of Owner Date Print Name Q:FORM&OWNERPERMISSION Arss ice se (1st floor): THE Assessor riap and lot number �.... ..�.� r�. -SE t `♦ Board of Health (3rd floor): ...... . � � �^ Sewage Permit number I. .... ..... � ��� `�°I� BAH39T/1DLE S Engineering Department (3rd floor): J. 'i, 1 , i, V �A0` House number ....................................... .... .�...... � { ar Definitive Plan Approved by Planning Board _______________________________19-------- . APPLICATIONS PROCESSED 8:30-9:30 A.M, :and 1:00:-2:00 P.M. only TOWN'- OF, - BARNSTABLE BUILDING INSPECTOR • APPLICATION FOR PERMIT TO ..:.:..L.!. � ...Q�t,V ty�. !X,•„�� e'�79e /c1...s odc� ,�a.....e-..::... ............. TYPE OF CONSTRUCTION ::........:.....( .......................... ...............................::. . :.........s. n ` .......... / tt ....... ................19 , TO THE INSPECTOR OF BUILDINGS: Cx � The undersigned.hereby applies for a purnit according to the following informbtion: Location ....... ..�4 {�r�N�R � c7 \v� C.-t, 1:i�t-� ` .............. ........ ............... ... ... .. R ......... .............................. ......... 74�Proposed Use :.. ,1v..1 t�?:� .....: Zoning District :... :.�1 ..............:..........Fire District ................. t.......................................... 14......:..Address �U (�V:1........ . ,� Name of.'Owner .. Urt\;'�... !L 7 w� 1f Name of Builder .. �4 �e. ._ c.. .....�..:.. ` �.........:? ..... Y :.........Address Name of Architect ................. .../V. .P.........................Address .................................................................................... Number of Rooms ........ Q .. ......:. :...Foundation �..r. CDNei" c�........ ........ e. .... . ...... ......... .......Roofing ..... . ..... �xwDad ..... ...:.....Interior ..... kN.w .............................Floors T ....... .... .... c ..... ,S. T 5 ff Heating ....rox`ot :.. rr-. ." ...... tN5............Plumbing ....... ! ...°. . FireplacV.�.... ....... ......: ...... . ...:.....Approximate` ......Cost �®t e:.a ...............:...:.......... Area �37�... .........:...... .. . Diagram of Lot and Building' with Dimensions Fee ............SlJ.....D............. "7 e ic-l K \ v OCCUPANCY PERMITS .REQUIRED FOR NEW DWELLINGS' 1 hereby agree to conform to all the Rules and Regulations of the Town of B rnstable regarding the above construction.. L Name .... .. .................................... Construction -Supervisor's License !l.�•1••"•'"• %.... MICK, LORNA ; •2558 Permit for I . Addition/Change Roof - \ S.ing ,..l.. family Dwle11ing......... 1.1c-k�cvo ' � . - - � --�__ 3 • Location - ... r �, • Centervil,le.................:........`.... Lorna Mick r � , Owner ....................... ....................: ....: ........ • � �r Frame _ . • - �.-. � ` �. + � • Type of..Construction Plot .................... Lot --...... . ..... ........ Perrriit',Granted January 11 , 19 89 4 Date of Inspection .. �- • �' I Date Completed' ..... . r,.......19p9 RV •4 :�' t 't .. � ' it �. �''� s •� 6 4 �.�,:aa.,,l ;,,,g:,;,1+G '�S& w"`+ate =�t++" `,f7'w; '43€ kvi�'.✓ .` t4' s'- :9 'F`r4+wr%ac�1^ a7p.ii.c='S' ,.•1w�!y+ '�ai: rayPlr`f�%N;+ {"' srTv::i.:zwf..r+.. ...fsr.•.-:.,ic:r.Ap-i,ut_:�;..i,�^ :,s 5 S Assessor's office (1st floor): : Assessors•snap and lot number A..... !�a _ �a ... .................... Board of Health (3rd floor): �1 fee Sewage Permit number 1. :.... ......!...�,�/e-- ..!:...!. ) S A.,.3 BAHd3TADLE, Engineering Department (3rd floor): �� rA°a House number ( �o i639 ...I.................... ''�0 MAI pr Definitive Plan Approved by Planning Board ------------------------_-------19________ . APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO .......� .�"..`.....�..,V�'fJS....��e `!r'...,rF.�..�7....`I......... l�%LJc�t�S ,C,04�G{ x}J�I . TYPE OF CONSTRUCTION � T^ -� ,I ~� �v 19 47 ! TO THE INSPECTOR OF BUILDINGS: r �w The undersigned hereby applies for a pe.rrZtit according to the following information: CCyy;; P� G ))� _t- r r Location .3".�� �� `� . \V \ �GR � , e"e�Te V71 �Y ........................................................................................................... Proposed Use 1 K1 t M 9,do`" , ..................................................... ..........................................................................................1 T Zoning District ........................ ....✓...- 1........................r...Fire District ..................... .z. .... . r ............................ \` - f /' 4 Name of Owner'...!',UY � , �..... �c ....Address .� I.L1.... h'M!C�. 1.... y.�� ... � l 1(� �Qn� G1Vr Name of Builder ........ tf GcJ<1 ° / f'.. .-"Address...... - Address l�` � j1 ...`...........( Name of Architect ...0..... ...t..... j.Oy.e.......................Address Number of Rooms ........J ...................................................Foundotien .. «1...... . . Cr eTG. ^.... "........................................................ Exterior .......................C. �Gr/�1/ ............�........?:�.!...�i_a...- Roofing ...vo '....:?"....: `. '. .(a: ..S1................................. r Floors ....:w1 !!�.,: ............. d. 00�.......:....... .........Interior ......!..`:11.tl.S!!`z ........................................................ y...... � E,7Z!s7uCi uHeating ?.\ ....r"..... .lf .............Plumbing ...... n ........................:..................................... Fireplace ...........':b.�' ...........................................................Approximate Cost ......�© .�.Q... �.............................. Area ........:,-:.3.7�.. ................ Diagram of Lot and Building with Dimensions Fee ............................................. too �6 i CI& E - - OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS ` I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .........."� ..... '.............��.......................... l..eR U.12-1�2. Construction Supervisor's license ...�L.:.............:................ MICK, LORNA A=212-023 No A.2558.. Permit for Bldg. Addition/change Roof ... .......... .................................... Single family Dwelling ................ ,z.g4 A4* �o� point Road Location ................................................................ Centerville ..........I.................................................................... Owner ....L.....or...n.a...M,i.c.k.................................... .. .. Type of Construction Frame.............................. .. .. .... ............................................................................... Plot ............................ Lot ................................ Permit Granted ...January 11..........19 89 . ......................... . Date of Inspection ....................................19 Date Completed ......................................19 I 1' Zlf 01 N 01 BARNSTABLL BU I LD ING DEPARTMENT 1 I' L . HOMEOWNER LICENSE EXEMPTION l « f� Please print. DATE >i JOB.LOCATION �� 43; t; m e6 r—� Street �*; - HOh1E ER _I eet aOWN „ ' rection .o town., s ,,.a� PRESENT MAILING ADDRESS . i home. P one � — N�.:�1 lit �,. o r Pone 1tY town to to The current exem __ l P 'co a -dwellin Ption for homeowners" h 9s of six. units or was extended to include owner-occu 1 y ess 'an to allow such homeowners to en a e ivi ua for hire. who does not possess a license acts as supervisor. 9 9 an-, pn ,.._..,. (State Bui 1 g Code provided• tha e own t the er din Section :DEFINITION OF HOMEOWNER: r , .°Person(s') who , a `. ' owns a ... ., -:. parcel of land on which he/she resides or intend ;side, on .which there 'is attached or detachedor is intended to be A person who constrcts more accessor a one to six fami 1 td re considered Y to such use and/or farmys�r�ctures, .. a,, t ;;';`',rt`•,; a homeowner. than one home in a Y, on.atform• acceptable to thec6uildmeowner" tW0'year period shall not be for all such work shall submit to .the Bu.iIdi:n v Performed under the0bui-lding thatil-. she shall be'responscl��� signed P ml ection 1b� s{f :The under "homeowner"homeowner" assumes resp 'b • Building Code and other applicable codes�n�luiliiy for, compliance with Y 1 aws h the. Sta�e' The undersi undersigned " rules and regulations. Barnstable i homeowner" certifies that he 8uildin p +an'd that he/she wi111 comply minimum inspectionl1Q understands the down of P y with said r Procedures and requirements P ocedures and requirements— HOMEOWNER'S SIGNATURE � ~ APPROVAL OF BUILDING OFFICIAL Y dar i ; t s t Note: - Three .to comply family dwellings ply with State Buildi 35,000 cubic feet,' or lan g Code Section 127 p 9er, will be required Construction Control . { x. v { �• :. HOME .OWNER 'S EXEMPTION The cod e state that : "Any Home Owner Permit is required shall hcrformin (Section log be exempt 9 work for which a building Home � ' � shall p from the provisions of this section : ; Owner engages a g of Construction Supervisors shall Person(s) for hire to do ) prov.lded=fhai "'If a act as supervisor. " such,;work, that such Home';. Ot'+ner! Many Home Owners who the p use this exemption are res orislblilties unaware that the , for Of of a supervisor y are'��. assuming'� . often re g Construction Supervisors, (see Appendix p, Stilts In Section Rules-:arid�RegUla±ions , unlicensed Se' lous.Prob►ems, 2•Y5) ., This lack 'of: awareness Persons particularly when the Unlicensed In' this case our Board" Home ; OwneCY h`ires`r ,A ' •as.SU personas I t would with I i censed Supery Iscannot.. ..._pervisor !S proceed against _.... ..u t t Ima to LY respons i b I e, or•• The .Home Owner a To ensure that Gt` g communjfles' r the Home Owner Is full certifyrequire •as part. of Y aware of his/her-, res that he/she understands the1ereSroit ponsibll;,i,t`-1es, manyr;�� last g this ► p ns applicatlori, that the Nom' pa a of . issue I b e . c u III Ow e n are f s t l es ,e.r: , to amend a .form current ) °f a supervisor y:: ;� and adopt such Y used by several 'On the a form/cert i f I towns Mr• . ,Jj. cation for Use in You . .mjy x" Your common t � r a y i" 5I. w 0c,-43- CSVTtRU LLE. f rtW55 O T a 25,iw .cT . ay- Zoo i?Pf�c z3 II• . C � �s=6 4 q=c v' 32°O . o Assessor's ma and lot' number ... �. .�-3 �-- SE90TIC SYSTER Irk' BE Its sTALL . I. � NRPLIA. �I 1�a I Ff t.. Sewage Perm it number LQ.• ... ...... P R i`' I4 '�'`"°`7 ` S ' IT 'r' COD 'D TOWN Qyo�TNETp�♦ TOWN, OF BARNS' "AM" i • i BABBSTABLE, i F° 1639. VM BUILDING INSPECTOR APPLICATION FOR PERMIT TO .....44d..B�.Six,.QQm....0...S.J.Z gle...Fam1 Iy..C�YdQl i.Clg...................... TYPE OF CONSTRUCTION ....�1''JO o d...f rm�...d d ,�. o ................................:............................................. ........�T,Aae...3.............197.5.... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ....SRO.t...3.,......38 ...Annabell.e...P.aint...Aaad.........Gen.teruille.r..I�,lu .sachuae.t:t.s...D.2fa.tj.Z Proposed Use ..Addia.ipridl..Badx om.........(Res.i.den.ce).... . .............................................. ........................... ZoningDistrict ........................................................................Fire District ...... .............. Name of Owner .RUZ5.ell...K—&!AaXY..Terke.lsaen...Address .3.8.4...Aarlate.11e.-P.oira-t...Road................... Centerville , Massachusetts- 02632 Name of Builder ..ash.e...&,9...c1..boae................................Address ....same...aa...dboae.............................................. Name of Architect ..s.84??e...Aa..DQ7.e.............................Address .... =Q...ms...?.1 4ku.e.............................................. Number of Rooms .....1Qldditienal........................:....Foundation ........10'!„•Po.ur.e.d...C...o..n...c...r..e...t..o.........-...."......... 6 in existence Exterior ..1„ .re•dyvo...a...on...sh a...i. ........................Roofing ..............Au Floors ....gdr.Pet...on...P1.yW.Qod... ase........................Interior ............... X:Q.QX............................................ Heating A.Q.r.0.e.d...air...acid.d...tQ...s;y.s.t.er! )...........Plumbing ....................ao e.................................................... Fireplace ...............nane.........................................................Approximate Cost .........c10-,.5QQ.,.QQ..................... ............. ... Definitive Plan Approved by Planning Board ________________________________19________ , Area 2 /"� S' 1.9 ..F.t...................... �. 6-d Diagram of Lot and Building with Dimensions Fee -- .............. ............................. SUBJECT TO APPROVAL OF BOARD OF HEALTH a I hereby agree to conform to all the Rules and Regulations•of the Town of Barnstable regarding the above construction. Name_..:...-� ...... .. Tezkelaeo^ Russell W. & Mary / ^ K � 17719 odd to mloola ` N� -----.. Permit for ---------.�-- � � family dwelling ' ..........`--.��— —.. ��~�---. w� ' --' ------ - Location --'...'.---.-.--.--.-'--....-- � Centerville � .-------------------------.. � Russell W. & Mary Terkmlmeo ' Owner .................................................................. ~ ` frame - Type of Construction -------------- . . . --------------------------. ~ Plot ............................ Lot ................................ � Permit Granted --..^Jg�.'3-----'_lg75 . ` * ^ Dote - V ' ' � Date Completed '—/c�./..���.�.�.��................. ~ � PERMIT REFUSED ' -----.--.------------..� lg � �. ------------.-------------.. ] � ............................................................................... ' � � � '-----'--'---'--------'—'^----- ---------'----------'~'-----'' ' � Approved ................................................ 19 ^ ------------------~^----'-- ' | ' --------------_------....--- ` ` , 'L THE rp�f TOWN OF BAR.NSTARLE DAUSTABLE, i "6 9BUILDING JNSP TOR I / APPLICATION FOR PERMIT TO •�� GIG L,,L�Z.? .... ........ ..:: TYPE OF CONSTRUCTION ................. ..Sl............................................ ...�.1�.... ........... ......��.+t�......... I ..........`..v6 ..... ...�......19. TO THE. INSPECTOR OF BUILDINGS: The undersigned hereby applies for a per 't acc rding to the following information: ...........� ��Location 7 ....................................................... ••..................... ProposedUse ............. ............................................................................................................................................................... ZoningDistrict ... ............................�............................Fire District .............................................................................. f . � J/ � Name of Owner ........ ........... ....... / �'� .Address /'� �. ........ ............ ..'�T.......I..................................... Name of Builder ..�........ ..... ...... ................................Address Nameof Architect ................................/.................................Address ................................................:................................... Numberof Rooms ...............................�!%..............................Foundation ............. ...... .................................... f Exterior ................ .............................................Roofing .............../..... ......... ...�°...���.... Floorsip t...`�...... .:✓...............................................Interior ......, .�'tr� ... ..`.. ..... ........................................ Heating ...............://'/ ............................... ...................Plumbing .......... .......... ..................................................... q v Fireplace ............... ........ ..................................................Approximate Cost ......................... ........G........8..................... Difinitive Plan Approved by Planning Board ________________________________19________. Diagram of Lot and Building with Dimensions NG FOR `THE PROPOSED-METHOD OF PRI�ISPOSAL r SANITARY WATER SUPPLY, SEWAGE AND DRAINAGE IS-HEREBY APFd,. / TOWN OF BARNSTABLE, BaARD OF HEALTH -A LICENSED' INSTALLER' MUST OBTAIN SEWAGE PERMIT, AN6 INSTALL SYSTEM. ey D F I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. me ....`........:.................... ..`.................. Terkelson, Russell W. ' DEC 3 11971 No ... 31.. Permit for one stor:T y ......... single famil dtirellin � 464/� 7-S %7,r ...... ....................... Location ......Lakewood Drive Centerville ................................................ ........................... Owner Russell W. Terkelson ......................................... .................. r Type of Construction ...................... .#IAA......... ............................................................................... Plot ......................... .. Lot ................3 ..........�3................ MaY Permit Granted 71 Date of Inspection A ..................19 '7f Date Completed 31 r PERMIT REFUSED i ................................................................ 19 ............................................................................... { i ................................................................................ ............................................................................... ............................................................................... Approved ................................................ 19 ............................................................................... r _ ti r f iI C 8 cp OR ! i s 4o'w i SUS ►� vrl AND HA*V k 7FRkS) SSA CeNTaRvI e a,X3.1 C►4►.k =