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0157 LONG BEACH ROAD
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Thomas F. Geiler,Director �A �0 l a 2014 Building Division �-� �lZ�ley Tom Perry, Building Commissioner �J TOWN TABLE 200 Main Street, Hyannis,MA 02601 — Office: yrW - Fax: 508-790-6230 EXPRESS PERNHT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number aUs0;2 pCJ. Property Address ! �oAl& LLr�Gif �f�� BVT l"Ifl esidential a Value of Work T �w� 06. Owner's Name&Address 6LA&tS ap )gfr Yia; W©ODV,-&W bgyC 5A►-5oT7q Contractor's Name APA21 bea r /lorl Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) �0 / 730� orkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I the Homeowner [�'I have Worker's Compensation Insurance. Insurance Company Name MAJ�IL SYI WTI Workman's Comp:Policy# S�- Permit Request(check box) ❑ Re-roof(stripping old shingles).All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-;ide Replacement Windows. U-Value .3 (maximum.44) 3"'Other(specify) J�C 14eC 'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. Signature Q:Fomis:expmtrg Revised121901 ® CERTIFICATE "� 'L`iA_ � � . ,a�oRo CAT E Of B I L ITY INSURANCE DATE(MMIDDIYYYY) 12/03/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLYAND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT,CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A_statement on this certificate does-not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Mark Sylvia Insurance Agency,LLC NAME: Sarah PHONE 404 Main Street 508 957-2125 No: 508 9572781 E-MAIL ADDRESS:mark marks Iviainsurance.com Centerville, MA 02632 INSURERS AFFORDING COVERAGE `NAIL# r INSURER A:Montpelier US Ins CO INSURED INSURER B:Travelers Insurance CO . . West Bay Management Trust 770A Main Street INSURER C Osterville,MA 02655 INSURER D: INSURER E• INSURER F: COVERAGES CERTIFICATE NUMBER: 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 TOWHICH 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF MNUDDYEXP /YYYY LIMITS A GENERAL LIABILITY MP0006001012633, 12/4/2013 12/4/2014 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 CLAIMS-MADE a OCCUR MED EXP(Any oneperson) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LA REGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG "$ 2,000,000 X POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED: BODILY INJURY Per accident $ AUTOS AUTOS ( ) HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS Per accident $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION UB-7615805A 3/23/2013 3/23/2014 WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN X ER ANY PROPRIETOR/PARTNER/EXECUTIVE E OFFICER/MEMBER EXCLUDED? N/A E.L.EACH ACCIDENT $ 500,000 (Mandatory In and E.L.DISEASE-EA EMPLOYE $ 506,000 If yes,DESCRIPTION under E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS below ' DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Residential Carpentry CERTIFICATE HOLDER CANCELLATION (508)790-6230' SHOULD ANY OF THE 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 AUTHORIZED REPRESENTATIVE f ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD y Liceotc or re islration valid for individul use only !:A.\ Office of Consumer Affairs& Busloest Regulation >i OME IMPROVEMENT CONTRACTOR before the expiration date, it found return to: 9lstratlon: 152124 Type: - Office of Consumer Affairs and,[Business Itegulatloti a iratlon: 8R12014 OBA 10 Park Plaza-Suite 5170. ry;r P Boston,MA 02116 WEST BAY MANAGEMENT TRUST ADAM HOSTETTER ' 770 A MAIN ST. — OSTERVILLE.MA 02655 Uodcrsecretary Not valid without signature Massachusetts - Department of Public Safety i Board of Building.Regulations and Standards ('nmtruclinn tiuln•n i\Ilr . License: CS-094302 ADAM %R 770 SUITE A MAIN OSTERVILLE M5A Oft Expiration Commissioner 12/22/2015 y ' s • T _ } awaxsTa1= "'"a Town of Barnstable ►639. A`� Fp" Regulatory Services Richard V.Scali,Interim 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 F Complete and Sign This Section If Using A Builder I,l.Ct/[� S �� ,as Owner of the subject property hereby authorize 1)lt"4 ( Ste► e dE�g /"16/+1� I?vS'r to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) ��3 l 6S*Aatureq<"Owner Datt Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. T:\KEVIN D1Building Changcs\EXPRESS PERMMEXPRESS.doc Revised 061313 v • ' by = < � The Commonwealth of:Massachusetts r1 rn Department oflndustrial Accidents =! ' Office of Investigations 600 Washington Street a ( / Boston,.V4 02111 r �yy sr st'll'.mass.govIdla Workers' Compensation Insurance Affida-.it: Builders/Conh-actoi-s/Electricians/Plumbers Applicant Information f Please Print Leaiblti Name(Business;organizadon;Tndicldual): A2AA6 JO-5 t 1Ef— Address: M-A J S i City`State/Zip: 'Phone#: Are you an employer? Check.the appropriate box: Type of project(required): 1.Ll 1m a a employer u7th 4• ❑ I am a general contractor and I employees(full and-or part-time).* have hired the sub-contractors 6. New construction 2.ElI 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_- re ed.] 5. ❑ '%Ve are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11:❑Plumbing repairs or additions [ myself <self. No workers'co right of exemption per MGL c. 152 b 1O,, c and we have no I-).El Roof repairs insurance required.], employees. [No workers' 13.❑Other comp.insurance required.] 'Any applicant that checks box#1 must also fill out the secaoa below showing their worker'compensation policy information. ?Homeowners who submit this affid,vit 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 showtag the name of the sub-conrnctors and state whether or not those entities have employees. If the-sub-contractors have employees,they must provide their workers'comp.policy number. I ant ati eutplorer that is protidittg workers'coniperisation ittsttrance for n{v eniploy-ees. Below is die poMi v and job site infornratiott. Insurance Company Name: JILtl7} is�s• y�, `/ Policy"or Self-ins.Lic. Expiration Date: ;;z3 1 L/ Job Site Address: 367�7 At S I � City:Stateizip. :attach a copy-of the workers'compensation policy declaration page(shol*ing the policy number and expiration date). Failure to secure coverage as required under Section 25A of NIGL c. 152 can lead to the imposition of criminal penalties of a fine up to 51,500.00 and or one-year imprisonment,as well as civil penalties in the form of a STOP IFORK ORDER and a fine of up to S250.00 a day against the,iolator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DL4 for insurance coverage verification. I do hereby cerrif-under thepains and penalties of pe ijn-that the information pro+idegd above is true and correct. Signature: Date: Phone Official use onh% Do not is-rite in this area,to be completed bt'cih•or towlt o,(ji'ciaL City or Town: PermitfLicense 9 Issuing Authority(circle one): 1.Board of Health =.Building Department 3. Cin,•ITou'n Clerk 4.Electrical Inspector Plumbing Inspector 6.Other Contact Person: Phone#: 6 Engineering Dept. (3rd floor) Map 4:;376,1— Parcel 12&4�Permit# V V House# /�7 Date Issued 21 '—f Board of Health(3rd floor)(8:15 - 9:30/1:00-4:30) Fee Conservation Office(4th floor)(8:30-9:30/1:00-2:00) �• ,.wu Planning Dept.(1 floor/Scho Admin. Bldg.) Definitive Plan Pla in Board 19 pP �3! g • 9ARNMBLE, �tFO Mph s`� TOWN OF BARNSTABLE Building Permit/,Application - Project Str ress Village 0 Owner �hAT 19 1 PAddress Telephone &6 9 7 Permit Requester First Floor square feet Second Floor square feet Construction Type Estimated Project Cost $ �`aj�V Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes ❑No On Old King's Highway ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half: Existing New No.of Bedrooms: Existing New Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use Builder Information Nam Telephone Number A�Z Address (j License# � c /? Home Improvement Contractor# low714 Worker's Compensation#�/,,)C _.17iQ a 6 w� NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT) SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATU DATE U D G PE IT qF OWI�REA par, �. wnb% V + 'r �... ULIN z01 ,r ;Gid ' Q 'd. •�' '�• r F 4r1 -, III (•. .._f: �l OEPARTMENT W PUBLD =TFf=TY oNF ASHBURTOP� F I.ACE:.. ttM 1:3V `w V. IiOST ,1 01108 :lfi (A'N"110i!: ' )Pd :i!Mh ''RV:1 AR L I':I`.NSF xp `r *I ee;) tor:, ,r receipt. ,rul c:ir.�nye r e,ddr nr,l.i li.catio;, . 1S>W'A OS�RVIt NA pm qO i0'd 55SbOZb805 ONIA00b -LInV3ZWO dib= ZO 86-bZ--+►RW � oFTMe r� The Town. of Barnstable SABA,ST.,,BI$ , 9� 6 � Department of Health Safety and Environmental Services prFo�.y' Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Buildinfy Commi: For office use only Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MCL.c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization.. conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence-or building be done by registered contractors, with certain exceptions,along with other requirements. Type of Work: Est. Cost Address of Work: 6A//2 Owner's Name 4 Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under S1,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Na a Registration No. OR Date Owner's Name The Cu111111a$fili�3F,ealth of�lfussaclrusetts ;, _ �w �Denartmc�rrlof It�dit~trtol cide»ts �_ �. '• �ll/ceo%%n�est/gallons ' \a'•"; _r',� 600`fi u-ihut�;iotr Sircc�r ;��` �:�" r :y . _�+� `gititrtn:�111a�s:::(I�1,11 •tr;.. �t- ���. r,Wdr,kcrs' C urance Affidavit , I.,,��I:�; ,• � ,�,: �''' a,pnitc:int information • -Please PRINT 1.J�Z1,� � -- name t I6C;ttion' /<� l t�OIO/(�%� Of�' '% C tom` �✓ ' +R� ii«��; .i i:i9 «?< dl s. .�'. ,�: - .I.• - : , -,.. � :,>'. y�i !,�.��`i "I..rl.q.�'"��4`t'�i'��.t. ��..��' � I,` ��� 9 „� r citv CD am a homeowner performing>all work myselfa r 40i' n?ta€ i t. t. . t,;.1�h 80 !' •❑ _I am;.a.sole.proprietor ..:a.n'.d.._h.�avre w n.'o�-aor�n1eF�iw1.o.�rk+m.m•,o ca P_ct )i � vaty�' r# � •� a .. a as ; , e .•►�w. .+mow,+-�•�uwr."rw- ►�tt�'wv".^"-'��e.;.,.,.._,...__...,.,.. •' -- �-........,.:..:;. - -_. ..._. _...,., ._ _..:. -.�.... .mot.- I am an en over providing workers' compensation foyr mv,emplo. s working on this job. ` .9'i. . , •1... ffi 9!t}q',,t.a. �' .tom »`�A #1•,. PIT r 1 r' 5« ... comeanv name: Rau 11rvT•, Qa=QRW - & $9�i�Fi4AE►€��g '` d r ess: P_fir Rc�x 9-40 ad •. R iat: l4r ` F'`; t:$ .fl, :F "{s i1„• a.. ciry Marston :Mills;MA 02'6.48, _;�''>d�t=> £ I`= �, ! j►hnnc`#:" 428-1 177 ;- insuranceco. rredit Ganarnl jnc (10 00liC14 SWC 17005906 I am a sole proprietor, general contractor;�or`homeowner(ctrcle'one)and have'hired the contractors listed below who hay e ._. - .w.. n.'v ..,::. w•rr.M�VwOWnw,4�..KW iiw•M'.,ur.,aw'••�`9.Ww'.t' .. ..-w .,r.. a. ,.• gi.c the following workers' compensation polices: s gomram•.namc: w, address:. . ".«+ sE ,11n`Xa «ttF. f. f1 insura nce co Y• <.b Jvolic� # - •:e.�:•, .*r.,-:- ..rrt•:�- " : . . re—,-wz�. .,4;v...,-,nos,.,. ....,•— e2.9.•-.:> .e•r...;-�-o--•�.--�- iddresc- phone#: 0t3 `.. il 1 l'� insurance co " `jnolic�•# Attach additional sheet if neces_sa7... +.`•,+�t •�:�'• _° a: ,�.,, ;�..y. ::L...�.... .�,.a•z ,,... 1:�"^»_ Failure to secure coverage as required under Section,2 A of NIGL 15 can7cao,'10; c�mpos(t(on of citiminal penalt�esfofla f ne up"to SIS00.00 aadiur one\'cars'imprisonment as well as civil penalties in the form of a ST&PIWORK ORDER and a fine of S100.00 a dad against mc,'I understand that n Copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. ,e :,:e.ti " t' - • .�:.. 1r ,, " ;t��« f�'r� if�� �x � *i`i�-,:`;.'.3t ;'r *�}c ,.I :. i do hereby cerrij•i ir!• t •pains acid p /tics of perjun•drat tlic information provided above is true and 6iiiet. .>> Si__natu.r Date Print name _ .... n,. - Phone 8 177 urrrrr official use only do not write in this area to be cum�lcted b� cin,oe town oRaal `1:t�« city or town: ' -.4k-permit/license# - rilluilding Department s{ t (tr fi V . i ,, Uccnsing.Board ,_ . .. • 0 check if immediate response is required iu,-��, } � rY,iA° " " Osclectmen's Ufficr ` " f" C3I1calth Department F COMM person: ; phone b nOther 4 � ,r-• ,.in to i..'Y.I!1•\' ..... •.�; �,,�ea ,�.4�.�' ��i , -- -. - - - -- -- xe o g N V f V'1 N �CSR DR DATE(MMfDDY) AcoRP CERTIFICATE aF ! `L, N ..I j��,> -2 /Y 08/06/97 LIODUCER ` z ? �W. "�¢�, THI$CERTIFICATE IS ISSUED AS&MATTER.OF INFORMATION '' ONLY AND"CONFERS NO RIGHTS UPOWTHE CE€ITIFICATE Drake, Swan & CrockerrHOLDER:�T.HIS CERTIFICATE DOES'NOTIAMEND:EXTEND OR 19 Lot's Hollow Rd. ,PO Box 429 1 a ALTER14 COVERAGE AFFORDED BY.THE POI ICIES BELOW. - ?Orleans MA 02653-0429 <: COMPANIES AFFORDING COVET AGE IDavid D Rusty' COMPANY --- ---- ' PIo,,cNo, 508-255_3212 Fax No. .__ A Assurance Co. of Amersc. INSURED ; COMPANY --_ --- -- - B Credit General Insurance Co. Paul J. Cazeault etal. DBA.Paul COMPANY J. Cazeault & Sons Roofing C P 0 Box 2781 COMPANY Orleans MA 02653 D CC`1EP GE$ iTHIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE I OLICY PERIOD INDICATED,NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANYCONTRACT OR OTHER DOCUMENT WITH RESPECT -O WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDEO.BY.THE;POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL- HE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES:LIMITS SHOWN MAY HAVE'BEEN REDUCED BY PAID CLAIMS. POLICY EFFECTIVE POLICY EXPIRATION CO TYPE OF INSURANCE POLICY NUMBER ,, L TITS LTR yDATE(MWODIYY) DATE(MMlDD/YY) GENERAL LIABILITY "% ' GENERAL AGGREGATE $ 1000000 a X :07AMERCIAL GENERAL LIABILITY CFP25552812 t 05/0'1/97 05/01/98 PRODUCTS-COMP/OP?- ,G $ 1000000 - CLAIMS MADE OCCUR PERSONAL&ADV INJUR - $ 500000- ^WNER'SB CONTRACTOR'S PROT EACH OCCURRENCE $ 500000 _ i -- FIRE DAMAGE(Any one I, :) $ 50000 — MEDEXP'(Any one persot $ 10000 ` AUTCiAOBILE LIABILITY COMBINED SINGLE LIMI, S ,:..NY A'JTt- 1_L OWNED AUTOS - BODILY INJURY (Per person) $ .,CHEDULED AUTOS }' TIRED AUTOS BODILY INJURY S i ION-OWNED AUTOS I (Per accident) - - -- PROPERTY DAMAGE S JGARAGE LIABILITY AUTO ONLY•EA ACCIDE T $ — '!Y AUTO OTHER THAN AUTO ONL` j EACH ACCIGi VT $ ' AGGREG; 'E $ EXCESS LIABILITY EACH OCCURRENCE_ $ !:\1BRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM $ �" VvCSTATU- ' H- WORt:ERS COMPENSATION AND TORY LIMITS �_- i _R i EMPL OYERS'LIABILITY EL EACH ACCIDENT $ 100000 THE PROPRIETOR! --- --- $ INCL SWC17005900 08/09/97 08/09/98 EL DISEASE POLICYLIN $ 500000 - PARTNERS/EXECUTIVE I OFFICERS ARE: EXCL EL DISEASE.EA EMPLO' =E $ 100000 OTHER ' I DE�"^IPTIJN OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS ,.. : Roofing CERTIFICATE HOLDER CANCELLATION: , ;: : j PEACOCI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANC 'LLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL EI.DEAVOR TO MAIL Mr.k T1 10 �e DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, { BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY k .OF,ANY,KIND ON T E COMPANY,ITS AGENTS OR 5EPRESENTATIVES.. AUTHORIZE E ATIVE IV - _... ,. , j ACORD 25-S(1195). .,.., ®`ACORD CORPORATION 1988 Asssor's map and lot number �oZOS.....^ se ............. rY �, y 0 �. ^ SEPTIC SYSTEM MM7 2S I It,-ISTALL�D IN CopPLIAMCE Sewage Permit number 1'^ VIM ARTICLE II OVATE" y0f7MET�� TOWN OF BAR - BARNSTABLE, i "6 9 BUILDING INSPECTOR c,,�•o wav a' .r APPLICATIONFOR PERMIT TO ... .. ... ................................................................................. TYPE OF CONSTRUCTION ... .. •••...... . ............................................................................. ..... . ... ........ �........19.2 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit ac rding to the following information: . ..� ....... . -� Location ... /�....... !• . Oz�c.................. e+ �. +ts c -C,t..................................................................... ProposedUse .... . � .,:C� ......... . t ................ ................:........................... Zoning District .............�, �.. -/ P.......................................Fire District Wit.<.. ...... ............ p�l<f..........:............ . ! .?'��!+!.:..................Address ... .�•?=°cEc�r,.. .. Rr?�� ... J Name of Ownerw..... . ..4.. c7 t Name of Builder ..� ... �.�.v......:.............................Address ..�G�2.A-14:....... ............ ... .............. Nameof Architect ..................................................................Address .................................................................................... Numberof Rooms ................................................................ Foundation ............................................................................. Exierior ....................................................................................Roofing ......XF'`- ............................................................. Floors ......................................................................................Interior .................................................................................... Heating ..................................................:...............................Plumbing .............................................:................................... Fireplace ......................................:...........................................Approximate Cost ......�.�..�Qg,.............................................. Definitive Plan Approved by Planning Board -------------------_-----------19--------. Area .......................................... Diagram .of Lot and Building with Dimensions Fee ............................................. SUBJECT T APPROV�B—A.RD—CE--NEAL-k► - I I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .. .. .. ...... ..... .. ...................... Orr, Dr. Robert No .17891.... Permit for .......dormer........................... ................... Lon Bach Road Location ...................................... Centerville ............................................................................... Owner ...............Dr. Robert Orr ................................................... Type of Construction ...........ffame.................... .... ...... ................................................................................ Plot ............................ Lot ........... August 18 75 Permit Granted ........................................19 Date of Inspection ....f. ..........................19 Date Completed ................................ . PERMIT REFUSED ................................................................ 19 ............................................................................... ................................................................................ ............................................................................... ............................................................................... Approved ................................................. 19 ............................................................................... ...............................................................................