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0137 LUMBERT MILL ROAD
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Permit Req t(check box) n 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) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: 'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc: ***Note: Property OV94must sign Property Owner Letter of Permission. A copy of Home Improvement Contractors License&Construction Supervisors License is r ired. SIGNATURE: Q:\WPFILES\FORMS\bui Linermit forms\EXPRESS.doc 08/16/17 r ,ra T'l�Canzurarn�eaItlt ojf?�assr€t�it<rsetts DVarhffeutaffirdwaidAccidwt_s Owe of Im.w6gadom . 600 Washbigton Street Boston,AIA 02111 wivtumasngavIdia Warlmrs' CampensafrcaInstmnceAfdavft:Sider-JCantractursMec,,tdciansiPhmibers AppHcapt Infw=finu Please Prim Le r iiy Name(Susme miLtatioa&fv daal- ALL- � V i C city/ Are an employer?Checktheappropriateb= ' Type of project r L I am a employer itfi 4 ❑I am a general contractor and I FIB P 1 ( = P� * 'have hued ffie subLcortractors 6. ❑Newc=stxnctim employees(fa andlor part-time)' art time). I❑ lam a sole p�ropnetof or partner- Tisted en the attached sheet . 7. ❑Remodeling Them sab-contractors have ship and have as employees $.,❑I7emalififltY working forxoe'is employees andhare won wre °fib �capacity. � $ 9- ❑B,uilding addition IN4 wa�r8�' camp i.- 5 Comp.kw aml regriired_] 6. ❑ We are a corpmafien and its 1OL❑E tP#icat repaim or adder 3_❑ I am a homeo-vmer doing all woda officers have exmdsed their 1 L❑Plutabingrepair:s or addititms. of mysel€[No w�kecs'�F- � rigl� exempfiog per MGL 17❑Roafrepairs . ,i,suraz,cereed]1 c.15Z,§1(4k and we have no employees.(No wodoers' �-❑Other comp.ksamce required.] •may agg� lac cbedsbaz 0l=mst also sn a3t,i a swdonbeiawshmaag&ek wnaee com.ppmsatinuporcy iafo�sao� #]3omeawaerswhosubmit d3isdfidavifimirkwd . tbpyastloiagsnwaakaud&mbiireoutddecontr rims— sdfrmitamwaffidadtmdica6oaMeb fCaat<sciorst'bsC AWJ This biro mast attached m[addi6-al shad 5hoWIM9 %M=Ue of the sub-comzsotom xad emitksbrne emplopees.If the sub-cent idwbzm emploFt-as,tfiey saarlmW comp.policy nmmbm I arrt arr errrpinFsr>geatis pra�zdirxg u�vrBeets'toarperrsatimt insrirarres 'or m}*r�rrprlvl�es $eIadv is thepol cy and1ob site inforinatiam It>suranceCompanyy2fame: k> �'U a/l.f�✓� 'Policy-AL of sw-ins.11C., �'— 6 Job S<fe Addtms�� citylStd&zip: Cam' 1-L y/ I ZQ . Aftach a copy ofthe workers'compensafionpoNcy-dedaration page(showing the policy number and expiration date). Failure to secure coverage as requim under Section 25A of Mtn.a 157-can lead to the imposition of criminal penalties of s fine up to$l OD.OD an&or one-yearimpdsogmeutz as well as civil penahies,in fhe fa=of a STOP WORK ORDERand a fhe of up to$O_O!O a dap against the vio . Be ad-%dsed tilat a copy of this state*-snap be forwarded fn the Of of IFavestigabaas of the DIA for ins a coverage,mdffrahhn. Idio&et-ctby cerhyy a s and peruMm a.fprdk7 tiattlre inf ormagmprm rLed abate is/tb=atLd carred Sizmtam- Phone ik lt 0, rd um Cady. Do not arrrta in fh&area,trr berrrpieted by city or tarc-n neat City-or Town: PermitUcense g Issuing Anfirar€t)r(carte Ong): L Board of$•eaIili I Budding Department 3.Cjtrown Clerk d.Electrical Inspector S.Phunbing Inspector 6.Other Contact Person: Phone#: ormation and Instructuous jjasSac Geheaal Laws chapter 152 rega=all.employes to Praviffm vFD!kc&c0liT ensation for f ck employees- t Pnrsaani to ,an�Irryre is defined as¢; y person in a service of another under any cant act ofbire, express or iiaplimd'oral or written-" An.employer is defied as-an mdigiffiA paxin�,asso�fi an,�PMdon or other legal a y,Cr nay tevo or more of fie foregoing engaged is a Joint eot erld=,and inclndmg the legal=p=mffz&w of a deceased employer,or the rmoiver, or trustee of an individual,PMt eashiP,association or otherlegal *,� ;yam�Ploy�- Howevea the orthe o afthe- residss �F� • owner of a dw•eIInghonsehavmgnotmmef3mtliree arbnents andvvho . dweIIing bons of ano$er who eemplops Persons fn do ,cons an or as WDIk on such dweIImg house thereto shall notbecanse ofsacli empl e�be dEemedto be an enlployra" � or on.Elie groin o bm7£mg appurEenanf • MGL chapter 152;,,g25C(6)also states the t¢every state or Ioral licensinga cy shall Withhold the issaance or renewal of a Tcerzse`or permittn operate a basiness or to constmct btul ' in the co—Gn Pealth for nay table evidence of theh �nraace.coYetagerequix-ed_ apglicanf-who has no� rodnced acceptable ofits oIitical subcfivisions shall Ad�onally,M(ff-chap • 152,§25dM states fiTe�crthe nor�y P enter into any tra - prance ofpublio wotic mmI a evidence of compliances the reTnremm s ofthis chapter 1ieenpresentrd.to the contracting. Applic-an-ts , Please 01 oil the woxea',comp - n affidavit courpIetely,b chug i e boxes that apply to your sitr a On and,if necessa=Y, PIy em s) e(s), address(es)and pho enumber(s)alongwithtlie=tfir�e(s)of ice. Limit Liaboy Compam (LLC)or L> aitedLiab - Partneahips(LLP)'withno employees other than the members or partners,are not rbqcdred to worms'=MP on insurance. If an LLC or LLP does have employees,¢policy is regoned. Bead " thattiais affida�/naybe sahmRtDd to tiro Depa-tment of Industrial Accidents for confirm,16 n of insurance co ATso be to sigh and dat�the affidavit The affidavit should b ez�tnmed to$e city or town that the appfi for the pe�+mrt or license isbeing mque- not file D epattm ' of L A s7tU91A_c;mA=:s. ShoaldYou have any 'ons g the law or¢You ael regahed to obtain a wnrkea compensa jonpoIrcL please,callth�Dcparbu at thenom,•�berlisfedbelow: Self-ins�edcampaniesshovIdene�tflieir s elf_ij,�rr,-an cejic:=sr,=mbcronfha aPprope " City or Town Officb1s f - Please be sate that the affidav t is couplet:;and �Iegibly. The Depulmenthas provided a space of the bottom. of the cant affidavit for you to fill out in the eves the ' oflnvest3gations has to condact you regaa dig aFPh P Lease be sure to fill in the peam itlIiceose rnr„bes '� will be used as a reference M=ben In addition,an applicant that must subuut multiple pem1WHceose appIrcafi�s any gMa year,need only sabmit one affidavit indicating cmxunt policy info=aation.(if nay)and under-lob She'A the applir,�Should w,rife�sII locations za (�Y°_ town)-"A copy of tbZeffidavit.thatbas been officially " 'd or ma�edbyihe city or gown may be proms tine applicant as groofthat a valid affidavit is on fle ford 'PCMm s or Incenses. Anew affidavit must be:fMm&out ear-h.l year.'¢here a home owner or citizen is obta>IIing at or permit not related in any business or commercial vet - (ie.adoglicens0orpm= ttobumleavesetc.)sm4p is NOT x�dtocomplete this affidavit I our co wdion and should.you have any gaestions, The Office ofln - "°n -totI ky dam for yo= op please do noth=aato to give us a call The Dej aE ft nt.'s address,telephone and fax rnmzber: Thu_Ca of I1 ns�tfs , �f Arient t =Ca of tio� osto-n,MA 02111 Fax#617 727 77D Kevised¢24-07 Tn asa 9PZrI(Fa ) Town of Barnstable r Building Department Services BAIUMABM XABR. ` Brian Florence, CBO 39. Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.ns Office: 508-862-4038 Fax 508-790-6230 Property Owner Must Complete and Sign This Section, - If Using A Builder 1 �. 1 I ,as Owner of the subject property hereby authorize �� &tot on my bebA in all matters relative to work authorized by this building permit application for: rx (Ad)Aress of Job) **Pool fences and alarms are the responsibility of the applicant Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signature of er Signature of Applicant Print Name Print Name Date Q:FORMS:OWNERPERMISSIONPOOLS d - Rev:08/16/17 r' Town of Barnstable Building Department Services Brian Florence,CBO c ' Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us 1639. Office: 508-862-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: E JOB LOCATION: -` number stmet village � "HOMEOWNER": name home phone# ork phone# CURRENT MAILING ADDRESS: city state zap code The current exemption for"homeown was extended to include owner-ojzcupied dwellings of six units or less and to allow homeowners to engage an individual for ' who does not possess a lice e,provided that the owner acts as supervisor. DEFINITION OF HO OWNER Person(s)who owns a parcel of land on h he/she resides or inten to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached accessory to such a and/or farm structures. A person who constructs more than one home in a two-year period shall not be consi a homeowner. uch"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/sh shall be re onsi a for all such work performed under the buildin ermit. (Section 109.1.1) The undersigned"homeowner"assumes respo bility for mpliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that hats a erstands the Town of Barnstable Building_Department minimum inspection procedures and requirements and that he/she will ly with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings co 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 omeown performing work for which a building permit is required shall be exempt from the provisions of this section( 'on 109. 1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to dos ch work,thht such Homeowner shall act as supervisor." Many homeowners who se this exemp'on are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Rega lions for Lice ing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,pa 'cnlarly when th homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicense person as it woul with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that, e h meowner is fully a re of his/her responsibilities,many communities require,as part of the permit application,that the;romeowner certify th t he/she understands the responsibilities of a Supervisor. On the last page this issue is a form currently used by several towns You may care to amend and adopt such a form/certification for use in your community. QAWPFILES\FORMSIbuilding permit fonnsuDPRESS.doc 08/16/17 J Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standard Constriction`SOpervisor CS-111305 ti E Tres 06/01/2021 ANDRE YARMALOVCCH "{ 204 CINDERELLO TERRACE MARSTONS MILLS MCZ A02648 Commissioner r' I �/�f->`"Tir�vrrrn�zci, � �1'l�l�i�,rtac�iiseCl., r + Office of Consumer A s $usi.es. regulation �6�riHOME IAMPR MENT CONTRACT; Reg�strah 1724T6 ? Pei. Expi n; T�2/20,1B; DBA BEL I NbS�h10 E I�VIPRO�iEfi71EN7' ANDREI YARMALO 204 CINDERELLA TER V _fit 'L „x•--- MARSTONS M.1LLS 0 648 r " ndersec y reiar i P�,',m,4/2018 M/DDIYYYY) ACOREP CERTIFICATE OF LIABILITY INSURANCE 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 have ADDITIONAL INSURED provisions or 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 BRYDEN &SULLIVAN INS CONTACT 88 FALMOUTH RD PHONE FAX HYANNIS, MA 02601 A/c o Ext AIC No: E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: LM Insurance Corporation 33600 INSURED INSURERS: BEL ISLANDS HOME IMPROVEMENT LLC 204 CINDERELLA TERRACE wsURERC: MARSTONS MILLS MA 02648 INSURERD: INSURER E: - - INSURER F: COVERAGES CERTIFICATE NUMBER: 40046413 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 MAYBE ISSUED OR MAY PERTAIN, THF.INSURANCE AFFORDED BY THE POLICIES_D-ESCRIBED,HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDLTYPE OF INSURANCE INSD SUBR POLICYNUMBER MMIDDYIYYYY MM/DDIYYYY LIMITS LTR COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ MA TRENTED CLAIMS-MADE OCCUR PREMISES Ea occurrence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: - GENERAL AGGREGATE $ POLICY❑PRO - PRODUCTS-COMP/OP AGG $_ PRO LOC OTHER: $ ... AUTOMOBILELIABILITf COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED E NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY - Per accident UMBRELLA LAB OCCUR EACH OCCURRENCE. $ I EXCESS LIAB HCLAIMS-MADE AGGREGATE. $ DIED I RETENTION$ $ A WORKERS COMPENSATION WC5-31S-615667-017 2/11/2017 2/11/2018 ,/ STATUTE EORH AND EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N NIA E.L.EACH ACCIDENT $500000 OFFICE(MandaR/MEM NH) E.L. E.L.DISEASE-EA EMPLOYEE $500000 (Mandatory in NH) If yes,describe under _ - DESCRIPTION OF OPERATIONS below" .. s... . . .. E.L.DISEASE-POLICY LIMIT $500000 ._. iC (ACORD 0 Add". a .. UGJLh1Y IIl�N GI'UYEI'W IIVNJI LIJE'A IIVIVJI�VCHIVLCJ , • i ,,.,��.uu1G,-a��3"altaCteed if.^..::iu+:y3_C I_rfaJ:rL'!) WORKERS COMPENSATION INSURANCE COVERAGE APPLIES ONLY TO THE WORKERS COMPENSATION LAWS OF THE STATE OF MA. This certificate cancels and supersedes all previously issued certificates,only as they relate to workers compensation coverage. CERTIFICATE HOLDER CANCELLATION STRAWBERRY HILL CONDOMINIUM SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 'C/O CAPE COD & ISLANDS PROPERTY MGMNT ACCORDANCE WITH THE POLICY PROVISIONS. PO BOX"1144 OSTERVILLE MA 02655 AUTHORIZED REPRESENTATIVE LM Insurance Corporation �VVf a ©1988-2015 ACORD CORPORATION. All rights reserved. r ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 40046413 1 1-615667 1 17-18 WC I n0270258 1 1/24/2018 9:21:57 PM (PST) I Page 1 of 1 - " Town of Barnstable ° Bui . ing.. rest--;A roved Plans Must be;Reta�iied on; ob andthis_Card Must a Kept e Post-This--;Card„So ,osted Uittll Flnal,lns ection Has:Been Made �;, , Permit ;r �#z,'e ter. Where 'Certificate of.Occu anc: �s Re,uired,swchzBulding=shall,Not be Occupied until a„Final Inspecteon has been made Permit No. B-16-2030 Applicant Name: Jonathan Whipple Map/Lot: 168-020 Current Use: Zoning District: RC - Date Issued: 08/09/2016 Permit Type: Insulation Expiration Date: 02/09/2017 Contractor Name: JONATHAN N WHIPPLE Location: 137LUMBERT MILL ROAD,CENTERVILLE _ Est Project Cost: $4,000.00 Contractor License: `CS-078683 Owner on Record: KARAMI, NANCY E rs `, Permit Fee $85.00 Address: 137 LUMBERT MILL RD y FeePaid $85.00 .. r CENTERVILLE, MA 02632 Date. v8/9/2016 a Description: Air sealing,Approx 1000 sqft Cellulose into attic, insulate kneewall,insulate hose, mstall�entilat n chutes,install soffit vent. rr Project Review Req : Air sealing,Approx 1000 sqft Cellulose into attic, insulate knee wall,.i,nsulat'echose install ventilation chutes,install soffit vent. Q .� µ Building Official ra. P. This permit shall be deemed abandoned and invalid unless the work authorized by th s�perm�4is,comn enced w(thm`six months after issuance. All work authorized by this permit shall conform to the approved applicationand=th'e.approved construction documentsor�whiehthis permit has been granted: All construction,alterations and changes of use of any building and structures-shall be in compliance with the local zoning by 6wsTand codes. & t• This permit shall be displayed in a location clearly visible from access streetWi or.road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. The Certificate of Occupancy will not be issued until all applicable signatube§by the Building and Fire Officials are prouid tl on this permit. Minimum of Five Call Inspections Required for All Construction Work: 1.Foundation or Footing 2.Sheathing Inspection 15 3.All Fireplaces must be inspected at the throat level before firest flue Ding is'�nstalled r 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection £ "f 5.Prior to Covering Structural Members(Frame Inspection) ''" 6.Insulation 7.Final Inspection before Occupancy Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. 0 lr-r-j "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). ,�,,pz� S�.✓5- Building plans are to be available on site All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Town -of Barnstable *Permit# Expires 6 nypndis fr in issue jate Regulatory Services U PERMIT Thomas F.Geller,Director 2007 Building Division 5 a� 07 A� m Tom Perry,CBO, Building Commissioner ���N OFARNS 1 ABLE2oo Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-79 30 EXPRESS PERMIT APPLICATION - RESIDEN ONLY Not Valid without Red X-Press Imprint Map/parcel Number 01 Lot Property Address f [ M b -1 r'p [Residential Value of Work s 00 Q Minimum fee of$25.00 for work under$6000.00 Owner's Name&Addresste Contractor's NameA a � I'z �� Sz,-�19 _Telephone Number' 9 6 y Y 2 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 [2-I have Worker's Cio/mpensation Insurance Insurance Company Name /Ue w % tz rn P-1 if A+r f �Vn 5 C o Workmen'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 existing layers of roof) Re-side 1 Replacement Windows/doors/sliders. U-Value r ,# (maximum.44 t/ ere required:.Issuance of this permit does not exempt,compliance with other town department regulations,i.e.Historic,Conservation,etc. t ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement.Contractors License is required. SIGNATURE: Q:Forms:expmtrg Revise061306 I t 3 - _ Y i • ✓�ie -P o��/�acfitioelta Board of Building Regulations and Standards 4License or registration valid for individul use only ` HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: '. Board of Building Regulations and Standards Registratiars 126893 One Ashburton Place Rm 1301 Expiration $/3/2008 Boston,Ma.02108 i T e Supplement Card yp THE Home DepotAf Home Serv`c ®'ANIEL PELOQUIPf 3200 COBS GALLERIA pICV1/ #20 — Atlantic GA 30339 Administrator Not valid without signature _................. j t 0.. Danya hahot 7743230034 p.5 HOME IMPROVENWNT CONTRACT rr Sold,Furnished and Installed by: Branch Name: VtS�'oo Date: THD At-Home Services,Inc. ��- d/b/a The Home Depot At-Home Services / 345A Greenwood Street,Worcester,MA 01607 Branch Number: `'Fly' i J04#: �a� Toll Free(800)657-5182 Fax:508-756-2859 Federal ID#75-2699460 ME Lic#C 02439 RI Cont.Licb 16427 `_ CT Laic#565522; MA Home Improvement Contractor Rcg.#126893 Installation Address: 1��? �b c[ Y1t� VDx Qtt mVn e t* 0L5:)- City State Zip Purchasers Last 4 Di 'ts of DrFv 's Lie.#&E .N►1olYr: Work Phone: Home Phone: ( ) ( ) Home Address: tJtA (If different from Installation Address) City State Zip E-mail Address(to receive updates and promotions from The Home Depot): �Ut� w,Sl� utrl7At'�,red Proiect Information: 1/We/You("Purchaser°'},the owners of the property located at the above installation address,offer to contract with Home Depot U.S.A. Inc. ("H me Depot" to furnish,deliver and arrange for the installation of all materials as described on the attached Spec She,et# incorporated herein by reference and made a part hereof. Home Depot reserves the right to cancel this contract if,upon re-inspection of the job,Home Depot determines that it cannot perform its obligations due to a structural problem with the home,pricing errors or because work requ' complete the job was not included in the Spec Sheet or Contract. DEPOSIT PAYMENT OPTIONSt� (Subject to fund verification and/or credit approv J 1. Check,Cashiers Check or US Postal Service Money Order Q p CONTRACT AMOUNT $ _ (Made payable to The Home Dep)t). *LESS DEPOSIT $ 2. Credit Card*and/or other payment options-Circle One Below i a Visa MasterCard Discover American'wess �— BALANCE DUE ���,].t�f�} The Home Depot Home Improvcmeatt Loan The Homc Depot CZt Card ON COMPLETION $J�fLI tsv Account =Existing Account (Hil &HDCC ONLY) *Minimum 25%of Contract Amount due upon Available Credit:$ _ (ML&HDCC ONLY) execution of this contract. Accx#: Exp.,Dater -Namc as it appears on card: Indicate Payment Method For *By my/our signature below,I/We agree to allow Home Depot to BALANCE DUE ON COMPLETION",: chart a the above referenced idi card for theideposit i icath . ,« leicr's Signatsrc ' - p v "May be subject to Credit Approval,Fund .- HIL or HDCC Authorization Codes Verification and/or Credit Card Authorization Deposit Final Payment # n bI # DAM Purchaser agrees that,immediately upon completion of the work,Purchaser will execute a Completion Certificate and pay any balance due. Purchaser also agrees to be jointly and severally obligated and liable hereunder. Entire Agreement:This agreement and its attachments, including any financing agreement, contain the complete agreement between the parties and can not be amended or modified unless in writing in a separate agreement signed by both parties. NOTICE TO PURCHASER Do not sign this contract before you read it. You are entitled to a completely filled-in copy of the contract at the time you sign. Keep it to protect your rights. Do not sign a.Completion Certificate before this project is complete. Law prohibits home repair contractors from requesting or accepting a Completion Certificate signed by the owner prior to the actual completion of the work to be performed under the contract. You may cancel this transaction any time prior to midnight of the third business day after the date of this contract. See Notice of Cancellation for an explanation of this right. There will be a serivzce charge equal to 10% of the contract amount if job is cancelled by Purchaser AFTER the third business day,but BEFORE materials are ordered.There will ' *' be a service charge equal to 25%of the contract amount if jab is cancelled by;Purchaser AFTER materials are ordered. BY MY/OUR SIGNATURE BELOW, IIWE AGREE TO BE BOUND BY THE TERMS OF THIS CONTRACT. I/WE,.• ACKNOWLEDGE RECEIPT OF A COPY OF THIS CONTRACT AND TWO COMPLETED COPIES OF THE NOTICE OF CANCELLATION. BY MY/OUR,SIGNATURE BELOW,YWE UNDERSTAND THAT THE AGREEMENT IS SUBJECT TO REVIEW OF MY/OUR CREDIT HISTORY AND I/WE AUTHORIZE HOME DEPOT TO VERIFY AND REVIEW MY/OUR CREDIT + R__.__.�..-.. -.�..,..w.,.,n+.T.ien nn�Tila• a17n TIM rAOr,TttT',A/r.'TIPMA AI T I[An ITTTV The Commonwealth of Massachusetts -- ---� -- Department of Industrial Accidents Office of Investigations d 600 Washington Street Boston, MA 02111 s� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): lwv.,� Address: 4f City/State/Zip: b ® Phone#: �� _ 7., 1 g Are you an employer?Check the appropriate box:.. Type of project(required): 1.19 I am a employer with 4. ❑ I.am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.El.I am a sole proprietor or partner- listed on.the attached sheet. t . 7• ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity, workers' comp.insurance. 9. ❑ Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL I LEI 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' comp: insurance required.] 1;3.0 Other *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 their workers'comp.policy in form ation-y -- 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site. information. Insurance Company Name: ( ,S i}'�i �/"S - Co Policy#or Self-ins.Lic.#: Expiration Date Job Site Address:_ 3 7 r!a.� `ll e� City/State/Zip C:�w1t��u,�/� O ?b 3 Z Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date): Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up.to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP.WORK ORDER and a fine of up to$250.00 a day against the.violator. Be advised.that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby certify under thepains andpenalties ofperjury that the information provided above is true and correct. Signatu Date �� a D 7 Phone#: ®� � 9y 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 11 Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. r Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is.defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the 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 performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability.Companies(LLC)or Limited Liability Partnerships(LLP)with no.employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have . employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or'iown 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"the 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 it 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 haveany questions, please do not hesitate to give us a call: The Department's address,telephone and fax number: , The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax#6177727-7749 Revised 5-26-05 www.mass.gov/dia . MFR#063 cm NFRC Omens Corning 100 Renovations Bottom Hinge - Vinyl Low E(HC.) —Argon National Fenestration Rating Council i •Energy savings will depend fg jr5 FyggVigla"fie and lifestyle •For more information,call or visit NFRC's web sRe at www.nfrc.org U-Factor 0 . 32 Solar Heat Gain 0 . 4 5 Visible 0 . 46 Coefficient Transmittance-------� . 3� -------0 . 6------- _. 50_ Manufacturer stipulates that these ratings conform to applicable NFRC procedures for determining whole product energy performance.NFRC ratings are determined for a fixed set of environmental conditions and specific product sizes. w� .� f> n, IND: REIN 00/GLASS SS/AP—R25 DP 4'5 Test Size: 48 x 32 order #:3039259010002 J0172 MAY 2 240? �R�STA��E CERTIFICATE NUMBER . ..:., _,,,, a •,_,_. ..,._ „� � � .. . � ? � �,. � . ,..���. t ,"��_ . ATL=001234410-01 PRODUCER ?HIS CERTIFICATE IS ISSUED AS AMMATTER OF INFORMATION ONLY AND CONFERS MARSH USA,INC. NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN THE hORledepOf.CeR�BQUeSIQRIafSh.00Ii1 POLICY.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE FAX(212)948-0902, - AFFORDED BY THE POLICIES DESCRIBED HEREIN. 3475 PIEDMONT ROAD;SUITE 1200 ATLANTA,GA 30305 COMPANIES AFFORDING COVERAGE.` a COMPANY 00492-TH D-IPUSA-O7-08 IP USA A STEADFAST INSURANCE COMPANY" y INSURED COMPANY HOME DEPOT USA,INC. B ZURICH AMERICAN INSURANCE COMPANY 2455 PACES FERRY ROAD NW -'"' BUILDING C-8 COMPANY ATLANTA,GA 30339 C AMERICAN HOME ASSURANCE COMPANY COMPANY D NEW HAMPSHIRE INS COMPANY COVERgGES -'� °,, .This Ceilifcatesgpersedes and replaces,a�y preylously^)ssued,certlfgate forth�,pohcy period ngted�below _?..m., °,THIS,IS TO CERTIFY THAT POLICIES OF INSURANCE DESCRIBED HEREIN HAVE.BEEN ISSUED TO THE INSURED NAMED HEREIN FOR:THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THE CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,CONDITIONS AND EXCLUSIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CID TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE(MMIDDIYY) DATE(MMIDDIYY)- A GENERAL LIABILITY IPR 3757 608-02 03/01/07 03/01/08 GENERAL AGGREGATE $ 4,000,000 X. COMMERCIAL GENERAL LIABILITY 'LIMITS OF POLICY ARE EXCESS' PRODUCTS•COMP/OP AGG $ 4,000,000 CLAIMS MADE fil OCCUR 'OF SIR:$1,000,000 PER OCC' PERSONAL&ADV INJURY $ 4,000,000 OWNER'S&CONTRACTOR'S PROT EACH OCCURRENCE $ 4,000,000 FIRE DAMAGE(Any one fire) $ 1,000,000 MED EXP(Any oneperson) $ EXCLUDED B AUTOMOBILE LIABILITY BAP2938863-04 03/01/07 03/01/08 COMBINED SINGLE LIMIT $ 1,000.000 X ANY AUTO , ALL OWNED AUTOS BODILY INJURY $ SCHEDULEDAUTOS (Per person) X HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) ELF-INSURED AUTO XO PROPERTY DAMAGE $ ' ,PHYSICAL DAMAGE GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN AUTO ONLY: _. EACH ACCIDENT $ a. AGGREGATE $ A EXCESS LIABILITY IPR 3757 608-02 03/01/07 03/01/08 EACH OCCURRENCE $ 5,000,000 X UMBRELLA FORM AGGREGATE $ 5,000,000 OTHER THAN UMBRELLA FORM $ C WORKERS COMPENSATION AND 2921209(CA) 03/01/07 03/01/08 X WC STATU- OTH EMPLOYERS'LIABILITY �. TORY LIMITS ER E, E 2921210(FL) 03/01/07 03/01/08 EL EACH ACCIDENT $ 1,000,000~ F THE PROPRIETOR/ X INCL 2921211 (AZ,ID,MD,VA) 03/01/07 03/01/08 ELDISEASE•POLICYLIMIT $ 1,000,000 PARTNERS/EXECUTIVE 2921208 D AOS OFFICERS ARE: EXCL ( ) 03/01/07 03/01/08 EL DISEASE•EACHEMPLOYEE $ 1,000,000 OTHER C 2921213(OSI) 03/01/07 , 03/01/08 - E WORKERS'COMPENSATION 2921212(KY,MO,NY,WI) 03/01/07 03/01/08 G TEXAS EMPLOYERS TNS-C44642086(TX) 03/01/07 03/01/08 EACH OCCURENCE 25,000,000 EXCESS LIABILITY SIR 2,000,000 DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLESISPECIAL ITEMS. CERTIFICATE HOLDER � � CANCM TIS}N 5 f - ° - - - SHOULD ANY OF THE POLICIES DESCRIBED HEREIN BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, e THE INSURER AFFORDING.COVERAGE WILL ENDEAVOR TO MAIL_3p.DAYS WRITTEN NOTICE TO THE FOR EVIDENCE ONLY - CERTIFICATE HOLDER NAMED HEREIN,BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION.OR `- ` LIABILITY OF ANY KIND UPON THE INSURER AFFORDING COVERAGE,.ITS AGENTS OR REPRESENTATIVES,OR THE , s ISSUER OF THIS CERTIFICATE. k MARSH USA INC. BY: Mary Radaszewski 1. � ,`j ram.-S��t 'r��r} t,•,e.�IF�, �. M 4 ----�-� MM�(3102)�N D�� VALI AS Of 0 8/07 2/2 r r: (MMIDD1YY) `Q# �T1QN1:. .:� � �ATI.00�1 3410 1 02/28/07 10 10 PRooucER COMPANIES AFFORDING COVERAGE MARSH USA,INC. COMPANY hom edepot.certreq uest@m arsh.com FAX(212))948-0902 E ILLINO.IS NATIONAL INSURANCE COMPANY 3475 PIEbMONT ROAD;SUITE 1200 ATLANTA,GA 30305 COMPANY F NATIONAL UNION FIRE INS CO 100492-TH D-IPUSA-07-08 IPUSA INSURED COMPANY HOME DEPOT USA,INC. G ILLINOIS UNION INSURANCE CO 2455 PACES FERRY ROAD NW . BUILDING C-8 ATLANTA,GA 30339 COMPANY H. €wio.�u�?-.;sax "MI'll r •..�^.y"t, r�,.)s tk3�* � :.'k h x CERTIFICATE t10LDER'" q g � > 'S`ta? ?.: " ''" rca '-�, vs s- a a.,�:" `7�...� -., 'xm``" ". ..��.E.c,.. `i'� sxax> a`'.,"' ,v, 'r'�r .r. a�..«....�...�n�,.�.,�. `v,. .�.. _. ..:..• axa.,,s>,xn..:-a..,...._:a:.,.,.. �. FOR EVIDENCE ONLY MARSH USA INC.BY Mary Radaszewskl +�`'3 � ' . NE i Town of Barnstable *Permit# % 12 Expires 6 months front Lane date Regulatory Services Fee , gu ry K"SS Thomas F.Geller Director Building Division: Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTLAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address C1�l (1,'/'7L 1 esidential Value of Work Owner's Name&Address W1 �- P� 2, /T Contractor's Name Q AC G.! � Telephone Number t6o�0- , Home Improvement Contractor License#(if applicable) �0C�5 Construction Supervisor's License#(if applicable) [44rkman's Compensation Insurance PERMIT ra Check one: X-PRESS ❑ I am a sole proprietor �I am the Homeowner J U N 2 5 2003 ,E I have Worker's Compensation Insurance / Insurance Company Name TOWN OF BARN Workiman's Comp.Policy# �� �lr•1' �� J Permit Request(check box) ❑ Re-roof(stripping old shingles) ❑Re-roof(not stripping. Going over existing layers of roof) D-ce-side '-"f ('c e w Ot IGO&.l o A 000f wv1'S ❑ Replacement Windows. U-Value (maximum.44) Mel (specify) 'CT r Z *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 A � I g Rig letRe ' Ea z °1T Expf'r,��F �,�5-fin i f Peter Johnson „r f t 7 PEN{ETLOPE LANCE TLI 3 Administrator Town of Barnstable Regulatory Services BARNU " ' Thomas F.Geiler,Director 163A``� Building Division ' Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize G �I��►�ts&/l to act on my behalf, in all matters relative to work authorized by this building permit application for(address of job) Si ture o er ate Print Name Q:FORM&OWNERPERMISSION Engineering Dept. (3rd floor) Map h Parcel Permit# �0 House# Date Issued 7' - Fee vzJ CFINE 19 ' BARNBTABLE. TOWN OF BARNSTABLE ` Building Permit Application Proj et)Address Village CcQ.v10 V//t-P Owner Address Telephone Permit Request 2-ot First Floor square feet Second Floor square feet Construction Type Estimated Project Cost $ 62-7(M 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 p Proposed Use Builder Information Name P � Telephone Number Address 17 1 License# JJ L t9- . Home Improvement Contractor# Worker's Compensation# 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 SIGNATURE DATE 7 BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) . fe ° cBs *3ra a `• "' �.?#s� ?�'Y'.' ` :,'i„�T,�.'..+: ZTa3'°Y .ty!�'.�25`.i.�1+JCl�t`IY•}7#s�nw:CF:�:rN4.ns: ��w1„�sSwm�.'3'�r""�$gi"��" r�"�:.' �^'�2" '• Fx�.4�z�8€�S'7 t . . °: The Town of Barnstable MAM�►arrer�sct:. • .� A��' Department of Health Safety and Environmental Services 1"9. Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner For office use only Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors, with certain exceptions,along with other requirements. Type of Work• 122 Est.Cost Address of Work: Owner's Name S Date of Permit Application: 196 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 WrM UNREGISTERED CONTRACTORS FOR APPLICABLE HOME I1ViPROVEMENT 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. / 1�ls b Da a Contractor Name Registration No. OR Date Owner's Name ? 2 -7 Assessor's map and lot number ..... ......... ................. , SEPTIC SYSTEM MUST BE I"!STALLED IN COMPLIANCE Sewage Permit number ...�. .. ...... ......................... WITH ARTICLE II STATE SANITARY CODE AND TOWN �PyOFTIIET��yO TOWN OF BAR1V9T XBLE 22 • i BARNSTABLE, o pYa•O� .M BUILDING INSPECTOR •+S APPLICATION FOR PERMIT TO .. . ... . ...... . ......... .... ... ........... . ... ...................................... TYPE OF CONSTRUCTION ���� ./t .......... .. .......................19.��. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ........ �T.....�.....h..v�✓���r7. '1�....!`�`:.............CevtTeS:..r..... ............:........:... ProposedUse i �' 'P... .' a �.1.�/....1�'`+r�`.f`/ Ky. ............................................'...................................................... Zoning District .......................................Fire District .... 0sr � .................. ... ......................... . .................... Name of Owner .....QkCt. ...�Pl. F.Y!�1...�/P:..............Address ..... /©3.. f ! .Vi��f�.. !�...... ...... Qva`.pe^.. Nameof Builder ........ E'............................................Address .....................�.`......................................................... snows Nameof Architect ..................................................................Address .................................................................................... ram Number of Rooms ........7...................................................Foundation .........„........f�o ..�:a�" '.c4'.'te..................... Exterior ....Wev.d....-1ncm.P.............................................Roofing ..........���wIWI.?..................................................... Floors ......... 4.4! ..'?e ........................................................Interior .......... IYW!"A.UIPW.................................. Heating . . ......® QA*.......................Plumbing Zk. SA �...... ... ... . Fireplace .......... ...................................................................Approximate Cosf .... M� 00... ...�.. .... ... ........ Definitive Plan Approved by Planning Board ________________________________19_______. Area .... .� ... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH /a ka �I I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .... L.......1.... ..: �a '... . .................... Thompson,. John T. Jr. No ... ... Permit for...,...two st OX.7........../....... .... ... .. single family dwelling .............................. ........................................... LocatioA�9..Lumbert..AM RoadX ............... -- ............................... ....... Centerv-11le ..............................;......................................;.......... Owner John T. Thompson, Jr. .........................................; ....................... Type of Construction ...............frame................ ........... ................................................................................ Plot ............................ Lot .................#9........... 10 b te er Permit Granted .......Sep .......19 73 Date of Inspection ...A . 7 Date Completed ...171..............................19 PERMIT REFUSED .................................... ................... 19 j . ..D. 07, ........../........................................ ................................................................................ ............................................................................... ............................................................................... Approved ................................................. 19 ............................................................................... ............... ..............................................................