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0009 MAUREEN ROAD
4� VV .1�. I'll-it e!Mv! i�MA7 k`VA1,1�,16t`1 "OUR To Alison, v vg- tel WNW §1 AQ:M p.q; P_� P018 'If% 1 4041 COMB �XA W "N' V�6 o"g;'g, nm g SIR, -1114, R RUN "M V WIP OWN IN 54 MR _q -INDr , QU ,yo QkgV1�W'", �IAVVR ,�11�4�, j;, 11,61.1. 'A�OWV"'NM. AU 9 &IR ".30, ong wMw1wwzg. -(�p 10 IBI 54we",-,4,i'l I kokg, V 'Al q WO ypg§, R, rg 'Sam , j W Ar k? PRIP P, g 'd, 'p, M .Mww MEN �'j Q F315 19i Vol 17�gov- '16, W, 'w;pw,`-,6%T.A'1I",`,., "N AWN".1 SilY gg `9 q, wp gwvg �,g rf,��pt� R., ,�Zjtf� 011 ZA V, 1) 111��_, 2,f 1104- X vi IR, 4- M, N MR 64"Al"T"M 0, 71 1 5.&e "'RM 5 7 04 -p 'T,�N N z q , KNOT 1419 .2,_v?A 49 r � tNE Application number..)6..-1....` —../.../ o 4C� m Fee ................. � .,.......................... p ��' AP Building Inspectors Initials............... ............. � 3 0 �I'��9 f� � ��� Date Issued..................!�. .�.I..(.�....................... r'I SUS ABLE Map/Parcel... .��.. ..-.. .................... TOWN OF BARNSTABLE - EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: &t)rt eel Q -e- NUMBER STREET VILLAGE Owner's Name:Wa l� J]Ae oh&"A�5 Phone Number 5ZV 72& 3�3 P—/ Email Address:CohS+p2!�cNq b 1P Cell Phone Number Project cost$ Check one Residential Commercial OWNER'S AUTHORIZATION As owner of the above property 1 hereby authorize to make application f r building permit in accordance with 780 CMR rr Owner Signature: dhiW Date: TYKE OF WORK EleSiding. [dWindows (no header change)# ti2 E-1 Insulation/Weatherization 12""Doors(no header change) #_J_ Commercial Doors require an inspector's review ORoof(not applying more than l layer of shingles) Construction Debris will be going to %OV9A CONTRACTOR'S INFORMATION Contractor's name `� _kmpni±�V1 Home Improvemtnt Contractors Registration (if applicable)# 1Tq& 7 (attach copy) Construction Supervisor's License# C)Ctq(&�R (attach copy) Email of Contractor eon► -fTty �j Phone number `Z2q (p �� ALL PROPERTIES THAT HAVE STRUCTUR S OVER 7 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. � �• t APPLICATION NUMBER ............................................................ *For Tents Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Purpose of Event Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location (s)of each tent If food is being served at your event please obtain a Health Department approval between the hours of 8:00am -9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval. *WOOD/COAL/PELLET STOVES Manufacturer# Model /I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number .I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures, specific inspections and documentation required by 780 CMR and the To n of Barnstable. Signature Aqzz Date qhol APPLICANT'S SIGNATURE , � O Signature iAx, A Date All permit applications are subject to a building official's approval prior to issuance. Off ice 0 HOME IMPROVEMENT CONTRACT OR TypE Individual Regis_ t� t�t�°n_ Exrii_ r�02/22/ 202020 ©`l KYLE A MARTIN I' i.1 KYLE MARTIN ; 466.3 BERRY HILCRD i' UnderseGK2tMY -,FST FALMOUTH phA'02536 I. Registration valid for individual use only before the expiration date. If found return to: Office of-ConsumerAffairs and Business Regulation 10 Park Plaza-Suite 5170 i Boston,MA 02116 I• Not valid without signature Commonwealth of Massachusetts . 1 Division of Professional Licenseire Board of Building Regulations and Standards Const uctiorl SiSpervis0r Y CS-094654 3 Q ires: 11/11/201! KYLE A MARTIN 466 BOXBERRY HILL RD 3 ' construction SupervIsort"-�.S EAST FALMOUTH MA 02536 use group which contain Untestncteed Buildings of 991 cubic meters)of enclosed Ie s than,35�000;cubic fee Apace- CL GOrpmissioner.. A edition the Massa&usetts Failure tapossess as cause for re"vocfat on of this license- State Building Codei For nformat►on aboui this mas s&vldpl C.aiL`(617)727 3200 or visit w.vvw 5 The Commonwealth of Massachusetts - Department of Industrial Accidents r Office of Investigations 600 Washington Street /` Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information IIAp ,, Please Print Legibly Name (Business/Organization/Individual): V ,l� p�AZI-k?yn Address: City/State// p�- �W" 4��(e Phone #: Are you an employer? Check the appropriate box: Type of project(required): 1. I am a employer with 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 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.1 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 12 Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13. Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. *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. 44�� ,,�,� Insurance Company Name:Q� � �fll' M&y �� • �' Policy#or Self-ins.Lic.#: Zoo l W5734 f 3 Expiration Date: Job Site Address: VIA City/State/Zip6ndt-�_ &U4 OZeo 3Z 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. I do hereby eertif, unyler the ains and en tie erjury that the information provided above is true and correct. Si nature: I o Date: qh�inl Phone#: 7:2 —i 73(Q 525-z f 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#: :. DATE O MM/DDNYYY) AC CERTIFICATE 4F LIABILITY INSURANCE 04130/2019 THISCERTIFICATE 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 endorsements. CoNraCT Jan Davis PRODUCER N PHONE 508 957-2125 tAIC.Fax 508 957-2781 Mark Sylvia Insurance Agency EMAIL mark@marksylviainsurance.com 440 Main Street INSURERS AFFORDING COVERAGE NAIC N Centerville MA 02632 INSURER A: Farm Family Casualty Insurance INSURED INSURER e: Kyle A Martin, INSURER 466 BoxberryHiil Road INSURERD: East Falmouth,MA 02536 INSURERE. 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 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. rA ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE CY N BER X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DP MACE TO RENTED REMIZ n� $ 100.000 CLAIMS-MADE a OCCUR ME EXP(Anyoneperson) $ S,000__ N . N 20OIX1756 9/25/2018 9/25/2019 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS-COMPIOPAGG s 2,000,000 X POLICY❑JECOT- a LOC $ OTHER' - COMBIIdE�D SINGLE LIMIT $ AUTOMOBILE LIABILITY BODILY INJURY(Per person.) $ ANY AUTO OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS PROPERTY DAMAGE $ HIRED NON-OWNED accident) AUTOS ONLY AUTOS ONLY $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION pTR E OTH- WORKERS COMPENSATION; AND EMPLOYERS'LIABILITY - E.L.EACH ACCIDENT $ 1,000,000 ANY PROPRIETOR/PARTNERIEXECUTIVE Y� NIA N 2001 W8343 10/24/2018 10/24/2019 A OFFICERIMEMBER EXCLUDED? N E.L.DISEASE-EA EMPLOYEE $ 1,000,000 (Mandatory In NH) If yes,descrbe under ' -" - - E..L.DISEASE-POLICY LIMrf $ 1,000,000 DESC I TION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS"I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Carpentry Kyle Martin has elected coverage on the workers comp policy. 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. Town of Barnstable Regulatory Services/Building Division 200 Main Street AUTHORIZED REPRESENTATIVE - = Hyannis MA 02601 01988 2015 ACORD CORPORATION. All rights reserved. FaX:5087906230 Email; ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD IM __ TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION r^ _ Map 7iZw Parcel Application # 2,2 -- Health Division Date Issued 3 1 Conservation Division ` Application Fee <:.. Planning Dept. 4 Permit Fee ��• bC Date Definitive Plan Approved by Planning Board -( �� /D. Historic - OKH Preservation/Hyannis Project Street Address Village ,� y � , Owner 0,,t Ve— J&AA Address Telephone Permit Request h r aCSw' 1� Square feet: 1 st floor: existing(W6proposed 2nd floor: existing proposed � Total new` ✓ Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure r`U Historic House: ❑Yes CY No On Old Kin 's Highway: ❑Yes of /40 . g � 9 Basement Type: Full ❑ Crawl ❑Walkout ❑Other Basement Finished Area (sq.ft.) 17 o 6 Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new ✓/ Number of Bedrooms: existing-new Total Room Count (not including baths): existing new First Floor Room CountZhi Heat Type and Fuel: U Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes e No Fireplaces: Existing � New Existing wood/coal stov L❑1 (No Detached garage: ❑existing ❑ new size_Pool: ❑existing ❑ new size _ Barn: ❑existing �ew maize_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION - (BUILDER OR HOMEOWNER) Namst A. �a Telephone Number Address �� -' ' XV License# Soo y Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE f FOR OFFICIAL USE ONLY f F APPLICATION# f DATE ISSUED ' MAP/PARCEL N0. .. ADDRESS VILLAGE. : OWNER = r y DATE OF INSPECTION: ! . FOUNDATION' 7 r '; FRAME +s ^ INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL ' PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ' ASSOCIATION PLAN NO. { i The.Commonwealth of Massach usetts • Department of Industrial Accidents. A.� Office of Investigations I' t500 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Ple e Print Le ibl Name (Business/Organization/Indivi dual): �� a Address: r City/State/Zip: C � Phone #: Are u an employer? Check the appropriate box: Type of project(required): am a employer with 4. ❑ I am a genera]contractor and I -�Y�� 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors .. _ . _ _ __.___ 2.❑ I am a sole proprietor.or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub=contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' 9 ❑ Building addition . No workers' com insurance comp. insurance.$ P airs or additions � Electrical re required.] 5. ❑ We are a corporation and its 10.❑ p 3.❑ I required.] a homeowner doing all work officers have exercised their I I.❑ Plumbing repairs or additions. myself. [No workers' comp. right of exemption per MGL 12:❑ Roof repairs insurance required.] t ` c. 152, §1(4),and we have no 13.0 Other employees. [No workers'. comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp,policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. y� � � � , Insurance Company Name: / Policy#or Self-ins. Lic.#: �067y �/ Expiration Date: ho Job Site Address: / 1/kZh'' PrCity/State/Zip: 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. I do hereby certify and f t s !ties of perjury that the information provided above is lie and correct. Signature: Dater Phone#: 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#: WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMATION PAGE { Associated' Employers Insurance Company Burlington, Massachusetts Nccl No ao95s (800) 876-2765 POLICY NO. I WCC 5006114012009 ITEM PRIOR NO. 40 WCC 50061112008 1. The Insured Michael Deluga dba Village Craft Building&Remodeling Mailing Address: 568 Santuit Road Cotuit MA 02635 (No. Street Town or City County State Zip Code ® Individual ❑ Partnership ❑ Corporation ❑ Other FEIN 04-3182146 Other workplaces not shown above: 2. The policy period is fro ml 2/23/2009 to 12/23/2010 12:01 a.m.standard time at the insured's mailing address. 3. A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here; MA B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident $ 10 0,0 0 0 each accident Bodily Injury by Disease $ 500,000 policylimit Bodily Injury by Disease $ 100,000 eachemployee C. Other States Insurance: COVERAGE REPLACED BY ENDORSEMENT WC 20 03 06 A D. This policy includes these endorsements and schedules: SEE SCHEDULE 4. The premium for this policy will be determined by our Manuals of Rules,Classifications, Rates and Rating plans. All information required below is subject to verification and change by audit. Classifications Premium Basis Rates Code Estimated Per$100 Estimated No. Total Annual of Annual Remuneration Remuneration Premium INTRA 355380 SEE EXTENSION OF INFORf 4ATION PAGE Minimum premium$ 500.00 Total Estimated Annual Premium $ 2,574.00 As indicated,interim adjustments of premium shall be made: Deposit Premium $ 2,734.00 ® Annually ❑ Semi Annually ❑ Quarterly ❑ Monthly MA Assessment Chg. $2,226.80 x 7.2000% $160.00 This policy,including all endorsements,is hereby countersigned by 11/23/2009 Authorized Signature Date GOV GOV KIND PLACING CLAIM NAME SAFETY STATE CLASS AUDIT OFFICE OFFICE.. CHECK GROUP Malcolm&Parsons Insurance MA 5645 7 564 Agency Inc WC 00 00 01 A(11-88) . 6 Freeman Street-P O Box 527 Includes copyrighted material of the National Council on Compensation Insurance, Stoughton,MA 02072 used with its permission. l ' :Massachpsetts' Dcpaiem�nrpt Public Safety A: Board of Buildin lations and Standards yCgnstruc`tion Supervisor*License te, Lq ense: Cg+ ,.50234 Rgstric+edto- 01 r � �I- rU' °I- MICHAELsIELUGAf k r� 568'SANTUI TTRD, r nr #T �T {r � f COTUIT MA.02 r r rr I Expiration 7/9/2010 +1f Cunwijssi' 30003 z� ,p 07/ie . .....al Yis Buai d Of Building Iteguhliand ClvndrriF.•, .1 111 — 10M IKP 0 ME T ONTR/1GTOR Regiitration., 105548 . Ez� at n Z'1417/2010 7r# 27197.:3` , �1 IT pe BA l VILLAGE CRAF UIL�IN 'OGELIfG M iael ®1lu a j T. T1 6 MA 02G35 Adinmi�tr rtor Buanl,oG 13uildi RcgRcgulil.ipns niid Standrrd;. j HOM IMP IO MEAT j 6Tkkiofz 1 Registration 105� 8 .: E treat A:_-7�)17/2010 Try 27197 ` I - T pe;_ DBAA 14 r 19FLI-AGE.CRAFj' UIL IN ".& t� OELIMG MA ael >P�t a. r��r3}a} -}.! tAM YI!!T y. UIT;.MrA 02G35 Atlnuni�traCor I�L�3t r{ cgt�B n�"I d for uidi►idul)lsc only ` � CI�1 ► 'dat.641'fotuiJ'tetw Board of Builc(Ing Regulations and Stands-Is' =x r Ohc Ashburto!`Ia'61 jn 1301 'Atoll,Ala.02109. rx � i I Not and iyitliout signs urc 1 FOPt@ MEMBER REPORT Level, Floor: Flush Beam software brown job.4te 3 PIECE(S) 1 3/4" x 1.4" 1 9E Microllalm®LVL PASSED k#�, y� °k} � t' yµ r ti ..: ..;r .�_f .,..�. , ...� .� Overall Length:18'7 ` U- 0 18. a All Dimensions are Horizontal;Drawing is Conceptual Desl ri Results` '_ Actual Location` �:9 Allowed ° N-Vt w �Result �+ �s , LDF System:Floor' Member Reaction(lbs) 5020 @ 2" 11944 Passed(42%) - Member Type:Flush Beam Shear(lbs) .4 @ 1'5 1/2" 13965 Passed(30%) 1.0 Building Use:Residential Moment(Ft-lbs) 22494 @ 9'3 1/T 36387 Passed(62%) 1.0 Building Code:IBC Live Load Defl.(in) 0.454 @ 9'3 1/2" 0.456 Passed(U483) -- Design Methodology:ASD. Total Load Defl.(in) 0.628 @ 9'3.1/2" 0.913. Passed(U349) • Deflection criteria:LL(U480)and TL(U240): • Design results assume a fully braced condition where all compression edges(top and bottom)are properly braced to provide lateral stability. • Bracing(Lu):All compression edges(top and bottom)must be braced at 14'11 7/16"o/c unless detailed otherwise.Proper attachment and. positioning of lateral bracing is required to achieve member stability: y Total" 'Availabler Re wired ti Support Reactions(lbs) r s $U OItS ` - PP ' 3 ,t t .,:. Bearing Bearing Q g ti Accessories g - Bearm Dead/Floor/Roof/Snow Y .- ...... ..:,.... ,yDz.,;:; rc+ v✓rd-..u: _.,.:..... '�'-' sF.e�"..l:s_.. 1 -Column-Spruce Pine Fir, _ 3.50 3.50" 1.50 1397/3624/0/0 None 2-Colurnn Spruce Pine Fir 3.50" 3.50" 1.50" 1397/3624/0/0 None I rJs f 2`h44 r a,; ri ��.. a •r�a'T s ��� � �,� qur" �t ''' }P °�uyt'" � �� �� s;, Tnbutary� ;;�iSl S W: x U,v Loads Cocattons Widhy ; Dead Floor Lrve, Roof Live Snow t. Comments rt (0 901 0) (nonSnow 1 25)< ,�7,75) �� 3 1 -Uniform(PLF) 0 to 18'7" N/A 130.0 390:0 - 0.0 0.0 30/10 13'attic loads 4 ForteTM Software Operator: Job Notes J Andrew Shakliks CGP Brown job... 3/18I2010 9:58:29 AM Mid-Cape Home Center 14 Maureen Dr iLevel®Forte TM v1.1,Design Engine:V4.8.0.1 (508)398-6071 x 4992. Centerville MA ASHAKLIKS@MIDCAPE.NET Page 1 of 2 Ott , V, it€VEL®Notes x a m iLevel®warrants that the sizing of its products will-be in accordance with iLevel®product design,criteria and published design values.iLevel@ expressly disclaims any other warranties related to the software. • Refer to current iLevel®literature for installation details.(www.iLevel.com) • Accessories(Rim Board,Blocking Panels and Squash Blocks)are not designed by this software: . • Use of this software is not intended to circumvent the need for a design professional as determined by the authority having jurisdiction.The designer of record,builder or framer is responsible to assure that this calculation is compatible with the overall project. • iLevel®products manufactured at Weyerhaeuser facilities are third-party certified to sustainable forestry standards. • The product application,input design loads,dimensions and support information have been provided by /^Forte Software Operator - - - - 1 SUSTAINABLE FORESTRY INITIATIVE ForteTM Software Operator Job Notes J Andrew Shakliks CGP Brown job ; ^3/18/2010 9:58:29 AM Mid-Cape Home Center 14 Maureen`Dr _ iLevel®.ForteT"^v1.1,Design Engine:V4.8.0.1 (508)398-6071 x 4992 Centerville MA ASHAKLIKS@MIDCAPE.NET Page 2 of.2 ' of'VKE T Town of Barnstable Regulatory Services BARNSTAB'EMAM ' Thomas F. Geiler,Director Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder 6�/n as Owner of the subject property hereby authorize to act on my behalf., in all matters relative to work authorized by this building permit application for. - (Address of Job) Signature of Owner to Print Name If Property Owner is applying for permit please complete.the Homeowners License Exemption Form on the reverse side. Q:FORMS:O WNERPERMIS SION Town of Barnstable cFTHE tom, i�, o Regulatory.Services snrtxsTnsLs Thomas F.Geiler,Director 639: �•� Building Division TFD MAy A Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508=862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code .S N A I The current exemption for"homeowners"was extended to include owner'occunied'dwellirio of sixvnits or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. N I DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109:1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official r i ' • } Note: Three-family dwellings containing 35,000 cubic feet or larger will be,required to comply with the State Building Code Section 127.0 Construction Control: r HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109:1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\homeexempt.DOC �' � - l � few ��- �►�► r � tk ry j ,71 3Hro) y TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION _.. Applic ation Map Parcel` - Health Division " Date Issued Conservation Division Application Fee CS Planning Dept.t. Permit Fee70Date Definitive Plan Approved by Planning Board Ll2Z�l0 Historic - OKH Preservation/ Hyannis -. Project Street Address 'd Village r`0f1 Owner Ott yO r6t lh Address. Telephone � 417 Permit Request ) Y, 4Z ke, Square feet: 1 st floor: existing 6 proposed 2nd floor: existing proposed �` — o`tal new Zoning District Flood Plain Groundwater Overlay Project Valuation 060 Construction Type 1 Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family -,w Two Family ❑ Multi-Family (# units) Age of Existing Struct 6 (r. Historic House: ❑Yes 1 No On Old King's Highway: ❑Yes 2 No Type:Basement T e: Full ❑ Crawl ❑Walkout ❑ Other r. Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft)170o Number of Baths: Full: existing_ new Half: existing new Number of Bedrooms: 3 existing-ew Total Room Count (not including baths): existing _L�new First Floor Room Count Heat Type and Fuel: ❑ Gas bdl ❑ Electric ❑ Other Central Air: ❑Yes ff<6 Fireplaces: Existing New Existing wood/coal stove: ❑Yes pJ No Detached garage: ❑existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use51-1 APPLICANT INFORMATION rn (BUILDER OR HOMEOWNER) Name / A Telephone Number Address L 4-1 y ' License# �13U� Home Improvement Contractor# Worker's Compensation # Ko �/r�� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJ CT WILL BE TAKEN TO n SIGNATURE DATE �� h a FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. r ADDRESS VILLAGE ' OWNER DATE OF INSPECTION: FOUNDATION FRAME 61 !o 9-�= INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING Alt a -712JAI10 DATE CLOSED OUT ASSOCIATION PLAN NO. '''~ Vie Cotnirtoniweartrt ofmassachusetts \ DeP .arfrnent ofrndustriafAccid'erzts Office of ff vestigations 600 Washington Street Boston, AL4 02111 J '�• www.m ass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/EIectriciatts/Plumbers A Ucant Znformatiori Please Print Le "bl Name (Business)organizadon/Individual): Address: City/ iate/Zip: L�/✓� Phone.#: e u an employer? Check e appropriate box; Type of project(required): 1. 1 am a employer with 4• ❑ I am a general contractor and l 6. ❑Now construction employees (f M and/or partaimc).* have hired the sub-contractors 2.El I am a'solc proprietor or partacr- listed on the attached sheet 7. ❑Remodeling ship and havcno employees Thcse sub-contractors have S. ❑ Demolition tcs and have workers'lo Mpy working for me in any capacity. e 9, ❑ Building addition [No workers'.comp.•insurancc comp. insUrance.t 5 [] We area corporation.and its 10.[J Electrical rap airs or additions . r6quirtd.] • 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 MG,L 12.❑ Roof repairs innu-ance required]t c, 152., §1(4), and we have no tmploytes. [No workers' . 13.❑ Other . comp. insurance required.] "Any applicant that chxka box#1 must also fill out the section below showing their workers' compensation policy infomration. t 1-lomcowncrC who submit this affidavit indicating trey arc doing all work and then hire outside contractors must submit a new afidavitindicating such. tContractors that cheek this box must attached an additional ahect showing the name of the sub-contractors and stoic whether or not those entidcs have employees, If the subcontractors have employcea,thcy must providb their workers'comp.policy number. ram an empfoyer that is providing workers'compensation insurance for ny employees. Below is the policy and job site inforrnatlon Insurance Company Name: IV id lZ7 Policy# or Self-ins. Lic. #: � Expiration Date: /r 4 b Job Site A•ddre55: City/State/Zip: Attach a copy of the workers' compensation policy deClaradan page(sbowing the policy number and expiration date). Failure to secure coverage as required under Seotion 25A of MGL c, 152 can lead to-the imposition of criminal penalties of a Eno up to S1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a day against the violator. Be advisee] that a copy of this statement may be forwarded to the Office of Investigations of the bIA for insurance coverage verification. X do hereby certify under th pai •andpe es of perjury tlt.al the information provided above."s true art correct, ' Si afore: Daft; PNQfj'tTLd #: use only. Do riot wale in is area, to be corrtpieted by city or town officiaC City or Tons n: Permit/Licenae# Issuing Authority(circle one); 1. Board of Health 2, Building Department 3, City/Town Clerk 4. Electricsd Inspector 5, Plumbing Inspector 6. Outer Phone tf; Contact Person: formation and histructions Massachusetts General Laws chapter 152 requires an c plovers to provide workers' compensation for their.ernployees: Pursuant to this statute, an employee is defined as !every person�n the service of another under any contract of hire, express or implie oral or written. , An employer is&fmcd "an indtvrdual,partnership, associatio corporation or other legal entity, or any two or more of the foregoing engaged joint enterprise and including the 11 gal representatives of a deceased employer, or the artner�phi association orI er`�cgal entity, employing employees, Howevcz the receiver.or trustee of.an indzvi p ! P, owner of a dwelling house having not moz/c than three apartrncand who resides therein, or the occupant of the dwelling house of another who c��ys persons to do mainfcne, construction or repair vrozk on such dwelling house or o "the grounds or building appuriezaa u`�ereto shall nobbeca c of such employment be deemed to be an employer." MGL chapter 152, §25C(� also statLs t"every state o.r 1'oca licensing agency shall withhold the issuance or reAePYai of license or permit to opJ a business or!to''co struet biWdings in the common ealth for any applicant wh has net produced•acgepta le evidence of coma dance vrith the insurance coverage required." Additional ' MSG,I.ohaptcr 152, §25C(7) s es 'Neither the ico onwealW nox any of its political subdivisions shall cnter•into any coz�tract for,the perfor nancc o public work usr acceptable Vdence of conlpI liznee'with the insurance rcquirezacnts of tbz�ss chapter have bellez%t presen cd to the contzal g authority. Applicants Please fll out the work rs' compensation adati't complctel ,by checking the boxes that apply to your situation and, if ' one nambe s alongwith their certiacatc(s) of necessary, supply cub-co,tractors) namc(s), add e s(cs) and x( ) insurance. Limited Liabilt companies(I LC) or ' ted I i iility Partnerships (C\I2)with no employees other than the members or partners, arc no requi#xcd to carry work comp asation insurance. If LLC or LLP does have employees, a policy is requix $fie advised that this davit l y be submitted to the Department of Industrial Accidents for co lion of urancc coverage. be s r to sign and date thc�affadavlt he affidavrt should be returned to thcar town the application for. pe 't r license is being requested, not the Department of Industrial Accidm Should you.F avc any qucstions,jrcg din c law or if you arc required to obtain a woxkers' c crop ensafion policy,please call tl� Department at t}e n c lis cd below. Self insured companies should enter their self-iusuranGc liccasc umaer on th a ropua-to hn . City or ToWp Official Plcasc be sure that the Lavit is c mpl e and p tcd lcgibl\',Th epartmcnt has provid d a space at the bottom of tho affidavit for you to 1 out in�jc event the fhec c f Invcs 'gaff 'has to contact you z' gaxding the applicant Please be sure to11 in the p zmit/Jicnse n cx hick will be used rc fcrcnce number. addition, an applicant davit indicating current that must submit mtiltplc p: 't/licensc apph ti as in any give yeax, nccd only submit Drip g Policy information(if Access and der"Jo iie Address" th appl ca oNA, hould write"all 1 cations in (city oz town)."A cbpy of the af�davrt t hAbeen.bfh i y stamped or k b city or town y be provided to the applicant as proof that a vaLd affi v7t is on Eric oz tre permits r lice cs. new affidavit ust be filled outeach year.WhDzo a home owner or ci is o�btainin. a lice c or ppmai not z ated o any business commercial venture (i e, a dog)icense ox'permit to burn l eves etc.) 'd pers g is NOT rc uire to co this afli vit Tho Office of Investigations would hkc thank you in a`vancc for your coo eratiozi,and should ou have any questions, please do not bmitatc to give us a call. _ Tlic Department's address, tcicphoac•and f n er: Thc� cd onwc—, th of Massa hill D ,aunt of Indust 4l A roldcnt `.. . E �ce,�of ZuyestipfIGUS U yNasHngtQn St-e,et MA 02111 TcL # 617,727 -Q ext4Q6 4r l-$77M- ASS E F 4 617-72�7-7749 Revised 11-22-06 sKE l° Town of Barnstable Regulatory Services 9 HARNSTAHMg" Thomas F. Geiler,Director 019.�aye Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, f &OWI , as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: b (Address of Job) Signature of Owner to 9V116 V) h 64 Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FORMS:OWNERPERMISSION {• r 7 ula ils and StandarJs Boa'-d o(Buildinb G 4. HOtJi IMp OVFMENT CONTRACTOR istrition 105 48 _ .Reg � 27197J: E.--- op 7l1�7/2010i. T� �ODEUTA ''�GIL ING 'nit-j-AGE:CRAFTpjl �! Y;� ppministrator - NJIT'.MA 02635 k �= i�liatis.►thutiitt "-1 Dip trtit'ciititit'Ptilific Sufch Bi►a il'of''Builtl'iit�, Rc6ul 1, Is`antl?Stantlurtl� NW Construction Supervisor ,License I 'License CS 50234 Restricted to 00 MICHAEL DELUGAr'? 568 SANTUIT•RD COTU IT, MA,026,35'' Expiration: ;7/9/2010 ('ununisitmc,r, Tr#: 30003 t r Buard,oC 13uildw�Rcgui�S��ns end�tandrrik: :,1 fi HOM INp NTRGOR � 0 Registration', 105, 8 I �r - an 7/17/2010Ez ia Tr# 27iM TYPe B4 V LLAGE CRA�IFj UILy r $ VGELI1IG Miael IOua ! r_ i BRD UdIT MA 02635 AJniinistralor ,Lt I ,,or►egist� t �l�a�Ld for uidn clul�isc only a rP lr>�ater IPfam d�ctu► Board of Bwlc�iiig iZegulations and StAnifgs ;a Onc As6burtou'P1acc Ran 1301 1:ostou,lllz.0210� ' ro .1 Not valid��itLout Si bna; rc 4 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMATION PAGE Associated Employers Insurance Company Burlington, Massachusetts Nccl No 40959 (800) 876-2765 POLICY NO. WCC 5006114012009 ITEM PRIOR NO. WCC 5006114612008 - 1. The Insured Michael Deluga dba Village Craft Building&Remodeling Mailing Address: 568 Santuit Road Cotuit MA 02635 (No. Street Town or City County State Zip Code ® Individual ❑ Partnership ❑ Corporation ❑ Other I FEIN 04-3182146 Other workplaces not shown above: 2. The policy period is froml2/23/2009 to 12/23/2010 12:01 a.m.standard time at the insured's mailing address. 3. A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here; MA B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident $ 10 0,0 00 each accident Bodily Injury byDisease $ 500,000 policy limit Bodily Injury byDisease $ 100,000 eachemployee C. Other States Insurance: COVERAGE REPLACED BY ENDORSEMENT WC 20 03 06 A D. This policy includes these endorsements.and schedules: SEE SCHEDULE 4. The premium for this policy will be determined by our Manuals of Rules,Classifications, Rates and Rating plans. All information required below is subject to verification and change by audit. Classifications Premium Basis Rates Estimated Per$100 Estimated Code Total Annual of Annual No. Remuneration Remuneration Premium INTRA 355380 SEE EXTENSION OF INFORMATION PAGE Minimum premium$ 500.00 Total Estimated Annual Premium $ 2,574.00 As indicated,interim adjustments of premium shall be made: Deposit Premium $ 2,734.00 ® Annually ❑ Semi Annually ❑ Quarterly ❑ Monthly MA Assessment Chg. $2,226.80 x 7.2000% $160.00 This policy,including all endorsements,is hereby countersigned by 11/23/2009. Authorized Signature Data y GOV GOV KIND PLACING CLAIM NAME SAFETY STATE CLASS AUDIT OFFICE OFFICE. CHECK GROUP Malcolm&Parsons Insurance MA 5645 7 1504 Agency Inc WC 00 00 01 A(11-88) 6 Freeman Street'-P 0 Box 527 Includes copyrighted material of the National Council on Compensation Insurance, Stoughton,MA 02072 used with its permission. / s 4 - - - _ -"f `i9jing 'suogepol 6ulpllnq se vans 4VO21 N3321f1VW 6:uolleaol dew ayl uo sainlea;leals.(yd o1 sdlysuo!lelaj alemaae luasaidaj lou op pue sauepunoq _ siaungV sauoe Ob'0:a6egiov ,11-IH3H All Wt/3 NMO2.19�uauMO-oO fUadoid aml lou aje 6ayl �s�aa�ed xel s,jossassy jo suolleluasaidai olydei6 Rluo aje ' M dew siyl uo soup laoied ayl 'spiepuels Roeinooe dew paysggelsa laaw lou Aew,OOC=j �aaed p910919g `00OM$:anlen passassV lel0l Sbl2if°J OInVO'NMO218:JauMO ;o ejeas epuofoq sluawa6jelu3 uoilelajdlalw Aoleln6ai jo uogeuluualap Aepunoq - : -. • 990:laaAed aZZ:deW le6al jo;alenbape lou s 11 "Aluo sasodind 6uluueld jo;sl dew slyl Si13WIV13S14 l9# � 6908Zz Ja LZ# 990aZZ f Z9# s „ LL08ZZ t 694 Ilk OLLBZZ ov# an M33 9LOBZZ 2�5 vVd y� _ o8z ot L90BZZ Oct - 9L08ZZ " „ v A i sz# J Z008808ZZ mazz O oz U 40JeW WGISAS uogewjo;ul 3i4dej6o9E)algelswe8;o unnol PjpA 1.. 4 a60 xw AA 9 gG 16or !o �r 1-4 AAL S }(� rw C► X b J 1 f/ ZS w � gzLm gig' � 9 ,1 v�w A��Ss � o it (oY Jer �-- I .5# f 9 � °%T"Er°�� TOWN OF BARNSTABLE t BAH MULE, i oaYA�• BUILDING INSPECTOR APPLICATION FOR PERMIT TO 3c7L... .........(:3'.ata ................................ .... TYPE OF CONSTRUCTION ....................)�XA M.114.....OF ........ .. ............... .............. ......C A...........19..��. TO THE INSPECTOR OF BUILDINGS: I The undersigned hereby}applies for a permit according to the following information: t (� , Location .......................9...........:�! .ls�.��'�?�..�. .........Rj....................�.q?�.(:� x.:1.>..�.1.te...�.........':':1.;):................... ProposedUse ....................1 a..X a!�.°C................................................................................................................................... Zoning District ...........................................I.............................Fire District ........ e.n. .¢.Y..1�.1.ri!�.... Name of Owner .Va.V.J. ... WUN..................Address .....�..`. .........�j......`. Nameof Builder ..... .......6.Y.'.Gl. .v1............Address ..................................................... .............................. Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ..................................................................Foundation ..... ........�-�E�1.�' i ........R.1.4a........... Exterior Q.Ue.>5...4. y4.(7P11odfing .......... -YA0.fT..... 11e.fl .C.cs:................................ Floors ....... .5?.E'lS Y.. e......................................................Interior ........5. 1 ?4!......V.> .�C'.. ..-...................................... Heating ........................Y..1.Q.. \.'0...........................................Plumbing ................ .................................................. Fireplace a� U.!!1. ..................................... Approximate Cost � ..U° ............................. ................. ............................................... Difinitive Plan Approved by Planning Board ________________________________19-------- . Diagram of Lot and Building with Dimensions Ck ® tn o �� I oa % J J 0 Lt9 p a �' 9 U- = Q, � 0 wow LU � � � < ` �W F, W uF'i Lij I U ¢ LUauY� tf1 � 1C I hereby agree to conform to all the-Rulesand Regulations of the Town of Barnstable regarding the above construction. Name . .. t.... ... .................... ...... . - Bro-m-, Duvid' G. -~---- No —..] . Permit for ..........garage ............. ` ' —^---`~^'--^^'—'— ---'^^^---'—`' x Location --.5�'Ivl .Io»ad.—.------.- \ � ..~_—..—..^.=,''=`====.--------.-- Owner .--./����!t b ��o��.----,.—.—.. � | ' Type of Construction ................XX#g..Q----- � � —.—.—.—^—..------..---.----..---.. � � ! Plot ............................ Lot ----------- � . } ' Ootm�e 7I / Permit_ Granted - ----- � ^ Date of y ~ Inspection . Dote Completed .. � | ` . . . - ` L PERMIT REFUSED. , ^� � ,.__,,.-__—_..--.-._.--....^-.—,. lV ~ ` ' ----^--^`^'~^—^^^'—'—^^—^—''--'~—^'' ^—.---._....-_-----..—~...—.~----.' � } ---~, ----~..~---,...--~...,—.-_., � - ~ ~- / | ~ .--...~.~.—,—.---....--~..-..,—~.~.— Approved ' .............................................. 19 . ` ' -------''—''-----~~'''—'—''^^^^'--'- -'------'---^----'—~^-----'^^^^' ' ` | ' | | | . . 83 ��Pyo�THETo�� TOWN OF BARNSTABLE r IAHHSTAILam 0"E, i "6 9 BUILDING INSPECTOR O APPLICATIONFOR PERMIT TO ......... .. . ... ....... ...................................................................................... TYPE OF CONSTRUCTION ........... ..... ....... ....................................................... ........................................... ...........19. TO THE INSPECTOR OF BUILDINGS: The undersig hereby applies for a permit a cording to the following informCa on: CLocation ........ ,�.. 12� �/� / ProposedUse ..... .................................... ................................................................................ ZoningDistrict .................................................................Fire District ...... ....................................................................... ev Name of Owner �� "6 ................... . . ........... P ....................Adcl ss/.r ................. .... Nameof Builder ��.................... .............................................Address ...................................................................................;. Nameof Architect ...........r.....................................................Address ......................... ........................................................ Numberof Rooms ..... .....................................................Foundation ... ... ................................................................... Exterior ............. ................Roofing ............ .......... ..............I............................................ Floors ..... ... ...........................................................................Interior ....... .. ........................................................................ . Heating ,... ..........................................................................Plumbing .............. ....... :... .:....::::.:............ Q� Fireplace ........ ..:.:..................................................Approximate Cost ........ ...../................................... .............. Difinitive Plan Approved by Planning Board ________________________________19________. Diagram of Lot and Building with Dimensions x `I /6 5� O �Q LU O LL tea, � z 0 i� r Qoo ` z w o (DaO � w Q O r� 0Wa�00 0 CK O c~n � a- �IL Q�� O O � w M to z W WUj -4 a LV Lu 0 ` �n hereby agree to conform to all the Rules and Regulations`©f t own f Barnstable re arding the above construction. Name .... . . Doherty Corp. a DEC 3 1 1919e st0 ry No ...13382... Permit for .................................... single family dwelling ............................................................................... Location cl Maureen Road ................................................................ s Centerville ............................................................................... Owner Doherty....C.orp. ................ . Type of Construction frame .......................................... ................................................................................ Plot ............................ lot .......#35.................. September 29 70 Permit Granted ........................................19 Date of Inspection Date Completed .......ll...'"-.,�.---------19 PERMIT REFUSED ................................................................ 19 ............................................................................... ............................................................................... Approved .................................................. 19 ............................................................................... ...............................................................................