HomeMy WebLinkAbout0191 MONOMOY CIRCLE ry. ..
Town of BarnstableBuilding
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163P Perm
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° WFi'erea'C rtificate`:of.'Occu anc �s>Re uiredrauchBuldm sFiall'Nbt�beOccu ieduntila:F�nallns ection;has;been,made, !ter 1t
Permit No. B-18-2473 Applicant Name: Keith Petipas Approvals
Date Issued: 08/03/2018 Current Use: Structure
Permit Type: Building-Sheet Metal-Residential Expiration Date: 02/03/2019 Foundation:
Location: 191 MONOMOY CIRCLE,CENTERVILLE Map/Lot 191 222 Zoning District:; RC Sheathing: ,
Owner on Record: AUSTIN, MICHELLE J 3 g
x Contractor Name KEITH PETIPAS Framing:
1
Contractor License` CS 082869
Address: 191 MONOMOY CIRCLE y a 2
"
CENTERVILLE, MA 02632EstProJect Cost: $ 1,000.00 Chimney:
Description: d er vent and hood vent for over cookto x`,� PemFee:
P rY P $85.00
Insulation:
Project Review Req: AS PER 780 CMR �Fee Pald $85.00
DN, 018 Final:
a e 8/3/2
ff
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Plumbing/Gas
Rough Plumbing:
.-- � -� � f� 0 .Building Official
Final Plumbing:
. ,
This permit shall be deemed abandoned and invalid unless the work authorized�by tthis permit is commenced within 4i months after issuance.
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am x
Rough Gas:
All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted.
All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoni g y laws�and codes. Final Gas: -
a
This permit shall be displayed in a location clearly visible from access st11 reet or1road apd shall be maintained open for public-inspection for the entire duration of the
work until the completion of the same.
{' Electrical
The Certificate of Occupancy will not be issued until all applicable signaturesby�the Building and F re Offcialsareproyided on this permit. Service:
Minimum of Five Call Inspections Required for All Construction Work %
4 '
1.Foundation or Footing �3E Rough: ,
2.Sheathing Inspection
3.All Fireplaces must be inspected at the throat level before firest flue lining is installed -Final:
4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection
5.Prior to Covering Structural Members(Frame Inspection) Low.Voltage Rough:
6.Insulation "
7.Final Inspection before Occupancy Low Voltage Final:
Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health
Work shall not proceed until the Inspector has approved the various stages of construction. Final:
"Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department'
Building plans are to be available on site Final:
All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT (J,vr✓�
Town of Barnstable Building
s. �PostThis Card So That•rt��s,l/isible From,the Streets A roued�Plans Must�beRetamed�on J„ob and,this Card Must�be Kept � -
ib Posted Until Final Inspectron Has Been Made x _ � `
. ,.x, #h .. K . A � . - Permit.
W„,here a Certificate of Occupancy s Requfred,.5ych Bulld�ng shall Not,be Occupied until,a Final InspeMion,has been made
.,a..... " '�,�,. 'sti_..,.. �...�,.�,�.,.,.., �..:,"��.,,....0.s�:_.a-,� A .''""` ,.;.=�,.�-
Permit NO.. B-18-2114 Applicant Name: Keith Petipas, Approvals
Date Issued: 07/12/2018 Current Use: Structure
Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 01/12/2019 . Foundation:
Location: 191 MONOMOY CIRCLE,CENTERVILLE Map/Lot: 191-222 Zoning District: RC Sheathing:
Owner on Record: AUSTIN, MICHELLE J Contractor Name KEITH PETIPAS Framing- 1
=2 Contractor License:' CS-082869
Address: 191 MONOMOY CIRCLE Z
CENTERVILLE, MA. 02632 Est",Protect Cost: $ 1,400.00 Chimney:
Description: remove and replace 1 window Perth Fee: $35.00
Insulation:
Project Review Req:. f Fee Pad $35.00
Final
x Oate.. 7/12/2018 ®1G
' Plumbing/Gas
4 Rough Plumbing:
R Building Official Finals Plumbing:
This permit shall be deemed abandoned and invalid unless the work authonzed,by this permit is cornmenced within six months'a" r;ssuance. Rough Gas:.
All work authorized by this permit shall conform to the approved application and the:approved construction documents foc'which this permit has been granted.
All construction,alterations,and changes of use of any building and strgctures shalE be incompliance with the local zoning by laws=and codes. Final Gas:.
This permit shall be displayed in a location clearly visible from access street or road�and shall be maintained open for public inspection for the entire duration of the;
work until the completion of the same. ,.. i s s:' Electrical
The Certificate of occupancy will not be issued until all applicable signatures by the Buildin&rid Fir&Gfficials are provided°on this permit. Service
Minimum of Five Call Inspections Required for All Construction Work: Rough:
1.Foundation or Footing
2.Sheathing Inspection Final:
3.All Fireplaces must be inspected at the throat level before firest flue lining is installed
4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low.Voltage Rough:
5.Prior to Covering Structural Members(Frame Inspection)
6.Insulation Low Voltage Final:
7.Final Inspection before Occupancy
Health
Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations.
Work shall not pro d until the Inspector has approved the various stages of construction. Final:
"Persons cont cting w' unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department
-rep Building plans are to be available on site Final:
11 Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT
Town of Barnstable
Regulatory ServicesFeues6montlrsfromissrredate
• sA ANACZQ Y?fi i
A.BLE,
�$ e639. �m Richard V.Scali,Interim Director
p
Building Division T ��,,yy�� OCT p�y
Tom Perry,CBO,Building Commissi geW/V®F ps 2015
200 Main Street,Hyannis,MA 02601 �qRnn,,
wit�v.town.bamstable.ma.us /V S /
Office: 508-862-4038 Fax: 50$-690-6230
EGRESS P7ERNUT APPLICATION - RESEDENTLAL ONLY
Ma / er
P p' 7- 2-L- Not Valid withour Red X-Press Imprint
arcel Numb
y
Property Address_ 1 q 1 0✓1c0 n'l c)�/ P�I� l�P/t e('U t I I
Residential Value of Work Minimum fee of S35.00 for work under$6000.00 ,
Owner's Name&Address.. Mcr d 10-a rl -f gcz6 sore
Mon o 0*1 a (C i MA_0 2-63 2—
Contractor's Name r ern al,�.tJ;r• gr 6 2n inn i Snn Telephone Number(401)T,2_2,`-q g,zn
Home Improvement Contractor License-.-'.'(if applicable) /7 37 q S- Email:
Construction Supervisor's License 4(if applicable) p ci_5 7 D
Xworkman's Compensation Insurance
Check one:
❑ I am a sole proprietor
❑ I°am the Homeowner
I have Worker's Compensation Insurance
Insurance Company Name _ A rep, cwt _[.nsu<a Y1ce_
v r
Workman's Comp.Policy 9 W C`l z.8n,S S 3.fL-2 3 9 L4
Copy of Insurance Compliance Certificate must accompany each permit.
Permit Request(check box)
❑ Re-roof(hurricane nailed)(stripping old sh�slesl_All construction debris will be taken to
❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof)
❑ Re-side
Er Replacement Windows/doors/sliders.U Value - -So (maximum_36)_of windows 2—
of doors: -
❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required.
Separate Electrical&Fire Permits required.
*Alhere required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
—Note: PropertykOwner must sign Property Owner Letter of Permission.
A copy o the home Improvement Contractors License&Construction Supervisors License is
required. :
0
SIGNATURE:
Q:A1VFFILESIF0R1N4SIbuilding permit formsEXPRESS.doc _
Revised 061313
+ a RI License 43wts
Remwal RENEAVAL BY ANDEMEN MALkenXd1?3243
byAnde CT License .s55
WINDOW uoereaT nAadmenGmyea, 26 Albion Road • Un;Coln,RI 02865 tend aim n1237
M Phone 866 5W 2235 Feu CIO i 633.6602; Ftdwal fax m a,s ossss30
w (� Southern New England Windows,LLCA/b/a
Renewal by Andersen of Southern New England (�
Je+ TOM WINDOW AND DOOR REMODELING AGREEMENT J'uG51
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Suwu)Name 1NAcrR ._M,#c! TAC06S•0, o,�of
ftm(i)Sweetltd9tesr,arySuwaWMo Code/Pa. 112 MQ JOM04 ClR
E-DtaRAdQiet> WRSAcbA� A L:r QM HomeTelephdne Humber QO 77�'���7 Telephone Humtier' I `/ / /ZA
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Buyers)hereby jointly and severally agrees to purchase the products and vic%or seres'of Southern\°c, Engtand�tiindoivs",mib- b/a Repetval
by Andersen.of Southern,New England(Contractor;},in:accordance)vitli.the:'terms and canditions'described on the,front and the reverse of.,
this agreement and on the attached specification sheei(s)(collectively,this 'Agreement"). p:Historic 0 Condo Q HOA_7_
Total jobAmotunt �dsa9'-' adri4istd Suiunt bate:_ Method of payment O Check O Cash . financed
_.,.
- �a9
Deposit Received � 9=11 .wks.
G(
r CredlE Calls are'accepted for deposit only:=maximum 113 of the
Balance at Start of Job{ �'" taropt t prOlut cost.(Pkose see Oedrt Card"ent Farm.)By signing this
Estinuted Agreemerrc:you acknowledge that the Balance at Stara of fob and ttie
Balance on.Substantnl -WAS.,
W Balance on Subsiantil Completion of job rrnnot be made by credit.
�itJ ompledon of job �a9s--" c5rd and.must be made bj persaial check bank check o'cash
utyer(s)agrees and understands that this Agreemiiit constitutes the entire understanding between'the parties,and that
there.are no verbal understandings changing any of the terms of this Agreement:Buyers)acknowledges that Buyers)
(1)'has read this Agreement,-understands the'terme of this Agreement'and has received a completed,signed,and dated
copy of this Agreement,inchiding the two attached Notices of Cancellation,on the date firekwritten'above and(2)was orally:
informed of Buyer's r➢ght:to cancel*hisAgreemeat.DO NOT:SIGN THIS CONTRACT IF THERE AREANY BIANKSPACES:
(Rhode Iceland Safer Only}Notice to Buyer.(1)Do not sign this Agreement if any of the spaces;intended for the agreed terms,
to the anent of then available information are left blank (2)You are entitled to a copy of this Agreement at the tune you @iga
if..(3)You may`pt any time pay off the fall unpaid balance'dae order this Agreemeat.a"in so doing'you may 6e entitled 6i
receive a partial rebate of the finance and insurance charges.(4)The seller has no right to unlawCally enter your premises
Or commit any breach of the peace to repossess goods purchased under this Agreement (S)You may cancel this;Agreement.
if it has not been signed at the;main office or a branch office of the;seller,provided you nodfy the seller ' his or ",main
office or branch office shown indieAg iiits.ntbyiiegistcred:oc eeitifieet mail,which sliall li posted not later thanmidmght-
of the third calendarday after the nay on which the buyer signs the Agreement,eaelnding Sunday said any holiday on which
regular mast deliveries are not made See the aecouupanymg notice of cancel addu form_for as eiiplanatson of buyer's rikht8.
Buyers)received the consumer education materials'provlded f+Y the Rhode Is!agd Contractors RegtstrdLori,Board. tryer'rlrultalrJ
Renewal by trier jf 11
New England Buyers) Buyers};
Sig-ittire of duct tVfanager. S' ature azure
C/�Q�S ,f�u-�o�/ 6(I�tTER J�(CORSo;✓ ;TORN Cb85o
Print Name of Prodtic't Manager Pnnrt-uame- Pnnt.Mdii
YOU,.THE BUYER(S),•MAY CANOEL THIS TRANSACTION_AT ANY.TIME:PRIOR'TO"MMNIGHT OP THE THIRD
BUSINESS DAY AFTER THE DATE-OF THIS TRANSACTION.SEE THE ATMCHED..NOTICE OF CANCELIL ATION FORMS
AN,BBpLANATION OF THIS RIGH T FOR :
—.—.. :_.._•� ,_-. __._ _
NOTICE OF CANCELLATION �( NOTICE OF CANCELLATION`
Date of Transaction I _
Q /S :You may cancel I Date:of Transaction 4 � �/-S You::n cancel-
thhs tratsacton;wtehout'any penalty"or,.obligation,within ! this transaetion,'without airy penalty- obligation,within
three,business-days from the abgve date.If you cancel,any , three business days.from.the,above date.If you cancel,any_'
property traded in,an
payments made by jrou•under Nit i property traded in;=arty payments made by you under dte'-
Contract or Sale;-and,any neptiable instrument.etcecuted' i Contract or,Sale;and arty negotiable tnstrumentettecuted
by you will be returned within ton business days,following by you will be returned witlurrten bushiness days following,
receipt by'the'�Seller of your cancellation notcei.and any I receipt by the.Seller-of your cancellation notice,-and'any.
security-•nterest•arising".out of the-transaction will be security interest;arising out, of the transaction will be
canceled.if you cancel;you must make available to the Seller I. canceled.If you cancel,you rhus ake available to the Seller
at your residence,in substantially as good condition.as when I atyour residence,in:suhstantially as good condition as when`
received,any goods detirered to you tinder Contract or 1 received,any goods delivered'to you under this Contractor
Sale;or ou ma,if you with,ca'tn�l r with tie mstructaon-s of j Sale;aryou-may;if you wish,comply witfi th'e instructions of
'mdfls5llf YiEgd m;hhpment of the goods at the the Seller regarding the return shipmentof the goods at the;
Seller's eexxppeense and risk if you do make due goods avalable $eater's tree and risk If you do make 41io goods available;
to the Seller and the Seller does not pick them,up within, to the•�er and the Seller>,does not pick them up within
twenty days of the date of cancellation;you may.retain or.. l twenty days of the date of cancellation;you may retain or
dospowo the goods without any further obligation.If you I .dispose of the goods without any further obligation.,if you'
make fail to. the goods available to the Seller,or if.you agree; I, fail tio,make the goodsavailable'to the.Seller;or:if you agree
to return the goods to the Seller and fail to do so,then-you- i to return.the goods• o the and
d fail to do to,then you
remain liable for p--mance.of ail obligations under the l remain liable for performance of all obligations under the
Contract.To cancel this transaction;rivatl or deliver a signed t6niu a To cancel this transaction,mail or delayer a signed=
avid dated copy of this cancdlation notice or any other l and dated copy'of this cancellation:notice ore any other'
written notice,or send a telegram to Renewal6yAridersen of I written notice,or send a telegram fo Renewal byAnderseri of,
Southern New.England at 26 Albion Road; ' coln,RI 02863, t Southern New EngglIand-at 266 Albion Road,L ncoin,R102865,
NOT LATER THAN MIDNIGHT OF. - i NOT LATER THAN MIDNIGHT OF -
1 HER(DateEBY CANCELTHISTRANSACTION. I I HEREBY CANCELTHISTRANSACTION.
JJ--
x
'au eislzrrtun pdkmama OaN- Buyirti'31�g'iatun` •3e1nt.Name - Datrt;
RM Copy White: Btger,Copy Yellow 'BuyerU_py:lrink
Southern New England Windows
d.b.a
Renewal by Andersen of SNE
t' Massachusetts-Department of Public Safety
Board of Building Regulations and Standards
Construction Supervisor
License: CS-09M7 i
ter,t r. i
BRIAN D DENNIISbN - -
I
7 LAMBS POND CIR s
Charlton MA 01507
Expiration
Commissioner 09/08/2016
� L.JC—�2G (�iryl9?/jl2fYlZLIlE'c2:t�G12 o�Vf�(.L7.06GUC�6�
Office of Consumer Affairs and Business Regulation
10 Park Plaza-Suite 5170
Boston,Massachusetts 02116
Home Improvement.Contractor Registration
Registration: 173245
Type: Supplement Card
SOUTHERN NEW ENGLAND WIMUWS LL Expiration: 9l192016 _
DENNISON BRIAN
26 ALBION RD
LINCOLN,RI 02865
" Update Address and return card.Mark reason for change
scA r G 2wa4v11 r Address ❑Renewal Employment lust Card
flier of Cowemcr ARairs&Business Rraalafioa License or registration valid for individul use only
IMPROVEMENT before the expiration data if found return to:
Office of Consumer Affairs and Business Regulation
Regiatratlon: 173245 Type. 10 Park Plaza-Suite 5170
Explratlon: 9/19/2016 Supplement Card Boston,MA 02116 -
___ SOUTHERN NEW ENGLAND WINDOWS LLC.
RENEWAL BY ANDERSON
DENNISON BRIAN
26 ALBION RD
LINCOW,RI02865 Uoderarcraary Not valid without signature -
f
The Commonwealth of Massachusetts
Department of IndustrialAccidents
i6AOffice of Investigations
I Congress Street, Suite 100
Boston,MA 02114-2017
,M sr°vW www massgov/dia
Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): SOUTHERN NEW ENGLAND WINDOWS
Address:26 Albion Rd
City/S,tate/Zip:Lincoln, RI 02865 Phone#:401-228-9800
Are you an employer? Check the appropriate box:
Type of project(required):
1.Q I ate a employer with 20+ 4. FJ I 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 8. Demolition
workingfor me in an capacity. employees and have workers'
Y p h'• 9. R Building addition
[No workers' comp.insurance comp. insurance?
required.] 5. We are a corporation and its 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions
myself. [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. v�Otherf./v dw rep�ct°/�'t en
comp. insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
$Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:ARGONAUT INS. CO.
Policy#or Self-ins. Lic.#:WC 928058352394 Expiration Date:8/21/2016
Job Site Address: l q l l�lorl o/h o v C;rc- City/State/Zip: ee44ervi t fP _
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--qfVGL 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\nsurance coverage verification.
I do hereby certi under the ' s and penalties of perjury that the information provided above is true and correct
Si ature: Date: — 7 15
Phone#: 4012289800
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
�1 SOUTNEW-01 PARKERNATHCO
CERTIFICATE OF LIABILITY INSURANCE F °A 1111=0""°'r'
8113I201b
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
j 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 eertiflcate holder is an ADDITIONAL INSURED,the pol(cy(ies)must be endorsed. If SUBROGATION 1S WAIVED subject to I
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 cNOAANA cr W1111s Certificate Center
Willis of New Jersey,Inc, •'PHONE )
clo 26 Century Blvd �JArc.No Eldl:(87 7)845-7378 (888 RA/c No> 467-2378
P.O.Box 305191 !ADDRESS:
Nashville,TN 37230 6191
1 INSURER AFFORDING COVERAGE I NAtC#
iNsuRERA.Selective Insurance Company of Southeast 139926
IN��D `INSURER B:OneSeacon Insurance Company 21970
_Southern New England Windows LLC I INSURER c:Argonaut Insurance Company 19801
DfB/A Renewal by Andersen
28 Albion Road j INSURER D:
Lincoln,RI 02865 ;INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR 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,
gE�XCLUSIONS AND CONDITIONS OF SUCH POLICIES_LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
ILT(Z TYPE OF INSURANCE POLICY NUMBER SUB P�D� POLICY VY) I LIMA
A X COMMERCIAL GENERAL LIABILITY ' i EACH OCCURRENCE $ 1,000,OOq
CLAIMS-MADEOCCUR I X iIS 2029459 08110/2015 08/10/2018 pRE � e S _ 1100'on!
I ` MED EXP(Arty ono person) 1$ 10,000i
_I I PERSONAL&AOV INJURY ($
GEML AGGREGATE LIMIT APPLIES PER:
X PRO X I ( [GENERAL AGGREGATE $ 3,000,0111i�
!POLICY JECT C LOC PRODUCTS-COMPIOPAGG I$ „3,000,t100'
OTHER:
AUTOMOBILE LtABILTIY ! . . f COMBINED SINGLE LIMIT
X ' Ea accident s 1,000,00
ANYAUfO I X �,S 2029459 09/10/2016 08110f2016 BODILY INJURY(Per person) b
IAUTO OSSJNED SCHEAUTOS
I 1 I BODILY INJURY(Peraccident) $
X i HIRED AUTOS X I AUTNONO ( I j I PROPERTY DALlAGE S
Prar accigerd
I i g
UMBRELLA UAB OCCUR EACH OCCURRENCE S
EXCESS LIAO CLAIMS-MADE AGGREGATE I s
.DED I IRETENTIONS 8
I WORKERS COMPENaATION i
B 'AND EMPLOYGVW LIABILITY YIN ( i X STATUTE 'Bi
ANY PROPRIETORIPARTNER/EXECUTIVE 000088028 08121f2015 109121/2016 E.L.EACH ACCIDENT S 1,�0 000
I OFFICERIMEMBER EXCLUDED1 N f.N I A I
,(Mandatory In NIQ I `: I EL DISEASE-EA EMPLOYFF S 1,0110,00
If yyes describe under
:DESCRIPTION OFOPERAT10N8below I I EL DISEASE-POLICY LIMIT S 1,000,00
C Workers Compensation 1 C928DW52394 Ot1f21f2015108/21/2016 See Attached
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached B mom space Is required)
THIS CERTIFICATE VOIDS AND REPLACES THE PREVIOUSLY ISSUED CERTIFICATE DATED:(IM i12016
Auto Policy includes additional insured When required by written contract/agreement as per policy form.
NSS Holding Corporation,Inc.and any,subsidiaries are included ao an Additional Insured as respects to General Liability when required by written
contract/agreement as per policy form
.I
CERTIFICATE HOLDER CANCELLATION
t i
i SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE i
THE EXPIRATION ,DATE THEREOF, NOTICE WILL BE DELIVERED IN !
ACCORDANCE WFT 4THE POLICY PROVISIONS.
AUTHORQED REPRESENTATIVE
01988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD
Gf ( � 6 ?
ppIIKE tqk, Town.of Barnstable *Permit#
tip Expires b months jrom issue dale
Regulatory Services Fee
• snxxsznBM
v� 16 9 � Thomas F.Geiler,Director o lG ZASf
QED MAC a (�
Building Division P"$E S a PERMIT
Tom Perry,CBO, Building Commissioner
200 Main Street,Hyannis,MA 02601 .)Olt
www.town.barnstable.ma.us
Office: 508-862-4038 TOWN (0f'axE2,,M9 790`.62Y0YE
EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY
Not Valid without Red X-Press Imprint
Map/parcel Number L
t .
Property Address l �h 0'1 a/M G y IA c le C e.n-fie /Z U d e--
[Residential Value'of Work 3 U!J r 0 U Minimum fee of$35.00 for work under$6000.00
Owner's Name&Address W AU-ey ` 1, J_A C u 6 j o 1,
l `1I /,40KO roll CI%Lcle- , +��g-re✓viIle M-i a2G32-
Contractor's Name (1 u Vt/ GUJ 1"�i ff a Telephone Number .mad'YZ� 9 S
Home Improvement Contractor License#(if applicable) # o 0 Ty
Construction Supervisor's License#(if applicable) C S 7 y(v Y D
EKvorkman's Compensation Insurance
Check one:
❑ I am a sole proprietor
❑ I ani the Homeowner
I have Worker's Compensation Insurance
Insurance Company.-Name X/47-/t'14 p/ � ,gAl�e .IVOYZU9/ 1N.) z/Z-1m e
Workman's Coup.Policy# N Ul CC v.Sf 113 2
Co of Insurance Compliance Certificate must:
PY P I'�Y
Permit Request(check box) .1'E+dditP �G
❑ Re-roof(hurricane nailed)(stripping old shingles) All construction'debris will.be taken to. Cl}S.e f lA 'W9 J rC S a mo wl C ff
M4.
❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof)
�itPr[iN lhov✓ ,3d' J
❑ Re-side 1 G�
#of doors
Replacement Windows/doors/sliders.U-Value 2 y LtJrAoc rt(maximum:35)#of windows D lI US le 1j u N c
*Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
'Note: Property Owner must sign Property Owner Letter of Permission.
A copy of the Home Improvement Contracto"iceuse&Construction Supervisors License is
requ ed ,
SIGNAT
C:\Users\decollik\AppDataV�cal(icrosoft\Windows\Temporary Internet Files\Content.Ouilook\DDV87AAZ\EXPRESS.doC
Revised 072110
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
' 600 Washington Street
Boston,MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Organizatioi/hdividual): C of�< 'I- i t�' V i'm e Z !!p eeV e t?2f'NY`
Address: Al uJ R IJ ,
ty p ,4 6� Phone# 3"i�
Ci /State/Zi L e. fit �' r
Are you an employer?Check the appropriate box:
Type of project(required).:
1.[Xam a employer with Iq 0 4. ❑ I 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
workingforme in an capacity. employees and have workers' .
Y P �'• 9. El Building addition
[No workers'comp.insurance comp.insurance.
We are a corporation and its 10.❑Electrical repairs or additions
required.] 5. ❑
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.
Insurance Company Name: IV4-71 1911"it- e- 10o l y� . `C v
Policy#or Self-ins.Lic.#: I W C G V r elj ZQ Expiration Date:
Job Site Address: I f Al °�! M G y ...Ci%�c I� City/State/Zip: �1�f��i/Z/� `.Ll,� G16 3 ..
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 Dwfor insurance coverage verification.
I.do hereby ce •der a pains and penalties of perjury that the information provided above is true and correct
Si attire: Date-
Phone#. . Pdr
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 x5.-Plumbing Inspector
. 6 Other.• ., . : - _ . . ,
Contact Person: Phone#:
Client#:47298 CAPIHOM
ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDbryy Y)
01/04/2011
THIS CERTIFICATE IS-ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to
the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER - - - CONTACT Karen Walther
Rogers Sr Gray Ins.-So. Dennis PHONE
O No EXc:508 398-7980 FA No
434 Route 134 aooRess: waltherka@rogersgray.com
P.0.BOX 1601 P DUCE
-
South Dennis, MA 02660-1601 CUSTOMER ID#:
INSURER(S)AFFORDING COVERAGE - NAIC#
INSURED INSURER A:National Grange Insurance Co.
Capizzi Home Improvement,Inc. INSURERS,ACE Property 8r Casualty Ins.Co
Capizzi Enterprises,Inc.
INSURER C: -
1645 Newtown Road
Cotuit,MA 02635 INSURER D:
.INSURER E: - -
INSURERF:
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.
INSLTR TYPE OF INSURANCE DDL UBR - POLICY EFF POLICY EXP
LTR NSR D. POLICY NUMBER - MM/DD MM/DD LIMITS
A GENERAL LIABILITY MPB1075H 06/08/2010 06/08/2011 EACH OCCURRENCE $1 000000,
X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED
PREMISES Ea occurrence $500,000.
CLAIMS-MADE OCCUR - - MED EXP(Any one person) $10,000
PERSONAL&ADV INJURY.. $1,000,000
GENERALAGGREGATE $2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO $2,000,000
POLICY F PRO- LOG - .. - $
A AUTOMOBILE LIABILITY BPO10786 06/08/2010 06/08/2011 COMBINED SINGLE LIMIT
A ANY AUTO M1M28044 06/08/2010 06/08/2011 (Ea accident) $500000
ALL OWNED AUTOS: BODILY INJURY(Per person) $
.BODILY INJURY(Per accident) $
X SCHEDULED AUTOS - - -
PROPERTY DAMAGE $ .. -
X HIRED AUTOS (Per accident).
X NON-6WNEDAUTOS U1 $2501500,000
X Drive Other Car U2 $250/500,000
A UMBRELLA LIAB X occuR CU61076H 06/08/2010 06/08/2011 EACH OCCURRENCE s5,000,000.
EXCESS LIAB CLAIMS-MADE . AGGREGATE s5.000.000
DEDUCTIBLE - $
X RETENTION $ 10000 $
B WORKERS COMPENSATION . NWCC45843208 12/25/2010 12/25/2011 X WC STATu- OTH-
AND EMPLOYERS'LIABILITY Y/N - - ER
ANY PROPRIETOR/PARTNER/EXECUTIVE - E.L.EACH ACCIDENT $1,000,000
OFFICER/MEMBER EXCLUDED �N N/A
,(Mandatory in NH)If yes,describe under E.L.DISEASE-EA EMPLOYEE $1,000,000 .
DESCRIPTION OF OPERATIONS below - E.L.DISEASE-POLICY LIMIT $1,000,000
DESCRIPTION OF OPERATIONS/LOCATIONS/.VEHICLES(Attach ACORD 101;Additional Remarks Schedule,if more space is required) -
Workers Comp Information included Officers or Proprietors
CERTIFICATE HOLDER. CANCELLATION 10 Days for Non-Payment
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
Town Of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS.
200 Main Street
Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE
m 198 -2009 ACORD CORPORATION.All rights.reserved..
ACORD 25(2009/09)' 1 of'I The ACORD name and logo are registered marks of ACORD
#S61971/M61970 MEE
✓sze vol oy✓acaaa�
Office of Consumer Affairs&Business Regulation. License or registration valid for individul use only
= OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Office of Consumer Affairs and Business Regulation
E Registration:._4:00740 Type: 10 Park Plaza-Suite 5170
ExpiraCtnnF23f2612 Supplement Card Boston,MA02116
CAPIZZI HOME`IMfj/E�171EfiT 1NC.
—�
;�i
r .
GARY GUSTAFSQfl=�='_i
1645 Newton Rd.
Cotuit,MA 02635
Undersecretary No . •d without signature
N1 (ssachusctts Delru-tmcnt of Public 5afch j
7 Board of Buii(lin±_ Regulation, and Standxitts
Construction Supervisor License
License:_ CS 74640 ,
GARY:GUSTAFSON
4 8 SHORT WAY
SANDWICH, MA 02563 :f
Expiration: 11/29/20'1
Tr#: 7058
('umnii«iuncr ...
1 i
r
Page 7 of 7
CAPIZZI HOME IMPROVEMENT INC.
SPECIFICATIONS AND ESTIMATES
STATE OF MASSACHUSETTS
LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT
I,
OWN THE PROPERTY LOCATED AT rfl 4ileq�0 07 1=-e,
IN � �� lLl� ,MASSACHUSETTS.
I HAVE AUTHORIZED CAPIZZI HOME IMPROVEMENT TO ACT AS MY AGENT TO APPLY FOR
A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR,THE MASSACHUSETTS STATE BUILDING
CODE.
I GIVE MY PERMISSION TO LESSEE
TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR,THE MASSACHUSETTS
STATE BUILDING CODE.
SIGNATURE OF OWNER:
OWNER'S ADDRESS: ��_
OWNER'S TELEPHONE:
LESSEE'S SIGNATURE:
LESSEE'S ADDRESS:
LESSEE'S TELEPHONE:
APLLICANT'S SIGNATURE:
APPLICANT'S ADDRESS`. 1645 Newtown Rd.,Cotuit,MA 02635
APPLICANT'S TELEPHONE: 508-428-9518
RESPONSIBLE OFFICER:
RESPONSIBLE OFFICER ADDRESS:
RESPONSIBLE OFFICER TELEPHONE:
[310 4
Town ®f Barnstable Permit# '-7 10'7 3
Expires 6 months from issue date
. Regulatory Services Fee - 2.s'�e
+ BARNSTAHLB, s'
MASS.
2639. �e� Thomas F.Geiler,Director
��D"�►`' Building Division
Tom Perry, Building Commissioner
200 Main street, Hyannis,MA 02601 XoPE �T
Office: 508-862-4038
Fax: 508 790-6230
ExPRESs PERmrr APPLICATION - REs�ENTIA �AY ZOO4
Not Valid without Red%Press Imprint TOWN OF BARNSTABLE
Map/parcel Numberpr4 �� Z�.Z
Property Address ' ' i
Residential Value of Work
Owner's Name&Address AA4 S Q bs
yu,'WC ,cam Cj 2(32
Contractor's Name1 V,L��C f`a+ �- Telephone Number 5� n7 7(J
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
(-I have Worker's Compensation Insurance
Insurance Company Name L 1 I�`e lX VL 3L, V4 1-t C C u ,
Workman's Comp.Policy# W ) �S— J o a
Permit Request(check box) d /Re-roof(stripping old shingles) All construction debris will be taken toAI I "" ` e `''l C y
❑Re-roof(not stripping. Going over existing layers of roof)
❑ Re-side .
❑ Replacement Windows. U-Value (maximum.44)
*Where required: issuance of this pent does not exempt compliance with other town department regulations.i.e.Historic,Conservation,etc.
***Note: Property Owner must sign Property Owner Letter of Permission.
Home Improvement Contractors License is required.
Signature-- �>
Q:Fonns:expmtrg
Revise053003
R
{
jl,il►erty Mutual Group
�.lbeik PO Box 7202
Portsmouth,NH 03802-7202
Telephone(800)653-7393
Fax(603)431-5693
November 14.2003
TOWN OF BARNSTA13LE
BUILD.NG DEPT
367 MAIN STREET
HYANNIS.MA 02601-
RE: Certificate of Workers Compensation Insurance
Insured: NICKERSONBOME IMPROVEMENT INC -
PO BOX 2476
ORLEANS,MA 02653 .
Policy Number` WC541 S-318102-023 F.:tiective: . "=.11/6/2003 • ..Expirations '`i 1;t6/2004
Coverage afforded under Workers Compensation Law of the fallowing state(s): MA
Emplovers.L_ i_ability
Bodily inituy By Accidcoc $ 1,000.000 Each Accident
Bodily Injury by Disease: S 1,000,000 Each Person
Bodily Injury by Disease: $ - 1,000,000 Policy Limits
As of this date,the above-referenced policyholder is insured by 1:M Insurance Corporation under the polity
listed above.
The insurance afforded by the listed policy is subject to all the terms,exdusions and conditions_and is not
altered by any requirement,term or condition of any or other documents with respect to which this certificate
may be issued.
This certificate is issued as a matter of information only and confers no right upon you,the certificate holder.
This certificate is not an insurance policy and does not amend,extend.or alter the coverage afforded by the
policy listed above.
If this polio is cancelled before the stated expiration date,Liberty Mutual will endeavor to notify you of such .
cancellation.
AM'HUR IZED REPRESENTAT.rvE
LWERTY MlrTUAL!NSURANCL GROUP
11,6 Ccaitiwld is trcCute4 by 1JRr-ItIY NWTUAL rNSURANCT GROUP mFp as Such ituW.inu Ix is--drn ded by those mmpanim-
cc: Insured: Producer of Record:
N.ICKERSON HOME IMPROVEMENT INC PIKE INSURANCE AGENCY INC
PO BOX 2476 P O BOX 16itt
ORLEANS.MA 02653 ORLEANS.MA 02653
l In znrr>Q; ,
y
1
a Page No.
NICKERSON HOME IMPROVEMENT, INC. 123802
P.O. Box 2476
HYANNIS, MA 02601 ® ®I' n
(508) 790-5880 Fax (508) 255-5107
PHONE ^_ � 11DATE
TO Mr. Jacobsoin 508-771-9264 ` 7/28/2004
191 Monomy Circle JOG NA%,IE i LOCATIGNI
Centerville MA 02632 Same
JOB NUArr,:ER (JOB PHONE
HEM o"Wom
Strip shingles off entire roof
Renail all loose sheathing
Install 8"white aluminum drip edge on all lower edges
Install ice &water shield on all lower edges and around all openings
Install black underlayment felt paper on entire roof
Install new flanges around vent pipes
Install 25 year 3 tab Seal King algae resistant shingles on.entire roof
All trash and debris will be removed and disposed of properly
All materials, labor and debris removal
OPTIONS:
*raibave
.. Install ridge vent at� rer lineal foot•
VPIY)AISE INDICATE SHINGLE COLOR AND YES TO ANY OPTION ON RETURNED PROPOSAL
v 1i..,Alc- 6b jet
Only items specified aifove are included in this proposal
Rotted wood repair is NOT included in this proposal
Materials guaranteed by manufacturers
Nickerson Home Improvement Inc. guarantees workmanship for 5 years
WE PROPOSE hereby to furnish material and tabor—complete in accordance wvith the above specifications,for the sum of: r
Dollars doi".ars(S
Payment to be made as folios: —^
deposit upon signing progress payments upon request, balance upon completion
All.maierial is guaranteed to be as specified. All %vork to be completed in a professional f '
manner according to standard practices. Any alteration or deviation from above specifica- Authorize
lions involving extra costs will be executed only upon written orders, and v.riffl become an Signature _
extra charge over and above the estimate" All agreements contingent upon strikes,accidents or
delays beyond our control. Owner to carry fire,tornado,and other necessary insurance.Our Not Asit
sproposal may be
:workers are fully covered by Vdorker's Compensation Insurance, vnthdrawn byof accepted vAthin 30 days.
ACCEPTANCE OF PROPOSAL—The above prices,specifications
and conditions are satisfactory and are hereby accepte>. You are authorized Signature
to do the work as specified. Payment will be made as outlined above.
��tu �A�,( Signature
Jaffe of Acceptance: WV
B a"ril ol' ir °ing cgu atiiStis al`SfYd1f License or registration valid for individul use only
HOME IMPROVEMENT CONTRACTOR before the expiration date. if found return to:
Board of Building Regulations and Standards
Registration: 133851 One Ashburton Place Rm 1301
Expiration: 8/17/2005 Boston,Ma.02108
Type: Private Corporation
NICKERSON HOME IMPROVEMENT
MARK NICKERSON
12 COMMERE DRIVE _ ;
ORLEANS,MA 02653 Administrator Not valid without signature
I,
4
�oF1HE r Town of Barnstable
P
Regulatory Services
�> MASS.n Thomas F.Geiler,Director
1639. & 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
I 06s�9✓U , as Owner of the subject ro e
P P riY
hereby authorize AJ)'G k 2r n rnP qm r3UrO,.l• to act on my behalf,
in all matters relative to work authorized by this building permit application for:
O'n C,rVIL4 C vi Je rvt'j
(Address job)
Stature of Owner Date/
�Z�CIO 065�rAll
Print Name
n•.MAMC•nQ7TTCD DIID A OTC,CCTn" .
Bf DATE .. SUBJECT--......................... ....... SHEET NO., OF
.KD. - tOATE JOB NO.... .... .......
_.... .......... ........ ..................,......
r
1
S 77 78
i
0
N
I� -A OF 14(gn '
WILLIAM, G,
� �Ho 19334sugo
,E
,•
C ERTIF r gD 'PLG17
76
iPL.r�.:� kit'
3 c6T -t 7
P1 , Bk. Z7z ' PG s S
s yo y✓�Ir yE,eE o�%... a�vr-Yr�.c 7-r X,� E ,A X T+E i � N Y M t tA C..
Z0411N� T✓S/.4 74PWN Gfi� R GISTEQ.ep LA N E-', S0RVEyog5
,�E6/5T"�k'' 1 PT I ► 4l� i
f Assessor's map and lot number -
r~ 4 SEPT!
7 f: INST SYS7 EM MUST
B
Sewage Permit number ..................................... ............... AL ►N•C E
..._ WJTH ARTICLE lIDMPLIgNCE
�J ' of THE r r" i ! A Q sTgrE a
t TOWN OF ;BARNS- . ����AND TOWN
Z ZXRNSTA&E, •
y r' 639.' DU'I1DIHG INSPECTOR
pp 'i67q �9� ,
Q MPY Or• :� �, a
- •-t t tY+ ii - ,
qj
c APPLICATION FOR PERMIT TO .........................................................................................
TYPE OF CONSTRUCTION a .
F ..... . .............. .............19....
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location ...... f.. .......................................................-.............. ..............................................................
ProposedUse ...,r�! '...............................................................................................................................
ZoningDistrict ............................................Fire District ...................... ....:.................................................
Nameof Owner ....✓ . ..... .. ......... ...........Address ........................................4. ..... .................................
Nameof Builder ...................................:................................Address ......:.............................................................................
Nameof Architect ..................................................................Address ....................................................................................
Numberof R ......... Foundation ...................................................
..i.............................................
Exterior ..:......................... ,..:.........................................Roofing ........���� �' � '
Floors ............................................ Interior .......r.•�,••.. .........................................................
40
Heating :......��r_..4... t.. ....................................Plumbing ....... .. ...............................
Fireplace ...... .... ................................ ...............................Approximate Cost ........:.. �.�...a%..-..v.................. .. ..
s
Definitive Plan Approved by Planning Board ________________________________19________. Area .....................
Diagram of Lot and Building with Dimensions
Fee .....................:........................
SUBJECT TO APPROVAL OF BOARD OF HEALTH
,/- d
� 7
I_ hereby agree to conform to all the Rules and Regulations of the Town of.Barnstable regarding the above
construction.
Nam- ........................... ...
Small, Alan E.
18493 one story,
Alb ................. Permit fo'r ....................................
!single family dwelling
ing
. ...............................................................................
L tB- l. kopor66y Circle
..oco i n . ...........
Centerville
...............................................................................
Alan E. Small
Owner, ..................................................................
frame
Type of Construction ..........................................
.. ........................................................:............
Plot ............................ Lot ............#77
....................
Permit Granted ...........June..29..........:...19 76
Date of Inspection .71,� .....19
Date,Completed ...............19
PERMIT REFUSED
....................................... ..... 19
.................
...............................................................................
.....................6.......................................................
................... .......................................
...............................................................................
A, proved
ro v' ..ed .......................................... ..... 19
I-
............ ....................................................................
................ .............................................................