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HomeMy WebLinkAbout0204 MONOMOY CIRCLE z =. ol I ° u F: Application number.......;B..` 1.+-36...- 22 Q, Fee ... . ........................5S.... .. ........... L a REV `"°"�' Building Inspectors Initials..... Date Issued.:..............j- 2 .... ................ BCE .. ... TQka of MRNS� Map/Parcel........�..`9..�............f..2 TOWN OF BARNSTABLE , r EXPE6TED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: H Qf I�a C� � U 1 NUMBER STREET VILLAGE Owner's Name: mk Phone Number_60 g &H Email Address: Cell Phone Number Project cost$ 606�oy a Check one Residential Commercial OWNER'S AUTHORIZATION � As owner of the above property I hereby authorize to make application I building pe t acco ance with 780 CMR Owner Signature: Date: 02 TYPE OF WORK ❑ Siding ❑ Windows_(no header change)# ❑ Insulation/Weatherization ❑ Doors(no header change)# Commercial Doors require an inspector's review Roof(not applying more than 1 layer of shingles) ' Construction Debris will be gouig-to A5 CONTRACTOR'S'INFORMATION Contractor's name Home Improvement Contractors Registration(if applicable)# (attach copy) Construction`Supervisor's License# 1 '(attach copy) Email of Contractor Phone number ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR/F THE SUBJECT PROPERTY-IS 1N A HISTORIC DISTRICT. YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. 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) j 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 Fuel source being used LP tank 20 lbs. or> Yes No____,if yes, a gas permit is required. Natural Gas Yes No ,if yes,a gas permit is required. 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�5129 J Lq-2, 2J— Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CNM the Massachusetts'State Baildmng Code. I uridepstand the construc ' inspection procedur ,specific inspections and,documentation required by 780 CMR and t e T wn of Barnstable Signature Date" t r APPL CANTS SIGNATURE 3 h 1 Signature Date 1 . All permit applications#e subject to a building official's approval prior to'issuance. "w- 5 4 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/Contractorsxlectricians/Plumbers Applicant Information Please Print Legibly (Name(Business/Organization/individual): Address: City/State/Zip: Obi O.V S'Phone#: 6'0?= Y 00 p I Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 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 workingfor me in an capacity. employees and have workers' Y P h'• $ 9. ❑Building addition [No workers'comp. insurance comp. insurance. required.] 5. ❑ We area corporation and its 10.❑Electrical repairs or additions 3.1q I am a homeowner doing all work officers have exercised their 1 L❑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.] 1N*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowner who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a ne•:r affidavit indicating such. :Contractor that check this box must attached an additional sheet showing the name of the sub-contractor and state whether or not those entities have employees. If the sub-contractor 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: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/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:ce fy U. der the p n�and a ties o perjury that the information provided above is true and correct. ,Signature: �''Date: 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 KCity/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other 5, Contact Person: n. Phone#: M Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide:workers;compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." 1 An employer is defined as"an individual,partnership;association,corporation or other legal entity,or any two or more '' of the foregoing engaged in a joint enterprise,and,including the legal representaii4i of'a deceased employer,or the r receiver or trustee of an individual partnership,association or other le al"enti p p, g_ ty,employirig employees. However the owner of a"dwelling house having not more.' three'apartments and'who resides'therem,or the occupant of the dwelling house of another who employs persons to do'maintenance,construction or°repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because,ofsuch employment be deemed to be an employer." f .-._r _- ....•-- -- _ -.-.-.-_ ..,:,.,.sue... ,_ :»,� _,,, ---h��-�'`"--�`c^"-."." MGL chapter 152,§25C(6)also states that"every state;or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither`the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority" Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the i e members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP doesYhave ' employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should _ be returned to the city or town that the application for the permit or license is being requested,not the Department of "lndustriai EiOCiden`ts.`Sh0iild you`nzve a quesiyon"'"'s r g ding dt6'aw or tf you e equ r"e`d'tl��litairi cerS`*" X compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permittlicense number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)"A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file.for future permits or licenses. Anew affidavit must be filled out each year.Where a home owner or citizen,is obtainin <a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and•fax number: -The Commonwealth of Massachusetts Department of Industrial Accidents ' office of Investigations 600 Washington.Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE . Revised 4-24-07 Fax#617-727-7749 www.maw.gov/dia r a Town`of Barnstable ' �1e0it q6(4;0 ' L" Expires 6 mo:!TS­ aMOMABIAue date Regulatory Services Feee 3' •` ` Richard V.Scati,Interim Director '�'f Building Division ' CDDk, 9, Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 ' www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY I q l Not Valid without Red X-Press Imprint Map/parcel Number 7J �J�J Pro erty Addres Qb—q I�l 6 r 3 Residential Value of Work$ I (� Minimuip fee of$35.00 for work under$6000.00' Owner's Name&Address I t,t t1 �2k O�- If 3�- Contractor's Name -,. - Telephone Number Home Improvement Contractor License#(if applicable) Email: l J nC.. •&)' Construction Supervisor's License#(if applicable) 23 1 6k�� ❑Workman's Compensation Insurance ftrEtfit, PONT Check one: ❑ I am a sole proprietor �+C r. a SEp O 2O1't m the Homeowner + el I have Worker's Compensation Insurance o WN OF BARNSTABLE Insurance Company Name Workman's Comp.Policy# V � 0 `7 Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑R -roof(hurricane nailed)(not stripping. Going over existing layers of roof) -side /C �- je Replacement dows/doors/sliders.U-Value _ (maximum.35)#of windows'' #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical Fire Permits required. 'Where required: Is is permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation etc. ***Note: o erty Owne ust sign Property Owner Letter of Permission. A opy of th ome Improvement Contractors License&Construction Supervisors License is - - r quir d. T SIGNATURE: TAKEVIN MBuilding C anges PERMMEXPRESS.doc Revised 061313 t 5 the Commonwealth of Massachusetts Department of In&sbial Accidents Orwe of Investigations VJ 600 Washington Street , Boston,M4 02111" yvrvrtr massgovldia Workers' Compensation Insurance Affidavit-Builders/Colo etorsJElectricians/Plumbert Applicant Information Please Print Lest b y Name >sffiesslOrg CitylState/Zip: (n/lfJA'+MA_d fA�i i-l.'l.S Done#: Are�uu'an employer?Check the.appropriate box: Type of project{regnired): 1.EVIL am a employer with:-3. 4: ❑ I am a general contractor and I employees(full and�'ar part time)* have the sub-contractors 6. ❑New cxutmti ' 2_❑ I am a sole proprietor or partner- listed on time attached sheet. 7. ❑Remodeling " ship and have no employees Thy sob-contractors have 8, ❑Demolition employees and have workers' working for me.in any capacity_ �° Q: ❑13uilcliag addition [Na workers'comp.insurance comp.iusurance.I required] 5_ ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work of icers have esemised their I L[]Plumbing repairs or additions myself[No workers'comp- right of eaemption per MGL 12_ of repairn insurance required.]i c. 152,§1(4),and we have no employees [No workers' 13_ Other tzgj lacy C i i rdu comp_insurance required] I 1 `} ;Any appkcant that checks boa#1 mart also fill our the secteau below shommig their watkets'conveosation policy infarmstiaa Hameowum who sabm6t this afl-idacntt nu tong ghey ue doing all work and then hie outside contractors mast submit a new affedsmt indicating such rcontractors that cbeck this box mural attached act additional sheet shams the natne of the sub-co is and state whether or not those entities hags employees. If the sub-cantmaoas Lane mployees�they nest provide thigr workets'comp.policy number. I am an employer that is providing workers'compensaion insurance for my ernptoysex Below is time policy and job site information. Insurance Company Dame: r)�L,06S Policy#or Self-ins-lac-,ft:�((— -f X T�`��T Expiration Date: Job Site Address: l City/State/Zip l '�,p NO� 1 v� 22 e �J� Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to securee ZIA as required under.Section 25A of MGL c 152 can lead to the imposition of criminal penalties of a fine up to$1,500 one- imprisonment,.as well as civil penalties in the form of a STOP WORK ORDER and a fine � of up to$250.00 ust olator_ Be advised that a copy of this statement may be fig warded to the Office of Investigations offor e coverage verification. I do hereby 71�7 tb ir s and penalties®,fgsrfruy brat fire in,�nrniatdnn prmd ab is bare and c orrect -Si mature: Date: i 1l Phone#: tiffl,cial rasa only. De not write in this area,to be completed by C*or town tfaciat City or Town: PermitUcense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.CitplFown Clerk 4.Electrical Iiispector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 6. Y 'j +� BARiVSTABIE, � f Town of Barnstable Regulatory Services Richard V.Scali,Interim Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis;MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder IW DOeK 1C ,as Owner of the subject property hereby authorizen.P� ( �'l��•1� :.�/1,�-� to act on my behalf, in all matters relative to work authorized by this building permit application for: C� (Address of Jo �� Signature of Owner Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the .reverse side. TAKEVIN_MBuilding Changes\EXPRESS PERMITNEXPRESS.doc Revised 061313 Rightf" C3-2 11/11-/2013 6.:,:55. 6: AR PAGE 3/,094: AC& CERTIFICATE CIF. LIABILITY INSURANCE '11.2013 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 AMEWD, EXTEND:.OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A.CONTRACT:BETWEEN THEISSUING:INSURER. Pi AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER: IMPORTANT:It the ecrtiftcate.holder is an.ADDITIONAL INSURED,the Ixutity{ies},miist ba cnlio[sed. If SUBROGATION IS WAIVED,. Sublcct to the turna and cunditions of the policy,certain policies may mquire.an cndorscmcnt A statemcrit.on thig certificate does_ _ not confer rights.to the certificate holderin Ifcu of such endorsement(&).. PRQDUCGlt - - mm CAPE COO IN'i AGC't -PHONE fr as Z48 VANTER ST HYANNIS.can s2o01 ,� r . r ,tp^NnFlkd;�;;iyF i't?llhi?t";rt+C.Y,eAI�b vi+IC+f _ . rl'I'sl+HhtF V'tIE Rr16 11 RSr r.efeaf:`t4(1'I'�F,.`�?(' F;4F INSURED rl\ HI SN iEAC+FIER tiili.H:gE LDBA , . MEAGHER DROTTIERS CONSTRUCTION G7 EIv1E13ALC1 STREET rrstrkf €i. hlAR,STQKS MILLS.MA Q2fi4g, ix NF E GQVERAGES _ T CE42TIFICAJENUMHER� �__, RFVIIQNNUA4BFR F, T11B IS.TO GERTIFf THAT THE POLICIES OF INSURANCE LISTED DELO HAVE DEEN I SSI)CO TO.THE iNSUREO Nx0.i6CJ�! ABOVE FOR THE POUGY`PERiODANDICATED. NOT1,'rTHSTANDINra ANY REQU RENIENT,,TERN1,O Z CONDITION OF ANY CONTP.ACT OP.OTHER DOGLIMENT kNITH RIESPECTTO NHICH THIS CERTIFICATE FdAY BE�ISSUED OF MAY PERTAIN,-'HE INSURANCE AFFORDED By THE PouCIES'DESCRIBED HEREIN IS S WECT TO ALL THE TERMS, EXCLUSIm'; .NND CONDITIONS OF SUCH PC7LICIEU.l.lhlrTS sHov.,N MAY I►AVE BEEN REDIJCED 131 RAID CLAIMS: INSR - IADD WFA .. - -PQLICY EFF. ; POLICY F.XP ttR TYPE-OF WSURAPN'E tINSR wvul KiU%V NUm&ER (AtmM0,NYYYlt tMU-DOIYVYy- y {,fHRS - GENERALIIABi.ITY i' _. - _. E CFr:flPGrP7r cSr C "s°........... 14a nlbt ?ArrE i3C.'Ui2 j i - t.fi t E=rF 11 r e-r;t.nr f EP_;QNAL&A b 4''!UP . rr t i i tw rKiftn fc I F AIF .' L-FY r t",7. CAT-LEWIES P_R- t - I akr r t , _ - t 4shltti 111.•`,wF.irk?r% F- AUTOMORIt.ELIA$ILIN ;AJ F-O 6CtA Y Vr y t/1' r 2tw✓s --•-� I _ 1 IAI ftt�7:i 'rs✓WS 1�1: { i a r RC 031 Y i,t 4Y tP rttr +Im 3 AU7 Lr....l A t04 � l `isyr rJ t«T I} '; rit .. _ 2C2 rrt,1A E $ , 1 iUMDREL1ALrAB. C-:;GUJ..- iEYCESS WORKIIAS COMPENSATION I {{ f U3 ANO�EMPLOYCATLLAeln �tClfi.�-1.tY1�` 1t ft.d1A ; 1 -7Qi4 I L ,C A6a1rLrr; 5')OJfJQi} ° .N C1S- 11 1:0 r itarav]r +rll:. 1 Ct..,15=n�C ..F'LY�FLOtCr $!i{IQ.Ci(3ii =aassesaA r _.rut=no: tsi:�.�,rie>r=.arm..•.-- s - r rl tx:� it Ftz;t.:� I,.t. St#IU,Q:11 . ecSCWPTION OF OPERATIONS9 LOCATIOt4S!VEHICLES(Asach.ACORD.101 AddMon'd Remaft Scha)alo,It mom 51ma rs ta4ulred) ' A1CAC)iER;.%mC1iAEL IS.COVERED.SY Ti I I- TIFICATE HQLDE-R TOWN OF BARh'STABLrAIJILDIhf DEFT SHOULD .ANY OF THE ABOVE DESCRIBED .POLICIES. BE 230 SOUTH STREET CANCELLED BEFORE .THE, EXPIRATION. DATE THEREOF: i IYAtiNIS.htA i�24iO1 NOTICE WILL BE OELIVERED IN ACCORDANCE..WITH THE POLICY PROVISIONS. AikYHORIZE✓)REPRESENTATIVE _ 4— L a.3/988.201Q ACOROCORPORATION:_Alfrights reserved. ACORD 25 201010S) The ACORD name and,1ag6-are registered marks of ACORD ��r �n-ni�ieoruaru�/�-r/C'%l(�r�:urcc�ccar,.(/t a � Office of Consumer Affairs&Business Regulation OME IMPROVEMENT CONTRACTOR egistration 162938 Type: Expiration: 4/27/2015 DBA MEAGHER BROTHERS CONSTRUCTION I MICHAEL MEAGHER JR j 97 EMERALD LN -,ds� — i MARSTONSMILL,MA 02648 Undersecretary Massachusetts iiepart w a ent of pudic Saf(,tY Board of Building l��grjlation, and vtand��rds r . (:unstructil)n SLiicrvisilr i License: CS402260 A MICHAEI S MEAGHEK ' 97 EMERALD LANE Marstons Mills MA 026a8 • rat� i•Irl '' �.;CC�4ratiOn s I 1105120 14 = Unrestricted contain 1ess Buildings of than an y Us enclosed space- 35'000 cable feete g roup WWch 91 m )of Failure to possess e State Build! current edition of ng Code is c th cause for re .e Massachusetts For DPS licensing in for � • formation visit: vocation of this license .. _ wwK,•Mass.Gov/DPS ., License or registration valid for individul before the expiration date.`If found return to:use only Office of Consumer 10 Park Plaza_ Affairs and Business Regulation. Suit 170 I Boston MA 0211 i No alid Without signature i' r t, r ?, ;t"F. Y. 4g1� G F { • - M ICo Olq - _� $_ LA ( , f ,t/},:fit •4, RICHARD• f hl 24048 ' Z0C. 7IOAi C�NTt1z�/ LLc3 j CIFR T/.c y TNAT 7-/-/E 44 ,SNOWiV yE,2E0.(/COM�L YS W122V SCE,L z-:: 7'-,UE S"/OE.0///E �NO S,!r 7 Cf� ,oL Ai(/ EQv/�E�IE�c/YS of THE �"ow�v of T �A 2 �A 81.r3 ANo /s 10 7- ZvT 9 I r s ,COCA TE-L� Wirs�/� TyE F,Goa�PG4/�! �, �iC Z�2 j a BA XT.E,2 OA TE_-- ` 7'f//S I(/oT BASSO DN AIi/ �E'G/STE.eEl� .�•M�O SU.eY6Yb!� -7'.e //T S1,1 �F 7-/7/ -sTE,eli/,CL�. M,4SS. 4 .Syv4-4,44Y Sf lbv1--1:> .VOT B� !!P•��-/C�/�/7' ��i[.L v(sIZ.i l7' l/,SEO 7-o OETP-�fivE ,wT�iNEs TOWN OF BARNSTABLE Permit No. Building Inspector �au�ran Cash -------------- -- ----- �9 "uo OCCUPANCY PERMIT Bond ---------- --- ----- Issued to Address Wiring Inspector Inspection date Plumbing Inspector Inspection date Gas Inspector Inspection date Engineering Department Inspection date Board of Health Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. ....................................................... 19......._... .................................................................................................................. Building Inspector -- ..,FROM' f TOWN OF BARNSTABLE SUILDWO DEPARTMENT Mr. Francis Lahteine 387. MAIN STREET HYANNIS, MA 02501 Town Clerk Phone: 775-1120 SUBJECT: ` FOLD HERE - DATE - January 10, 1985 MI E S S A G E Work has been completed under Building Pemmit #26638 (William Cooper) . Please release Bond.. A SIGN D DATE. - .. REPLY ' SIGNED - N87•RM1 _ '. RECIPIENT:•RETAIN WHITE COPY,RETURN-PINK COPY • - PRINTED IN U.S.A. - SENDER` SNAP OUT YELLOW COPY ONLY-SEND-WHITE AND PINK COPIES WITH CARBON INTACT. 3. Aitssessor's map and lot number, y .1. .. ..... - • Y �Q�oa THE Sewage Permit number ........ .......... ........� .., ' ' '¢L.-{��1yj} s • tom' . (` r •t. vaE • • i Y •� r House number ........................... �./ ......: ll.. ......:.... * . IAN C EHob % LE39. r «a• 4 �MP'f a'' t AND TOWI\1 OFBARI�STABLE -� a ;. } BUILDING INSPECTOR APPLICATION FOR PERMIT TO Ev......? 1 I draw CAPS •••war hf� P.l�c..•••�LC r TYPE`OF CONSTRUCTION ..... 1 :. ......... .........:.... i P t TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies.for,.a'permit according to the following information: Location ..... .... ` ` 1`11©1J . X.......L� tiZel` -...., ! VIL.I;E. .r:. ` :..... ................... E' t -Proposed Use .��1,1 C�LE t-�.�Mq......... ..... ............................. Zoning District .....Fire District ... ..........:... Name of Owner, ��-�-4!3�`'4......... ?_'t -.:........Address ..................>TT.GETo<L7 .....................................................SS ` Name of Builder V�3lLl_... 1=..V �...... ...............Address `cv•<;Z t h1!tC ................................. Name of Architect { Address ...................... ....................... P ll ". Number of Rooms' L X �(p.l ©.. ` vy2Ea oc� 7 ,............. Foundation ,... ...... . .... . Exterior .:UJ1 l ....... ✓ .....`.. ;.......Roofing ......... t f kr.-C ....... ............................. a Floors. ..� ? .......:�'.....��. ��Q Cr-'.........Interior .......Z--,........5 £ •�2 �r��.... :...... Heating .\...P1� .... ..... ............Plumbing ......... :�- 1...X. ... . .... C.)........:.........'...,.. ;.........:..............Approximate Cost Fire lace l�-� .. .......................... ....................... .......'........ p 9 ------------ ------t 9--------. Area,; ... ........ .......__....Definitive Plan Approved by Planning Board __ :______ ��� Diagram of Lot and Building. with Dimensions Fee .........:::........ SUBJECT TO APPROVAL OF BOARD OF HEALTH g /,9, w ,. OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all,the Rules and Regulations of the.Town of Barnstable regarding theabove construction. Name .............................................................. .............. "' Construction Supervisor's License ... z.9s3" COOPER, WILLIAM - N' '2668.s.. lz....tO '............... t F 'o o Permit for r- �` Single Family Dwelling Location ..J.•R.t..5........20.4.,lbwmy.. 7.rcj e.: Centerville - - .................................................................. Owner ...William•Coop. ........................... Type of Construction .FXaRe.......................... s ......... ................................... ..... ................... Plot'.. ...... . .... Lot ...................... June 28 "' ;Permit Granted �. '` 19 84 Date of Inspection .......................... . .. .'19 p .....l.. �.... S,!��......J9� '' r Date Completed - Ale eA s jr �.j' �' ' �1 � ` .sue*. "�` .. '� ,�! �,� t-l � „•.+'' ,. � � �' r 1z.