HomeMy WebLinkAbout0396 NOTTINGHAM DRIVE ��
b
f TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map�� Parcel 3 Application# 02LId q6 35 9
Health Division
Conservation Division Permit#
Tax Collector Date Issued
Treasurer Application Fee
Planning Dept. Permit Fee {6 y
Date Definitive Plan Approved by Planning Board
Historic-OKH Preservation/Hyannis
Project Street Address '3 5 Al � IO,
Village
Owner fora' I 1"."L /0 �� /°� Address G= l 2— 44r0v e19
Telephone CY/ D
Permit Request W A VAuk 0,A 19 tit 1,W died,
w
G7
W
Square feet: l st floor:existing proposed 2nd floor:existing proposed Tot`a�Y*I new
Zoning District Flood Plain r" Groundwater Overlay �--
Project Valuation °-ee, Construction Type k1*44
Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family ® ""- Two Family ❑ Multi-Family(#units)
Age of Existing Structure 3O Q-1-- Historic House: ❑Yes AIT6 On Old King's Highway: ❑Yes ARVb
Basement Type: afulI ❑Crawl ❑Walkout ❑Other
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft)
N) Number of Baths: Full:existing new Half:existing new
Number of Bedrooms: existing 2 new
Total Room Count(not including baths):existing new First Floor Room Count
Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other
Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove-, ❑Yes ❑No
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 Urgo— . If yes, site plan review# ee
Current Use s A t, Proposed Use
�J BUILDER INFORMATION c/
Name rJ crw,& 4-n, Telephone Number
Address _: saw " g License# 0
h e.wn c`S 0 24. ti j Home Improvement Contractor
Worker's Compensation# 70 9& 2-2 aol-
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE DATE
F
I
jt FOR OFFICIAL USE ONLY
r
PERMIT NO.
DATE ISSUED
MAP/PARCEL NO.
ADDRESS VILLAGE
} OWNER
i
DATE OF INSPECTION:
FOUNDATION (3�Scs+ S ����®`11—
`J' f
¢ FRAME
INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
FINAL BUILDING
s
DATE CLOSED OUT
� s
s ASSOCIATION PLAN NO.
mnt_rrpT.^w •rT1fTl�m TT w 1 II
/V - �'
33'r SA-"" ^
L O - ,
- �.: .
k
7".'ram c'-3Ji��>/ti ._ ��Tij•-�i":E LJ�y7c���E.,1, T..
•are^'"""c•�f.� i� � r�l�-J cat I .
11 / tv/ Z.Uvo. J 1is : 1[ h'M ;. `^" 9.764 ® 02/02
ISSUE DATE 1111012008
ROPUCER r 3:
I�I1I1er McCartin I TFIIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
r' I vONFERS NQ R1dH(($ 7PUN T i CERTIFICATE HOLDER THIS CERTIFICATE
a Dcl� 8L O".1ei1 I Po NOT Ei... . LXT[�tD O i Intg Ins Agcy R ALTER TID3 COV[I2AOL AFPORCID BY TIIT; I
_ l POLICIE3 BELO
P73 Immough Road --
�lyarnis,Yu 02601— COMPAAI'IES AFFORDNG COVERAGE I
rVJMZ Ctcston
(3ba William W Crostcm Emidingeontractor COMPANYA AI.M.MuWal Insurance Co
I O Box 138T j
F)stetville.NA 02555
THIS I3 TO CEKTIFY TIC I TFE POLICIES OF INSUP.ANCE LISTED BELOW HAVE BEEN ISiCED TO THE IN3URED NAMED ABOVE FOR THE POLICE`PERIOC 1DICATED,NOTWITH3TANDINd ANY REOL IREMIENT,TERM OR CONDITION OF ANY CONTR4CT OR OTHER DOCUMIENT WITH RESPECT
I TO ALL
:i THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT
! TO ALL"HE TERMS,EXCLUSLC-INS AND CONT:ITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAIL;C
I— --— -- -- LALX4s.
CO �PEOFINSUBAVCE POLICYEFFECTIVE POLICY EXPIR.►TION
! LTR POLICY NUMBE� DATE(NM/DG/Y7) -DATF miHDD.'YY) LIMITS
GENERAL LL18iLIT5' L —_---.--- - bEN ERAL AO�RLtiAT'
! I C•DVCTS-:,OqP/OP ACC °^1=JONiL3F.C10.L Or7JEBAL LiAEIL:IY PR
-
PERSONAL&AD'J.I1IJURY
=C...AIMS MADH=OCCUF. I _
- I EACH OCCURRENCE
F.RE DAMAGE iA y=tirc) ---�
— - N'u"."LlfsE(AMIA Pasco) —1
AIITOMORU.F.LIAl'ILITY —�
COMBINED SINGLE
A.V'l AV. UNIT
A:L 08RJED AVrOn. BO_ILY INI7RY "1I
iCtkD P.UtUS I I (1'rprnan,
I I:ItED AJ-T03
NON-0NM?D AUT_S e30'9LY INIJRY
i 7ARAGE LIPb:LCfl _ - I I (Percuka.)
— --------1— ! PROPFRTY DA MA GX - -
EXCESS LIABILITY ,. ..
EACH OCCURRSHCE
UNERELLA FORM
I AGGREGATE
OTHER THA!`UMF tE�_�:.FDRt:: ., - I� �.
.. a -
WORICM CONIPLVr,.{.ION AND ;TAT LIMITS STATE OTHER
EMPLOYI+ZtS LIABtL!f:' - MA
HE PROPRIETGR' .: ..
A APnEFsiL7.PcuTys FL EACH ACCIDENT S 1,000,UUO
?FICIERSARE: ..7013419022008 O9108/2008 WOK2009 !:NCI FYCt ELDISEASE•POLICYLIMIT S 11,000,000 !
EL DSEAS&•EACH
1 _ _
I (EMPLOYEE S I.000,OOO I
ILCONmNlTS7_5f§j�kCp iI01 Ol;OPERATIONS OR LOCATIONS':`
�WILLIAhf W CROSTO:S S 01 COVERED BY THE WORKERS,COAVENSATION POLICY.
WVORKER'S COIWENSA7 VON COVERAGE APPLIES IO MASSACHUSETTS EMPLOYEES ONLY.
I
T I
tl
L. r<;
I^ _ .J OULD ANY OT T]ILJ AUOV• DIJSCRMED POLICIES DE CANCEL T DE WIFE TUE E MIRATION DATE
J k. Raw
t. I F,TSUING COMPANY'AUL ZWDEAVOR TO MAIL 10�L7t TTTEN NOTICE TO TAE CERTIF[CAT�
- OT DRR VAMFHE ISn TO M-T EFT,RT)T FATTITRF r0 MAR.STTCH NOTTC'F'.SHATI.wo,%F Nn ORT.T(TATTt?K
liOR Ll"'UTY OF A_VY KLVD UPON THE COMPANY,ITS AGENTS OR RIYF.ESENTATINTS.
! t I I
LI_____Z=
AUTHORIZED REPRESENTATIVE '
I
5839
' , -► The Commonwealth-of Massachusetts
Department of Industrial Accidents
j 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/organization/Individual): aJ ��J e�'S/O k 1.4� , �1 �i►�
Address:
City/State/Zip: �S °tn'`�`t'�� a P1L6+ Phone#: �' '
Are you an employer?Check the appropriate box: Type of project(required):
L®I am a employer with 4. ❑ I am a general contractor and I
6. ❑New construction
employees(full and/or part-time).* have hired the•sub-contractors F
2.❑ I am a sole proprietor or partner- listed on the attached sheet.t 7• B nemodeling
ship and have no employees These sub-contractors have 8. ❑Demolition
workingfor me in an ca aci workers' comp:insurance.
Y P t5'• 9. ❑Building addition
[No workers' comp.insurance 5. ❑ We are a corporation and its
required.]
officers have exercised their 10.❑Electrical repairs or additions
3.❑ I am a homeowner doing all work right of exemption per MGL 11.ElPlumbing repairs or additions .
myself. [No workers' comp. G. 152,§1(4),and we have no .12.❑Roof repairs
insurance required.]t employees. [No workers' 13.❑Other
comp.insurance required.]
*Ai3y 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 now affidavit indicating such,
tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information.
I am an employer that is providing workers'compensation insurance formy employees. Below:is the policy and job site .
information.
Insurance Company Name: �`� =1��1.�t✓[^ �-��-
Policy#or Self-ins.Lic.#: 7013 IP Z2 &&I— Expiration Date: l "S'
Job Site Address: It Al cd°l�'aS ��' City/State/Zip: [=l h`'t"tv'P'A r44—
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-.e. 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification. -
I do hereby certi nder Ins' s nd a hies of perjury that the information provided above is true and correct
a
Signature: Date:
Phone#: ti]s k 9 t&_4 f
Official use only. Do not write in this area,to be completed by city or town of
City or Town: Permit/License#
Issuing Authority(circle one):.
1.Board of Health 2.BuiIding Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
Town'of Barnstable
Regulatory Services
9�Axr' es ,$ Thomas F.Geiler,Director
Building Division
Tom Perry, Building Commissioner
200 Main Street, Hyannis,MA 02601
Mce: 508-862-4038 Fax: 508-790-6230
Property Owner Must
Complete and Sign This Section
If Using A Builder
as Owner of the subject property
hereby authorize 13 11 6., to act on my behalf,
in all matters relative to work authorized by this building permit application for:
(Address of Job)
A, [ Z OtU
S. ature of Owner Date
eoA�r�7 011iA
Print Name
Q:FORMS:OWNERPERMIS SION
:� Z. 7J0'IYJ/iIZ47U(�iPAAUt.O� ft"flll6 -` ' _ .,.-
a �\ Roard of.Building.Regulations and 56 t�r� is ; _
License or:reglstratl0n�N al>d for wd wdul asF��I�,
HOME IMPROVEMENT`CONTRACTOf � before the;expiration date,slf found%return Ca
- _ Registration 100023 a '° Board of I3ailding:Regulaons.anci Stauclac`d '
wo
Expiration]ff /2010 Tr# 26781 ' t � Onc A5s6burton,Place Rm 1301 y .
=L Boston Ma.021.08 =
` ti_! -
► ' 8ILL CROSTON BUILDING CONTRACTOR* . ;----
M V*L,L-AM CROSTON
$5 SUOMI RD
1 MA 02601.. t �
r_: Adtmnl�trator < t , loot�altd�Athoutsignature r;
-6? ✓lze-�anr�,w7uuea� a�✓�aaoac>tuiae�a
( Board of Building Regulations and Standards s
a , Cons_traction Supervisor License
;r..c •* L•ibo se' CS 14112
Expiration=4-/25/2010 Tr# .22290 .
j o- -_• {
,, Restrlctlon-00�,
t WILLIAM W CROSTON 6
s
} 55 SUOMI RD �. '�i,.�_ ✓� I'
�* HYANNISj MA 02601 Commissioner
v
h
f
2 .. ,, N
TiL! D h �
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Town of Barnstable *Permit# aaC
X-P i S PERM
Regulatory Expires 6inonthsfroni issue dale
MAY 2 5 2.006 g Services Fee
Thomas F. Geiler,Director
TOWN OF BARNSTABLE Building Division
Tom Perry, CBO, ]Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038
EXPRESS PERMIT APPLIC Fax: 508-790-6230 '
ATION - RESIDENTLAL ONLY
Not Valid without Red X--Press Imprint
ip/parcel Number /®q
)perty Address ,� A
22
� r^ max, -�-..�d i ��-•�
Residential Value of Work �oa Minimum fee of$25.00 for work under$6000.00
ner's Name&Address C
tractor's Name ,q V-V, �� r
i \ Telephone Number
ie Improvement Contractor License#(if applicable)
ttruction Supervisor's License#(if applicable)
'orkman's Compensation Insurance
Check one:
❑ I am a sole proprietor
❑ 1 am the Homeowner
Q I have Worker's Compensation Insurance
ince Company Name
man's Comp.Policy#
Of Insurance Compliance Certificate must be on file. 6
t Request(check box)
Re-roof(stripping old shingles) All construction debris will be taken to �t`►/�-o v� � t
S�r5rti1. �
❑Re-roof(not stripping. Going over_ existing layers of roof)
❑ Re-side
❑ Replacement Windows. U-Value
-----__(maximum.44)
'"Where required: Issuance of this Permit does not exempt compliance with other town de
partment regulations,i.e.Historic,Conservation,etc.
***Note: Property Owner must sign Property Owner Letter of Permission Home Improvement Contractors License is required.
TURE: 1
.xpmtrg
405
The Commonwealth ofMassachusetts
` Department of Industrial Accidents
07Office of Investigations
r a 600 Washington Street
Boston, MA 02111
ivww mass.gov/dia
Workers'.Compensation Insurance Affidavit: Builders/Contractors/lElectricians/Pluiamlbers
Applicant Information Please Print Legibly
Name puiaess/organizationadividu4: A t
Address:
City/State/Zip: c f� Lr t , -- Phone#: `fib g �( ``c
r'
Are you an employer? Check the•approprlate box: Type of project'(required):
i,❑ I am a employer with 4. ❑ I am a general contractor and I s, ❑New construction
employees(fall and/or part-time).* have hired the sub-contractors
2.[/I am a sole proprietor or partner- listed on the attached sheet ? Remodeling
ship and have no employees These sub-contractors have 8: ❑ Demolition
working for me in any capacity. workers' comp.insurance, . g, ❑ Building addition
[No workers'Comp.insurance' 5. ❑ We are a corporation and its ,
required,] officers have exercised their 10,❑ Electrical repass or additions
3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ P mg repairs or additions
myself.[No workers' comp; c. 152, §1(4),and we have no 12, Roof repairs
imirance requited.] t , employees. (No workers'
comp,insurance required.] 13.0 Other
*Amy applicant that checks box#l-must also fill out the section below showing their workers'compensation policyiuformation.•
t Homeowners wbo submit this affidsvit indicating they are doing all work andtheu hire outside eontactora must submit a mew affidavit indicating such
Contract=Saf check 2is tibx must attached am additional sheet showing the name of the sub-contractors and their workers'comp,policy.infarsns =.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information. {
Insurance Comp any Name:
Policy#.or Sclf-ims,.Lic.#: 7 � Expiration Date: -
f
Job Site Address: Act L-.*,
CityJStateJZip': C .e w(,�
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secare-coverage.as required undet Section 25A of MGL c. 152 can lead to the imposition of crimial penalties of a
fine up to$1,500,.00 and/or one-year imprisonment, as well as'civil penalties in the form oi'a STOP WORK ORDER and a fine
of up to$250.00 a day kgainst the violator. Be advised that alcopy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
t
1 do hereby certify under the pains and penalties of perjuiy that the information provided above is true and correct,.
c
Si mature: Date: S^ 2
�J
Phone M
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 Departmett 3.City/Towm Clerk a.Electrical inspector 5.Plumbing Inspector
6, Other
Contact Person: Phone#:
General Laws chapter 152 requires all to ers to ro 'de workers' compensation for their b to oes.
Massachusetts p eq emp y p mP mP y• ,
Pursuant to this statute, an employee is defined as"...every person in a service of another under any contract of hire,
express or implied,.offal or written." �
An employer is defined s•"an individual,partnership,association, corporation or other legal entity, or any two or more
of the foregoing engaged ' a joint enterprise, and including the 1 al representatives of a deceased employer, or the .
receiver or trmstee of an m 'dual,partnership, association or o er legal entity,employing employees. However the
owner of a dw;11ing house ha ' g not more than three apartm and who resides therein, or the occupant of the
dwelling house of another who loys persons to do mainten ce, construction or repair work on such dwelling house
or on the grounds or building app ant thereto shall not be use of such employmentbe deemed m be an employer."
MGL chapter 152, §25C(6)also states th "every state or to al licensing agency shall withhold the Issuance or
renewal of a license or permit to operate business or to onstruct buildings In the commonwealth for any
.applicant who has not produced acceptable vidence�of c mpliance with the Insuranee�coverage required."
Additionally,MGL chapter 152, §25C('l)states 'Neither th commonwealth nor any of its political subdivisions shall
eater into any contract for the performance ofpub 'c work acceptable evidence of compliance with the insurance
requiremecits of this chapter have been presented to a co acting authority."
Applicants
Please fill out the workers'compensation affidavit comp t ,by checking the boxes that apply to y=situation and,if
necessary,supply sub-contractors)name(s),address(es) ud no numbers)along with their certificate(s)of
insurance. Limited Liability Companies(LLC)or Limite I Li Partnerships(LLP)with no employees other than the
rmmbers or partners, are not required to carry workers' mpeusatz insurance. If an LLC or LLP does have
omployees,a policy is required_ Be advised that this affi avit maybe bmitted to the Dep artment of Industrial
Accidents fur confirmation of insurance coverage. Also a sure to sign. d date the affidavit. The-affidavit should
be returned to the city or town that the application for the erwit ar license being requested, not the Deparfinent of' .
Industrial Accidents: Should you have any questions re ding the law or if u are required to obtain a workers'
compensation policy,please call the Department at then er listedbelow. .S -insured companies•t>houM=a=1heir
self-insurance liccnse number on-the appropriate Eno.
City or Town Ofricials.
Please be sure that the affidavit is complete and printed legs : The Department has ovided a space at the bottom.
of the affidavit for you to fill out in the event the Office of In esti cations has to contact ou re the applicant
Y g g
Please be sure to fill in the permit/license number which will a used as a reference umm or.
In addition,an applicant
that nmst submit multiple permit4icense applications in any ' on year,need only submit no affidavit indicating current
policy information(if necessary)and.under"Job.Site Address' the applicant should write' Il locations in-_(G1ty or
bwn),"A copy of the affidavit that has been officially stamped r marked by the city or to. may be provided to the
applicant as proof that•a valid affidavit is on file for future p or licenses. Anew affida 't must be filled out each '
year.Where a biome owner or citizen is obtaining a livens a or p 't not related to any busines or commercial venture
(i.o. a dog license or permit to burn leaves etc.)said person is N required to complete this a avit
The Office of Investigations would like to thank you in advance fo your cooperation and should u have any questions,
please do not hesitate to give us a call.
TheDepartment's address,telephone and fax munber;
The Commonwealth of Ma achusetts
Department of Industrial A idents
Office of Investigation
600 Washington Street
Boston, MA 02111
Tel,., 617-727-4900 ext 406 or 1-877-MASSAF'L '
Revised 5-26-05 Fax#617-727-7749
Mass.Uov/d:ia
°fzMET Town of Barnstable
ti
Regulatory Services
9 MAss � Thomas F.Geller,Director
Building Division.
Tom Perry, Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.b arnstabl e.ma.us
Office: 508-862-403 8 Fax: 508-790-6230
Property Owner Must
Complete and Sign This Section.
If Using ABuilder
I, ,as Owner of the subject property
hereby authorize to act on my behalf,
in all matters relative to work a orized bythis building permit application for.
'r' C9
'410 *
(Address Job)
r •
Sig f er ate
ro
Print lame
Q TORM&OWNIWERMISSION
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Reg. No. Applicant Street ICity State Zip Name Title Expiration
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108615 MERRILL Skunknet Centerville MA 02632 B Owner 8/20/2006
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BBRS Privacy Statement
http://db.state.ma.us/bbrs/hic.pl 5/26/2006
``���•„ .e TOWN OF BARNSTABLE Permit No. --------.__---------
l IIA"n,u Building Inspector cash
...� �!' --------------—-------
—-
t079• �p
OCCUPANCY PERMIT Bond ----—_-------—j4 In��
No building nor structure shall be erected, and no land, building or structure shall be
used for a new, different, changed, or enlarged use without a Building Permit therefor
first having been obtained from the Building Inspector. No building shall be occupied until a
certificate of occupancy has been issued by the Building Inspector."
Issued to Address
Wiring Inspector Inspection date
Plumbing Inspector Inspection date
Gas Inspector Inspection date
Engineering Department 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.
19......__ ..................................................................._. ......._._...._._._ .M._
Building Inspector
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93
Assessors ma and lot numb �.� r................. ................
�� � CF THE T0�
Sewage Permit number STEM M °
INSTALLED IN COM LE, i �
House number ...................... ... ..C� .................. WITH TITLE b 1639•
t� ENVIRONMENTAL COD
TOWN. OF BXRNSTAffL*ULATION.S
BUILDING N'SPECT R
APPLICATION FOR PERMIT TO
� .... ...... ......................... . ...�.......................................................
TYPEOF CONSTRUCTION .........t/ J .................................................................................................... s
. ......................19 7 .
TO THE INSPECTOR OF BUILDINGS: r
The undersigned hereby applies for a ermit according to the following information:
lA
Location ....(�?� ... .....` .............� ....... ............. .................................................................................
.......... . ...... .......... ............
Proposed Use - / :. ............... .......I.........................
ZoningDistrict *.!�"...`. .. /..... ..�-: ......j.... ... : .... ................. Fire District ... . .. .
Name of Owner 1� r
... .... ....11. ..�... ...... ................... .................Address .....................................................................
t� lI rf Q- Cr �(
Nameof Builder .....:..............................................................Address ....................................................................................
.Name of Architect ..................................................................Address ....................................................................................
Number of Rooms .............e ....... ............ ............................Foundation ... o. './/JJ.. :......................:...............
Exterior .... Yl ....................................Roofing . .'......... .............
j L
Floors .... .................../............. .................Interior .......t ....... ..... ................................. .......................
�Gc��
.........................Fieating ........... .�..../.� .........
..... Plumbing ..................................................................................
Fireplace ..................(....................................... ..................Approximate Cost ........3s� .................... ........
17
Definitive Plan Approved by Planning Board __ _ ____ ______________19/ Area ( / ....... ........ ... .. ... . . .
Diagram of Lot and Building with Dimensions Fee
........ ..
SUBJECT TO APPROVAL OF BOARD OF HEALTH
69)e
I hereby agree to conform to all the Rules and Regulations of the Town o Barnsta 1'e r arding the above
construction.
Name ... . .... .G ... .. . ...... .............................
Delaney, John
�o I.................. 21901 Permit for .......one...stopy.........
...... ......
single family dwelling
.............................................................................
Location .......... Drive........,
..........
..........................Centerville..............................
Owner John.pqjqp�_v .............
..................... ..............
Type of Construction ............... r=e................
..................................................................................
Plot ....... Lot ............#33..............
ember 19' 79
Permit Granted ..... ......................... 19
Date of Inspection ...... . .........19
Date Completed ....:7.19
PERMIT REFUSED
M
. ............ ...... ... 1197
..............
. . ... ........
..........
M >
. ....... .. .. .. . ..... .... .........
--!�......... .. .
*-4�1. ..........
. ......... .1WW•2.s... ................
.. ..................................................
1.
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................................................
tr
tool—
� :3
Apprcual......<..f P................................. 19
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...............................................................................
...............................