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HomeMy WebLinkAbout0410 NOTTINGHAM DRIVE yra�o-t�,�.C2,� v rt 41 x � � �oFtHE Toq, TOwI_l OfBa 'I15tb1E', - *Permit P p Expires 6 montl rom issu ate Regulatory Services Fee SARNSM LE, " MASS. 1639.—��� Thomas F. Geiler,Director. io Building Division r s'Tom Ferry,CBO;,Building Commissioner =` _,200 Main'Streei,Hyannis,MA 02601 ` www.town,barnstable.ma.us., Office: 508-862-4038 Fax: 508-79076230 EXPRESS PERMIT APPLICATION' RESIDENTIAL ONLY e Not Valid without Red.X-Press Imprint Map/parcel Number Property Address d fin' ff ❑ Residential Value of Work Minimum fee of$25.00 for work under$6000.00 s Owner's Name& Address SY - • �� - lL1., Dot 6 3.) Contractor's Name j� nay,,r �� .t �a Telephone Number , 3 60 - � OYV_— t. Home Improvement Contractor License#(if applicable) Construction Supervisor's License (if applicable) + '❑Workmen's Compensation Insurance . Check one: PRESS� PERMIT ❑ I am a sole proprietor - MAR 2 ' ❑ I am the Homeowner ' r= 2010 have;Worker's Compensation Insurance, WN OF BARNSTAbL E . Insurance CorripanyName h0lIGG Workman's Comp.Policy t ' Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check-box), ` r P-'ke-roof(stripping old shingles) All construction debris will be takento ❑ Re-roof(not stripping.`Going over F. existing layers of-roof) ❑ Re side t p ", #of doors' r .. f Replacement Windows/doors/sliders+U Value ,, (maximum'..44)#of windows v - s t *Where required -Issuance of this permit does not exempt compliance with other town department regulations;ix Historic,Conservation,`etc: to ***Note: `. Property Owner'must sign Property Owner Letter of Permission „•g A copy of the Home Improvement Contractors License-& Construction Supervisors License is regwred b ' SIGNATURE: Q:\WPFILESTORMS\building permit forms\EXPRESS doc } # Revised 090809 �, e a The.Commonwealth ofMassaehusetts 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 Le ibl Name (Business/Organization/Individual): Address:�� City/State/Zip: Phone #: dk 3 C O Are y u an employer? Check the appropriate box: ^ d Type of project(required): 1. I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees (full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. T.❑ Remodeling ship and have no employees These sub-contractors have g• ❑ Demolition workingfor me in an capacity.'. employees and have workers' Y9: ❑ 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_-[Noxworkers,'comp. _s _ right_of exemption per MGL z0•..Roof_repairs., ..-�_�. , .m insurance required.V 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: Policy#or Self-ins. Lic.#: tiI/ C 6-6 rr// ,3 0 la�c 9 Expiration Date: Job Site Address: 6/0 _ /% on City/State/Z ip: ,b , 6�3 Attach a copy of the workers' compensation policy declaration page(showing policy number and expiration date). °� the 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 certi der the ppjjains and penalties ofperjury that the information provided above is true and correct. Si n4ure: 6r�f '. Date. 3 Phone# � d �`l✓'_ Official use only. Do not write in this area, to be completed by city or town offcial. 1 ,' 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#: 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." 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�epresentatives of a deceased employer, or the receiver or trustee of an individual,partnership,association or other egal entity,employing employees. However the owner of a dwelling house having not more than three apartments d who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenan construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not becai e of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or to t licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to onstruct buildings in the commonwealth for any applicant who has not produced acceptable evidence of mpliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7) states"Neither t e commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public wor until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the ontracting authority." Applicants E Please fill out the worker's,' compensation affidavit c mpletely,by checking the boxes that apply to your situation and, if necessary,supply sub-con tr`tor(s)name(s),addres (es)and phone number(s)along with their certificate(s)of insurance. Limited Liability ompames(LLC)or invited Liability Partnerships(LLP)with no employees other than the members or partners,are not re aired to carry wor ers' compensation insurance. If as E C or LLP does liave� employees, a policy is required. Be advised that t is affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverag Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that th�applicati for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any que ions regarding the law or if you are required to obtain a workers' compensation policy,please call the Dep me t at the number listed below. Self-insured companies should enter their self-insurance license number on the appro,ri e line. City or Town Officials Please be sure that the affidavit is complete a d pr' ted legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the even the Of e of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license n her whic ill be used as a reference number. In addition,an applicant that must submit multiple permit/license ap.lications in an iven year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address' e applicant should write"all locations in (city or town)."A copy of the affidavit that has beer officially stamped or arked by the city or town may'be provided to the applicant as proof that a valid affidavit is oxi file for future permits or rises. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not r ted to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to mplete this affidavit. 1 The Office of Investigations would like tq thank you in advance for your cooperation d should you have any questions, please do not hesitate to give us a call. r The Department's address, telephone andifax number: The Commonwealth of Massachusetts tepartment of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 4-24-07 www.mass.gov/dia A DATE(MM/DD/YYYY) k TM. CERTIFICATE OF LIABILITY INSURANCE 05/29/2009 PRODUCER Phone: (508)987-0333 Fax: 508-987-0063 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION OXFORXINSURANCE AGENCY INC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE _P QBOX370 _ _ T- ,__,HOLDER.—THIS-CERTIFICATE DOES-NOT-AMEND;-EXTEND OR-- - OXFOROMA 01540 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC# INSURED r INSURER A: -A I M Mutual Insurance Company LIBERO MOLINARI INSURER B: DBA MOLINARI HOME IMPROVEMENT 11 SHEEI PASTURE WAY INSURER C: EASTSAUDWICH MA 02537 INSURERD: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICYPERIOD INDICATED, NOTWITHSTANDING ANY REOUIFEMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAN, THE INSURANCE AFFORDED BY THE POLICIES'DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L TYPE OF INSURANCE - POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LTR INSR - DATE MM/DD/YY DATE(MMtDDtYYI LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE:TO RENTED $ PREMISES(Ea occurence) CLAIMS MADE OCCUR MED.EXP(Any one person) $. PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GFN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG. $ PRO- POLICY JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ r HIRED AUTOS BODILY INJURY NON-OWNED AUTOS , (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY + EACH OCCURRENCE $. OCCUR CLAIMS MADE AGGREGATE $ $_ DEDUCTIBLE $ RETENTION$ WORKERS COMPENSATION AND ' AWC7008113012009 05/21/09 05/21/10 TORvuMlrs DTHER EMPLOYERS'LIABILITY A ANY PROPRIETOR/PARTNERIEXECUTIVE E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? If yes,describe under E.L:DISEASE-EA EMPLOYEE $ 100,000 SPECIAL PROVISIONS below El.DISEASE-POLICY LIMIT $ 500,000 OTHER: DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS The workers'compensation policy does not provide coverage for Libero Molinari CERTIFICATE HOLDER CANCELLATION TOWN OF YARMOUTH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE 1146 ROUTE 28 EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER.NAMED TO THE LEFT,BUT FAILURE SOUTH YARMOUTH,MA 02664 TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, IT'S AGENTS OR REPRESENTATIVES. FAX#508-398-0836 a AUTHORIZED REPRESENTATIVE r Attention: G=-/ Joseph E.Anastasl ACORD 25(2001/08) . Certificate# 44826 ©ACORD CORPORATION 1988 < r` Page No. jl'v of Pages. ® 9?THORNTON DRIVE - 11'(ANNIS MASSAC14US'ETT' 026�1" - / ,gyp 'R• 15 f i Phone/Fak (508) 771-52 a Hyannis PHONE' DATE � TO JOB NAME/LOCATION i- /, '1 rt VI-)-r'TThIC:t ix1,4 1'10 - - - i�r.-1,1-T-t:0 l 1 T I t i:: M�ti rt'"?t' 7• r .• .. f.' JOB'NUMBER;,;. ;.; JOB PHONE 4 We hereby submit specifications and estimates for: - ;.fc1-rTsoc ;or�n�- i.t-tr'✓` J-'1.,�� fo- I 4 "rf„"7Tf.; f1C' t"if'T r'Thlr"• r)r)f'1A; 01-'"iI,I I lz"•• _ _ - I dl "I I.IC"r'/1f i I,AG"T"/\i rtiCJ T(1 I"r^„^:C (lt-I C}f'Y'7(';M i f ("Tr. /\Hilt �� ..c dV l"P,I i ,ir�'IA 1IC"NIT r.:tTnC C,I /`G"?!_!7�, I, t V , r_J wn Tt!C, I"r,! i �.r ns�,�n iir r ei c l�Tr! I} nnir� r ! 0 r.rX, 'c? ;rlai r /+tom, -LI r'rI,r`'T L"T K I Q!.0 .:-.('`G'C)"�'7'<'T'�!'1"� C't' r..f`r/,c r,-'C, 'Ttel 2l �:'.L i t-,!"l V.i-} }' - fl6 -T-t_i(16: ni ir�l-! r^� G'/'tl.l L•!f� r� ( �.. i f iF'w,•G T'�r - C I !t l"TPFr' .-�r1 i"L(tr /\I�f11/C.:' ialr)ptz tF7 r`• l r`t/ t'1 CIiT'flf /tirf1! IN17, ,'6:1.11wflf ''e' t i,iri t f,ll"rE .C) �I / I-1 !ylat'"(')_ l,Ii r c,/110t 1 f 1 f 4�. - - '- S l�-c.!-c t^i fd ^I P " •r- w�-�' .fad'L., Y7"'t.r'i. I r-',. �t i `S �7 1 � � ,. x i r:-I,! lt,!r-tR G rwr) Mtil r , r T H T'C)"!"V VC-AR GIADC)/lhI"i"V r)hs r uTKI(7`I G*C: �,/ 'TAtC )I•,>C"f, i itI11)(fr,A,":1,I / f'`fNIf")C1•,IG'�T rf'tlil•, -:�\h,l•.) ! f 1t.?.r.� 1•'T+. "t ;l�t-1rj(�ntCl r - ` I NUR 1PTapDT* hereby to furnish material and labor—complete in accordance with the above specifications,for the sum of: CTilf T..IJi"tI ICPti*If"' ,hl"I'hIC' 4T! if.it^t)G r, r.. _ _ doflarss'($'o l ". , Payment to be made as follows: 1,i.I C' !..!ill !:` 'r'r) 4 r,./\T!t' 1 11")f,l( r I I M it 1 C h 1 f �'M 1,1-.t. . r"t C I-W r .T!l:i!",11 f:.; .I Y r1 t J_!.!. 1"o-J+. 4.^i 1, i.l t.,�:. 'T'(1 I":1 r= f")Iti „1 7P)1:Yi,1 (`f",i4ii:,1 '1T'T flt.l .,.. - ...,. �'. All material is guaranteed to be as specified.`All work to be completed in a professional manner according to standard practices: Any alteration or deviation from above specifica- Authorized tions involving extra costs will be executed only upon written orders, and will.become an, ,.Signature extra charge over and above the estimate. All agreements contingent upon strikes,accidents or delays beyond our control. Owner to carry fire,tornado,and other necessary insurance.Our Note:This proposal may be workers are fully covered by Worker's Compensation Insurance. _ ;,�;'; withdrawn by us if not accepted within days. 1pq The above prices, specifications ,� ��,• and conditions are satisfactory and are hereby accepted. You are authorized signature P Y I f . to do the work as specified. Payment will be made as outlined above. Signature Date of Acceptance: __ 'e �T ME .r - r Board ot�iui ing egulan-OR am tan a � p t Lic se or r egistra s�oti i andlfor in �v d J use onl L � HOME IMPROVEMENT CONTRACTORt �q , bet4�e the eapirat on date If found return 30 � Board f uildmgk.,a ations and, tandar.ds� ` s - Registrations 102322 6pe Ashbuiton Place Rm 13Q1 IN Expiration 71/2010" Tr# 274fiq t Boston,M'} 02108 TYPe DBA y 4 f � " NIOLINARI RC30FIN �,1 r s .� Libero Molrnan� � / 1' SHEEP PASTURE 1 VAYJ ' ?P �r % N,otvalid'vu�t�iat�t;s�gnatute - " EASE•SAND1%VICH MA(3257 Administrator s x r . y 'r 41assachusett4-Dep trtmen of Public atef� Boird of�$wld�n�Re�-A ttions and Standa►d �r �Cogfructioh Supervisor License J'. 40124 License :,CS 4, y. j Restricted-to* -; x n p LIBE.,RO JFt MOLLINARI t ter ' 11 SHEEPPASTURErWAY E,SANDWICH MA 02537 Y ri Expiration: 3/29/2011 ' Tr#: 13254 (:onun4Ss14net n Assessor's Office(1st floor) Map ` Lot a M 4 5�5 r Conservation Office(4th floor) a _ 7Fee' Issued 9 �J Board of Health(3rd floor)(8:30-9:30%1: 0-2:00) �f�4'r Engineering Dept.(3rd floor) House#1 �1z) �� ! P n ept st / ool i BARNSTABLE. ti pp ed la ng oar 19 6 Eo"uet" TOWN OF BARNSTABLE Building Permit Application �✓ Project Stre Tess a ® �/[� ypip� � ✓�= ,�/V EiQy'>c 4&1 Village Z5��N Owner_ i7MpNT✓ 9`�AIA✓ �� ( d/ARA) Address Y/d Telephone Permit Request 1- Total 1 Story Area(include 1 story garages&decks) q square feet Total 2 Story Area(total of 1st&2nd stories) square feet Estimated Project Cost $ Zoning District Flood Plain Water Protection Lot Size /s'06 Grandfathered? Zoning Board of Appeals Authorization Recorded Current Use Proposed Use Construction Type_4ja R_716�'A/ SNP Commercial Residential Dwelling Type: Single Family Two Family Multi-Family Age of Existing Structure Basement Type: Finished Historic House Unfinished Old King's Highway Number of Baths No.of Bedrooms Total Room Count(not including baths) First Floor Heat Type and Fuel Central Air Fireplaces Garage: Detached. Other Detached Structures: Pool Attached Barn None Sheds Other Builder Information Name . Ao R i3�e, D �o �`� Telephone Numbef_ D,?: Address /,ZO 7" - License# �vvs/� c/1/if/iS ff p �L) ome Improvement Contractor# Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATU BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY PERMIT NO. #10453 r DATE ISSUED Sept 19, 1995 ' MAP/PARCEL NO.;' 1.71.0 9 4 ADDRESS 410 Nottingham Drive VILLAGE Centerville, MA 02632 OWNER Edmond- Camara DATE OF INSPECTION: FOUNDATION r FRAME r ' INSULATION . r FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL r GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT s ASSOCIATION PLAN NO. . . . °: The Town of Barnstable NAM ,g Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508 790�227 Ralph C.t� Building Commissioner Face 508 775-3344 For office use only Permit no. Date AFFIDAVIT HOME 1WROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICAITON MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,-removal, demolition, or construction of an addition to any pre-adsting owne! espied building containing at lean one but not more than four dwelling units or to structures which am adjacent btu g g to such residence or building be done by registered contractors,with certain=eptions, along with other requirements. Type of Work: A9AAS C, / Est.Co Address of Work: 411 ^ Owner.Name: Date of Permit Application: 9 I hereby certify that: Registration is not required for the following reason(s): Work excluded by law _Job under S1,000 �..�Building not owner-oowpied Owner pulling own permit Notice is hereby given that: CON RACfORS OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH t?NREGISTFiED FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner. Date Contrac tor name Registration No. OR Owner's name T'�atP i Mill 1 (Z00E o2X4 RAFTERS NOT[; ALL WnUD l� n Lt_ l7�r►�ENsIoNAt t�iNE, `fkµ ,TAP PLA7Z6 Gne,t-E END LOUVER-S opQ n�vt � vvN, Lop,►.1GR Ix PuRLINS POSTS i PLYWOOD SoIStS v,1 1814CKING'r °`TM"• TOWN OF BARNSTABLE Permit No. - --- -------------------- I ,u,nw, s Building Inspector ,ve Cash ---------—-- �o r►r r. OCCUPANCY PERMIT Bond ----_--------- C�/ N4 o 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 11 0 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, f� ...................................................... 19 _ _ .........._................»........... ._............ .... .� .�...»......�_. ...._.. ._._ Building Inspector r. EX S .76 r J . 0 AD _ - F'Lo7- PLAV 3 17r ti S J•f.3/�'�"T=/ //t/ /,4 r;*:=` -/,E-E:Jy J \\ h, � ;01 T; ?1' .�� .,���+dti'.,✓`� /�S SH_�rv�L Ati'Ci_,��.s.y�-_�_CDn�F;�,C�.y vt�/TN Tr tJF :f-/�. TOvt/.'v OF �'�1�',.+I .f w•��. ��,� .''�' A 's map and lot number ......'.:/..`1. / —,! l SEPTIC SYSTEM MUST "ETo SR,A INSTALLED IN COMP Sewage Permit number ....e.Q-.�...20........W"�:• 8��} WITH TITLE 6 'r �.e7/l b ENVIRONMENTAL. COD t BAHB9TABLE, : House number N a TOWN REGULATION '°� go,.Mix ` ' TOWN OF BAI NSTABLE- BUILDI G INSPECTOR APPLICATION FOR PERMIT TO ................. ....................:. ..... ............................................... TYPE OF CONSTRUCTION ........... ... . ...... !1 ........................................................ ........... .................................................... a....Cv ...........................19.. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby �¢apfplie for a ermit ccord* to the following information: Location .�/� ..1.....Yv ........... � .. ..................... .................. ................................... ProposedUse .... . .:�................................................... ...................... ..... Zoning District ......1�........1..... .......... ................................Fire District .......................`.!!��! .............[.... . . ... ......... ........... .. �� � � � Name of Owner ... ..:.�......�S�Q-.�:... .. ..................Address f..�...J.� ................................ ...`��.....:� i1 it %* tI of 1% 1 t Nameof Builder ....................................................................Address .................................................................................... .Name of Architect ..................................................................Address .................................................................................... Number of Rooms ........ ...............................................Foundation .. . ... .G..............................:.............:. Exterior ...6 .. / .................... ....G�.��'���i�. .. ..(�.,.:.....................................Roofing ...j��.�.� �... ................... Floors Interior Heating ..................................Plumbing Fireplace .............../................................................................Approximate Cost ... .............................1................ Definitive Plan Approved by Planning Board = - -- ---------1971---. Area ... ...... Diagram of Lot and Building with .Dimensions Fee &� —�................................... SUBJECT TO APPROVAL OF BOARD OF HEALTHC)iJ U U I I hereby agree to conform to all the Rules and Regulations of the Town of Barnsta, re ding the above construction. am ................ .. ... . .............. DELANEY, JOHN i_. �� 22124 '................. Permit for .One....Stary........... �.:..::.....Frame...Welling.............................. Lot #34 4 Location ..........................1.0...N-Qt.tin.ghan1--Dr> ; Centervil .........................................a................................... t Owner ...John..Delan4'1'............................... ..r , t Type of Construction ......E:rame.........:............. ................................................................................ . _ t Plot ...:........................ Lot ................................ Permit Granted ...A.pr.il...1.6.............:..19 80 Date of Inspection ....................................19 P Date Completed 19 t PERMIT REFUSED r s. ..... . 19 A :i Y .. ..��.5..�. .............................`r:.......... , ...................................................... i ... .. ."M..- .................................................... ............................................. I (M APP py - - ed S .............. ............................................................................... _