HomeMy WebLinkAbout0419 OLD STAGE ROAD ID
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i ce)
mot , Town of Barnstable *Permit# y
�p Tres 6 mg rths ron:issue afe
Regulatory Service ��ee
+ uxxsrnat� f
"t^� 0E Richard V.Scali,In D►re t r"
" Building DivisfiWG 0 5 2015
Tom Perry,CBO,Building CoMN �A �-�
200 Main Street,HTa %& 6
www.town.barnstable.ma:us
Office: 508-8624038 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
Not Valid without Red X-Press Imprint
Map/parcel Number 190 /Z
Property Address `► �9 y�� Sflc re j�c' //e
(iesidential Value of Work$ Minimum fee of$35.00 for work under$6000.00
Owner's Name&Address 61-a ce
4/ Sf� e p 3 L
oct_ e 1 A l G
emn-
Contractor's Name� N �_F�. V�/t N vID�S F NN/ O . Telephone Number �b/-?�-�` ! g�
Home Improvement Contractor License#(if applicable) c�1732 j� Email:
S
Construction Supervisor's License#(if applicable) D 7- 0 7
Workman's Compensation Insurance
Check one:
❑ I am a sole proprietor
❑ I am the Homeowner
1K I have Worker's Compensation Insurance n
Insurance Company Name Iv llUc7
Workman's Comp.Policy# W6
Copy of Insurance Compliance Certificate must accompany each permit.
Permit Request(check box) ,
❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to
❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof)
❑ Re-side
Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows
#of doors:
Smoke/Carbon Monoxide detectors 4 floor plans marked with red,S and inspections required.
Separate Electrical&Fire Permits required.
*Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc-
***Note: Property Owner must sign Property Owner Letter of Permission.
A copy of the Home Improvement.Contractors License&Construction Supervisors Ucense is
required.
SIGNATURE:
T:IKEVIN D\Building Changes\EXPRESS PERMITIEXPRESS.doc
Revised 061313
" - REenewal = NEWAy� 'ADEL'$ NRSEN rAar732�s1/�rKk10 Cru.Xnx'aoc3ssss
Yse 1"a��'m 24 Albion Road • Lincoln,R102065 rr tend Firm 01237,
Phone 866.563 2235-Fax 401:633.6602:
Faf m Tax it)alli-O6fi66.,0
Southern New England wiudowi,u c a/b/a '
Renewal by Andersed of SontlternNei.Enabtnd
CUSTOM WINDOW AND DOOR REMODELING AGREEMENT"
Bye*() _ SE ogre ofAVwff ne_YJ�.z
8uyvfs)SoaetAddrei Snit,slid Zip Cede I M.Bme
69/
UWmss 4
� r
AM W es/ - NoineTekgAaie Num /jam) - .... ,...._ :tom/�NbrfiTdepAoneNumticr:
Suyer(s)hereby jointly and severally aRri ct to prim hase'the products.ind/or:vcrviex s of:Southern New England Win 17Ws,L- d..- Renewal
by Andersen of Southern New England("Gunirac:toe);inaixoidance;with a the ternls'."d mdidons described on the fitmt and the.reverse of
this agreement and:unthe;attachee+�ddsppecci�ifiie�eatio)}.sheet(s)(tfgleuively,this,'Agrecment":)... ❑Hletor[c O:Condo:❑HOAZ;
Toaljob AmouritY,Z_/_L(L, Dilinaue StarunE Dace Method of Payment Q-Check t]Cash ,r.6a ied
Deposit Recelved'(3346)
Credit Cards are.accepted for deposit only.-maximum I/3 of the
Balance,at Stark of Job()3X} - _ project cost(Pkace see Gedrt Card"em Form.)Bystong the
Esdmaud Compled ace Agreement•you adtnow1 edge that the Balance at Start job and the
lance Balance on Substantial QQ� �� ��� % Ba on Sutisontial dompledora of job cannot
tie made by credit
Completion of job(33%}�/ ��-+ grd.and must be made.by personal dKil,.bar&check,or cash:
Buyer(*)agrees mad understands that this Agreement constitutes the*nib*understanding Between the partwes,and that '
tberie.ace no verbal underataadings chaagmg ray of the terms of ibis Agreement.Bnyer(s)aclmmiiledges that Boyer{s).
(1)has read this Agreement,understand*the terms of this Agreement,and has received a completed,signed;and dated.
copy of this Agreement,including the two attached Notices;of Cancellation,on the;date8rst written above and(2)was orally,
informed of B"ayer's.right to caitcet thas'Agteeement,DO NOT SICN THIS.CONTRACT IF THERE ARE ANY BLAN$SPACES.
(Rkode lelairdSalse On/y)Notice to Boyer:(1).D4ia6t alga this Agreement if say of the spaces intended for.tlte:agreed terms
to the extent of then available saformadon are left blank (2)Yon are entitiod to a cep- f ebss Agreement at the'time you sign
it.(3)Yon may of any time pay off eke 1 unpaad balance due wader this Agreement,and m so'domg you may be,entitled to ,
receive'n partial rebate of the.Bnaace and`.insuraoce charges.(!)The sdler,has no rightto unlitwfally.eater your premises• `
or contmat any breach of,the pence to repossess good®put,—_ed ender tbis Agreement (S)Yon may cancel this Agieemeisi
d it not been signed at the main ofce'er a branch office of the seller;provided Yon no ifyth- seller at hair or,her main•:
office or branch ogee shown its the Agreement-by registered or.certiSed mail;,wLicb shall be posted not later than midnight
of thelddrd calendar day'after-the dry era which the buyer signs the.Agreement,exctading Stmday and anY holidsy on which
regWar mar!deliveries war aot;made:See the senora as". 'no of eancellatioa form for as bnye
P Y" .
e lunation of s'it rights.;;
Buye'r(s)trceived th consumer,education material,prrnnded by they Rhode Island Gotiir tc(onf R'cgistralidn'1}oard: (Bupe's fnrGals)
Renewal New England Bnyer(s)'
Buye{s);
Bye G' =
acute bf Prbdudr a Sigi stun Signature
N intName ofPmcluct Manager Print Nanre 'Pent 1Vanie
f YOU, THE BUYER(S),,MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD'
BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION SEE THE ATTACHED IYOTICE.OF CANCELLATION FORMS
FOR AN EXP i][ON OF THIS RIGHT"' r
-1- - - - -- �c-
_ C LAI`TION ^. NOTICE OF CANCELLATION `
Date of Transaction c. You maji cancel l s Date of Transaction _ You may cancel
ditr tramactron,:wi ''Pen ty or obligation,wtdein thas�transaetton,witisout any penalty.,or obligation,witf►in
three btestness tfays from`.the above date.H you cancel,any, three business days from the above date if.you.cancel;
property traded n,any payments'n5ade-by you under the 1 property,waded. Ar city payments made by;you;under',the
Contract or Sale,and any,negotiable instrument executed .i Contract or Sale,,and any,negotiable instrulrient executed.
by you will be returned widhin ten business days following. I b.lion wilt be returned within ten business days following
receipt by tit*Seller of your cancellation notice;''and any: I receipt by flee Seller of your cancellation notice,and.any'
security interest' arising out.,of the. transaction'will be secu' ty interest arising out of tlie' transaction 'will.be
youed tf you cancel u must make available to the Seller I canceled.lf you cancel, mtut make available to the Seller
caned yyoo yyoouu
at eesiden'ce;rn substantratly"as good condition as where. 1 at your residence nt substantially ai good condition as�wv e -
received,arty goods delivered m you under this Contract or I received,anjr goods delivered m,you under this Contract or.
Sale;or you may;if.y—wish;eoriiply.vvith`the instructions ot• I Sale;or,you rr►ay,dyou wish;coinpljr witle rho iintrirctions of
the Seller regarding the return skipment of the goods at the' der Setter regarding the return:shipment of fire goods at the
Seller's eexxppeense and ritii:If you do make a i gg0000ds.available Seller`s`exppeense and risk.if you do make the ggoods.available
,to,the Seller and flee Seger does_not pick:.diem:up wiNain. ba tfier Sellerand the Seller does no pick tit'erri up withem
tweiety days of the date,of cancellation,you may retain bs I twenty days•of the date of cancellation;you may retain or•
dispose'' the goods without any furdter. igation.if.you 1 dispose of the goods without arry.furdter obligation If rocs
fail to milii the goods available Co the Seger,or,if you agree: I fail to make.the goods available to the Seller,or,if you agree:
to return Roods
s to the Seller and fail to do av;then you i to return the goods,to'the Seller and:fail to do 30,tlten you:
reriiain liable: parformauioe of alt obligations under,the t remain liable 114r.performance:of ail obligations under the.
ContiatyTo caned this:transaction,mail or.&liven a signed ContraciLTo cancel this transaction,mail or deliver a.signed'"
and dated co" of this cancfllation notice or an}r other I and dated copy of this cancellation notice Or',;any other
carmen notice,or send a eg to Renewal byAndersen o/ 1 written notic%or send a telegram to Renewal byAnder wen of,`
Southeitit New England at I6 a on Road of ;RI 02865; I Southern New England at 2b Albion Road,Lincoln,RI 02865;,,
NOT LATER.THAN MIDNIGHT Or I NOT LATER THAN MIDNIONT OF
(per) i (D�)1 HEREBY CANCELTHIS.TRANSACTION: HEREBY CANCELTHISTRANSACTION.
a: s htrt N.ni tins' •'asyerti$rprur. rairK iiam.i n.et+; -
PJ A t 6W.Whke.' Buyer Copy:Yellow- Buyer Copy.Pink '
y
Southern New England Windows
d.b.a
Renewal by Andersen of SNE
Massachusetts-Department of Public Safety
Board of Building Regulations and Standards
Construction Supervisor
License: CS-096707 ?
BRIAN D DEMQS6
7 LAMBS POND£IRS`
Charlton MA 01507
Expiration
Commissioner 09/08/2016
IX
20W t 6�G.lu6ae�l
Office of Consumer Affairs find Business Regulation
10 Park Plaza-Suite 5170
Boston,Massachusetts 02116
Home Improvement.Contractor Registration
Registration: 173245
Type: Supplement Card
SOUTHERN NEW ENGLAND WINDOWS LL Expiration: 9/192018 _
DENNISON BRIAN
26 ALBION RD
LINCOLN,RI 02865
Update Address and return card.Mark reason for change.
sco t 0 20M-WII = _- Address E]Renewal 0 Employment Lost Card
C7ba�r nrniu.+c4(�r�C�t r::nrbwr.//s .
bite of Coast—Affairs&Rusinem Regutetion License or registration valid for individul use only
n IE MPROVEMENT CONTRACTOR before the expiration date.If found return to:
;. Office of Consumer Affairs and Business Regulation
Registration: 1M45 Type. 10 Park Plaza-Suite 5170
Expiration: 9/19/2016 Supplement,--_ - Boston,MA 02116
SOUTHERN NEW ENGLAND WINDOWS I.I.C. - -
��� RENEWAL BY ANDERSON
DENNISON BRIAN
26 ALBION RD -
LINCOLN,RI 02865 Undersecrttary Not valid without signature _
_ Vie ®mrnonwealth of Massachusetts
Department o P f IndustrialAccidents
Office of Investigations
I Congress Street,Suite 100
BOstOn MA 09114 2017
www.massgov/dia
Workers'Compensation Insurance Affidavit: BuildehrslContractolrs/EIectricians/PIumbers
AoDlicaat lttnfnrmatiion
Please Print Legibly
INaine (Business/Or anization/lndnidval): SOUTHERN NEW ENGLAND WINDOWS LLCG
Address- 26 ALBION ROAD-
City/State/Zip: LINCOLN, RI 02865 Phone#: 401-228-9800
Are you.an employer?Check the appropriate box:
I.0 I gin a employer«ith 20 4. ❑ I am a general contractor and I Type of project(required):
employees(full and/or part time)_= have hired the sub-contractors 6_ ❑New construction
2.1
.❑ I am a sole proprietor or partner- listed on the attached sheet 7_ ❑Remodeling
slip and have no employees These sub-con tractors have g, Q Demolition
1111orking for me in any capacity. employ=ees and have Nrorkers-
Ni o workers' comp.insurance comp- insurance.= 9_ ❑Building addition
required] �- Q We are a corporation and its 10-❑EIectrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their I I-Q Plumbing
myself. [No workers'comp. right of exemption per TVGL repairs or additions
insurance required-] 1 C. 152: Sl(4):and���have no 12-Q Roof repairs
employees. [No vtrorkers 13-Q Other DOOR REPLACEMENT
comp. insurance required.]
`Ally applicant that checks boa=1 must also fill out the section below shoeing their workers compensation policy information_
Homeonners who submit this affidavit indicating they are doing all work and then hire outside con tractors must submit a net,affida-tntindicatin_Q such.
Contractors that check this box must attached an additional sheet sho'Mite the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must pro�'ide their workers'comp_policy:numbe`
am an employer that is providing workers
i 'compensation insurance for my. employees Below is the policy and job site
information. 'I
Insurance Company Name: ARGONAUT INSURANCE COMPANY
Policy#or Self-ins.Lie.#. WC927938352394 08/21/2015
Expiration Date:
Job Site Address:_ I9 Duct/��ie e /2e1 City/State/Zip:
Attach a copy of the workers' compensation policy declaration page showin6
Failure to secure covers as re p g -the policy number and expiration date).
gaited under Section s v of MGL c_ 152 can lead to the imposition of criminal penalties of a
fine up to$1,600.00 and/or one-year imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine.
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage-verification_
I do hereby certify under the pains and penalties of perjury tlurt the infonnadon provided above is true and correct.
SIQi2atare.
,
Phone#: 401-228-9800
F,Sci,ause only. Do not ivrzte in this area,to be completed by city or town official.
I'owra. Permit/License#
Authority(circle one)_of Health 2.Building Department 3.City/Town CIerk 4.Electrical inspector 5.Plumbing Inspector
Person: Phone#:
lNgugma DATES
[ cA 0 t.s HLY ,c*FERS NO MGM
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' ,CE2lBED PQLECIES
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ACCDRfiiBFdCEYdEFti POtlGTP ONISffiW.�
�sbatizefagss 75�; - _ A11TitOr''QzA.REAP.�EF7TA73fF� - - - -- -
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:
oFt►+e.r lgwn of Barnstable *Permit# (�
ESSPER Expires 6 months rom issue date
RR Regulatory Services Fee s
r r �oOV
awxxsTABLE, : JUL 1 Thomas F. Geiler, Director
Muss.
9�p 0:59. . Division 0'7�Zzhl
rEbrAp'�a OWN 0� BARNS7ABL�uilding
Tom Perry, CBO, Building Commissioner
200 Main Street, Hyannis, MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax:'5087790-6230
EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY
Not Valid without Red X-Press Imprint
Map/parcel Number 190
Property Address *1 o L-'D S" Cc;L 1 � . & ,' 1—7 -Ut, Lice
X_Residential Value of Work C900 Minimum fee of$25.00 for work under$6000.00
Owner's Name&Address t uc I.-�--L `f' 614Y-c6'
Contractor's Name �y✓L Pfi"t✓ cc/ � � Telephone Numbers
Home Improvement Contractor License#(if applicable) 4 ('s"
❑Workman's Compensation Insurance
Check one:
❑ I am a sole proprietor
❑ I am the Homeowner
❑ I have Worker's Compensation Insurance
Insurance Company Name l G��
Workman's Comp.Policy# cl
Copy of Insurance Compliance Certificate must he on file.
Permit Request(check box)
07 —roof(stripping old shingles) All constr6ction debris will be taken to Cit�
❑ Re-roof(not stripping. Going over existing layers of.roof)
❑ Re-side
❑ Replacement Windows/doors/sliders. U-Value (maximum..44)
*Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e. Historic,Conservation,etc.
***Note: Property' Owner must sign Property Owner Letter of.Permission.
A copy of the Home Improvement Contractors'License is required.
SIGNATURE:
Q:\WPFILES\FORMS\building permit forms EXPRESS.doc
Revise020108
.=
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/ContractorslElectricians/Plumbers
Applicant Information Please Print Legibly
Name(Businesslorganization/Individual):
Address: 1* l) C/t��..i/ C14
City/State/Zip: �C `" 4IrA_ Phone.#: S 6�� 77 e 6
Are you an employer? Check the appropriate bov Type of project(required):
1.❑ I am a employer with 4. I am a general contractor and I
* have hired the stab-contractors 6. New construction
. employees(fnll and/or part-time). K emodelin
2.�am a'sole proprietor or partner- listed on the attached sheet 7• ❑ g
ship and have no employees These sub-contractors have 9. ❑Demolition
wodcing for me in any capacity. employees and have workers' 9. ❑Building addition
[No workers' eOmp.. ne comp.IIISUIrr1ILCe.$
miranc
rtquired_] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions
3.❑ 1 am a homeowner doing all work officers have exercised their I LEI Plumbing repairs or additions
myself [No workers'.comp. rigbt of exemption per MGL 12 €repairs
incur anCc required]t c. 152, §1(4),and we bane no
employees. [No workers' 13.0 Other
cow,insurance required-]
*Any applicant that checim box#1 roust also fill out the=ction below showing their wmi=s'eornpri soon policy infra nation_
t Ha=owncrt who submit this affidavit indicating lbay are doingall work and then hire outside contractors crust submit anrw affidavit indicating such.
tContractnrs that check this box unist attached an additional shect showing the name of the sub-conuacton and state whether or not those rntitics have
enployecs. If the sub-contractors have enaploycrs,they must pmvidb their workers'camp.policy number.
lam an employer that is providing workers'compensat%an insurance far my employees Below is the polity and job site
information.
Insurance Company Nazne:
Policy#or Self-ins.Lic.#: �� 6 5� Expiration Date: l d�_
rob Sitc Address: a•.-
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secun c coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine uip 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 thq violator. Be advised that a copy of this statLmcrit may be forwarded to the Office of
Inyestizations of the DIA for insurance coverage verification. —
I do.hereby cerWP7 under the pains•and pe ' tof perjujy that the information provided above is true and correct
Si c: Data: l a —
Phone
O feeler!use only. Do not write m this area,tb be completed by city or town of xiaL
City or Town: Permit/License#
Isndng 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#:
oF'THE T Town of Barnstable
Regulatory Services
` g"R' S. Thomas F. Geiler,Director
1639. `��
reo.3 1% Building Division
Tom Perry, Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
Property Owner Must
Complete and Sign This Section
If Using A Builder
PO—C11-�C1 , as Owner of the subject property
hereby authorize 2?`t �x Pam " to act on my behalf,
in all.matters relative to work authorized by this building permit application for:
(Address of Job)
i
C
Si a e of Owner Date
Print ame
If Property Owner is applying for permit please complete the Homeowners License
..Exemption Form on the reverse side.
Town of Barnstable
�pF THE Tp��
0 Regulatory Services�'
• Thomas F.Geiler,Director/
swxxsrwar t, :• '.
MASS.
039. ��� Building Divisio
ATfD Iu'�R Tom Perry,Building Co ssioner .
200 Main Street, Hyannis, 02601
vrww.town.barnstab .ma.us
�• Fax: 50
' Office: 5�08-862-4038_ - _ 8-790-6230—
HOMEOWNER LICENS EXEMPTION
Please PH
DATE:
JOB LOCATIO-h-
number street village
"HOMEOWNER":
na •e home one# work phone#
CURRENT MAILING ADD S:
cWtho
state zip code
The current exemption for"ho\wn extended o include owner-occupied dwellings of six units or less and
to allow homeowners to engage an ' for hire w o does not possess a license,provided that the owner acts as
supervisor.
FIIVTTION OF HOMEOWNER
Person(s) who owns a parcel of land he/she r ides or intends to reside, on which there is,or is intended to
be, a one or two-family dwelling,at
etached tructures accessory to such use and/or farm structures. A
person who constructs more than one two-y r period shall not be considered a homeowner. Such
"homeowner"shall submit to the Builrer on form acceptable to the Building Official, that he/she shall be
res onsible for all such work performed the inpermit. (Section 109.1.1)
The undersigned"homeowner"assumes responsibility fo ompliance with the State Building Code and other
applicable codes,bylaws,rules and regulations.
The undersigned"homeowner"certifies that he/she u erstands the own of Barnstable Building Department
minimum inspection procedures and requirements and that he/she will omply with said procedures and
requirements.
Signature of Homeowner
Approval of Building Official i
Note: Three-family dwellings containing 35000 cubic feet or larger will be regtured to comply with the
State Building Code Section 127.0 Construction Control.
HOMEOVMER'S EXEMPTION
The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions
of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a persons)for hire to do such
work,that such Homeowner shall act as supervisor." %
Many homeowners who use this exemption are unaware that tr ey are assuming the responsibilities of a supervisor(see Appendix Q,
Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly
when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would writh a licensed
Supervisor. The homeowner acting as Supervisor is ultimately responsible.
To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,
that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by
several towns. You may care t amend and adopt such a form/certification for use in your community.
Board"Building Regulations and Standard
HOME IMPROVEMENT CONTRACTORLicense or registration valid for individul use only
before the expiration date. If found return to:
•• - Registration n 105488 Y
Expiration Board of Building Regulations and Standards
7/17/2010 Tr# 269518 One Ashburton Place Rm 1301
V TYPe Individual Boston
+w � ,Ma.02108
ARTHUR M.PACHECO ri }
Arthur Pacheco s`, -- f
133 ASHLEY DR
CENTERVILLE,MA 02632
Administrator -�—
Not valid without signature
t
Assessor's map and lot"number ....... ......... .....:... ,�/ ��'��� S
'` SEPTIC SYSTEM %`11jS 1 EL
Sewage Permif number ...................1�d.Y4:�.........:................ iNST LLED 1i�1 Z�I`s1 UA(vC .
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9 039 ` DU 1DI� G ! INSPECTOR
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• APPLICATION FOR PERMIT TO .. .. .. . .:.. .....................................
TYPE OF CONSTRUCTION t?z?..`. ....... .....` �f S ON. ,.......... ..............................
t •
197�
TO THE INSPECTOR OF BUILDINGS:
x The undersigned herebyher/eby�applies
_for ya4permit accord oing t the following information:
Location ...YLY.....1� ..... 7..:R. ../. .....R.C!.:...............!N.k.........F.�.............................................................................
ProposedUse ..... J-�.....l.0 .R.c?.!?.............................................................................................................................................
.............Fire District ..C'� �f: Q5
Zoning District .......�...�:..................................... .... ......��...........................................
Name of Owner .C�rJ.,Cq� .f!.....!,:•�G►LCCc.........................Address .y.11...0.(d `s�� q.� �c� ��t'^D.[....`.!.Cjt..
d L(f - llD...................... d
Name of Builder .l`�4..M. .. !t�Qr9LQl .S '�!9I.•.StS.Add ress a?.5....J' At`.�u��i...f-........
..................
Nameof Architect .......✓Ut?ti .C-� .........................................Address .............:......................................................................
Numberof Rooms ............I...................................................Foundation ..... ......................:.....................
Exterior .... ....... . t v�.f g .......5 .6"`�.�� .� ................................
Floors ....... /f S ,ram ..............................Interior ........A�4.L
Heating 4
....................................:..................................Plumbing ..........N .G` .....................................................
Fireplace ...... ... t?!`�. ............................................................Approximate Cost ......tlt.0......................................................
Definitive Plan Approved by Planning Board ________________________________19________ . . Area ..j�a ...� ..�..f..:...........
Diagram of Lot and Building with Dimensions Fee. .......... ..... ............................
SUBJECT TO APPROVAL OF BOARD OF HEALTH
s
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I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the abolve
construction.
Name . p,/s.G�.:. .....................................
Pacheco, Eugene r
,r
jj
No ...d 20157 Permit 'for add to dwelling
l ,
.......................
............................................
Location .........419 Old Stage Road ,
Centerville 1
...............•........•••....................................................
Owner Eugene Pacheco
.....
- t
Type of Construction .....fr...........ame..........................
Plot ...............................Lot ................................ i 1
Permit Granted MaY 2 ....19 78
.............. ................... F
Date of Inspection ........19
Date Completed .... � r�.......19
PERMIT REFUSED t
e: ......................................................... ..... 19 i
............................................. ................................
i ....................................................... ... .........._..
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........................................................ I
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............................................................................... .X
pproved ................................................ 19
............................................................................... -
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