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HomeMy WebLinkAbout0029 PADLOCK LANE aq �cr�C 1oc-J� �:� � ® �!� _� ., - .� .. a w n 0 i .. ,.o q .. a .i � o P 5 __ .. _ ,. .� A .i '�� F e � e .. � � o - � , n ., .. .. § _. a - ,. � .. _ �, � _ �` .. s � .. a � �, - �, n ,, .. as t � o. r �, •. � , ., s p' - �, - � _ �. .. ., ,� ,. r .. - .. .. .. 1 Application number..... .-fx Date Issued...............................................I......... ......... MASS Building Inspectors Initials.... Map/Pa rce l..172.3.......63. TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION:. ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: NUMBER STREET VILLAGE Owner's Name: A-4 ke ri Phone Number Email Address: Cell Phone Number Project cost $��� Check one Residential Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR Owner Signature: Date: TYPE OF WORK ❑ Siding 0 Windows (no header change)# E Insulation/Weatherization Doors (no header change) Commercial Doors require an inspector's review 0 Roof(not applying more than 1 layer of shingles) Construction Debris will be going to CONTRACTOR'S INFORMATION Contractor's name -` Home Improvement.Contractors Registration(if applicable) (attach copy) Construction Supervisor's License# (attach copy) Email of Contractor r ,epch nenumber ALL PROPERTIES THAT HAVE STRUCTU ES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN 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) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. 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 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 Cell or Work number I.understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLICANT'S SIGNATURE R Signature Date d 70 `�l� All permit applications are subject to a building official's approval prior to issuance. Comonwealth of Massachusetts m yf Division of Professional Licensure ` Board of Building Regulations and Standards Constrtrctio _ specialty Empires 041131202D CS.SL-099913 TROY A THOMAS 499 NOTTINGNA DR L r � CENTERVILLE MAy S COminissioner n_J/ceo��arna�rcc ealC�nn l�i�ccasacluselhr Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration stration valid for individual use only TYPE Zoroorafion before the expiration date. If found return to: Regstrat- Expiration Office of Consumer Affairs and Business Regulation _ 18122 E 06/08/2020 Boston,MA 02108 One Ashburton Place-Suite 1301 TROY THOMAS HOMEIMPROVEMENTS,INC: TROY THOMAS 499 NOTTINGH, DR Not al d without signature CENTERVILLE,MA 02632 Undersecretary DATE(MMIDDIYYYY)' ACC)® CERTIFICATE 4F LIABILITY INSURANCE Fo5/2s/2o1s [IREPRESENTATIVE IS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS RTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE.COVERAGE AFFORDED BY THE POLICIES LOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the poticy(ies)must have ADDITIONAL INSURED provisions or be endorsed.. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement On. this certificate does not confer rights to the certificate holder in lieu of such endorsements). CO ACT FRODUCER NAME: Donna OStrowski Mark Sylvia Insurance Agency,LLC PHONE 508 957-2125 FAX No: 508 957-2781 a 404 Main Street E-MAIL (nark@marksylviainsurance.com Centerville,MA 02632 NAIL INSURE S AFFORDING COVERAGE INSURER A:Farm Family Casualty insurance INSURED INSURER S' - Thomas Home Improvements LLC INSURERC: PO BOX 177 INSURER D: Centerville,MA 02632 INSURERS: ~ INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES Of INSURANCE LISTED BELOW LICY PERIOD HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE PO INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH TH{S NCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURA EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. AD L SUBR POLICY EFF POLICY EXP LIMITS TYPEOFINSURANCE POLiCYNUMBER MM/DDrYYYY MMIDDIYYYY 5/01/2018 5/01/2019 EACH OCCURRENCE $ 1,000.000 A X COMMERCIAL GENERALLIABtL(TY 2001X1416 r�--y--I� PREM SES Ee OCCUM Ce S 100,00fl CLAIMS-MADE t ^ �OCCUR 5,000 MED EXP(Any one person,S PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 " GEN'L AGGREGATE LIMIT APPLIES PER: PRO- PRODUCTS-COMPIOP AGG $ 2,000;000 J X POLICY❑JECT El LOC $ OTHER: I COMBINE INGLE Ea a iden IT $ AUTOMOBILE LIABILITY cc " BODILY INJURY(Par person) $: ANY AUTO � $ � - OWNED SCHEDULED BODILY INJURY(Per accident) AUTOS ONLY AUTOS PROPERTY DAMAGE $ HIRED NON-OWNED -(Per aC ide t AUTOS ONLY AUTOS ONLY $ ` EACH OCCURRENCE UMBRELLA LIAB S OCCUR ! EXCESS LIAB ` AGGREGATE J�)_----^ CLAIMS-MADE I } l I9 P EU OTH- S DED RETENTIONS 2O01W8053 5IO1/2018 S A R A WORKERS R AND EMPLOYERS'LIABILITY E.L,EACH ACCIDENT $ 1.000,000 ANt'PROPRIETOR/PARTNER/EXECUTIVE YIN NIA E,�,DISEASE-EA EMPLOYEE $ 1,,000,000 OFFICERIMEMBEREXCLUDED? a (Mandatorytn NH) 1,000,000 if yes,describe under E.L.DISEASE-POLICY LIMIT $ ;DESCRIPTION OF OPERATIONS bef- DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(AGORA 101,Additional Remarks Schedule may bee attached it more space is required) .Carpentry In coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived or extended the coverage provided by the policy provisions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN . Troy Thomas ACCORDANCE WITH THE POLICY PROVISIONS- 499 Nottingham Drive Centerville,MA 02632 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Thomas Home Improvements Proposes to perform the following work: . Location of proposed work: Karon Watt 29 Padlock road Centerville, MA 02632 Date on which construction should begin: September 2018 The homeowner hereby acknowledges and agrees that the scheduling dates are approximate and that such delays that cannot be avoided by the contractor shall not be considered as a violation of this contract. The contractor agrees that when such delays become known to the contractor,the contractor will advise the homeowner as soon as possible. , The homeowner hereby acknowledges that in certain remodeling work,the demolition process may reveal defects in the existing structure which must be repaired, creating additional work which may need to be carried out in order to complete the work described in this contract. In such case the homeowner agrees that the duration of the work and the schedule date of completion may differ,and that such variation is not to be considered a violation of this contract: Cost for labor and materials under this contract: $2,725.00 Proposal to install Azek PVC trim on rotted trim areas discussed would be -Proposal to install 2 JELD-WEN fiberglass entry doors&2 Harvey storm doors would be an additional $3,998.00 it NOTICE REQUIRED BY LAW With the agreement of the contract$500.00 of estimate is due. Further payments under this contract are as follows: 1/2 of the estimate due at the start; and remainder due at completion of the job. Balance of all materials and labor shall be payable in full upon completion of work described in this contract. Payment as agreed upon shall be made when due. Any payments which are delayed shall be subject to a finance charge of 1.5% per month. The contractor warranties the work completed under this contract for a period of one year from the date of completion. During the stated warranty period the contractor shall be responsible for the service of the repair or adjustment, but the contractor shall not be responsible for the normal maintenance, repair due to abuse, misuse, and or normal wear and tear,which shall be the responsibility of the homeowner. All warranties for the materials supplied by the contractor shall be passed directly to the homeowner. The homeowner may be required to register or mail in such warranty card or evidence of ownership in order to activate such warranties. Homeowner failure shall not create any responsibility for the contractor under the warranty provisions; the choice of repair of replacement shall be at the discretion of the contractor. The homeowner acknowledges that the form, content, and notices contained in this contract are intended to comply with the applicable portions of the Mass. General Law Chapter 142A, and regulations promulgated there under. In the event of any instance of non-compliance, only such portion shall be invalid and the remainder of this contract shall be in full force effect. In addition, any such portion not in compliance shall be read and interpreted so as to have its intended meaning to the maximum extent allowed under such law and regulation. Signed as a sealed instrument on this date: Date: Homeowner Contractor 1 The Commonwealth of Massachusetts �'' Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia a Workers' Compensation Insurance Affidavit: Builders/Contracto_rs/Electricians/Plumbers Applicant Information /Please Print Legibly Name(Business/Organization/Individual): Address: City/State/Zip: ✓t n4A Q Phone#: Are you an employer?Check the appr6priate box: Type of project(required): 1. a employer with 4g' 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: modeling 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 are a corporation and its 10.❑Electrical repairs:or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.[I Roof repairs insurance required.]t c.-152, §1(4),and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#I 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 anew 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: rVM^ " e .a. Policy#or Self-ins.Lic.#: IJdaS 3 Expiration Date: Job Site Address: �� o" +q City/State/Zip Av .� Attach a copy of the workers'compensation policy declaration page(showing the policy number and ex ration 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 certify under the pai penalties of perjury that the information provided above is true and correct Signature: Date: J ` Phone#: �J_,o Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector.5.Plumbing Inspector 6. Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. suant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, exp ss or implied,oral or written." An emp yer is defined as"an individual,partnership,association,corporation or other legal entity, any two or more of the fore ping engaged in a joint enterprise,and including the legal representatives of a decease employer,or the receiver or 11 tee of an individual,partnership,association or other legal entity,employing em oyees. However the owner of a dwe ' g house having not more than three apartments and who resides therein,or a occupant of the dwelling house of other who employs persons to do maintenance,construction or repair rk on such dwelling house or on the grounds or 'lding appurtenant thereto shall not because of such employment b deemed to be an employer." MGL chapter 152,§25C(6) o states that every state or local licensingagency sha withhold the issuance or Y renewal of a license or permit operate a business or to construct buildings in t e commonwealth for any applicant who has not produced ceptable evidence of compliance with the in ranee coverage required." Additionally,MGL chapter 152, §25 n states"Neither the commonwealth nor y of its political subdivisions shall enter into any contract for the performa a of public work until acceptable evide ce of compliance with the insurance requirements of this chapter have been pre nted to the contracting authority." Applicants Please fill out the workers' compensation affiVdr ompletely,by check' the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),a s)and phone num r(s)along with their certificate(s)of insurance. Limited Liability Companies(LLCm' ed Liability P erships(I LP)with no employees other than the members or partners,are not required to carryrs' mpensation- surance.. If an LLC or LLP does have employees,a policy is required. Be advised th affida it may b submitted to the Department of Industrial Accidents for confirmation of insurance coverlso be re to ign and date the affidavit. The affidavit should be returned to the city or town that the applicar the perm o license is being requested,not the Department of Industrial Accidents. Should you have any qu regarding law or if you are required to obtain a workers' compensation policy,please call the Departmee number st below. Self-insured companies should enter their self-insurance license number on the appropri . City or Town Officials Please be sure that the affidavit is complete and printed le ibly.,fbe Dep ent has provided a space at the bottom of the affidavit for you to fill out in the event the Office f Investigations has t contact you regarding the applicant. Please be sure to fill in the permit/license number whi will be used as a refere ce number`In addition,an applicant that must submit multiple permit/license application m any given year,need only ubmit one affidavit indicating current policy information(if necessary)and under"Job S' e Address"the applicant shoul write all locations in' (city or town)."A copy of the affidavit that has been officially stamped or marked by the city r town may be provided to the applicant as proof that a valid affidavit is on file or future permits or licenses. A new davit must be filled out each year.Where a home owner or citizen is obtain' a license or permit not related to any b iness or commercial venture (i.e.a dog license or permit to burn leaves etc.) aid person is NOT required to complete 's affidavit. The Office of Investigations would like to thayou in advance for your cooperation and sho Id you have an questions, Y Y please do not hesitate to give us a call. The Department's address,telephone and fax n ber: The Commonwealth of Massachusetts Department of Industrial Accidents ' office of Investigations 600 Washington.Street Boston,MA 02111 Tel.#617-727-4900 ext 446 or 1-877-MASSAFE Revised 4-24-07 Fax#61.7-727-7749 www,mass.gov/dia Assessor's map and lot number,`_ :.... .�. ........DZ �— p G ' .... .. ... ' . G' . i •', ,.< '� • Py0 Off♦ THE Sewage Permit number..�:;W.�..�. • w�' �� .� BAUSTADLE. House number ....... ......:...;... SEPTIC-SYSTE 9a. INSTALLED IN CO ' T B W OF. ,BA RNSTALEITHTITLE E��I�RONMENTAL CODE AND SOWN REGULATIONS BUILDING'' INSPECTOR APPLICATION FOR PERMIT TO .....................................:........................................................ TYPE OF CONSTRUCTION �5 .n......: ®o ..... .... ....... ..................................... tiJ) ' ................................ TO,'THE INSPECTOR OF BUILDINGS: The undersigned hereby applies 'for a*permit according to the following information: Location .........07.9..... .E 1 .... ,i1!'/.;..... .CZWZ_CX(!4'i............ ?.:.4... ..................................................... Proposed Use .........San......./�/ : ...::...�l.Uf�Ylt` '.0.. ....... .. .. ... Zoning District ...... . ..............................................................� Fire District � F ..... .. .. ..................... ........ Name of Owner ....:eD. ti'.T.. I...L..l.'.° �1.........:Address .... ..hI6Cr,.. ...l�g' /�F7!✓/`�4....... Name of Builder. �... . LFIG. ...../:e'," .&/"4ddress ...7A'.:4.,.Z.!':7N.... .................... Nameof Architect .:......... ...........Address....:.....:................................. .................................................................................... Number of Rooms Foundation 6h U1C c c .................................. ..... ...7q.6:r... .WI.— o....! ..T.........;. Exierior f.tc. . li~5.......4t ..Pfl.+~:....Te.!H!L.:.:........:.......Roofing :....'4s`?at �-� ......... :.................. .. �' .... �..........................................................' Interior .. �F'.�/lJC�.:.. 1.!?L.. l fit??.................... Floors ..f� Heating ..........1-4 ?a..c.................................. ............................... Plumbing ........._e". 1..'........................................................ Fireplace ....::.... �.(/..'.G....:........:.:...:...........................::........:+;.Approximate Cost .........s j.QS�.C?: Definitive Plan,Approved.by Planning Board`______:________—_____________19________. Area /.. .rl:.X. �a '. ........ Diagram .of Lot and Building with Dimensyions ~ , Fee .......................... SUBJECT TO APPROVAL OF BOARD OF HEALTH +o �X/sry5 �cc�, r y�cw SUN IZA, ® OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS., - I_hereby agree to conform,to all the Rules and Regulations of the Town of. Bainstoble regarding the above construction. Name .... .... .................................. Construction SupervisoPs License . ................................ PROUTY, ROBERT M. 25419: Build Addition No ,,... Permit for .................................... - �* 'single FamilyY. Dwglling.............. r,, Location .. 29..Padlock...LaX?�.'.................... Centerville ..� j, ................... ......... w Owner` Robert. M. Prouty.................... TYPe of Construction tame....... 4*. .. .. ....... ........r............. ................ �+ - Plot ...9n�.........'....... Lot ................................... � � ;�� '.- :R • i., _ � :\. S•-.• � ,%a. . r y August r Permit Granted .........................................19 8 3 Dote, �ct%io--rn_7.__'e_'?/i., Y........... .z19 Y3tk 'r Da`te Completed ....... ...19f-3 } { ��.. r - } g47 - t'y r "y r ' !`! ,,: ,..Y �.3". to _ ...J.i - .�,shy .•._.i 1 FEE ~ TOWN OF BARNSTABLE, MASS. a d 19 0 wQDo �•� THIS IS TO CERTIFY THAT A PERMIT IS HEREBY GRANTED TO � VA > O w7 beA— (PROPERTY OWNER) (ADDRESS) 03 b 1p.a TO ............................................................................................_............................»_......_...__....................................................................................................................... l A 'b (BUILD) (ALTER) (REPAIR) �! acs d .(TYPE OF BUILDING) j (APPROXIMATE SIZE) O c 0 ~ ...................»...........................�..._.....«. ..._.......................................................................................................... .......».....»...._.......__.........._ o�p LOCATION ..............»._......_. ....�..._»......_._.._....»....___.._.......................................»......................_....................._........... .._._...»._._ V y (STREET AND NUMBER) (VILLAGE) 3 NAME OF BUILDER OR CONTRA TOR A o d� APPROXIMATE COST 4) cc I HEREBY AGREE TO CONFORM TO ALL THE RULES AND REGULATIONS OF THE TOWN OF BARNSTABLE, REGARDING THE ABOVE CONSTRUCTION. oWoa • U^. a 01 d�N (OWNER) (CONTRACTOR) � caa N�a O O kw 06 A BUILDING INSPECTOR Subject to Approval of Board of Health. "' I ! , . il in 111 sue?!1' Ae $�17k,kIaYF s�,i t3S e'� w� ° AzS a � .;axle 5'C-. rV t �+ 71 ,,y{F: Y a..a ...� rr t' � 9 ,its �. .• ,r. _ 4 } Y ---r�h..y-.....+L..r.--.�_.�-ti+� ..t..�----'�".�"-".'...w-.---ti .-^ti,..+ -.. t.ti_,...r-�1,..w---•'�1.�. ti^-ti-� .�^'L�..na.--..+...�.�.Y`�.....-..-,ti""�.^rv,.+r.✓..-.ram-r'.T 4 Assessor's map- and lot number ...........................................14 f .. INSTAILEV Ifs 6'OMPLIANCt Sewage Permit number .. ............. . . ........................... - WITH ARTICLE I9 STATE .A ibj �j, 1 f CF 7H E p� WN O.d- BAR �� `1'1 ■.� D T� r �Q� �o TO N SS ,� 4*1 AMS` DULLDING: INSPECTOR ~� APPLICATION'FOR PERMIT TOa C �� .. QN .. }�.7....i;&C....` �I!Y.ECC.IN6...... TYPE OF CONSTRUCTION �L�. �i���,�// dv LLi.V6" TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ... ��`! u� ......Th-P.Ld .K........k..4;N (2 IV.7.7F_ LE......................................... ProposedUse .... ..................................................................................................................................... Zoning District .... ................... Fire District L .1�`!2r/(I..�C .................................. ..... .................................. Name of Ownerl/t .!W� .L...' .�..1.:r?.1� 4? � ddress �✓�a��.. ,.r C t, �sl!.. Y�C�� , Nameof Builder. ..................................................Address .................................................................................... Name of Architect �J .���. .! �� ...- O;X. ?i��. I (....Address .......(- . C�.10 ,a..... .. . .�� ...................... Number of Rooms ......L.......................................................Foundation�� 5 �'CC- ......QP..QQ................................... Exterior .....J.(iI '.. g . t2 .Interior ....—.yam.��Floors .....��:.....1..4r.1............................................................ J/ ..�(�!�'.L..................................................... Heating ... ....................................................Plumbing �! � IT z... Fireplace ....... &..,?...............................................................Approximate Cost ...... .I~?,.���.©....```................... . ...... Definitive Plan Approved b Planning Board -__--__-_____ ...........................................5z� �'' PP Y 9 ------------------19--------. Area Diagram of Lot and Building with Dimensions Fee 3 ��.. ... ......... .... SUBJECT TO APPROVAL OF BOARD OF HEALTH .J O T , I hereby agree to conform to all the Rules and.Regulations of the Town of Barnstable regarding the above .'A/C construction. ` �, CAI / ,1 .l Name .... ...:. . . . .. ... ........................:>....:.. :................. � � aaniel"a. ur«mvo Jr. , Inc. ' ! ` � No ..........L7&48ermkfor .......91�1�.. tmrY"--.. ' ..................... ��� ` Location .��... ]���l��� �a�e . ---~--------. ^ / � ' ........... ^ ^ . ` Ow/ne, ..............IAiq�el..��..8�]�Y�./I�:^.Ip�` , ` Type of Construction --..%KAM9---._--. ' ._ . - . ��-----.---..^------------.---.. ` . #24 . . Plot Lot � ._-----.--.. ----------.� � . . . . d Jo�m l� 74 Permit Granted --- lA � \ ` ' Date of '' ` . ~ - � . ' '1* , . - _ _ ' Dota� Como��o6 . ^. . -/� -. . . � ��t0�y�� � PERMIT REFUSED ` lV ` =�----_--.. .---.---.----. . ! 'w . ............................. -----.-.--.-.---.--. ) -'-:�''--'�'-_---`'--^--^^^'------�' / -.-��--.-.-----------.--~----.. . / '--�''..----------...----.---..-.. . � . � ^ _--------------.. lA -`Approved ^-.-~ 'r-----------------------'-' -----------------'-~-^---^-'' ` / -