HomeMy WebLinkAbout0324 PATRIOT WAY u 9
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Town of Barnstable *Permit
Expires 6 inn j issue date
Regulatory Services Fee
• BARN61'ABI�.
• Richard V.Scali,Interim Director
&b,�6�A� �Building Division r7I31)Jy
Tom Perry,CBO,Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.bamstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
Map/parcel Number Not Valid without Red X-Press Imprint
jI�U, -1 ���n ) 0
Property Address 2`1 �CUAYA, 6 V Cjt�l��V►1i Y` lX�
[Residential Value of Work$ 2-i 0o Minimum fee of$35.00 for work under$6000.00
Owner's Name&Address
� G✓1"Y1 � �� �/(101 ��
Contractor's Name w& En wov Telephone Number
J O Home Improvement Contractor License#(if applicable) Email:_' �c�a,pe�,ul�le����S-�S•��
Construction Supervisor's License#(if applicable)
M Workman's Compensation Insurance gyPRESS IT
Check one:
❑ I am a sole proprietor a 'UL �
❑�am the Homeowner 2014
L� 1 have Worker's Compensation Insurance
Insurance Company Name 1 C6'\jA &ifWATMN F'13ARNSTABLE
Workman's Comp.Policy# 11 y"C
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
e-roof(hurricane nailed) not stripping. Going over existing layers of roof)
Re-side It 6S
❑ Replacement Wrndows/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 License is
required.
SIGNATURE:
TAKEVIN g g Muildin Chan a XPRESS PEIQMXPRESS.doc
Revised 1 313 ,
e 06 _ ,.
f ,1
..........
Capewide Enterprises,LLC
ACCEPTANCE OF PROPOSAL
The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to
do the work as specified. Payments will be made as outlinedabove.
Customer Signature
Date: j1) /j�j '�L} _ Signature
Authorized apewide Enterprises Representative
t
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
'600 Washington Street
Boston,MA 02111
www.niass.gov/dia
Compensation Insurance Affidavit: Builders/Contractors/Electricians/plumbers
uilders/Contractors/Electri ianns nt Le er
Workers Comp Please
ib
Avylicant Information
Name(Business/organization/Individual):
-------------
Address:
City/State/Zip:
♦Q �{Phone#:
Type of protect(required):
Are ou an employer?Check the appropriate I am a general contractor and I 6• �]New construction
1,( I am a employer with have hired the sub-contractors ? 0 Remodeling
employees(full and/or part-time). " listed on the attached sheet.
2.El I am a sole proprietor or partner- ,.. g, [J Demolition
Those sub-co have addition
ship and have no.employees workers'comp.insurance.
9. ❑Building
working forme in any capacity. 5 a We are a corporation and its I O E]Electrical repairs or additions
[No workers' comp. insurance officers have exercised their.
required.] right of exemption per MGL ME]Plumbing repairs or additions
3.❑ I am a homeowner doing all work c. 152,§1(4),*and we have no 12.H Roof repairs
myself. [No workers' comp. " employbes.[No workers' 13• Other
insurance required.] ', comp.insurance required.]
lcy
•Any applicant that checks box#1 must also
ndicatin out the sectiondoing all work end then hire outside contractors most subi information.new affidavit y iinfonnation.
t Homeowners who submit this affidavit ch Indicating
;Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers comp.p �'
I am an employer that Is providing workers'compensation.insuraneeformy employees Below is thePolley andJob site
information.
aA
Insurance Company Name:
C �J" I Expiration Date:
Policy#or Self-ins.Lie.#: 2J U�Z 2-
city/State/Zip
\
Job Site Address: h±We(showing the policy number and expiration date).
Attach a copy of the workers' compensation piilicy de laratlon peg ( g
Failure to secure coverage as required under Section 25A of,MGL e•en 2 can
in the formlead to the of a STOP WORK ORDER imposition of criminal tand a fine
fine up to$1,500.00 and/or one-year imprisonment,as well as ctvtl p
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
'for insurance coverage verification.
Investigations of the DIA
I do hereby certify under the pains andpenaltles,ofperjury that the Information provided above is true and correct,
.. nsitw .
Si nature:
Phone#: �1 s
Official use only. Do not write in this area,to be completed byVity or town official
City or Town Permit/License#
Issuing Authority(circle one):
1. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector.
6. Other
Phone#:
Contact`Persons
AC o® CERTIFICAT DATE(NIMDDIYVYY)
E OF LIABILITY INSURANCE 4/22/2014
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOE$ NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must 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 endorsemen s.
PRODUCER GONTA
Rogers&Gray Ins.-Kingston Branch PHO NAME' FAX
63 Smith:Lane AI No)-.877-816-2156
Kingston:MA 02364 EAornR ss
INSURE S AFFORDING COVERAGE NAIC#
INSURER A
INSURED CAPEENT-01 INSURER B:
Capewide Enterprises LLC INSURERC:
J.P.Macomber&Sons INSURER°:
153 Commercial Street
Mashpee MA 02649 INSURERE:
INSURER F
COVERAGES CERTIFICATE NUMBER:1865828735, REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ADOL SUBR POLICY EXP
LTR TYPE OF INSURANCE NWVD POLICY NUMBER LIMITS
A GENERAL LIABILITY 8500050813 0/2014 /30/2015 EACH OCCURRENCE $1,000,000
X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED
PREMISES(Ea ocanence $250,000
CLAIMS MADE a OCCUR MED EXP(Any one person) $5,000
t
PERSONAL&ADV INJURY $1,000 000
GENERAL AGGREGATE $2,000,000
GEN'UAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2 000,000
POLICY X PRO-JECT L1 LOC $
A AUTOMOBILE LIABILITY 1020017539 20/2014 20/2015 a accident) 1000 000
ANY AUTO BODILY INJURY(Per person) $
ALL OWNED SCHEDULED
AUTOS X AUTOS BODILY INJURY(Per accident) S
X HIRED AUTOS X NON-OWNED, x. PROPERTY DAMAGE
AUTOS Per ecddent $
$
A X UMBRELLA LIAB OCCUR 4600650814 ,20/2014 [111030/2015 EACH OCCURRENCE $5,000,000
EXCESS LIAB CLAIMS MADE -
AGGREGATE $5,000,000
DED IX I RETENTIONS 10 000 $
A WORKERS COMPENSATION [120510414 14/2014 /14/2015 X WC STATU- OTH-
AND EMPLOYERS LIABILM
ANY PROPRIETOR/PARTNER/EXECUTIVE YIN EL EACH ACCIDENT $1,OW,000
OFFICER/MEMBER EXCLUDED? N I A
(Mandatory in NH) EL DISEASE-EA FAtPLOYE $1,000 000
Iryes describe under
DESCRIPTION OF OPERATIONS below L DISEASE-POLICY LIMIT $1 000 000 E
Leased Rented Equip LR LImit $50,000
DESCRIPTION OF OPERATIONS!LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space is requtred)
1
CERTIFICATE HOLDER CANCELLATION
' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED.IN
r .
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORQED REPRESENTATIVE
01988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25,(2010/05) The ACORD name and logo are registered marks of ACORD
�rieoomvnw.urseal�i a�Cac�itca
Office of Consumer Affairs&Business Regulation License or registration valid for indiretul use only
ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
k'VjePgistration: .EMENg Type: Office of Consumer Affairs and Business Regulation
iration 7/ /2016 Ltd Liability Corpor
10 Park Plaza-Suite 5170
Boston,MA 02116
CAPEWIDE ENTEFiPRTS' S L L G
RICHARD CAPEN a
4507 R RTE 28 g '
COTUIT, MA 02635 Undersecretary of valid withodaignature
Massachusetts -Department of Public Safety., -.
Board of Building Regulations and Standards
Construction Supervisor
Unrestricted-Buildings of any use group which
contain less than 35,000 cubic fect(99im3)of
License: CS-OS9TVS 273 enclosed space.
RICIIARD M CAP.
N
122 WHITMAR)RD -
Coah MA 0263
Ai
r
Expiration. Failure to possess a current edition of the Massachusetts
`J.�*�• 11127/2015 State Building Code is cause for revocation of this license.
Commissioner
For DPS Ucensing ioformatj0n*It: www.Mass.Gov/DPS
I
« ci� 5h 3)1dA
3
Town of Barnstable *Permit#
4 4
Regulatory Services Expires 6 months from issue date
' BAR1'ABLE
KAM
9 1e39. A�� Thomas F.Geiler,Director `
�p Mho
Building Division X-PRESS PERMIT
Tom Perry,CBO, Building Commissioner
200 Main Street,Hyannis,MA 02601 MAY 0 8 26Q
Office: 508-862-4038 www.town.bamstable.ma.us
EXPRESS PERMIT APPLICATION - RESIDENT
Fax: 508-790-6230
Map/parcel Number_,/ !` }'
`/ Not Valid without Red X-Press Imprint BARNSTABLE
l 7 '
Property Address 3 e,fz,y+ w�� C�{�-u rl(e ^A U 2d1 Z
Eh Residential Value of Work d S 7f e✓ Minimum fee of$35.00 for work under$6000.00
Owner's Name&Address ��Xn L'i r�P/ 2CI 19c�j,Q}2 (��
Contractor's Name �j,�q /�P� �� ,SD
Telephone Number G
Home Improvement Contractor License#(if applicable) y Qf 3
Construction Supervisor's License#(if applicable) C1 S 1I I
RWorkman's Compensation Insurance
Check one:
❑ I am a sole proprietor
I am the Homeowner
I have Worker's Compensation Insurance
Insurance Company Name G�r�
Workman's Comp.Policy# 02Z41 AI7"2
Copy of Insurance Compliance Certificate must accompany each permit.
r
Permit Re uest(check box)
�f Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to Mum I�G 11
❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof)
❑ Re-side
#of doors
❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows
❑ Smoke/Carbon Monoxide detectors 4'floor plans marked with red S and inspections required.
Separate Electrical&Fire Permits required.
*Wbere 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 License is
required.
SIGNATURE:
C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\QRE6ZUBN\EXPRESS.doc
Revised 053012
f
v' License or registration valid for individul use only fie(22arnmmrrsea�t�i o1g4_aa0Ae1jea
before the expiration date. If found return to: 2L\ .Office of Consumer Affairs&Business Regulation
Office of Consamet Affairs and Business Regulation SOME IMPROVEMENT CONTRACTOR
10 Park Plaza-Suite 5170 egistration 143053 Type:
Boston,MA 02116 expiration:_.6/14%20--4= DBA
KEATING CONST
TIMOTHY KEATING`- r
54 LOWER BROOK RD
Not valid without signature SO.YARMOUTH,MA 02664 =
Undersecretary
Massachusetts -Department of Public Safety
Board of Building Regulations and
Standards
Construction Supervisor Specials
} License: CSSL-099351
TIMB.KEATING= "
� 7
54 Lower Brook R$. l
South Yarmouth lirlA 0266
ae
Expiration
Commissioner 05/11/2014
i
i
The Comtnor mwkh trf h as Chusetfs
1?�artmea�t of IrulrsslriolAccidents
O,�rce of estxgatons
GOD Washington.Street .
Boston,MA 02111.
wuwv.massgvufdaa
Workers' Compensation Insurance Affidavit:Bud rs/ a 1p'Ia it rs
Applicant Information
Please Print L "b
Name 0hisinesstorganizahonil d midnal.):; nM �C-PL f����I
Address:
City/StatelZip:sw _L11ro 04 O my Phone# Sow 76d 21 D 2
Are you an employer?Check appropriate boz: T} of Pm)
ect
1:�] I am a employer with 4. ❑ I am a general contractor and I
s have hired the sub-�ora 6:'Q New consbnictton
employees(full and/or
2.❑ 1 am a sole proprietor orpartner- listed on the attached meet 7. Remodel*
s and have no 1 Tle 'cow have
ship employees 8. 0 Demolition:
wodcing for me in any capacity employees and have wodcers
(No workers,comp.insurance comp_:muraeft'l 9-: Building addition
5. We are a cosgofati4ou and its io F F3ectrical repairs or additions
3.❑.I am a homeowner doing all work dflicm have exercised their::.. 11.Q Plumhing;xepairs or additions
If o worlrert right of exemption per mGL
cep limp. c.152,:§1(4),`midwehave Itoofrepairs
-] 13:0 Other "
employeees.�Io workers°
comp.insurance requnted.]
*Any epptkaat thst cbetks bon#i must also sn o u the shorn betow skewing lher anew compeautionpoiuy inforom EML
Homeowners who wbmit this dEduicindmftS tttey are doing all wok and then hire oumide contactors man submit a uw i iidarai indicming Stroh.
kcn ctors Mat cbeck this boot must attached an additional sheet showing the anise of the aab-aontrattm and stine wbetber or net those entities bne
employees. If the sub-conactorsbaaeemp1oyees,th+e}'mn Vzvvide rworkers'romp•Policy'number.
I am on employer that is proyMrrg workers'compensation insurance,for my emFIVmL Berate is the policy and job site..
irefortrtation.
Insurance Company Name Cy
Policy#or Self-ins-Iic-#: Z Z�/�/17-2-/U`. Fitatian Bate:
Job Site Address: 32 �4. /e citytSfatelZp. F Cw;l/P dy l'" G 26�z
Attach a ropy of the workers!compensation olicy declaration page(showing the policy number and expiration date):
Failure to secure co enrage as rid tinder Seclson 25A of 114GL cV 152 can lead to the impositionof criminal penalties of a
fine up to S 1,500.00 aadlor one-year ic4dsoninent,as well as civil penalties in me farm of.a STOP.WORK ORDER and a line
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be Anwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I A)hereby carh�fy seder th ins cnd pe�eaittes o,fp euy that the injors�ation provi6d above tabs true and correct
Phu #:
Official use onb r Do not write in this area,to be completed by'dtp or town ohlda
City
or Town:
Permit/Liceuse#
Issuing Authority(circle one):
I..Board of Health 2.Building Department 3.CiWTown Clerk :#.Mectrical Inspector S.Plombmg Inspector
6.Other
Contact Persons Phone#:
6
CERTIFICATE OF LIABILITY INSURANCE
DArE iMM+DD.'Y"
d THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON Ill C F03/08/2013ERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE' COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN G INSURER(St, AUTHORIZED
REPRESENTATIVE OR PRODUCER.AND THE CERTIFICATE HOLDER. 7HE ISSUIN
IMPORTANT: If the certificate holder is an ADDITIONAL INSUREll the the terms and conditions of the policy, certain policies may require an endorsement. A statement on confer
yp*li {ies) must be endorsed, If SUBROGATION IS WAIVED, subject to
certificate holder in lieu of such endorsement(s)" this certificate does not
PRODUCER rights t0 the
Schlegel 6 Schlegel Insurance Brokers Inc NAME.
34 MAIN STREET PHONE --
LAIC,No.E.O. --' --
E MAIL __.- .._._.„. _.... L.,(A/C.,No):
ADDRESS - --West Yarmouth, -
PROO ------'-'
-
INSURED - -.
IA;SURER!S1 AFEORDIhG COVERAGE
Timothy Keating Dba Keating Construction
INSURER A COLONY INSURANCE _
54 Lower Brook Rd INSURER aC'NA "-
' INSURER C
South Yarmouth, mA 02664 INSURER
INSURER E
VERAGES INSURER F
CERTIFICATE NUMBER:
THIS Is TO CEPTIFY THAT THE POLICIES Cr INSURANCE lSrF.(, BELn;.�, ,� REVISION NUMBER:
INOICATED NO*1 THST N REOIJIREtIENi. i iA� BEEN I O THE INSURED NAMED ABOVE A DIN AN'r ERM DR Cr SSUED r
FRl'tF+t=�Tr; roi, AF. ISSUED (DR 77. �NDl11nN GI' A,NY CONTRA
CT :OR THE POI 'Y PER „?
HY PERTAIN THE INSURANCE aFF rR) OR OTHER DOCUMENT k"pi RESPECT T4 ft-1CH
EkCLUStONS.AN Cr NEIT'IONS Or SUCH POLICIES LED 8Y HE POLICIES CJESCRIBE HEREIN t SI
UMI IS SEfO'vJN MAY HAVE BEEN rtF=DuCED BY PAID CLAIMS S JBJECT Tn ,;L:. ,HE M,,
1H5R: — - - - .- ------ EI'
TYPE OF INSURANCE ' -
'INSR yyyp! POLICY NUMBER i'OLICY i:F�� i POL crt-xp
GENERAL LfABII ITY -
A I IMMJODM'YYI IMMIDD+YYYY)
GL3594 908 LIMITS
X „R-.,.rMl F- R„l _a ;T., 03/10/2012 03/10/2013 EACH OCcuRRELCE =$1,000,000
_L +sNn E X .CUR 03/10/201303/10/2014,?REMISEs,Eaoc a,.e; s 100,000
_.
MEDE q6n o_resonl $5,000
51,000,000
-PPL Ea GENET AG l : s 2,000,000
Oc P"DL S �,OVPOP,GG 1 s2, 00,000'
--
auTOAIOBILE Llaeam
tEa acclaent5
son, S
801' i e�accla"I, a
. PROPERTYOnAl ,.-,.____.._ ...
UMBRELLA LIAR
Of„CLIP
EXCESS LAB EACH ali)RRE:ICE
.__.... _1'kS MA
DE,c.�,E
aGGREG�TE .s
- -- s +B WORKERS COMPENSa TION -•- _..._ ,,-,
AND LMPLOYERS LIABILITY 102241,137-2-10 !s
t W:JPAiF �R.C3 Y rN 03/09/2012 03/09/2011 X i ° u :GTH NhH E!:ECU�.Ii7- — ? CR,LIMITS
E E�rd Me l ^ ' =E,' Y T N A 03/09/2013'03/09/2014~
ER i
M nn IIY 1H1 -., E L EACt' Ci:OEfT c 100 000
It�ER�-:JNS d?Inx •: E i^Cll5cg5`.,_.F_TE!.1PLti,�E .. 100,000
-?FL Ot5E.45E.poi _rLtMtr s 500,000
,Anxh ACORD!01,ACthl,Unal Ramarga Schadul@,f7 more space,s rt•gvlredl -
CERTIFICATE HOLDER
CANCELLATION
SHOULD. .ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF• NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PRO IONS.
AU
EOREPRESENTATIVf t
ACORD 25(2009/09) The ACORD name and logo are registered marks of ACO D198 09 ACORD CORPORATION. All rights reserved.
+ BAMST"M r
� ,� Town of Barnstable
Regulatory Services
Thomas F.Geiler,Director
Building Division
Thomas Perry,CBO
Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
Prr �
o e Owner Must
Complete and Sign This Section
If Using A Builder
O q-a as Owner of the subject property
hereby authorize I +�"�. /�`Pc ��f PQ� 11 e`V25 6G�f6e't*; to act on my behalf,
in all matters relative to work authorized by this building permit application for:
(Address of.Job)
Signa re of Owner Date
t -
J
Print Name
If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the
reverse side.
C:\Uscrs\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\QRE6ZUBN\EXPRESS.doc
Revised 053012
I;
F1KWE r Town of Barnstable *Perm Lue
Expires 6 mon/ rl
Regulatory Services Fee
{MI Y
• BARNSTABM
v� 1639. Thomas F.Geiler,Director
Building Division
Tom Perry,CBO, Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
Map/parcel Number
% 3/' L Not Valid without Red X-Press Imprint
Property Address / �� L (/�✓Gt�' e
[�Residential Value of Work Minimum fee of$35.00 for work under$6000.00
Owner's Name&Address (o US�{J�l r/��yis� lye rfi
Contractor's Name �)(iplltllU _Otofi �A de,lamA Q''l_ Telephone Number ZfOO)fl 7 `007
Home Improvement Contractor License#(if applicable) �✓✓�8
Construction Supervisor's License#(if applicable) CS . Z—]
❑ ®p®ESS
Workman's Compensation Insurance �7
Check one: -
❑ I am a sole proprietor
❑ I am the Homeowner APR 18 2013
FVI have Worker's Compensation Insurance l /� IA'
Insurance Company Name _ � �� ���eCi'h� ®vVN
Workman's Comp.Policy# 00 15-9-a_� P- i I ARN,3TA,e
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)
VRe-side PCL!
#of doors
❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows
❑ 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 License is
wired.
SIGNATURE:
C:\Users\decollikWppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\QRE6ZUBN\EXPRESS.doc
Revised 053012
4_
;.� The�'t�rrerxrotrt��lth t�,�' rr�suel�a�s�tts _
De
parfineiit crf I itshia[AccideHis.
U,�rce Qf In�xesligations _
600 W=lrington Sheet
Bvst,� , 4 fl21'11la
'4V4 era' Ct m pensa_un Insurance Affldavi Builders) rnt a rs I ct is ns/Plumbers
Applicant Infoamiafion Please Print Imgilii_y:
l�danie��sgtOrgarrizatitxi�llntlividuai3_ L�rU� �� �I�I�� ��
Add s_ l53 CQMMMC-4� cynl-,
City/State Zip: � 6 2�9 one#_:: t�� `�7.7:_��7
=.emp!
employer?Ch.6e the appropriateboz T of ro act r4. »I ama era)contractor and IYPe F ] { egnn ed}:
oyer wi11x Z 2 ❑ 6. ❑Neu eonsixation
tuxgsloyees;(full andlur pit 3ime)s have bired the sub-contractors
2 ❑ I am a solepuprietot or.pa tner. listed on the attached sheet 7. El Resnodelin
slip and have no employees Theme sub t ontractors:Have 8. ❑Deuialition
w forme in an c ci employees atnd.have w..... '
y 9.:;❑Building atldinon
iNa Wor M.,:comp.insurance, comp.insurance 7
reed] : . ❑ �Ve are a cotp Ora ti and its 10.❑Electfical repairs or additions
3_❑ I aiim a homouer all work offitrs bare exercised tltesr 11_. Plunpbrn repairs. or additions
elf o workers mg t of ea.emlrt ou per MGL ❑
mY � �►P 12❑Roofrepans
c. 152..§1(4k and me have no
.;employees-[No:workers
13�
comp'insn<auce required] -
w a lita that checks b:#1 mast also fill out tthe sectian below sho z their.workers'c aiau
�mP :, F+oS'infarmatima
Homedarua>;s who submit this affidavit iudtcatmg are doing au wo:and then hire outside contmactors maurt submit a new affidavit in&catiq;s-n
t6ntractors`that chcke this boa mltst attache an addiii+sast sheet 11 showing flee s me of the sutrca®ttactois and state whether or not those en ities have
empllayeEes::ifthe subtotkuzetan have eisrpl a5 i S amass i ttidg t}ie6a w arlgrs'::tip.pt6licy.Inimber.
ir:rm art employer:that is:providing Worke.,rs'coutper�sadon.insurance f or�iq empla3reex Betattx is:the policy ctrtd fob site
ir�fotvttatiarr, D /�"
ksurranceCOMP.any Namme: �/I (/�
Polley#of Sell=itis lie #':_ i f,I LJ ( �� �] Fa�piratfon Tlate Cad / 3
Job Site Address:3 z P. In tq 4 ZfD3Z
Attach a:copy of the*,orlkers'minpens lion policy declaration; age(showing the policy number and expiration date).
Failure to:secure.colvlerage as required undex Section 25A of MG c:152 can lead to the iiaposition ofcr�1 penalties of a
fine up ta:$1,500-0U andtor one-year imprisonum n, as well as chu pet�atties in the'form of s STOP WORK'ORDER and a fame
of up to SMO 00:a. against tit :vxolator Be advised chat a copy;bf this.statement maybe forwarded to dii:Offici of
inve tigations off the DIA flee insurance coverage vsarification_
I:do lteretay certify rite der.tk pants oriel psis dWas of pr t rye that fi a in o. iatrrrrt prrn��ti abatae is terse and correct
Si tore: Date: ..
Phone
19,;�acial rise only. Da itet write its this area,t&L@ completed by.city yr tatvn�r�ciat
City or Towel: FermitlLicense#
Issuing Authority(cirrhe one):
I.Board of Health 2. uiltl ng 1}epitrtment 3.City rGn Clerk :�=Electrical Inspector 5.Plumb ttg Inspector
6.Other
COlit Ct PersOAG Phone#:
6
f✓
�FTME Tp�
MRNSTABLE. ' .
Town of Barnstable
i67p• �0
�fD Mp't s
Regulatory Services
Thomas F.Geiler,Director
Building Division {
Thomas Perry,CBO
Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
Property Owner Must
Complete and Sign This Section
If Using A Builder
as Owner of the subject property
hereby authorize � 17����e �Y�feY�Y).5 � to act on my behalf, -
in all matters relative to work authorized by this building permit application for:
(Address of Job)
nature of Owner Date
Print Name
If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the
reverse side. "
C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary.Internet Files\Content,Outlook\QRE6ZUBN\EXPRESS.doc
Revised 053012 �`'
Client#:61439 CAPEENT
ACORD.. CERTIFICATE OF LIABILITY INSURANCE DATE OGWONY
TEOGWONY
04116/2012
'THIS CERTIFICATE IS ISSUED AS A MATTER:O.FINFORMATION ONLY AND:CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOWJHIS CERTIFICATE OPIMURANCE.DOES NOTCONSTITUTE A CONTRACT'BETWEEN THE.ISSUING INSURER(S),AUTHORIZED
REPRESENTATIVE'.OR,PRODUCER,AND THE CERTIFICATE.HOLDER.
IMPORTANTHI!the certifleatiholder.ls an ADDITIONAL,INSURED,the policy(les)must;be endorsed.If SUBROGATION IS WANED;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..endoreement(s).
PRODUCER ; Linda Taddia
Rogers 8 Gray Ins. Kingston Fk "Eo E 508-746-3311 No;:877-816.-2156
Nxt:
63 Smiths Lane eIl ; Itaddia@rogersgray.com
Kingston,MA 023644700- ...INSURER s AFFORDINo COVERAGE • NAIC s
508 746-0055 L INSURER A:Arbelie.Protection CO 17000
INSURED INSURER 6:
Capewide Enterprises LLC
INSURER C:
J.PMacomber Sons: -
INSURER D:.
PO BOX:763 INSURERS:.
Centerville,MA 02632
INSURER F
COVERAGES CERTIFICATE:NUMBER
REVISION.NUMBER::
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED SELOW HAVE BEEN ISSUED TO THE INSURED.NAMED ABOVE FOR THE POLICY.PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE.INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS:OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS;.
INS ADDL UB POLICYEFF POU .EXP LIMITS
TYPE OF INSURANCE POLICY NUMBER MID MMID
A GENERAL LIABILITY CPPBSQOOSO813. 4/30/2012 04/30/2013 EACH OCCURRENCE s1 000000
X COMMERCIAL GENERAL LIABILITY PREMISES ,!li /rt D etiCe $250 000
CLAIMS4AADE I AI OCCUR MED EXP(Anyone non $5 000
PERSONAL&ADV INJURY S 1000 000
GENERAL AGGREGATE S2000 000
GENL AGGREGATE LI MIT APPLIESPER* PRODUCTS..COMP/OP AGO s2000000
POLICY PRO-JECT LOC. $
A AUTOMOBILE LIABILITY 55944400004 4/20/2012 04/20/201 CMe acclognt)
OMBINED SINGLE LIMIT 1,000,000
ANY AUTO BOWLYINJURY,(For pm eon) $
ALL OWNED SCHEDULED BODILY INJURY(Per soddent) s
AUTOS X AUTOS
NON-OMED PROPERTY DAMAGE 3
IXHIRED AUTOS x AUTOS Per aciid entt
S
A X UM 13RELLA UAB occuR 46000508/4 41.30/2012 04130/201 EACH OCCURRENCE s5 000 000.
EXCESS.LNB CLAIMSMADE AGGREGATE: $5 0.00 000
DED X RETENTIONS10000. $
WC,STATU- OTH-,
A woRms commsAnoN 00.54370411 4/14/2012 04/14/201
AND EMPLOYERS'LIABILITY Y./N
ANY PROPRIETORIPARTNE CUTIVE E L.EACH ACCIDENT $500 O0O
OFFICERIMEMBER EXCLUDE07 a N f.A
(MandatoryinNH). NO EXCLUSIONS, E.L.DISEASE-EA:EMPLOYEE E500000.
IfytM descfte under. E.L.DISEASE.-POLICY LIMIT $500 606
DESCRIPTION OF OPERATIONS.below
DESCRIPTION OF OPERATIONS 1 LOCATIONS.I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,It mom specs.Is required)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF,. NOTICE WALL BE DELIVERED IN
ACCORDANCE WITH THE POLICY .PROVISIONS,
AUTHORUIED REPRESENTATIVE
__.
6 106
L-2010 ACORD CORPORATION.All rights reserved.
ACORD 25(2010105) 1 of 1 The ACORD.name and logo are registered:marke of ACORD
#S80369/M80368 CJF
..........._......
— _...._..._ _—._...__.._ -
vhe 1panvnzoouueall/i a��C�/�czaeac�uWeG7�
Office of Consumer Affairs&Business Regulation License or registration valid for individul use only
OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
egistration: 143358 Type: Office of Consumer Affairs and Business Regulation
xpiration: 7/8%2014 Ltd Liability Corpc: 10 Park Plaza-Suite 5170
Boston,MA 02116
CAPEWIDE ENTERPR 'fi5;
RICHARD CAPEN
4507 R RTE 28 �—
COTUIT, MA 02635 Undersecretary Not valid with ou gnature
+ t Massachusetts Departrnent of Publ€c, 5zafet,,:
Board of Building Regulations af,cl 5tanrtardF Unrestricted-Buildings of any use group which
(on%tructian Super%i.ur contain less than 35,000 cubic feet(991m)of
License:CS-0 273 enclosed space.
�.Wa1A1 D.1b1 C-AFtIN
12 21 WHIT?�.t x
Failure to possess a arrant edition of the Massachusetts
Expiration State Building Code is cause for revocation of this license.
Commissioner 11/27/2013
For DPS Ucernina information visit: wvwv:Mass.Gor/DPS
TOWN OF BARNSTABLE
BUILDING PERMIT
PARCEL ID 193 148 GEOBASE ID 11993
ADDRESS 324 PATRIOT WAY PHONE
Centerville ZIP -
LOT 7 - BLOCK LOT SIZE
DBA DEVELOPMENT DISTRICT CO
PERMIT 7712 DESCRIPTION OUTSIDE SHED
PERMIT TYPE BADDS TITLE BUILDING. PERM.IT ADD' SHED
Department of Health, Safety
CONTRACTORS: MC GRATH, JAMES D. and Environmental Services
ARCHITECTS_ w
TOTAL FEES: $50.00
F OND $.00
CONSTRUCTION COSTS $.00
437 NONRES./NONHSKP ADD/CONY 1 PRIVATE P:c '
* UABM •
MAS& J
{OWNER WERNER, JOSEPH & CHRISTINE 163
� A�
ADDRESS 324 PATRIOTS WAY
CENTERVILLE MA
°
BUILDINO'D�VI3` O
DATE ISSUED 06/28/1995 EXPIRATION DATE BY
DIVISION APPROVALS FOR
' i► CERTIFICATE OF'OCCUPANCY
TO BE SIGNED BY EACH DIVISION HEAD UPON COMPLETION
BUILDING: - DATE:
r J COMMENTS:
PLUMBING:- , DATE:
. COMMENTS:•
i
ELECTRICAL: ^ DATE:
6[` COMMENTS:
GAS: DATE:
COMMENTS:
CONSERVATION: DATE:
COMMENTS:
OKH: DATE:
o COMMENTS:
HISTORIC: DATE:
COMMENTS:
FIRE DEPT.:• DATE:
COMMENTS:
OTHER: DATE:
COMMENTS: t
TURN THIS IN TO THE BUILDING COMMISSIONER AFTER ALL SIGN-OFFS AR,v
COMPLETED.A CERTIFICATE OF OCCUPANCY WILL BE ISSUED AT THAT TIME.
TOWN OF BARNSTABL£
BUJLDINC PERMIT
PA1 C$ ID 1.93 ,1`4B ;' 790�ASE ID - :f a93
ADDRESS 324 PATRIOT .WAY PHONE
dentervi.116. . ZIP
l LOT ;t� 7 �_ ��'� , BLOCK = k ' LOT SIZE
DBA i., £ k' :, . `! DE- ELOPi ENT DISTRICT .CO �
PERMIT'.E �771:21,
DESCRIPTION O[ TSSDE`. SHED
PERMIT TYPE N ADDS, TITLE BUILDING PERMIT ADD SHED
• ,W artment of Health Wet
P Y
CONTRACTORS:a M'C CRATH,> JAMES D. ��. ,� �
ARCHZTcT and`Environmental Serviees 'll
TOTAL kisr-_. 450.00
' BOND �;.t10 �1w.
CONSTRUCTION COSTS _ .00.
I
437 NONRES./KONHSKP ADD/CCNV 1 PRIV'ATE. P (*0
* a►xrrsrABLE. • ,
MAS& �► ;.
OVINER I :WERNER., JOSEPH � ClIK ST I NE
ED, ADDRESS PATRIOTS WAY.
` CENTERVILLE MA
t BUILDI I . IO
DATE ISSUED 06/28/i.995 EXPIRATION -DATE BY
THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY.EN-
CROACHMENTS ON PUBLIC PROPERTY,NOT-SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR
ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS
:PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY'APPLICABLE SUBDIVISION RESTRICTIONS.
MINIMUM OF FOUR CALL INSPECTIONS REQUIRED
FOR ALL CONSTRUCTION WORK: APPROVED PLANS MUST BE RETAINED ON JOB AND
WHERE APPLICABLE, SEPARATE
1.FOUNDATIONS OR FOOTINGS THIS CARD KEPT POSTED UNTIL FINAL INSPECTION
HAS BEEN MADE.WHERE A CERTIFICATE OF.00CU- PERMITS ARE REQUIRED FOR
2. PRIOR TO COVERING STRUCTURAL MEMBERS �
ELECTRICAL,PLUMBING AND MECH-
(READY TO LATH). PANCY IS REQUIRED,SUCH BUILDING SHALL NOT BE
3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. ANICAL INSTALLATIONS.
4.FINAL INSPECTION BEFORE OCCUPANCY.
. � 1 R to", - p s - e
BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS
1 1 1
2 2
3 1 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT
2 BOARD OF HEALTH
OTHER: SITE PLAN REVIEW APPROVAL.
WORK SHALL NOT PROCEED UNTIL PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON THIS
THE INSPECTOR HAS APPROVEDTHE STRUCTION WORK IS NOT STARTED WITHIN-SIX CARD CAN.BE ARRANGED FOR BY
VARIOUS STAGES OF CONSTRUC- MONTHS OF DATE THE PERMIT IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICA-
TION. NOTED ABOVE. TION. 508-790-6227
i
BUILDING
PERMIT
�'�,
4e'ssor's Office(lsf floor) Map v/J Lot g44,2L��mit# -) I
Conservation Office(4th floor) U a/V Do".), Date Issued
Board of Health(3rd floor)(8:30-9:30/1:00-2:00) i_ Fee-
Engineering Dept.(3rd floor) House#r aq
E
t~(�st ee Bldg.) �� �SI
�® BABN5rABLE.
Definitiv an Appr by Planning Board 19 ®> /* r e
TOWN OF BARNSTABLE.,
Building Permit Application . ®�,
Project Street s IOIQ 7;/,/O T WA
Village -CE �cz_v.>G�.E
Owners £P N �— nt - f2 Address Ja
Telephone C-So e)2 /z 11 y
Permit Request OUT agog S o A 6X /✓f1S
Xotal 1 Story Area(include 1 story garages&decks) square feet
Total 2 Story Area(total of 1st&2nd stories) square feet
Estimated Project Cost $ /300
Zoning District Flood Plain o Water Protection
Lot Size Grandfathered ? 1„
Zoning Board of Appeals Authorization Recorded
Current Use /t Csiae'., ilr Z- Proposed Use
Construction Type T%o S�r A^i a ,(£.a I4
Commercial Residential
Dwelling Type: Single Family ✓ Two Family Multi-Family
Age of Existing Structure If 917 R- Basement Type: Finished-
Historic House 641 Unfinished
Old King's Highway Al
Number of Baths Z No.of Bedrooms
Total Room Count(not including baths) 7 First Floor
Heat Type and Fuel Central Aires,/,o Fireplaces I
Garage: detached. Other Detached Structures: Pool
Attached ✓ Barn
None Sheds
Other
Builder Information
Name0k/cr-r _Telephone Number /- Poo
Address P 9 OoY r79f /29 License#
sy
G�ic � Gc �Ts2N Home Improvement Contractor# l„9
S. D eNwr-5 �� ����Q 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
SIGNATURE DATE
BUILDI RMIT DENIED FOR THE FOLLOWING REASON(-)
f! a. FOR OFFICIAL USE ONLY
� S r
F„
PERMIT NO. #7 712 t `�
DATE ISSUED June 28, ,1995 '- { !"• '' ;f:
MAP/PARCEL NO. 193. 148
ADDRESS 324' PATRIOT Way - VILLAGE Centerville, Mki 02682
OWNER Jostph•i& Christine Werner
DATE OF INSPECTION:
FOUNDATION
FRAME y
INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
GAS: ROUGH :FINAL t.
FINAL BUILDING
DATE CLOSED OUT t
ASSOCIATION PLAN NO. ;-'
PC-
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1�dll.�{ 1r=L�W _ Ilb >L 3 • 33b �•PA p';
sms TIC v (C70 r?4.P0. � 1 ♦ j t ,M l f r ? k..
USA- l0o0 6rAL v✓ $,L .. � �,�� , k , yy,r€:{".} :I
�ISPosAt_ PIT USE. (00o GAS.
_. SUEWALL AeeA = 15D S•F'.r �.
>
3'1S 6AV. ` per z l
BOT OoK AZEA.
c SIC> fib. se tbo K
` TcrrAL.. -�ESIGW •�25 l..Rt�. . } ' Lauc.
3W&PD.
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+g z u;rl� Tc► I �ceM��d=: O�V 0w � uF o�1�: �_`T" ,
7&
es��`s ma and lot number .../.1...`.............. ............. .
�? p SEPTIC SYSTEM MUST faro
INSTALLED IN COMPLIANCE
7
SewagekPermtt number . tiViTt� ARTICLE lI STATE......:.....:..................................... Sd�
oft f,!ITAIZY CODE AND TOWN!!!
t"ET° _ .V TOWN OF' BARNS AIB`,E
H9HBSTAk
9 DUI:LDIHG INSPECTOR
S Y a.. 17
M is cl -+
�=
t4 APPLICATION.;FOR='PERMIT T ........ C/� .L?:..... .........................'`' '
YL' ... . ••.........................................................
TYPE OF CONSTRUCTION ...............60• ?4?!I ......?•��✓��: ........... . ...... ..................... ..............
................................................19........
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location .... �. `7 ! ip� GCJi7
Proposed Use S...... .......................................................................................
/�........................................................
ZoningDistrict .........................................................................Fire Distract .. .:..................................................................
Name of Owner .. IJU�...,�� .................Address Z'.o:.. ,�0�'.... �—. ...............
Nameof Builder ....................................................................Address ..................................................................................:.
Nameof Architect ..................................................................Address ....................................................................................
Number of Rooms ... ... :.....
....................................Foundation ....... ..,(...�:........../ ..........................................
Exterior ............................ ..........................Roofing ........... . .. ........................................................
Floors ...� G° �F... ..... ...........Interior ...4.;.� .:...... ....... ..............I................
Heating ...�`,...o/�................................Plumbing ....../...... ...:......................................................
Fireplace ...C/ ....................................................................Approximate Cost ....-�.............�.G.......................................
Definitive Plan Approved by Planning Board -----------____---------------19________. Area ..... .. . ...............
Diagram of Lot and Building with Dimensions Fee .:./..11... ......
SUBJECT TO APPROVAL OF BOARD OF HEALTH
co
f �G4—
5� o
7.
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
f
Name ...................................................
Suffolk Realty Trust
19909
1 1/2 story
No:..................Permit for ....................................
single--family dwelling
. ....................................:...........................................
Patriot %Way (house #324)
Locatior?0I .. ..........................................................
Centerville
........................................s......................................
S'ffolk Realty Trust
Owner ............!.....................................................
Type of Construction ...........frame.....................
................................................................................
Plot ............................ Lot ..........#7..................
Permit Granted .......January 19 78
..............
Date of Inspection Z*,********,**'1 99
Date Completed ...!W. ��� ...........9,
PERMIT REFUSED
................................................................... 19
................................................................................
I................. ................................................
.......................
...............................................................................
-Approved................................................. .19
...............................................................................
............... ......... .................................................