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HomeMy WebLinkAbout0020 PEN LANE o Q TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION ZO(Map Parcel 12 Application Health Division Date Issued 1 Conservation Division �� Application Planning Dept. Permit Fee 0".2 Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address P'd Village �n,w^✓i./te— Owner_ os���-�yf'/ ��i �?/ �`��� Address Telephone Permit Request Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type jA&o/— Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family W Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other ,t Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) X Number of-Baths: Full: existing new Half: existing _f23 1 new," w Number of Bedrooms: existing _new r t { C> Total Room Count (not including baths): existing � new First Floor Roa" Count Heat Type and Fuel: ❑ Gas ❑"Oil ❑ Electric ❑ Other cn Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove;9❑Yo ❑ No Detached garage: ❑existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing �ew�size_ Attached garage: tle*xisting ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# /J Current Use 0 w4-Gf- Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Telephone Number 60- Address � .�C, �� �lL �a�G3y License # C� � Home Improvement Contractor# �� Worker's Compensation # 74—6, ALL CONSTRUCTION DEBRIS R SULTING FROM THIS PROJECT WILL BE TAKEN TO n B al SIGNATURE DATE 4� ,. FOR OFFICIAL USE ONLY APPLICATION# DATE.ISSUED MAP/PARCEL NO. F t ADDRESS VILLAGE OWNER w DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE i :4 ELECTRICAL: ROUGH FINAL i PLUMBING: ROUGH FINAL t S GAS: ROUGH FINAL FINAL BUILDING '�1 DATE CLOSED OUT ASSOCIATION PLAN NO. Department oflndusb ialAccidents ..Office oflmestigations___.600 Washhwtoit Street Boston,'MA 02111 - www.massgov/din Workers'Compensation Insurance Affidavit: Builders/Contractors/Blectricia3is/Plumbers Applicant Information Please Print Legibly Name(Business/Or mli?ahon/Individnd): l f Address: City/�tdiP�ZID:. ��i�it/%S .�T�",7"� :i'%/��/��nnP#• � �7�� - /�``�-Z-�•1�- F e you an employer.? Check the appropriate bog: Type of project(required); I am a employerwith /�- . 4. ❑ I am a general contractor and I employees(full and/or part-fine).* have hired the sub-contractors 6. ❑New construction I am a sole proprietor or partner- listed on the attached sheet, 7. [J Remodeling ship and have no employees These sub�ouitractors have 8. ❑Demolition working for me in any capacity. employees and have workers' 9 Building addition . [No workers'comp.-mFurance. comp.insurance. ❑ g required.] 5• ❑ We area 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. [No workers' comp. right of exemption per MGL 12.❑Roof repass insurance required.]t a 152, §1(4), and we have no employees. [No workers' 13.❑ Other comp.msu rance required.] *Any applicant that checks box#1 must also fiU out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they arc doing aU work and then hirr outside contractors must submit a new affidavit indicating such. $Contractors that cbeck.this box must attached an additional sheet showing the name of the sub-coahactors and state whether or not those entities have . employees. If the sub-contractors have employees,they most 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.Lio.#: Q y Z Expiration Date: v l 5 dD C3 Job Site Address:_���/ City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of rrir' * al 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 hereb y fy nder the p ' e f perjury that the information provided above is trig and correct Si Date: Phone#: . . L5a- ��s Official use only. Do not write in this area to be completed by city or town official City or.Town: PerinifiJLicense# Issuing Authority.(circle one): 1.Board of Health 2.Building Department`3. City/Town Clerk 4.Electrical Inspector. 5.'Plumbiag Inspector 6. Other Corutgct Person:. Phone#: IMOTECE • � ,,,E �.�. .. x T,. �® 3 TO EMPLOYEES �� �� EMPLOYES :. The Commonwealth of Massa6huse stt' DEPARTMENT OF INDUSTRIAL ACCIDENTS 1 Congress Street; Suite 100, Boston, W 02114m2017 617-727-4900 -.http://www.mass. o�ia As required by Massachusetts General Law,Chapter`152,`Sections 21,22& 30,this will give you notice . that I (we) have provided for payment to'our injured employees under the above-mentioned chapter by insuring with: LM INSURANCE CORPORATION NAME OF INSURANCE COMPANY PO Box 9102 Weston, MA 02.493-9102 1-800-762-5026 ADDRESS OF INSURANCE COMPANY WC5-31S-386521-012 07-25-2012 07-25-2013 POLICY NUMBER EFFECTIVE DATES JOHN P RUSSELL INS AGENCY INC' (781)344-0098 NAME OF INSURANCE AGENT PHONE # 65' PEARL ST STOUGHTON MA - ADDRESS OF INSURANCE AGENT RAYMOND O'MALLEY DBA RAYMOND PO BOX 976 EMPLOYER ADDRESS EMPLOYER'S WORKERS'COMPENSATION'OFFICER (IF ANY) DATE` MEDICAL TREATMENT The above named insurer is required in cases of personal,injuries arising out of and in the course of .employment to furnish adequate and reasonable hospital and medical services in accordance"with the provisions of the Workers'Compensation Act.A copy of the First Report of Injury must be given, to the injured employee.The employee may select his or her own physician.The reasonable cost of the services provided by the treating physician will be paid by the insurer,if the treatment is necessary and reasonably connected.to the work related injury.Incases requiring hospital attention, , employees are hereby notified that the insurer has arranged for such attention at the NAME OF HOSPITAL ADDRESS TO BE POSTED BY EMPLOYER Insured Copy Regvlator_y_Ser_-wes - - ----- -- - a�eas— Thomas F.Geiier,Director 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 ti Complete and Sign This Section . ,If Using A.Builder J O as wner of the sub'ect ro V ,. p pay hereby authorize to act on my behalf; in 2E tnatters relative to work authorized by this building petmit (Address of Job) Pool fences.'and alarms are the responsibility of"the applicant. -Pools are not to be filled or utilized before fence is installed and.all final inspections are performed and,accepted. S• e of Owner e of Applicant Date Q:FORMS:oWNERPERMISSI0NP0oLS 62012 THE rpy� os Regulatory Services --- -- - — — Thomas F.Geller,Director } 3F Building Division TFD Tom Perry,Building Commissioner, 200 Main Street, Hyannis,MA 02601 www.town:barnstable.mia.us Office: 508-862-4038 Fax: 509-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: street village number "HOMEOWNER': name home phone# work # n CURRENT MAIIdNG ADDRESS: city// can . state �P de i tY The current exemption for"homeowners" extended to include caner-occupied,dwellinnss of six units or less and to allow homeowners to engage an individ for.hire who does n possess a license,provided that the owner acts as supervisor. D ON OF Ho OWNER Person(s)who owns a parcel of land on which she resides or' tends to reside,on which there is,or is intended to be, a one or two-family dwelling, attached or de ched structure accessory to such use and/or farm structures; A person who constructs more than_one home in a -year pemo shall not be,considered a homeowner. Such Official a form ce table to the Building Official,that he/she shall be submit to the Building P "homeowner shall sub g . responsible for all such work Rerfbr=d under the b din t (Section 109.1.1) The undersigned assumes responsibility fo ca liance with the State Building Code and other j applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understan the Town.of Barnstable Building Department minimum inspection procedures and requirements and tha�J1`he/s will comply with said procedures and requirements. l Signature of Homeowner Approval of Building Official ic feet or larg will be required to comply with the Note: Three-family dwellings containing 35,000 cub State Building.Code Section 127.0 Construction CongfoL HOMEOR'NEKIs EXEMPTION The Code states that "Any homeowner performing work for which a building permit is quired shall be exempt from the provisions of this section(Section 109.1.1 Licensing of construction Sup tsors);provided that if the homeo er.engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use-this exemption are una that they are assuming the responsibi'ties of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Sec ion 2.15) This lack of awareness often ults in serious problems,particularly when the homeowner hires unlicensed persons..In thiscase,our oard cannot proceed against the unlicense erson as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately onsible. To ensure thaf the homeowner is fully aware of his/h responsibilities,many communities require,as of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On thelast page of this issu is a form currently used by such a forai/certificationfor use in your community. several towns. You may care t amend and adopt _ Q:forms:bomeexempt I Massachusetts - Department or Public Safet% Board of Building Relgulations and Standards Construction Supervisor License License: CS 30857 RAYMOND M OMALLEY PO BOX 976 ' DENNISPORT, MA 02639 Expiration: 11/16/2013 Conuuissi°Oer Tr#: 7640 iebmvn�wauoeai"�C �a�u�eCta . License or registration valid for individul use only Office of Consumer Affairs&Business Regulation I before the expiration date. If found return to: ME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Regulation IV. gistration f28444 Type: 10 Park Plaza-Suite 5170 piration 4!8/2-013 DBA Boston,MA 02116 RAYMOND O'MALLEY CONSTRUOTION RAYMOND O'MALLEY` z 30 DEPOT ST DENNIS PORT,MA 02639`trr Undersecretary t valid without signature . i ems- Bk 27106 P:051 •-7843 02--05-2013 . a 10=35u DEED MTRICPION ! in �.*.•;O'Malley:, et iibl - One Ship and Way; Suite 1190, lyedfo , MA 02155 V i w OW .Bax ?.. ' W '.2Q:.LP:en•`..Lank-Cez a].e,.:M 1' _ gp Q�a �,1 le '.. 7+y'(+��} �7{ 71.E �17]�ey• r... ,'r'1 !• e!'r�r i5'rl.•.f',ke'r'+�?�w.'s=� e*.!i'I:T*N_ 'f ql i,r,.i':I.I. :^t.M' 1. S�!'�fi�.'.l`..•.,. .,Sr..y.;f:. ..�,,.c h •..F �d�.�,{;} py�y,( ..�.. + �[J.il1�r:L.� ecL :r.lvl ..l 1�0._? !!R7✓'I+M��y:, '�( L •v7•• IaSt::Lan (fieZO e,"Centervi]le MA esnt O'.Ma1ley,.1 #99P1'07.0.1,P1 Barnstable•:fto W, AAKevin P. O1�4a1 i- �1[j' •Y v a Ali MAR gu . . ':: x 3•}�• az Aw uµ'. Ali OR - 77 / Bk 27106 Pg 52 #7843 NOW, THEREFORE, Kevin P. o'Malle e . Y, t does hereby(owners Y place the fokw*S restr 0don on his above-M enced land In a �rd"ance with his tunW-hhe•land and be bindm u �a • 9• pon aif,sumemrs in e; 20 Pen, Tana. Oenter Ville,, MA upon tfie lot a hou { containin may have consbu Davin P• o'Mal.lee SRO more than c nsn„y tare agrees tttaffibms. be e. restWon Ong z—.0 en lot,ated on za Pen permanent deed hoVvn on(fie An recorded in Plan Book 3793 Or on Land Court Plan Not licable. - r Paged. 2� 3;�t1d For We of Ket o'Mall 233 -_""in-P�------__��e�e�o1f0 . ; _ wfng deed' Book . 3793 Pa Testament s the Last Will and '•°o� tied AS a sealed firument of Mildred E.24th Malley day Of J 99P1670EP1 Barnstable.Probate Ct. anes 2013 Slgnature • Oumer's signature - Owner's signature '' ` 0110ONV�pq�,TH OF lifiASSACHUSMSMOM as VO 20 /3 JCM) Then Person appeared th A 1 �v ��F�Gx �the arced ti �Q1°Wn t1�Sri9 t0 Person �acicn P foregoing butrumsnt and` 0 r ' t1 .0 same to be /sact and d ead� bsfbre me, HARD A,wcocn�tH !!t ��� Comm. eaNh oPnbllo j I �7 ommonw f a � .. N°tS Pubilc .. • 'BARNST r ; a.:s.+sa. ABLE.REGISTRY OF DEEDS +: ti Fapcc% e�as�Ho fG�c�FaR aX FaP=DO?VP �o Pa-i wie �. - cayrercvu.l.e,n,•. ���.aarr a x e RrFRR5 a la•oZ, tcurR'ncs o 3a•oc. Ve•cax PLYM/PCP SFCATHHO - eg+nzPrw.T srriazs f1TTIG �i . ^LL"sTPRILR STW �.. e x a JLFTS a u•as rR-r�rtSLA. 4 X 5 AIAI CLJTTMZ SCMT W/tali.I.Cm �x e rnsan 4/e'OAP.ORYWKL - n• 5k . ex4 W Y o UVII'IG RM. aaw/v 4 26•"HSLO e x to Jor"0 la•'a . - 10 O 9/4• PLY. �RGL'R 4.CV. Va£PPd't G V4•recK rrLU R-V) QR x a PR�aFiLPC TRr/� ELL W/HII.PPJIA/�Tlai M cw_-m CUIV. 4-a X 10 C0(3PTR - fi 9 Ve•Gln LAZY Gai s itt oR.tie ac✓ �• -4•cola.aw . _ C-4• GLOSS ./IiCJ I IC/I I / \—/ \ .:1./QL 3/6••C-0• . wnpow 5alecvLe EXISTIING f�r-eiDE'iGF- fog 20 FETI L l"Off e rc rb o wxsr mnewu G�]ITERVILI E �/°� � so x ob rvxrb Vwfly AL.L c+MET15C t5^T SITe b xrb n ro xro avers O .. . 2 INV H^L-f7 D^TH © ILY 9I1 PN UTILITY o II WOfzK r 17 OFF; c c L V-O'X T-O'�-j .�i2�'�D pOOR5 93-2• -----�---- ' EHI I I I I I i i I it I i I C in I I " I I 4'-0' LO W I� LIff V lil— I LAC/v I I L1 V I 50N E 4/4'•4'-0• ff -nN(3 REeiDffNGE FOR EXIST,G Pax Mfz. �f�YMONP O'I''If�L�LEY 20 FtN L/WE CrNlr MLLE, Mfg y VMFY N.L GtY cNeiON5 PST e4ir iU 1 U e O5 c" ° KJTCHffN _ ©PINING �I'l. NDOK D^TH� I'I^5T� D�� JV-4' 5'- 4'- 131- ' L M.CLIcrn o�E Mr e Q O O 5 O O mh P/bio do 0 ur CLZ)SC7f � UVING O 0 O 26 O' 4-0' V I I E LLB V L—L r fLQ � a / V I 5G^LEE 1/4'-T-O' . 26-Of 24'O• .. O' '-G' 10'-6• 5'- ' 3'- ' S'-1' . I LO. —— Ir------------------------------ : ,<:'- r------------- -------------, ! I I �� I I :': I I •- I I I O• I I I aFPW^.bale Y pRal et.ev. I I II ' I I L J L J L J I I I U '-O' - rv'-V "_O' cn -1 :y I . : i I ;•;: I 71 I ;.: I L— -----.y. .p;:.i.--t—**-----------------� .� i II I .'•� ---------- ---_---'------------- I II EXiSTII'IG f��pq-iG� FOfz : I ;;; I I ,� I M�. �F��l'I'IOf ip O'f'I�LLEY ° 20 PE1i LpWE I L ——— -----J i t�'IItRVILI.E h'IP. I < VgaffA-LPrIE1gCN5^T54Te — ------------ — ------------ 26,_O. 44,_0. 50'-0' 5C,^LE 114• f-O' th TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application # �®�'(,, Health Division Date Issued oW Conservation Division Application Fee Planning Dept. Permit Fee , A?) Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project-Street°Address Village—le- ,v i//C CAddres—s� �52wr-c"ii (Telephone (Permit-Request'— cs ►�- ��vs r v ��%4 �-&ZQ- a� t�- �XNe� V,v� "ter_ /% `itl Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Projec-t=Valuation—;��a Construction Type Lot Size Grandfathered: ❑ Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure -.�i Historic House: ❑Yes XNo On Old King's Highway: ❑Yes No Basement Type: L<l ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing world/coal stove: ❑ s ❑ No w Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: 0!existing news+ size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: - , c c� Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ �� m v Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name pl onb Number Cvr�wi 1�� � )_z re a t� � License # Home Improvement Contractor# Worker's Compensation # Zee Ac)96 ALL"sCONS,.TRUCTION•`DEBRIS'RESULTING FROM':THIS.PROJFCT WILL BE TAKEN TO _.. SIGMA U FD V�I�``•4Z FOR OFFICIAL USE ONLY LICATION# TEISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER s , DATE OF INSPECTION: 'x FOUNDATION FRAME 0,111 lk, cig slqj,t INSULATION 9 6Ile 5 IV _t f{ FIREPLACE " ELECTRICAL: ROUGH FINAL u PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING '3)2-"711 DATE CLOSED OUT ASSOCIATION PLAN NO. 4 The Commonwealth of Massachusetts Department of Industrial Accidents frOffice of Investigations 600 Washington Street ilia / Boston,MA 62111 c www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/PTnmbers Applicant Information Please Print Leobly N B ss/Organization/Individual). C� A✓dclress�� aJC 76 �C- ty/State/Zipel�s Phone #: cSe 9k3;11 Are you an employer?Check the appropriate bo 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.❑ 1 am a sole proprietor or partner- listed on the attached sheet. t , 7• ❑ Remodeling ship and have no employees These sub-contractors have ! 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ElWe are a corporation and its 10.❑ Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work 'right of exemption per MGL 1 l.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.]t- 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 oontraciors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contract6rs and their workers'comp.policy information. I am an employer that isproviding workers'compensation insurance for my employees. Below is thepolicy and job site information. 1 Insurance Company Name: 61r a'-l✓< Policy#or Self-ins. Lie.#: toc 00 741�-1,20131 Expiration Date: Job Site Address: "10 Py 06/a- City/State/Zip: e�ly�,�/c Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL 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 c nder the pains d p o rjury that the information provided above is true and correc4 Si Phone#:[[ 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. ti . 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,partners 'p,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and eluding the legal representatives of a deceased employer,or the receiver or trustee of an individual, partnership, sociation or other legal entity,employing employees. However the owner of a dwelling house having not more than ee apartments and who resides therein, or the occupant of the dwelling house of anothe who employs persons o do maintenance, construction or repair work on such dwelling house or on the grounds or build' appurtenant theret shall not because of such employment be deemed to be an employer." v MGL chapter 152, §25C(6)als states that"ev ry state or local licensing agency shall withhold the issuance or 0 renewal of a license or permit t operate a b iness or to construct buildings in the commonwealth for any applicant who has not produced a ceptable vidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25 7)sta s"Neither the commonwealth nor any of its political subdivisions shall + enter into any contract for the perform an e o public work until acceptable evidence of compliance with the insurance " requirements of this chapter have been pre to the contracting authority." Applicants Please fill out the workers' compensation a davit c pletely, by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s) address(e and phone numbers)along with their certificate(s)of insurance. Limited Liability Companies(L C)or Limite Liability Partnerships(LLP)with no employees other than the members or partners, are not required to c workers'co ensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised at this affidavit ay be submitted to the Department of Industrial Accidents for confirmation of insurance cov rage. Also be sur to sign and date the affidaviL The affidavit should be returned to the cityor town that the appli ation for the permit o license is being requested, not the Department of Industrial Accidents. Should you have any q estions regarding the ,v or if you are required to obtain a workers' compensation policy,please call the Dep nt at the number listed elow. Self-insured-companies should enter their self-insurance license number on the approp a line. City or Town Officials Please be sure that the affidavit is complete an printed legibly. The Departure t has provided a space at the bottom of the affidavit for you to fill out in the event a Office of Investigations has to tact you regarding the applicant. Please be sure to fill in the permit/license num r which will be used as.a reference umber. In addition,an applicant that must submit multiple permit/license a.pplic 'ons in any given year,need only su it one affidavit indicating current policy information(if necessary) and under"Jo Site Address"the applicant should wr "all locations in (city or town)."A copy of the affidavit that has been o cially stamped or marked by the city or wn may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affi vit must be filled out each year. Where a home owner or citizen is ob a license or permit not related to any bus' ss or commercial venture (i.e. a dog license or permit to bum leaves etc.)s id person is NOT required to complete this davit. The Office of Investigations would like to thank I u in advance for your cooperation and should ou have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax numbYl Oro 4 The-Commgnwealtli of Massachusetts F , Department of Industrial Accidents Office of Investigations 600 Washington Street Bogtan MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax 4 617..727-7749 Revised 5-26-05 ww.mass.:gQv/din I i HIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE ERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN HE ISSUING INSURERS AUTHORIZED REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER. IMPORTANT: If the Certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION S WAIVED, subject to the terms and conditions of the policy, certain policies may require and endorsement. A statement n this certificate does not confer rights to the certificate holder in lieu of such endorsement PRODUCER John P Russell Insurance Agency 65 Pearl St Stoughton, MA 2072 COMPANIES AFFORDING INSURANCE COMPANY A GRANITE STATE INSURANCE COMPANY INSURED Raymond O'malley Po Box 976 Dennlsport, MA 0263"000 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAA�ED ABOVE.EOR THE POLICY PERIOD INDICATED,NOT WITHSTANDING ANY REQUIREMENT,TERM OR CONDITION 0 ANY CONTRACT OR OTFkA DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHt9MN 3.1 MAY HAVE BEEN REDUCED BY PAID CLAIMS. Co LTR ME Or INSURANCE POLICY NUMBER POLICY EFFECP41DATE POLICY EXPIRATIONDATE A WORKERS COMPENSATION D EMPLOYERS'LIABILITY LIMITS E PROPRIETOR/ PARTNERSIEXECUTIVE OFFICERS ARE: NCL❑EXCL❑ 1 9647031 1 7/25/2010 1 7/25/201 1 STATUTORY LIMITS OTHER CaerageApplleetoMAOperetlaneOriy. EACH ACCIDENT $ 100,00 DISEASE POLICY LIMIT $ 500,00 DISEASE-EACH EMPLOYEE 100 00 DESCRIPTION OF OPERATIONSNEHICLES/SPECIAL ITEMS RE:THE WORKERS COMPENSATION POLICY DOES NOT PROVIDE COVERAGE FOR RAYMOND 0 MALLEY. CERTIFICATE HOLDER CANCELLATION TOWN OF BARNSTABLE SHOULD ANY OF TMEABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE 200 MAIN ST WIMTETME POLICY PROVISIONS. HYANNIS, MA 02601 AUTHORIZED REPRESENTATIVE Parcel Detail Page 1 of 3 f r s 6 Logged In As: x Friday, June- 10 Parcel Detail-*' ,. 2011 Parcels Lookup Parcel Info Parcel 19---- ___."- _ _,_. __ Developer o r69 _ _,_ ID Lot Prl Location 20 PEN LANE 94 .Frontage Sec ( Sec h . Road Frontage' Village CENTERVILLE Fire i -ICOMM District Sewer777 Road Acct � Index Interactive Map Owner Info : . Owner;OMALLEY,JOSEPH P&MILDRED E CD C/0 OMALLEY, KEVIN P ESQ Owner Streetl;ONE SHIPYARD WAY .._ . Street2' , ,• y L State iMA Zip` y Clt 'MEDFORD 02155 country' ' r. Land Info 4 g u- Acres (0.37 Use'Sin le Fam MDL-01 � s I Zonln ;Rc �Nghbd,olo5 J Topography GLevel' Road=Paved ) k Utilities !Public Water,Gas,Septic;,. Location Construction Info .0 Building 1 of 1 Year, - Roof - Ext _ ;_m ___ _ w 1979 � � lGable/Hip Wood Shingle Built' Struct Wall' a LIVI11g 1370 Roof[A's h/F Gls/Cmp AC�None � f , Area'. x Cover Type ._. .. -. Style Spht LeVel I IntlDrywall ( Bed "3 Bedrooms 4 ( 4 W'a 11 Rooms r Residential Jiltlr Bath 12 Full+ 1 H J Model Floor J Rooms' Grade .. Heat Total 4z http,://issgl2/intran&t/ptopddta/ParcelDetail.aspx?ID=13968' a'� r 6/10/201,1 tl n, Office of Consumer Affairs&Busidess Regulation License or registration valid for individul use only Q ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: t28444 Type: Office of Consumer Affairs and Business Regulation xp+rat+on. ; 4/8/2013 DBA 10 Park Plaza-Suite 5170 Boston,MA 02116 RAYMOND O'MALLEY CONSTRUCTION RAYMOND O'MALLEY: 30 DEPOT ST DENNIS PORT,MA 02639 - Undersecretary t valid without signature •,_. it ts'.achu etas-Dch�t+t+t�ent t:,i'Public Safety Board of Building Regulations and Standard., Construction Supervisor License License: CS 30857 Restricted io: 00 RAYMOND`M OMALLEY PO BOX 976 DENNISPORT, MA 02639 r. Expiration: 1 1/1 61201 1 Tr=: 7908 %'_O' 6'-6'M.O. too 2 _ n.o. F------------------ -- -- � ------------- -- --------- '`: I I _ I = I col I I I , I L J I .`.• I I . ' I I1 y PROP a e/. QF�t12%PXJvE Ln I I L J L J L J 2'-0 L---------------------------------jtl -----.----------t------------------ i II iC EXISTII`iG RESIpEhiGE FOR : I �.' I I i �� � ' NI I II i � l 20 PEfi LfWE I G�ITERViLLE, flf� I L------------- ------------ P77, . VMFYA-L.{anRiaCN5AT5Tc —————— — ------------ 24'-Oi ffOV I I D/ \-fl O �L�/ V I SGAIX 4/4'-4'-0' M5flNO RE D NCff FOR 20 Fa'I L.PJ'fE G�i MU F-, Mfg VVRfY^.c+Mayeia-is^T 9TF .o. Q 5 �^ KTGHffH �f�KFf�ST PINING Fm. ic))j HOOK D^TH Mf�ST� R D b D^TH p _ UN.CLOE,. 0 €QI Q � O 0 0 U GIST. O-W O O FOYER O � - DffPgoot-1 #2 2'-4' 10'10' a o 24'-0l U PPr EL 50/'AZ eCH ULE EXISTII 1G RESIpffh .T-� ffoR ncr, unncow sa+ewL- NI(�. r2�Y(''IOrip O'f''I�LL�Y em:a� MM "` 20 Fri L.PV'iE - x e vax VMFr ALL.PMFN5lQi5^T eiTr - . vo x ro evroe O 2 o I �i U o 1 P 0 r H/ V.I D \I H © . © F/,*",l'IILY RBI. UTILITY - � O 0 _ 0 w�nc� WORK eH OP 0 V-0'x T-o'I��fflllp POCIR5 u IT-2' F------- ----, I r----- -----� G1L TNiK I I �� I I LD I I' 1 I I I p I I I I 26'_O• 24'-0' ELI V i SGALE 414'-4'-0' - EA5-fl NO FT9Pff Cff PCR: �R � oNp are Y ex fapmDo^m, . 20 PM L/NC 72 . myTffgnus,nn Q 2 x b Rl.P 0 1610-0. . .Tm 0 22•O.G. VQ'CPX FLr kllop SFC.'.hWO 236f^SPK-LT� f�T11G ST^9=5TW - Q X 6 JC576 0 Ye•o.G Wi9 AiELJL 4 X E,N1M CUTTER Vli1L SCMTr W/C4M..V VT I XBP - v2'CiIP.GRTW�`11- .' 2X4 VaJPI 016'OL & PINING Rl 1. i2�XP.�� v o 2 x 40 JOSTS 0 01 04. - - C�HO Q 9/4'T MY a" FLZkIZ� E1LV. v2�� 6 V4'FMM Wi L R-0 24 X o 5 Eu. W/AL f191.1/� - - - 4-2 x i0 CAPeR /yi T6 I� 2 V2'W.L^LLY C0:5 F Fri 9' 4'CGiiG sw . FPL CPI-CC CUIV.. . D Y-4' (Jf\L/✓✓ �/l�/�I C./I I / \'/ \ SGNE 3/B'-1'-0' . TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map ` Parcel Zia Application S Health Division Date Issued Conservation Division Application Fee .5 Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board co7 I1P)II Historic - OKH _ Preservation/ Hyannis Project Street.Address )Q PE-N QANU CC--k —aYLUI Village CCNr�-�-y t Owner I E101N O'rAACLE`/ Address ONE SZ9iVOYArtd W,1 W1&7CI �QC(L AA: Telephone _�� I - 8'�� _ 61094k t3v510i&_53 --& 7ool 26 Permit Request Foal IP _TeC,10&k, s�ev%,L0 oI c,NLO.-r 1ekA 5l4&c-;TdqKL NS V L,411 o /J 11/N t, L-0041 1v WA-V2 oo(l �GOCD/.l e d t L - Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay 0® Project Valuation 000- _ Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family 9/ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes O-<o On Old King's Highway: ❑Yes LSYIVo Basement Type: aFull ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas it ❑ Electric ❑Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size Pool: ❑ existing ❑ new size _ Barn: ❑J existing ❑ new Sze_ Attached garage: ❑ existing ZI new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑-Yes ❑ No If yes, site plan review# ' Current Use Proposed Use r APPLICANT INFORMATION U_;,`M�V,& j , (BUILDER OR HOMEOWNER) Name Rz`bAAT-10r'45 Telephone Number n� `7` O 1 Address D & AML-AtCAN u-Ni License# 7 q 1 D 3— cJ b• 3)eNNL Home Improvement Contractor# J a 101 5V Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE w DATE FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE .. OWNER DATE OF INSPECTION: F FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL " PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION� PLAN NO. ie The Commonwealth.of Massachusetts., Department of Industrial Accidents Office of Invest gations 600 Washington Street =`"a Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electriciins/Plumbers Applicant Information Please Print Legibly Hanle (Business/Organization/Individual): Whalent-Restoration Services Address: 22 American Way City/State/Zip: South Dennis, MA 02660 Phone #: 508 760 1911 Are you an employer? Check the appropriate box: Type of project(required): L [T I am a employer with 4. ❑ I am a general contractor and I 6. ❑ New construction employees(full and/or pan-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. $ ❑ Remodeling shipand have no employees �, These sub-contractors have 8. ❑ Demolition mP � w working for me in any capacity. r. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its - required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. t c. 152,§1(4),and we have no 12.❑ Roof repairs insurance required.] t 1 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 a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Arbella Protection Co. Policy#or Self-ins.Lic. #: 9091320408 Expiration Date: 4/1/11 Job Site Address: ao RN c C City/State/Zip: �AJ'_Ut 1(1=_ Attach a copy of the workers' compensation policy declaration.page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby certify unde the pains and pens ties of perjury that the information provided above is true and correct Signature: Date'' Phone#: szz 5 —x t) i c `l 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/Towu Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: late: 1/18/2011 Time:'9:11 AM To: Kevin O'Malley @ 9,1508-760.9995 Rogers It Gray Ins. Page: 001 Client:#: 32193 WHALRES ACORD. CERTIFICATE OF LIABILITY INSURANCEF7ATE(MMIDDIYYYY) 111 812 01 1 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 DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:Ifthe certificate holder is an ADDITIONAL INSURED,the policy(ies)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 endorsement(s). PRODUCER CONTACT NAME: Rogers&Gray Ins. -So. Dennis 508 398-7980 434 Route 134 Arc No Ezt: Arc,Nu ADDRESS: P.O. Box 1601 CUSTOMER ID 0: South Dennis, MA 02660-1601 INSURER(S)AFFORDING COVERAGE NAIL 0 INSURED Whalen Restoration Services Inc INSURER A:Arbella Protection CO 17000 22American Way INSURERS: INSURER C: South Dennis, MA 02660 INSURER D: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: 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, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICY NUMBER MMIDDNYYY MMIDD1YYYY LIMITS A GENERAL LIABILITY 8500040398 D410112010 04/01/2011 EACH OCCURRENCE $1,000,000 DAMAGE X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $100,000 CLAIMS-MADE FE OCCUR MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS-COMP/OP AGG $2,000,000 POLICY PRO LOC $ A AUTOMOBILE LIABILITY 74917400001 0912612010 09/25/2011 COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $1,000,000 BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ X SCHEDULED AUTOS PROPERTY DAMAGE X HIRED AUTOS (Per accident) $ X NON-OWNED AUTOS $ $ A UMBRELLA LIAB X OCCUR 4600021586 D410112010 04101/2011 EACH OCCURRENCE $ EXCESSLIAB CLAIMS-MADE AGGREGATE $1,000,000 DEDUCTIBLE $ X RETENTION $ 10000 $ A WORKERS COMPENSATION 9091320410 10112/110 04/01/2011 X TWC ST ORYU IT FIR AND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVEY 1 N E.L.EACH ACCIDENT $500,000 OFFICERIMEMBER EXCLUDED? NIA (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $500,000 It yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$500.000 DESCRIPTION OF OPERATIONS 1 LOCATIONS(VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) Workers Comp Information Included Officers or Proprietors Project:One Shipyard Way,Medford, MA 02155 CERTIFICATE HOLDER CANCELLATION 10 Days for Non-Payment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Kevin O'Malley ACCORDANCE WITH THE POLICY PROVISIONS. 20 Pen Lane Centerville,MA 02632 AUTHORIZED REPRESENTATIVE 0198 -2009 ACIDRD CORPORATION.All rights reserved. ACORD 25(2009109) 1 of 1 The ACORD name and logo are registered marks of ACORD #S624931M614390 MEE t w �'Iassachusclts- Department of Public Sufch C Board of Builtlin�„ Regulations and Stund:utls + Construction Supervisor License t License: Cs 74928 l s WILLIAM WHALEN 122 POND STREET BREWSTER, MA 02631 ' Expiration: 8/10/2012 '• ('ununiioner Tr#: 70 S m License or registration valid for individul use only -\ Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation Registration: 129244 10 Park Plaza-Suite 5170 Expiration: 7/30/2011 Tr# 287004 Boston,MA 0211.6 Type: Private Corporation Whalen Restoration Services Inc. William Whalen - 22 American Way '' South Dennis,MA 02660 Undersecretary Not valid without signature r Town of Barnstable Regulatory Services snxKsrABI-F- ' Thomas T+••_ Geiler,Director q`b 165 9- ��� :Building Division f0�.lA a Toni Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 ivtvw.town_ba.rnsta�ble.ma•tis Fax: 508-790- Office: 508-862-4038 property Owner Must Complete.and Sign This Section if Us ins A.Builder I, NEVI N O MA U5� ; as Owner of the subject property to act on mybehalf, hereby authori7.e III all ma tters relative to work autho6zed by this building permit application for. N c egNg- eI:rAl � a 1l E (Address of Job) Signature of Owner Date z� s ui J D°PAAI[&-%/ Print Name lfpro-perWOwner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. i A F1 ^ 777 14 a r ak yy t r fEP �s 'a,}s of aA a•P h :.: P�5. a e } . i J n5 g e : n V'y •,Y a a �t.'r•.� �t��l4S iN�C�c�cd. 1�1� ARc�S to `mac $�$cwvw� �z- C9 Cd asQ sr- �c-w.® l�l4S 1tiC.,l.v dE SC�c/�R.�-C-- 2voe�s on► ��. �.,ILST FCca®t/�.. A-PP/lo V, �2.c�5 01= �►� .17 „�•'"` TOWN OF BARNSTABLE Permit No. ......21685_�___-- Building Inspector sanMANIL Cash ___--- 1639 OCCUPANCY -PERMIT Bona �acgv No building nor structure shall be erected, and no land, building or structure shall be, used for a new, different; changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by-the Building Inspector." Issued to Daniel Sullivan Address l or g 70 Pen, l•,t ne., fm1~ery l 1p_ Wiring Inspector �� � Inspection date/2- Plumbing Inspector ems. z_ Inspection date_ Gas Inspector ; 1 Inspection date . Ptngineering Department Inspection date i 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. _... .. _... , ............. Building...Inspector ',�Asssssor's map and lot number ... 9 0 ��8?ENI MU " Sewage Permit number MTAUAD IN trOM 1 9TODLE, i ✓'T House number MAsa . ... ....................................................... WITH TITLE 5 9 0 6� ENVIRONMENTAL CODE C ypv Ord '^ TOWN OF BARNS'�°�IMTAT'ONS -- BUILDING INSPECTOR n APPLICATION FOR PERMIT TO D.Wj.j7.k,5;7.1.. ................................................................................. TYPEOF CONSTRUCTION ...... .. ...... .............................................................................................. f ............................�................19..?.9 THE-INSPECTOR-OF,-BUILDINGS: The undersigned hereby applies for a permit according to the following infor ption: Location .:`4 .................... ...: ..:®`..�....... ....7................ . .o....... .. ProposedUse ....3..0. ef�.4 !J ls.......................................................................................................................................... ZoningDistrict . 1\.... ........................................................Fire District ...... .1.. .................................. ................ .......... Name of Owner DA 'F.4..... ............Address ./. 7` ...` %.y.;.... .HA.d..F!l Nameof Builder .....Address `^+............................................................... .................................................................................... .Name of Architect ...................................................................Address .................................................................................... Number of Rooms .........`N.....................................................Foundation ... !*.t�X-ir..-..��....................... Exierior ... .....�.:5. -f�`-1............................................:....: Floors .....4f Ri e4.0. .........................................................Interior .................................................................................... .... ........ -„;.,..V'-Heclti'ng .... '....:::........................................Plumbing Fireplace ....... ..p . ...............................................................Approximate Cost ...°�....��,.�.vr........................................ 17o Definitive Plan Approved by Planning Board -------------------_-----------19________. Are ........................................ 6 O Diagram of Lot and Building with Dimensions //�" Fee .�6....................................... SUBJECT TO APPROVAL OF BOARD OF HEALTH r i i I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. 4 � \ LName ........ ..................... Sullivan, Daniel - A=193-2 ---'�;� Mo 216.85. Permit for ....1�e.atory..sIngl.e family dwelling }.,............................................................................ i-�Ocation ........lot..#69.....20..P.en..Lane............ ..............................CenterviIIe......................... Owner ..........Rard.el..$.ul..1 i.van....................... Type of Construction frame................... ` Plot ............................ Lot ................................ Permit Granted ...:...Sept. 27 ........19 79 Date of Inspection ./..[.../.�......J�.......!.....19 Date Completed � �..............19 Vt PERMIT REFUSED �. . ... 1--. ................................ 19 r 0 ....... ..z.................................................. y f. .... ..................................................... ..... .t.`'y'} ................................................... fn ...... W '.:4................. ............................... ayol , Apprb"v ...... ....................................... 19 ............................................................................... oa f_ ..............