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Home My WebLink About0043 PHINNEY'S LANE n 'o y r y, c 3PH7 XW15y) Town of Barnstable oFTME Regulatory Services 7g)2.5,11 JJX Q` Thomas F.Geiler,Director (✓ MAW Building Division 1639.�A`�� Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax:' 508-790-6230 PERMIT# .� l`O ` " FEE: $ S SHED REGISTRATION 200 square feet or less 3 1L c Location of shed(addresAl Village I Property owner's name Telephone number -n g 1 � o7c7 c�So .s Size of Shed Map/Parcel# " w 51. r- M ; Ib t Signature Date Hyannis Main Street terfront Historic District? I�} Old King's Highway Historic District Commission jurisdiction? .1 Conservation Commission(signature is required) mL� Sign off hours for Conservation 8c00=9:30&3 30=4:30 PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS: THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN Q-forms-shedreg REV:042911 f MORTGAGE INSPECTION PLOT PLAN cur NORTHERN ASSOCIATES, INC. 630 TURNPIKE STREET NORTH ANDOVER MA (508)975-7117 NORT&A60R JOHN SIINK�&& TyyHERTESnAA A FERRARO DEED FIEF'. 9779 / 98 CITY STATE 43 PH LEi S NA �_�n/ ��REF. ASSESSORS DATE -I 1 / OP /92 ,/0g rt; W R—WO at- 1— L ,I i s7nw �C� �iaav 44 ; I - m M i M Z tv 01\ I0 CERTIFIED TM FOSTER MORTGAGE CORPORATION I FURTHER STATE THAT IN MY PROFESSIONAL NOTE: This mortgage inspection was prepared tru 4 OPINION the principle satursis and accessory specificaly for mortgage.purposes and Is not to yt11 OF outbuildings, CONFORM upon as a survey. Northern Associates, Inc. pas no responsibility for damages resulting from reliance by anyone other than the said mortgagee its assigns in with the setback requirements of the local zoning oonnecdon whh Its proposed mortgage to said ordinances.and that there are no artcroaclvnenu of rtwJar gj improvements either%PY across property Ikres except as ..... ## .90T80 shown.P DANELr1T$ O/ I&Oe !,�'�ECISTEA��,�yC ALSO: T�S Thla mortgage Inspection was prepared N� Vim" a 1.PropeKLjs�'t in a Flood Hazard Area. whh the Technical Standards }or Monga Loan SUft 0 2.Pmpery is in a Flood Hazard Area. Inspections as adopted by the Massachusers ssociati i//' 0 3.Information is insufficient to determine Fkrod Hazard. of Land Surveyors and Civil Engineers,Inc. �G c rk .�`fZ� Flood Hazard determined from latest Federal Flood r '^ �{ h r. _ . { .. *.. h'�}F'��y�'�lt: e r=�„t.� t�.kF \�ifi'y�•C�` 4+y'`\ 104 lir � _�, ��' " ,�.+...:.,..,..•.may. *'- �✓' '� {r`�K�� . ._ x51 v.• n 'a, �' r'. f .a. �' l M1 r- t � Theresa Mariano From: ecareerworkflow@usps.gov Sent: Sunday, July 31, 2011 5:34 PM }' To: capecodtarchick@comcast:net Subject: Acknowledgement of Application A Y' Attachments: Acknowledgement of Application.PDF t � � y , e yC49n �g July 31, 2011 64en B r1,,1S4-r. entail Subject Line: U.S. Postal Service - Acknowledgement of Application t� . Thank you for, your_application for the position of RURAL CARR -ASSOC/SRV REGF ' • j RTE Rural; Boston District located at BREWSTER. We appreciate your interest in the vacant position. You will be considered under the competitive procedures for this vacancy and advised of the application status when a decision has_ been reached. Kind Regards, i Human Resources The email is an automatic system .generated reply. Please do not respond to this message. • 1 � � � 4 VAIN Vic` � r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION t' Map v Parcel Application# ( � v Health Division Conservation Division \ Permit# Cc Tax Collector �� `� Date Issued 1 Treasurer Application Fee Planning Dept. �Y Permit Fee `P30, gv Date Definitive Plan Approved by Planning Boar Q�, 31�� Historic-OKH '� Preservation/H nis Project Street Address L4 3 P h t h ►1-e.� S 0A h-c Village_e; VC Owner L (,�64 h�1 c 6VI I I-C Address l ywl-e C-eom Telephone Permit Request C 1 ic+OhJtiT 6V-C"k Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation _N 10 cD O Construction Type W 00 p Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes - ] No I Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other 4=►. - Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) c j Number of Baths: Full:existing new Half:existing i 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 wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑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 BUILDER INFORMATION Name —r i4 hU �*` Sf� C'oyill�e.. Telephone Number; 77fL 55 Address License# e)Ly n-iPh S Home Improvement Contractor# Gt Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Ainm 5- c 4 SIGNATU E _ 6 DATE ID t% FOR OFFICIAL USE ONLY .r t PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME ` r INSULATION 1 FIREPLACE ;� f ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ~ ASSOCIATION PLAN NO. r , J A. l �HE Town of Barnstable *Permit#,-,t 7 �OF t�ti Expires 6 i of t6s jrom issue dale Y Regulatory Services Fe " BARNSTABLE, +� �— v� 639. `�� Thomas F. Geiler, Director �� HIED MPt A 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 Not Valid without Red X-Press Imprint Map/parcel ti.9 a p I Number --�-- Property Address -- /3 j�� Z6 � ''(-,4k- i Residential Value of Work_ ,e)d _ Minimum fee of$25.00 for work under$6000.00 Owner's Name& Address Contractor's Name . _ZoV�,111_2 e��X. Telephone Number I Ionic Improvement Contractor License# (if applicable) g ' Construction Supervisor's License#(if applicable) /"Workman`s Compensation Insurance X-PRESSPERMIT Check one: ❑ I am a sole proprietor MAR — 9 2009 ❑ I am the Homeowner I have Worker's Compensation Insurance TOWN OF BARNSTABLE* Insurance Company Name Workman's Comp. Policy #__ em eu/ Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) [ Re-roof(stripping old shingles) All construction debris will be taken.to ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders. U-Value (maximum .44) *Where required. Issuance of this permit does not exempt compliance with other town department regulations,i.e. Historic,Conservation,etc., 'Note: Property Owner must sign Property Owner Letter of Permission. - d A copy of the Home Improvement Contractors License is required. SIGNATURE: Q`N Pl II.I.S\PURMS\building permit forms\EXPRESS.doe Revised 100608 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations- 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Eleetricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual):� Address: 9 City/State/Zip: 2 '� d I� Phone.#: Z2 �� a Are you an employer?Check the appropriate box: Type of project(required): 1.�I am a employer with 4. ❑ 1 am a general contractor and I employees(full and/or p -time). * have hired the sub-contractors 6. New construction art ..2:❑ I am'a sole proprietor or partner-' listed on the attached sheet. 1. .M Remodeling ship and have no employees These sub-contractors have 8.'❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'-comp.-insurance comp.insurance.$ 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 12.0 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#1 must also fill out the section below showing their worker;'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ?Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the subcontractors have�empI yees,they must provide their workers'comp.policy number. I am an employer that is providing workers compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure fo 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 un er the pains�and penalties ofperjury that the information provided above is true and correct - Signature: i Date: o el Phone#: 7_;� - Official use only. Do not write in this area,to be completed by city or town of 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 M Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their.employees. Pursuant to this statute,an employee is defined as".:.every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing-enga m a join :Ri rpns` eta -m�u-ding`—jen -reps sen-fative-i uf-xde�as i receiver or trustee of"dividual,partnership,association oleg entity,employing employees.'However the owner of a dwelling house vmg not more than three apartmd o resides therein,or the occupant of the . dwelling house of another wl3�employs persons to do maintensiruction or repair work on such dwelling house or on the grounds or building aP urtenant thereto shall not be such employment be deemed to be an employer." MGL chapter 152, §25C(6)also state that"every state or lonsing agency shall withhold the issuance or renewal of a license or permit to oper e a business or to ct buildings in the commonwealth for any applicant who has not produced.accep le evidence of coce with the insurance coverage required." Additionally,MGL chapter 152,§25C('n s s"Neither the nwealth nor any of its political subdivisions shallenter into any contract for the performance or ublicwork unptable evidence of compliancewith the insurance requirements of this chapter have been presentedto the contruthority." V Applicants Please fill out the workers'compensation affidavit c mple ly,by checking the boxes that apply to your situation and, if necessary,supply sub-contractors)name(s),address(e d phone number(s)along with their certificate(s)of insurance. Limited Liability Companies'(LLC)or Limi Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' ensation insurance. If an LLC or UP does have employees,a policy is required. Be advised that this affi yr may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Als be su a to sign and date the affidavit. The affidavit should be returned to the city or town that the application for a permit r license is being requested,not the Department of Industrial Accidents. Should you have any questions r garding th law or if you are required to obtain a workers' compensation policy,please call the Department at th number list below. Self-insured companies should enter their self-;nu anr_e license number on the appropriate line City or Town Officials .Please be sure that the affidavit is complete'and p ' ted legibly..The Dep ent has provided a space at the bottom of the affidavit for you to fill out in the event the O ce of Investigations has contact you regarding the applicant. Please be sure to fill in the permittlicense number Which will be used as a refer a number. In addition,an applicant that must submit multiple permit/license applicaiidns in any given year,need only bmit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should rite"all-locations in - (city or town).".A copy of the affidavit that has been offigially stamped or marked by the city r town may be provided to the applicant as proof that a valid affidavit is on file r future permits or licenses. A new davit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum d leaves etc.)s ' person is NOT required to complete this affidavit The Office of Investigations would like to.thank u in advance for your cooperation and should you have any questions, please do not hesitate to give us a call The Department's address,telephone-and fax numb The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigation 600 Washington Street Boston,MA 02111 TO. #617-727-4900 ext 406 or 1-877-MASSAFE Revised 11-22-06 Fax# 617-727-7749 www.mass.gov/dia r` 'THE r, ti Town of Barnstable Regulatory Services Fi AB& E$ Thomas F.Geiler,Director E16 616 Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize J�t�r,�J� �ljx �� to act on my behalf, in all matters relative to work authorized by this building permit application for. 3 �3 1'iVlypeYS 4-V (Address of Job) S g'a.ture of Owner Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FO RMS:OwNEUERMISSION Town of Barnstable N"P�o4 TFtE Regulatory Services Thomas F. Geiler,Director r Al RAiCTIRT� _ 1dA9.4 163g. Building_Division PrFD Tom Perry,Building Commissioner _... . _ .. ..... .200 Maili=Streeit Hyannis-NIA 0261)1 _.. ..... _._. . . _._.......... www.town.barnstable-ma.us Office: 508-862-403 8 Fax: 508-790-6230 HOI%1EOwNER LICENSEE MPTTON Please Print DATE: JOB LOCATION: num,104 street village "HOMEOWNER': name home one# work phone# CURRENT MAILING ADDRESS: �cityhowo state zip code The current exemption for"homeowne s"was extended o include owner-occupied dwellines of six units or less and to allow homeowners to engage an in ' ual for hire o does not possess a license,provided that the owner acts as supervisor. EFINTITO OF HOMEOWNER Persons)who owns a parcel of land on whit he/she resides or intends to reside,on which there is, or is intended to be, a one or two-family dwelling, attached or ,tached structures accessory to such use and/or farm structures. A person who constructs more than one home in a o-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Offici on a form acceptable to the Building Official,that he/she shall be re onsible for all such work performed under the ' ' din ermit. (Section 109.1.1) r The undersigned"homeowner"assumes responsibfi or compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. t( The undersigned."homeowner"certifies that.helshe unders . ds the Tpwn of Bu_=table,Building Department minimum inspection procedures and mquiremnts and that h be will comply with said procedures and requirements. 't Signatzrm of Homeowner Approval of Building Official Note: Three-family dwellings con 35,000 cubic feet or l ger will be required to comply with the State Building Code Section 127.0 Construction ntrol. HOMEOWNER'S EXEMPTION The Code states that "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 1D9.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a peson(s)for hire to do such work,that such Homeowner shall ad as supervisor." Many homeowners who use this==iption are unaware that they are as si m ing the Tespchn litres of a supervisor(set Appendix Q. Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hors unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her msponnbilitiea,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responnbilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt sueb a form/certification.for use in your community. Q:forms:homoexcmpt l T License or registration valid for individul use only Board of Building Regulations and Standards }HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Board of Building Regulations and Standards' Registration, 100497 One Ashburton Place Rm 1301 _ 2i8012 Expirratiori 6/118/2010 Tr# II Boston,Ma.02108 { ( T. e Pnv to Corporation I g Yp. ny i DAVID COX INCi1 Y David Cox — '19 LAVENDER LN !�% i Not valid without s' nature W.YARMOUTH,MA02673 Administrator . _1 i . .._. ., Bui mg egu ation�and tan Ards i onstruction Supervisor License License: CS 63537 6 Bgthaate1..0/15/1953 irat� 1 009 Tr# n 015/26313 IRestnc on-0:0� ( DAVID R COX PO BOX 401 xr f — �` S:YARMOUTH, MA 0266477 Commissioner FROM: TCI: 15087906h?-`'0 Ia- ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID ODUCER �fl GATe(MM,DnYYYY) W -ODUCER — AVTD-2 07 21/0 8 ZHIS CERTIFICATE IS WUEO AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Northwood Ins. Agency, Inc:. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 805 West Main Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW Hyannis NA 02601 , Phone: 508-771-1632 rax:,508-393-2935 �IPISiJRIERSAFFORDINC3COi�ERArsE � �IAIC4 INSURED INSURER A: Travelers Inourance>I -Co. i INSURERS: 'rraoeleso xwuran44 Cee,psny David Cox, Inc. INSURER 0; P. 0. Box 401 INSURER D: 5 Yarmouth MA 02664 INSURER E; COVERAGES THE POLICIES OF INSURANCE L*reD L OW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANOINO ANY ASCUIREMENT,TERM OR CONOITOP ANY CONTRACT OR OTHER DOCUMENT WI"i H RESPECT TO WHICH THIS CERTIP{CATE MAY BE ISSUED OR MAYPMAIN,T1&INSUR3KCFAfFCRa BY THE POLICIES DESCRIBcD HEREIN 18 SUWECTTO ALL THE TERMS,EXCLUSION$AND CONDITIONS OP SUCH POLICIES.A30FJERATE 1.078 SHOWNY HAVE SEEN REDUCED OY PAID CLAIMS. DNSR POD Q es LTR NSR -<TYPE ihN-SURANC POLICY NUMBER I DATEp0 �p T M � � N LIWrS GENERALLUISIMD' =-� EAC4OCCURRENCE s 1000000 A Ca"Menl%-GHNEPALL1!�I��typ..ITY 680-J481Da796 03/14/09 03/14/09 PREMISES Meocevrance s50006` •CLAIM84MOE �'OGCUR 1 MEO EKP(Any one person) s 5O®O X BlAsine'" Owne� PERSONAL A ADV INJURY $1000000 , GENERAL AGGREGATE $ 2000000 GENL AVOREGLIMIT APPLI S PER: PRODUCT$•COMPICP AGO 42000000 POIICV 'PRO. LOC C01, 2000000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea aceidsnl) s I ALL OWNED AUTOS , -I BODILY INJURY iSCHEDULED AUTOS (Per person) 3 HIRED AUTOS BODILY INJURY INON•OWNEDAUTOS (Per=Jda(nl) $ i PROPERTY DAMAGE ! I (Par aooldant) GARAGE UABILITY �^ AUTO ONLY-EA ACCIDENT s ANY AUTO OTHER THAN EA ACC s AUTO ONLY: AGG S EXCESWUMeRELL.A LIABILITY 1 EACH OCCURRENCE s 'OCCUR CLAIMS MADE ASGREGATE s DEDUCTIBLE s RETENTION E s WoPKER8 COMPENSATION AND fORV LEMIT3 ER A NYY PROPR)ETORETOR/PARTNERIEXELU714'i;; A N LOVERILiTY 6=89103042207 07/15/07 07/1S/08 E.L.EACH ACCIDENT $ 100000 OFFICER/00W.NIBEREXCLUDED? GMM91OX742208 07/15/08 07/IS/09 E.L.DISEASE-EAEMPLOYEE 3100000� 11 yyas,deserlbs under SPECTALPROVISIONSbelow c.L.DISEASE-POLICY LIMIT $ 500000 OTHER I DESCRIPTION OF OPERATIONS/LOCATIONS t VEWICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION TO+(aisAR SHOULD ANY OFTHE ABOVE.0E8CRIBED POLICIES 52 CANCELLED$SPORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVORTO MAIL 10 DAYS WRITTEN TOWN Or DAMS TJLBLE NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LBPT,BUT FAILURE TO DO$0 SHALL Building Dept. IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 367 MAIN STREW HyAmXS Kk 02601 REPPeseNTATIVES. AU' _D RE9 ACORD 2525(2001!'08) C�)ACORD CORPORATION 198E TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map / Parcel Permit# _ O 9�� a Health Division �/71� Date Issued 2 _ O Conservation Division �r W1.0U- yAk - Application Fee U ke Tax Collector A / Permit Fee l� Treasurer Planning Dept. EXISTING EPTIC(SY EM Date Definitive Plan Approved by h in . r LIMITED TO , OF BEDROOMS- Historic PM ) Nam' Prese aJ Project Street Address 45g I'll e Village�� `� ��C_ - Owner P Address V 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 Lot Size Grandfathered: ❑Yes Cl No If yes, attach suppor docume to atiorm. 3 Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) `•v co Age of Existing Structure Historic House: ❑Yes ❑No On Old King'.'..Highway❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout . ❑Other \'Q 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 wood/coal stove: 0 Yes ❑No Detached garage:❑existing ❑new size Pool: ❑existing ❑new size Barn:O existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing O new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes XNo If yes, site plan review# Current Use Proposed Use V1LUA ( -)A1_ejC BUILDER INFORMATION Name e o -i4phone Number _M� �PT_3� a� ` Address o C License# _(__,,) b b coa ce s Home Improvement Contractor#VA rc �S. CS.,� s �`� r�-Y �, Worker's Compensation# � (._ -:kD ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE ' ` DATE Z �J FOR OFFICIAL USE ONLY _ 4 4 ri PERMIT NO. DATE ISSUED-- MAP/PARCEL NO. - a , - ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE x , ELECTRICAL: ROUGH FINAL. PLUMBING: ROUGH FINAL m GAS: ROUGH � FINAL 0 FINAL BUILDING a ~ � tV M ,4 DATE CLOSED OUT rr ASSOCIATION PLAN NO. Cif 0 BEC-30-2004 13:58 From:MIDCAPE 5083984559 To:15084324707 P.4/5 Line Item#: OOU2" Line Item Oty: 1 Initial, Location: RQSixe=6'11/211Wx5117/811H unit Size=61a118"Wx5' 13/8"H Composite Unit-Casement 90 Degree Box Bay - Part Number;0000000 a Mulling Location:Shop(Warehouse) Mull Priority:Vertical Say Option Type: Standard Bay-Projection Platform Board: Top and Bottom Platforms Casing: flop Auxiliary Casing Trim Board: 3.1/2"Rlgid Vinyl Trim Board Unit Code/Itom Size: 90-P6050-15 Operation/Handing:L-F-R Comments: ••-• • Qty Part Num Item Size Description Total Price Extended Price 4. Group Casement 90 Degree Box Bay(1.2.3) Shop(Warehouse) 1 1371306 C5 SD EXT JAMB, SIDE 90 DEG BOX BAY'5 1/4 WALL $ 75,31 $ 75.31 PIR 1 1370704 C3.15 HEAD AND SEAT BOARD, 90 DEGREE BOX 5 $ 195.64 $ 195.64 1/4 WALL 1 1370804 C3-15 PLATFORM,90 DEGREE BOX $ 113,90 $ 113.90 1 1613608 150 IN CASING,WHITE AUXILIARY W/SCREWS RIA �$ 27,47 $ 27.47 1 1355020 9FT PAIR CABLE SUPPORT,SYSTEM $ 18.22 $ 18.22 1 2330102 3 1/2 X 6 FT CASING,WHITE PS RIA $ 21.04 $ 21.04 1 2330120 3 1/2 X 10 FT CASING,WHITE PS RIA $ 29,48 $ 29.48 COMPOSITE:Total mulling charges $ 223,18 $ 223,18 $ 704.24 $ 704.24 .... ..... .... 400 Series, PSC Single Units Unit CodelItem Size: CR15 Operation/Handing: L Part.Number 1309420 Exterior Color White Interior Color, Clear Pine Glass Type: High Performance Glass , Insect Screens:White. Hardware Color.Anderson Classic Series-White Comments: _ City Part Num . Item Size .,- Description Total Price 'Extended Price 1 1309420 CR15 Unit,White/Clear Pine, L Handing,High $ 206.36 $ 206.36 r Performance Glass 1 1346030 CR5 Insect Screen,White $ 17,42 $ 17,42 1', . 1361536 Hardware Pack,PSC,Anderson Classic Series $ 4.02 $ 4.02 White $ 227,80 $ 227,00 QUOTE: 001142 Print Date., 12/30/2004 Page 4 Of 5 IQ Version:. I04.2 �.� `�` �=� ✓lie T�anvrriaruoeca�i o�,:!�`aaaac�uae%�a. : :a BOARDOF BUILDING REGUtATIbNS 11y License bNSTRUCTION SUPERVISOR Cam _ ! N'umbei C` 086268 1 Butla�ate10a/1966 i Ezptres ?2/05/2006 Tr.no'. 86268 I Res�r6ted'Q0� u !� VVILLIAM M SHE LEY Jk ' j 'u HARWICHPORT, MA 02546 Administrafor i i I i I ' i I i I I I I I j I oF, r�ti Town of Barnstable °;. Regulatory Services Thomas F.Geller,Director ..Building Division TomPerry, Building Commissioner 200 Main Street, Iiyannis,MA 02601 www.town Barnstable;maxs Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using ABuilder c as Owner of the subject property. hereby authorize to act on rnybehalf, n all rriatters relative to work authorized b7dh s building permit application for;, i✓iR�reSti,��`2 E VA (Addiless of Job) b&' , Signature of Owner D to Print Name ®- vvl—U0-zuu4 WED 02,33 FM MARK SYLVIA INSURANCE 508420_ 9227 P, 01/03" ®® ACOR TM CERTIFICATE _.__.. ._�. PROD�G E OF LIABILITY INSURANCE MARK SY LVIA INSURANCE AGENCY 508-428-0440 ., T °ATE(MMIDD/YYrY 969 MAI STREET HIS CERTIFICATE IS ISSUEp qg q MATTER p� 10/06/2004 'i ONLY AND CONFERS OSTERVI LE MA 02655 HOLDER, THIS CERTIFICAOTEp0E5 NOT TIFICA I ALTER THE COVERAGE THE CERTIFICATI AFFORDED BY THE P END OF I INSURED POLICIES 6ELOW INSURERS AFFORDING COVERAGE G EATER HARWICH CONSTRUCTION I INSURERA i FARM FAMILY CASUALTY INSURANCE I NAIC P( BOX 858 INSURER e: H RWICHPORT, MA 02646 I i INSURGRC• INSURER D: I COVERAGES r NSURER E: I N POLICIES F INSURANCE LISTED BELC@W HAV N�gq�lFD TO THE INSURED NAMED ANY REQUIRE ENT, TERM OR CONDITION I MAY PERTAIN,THE INSURANCE AFF O' ANY CONTRACT OR OTHER INSURED ABOVE FOR THE POLICY POLICIES.AGG E ORpAC A THE POLICIES DESCRIBED HEREIN S SUBJECT TO ALL THE ICY PERIOD INOICATEp,.NO WI H R GATE LIMIT SHOWN MAY HAVE BEEN REDUCED 8Y PAID CLAIMS. WHICH T T T STANDING m(aR 'pp•j "" HIS CERTIFICATE MAY TERMS,EXCLUSIONS AND ISSUED OR . ' BE S �NuMBER ND CONDITIONS OF SUCH GENER/LLIA8ILITY POLICYEPFECTIVE POLICY EXPIRATION;" A I00110ERCIALGENCRALI.,IABILITY -I LIMIT9�? j CLAIMS MADE IX I OCCUR OBlO3/2004 . I EACH OCCURRENCE i X C NTRACTORS. 0 0 , O6/ 3/2O 5 DAAAAGESORENTED PREMISE., �occ renca IX AC VANTAGESPECIAL. .� �MEDCXP(Anyoneper:on) O OOO I I _.. 5 3 I GEN'LA CREGATE LI T PERSONAL d,ADV INJURY rJ-r000 _-..-. MI APPLIESPER:I IGENERALAGGR6GA7E S PRO, Po.icv I I s 2 000,000 60C i PRODUCTS,COMPIOP AGG I g . auroMc BLL1auAB1uTY ' 1,000,000 AN AUTO I ALI OWNEDAUTCS ' COMOINEO SINGLE LIMIT I BCCident) $ISCf EDULEDAUT03 (E9 I I I HIR DAUTOS IDODILYINJURY I + I $ NO )OWNEQAUTOS (Per peranu)I -.. OODILY INJURY er n (P cadent) g 1 CARAGE LIABILITY I PROPERTY DAMAGE I (Par JcaQDnI) 5 OONLY r EA _ -I AN AUTO I i I I AUTACCIDENT , E I 'EXCESS/ MBRELLA L_IABIUTY OTHER THAN CA AGO, $ . ' I AUTO ONLY; 1....._�OC UR I A t CIAIMS MADE I EACH OCCURRENCE I I y - L...-I_DE JCTIBLF_. .. ,. , I AGG .. ... __ ..._REGATE / .... RET NTION WORKERS CONPENSATION AND $ I - EMPLOYERS,U BILITY- ANYPRGPRIE7c R/PnR7NEP/EXECUTIVE 2001 W6324 I WCS1'ATU,OFFICER/MEMO r_'R EXCLUDEo I O6/24/2004 TORY LIMITS; X OTH) 05/08/2005 ER I II Ye6,deecrjhn u der SPECIAL PROVI IONS Uelcw I E.L.EACH gCCJOENT $ 500,000 OTHER - E.L.DISEASE I EA i —�- EMPLOYE[ $ . 500 O00 E.L.DISEASE I' POLICY LIMIT $ 500 000 I I. OESCRI 0 FOPE TIONS/LOCCARPENTRY ATIONS/VEHICLESIEXCLUSIONSADDEDBYENOORSEMIINTlSPE CIAL I ' PROVISIONS CERTIFICATE H LDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICI 11 ES BE CANCELLED BEFORE THE EXPIRATION GR ATER HARWICH CONSTRUCTION CO, LLC DATE THEREOF,THE ISSUING INSURER WILL FNDEAVOR TO MAIL. 30 F (508)432-4707 - - - NOTICE TO THE CP,RTIFICATE DAYS WRITTEN HOLDER I+1;0.NIE,pZ K� , — I LL IMPOSE NO OBLIGATION OR LIABILITY,OP ANY K F"'BUT FAILURE TO 00 30 SHALL — ---..RE9ENT ATIVp� IV�1V'T@ R9Ny4R6R,.IT$ +ANTS OR' ftEP , v i N AUTHORIZED RGPRESENTATIVE I ACORD 25(p 08) ,r C PORA ION 1988 y ReceiYed Time Oct , 6 , 12 :49PM ,a ,r apt w ray. ' `' .. :_ 'w. •x � `r. �' �ar ptr� W,,w gyp, ,�� " ]. �:�- e a , � � �� 'r�r P• � �a a rasa 1.,:W+--�"�._ "k"�-�� `�- '�.}# �. � +�q�'f y,z-• IW t . + �, � .� ,�� srr.�cq, p, � � -e,`"�' ,,�C !��-� � - may• y,' rP, m E.6 s e""s�rw�y,,"„ „� .B U� F�'' "^�°_'1:. �✓� t V � s a a " .n Y. 3 .n } m � � .,,h - a • x� - _. d...� ^Ne`•§�! ,,: � '..i �., s•'�- fi .• A p�R 455'F�-� 'i 1 ; e'y�y.��'Y.,`� •+ _ "A ,ns',,ew'' P... + � e 3 y a'�-.,° ;k"'e sF� ��<p, -oz. A f .tp? `�s`�'Y` a'.r � . � T♦a 2,W ,.s',.. • •�'.f -r R.,.7 ,Y�-•h��'a y��x�s<,:s,,,.r= N _.. e s-s, � � :: • �+' ..:�a-.�*'a"'�2�?:Mb- �.e,..•.�..;� a. �, ,.. s and Standards ing Regula on rdoBoa One Ashburton Place Room 1301 I n: assachusetts 02108 M I Bosto a" m rovemeri Contractor,Registration - Home I p 4 ` Registration: 142519 I i jf Type: Ltd Liability Partnership l Y bS � 1t Expiration:. 417/2006 Grater Harwich Construction Co LYtC a = 't 3 I William Shelley, Jr. 565A Route 28 ` � ��=�- }��/ HarwichpOrt, MA 02646 Lost Card Update Address and return card Mark l yment reason for change• a .... p Renewal Address El �7e Vanvrrca�iure o s a` StandardsLicense or registration valid for individul use only before the expiration date. If found return to: � Board of Building Reg Regulations and Standards HOME IMPROVEMENT CONTRACTOR Board of Building Reg r 5 one Ashburton Place Rm 1301 Registration 142519 Boston,Ma.02108 Exprratror 4�712006 lugLtd Liability Partnership Grater Harwich Construction Co L C , William Shelley - I' 565A Route 28 ;r.r . Not valid witho t signature Harwichport,MA 02646 Administrator , i ' oF ,E rO�w Town of Barnstable Regulatory Services snEuvsrnBLX. Thomas F.Geiler,Director 9 11tA89. �A 1619. p�� Building Division QED MP'� Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no` Date �2— AFFIDAVIT HOME Lv2ROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: Estimated Cost IM_ � L.L IIV 1��f�- -- `�— � Address of Work: �� Z11-lG ° Cal- Owner's Name: Date of Application: 7ZB5 yv)e�I2 C) I hereby certify that: Registration is not required for the following reason(s): QWork excluded by law ❑Job Under$1,000 []Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PE Y I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR Date Owner's Name QIorms:homeaffidav The Common Wealth of Massachusetts uric ( Department of Industrial Accidents �r office ofinyestigations lal _600 Washington Street Boston, Mass. 02111 Workers' Compensation Insurance Affidavit /& 2; /%/OF.r ,ii%dy/n,ver, /! f.'✓ !s f x a` f:'. 4i X :c' xf�% j� PR11NNA bl > „ .,.... . addres city S state: �. zi . phone# work site location(full address) I am a homeowner performing all work myself. I am a sole proprietor and have no one working m any capacity �', �.��' /1�i,�,i';y1�ia/�/�i�a✓ v'.c��/6 % /Y,."flµ„r$9rci�,u�/aa"//f.'"ix�/�Fti�,6ufsL',U //.�I�Su,�/l�fi'k,�i.N.:,.,: �`,f,.«l ,;;:: ,a!„a ,>�...�� /.f(/fi��i /�� 6� ✓ice/ I am an employer providing workers' compensation for my employees working on this job. company nnarne: Q�� U addres 1 U � C�. C� insurance�co� olio =#, I am a sole proprietor,general contractor,.or homeowner(circle one) and have hired the contractors listed below who have the following workers' compensation polices: co"m'p'anY°'name r add"Tess insuran eeco„ - policy`# s � address• i city.: Phone# insurance co policy::# /a ^"YY / zd ^Sr :3] v �j/ ✓L/ 9' %ff 1 t v l Y '////�i„ /�j Sk%'" A�� Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of•a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a S'rOP WORK ORDER and a fine of$100.00 a-day against me. I understand that a copy of this statement-may be forwarded to the Office of Investigations of the.DIA for coverage verification. do hereby ce fy unr! rMf1djnaftiLw.oJ'per;jury that the infnrnlatlnn provided above is nrre nrir!correct. S ignature Date Print name �� 1 Phone# ® �Z /106P official use only do not waste in.this area ro be completed by c rtN of town official city or town: permit/license# 711tiilding-Department Licensing Board Selectmen's Office rl�eck if immediate response is required ❑, �Ilealth Department contact person: phone#: F Other (revised 03/12/ P1A) - - T T Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all e►/ployers to provide workers'' compensation for their employees. As quoted from the"law", an employee is defined as very person in the service of another under any contract of hire, express or implied, oral or written. An employer is defined as an individual, partnership, associatio► , corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the le al representatives of a deceased employer, or the receiver or trustee of an individual , partnership, association or ther legal entity, employing employees. However the owner of a dwelling house having not more than three apartme is and who,resides therein, or the occupant of the dwelling house of another\who employs persons to do mainten nce , construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not be use of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or to al licensing agency shall withhold the issuance or renewal of a license or permit\to operate a business or to nstruct buildings in the commonwealth for any applicant who has not prod uced\acceptable evidence of co pliance with the insurance coverage required. Additionally, neither the commonw alth nor any of its politi al subdivisions shall enter into any contract for the performance of public work until ace table evidence of coi pliance with the insurance requirements of this chapter have been presented to the contracting autho ty. Applicants Please fill in the workers' compensation affidavit ompletel ; by checking the box that applies to your situation and supplying company names, address and phone num rs alon with a certificate of insurance as.all affidavits may be submitted to the Department of Industrial Accidents r con ►rmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to he c ty or town that.the application for the permit or license is being requested, not the Department of Industrial Accide► s. Should you leave any questions regarding the"law"or if you are required to obtain a workers' compensation policy, ease call the Department at the number listed below. City or Towns Please be sure that the affidavit_is complete and printed legibl The epartment has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Invest cations as to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used s a refer ice number. The affidavits maybe returned to the Department by mail or FAX unless other arrangements hav been ma The Office of Investigations would like to thank you in advance r you coop ration and should you have any questions, please do not hesitate to give us a call. ez:s""' _�' '`R'r �"r' "ri xa ,h The Department's address, telephone and fax.number: The Commonwealth Of M ssachusetts Department of Industrial ccidents Office of Investigation 600 Washington Street Boston, Ma. 02111 \ fax#: (617) 727-7749 phone #: (617) 727-4900 ext. 406 /' C' tA 1 Cam/ vV/MDD (`ILA 8eN CCU I Ta ,'�/l t�� ' Q Ri �' �r�� __ ...�...�...,.._..,� 1 `,�;---- - — i . 2 X 2 - �' .�r�.......�.,..e�. /L�� 1/I �� I��C -� ��Uc �� . `,,' `� P, TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map c)C) Parcel Permit# d Health Division — 3R o'J`Y Date Issued err— Conservation Division . J 63 Application e Tax Collector � 4 Permit Fee f Treasurer SEPTIC SYSTEM MUST BE Planning Dept. iNsTA:I.ED IN COMPLIANCE Date Definitive Plan Approved by Planning Board V"TITLE 6 VMRONMENTAL CODE AND Historic-OKH Preservation/Hyannis 1roWN REGULA°.IONS Project Street Addr ss Village . 2 Owner M �c"PS� �' \�� 3c�o Address Telephone Permit RequestV P_ Square feet: 1 st floor:existing proposed 1oa 2nd floor: existing proposed Total new�a Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type V30o A M 4z-- Lot Size � c�-� Grandfathered: ❑Yes ❑No If es, attach supporting documentation. Y PP 9 Dwelling Type: Single Family 411 Two Family 0 Multi-Family(#units) Age of Existing St ru ure S Historic House: ElYes ' 0 No On Old King's Highway: ElYes No Basement Type: Full Cl CraS ❑Walkout ❑Other Basement Finished Area(sq.ft.) ABasement Unfinished Area(sq.ft) (� I Number of Baths: Full: existing new Half:existing new czz Number of Bedrooms: existing 3 new `' �ry Total Room Count(not including baths): existing 5 new First Floor Room;Count Heat Type and Fuel: Ga ❑Oil ❑ Electric ❑Other ,� Central Air: ❑Yes No Fireplaces: Existing New Existing wood/co I stove:r' Yes ❑No r Detached garage:❑existing new sizeA XA Pool: 0 existing 0 new size Barn:❑e isting aew'size Attached garage:O existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of AppealZAorization ❑ Appeal# Recorded❑ Commercial ❑Yes If yes,site plan review# ; Current Use Proposed Use BUILDER INFORMATION p , Name.3 �� c— Telephone Number T8' Address A� ; n e-4S License# a Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE i - lr t FOR OFFICIAL USE ONLY • t PE:tMIT NO. t DATE ISSUED 1 � � ,, n-• ;; r MAP/PARCEL NO. ADDRESS -VILLAGE OWNER DATE OF INSPECTION: ? FOUNDATION s` _ Z 7 FRAME ' _ INSULATION FIREPLACE I ' ELECTRICAL: ROUGH FINAL, PLUMBING: ROUGH FINAL— , � - 'l -•---.,` `"•� -.. r; 't GAS: ROUGH : ; FINAL FINAL BUILDING elk { DATE CLOSED OUT 1. . ' ir. 4, ASSOCIATION PLAN NO. _ 1 1 '4 r "If lei Assessor's map and lot number .............. _ r r ................. . yr SEP I IC SYSTEM M Ne roe ",Sewc'ge Permit number /!Is> .............. ��p ''� f INSTALLED IN COIF WITH TITLE 5 • 3. House number a LE, TOWN REOU IO OYara� TOWN OF BARNSTABLE BUILDING , INSPECTOR �� APPLICATION FOR PERMIT TO .../ .................. .... ....+1V............... .................................................... TYPE OF CONSTRUCTION TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according tot the following information: Location .... ......r ^"...�.�.! . r..�s{..�..5.....��. �- "� ....... . '? .t' C,f�t�� /-� �� ./�i...:..... ................................ ProposedUse ......`�� ..... 41-1 ".rt�...`�. .t`?. '...............................................................................0....... ZoningDistrict ................h..f!... ........................................Fire District .1....�................................................... / ................ Name of Owner .h.��.�1..a�c^G'X "�!c-4-1/-C A/ Address ... �!'..la. ,.... ./'. .QJ�� el Nameof Builder .! .i Address- .................................................................................... Nameof Architect ..................................................................Address ............... .....................................0.............................. Number of Rooms ...... .......................................................Foundation ......�1 .��qX!.-7` ..................................... Exterior ......`��i�i.�.y�......�..................................................Roofing ....... ................................................ Floors fi P (tom e-........0.................................Interior ......, ':." ....................0............................ Heating ... :..............................................Plumbing ....... � -- Z.. Fireplace ......:5' ..:�-.......................................................Approximate. Cost ............ ...f,`.. ... -................. Definitive Plan Approved by Planning Board ________________________________19________. Area ..:.......... .. ......................... Diagram of Lot and Building with Dimensions Fee yy�� C!..................... SUBJECT TO APPROVAL OF BOARD OF HEALTH a OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. o Name 4r a.. «� Construction Supervisor's License ...CSC?.... .� - 'S MZDBERG, RICHARD A. & RICHARD N. Permit for ..Remodel Dwelling ............................ Sinqle Family Dwelling .................Single Location 1..4.3...Phi.nney. .s...L.a.ne........ ........... .. ....... ....... .. .. .... Centerville i. e� ............................................................................... Owner...... Richard A. & Richard N. Smedbe�g .......................... .i �+ � _� r .- � -, � - Type of Construction ....Frame........................... .... .. .... . .............r................................................................... Plot ............................. Lot ................................... - �" r r .. ( t PermiteGronted -...:..Augus.t...3.,...,........19 83 Date of Inspection *........19 Date.Completed ............... 195 r ty