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�pF THE Tp�y
Town of Barnstable *Permit# e)/S DD
�P O ror issu e
* Regulatory Fapires 6 mont Services Fee
w anxxsrABLE,
16 9 � Richard V.Scali,Director
iOrEp MPS p -
Building Division
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
Not Valid without Red X-Press Imprint
Map/parcel Number A3D Qt-1 _
Property Address ,��f I hInq elis ,biv_ CC,-Ie ifie Ift or_-V.,3a
❑ Residential Value of Work$ `7,500 or, Minimum fee of$35.00 for work under$6000.00
Owner's Name&Address E ID C0 4
16 Lein l-ot Sc dwict% Vkh. oAS&3
Contractor's Name kt,, P4C.� Telephone Number St) G .3-6 q ~;c(S 6
Home Improvement Contractor License#(if applicable) %7&5 7 0` Ema �, "Peg"-To
Y�yrt
Et(dii��+�21 �I&nUVdU a
Construction Supervisor's License#(if applicable) C'
FEd `9 2015
❑Workman's Compensation Insurance
Check one: TOWN OF BARNSTABLE
am a sole proprietor
4 ❑ I and the Homeowner `J
❑ I have Worker's Compensation Insurance
Insurance Company Name -
Workman's Comp.Policy
Copy of Insurance Compliance Certificate must accompany each permit.
Permit Request(check box) �
e-r of(hurricane nailed)(stripping old shingles) All construction debris will be taken to l/hf q! M J_4"
Sr{u-ere
❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof)
❑ e-side
Replacement Windows/doors/sliders.U-Value • 3P (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: l 1Gr1A Pajul
Q:\WPFILES\FORMS\building permit formS\EXPRESS.doc
Revised 061313
J
Massachusetts -Department of Public Saf&y j
Board of Building Regulations ulations and Standards y
i
Construction Supervisor -
License: CS-092958
SHANE PACHECQ-`
81 Jasper Road s
Marstons Mitts WA 0264% �
Expiration
Commissioner 10/17/2015
Office of Consumer Affairs&Business Regulation
ME IMPROVEMENT CONTRACTOR
egistration: "Obvio Type: ;
xpiration: 1 Individual
I SHANE-PACHECO °zl x pE z i
SHANE PACHECO e
i
- 81 JASPER AD
MARSTONS MILLS MA 02 Undersecretary, j
s
Unrestricted-Buildings of any use group which
contain less than 35,000 cubic feet(991m) of
enclosed space.
' 1
s
Failure to possess a current edition of the Massachusetts
State Building Code is cause for revocation of this license..
i
For DPS Licensing information visit: www.Mass.Gov/DPS
License or^registration valid for individul use only
•i � before the ex iration date. 1f found return to:P
j office of Consumer Affairs and Business Regulation
10 Park Plaza-Suite 5170
Boston,MA 02116
I`
i
Not valid without signature
-- . .. -=- - - -
The C'onimornvealth of Massachusetts
Depart nerxt o,f bndustrial ecidenis.
r
�-- Of fire of lnves'tigations
r
'�� 600 Washingtoxr.Street
Boston,AL4 02111
rurv_ff:mass gov/dira
�►,rnrkers' Compensation Insurance Affidavit:Builder slConti.-actors EI iiciansfPh mbers
Applicant Information Please Pi int Le tblN,
Naive(Ht>tinesvorganizatioulln idua): ectc_kwi-
Address.- 81 Tu S 12 e'r J2
City/Stat,lZipL- YVIG�s�a�s Mt��S l'1�C Phone,#i .5"0 '91YS ro
Are you wt employer;`Check the approp late:bav: Type of:.project(required):
with
4. ❑ l am a general contractor and I
1.❑ l am a employer6_ ❑Nevcr construction.
loyees(full andlor part-time)_* have hired the sub contactors
2.[ Iam a sole proprietor orpartnes- listed on the attached sheet. 7. ❑Remodeling
slip and have no employees These sub-contractors have g_ ❑Demolition
working for me in any capacity_ employees and have wormers' p- ❑Building addition.
[No cvorlccss'comp_insurance comp_insurance,
required-] 5- ❑ re We a a corporation and its 10-0 Electrical repairs or additions
ofticers.have exercised their 11. Plumbing re airs'ar additions
�_❑ I am a homeowner doing all work ❑ la P
self o workers'c riLrgl t ofesemption per 1v1GL
myself (N �- i�. I�oofrepaixs
insurance required.] c..152,§1(4),andwe have no, �,/
g 1 employees_[No workers' 13'1 Other fn/fhG'U1�S
comp:insurance required.]
•t`inY sppli'csnt drat checks boa#1 not also fill ors the section below showing their mrodcere campe�tion palicy information
#Homeoavners who submit this affidac at indicating they are damg su wc&and then mm outsids contractors most subnur sinew off davit indicating such_.
LC'aattra.CrorS tl at:check tins box rarest attached an aiddwomd sheet showing the name of the and state whether or not those entities have
enrp-Joyee;. If the sub-contraetoes have einjdoyees,they rintstprovide their workers'tmvp.policy number.
I rtraa sari employer titans pros-dirt yvorke,rs'congm.nsaliott ittsuraatce for rity eniploy?ees. Below is the poliq and job sate
infot•matiott
Insurance Company Nance:
Policy#or Self-ins.LC 4f': E�.°piratiori Date:
Job Site Address: CitylStatelZip:
Aft ach a copy of the workers'compensation policy declaration page(shoming the policy number.and espu-ation date).
Failure to secure coverage as.required under Section 25A of NfGL c- 152 can lead to the imposition ofcrin�i ral penalties of a.
fine up to S 1,5D0.00 andor one-year impnisonment,as are-11 as cavil penalties in the fount of.a STRIP WORK ORDER and.a fine
of up to$250_00 a day against the violator. Be advised that a copy of this statement Wray be fbnvarded to the Office of
-'Investigations of the DLa.for insurance coverage verification_
I do hereby cerhf,unde the paintsz
peevia`lttes of pe.q'm rt'titat tlTte iriforrtiafiolt pt-mr-ided abos a es trnt.e acid correct
Si tune: Grit ��' ' Date:
Phone a:
Official trio only. Do not write in this.area,to be carnple.•ted by cio or town of ciaL
I
City or Toi n: Permit/License
Issuing Authority(circle one):
1.Board of Health 3.Building Department 3.Cityffown Clerk 4_Electrical Inspector S.Plumbing Inspector
6.father
Contact Person: Phone#:
6
r�
4
* BARNSrABLE.
MASS. Town of Barnstable
rFD MA't a
Regulatory Services
Richard V. Scali,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 G° to act on my behalf,
in all matters relative to work authorized by this building permit application for:
(Address of Job)
a s
Signature of Owner Date'
1 .
Print Name
If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the
reverse side.
Q:\WPFILES\FORMS\building permit forms EXPRESS.doe
Revised 061313
Town of Barnstable
Regulatory Services
Q�oF�He roy,� Richard V.Scali,Director
Building Division
* STABLE, " Tom Perry,Building Commissioner
y MASS.
1639• Aim 200 Main Street, Hyannis,MA 02601
lFn � www.town.barnstable.ma.us
Office: 508-862-4 8 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE:
JOB LOCATION:
number street village
"HOMEOWNER":
name home phone# work phone#
CURRENT MAILING ADDRESS:
city/town state zip code
The current exemption for"homeowners"was ext ded to include owner-occupied dwellings of six units or less and to allow
homeowners to engage an individual for hire who d s not possess a license,provided that the owner acts as supervisor.
D FINITION OF HOMEOWNER
Person(s)who owns a parcel of land on which he/she r ides or intends to reside, on which there is,or is intended to be,a one or two-
family dwelling, attached or detached structures accesso to such use and/or farm structures. A person who constructs more than one
home in a two-year period shall not be considered a homeo ner. Such"homeowner"shall submit to the Building Official on a form
acceptable to the Building Official,that he/she shall be res o sible for all such work performed under the building permit. (Section
109.1.1)
The undersigned"homeowner"assumes responsibility for compy ce with the State Building Code and other applicable codes,
bylaws,rules and regulations.
The undersigned"homeowner"certifies that he/she understands the T wn of Barnstable Building Department minimum inspection
procedures and requirements and that he/she will comply with said pro dures and requirements.
Signature of Homeowner
Approval of Building Official
Note: Three-family dwellings containing 35,000 cubic feet or larger ill be required to comply with the State Building Code
Section 127.0 Construction Control.
HOMEOWNER'S EXEMPTIO
The Code states that: "Any homeowner performing work for which building permit is required shall be exempt
from the provisions of this section (Section 109.1.1-Licensing of construction upervisors); provided that if the homeowner
engages a person(s)for hire to do such work,that such Homeowner shall act as pervisor."
Many homeowners who use this exemption are unaware that they are assu ing the responsibilities of a supervisor
(see Appendix Q,Rules & Regulations for Licensing Construction Supervisors,Sect► n 2AS) This lack of awareness often
results in serious problems, particularly when the homeowner hires unlicensed person 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 responsibilities,many communities require,as part of the
permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page
of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in
your community.
Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc
Revised 061313
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map Parcel �L Application #
Health Division Date Issued l Z fc�
Conservation Division : Application Fee
Planning Dept. _ Per`mit Fee �3)5
Date Definitive Plan.Approved by Planning Board I u`h�
Historic - OKH _ Preservation/Hyannis
Project Street Address or` t iJAJQNS hA,
Village
Owner �' RQ 4 %SS Address Q `kaowwq k
Telephone ® � S D
Permit Request kA-Mh i U%4 A!ce ukase i N .,` i
Square feet: 1st floor: existing proposed 2nd floor: existing_ proposed Total new
Zoning District Flood Plain Groundwater Overlay _
Project Valuation A 000 Construction Typea ► 1 'et .�
Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family Two Family ❑ Multi-Family (# units)
Age of Existing Structure Iq-7`I Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No
Basement Type: ❑ Full ❑ 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 I ❑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 U
Commercial ❑Yes ❑ No If yes, site plan review #
Current Use Proposed Use
APPLICANT INFORMATION
(BUILDER OR HOMEOWNER)
Name C r �J�;�tt�..) Telephone Number S0r' ��(�L'
Address Mrm&A License # oOT�T
MAIAltS Home Improvement Contractor# 153 5_4-7
Worker's Compensation #
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE DATE
I
`r FOR OFFICIAL USE ONLY
APPLICATION#
-DATE ISSUED
'1
!y .,MAP/PARCEL-NO., {
ADDRESS VILLAGE r
OWNER
°s DATE OF INSPECTION:
FOUNDATION ' '
FRAME
7
J
INSULATION
rk .
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL .
GAS.•i =z ROUGH FINAL
J-FINAL_BUILDING r
I . DATE_CLOSED OUT
ASSOCIATION PLAN NO.
SCFa
Sy �
}
r
The Co.rntrtort)i)ealth ofMassac/zusetts
Liepartment of Industrial Accidents
Off ce of Investigations _
600 Washington.Street
t Boston, MA 02111
i WwMrnass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/ElectricianS/Plumbers
A_pplic.ant lrl.forrnatlon Please, Print Le ibly
Name (Business/Organization/lndividual): CA C yl AJ Sl2 �,U' t � J_/� ('
Address:
City/State/Zip: _ L Phone #: r4
Are you an employer'? Checic th appropriate box: Type of project(required):
4. 1 am a general contractor and I
1. 1 am a employer with _ Z,Q U 6. ❑ New construction
_ eiriployees (full and/or jaart-tinge).* have hired the sub-contractors _ ._D ..-_... ..._ . .. ..g .
2.� � 1 gin a sole propriator.or partner- listed on the attached sheet. 7. Remodeling
ship and have no employees These sub-contractors have g• El Demolition
employees and have workers'
' warkung for mein any capacity. '9: ❑ Building addition
[No workers' comp. insurance comp. insurance.t
required.]
5. ❑ We are a corporation aiid its
10.❑ k lectrical reparrs or ldditions
3.❑ tarn a bomcowner.doing all work officers have exercised.their 11.❑ Plumbing repairs or additions,
�] Roof myself.. [No workers' comp.
right of exemption per MOL 12. 00 repairs
p
insurance required.] t c. 152, §1(4),.aod we,have no 13 -0tber
employees, [No workers' . � `-
comp.insurance required.]
Any applicant that checks box#) must also fill out the section below showing their workcrs'compensation policy information.
Horncownrrs who submit this affidavit indicating they are doing all work and them hire outside contractors must submil a new afTidavil indicating such,
t cs have
IContractors that t:hcc4;this box must attached an additional sheet showing the name of the sub-contractors and state whclhcr or not those cn i ti i
employees, tf_ti,c sub-contractors have employees,they must provide their workcrs'comp.policy number.
f am an employer that is providing workers' compensation insurance for my employees. Below is the policy,and job site
inforrrrutior� - 1 I
Insurance. Company Name:____ l�, .� //l _._ ���CeCQy
Policy ll or Self-ins, Lic. #: Expiration Date:(0
tl �' �} City/State/Zip/State/Zi >�ir��.�Jk1�� �
Job Site Address: Nei S tU• p
Attach a copy of the workers' compensation policy declaration page (showing th•e policy number and expiration date).
Failure to secure coverage as required.uodcr Scction 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fuse up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form K of a STOP WORK,ORDER an
of fine
of up to $250,00 a day against the violator. Be advised that a copy of this statenleot maybe forwarded to the Office'of
investigations of die DIA for insurance coverage.verifacation,
y.
1 do hereby certify ur e pa' and penalties of perjury that the information provided above is tr"e arid correct.-
5i�naturc _ Date: / ��1'�,_
t S 7 �5_
. Phonell:
Official use only. Do not write.in this area, to be completed by city or torr,n nfjeial
City or Town. '. Perrriit/Lieense lF
[suing Authority (circle one): " °
Board of_I-leatth 2,.,13uilding Departnnent 3. Cif,/Town Cle.rlc 4. Electrical Inspector S. Plumbing InslY�ctor�
6. Other_
Phone d:
Contact Person:
f
10 Park Plaza - Suite 5170
Boston; Massachusetts 02116
Home Improvement Contractor Registration
; 01 Registration: -153567
Type: Private Corporation
- _
Expiration: .12/15/2012 Tr## 206433
CAPE COD INSULATION, INCw__
HENRY CASSIDY f ; � 7,1
455 YARMOUTH RD. Y
HYANNIS, MA 02601 � :.�
I-•�.--� �+`fir-`
A 'Update Address and return card.Mark reason for change.
r
Address Renewal Employment Lost Card
DPS-CA1 0 50M-04/04-G101216 i
office
o` mer Affairs§LBus nc Regul Hon License or registration valid for iruividu!use�n!y
HOMRO ` 1rEQFl" Luaetla before the expiration date. If found return to:
Registration: 153567 Type: Office of Consumer Affairs and Business Regulation
Expiration: 12/15/2012 Private Corporation 10 Park Plaza-Suite 5170 ;
9
Boston,MA 02116
OD INSULATION,INC ti
HENRY CASSIDY
455 YARMOUTH RD u $ 1• �� yB � r
HYANN IS,MA 026011`
c�A undersecretary t Iid ith t si ture
Massachusetts- Department of Public S.IfctN
Board of Building Regulations and Standards
Construction Supervisor License . -
License: CS 100988
HENRY'CASSIDY
8 SHED ROW. ,
WEST YARMOUTH,_MA 02673 }
Expiration: 11/11/2013
(ununissiuner. Trt#: 7620
•
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' CORD,. CERTIFICATE OF LIAR- ILITY INSURANCE OArl 11YIIY,DU!YYYiI
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THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CLRTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED I3Y THE POLICIES
dELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER,
IMPORTANT:If thc certificate holder is a
n AU DITIO NAL INSURED,the policy(icsJ mustUe nor d -eti.lf SUBROGATION IS WAlULl7,subject(u
!Ile Iu il'ID end ro nditic:uls of the Ilolicy, certain-pOlic ies may require an andorsamant.A statement on this conifieate does IIOt conl r riallls to lhc:
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-�Nu C t nvul I IGIv5,OF SVCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
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6'y'aritnrs C0fhP Intormation Included Qffict:ra or Proprietors
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(5rsr.Arracht:�l DaScriptigna) -
:ciiTlF'ICA'I k HOLDER CANCELLATION 10 Days fof Non-Pat meat
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SHOULD ANY OF THE ABOVE DESCRIBED POLICIES 13E CANCELLED GEF01ZE
V THE EXPIRATION DATE THEREOF,NOTICE WILL BE DLLIVERC-D IN '
ACCORDANCE WITH THE POLICY PROVISIONS.
I AUTIIORREU REPRESENTATIVk
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" 91988.2009 ACORD CORPORATION,All rights IUseiwd.
:(JttD 25(.1009109) 1 of 2 The ACORD name and logo are registered marks of ACORD
H+Sti8575/VId8179
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I
HOME OWNER WEATHERIZATIONMORK PERMIT&FUEL RELEASE-
PLEASE FELL OUT AND SIGN THIS FORM IF YOU ARE '
`THE APPLICANT W
HOME OWNER.
hereby consent to"and agree that weatherizationwork may
done by the Weatherization Program of Housing Assistance Corporation (herein after referred as .' .
"Agency") Qn the property located at: a
The weatherization work done will be based on programmatic priorities and'availability of funding and it
may include all or some of the following measures:
Weather-stripping &caulking of windows and doors,insulation of attics,'.sidewalls &basements,attic
and other ventilation measures and'possibly replacement of badly deteriorated windows.Inconsideration'
E y g
of the weatherization work to be done at m home I agree to the followin
1. I give permission to the "Agency" its agents and employees to travel onto or across'said'prop erty`
with such equipment and materials as may be necessary to perform weatherization work on'said
property: ;s
2_ The Housing Assistance Corporation reserves the right to inspect the fuel or utilityJbill for the
weatherized unit on an ongoing basis for no more than five(5) years after the weatherization
work is•com.Pleted Y$.,
I have read the provisions of this agreement as listed and freely-give my consent. s
Home Owner: (Signature) i „� �'�' - .• a
Date:
Agent: (signature)
A ;
. 1
Date: -> t
i HAC approved Weatherzzation Com an t ",
p y �.
All Cape Energy .Btnlding Performance `Caliber Building&Remodeling f
Cape Cod ln, ati6 F - .Cape Sade Frontier Energy Solutions=. Lohr&Sons
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Michael T.McMah6ii .' Niall Hopkins Builders ' Resolution Energy
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4 � IN=SUIT T i
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PIBBBOLA99, OUTTA 99 `INBULAOAM 9C!1UNB6D
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Town of Barnstable
Regulatory Services
Building Division,
200 Main St •k a d "a h '$
Hyannis;'MA 02601
, �
Date: 2-28-2012
Dear Building Inspector
Please ac`ce tthis Affidavit as documentationtthat"Cape~Cod Insulation,"Inc.,j'e` r.med&��
P
comp leted the insulation and weatherizatiorL'work at the ro ert listed.below. Ca e Cod F
Insu a `tion`did this', accordance to the sbecifkc 6 ns•listed on the building permitp
application:All work has;been inspected by.a certified'Building Performance Institute
`(BPI) inspector:. All work preformed meets or exceeds Federal & State Requirements "
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Property.Owner"'."° ` :r Property`Address F t�'Village` "
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Jean Bliss ,t�• t 21 Phinney.s Ln Centerville-
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'' 'N^ � _.4 A � 4 Jp �. ,.'l� ;,ter �, • f. R qA'.
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Insulation Installed ,`Fiberglass Cellulose'T R'-Value ` . Restricted ' , Unrestricted
,
YCeilings j � '(X) (.12t°) z (* ) M(X) _ k
Slopes
Floors/Sill Plates:" (-X) ( ), ,.,�h (:19 ) t �(' ') �, (X)
Walls , wE mod. ( )''
Since y ;.. a B,• �; B' ,
Henry E Cassidy,Jr, President'.
°* Cape,Cod Insulation, Inc. F k=
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Assessor's map and lot number .. .. ................ ..... a?, SEP SYSTER MUST B
INSTALLED IN COMPLIANCE
C WITH ARTICLE 11 STATE
Sewage Permit number ......... ............... .............
SANITARY CODS AIV® 7C1
IRLluLAMW
7HE.T°�� TOWN QF , BARNSTABEE
i BARNSTABLE, •
"b .•� BUILDING I INSPECTOR
�fp 39 p
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APPLICATION FOR PERMIT TO .........: ....... ...... ..........
Ile
TYPE OF CONSTRUCTION ...........................................................
. ............ ..... ........19
TO THE INSPECTOR OF BUILDINGS:
The undersig reby applies for permit according to a following informs 'on:
q
Location .. ..f...... ..... r................................
ProposedUse .. .. . . .... .... �..., . .... ...... ...... . . . .. . .......... .......................................... .... ........ .........
......................Fire District ... ......... ....^.. ... ..�...... .
Zoning District ... ... . ... ... ................ ..... ...........
......Address .� �J�r?.? :. ..:.....>....✓..:...
Name of Owner .....,✓.�Z %t'?fN.�!..�!l.. .. ...........:..........
11 I �1
Nameof Builder .........................................�.........................Address .....:...............................................4..............................
•9 I � I � �
Nameof Architect ............ ....................................................Address .................................................................... ...............
Number of Rooms ....... ..... .... . ..............................Foundation .( ..... ............ ..... .. ...............:...................
...�. ... ��.
Exterior ... .... ...... Roofing .... ...... ....... .. . .. .... ..... .................................
Floors .....................Interior ... ..
Heating ...........................Plumbing .... ...o. 1 ....
Fireplace ......C/ �.� pp a p �. ................. ............................A roximate Cost y/P' �.. ZJ.!..fi457 t.............. ... .......
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Definitive Plan Approved by Planning Board ________________________________19________ , Area .........................�..............
Diagram of Lot and Building with Dimensions Fee ......... f�..�• ••• ••"•••
SUBJECT TO APPROVAL OF BOARD OF HEALTH ® P ¢
`�'',�'``� Taro
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I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Name Z. . ✓J..'L.. � .
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Jmbmzmon° W±llliemuA=
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N� _l7l82_ Permit � _��e..a����____ ` � � ' ^` ` � -
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^vc"/ � ' eys Lanm�Av
__...._____~_______, .|
`________..�e� .te��1lle__________
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Owner Wl%%ian� ^&. Johnson
----------------'-----'
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Type of Construction —___1ram�'______
. �
---'.''�^------.--------------.. | -
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Plot ............................ Lot -----------
'
Permit Granted '.21 1979 ' �
oota of Inspection
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Date Completed .� �
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' . .
'
.
PERMIT REFUSED . '
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