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0171 SOUTH MAIN STREET
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',r ',:3, ,.., it v4't' �a;. :I y. r:Xr .,t.,«::z�.�• 't• Lv# ,pia•-- „y„1vy. � .� Town of Barnstable Building • 1P- 6 'S"T_is Card So That rt is V�silil"e From;the Street,-Approved Plans-Must be Retained on Job and this Card;Must be Kept, �AItN3YABIL. -� - .`.."r n' :, atw�s Posted Until Final;Inspection Has Been Made m Where a,Certif—z to of Occupancy�s Required;such Building shall Not be Occupied'until a'Final Inspection hes.been made it Permit NO. B-18-2622 Applicant Name: CAPE COD INSULATION INC Approvals Date Issued: 08/13/2018 Current Use: Structure Permit Type: Building-Insulation-Residential Expiration Date: 02/13/2019 Foundation: Location: 171 SOUTH MAIN STREET,CENTERVILLE Map/Lot. 208-081-001 Zoning District: RC Sheathing: Owner on Record: SCUDDER, RICHARD M&JOAN M Contractor NameLL. CAPE COD INSULATION INC Framing: 1 Address: 171 SOUTH MAIN ST Contractor License 153567 2 CENTERVILLE,MA 02632 '� �. �� �' i. Est Project Cost: $3,700.00 Chimney: Description: Weatherization 'Permit Fee: $85.00 Insulation: Fee Paid:` $85.00 Project Review Req: , Final: Date. ` 8/13/2018 Plumbing/Gas Rough Plumbing: a -w - • ;=.`{`%Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months afterµissuance. Rough Gas: All work authorized by this permit shall conform to the approved application and thesapproved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. Final Gas: This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for,public inspection for the entire duration of the work until the completion of the same. " < .- -- -- � Electrical The Certificate of Occupancy will not be issued until all applicable signatures the Building and Fire Officials ere provided on tFispermit. Service: Minimum of Five Call Inspections Required for All Construction Work 1.Foundation or Footing Rough: - � 2.Sheathing Inspection �Mz � +•� 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT a :Town f Bar Building o Barnstable Post This Card SoThat it is Visible From the Street-Approved Plans.Must tie Retained on Job and this Card Must be Kept -. p n. r� I . 3 • Posted Until Final Ins°ection Has Been Made. y t + r Where a Certificate of Occupa cy s Requ red;;such Building shall Not'tie Occupied until a FinaP°Inspection has been'rrraJe- Permit Permit No. B-18-2622 Applicant Name: CAPE COD INSULATION INC Approvals Date Issued: 08/13/2018 Current Use: Structure Permit Type: Building-Insulation-Residential Expiration Date: 02/13/2019 Foundation: Location: 171 SOUTH MAIN STREET,CENTERVILLE Map/Lot: 208-081_-001 _ Zoning District: RC Sheathing: Owner on Record: SCUDDER, RICHARD M&JOAN M _ Contractor Name'.,CAPE COD INSULATION INC Framing: 1 . Address: 171 SOUTH MAIN ST Contractor License: 153567 2 CENTERVILLE, MA 02632 Est. Project Cost: $3,700.00 Chimney: Description: Weatherization '` $85.00 P ' Permit fee: Insulation: ' tl:� k Project Review Req: � Fee Pai $85.00 Date. _ 8/13/2018 Final: �7- z^.7�.._ Plumbing/Gas t Rough Plumbing: T Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months'afteOssuance. a Rough Gas: All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and structures shall°tie in compliance with the local zoning by-laws and codes. Final Gas: This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open four,'public inspection for the entire duration of the work until the completion of the same. .;x Electrical The Certificate of Occupancy will not be issued until all applicable signatures,by the Building and Fire Officials are provided on this,'permit. Service: Minimum of Five Call Inspections Required for All Construction Work ° 1.Foundation or Footing �F s Rough: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT TOWN OF BARNSTABLE BUILDING.PERMIT APPLICATION Map Parcel 'TOWN OF BARNSTABLE Application #��J pp Health Division 7513 f:1'C 13 All g: 56 Date Issued Conservation Division Application Fee C� Planning Dept. . Permit Fee Date Definitive Plan Approved by Planning Board `'3`V Historic - OKH _ Preservation/ Hyannis Project Street Address j��� ��0 1 i 4I1944/' Village 4fd zx::�!%gd, h to Owner Address Telephone �-O e734 /g.� Permit Request gAzehlemlt 25fz ,xmz Zr Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 740r 6 Construction TypeJ&.1" Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family L! Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes J2-No On Old King's Highway: ❑Yes EMo 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 ❑ 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, _ APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name G�,0e "'Oe2tJ1,41! �z Telephone Number bh7J l72 S f Address License # J moo ' W 1J7I4 Home Improvement Contractor# / 6✓:9 4 Email Pki /,/� Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO r SIGNATURE DATE �Jblrz ' FOR OFFICIAL USE ONLY r = APPLICATION # DATE ISSUED 1 MAP/ PARCEL NO. 1 ti i ADDRESS VILLAGE z r - "{ OWNER f f DATE OF INSPECTION: FOUNDATION ' FRAME INSULATION t FIREPLACE t ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL f FINAL BUILDING i i DATE CLOSED OUT ASSOCIATION PLAN NO. I , The Corrunonwealdh ofhlassaaJ'tusetts ' beM(theni of Xndust�lalAoo�del>is � r Congress S'lreet, S`utle 100 �oslon, MA 02114401 r www,Mwg0v1d1a �1rot�korsr Compenoatlon Inauranoo AMzyRii,$u lid ers/Contractors/llectriclans/Pl.umbers, TO U MBI)WITHTH'E p'DRhY1t�t`IK0 MITTjopj. Y, Name (8ws tworgmlt&60 Indivldufl); C„� Cod Insulation Address► IS Reardon Circle Clt Nts/Zip► SGUth YsrmouthVA 0M4 phone #; 808.776.1214 ,4rr you an rmployeri Cb►ak the tppropr{oh bort _„_____ II�Ismermployerwlth�4s,� amploycea(Niiand/otpsrtlime),r �`YP40�proJeot (requlrad) Lc]I am a sole proprfator or partnership and htYe no employees working forme In ?I ❑ New oonstrucdon 1 0 Remodcl.ing eny ospsolry,NO workers oomp, lruuranoe r�vlred,) g YI�I em a homrowner doing nil work myealtl,No workers'oomp, lnsuranoe requir(d.)► 91 ❑ Domolltlon MI�I ln1 a homeowner MI w1ll be Wng oontra*n 14 vondvat dl work on rri ro e snruis the{t11 eon�ao►om elthar hbyb workers'vompensallon lnsuranos or vi soi�l I will 10 ❑ 8uildlag add¢tlon proprSelotswlVs no cmploybes, 11,[] �(aotr•Ioml repairs or add.+ S,C]1 am a;rnlml oontrboror and I hbye hired the sub,00nbeotorl Iisled on the bstaohad sheaf, '(he o104onbbo�rs mye empioyaes and have workers'oomp on to j 12,❑plumbing repairs or addl, 131[]Roof rcpa�s 6,[]WI U4 a aorpOndOn end itd Of�04r1 hbYe eXerelrld their�$hl pf'rxempdca per���0, 141 � Iit,¢1(ty;and we hive no ertsployees, (No workcn'oomp, Inswanoe roqulred,) Other wBQtheClzatlo rAny spill oenl rhbi .......k X I marl also fll ou4 r seo4 on bs ow show nlp ihelr workere' oompensatlon polio Info 1 Homsownrn who rubmf��Jr` daylt IndlWng thry do{na all work and then hire ovwidv oona'botors mu9i ry rCon�sobors Vut ohaok u,Js OoK must attaohed an bddldonal sheet showing we nvns�of the sub.vonrrbators and state whrmalJon ampleyeesl If the tvb.eonaaoton hxvt am fo ees thr�mud roylde Uselr workers oom , llo number, bmle b new at�ldavll IndloaNng suoh employe? Ali is provld>asg workers+ oomp¢��lon Jnsurarsce for m am that or not those entitles have Grttormation. Y ployees, Below Is theand ob sir lnsuraboe Company Namet Atlantic Charter poldey / " Polioy k or Self�lrrsl I�lo, �► WCECO4 31902 -: ` • " �xplratlon Date 08/30/201ad Job Silt Address. 171 oyr , Ike Attaoh a oopyoftba'worMnl oompcnsatlob policy dcclaration paget9 City/State/Z1p►, ozG �'z • ��• Failure to seoure ooverage as resulted under MOL e, � �,,�the pelloy number and expiration d, •' �'�'}�• a'ndlor.one�ytar Imprisonmenk, as wall a.s olvll ponaltles?n§ha form o�a snal Y{illation punishable by a pna up to SI,S00 day sgalnsk the ylolator, A oopy of t}t�ls stat.em�rtt May forwarded to the 0 F C ORDS� and a fSne of up to 5250, " oovarage Yerl>3oativn, tom of Investigations of t?te blA for Insurer !do Hereby oertlty *tle f/ ,, PrMded abovHa91 A � '$� �Y Oj/►OW use only, Do not write !n tltGt rites, to be oorrtpteGed by cJ or to'.,, �' wtt o,IylaGaG City or Townl CssuingAuthority (olrola one)► PormltlLloense � I, BoBrd.o�i3'oalfh 2, Building Dapartmeni g, Clty�'own Clcrk 4, �lcot 6,Other rloal Inspector 1151 Plumbing Ins.pecto Contact Ptrsonl�__ I ' CAPECOD-27 AMAHLER CERTIFICATE OF LIABILITY INSURANCE FD 06/ 5/2 0512/Y018 068 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: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsements . PRODUCER C TACT Rogers&Gray Insurance Agency,Inc. PHONE 434 Rte 134 A/C,No,EXt: ac No:(877)816-2156 South Dennis,MA 02660 AI mall@rogersgray.com IN URER S AFFORDING COVERAGE NAIC q INsuReRA:WestAmerlcan Insurance Company 44393 INSURED INSURERB:Safety Indemnity Insurance Company 33618 Cape Cod Insulation,Inc. INSURER C:Endurance American Specialty Insurance Company 41718 18 Reardon Circle South Yarmouth,MA 02664 INSURERD;Atlantic Charter Insurance Company 44326 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, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, ILTR NSR TYPE OF INSURANCE AODL SUER POLICY EFF POLICY—YE POLICY NUMBER LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 1,000,000 CLAIMS-MADE [X OCCUR BKW(19)53328281 04/01/2018 04/01/2019 DAMAGE TO RENTED PREMI ES(Ea occurrence)— 1 100,000 MED EXP(Any onePerson) 5,000 PERSONAL&ADV INJURY 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY lder 1-1 X holder d LOPeacrlp of operations PRODUCTS-COMP/OPAGG 2,000,000 aee OTHER: B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 ANY WNED 6232707 04/01/2018 04/01/2019 BODILY INJURY Per person) $ OWNED SCHEDULED AUTOS ONLY X AUTOS oN py�NEp BODILY INJURY Per eccldent X AIJS ONLY X AUTOS ONLY P�tOPERdY AMAGE er eca ent C UMBRELLA LIAR X OCCUR EACH OCCURRENCE 2,000,000 X EXCESS LIAB CLAIMS-MADE EXCl0006635003 0410112018 04/01/2019 DED RETENTION$ 2,000,000 AGGREGATE D WORKERS COMPENSATION AND EMPLOYERS'LIABILITY PER OTH- ANY PROPRIETORIPARTNER/EXECUTIVE Y/N WCE00431903 06/30/2018 06/30/2019 TUTE ER MFFICER/MEM EXCLUDED9 NIA E.L.EA H ACCIDENT 1,000,000 andatory In 1,000,000 It es,describe under E.L.DISEASE-EA EMPLOYEE DES RIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 11000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Workers Compensation Includes Officers or Proprietors. /Additional Insured status is provided under the General Liability and Auto Liability when required by written contract or agreement with the Certificate Holder, Excess Liability is follow form. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All riahts reservers. I • c Oommonwealill Of Massachusetts (Division of Profess oval LIC nsure ;Board of Building ReVUlatlons and St andards Con Up CS•100988 'r Ires; 11/11/2019 eo 71 I�I�Ft:�,,. HENRY E CAS .Y 'SID ,1'"•I'10'(t'�f' 8 SHED ROW'--,. WEST YARMOG7�f MAtiO t�Cl /"� Commissioner`~ C,4, Office of Consumer Affairs and Business Regulation 10 Park Plaza • Suite 5170 Boston, Ma #�hbU tts 02116 Home Improveme.;',t'Co•,tractor Registration Type: Corporation Cape Cod Insulation, Inc `` ' l��''''` Registration: ,.; 153567 18 Reardon"Crcle I ''t'•,t`�:',' Expiration: 12/14/2018 s;: So. Yarmouth, MA 02664 , CA 4 t' zon+•oast 1r Update Address and return card. Mark reason for change, �a�'amy�caoarvorrl�u��G�aadu.�rwetlJ ..._�.,�{�r,;;�.1,^,.'�_n.T•1'll'.I;;;,t,_n wry; t,nv, _ Office of Consumer Affairs&Business Regulation y HOME IMPROVEMENT CONTRACTOR 1' >> TYPot Corporation Registration valid for Individual use only ,� x>tj5l $gl tretlon before the expiration data, If foun }: 1"kAUD Office of Consumer Affairs end' urn to; •.? '% hil' @3. d7 / /2018 10 Park Plaza. al 9 atlon :5:.,: 5•:::,..:, ,t. 12 14 e s s Re ul r' )� i' t;' Bo 170 Cape Cod Ins ulatf'fti.1) Off" t�, slon,MA, 11 5'. Henry Cassidy': 18 Reardon $0,Yarmouth,MAQ,2't#; '' Vndorsewetary t al hout si atuy r DocuSign Envelo a ID:A5FBCF49-EC2A-4AF3-B65D-ADB8A3AF2CFF Permit authorization mass c-ftve Form 5--Qs& enemy~WXV. Site ID: 3400790 Customer: Joan Scudder Joan Scudder owner of the property located at:. (Owner's Name,printed) 171 South Main Street Centerville, MA 02632 (Property Street Address) (CO) hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor.listed below to act on my behalf and obtain a building permit to perform insulation and/or weatherization work on my property. DOCUSigned by: II Owner's Signatu gC4C199ADOAD4F0... Dat6/29/2018 i 2:07 PM EDT mcaaa�oa��raosaooa+�xsa+�a�ra,�a�aact�iao�taea �sc�aaaae+era+ra�e� +�aao�tr�oo+�aaaaaaaaa FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the -above referenced project: C n,Q P, aa to An Participating Contractor Date Name: RISE Engineering Phone: 401-784-3700 Email: For Office Use Only Rev.102015 Town of Barnstable *Permit## �-'`�� Q Expires 6 monthsfronj issue date BARM"Ml Regulatory Services Fee 5 , C Thomas F.Geiler,Director IT Building Division . EE@ Tom Perry,CBO, Building Commissioner JUN 15 2007 200 Main Street,Hyannis,MA 02601 TOV I"t- WABLE www.town.bamstable.ma.us Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY t� Not Valid without Red X-Press Imprint ® p\� Map/parcel Number_Q® �� o o O� Cv IL Property Address Z72 1 Q ✓t 11-e residential Value of Work 5 (D Minimum fee of$25.00 for work under$6000.00/ Owner's Name&Address Contractor's Name_ /�� J>ZA �� Telephone Number 50 g,—q ooZ Q Home Improvement Contractor License#(if applicable) 6 .5 3 l� Construction Supervisor's License#(if applicable) zworkman's Compensation Insurance Check one: ❑ I am a sole proprietor 4.11 ❑ I am the Homeowner ,iR I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy#_ C(� 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. 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. ro Owne must sign wner Letter of Permission. Home ' ense is required. SIGNAT RE: Q:Forms:expmtrg Revise071405 I J • d - . Board of Building Regulations and Standards One Ashburton Place - Room 1301 Boston, Massachusetts 02108 Home Improvement-,Oorractor Registration Registration: 112536 Type: DBA FRASER CONSTRUCTION CO. Expiration: 3/23/2009 Tr#'127920 DEAN FRASER _ P.O. SOX 1845 COTUIT, MA 02635 oPS-CA1 0 soon-05/08_ac84s0 Update Address and return card.Address Renewal Mark reason for change. - ----- — Employment Lost Card T � � � — -- Board of Building Regulations and Standards lop HOME IMPRUXEMENT CONTRACTOR License or registration valid for individul use only before the expiration date. If found return to: Registration: 112536 Board of BuildingRegulations bons� and titan . , Ex halords p tiain: 3/2 009 One Ashburton Tr# 127920 Place Rm 1301 1 he: DBpri Boston,Ma.02108- FRASER CONSTRUCT-ION GO.y jy? — DEAN FRASER % 4556 RT 28 COTUIT,MA 02635 Administrator Not valid without signature DATE M D PRODUCER IS CERTIFICATE IS WISE & QUINN INS AGCY ON AND ISSUED AS A MATTER OF INFORMATION LY CONFERS NO RIGHTS 4 UPON THE CERTIFICATE- �49 PLEASANT ST AL ER THE COVERAGE AF TE D S NOT POLICIE EXTEND OF BELOW. BROCKTON 24WCB COMPANY MA 02301 ' COMPANIES AFFORDING COVERAGE INSURED A HARTFORD UNDERWRITERS INSURANCE COMPANY ERASER CONSTRUCTION CO COMPANY PO BOX 1845 B COTUIT MA 02635 COMPANY C COMPANY ;:::...::::... .......... THIS IS TO CERTIFY ::::::::.::.;•:;::-:-:•;;•:.:;,;:•;;:•;;•;::;:.;:.;:.:::.:;:.::-:;;::;::.:•:•;:;:.::::.::.::::.;:::::•;;:•;:.;:.;:::;:-;:»::.;;•::::<-;:::::::;:::::.:::::.::..........THAT THE POL :.::::::.::.:.;::::•:-;:-:;;:-;:•::-;:-::•:;•::•::.::.>:.;:.;;;•;>:.;;;:.;;:::;:-;>:::-:;.;.:.;-:•;;:;•:;;:•;:•:-:;-:::-;:.;:•:;;.;.;-;::-;;:;;•:;:.;:.;:;;:::::::::......... INDICATED, ICIES OF INSURANCE ...........:::::::::::::.:.:.;::.::.;::.:LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAME D, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPETHE CT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. co MS, LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION _ GENERAL LIABILITYDATE(MMkDDX" DATE(MMWDIVV) LIMITS COMMERCIAL GENERAL LIABILITY GENERAL AGGREGATE $ CLAIMS MADE D OCCUR. PRODUCTS-COMP/OP AGG. OWNER'S&CONTRACTOR'S PROT. F PERSONAL&ADV.INJURY $ EACH OCCURRENCE $ FIRE DAMAGE(Any one tyre) AUTOMOBILE LIABUJry $ ANY AUTO MED.EXPENSE(Any one person) $ -ALL OWNED AUTOS COMBINED SINGLE LIMIT $ SCHEDULED AUTOS BODILY INJURY HIRED AUTOS (Per Person) $ NON-OWNED AUTOS BODILY INJURY (Per Accident) $ GARAGE LIABILITY PROPERTY DAMAGE $ ANY AUTO AUTO ONLY-EA ACCIDENT $ OTHER THAN AUTO ONLY: EACH ACCIDENT $ EXCESS LIABILITY EACH $ UMBRELLA FORM EACH OCCURRENCE $ OTHER THAN UMBRELLA FORM " AGGREGATE $ A WORKER'S COMPENSATION AND EMPLOYER'S LIABILITY (UB-794X619-1—06) THE PROPRIETOR/ 09-26-06 09-26-07 STATUTORY LIMITS PARTNERS/EXECUTIVE X INCL EACH ACCIDENT $ OFFICERS ARE: EXCL DISEASE-POLCY UMIT OTHER $ DISEASE-EACH EMPLOYEE $ 500 000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CE ,..........::::::::.�:::.;;;:.;:.;:;.:�;:.:;.;:.;:.;»::�:.;:;:.;:•»:>:.:.::.;:.::::.;:.;:.;::::::�:;;.;:.>::;::;:;.;:;.;>:;.;;:•;:.;:::;:>::.:;;;;:;•:;•>;::::.:.;....•..:...:..,.;..............ER AFFECTING W COV SHOULD ANY OF.THE ABOVE DESCRIBED POLICIES BE .. CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COAAPANY WILL ENDEAVOR TO MAIL ERASER CONSTRUCTION 10 DAYS WRITTEN NOTICE TO THE CERTIFICATEHOLENDEDER AORMED TOMAI PO BOX 1845 LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR THE COTU I T MA 02635 LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE :.�.F,:1�:.�GNp�.iy♦�IJ�R]{.ii:�i::::is�iii::i:i:�iiiji'}isvi:iq:L::?::::ii}iii:isi:::iiiiiiiii::::::i4i:::i:ii'ri:�:i:v.:i.i-.�::::::.::.......... .4.•......^'::::::.�:::i-iiii:iiJ:�i'r:{;•iii :iiiiii:•iii::i::iiii}ii:isisiiiiiiiii:iiiii:�i:i�::::isiiii:iii:v4iiiijii:>i}iii:!�i:ii::ti?�:?:?•'ri}i•:n:�:.:�.�...........'. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Streei Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): I /(QaQ, ������t�(� � Address: City/State/Zip: A AA )Vl� Q 9,63S Phone#: SO g qA a ogq g Fo you an employer?Check the appropriate box: I am a employer with 4. ❑ I ama general contractor and IType of project(required): employees(full and/or part-time).* have hired the sub-contractors 6 ❑New construction I am a sole proprietor or partner- listed on the attached sheet. ❑Remodeling ship and have no employees These sub-contractors have 8. .❑Demolition working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5• El We are a corporation and its 9. ❑Building addition required.] officers have exercised their 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL I 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' ' comp.insurance required.] 13.❑ Other -*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 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 their workers'comp.policy information. I am an employer that isproviding workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: , Policy#or Self-iris.Lic.#: I x fj Expiration Date: 7-- Job Site Address:_ / 7 ® kt1 c-—' n � City/State/Zip:— ,,,(Ile 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, l 52 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 hereb_ er t s and s o per ry that the information provided above is true and correct. Signature: �•. Date: 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#: //2007 09:58 5087785966 - ,- --• HYLINE CRUISES PAGE 02 Clean 8i Remove - Debris from work area daily. TOTAL INVESTMENT: XT AR 25 - Partial South Facing Side of addition $2,205 XT AR 30 - Partial South Facing Side of addition $2,275 Payable immediately upon completion NO MONEY DOWN - NO Payment at the start or part way thru Payments accepted are: CASH- CHECK-MASTERCARD-VISA-AMERICAN EXPRESS 'Any payments not made within 30 days of completion will be charged 1 ''/2%for every 30 days the payment is late. Possible Extra-After the shingles are removed from the roof, we will lift one sheet of plywood to make sure that the insulation is not up against the plywood sheathing preventing ventilation from the eaves to the ridge. If it is, ventilation panels will be installed by; removing the plywood sheathing, installing the panels, turning the plywood over and then re-installing the plywood. If needed, this would be charged for as an extra at the rate of$4.00 per panel including Materials & Labor. There are 6 Panels per sheet of plywood. Possible Extra -Any rotted or otherwise deteriorated trim boards, plywood sheathing, lead flashing, or other carpentry needing replacement will be done and charged for as an extra at the rate of$50.00 per hour, plus materials, plus 20% overhead mark-up on total extras. FRASER CONSTRUCTION Warranties the labor for 12 years FRASER CONSTRUCTION Warranties the shingles against Blow-Offs for 10 years. CERTAINTEED Warranties the shingles and labor 100% through the Sure Start Warranty duration. • CERTAINTEED Warranties the shingles to be ALGAE resistant for the duration of the Sure Start Warranty depending on the shingle that was purchased. Any deviation or alteration from above specification will be executed upon written orders and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays are beyond our control. Owner should carry fire, tornado and other necessary insurance upon the above work. We, if not accepted within thirty days may withdraw this proposal. FRASER CONSTRUCTION: Carries Workman's Compensation and Public Liability Insurance on the above work, certificate available upon request. DATE OF ACCEPTANCE: 9 Q� I Homeowner Fraser o ruc on b. Ey' , J Tcrwn.;of.Banstabae, . Expires 6 months from date. Mass. Rkgu story Services Fee.. . v $ 019. Thomas F.Geiler,Director Building Division Tom Perry, Building Commissioner X-PRESS PERMIT 200 Main Street, Hyannis,MA 02601 0 C T Z Q03 Office: 508-862-4038 Fax: 508-790-6230 BARNSTABLE i EXPRESS PERMIT APPLICATION - RESIDENTWVOW ' Not Valid without Red X-Press Imprint Map/parcel Number a0$ 00 Property Address �( X �O j9v'i U fZ Residential Value of Work o S� Owner's.Name&Address , 'S -u A4.,_ /yl vy Contractor's.Name aea-� C (-fie S 3� Telephone Number /�%' Home Improvement Contractor License#(if applicable) Construction Supervisor's.License.#(if applicable) P9Workman's.Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner ❑. I have Worker's Compensation Insurance. Insurance Company Name /' f lei J'Z �✓ Workman's.Comp.Policy# 7 S 7 GJ AJ 04 Permit Request(check box) Re-roof(stripping old shingles) All construction debris will be taken to ((Ct4 /yL atl'-4 ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows. U-Value (maximum.44) s i *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. ome rovomfeS Contr ors L en se is required. n signature 2:Forms:expmtrg tevised121901 P�°Ft Toys Town of Barnstable Regulatory Services BAMSTAB9MAM 'g Thomas F.Geiler,Director �iOlE1 39. Building Division Tom Perry, Building Commissioner - 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I^ � - S�v ,as Owner of the subject property- hereby authorize +� `-✓1 G'S-P- Z to act on my behalf, in all matters relative to work authorized by this building permit application for: , (Address of Job) ignature of Owner D to Print Name ' A.lflT)LdC.l1Ti1AT4DDBD�ATCCTl11J _. .. - - v (. ,ula ions and Standards 'ace - Room 1301 i Iliusetts 02108 5£9Z0 bW'linloo NOE)"8V1 LL r 2i3S"3 Nb3a t °�N011 f 12-ISNOO 83SV8=1 trayrc� 'v aap 500Z/EZ✓£ -- PJeog uggeJidx3_ 3Jojaq 9E5ZGI ti:uor eJ;Baa Mail aOlObZl1N001NgW3AOaW13WOH sPJepaIns Pus suOyeln�a u$nrplina JO PJeog i i f FRIEDLINE& CARTER ADJUSTMENT, INC. 436 Main Street, P. O. Box 338 Hyannis, Massachusetts 02601 Tel. (508) 771-3232 FAXJ-508) 790-2344 TO: O Bu' ing Commissioner or Inspector of Buildings O oard of Health or Board of Selectmen O Fire Department. TOWN OF Centerville TOWN HALL ; , MA RE: Insured: SCUDDER, Joan & Richard Property Address: 171 South Main Street �J Centerville, MA Policy Number: H0320686 , Type of Loss: Fire Date of Loss: 4/21/2003 File#: 96452 Claim has been made involving loss, damage or destruction of the above captioned property,which may either exceed $1,000.00 or cause Mass. General Laws, Chapter 143, Section 6 to be applicable. If any notice under MGL, Ch. 139, Sec. 3B is appropriate, please direct it to the attention of this writer and include a reference to the captioned insured, location, policy number, date of loss and file number. On this date, I caused copies of this notice to be sent to the persons named above at the addresses indicated above by First Class Mail. 1 N.-LAGUE Adjuster 4/23/2003 4,; . �--- - _� a `� �S (�' -, r �� -�J \J � �- /v^///1 / L /�//� i� � {F TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION A. Map_ a ®� Parcel owl , 00 / Permit# a q (2(6 - Health Division Date Issued Conservation Division + Fee Tax Collect Treasurer < Planning Dept. + Date Definitive Plan Approved by Planning Board Historic,OKH Preservation/Hyannis + Project Street Address }_ 1171 50-u I Yl 4/0) Village '1 Owner ACAO- Address Telephone Permit Request 0&&zd5 Square feet: 1st floor: existing proposed 2nd floor:existing proposed Total new Estimated Project Cost 6 000 Zoning District Flood Plain Groundwater Overlay 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 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 ❑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 TRASER CONS11 Telephone Number Address 71 TARAGON CIR. License# COTUIT MA 02635 _ Home Improvement Contractor# llaY3 6 Worker's Compensation# /Sy 0_5e3 012 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO VG4wcayf'�^ SIGNATUR DATE — ' `?A hi FOR OFFICIAL USE ONLY - w PERMIT NO. Al DATE ISSUED MAP/PARCEL NO. . . i ADDRESS 3 a - VILLAGE ;„ ' OWNER °' n DATE OF INSPECTION FOUNDATION f r FRAME i INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH ` FINAL ' GAS: to ROUGH FINAL FINAL BUILDING ' A'DATECLOSED'OUT ASSOCIATION PLAN NO. The Town of Barnstable Department of8ealth Saft and Environmental Services B WdinS.Division 367 Main Sftwl, MA 02601 Office.- 508.862.4038 Ralph Crasser Fax: $08-790.6230 Buitdirg'Comminlona AFIMVIT NONM IIYMROVOUNT CONTRACTOR LAW SUPPLEMENT TO PERIIHT APPLICATION MOL L 142k nqutm datdw uadaa raoonratias, ,modezniaatior,corvasior6 tmprov=096 ramovA damMk%or conowft ofen adMw to say peaeodit owuw occapied EMUS 0001210188 at iemt=*buttatmors to hwdw ft mils art*gme m+es which are a4acert to such m1donce orbaitdin8 be done by rid nonom wa wo&wwWd0a%along witb other Type of Work: Bsdmated Cost Address of Woft /� e •`' Owner's Dave of Appffm*t: .---,;F/-) I het+eby 16e� ' UsMmdm is not r ibrthe ibilo iog nsm*s� Owo* W kw O06 UnftSI.000 O6ui1fg tmt owna�ooaupteet CPwwPft0wP Notke D hw*gim dieft OWNERS PULLING TAEIR OWN PERMIT OR DEALING WITS UNREGISTERED CONTRACTORS FOR APPLICABLE HOMZ IdMROVEMENP WORK DO NOT HAVE ACCESS TO TM ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL e.142A. SIM=UNDER MALMES OF PBRJtJRY I hmeby aPPIY it 6 tunnit a ft awe of dw owrm: . . Ccoor Name . Registeadon Na OR i Dam OwWs Name gt�rA�dsv i F HOME IMPROVEMENT CONTRACTORS REGISTRATION oard of Building Regulations and Standards One Ashburton Place - Room 1301 Boston, Massachusetts 02108 HOME IMPROVEMENT CONTRACTOR Registration 112536 Expiration 04/06/01 ----------------------- --------- - Type - DBA r HONE INPROVENENT tONTRACTOR Registration 112536 FRASER CONSTRUCTION co Type - M DEAN C. FRASER a Expiration 04/06/01 71 TARRAGON CIR COTUIT MA 02635 FRASER CONSTRUCTION co DEAN C. FRASER 11 WARRAGON CIR . TUIT NA 02635 f The Commonwealth of MasswAustt Department of lndrmW&l Accidents WlcM 1 -4 -iFmw 600 Wasliington Street Gaston,Mass. 02111 Workers' Cow adon Iosnramee AtAdavit ��..,e• FRASER CONSTRUCTION 71 TARAGON CIR. ❑ I am a g �� I am a sole - and have no one worldna in am ca ' I am an employ�rl Wing '�on for my employees woricing on this job. cemnanvnatne• •, '� "1'AQAf►AM f+1D . . �tdare,s• :Y COU1T MA 02635 .. ; •per• "(SOB) 428-2292 :: >.�:.•. .. ' . �. t.�:>.. ohane*• tf� "'� g� n ugli co: 6-1 I am a sole proprietor,general tnntraator,or homeowner(dr&on_#and haw hired the contractors listed below who have the following workers'compensation polices.• • MMw.MV 1.f1MM •. . •.. 'S7 .y 'ti.?Zis :2:•'. ...:... .•.. ":<:.:,Nf•+y.{..:r . :n;.. •• �,.. y ,,� •w..`.i.'... .•yc.,y vti'" �>.. ,..•.: :''.... cIN* a ane�l: :•ss 11a0. flle ..�:++ns.n. v'•'`�i'i..oc"� 5�:;'. :.':+. v:::.;,::;•.. ,,.y ;ti::' :.:e'.: ••yore.:.• .� Yr�;:..�:•: :Sa.>X;+,�•�'• I�IO"any name• - -- --- address• Jim d. J .k: : '• � 4i .. .a e. :, r yM��s•Ae••: `.N• :•>•f�• �� y:sur/' v`Y K... ��+'•° .y�,:•.�_a $y., y0' •Y '�• _ .•J+a•'M'COW....V •.• Fiy..' .. .yj•• ..�.,•V•'.}}''yY4'k:'�iQ�iAw•r'r':4 .v.. FaMm to segue coverage ss raquk"mdw dndoa 2"of:NGiL 152 eaa bed to tb harx0m oterbaiad peaddes ate ON up to St,soo oo and/or one years'i Wd"Oms"ar wan d cim panam s in the hrm ors STOP WORK ORDER and a On of S100.00 a day ap ho me. I tmdersland 60 a copy of thh smummmy be famarded to the Meof Iaresdp dm Oahe DNhresmtape ve dbdm. 1 do herby the a! ofpedw'dog the ir{/onmde provided akm it tw ondaon+aat Sipiatnre � --- - Psiat name �D ogq.� [^�..�����^ P'hnee�!�, �/�•-C)� eo alassonly do notweNeinddsanato beemnpleted by MYortmmoOhhtdor tmm petndtNcans r!, 0H�d d ng Depart:ame ch chak tiasaudWe reepomas mpdnd G8 'sue eaMast persons h � er . I c, ,L t-8LL #ud 0 I J9Z0 EW ` s t uuPAH 98 I . Oqs JalpmNvasg 8I, IV Paw1o3,Jad NioM : .Jo j POLL 6VOZIi # uoT ,7g.J4st$a d OvE9S0 # asuaot7 t,098-ILL (809) #ud Z89ZO VW `allIAZI3.LH30 AVM .LOId.LVd t, AHVdW00 OHI(IljnH azinHOS � I 'Il DEPARTMENT OF PU8LIC SAFETY COMMONWEALTH 1010 COMMONWEALTH AVE. OF BOSTON,MASS.02215 t�!" MASSACHUSETTS LICENSE EXPIRATION DATE CONSTR. SUPERVISOR OT/31/1994 EFFECTIVE DATE LIC-NO. RESTRICTIONS NONE08/01/1991 056340 WILLIAM L SCHOLZE PATRIOT MAY i SS R tENTERVILLE MA 02632 ' PNOTO(BLASTING OPR ONLY) FEE: I 0.00 HEIGHT: NOT VALID UNTIL SIDNQO By LICENSEE AND OFFlCM v i STAMPED-OR SIGNATURE OF TN COMM65 E DOB: 0/29/1954 00 THIS DOCUMENT MUST 61 RE OF uCENSEE CARRIED E THE PERSON O • - THE HOLDER WHEN ENDAK3 MIS$IONER DINERS�RIGHT THUMB PRINT ED IN THIS OCCUPA T101. 20OW2.87.81429 i i P s. 1 �I11� J ..,,4 p TH OF MASSACHUSETTS` DFrAR,MENT OF I?KIDUSTRIAL ACCIDENTS 600 WASHINGTON STREET BOSTON, MASSACHUSE I'S 02111 fames J Garnooei' lo--�i:ssione WORKERS' COMPENSATION INSURANCE AFFIDAVIT 1, (licensee/permirtcc). with a principal place of business/residence at: (City/State/Zip) do hereby certify, under the pains and penalties of perjury, that: [ J 1 am an employer providing the following workers' compensation coverage for my employees working on this job. Insurance Company Policy Number ,V/l am a sole proprietor and have no one working for me. ( 1 I am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed below who have the following workers' compensation insurance policies: Name of Contractor Insurance Company/Policy Number Dame of Contractor Insurance Company/Policy Number Name of Contractor Insurance Company/Policy Number 0 1 am a homeowner performing all the work myself. NOTE.: please be aware that while homeowners who employ persons to do maintenance,construction or repair work on a dwelling of not more than three units in which the homeowner also resides or on the grounds appurtenant thereto arc not generally considered to be employers under the Workers' Compensation Act(GL C. 152,sect. 1(5)),application by a homeowner for a license or permit may evidence the legal sutus of an employer under the Workers' Compensation Act. 1 understand that a copy of tilis sratcmcnt will be fo,,-a:dcd to the Department of.lndustrid Accidents' OGiee of lnsurancc for.coverage verification and that failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition ofS.timinal penalties consisting of a fine of up to S1500.00 andlor imprisonment of up to one ye and civil penalti ar cs in the form of a Stop Work Order and a fine of S100.00 a day against mc. 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Engineering Department(3rd flo House number Definitive Plan Approved by Planning Board 19 ` APPLICATIONS PROCESSED 8:30-9:30 A.K and 1:00-2:00 P. +only TOWN OF .B'ARNSTABLE BUILDING ' INSPECTOR APPLICATION FOR PERMIT TO kn S, i �y_t r-jq,-�0 b d2 a Y►, gj�) w TYPE OF CONSTRUCTION 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following infor lion: ` Location f /'7// /V (2- LL L Proposed Use �-S i ra L�/t]t J�a L— I` Zoning District Fire District S� Address 7 I S o v�/la7h� �, C fir✓ �yy?�,Name of Owner Gt l21? � Lf n�� 1 Name of Builder �3 I L Z J C 14 11 t_Z�-� Address ✓-t 1 y !�//'� C 13 t✓ �2 Ul L Name of Architect C 14 Address Z f1 Number of Rooms - >2 � Foundation ), L LL 2�n L �17Y? C rL Le,FZr Exterior 5A JAJ L, L?":�- Roofing /Q 5✓>A4tQ :T" Floors 6424t3r �ms L Interior ��i2 ►;l w�a 1. L Heating Plumbing Fireplace zS Approximate Cost 0 Area Diagram of Lot and Building with Dimensio Fee 1 (415 1 X �RAgeJ�" oci` �x�sTt��7 �LA 5 L. M 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. Name /Z� Construction Siipervisor's License 05 fl 3 Ll Q SCUDDER, MURRAY j No - 3 3 Permit For ADDITION 4 Single Family Dwelling Location 17-1 South Main Street Centerville J Owner Murray Scudder Type of Construction Frame Plot `' Lot -r i j April 1 94 Permit Granted 19 Date of Inspectio s Frame 19 Insulati®,n 19 ' r �-`FiOeplace 19— s Date eompl ted 19 a t Yam, �'� �•,� A � 4 _ u