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HomeMy WebLinkAbout0072 THREE PONDS DRIVE 6 4 i M1 m r ; w -ACOT Town of Barnstable Permit# Expires 6 months from issue date Regulatory Services Fee yC� • C Thomas F.Geiler,Director Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 0260110 v jj www.town.barnstab le.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERAUT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address :7d tf-I f taP ��hn��. nl ( ��71F 'r�/t// !`L az2 a 3 �dL [EtI esidential Value ofWorkl_cTe72 Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address_ 1 23Q L* i _ (!y X C t-pz an Contractor's Name l Telephone Number Home Improvement Contractor License#(if applicable). Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance check one: ❑ rarn a sole-proprietor Fg/i am the Homeowner ❑ I have Worker's Compensation Insurance ®PRESS PERMIT Insurance Company Name O C T 1 2.2 0 A7 Workman's Comp.Policy# ' TOWN DE RA► NSTABL.E Copy of Insurance Compliance Certificate must be on file. Permit Request(check box)Pl�e'-roof(stripping old shingles) All construction debris will be taken to 4•,j All ❑Re-roof(not stripping. Going over existing layers of roof) O-Re-side - Replacement Windows/doors/sliders. U-Value (maximum'.44)Aact 04�n 4 ' *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: i f.,I R0. A copy of Home rovement Contractors License is required:" ` SIGNATURE: Q:Fornu:expmtrg Revise061306 r .: The Commonwealth of Massachusetts Department oflndustrial Accidents Office afInvestigations 600 Washington Street ._ . Boston M4.02111 - www.?nass.gov/dia Workers' Compensation Tnsur=ce.A€fidavit: Builders/Contractors/Electricians/PIumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual):. •Address: _e City/State/Zip:-_C�n i-QtV L I I)- l��lt�{-'e�t,�� Phone.#: G Are you an employer? Check the appropriate box: Type of project(required):• 1.❑ I am a employer with 4. [] I am a general contractor and I employees(full and/or part;time).* have hired the shb-contractors 6• ❑New construction . 2.❑ I am asole proprietor or partner- listed on the-attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. Demolition working for me in any capacity. employees and have workers' insurance.#' 9._0 Building addition co [No workers' comp.insurance mP• r quired.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions officers have exercised their 3. I am a homeowner doing all work 11.E Plumbing.repairs or additions amysel£ [No workers' camp. right of exemption per MGL insurance required.]t c. 152, §1(4),and we have no 12.❑Roof repairs employees. [No workers' A3.0 Other comp. insurance required.] , 'Any applicant that checks box#1 must also fin 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. xContractors that check this box must attached an additional sheet sbowing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors lave employees,they must providh their workers'comp.policy number. ram an employer that is providing workers'campensafion 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),, Faihtre,to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine tip to$1,500.00 and/or one-year imprisonment, as well as civil penaltius 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 bIA for insurance coverage verification ' I do hereby certify under the pains•an pe/ hies of perjury that the information provided above is true and correct: Signature: Date: Phone#: rTqsuing cial use only. Do not write in this area,'tb becompletedbycity or town ociaL or Town: Permit/License Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town CIerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: . Phone#: f �oFTHEr Town of Barnstable Regulatory Services EAMSTABLE, : Thomas F. Geiler, Director tAsa �pl039• 1% .Building Division ED ftAA'I Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 ------------------- HOMEOWNER LICENSE EXEMPTION -� Please Print DATE: It% ! / JOB LOCATION: 7 1L a number 11 J street village "HOMEOWNER": � 0`1' l . /!V �C �•�� t ` name home phone# work phone# CURRENT MAILING ADDRESS: ck k W7 l r Ise r7 Y/�� NA 62 a1)1 city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be, a one or two-family dwelling,attached or detached structures accessory 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 homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes,responsibility for compliance with the State Building Code and other . applicable codes; bylaws,rules and regulations. The undersigned`.`homeowner"certifies that he/she understands the Town of Barnstable.Building Department. minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. "��Cj/_/_ I . - Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127:0 Construction Control. 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 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires 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 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. w Town of Barnstable *Permit# Expires 6 ionths from issue date Regulatory Services Fee Thomas F.Geiler,Director X-PRESS PERMIT Building Division MAY 18 2006 Tom Perry,CBO, Building Commissioner OW 200 Main Street,Hyannis,MA 02601 TC�VVN �F BARNSTA�L� www.town.barmtable.ma.us Office: 508-8 YVN Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Numb` J756 b Property Address 70. lbree- lCbn 01-. �GPi7t,E4­yt1le / /A OZ 66'SL ©Residential Value of Work OZ�Q Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address A lb el-r 4, Siban Jr 7a fnr� l�G�dS Dr. Ca-)tP yi/bol �m- Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor 0 lam the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) Q Re-roof(stripping old shingles) All construction debris will be taken to I-Ak ❑Re-roof(not stripping. Going over existing layers of roof) 0 Re-side Replacement Windows. U-Value (maximum•44) Awe•sc^ `fie' g«`'�s *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. 'Note: Property Owner must sign Property Owner Letter of Permission. Home Improvement Contractors License is required. SIGNATURE:. Q:Fomu:expmtrg Revise071405 The Commonwealth ofMassachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia- Workers' Compensation Insurance Affidavit; Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LesibIy Name puduessloro oi?ationadividu4: Q,\V e e T L.S V W z� Jr. Address: —l',.. 'Chcee City/State/Zip: • C'�,,cee•��11,e ,Nib oZ-Lo Phone#; �� fin•�y3 Are you as employer? Check the-appropriate boa: Type of project(requireai): 1,❑ I am a employer with 4. ❑ I an a general contractor and I 6, El New construction employees(fall and/or part-time).* have hired the sub-contractors 2.El am a sole proprietor or partner- listed on the attached sheet$ �• ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp,insurance, g. E] Building addition [No workers' Camp.insurance' S, ❑We are a corporation and its exercised their 10,❑ Electrical repass or additions required.] officers have e 3.® I sm a honieowner doing all work right of exemption per MGL 1117 Plumbing repairs ox additions myself,[No workers' comp. c. 152,§1(4),and we have no 12.[]Roof repairs insurance required.]t . employees.(No workers' 13,❑ Other comp,insurance required.] *Any"licamt that checks box#1:must also M out the section below showing their workers'compensation policyinfounation: t Aoraeowners who submit this affidavit indicating they ame doing all work andthen hire outside ceatractors most subs t a new affidavit indicating such tCor h actors that check Ibis boa must attached an additional sheet showing the name of The sub-comtractors and their workers'evmp,policy imffbrmnation. I am an employer that is providing workers'compensation Insurance for.my employees. Below Is the policy an d,fob site - informatdon. :r Insurance Company Name: Policy=or Seimmi.Lic. panimtim Date: . Job Site Address: City/state/*, Attach a copy of the workers' compensation p.oUcy declaration page(showing the policy number and expiration date). Failure to secure-coverage as required undet Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,50490 and/or one-year imprisonment,as well as civil penalties in the-form of a STOP WORK ORDER and a fine of up to$250,00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DLk for inmmance coverage verification. I do hereby certo under the pains and penalties of perjury that the information provided above is true and correct srnattire:;:> 010-41t L s1111-a, Phone#; r�l��• ��U. nr�3 Do fwf Ir.GIs rwa,to be C,� d€ C4 or tM dyj,9--,;d City or Town: Y ermit/i+i reuse# Imuial$Authority (circle one): l 11.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical inspector 5.Plumbing inspector l 6. Other i Contact Persou: Phone#: Information and Instructions Massaghusetts General Laws chapter 152 requires all employers to provide vbrlsers' compensation fortbeir employees. Pursuaat to this statute, au employee is defined as"...every person in The service of another under any contract of hire, egress orimplied,.oial or Written." An employer is defined as•"an individual,partnership,association,corporation dr other legal entity,or any two or more es of a deceased employer,or the . joint enterprise, and includin the legal r esentatry emp Y , of the foregoing engaged m a] g �' receiver or trustee of an individual,partnersht, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartinents and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair worksm such dwelling house grounds or on The Or building appurtenant thereto shall not because of such employment be deemed tobe an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall wtthbold the issuance or renewal of a license or permit to operate it business or to construct buildings in the commonwealth for any applicant who has not prodaced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commomvealth nor any of its political subdivisions shall enter into any can-tact for the perhnnanct ofpubHc work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please M out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)wme(s),address(es)and phone number(s)along with their certificate(s)of inmrance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or p artners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage, Also be sure to sign and date the affidavit. The-affidavit should be riturned to the*or-town fhat the application far the permit or license is being requested;not the-Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the member listed below. Self-insured compamos&=M r er�heir self-insurance license number on-the appropriate lime. City or Town O flelsls - Please be sure that the affidavit is complete and printed leg11y: The Depart menthas provided a space at the bottom:. ` of t afddavit for you to till out.in the event the Office of Investigations haws to contact you regarding the applicant - Please be sure to fin in the permit/license number whlch will be used as a reference number. lh addition,an applicant that must submit multiple permit/license applications in any given year,necd only submit one affidavit indicating auaent policy information(if necessary)and under"Jah Site Address"the applicant should write"all locations in_(city or town),"A copy,of the affidavit tat has been oiricially stamped or maAedby the city or town maybe provided to the applicant as proof That.a valid affidavit ism file for future permits or licenses. A new affidavit must be filled out each ' year.Where a home owner of citizen is obtaining a license or permit notrelated to any business or commercial venture (ine.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would Else to thank you in advance fox your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax m nber: The C-n=onwealt of Masswh=e 3 Deputmert of Industrial Accidmts Of-ace of Inve-ft. R&M 600 Washington Street Boston, MA 02111 Tel, #617-727-4900 e-rit 406 or 1-877-MASSAFE Fa{4-' 617-727-7749 Revised 5-26-05 Ww 7;.i-1i ass.gov/dia i °fzM�Teti Town of Barnstable R.egulatory Services sr�i.E, Thomas F.Geiler,Director m Building Division. Tom Perry, Building Commissioner 200 Main Street, Iiyaanis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section. If Using A Builder I, A l be r-T L. SL lv a,_,�r ,as.Owner of the subject property hereby authorize I r.a, tann s San= to act on my behalf, in all matters relative to work authorized bythis building permit application for. -i,, -rhre-e fbnas Ds,, Cen-retvi Ilse (Address of Job) W�A, � r,� o S l 8 to(o Signature of Owner Date A ( Silva,. Print Name Q:FORms:OWNERPERMIS SIGN + lie B acon. February 28, 2006 Town of Barnstable Building Inspector's Office 367 Main St. Hyannis, MA 02601 Insured: _ Walter& Albert Silva, Jr. Property Address: 72 Three Ponds Drive., Centerville, MA Underwriting Company: The Employers' Fire Insurance Company Policy Number: FBSX28059 Date of Loss: 02/19/2006 Claim Number: OAA182831 BG6A Claim has been made involving loss, damage or destruction of the above-captioned property, which may either exceed$1000 or cause Massachusetts General Laws, Chapter 143, Section 6 to be applicable. If any notice under Massachusetts General Laws, Chapter 139, Section 311 is appropriate, please direct it to the attention of this writer and include a reference to the above-captioned insured, location, policy number, date of loss and claim number. Damage: Power surge protector caught fire, smoke damage to dwelling. On this date, I caused copies of this notice to be sent to the persons named above at the address indicated above by first class mail. Signature: Wendy A. French, Senior Adjuster j ( -,. }J.• •}.,3 `f� �..s ..r..i,, r . .! se. r , i F•+` v . :1 :�i .1 '.` tr rf 'r J•` :.Ss. F`r+. f. (-. :}P$}: 1 r'..) f If.- dy , 3, i f x'. lt,� i:g•:j. t.-. -.ice,: iSeS=;{ a-'. Jsi.i 2. '.. �%...a �<<`.. . ;Tfi... + _ `r.. +); � -` .. OneBeacon Insurance Group Claims Department 8 Essex Center Drive,Peabody,MA,01960 Phone:(978)817-3128 Fax: (888)789-7339 www.onebeacon.com �•3�'., TOWN OF BARNSTABLE Permit No. -______--_- - I Building Inspector Cash OCCUPANCY PERMIT Bond No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to f)OUgla6 Lebel Address iaOX 104 maricuns rMiat: Wiring Inspector Inspection date Plumbing Inspector 1 - Inspection date Gas Inspector Inspection date Engineering Department Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS. .........................................I...........1 19......__ ......................................................................__..................._...._._.._._._ Building Inspector t +w xr s d ff Z71 j 7 2. f i ON t r rx A� Tp �j „ :'• t iS sY,i m } s y 1 Ip. 3p ,. i d } CERTIFIED PLOT PL A x NEW CONSTRUCTION ONLY : TOP OF FOUNDATION IS FEET IN ABOVE' LOW POINT OF ADJACENT ll"EST L 4'Y ROAD. � SCALE: I — . "iO DATE=Tah 3GAl 97 a ; E'L®RE®GE ENGINEERING CO. Il I CERTIFY THAT THE CLIENTQ. e e 7, .Fe 7700�r SHOW ON THIS PLAN IS LOClA� 1, EGIS`TERED REGISTERS® g . . CIVIL I LAND JOB NO. ON THE GROUND AS INDICATED'-AkO� n CONFORMS TO THE. ZONING, LAWt t, ENGINEERS SURVEYOR DR. BY �J ' OF BAIdNST BLE / A,�SS►: ` "` 433 NO, MAIN ST 712 MAIN ST. CH. BY. _ 7 c, ' SQP, YARMOUTH MASS. HYANNIS MASS.. OF , / ------�-� a . . SHEET �. l?,4 T.E_.-�.._.,� �;;5--�-�-:m�N D--'S U " ' e s!/ �!?/13L/LQ�I'I/��2��%7� �/1� 7ZQiG�ZPP//1•G1T.ti� Commissioner. — oLr �ite JLQO�GCULG, oLw�u2Gte, ���� 02�-�6 PAUL T.ANDERSON Regional Environmental Engineer January .3-1, 1979 This Department is in receipt of an application under General Lairaso Chapter 131 Section 40, filed in the I\bm of Douglas W. Lebe1 Rnx 16ATMa"rSJnnc M; 11-;- 09648 O mer Of Land Same City/T XIM R^rn S tnh 1 P Location 72 Three Ponds.Road, Lot A-12 . The following information is required to be forrmrded' to this office for a conlplete filing: ( ) Notice of Intent ( ) Environmental Data Form ( ) Plans ( ) Locus Map - This project has been designated by File Plumber SE 3-433 ( ) The plans for the secjage .disposal system do,not meet the recuirerients of Title•5 of the State Environmental Code. ( ) A Chapter 0-1 Permmit may be required by the Division of Waten,rays. ( ) A Permit may be ratui.red by the Army Corps of Engineers. For the commissioner Paul Te Anderson, P.E. Pegional.•Environmental Engineer cc.-. •-Ccmaission ( ) Board of Health 3 A !s map and lot number E ..................................ssessepr ...... grPTIC SYSTUVI KIM B THE 77 INMTALLED IN COMPLIANCE Sewage Permit number ......................................................... WITH ARTICLE 11 STATE . A 9,ANITAIAw CODE AND TOWN 33AMSTABLE, House number .......... .. MA". ........... :...................................... U Am 0 N S. 63 9. j M TOWN OF RARNSTABLE BUILDING , OASPECTOR APPLICATION FOR PERMIT TO ......... i>.......... .................... 7 ....................... ....... ...I................ TYPE OF CONSTRUCTION ....... ........ . . a...............................1928 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: .......... ....... ......................... Location ... .e... . .. .'4...../ . ........ ...�.. .14. Proposed Use ...... .......cc,0.1..-�? . ........1)z ae— /(!y.......................................................................................... Zoning District .......Ifo-C......................................................Fire District ..6v A.4'q./z......— ............ ......Address ..... . ............re�$.6. .. ..Name of Owner ....D�t"?-1 ..... ?X , Nameof Builder ............. .....................................Address ................... ............................................... Name of Architect ............7777.........................................Address ...... ............... ............................................... . .......... Number of Rooms ....... ....... ........................Foundation .......P.7.'A . .......... . .............................. ExlerioA?�r dy..i� .Ib�oofing .......... ........e5.. '. C:`:'��.................... Floors ....61? ....................... Interior ... i z'.'* ..................................................... ........... .................... -/.-;llr-% dq 4- Heating ..................................Plumbing ..... $.. . ............................... Fireplace Approximate Cost .... 0-0........................... .................................................................. Definitive Plan Approved by Planning Board -------------------------------19--------- Area ....../ ......5�4.. Diagram of Lot and Building with Dimensions Fee .......................................... SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Town 4ofrnsta le rega,.rdi t e ve a, construction. Name .................. ..... ............................ .......................... LebeI, Douglas W. _ . . , Ns _2IUI9_ permk for __I..1/2..�torv__ '�----..---.--.—..--.--~................... . . . Location .....72.. . ..Road................. . . —..—.—..--. ��—.—.-------.. - �. �abel Owner ---pPMgj��-------------.. Type of Construction ................tMM!P............... ' . . ��-------------------------- . , ' Plot ............................ Lot ............... ---. ^ ' . . � . . 6 ?9 ` ^� . Permit Granted ----.�.�.��.���/�---lV Doha of Inspection .................................... ! uon, Complete ��- ' . ' . . ' ' . .- . � . . � ' | � � PER8&I* REFUSED ` . ' _---._—.--...---------. lV ^ . ... .------...----.------- — —' � � - ~ � ^-_—~~.-...`-----.. —.... ----~—. . . . . � .................`,_.--_—....---.—.......—..�.L ` ^ . , . . —'-----'—~^'—^—'-----^^—''^---^'— ' Approved ................................................ lQ .-----^------^'`---�:.-'—^'~^^'`~^' ` --'--------^^------`r—^^^^'—^~— , `- , . Assessor's map and lot number ............................................ f '� J -. 7 1' �pF TH E Q Sewage Permit number ........................................................ d� �-n 1 Z BARNSTABLE. i House number - r MAG& �p t 6 Mix a' TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO .............. ?..........�............. .r .......................... cV .................... TYPE OF CONSTRUCTION . �- ................................19..�! t TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ...%-:.f ...:...�........ ... �P Cr ti ::.: !1 . .. ��!+.................... .. ..}. .... . ......... ProposedUse .... .�'... f .. .:-^..�: .......�1.. r ,! ..... ....................................................................................... Zoning District .... ��. � �"...�� ......... ...../.........../............. ./.......Fire District .............. .-...�„.......... � Name of Owner .. ( ca :!'.. ... ✓..../ r �,� ./ Address .....�X�n %►l�� T`� �.. �� .��G ........ ..... ......... . ....... .. Name of Builder "5 -'� ......................Address S ....................:......................... ..................::.................................................................. Name of Architect ...........:77�.�........................................Address ...........`........................................................................ Number of Rooms '��..... .........................Foundation '.._.. ........ .... Exterior'�C/✓r/zc� / r � ,N �C4f�b�re:&oofing .......... •vd. �........ �,ryJ;.� l .................... Floors ... .Interior .......4?.e'..��:........................................................... Heating . . /... .r:? '..........'..../.-....................................Plumbing ... 6 ? �/I S ,t'................................ Fireplace V/ ..................................................................Approximate Cost ji?`7 e::O .� r, �. .... .... .......... „ ........................... Definitive Plan Approved by Planning Board ________________________________19________. Area 1-2�".k).......ram Diagram of Lot and Building with Dimensions Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regardi g'the above construction. / Name ......... zt,� ......�.............................. ......................... Lebel, Douglas W. A=173-70 No ........21019permit for ....1 1/2 story ..............single family..dwelling................ Location ..........72 Three Ponds E '�Y-� ................................. Centerville ............................................................................... Owner ............Dou las..W...Lebel Type of Construction .......�..amp....................... Plot ............................ Li . ....... ........... .... a Permit Granted .......February 6 79 ..........................19 Date of Inspectia ....................................19 Date Completed .......................................19 PERMIT REFUSED Y. ....... ............................ � � ............................................................................... Approved ................................................ 19 ............................................................................... ................................................................................