HomeMy WebLinkAbout0006 CRYSTAL RIDGE ROAD � �y�-�- ,�.�-� ,mod
t S TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map Parcel-0 0 2- Application # o2e,/Sd
Health Division Date Issued /
Conservation Division Application Fee
Planning Dept. Permit Fee 3� .
Date Definitive Plan Approved by Planning Board
Historic - OKH _ Preservation / Hyannis
Project Street Address QOnJ
Village +U; -�-
OwnerNMQ I Co I E 10 e�Corn Address & c_rN154n 4 m cl-,e Mad
Telephone H a n - �iC1 S(,)
Permit Request -Ln61611 IQ 11 ci il(Jo5e- -w.) 1410' own Ct ►G._ Z 64a l a" 6�
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuatio �� 3zne:> 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
APPLICANT INFORMATION
(BUILDER OR HOMEOWNER) , 71
Name MAA o� A,)e l y Bed;fd Telephone Number 3708�I ac S_77G
Address C_ License# Q �10 8 IS
ew ?_jrA tMA Oc'01 6 Home Improvement Contractor# 1,0 7�1 19 S
Email Worker's Compensation # 165-8SY6 0 01-o3
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO / I
DATE
SIGNATUR `
rn t
FOR OFFICIAL USE ONLY
APP`LICATION#
DATE ISSUED
MAP,/PARCEL NO.
ADDRESS VILLAGE
OWNER
µ DATE OF INSPECTION: --
r
FOUNDATION
ti +
E- FRAME.
sJ INSULATION
FIREPLACE
' ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL `
'f
GAS: ROUGH, FINAL'=
FINAL BUILDING. �K '
DATE-CLOSED-OUT
A
ASSOCIATION PLAN NO. ^
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
M -
600 Washington Street
Boston, MA 02111
www.mas&gov/dia
Workers' Compensation Insurance Affidavit: Build ers/Contractors/Electricians/Plunabers
Applicant Information Please Print Legibly
Name (Business/Orgatuzation/Individual): JM of New Bedford Co. , Inc.
Address: 423 Coggeshall Street
City/State/Zip: New Bedford, MA 02746 - Phone #: 508-992-5770
Are you an employer? Check the,appropriate box: Typ
e f
project(required):
1. I am a employer with 4 4. ❑ I am a general contractor and I ❑ ew construction
_ employees (full and/or part-time).* have hired the sub-contractors
2.U I am a sole proprietor or partner- listed on the attached sheet. 1 7• ❑ Remodeling
ship and have no employees These sub-contractors have 8. ❑ Demolition
working for me in any capacity, workers' comp. insurance. g. ❑ Building addition
[No workers' comp. insurance 5. ❑ We are a corporation and its
required.] officers have exercised their 10.0 Electrical repairs or additions
3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.❑ 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' Insulation
comp. insurance required.] 13•( pther
*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
tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'oornp.policy information.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and joh site
information.
Insurance Company Name: Continental Indemnity Co.
Policy#or Self-ins. Lic. #: 4 6—8 5 5 6 3 7—01 —0 3 Expiration Date: 6/2 2/1 5
Job Site Address: 5I [�� �� City/State/Zip: 3 S'
�►Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify n the pains an p nalties of perjury that the information provided a ove 's true and correct.
Signature:
Date:
Phone#: 508-992-5770
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 InspE:Plumbfingr
6. Other
Contact Person: Phone#:
ACORD CERTIFICATE OF LIABILITY INSURANCE 0 6/2(MM/7/212 014
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(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to
the certificate holder In Ileu of such endorsement(s).
PRODUCER CONTACT
NAME:
Applied Risk Insurance Services Inc. PHONE ;FAX
10825 Old Mill Rd r A/C,No,Ext: (877)234-4420 ;(A/C,No): (877)234-4421
Omaha, NE 68154 E-MAIL
ADDRESS:
(877)234-4420 PRODUCER
-CUSTOMERID#
INSURER(S)AFFORDING COVERAGE NAIC#
INSURED INSURER A: Continental Indemnity Co. 28258
JM of New Bedford Company, Inc. INSURER B:
423 COggeshall St INSURERC:
New Bedford, MA 02746-1758 INSURERD:
CTL 1273 891374 INSURERE:
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 CONTRACTOR 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.
INSR ADD SUB POLICY EFF POLICYEXP -
LTR TYPE OFIN3URANCE INSR WVD POLICYNUMBER MM/DD MM/DD
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE
DAMAGE TO RENTED $
CLAIMS MADE OCCUR Ii JII PROMISog
$
I
EXP n $
PERSONAL NJURY $
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERALAGGRE ATE $
PRO- •• I PRODUCTS-COM $
POLICY LO ! $
AUTOMOBILE LIABILITY
ANYAUTO �- EOMaBINED SINGLE LIMIT ccldentl $
ALL OWNED AUTOS .L� BODILYINJURY(P r �rson $
SCHEDULEDAUTOS $
iQ121LY INJURY(Pera jde
HIRED AUT03 ! PROPERTY DAMAGE
NON-OWNEDAUTOS I (Perac 1-an $
$
UMBRELLA LIAR OCCU EACH OCCURRENCE $R $
j �
EXCESSLUIB CLAIMS MADE r, AGGREGATE
DEDUCTIBLE $
RETENTION $ $
i
WORKERSCOMPEN3ATION $
AND EMPLOYERS'LIABILITY STA
Y/N X i WC LIMTU OT
- ! H-
ANY
R PR
A OF ICER/MEM ERPEXCLUDEED ECUTIVE�N/A L� 46-855637-01-03 O(/22/2O14iO6/22/2015_E.L.EACH ACCIDENT $ 1,000,000
(Mandatory In NH) I E.L.DISEASE•EA EMPLOYEE $ 1.0
00,000
H yes,describe under
SPECIAL PROVISIONS below
E.L.DISEASE•POLICY LIMIT $ 1,000,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(AttachAcord101,AddklonalRamarks Schedule,]?more space Isrequlred)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED
Town Of Barnstable IN ACCORDANCE WITH THE POLICY PROVISIONS.
200 Main Street
Hyannis, MA 02601 AUTHORIZED REPRESENTATIVE
ACORD 25 (2009/091 _.___ ____ _ -.
�2783118
-�� JMOFN-1 OP ID: LG
AMDNM
`Ce,.OR/> CERTIFICATE OF LIABILITY INSURANCE DATE 1111II1412@014014
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 Pollcy(les)must be endorsed. If SUBROGATION IS WANED,subject to
the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the
Certificate holder in lieu of such endorsement(s).
PRODUCER CO
Hmphrey,Covill 8,Coleman NAME Raymond A.COvill
Insurance Agency Inc. IAIC PHONu .508.997.3321
195 Kampton St. t.'O.Box 1901 E4AaL
New Bedford,MA 02741 DRESS:
Raymond A.COVIii INSURER(a)AFFORDING COVERAGE NAIC S
INSURER A.Commerce Insurance Co. 347554
INSURED J.M.of New Bedford Co.,Inc.423 Co INSURERS,Torus Specialty
,rehall Street
New Bedford,MA 02746 INSURER C:Endurance American Spec.
INSURER D:
[INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTRNSR TYPE OF INSURANCE D POLICY NUMBER M/Dp E MM DY EXP nnnm LIMITS
C X COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE $ 1,000,0001
CLAWS-MADE OCCUR X CBP10000429401 11/15/2014 11/15/2015
PREMISES $ 100,00
MED EXP(Any one person) $ 5,00
PERSONAL&ADV INJURY $ 1,000,00
GENL AGGREGATE LIMIT APPLIES PER: I i GENERAL AGGREGATE $ 2,000,00
POLICY D JECT LOC
OTHER:
PRODUCTS-COMP/OP AGO $ 1,000,0Q
i ,
$
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
A ANY AUTO I aeddent $ 1,500,00
�BORY16 106108/2014 06/08/2015 BODILY INJURY(Per person) $ALL OWNED X SCHEDULED i
AUTOS BODILY INJURY(Per accident) $
X HIRED AUTOS X NON-OWNED
AUTOSeecider DDAMAG $
X UMBRELLA LIAe X
O $
OCCUR
B EXCESS L1AB CLAIMS-MADE 18117SC143ALI EACH OCCURRENCE $ 1,000,00
DIED X 11/15/2014 11/19/2015 AGGREGATE
RETENTION 10,000 $
WORItER3 COMPENSATION $
AND EMPLOYERS,LIABILITY Y/N I PER OT
ANY PROPRIETOR/PARTNER/EXECUTNE ❑ STATUTE ER
OFFICER/MEMBER ECCLUDED7 N/A f E.L.EACH ACCIDENT $
(Mandatory in NN)
If yes deacrlba under ' E.L.DISEASE-EA EMPLOYE $
DESCRIPTION OF OPERATIONS below
E.LDISEASE-POLICY LIMIT $
DESCRIPTION OF OPERATIONS/LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached H more space is required)
Conservation Services Group/National Grid/NSTAR Gas are included as
dditional Insured on the General liability policy.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Town Of Barnstable THE EXPIRATION DATE THEREOF, NOTICE WILL, BE DELIVERED IN
200 Main Street ACCORDANCE WITH THE POLICY PROVISIONS.
Hyannis, MA 02601 AUTHORIZED REPRESENTATIVE
ACORD 25 2014/01 01988-2014 ACORD CORPORATION. All rights reserved.
( ) The ACORD name and Innn nro re..leae,..r.._a._ -...-__
unrestricted-Buildings of any use group which
contain less than 35,000 cubic feet(991m)of
enclosed space.
('un+Iructiun tity,cr�iwr
CS404088
ELWELL H PERRY
1454 MAIN ST
Failure to possess a current edition of the Massachusetts Acushnet MA 02743
State Building Code is cause for revocation of this license.
For DPS Licensing information visit_ www.Mass.Gov/DPS
eol
05/20/2015
�Fl,.�i rvirurnirrrrrril//ry !lnJJrrr.11rrJr//�
Office of Consumer Affairs&Business Regulation License or registration valid for individul use only
' (&TOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Registration 103195 Type: Office of Consumer Affairs and Business Regulation
�, �� Expiration: 7/6/2016 Private Corporation
10 Park Plaza-Suite 5170
Ares: Boston,MA 02116
JM OF NEW BEDFORD CO.INC.
ELWELL PERRY
423 COGGESHALL ST. g tip
NEW BEDFORD, MA 02746 Undersecretary Not valid without signature
i
OWNER AUTHORIZATION FORM
(Owner's Name)
owner of the property located at
po- d _
(Props Address)
(arty Address)—
hereby authorize V—� ' ` C.�
(Subcontractor)
an authorized subcontractor for RISE Engineering,to act on my behalf to obtain a building
permit and to perform work on my property.
Owner's Signature
x Date
TOWN OF BARNSTABLE Permit No. . �6 L
BUILDING DEPARTMENT
I ""� } TOWN OFFICE BUILDING Cash
679
�auY' HYANNIS,MASS.02601 Bond ................
CERTIFICATE OF USE AND OCCUPANCY
Issued to Horst Dorner
Address Lot #8, 6 Crystal Ridge Road
Cotuit, Mass.
USE.GROUP FIRE GRADING OCCUPANCY LOAD
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 AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE
BUILDING CODE.
February 7 , 94
Building Inspector
i
COMMONF EALTH DEPARTMENT OF PUBLIC SAFETY -Z'
O BrN/�t0
vvi I ONE ASHBORTON.PLACEIa[r�s
MASSACHUSETTS - 80$'16F1, � .
LICENSE CAUTION
EXPIRATION DATE CONSTR.-SUPERVISOR
04/19/19 96 EFFECTIVE DATE LIC-NO. FOR PROTECTION AGAINST
RESTRICTIONS THEFT, PUT RIGHT THUMB
!NONE '� �'1 F"�' 06/30/1993 005645 PRINT IN APPROPRIATE
o BRIAN T DACEY BOX ON LICENSE.
° 62 FERBR OOK :LANE ° BLASTING OPERATORS
m CENTERVILL MA 02632 MUST INCLUDE PHOTO.
PHOTO(BLASTING OPR ONLY) F
b 0.00 NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY PAID �
HEIGHT: STAMPED-OR-SIGNATURE OF T OMMISSIONER
:IUN 2 2 1993
THIS DOCUMENT MUST BE « SIGN NAME IN FULL ABOVE SIGNATURE LINE
CARRIEDON THE PERSON OF IGNATURE OF LICENSEE /�
THE HOLDER WHEN EN'
N Dr. .s•
OTHERS-RIGHT THUMB PRINT GAGED INTHIS OCCUPATION. �ER
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COMMONWEALTH OF MASSACHUSETTS
DEFAIC'MEN"r OF LNDUSTRIALACCIDEIITS
600 WASHINGTON STREET
GanDOel BOSTON, MASSACHUSEIZS 02111
sS�one WORKERS' COMPENSATION INSURANCE AFFIDAVIT
censedpermiaee) _
z principal place of business/residence at:
U,2 6 3 a-
(GryJSureMp)
L,rr-bytify, under the pains and penalties of perjury,thar.mployer providing the following workers' compensation coverage for my employees working on this
rice Company Policy Number
am a sole proprietor and have no one working for me
am a sole proprietor, Waal Contnaor r homeowner(circle one)and have hired the eontraaors listed below
ve the following wor ers compensation insu==policies:
of Contnaor Insurance Company/Policy Number
of Contnaor Insurancc Company/Policy Number
of Contnaor Insurance Company/Policy Number
m 2 homeowner performing all the work myself.
N07T-- .Please be aware tilt while bomeowricn who emoior Persons to do mLmtenancc. construction or repair work on a
�e of not more tbLn three uniu to watch the iomeawricr ciao resides or on the Em"cr aPputZrnaot tberttn are not[snerul�'
Ted to be cm-ploversuaarr the a'oricen' Comveasauon Act (Gig C 152.sea.. 1(S)). application by a bomeowoer for a lieersse
nit may MG.Cocc itc ieFa1 suns of as empiover under the Woriten' Compensation Act
tand that : Corr of this state:-crtt will be forwarced to the Deoar::ttent of lndustria!ArAdena' Office of lnsuranc ref�rtraer
ion inc :tta: i'iurr to secure a7yrrare as reeuircc under Seeaon_5A of ViGL );= an leas to the imposition of e.W nzJ �;�nc
ne of:tine of up to S)500.00 and/or im : n:
pruont:c .t of up to one. and a%v ptmiu= in the Corm of a Stop Qiorc Orde. and a
100.C.0 a day a€a:nst me.
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Assessor's ofFce(1st Floor):
Assessors map andlot number T �� �r 1ISEP7'1C SYSTEU NURT BE
Conservation INSTALLED W CCWPPi:,dNCE
Board of Health( rd floor): WITH TM ). 6 { ��
N'( sb, DASIIT�DLL i
Sewage Permit number O��'�t/ �•� ������6�;K�� a��. .-��1 �`'" eta AND
Engineering'Department 3rd floor: �' F
House number Ito rtar
Definitive Plan Approved by Planning Board /l a f 19 �
APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only
TOWN OF BARNSTABLE
BUILDING INSPECTOR
APPLICATION FOR PERMIT TO 17�Q
TYPE OF CONSTRUCTION _ (N O /
19 90<
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following informatkyr'
07 It
Location
Proposed Use
Zoning District Fire District _U
Name of Owner ICJ Address
Name of Builder Address
Name of Architect / Address
4-2�a—
Number of Rooms (D Foundation
Exterior Roofing
Floors 11.1�2L I/ (/�v Interior
Heating . Li�V.� �Y �tJ Plumbing ��1� � .�
Fireplace ��fCCi,LGl1YvtGF Approximate Cost
Area / Y
Diagram of Lot and Building with Dimensions ,! .�d Fee
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
l
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction.
Name
Construction Supervisor's License
DORNER, HORST
No Permit For BUILD DWELLING
Single Family Dwelling
Location 6 Crystal Ridge Rd. (Lot 8)
r Cotuit r ,f
Owner. `-Horst• Dorner
Wood Frame
Type of Construction
Plot ( 'Lot 1
r" Permit Granted October 6 19 93
Date ofyn'�pecti ✓//7 � g
at o pl' d 19ZZY
1
• r
f
TOWN OF BARNSTABLE, MASSACHUSETTS ®V iT
ti-s6-�. 1, DATE UGt 19 9� Y T4 36223
C�il(�� PERMIT NO.
APPLICANT l3ayside Buildil-19 Co. ADDF_SS _'•U• , .Sox 93F centerVllic 4005645
(NO.) 11(STREET)) 7 -(CONTR'S LICENSE)
DWELL
PERMIT TO buiid J.�Jt1Lli:C1 ( l ) STORY_ v-•-i-'=c1 C.? l��:i-aii vT Dwe. .1T1�t"vBERNG UNITS_
(TYPE OF Lot
N0: (PROPOSED USE)
AT (LOCATION) ot #8, 6 Cr Sta1 1Zidcje Road, cot.Ult ZONING(N0.) (STREET) DISTRICT
BETWEEN AND
(CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT-BLOCK-SIZE
BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
sewuye #92-58
"-REMARKS:
r.
AREA OR
VOLUME 2910 ai• It. ESTIMATED COST 23G� GGG. FEE MIT 173.25
(CUBIC/SQUARE FEET)
B hors[ Dor;: r
":'OWNER
Germany BUILDING DEPT.
ADDRESS 2 BY °
r
THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF. EITHER TEMPORARILY OR
PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE AP-
PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED
®
FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS
OF ANY APPLICABLE SUBDIVISION RESTRICTIONS.
MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS -WHERE APPLICABLE SEPARATE
INSPECTIONS REQUIRED FOR CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR
ALL CONSTRUCTION WORK: ELECTRICAL, PLUMBING AND
1. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS.
2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL
MINAL INSPECTION
TI TO LATHE FINAL INSPECTION HAS BEEN MADE.
3. FINAL INSPECTION BEFORE
OCCUPANCY.
POST THIS CARD SO IT IS VISIBLE FROM STREET
BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS
ct '_��o�7
Z 2
3 HEATING I P 7TION APPROVALS ENGINEERING DEPARTMENT
/.v 6
2 BOARD OF HEALTH
OTHER e SITE PLAN REVIEW APPROVAL
PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION WORK SHALL NOT PROCEED UNTIL THE INSPEC- INSPECTIONS INDICATED ON THIS CARD CAN BE
TOR HAS APPROVED THE VARIOUOS STAGES OF WORK 15 NOT STARTED WITHIN SIX MONTHS OF DATE THE ARRANGED FOR BY TELEPHONE OR WRITTEN
CONSTRUCTION. PERMIT IS NOTIFICATION.
FRONT. ELEVATION
-CEILING ASSEMBLY G.YIA.' •
TOT&I-ol' .R
7C? SURF-r` WI11DOWS:
f v-". lrFIZcRriLaSS
INSL'LATIC:1 .}t.
`-- SHEETROCK
DOORS
• BOTTOM SURFACE
R= 0.61
PLYWOOD - •r
INSIDE.' SURFACE X. _ ads..
0.62 . R? 0.63 REAR* ' EL'E •_VATION s' gq
WALL ASSEJJBLY G.w.A:.f :; :J.�r. ;,• , :
)0 Ile SHEETROCK ,.:.' 4•
4GLEs R 0.45. TOTAL R - '0g/•79.
0.87 LL///_
'SIDE FIBERGLASS .....' . �: :' •:5 :'�' :. �`
:FACE' INSULATION. 'r.•:..: ';: rt:`
0.17
SURFACE RESISTANCE
Rs0.61
FINIS OORSi
H FLOOR f f �'•�''' 3 d
� a'r•�',.�fir.:_
1120.91
1/2" PLYWOOD FLOOR
ASSEMBLY _ ..'•::fir
I SUSFLOOR TOTAL.
' R=A.62 U = ,:037 . -HT . SI^E. EL
RI EV TtC• '`'
91DEfq
.17
:�: .•c ,i�: �� ,WINDOWS:
" FIBERGLASS
..�w• `.
i• INSULATION 1 :.
:1C. • R= d FOUNDATION ! .
WALL ctSSci/,aLY . I `
-L7j�.SHALL ` -000F.S: ` •'r•:� � i /�.
�. .•.•S SU?FACE RESISTANCE (h1AY BE .'USED N/�.
• R s 0.61 INSTEAD OF FLOOR
••' INSULATION ) .:+ t...
. ' '••► TOTAL' R= LEFT :S10E`:l±!
11YEI;ACE
' GCK. r:t\uQiYS:
tit
R s 5 DOORS '
_s:
iN UL t,
LY INSTALL C` a �1TiG�1 SECTION
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