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a:RAMSMOM ,Post This Card So.That it is Visible From the Street-Approved Plans Must be RetaiLned on,Job and this Card Must be Kept
A. �PostedUntdFinal,Inspection Has Been Made. - - ��rn11�
Wher`e a Certificate of�ccupancy'is Required;such Building shall Note be Ocoupieduntil a Final Inspection has been made. Yll
Permit NO. B-20-91 Applicant Name: PETER J APPLETON Approvals
Date Issued: 02/05/2020 Current Use: Structure
Permit Type: Building-Deck Expiration Date: 08/05/2620 Foundation:
Location: 60 CENTERVILLE AVENUE,CENTERVILLE Map/Lot: 226-113 Zoning District: RB Sheathing:
Owner on Record: BERGEN,WALDEMAR TR Contractor Nam PETER J APPLETON Framing: 1
z ;
Address: 1325 S PORTOFINO DR UNIT#306 Contractor�Licerise CS=005414 2
SARASOTA, FL 34242Q , Est..Project Cost: $ 10,000.00 Chimney:
Description: remove old deck and replacing with new-same size 16 x 20 Permit Fee: $ 110.00
Insulation:
Project Review Req: Fee Paid:, $ 110.00
Date r 2/5/2020
Final:
Plumbing/Gas
r Rough Plumbing:
' Building Official
Final Plumbing:
This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after'issuance.
All work authorized by this permit shall conform to the approved application and the'approved construction documents for which this permit has been granted. Rough Gas:
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 forypublic 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 sign atures,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 Rough:
2.Sheathing inspection ;a. �� _ >•= ^.
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 <
F 3 t Legend
Parcels
s, Town Boundary
Railroad Tracks
Buildings
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Approx.Building
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Painted Lines
a� Parking Lots
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Driveways
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SCANNED
#38
FEB 0 5 2020
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Map printed on: 12/9/2019 This map is for illustration purposes only.It is not Parcel lines shown on this map are only graphic Town of Barnstable GIS Unit
adequate for legal boundary determination or representations of Assessor's tax parcels.They are
Feet regulatory interpretation.This map does not represent not true property boundaries and do not represent 367 Main Street,Hyannis,MA 026oi
O 21 42 an on-the-ground survey.It may be generalized,may not accurate relationships to physical objects on the map 508-862-4624
reflect current conditions,and may contain such as building locations.
Approx.Scale: 1 inch= 21 feet Q cartographic errors or omissions. gis@town.barnstable.ma.us
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,APPLETON CONSTRUCTION 50 -
37 BAIRD`WAY Tel
(508
CENTERVILtE.°MA 02632_ 11c. #005414
PROPOSAL SUBMITTED TO
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STREETATE
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CITY,STATE ANO11111,111-1111-
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We hereby submit spe6ificatsons andlllI
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' pro�Qsr hereby to;furniah material and labor.—complete in accordant a with the above specrfic lions,fora
he sum of:
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Payment-to be made as folt :.owa ($
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';All matanai ra guaranteed:to be as specified All work to be completed in a
warkmarihke manner according to atendard practices Any alterations ar deviations. Authorized
6om the:above specifications involving extra.c6*will be executetl only upon written Signature '
ordere,and will.become an extra charge over8nd above the estimate.`AlPagreemente.
;:contingent upon strikes acgldents ordef
: ..
ays beyond ourcontrel.,Owster to:carry.fire, '
wind damage and;.other:necesaery',inaurance:r Our workere aro:fully covered b ota; Thus Proposal,may.be '
Workmen s Corimpensauon:Insurance.' "
Y' withdrawn by us if no
t accepted within
day9
rirl'-` rlo�►ul�al sp The:above prices.
Aecdieatsona and conditions ere
satiafacto aitd are.here
►Y. . by accepted. You are Signatu
authonzad to do tte work 88 specihed Payment will be made as outlined above.
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,Gate of Acceptance
I
BUILDING DEPT.
JAN 2 2 2020
I OF BARNSTABLE
NOTICE 96TICE
TO e TO
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EMPLOYEES EMPLOYEES
x
The Commonwealth of Massachusetts
DEPARTMENT OF INDUSTRIAL ACCIDENTS
1 Congress Street, Suite 100, Boston, Massachusetts 02114-2017
617-727-4900
As required by Massachusetts General Law,Chapter 152, Sections 21, 22, &30,this will give you
notice that I(we)have provided payment to our injured employees under the above mentioned
chapter by insuring with:
l
Associated Employers Insurance Company
NAME OF INSURANCE COMPANY
P.O. Box 4070 Burlington, MA 01803-0970
ADDRESS OF INSURANCE COMPANY
WCC=500-5013114-2019A 03/24/2019-03/24/2020
POLICY NUMBER EFFECTIVE DATES
411 Route 28
Chagnon Insurance Agency Inc West Yarmouth, MA 02673
NAME OF INSURANCE AGENT ADDRESS PHONE
Appleton Construction 37 Baird Way Centerville, MA 02632
EMPLOYER ADDRESS
02/22/2019
DATE
MEDICAL TREATMENT
The 'above named insurer is required in cases of personal injuries arising out of and in the course of
employment to furnish adequate and reasonable hospital and medical services in accordance w#h the
provisions of the Workers Compensation Act. A copy of the First Report of Injury mast be given to the
injured employee. The employee may select his or her own physician. The reasonable cost of the services
provided by the treating physician will be paid by the insurer, if the treatment is necessary and
reasonably connected to the work related injury. In cases requiring hospital attention, employees are
hereby notified that the insurer has arranged for such attention at the
NEAREST AND BEST MEDICAL FACILITY
HOSPITAL ADDRESS
TO BE POSTED BY EMPLOYER
NG®EPA -
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Code Cxe.cr'satien Gros Area Effective.Area living Arca -
BAS First Floor - 2054.;,. 2054 2054
BMT Basement Are 3 1320 0 0
FPC Open Porch Conc.Floor 54 0 0
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WDK Wood Deck 304 0 0
Y� Va re3hfer F
Code Ccs cription - Units - `U nitpnae - Year:BuiIt Value 6bmmentc
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BFA Bsmt Fin Avg 600 $17 36 1988 $7 200
BGR2 2 Stall Bmt Gar 1 $3,244.00 1988 $2,200
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!Registration valid for.individual use only
f before the expiration date If found return to:ulation
office of Con ton Streetir suite Business Reg
{ 1000 Washing
Boston,MA 02118
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���pan�rnza?uuea�'airs&Business
VEMENGO�TRACTOR
Office of Consumer{itf IndaAdtial
HOMEIMPRO
TYPyE'c,
ra ions 0710512020
103218 � �
PETER APPLET V`_
PETER WAY , Undersecretary
3?SAl 02532``
GEN(ERVILLE,MA r i
Commonwealth of Massachusetts
Division of Professional Licen tan
Board of Building Regul lions and Standards
Consk Nisor,
�ires:0610812020
CS-005414 ? '� 11
PETER J APPLETON s
37 BAIRD W A>¢ 0263 � S n ;
CENTERVILLE�NF�
Commissioner
111
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gQk The Commonwealth of Massachusetts
Department of IndustrWAccidentv
Office of Investigations
600 Washington Street
Boston,MA 02111
www.massgov/dia. '
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Ledbly
6
Name(Business/Organization/Individual): 1.6-6L 444 C_ pX___V4
Address:
City/State/Zip: Phone#: S 7 d
Are you a ployer?Check the appropriate bog: Type of project(required):
1: am a employer with � 4. ❑ I tam a general contractor and I
employees(full and/or part-time).* have hired the sub-contractors 6. ew construction.
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remode'
ship and have no employees These sub-contractors have g• ' 'on
working for me in an aci employees and have workers'
Y capacity. z 9. ❑Building addition
[No workers'comp.insurance comp.insurance.
required,] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11-❑Plumbing repairs or additions
myself.[No workers'--comp.. -- 1 right of exemption per MGL 12.❑Roof repairs
insurance required.]t c. 152,§1(4),and we have no
employees.[No workers' 13.❑Other f�!G o5bCi�"
comp.insurance required.]
*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 mast submit anew affidavit indicating such.
$Contractors that check this box must attached an additional sbeet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. ••
I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lia#: ( —5'Gl� t31` ag Expiration,Date:
Job Site Address: �� �/ud�l �-- City/State/Zip: �'Qye,1141A
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 cj#6undAthep ' aWpenafties of perjury that the information provided above is true and correct
Si ature: 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.C#y/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#s'
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire,
express or implied,oral or written."
An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152,§25C(6)also states first"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public-work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of.
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,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 returned to the city or town that the application for 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 number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in.the permit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for f rt re permits or licenses. A new affidavit must be filled out each
year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit.
The Office of Investigations would hike to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address,telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111 -
Tel.#617-727-4900 ext 406 or 1-877-MASSAM
Revised 4-24-07 Fax#617-727-7749
www:mam.gov/dia
Application Number...........
................... .........................
BUILDING DEPT.
• ELARNSTABLF, •MASS. Permit Fee............. ................Other Fee:.......................
03g6
JAN 2 2 2020
TotalFee Paid............................................................... .......
TOWN OF BARNSTABLE
TOWN OF BARNSTABLE Permit Approval by....... .............:.on......: . .... ..Z�.I.z...
................
BUILDING PERMIT
Map....... t L11.................Parcel........... ..........................
APPLICATION
Section 1 — Owner's Information and Project Location
Project Address ft,4,-,r ui
17 Village—eakJ�,
Owners Name. SCANNED
Owners Legal Address C`eFEB 0.5 2020
City clielJoruv)(0 State zip OC9�3
Owners Cell# E-mail
Section 2 —Use of Structure )
Use Group_ F-1 Commercial Structure over 35,000 cubic feet
❑ Commercial Structure under 35,000 cubic feet
❑ Single/Two Family Dwelling
Section 3 —Type of Permit
El--New Construction ❑ Move/Relocate [:] Accessory Structure ❑ Change of use
U-Se—MO/(entire structure) 0 Finish Basement 0 Family/Amnesty El Fire Alarm
Rebuild P---6eck Apartment El Sprinkler System
F-1 Addition Retaining wall Fj Solar
Renovation ❑ Pool El Insulation
Other—Specify
Section 4 - Work Description
/?,P LAsu Le,
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Last updated: 11/15/2018
i
Application Number.....................................................
Section 5—Detail
Cost of Proposed Construction/0 G(P LU Square Footage of Project
Age of Structure yns Dig Safe Number
#Of Bedrooms Existing Total#Of Bedrooms (proposed)
110 MPH Wind Zone Compliance Method U49A' Checklist ❑ WFCM Checklist ❑ Design
Section 6—Project Specifics
❑ Wiring ❑ Oil Tank Storage ❑ Smoke Detectors
Plumbing ❑ Gas ❑ Fire Suppression
❑ Heating System ❑ Masonry Chimney ❑ Add/relocate bedroom
i
Water Supply ❑ Public ❑ Private
Sewage Disposal ❑ Municipal ❑ On Site
Historic District ❑ Hyannis Historic District ❑ Old Kings Highway
Debris Disposal Facility: I am using a crane ❑ Yes ❑ No
Section 7—Flood Zone
Flood Zone Designation
Within or adjacent to a wetland, coastal bank? Yes ❑ No ❑
Section 8—Zoning Information
Zoning District Proposed Use Lot Area Sq. Ft.
Total Frontage Percentage of Lot Coverage #of Dwelling Units(on site)
Setbacks Front Yard Required Proposed
Rear Yard' Required Proposed
Side Yard Required Proposed
Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No
Last updated: 11/15/2018
Application Number........................................... -
Section 9- Construction Supervisor
Name Telephone Number
Address r�/V - 6+ City�c�/` State )41 Zip ®�
License Number ` License Type Expiration Date aC7-U
Contractors Email / -2 l_ 6 K. Cell #
I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780
CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and
documentation require MR the Town of Barnstable.Attach a copy of your license.
Signature Date
Section 10—Home Improvement Contractor
Name 4.� Telephone Number <-o F St q`mac L
Address S? �✓rl� City � - � State y4 V4 Zip 0�2
Registration Number �O Expiration Date -7 5— O
I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780
CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and
documentation re y MR the Town of Barnstable.Attach a copy of your H.I.C...
Signatur Date
Section 11 —Home Owners License Exemption
Home Owners Name:
Telephone Number Cell or Work Number
I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780
CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and
documentation required by 780 CMR and the Town of Barnstable.
Signature Date
LI 'ANT SIGNATURE
Signature Date
Print Name Telephone NumberD���b
E-mail permit to: Z�a,WLe_ 7?�, �, �_C-0�
Last updated: 11/15/2018
Section 12 —Department Sign-Offs • ,
Health Department F Zoning Board(if required) ❑
Historic District ❑ Site'Plan Review(if required) ❑
Fire Department ❑
Conservation ❑
For commercial work,please take your plans directly to the fire department for approval
Section 13 — Owner's Authorization
i
i
as Owner of the subject property hereby
authorize to act on my behalf, in all
matters relative to work authorized by this building permit application for:
(Address of job)
Signature of Owner t date
Print Name
i
Last updated: 11/15/2018
Assessor's map and lot number .... .�e
.�.. ...
CF'rN E T�
Sewage Permit number � .. ......
.h' Z 33MUSTADLE, i
House number .....................:.................................................. r MA IL
Apo,1639• \00
MAY a'
TOWN OF BARNSTABLE
R BUILDING INSPEC OR
APPLICATION FOR PERMIT TO .............. 1. ......................
......................./............................................
TYPE OF CONSTRUCTION ................. i�.€ f� � '............................
....... . ...............9.
TO THE INSPECTOR OF BUILDINGS:
l
The undersigned hereby applies for a permit according to the following information:
Location ' ef`� �� C �i'leVl�'i` Ssj •
�.........� ...... . . ..................................... <.........................
ProposedUse .....�1..!//: K. ....... ......:�.:� tit, .......................................... ..........................................................
i�
Zoning District ........ `.. ..........Fire District
bb.,�p. ...............n........................ ......... ........................................................
Name of Owner ....��`.'.... ........................................Address ...... •� .... ...... ...°..":....` f4
Name of Builder .................!4 -.h )Address t5 < �-'
Nameof Architect .................................:.••••...........................Address .....................................................................................
..........Foundation . �U l UuC.t�e/Q ••
Number of Rooms .......... ....................................... .............. ................ ...............................
g .
.Roofing ....... ���
Exterior �C� .....:�,••..f�.............................. �:' �i
Floors .Interior 4 11
f�C V . e'......................................
Heating .... •.•• ,4..........-Cay.... �j ems: .........................:...Plumbing ..................................................................................
Fireplace ....................1.!r.. .....................................................Approximate Cost ... .. ...........F QO ......................... .............
.
Definitive Plan Approved by Planning Board ________________________________19________. Area � .a...................
Diagram of Lot and Building with Dimensions Fee S..................................
SUBJECT TO APPROVAL OF BOARD OF HEALTH
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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 .. . . C... ................... ........................
Construction Supervisor's License ..........6.0. .< au... .. ..... .........
W. BERGEN A=226-113
No 28880 Permit for ....................................UILD ADDITION
Single Family Dwelling
Location 60 Centerville Avenue
Centerville
...............................................................................
Owner W.•...Ber. ..g.en
.. . .... . ...........................................
r
Type of Construction Frame ,
..........................................
................................................................................
Plot ............................ Lot ................................
Permit Granted ...... 4.Kxuaxy..2.4.3..........19 86
Date of Inspection.....................................19
Date Completed ......................................19
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Assessor's map and lot number ......a..ca�. .(4 .. ....f f:... SEPTIC SYSTEM MUST BE
FTHET
- INSTALLED IN COPAPLIA
Sewage Permit number ............... ...��9... .,
WITH TITLE 5
-�� ENVIRONMENTAL COD
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ou LE,
Hse number. ......................... .....................
TOWN REGULATIONS owaY.a�Om
TOWN OF BARNSTABLE
BUILDING INSPEC OR
APPLICATION FOR PERMIT TO
d _ ,� .
TYPEOF CONSTRUCTION. .................. .... .............f._..........................................................................................
i nt L1....... 4...............192
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
� aLocation � 1 ....... � C �i...... h/ .. L..'.�' ...................................
L/
ProposedUse ...... .. . . . . . ... ........ ............ ............ . .............................................. ..........................................................
Zoning District ........ ... .... ............n.......................... . ...........Fire District �
Name of Owner .... .:....'CC`. �f�1.....................................Address 4J7jd &�, tc{l � `k'• �pl�t�h���,
Name of Builder C t` 4SJAddress ....... '.✓.�. . ....................6.Ah f/)`k.
Nameof Architect ...................................... ........................Address ..............................-...................................................
Number of Rooms .................................................................Foundation ......... ...............\......................e:....'...............
Exterior ................. !`'..............................................................Roofing .............. .1.�&,p.............................. .......'..................
Floors Interior f�' .Wq �.
................... ............. .... ............................................................
j/ �d 9 ..Plumbin ............................................................
Heatin g !/..Q....... .......... .u.....��...3......................... g ...................
Fireplace .:........... Approximate. Cost ..... .
P(..Q
Definitive Plan Approved by Planning Board ________________________________19_______ . Area ...... ........../
Diagram of Lot and Building with Dimensions Fee ......
L'.......................................
SUBJECT TO APPROVAL OF BOARD OF HEALTH
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New 441'
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$2°
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/due
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 .... .. ... ...................
Construction Supervisor's License .......... 1.o?.(..... j
W. BERGEN
40
No .,gAMP.... Permit for ...BUILD ADDITION
. ....................
Sin lejamily..PW�jjing....................
.................a.... ........... . ....
Location .......60...C.en.t.e.rvi.l.l.e...Av.e.nue............... . .... . . ...... . . . .... . ......
Centerville
...............................................................................
Owner .........W.-.A.eU.e11......................................
Type of Construction ......Frame..........................
.......................................................................
Plot ............................ Lot ................................
January-24, 86
Permit Granted ........................................19
19
Date of Inspection ....................................19
Date Completed ..................... .................1 949,11"
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