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"', '.'�", ,,'Ii 1, ,� ���_�,I �; ��.,,�,,- , : -L�,-, ­.�. . -, " �, I . 7�,,,11, ,�_1`�`�"_ � 1"`,:�,,_', � ­ �,' � .���,", &A Ali� , . , , , �--;:.t­��',' ,_ , ��',l !:'�',:,-�.,,",�,��" .� , , 11 � 0 I 0002JARWIT, t­,�� L�_��,, ,, ,I �� ,-, , ,�,'� - ,,,.,-_, ,",_ ,� :: -": VA�;til�ll ,; V: 1-i 1. -�, , , I �1�1 I " -"�� __L� � __ . � "W xn ,� 41 1 HAS; � t t ` Town of Barnstable *permit# �OF THE)(]�.� {.ay,J E�'=w➢+j j Expires: ro fronr_rssue elate Regulatory Services Fee IARNSTABLEI + I MASS. Thomas F. Geiler,Director �,� �l RFD MAC Building.Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number 7 ` V �— I Property Address ,1 ii -- 1 Residential Value of Work Minimum fee of$25.00 for-work under$6000.00 Owner's Name&Address Zn l,/' / Contractor's Name 42�-S LIQ))2e (7,p—,17 Telephone,Number �2 �f:C, -7 Home Improvement Contractor License#,(if applicable)� y 6 Ely Construction Supervisor's License#(if applicable) 7 �/ ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner A-I have Worker's Compensation Insurance Insurance Company Name Ins-s� Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction.debris will be taken to ❑ Re-roof(not stripping. Going over existing layers of roof) 'Re-side �? #of doors P.Replacement Windows/doors/sliders. U-Value CY'. (' (maximum 44)#of windows *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License& Construction Supervisors License is required. SIGNATURE: 15:52 5089973324 HICK INSURANCE LVKJQ- PAGE 02 CERTIFICATE OF LIABILITY INS1' ' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMRTION ONLY AND CONFERg U MNICE OP ID LG DATE(M►A+DDrYYyYI CERTIFICATE DOES NOT AFFIRMgTIVEEy.OR NEGATIVELY AMEND,EXTEND OR ALTER THE 07 � 10 BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CO RIGHT$UPON THE CERTIFICgTE WOl- R.THIS REPRESENTATIVE OR PRODUCER,AND 7}IE CERTIFICATE HOLDER, COVERAGE AFFORDED 15Y THE POLICIES JM Nrtt�'CT BETWEEN THE ISSUING INSURER(S),AUTHORIZED R I t e cern cafe ho der a an D fhe termS and conditions of the Polfc ,a L U D, Y attain policies may require an endorses mule a en ors® , I U certificate holtler in ileu of such snap T1 i PRODUCER rsetnent(s)• endorsement. A statement on this ceftiifl Al D,su ject to cats does not confer rights to the xuhreY, Covill lr Coleman Insurance Aget1C NAJu(E; 3.95 Rempt:on St.x, Ina. New Bedford P-0• Box 1901 � 'g. MA 02 741 AoORE53: '— -- AJC.Na)- phone:508-99773321 - --�^ — INSURED CUSTOMERInjI. X]UMy)g1 - Xenue t INSURERMSI AFPOR0ING COWRAGE ClearvM'110-e Improvement oveme INsuRERA; Commerce Inautance Co. NArclp 5 weeden. Place r°peau,�nt INSURERB: Norfolk 34754 Fairhaven MA 02719 Dedham INSURERC: 23965 INSURER D: COVERAGES 1NSUM E; THIS is To CE CERTIFICATE NUMBER: lNsuRER F; RTfr r THAT 7}{E pOLICIE E OF INSURANCE L(STEb BEt,OW HgyE QEEN IS8U11 E0 Tp TWE INSURED NAMEb AsOyE FOR THE INDICATED- IVOT+MTi13TAN01NG ANY REQUIREMENT,TERM OR CONDRION OF ANYCONTR 11 pCTOR OTHER DOCUMENT WITH REVISION NUMHEa; CERTIFICATE MAY Cr LDSUED OR MAY PERTAIN,THE INSURANCE NDITIOR F ANY POLICIES DESCRIER HEREIN JS SLIB,I EXCLUSIONg AND CONDITION of POLICY PERIOD SUCH f O ICIEs,LIMITS SHOWN RESPECT TO TERMS, L MAY HA. ECT TO ALL THE LTR TYPE OF INsuagNCE �BEEN REDUCED BY PAID CLAIM$, TERMS. GENERAL LIABILITY INSR POLICY NUMBER $ X COMMERCIAL GENERAL LIABILITY LIMITS CLAIMS- R0652279,A E OCCURRENCE S ACH 1,000 ����OCCUR 02/0!/10 - 03/OY/11 �iOO D PREMISES a occurrence $5 0,000 X. MED EXP(Any one person) $5, GEN•L AGGREGATE MI APPLIES PER: PERSONAL d ADV INJURY S 1,0 0 0,D 0 0 X LICY P GENERAL AGGREGATE AUTOMOBILEWA81L1TY LOC $2,000,000 PRODUCTS.COMPIOP AGG S 2,0 0 0,0 O 0 ANY AUTO - S ALL OVAJE0 AUTOS fC-a O aBINED SINGLE LILt� $ I X SCHEDULED AUTO$ BODILY INJURY{Pei psrgp� $ A X FIIREDAUTD$ I• 100000 BODILY INJURY{Per SI 2300000 X NON OWNFID AUI RYJ3 9 2 PROPERTY DAMAGE ) o?/ae/So aA/aa/1.1 (per danQ R1000()0 UMBRELLA LIAR $ EXCESS LIAB OCCUR CLAwq-MADE S bEDUCTI E - EACH OCCURRENCE . RETENTION S AGGREGATE $ WORKERS Compt:NSATION . AND EMPLOYERS LIABILry _ ANY PROPI JUUOWPARTNERIEXECUTiVFYIN OFPICEaJMEMBER EXCLUDED? TORY LmAfiS (Mandatory In Nf{) 1A ER If DESCRI aeiba urtlsr E.L.CA ACCIDENT PTI ON OF OPERATIONS Oefow - - b E.L DISEASE-EA EMPLOY $ F.L.DISEASE-POLICY LIMIT S DESCRfPT10N OF DPERATJONS 1 L OCInc. 1 YEWICLES IA�Ch ACORD iDt,Ad�1vmM Remarks Scheeub K mo,B apato le rage insuredCas�reapectlto�t:heaQeneral -LiabilUJ & y. and all epb8idiarigg ire flamed a Adfl,itiotlal y Gominercial-Auto policy. CERTIFICATE HOLDER CANCELLATION LOVES-1 SHOULDANY OF THE AHOvE DESCRIBED POLICEE8 BE CANCELLED BEFOr�TH! PUtAT1ON DAB THEREOF,NOTICE 1MLL BE DELIVERED IN Loweta Compouiea, IJac. ACCORDANCE WITN THE POLICY PROVISIONS. Attn: I3 Insurance' PO Box 1111 A...... ZEDREPR£S%rTATrM N. Wilkesboro NC 28656 LICORD 2009/09 "98edOMORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD e { Al c Or ,tn;t . . ;,;rE{tar cta ,c :,>,, 75153 rr •r:; 00 ENE ENDALL 5 WEEDEN PLACE FAIRHAVEN, MA 02719 '�'• 1/1 2J201 10058 K L J ' 3 J • a e f! a 9Xe �anz nuyrculea / o�/ eaac�icaelta - Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation Registratiory 148688 i0'Park Plaza-Suite 5170 Expira€tgr Boston,MA 02116 y - 7 S'u@ -ment Card ' LOWE'S HOMES G1tP.S�t�r •k� JAY MI RODRIG611Z-.r,~r; . i. 136TURNPIKE Rd SUITE=A00 - SOUTH BOROUGH MA 01772 Undersecretary Netwalid without signature ,-vv `5 9 Z • ;� -The Commonwealth oflVlassachusetts Department of Industria4Accidents . Office of Investigations 600 Washington Street f Boston MA 02111 `�Zw www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individuat); Laos, S Address: fti r City/State/Zip: IJ6 h2 / Phone #: Are you,an employer? Check the.a-ppropriat Sox: Type of project(required): 1.❑ I am a employer with 4. I am a general contractor and I _ 6. 0 New construction employees (full and/or part-time).* have hired the sub-contractors 2.El am a sole proprietor or partner listed on the attached sheet.. 7, Remodeling ship and have no employees These sub-contractor's have g, Fj Demolition workingfor me in an capacity.' employees and have workers' y . . 9. ❑.Building addition [No workers' comp. insurance comp. insurance. required.] 5. We area corporation and,its 10.❑Electrical repairs or addition 3.0'1 am a homeowner doing all work officers cers,have exercised their I LE]Plumbing repairs or addition myself'[No workers' comp. : right of exemption per MGL ' 12.[j Roof repairs insurance'required.] t C. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp.insurance required.] *Any applicant that checks box 41 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 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 insfiran'ce for any employees. Below is the policy and job site information... Insurance Company Name: f AV/ S� j Policy# or Self-ins.Lic.M. . Expiration Date:. Job Site Address: City/State/Zipe/1rl �9��/2 Lja Attach a copy of the workers' compensation policy declaration (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MOL 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 STOP WORK.ORDER and a fin( 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 under the pains andpenalties of perjuy that the information provided above is trite and correct. Si nature Date: l ICJ • Phone#: � l� ' . . 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 ofBea,lth 2.Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other I ti Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an emplo},ee 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 that"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 conunonwealth 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 pen-nit 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 of 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 markedyby the city or town may be provided to the applicant as proof that a valid affidavit is on file for fixture 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 like 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. N 617-727-4900 ext 406 or 1-877-MASSAFE Fax N 617427-7749 Revised 4-24-07 www.inass.gov/dia r -. �YHE r Town of Barnstable c Regulatory. Services ' BARNSTABLE, ' Thomas F. Geiler,Director ru,as. - 9� A ,1. Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.b arnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner'Must Complete and Sign This Section If Using A Builder. • I, �( �j ��� „� J(J�( J 7'YJ / , as Owner of the subject property , hereby authorize 10 to act on my behalf, ^in all matter's xelative to work authorized by this building permit application for. 17 (Address of job)/ Signature of Owrer.. Date Print Name - - a ,If Property Owner is applying for permit please complete the 'Homeowners License Exemption Form on.the reverse side: 0 Town of Barnstable Of HE rV • o Regulatory Services • ' Thomas F.Geiler,Director BnatvsrABLE, MASS. s 63 9* Building Division v� - PI�D �a Torn Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 wmvw.town.b arnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION r Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": work hone tl name home phone#i p CURRENT MAILING ADDRESS: 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. 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. F 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 1 om I -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to dQ such work,that such Homeowner shall act as supervisor." dix • Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appenparticular particularly Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often.results in serious problems, ly 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 helshe 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. n.kwnnn G(z\Fr)PM.R\hnmeexemot.DOC o � 1. ' amass . Btrston�11�A p�IX� _ Workers_ � 1 A hca11t psaion ai + Gai x ic �usfF IN Name 'bl Aftew. Are yob aa.;ewployW_. ec t# aPP TT 1. I am-a eaoioy wig 4 Ana agette r f fr d): CMPIDYCM(fa auftipart hay, 2 ( I ant a solc pP�icf or3er '00o 3 t y Ay a have no emp These suOontrac �sd work Mg forme in any Caiiacity. [N° r'°rkes'carp•i�nsiic Suanee, . acor Q mg addaron 3.❑ I Am a►nar> ads haueit TiY Et or.aditid db w all:aorg (IJo works'`eomp; c haas,or additions e Yumea.]t lid"€•rcpa� s T3 t appa c bCac1' st a :g� � 't �L ' �r w " ek . �- � M a =CIL R711 an l7tfp ��i�Qr� �7V�����.1� •.. . ' h * ��;�ok Sura sift InnOe Company N ame. ' d. Policy#or Self-i ft.Lit* F Ja�p Site Address: Attacg a e }r orthe.rvor '�mpenn1 'dRr Fare m seMe Maier won S ,500 MvyY'' j 5 y�Tly� �� fine��' �' Va/ Y°+ � rV� Nd ./lI{9jY�l (y <W �.t� ofnp to$250.00 a day. weE.as cp ffi o Pes Of a DIA F a 'AY.e `tluss� me�t ammd a# ' f�i rosaraIIce coverage� cntios, ', ���e�ffioce.of r4hd 'rwtderthF parrsp ofpry � ; rnfa+ ra�yox p�obat►�fit prrd correct. ,. .. r.. metal r+se Do rrat wrke h:.lh�s area, aty or Town: a 1=0bg Anthortty(drde We 1<.Board Of.$eaith 2.AdIdIii 6.Other � '� k 4r �' or. Pltimb�ng Inspector Contact Person: , r a y . INSTALLED SALES SPECIALIST NUMBER... CUSTOMER w STORE N . "� STREET ADDRESA ) ✓ STREET_ADDRESS 2 CITY STAT ZIP' CITY STATE' ZIP TELEPHONE TELEPHONE00 DAT LOWE'S HOME CENTERS,INC.'S MA HIC NO,: 148666 CASH BANK LCC REG F, .. - CARD CHARGE FEIN:56-0748358 , INSTALLATION STREET ADDRESS, CITY STATE ZIP S TA Zf Contract Total *a licable tax included Q . p Are permits required for this installation?: Yes .[ ] No P V p 4 f�. NOTICE TO CUSTOMER:Federal.law requires.Lowe's to provide you with the pamplet Renovate Right:important Lead.Hazard Information for Famil- ie.4;Child:Care Providers and Schools.By signing this.Contract;Customer acknowledges having received a copy of this pamphlet before work began.: informing Customer of the potentiahrlsk of the lead hazard'exposure from'renovation;Activity to.be performed in Customer's dwelling unit, Work is to commence upon reasonable availability of Contractor and/or availability o any special order orcustom made Goods which is anticipated to be 2 `�C -' Q [fill in date]. Estimated completion date is ZA 3 a. ''/ [fill in.date]., Said estimated substantial completion date.is not of the essence. Contingencies that may materially change said estimated completion date follow:: (if applicable insert a statement of such contingencies). IF THE CONTRACT TOTAL IS$1,000.00 OR LESS Customer must pay in full., COMPLETE THIS SECTION ONLY WHEN THE CONTRACT TOTAL EXCEEDS$1,000.00: [ ustomer to Pay in Full; OR [ ]Customer to use'the following'payment schedule: (1)Deposit $ to be paid.upon siging contract..Deposit should be 1./3.the total contract.price;and (2)Payment of$ to be.paid anytime after this Contract Is signed and.before commencement of installation,I/We authorize Lowe's to do one of the following(check appropriate box below): [ ]Charge my/our credit card for the amount of the payment indicated above Anytime after.the date this Contract is signed; or [ ]Deposit my/our check for the amount of the payment indicated above anytime after the date this Contract is signed;:and- (3)Final payment of$100.60 to be paid upon completion of the installation.and.both parties'satisfaction. NOTICE REGARDING ARBITRATION AGREEMENT FOR CLAIMS COVERED BY M.G.L.c 142A LOWE'S AND OWNER HEREBY MUTUALLY AGREE IN ADVANCE THAT IN THE EVENT LOWE S HAS"A DISPUTE CONCERNING THIS CONTRACT,THAT LOWE'S MAY SUBMIT SUCH DISPUTE TO A PRIVATE ARBITRATION SERVICE WHICH HAS BEEN;APPROVED BY THE SECRETARY OF THE EXECUT- IVE OFFICE OF CONSUMER AFFAIRS AND BUISNESS REGULATIONS AND,THE OWNERSHALL BE-REQUIRED TO SUBMIT TO SUCH ARBITRATION AS PROVI�IN G. By: Date •a s�► Lowe's a Centers,Inc/ B j_.f GG�G e� d`�i7 �4e <_ = Date � ,���w►� ) (sied cv,- J o6S . 5 [I-V-fixah 2,® yOFTMET��� TOWN N OF BARNSTABLE ' Z BAHB9TA11LB, i NAM �•� BUILDING INSPECTOR am a' APPLICATION FOR PERMIT TO !�/��� A. .R� PE,� ............................... •.........................j... ...................................... TYPE OF CONSTRUCTION ........ ��'.?, `'r 41 � �-' ...........................�J���r............19.`�� TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .... �.......�t.(� �,. ....... .f........��..o.�f ........................................................................... ProposedUse ............ ............................................................................. ......................................... Zoning District ... . . ..................................................Fire District .... 57 �1/..Li Name of Owner 1 0,455, .................................y........Addresses... ...../.......Y...4:ls ..G...f�.�.......... t... _ Nameof Builder ... G...............................................Address .................................................................................... Name of Architect P�!.!S.!jAg:? 1�/C-LtiKA CZS 1c� Address ...!..�. �✓✓ /I✓�1��✓.. .. ............. ........ ................. Number of Rooms ...............Foundation ............................................................... Exterior ....111J.�01� f Nis S! �A L% /.......... ....................................Roofing .....:�................. ..................................................... Floors ......?. YweOj ......5 �t R. �.....:.................Interior ..... ............................................................. Heating ...:�:�?..1....w ~�� /d l L- Plumbin ��r��' ..............1....................................... g ............................................................................ .. Fireplace ........QNE...............................................................Approximate Cost ..... : .6.®...` .� . .. .. ..... Definitive Plan.Approved by Planning Board �______19 O � =� Diagram of Lot and Building with Dimensions ? � z .� n J SUBJECT TO APPROVAL OF BOARD OF HEALTH ' w Ld = m m . p ¢ , i 'L V Li. C, F--;, Uj t vD }%7 d >- �v O Uj It > Cn = � Q ~ W ZZ LLJ Q (D ^ a gr4 ;;q jjLd - - bvf C! ff7 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. I. Name Daniel A. Brown Jr., Inc. No ...15658.. Permit for .......one story .................. single family dwelii ng ..................................... ...................................... Location .Q� Coach--Light Road . ......................................................... i Centerville .............................................................................. Owner ....... a'niel..A....Brown Jr., Inc. � �'. frame - ,rf_ Type of Construction .......................................... ................................................................................ q a Plot ............................ Lot ...............:................ jl� Permit Granted ....... ..... .....19 72, Date of Inspection ....................................19 yj 3 Date Completed ....�.. . .... ............19 P®'q P C_ PERMIT REFUSED ................................................................ 19 ............................................................................... .........................:...................................................... .................................................................... ....... ............................................................................... Approved ................................................. 19 ............................................................................... .................... ......................................................... 4