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f
YOU WISH TO OPEN A BUSINESS?
For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you
must do by M.G.L.-it does-not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis..
Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601. (Town Hall) and get the Business Certificate that is
required by law.
i DATE: l'7 l Fill in please:
APPLICANT'S YOUR NAME/S: n
_BUSINESS YOUR HOME ADDRESS:
t:_•A"�, th1�i,: iy�' .4i.n;'r��'1"-•,'y'a,'r.I O .
TELEPHONE # Home Telephone Numbe "'S
EIN #: E-MAIL:
NAME OF CORPORATION:
NAME OF NEW BUSINESS k �� TYPE OF BUSINESS ' s s� S
IS THIS A HOME OCCUPATION." . YES'/ N
ADDRESS OF BUSINESS./�1 r 'r` iMAP/PARCEL NUMBER /c� 6 (Assessing)
When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of
Barnstable. This form is intended to assist you in obtaining the inform ation,you.may need: You MUST GO TO 200 Main St. (corner of Yarmouth '
Rd. & Main Street) to make sure you have the appropriate permits and licenses.required to legally operate your business in this town.
1, BUILDING CO *Athorized
ER'S00FICE This individ In of a y rmit requi emen s that pertain to this type of business.
Sign
COMMENTS: r i �
2. .BOARD OF HEALTH
This individual has been inform mit requirements that pertain to this type of business.. -
Authprized Si nature*+
COMMENTS:
3. CONSUMER AFFAIRS [LIPENSING TJITY)This individual ha en informe ofte i kg
requirements that pertain to this type of business.
orized Si ature**
COMMENTS:
YOU WISH TO OPEN A BUSINESS?
For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you
must do by M.G.L. -it does-not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis.
Take the completed form to the Town Clerk's Office, 1st FI., 367 Main St., Hyannis, MA 02601. (Town Hall) and get the Business Certificate that is
required by law.
', . >,:;•..: -. Y' ,:�'..,.. :! DATE: r Fill in please:
APPLICANTS YOUR NAME/S: Lag
i:•;;It•fib.,,.,:,x'
BUSINESS YOUR HOME ADDRESS: �' '
C
1. 14
TELEPHONE # Home Telephone Number
�' '" ;�.a:r.+'::r ;;l:�er•:';; EIN #: E-MAIL:
NAME OF CORPORATION:
NAME OF-NEW BUSINESS ,, TYPE OF BUSINESS r << S
IS THIS A'HOME OCCUPATION`? . • YES'/ N
ADDRESS OF BUSINESS.q- 'r- A,- c�MAP/PARCEL NUMBER /8 (Assessing)
When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of
Barnstable. This form is intended to assist you in obtaining the information you.may need. You MUST GO TO 200 Main St.— (corner of Yarmouth '
Rd. & Main Street) to make sure you have the appropriate permits and licenses.required to legally operate your business in this town.
I. BUILDING COMMISSIONER'S OFFICE
This individual has been informed of any permit requirements that pertain to this type of business.
Authorized Signature**
COMMENTS:
r
2. BOARD OF HEALTH
This individual has been inform mit requirements that pertain to this type of business.
Authprized Si nature**
COMMENTS:
3. CONSUMER AFFAIRS (LICENSING AUTHORITY)
This individual has been informed of the licensing requirements that pertain to this type of business.
Authorized Signature**
COMMENTS: .
O�THE Town of Barnstable *Permit# 1 3
"res 6 months rom issue date
fe"� Regulatory Services e f Z410
sARNSTAaLE.
y Mass. Richard V.Scali,Director
�pT i639.%
fDN10 Building Division �- -
Paul Roma,Building Commissioner
200 Main Street,Hyannis,MA 02601 NOV O 8 2010
www.town.barnstable.ma.uS. pp�11
Office: 508-862-4038 OWN O� Ul`1RNSTABL&-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
Not Valid without Red X-Press Imprint
1,Map/parcel Number 1� _O O?_�._ ,
Property Address `q l-6 O CA R to- 9,8. �e.,-.-�-e.R /tL.L-2 M A
❑ Residential Value of Work$ o r �inimum fee of$35.00 for work under$6000.00
• r -
Owner's Name&Address C(L a c�Cel: 7 ''�
PC)C)ny, L6l., OsTe.ad tt.Le, lbw 0265
Contractor's Name Qo.c, Telephone Numbers [ Y 7 ' ,g
Home Improvement Contractor License#(if applicable) ,1Ca 3D. Email: n E L0 L6 A,,r\n-,Ke . C_•;.,rr,
Construction Supervisor's License#(if applicable) C.S — O G �}
Workman's Compensation Insurance
\\ Check one:
❑ I am a sole proprietor
❑ I am the Homeowner
I have Worker's Compensation Insurance
Insurance Company Name ASS GC e--� C" (o/!Lrr V`C-U t'A-1,1C-f 6
f
Workman's Comp.Policy# 0 C C ���O ` S o�"�i 1i S AC> i8 A
Copy of Insurance Compliance Certificate must accompany each permit.
Permit Request(check box) '
❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to
❑ Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof)
1 Re-side
❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows:
#of doors:
❑ Smoke/Carbon Monoxide detectors 4 floor plans-marked with red S and inspections required.
Separate Electrical&Fire Permits required.
*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:
QAWPFILESTORMS\building permit fonns\EXPRESS.doc
06/20/16 e;
1t
?lie Comniornvealth of-Vassach"Setts
Departrumt crf fmikstrialAcciderds
- -- Office of• 77eytigoam.
600 Waslihigion Street
Baston,A 02111
kt mitmasmgovfrlia
-tark-ere CrmpensatianInsuranceAffidavit:Bmlders/GantraciursJEIecfricians/Phunbers
Applicant Infarmafan Please Print F.eQr-blv
Naim(Bus lessf()rgantzakourfn&ddaaly I r i- C o e 16 j2 -
..
City/Sta.&Zig �`� r J < t(ei�, IiN` (� ® S"J Pl�on
Are you an employer?.0 heckthe appropriate box: Type of project(required):
1.5t,l am a employer with_ 4 ❑I am a general contractor and I 6. ❑I etv consi=arcfian
employees(fish ar<dfor part-time)-* have hired the soli-contractors
2.ElI am sole etar ar listed on the attached sheet 7- ❑Remodeling.
a odeling
P�� These stab-contractors have
slop and have no employees 8-,❑Demolition
w g for in an employees and bat, wtt€icess'
od;_ino Y capacity- 9. .❑S.uifcfsag addition
S4" i
[go Q6M& Camp,inc•UrdnCe comp-in ranee .
required-] :5. ❑ We are a rporafion and its 10 ❑Electrical repairs or additions
3.❑ I am a homeowner doing all work officer have exercised their 1L❑Plumbing repairs or additions
myself[No wor 'gip- right of emmigfion per MGL 13.❑Roof repairs
fim rrance regaired-]i c.152, §1(4h and we have no
employees.LNo,WGAMrs' 13_�other
comp-insurance required.]
'Any appliczotgnt chedimbos 91 mast aLw filloitthe secdcabeLow shavdng dm-mv;odcee c=pmotiaapuycp iMformsa=
I SameonMem who submit this afiidavu;rff;cxIbng they are doing ag vat sat then lme outside com ftsctOrsamst submit a new affidar t mdicatia9 well
ICortaactum ffist chedr*is boa must sttarlse3=additions]sheet showing the aanke of the snb-coact mi sad state whether.ar not Chase entities ham
employees.Ifthesub-caatmctoshave employees,dhey=tstpmr dethek wodtr3s'camp,paltry number-
I ant au enipr tlitrtisprofzriirz�workers'coatpertsrtftart irtsriratace for xc}*cnrp��ees $eIoty is the palic}'rut�3 jvla site '
information i5 z.-t. t A.S U`-/4-u6 e- C•o-4 p A:1ti.
Insurance Companyy X`ame: 4-V
Policy 4 or Self-ins-Lic_ - Expiratibn Date:
Job Site Address; Cityl5tateiz�g:
Attach aropy of the work-ere coxapensationpoIicy declaration page(showing the policy number and expiration.date).
Failure to secs coverage as required under Section 25A of MGL c.152 can lead to the imposition of criminal penalties of a
fine up to$U00:00 ar d lbr oni-yearimprisonmmk as well as civil pe-nalties.ih the fan of a STOP WORK ORDER-and a fine
of up-to$250.00 a day abaind the violator- Be ad;dsed that a copy of this statement maybe fkwarded fn the Office of
Investigations of the DIA,feu insurance coverage verifcatian-
I aFa ltt?rRby ecrrti rutd$r the prams and r ' s of et a fl�atflts iu;{armafzorrprmirled abm�s is trtrg artd crrrrect
Sisnature:
� � �2 �% /I hake 1
ORTCiat use artly: Do trot write in this area,ter be minpleted by city artonvi ojoWat '
City or Town: Permit ;Tense#
Issuing A.utharety[circle one):
L Board of Health 2.Building Department 3.Cityffown Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
F
Tafarm anon. and lastractions `
Massachusetts General Laws chVter,152 req�res an employers to provide woes'compensation for their employees.
Ito tbis sfat ,an M7q7layee iS deed as."__every Person in the sezvice of another under any contract ofhire,
=press or implied,oral or writ"
An.ebrploy�is deemed as"an indrvidrlal,partnersfiip,assoQatian,corporation or other legal mtny,or any two or mare
of the foregoing engaged in a joint mterpase,and inclnding the Iegal represeZ3tafives of a.deceased employer,or the
receiver or trustee of an mdividnal,parbaeasbip,association or otherIegal entity,employing employees- However the
owner of a.dweMag house having not more tbaa three apartments and who resides therein,or the occrPant of the -
dWe i g horse of anofher who employs persons to do maintenance,construction or repair work on such dwelling house
or orl ereto shall because of such employment be deemed be an employer."
the grounds or buiMmg appurtena�th
MOL chapter 152,§25C{6)also states tdiat"every siaie or local licensnig agency shaff withhold$ae issuance or
renewal of a Earn a or permit to operate a business or to construct buRdings in the commonwealth for any
applicant Who has notproduced acceptable evidence of compliance*ifiz the ffis rarsce coverage x er_ red_"
Additionally,MGL chapter 152,§25C(7)states¢Neither the commanweala nor any ofits political subdivisions shall
enf'Fr into any contract for the perform mc:6 ofpubho wD3 is until acceptable evidence of compliance with the fi u-a c;6..
requirements of this chapter have been presented to the cow ctiag antb oiay."
Applicants
Phase fDl o-ct the workers'compensation affidavit completely,by c he cI the boxes that apply to your situation and,if
necessary,supply sub-ontractor(s)name(s), addresses)and phonenumber(s) along witiithtir certificates) of
;ncRrance_ Limit-,dLiability Companies(LLC)or Limited Liability'Partneisbips(LLP)withno employees other ff=th.e
members or partners,are not rbgaimd to catty workers' compensation in mn-ace. If an LLC or LLP does have
employees, a.policy is rmpfied. Be advised that this affidayitmaybe srrbm>ttr-d to the Department of Industrial
Accidents for confnmaiion ofinsTuance-coverage: Also be sure to sign and date-the affidavit--The affidavit should
be retomed to the city or town that the application for the permit or license is being requested,not the Department of
LnAnsti,al.Accidmfs. Should you have any questions regarding the law or ifyou are required to obtain a workers'
compensation policy,please call the Department at the numberlisted below. Self-turned companies sbonId enttr thair
s eIf-i sores„ce licease number on the appropriate line.
City or Town Officials
Please be sore that the affidavit is complete and priined.legi6Iy. The Department has provided a space at the bottom
of the affidavit for you to f I out in the event the Office ofInvestigations has to coact you regarding the applicant_
P leas e b e sure to fr71 m.the pent crose nwnber which wM be used as a reference nunber. In-addition,an applicant
that must submit multiple pemutllicense applications in arty given year,need.only submit are affidavit indicating rrtmnt
policy infonmation(if necessary)and under"Job Site A_A&=s"the applicant should wrde"all locations in (may or.
town)--A copy of the affidavit that has been officially stamped or maimed by the city or town may be provided to the
applicant as j')roofthat a valid affidavit is on file for foime permits ens or licenses- A new affidavitmust be flied out each
year.We her a home owner or citizen is obtaining a license or pe zmit not=fated to any business or commercial
meral veature
(i e. a dog lise cen or peimict to burn leaves etc_)said person is NOT rcTiiied to complete tdus affidavit
'Ihe Office of InvestigaiiDnS would EM to thank you in advance for your cooperation and should you have any questions,
please do not he shate to give us a call
The Deparime nfs address,telephone and fax nnnber_
'fie C.G n0aWmj*of MaswAuszetEs
IIeg�e�caf lndus�ial A�cidont�
C)M=of lavestigafio=
F�4�a�hmgtan Sty "
BQs MA 02111
T(�-L:1617' -49GO=t406 or 1-& I LASaAF
Fax 9 617 727 7M
Revised 4-24-07 magfdia
Town of Barnstable
Regulatory Services-
: .
XAM Richard V. Scali,Director"
6 9.
►'� Building Division.
Paul Roma,Building"Commissioner
200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us
__Office: 508-862-4038--- ----- -- - Fax: 508=790-6230.-..__
Property Owner Must}
Complete and Sign This Section
If Using A Builder
as Owner of the subject property
I' ^^ � l Pay
hereby authorize !,kid,R,�I� y to act on my behalf,
in all matters relative to work authorized by this building permit application for:
(Address of )
**Pool fences and alarms are the�resporis biliip of thCapplica.nt Pools
are not to be filled or utilized before fence is installed,and all final
ins ections are performed and accepted.
S' -o er Signature of Applicant
90.
Print Name Print Name
Date
QTORMS:OWNMUERMISSIONPOOLS
Town of Barnstable
Regulatory e e u ato Services
g rY
oFt ,y Richard V.Scali,Director
Building Division
t MRNSMIX ' Paul Roma,Building Commissioner
nsass. �
039. 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:
JOB LOCATION:
number street village
"HOMEOWNER":
name home phone# work phone#
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.
Y � �
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.
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
this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in
your community.
Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc
06/20/16
31 Commonwealth of Massachusetts
Division of Professional Licensure
Board of Building Regulations and Standards
I ConstrVCM6 Supervisor
CS-065898 Wires:07110/2019
ftoTT S SHif`I.i1S
��BIt1A1T pA7�y M2D :.
00MVIWE MA 02osfi.. �• "F as
M
r}I�l 00
Commissioner, c .
6
* IflgR�6 k Y
Office oiau Regulation
HOME iMPAOVa=1V M COMACTOR
TYPE.CoropapW Re9f radon valid tot tfidlvidu�uie coy
before the expiration date. R tound return to:
1 , 10J0312019 QfkCe of C0n*urW-Attars and Business Regwiatfon '
TRI-S DEVELOPMENT CORE' ti 10 3''a*"Aze-suite 5170
8081 i'*AAA 02114 -
S+�TT ShiIELDS •+}+�' "z �'f X •l f - _ f i �J,,..� ^✓ < +`
72 BRIAR PAT-Ctt Ro�1(3
OSTERVILLE,MA �—
Undwsm" Not vaitd without signatum
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY
INFORMATION PAGE
Associated Employers Insurance Company
54 Third Avenue, Burlington, Massachusetts 01803-0970
t
(800) 876-2765 NCCI NO 40959
POLICY NO. WCC-500-5007148-2018A
PRIOR NO. I WCC-50G-5007148-2017AI
ITEM
1. The Insured: TRI-S Development Corp
DBA:
Mailing address: 72 Briar Patch Road FEIN:`*-"'8313
Osterville,MA 02655
Legal Entity Type: Corporation
Other workplaces not shown above:
The_policy period is from 05/01/2018 to 05/01/2019 12:01 a.m.standard time at the insured's mailing address.
3:: .A -'i;Workers Compensation Insurance:Part One of the policy applies to the Workers Compensation Law of the
states listed here: MA
B. Employers'Liability Insurance:Part Two of the policy applies to work in each state listed in item 3.A.
The limits of liability under Part Two are: Bodily Injury by Accident $ 500,000 each accident
Bodily Injury by Disease $ _ 500,000 policy limit
Bodily Injury by Disease $ 500,000 each employee
C. Other States Insurance: Coverage Replaced by Endorsement WC 20 03 06 B
D. This Policy includes these Endorsements and Schedules: SEE SCHEDULE
4. The premium for this policy will be determined by our Manuals of Rules,Classifications, Rates and Rating Plans.
All information required below is subject to verification and change by audit.
Classifications l Premium Basis Rates
Code Estimated Per$100 Estirriated
No. Total Annual Of Annual
Remuneration Remuneration Premium
INTRA 404881
INTER S CLASS CODE SCHEDU
Parcel Detail Page 1 of 4
a
Logged In As: Parcel Detail Wednesday,August 2 2017
Parcel Lookup
Parcel Info
Parcel ID 189-003 Developer lot
Location 1,1949 FALMOUTH ROAR Pri Frontage 140
Sec Road , Sec Frontage
Village Centerville � � Fire District C-O-MM
Town sewer exists at this address INo I Road Index 9522
Asbuilt Septic Scan: ' MI
Interactive Map
1890031011
' �+
Owner Info
Owner BERRY,JOHN F Co' %CROCKER,.JAMES H
Owner
Streett ISYLVAN LANE REALTY Street2 MWIANNO AVE
city JOSTERVILLE � State jMMA zip 02655 - country
y
Land Info
Acres 1.53 � I use Single Fam MDL-01 —1 Zoning R righbd 0104
Topography Y Road
Utilities[7 _Location fo —771 i
Construction Info
Building 1 of 2
Bunt 1972 Suuci Gabh/Hip wM Wood Shingle
Living
Area 2544 cover sph/F Gls/Cmp TyApeNone
.. .«< rt,.,
Style Ranch Walj Drywall Rooms 2 Bedrooms
Model Residential Floor Hardwood R000ms 2 Full-0 Half _
Grade verage„ TYpe Hot Water Rooms
Stories Heat1 Story Fuel QiI F ation Poured Conc.`
Gross Area 4196 �
a�
Building 2 of 2
Built 1972 _71 Strruct Gable/Hip wM Wood Shingle
uArea 1440...� cover sph/F GIs/Cmp TyApe No: =]
Sir MBed
edical Bldg Wall.nt Drywall a Rooms OO <
Model Commercial Fla r Quarry Tile Rom 1 Full-0 Half
Grade rage Type Hot Water Rooms
Ave (
http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=12895 8/2/2017
P$�rcel Detail Page 2 of 4
Stories f Heat ail - Found poured Conc.
Fuel •atlon
e
Gross 2
Area 880
....... ................... ..................................... ........... .........
Permit History
Issue Date Purpose Permit# - Amount Insp Date Comments
Visit History
Date Who Purpose
12/16/2008 12:00:00 AM Paul Talbot Cyclical Inspection
8/25/2008 12:00:00 AM Jeff Rudziak In Office Review
8/10/2004 12:00:00 AM Paul Talbot Meas/Listed-Interior Access
.,. Sales History.....
........ ...... .. ....... ......... ........ ........... ........
Line Sale Date Owner Book/Page Sale Price
1 11/8/1984 BERRY, JOHN F 4311/116 $0
2 4/3/1981 BERRY, JOHN F&DIANE A 3263/261 $0
3 4/7/2017 CROCKER, JAMES H JR 30404/329 $250,000
Assessment History
Save Building Total Parcel
# Year Value XF Value OB Value Land Value Value.
1 2017 $272,600 $46,300 $6,600 $90,000 $415,500
2 2016 $272,600 $46,300 $6,600 $90,000 $415,500
3. 2015 $266,600 $42,600 $6,900 $91,500 $407,600
4 2014 $266,600 $42,600 $7,000 $91,500 $407,700
5 2013 $276,800 $42,600 $7,200 . $91,500 $418,100
6 2012 $191,000 $33,500 $6,200 $91,500 $322,200
7 2011 $307,600 $0 $0 '$.123,300 $430,900
8 2010 $307,100 $0 $0 $148,100 $455,200
9 2009 $312,700 $0 $0 $144,000 '$456,700
10 2008 $208,400 $0 $0 $204,500 $412,900
12 2007 $208,400 $0 $0 $204,500 $412,900
13 2006 $208,400 $0 $0 $206,200 $414,600
14 2005 $199,400 $0 $0 $184,900 $384,300
15 2004 $187,500 $0 $0 $123,300 $310,800
16 2003 $109,000 $0 $0 $73,600 $182,600
17 2002 $109,000 $0 $0 $73,600 $182,600
18 2001 $109,000 $0 $0 . $73,600 $182,600
19 2000 $106,000 $0 $0 $57,700 $163,700
20 1999 $106,000 $0 $0 $57,700 $163,700
21 1998 $10.6,000 $0, $0 $57,700 $163,700
22 1997 $125,800 $0 $0 $46,100 $171,900
http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=12895 8/2/2017
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I
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION_
�7"
'Application
Map- Parcel # q
Health Divisid, Date Issued
Conservation Division Application Fee
Planning,Deptf Permit Fee'
Date Definitive'Plan Approved by Planning Board
Historic _'OKH Preservation Hyannis
A-,
Project Street Address Lk -% 2-CD
Village
Owner LA" Address
Telephone 4 L4 L4 I
Permit Request 2 P L-A cZ G a t oi
Square feet: 1 st floor: existing—proposed 2nd floor: existing—proposed Total new
Zoning District Flood Plain Groundwater,Overlay
Project Valuation '6ka0_<:> Construction Type
Lot Size Grandfathered: Ll Yes L] No If'yes, attach supporting documentation.
Dwelling Type: Single Family Ll Two Family LJ Multi-Family(# units)
Age of Existing Structure Historic House: LJ Yes WNo On Old King's Highway: LJ Yes dNo
Basement Type: Ll Full LJ Crawl Ll Walkout Ll 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 ount t'Z=
Heat Type and Fuel: LJ Gas Ll Oil L3 Electric Ll Other
c-A Z
Central Air: LJ Yes Ll No Fireplaces: Existing New Existing woodfdal stovubo Ll Y& Ll No
Detached garage: 0 existing Ll new size—Pool: Ll existing Ll new size Barn: LJ 2 sting U never size
Attached garage: Ll existing LJ new size —Shed: LJ existing Ll new size Other:
Zoning Board of Appeals Authorization LJ Appeal # Recorded Ll
Commercial L3 Yes L) No , If yes, site plan review#
Current Use Proposed Use
APPLICANT INFORMATION
(BUILDER OR HOMEOWNER)
Name DL%.Qe�2_ Telephone Number -5 445S 15ORLib4o
Address License #
Soi< -VA q 4aywo-4 Home Improvement Contractor# 12 06 9157
M4 — Worker's Compensation #1JC1ZI!G3!Y6% 0 9 OZ
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
q _a4woxr, 1 -
SIGNATURE DATE U..di 0 cl
FOR OFFICIAL USE ONLY
`APPLICATION#
A ..
DATE ISSUED
MAP/PARCEL NO.
ADDRESS VILLAGE
x
OWNER
}
F
DATE OF INSPECTION:
}
FOUNDATION
FRAME
i
INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL
x
r PLUMBING: ROUGH FINAL
}
GAS: ROUGH FINAL
FINAL BUILDING
DATE CLOSED OUT
1 ASSOCIATION PLAN NO.
1ne t—ommonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
www massgov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/ElectrWians/Plumbers
Avolicant Information Please Print Lezibly
Name(Business/Oiganization/Individual):
Address. l
City/State/Zip: Phone
Are you an employer?Check the appropriate box
Type of projec*y.equired)
1.9 1 am a employer with 4• ❑ I am a general contractor andd
employees(full and/or part-time).' have hired the sub-contractors 6•,0 New construction
12.0 I am a sole proprietor or partner- listed on the attached sheet. N 7. ❑Remodeling
ship and have no employees 'These sub-contractors have g, 0 Demolition
working for me in any capacity. employees and have workers'
[No workers'Coro.insurance comp.insurance.# 9. [D Building addition
required.] 5. []`-fie are a corporation and its 10-C]Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised�nr. 11•0 p ing repairs or additions
myself.[No orkers'comp. right of exemption per MGL
insurance rAq iced.]t c. 152, §1(4),and we have no 12• Roof repairs
employees.[No workers' 13.Q Other
comp.insurance required]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy inforrr 'on.
tt Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
•Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whefer or not those entities have
employees. If the subcontractors have employees,they must provide their workers'co olic "r ber.
comp.P y-fir
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and Job site
information.
Insurance Company Name: Lf tM4-y
Policy#or Self-ins.Licl: 14) 222 IS 301t 2;%_ Expiration Date G"T9
Job Site Address:1 U�� �to� qc6 City/State/Zip:
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 S 1,500.00 and/or one-year imprisonment,as well as civil penalties in;the ffomn of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copyl'of this statement may be forwarded to the Office of
Investigations of the I1IA for insurance Coverage verification.
I do hereby certify under the pares and pen es 9. perjury that the information provided above is true and correct:
Si tune: •• 2 d
Date: J _
SO8 �� t
.Phone#: 9 �;b�-{.a
F
se only. Do not write in this area,to be completedby city'or town q fficiaL
own: Permit/License#
uthority(circle one):
of Health 2.Building Dlepartment 3.City/Town,,Clerk 4.Electrical Inspector 5.Plumbing Inspector
erson• 'Aone#:
S.
ggg
t.
V' Board of Building Regulations and Standards
L One Ashburton Place - Room-1301
Boston. Massachusetts 02108
Home Improvement Contractor Registration
Registration:, 128957
Type:. Individual.
Expiration: 6/14/2009 TO 131109
Oliver Kelly
Oliver Kelly
9 Peregrine lane
S. Yarmouth, MA 02664
Update Address and return card.Mark reason for change.
DPS-CA1 0 50M-05106•PC6490 E] Address E] Renewal F� Employment Lost Card
—- ._--___
�/�
. - O.1lYlIZGJtflICCLGIOL `
✓2 .
Board of Building Regulations and Standards License or registration valid for individul use only
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Registiation 128957 Board of Building Regulations and Standards
One Ashburton Place Rm 1301
Expiration: 6/14/2009 Tr/! 131109 Boston,Ma.02108
Type:-individual
Oliver Kelly
Oliver Kelly
9 Peregrine lane
South Yarmouth,MA 02664 Administrator Not valid without signature
6. ♦i tsa chu eit. Department of f iii lip S ti`t iti *: r
i3o a d+ot Builr+in�� Regulations and St rrtl.w d•
.'.`. uf:tic g2i1p'y
License CS SL 99167-
Restricted to: RF,%3 ,
air
OLIVER KELLY .
9 PEREGRINE.LANE
SOUTH YARMOUTH,.MA 02664O
}'
.,Expiraticra .912812011 3
E.
i nnn1�..;,n:cr T r7 99167.'
� tl 'QED 14:26 H1 508 8 1.21A D(.WLINNG & WNEII: IN" C 001/001
1/14/2009 9:59 PAGE 002.1002 DAG
Lilb"Alntuali Group
1 e Hber P.O.Box 9090
` mutum. Dover,NH 03821.9090
Tcicphonc(800)653-7i-
Fax(60?}-245-5330
._nt:ary 14,2009
"OF FAUiOL"iTI
i•J �'U I��L,L SQL3�� •
�x.i.'ClTH, Mt� 42540
�.s�:: •1:`rtificnte of Wpxkctx Cnmpcnsa�6,-�;a 7(nsurancc
-nred: OLIVERE=- Y
9 PEREGRINE LANE
SOU'T'H YARMOU'IK NU 02664
.....y-`lumber: WC2-31S-33'88Wn,28 Effective: 12/28/2008 RxpimTian:,.12/28/2(09
t rs ;e afforded under Workers Cormensation Low of kze folowing stste(s j: l
LL u72YS LL9bi1;1.g a liti;)! - I cicfie urn�+nFtc�r:?;;rtnG�azvrrar F.ler_tion: ,
_!'- rn un,By Accident $100,00t) Each Aaaident { 171it.aworken'compensation
policy does not provide
- .,;3UY1vWrybyDismw(g $ 100,M) '&cb Parson - ovcrvgctor.
�Ly 4nj«tj by Di»a c: $500,000 Pofty Limits o,t �•!Y,zI 1 Y
:tris date,die above-referenced poLcyhotde"r s insured by Liberty Mutu-i Fire[nsuranw Co
i U-V:policy listed above.
u:sumnce afforded by the listed policy is object to all the terms,exclusions and conditions,.nd is not.
:t-ad by-any requitement,term or condition of any o_othef decunents wish respect to which this
t.f,catc:may be issued.
:Creficate is issued as anutter of infomia*;ion cmly and co=i`_rs no ri_&it upon you,the certificate
T1Ls certificate is coot an insurance polity and does not emend,erre7d�of Slut the coverage
by the policy listed above,
;:s poky is c.-mcdled before the stated expiration date,Liberty Mut ml-,Diu endenvcr to notify you cif
ce-ell�.iian_ut _ -
-
+lUTHORaED REPP.ESENTATWE
LMrRTY MUTUAL MISURA,'VCE GROUP
aiificaLe is r�ceoved QY LBF2TY�SU PCiAL LVStR2AtCo GRUC^m mxpecn ssh isanrsneo 9s is nfmbcd by lnet comtpwlrs-
2,zsuted: Pioducer of Recorrb
C-1,�TEA KEUY SAWN DPIPEit.JINSU►tANCEAGE-1(.'Y INC
:'EREGFcr\E LANE, 12ENTERPRISE RQAD
;:.;ii.I:HYAR_MOLTIT-�'rMA. 0260 HYAI`,WS, VA 02WI
I -
KELLY ROOFING ;
rj 9 PEREGRINE LANE
.SOUTH YARMOUTH PH/FAX 508 775 4498 MA. REG.# 128957
f MA 02664 Cell 508 509 4640 LIC 99167
March 16, 2009 INSURED
Proposal submitted to Dr. John Berry of 1949 Route 28 Centerville MA.
We propose to supply all materials and labor necessary to remove and replace the
existing roof at the address above
All debris to be removed to town transfer.
8"Aluminum drip edge to be installed on all eaves. ,
Ice and water damage protection membrane to be installed on first three feet of eaves and
in all valley areas.
Remainder of deck to be covered with#15 felt paper.
30 year limited warranty Architect style shingle to be installed.
Bathroom vent pipe boots to be replaced with new.
Ridge vent to be installed on entire length of all ridges with hand nailed caps.
Chimney flashing to be repaired as necessary.
Protect all walls,windows, decks,plants and shrubs etc. during roof strip,
Obtaining of town permit. _
At a total cost of$8600
t
Payment Schedule;50%at commencement,balance upon completion.
Respectfully submitted, Oliver Kelly
'Proposal accepted by - Date 3 12009
7HE. TOWN OF BARNSTABLE
i
i BARNSTABLE, i
"6 9
0 Y BUILDING INSPECTOR
PY a' � �
APPLICATION FOR PERMIT TO `�
TYPE OF CONSTRUCTION ..........Y..(/. ......................................................................
!..... j..................19
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location ...... .......... ..................... `.. a..............................
ProposedUse ...... ............................................................. ..............................,.........................
ZoningDistrict ........................................................................Fire District ....................................................f •�a.+
.............................................................
Name of Owner .. .... '.. � .................Address e7...� `1'o/,.t / i...................
Name of Builder dress . ......( ..............,...............
.Name of Architect .............................................. ................Address ........ .......................................................................
Numberof Rooms ..................................................................Foundation ...................................................:..................:.......
Exterior ..................................:.................................................Roofing ... �'' ....................... ,.. .........
Floors .......................................................I...............................Interior ................:...................................................................
Heating .................................:................................................Plumbing ............................................................ ........
Fireplace ..................................................................................Approximate Cost ....z`s .:;........................ .........
O�
Definitive Plan Approved by Planning Board -------------------—-----------19_______-`, "e
Diagram of Lot and Building with Dimensions ca
SUBJECT TO APPROVAL OF BOARD OF HEALTH
A LICENSED INSTAL 1VIU5T OBTAIN SAG
�'Y Id. _ ® P1I�nA�tT=fkl 'JI RAL.1 rtWl : 1MJ rO:
SANITARY WATER SL Y, SEWAGE- GIS O=AL
AND DRAINAGE IS HEREBY At'PR0 D
=7 -'g= TOWN OF BARNSTABLF-,
BOARD OF HEALTH
Cj CT-
I. ` o •
I
0
g ,e- <
7
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regar ing the above
construction.
• P
Name .... .........................<�4! f..
P'I
Lane, John B. -
Deck &
168 add carport to
No ...... .......... Permit for ....................................
i
dUrelling
.....................................................
Location ......1949. Falmouth. ..Road
..................
..... ...... ........ .........
Centerville
Owner ...........John. ..B.....Lane
...... .. .. . .....................................
Type of Construction
frame
................................................................................
Plot ............................ Lot ................................
Permit Granted ......Saptembar..6..........19 72
Date of Inspection ......................19
Date Completed 19
PERMIT REFUSED
................................................................ 19
...............................................................................
.................................................. ........................
................... ........................................................ �{
1
...............................................................................
Approved ................................................. 19 s
............................................................................... t
.................... .........................................................
Assessor's map and lot. number .... ....:.... ...�; .... .........
Q.
SEPTIC SYS'I "M BE
Sewage Permit number �p INSTALLED IN CO .IA"
A �L • c•.....:.rle
WITH ARTICLE, a sTATE
SAKI X"M 7XM
o*7NEro TOWN OF BARNS
Z HAHBSTOII i
16 9 - NUILUNG INSPECTOR
O E MPY
�. . R�
APPLICATION FOR.PERMIT TO .....r �...... ........L�......... .......:.....PC .....1.:r..) ......... ,...
TYPE OF CONSTRUCTION .......(X:.�.>Q:sz).........(.� . ..Q.R.—..T—T -,,,................................................
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location .......l,�o..) ..... ... ........ f
ON.. .....wam..........C.E.0.71�R )11..Lr.liF.....................
p
ProposedUse ........:.�,...7..��t.�..�.�.........�.......... .......................................................................................
ZoningDistrict ......... .. �............................................Fire District ..............................................................................
Name of Owner ..1,,. �' ... F.`�. .1�'�......Address ...1. .M.I It1 l /�M A.-
ll
Name of Builde� 1�.1. .�...........U.�� }...............Address ..... Kl.%o.11�/.7f .... . ....'�.......
Name of Architect .t .� .��1��.. . dC�� ....�. L�.....Address
y
Number of Rooms ..................................................................Foundation .......Pco..... ..t �?.Q. .............
�l �.. .�-\I.......Sl.['3. .� `.............RoofingRf,.D.....C���AV........Exterior ... . . .... ...........................
Floors ..... .......................................Interior <�i.i- ..............,.................................
Heating ...........\. .t�1.C�'.......:............................................Plumbing .......... .. .........1................................................... j
6I
Fireplace ......... .N. ...............................................Approximate Cost ......... 00.q.............................. .
�7 �. .
Definitive Plan Approved by.Planning Board ________________________________19--------. �. Area .......................�................
.
4
Diagram of Lot and Building with Dimensions /�
Fee .............................................
SUBJECT TO APPROVAL OF BOARD OF HEALTH
i
" 406C
i
I hereby agree to conform to all the Rules and Regulations the wn of Bar r. a ding the above
construction. ,
No ..... ........ ...... .
� -_-_-_-" Eugene- .
� No ..... Permit perm'itfor _�arage______..
H �
/ ----~----^—~-------^—^—^---' 4
r
Z. Location ---���«m���..���—.---------.
.. .
` Centerville
` ---_----------------------
'
1 Owner ----. ^Werxuotb
�� — .....................................----- -- '
. ~ '
�\ Type of Construction --_.framm_______
-----�-------------,------'
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Plot ............................ Lot ___________
December 30 74
Permit Granted ----' . lP
�
Dote of Inspection
^
Date Comp
lefe6 ------------.]V'
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. .
PERMIT REFUSED
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-------------------------.—
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Approved —�—�--------.----.. 19
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tFEE $39.00
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29 Ty WN OF ,,'BARNSTABLE-1 MASS..
a.
THIS IS.TO CERTIFY THAT ,,A PERMIT IS HEREBY GRANTED TO
...........�...: ' _....AV
04
._ ......... ._ __1....._. _.... .... .......
O�3� 4 (PROPERTY OWNER) ,,,fir (ADDRESS)
wea + TO ...:.: ........ .._. ................................
.H a3 b (BUILD) y (ALTER) (REPAIR) •• ,
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' ........ ........ ....... __.:. __ __
(TYPE OF BUILDING) (APPROXIMATE SIZE) _R
LOCATION t 63 �i3tt'D ►
... ._....... _.. _. __._
d (STREET AND NUMBER) (VILLAGE) y
NAME OF BUILDER OR CONTR ACTOR Dma0t __
APPROXIMATE COST ._....... ......._ �'0 _..__. .
b . _ _.....
............... ....... � __... ..__._.
IQ
�M I HEREBY AGREE TO CONFORM TO ALL THE RULES AND REGULATIONS OF THE TOWN
OF BARNSTABLE,�REGARDING THE ABOVE CONSTRUCTION.
_._...__...._........................................................ .... ............_................................................
h d - (OWNER) (CONTRACTOR)
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BUILDING INSPECTOR
Subject„to Approval of Board of Health.
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b P 17 51
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THIS IS TO CERTIFY THAT A PERMIT°IS HEREBY GRANTED TO
• � � °, � (PROPERTY OWNER) » (ADDRESS)
TO .:.:...............: ..............................I.. ...»* ...a »__»_ ...... ................... .»»»
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(TYPE OF BUILDING' IAPPROX MATE SIZE)
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dtervi,o Q LOCATION ... mol
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(STREET AND NUMBER) - -- (VILLAGE)
\ NAME OF BUIL ER OR CONARAA4 R
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APPROXIMAT COST
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tow 1 HEp� EBY AGREE TO CONFORM TO ALL THE,RULES AND REGULATIONS OF THE TOWN
OF BARNSFABLE, REGARDING- THE ABOVE CONSTRUCTION.
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- + *-- BUILDING INSPECTOR
Subject to Approval of Board of He h.
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TOV-7N OF BARNSTABLE BULK RATE
COUNCIL ON AGING U.S. POSTAGE PAID
198 SOUTH STREET NON—PROFIT ORG,
HYANNIS, MA, 02601 PERMIT NO. 2
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Assessor's map and lot number ..1.59':............�, - 8"TEM MOST BE
N TAB.LED I'1, G AM—ft a1�C�
3s-� WSTATE
Sewage. Permit number .............,...............................:.. ......... SMITARY OvOI: Q'
G'ULATIO �...
w' yoF1111Ero�� TOWN ' OF BARNSTABLE
BAHB9TNILE, i _ �"'
M
w•, B.Ul,.LDING INSPECTOR
�p 1639. `009
MPY p'' r
- ' 1X7
APPLICATION FOR PERMIT TO ........ r? -. ..'.......................................................................................
11 TYPE OF CONSTRUCTION .... :`� C..,-1..'�T.. .... .......Q. Z>........................................:........
.........................UA. ..............1974
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit)according to the following information:
Location ...7 d..).....�.�J�.........[�.1..�.6\)�.!S'...!!1/.�.H........... ..................................................
ProposedUse .........c,a./........ . ..................................................................................... ......................................
Zoning District ..............R ........1. .....................................Fire DistrictlJT �14�r! ��`.I.t�.l
Name of Owner Eoco.aw.r....... 11............Address G..Ha !,....:......d9 s•� �— .......
11 13M01L.E I'FA
Name of ..........Address ........ �A. .� S.....................
1111 � o l- f�C 2 o c�S' 37
Name of Architect. .1.HF.21�...�J.O..I .�S..... .i�c.......Address ....H .Z)�M0....�.If�1r1Ls° �!^{..!.................
Number of Rooms ............... ............................................Foundation ..............�Qv.�.��........Q.tJ.��.?.'.��-,.......
Exierior 4A:T... ��I.pl. ors'.................Roofing .L.R... . ........................................
Floors .... +P. ...............................................................Interior .1 .......v.J.�.fi..Jz...!.. �.��.. ..........................
Heating =. ... `L.... .R��...........................Plumbing. V �3 `!�T .
Fireplace . .......Approximate Cost 4d
......
® �.Definitive Plan Approved by Planning Board -----------_______-------_---19_____ . Area /40
......................................
p0
Diagram of Lot and Building with Dimensions Fee .......�,��
..............................
SUBJECT TO APPROVAL OF BOARD OF HEALTH
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I hereby agree to conform to all the Rules and Regulations the wn of Barns t eg rd ng the abo e
construction.
Nam �..... -.... ....... . ...... . ' ..........
Wermuth, Eugene
No ..1.729.2.... Permit for ........l,..l./.2...a tory.,..
A ngle...fAmi.ly...diel1.i '—
Ag=.age..........
Location y......... :&J
............ 4
...................Centerville........................ ..
Owner ......U9eAe..We=utbt.................... � bC f
Type of Construction frame......................
s �:.o. ....!'.........-. ..................................................
' -Plot ............................ Lot ......#3.....^.............. del
L
`Permit Granted ............ ........19 74 — R !
spate of Inspection ... �19
` ,Date Completed ..Jl.:.�!. 19 /` ! c- �s k- _. C
r
PERMIT REFUSED
�
9 +•may 1„ � �, � ."� _ -..�, � l-.- j •
................................................................. 19 `r ,�' ` ,^ t 1.
.................................................... ,............ ~ v :� � •?C�j r
7
.........................................................!........`.... .. ... - r /
y .............................................................................
.........................................................................
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` Approved'................................................ 19
y - ..... ..............................................................
• 1
...............................................................................
Assessor's map and lotE� ..�. ��...............�.,'E?
Sewage Permit- number ......................................s..:..,...........
, Q
FT"Et TOWN OF BARNSTABLE
i BARX9TADLCd, i
"6 BUILDING INSPECTOR.
MPY a'
APPLICATION FOR PERMIT TO ...........�� �� )-- /
TYPE OF CONSTRUCTION
....... ...^...... .................19..1.
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location ..),o.1............??........,.��. .N. .S.... ...............�.H.�...... .........................................................
ProposedUse ........ .............................................................................................................................
Zoning District ...........�� -A.......................................Fire District l.��F�14Lt�..� ST.!: .
................. .................
Name of Owner .f E..R A.07. -\..........Address .!5. 1? �a /-/fq m
.............. :. ...r............................�.........
1 ) UK)ci^ f- ...1MM4 l. hltic-
Name of Builder ...... U.)�.. TL��:.........Address ........Y.A..?..IMF..V.TJ�.f.—YAC)SS'............!.......
�1 \ o l- t-)C Ro0c' S►.
Name of Architect !�! Q.�.H►`�0 �)O,Mf-3....�.I��.C� ....l .0 S`O.A1..... I�t_S' tJ `{
...:... .. ....... . ........Address ... .. .. .......... ...............:.................
�i _
Number of Rooms `............................................Foundation ... ...... off. . ..........p.)JC12.!: ��........
Exterior 4AAXD .................Rooing D...a.ph... . ......................................... j
t Floors � 1
1
li ................................................................Interiotr X9.........
Heating ..+ .w...7P�!.....�-..a. ?...........................Plumbing ...................
Fireplace Fireplace ...... ...........................................................Approximate Cost ....... 0..........................
�+`1.......
Definitive Plan Approved by Planning Board ________________________________19________ . Area 14gd � ,......................................
Diagram of Lot and Building with Dimensions Fee ~�
SUBJECT TO APPROVAL OF BOARD OF HEALTH
6-7 6 ® t �
17
7
v
�aq
I hereby agree to conform to all the Rules and' Regulations oaf ttnW-Town of Barnst,b-le egd ing the abo e
construction.
Nam ........... ... ...................
Wermuth, Eugene
No ....17292.: Permit for ...1 1/2 story,
„single family duelling
Location Vpwinn's�Way
................ ...................................
Centerville
...............................................................................
Owner Eugene Wermu.th
........... ..............................
Type of Construction frame
YP .................................
1,
................................................................................
Plot ............................ Lot ........... 3.................
�Y f
Perm,t*Granted ........Augus.t..28............19 74
Date of Inspection ....................................19
Date Completed ......................................19
PERMIT REFUSED
................................................................ 19
...............................................................................
r
...............................................................................
Approved ................................................ 19
...............................................................................
..................... .........................................................
4
Assessor's map and lot number ....... j...... .. ....... ......... (f '-
� ? .3
f
Sewage Permit number .......a... �..... � �' -Q.�'�
yo�TNETo�f TOWN OF BARNSTABLE
BARNSTAME, i
N 9
O BUILDING INSPECTOR
O'EPY�`
APPLICATION FOR PERMIT TO " .. . ..�-.. 1C.NRQR��
.
TYPE OF CONSTRUCTION .....LA..�.....7�?� ��'>�. C 1� F T r-
F C.. . . 3
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location � 0. I 1 M ih 0 �/ i`�`� .-
.........:................................................... ........
ProposedUse �Q .�ar� ...........: ........��: .........................................................................................
..............Fire District ....................................................Zoning District ...�..-.................................................... y..........................
Name of Owner � t4.� V_�N:NRAwTA......Address ....'.d�./ M I �(Hl7/% .z..!..'..! '. .................
11 U AIC4 VfMAl
Name of Builder< ..............Address ..... kl�4 A.)
Name of Architect . .....Address ..6 0 LQ,S .....................I.V...•...T.
Numberof Rooms ..................................................................Foundation ........... ............................................j.........
Exterior ( !�.t } �.. .<ti.\1 I�E ' P �..... t'1r Roofing ............_....
Floors 0—,jh=.iFJ. Tr..........................................Interior ...........: ......... c.ar.!-1................................................
..... ...
"_
Heating .......... 1C?, C""'�F.�1 �' ............................................:...Plumbing ..........�..` ?.......`-:�. ..................................................
Fireplace ......... ................................................Approximate Cost
................................. ..
Definitive Plan Approved by Planning Board -------------------_-----------19________. F Area � ...1.. .....e:.f V
Diagram of Lot and Building with Dimensions Fee '.............. ..............................
SUBJECT TO APPROVAL OF BOARD OF HEALTH I
s '
t!
FIC�U� E
hereby agree to conform-to all the Rules and Regulations of t Town of Barnstableregarding the above
construction. _
Name ........... .......Ef l.........................
Wermuth, Eugene
17515.... Permit for .....erag.. .......... ......
No ............. ......
... .. ..........
.............................................................V
Location Q44MLs—Way....!qL 4,
.............................
............
Centerville "Rd A
..............................................................................
Owner ...........�Ng
.!�pe Wermuth
. ...............
Type of Construction ........f.r.ame........................
................................................................................
Plot ............................. Lot ................................
Permit Granted ......December..30.........19 74
Date of Inspection ....................................19
Date 'Completed ......................................19
PERMIT REFUSED
................................................................ 19
...............................................................................
...............................................................................
...............................................................................
...............................................................................
Approved ................................................ 19
...............................................................................
...............................................................................