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Engineering Department (3rd floor) G / (� 'oc 1639. 0m� Housenumber ............................................../......................... ,sue ` APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only TOWN OF BARNSTABLE z�_/,/ BUILDING INSPECTOR _ APPLICATION FOR PERMIT TO �.5:.�......!.. �-- 5... ���"�. ``�'t `L TYPE OF CONSTRUCTION .....L�t�.G�G?.ID......�. :. 141. '.........1................ .................. f.................. --------------------19f TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: LocatioLar- , .::`". ........rl?..`..`.F` '.` `'t..s � :..:.........` ..t.►.� � :.'.`` ..... . .`.1.: . . .:.........e'.. .,1 . .. ......... " .......... Proposed Use ... � �1,1E .l2, t 5....• .: ,r,(�-�.: .... / i2 t/.`.f ....... � ..............................' :............................. Zoning District ....Fire District ........:.,,. r.......... p ..................................................................... Name of Owner I / x1` t.,r`.... �.1, .. �' r! P�•�LYAddress .. :.` rrl'c .....t. . ................... ! i..... ........ ,. ... t,k ,; . . o k4:...:....... .:. .. �.. ..?.r....:� Name of Builder ..`....�.�..�` (...: ` !........:.Address () Nameof Architect ................................................................Address .................................................................................... Number of Room's ............ ?..................................................Foundation 1�j C' �'G. �`� F� ......�.44. 3 ......<�...................... ` �. ( f/ d yR4ofng 5� � . . �k,w, ....... Exierior(r. A` C. C � .. .. .. 1..f.C.: ✓GL-Zf :..../ J.J -( .. e ....................Floors ... ........Interior ( r Heating ........... . ..................................:..................................Plumbing ....t..,.............k:.....d...... 1-4 Fireplace dl)// ......Approximate Cost �v (�a Definitive Plan Approved by Planning Board ------ _`l_ --------19_ Area `r.!.C. ............. Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH Lj IX R i 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. _---- 1� /�� Name j / .,r. t f. .�1....... ./1.. '(: ..... Construction Supervisor's License ..(`./t�........!`/. ... PLYMOUTH BAY DEVELOPMENT A=169=011-001 1 No ....29253 Permit for ....1 Stor Single Fami Dwel 'n $.................. Location ,Lot �658, 2pO Falmouth Road ............. ..... 9..... Centerville Owner ......Plymouth Bay Development 1 Type of Construction ....Frame ............................:......... ........................................... Plot ....:....................... Lot ................................ Permit Granted April 2.k .......19 86 Date of Inspection ....................................19 Date Completed - (70 �« ���� � ❑❑fi�nn MAY 6� gTown of Barnstable *Permit# 3 �+ L l Expires 6 ma om issue e yT egulatory Services Fee • AS& ®F B eiler,Director 65g. SRN Building Division123 Tom Perry,CBO, Building Commissioner OW 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma us 0ffice: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number 1(0 9 150 Property Address o7o1Uy �4�i'Jad><�i /d' Ccn-('crvi%/e [Residential Value of Work 3 <a0. o o Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address 01 j11 t A41CO6G Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) _44.�� Construction Supervisor's License#(if applicable) C S- p 9a 9S9 19W_11'0'rkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner RI have Worker's Compensation Insurance Insurance Company Name Workman's Comp. Policy# 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) ❑ Re-side #of doors 0 Replacement Windows/doors/sliders.U-Value ' 3a (maximum.35)#of windows /S ❑ 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: �S1j4K �ll�La 2:MPMESTORMS\building permit forms\EXPRESS.doc ;'evised 053012 I £LOZ/L L/0 L - " u0iwjidx3 Jau!oissiululoo a istration valid.for tndiv►dul use.only nse or r r- Llce g the expiration date. If found return to -.. before Z£9Z0 ,Vk d I IIA2I�ZN�� 0fli, of Consumer Affairs`and-Business Regulation.. Q2I SUAdH£bI fi 10,R'ark'Plaza`-Suite 5170. .. 0H��d ,�- Boston MA 02 , 116 896Z60-So :asuao!l i i �ns!.uadn3 u1>UanitsunJ e spjepuels pue Su o!;ein6aa 6u!PI. 8 in r 3o P�eoB QG t+ 4191es a!Ignd 10 luau'1jedaCI sI4asnyoessew d Not valid without signature Al I Office of Conmff 1&Bdsines/ ght l;c Safety - 'HOME IMPROVEMENT CONTRACTOR _ t Registration artmen of Pd Standaron ds 164440 Type• Massachusetts-RegulatlOns an Expiration 10/6/2013 Individual guildin9 `r�;yur S PACHECO - 58 t ? Board.of uctiun cup' Coo,tr e:CS-0929 r>� I Licens SHANE PAC HECO, 143 HAYES RD CENTERVILLE MA 02632 2 Undersecretary 143�Y�s��0263 CE�EgVIb. ExP?120J3 G r-: ' The Commonwealth of Massachusetts. Departn enf of lndits#rirrl Accidents Office of Investigations 600 Washington Street Boston,.AL4 #2111 . nIn".Mass4ovldia Workers' Compensafion Insurance Affidavit: Bxgders/Contractors/Ekectricians/Plnmbers Apphcant Information Please Print LeA - Name l): 4C ice- A.ciidrt=ss: CityfStat>~(zip: 1Y)4rJ4,,J /�),//J a;.*ye Fhane 4: sa8 �6y�YSG Are you an employer?Check the appropriate box: Tyke of project{required): am a contractor and I 1-LI 1 am a employer with � 4. ❑ I employees(full an&brpart iinw)_* have:bired the sub-contractors 6- ❑I+Tew ccrosfrucfiou ?.❑ I am a sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling ship and have no i These sub-contractors have ogees S_ ❑Demolition working for me in any capacity. employees and have workers' [No workers' comp-insurance comp_insurance.j �. ❑Building adt3 lion required] 5. ❑ We area corporation and its 10.❑ Electrical repairs or additions 3_❑ I am a homeowner doing all work officers have exercised their 1 L❑Plumbing repairs or additions myself [No workers'comp. right of exemption per NIGL 12.❑Roof repairs insurance requueci.]r c. 152, §1(4)and we have no �n� J employees.[No workers' 13.E ''Other comp.insurance required.} •Any applicant that checks box Al must also fiA out the section belawshawui9 then compensation workers' policy iff—tiaa Y Homeowners who submit this affidavit indicating they are doing all vcd and then hue ou=&contmcwrs mast sobinu anew affidavit indicating such. jC intracton that cl>eck this boot mast attached an additional sheet showing the name of the 9mb-contractors and state whether or not tbose entities have emplayees..If the sub-contraamn.haae employees,they=inpmvide their workers'ramp•policy number. I arum an employer that is providing workm'congwnsat vn insurance for my employee.& Bestow is the padlic.,y and job site informadomr. Instance Company Name: L i t,,-I Policy A or Sdf ins-Lit.it: 01-f Expiration Date: y /7 Job Site Address: d.�O t f /.-�IV A �01 City/State/zip: 6174-0%( lklt 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_ M can lead to the imposition of criminal penalties of a fine up to$I,500 00 and/or one-bear imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to time Office of Investigations of ike DIA for instance cm-erage verification_ I do hereby cerh;fy murder the poi andpe9nafties of perjury thatdie information proWded ab nv is true and correct Phone M S61 6 36 V d VS G ©,(Zdal aw only. Do not mite in this area,$a be completed by city or teton official City or Town: Permit/License Issuing Authority(circle one): 1.Board of Health 3.Building Department 3.Cityf'own Clerk 4.Electrical Inspector S..Plumbing Inspector 6.Other Contact Person: Phone#: 6 Pv � + BARNSrABIZ ,�� Town of Barnstable plft)MA'S� Regulatory Services Thomas F. Geiler,Director Building Division Thomas Petry,CBO Building Commissioner 200 Main Street, Hyannis, MA 0260.1 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 i I, WA %NE PA Ck EGO ; as Owner of the subject property hereby authorize SHANE Al CHFco to act on my behalf, in all matters relative to work authorized by this building permit application for: Ord L/ �4/I�7 a✓�h ��/ l_C'il'+Ci✓i��t (Address of Job) Signature of Owner Date WA yNr- PAC HE"Co Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on.the reverse side. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 070110 I °FtME r � Town of Barnstable Regulatory Services BAErYMBLE• " Thomas F.Geiler,Director 9�A 16 a��� Building Division + lEo,,,tpr _ Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.m.a.us Office:. 508-862- 038 Fax'. 508-790-6230 HOMEOWNER LICENSE EXEMPTIO Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# ^ CURRENT MAILING ADDRESS: city own state zip code The current exemption for"homeowners"was extended to includ owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hi who does not poss ss a license, provided that the owner acts as supervisor. DEFINITIO OF HOMEOWNER Person(s)who owns a parcel of land on whic he/she resides r intends to reside, on which there is, or is intended to be, a one or two- family dwelling, attached or detached structure accessory such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be consider a home wner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she sh 11 be r s onsible for all such work performed under the buildin ermit. (Section 109.1.1) The undersigned "homeowner"assumes responsibi or compliance with the State,Building Code and other applicable codes, bylaws,rules and regulations. The undersigned "homeowner"certifies that h she underst nds the Town of Barnstable Building Department minimum inspection procedures and,requirements and that he/she ill comply wit said procedures and requirements. :Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or ger 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 i supervisor." Rules&Regulations for Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, g Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board,cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 070110 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY Liberty MUt I u , INSURANCE ff ' AR INFORMATION PAGE I 175 Berkeley Street Boston,MA �16 Issued by LIBERTY .MUTUAL FIRE INSURANCE 16586 s` Policy Number WC2-31 S-3 8 6119-013 Issuing Office 16C 1 RENEWAL OF: WC2-31S-386119-012 Issue Date 05-09-13 Account Number 1-3 8 6119 . Sub Account 0000 1. Insured and Mailing Address # SNIP REALTY DEVELOPMENT LLC RISK ID 000950881 81 JASPER RD MARSTONS MILLS,MA 02648 Status 46 - LIMITED LIABILITY CO I Other workplaces not shown above: SEE ITEM 4. PREMIUM-EXTENSION OF INFORMATION PAGE 2. Policy Period`The policy period is from 0 4-17-2 013 to 0 4-17-2 014 12:01 A.M. standard time al tte Insured's mailing address. 3. Coverage A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law o I he 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 our liability under Part Two are: Bodily Injury by Accident $ 100,000 each accident Bodily Injury by Disease $ 500, 000 policy limit Bodily Injury by Disease $ 100,000 each employee C. Other States Insurance: Part Three of the policy appli SEE END WC 20 03 06A es to the states,,if any, listed here: D. This policy includes these endorsements and schedules: SEE EXTENSION OF INFORMATION PAGE 4. Premium: 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. Code Premium Basis Total Rate per$100 Estimated Ann i II Classifications Number Estimated Annual Remuneration of Remuneration Premium See Extension of Information Pa e _ , l Minimum Premium $ Soo (MA) Total Estimated Annual Premium $ 5,289 Premium will be billed ANNUAL Producer 0004-059180 FRANK L HORGAN INSURANCE AGENCY INC 44 BARNSTABLE ROAD P 0 BOX 250 WC 00 00 01 A 01987 National Council on Compensation Insurance,lnc. WC 00 00 01 B(NIJ) Ed. 07/01/2011 All Rights Reserved Page e1of1 9 , t •. E i Insured Copy LIBERTY MUTUAL FIRE INSURANCE COMPANY P.O.Box 9090 Liberty Dover NH 03821-9090 Mutual® Telephone: (800)653-7893 Fax: (603)334-8162 Email: IMS@LibertyMutual.com Quote Number: 601814-01 Insured: SMP REALTY DEVELOPMENT LLC Quote Period: 04/17/2013-04/17/2014 81 JASPER RD Issue Date: 02/01/2013 MARSTONS MILLS MA 02648 Legal Status: LIMITED LIABILITY CO FEIN:421729572 Principal Title SHANE PACHECO MEMBER Workers compensation insurance offered by this quote applies to the following states: MA Employer's Liability Limits of Coverage: Bodily Injury by Accident: 100,000 Each Accident Bodily Injury by Disease: 500,000 Policy Bodily Injury by Disease: 100,000 Each Employee Location Number and Address (Notify us promptly of any location changes to avoid issues regarding coverage.) 001 81 JASPER RD,MARSTON MILLS,MA 02648-0000 Loc. Class Estimated Ratel State # Code Description Exposure $100 Premium MA 001 0042 LANDSCAPE GARDENING&DRIVERS 21,000 4.03 846 5403 CARPENTRY NOC 0 9.61 0 5474 PAINTING OR PAPERHANGING NOC&SHOP 31,500 5.09 1.,603 OPERATIONS,DR 5645 CARPENTRY-DETACHED ONE OR TWO FAMILY 26,250 8.68 2,279 DWELLINGS 5651 CARPENTRY-DWELLINGS-THREESTORIES OR 0 8.68 0 LESS .. ... Location Total 4,728 PREMIUM SUMMARY Charge Description Factor Status Premium MA TOTAL CLASS PREMIUM 4,728 MA STANDARD TOTAL 4,728 EXPENSE CONSTANT 338 MACHWC(SURCHARGE) 1.042 199 TERRORISM RISK INS ACT 2002 1.030 24 IM 0090 0311 .Account Number: 1386119-0000 Pagg 3 of 4 PREMIUM SUACAARY Charge Description Factor Status Premium MA FINAL TOTAL 5,289 Total Premium and Surcharges $5,289 The above rates are subject to state mandated changes. The factors used in rating this quote are also subject to change pending promulgation of final experience modification and classifications/exposures from final audit of your current workers compensation policy. If your operations,payroll exposures or any other pertinent information has changed or differs, notify us immediately so a revised quote can be issued. To notify us of location,payroll or any other changes,please use the above contact information. ............. _.. . IM 0090 0311 Account Number:1386119-0000 Page 4 of 4 PPO 10 ® CERTIFICATE OF LIABILITY INSURANCE l DATE,MM/°DIYYYY) ACORO THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER FRANK L HORGAN INSURANCE AGENCY INC CONTACT NAME: 44 BARNSTABLE ROAD PHONE A/c No): HYANNIS, MA 02601 EMAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC If INSURER A: Liberty Mutual Fire INSURED INSURER B: SMP REALTY DEVELOPMENT LLC 81 JASPER RD wsuRERc: MARSTONS MILLS MA 02648 INSURERD: INSURER E: - INSURER F: COVERAGES CERTIFICATE NUMBER: 16236444 REViSiON NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDLITYPE OF INSURANCE NSR SUER POLICY NUMBER MMIST MM TR /DD/YYYY LIMITS L GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY - PREMISES Ea occurrence $ CLAIMS-MADE OCCUR _ _ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PRO LOC $ - COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY Ea accident $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ $ UMBRELLA LIAR HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE - :AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION WC2-315-386119-Q13 4/1]/2013 4/17/2014 WC STATU- 01�1- AND EMPLOYERS'LIABILITY - TORY LIMITS ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 100000. OFFICEnRdBMDER EXCLUDED? �..N 1 A _ (Mandatory In NH) _ E.L.DISEASE-EA EMPLOYEE $ 100000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space is required( Workers compensation insurance coverage applies only to the workers compensation laws of the state of MA. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TOWN OF BARNSTABLE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200 MAIN ST ACCORDANCE WITH THE POLICY PROVISIONS. HYANNIS MA 02601 AUTHORIZED REPRESENTATIVE Jeff Eldridge ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25y(2010/05) Qp q1 The ACORD name and logo are registered marks of ACORD '1'h1 SN certi3T icateCLIENT cancels`anCt�supe°rseclesg ALL/prev.lo:sFly AN Pasa icertificates. previously issu TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map t Parcel_ Health Division r z ,st U; LiAf �� �rT "' Date Issued Conservation Division 1—� S• ���1�(� �; JU14 �.� 1PPp�ication Fee Tax Collector Permit Fee Treasurer /2/K �� ///�O,Pv - ►W8 10 STEM MUST BE Planning Dept. I;�gS ' �.L D 114 COMPLIANCE Date Definitive Plan Approved by Planning Board .�Y]Ti�TITLE 5 ENVIRONMENTAL CODE AND Historic-OKH Preservation/Hyannis TOWN REGULATIONS Project Street Address 22 4Lr'^n Village S li Owner Address Telephone *0 Oo Off ZZ/ 6 F0 Permit Request 6a c c-i ed d 36 r elly a si7RO 0/V ,_�0A4e s s Ion 6 h o US e- /Q60 AL 6edm WEEL-divI � Square feet: 1 st floor: existing 700 proposed 2nd floor: existing � proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size a c(r, Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family ur-1, Two Family ❑ Multi-Family(#units) i Age of Existing Structure �S ��5 Historic House: ❑Yes �o On Old King's Highway: ❑Yes ❑No Basement Type: fff-u II ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) 660 Number of Baths: Full: existing '� new Half: existing new Number of Bedrooms: existing 'L new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: P.Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes C& Fireplaces: Existing New Existing wood/coal stove: ❑Yes 2I[No Detached garage:❑existing ❑new size /Ji4 Pool: ❑existing ❑new size j� Barn:❑existing ❑new size Attached garage:❑existing ❑new size X-R Shed:Xexisting ❑new sized Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Name �u �c° ��n�" � ��1 Telephone Number / S U� 71-1- z 727 Address (L"j/I� �� ��,"I-.e-- License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECTWILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY R i PERMIT NO. DATE ISSUED MAP/PARCEL NO. ' ADDRESS - V ILLAG E OWNER 7 DATE OF INSPECTION: FOUNDATION FRAME , INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL - PLUMBING: ROUGH FINAL- - GAS: ROUGH - FINAL- FINAL BUILDING ` DATE CLOSED OUT ASSOCIATION PLAN NO. 06/10/2002 13:06 5087900609 I.JCTP INC PAGE 02 The Commonwealth of Massachusetts Department of Industrial Accidents �TOWN fJidNd bolt Washington Street Boston,Mass. 02111 Workers' Com ensation Insurance A Odavit locatiCM: ._o µ i citv ❑ I am a meowner PerfoMing all wo*myself. I am-a.able etor and hm no one working in an ❑ I am an lem foyer providing work-n' compensation far mr employees wlin o g job, or t* 14-0 s, & li t< rye ® I am a le proprietor,mineral contractor,or homeowner(circle ours)and bane the oontractors fisted below who have nb workers'competlsaeton palaces the� g : • Own sr. tn}1 snit i,y.r^k°#' x :t Y • r t t * { ! t 3 t S y {� f S fe 'St�•95.� "�Lb� � � ;..>... €�sll<�< ��t,tSs i,s'�s <�« f t r f < q t!r �£ ,��? ��v i,��; •.s >2 a•.. f I 4 Y,t £ 9f 2 L s •� f s f t t s G ! Y£ Cr S s u M F•+�.�f f• ��k �! 2x Y <S < _ S f £ .,At )r{ bblS fk •ta! ?^e it j. S .'..: � r, i � �,k�.u�.A�SN S'...:.:t 6. �sktl y�'w:fn � i M., Sh/{ {•'�5��: .:fk>c�"y��•ip9� � fY •iSi ! F 9 Ra eov as t qufted NUdar 25A of MOO IS]can bod to&0 its aM or patalflea of a Roo vp bs 51,500.00 EnNor one yon,ia4d wMaNd am won a d va pas dda IM the toms of a Strop WORK ORVER and a One of sloe. a day welfa t me. I TMdv4kMi fat• copy of v* may be lbrwar&d to Om Ofthm of Inver Of flo DIA$Dr anve W vvlf Ed— I do haeby citify cruder the p ' and penahis of perjury*gg the infor►na*x provbded above is av or mod correct Siaaature `' Anthony R. Prizzi, Il Phame 508-778-2777 ]Print mane ---- oledal asal oNp do�wift fn fda arse to be completed by dO or loam oQ rfol dty or t ..� - — onsc p OI Hoard --------------- ['diacliitimanedlat•aaxpa�e to rsgolrad �ffid 's Ofpee . ©HtakeDepae�t cmodast p��; aros a Mau %.erttflrate of fflame �� acc REGISTERED ISSUED BY 71 ""a'• FABRIC Dote NUMBER TOPTEC, INC. manufoctu►ed , ~ 1905 N.E. MAIN ST. •we rt►`�pt 31. 02 SIMPSONVILLE, S.G. 29681 3-31-97 It ET This is to certify that the materials described on the obverse side hereof have been flame-retardant treated(or are inherently nonflammable). J FOR ADDRESS TENTS ADDRESS90 MTDTECH DR CITY W YARMOUTH STATE Certification is hereby made that: (Check "a" or "b") I (a) The articles described on the obverse side of this Certificate have been treated with a flame-retardant chemical approved and registered by the State Fire Marshal and that the application of said chemical was done in conformance with the laws of the State of California and the Rules and Regulations of the State Fire Marshal. Nameof chemical used.....................................---..._._....................Chem. Reg. No......... ------- ....... ..... m Method of application--__ (b) The articles described on the obverse side hereof are made from a flame-resistant fabric or material in ® registered and approved by the State Fire Marshal for such use. Ln LO The Flame Retardant Process Used WILL NOT Be Removed By Washing _ 9 MODEL TX301000 .V CV 'r SERIAL# 970943D None of odudion 3uporinrendont UD . s of r� TOWN OF BARNSTABL'E Permit No. ..L9253 ~� BUILDING DEPARTMENT { H°8MAN' I TOWN OFFICE BUILDING Cash r�ff,,..... ��'�oriv► HYANNIS,MASS.02601 Bond ......../.v�. j CERTIFICATE OF USE AND OCCUPANCY Issued to Plymouth Bay Development Address Lot #58, 2204 Falmouth Road Centerville, Massachusetts USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE .WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE i BUILDING CODE. r 'October 28, ' 19 86 Building Inspector w a� `�� °•,w TOWN OF BARNSTABLE t BUILDING DEPARTMENT TOWN OFFICE BUILDING NASAL 1039 � HYANNIS, MASS. 02601 �F MEMO TO: Town Clerk FROM: Building Department DATE: 0 fo An Occupancy Permit has been issued for the building authorized by Building Permit # ........... ................ .................. ... ... ....._......».......... issued to ......_....».... »»»�//mot Vl � .»» . --�.• ,• 1/„ »»». » __». _.» » . Please release the performance bond. 0 -� a<, \ ti Foi�vOA7"1cr✓ \ 3 5 � r .9e�� � 0 J a � CERTIFIED PLOT PLAN LOCATION G?: r� !!e.L.4.� ...!}?�?•. . r J SCALE /. - ?'a DATE PLAN REFERENCEE�!�!G �GT' . . . . . . ... . .. . . EDWARI�, -` ✓` r tiro, 26100 • ICERTIFYTHAT THE Ev1S7iivG FvG.r� ..*. . .. . . . 9E-�STER���q"� SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS SHOWN HEREON AND THAT IT CONFORMS TO THE L Ld �J SETBACK REQUIREMENTS OF THE TOWN OF .WHEN CONSTRUCTED. DATE REGISTERED..LAND SURVEYOR . ,. BUILDING TOWN OF BARNSTABLE,' MASSACHUSETTS PERMIT JOB WEATHER CARD DATE 19 PERMIT NO. - APPLICANT ADDRESS IN0.) (STREET_)„ (CONTR'S LICENSE) NUMBE OF PERMIT TO' (_) STORY OWELLRNG UNITS (TYPE OF IMPROVEMENT) NO. F (PROPOSED USE) 'I ZONING t AT (LOCATION) -' DISTRICT { IN0.) "(STREET) BETWEEN / AND (CROSS STREET) (CROSS STREET) I LOT SUBDIVISION LOT BLOCK SIZE BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION • 1 .. (TYPE) .REMARKS•.`^ Al ' t AREA OR PERMIT VOLUME ESTIMATED COST FEE „- ( SOUARE FEET) OWNER ADDRESS Tr ' BUILDING DEPT_ BY THIS PERMIT CONVEYS NO RIGHT TO'OCCUPY- ANY STREET, ALLEY OR. SIDEWALK OR ANY*PART THEREOF, EITHER TEMPORARILY OF woo. PERMANENTLY:. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE AP- PROVED BY.THE JURISDICTION: STREET OR ALLEY GRADES AS WELL AS DEPTH AND CATIONOF PUBLIC SEWERS MAY BE OBTAINEI FROM THE DEPARTMENT OF-PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOF_S`NO`f RELEASE THE APPLICANT FROM THE CONDITION, ._ '.OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM '.OF...THREE CALL APPROVED PLANS MUST BE RET INED ON JOB AND HIS T WHERE APPLICABLE SEPARATE -+)_• INSPECTIONS REQUIRED FOR .� PERMITS ARE REQUIRED FOR AL,�. CONSTRUCTI.ON WORK: CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN ELECTRICAL, PLUMBING AND t. FOUNDATIONS OR FOOTINGS. MADE. :WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS. 2. PRIOR TO,covERIRG STRUCT URAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL MEMBERS DON BEFORE: FINAL INSPECTION HAS BEEN MADE, . 3..FINAL''INSPECTION BEFORE: v N POST THIS CAR® SO IT IS VISIBLE ..FDnM STREET y _ BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPEC N APPROVALS ii�• I 1 1 G i 2 2 All" /t, 2 � Oars' - 3'. - HEATING INS CTING A PRO ALS REFRIGERATION INSPECTION APPROVALS �E ING 09 l .O H,E —_-_ -_ __— -- 2 KIM 10 a ®A 'WCRK SnAL_.. NCT PROCEED UNTL THE PERMIT WILL BECOME NULL AND7VOID IF CONSTRUCT40N INSPECTIONS INDICATED ON THIS CAR; NSPECTCR HAS APPRCVED 7HE: VARIOUS WORK IS NOT STARTED WITHIN 5N MONTHS OF DATE THE CAN BE ARRANGZD FOR BY TELEPHO.N( STAGES OF CONSTRUCTION. PERMIT IS ISSUED AS NOTED ABOVE. OR WRITTEN NOTIFICATION. .� I ' a HE'!g"EBY CERrIory r IL,r o 407/J AiOt l TZPi/N FED "► AS Sw#N av THE.fcacmw, FZ40,0 AMAO&WC R4 Ar, .r0* 4NC- '4•. , .A407C. •NORTH ARROW NOT,TO �" y S'Gt�AR+P tj1 ;s, f �Npc.1�v� ea�w .z.Y y0 � y Q1 y y (4 57--- r, o c c4 2 _ ti a y ' t " INLa z Twig P44r amm mm. AU4.Plf m"` FO1. NPATAX 4OC*4T 44N (/SE OF THE 64MK aV4 Y. l/Nveq AfQ CIRCUMSTANCES ARg o F'FSE'TS 'TO B ' ETC, .- Al /p jY:Pu(MOUT r-Dep m"Xwe w i ROBER'fE. E� T I6WA U RAYMOND' •ISE' T AAAAMA A4. QZMrg, ry 9 No.215GIST 83 Q yl J'Z � j_ a Assessor's office'(1st floor): Assessor's map.and lot number ....... .................................... Q OF THE Toffy Board of Health '(3rd floor): _ SEPTIC SYSTEM MUST BE Sewage Permit number ................... ��. .. .... ...,. INSTALLED IN COMPLIANCE : BaE39T/1DLE, Engineering Department (3rd floor) 11�G WITH TITLE 5 'oo ir6 . AS House number ................ ......... ......... ......... ...... .. ENVIRONMENTAL CODE AND o ypI APPLICATIONS PROCESSED 8:30r 9:30 A.M. and' 1:00-2:00 P.M. -only' Tnwm REGULATIONS - A P P R 0 V E U� Wo ''OF BARNSTABLE Barnstable Conservation C 5 .� ILDING INSPECTOR Signed Date 4 I f APPLICATION FOR PERMIT TO ..'.u4 '�� .. ......� ;..........4 �.°`f l........................... a ................ TYPEOF CONSTRUCTION ..... .......................:................................................................................................ ...... 19k TO THE INSPECTOR OF BUILDINGS: . The undersigned hereby applies .for a permit according to the following information: . f........ .: ............ � ........Locatio. ..... . � ........ Proposed ....F �6I ....... !~ ..... ................................... V Zoning District ......-C ..........................................................Fire District .........co.. Name of Owner. .. t✓ ' OPe�l4ddress .. ��}... d�c )Z�.�.......�1� .` !1 � 1 Q2,? Name of Builder ...... . ..... . .7 �� 6 .../.. .f....... ! 14...bz 0 .. 7�'..'�-`�'°1�.. .. .Address .a. ....... i � Name of Architect ( .. ........................................Address ................... e Number of Rooms �/ ".7...............:..................................Foundation rC�v! ... �. .....z 2 a ExieriorUt.t:le— ..! ..... / ..�dtll� aofing ... ! � ... .. ............ Floors .. . . .Q.� . . Interior jJ.U�. y ..... 17 Heating .i�C�' ... / ................Plumbing ....C ��^'v�► . .. ..➢�.l...C .......... ..... !C..... ... ....... .. / - . Fireplace ..............:.... /../?`...........:......................................Approximate Cost ....... .Q.a.. ........ . LL � Definitive Plan Approved by Planning Board _____ _ _ _____ Area .. . . ............. . .. Diagram of Lot and Building with Dimensions Fee ............: ! `�..tom.......... ............ SUBJECT TO APPROVAL OF BOARD OF HEALTH tj Jq coo / ��0 f p' 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 ...I I ....... .... ....... .......Construction Supervisor's License ..... ktn PLYMOUTH BAY DEVELOPMENT _0 29-253 11 Story 2 No................... Permit for ................................. .........Single...Faml.ly...,.D.wellin� .................... ...... . . ...... . .. Location ..... 4204 Falmouth Road .......... ......... ........................ Centerville z .............. ....... ... ... .........l........................ Owner Plymouth gaf DevelopT��� ................... .a......... ........ Type,of Construction ......"Frame ........................ T el. ...................................................... ....................... Plot. Lot ................................. Permit Granted. Apxil.'24.......... ...19' 86 Date of.Inspection ...19 Date Co plet'ecl ... ................... . 51 M Cr ri j Jr