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HomeMy WebLinkAbout0016 HILL CREEK ROAD . ,. , . - �:: �, . :. . . �: _: ., _ � � -�� ,. . . , . � e. r°•� - N K r..� ,� .� r � :. �. -.� f vi �� _ - 'a Y' • . � r -i. � FF .. .. i .E 4 � ` .. � n _ .. r ` � T r ... _, s.. � ., .. Y . „ �- _ .. .i -.> ., � �. .. _ P 4I .. � 4 �� o � ` TOWN OF BARNSTABLE BUILDING P IT APPLICATION Map Parcel 2 .3 AM 26 AzrApplica�ion �3��3 r:, Health Division Date Issued 3� j Conservation Division Application F J Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/ Hyannis Project Street Address ay Village Owner- Address Telephone J Permit Request � f,!r A ep2 o,' 9 ; YAK Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation i :g5) Construction Type,� ��"� Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family 5L Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes )OLNo On Old King's Highway: ❑Yes,-�9_No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas' ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # , Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use —Proposed Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name �L� mad /i/�!!`,.7%a� Telephone Number 70 `f Address �ZIC 9"e e%z License # Home Improvement Contractor# Worker's Compensation #12elaDd��✓�l��J ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 4 FOR OFFICIAL USE ONLY APPLICATION# DATEISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER e• DATE OF INSPECTION: �FO.U.NDA�I.ON3u =, u, -,t,,v 4Lrrj, ,.. f FRAME r-ry A. r-n"" . INSULATION_i.,--„r_ ..,.- . . �.. H FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING,-- DATE CLOSED OUT ASSOCIATION PLAN NO. r t J r t OWNER AUTHORIZATION FORM (Owner's Name) owner of the property located at 11 G-re e.t Z c�c 1 , (Property Address) (Property Address) hereby.authorize Gr '10 (Subcontractor an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a.building permit and to perform work on my property. Owner's Signature t 1 Date e j v ': .;,., �lrt.`xaclursctts = Deliart111011 of PLIMiv �afct� "�' Huard uf• litril'ilin� I:c;;uLuiun.� and Jt:uul:utls - constru•ptiort Supervisor License � ry• - , Llcen �'r.Ca. 100988 w'"hmhr i HENRY CASSIDYa�wa+x�! r' a s . 8 SHED ROW WESj:r YtARMOUTH, MA 02673 Expiration: 1 1 11 1/201 3 l ,.nuuis�i,wel' Trg: 7620 = � Office: of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 153567 Type: Private Corporation Expiration: 12/15/2't114 Tr#" 23;ie3t CAPE COD INSULATION, INC HENRY CASSIDY 18 REARDON CIRCLE SO. YARMOUTH, MA 02664 —. __..-__ Update Address and return caul. Murlc reason for change. 6 M . L Address L_I Renewal I ) 1?1111jiloynleut I I Lust Card �f rrrr.ur,�,rurc:rrll�.c/ darn.�rr.iclCJ , w ut�irc ut Cuusumer All'alrs S Business Rtgulatiou License ur registration valid for individui use only �I IitOM�IMPROVEMENT CONTRACTOR before the expiration date. If found return to: a �a9istration: 153567 T e:. Oft-ice of Consumer Affairs and Business lie ulati n' Y P 6 0 xpiration: 12/15/2014 Private Corporatic•ri 10 Park Plaza-Suite 5170 y Bostuu,MA 02116 1Nf'i� il.)iiVtiIJLA rle)N, INC. I Ict ft(:r1IiD(.)N I,IRI,LL } 'i;\R.v10lJTf1:MA 02664 Uuticrsr.crclary of Val wit'no t ' uat re CAPECOD-27 MYOUNG CERTIFICATE OF LIABILITY INSURANCE DAT 7/812DIYYYY) _ 7/8/2013 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 License#PC-514062 CONTACT NAME; .Margaret Young Rogers&Gray Insurance Agency,Inc. PHONE FAX 434 RIB 134 A/c o Xt: AIC No): South Dennis,MA 02660 AIL ADDRESS:myoung@rogersgray.com INSURERS AFFORDING COVERAGE - NAIC# tlusUReRA:PEERLESS INSURANCE COMPANY INSURED _• INSURER B:COMMERCE INSURANCE COMPANY - Cape Cod Insulation,Inc. _ wsURERC:Evanston Insurance Company 18 Reardon Circle INSURERD:ATLANTIC CHARTER INSURANCE GROUP _ South Yarmouth,MA 02664 INSURER E: - _ r INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD ' INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM,OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE .ISSUED"OR MAY PERTAIN, THE INSURANCE AFFORDED BY-THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IL TYPE OF INSURANCE ADDL SUBRI POLICY EFF POLICY EXP - > LIMITS INSR D POLICY NUMBER. MMIDDIYYYY MMIDD/YYYY GENERAL LIABILITY _ _ - _ EACH OCCURRENCE ` $ 1,000,000TO RENT - ._ A X COMMERCIAL GENERAL LIABILITY CBP8263063{ 4/1/2013 4/1/2014 PREMISES(Ea occurrence $ 100,000 ' CLAIMS-MADE OCCUR MED EXP(Any one person) $ . 5,000 PERSONAL&ADV INJURY $ 1,000,000 f. GENERALAGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY JE PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT` Ea accident $ - 1,000,000 B _ ANY AUTO 13MMBCKVMK 4/1/2013 4/112014 BODILY INJURY(Per person) $ ALL OWNED rSCHEDULEDBODILY INJURY(Per acc dent) $ AUTOSAUTOS $X HIRED AUTOS AUTOSNON-OWNED i PROPERTY ER ACCIDENT) MAGE ( $ X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 1,000,000 " .0 EXCESS LIAR CLAIMS-MADE XONJ453512 -4/1/2013 • 4/1/2014 AGGREGATE $ 1,000,000 DED 1 X I RETENTION$ 10,000 R $ WORKERS COMPENSATION 1NC STATU- OTH- AND EMPLOYERS'LIABILITY - TOR LIMITS - D ANY PROPRIETORIPARTNER/EXECUTIVE YIN WCA00525904 ,613012013 6/30/2014 E.L.EACH ACCIDENT $ 1,000,000 OFFICERIMEMBER EXCLUDED? ..❑ N/A v - (Mandatory in NH) E.L.DISEASE.-EA EMPLOYEE $ 1,000,000 it es•describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ r, DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks_Schedule,If more space Is required) - Workers Compensation includes Officers or Proprietors. Addtional Insured status is provided under the General Liability when required by written contract or agreernent with the Certificate Holder. CERTIFICATE HOLDER- CANCELLATION t SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION. DATE THEREOF, .NOTICE WILL BE DELIVERED IN Cape Cod Insulation,Inc 0 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All-rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD' ` r The Commonwealth of Massachusetts Department of Industrial,Accidents Office of Investigations .600 Washington Street a Boston,MA 02111 www.mass.gov/dia Workers, COUIPeusation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers A licant Information Please Print Le >ibly Name (Business/Organization/Individual): Address: City/State/Zip: /� 6Z ' Phone Are you an emplo er? Check the appropriate box: El I am a employer with, 4. 1'am a general contractor and I Type of project(required): l. employees (full an&or part-time).* ' have hired the subcontractors 6. New construction i 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling Ship and have no employees These sub-contractors have g, [] Demolition ' working for me in any capacity employees and have workers' ! [No workers' comp. insurance comp. insurance.t 9. '❑ Building addition required.] 5. 04e are a corporation and its 10.0 Electrical repairs or additions i 3.❑ I am a homeowner doingall work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12,❑ Roof repairs insurance required,] t C. 152, §1(4),and we have no - 3a.❑ I am a homeowner acting as a employees. [No workers 13.E] Other�/yli general contractor(refer to#4). comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their worker'campensatiod�oGcy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside eontractorn must submit anew affidavit indicating such. tContmcton that check this box must attached an additional sheet showing the name of the sub,-outracton and state whether or not those entities have employees. if the sub-contractors have ernployees,they must provide their workeW comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site informatiorz • ; Insurance Company Name: /,/�.S/7%G `?�7i�✓�`'f� ' Policy /� ' j " #or Self-ins.,Lie'#: Z9 z Expiration Date: I _ Job Site Address:, City/State/Zip:Y/& 9 Attack a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification: I do hereby certify under the pains and realties of perjury that the information provided above is true and correct t _ Date: �p�F 5177✓// 2 lY " Official use only. -Do not write in this area, to be completed by city or town official City or'Town: Permit/License# Issuing Authority"(cirele one): 1.Board of Health 2, Buildlgg.Department 3.Citygown Clerk 4.Electrical Inspector,5. Plumbing Inspector 6.Other Contact Person Phone#t T0" 0FIP A RN S TA INS U L AT 10 N2013 SEP 21 I�F1 N® PI.-35 SFAMFF55 SPRAT FOAM SYSPFNOFY RAM OYTtFRS CF M**®AL �vp„ 1-800-696.6611 rt =_� ok BIZ-7 Town of Barnstable Regulatory Services Building Division 200 Main St Hyannis, MA 02601 a Date; Dear Building Inspector Please accept this Affidavit as documentation that Cape Cod Insulation, Inca performed & completed the insulation and weatherization work at the property listed below. Cape Cod Insulation did this in accordance to the specifications listed on the building permit application. All work has been inspected by a certified Building Performance Institute (BPI) inspector. All work preformed meets or exceeds Federal & State Requirements. Property Owner Property Address Villa g �b 1� 1 Cd'�e P A ��v y . Insulation Installed: Fiberglass Cellulose R-Value Restricted Unrestricted Ceilings ( ) . ( X) ( (^ ) (X) Slopes ( )- (, Floors 1 Walls ( ) r .: { ` ) ( ) ( ` ) ( Y, Sincerely He y E Cas y Jr, President i;r Cod I ulation, Inc. -'fix` • T - W ai2k Nb-T po a A5 a r $12A1l 3 Main File No.1 !nt-201 11 Pa a#11 Building Sketch Borrower Daniel &Mary Luczkow Propeay Address 16 Hill Creek Road r City Centerville County Barnstable State MA Zip Code 02632 Client Cape Cod Cooperative Bank sl-'�e� e m cra �lit w, y OffiJ In9rountl Puol With Pool House h. R Lj r� covered✓✓✓vergoia G/ eae� ,vi �4,- PwLi door IXJ(S VV_ wthHolwh ♦��W ✓ � �/'V`�W•.� • / Wont Deck Wood Deck .wood Dent 24.0' •' �� W/O Kitchen Dining , •t�� �h�� Bath Clst V+j � _ `V " zcar atecnee L-,T� /V7ly✓) Geroge Living Room b 5 kth Bed—. aedlDen24.0. AB. Gst A f �/J Sketch by Apm N"' a0: �'�q�� ,� k�� 1 )�`y,c3�l.9 „(((rr Main File No.16HillCreek-Cent-201 11 Pa a#12 Building Sketch Borrower Daniel &Mary Luczkow Properly Pfoperly Address 16 Hill Creek Road + - City Centerville County Barnstable State MA Zip Code 02632 Client Cape Cod Cooperative Bank S Lys : - \ .0' BaLD - LOetk w Se0room - Bath Bewroom _ t Family i.. Cist ` T - 2ao Floor - •� Clst - - - L 4.0, C.0' 4.0' Clsl o pen - eaeroom smar -. • C15t 4.0- m . . a0.o' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION « I CC��as Map Parcel cc) Application . Health.Division_ Date Issued Conservation Division Application Fee Planning Deot. Permit Fee 3 Date Definitive Plan Approved by Planning Board �W3�1t V, Historic - OKH _ Preservation' / Hyannis w rojectaStreet Addres- Ownef r G Address ma- Telephon. - ,� A �Per-mitiReques_ t,.C/*nYf j h�.rs�_ e.Yclr1+�` rur.f- c1. ..� �6s2P+•c.� s /.cue,— 4Gc� Aa�z_ 4T_ �B✓4 — f l S�C. 1 �Qot C 1111rW qt-1 lour Imej rmw,, Gre r-t'rk� Off.A O -a JA �CG� W# �s1 L�cCfn?ch✓M rI LLI�. �larh Ir l� C' i� . rr~ I,a,ll F,uae Are is A fo ex:5+;►, otl I-'-g 6Aec.l &46e. � �YG c,ticll 4,1/'b� bur'I It &Vel' b k plait Squardfeet: 1'st floor: existing proposed 2nd floor: existing proposed Total new Zoning District _ Flood Plain_ __Groundwater Overlay Project;Valuation c df Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished-Area(sq.ft.)—_ Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new . Half: existing newCD Number of Bedrooms: _ existing —.new Total Room Count (not including baths): existing _ __—new First Floor RoomCount Ca Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: 0 Yes® No Detached garage:,❑ existing ❑ new size--Pool: ❑ existing ❑ new size _ Barn: ❑existing ❑ new s --e_ c� Attached garage: ❑ existing ❑ new size __Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑. Commercial ❑Yes ❑ No If yes, site plan review # Current Use _ —� Proposed Use — - - - APPLICANT INFORMATION - --- - (BUILDER OR HOMEOWNER) ' Names �'1'l0�� �����dTeiephone-Number- � Ctt Address, License # y _ Home Improvement Contractor# — Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO _SI.GNATURFDATiE % FOR OFFICIAL USE ONLY Ar APPLICATION# DATE ISSUED MAP/PARCEL NO. T ADDRESS VILLAGE , r • OWNER " DATE OF INSPECTION: r' FOUNDATION ' FRAME ,c INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL ,r GAS: ROUGH FINAL R. a s FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. i The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations kip. 600 Washington Street Boston,MA 02III. www mass.gov/dia. Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individnal): 0�t2i-h Address: ud 0yc 6..,1 City/State/Zip: &7a 3 S r/3, 4 c�a P one#: CS-o) / - 0?69(5 Are you an employer?Check the appropriate box; Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6 ❑New construction 2.XI am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees 7 These sub-contractors have •g• Demolition working for me in any capacity, employees and have workers' [No workers' comp.insurance comp.insurance.$ 9, ❑Building addition required.] 5. We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doingall work officers have exercised their 11,❑Plumbing repairs or additions myself. [No workers'. comp: right of exemption per MGL insurance required.].t c. 12 152, §1(4),and we have no .[:]Roof r � ' ep employees. [No workers' 13.❑ Other comp•insurance required.] *Any applicant that checks box#I 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 insurance for my,employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: 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$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a_STOP WORK ORDER and a fine of up to$250.00 a day against the violator'. Be advised that a copy of this statement may be forwarded to the.0ffice of Investigations of the DIA for insurance coverage verification I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: - / Phone#: C i0, . 1 z � ( � 6 7 a a., Official use only. Do not write in this area, to be.completed by city or town official 3 City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk ,4.Electrical inspector, 5.Plumbing Inspector. 6. Other Contact Person: Phone#: r The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, M4 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Buflders/Contractors/Electricians/Plumbers Applicant Information Please Print Le 'bI Name (Business/Organization/fndh ideal): m/ vL Address: C y- /State/Zip:�_ t _ CR_ v l Phone#: G Are you an employer? Check the a ro PP Priate box: 1.❑ I am a employer with 4. I am a general contractor and I Type of project(required): employees(full and/or part-time),* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner listed on the attached sheet, 7. Remodeling ship and have no employees These sub-contractors have working for me in any capacity. employees and have workers' S. Demolition [No workers' comp, insurance comp..insurance,� 9• ❑Building addition . 3.❑ required_] 5.:0 We are a corporation and its 10.11 Electrical repairs or additions I am a homeowner doing all work officers have exercised their myself. [No workers' comp, right of ex 11.❑Plumbing repairs or additions 4),a on per MGL 12.[]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#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they sre doing an 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 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 providu=g workers'compensation information. insurance for my employees. Below is the poficy and job site Insurance Company Name: Policy#or Self-ins,Lic.#: Expiration Date Job Site Address: City/State/Zip: ------------- Attach a copy of the workers' compensation policy declaration page,(sho"Ing 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 cruninal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the foam of a STOP WORK ORDER and a fine Of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the p d penalties of perjury that the information provided above is.true and correct e—� Date: Phone#: FEP�erson: only. Do not write in this area, to be completed by city or town offzciaL ne Permit/License# hority(circle one): Health 2.Building De artment P 3. Crty/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector son: Phone#: 4 HE r Town of Barnstable Regulatory Services * BARMABLE, Thomas F.Geiler,Director MASS. 039. A•�� Building Division ED Mp•'I Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print AT TE: JOB LOCATION:, `number street village �HOMEOWNER�': ,��f name / �� home phone# work phone# CURRENT MAILING ADDRESS:) //� r ionv/& 11411 a;6- �3 D- city/town stare 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. �.Signat _ 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 personas it would with a licensed 1 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. i Q:forms:homeexempt ♦, �IHE Town of Barnstable Regulatory Services RMAURMN Thomas F. Geiler,Director i639. � Fn►�e►t" Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit. (Address of Job) **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled before fence is installed and pools are not to be utilized until all final inspections are performed and accepted. Signature of Owner Signature of Applicant Print Name Print Name Date Q:FORMS:O WNERPEF MISSIONPOOLS Assessor's Office Ost floor Ma / -Lot % /C Permit# 46.- Conservation Office Oth floor) -6111193 Date Issued (o l q 9,510 Board of Health Ord floor > Engineering Dent. Ord floor) House# S� UST BE Planning Dept. (1st floor/School Admin.Bldg.): INSTAL DANCE Definitive Plan Approved by Planning Board 19 ENVIRO ODE AND (Applications rocessed :30-9:30 a.m.& 1:00-2:00 .m. ATI0 s x f TOWN OF BARNSTABLE Building Permit Application' : , Project Street Address 16 17111cl?ext Villa e (ra !f°�� Fire District Owner / lylee/ Address Telephone Permit Request: IC?>).t f� -/v Zoning District Flood Plain Water Protection Lot Size Grandfa eyed Zoning Board of ApMls Authorization Recorded Current Use 4&f1nGs9(f9 Proposed Use d Construction Tune lVd-0-0. �^✓xc,G> Existing Information Dwelling T)W: Single Fa Iv Two famil Multi-family Age of structure Basement tune zap � o Historic �House 0 Finished _ ' Old King's Highway f Unfinished Number of Baths No. of Bedrooms Total Room Count(not including baths) First Floor Heat Type and Fuel Central Air Zo Fireplaces Garage: Detached Other Detached Structures: Pool Attached Barn None Sheds Other 1 Builder Information n �o ub YZ 78--0 Name�i /`T Telephone number Address License '57001;171 o Home Improvement Contractor# Worker's Compgnsation # NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN (AS-BUILT)—SHOWING-EXISTING.-AS—W-ELL_-AS- PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL B �.l G��u71 O JEC W L E TAKEN TO /a' � AIA110, Project Cost 4000 Fee "t-5 0, SIGNA TLfu DATE BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) BPERM T i 187.024 FOR OFFICE USE ONLY #6097 - 16 Hill Creek Road ` ADDRESS- .-�' �' � VILLAGE Centerville, MA - } i, • . OWNER Michael C. & L. Pajolek — DATE OF INSPECTION: ' r fir' - �fi ; .R ;•�' � �` ; Y �, `�. ^^ ,' I - FOUNDATION FRANE f ` INSULATION. 'FIREPLAC `ELECTRICAL: ROUGH' FINAL f PLUMBING: ROUGH FINAL t' GAS: ROUGH FINAL` FINAL BUIUDII DATE CLOSED �•� �� � ''� � +1 � 1 ' .,ram _ ASSOCIATE P All s 1 t `4 � fie �a�;n?yroouuea�� a��.i2�iza�,zcliccaef.� ------ ---------�.__. . o 1-101,,!E 1iviF,',ROVEIvIE N'1 CON'I"kA(.,TOE�� R�-6 [�i I;A1 I01"1 - FIo,-:iTc_, c;1 t u.; .lc,i.-n; I'<e;yu.1 �at,:iUns and Standards One Ashburton Place - Room 1301 HOME I Ili PFZ0V(: Ili C 0 N F\1ACT0R Registration 110216 Expiration 10/09/96 -rYpe __ PRIVATE CORPORATION T A NELSON CON. TRUC`f-IOI`d CO INC FAO B O X �!9 1112 Ili A l IA S-if if 1. OSTERVILLE MA 02655 , } ---------- The Town oti me r� �,-�- Barnstable' - �. . of ,� ��- - ,asp, �0$ Department of Health Safety and Environmental Services Building Division 367 Main Strect,Hyannis MA 02601 Office: 508 790-6227 ; Fax:: 508-775 3344 TPh men �J ;; rng Oommissioner . . For office use only Permit no. Date t HOME IMPROVEMENT O iliil.TOR LAW K SUPPLEMENT TO PERMTAPPUCAIYON ` MGL c. 142A requires that the'kconstruc ion,allz . ACM improvement, Tem0%2L demolition.or construction of an addition to' any pn�oistirig GWM building containing at-least one but not more than four dwelling to such residence or buildin be done units or to which ate g by registered contractors,with certain exceptions,along with other requirements. TypeofWork 'REN( VATION r.g(.���.n n AddressofWork: 16 HILL CREEK ROAD CENTER_VILLE MA 02632 OumerName: MR -AND' MRS 'MICHAEL' PAJOLEK Date of Permit Application: 16 J U N E 1995 I hereby certifv that: - o•_...,......._..C:iCy^W. ate. a,.c awaVMartg redSpl7(S): Work excluded by law Job under S1,000 Building not cmma-Occupied Oaiter pulling own permit Notice is hcrcby given that:r OWNTERS PULLING THEIR OWN PERMIT OR DEALING %vrm UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IWROVEWNrr WORK DO NOT HAVE ACCESS TO THE, ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c- 142A SIGNED UNDER PENALTIES OF PERJURY I hcrcbti 2Iir)1V for.2 pern ii 2S the ZrCnt of Jhc oXt-ner: 16 JUNE ,j995 T ,A NELSON CONSTRUCTION CO INC 11021 6 ' Daic Contractor namc ,Rcgisuation No. OR Datc Ouwncr's namc I 11/02/94 17:02 V6177277122 DEPT IND ACCID 001 Catwnoluuea&L o/ Ma.JJaclutL etb ' .aUaParfinenf o��nr,�uafria��ccic�en,Ee 600 1/Va��rin�ton S'f�ef ,lames J.Campbell &.&ton, MwaacLaf& 02f f f Commissioner Workers' Compensation Insurance Affidavit I, THOMAS A NELSON T A NELSON CONSTRUCTION COMPANY INCORPORATED (tksasca/permiacee) . with a principal place of business at: 1112 MAIN STREET P 0 BOX 749 OSTERVILLE MA 02655 (Mylst"iZty) do hereby certify under the pains and penalties of perjury, that: ( 1 am an employer provid'mg workers' compensation coverage for my employees working on this job. WAUSAU INSURANCE 15-22022 Insurance Company Policy Number () I am a sole proprietor and have no one working for me in any capacity. () I am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed below who have the following workers' compensation policies: Contractor Insurance Company/Policy Number Contractor Insurance Company/Policy Number Contractor Insurance Company/Policy Number () I am a homeowner performing all the work myself. I understand that a copy of this statement will be forwarded to the Office of Investigations of the DTA for coverage verification and that failure to secure coverage as required under Section 25A of MGL 152 can lead to the Imposition of criminal penalties consisting of a fine of up to S 1,500.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of 5100.00 a day against me_ Signed this IX day of JUNE 1995 4 Lice /Permi ee Building Department Licensing Board Selectmens Office Health Department TO VERIFY COVERAGE INFORMATION CALL: 617-727-4900 X403, 404, 405, 409, 375 TOWN OF BARNSTABLE BUILDING PERMIT # it 1' sor's office(1st Floor): G ssor's i>`tap and lot numfi�dIC °E 1bINSTALLED1N CO Conservation(4th Floor): O ,,9y e w Board of Health(3rd floor): WITH' : ear�ranct Sewage Permit number L2EN ONMENTAL Engineering Department(3rd floor): c-/� (J�,Y�IT� TOWN REGULA r b. House number a Definitive Plan;Approved by Planning Board 19' �" r APPLICATIONS PROCESSED,8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN OF BARNSTABLE BUILDING = INSPECTOR APPLICATION FOR PERMIT TO 'TYPE OF CONSTRUCTION LA/()6)) �d J 19171/ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location 91CL— Cp`��K R(34,6Cd�h' 2V`Cl-Ltd Proposed Use ADDT7-/O �O !mil yCMEA/ Zoning District / D Fire District y( / Name of Owner I/'� "f /SAP k� OL-�� Address 1 PiLL GZG�X R& C,Ee Name of Builder / ' I( t' 461 t'�\5W Address 1WX a l9- Y,+,kA7(1 fTiLAT' d ,5 Name of Architect 0��� Address Number of Rooms 0 Foundation (51/VCQ&c 2/.I S 0�gAf, Exterior CL��� S�/ �� Roofing �SP/ghl,-T-/ El s Floors Interior VI/l 4,t-- " d Heating O/L- Ro Plumbing AmLtE: Fireplace Approximate Cost o Ges Area �y S F Diagram of Lot and Building with Dimensions Fee OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name Construction Supervisor's License �'� � K, MIKE & LISA k No 36449 Permit For BUILD ADDITION l Single family Dwelling y Location 16 Hill Creek Road Centerville r Y I r Owner;• Mike & Lisa Pajol ek Type of Construction Frame t Plot Lot o Permit Granted January 21 , 19: 9 4 Date of Inspection: Frame 19 + Insulation 19 Fireplace 19 . ZZ/ Date Completed 19 rnCQ 7 Q L ti Lc r z3 c, " co ,, 1- J K \` �,V o q� K. s r � Z7 _ tf ` PREPARED FOR- aBE1.SCd , wdF-i J r, SCA;?PA4A P,-333 CERTIFIED PL 0 T PLAN i. :.SCALE'' ''= DATE iI-ZI-F�L }''REFERENCE: LOT 22 P.B. .P. L.C. P. ?'7 col A I ''� OFi - FLOOD ZONE / HEREBY C£RT/FY THAT THE BUILDING o; GEORG v�\4 r SHOWN`ON THIS PLAN IS LOCATED ON THE W. ' c 0 GROUND AS SHOWN HEREON AND`' THAT/T d Dok=S CONFORM TO THE ZONING Ist�`��.�� Br-LAWS OF THE TOWN OF BW SL B F SUR`I� WHEN CONS RUCT£D. LOW A W£L L£R, INC. 714 MAIN STREET NAG -�a..L1r'8 �o YARMOUTH, MASS. DA TE `—� COMMONWEALTH DEPARTMENT OF PUBLIC SAFETY 9 .._- OF. ONE ASHBORTON.PLACE FellUPetoPok89+4a4vrr00i MASSACHUSETTS BOSTON,MA 02108 M+ssaobu+ottx State Bolfding Codalocasse Iorrevocation L S>r E td S E Of 0.yc�; t)i STf't. ?,UPERVISfl 9IM81108mo- CAUTION EXPIRATION DATE 1 1 /26/1 99 5 FOR PROTECTION AGAINST RESTRICTIONS EFFECTIVE DATE LIC-NO. THEFT, PUT RIGHT THUMB NONE T 06/3J/1993 031271 PRINT IN APPROPRIATE F ° BOX ON LICENSE. P A U.L. _.A. �D.,E_R�Q-:'y —_----- � 6 A !�R I A ii i. E N BLASTING"OPERATORS z YARMOUTHPORT MA 02675 m MUST INCLUDE PHOTO. ` PHOTO(BLASTING OPR ONLY) Flf4 0.o o + U NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY ' HEIGHT: I Z: STAMPED-OR-SIGNATURE OF THE COMMISSIONER L THIS DOCUMENT MUST BE « SIGN NAME IN FULL ABOVE SIGNATURE LINE CARRIED ON THE PERSON OF WEOFNSEE THE HOLDER WHEN EN-OTHERS-RIGHT THUMB PRINT GAGED IN THIS OCCUPATION. ONER J SL9Z0 tlW ly0dN1(IOWytl aolvalsw)waa 3Ntl1 39tllyytl� ` f NOSy30Ntl .y �(ttl NOSy30Ntl y 1(ltl.: `, S6/80/I1 uocjelldX3 _ adll F ltl(l0IAI0NI - Oz011 uo?�ea�s':Oay y013tly1N00 1N3W3A08dWl 3WOH COMMONA -A.LTH OF mAssA.CHUSE�M DF-'/,-�:N.FJ�TTOFINDU ��• S� CCIDDNrIS . _ 600 V,716 1-1 FN G TO N STi3Z- T James BOSTOiN, MASSACHUS=S o2111 c•— :ss•one -WORKERS'COMPENSATION INSURANCE AFFIDAVIT (l iccnscc/perrni acc) with .2 principal place of business/residence sc ; <Gcy1Sta(c/Zip) do hereby ecru{); under the pains and penalties of perjury; Char. j) l am an employer providing chc following workcrs'compensation coverage for mycmployccs working on this lob_ Insurance Company Policy Numbcr I am a sole proprictor and have no onc working for mc- j 3 1 am 2 sole proprictor,gcncrJ eontnaor or homeowner (ardc one) and have hired the contraaors fisted below, %k-ho h2vc the following worker;eompc=uon insurance policda: Nmmc of Cont moor Insurance CompanylPolicy Numbcr T N2mc of Contraaor Insurance CompanylPolicy Numbcr X-2mc of Conmaor Insurance CornpznylPolicy Numba Q I am 2 homcowncr performing 211 the work mysclC NOTE Pkas<be a•+:rc that wbt�<botrcowacrs who employ person:to do taaiatcatao,coactrtsaioa or rcpaic.wodc on a 2•Mdlinb of not more than tbrc<uniu is wbi6 tb<bomco...acr also resides or oa the r-rcuads apputcaant tbcrcto as Dot Ecrxrally considcr<d to be cr�ploycts uLct tb<Gor:crr'Ccrpca:atioa AR(GL G 152,<ccz 1(5)),applint;oo by a boraco•wact for a Iicccsc or p<rnit r..:y cvidcccc the 1cfJ stsma cf�<r_ loy<r uodct the GotlCcts'Cornp<oration Act caccrst:nc tn_t- copy of finis szctcncn(wiu oc for,vdcd to t*r c Dcpa:. .cnz of)ndustriJ Acodcnu'Orrcc of lnsv::ncc for.co-cm;c vcrifrcat;on=nd th-t h-lurc to sccvr<covcr�c;s rcSuircd undcr Scc6on 254 of MGL 152 can k24 to the imposition o[-,c6m na]pcn-)ucs cons;sting of a fine of up to S1500.00 zrid cr i=pruonrnrnt of up to onc year and c;,Q pcnalt;cs in the form of:Stop Vock Orda and a I fine of S100.00 a day against nv— Si'ncd this d2y of 19 ! l UccnsccfPcrmittcc ' " - Licensor/PcImitzor Assessor's office(1st Floor): , Assessor's map and(-'number !�—� -. SIEPTIC SYSTEM ��*TH(T�` Board of Heal (3rd fl or): _ �a�ST�Q.�E®'� ���Sewage Permit number l 0 f o.� eve ' WITH TJ ®�t��� e 9TSDLL i Engineering Department(3rd floor). �� � � '� �o Mua House number T� (r+ r O 1039. Definitive Plan Approved by Planning Board 19 APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only r TOWN - OF , BARNSTABLE BUILDING IHSP CT AR APPLICATION FOR PERMIT TO vt y U"n ��✓'� OD QI L-& e '7 �► �R��' TYPE OF CONSTRUCTION k^/ 001('(!6✓l Se i'� 19 ° 0 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: NM Location 6 Glee ��• ` e��e� V��� �' Proposed Use aVJ\ `moo VV\ Zoning District `� Fire District Cto Name of OwnerWlt•41"r5. fflixeP - `e Address Name of Builder C "kpr �h`g�s0� Address 1 io^ck-k ci-1 uk-1 . �CtJ e'fc I ASS c oas G� Name of Architect Address 1qV'1 to Number of Rooms Foundation e Exterior �' q Roofing Floors Interior Heating ,, ®r I Plumbing G� _ f� GW� Fireplace ' Approximate Cost S 0 O 0. Area Diagram of Lot and t a g-with Dimensions Fee OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable reg ding the bove construction. Name '^j Construction Supervisor's License 0 G ( -f PAJOLEK, MIKE No 33958 Permit For Add Family Room Single Family Dwelling T Location ' 16 Hill Creek- Road Centerville i Owner Mike' Pa j olek { 3 - --� - 2 Type of Construction Frame 4 Plot Lot Permi"Granted September 7 , 19 90 y :-'Date oHnspection t 19 -' Date Completed / / z /P1 19 C)-q ITI ir t�r rX, Assessor's office(1st Floor): y� !/ Assesso($map and lot number �O e� 7 UST BE poi >o� SEPTIC SYSTEM�"� TN E hoard of Health(3rd floor): f �•:` T a `■ EI) p/�y5��/y���p!,� AF,,,` Q� �U�:�G�01`�V '��`f9JY®Y 4w:L" U�9 Sewage Permit number Q^'� a d� WITH TILE 5 Engineering Department(3rd floor): q jJ B�ngeTs tL S House number EWIROXVE AL Vie.;: ., oo MAS e� Definitive Plan Approved by Planning Board 19 6MUL�wti`"�"`� �o raY A, APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only ApPRO ° 24 81WvnN OF BARNSTABLE UILDING INSPECTOR J—��SAOPACATION FOR PERMIT TO TYPE OF CONSTRUCTION ,L��c�/b t 19 � TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information:: Location Proposed Use Zoning District Fire District Name of Owner / ��`r�� �L'�� ��10���C Address Name of Builder Address Name of Architect Address Number of Rooms Foundation Exterior Roofing Floors Interior Heating Plumbing r f Fireplace Approximate Cost Area Diagram of Lot and Building with Dimensions Fee �� 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. me Construction Supervisor's License F POJOLEK, MICHAEL & LISA No—u 33259 Permit FoT4 INSTALL POOL ter +r ;T Single Fami-ry Dwe11'F, a. 4u I ad Location 16 Hill Creek R Centerville Owner Michaeh &:.L' Pojolpk Type of Construction in ound Sun!re } Plot Lot ' M9 1 si 'Permit Granted October 4 - 19 89 - - 3F• f Date of Inspection 19 1` D&Compl ted �//� 19 F a R t ::. i 1 r 1' LO r 03 - _ ` 4 t TANKIV \ ZZ P j Le.Zi Off• _ .. M ...• PREPARED FOR- A13F-Lsc� cd�J � S��aC-J &= 533 r , CER TIFIED PL 0 7- PLAN <.L0CAT/ON :SCALE ' DATE iI- ZI-PAL 'REFERENCE: LOT ZZ . i B P P'BoiA '�•. � ���,Z� ,So� ,fit FLOOD ZONE C c�� GEORG ~ M, / HEREBY CERTIFY THAT THE BUILDING ._` .f' SHOWN ON THIS PLAN IS LOCATED ON THE W' GROUND AS SHOWN HEREON AND THAT I T r ODDS CONFORM TO THE ZONING ITT i BY-LAWS OF THE TOWN OF su WHEN CONSTRUCTED. y C , LOW-9 WELLER, INC. / - °; 714 MAIN STREET ' YARMOUTH, MASS. DA TE Assessor's map and "lot number- .............. ,... •... THE A Sewage Permit number .. !(.. d .... ... ... : .,� �L�lf�- +S r,``Q�o� �♦� /' ro TF �. House number_ ......°........ ....� .. :..... :..................:..... 0 E L BAHHSTIID MA86 iT14 'b • r-. 0 39• �"��`�E � � �o war a� - -► i- TOWN 0F, .BARk§1TvX,1%v;)B j } { °.1��7,.i�eJ��is • F rA l BVILDING •' INSPECTOR APPLICATION FOR PERMIT,TO �,/l�l. .17 ': /. + .� ... ��� .... . ............................... TYPE OF CONSTRUCTION .:...Uli'�.P. 1�... ��!}1 .....:........... f '` Y ............... 19..GP ' TO THE INSPECTOR OF BUILDINGS, The undersigned hereby applies for a permit according to the following information: Location ."!`'�.../1.�G.�r.... -��L��� /��....... ..........�tr ......................................................... Proposed Use .....r—fA1:4,-y...... .......................................................... .. Zoning District ........ ......al!2-A/1724.4,��.............................:....Fire District CIF!/ ........... . `..Name of Owner ::��..... .......... . .... ................Address .................................................................................... Name of`Builde ................Address A.....� ... . .............J....................... Name of Architec .......... ... .......Address ...... ................. ............................. Number of Rooms ......0. ....... ...............Foundation ��..... �� �................ ............... ....... Exierior .... ...... ............... ..............:...........................::.........Roofing ....... . Floors f�a.�1>....�i`. .....�'r��1.tOX-7.................:...................Interior .............. ............../ .:.......:....................................... Heating ... ............................. .....Plumbing.........fi....... J . ..................................... Fireplace ... 1%2<! �.�! d ........ ..........Approximate Cost ..� �<. ?7.............................. Definitive Plan Approved by Planning Board --------------- _----___-_-_____19- Area `a`7` Diagram of Lot and•Buildin with Dimensions f e u l & g 9 j Fee ........ .�a..�...................... SUBJECT TO APPROVAL OF BOARD OF HEALTH 4 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 .......Gfc... .... - - ................................. Construction Supervisor's License ... .......... ti v GAe&L , .JDHN 24891 One Story ............. Permit for.... .................................... Single Family Dwelling Location f0t #22.........16 Hill Cr.eek Road .. •; Centerville ' ............John Garre................................:... Owner ................. .............................................. r�. `1' s Type of Construction Frame - ' ..................................... Plot ............................. Lot .. ^ . March 29, ~ Permit Granted ........19 8 s Date of Inspec�o .:"...!'.:?.......�....`..`........19k . .z;? A�P3 Date Completed �. . K� ...19 Pi D',/ w/rx r Dew , ". TOWN OF B.ARNSTABLE Permit No. -_--__-------------------_---- ".��T.� Building inspector cash' "YL ____________-________ � -. 711�� OCCUPANCY PERMIT Bond Issued to Address 1rnt- -#?? 16 P411 C'roPk Road CenterAllP Wiring Inspector � Inspection date Plumbing Inspector % f. Inspection date Gas Inspector / Inspection date Engineering Department Inspection date Board of Health X / Y Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. /J/1 .................................................... 1�........... ..........' x::'..: ::_......-<„,. ..........J..../.... Building Inspector -I9 , S. 88 em r TIN MIC \ ` MAN e5 •3 -ts z_ g411 �$o�'r q3 0 o.�ox Itcl .3 1 V I � �87 •Z t00 % .00 1 C'' o fig, 151►UGVcr� FAMtt_Y - 3 BEORo45M .._ - .up ± GAPMAG C- ow .G�XD62 306 PD .. , S(c.PT1G TA1�1K = 33oK15o'/. =•495G.P. o .' %000 GAL. `o15Po5A� P1-r ' v5E Ivoo GAL_. 5 t DG Y/A�L A¢ • n 1 gO 6A I o .F X 2• a 3?SG.Po _ SEE . SHEET L- �5 go TOM AQt_-�p►: . 1� �F•_ p._ �,a� P ,.,�N X Ito 'TOTAL— G ;`Tt�TA1. �A►LY F%-OW = 3306RP PER.GoLD•TIDN RATe t 1'4IN ZMIN 07-1-6SS r _ OF bfgSs -;N Of Mgss s WILLKM AIAN c� G / $ N Y E JONE.S ;I ,p No. 19334 0 ?r54Cfi lgkd SUR�� TOP FWD=�7 .0 FG : 90 1.0/%M >3 MST GAL.. MST'l. Sub SolL- 60K INJ. Ss�T�G 86,0 • E��T. D (000 8'L7 TANK I NY, WIT41 87:3. P.7•� _ . . ., , k, WASNGD �{ r ei• 0 PLO PLAN PROFLL� I.oGA-TroN G6►�i`�'E�.�! l L.L�' - 'I'1� O NO SCA•l.E _ rjGALa PA•?'E 31/Sf g3 "No w�TEtt. • Z/ PL-Ati1 REFE2EN CC L G P. RT 1 F Y 1vlPL � Ntzczso>,1 VJITN-T i4S e,I cEL%W V-- �.••.U T Go `!5 Auo S6'tF .GK R.6Qut�LrcMEN'f� tAO oFT E o L TOWN O��hRNST^$l..E'AN� 1!s �.,..G• Z"1 0 1,OGp.TE WlT IA1 'T (+1 0" PL IN DAT1=� BAXTQv-a WY INC. '® UAe1®'5 u R,v EYo� �"TI�IS PL&Kl i,i t jorr BASrp_ ... AN C>STfciZ.VILLE • ~5• I. 1 1�51-Q,uMr--NT SU2vG-Y �/�NEroFt~'SETS 6ucw,� M NOT DG- V�l .C�TCr OGTt..N.,J'^1►•1C t_r.�.. tr 11lG�� /DPP t.1r A!�'r V�H � ���r �U AI . a _J 0. �LIV ....................... O'> >' Z RICHARD A. BAXTER Na 24048 C-M ZTIFtET:) 'pLor En .A w LDCATlo1J CewTarwlc.ta �c �n ,pATl= ��Zs/g3 -- crwrir- T"AT T140& �pvljDl�'(igt� St.1o,w►•► ____ R��EiZE►JGE wSRr.oN Go AptI W ITIA TN6 SIIIE.LlWC-- L.Or 2� AWD SeyZAC4 QEQUIRENtENTS 0 P TN f -icwu OF `tNAfRt45T49LS A-64t) I'S WW CovmTA 2195O t q'�- h� l.oGa►T'tro WIT" u 'CWFLOOD PLAN BA*AT Z v.' otz� DATE; .S -%S - S3 _ REGISt'UZ�D 1�t,1� 5Ue `f THIS at_a� is LI P5ASE'� vN A�•l OSTF—ZV%�-� o Mass. lwtTm J"Ee.1T ScJQvr-%( 4,nAc— c�FsA Si=TS ApP t.a GA.►�1'T' r— �1GT 0G U15UO TO oeTr.QMIN� LOT LlHe Sp�� EL-AC4VA I I I � i flac�ric I C7�o.n�e a operc�4 j i � I 1 ` N A o. -6ED�ooH I � i - C�j T./e�inA�6/a I •� I n I ATN___ i `5ec�ion A-A sewn B-B a B-A 4 rrf P/I✓OLE.0 .?ES/oENIE .��M� L I I i 4'//.pUW • 1 cc./•y I y e I r7 \Iz A cQ�o I ( .nscofE R ® R R I R R 12 - chnngqc - F•�tvK I � I n 4 Q c.tl .Gt7h �I _ Q 111 • P.�/OLEK .PESiyE/vYE tt tr ,., ,.. e. e. ,.., i ,.0 r 1. ,,,,: w. .._„ n.,.._ ,., „ '.:c..4 +;..i.n.t.- ♦,.e.aai..;ss' - , , t , - , a I :� r, 12. ' „ R3?- RaoF _BAN t k . a , X6 oAK,RAFrF.� 0 o c WAWA.. � r , - 4 , 0 71 ` oAK Tt� i e e. x , 4 A _ w , t WALL ANL 'P .. .. ,. , w X 5�' „ 8 OAK WOOD FOP, „ ° -- AsP�.y woo� ; I' ,.a , .: ,. Pr s , pE5iC - F r a. : ^ ^.* DE 41, Focyl , , t , yy C r i t 4 t ~r : 3 a C'�J�I� 1 / Y , 'SECT �r C 1T10 0 117 o Pos D DD 1� -F R - I•`.N N El.. oNS'1'R u-C.T 1 N. . .,_ P Ro ,. /"'t , 5CAL� o L I5 -� 1 I P 0 P X :ry s , , ,1. � _ N� - 7 eR��K �n Nov�M ��R 1 R Ll„ jo , N TE'RV ILI. M R i. ..: •, v.,..-. s! ..6r.-,o-. .... ... .. -;.. ....;n ,'"< '.,:... F.«'4C, �'Y.�.;�, et`7`F.,��d'.,.�p.,'€„ •,..y .. .J�.'' s Y: S CAL CoNs rIaN. •:SA -�- 1`�[i KE PASaLK _. '....._ -_ C?0. 3oZC 25 a 6 AiLl C Rt F' K ROAD PRA ._ AKMdLk.,l `?Op'-r, MA C EN TER u f .1.E ], MA • �.. _..._. � Nov . 12. ' JZ_X StST �►JC� NoM - t . T 1 1 - ��_ T_ 1 � _ram I I- r "1._ 1 -7 I i._._�--I-t � � i F t -----•lam -- ' : � - �-- �_ �._ I f t s , _ri • n � if 1 - -I l f.T T : : t r , : f r '4 o .. x • of GENERAL SPECIFICATIONS Jc" ;f'(l r - • SIZE Z 3 x 4w,:; DEPTH to 8 ,or SQ. FT. -el PERIMETER1Ferrs%r:L xx PO VOLUME ► Southboro, Mass. 01745 42 Turnpike Road—Rt. 9 Hanover, Mass.02339 803 Washington Street(Route 53) MACHINE TRACTOR : BACKHOE ❑ Er (617) 401-0228 (617) 235-3583 (617) 826-3631 STUMPS # LOADS # FILL AWAY ❑ D.O.P. 5'?'E A a '` r .' _ t._, GRADING -—YES ❑ NO of RAISED BEAM AVO „ ft. 6 ft. 12 LIGHT # 110v ( 12v ❑ FILTER _ SIZE a PUMP SIZE _ 4" _�.-- a., SKIMMER # - � 11/2" 2" ❑ 's' . ` RETURNS # > .. 1 t/2" _ 2" ❑ POOL CLEANER ;, STUB CLEANER \ w/HYD < ---- t MAIN DRAIN RO VALVE SEPERATION TANK YES ❑ NO HEATER A",.;,= BTU - I :� 1 O THERAPY SPA � . SIZE `--.. JETS - ------- -------- — SKIMMER �ft`Ss El NO ❑ , MAIN DRAIN— �'' SKOA.. ❑ NO ❑ Vi ": It ;, •,�, a -- �, < . c.� LIGHT 110v [ �12v ❑ u ��'c :c /.11fl BLOWER YES ❑ NO . COPING TILEawk 4 -- --- 11 �`"'- - - BOARD SIZE , COLOR - LADDER — :._ STEP RAIL fig- 4 ❑ #tTEF - 7 -C RV COEUR C, t CHLORINATOR _ -- I fto16.10 � TIME CLOCK ter, 220y Y . SE_ rIG ROPE RINGS w/ROPE & FLOATS `},•kS"`•' / +uC'1'f.�`�� � jam: - r- -T�.�.r: - � '"�� BACKWASH DECK by ---------- --- L FENCE by: a.r _ DIRECTIONS ELEC. by: TREESby _ -- -- -- _ I 1 } WATER FOR GUNITE ��►--- '•�' 7-_..g�.. ��......_.:._ . SET BACKS - -- --- ---------- t 74) FRONT SIDE - f I REAR BLDGS. !� _ ► NOTES SALESMAN DRAWN DRAWN CHECKED f Name - i Address _ / 1 GENERAL NOTES: OWNER ,� FILL OR STONE 1 Electrical,gas and fence work by others Cito _ feu' iAt@ r�'L t'.Of�@ -�% ` ELEVATION Wet down concrete shell at least twice daily for 7 days. Owner to determine correct elevation as noted or established Brought to lob by addendum 2 Heater venting by others Res. Phone' � ''_1— _r^r BUS. Do not turn on pool light when pool is empty on excavation day Pool area to be fenced,per County or City Ordinances.gates 3 Up to eight hour pool excavation allowance Permit # Insp. Job # Do not use rubber hose when filling pool as it will mark plaster No grading unless specified to be self closing and sett latching by owner 4 Additional Work by addendum only CERTIFIED PLOT PLAN YES fff"' NO �_ .,. .. -"--. _ -.. _ .. _ _; __. -•. ,. <' .. " t _ r.... ;•qfl..A.,. 4,F •4 � Z.'` .k. ,*Y i, \ :�e!-'�'a, .'.,"�h F O �➢ .s+ry.:".o .. -. .. .. , -r. ,s .. , e ,. ..- i , ,.'x!"ic:. .. .� e n r• r .+/ :I Ay .r• .: �y, ry Id gyp. i . ,:' _ ,. :. .' ., �: -.. .. . . �, .. ,. g iF .,v -�,•. 'i sib. e >-�R... :� .. � .. . .. , " - < ,- - - • <, :-n..-"?•re s .. 7`��"._o ..;Pi.. d .- - '.+.� ri 4.e�F. 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APPROVED : , , , , , , �, � 15 � 4: y � O NOTE CHANGES _ _ - , UM OF BAR S1' LE ' _ - - . _ � . • . . �- ,-� Building Inspection Department AT (tom f} _ .. � / I �. ,' .- '" - „ ' '.. >.. , � - •�` _>� l _ 1. �.1 � - - h'aC _ , 1 l n - s _ , - y r' , , 1 i b 1 • r • . . , • f� _ 1 t TM j{