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0096 HOLLY HILL ROAD
a 4 � Y r - r. (i , t r- NL - V > , l J - GORDON L.NORTON AND FRANCES F.NORTON 2012 JOINT REVOCABLE TRUST AGREEMENT' We, Gordon L.Norton and Frances F.Norton, of Centerville, Massachusetts,•as Settlors (in our capacity as Settlors,hereinafter referred to as "we" or "us") make this trust agreement with ourselves as Trustees(hereinafter collectively referred to as the "Trustees")and deliver to the Trustees the sum of One Dollar($1.00),receipt of which is hereby acknowledged, said sum together with such additional property as may hereafter be added thereto by us or by any other person and accepted by the Trustees,together with the investments,reinvestments and accumulations thereof(all hereinafter referred to as the"trust estate"), shall be held by the Trustees,IN TRUST, and held, administered and distributed as hereinafter set forth. This trust and any amendment hereto may be referred to as"The Gordon L.Norton and.Frances F.Norton 2012 Joint Revocable Trust Agreement". 1N. SECTION 1 ' 3 Definitions " Each'reference hereinafter contained:`: 1.1 to "child" or"children'.when referring to a child or children of ours is to our children, Gordon L.Norton III,Melanie N. McGovern, and Stephen E:Norton, or to any one or more of them, as the case may be; 1.2 to "Trustees"or"Trustee" and any pronoun referring thereto is to all Trustees from time to time serving; and. 1.3 whenever the facts or the context shall require,the singular and the plural shall r include the other and the use of any gender shall include the other genders. G o While Both of Us Are Living 1.4 While both of us are living,the Trustees shall pay to or apply for the benefit of either or both of us so much of the net income and/or principal of the Trust Estate as.either one or both of us may from time to time direct. If in the reasonable judgment of the Trustees either -of us should ever become so physically or mentally incapacitated as to be unable to manage his or her own financial affairs,the Trustees may from time to time pay or apply income and/or principal of the Trust Estate to or for such person as the Trustees determine in the Trustees' sole and absolute discretion in such amounts and in such shares and proportions as the Trustee in the Trustees' discretion deems advisable, and the Trustees are authorized in the Trustees' discretion (but without being under any obligation so to do)to pay premiums on any policies of insurance on the life of either one of us or on the lives of both of us which are payable to.the Trustees,to the estate of either of us or to the other of us. 1.5 Upon the death of the survivor of us,the Trustees shall add any accumulated income to principal, and the Trustees in the Trustees' discretion may pay accrued income to the estate of survivor of us or to the beneficiary or beneficiaries entitled to income after the death of the survivor of us., SECTION 2 Upon the Death of Either of Us and While One of Us is Living 2.1 Upon the death of either of us,the Trustees are authorized to pay either directly or to the personal representative of the decedent(even though the Trustees and said personal 2 and the issue of such beneficiary, shall forfeit and cease to have any right or interest whatsoever under either of our wills, either of this trust,under this trust agreement, or in any portion of our estates and, in such event,we hereby direct that our property and estates shall be disposed of in all respects as if such beneficiary, and the issue.of such beneficiary,had predeceased both of us. It is our intent that to the fullest extent permitted by law any person who commences or joins in any litigation opposing the probate of either of our wills or contesting the validity of either of this trust, or this trust agreement or any of its provisions, and the issue of such person, shall be totally disinherited by us and shall take no share in either of our estates. To the fullest extent permitted by law this provision shall,survive any litigation however the same may be resolved, SECTION 17 r Disclaimer as to Titles All section titles are used for convenience only and have no legal or binding effect upon, this trust agreement. IN WITNESS WHEREOF, said Gordon L.Norton and Frances F.Norton, as Settlors and as Trustees,have executed this Trust Agreement in duplicate original this 9 day of December, 2012. w Witless as to Both: ; Gordo L.Norton Frances F.Norton L .2g COMMONWEALTH OF MASSACHUSETTS COUNTY OF BRISTOL On this day of December 012,before me,the undersigned notary public, personally appeared Gordon L.Norton, [_] personally known to the notary-OR- [_] proved to the notary through satisfactory evidence of identification which was ,to be the person whose name is signed on the preceding or attached docuRient, and acknowledged to the notary that such person signed it voluntarily. Notary ublic :- iF s. EiRas My co -ssion expire �' h 10 IV Phy Gommission EEam�es March M 2Q1'F� COMMONWEALTH OF MASSACHUSETTS COUNTY OF BRISTOL On this �41— day of December 12,before me,the undersigned notary public, personally appeared Frances F.Norton, [`] personally known to the notary-OR- [_] proved to the notary through satisfactory evidence of identification which was ,to be the person whose name is signed on the preceding or attached document, and acknowledged to the notary that such person signed it voluntarily. Not Public My commission expires _ - OEM * ' Gommonwsz h of massauhusets i Ma SS 2 2 api es 0 ACCEPTANCES Gordon L.Norton acknowledges the delivery to him of the foregoing instrument and accepts the amendments hereinbefore set forth. Gordon L.Norton, Trustee Frances F.Norton acknowledges the delivery to her of the foregoing instrument and accepts the amendments hereinbefore set forth. Frances F.Norton, Trustee 30 SCHEDULE' ----------------------ONE ($1.00)DOLLAR------------------------' RECEIPT The undersigned have received the properly listed on the above schedule this 19 th day of December, 2012. Gordon L.Norton, Trustee Frances F.Norton,Trustee + 1722423 1/11699-2 j 31 -. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map g Parcel oil Application # �'l� Z q bS Health Division Date Issued servation Division Application Fee Planni g Dept. Permit Fee FS Date De'nitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address Village Owner ycLn cf,5 e C+o 0 Address ei Telephone 54 4 Permit Request Ned kA P [ow +0 7�k, LrG<S v'1 m+ 8 e4w Square feet: 1 st floor: existing proposed 2nd floor: existing proposed ' �,Totaew T Zoning District Flood Plain Groundwater Overlay ' Project Valuation 0 0 Construction Type - '�,• Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting doY um6 ation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) rn i . 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 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 ❑ C)-r, Commercial ❑Yes )(N0 If yes, site plan review # , Current Use Proposed Use I P0 APPLICANT INFORMATION (BUILDER OR HOMEOWNER) c c Q [1 p Name Q` e. J vt-l", Telephone Number Address �L j a License#_ C L d 1'l f �( 6� Home Improvement Contractor# Email Worker's Compensation # WC OR 55 d -7-06 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO C.em.9'u A SIGNATURE DATE S l '•i + FOR OFFICIAL USE ONLY z` / PPLICATION # DATE ISSUED i MAP/ PARCEL NO. ADDRESS VILLAGE OWNER 1 • L r s DATE OF INSPECTION: FOUNDATION f FRAME f INSULATION FIREPLACE a ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING 'I DATE CLOSED OUT ASSOCIATION PLAN NO. 'r Building Permit Authorization I, Stephen Norton as owner hereby give my permission to Cape Save, Inc. 7-D Huntington Avenue South Yarmouth, MA 02664 Office: 508-398-0398 to take all necessary steps to obtain a building permit to perform work at my property located at 96 Holly Hill Road Centerville, MA 02632 Signed (2 Date ACO CERTIFICATE OF.'LIAB.ILITY INSURANCE PATE(MMIDD �i 4/12/2016 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 poilcy(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 endorsements. PRODUCER r NAME Risk Strategies Company Risk Strategies Company Pn E E (781)986-4400 „O FAQ No,:(781)9634420 15 Pacella Park Drive ED ss:randolphcld@risk—strategies.co , Suite 240 INSURER(S)AFFORDWG COVERAGE NAICS Randolph MA 02368 INSURERASelective Ins. of America _ INSURED .. INSURERB Allmerlca Financial Alliance Ins CO .10212 Cape Save, Inc , INSURERC:Star Insurance Co - 7 D Huntington Ave, ^ INSURER D: INSURERE: _ South Yarmouth MA 02664I INSURERF: COVERAGES CERTIRCATE NUMBER:CL1641211375 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 SUBJECTTO ALL THE.:TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES..LIMITS SHOWN MAYHAVE BEEN REDUCED BY PAID CLAIMS. ILTR kDDL TYPE OF 94SURANCE R POLICY NUMBER. MMIPOLICYEFF PMOII EXP LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000y000 A CLAIMS-MADE Fx1 OCCUR PREMISES Ea ocaurence $ 100.,000 X 51994460 r • , :16/16/20i5 10/16/2016. MEDEXP oneperson) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000- GENL AGGREGATE 2000 006LIMITAPPLIES:PER; � i 1 - • r GENERAL AGGREGATE. $ , POLICY' 1ECTT .❑'LOC PRODUCTS-COMP/OP AGG� $ 2,.0.00,OOt. OTHER` . $. AUTOMOSILE:LIABIL(TY COMBINED SINGLE [M $ 1,000,000 Ee-acciderdL___, ANY AUTO' ''iT' - - -BODILY INJURY(Per'person) $ B ALL OWNED SCHEDULED , .AUTOS X -AUTOS AWBA4fi7966,00 11/6/2015 11'/6J2016 BODILYINJURY(Per accident) $ NON-OMED PROPERTY DAMAGE $ X HIREDAUTOS X. AU70S ``: Perecadent X UMBRELLA LIAR X OCCUR - - EACH OCCURRENCE $ 1j600,000 A EXCESSLIAB CLAIMS-MAC .'; L AGGREGATE $ 1,000. 000 DED X RETENTION$ HIL.. S1994480 `A _ •' 10/16/2015 10116/2016- ` WORKERS COMPENSATION .. - ..- t . . - .- ._ ANDKERSC COMPENSATION t ti Officers Included for Ir ��., r",t X SSTTUTE ERH. .r ' ... _ -a ANY PROPRIETORIPPRTNERlE'XECIITIVE-Y f N coverage E.L.EACH ACCIDENT $ 500 060 OFFICERNEMBEREXCLUDED? N❑N/A C (0.landatorylntdH) HC065.540.700 419/2016 4/9/2017, E.I.DISEASEtEAEMPLOY $ `500 000 .i(. '-Y�' i - - Ifyes,descnbeunder :-: DESCRIPTION.OFOPERATIONSbelow E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS:I LOCATIONS I VEHICLES(ACORD 161,Additional Remarks:8chedule,may be attached if more space is required). National Grid Corporate Services LLC d/b/a National Grid, Action Inc, Colonial Gas Company-and NStar Electric are all included as-Additional"Insureds with respects to the General Liability coverage-of named insured as required by written.contract. CERTIFICATE HOLDER CANCELLATION SHOULD.ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE: +, HOUSlIIQ Assistance Corporation'4 ++ THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Cape Light Compact ACCORDANCE WITH THE POLICY PROVISIONS. Barnstable County 'r 460 west Main Street AUniORIZEDREPRESENTAWE ~ ' Hyannis, l-a 02601 Michael Christian/:CLC �' 1; ©1098-2014 ACORD CORPORATION. All rights rmrved. ACORD 25(2014101) The ACORD name and logo are:registered marks of ACORD INSII25:(201401) The Commonwealth of Massachusetts Department of Indusaial.Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www massgov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electneians/Plumbers. TO BE FELED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/Individual):Cape Save Inc Address:7-D Huntington Avenue City/State/Zip:South Yarmouth, MA 02664 Phone# 508-398-0398 Are you an employer?Check the appropriate box: Type of project(required): L.0 I am a employer with _15 employees(full and/or part-time).* 7. E]New construction 2. I am a sole proprietor or partnership and have no employees working for me in 8: Q Remodeling any capacity.[No workers'comp.insurance required] 9. El Demolition 3.E)I am a homeowner doing all work myself.[No workers'comp.insurance required:l t 4.0I am a homeowner and will be hiring contractors to conduct all work on:my property. I will 10[]Building addition ensure that all contractors either have workers'compensation insurance or are sole 1 L Q Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs.or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance:+ 6.❑We are a.corporation and its officers have exercised theirright of exemption per MGL c. 14.Q Other Insulation. 152,§1(4),and we have no employees.[No workers'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 indicatingthey are doing all work and then hire outside contractors must submit anew 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 Star Insurance Co. Policy#or Self-ins.Lic.#' WC085540700 Expiration Date: 4/9/2017 Job Site Address: 96 Holy Hill Road City/State/Zip:Centerville Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MOL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-yeas 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.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 th pains and penalties of perjury that the information provided above is true and correct Signature- Date: 8 15 16 Phone#:508-398-0398 Official use only. Do not:write in this area,to be completed by city or town official City or Town; Permit/License# Issuing Authority(circle one): 1.Board of Health L Building.Department 3.City/Town Clerk 4.Electrical Inspector $...Plumbing Inspector 6.Other Contact Person: Phone#• Office of Consumer:Affairs and Business Regutatlor : 10 Park Plaza-.Surte 5170 $oston;:MAss-achu efts 02116;,: Horne Improvement;Contractor Reglstratlor Registratwn 17138Q ��'-�+' -: Type Corporat►in . Expiration " 3114/2018 Tit 419291 CAPE SAVE INC. WILLIAM McCLUSKEY 7-D HUNTINGTON AVENUE nl -f' SOUTH=YARMOUTH 'MA 02664: ,' , k Update A"ddress and return card Mark reason for change. . v" Addr,'ess. G Renewal: Employment Lost Card .SCA 1 0:20M-05/11. 9Q91Gfil1Q7Y.GLlGCLI��.Q��.I��CCJdCLCfLCIgC� " Office of Consumer Affairs,&Business Regulation L'icense or registration valid for�ndivtdul;use only. _ HOME IMPROVEMENT CONTRACTOR before the expiration date. If found`return;to• Registration 171380 TYpe Office of Consumer Affairvand.Business Regulatiou Expiration 3L4/2018' Corporation 10 Park.Plaza-Suite 5170 3 Boston,MA 021.16 CAPE SAVE INC. e I WILLIAM MCCLUSKEY � 7-0 HUNTINGTON AVEN-5N SOUTH`YARMOUTH MA'02i Undersecretary Not valid' i signature . Massachusetts-D.epartment of`Public Safety ;Board of Building Regulations an btaridards o iiii riifir�nuinmv 725w "License: CSSL 10277fi WILLIAM.J:MC G` U 37 NAUSET ROAD 1 of Wesf Yarimouth MA VIC mow.; Expiration Commissioner 06/28120,17` Cape Save Inc. 7-1) Huntington Avenue South Yarmouth, MA 02664 Tel: 508-398-0398 Fax: 508-398-0399 10/31/16 Thomas Perry CBO W Town of Barnstable ` Building Division ZZ, 200 Main St. Hyannis,MA 02601 N RE: Insulation Permit 16-2405 Dear Mr. Perry This affidavit is to certify that all work completed for 96 Holly Hill Road, Centerville has been inspected by a third party Certified Building Performance Institute(BPI) Inspector. All work performed meets or exceeds Federal and State Requirements. Sincerely, William McCluskey TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION i 4 Map ��� Parcel 0912 Permit# !!!� Health Division Date Issued Conservation Division �� � � O Fee 1/ / Tax Collector ma ((�IEPTpC SYSTEM MUST BE Treasurer UA—uVO I �( INSTALLED IN WiTi�'�'I '#,,,�MPUANCE ��12�2v� . Planning Dept. ENVIRONMENTAL CODE ND Date Definitive Plan Approved by Planning Board TOWN RE64LATION Historic-OKH Preservation/Hyannis Project Street Address Of Village �� U 6 C e Owner c)pw WA)o c<�sAc4aWZ//G Telephone Permit Request 1-7/V45 ZA0 9ORlnn� Square feet: 1st floor:existing proposed 2nd floor:existing proposed 3� Total new (L Estimated Project Cost �'TAS— Zoning District Flood Plain Groundwater Overlay 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 to On Old King's Highway: ❑Yes DOW Basement Type: C Full ❑Crawl ❑Walkout ❑Other / Basement Finishe/d Area(sq.ft.) Basement Unfinished Area(sq.ft) �!o Number of Baths: Full: existing new Half:existing new Number of Bedrooms: existing new T 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 /%ifNo Detached garage:❑existing ❑new size Pool:❑existing .❑new size Barn:0 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 Use _ BUILDER INFORMATION Name �� y ��oyo&,s Telephone Number ©� 771 Z-1 Address cz, /4 /vim License# e �Ze? Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM TH112 PROJ T WILL BE TAKEN TO SIGNATURE DATE -__1 —1 lei--"" 6?o FOR OFFICIAL USE ONLY - PERMIT NO. ' , DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE r- ~OWNER, °`��:� _ y � ", • - • :- • . ` DATE OF INSPECTION:y r FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH: FINAL a " a PLUMBING: ROUGM FINAL r �s ROg �' FINAL GAS: 69t Ir++ . . FINAL BUILDING -� t3r " � DATE CLOSED OUT tit ti � - ASSOCIATION PLAN NO. ® Y { SMOKE DETECTORS O.K. STABLE B DING DEPT. -cam 71 -�D/I\4 n -� A S r , i 730CfltAppo oftj Fmcs ipttre Faelcale for One and Two F=ilY Rent MZW Buudanp Heated with Food Fueb MAXIMUM MWIMUM Guzing asWd Floor Bn== Slab C00ii"1 ARM,CK) Uwalue It value R vailm` Rrvdun' wau P6bum E+duicr' 1= >l� ' S70I to-49LD HeadowDam Q 12% 0.40 3 111 19V It 10 1 6 Nommi R 12% lb 30 _ . 19 - 19 10 6 mumw s 12% 0.S0 13 19 10 6 S AFIJF T 15% 0.36 31 13 25 WA ' WA Norma! U IS'Xi OA6 31 19 19 10 6 Nmmd i37i &44 3-013 23 WA ::I !S AFVE w is% OM 30 19 19 10. 6 S AF{JE Xwjp om 32 13 25 WA WA Nam d Y0.42 f 31 19 2T WA WA NomW Z142 33 13 19 10 6 90AFEIEAA0.50 30 19 1 19 10 6 T 90 AFUE 1. ADDRESS OF PROPERTY. '� Gee 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: 3. SQUARE FOOTAGE OF ALL GLAZING: G � 4. %GLAZING AREA(#3 DIVIDED BY#2): S. SELECT PACKAGE(Q—AA-see chart above): fl NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. BUILDING INSPECTOR7AL: YES: NO: tforms-080303a The Commonwealth of Massachusetts Department of Industrial Accidents � office O11085918980S 600 Washington Street = Boston,Mass. 02111 Workers' Com ensation Insurance davit name: f '�t�-� k/ 0 N&,s location: xJ city 0Cf/f, y/ phone# 0 7713 Z./! , ❑ I am a homeowner performing all work myself. I am a sole prietor and have no one worki>z in any achy ❑ I am an employer providing workers compensation for my employees working on this job. .... . comaanv name• :.::. 6iroae# '.......................................................... :.:: city ........,. ::.::: :;...:.:::.;;:.;:.:::: :::;: ::;:.;.;.;:.;;:.::;.>...........::::: ::::::... insurance co. oLcv#:.:.,....... ... ❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: comoanv name: . :,:«:::;>.::>:: .. ........... ..... address. .. . :::;.:::..;.::>:;.;:::,;.:;;:: . ... ................................,...............................................:.:. >....................hon city ,...:::::>:.,.:.. .::........ iiF . {:;ii:C:i:'j:?;:;:j pow",YJ \ � �#:�'�y:•;: i�:;:;:;>?:;+:::}.: ' :?iii: ;:;''Fi:;':;i:;:::i:,Ji:;:,i:ih:i:'i?:._r::..::._::.:.:i•ii: ?:i.i:�:.:: ineuran Oil caamany name- I ............::: address. `one# city` Room Fanure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a Ste 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 5100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification I do hereby certify under the pains andpen#ff of perjury that the information provided above is h w.and correct Signature Date C>FQ Print name f,- >Phone 0 0 < 71-5:�—J/ MIN Cchec ly do not write in this area to be completed by city or town official pern*Mcense# ❑Building Department OLicensing Board mediate response is required ❑Selectmen's Office ❑Health Department n: phone#; ❑Other Ucyzed 9/95 PJA) o� The Town of Barns a le Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building'Commissioner Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: Ih �w 2rj!eZd Cost Address of Work: Owner's Name: Date of Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job Under$1,000 Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner. _ Date Contractor Name Registration No. OR Date Owner's Name g1orms Affidav ESTIMATED PROJECT COST WORKSHEET Value 7 � lb v v ! / s 4uare feet X SWs : foot LIVING SPACE q q o GARAGE (UNFINISHED) square feet X $25/sq. foot= PORCH square,feet X $20/sq. foot= DECK square feet X $15/sq. foot= OTHER square feet X $??/sq. foot= Total Estimated Project Cost ,9 75 g990915b • - ✓�V/O�1MJt09Ul�E(l�U6 O� U09CIa HOME IMPROVEMENT CONTRACTOR Registration 113598 aT.ype -..;INDIVIDUAL ,Expiration -16/29/01 FRANCIS JONES 3 ';356:BAY LN ATERVILLE MA 02632 }; AbmimsTRATOR . Ile iivrnonulealU a�/�aaaac6u�aeJfia BOARD OF BUILDING REGULATIONS censer CONSTRUCTION SUPERVISOR Number CS_,, 005648 � ;. Ecpires.07/14/2001 Tr.no: 20 --— - �testncted To: 00 FRANCIS JONES . 356 BAY LN CENTERVILLE, MA 02632'sue ! 5 Ad min'�strator # �KX ' 1 ! I III -i I 1 I i- _-------- ��-�..�� x�g P . ��� �',� �� .� TOWN'OF BARNSTABLE BUILDING PERMIT APPLICATION, Ma p Parcel Permit# Zg rl q'8' Health Division&41�zvw ,W G� Date Issued Conservation'Division 3 . Fee. a s Tax Collector C /� t �� SE �� SYSTELe,MUST SE Treasurer C �Y�� �3�c �Qq -INSTALLED IN COMPLIANCE WITH TITLE 5a, Planning Dept. ENVIRONMENTAL CODE AND Date Definitive Plan Approved by Planning Board t TOWN REGULATIONS Historic-OKH - Preservation/Hyannis Project Street Address Village v f l Owner P � eo ' (5° 0 4ess l Telephone �50 r � Permi Request CON-5 tC 1 .80ae- , lJr Square feet: 1st floor:existing proposed 2nd floor: existing proposed Total new Estimated Project Cost o. Zoning District Flood Plain Groundwater Overlay Construction Typed 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 XNo On Old King's Highway: ❑Yes tKNo Basement Type: ❑Full O 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 0 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 BUILDER INFORMATION p Name r/4� y�� Telephone Number SCE , 7-71 5 2 Address (o_ License# Home Improvement Contractor# /U 0 2 Worker's Compensation# l ALL CONSTRUCTION DEBRI RESULTING-FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 3" A FOR OFFICIAL USE ONLY PERMIT NO. is A — .. t t " �.'" .. t ,N - ti,.r �r ... ' • DATE ISSUED MAP/PARCEL NO. ' ADDRESS_ ^v? t VILLAGE OWNER AL DATE OF INSPECTION Y - FOUNDATION t FRAME r' t•- µ INSULATION ' FIREPLACE ELECTRICAL: ROUGH FINAL .r PLUMBING: ROUGH - FINAL, y GAS: !� ROUGH FINAL' V `y x FINAL BUILDING ,.T t,�' ✓ > .� ! '� F § it , DATE CLOSED OUT r .; ASSOCIATIONTLAN NO. x. The Town of Barnstable 10� Department of Health Safety and Environmental Services- Eo ' Building Division , 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph.Crossen Fax: 508-790-6230 Building'Commissioner Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: ( � Estimated Cost y�O0 Address of Work: c) (?(f 42 of!/e-, Nz Owner's Name: ! C rlJ Date of Application: Z I hereby certify that: Registration is not required for the following reason(s): r_iWork excluded by law Job Under$1,000 Building not owner-occupied Downer pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner. ,!2 A Date Con r Name Registration No. OR Date Owner's Name q:fornu:Affidav -r_ ' _- The Commonwealth of Massachusetts -:... �g� == _=�.L Department of Industrial Accidents -- Office oflnrestigadoos =_ 600 Washington Street Boston Mass. 02111 Workers' Com ensation Insurance Affidavit name: �G •� location: G' city phone# 7 7/ 3 � ❑ I am a homeowner performing all work myself. I am a sole ro rietor and have no one working in��acity % %%%% %/%% ///�//O%/�%///////�/////%/%%/%/%////G/%Iaman employer providing workers' compensatioy employees working on this job. company name: address: city phone#- insurance co. policv# ❑ I am a sole proprietor, general contractor, or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: company name: address: city: phone* insurnnce co. olicv#. company name: _....... address city ...::. phone#: insurance co. ... .:. .... Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to s1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a Wte of S100.00 a day against me. I understand that a copy of this statement may be forwarded to the OMce of Investigations of the DIA for coverage verifleation. I do hereby certify u e pains arpd p aloes of perjury that the information provided above is true and correct 'go- Date Sigiature / _ Print name Phone# official use only do not write in this area to be completed by city or town official city or town: permit/license t! ❑Building Department ❑Licensing Board Q check if immediate response is required QSelecunen's Office ❑Health Department contact person: phone tt; ❑Other ...:;...:......•: :...... (tevued 9/95 PIA! Information and Instructions k Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", an employee is defined as every person in the service of another under any cc=-"Z-, of hire, express or implied, oral or written. An employer is defined as an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receive. c: trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling-house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally, neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the`law"or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. City or Towns - Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permidUcense number which will be used as a reference number. The affidavits may be returned io the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents amce of Investigations 600 Washington Street Boston'Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 Assessor's map and lot-number ...(.4.. .�...�-�..'....... �� O Sewa e' Permit number ............ ...........`?'.9� � ,/ow .t/c%f1' 4 e `/j� . g LEtycG��.�-L �FTNET� TOWN OF BARNSTABLE r � , t 4'. _ 8'm TADL NAM ' N s6}9• BUILDING - INSPECTOR `0� APPLICATION FOR PERMIT TO ... ,b�.►(,f:C�. : ( .V..IS� .........�eAF-' ��.. .. .PL� .......................... TYPEOF CONSTRUCTION .......4t?. ?4T1,�.....?........................ .................................................................. ....... *�..................�9. . -- TO-THE INSPECTOR OF BUILDINGS: - The undersigned hereby applies for a permit according to the following information: Location ...sciakkew....... ........... .. r �lr..1lii. .� . . ...1.1.1�i..S. ............................................................. ProposedUse ...... ikf..44P. g ........................................................................................................................................... S� ZoningDistrict ........�:�..^ .............................................Fire District ................. .... ....................................................... Name of Owner Ar.+fty-'S..... .. Address .................................................................................... Nameof Builder .....1i. P.$..:....................Address ...,50........................................................................... Name-c,f Architect ...........Address ................................................... Number of Rooms ....................r— ..............................................Foundation ....!Gi.kf?GX+...................................................... Exterior .....af..lh�7...L,.4s,.....................................................Roofing .....A�. �1L .................................................... Floors5'rf.?. G�.l T. .....5� � .......................Interior ... -.......................................................... Heating ............ .,. _...........Plumbing 00 Fireplace ..................................................................................Approximate Cost ..... �. ..... ............................ ..... Definitive Plan Approved by Planning Board ___-_-____-_--___---.-------19--____--•0 Area SSA s - Diagram of Lot and Building with Dimensions Fee ........./4;).............. SUBJECT TO APPROVAL OF BOARD OF HEALT 30 AV - 40 P EIJ - `--l♦ Cr x l S l W k`y - �--�-� �U�SC it IJ t A'd 1 4. Tv 2 S 1 D6 L,v t tli: tL 1 hereby agree to conform to all the Rules and Regulations of:,..Te own of Barnstable regarding the a e `S construction. 6 Name .. .................... .................................... �C - - - _ -- �.�$ of - � �, ��' •* � � �rL d 7- I � log { OTIM -el meoo W"" a�,��a;aae/auaet7' OEPARTNENT OF PUBLIC SAFeTY CONSTRUCTION SUPERVISOR LICENSE Number Expires: Rest Died<.to..' RAW JONES:: 356 BAY'llN° CENTERVILLE, NA 92632 TOa� � �y��oamcnrnn�aealOi o��ra0ad6ufelL �1 HOME IMPROVEMENT,CONTRACTOR A Registration 113598 4 TYPe , y INOIVIDUAL k xplratlon ' 06%19./99 FRANCIS JONES a; ' 356 BAY EN r>u of v �o' 16�ItERVILLE MA 02632 .ADMINISTRATOR t + : <e TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION - 5 Map Parcel 69 Z �`�` Permit# Health Division Date Issued Conservation Division 1 Fee Tax Collector .'„ I SEPTI C SYS TEM TEM Treasurer INSTALLED IN COMp��E Planning Dept. VM JMXa Date Definitive Plan Approved by Planning Board RONME T NTAL CODE AND (� �!V(V REGULATIONS Historic-OKH Preservation/Hyannis ]f Project Street Address ' 3O Village /l Owner ` Address T J1�a r f Telephone Permit Request CS" ° / L, �'i✓p Square feet: 1st floor:existing proposed �oe 2nd floor: existing proposed Total new 50y r Estimated Project Cost ice, Zoning District Flood Plain Groundwater Overlay 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: YFull . ❑Crawl ❑Walkout . ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft), q Number of Baths: Full: existing new. Half: existing new Number of Bedrooms: existing vZ- . new �— Total Room Count(not including baths):existing new First Floor Room Count -T Heat Type and Fuel: as ❑Oil ❑Electric ❑Other T � 4 YP G I Central Air: ❑Yes XNO Fireplaces: Existing New Existing wood/coal stove: ❑Yes .60 Detached garage:0 existing ❑new size Pool:❑existing ❑new size Barn:O existing ❑new size Attached garage:�existing ❑new. size Shed:0 existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use _ BUIL ER INFORMATION Name /�I� ©NETS � Tele hone Number Off" '7 7/'3�2-� A Address 315-6 64d L_ +AJ e License# Q ® J'5'1P Y 8 Gem I'`e Hue Home Improvement Contractor# l 3 5?3 Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE a 0 —12— ^ ,9/ FOR OFFICIAL USE ONLY ' PERMIT NO. ' ,•. r DATE ISSUED MAP/PARCEL NO,. ADDRESS s VILLAGE OWNER . DATE OF INSPECTION: ' ry FOUNDATION FRAME 'INSULATION '" - FIREPLACE ELECTRICAL: ROUGH - FINAL,'-_ �r s ; r.. PLUMBING: ROUGH FINAL •} ,;�1 �,- GAS: ROUGH FINAL ` t t 4 { FINAL BUILDING 5 , Cal joi DATE,CLOSED OUT MOT 4 ASSOCIATION PLAN NO.;._ .. in ESTIMATED PROJECT COST WORKSHEET, ' Value k LIVING SPACE square feet X $55/sq.,foot GARAGE (UNFINISHED) square feet X $25/sq. foot= PORCH square feet X $20/sq. foot= DECK square feet X $15/sq. foot= 6 .t) _ � OTHER square feet X $??/sq. foot Co.= ��� Total Estimated Project Cost 13, F k . g990915b The Town of Barnstable AM Department of Health Safety and Environmental Services . Building Division 367 Main Street,Hyannis MA 02601 Office: 508-8624038 Ralph Crossen Fax: 508-790-6230 Building'Commissione: Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: LA69 jj&%ot-L Vf&WKAhJ Estimated Cost Address of Work: q1P l r'it `d t Lt Owner's Name: 4M,-&UA Date of Application:_ I hereby certify that: Registration is not required for the following reason(s): Work excluded by law E]Job Under$1,000 Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the o er. Q�5& � 3 Date Contractor Name Registration No. OR Date Owner's Name q:fbr ms:Afftdav ��a y, w The Commonwealth of Massachusetts :J . -= ' Department o Industrial Accidents a,:-- — P _ Office ot/oresuffatioos 600 Washington Street \ `4; Boston,Mass. OZlll WorkersI CoA sation Insurance Affidavit name: S alms location• ,3-sto `- PCA"NE!,�� C"� u I l t city i�eo�e P 0- 1 k �h$5 phone# ,171 � 2-``? I am a homeowner performing all work myself. . I am a sole p.7 n,etor and have no one workiz in anv achy 'O%%%%/%%%%%/%%%%/%//G%/%%%%%/%%%%%%/G/%%/G%%%/%/%//%%//%/% %%�O/%%%%%%%%%%%%%///G%%//%/%%%/%%//%%//%%%//%%G//%/%%%��%%///////////%%�%///, I am an employer providing workers' compensation for my employees working.on this job. ::::::: ::: : ::: :::::: ::::::: eom anv name: >;....::;:; >.,.I. .:. :.. ;i..:;:•;:.::.-*......::.:;:.;:::.:::.;;:.;.;.::•.:.:.;::.;.:::.... :: nddressc u-..;.....-,.:....: ........-.-.,.....:-..--,...:-..,;.:...;�"-.,..,.�.-.�...,,'...,.::.'-..�.....:."...X..:.,-.;...-.:;-..".�;....:::�*.-..�'.:*..:."..*..-',-.—..,-----............*.::::::-.,..i:.m,..:**--.-:.::.`.,:-�,.,--...-.*.*...-..--......-'.X:-.i*.-..-..:.,:-;::..:::::...�:..*-....:....:.:.I.......,.;..,.-........".,..-:..-.........,,.....: <: : nhbne#. _::::::,:::: cites ::: .: ohcv# insurance co. ><>::::: //% ❑ 'I am a sole proprietor, general contractor,or homeowner(circle one)and have hired the contractors listed below who have . the following workers' compensation polices.: :.;..;;::.;...::.::::.::.:.. wm anv natne. address. x. .:.::.::.:::....... ...................... :.: .::::::::;;:::.::.::.::.::.:.:........:...::........ :...........::. ::.,,:.;:.. ........................................................................ :............:....................:...........................:::.::.............................................:.. ............. .............................................. ............................................... ........................:................................................_............................,,.;............;.;.......::::i4::::}}:w>:ii:•.N::n� t>.::»ii:�^ii:iii::iiii}:i::i•:i:ii- --:�i::"v �::.::..:.:v::w:::::v:.::.:...........................::.......................... :.i: :::::::::::i::::::::,i:':.:: :is�:::;:::':>:: ::ii::iiti::>:•>:•>i>'»:::> ?•i:•i:•>i:�':.}v(:::::::ii::: .. ...............:::.....................;...:,........... .................... :. .:::::,..:.::.::i?:•::ii:ii:•>};:i::ii:;i:•>:i:w:i'.;4::iii:ii::::: v:::::::::::::::i::is::':` :: ::.................:::::>;:.::;:::<:<.;.;:.:: :::::::::::>.;.::..::.;:::::;:;> one:# :. citv� h` »><::<:» ::.:.::.:.:.:..:............... .................. €`i.,. ;:<:;ii.:::::::.:: ..::::,........ . ._. _:::::<c:v:::••<•>::>'•:ii.>:.>::,:::.::::::::::::::::.::.::::::.::.�:::::.::::.:::.�.::::._:::::.:::.:.......::::::::.:::: ::.:::. . ..#::;::x:: c;':::Gs::i%:I::::.::>::i.:':;::';::'•»:..;:.....X::»>:.;,.::::»;.::;<:.;ya;;'.::.>}:•;a ';::•:%::: insuranceca :.::::.:::::::::.: ::..:..:::...: ::...:::...:...:.:::.... .:........ .:. ... oltcv c anv names - :. address. .::..:::..::::...::.:::.>::.;::.;:.:: :....:...:::::..:.:.. :.:........ < :::<:::::::::;::::;::<::::::;::;«:::;:.: --:-:;*.*.;>:::::.»;:.<..::.::::.::; pfione it :::'<..-- c: C1tP 3 ::: :::'::::r:: ;:;:: ::i:::%::;;;:::.i::ii::::::.`•ii':::>ii:::rci::;.;:2'i:::::: :_::::i :<r'G::::i; .::,::::::::ii::t:::i;::::>::::::::::`•::ii::>:::::::i:::::::::: iesnrance co.......::.......... :..:.:.;.%.:;::. :: :::::,.;.:::.;:::;.::. . Failure to secure coverage as requited under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a 8ne 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 tine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I . I do hereby certi the pains�pen ies ojperjury that the information provided above is trrw.and coned . Signature Date l0 ~1I-.. - Print name 1`)e,t S o sU P Phone# ` I 'S--t q__- official use only do not write in this area to be completed by city or town official . city or town: permit/license# ❑Building Department ❑Licensing Board ❑check if immediate response is required ❑Selectmen's Office . ❑Health Department contact person: phone#, - ❑Other�� Ugmed 9195 PJA) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An employer is defined as an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the'occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and d hone numbers with a certificate of insurance affidavits may be supplyingco an names address an umbe s along as all company � P � Y submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be rehimed io the Department by mail or FAX unless other_arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents efflce of lmlestlgations 600 Washington Street Boston, Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 730 MIR Appoeft i . • Table-rs ' presu ipti ve Packages for dw and Tw04Fa1UdY Residential Boildia Heated with Food rasa MAXIMUM MWIMUM Glazing can Ceiling Wall floor 860ttamt Slab N ��B ) U-vaim: R4%&wy R•vW=' &velueJ wall Paimcm EMa=cY' patinae R.vahwe it-vaim, 5"1 to 000 Heating,Denm DaW Q 12Y. a40 31 13 19 10 6 Normal R 12SS 032 30 19 19 10 6 Normal S 0J0 31 13 19 10 6 B AFUE T 15% 036 31 13 23 WA WA Normal U 13% 1 0A6 31 19 19 10 6 Normal w 13% OJ2 30 19 19 10 . 6 u AFEM x IV15 C32 31 13 2S WA WA Normal T 11Y. 0.42 31 19 .2S WA WA Normal Z IVA 0.42 31 13 19 10 6 90AFUE AA 11'/. OJO 30 19 1 19 10 6 90 AFUE 1. ADDRESS OF PROPERTY. ` 0 /4 trcd 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: � 3. SQUARE FOOTAGE OF ALL GLAZING: L t. 2-3 4. %GLAZING AREA(#3 DIVIDED BY#2): o � > S. SELECT PACKAGE(Q—AA-see chart above):. l �� d 9 NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. BUILDING INSPECTOR APPROVAL: YES: NO: q-forms-080303a L 780 CMR Appendix J Footnotes to Table J5.7.1b: {s and Glazing area is the ratio of the area of the glazing assemblies (including slid glass doors, skyle igh . basement windows if located in walls that enclose conditioned space,but excluding opaque doors)to the gross.wall area,expressed as a percentage. Up to 1%of the total glazing area may be excluded from the U-value requirement. For example,3 W of decorative glass may be excluded from a building design with 300 fl of glazing area. =After January 1, 1999, glazing U-values must be tested and documented by the manufacturer in accordance with the National Fenestration RatingCouncil (NFRC) test procedure, or taken from Table J1.5.3a. U-values are for whole units: center-of-glass U-values cannot be used. ' The ceiling R truss construction.do.not assume a raised or oversized t construction. If the insulation achieves the full insulation thicknes s-over the exterior walls without compression, R 30 insulation may be substituted for R-3 8 insulation and R-38 insulation may be substituted for R-49 insulation. Ceiling R-values represent the sum of cavity insulation plus insulating sheathing (if used). For ventilated ceilings, insulating sheathing must be placed between the conditioned space and the vw`u� - Pv:don of take.: 'Wall R-values represent the sum of the wall cavity insulation plus insulating sheathing (if used). Do not include exterior siding,structural sheathing,and interior drywall.For example,an R-I 9'requirement could be met EITHER by R-19 cavity insulation OR R-13 cavity insulation plus R-6 insulating sheathing. Wall requirements apply to wood-flame or mass(concrete,masonry,log)wall constructions,but do not apply to metal-frame construction. ''Ihe floor requirements apply to floors over unconditioned spaces(such as unconditioned crawlspaces,basements, or garages).,Floors over outside air must meet the ceiling requirements. `The entire opaque portion of any individual basement wail with an average depth less than 50%below grade must meet the same R value requirement as above-grade walls. Windows and sliding glass doors of conditioned basements must be. included with the other glazing. Basement doors must meet the door U-value requirement descnbed in Note b. 'The R-value requirements.are for unheated slabs.Add an additional R-2 for heated slabs. ' If the building utilizes electric resistance heating use coinpliance approach 3, 4, or 5. If you plan to install more in equipment, the equipment ent with the lowest than one piece of heating equipment or more than one piece of cooling eq pm eq P efficiency must meet or exceed the efficiency required by the selected package. 'For Heating Degree Day requirements of the closest city or town see Table J5.1 I a NOTES: a)Glazing areas and U-values a maximum acceptable levels. Insulation R-values are minimum acceptable level re s. R value requirements are for insulation only and do not include structural components. b)Opaque doors in the building envelope must have a U-value no greater than 0.35. Door U-values must be tested ce with the NFRC test procedure or taken from the door U-value and documented by the manufacturer to accordance in Table J1.53b. If a door contains glass and an aggregate U-value rating for that door is not available, include the glasscarea of the door with your windows and use the opaque door U-value to determine compliance of the door. One door may be excluded from this requirement(i.e.,may have a U-value'greater than 035). . . component includes two o c) [f a ceiling,wall,floor,basement wall,slab-edge,or craws space wall comp r more areas with, different insulation levels, the component complies if the area-weighted average R-value is greater than or equal to the R-value requirement for that coinonem Glazing or door components comply if the area-weighted average U- p g value of all windows or doors is less than or equal to the U-value requirement(0.35 for doors). 43 HOME-IMPROVEMENT CONTRACTOR Registration 10598 Type - INDIVIDUAL _ Expiration <06%29/O1 -' . FRANCIS. JONES r. 356 BAY LN ERVILLE MA .02632 ADMINISTRATOR � �,_ .... � ��te -f�omntan�uea� o�✓�waoac�ruoel74 BOARD OF BUILDING REGULATIONS eense CONSTRUCTION SUPERVISOR - Number CS 005648 e. I. Exptrss0�7/�4/2001�.� Tr.no: 20 -_Restnc6ed To: 00 FRANCIS JONES 356 BAY LN CENTERVILLE, MA 02632 Administrator 4/y �k aCh j 7 ! 1 o es Cotes 77 !.3'Z/9. „J_". Mon, -Engin&ring Dept. (3rd floor) Map Parcel �' Permit# Q House# Date Issued Board of Health(3rd floor)(8:15 -9:30/1:00-4:30) � Feed ,4� 4�4-,crIJ Conservation Office(4th floor)(8:30-9:30/1:00-2:00) Z Planning Dept.(1st floor/School Admin. Bldg.) /r�G3 ! oFTNE, Def' v an Approved by Planning Board En-, 1 "�ryS♦� yv Ci0^a� iB NNABLE v, TOWN OF BARNSTABLE Building Perm' A is n P treet Address462 Village 6�k Owner 4nf,J f,.;, —G�� , r, Address .� Telephone G Z q Permit Request j- Jell1-01 Owl � C-ry r le 6 / AP First Floor Pc' ` G square feet Second Floor square feet Construction Type Estimated Project Cost Q G d Y LO Zoning District Flood Plain Water Protection Lot Size /!2d va Grandfathered�Yes ❑No 41 Dwelling Type: Single Family Two Family ❑ ' Multi-Family(#units) Age of Existing Structure VIJ Historic House ❑Yes � No On Old King's Highway ❑YesXO Basement TypeKFull ❑Crawl ❑Walkout ❑Other Basement Finished Areas .ft. Basement Unfinished Areas .ft ( q ) ( q ) Number of Baths: Full: Existing New Half: Existing New No. 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 ❑Yes1CTo Fireplaces: Existing New Existing wood/coal stove ❑Yes �o Garage: ❑Detached(size_) Other Detached Structures: ❑Pool(size) ❑Attached(size) 2 ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use �i 2� ( Proposed Use Builder Information Name Y W Telephone Number 5 , Address 'License#fil - mr- X c Home Improvement Contractor# (fie Worker's Compensation#_, (92 in Q !C Z?l 4< NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROICT WILL BE TAKEN TO SIGNATURE DATE l �� BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) r 2 Ir �� S - \ ws' .� - f a`_! "�`� Y �_ T ~ ,. .� _ �'� 1 J l a t a y � �a� .w t.- •t'i•'—. i i _ �..a..;ti......4�.•7.. ......... .., ,.._.. . . .. ... .��.......,_). .. - •..."...:�...,_1�.,.,Ji.�s .wri..�.:Lu.).r.t:�.i�S �:k.::w )A.,m[oY..�S..,.art:2:a._.�.z..:.•!':%.,.4:VA'..0�,.`.ar•::ab.t:r..�s ctt_<.,1�.�.`.l t:`. r :ems w-- - _ The Commonwealth ofMassachUSC&S Department of Industrial Accidents _ � Bm�ceavin�esl7q�s ��- - 600 Washington Street Boston,.Mass. 02111 Workers'Compensation insurance Affidavit me: - 1QCltion• Q X?7G X 17 ' cityG. h ❑ 1 am a homeowner performing all work myself am a sole proprietor and have no one working in any capacity ❑ lam an employer providing workers' compensation for my employees working on this job. sampanX names dress- .. . . •. � � .• .. I SItV: •phoaeft•_ �insurip. ce co: polidy# Mangum ❑ t am a ole propriet ,general contractor,or homeowner(elrcle one)and have hired the contractors listed below who have the foliowlnd workers'comp sation polices. to a an e": addre sr cifv: tpin sari - •olienelt• inAura alp ce eti tt' Failure to secure coverage as required wader Section 25A of MU 152 can lead to the imposition of criminal penaltia of iiut up to$1,500.00 and/or Doc years'Imprisonment as well as elvil penalties in the form of a STOP WORK ORDER and a,tine of$100.00 a day against me. I understand that s copy of this statement maybe forwarded to the()[rice of Jovestigatin"Of the VIA for coverage verification. I do/twehy certify rondo the pains pertIf ies of perjaty chat the i4armir ion provided above it trac a►ad cornea. Signature Date 15. Print name Z(5J heat# V n�cial use only Jo not write in this area to be completed by city or town official city or town: permiNicciae# l;ttilding Department ❑tieenfing chard \N� Q check irimmediate respoese is required oseleetnata's Ofriee OHeaith Department contact person. phone#; rtOther (nevi%cd 1/91 r1A) - � ii -- Information and Instructions A. Massachuselts General Laws chapter 152 section 25 requires all employers to provide workers'compensation for their employees. As quoted from the"law",an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An employer is defined as are individuai, partnership,association,corporation or other legal entity,or any two or more of the Coregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer, or the receiver or trustee of an individual ,,partnership, association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGT-chapter 152 section 25 also states that every state.or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business 6r to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of pub)is work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants ' Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and supplying company names,address and phone numbers as all affidavits may be submitted to the Department of Tndustrial Accidents for confirmation of insurance coverage, Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you are required to obtain a workers' compensation poiicy,please call the Department at the number listed below• City or Towns Please be sure that gtlie affidavit is complete and printed legibly. 'The Department has provided sp ace at the b ottom of Please the atdavit for you to fill out in the event the Office of Investigations has to coma y regarding the applicant. be sure to fill in the permit/license number which will be used as a been reTriference number. The a�'idavits may be returned to the Department by mail or FAX unless other arrangements haveThe Office of Investigations would like to thank you in advarice for you cooperation aid should you have any questions, please do not hesitate to give us a call. . The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office tot lalro5dwoos 600 Washington street Boston,Ma. 02111 fax N: (617)727-7749. phone#: (617) 727-4900 ext.406,409 or 375 etge � t 'pFA �k°"��n.tiz`�y?` k•tid" - ,y ,,„ a �,'v �,'� S ;'�T+•:.:z� �Mtn� '� r �.� K pa, 5 � �,h-a� '��.t.a< � t=�{ i `i3^;h "yL ?" 4s �'s... *.r .•a"L'oF"�' T Ji'�"'#'3',,.rrt t., sM_.k;aM,,"': t'Imam- " -c. ���K '� •, •'4• i .'x3' Aw ss..«a: s i -,;c3 yd7. 'r„SJ�'� ip,�� 'A _ w:• .� + � �'i' ,r ; 4 8-s °�:}, .�,. x ya 9`.�,,. p...�,s; y'•a°". •t{ c.:.r- T�.�., .,,.?. �.,+�s :ry,a. ,,$��' r '•'�,tf ;w:., •u"i' �`� �.,:>'�-�'}• �' °�' �. � :};:�wCts�. a �'�� Y' •,• +''� ' r"SFi,., .Yi.., ';..�i:< r`5 ,;.,,.: r:e. 2a' �� 31.. .c. ^'h+ ,,.s `� .se'�e- s+ti: r -c , ra nee e �t•. -� ,a �f?rti �;. �� r�.;->~ � � � �s. All; ' Y�k"'s� ; ylYp"<• "f'.4 4}" r�;i + 3 °-', �'.:.�• @ �+ri?a., 2u -_ nt -.T, s• '4 Yid vr`'fra'e¢ r$.,.��F.. 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'S r Ael ..ili�..r 1�::.�'� �,4f`ry�,.F:r m _ � ® 6^� ..6:'-�� 5•t'"_ ��...1�.3�'p .Y � 'a} :� "�+'-4�'4,}:''"r�^�„+AA."'�:�'"'r cs k', ^x...,� r��3 K�✓fr. :�1� =-�i/.-_ �t'.��.�y�..+. ...'�'}zT'�ie „y*:. J,'-. rn.. :� -.s• c,.-, �F -f^� �- -t, s.�. a+��r "�:.•... .3'i''±7 3.�-r �'IzFz.�� �. -.� �F— -Y «. ,�::a `�'�,�>.t. �' x"��•:s'y�,��,g`�it)r�.•,�_r." .F� r s�K mz+~ .+i`'.-s x.,.'Yk .�S':� ,,a -r>✓a.r,x,�l'k"!„`.p'xyEbs,. �'+„r--'F'+"°. yrty , ..�`+ `• = sa ti Ft H�a€�rF t�y 'ah';l "S,10. M' ..1E. f "'`'`s;, �H�-� ois��t= a ,�iy�F-r� ��' �8 r 5 -•. _-- � If.i a ,s e F � ;;,,.,r�� y�,�,",� a �-�,. r,.r ".v��.•�}�3,; .-� �:���`'�it�.� y�,`P`*s``'#.n.a..�. ;�` r�y�,,. .r��%.�,�y.a{ -''try .>(�,""t t.:� `� � '�u,,'`�r'Pa�"�,.;a�'�,';.;# ".�+'3. ,+rla ,'S 1r�: r? "'�' � ` ; s . P'p .i::i -� .Y. ''c'7`,•% o 3 d ''4«'`r :?� 'C`-..:'.'y'' ,:,af' ��_r�- ,v ���.�'`� .i'l�iFnY ,•a" .f'-,gsy"y z«�` ,.�i^,i �a� �.-,K�„,r�-,.#' � £ ..tt� iT; * �a �3�,' . ym G-a,r �� S .. ® g ����{ x'hs€��r�3�li�+•fiiy,��f �'a�'"�v��u.+3�/S'��" '-. W^45.r r i ,;"��^� � �'Wit' �+.t" «n'.5� �x��i� ���� �t��i�,+ -""e`Y�`•� '°-'.3c.`r a,_, �..9 +�n�..:� � �. e{ ,���"s{��a��; K>t M'' 7i ��dr b�h�� i h VE . The Town of Barnstable • �xxsTnsra. • ` �m� Department of Health Safety and Environmental Services r6�,9. Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner For office use only Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the "reconstruction, alterations, renovation, repair; modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors, with certain exceptions along with other requirements. F ;//*ct 1!?�e�nI Q`Cl f� Type of Work: a��.-� d�/��f Est.Cost Address of Work• __�l? Owner's Name � t CJ C 1! Date of Permit Application: c I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under$1,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR Date Owner's Name - �--•.. t.--r P^• ti- »..-..r...�y,...Y.y. . r ... ..�.,r„w....,•. - ,,_..�•r_'. - �.-. -�... . . .,,.-,...-.... .w. r..•-. • +-ram«..`vim.,.- ... � Assessor's map and lot number � ............• G O iY � iow �raysT e T Sewage: Permit number. ............. ................. ...�� T ..... . .... `t"ET°��o TOWN OF BARNSTABLE , i 13AUSTABLB, M6 .•� BUILDING INSPECTOR APPLICATION FOR PERMIT TO ... ,t .►;a.G�'�jZ.1. ..Cam .•••••••.•�e!4• 'F �%•• ••�P ••••UZ4 � r TYPEOF CONSTRUCTION ....... .��?. ......f................................................................................................ f .�t..........7.................19. . TO-THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to thel following information: Location ...SjCV-&1&&V .......tJ4�1. ...........l.r.�. 1. M'..V..i..!.! ...j.. (..�s.�.............................................................. ProposedUse .....QA•F..Aadl:g�........................................................................................................................................... 1 ZoningDistrict ........ '. ....................................................Fire District ...................... ....................................................... Nameof Owner .v.r..... Address .................................................................................... Nameof Builder .....................Address ...15.0.......................................................................... Name of Architect ..............Address .................................................... .................................................................................... Numberof Rooms �—....................:.............................................Foundation ..... .«.................................................... Exterior .... ..lh ..l.•,4 ..........................................:...........Roofing .....�.:5.`.�?/' A�-�.................:............:..................... �`.. ..... . .Interior .....................................................................................Floors 0.0Gf.I T ...................... Heating --............................:....................................Plumbing .................................................................................. MP _ �'0® 00 Fireplace ......................... ....................................Approximate Cost ..... ......Definitive Plan Approved by Planning Board ---------------________-_ S - -19- ---.�0 W Area .............. ................. Diagram of Lot and Building with Dimensions �� ? Fee ......... ..' ... .. SUBJECT TO APPROVAL OF BOARD OF HEALTIC 0 .p-e co 10 , _T CO -- O�EIJ Cs�►�lei` � L...+OT i l.. x l S i 1 Wc., P ejas ZX kr --� �I o s� $c� 1 � 4. �� ? s 11J6 L-t- ! �rl L 1 hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the a e S construction. a � NameE.... ?'`:......'�....................................................... Genova, Mr. & Mrs. F. D. No ..LZMA... Permit for ........aqd breezeway ........................ .....qi ................... Location ........... .... . .�'............................ ......................... .............................. Owner ............H-.r,...& D. Genova .......... .............. Type of Construction ........f.rAQW!....................... ................................................................................ Plot ............................ Lot ................................ Permit Granted ..............October 7......19 74 ................ Date of Inspection ..................... ...............19 Date Completed PERMIT REFUSED ................................................................. 19 ............................................................................... ................................................................................ ............................................................................... ............................................................................... Approved ................................................ 19 ............................................................................... ............................................................................... THE TOWN OF BARNSTABLE BARNSTABLE. 1 639. J MAI BUILPING INSPECTOR APPLICATION FOR PERMIT TO .................ras,............ ....... )11_t_S.kC.,d,4_x......................... TYPE OF CONSTRUCTION ..........................W..................;. .... ............................F ........................ 6 .............. ............. ,99.. . TO-THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to t C following information: C w' CI -- j�� Location ......... 30A.......... /*�"** .V/.��..C!'?:.� Proposed Use ...........Teo.1,&,. .c-L................................... Zoning District ................ ......................................Fire District ......... .... ........................... �L r.'T6-11 h4C456V_- /d Name of Owner ..A!.... .........Address ...e..4�...(�p.. ............. ......... .................. hu ... .. .......... Name of Builder ...... 1)�.Y//;'ArcHress .......... & I Nameof Architect ..................................................................Address ..................................................................................... Number of Rooms ................. .T ...........................................Foundation ...... C.......................... Exterior ................ .............................................Roofing • .....*... ..... . . .. ................................................. Floors ...............OCk..........................................................Interior ............ Heating .............. =..W00.*ft.... .k4f........Plumbing ............... ................................ ............. Fireplace ...................Q.KIE. .................................................Approximate Cost ......AA3, ........ .. ................................. Difinitive Plan Approved by Planning Board --------------------------------19--------- Diagram of Lot and Building with Dimensions � tt O#X3 rri ED z 0 >--q m > 0 U) V) M rri ay r r rr- rr rn rT, Llkn m to ;;.q _< M 00 C= rn > (A C) —I o .0.Tj Qn, r d-IS U) rri 0 Ga 0 M > 0 r7l I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ........... .. ... .. .. ... ............ ...... .................I..... .... .....�ingle family dwelling Location 4 Centerville Type of Construction ----z'.r.a.me................... -----.---~----.------.------ /�- 3 `{-_-�9 /�- ��O Pk�'-..��----�-.�. Lot ----..���---- / ( _ ' �otobmr �q ----^- _ . Permit Granted --------.��-'--.l9 -^ � . Dote of Inspection . --.lg Dote Completed ------------.]q . ° � . / . / PERMIT REFUSED , f lA----------------------' .--~----.-.----.---.---------.- . . --------------------------' .---.----.-------.---.---..--. � . | ' '------'-'-'---~--'---~^-'----' Approved � ~ .......................................... lA ' ^ -------'----------^--~~---`- --------------------~...-.-... / ' � \ N ' .Y � � .� 2✓�37 :�-ts ri'i. CK,��41 d�Y, ` .t` ttt A-.w�,� �K � - .t kl _ - �„. MCP >. � �-,.• ����< _ ..>, �F. a ,'„�;��. xr .� �i�'" s `7, ,..+q> ':t, � 3- � R� - .` �. M...., x.;P� -E . S '><': c i ,a rt ,_,., �q �.y,, � .. _ -r r �• i{} .a�- :? x R•, s'" 14 W �Y -r§'r `ter � €�:,c7 t•4 ri.• le=a r f Go rn 4�4 � Y i •"}�F.M' ' � 'act ,t "�Ys� � 4 '+. t 4�z�.T" *[ � � nt � ' -~� 1 s �� 1i�}F� •�' _.�. r�^ Y E �3�?✓3+ i �' x 1xt^ 4 :,t'F�' --' r .F'P�:?'�`` r `w", .i/ �M1 � _ a S _J 1. c ... � 1. ... \ , ..., ... - ..., ;q.......::_.:_:a:.. ...4 / \, / �;, :I-i., � gym:' ':f•-'4.:: ._J ..m �../ � (. , •,,;,,,,• )`� ' '\• � �.,..\ �`�; a ;,• .:� "�.,....� ��.•,/, > f,. - '•1 ,/ my.p�. •• �' - e ���... /.........,� /.. a ,; +iY'o{ l . , \ - l _ , _ s ; 1 �°._/ r :x aw, sva .o v �_,.•' �--. \ t' � RE _E �•,,s�F�,.\ r'.: / p �� • ( r �.' � � ,: '� Ray /.,•". y ``•,,.r•-` o,E ��.`i 9 t `{ 'Y- ♦,oE \ /�— .mE \ i ;r j /' \ \ l \r ���ads .yT' .• t . RdT�._ Oo® _' '' •mE �. _ ,� / .'/- --•gyp �� ,l r _ , a47' , 1 ♦ �AW Y r \ .40 �\\\ ram•, i , __ ;-' / a=r^ ,�` ; , a :a` � E• �lRgop �_-_-� \ / � f:Q,• *;,,z, '-�°'x:� � �/• ``�, _.i,��� S � � LPL m f:�s�. y. aVp a_' l w ''••--��ww�� \ i\,""'--•. ``l :��'- '\ �\ \, i 3.;4 ::.'�:. �A� \�we %�I,is_ p p :i•E•... �ti \, �\ \\.`w:\r. \\ \`--� VE ', \` '\�yV ,1 ' t:' l — �'m0- O •Wi N ,• E r, tr-' , ! =... , , � `� `\`♦«\-•. � ��`, �"--._ �� I ter .'r--"\ p~� „- '^"'�\\ �� \ Y m � . I r -Ir � 'f Cob r •`. .x ,..., a �l �. --� ram:: �'-\ �,• :` I �eop :c° .....�. JC ��..+' / 0 '_ '.j:.;, \ \'--•\ •'_--is _ \\ ~\` � �:\� •� L•._,' 'f _ __./; f atop /t�:'�" ��,.. ,�,• / \ \\\\;\ �,\ _~Ya ,~ c --.{ ,.�,.' `J any `•, �:�. - /�� q". T;_ / 'y� \; ;' :' J1'1 _ x , " `\ orb/a/ / }•p r E y z', q .�� \••.-, �`',,� \`\ ,\ •� __ \ .,� _ , 11 n ' , / , , yr r - w _ TOWN OF BARNSTABLE G.I.S. UNIT PRINT DATE:9/22/98 NOTE:PARCEL BOUNDARIES ARE GRAPHIC REPRESENTATION 1 oo S ONLY.. ' P t