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Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office:-508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL'ONLY Not Vand without Red X-Press Imprint Map/parcel Number Property Address 34 (Residential Value of Work Minimum fee of$35.00 for work under$6000.00. Owner's Name&Address dk ova Contractor's Name C �� Telephone Number (�Va , +7"��j Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) /00 -PRE IT �Workman's Compensation Insurance Check one: ❑ I am a sole proprietor J U L 0 9 2012 ❑ I am the Homeowner I have Worker's Compensation Insurance�/J Insurance Company Name �� / '( ,� TOWN OF BARNSTABLE Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit Permit Request(check box) Re-roof(hurricane nailed)(stripping old shingles) All construction'debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over- existing layers of roof) ❑ Re-side #of doors ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#,of windows *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic Conservation,etc. "*'Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Ho I rove ent Contractors License&Construction Supervisors License is re , SIGNATURE: C:\Users\decollik\AppDataV..1 endows\TemporarylntemetFiles\ContentOutlook\DDV87AAZ\EXPRESS.doc . Revised 072110 l K: , The Commonwealth o Massachusetts Departrttetit oflndus&ial Accidents Orke of Invtestigations .. _ 660 Was"igton Street ; Boston,A"02111 wirnntnss.gowldia r ; Workers' Compensation Insurance Affidavit:Baders/Contractors)Electricians/Phambers Applicant Information 1Please Print Leziikly Name(Businessior�td/Inditridnat): Address: City/sta&ZiZip: Phone f- Are you an employer?Che&the appropriate box: Type of project r LAI am a employer with_� .4. ❑ I am a general contractor and I ❑ employees(full and/orpeat-kime).s have hired the sub-cantiactors 6. New oanst uction 2.❑ employees a sole proprietor or p,-6n - M listed on flee attached sheet 7. ❑Remodeling T _ slip and have no employees .sub-contractors have S. ❑Demolition. working for me in any capacity. employees and have workers' 9. ❑Building addition [No wodms'comp insurance comp_insurance.z required] 5. ❑ ale are a corporation and its 10.❑Etech ical repairs or additions officers have exercised their I L Plumbin airs or additions 3_❑ I am a homeowner doing all tavorl< ❑ g rep myself[No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required_]I, c.152,§1(41 and we have no employees.[No workers' 13.❑Other ' comp.insurance required.] 'Any Wficsffi 1hat checks bm#1 must alw 5ll out&e section below showing der wuleis'ovmpensartaon police imtaeirioa' i Homeowners wbD submit this affidm indicating titey are doing all we&and&m hire ostode contractors must MbMit anew affidavit Indicating such. kaatractnrs Mat check this box must attacbed an additional sheet dunimg the nsme of the sub-coutrartozs and state wbetber or zM ftse emdtks bane employees. If the sob-contractors bane etakployeees,they must provide their workers'comp.policy ntmrber. ; I am an employer that isprovdding workers'comperns &n insurance for trry employees. Below is the policy and!job site lvforaration. Insurance Company Name: Policy#or Self-ins.Lic.#: lA,� — !g 3710 g—00-1 2 ExpitstionDate: o eo Job Site Address:. G�Yy�t�ye� Anne i City/Statelzip: , Attach a copy of the workers'compensation policy declaration page(showing the policy number ang 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 Ike form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of .- Investigations of the DIA for insurance coverage verification. I do hereby certify v e s ndl n o irry the a information protidled above"--and carrect Si e: �r Date: Phone#: O dal use only. Do not write in tliis area;to be codnpleted by sty or hnvn offldaL ; City or Town: Permit/License it Issuing Authority(circle one): 1.Board of Health 2.Bundling Department 3.City1rown Clerk 4.Electrical Inspector S.Plumbigg Inspector . 6.Other Contact Person: Phone#: 6. e .. t CERTIFICATE OF LIABILITY INSURANCE105/16/2012 THIS CERTIFICATE M MSUED AS A MATTER OF INFORMATION ONLY-AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE WE NOT APFIRMATMELY Oft NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF Rt8tIRANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE MOUING INSURER(ft AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: tglW 10 an ADDITIONAL INSURED, the poi"I 6) mum be ellt ww& N suMOCAMN 15 wAivr%D, subject,to the toms and comet ons of the policy. eeddn policies asy reVRbs All mldomwnOnL A atatemem on da eeADlcete door not aorft+ rwa to the certMcM hinder In Iletr of smh wulumemo"&I. c_ SCHLIML It4SCRAi= BROIMM nX PHONE Er (509) 771 - 9381 50@-771-0663 34 henna STREET At�m9s 913===MULti=jVZ t ZW MT ° � aietaewe ror. . WEST YAtQfOUTH, Nh 02673 rmuREIRINAPieRNBnonvFAAOP louetl VaRmo AtZBRFRAPlBSLaIR HVTOAL DM^ GArd=R COMTRUCT2CM RICIUM GRIWMR g ammsl[DI.IH$RTY MOTIl1LL ° 92 Park Place Ersl>RD[c- 9IsaAER o: - masApee, mA 02649 Mum E, COVERAGES CMUMATE 14UMM: REWSION NUMBER: TMS 1$ TO CERTIFY TWAT THE POUr.M OF INSURANCE UVW BELOW HAVE BEEN -S$MD TO TM INURED NAWD AROW FOR THE POWCY PERIOD INDICATEO. NOTWRM6TANDING ANY REQUUMLENT. TERM OR CONWION OF ANY CONTRACT OR OTHER DOCMNT WRN RESPECT TO 1AHe4 THIS CERTIFICATE 1AAY BE ISSUED ON MAY PERTAIN. THE WMIANCE APPORDED BY THE POLICAES DESCRIBED HIMIN,IS SUBMT TO ALL THE TERNS, EXCLUSIONS ANQ CONDITIONS OF&"POLICIES.LI ITS SHOWN MAY HAVE BEEN DICED BY PAID CLANS. U11 TYPE OF DOURANCE SIZE WYD POLICY►AWBaR IZFrd00/vYYYI fellso"" Lam A 0e114'I'uAMLM CPP0709341 00/20/20 09/20 44c"OectmOwn S1,000,000 NCO— uR!auA�tBs>F1tAL LUIBdIry PR6�Ut IEA eooun S50,000 cUwis KW OX OCCUR } ' ttEDElv+l�m P m ' S5,000 fl P�,AL&AMPAW $2,000,000 _ OBIEMAOGRIGAIM $2,000,000 s M&AOQXfoATEUWAPPRIEFPB't - _ } PADpIICTS-COMPAPA6a s2,000,000 .. POLICY J"="- ROC AUTOMBU LIABKnY - .. C 8e18tE UpiR sAWAUM , + � (m aeddatlll ALLOwNEOAUfOC, - 4 AOffivi%Aw(PR Z WHEKR80IA.®AUTOS PAOPERMWO"A S - okvm nON-0WAED AVIOB - ' { - s EZCEBs Use C(/dR�rlIAOE � AflORt:t+ATE. Z ''. OP-DUC11Bts � 4 .• /06/20 Mt/�/20 TOaY tAEAt E77. JWCS-320-376359-022 OC AM FAVLOWAV UARIUY YIN ANYPROPAIETOmAMMIEXECLATIA! { t _ EA.EACH A000tM s 100,000 oFflcERAtcRt7eSAmEOT D MIA w►ro100 ELOLSEA9E-EAEIe+tora>e >t 100,000, unoro� Frl 'a+oPoPPRArrorA seta. , QI.o -POilGYt80T s 500.1 000 StACarPTIa+oPOPt�I+sTwRSTtACAUOFmrvgBa. low&Ac mlow.Adomm"; sFAnMOMIfffam SZan,mwftS! - ncamw Q►R mR Hu ELECTED I= To BE COVE= men s=s cvmsm 11101113m" CCHMS07,019 POL!CX CERTIFICATE HOLDER CANCE"TM ^� VWUW AW Of THE�As pBSCRIBEo�POLCIBS W OANCELLBD BEFORE t TXE - EVIRAMN. DATE TNT, NOTICE` wIW BE I)SWERS) DI ACCORDANCE VM THE POLICY PRONSIONS. , . AUIIgp4EDRFpf�tB/TA .. EDT A RPORATtC7N.All fights Mined ACORD 23(zoo810111 The ACOFiIti nmw turd bW Ate registaned of A00RD r I A "' Town of Barnstable Regulatory Services Thomas F.Geiler,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us . Office: 508-862-4038 Fax: 508-790-6230' - Property Owner Must F - Complete and Sign This Section If Using A Builder , 1' ,as Owner of the subject property hereby auth ze Y to act on mybehalf in all matters relative to work authorized by this'biulding pe`•r t application for: (A of job) t.Pl�, Uf6le Y'l"li• �3Q ' 1. ISigna e of Owner _ ,'� " Date g ak 'Print Name If Property Owner is applying for permit,please'complete the Homeowners License Exemption Form on the reverse side. t C:\Users\decoUik\AppDataVocal\Nficrosoft\Windows\Teinporary Internet Files\ContentOutiook\DDV 87AAZ\EXPRESS.doc Revised 072110 Office of Consumer Affairs &Business Regulation- Mass.Gov Pagel.of 1 The Official Website of the Office of Consumer Affairs&Business Regulation(OCABR) Consumer Affairs and Business Regulation Home, Consumer Home Improvement Contracting HIC Registration Complaints Registration# 143074 Home Improvement Contractor. Registrant GARDNER CONST: Registration Home Page Name RICHARD GARDNER Address , 92 PARK PLACE WAY City, State Zip MASHPEE, ma 02649 Expiration Date 06/15/M14 Complaints Details No complaints found for this registrant. You can also view arbitration and Guaranty Fund history. Back To Search Office of Consumer Affairs&Bus nesg ho HOME IMPROVEMENT CONTRACTOR o Registration- Massachusetts -Department of Public Safety 143074 Expiration _6/15%2012 Type:. Board of Building Regulations and Standards Pik _ DBA. Construction Supenisor Specialty GARDNER CONSTI& _ 3 f License. CSSL-100471 V !N 11 i �vscT�r.s RICHARD GARDhE RICFIARD H( tDNER �� 92 PARK PLACE W�,v jJ 92 PARI{PL.YCEtW MASHPEE,ma 02649 MASHPEE 11jA 02 _ .649 h Undersecretary Commissioner Expiration - 01/29/2014 http://services.oca.state.ma.us/hic/licdetails.aspx?txtSearchLN=43762 7/9/2012 Town of Barnstable m�6� Expires 6 months from isliv—date Regulatory Services Fee , 5 Thomas F.Geiler,Director Building Division ) l Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY j Not Valid without Red X-Press Lnprint Map/parcel NumberU� �� ~ Property Address 3 MLI C irr/i�J Residential Value of.Work Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address J Gt I —(✓1��1 U I I Contractor'..s NameHcflj"� �CU� .� Telephone Number, -Home Improvement Contractor License#(if applicable) U�� Construction Supervisor's License#(if applicable)_ S � 9w1 orkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner ZI have Worker's Compensation Insurance Insurance Company Name �l 1�UG, X-PRESS,PERMIT. Workman's Comp.Policy# 'W��— 3,S i�p��—y�� DEC 16 Copy of Insurance Compliance Certificate must be on file. - TOWN OF BAR�►STAB EE Permit Request(check box) ❑ Re-roof. (stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping, Going over existing layers of roof] ❑.Re-side [Replacement Windows/doors/sliders. U-Value_ (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town depatYment reeulationh@1e k1stonc Conservation,etc. ***Note: Property er must sign Property Owner Letter of Permission. co of'the Home Improvement Contractors License is required s SIGNATURE: star, Q:Forms:expmtrg Revise061306 I Town of Barnstable. Regulatory Services NAM' I'E' • Thomas R.Geller,Director Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town,barnstable:ma.us Office: 508-8 62-403 8 Fax: 5 08-790-62.3 0 Property Owner Must Complete and Sign.This Section If Using A Builder as Owner of the subject property hereby authorize Wrc"k CIS I�I G.�4 to act on ray behalf in all matters relative to work authorized by this Molding permit application for: ,,' or .• Address of Job) Sign of Owner Date C�ic511 Print Name OFOFMS:MtURPERMISSION Liberty Mutual Group Liberty P.O.Box 9090 mutum. Dover,NH 03821-9090 Telephone(800)653-7893 Fax(603)-245-5330 February 12,2008 TOWN OF BARNSTABLE ATTN:BLDG DEPT 200 MAIN STREET HYANNIS, MA 02601- RE: Certificate of Workers Compensation Insurance Insured: MARKWOOD CORPORATION 110 BREEDS HILL RD UNIT 10 HYANNIS, MA 02601 Policy Number: WC2-31S-319674-038 Effective: 2 /1 /2008 Expiration: 2/1 /2009 Coverage afforded under Workers Compensation Law of the following state(s): MA Employers Liability Limits,): Sole Proprietor/Partner Coverage Election: Bodily Injury By Accident: $100,000 Each Accident Bodily Injury by Disease: $ 100,000 Each Person Bodily Injury by Disease: $ 500,000 Policy Limits As of this date,the above-referenced policyholder is insured by Liberty Mutual Fire Insurance Co under the policy listed above. The insurance afforded by the listed policy is subject to all the terms,exclusions and conditions,and is not altered by any requirement,term or condition of any or other documents with respect to which this certificate may be issued. This certificate is issued as a matter of information only and confers no right upon you,the certificate holder. This certificate is not an insurance policy and does,not amend,extend,or alter the coverage afforded by the policy listed above. If this policy is cancelled before the stated expiration date,Liberty Mutual will endeavor to notify you of • , such cancellation. - AUTHORIZED REPRESENTATIVE LIBERTY MUTUAL INSURANCE GROUP This.Certificate is executed by LIBERTY MUTUAL INSURANCE GROUP as respects such insurance as is afforded by those companies. cc: Insured: Producer of Record: MARKWOOD CORPORATION FREDERICKS INSURANCE AGENCY INC 110 BREEDS HILL RD UNIT 10 P O BOX 427 HYANNIS, MA 02601 OSTERVILLE,'MA 02655 a ' ,/�aooacu0elld �i�e&wmwweald g Y I Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR,, before the expiration date. If found return to: Board of Building Regulations and Standards Regist[atlo ft 100871 One Ashburton Place Rm 1301 Ezpfrlor g/24/2010 Trll 267906 Boston,Ma.02108 Rate Corporation MARKWOOD TIMOTHY PEARSON } 110 BREED'S HILL ROAD UNtT 10 HYANNIS,MA 02601 Administrator Not valid without signature a y ContJbudldh gUpr bor LJcofm L � Cs 588Y BIr1� .11/1?/195� 1?�200s Tri 6849 Poses CEN'1ERVILLE,MA 02l - Commmonor The Commonwealth of Massachusetts Department of Industrial Accidents tl Office of Investigations d 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance.Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information rr Please Print Legibly LL� Dame(Business/Orgauizatiowbdividual):. /" f ('"d 6,rpp Address: I(V i 1 City/State/Zip:_ &M,-)4, J'1 . (�o�ljl Phone.#: q 77,-G?7 Are)wu an employer.?Check the appropriate bog: Type of project(required):, 1.U I am a employer with 3 4• ❑ I am a general contractor and I * have hired the sub-contractors 6. ❑New construction . . employees(full and/or part-time). . 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' insurance.$ 9. ❑Building addition • [No workers'comp.insurance comp. required.] 5. We are a corporation and its. 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.]t c. 152, §1(4),and we have no 13.❑ Other 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 indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractor;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. c Insurance Company Name: �^ ��(J' I 4CAtj C Policy#or Self-ins." #:Lic. W G — �s—3 7�7L�—y��/ Expiration Date: V Job Site Address: OeYrI �d City/State/Zip: �� . . Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date)(4ZI'?a 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 her I7 rortiy under erns and penalties of perjury that the information provided above is true and correct: Signature: Date: Phone#: 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 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other . Contact Person: Phone#: TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map q Parcel /0 Permit# �/a �YHealth Division , - c y er �j�] Date Issued / 7 Conservation Division / Application Feet"0 Tax Collector 02 c2 K)L 3/f 1/0 Permit Fee 5 Treasurer -- I'C ✓ �a 3 '7 OREPTIC SYSTEpA MUST BE Planning Dept. INSTALLED IN COMPLIAN Date Definitive Plan Approved by Planning Board t`afTH TITLE S " NZNTAL CODE ANE Historic-OKH Preservation/Hyannis T ' :r:7�Lfi TICNIS Project Street Address Village AA Owner Address Telephone Permit Re q st Square feet: 1 st floor: existing proposed" 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay l y o Project Valuation <�Lb DOD Construction Type ' Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family U/ Two Family ❑ Multi-Family(#units) Age of Existing Structure au Historic House: ❑Yes o On Old King's Highway: ❑Yes C(No Basement Type: dFull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) F dumber of Baths: Full: existing new Half:existing new Number of Bedrooms: existing_ new Total Room Count(not including baths): existing new p First Floor Room Count Heat Type and Fuel: W Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes 4% Fireplaces: Existing V New Existing wood/coal stove: ❑Yes 2'No Detached garage:❑existing ❑new size Pool: ❑existing ❑new size Barn:❑existing ❑new size Attached garage:iexisting ❑new size Shed:l`existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use p BUILDER INFORMATION Name a p Tele hone Number Cd Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE `�7 D i -x FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED - a, 7 MAP/PARCEL NO.IL ;r ~' -- _ ~'"• _ ADDRESS i VILLAGE OWNER DATE OF INSPECTION: FOUNDATION - •' � r , .1 '.-• :� `�'`s t�v ��` r• — �' .� "'." FRAME INSULATION Q�ul� , I FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH • FINAL GAS: ROUGH FINAL; , FINAL BUILDING �' " x • — DATE CLOSED OUT' Vir ;o : ~ 1 ASSOCIATION PLAN NO. I•' t r The Commonwealth of Massachusetts Department of Industrial Accidents Office VUHMOs11992AMS 600 Washington Street y Boston,Mass. 02111 a�y Workers' Compensation.Insurance Affidavit ...� ,dea name. hone# ,, -2 ci (] I am a ho eowner performing all.wor myself. I am a sole proprietor and have no one working in any capacity (] I am an employer providing workers' compensation for my employees working on this job �N £�S� r3xiMt 4 .£; =-r?',� gtav��t,,F,�yt�:;^�x-�y,V l; Mti- �n,3� ,.� ..a G s,.. �. - e+,. ;y4 t• r Gr r _ j.�,i.. IMM", rx-�f'� k r is S F V- scom an itlame. �r �u',.,r9 � .s s .0 -�. i rr r sr V �r .1 x -,y�•;:' ;ax. +ySl�l"-r`s : yR. g. r ems*-: "�,rr .'�`s iF7zlry '1 m-. jKt c��r)z. 'tz zY ieddT��AN-11s�=xt f� ¢ 4 trr a+w rt r A a xr e _$not � 3 p i )x d r ,^f37 r -�x.��„ x r4� a-v •es�. "tea a x rr -t s v;... -r Z t ,� ;' � `ta 7a:';x3'''ait�� l X v .� ;$� ,.('�'a"";F ,a�N'•.-ri.'�-�� i ;.� ( '>S.�C� rr r -{i rA { 1 r, yz._ _{i::_��._ _ as�+� �;;ElI am a sole proprietor,general contractor,or homeowner(circle one) and have hired the contractors listed below who have the following workers' compensation polices .vr .nlaCr'i,c M '�"}'?ca - 7. 1?? a .'c"H',>•' -Zc r"Y '"♦ ..w4ts. � "Y`J'. dd �,y r'f�� ,:zKJ`rv� �7 r �_.t .rrL� 'S'q s`t'l45P,fi uty s z*2 5'N�r`� iz-Csq � kr E_. ,}jsK t sr'y s'w'Tdsd •�r � f s';.as`}.:t� 1 li ti_ chrk 'Si^ r c COm flit Il fl C s hr may q�-s�,3.Fs�-X� ''s��,,.��2t$y�"•d,(e`''�C'tk�`�R3k+�#*.h i>riy h 5, `f4 r.�M.��' J� � } tv_ t' r = y;T' s,`Y� tr... t K''t.rJ a i S r:� � _�r -.(n�sz Y µf,�"I Z_ ks't'1F:', x�`�' "�.c* itv VrbT� �a��l�.;�r �° r^•'y.-3c i svr',..c k r � :.�r 1 S r •t:l�, ;�`t'''`�;lVi:r b :4s�`�it, ,rTti45 1�f � Str`f V v' �$.�=u�� "�xv`•'J.i�^�r'ra'�5'._�'�;'�^;'Ssi•S w�.� 4ri S-�: ��.V"JY sue," '� c. ty wy:.a=�r�,ye.'e... '�.,s_�J {7r`' .'ST+�1�. �.fqu,�.�^. z h =�i r t Insurance ca .-y�-�. ,y, y �} ,�, '� LY i( i.'�' .+ }. ti •..� �. C.yY v+'� &. </F fL .f t� � y r"} T^ 1r?Kr, �LJ' SFai x„�Y :1'T'i31'iy.+dkl' '-^''�5�1` �a:j•'1 .'y;:1�4r. ,6J ''sx,a;�i l.. 4 ve. ,t ,a. is } 1 1 r f .rr 31 4.1 at ky a hl�.. a .e�.Nr,.St v lV. Ir�`ah .iG ,. RA 11'�.)' K Coniii n �. ..r 4 X�t• .. _ zh ��xl r +� �'t u ',r' �,+E=M`a�� fy+.�'C+ "�"Y'�'vn+e s'1�1tr}: ;-.�e�5v:`}4r,F'... ..0}� r.x � rd�.��, Y 4:� a�*,.+..��N�� Yrxr` �� r.—s°ax � r k�} x �� }`-� 1�� d�,r..L A v��`"w"°,�s � �+3�".+�t��•�tr.-``i l'�'+'Y' .,x;.rp�r'�' sr t'[ '.,,,a �,J a , -aufct�• ry wF.n rxY''s4r r'+a Vt..'r«t+ Lr t,}Y f s�4+ a .?' ,u,�''J '`a�Xv_' y� �S3rS.:r x vl.'i� ',. +'frk' atlr83s �Fa � :ems , FL}•;.-,"+- y v w.t 5 tc,��e=v.rf#e:,.-�j"r -eS'.;�yµ:Gi ,-2 _.:. 'f ^.S�3,� r !_�'ry , - Y r lyM. C�Yr � ,V 9,,t�,i� � �'}�l -_Y} K �" .1�6,t1��` �¢3s'ig x�'�� .. ��,tm`.�� w`� c k vr^ r +yfS;' �1a I > � r f U.",;�=•fi ln$urflilCe 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$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$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 do hereby ce i under the pains nd pe ties of perjury that the information provided above is true and correct. Date 9 Y�" 03 Signature Phone# Print name 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 n check if immediate response is required ❑Selectmen's Office ❑Health Department contact person: phone#; 710ther i (wised 9/95 PIA) ► r t 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. • 4 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 Iicensing 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. Im 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 permit/license number which will be used as a reference number. The affidavits may be returned to 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. IN The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406 �opIME Town of Barnstable ti Regulatory Services ' $ H''B'E ' Thomas F.Geiler,Director KAM �00 Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 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 c / 019C1 Address of W ork: Owner's Name: - 1�4 bi Lab Date of Application: I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 DB ding not owner-occupied er pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME MROVEMENT 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 i Date Owner's Name r - w . RESIDENTIAL BUILDING PEPMT FEES APPLICATION FEE New Buildings;Additions $50.00 Alterations/Renovations $25.00 Building Permit Amendment $25.00 FEE VALUE WOgKSHEET NEW LIVING SPACE 14 0 square feet x$96/sq.foot= -44 x.0031= 4 1.. 6 plus from below(if applicable) ALTERA.TIONS/RENOVATIONS OF EXISTING SPACE square feet x$64/sq.foot= x.0031= plus from below(if applicable) GARAGES(attached&detached) q- square feet x$32/sq.ft. x.0031= ✓ = �� ACCESSORY STRUCTURE>120 sq.ft. A- >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= x.0031= STAND ALONE PERMITS Open Porch x$30.00= (number) Deck x$30.00= (number) Fireplace/Chimney x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) 1 ^� Permit Fee The Town of Barnstable Regulatory Services Thomas F. Geiler, Director Building Division Tom Perry, Building Commissioner 200 Main Street,Hyannis MA 02601 iffice: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE. 9—Po -D JOB LOCATION: GL.t�Ge.1/ n m er street ti village A "HOMEOWNER': J "72S 66 nam home phone# work phone# CURRENTMAIIING S: ty/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Persons)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 r. Department minimum inspection procedures and requirements and that he/she will comply with said o dares and requir ents. .. Sign a of Homeowner Approval of Building Official r Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control HOMEOWNER'S EXEMPTION ' The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed-Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that lidshe understands the responsibilities of a Supervisor. On the last page of this issue is a fnrm ri,rrently user]by several towns. You may care t amend and adont such a form/certification for use in vour community. `Ot IHE' ti . The Town of Barnstable SAAAS&LE.e MASS. Department of Health Safety and Environmental Services a o 679. �e �Eo Mpg Building Division 367 Main Street,Hyannis,MA 02601 )ffice: 508-862-4038 'ax: 508-790-6230 PLAN REVIEW Owner. lo.C_ Qz- 1 c) �� Map/Parcel: Project Address'34 J ' Builder: (�WyY e,y CASP t The following items were noted on reviewing: r u : Q Q p • Reviewed by- -- Date -�G'� P`oFtHe►oyti° The Town of Barnstable BA RNSTABLE. Department of Health Safety and Environmental Services 'i 9 MASS. 0q 1639. �0 PfEU MP Building Division 200 Main Street,Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Inspection Correction Notice Type of Inspection ►'?5 0 la4l 6)1 Location 31� �ay.c� 40fie WJ Permit Number �755 7, Owner Builder One notice to remain on job site, one notice on file in Building Department. The following items need correcting: D ' I ,Y�S ee�s R-30 SD4Ce \/G t Garr- e 6A ! G( X v rn Please call: 508-862-4038 for re-inspection. Inspected by Date / U T��1 t_�r �t`_ow _ lib •c 3 + fib G�PtT '` rr=Vrlc. `r k = 330,E 60 % • A-9r?'6.Pv. j '73.g LSPG'_:,L�.L._ PIT_ USE (COO. G��- .• ,' NI' r 2 t5O S P. EA -a--. TOTAL 'C>EcS16Q = 425 �j•P.L7. � r 'T-oTA t.- tUA4-t Lam( t-LDwDIV = 330 6.PD /3 Al,AN ez wr pp 4�,t �r'°Vu. ' :,34,� 1Y` t_ '=�', �( •�`� b` g. � 22 .^r` ,,• �� ( �`'.'• ' Ted •,<. '' (D .�j0 ---'" r fIdPPL' t Ott IiN. sva,L 4''pv� z 'Box YGG Sc+>rlc to � r tOop N•O IR1�G t111•' •�� avy GAL. ti� Z �r.a✓t� L�acH •A ; Tit IWA:uED ' L SToNC_ 90,a f i ,(a�ta <<.tZTtF1CD PI.OT' Un rssLls.LE c;c.AL4U ':. V T i 1=�! 'r�.l�T . T '• CoVo1 _;-t�;..i�t_t�l..t Gc�V1rL�ls �v t i•4{ T�=t� , S:vt`..�..i�� ,.. Lo .�tl a c�'l:y�+c t� t�.r C�J t�E�t�c�u'C p l�F• r�?tr T -A. t2CGlS"fC,RiU LJLLIU �Uti✓��GY:'�t.:<,: T, c.J o•r tr. J Uaa ,%W , IJ 1-00:A,C-:.k.1; ;Ut:\!l_y' ;� TI•tL;y Cif"l:;%�"�. �I�GWtA :•>r l':;t:_ c.1�,C�c� Tu 1'�r._1�� t_,�l��Jl._ l.�'>'�" l ;tif�:�a _._— _._�, _..:.�..._. __ �. � ..._, .� �. .:. �y ?f. �� ,, TOWN OF BARNSTABLE Permit No. ------------------------------- { Building Inspector 11AUSTAU cash 7 I", • ------- 'o peso. p° — — �orpY•\ OCCUPANCY PERMIT Bond No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to 2ivf:. rside. Const_ructi-A Address Wiring Inspector !.! Inspection date Plumbing Inspector Inspection date Gas Inspector Inspection date Engineering Department 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. .....................................................1 19...... _ .........................................................................................................._...... Building Inspector r {� rAss is ma and lot number ��. ............/. ...... .... p ;. aa H Sewage Permit number ......... .O1....�. 8..!P...................... SEPTIC SYSTEM MUSTZ 'BAHB9TODLE, i House number ...�3u..............�/ .......,.............................. a INSTALLED IN CI� P - ',o,16 9:' e� TOWN ;OF BAR 6 L . �T a� BUILDING., INSPECTOR rk APPLICATION FOR PERMIT TO `-� x2s e� � ( TYPE OF CONSTRUCTION ........... ..... ....................................................................... ° �l u.�.....�.6..........19( TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Lo Q Location ...................... ,,....� -i �� . . L... ....� - ... ........� T U.. ................................................... ProposedUse .... .. .................... .. .`- . ..1�- .5f Q�9..�................................................................................ ZoningDistrict ........:...............................................:...............Fire District ........ b�-'0...................................................... Name of Owner .!.kl.v Sr � C�......Address /i301 l..... ..��.......................� .�.�.......................... Name of Builder ............S Tub.....................................Address ...............�j .r.. ................................... Name of Architect `.. Address :..................................... O Number of Rooms ....:..Foundation. ...:. ... ............... .... Exterior ` GX,""�✓ :....................:.......:.......... .........Roofing ..a` ..:aS°! ............... .....:................................ �... 0 — �rQralou- � s 7 Floors Interior ....... .... ................................ W Heating ............ /e).......B�G..........:................. Plumbing ........Z..��6 .!."�J................................................. Fireplace ..................................................................................Approximate Cost .......?.. dd• .. . ' Definitive Plan Approved by Planning Board ________________________________19-------- . Area ,�.............................. t �a ace Diagram of Lot and Building with Dimensions Fee �— SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to,conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .. . ............................................ 1 RIVERSIDE CONSTRUCTION ti 23292 One Story ham+ . Permit for .................................... .... Single...Family,....Dwelling............... Lot 9 f1 � � r • Location Centerville nj _-^�5 . ........................................................................-....... Riverside Cons t' =j Owner ........................................ 1i.L1C .�.QT3..... ( ' 4,r Type of Construction`, F:r.amp............................ Plot Lot ................................ ' t Permit Granted ...:.�7.u.ly..1 i... �.......19 81 ) 1 h9�� /✓Date of Inspection �+ .... Date Complete .................... ...�9 PERMIT REFUSED ,! . 19 ................dj.+..iiyy`�. L ...1......... ....:/.... .......... - i✓ .............. ...ne.. .,}¢ ..................�... !-..�d.'........... AD �- Cli ............. ..............................................1.. t Appro d ..... .................................... 19 Ti•� / 4 ttf � i px AI p /o� � , Assessor's ma and lot number .............�'..... ..... .. �... ...... �pf THE rp� Sewage Permit number .........1 38 d�P ♦� /� Z 33AWSTABLE, i House number ...�.L[.................�1_,.. y MAea p� O p ib3q. 0 mxf a�6 TOWN OF BARNSTABLE BUILDING INSPECTOR Ccox��R2u�" 1ic�-2. APPLICATION FOR PERMIT TO .................................�..^....................,............... — TYPE OF CONSTRUCTION ...........( o .....�/r-�• ��.................` ................................................. �..i.u.�.........(..b..........19.�f/ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ......`............ .... G�.....`'�...�.�-. .....�.Ys� i'��(✓/C; ..................................................... O 4W 1� 5 M............Proposed Use . .........../..... .................................................................... ZoningDistrict ........................................................................Fire District ........Cl ...................................................... Name of Owner .!.�./.v. So4Q-ecn -_ uieY+ Address /'" 4� �U ��-�V�.. ........... .............. ....................................................................: Name of Builder .................1....?........:.....................................Address Nameof Architect ..................................................................Address ..................................................................................... Number of Rooms ............ .............................................Foundation .....<... [�.....OU�'.' p I! I Exlerior ....`.:c�'.'.a...✓...........................................................Roofing ...q.a�..��.�/� ..................................................... l Floors fo r C140o ....................................Interior .... � ............................................................... Heatingf � � r�!.4...............................Plumbin ........ Fireplace Approximate Cost ............. ........................... Definitive Plan Approved by Planning Board _ ____________________________19________. Area �...........::....:..:......... Diagram of Lot and Building with Dimensions Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to-conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ... 9, 0� .............................................. RIVERSIDE CONSTRUCTION ' � . 33392 No Ooe--Stc) -----.� Permit for .. — ��. -- � �. --- . � . ^ . . ' .__.�Sinqle.................I7ao�i ..DvvelIi�Aq___. ^ - Location _ ..�\g��_Doad � .Ceotezville --------------------------. , ^ Owner ...Bive��ide_Construction ` . Type of Construction .....��-------- � . --------------------------. ' Plot ............................ Lot ----------' ' . . ' ' Jo Permit Granted , Date of ` / . Date Completed ' n REFwgmD ................. -------------. lV � .................... ^—_------------------.—.----.. ' . � ---------------~^---'--- . . . . --'f�~"`f~~ '� �__�_____.. - � ^ ' `Approved g � � ---------------- l ' ----------------------.—.-- / / � ............... ...................................................... Assessors map and lot number ............................................ FTHE Sewage Permit number . ...4':`t......;� �...... ge diC SYSTEM I `-111AL` ED IN ,p�p��y�C9B� BASBSTeDLE. i uu s P1 E. �W 6a®/fSf{Y House number ..... .:1........:.:..... ....................:.....e...^......:.... . . LBO e 9 ' WITap`-�' TITLE 5 �O MPY TOWN OF BARNSTA,-R, � iONS BUILDING INSPECTOR APPLICATION FOR PERMIT TO ..1.x4►ZN.S.].T42 ... fRY.�ov�ed �..c; TYPE OF CONSTRUCTION ..1a.�h-oa...F!f.& G�............................................................................................ W.R...... . TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for as permit according to the following information: ..�.Location ... .'►...:J .y.�� ...A.klYx...t4.PQ........ zw.,.Y. AL e................................................ ................................... Proposed Use Zoning .District ........................................................................Fire District .............................................................................. r•�V`1rs 'T� Name of Owner .1''....................... :...i,�v c'! ..................Address .?.�.. �.�t.9 C..N.f�111. ?Pa.....1 �Yy�l�4......... tt . Name of Builder .�9M►1 ... e. .I NC.........Address .XY.4.:P�.,��►.!GIS.��C211V4�1.1... J�o!�� 1 `Name of Architect ... � ............................Address ..................................:........................ yxy Number of Rooms ........................:.........................................Foundation ...6WI16...pee.akkR ..... �h�a��1 P. ....!ers .... ........... Exterior PbS ......Roofing ....l..!.4rwl9.►'-.Al9.P.................................................... Floorsrr....... .!�..hu��,C.!r'...........................:....................Interior ...............................................:.................................... Heating ............... ...........................................................Plumbing .....u.0............ ..... ........... 00 Fireplace ..............ko...........................................................Approximate Cost ...� ................................ Definitive Plan Approved by 'Planning Board ---------------__-_-----------1,9________. Area ........(...l... ....'�"............. Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH 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 .Oft.. . .... �4+-..P. !!�.!................ —�' Construction Supervisor's License ...ovel Z (#........... IS G BUTLER, J. P. MR. & Mrs. f is •?� �° � � - 2 K.* Mati / No ...............y. Permit for ...............9�t......�....... i Sin le Famil Dwe l Location .34..JoY. .. ?�.RS?ad... Z.. ................ 1P....................................... t 1 rt Owner J P. Butler Type of Construction ...Frstele............................ oPlot ............................ Lot ............... :h ........ ems' --4 Al Permit Granted ...June 7, :19 84 Date of Inspection ...................... a :, e4 - Date Completed "::. ..9z f - ° • l e " r •T 5 - , +-�. � y„�•a �k'^• ' • � - , •. 'it 1 • rt y,~ .+rr✓ Assessor's map and lot number ............................................ THE Sewage Permit number .........:f,.,44 ..... 33AUSTABLE, House number ..... ......................................I..................... NAG& 1639. COTE a OR Or TOWN OF. . BARNSTABLE BUILDING INSPECTOR .V- APPLICATION FOR PERMIT TO ...... ....... ......................................... TYPEOF CONSTRUCTION ..... &4P............................................................................................. ,KJX.� ............ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .....3.4....Zp i1. ....A.tw aQ.>s!.4....... .... ... ......................................................................................... ProposedUse .....S-9 j('—C:A.9..j.....g")7. ..................................................... ..................................................... ZoningDistrict .........................................................................Fire District .................................. ........................................... Name of Owner ..................Address ........ Name of Builder C.N.A.19...mf�15 .........Address Name of Architect .... ,�...........ee� ..............Address .....14 A P.,ti..t ........................................................... Number of Rooms ..................................................................Foundation ... ....................... ... ........... Exierior .....P-9.'r .... ......................................Roofing ....B..q.W.. .................................................... 11 Floors .......P+ ... ................................................Interior ................................................................................ Heating ..................................................................................Plumbing .................................................................................. Fireplace ..............&.()...........................................................Ap proximate Cost ...... .................i.................. Definitive Plan Approved by Planning Board--------------------- ---------19--------- Area ........8.9.....4�1.............. 0 Diagram of Lot and Building with Dimensions Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH 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. N m a e ................ Construction Sup&visoPs`, License �. ............... BUTLER, J. P. MR. & MRS. AF=209-108 No .26559 Permit for ..�aiti-on ................ Single Family Dwelling Location Road .................................... Centerville ............................................................................... Owner .... ...P. Butler Type of Construction Fr ............................... ................................................................................ Plot ............................ Lot ................................ Permit Granted ...June...7.1......................19 84 Date of Inspection ....................................19 f Date Completed ......................................19 1 1 _ ! GARY A. ELLIS C Q NORTHSIDE p` BUILDING CONSULTA1yTS, INC. s ) ` FINE (HOME BUILDING & RENOVATION . - { 141 MAIN STREET•YARMOUTHPORT •MA 02675 b (508) 362-2210 • (508) 362-9802 • Fax: (508) 362-5269 a , F� 4 v y ! , u 1p op 13 .. .:., _ Y p. 0 e . Ir a.v 6vul UY d VUVP T . n v ?O .Si'. 1 o i e 1¢ 40 ,{ GARY A. ELLIS s ` NORTHSIDE 71 T ce T COI�SQLTAN S FINE HOME BUILDING & RENOVATION t I Q 141 MAIN STREET•YARMOUTHPORT•MA 02675 4 (508)362-2210 (508)362-9802 _ z Way, I Cacc t.& T=Ltfm -Pr0Pz"Y: C uW-vrvi Lori 6 X0. .601 34 dwef�i Area 15,000-.j 6W, V 135 71 .Loci 10 I 6260 184 iN of ref �looc��ane�:�5o001 0005G pOdr �pt'Leo � +��- .� y PAUheQ1vcerrifj�� m rt' s T. n � ; � r I' G M v GROVER 3)rice 6T 34yers ,-PG. sr /P�ywtou Mortgage Company No 3t3tt The drveUiitig shown: h¢reon, does not �faU in,M s erica qzE -k-{�ooc� o ° { ,,.��,,,,,y /ST'E� ftaza W area, wldi,ail.eRctive date Of 8 -19-65.aYI rdw Wa fibril su the dwelling does^ �-t-o-�Le local;.�oni laws trt,e��-e-' ``'`.. wtt.e nine construction, ' z , Knt res ec to.hor� orL�ul dtmert/stortaT setback x�ec�L'.ir� nemts or is ex tt4)r firom, vtolatton ert orcen scale: 1" = 40 �/,,�;. r,�� Date: 3 ,23, 94 d 60m under JYl1rWJ. JerWrat.ja1�Vs C�''t'�`•' 4oA-_SecrL'0rV 7. File No. 1774 94 PLEASE NOTE: The structures as shown on this plot plan are approximate only. An actual survey is necessary for a precise determination of the building location`arid encroachments, if any exist, either way across property lines. This plan must not be used for recording purposes or for use in preparing deed descriptions and .must not be used for variance or building plan purposes. This plan must not be used^o-locate property lines. Verification of building locations, property line dimensions, fences or lot configuration can only be accomplished by an accurate instrument survey which may reflect different information than what is shown hereon. Please note that this is "NOT A BOUNDARY 'SURVEY" and is "FOR MORTGAGE PURPOSES ONLY". COLONIAL LAND SURVEYING . COMPANY, INC. 269 Hipover Street • Hanover, Mass. 02339 Phone: 617-826-7186 Fax: 617-826-4823 SPILLER'S 566207 p � SKETCH ADDENDUM Borrower/Client Property Address City County _ Lender Appraisals Certified Real Estate Appraiser•MA License#4354 Judith A. Caccioli, Phone: 508-775-6092 34 Joyce Anne Road Fax: 508-775-3949 Z. , " Centerville,MA.02632 email:CCrose96@aol•com t .... ... .... t . 4 i _..-_I.._..... , . t t Po.rGh p. b ga A , o�• 4 VV S _ 'A,a 110 , R ao FW-73A 01980 Forms and Worms Inc.,315 Whitney Ave.,New Haven,CT 06511 All Rights Reserved 1(800)243-4545 -Item# 112900 - 00' GARY A. ELLIS NORTHSIDE BUILDING ---- ---- CONSULTANTS FINE HOME BUILDING & RENOVATION _ ��'-s--V - -•_`I- - (�/'. ."_ "- 141 MAIN STREET•YARMOUTHPORT•MA 02675 (508)362-2210 (508)362-9802 t .� 76, 11� �l� i I r � 0 --- ----------'-- 400 lie. , •a ZZ. . Pie l a ' ___._ ... . _. ......__. - GARY A. ELLfS NORTHSIUE 4WO o �ro �, _ - - --- - ----- --- � � j BUILDInG _ CONSULTANTS, INC. 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