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HomeMy WebLinkAbout0367 LAKE ELIZABETH DRIVE .,� 6 � _ �K�_ 1��za �j��-��x } w . : . a .� r LL' ,� .. ., Q: _ v e ,y - t _. O .. _ �. .. o n C .. - ... .. ,r � - z .. � p � �� a o o - n ,. 0 �, _, � __. '. ,. _� f TOWN OF BARNSTABLE BUILDING,PERMIT APPLICATION Map 7 Parcel O 1(e Application# Health Division Date Issued 3Y Conservation Division Application Fee Planning Dept. : Permit Fee / /0 , Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/ Hyannis W� Project Street Address 13(�" y�- Village CE54k GkVT-LC— Owner bLG A "1 ACIASi40V Address 36 4" "tic& TRJ VC' Telephone Permit Request RL-V -6DoL qwo g-,_kS`j1r4& '51M Vrvs '(3IJTMaYel - AuA �is�r :7y8,,-TDI urs AT40 S i4qu Byv=+ n d msw i ce Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuati 20,000 Construction Type AtM3Oir- Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ice` Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes 2 No On Old King's Highway: ❑Yes Basement Type: ❑ Full drawl ❑Walkout ❑ Other 19 Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.i�Z Number of Baths: Full: existing new Half: existing o �9 Number of Bedrooms: 3 existing —new 49V � OP Total Room Count (not including baths): existing new First Floor Ro ount Heat Type and Fuel: ❑ Gas ❑Oil ❑ Electric ❑ Other srq�C F Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes LTNo Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size — Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size — Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use I APPLICANT INFORMATION (BUILDER R HOMEOWNER) Name I'T'tLl NOM(l 011'NIrll Telephone Number �y�� ?Cfa Address 1 SS License# C S 06 0 5 cl4'1 Home Improvement Contractor# EmailQl��C �U�Z1�r4re-ULT11 Z&-I o s4(r Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SO I v`Tvi (rro^ocS M pr DATE 23 SIGNATURE _ �� i - t FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER ` DATE OF INSPECTION: FOUNDATION FRAME 00 INSULATION 311v& FIREPLACE -, ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING / -CI r DATE CLOSED OUT ASSOCIATION PLAN NO. t __..._.-_._...........___....___.__....._..__..._.__.__... -- �e�poa�vnzoaicueccll�o��aaaac�ccoeG(� Office of Consumer Affairs&Business Regulation License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Wr Registration;<:1.25537 Type: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Expiration:.=-1115/2-0118 Individual T, -- , Boston,MA 02 16 ANTHONYSEAMUSQ_UIN10 ''T�:: 1 ANTHONY QUINN 155 DEPOT ST DENNISPORT, MA 02639 Undersecretary Not valid without signature Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-068599 ANTHONY S QUINT 155 DEPOT STREET Dennis Pert MA 6263 jol _ v- Expiration Commissioner 04/06/2016 a , RE:Authorization to do remodeling work in the house. We,Olga and Dzhangir Dadashev,owners of 367 Lake Elizabeth Drive,Centerville, MA 02632 are giving permission to Antony Quinn, License#068599 to do remodeling work in the house beginning February 2016. Sincerely, Olga Dadasheva Dzhangir Dadashev 1 1/21/2016 ?7te Commorrloeal'th of-Vassachusetts' , Departanew of 1nd=trial Acddeyz& -_ Off"of'imwsttga ans a 4 ------- -' - -----600-Washirigio>n str+eet— Boston 41A 02HI _ - v#inv mas&gvv1dla Workers' CamP ensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers A.,,,�' f T f yrMa—f r—M, Purses Print I arr�"My �PFII'�•ri�r�oa- n¢aa a Name (�J-7,NrQ ' Address: 1 SS CitYrsta& :l��,1J15 P6,15— M-07LYfflhone- ' .261 Y Are you an employer?Chee the appropriate box: Type of project(reguul ed): I.❑ I am a employer with 4 ❑I am a general contractor and I 6. ❑New construction loyees(full andfor part time).* have hired the sub-contractors ^� 2. a sale proprietor orpartner- listed on the attached sheet;. 7. 21�znodeliqg ship and have no employees.- These -contractors have g. ❑Demolition Working forme in any capacity- employees and have wodwrs' g. ❑Building addition jNo workem'comp,insurance Comp-�aaml - required-] 5. ❑ �We area corporation and its ld ❑Electrical repairs or additions" 3.❑ I am a homeoumer doing all work officers have exercised heir 11_❑Plumbing repairs or additions mysel€.[No workers'comp- right of exemption per MGL 12.❑Roof repairs insura a regnut d j f C.152, §1(4�andwe have no employees_(No workers' 13:❑Other camp_insurance required_) *Any sppKcsutthst checks box#1 nmsi also fill out the secdon below shcrvdnz their worisexe compensatian paRcy informauoa_ T Ho-meoarnecs who submit this OWarit=dkzdz g they are doing all wa k sud then bire au=de contractors act submit anew a$idwrk indif9�such ZContmctom that check this boa must attached an additiaoal sheet showing the acme of the sub-contactom and state whether or nut those entities have employees.If the sub-c=tmctors have employee%they mast gmtiide&ek worken'comp.palicg number- lam an itmtrartce for my amplayem BeIoty is;Repotted aizd jab sate information" ._ - _ Insurance Company Name: a , Policy;g or Self-ins.Lin Expiration Date: t Job Site Address: Citv/staielmp: Attach a copy of the workers'compeirsationpolicy declaratian page(showing the policy number and expiration date). Failure to secure coverage as required.under Section 25A of MGL c. 152 can lead to the imposition of criminal penahies of a fine up to$1,50a OQ and+'or one-year imprisonment,as well as civil petralties.in'the farm of a STOP WORK ORDERand a fimt: of up to 0_ a day against the violator. Be adUdsed that a copy of this statement may be forwarded to the Office of Investigations the DIA for insuranct=coverage verification— Ida hereby c under tha pairs andpenaWes ofpedwy tharthe hzformadbn-proW&Jabm a is barb and carrect Siamature: Date: ' 2 3- Phone i€ j t�s1 —2C>t tf 02idal use enty. Do itat wrke in tldtis area,to be crrrnplete.+d by city ar tart•-t of fiat City or Town: Permit! cease# Issuing authority(tdrde one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions , Maccar] setts General Laws djaptrr 152 requires all employers to provide worker'compensation for their employees. Pau to this stye,an Pmployee is defined as."_.every person is tlao service of another under any contract of hh,, express or implied,oral or writem" An esrrpfvyer 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 trastee 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 maintc aa=,consfraclion or,repair worm on such dwelling house or on the grounds or building appz fenar>t thereto shall not becansc of such employment be deemed to be an employer" MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold 1he 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,MGL chapter 152, §25C(7)states`Neither the commonwealth nor guy ofifs political subdivisions shall enter into any contract for the perf!m ancc ofpubho wozk until acceptable evidence of comp Han ce;with the ibsura ce._ requirements of this chapter have been presented to the contracting aufhozityf : Appficanis Please fill out the workers'compensation affidavit completely,by checking me boxes that apply to your sitnation and,if necessary,supply sub-contractor(s)name(s), addresses)and phone numbers)along with their certEcate(s)of insurance.nce. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not regtmed to carry workers'compensation insm73nce. If an LLC or LLP does have employees, a policy is required. Be advised that this aff dam maybe suhm tt-si to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit The affidavit should be retamed to the city or town that the application for the permit or license is being requested,not the Department of In astrial Accidents. Should you have any questions regarding the law or ifyou are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insmance license noniber on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and pried legibly. 'lire Department has provided a space at the bottom of the affidavit for you tD fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the pemsit/license number which will be used as a reference noinber. In addition,an applicant that must submit multiple penniVEcense applications in any given year,need only submit one affidavit mdicating current policy inlf6rnation(if necessary)and under"Job Site Address"tie applicant sho��Id write"all locations m (cry or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for fnfnre permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit The Office of Investigation would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: Deparbnmt of l icdustial Accidenta of ftvegtigatioa 640 WasbiVort Sl=t Bastou,MA G21 I I Tel.#617'27-4-900 cut 4-06 or 1-977-MAS AFE Fax 9 617 727 7749 Revised 424-07 �� C is'��r t1 t 6 0 �► C) tin a o = z cr z C\2 m i - .� o in 3; t o r C-^bL '1 2 cs C; �1 t L2�f►L� v Z �-- I���� R S �,;��, !�'� 626--act � 42-.ci 4- IN, I 'I �1LL l'xt-JQ S I-J-tip '-1 S,.' 1�: (JLIJCE° Town o Barnstable *Pernut# Expires 6 months from issue date Regy1a.t®ry Service's Fee �1 ERK41T Thomas F.Geiler,Director e JUL Building Division �� 7030�1��� 2 9 101[� Tom Perry,CBO, Building Commissioner TOWN OF BARNS/AsLE 200 Main Street,Hyannis,MA 02601 wwwaown,barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 - EXPRESS PEIt1VIIT APPLICATION - RESIDENTIAL ONLY aa Not Valid without Red X-Press Imprint Map/parcel Number �(� 1 � Property Address jj�-Itesidential Value of,Work ""' `• Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address� /j'y7 06c as h 4e J ' U— Contractor's Name Telephone Number y.,) a 9 { Home Improvement Contractor HLicense#(if applicable) Construction Supervisor's License#(if applicable) C w Oworkman's Compensation Insurance Chedl one: w ❑ I am a sole proprietor ❑ I am the Homeowner 2,I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# LL 0 3 g I M b _a 9 Copy of Insurance Compliance.Certificate must be on file. _ S Permit Request(check box). . ' Q Re-roof(stripping old shingles) All construction debris will be taken to ~` Re-roof(not stripping. Going over existing Iayers ofioof) Re=side Replacement Windows/doors/sliders. U-Value (maximum.44) v . *Where required:,Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic;Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License is required. SIGNATURE: Q:Forms:expmtrg Revise061306 The Commonwealth of Massachusetts Department of Industrial Accidents dtea Office of Investigations m ' .600,Washington Street ,r Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers ApWicant Information Please Print Legibly Name (Business/Organization/Individual): TA a,&A � � � — L LC, Address: f City/State/Zip: 1� b�635 Phone#: 56 9-Y a,? — o? Are you an employer?Check the appropriate box: Type of project(required): l ZJ am a employer with g 4• ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6 ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' . [No workers' comp. insurance comp. insurance.: 9• ❑ Building addition required.] 5. ❑.We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. zContractors 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 polkcy and job site information. Insurance Company Name: __r 6� �- U 6 -® , Policy#or Self-ins.Lic.# 1 r'�� GExgYfalli Dad 1 Job Site Address: Z� 4 h✓`fBl.. City/State/Zip: , vl Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition.of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi e d pe lties of perjury that the information provided above is true and correct. Si mature: Date: Phone#: 5Q 9' Ayi�b p 9 a FA 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.Plumb 6. Other ing Inspector ' Contact Person: Phone#: r Badina adards HOME IMPROVEMENT CONTRACTOR License or registration valid for individul use only R®Blst before the expiration date, If found return to: .so �i standards r ftu —:4=011 T►# 281021 One Ashburton Place Rm 1301 Type: w Boston,Ma.02108 FRASER CONI9IIMFN C.O. ;r. DEAN FRASER1 . 104 TWINN VIEW E E FALMOUTH,MA 02536 Adminldmtor Not 077 B oar o � a 'm g .e Ashburton Place m Room 1301 Boston_ Massachusetts 02108 Hone Improvement-C�ptractor Re�jstratjon Regiatration: 112NO Type: DBA FRASER CONSTRUCTION CO. Expiraflon: 3Q3@011 Tr# 2'81021 DEAN FRASER P.O. SON I U5 COTUIT, IAA 02835 Al i; aoM osros nsauFo Update A.ddrese and return card.Mark reason for change. s10aa12o08 Address RenewalEJ11;lnploy"t host Card �' ��' �`-� _ • • uY aaaa L IaVAL YI VVY L Waf VVd •Vd , ACOR®e CERTIFICATE OF INSURANCE PRODUCER DATE(MMMD\YY) 09-29-09 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION WISE&QUINN INS AGCY IN ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 449 PLEASANT ST HOLDER. THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. BROCKTON,MA 02301 COMPANIES AFFORDING COVERAGE 24WCB COMPANY A HARTFORD GROUP INSURED COMPANY FRASER CONSTRUCTION LLC B P.O.BOX 1845 COMPANY COTUIT,MA 02635 C COMPANY D COVERAGE THE 15 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,TERrfi OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WNflCH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HERON M SUBJECT TO ALL THE TERM EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER DATE(MMMD\YY) DATE Vag GENERAL LIABILITY GENERAL AGGREGATE COMMERCIAL GENERAL PRODUCTS-COMP/OP AGO. $ CLAIMS MADE OCCUR. .OWNER'S&&CONTRACTOR'S PROT. PERSONAL&&ADV.INJURY $EACH OCCURRENCE $ FIRE DAMAGE(Any one fire) $ AUTOMOBILE LIABILITY IVIED.EXPENSE(Any one person) $ ` ANY AUTO COMBINED SINGLE LIMIT $ ALL OWNED AUTOS BODILY INJURY(Per Person) $ SCHEDULE AUTOS BODILY INJURY Per Accident) NON-OWNED AUTOS HIRED AUTOS PROPERTY DAMAGE $ GARAGE LIABILITY ANY AUTOS AUTO ONLY-EA ACCIDENT $ 1' OTHER THAN AUTO ONLY: EACH ACCIDENT $ EXCESS LIABILITY AGREGATE $ - UMBRELLA FORM , EACH OCCURRENCE $ OTHER THAN UMBRELLA FORM AGGREGATE $ WORKER'S COMPENSATION AND A EMPOLYER'S LIABILITY UB-0341 M556-09 09-26-69 09-26-10 STATUTORY LIMITS X THE PROPRIETOR/ 1 . EACH ACCIDENT $ 500,000 PARTNERSIEXECUTIVE INCL DISEASE-POLICY LIMIT $ 500000 OFFICERS ARE: X EXCL DISEASE-EACH EMPLOYEE $ 500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICT10Ng/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COUP COVERAGE, CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE ERASER CONSTRUCTION LLC EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT PO BOX 1845 FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NOOBUGAT10N OR LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. COTUIT,MA 02635 AUTHORIZED REPRESENTATIVE ACORD 25-5(3/93) Ramani Ayer r I ,� � O�r`�;�:n!'! <... �• Nb�Bp�A��*,t8;l1SY&t'�'.;,, I li 1 V1D16'stHfehi Aim 4 ' 1 FRASER CONSTRUCTION, LLC: Carries Workman's Compensation and Public Liability Insurance on the above work, certificate available upon request. DATE OF ACCEPTANCE: 2 2-0,1 U ction, LLC Homeowner� Fraser Coast f . e s Town.of Barnstable "*Permit Expires 6 months from issue date Regulatory Services Fee ?� , Thomas F.Geiler,Director Building DiviSi®n lof 31J6 Tom Perry,CB®, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 568-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION = RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number o� 3 b Property Address E24?Lcsidential Value of Work s Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address --�� - �Q -ca-b Contractor's Name Fx(�, . .. Telephone Number.Jc"0�,- -,�2 P-61 Home Improvement Contractor License#(if applicable) P 3(V Construction Supervisor's License#(if applicable) (AWorkman's Compensation Insurance k R .S _ F Cheel one: ❑ 'I am a sole proprietor O C T 3 0 2008 ❑ I am the Homeowner 0,I have Worker's Compensation Insurance TOWN Insurance Company Name T Workman's Comp.Policy# LL 2 — 0 3 q 1 rY1 ,j-5� —d Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) J` ' [&Re-roof.(stripping old shingles) All cWtruction 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 n6t exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. *"Note: Property Owner must sign Property Owner Letter of Permission -.A copy of the.Home Improvement Contractors License is required. SIGNATURE: C' pY I �I Q:Forms:expmtrg i t Revise061306 J 1I:,79 - I The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): FA o-�� CeaJ ,d , L LC, Address: City/State/Zip: d6)b_ - J,- Phone #: 56 9 s YO-9 Are you an employer?Check the appropriate box: Type of project(required): 1 -1 am a employer with 4. ❑ I am a general contractor and 1 6. ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g. ❑ Demolition workingfor me in an capacity. employees and have workers' y p �'• 9. ❑ Building addition [No workers' comp. insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I I.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: (1 P3 — (� 3 q{ fy) 55 6 — y Expiration Date: Job Site Address: 3rO 9-• ,,of Q City/State/Zip: Lour► J os F'l�� /i�/9- Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi he nd pe ties of perjury that the information provided above is true and correct Si ature: Date: ' Phone#: UQ�" Yoe 0/2 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#: RightFax N3-2 10/1/2008 1 : 56: 31 PM PAGE 2/002 Fax Server ::...:.:........:.:....:...:......:...;..:....:::.:::.;..::.... ::: '::•::•::•r; ISSUE DATE .tit t•:= r= f := =:......: THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLl' PRODUCER AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT ANIEND;EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. WISE&QUINN INSURANCE AGENCY COMPANIES AFFORDING COVERAGE 449 PLEASANT ST BROCKTON MA 02301 IHITE AN A HARTFORD UNDERWRITERS INSURANCE CO LETTER INSURED COMPANY B FRASER CONSTRUCTION LLC LETTER PO BOX 1845 COMPANYC COTUIT MA 02635 COMPANY D LETTER coliPANY E LETT ER THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOV E FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT-TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS CO TYPE OF INSURANCE POLICY NUMBER POLICY POLICY LD1'I1TS LTR EFFECTIVE DATE EXPIRATION DATE (MMIDD/TY) MM/DD/YY) G GENERAL AGGREGATE $ GENERAL LIABILITY PRODUCTS-COhiPNP AGG. $ ❑COMMERCIAL GENERAL LIABILITY . PERSONAL&ADV.INJURY $ ❑ CL DJS MADE ❑ OCCUR. EACH OCCURRENCE $ ❑OWNER'S&CONTRACTOR'S PROT. FIRE DAMAGE(Any One Ere) $ ❑ MED.EXMNSE(Anvonepemn $ AUTOMOBILE LTABELrIY COMBINED SINGLE LIMIT $ ❑ ANY AUTO BODILY INJURY $ ❑ ALL OWNED AUTOS iTer Person) ❑ SCHEDULED AUTOS BODILY INJURY $ ❑ HIREDAUTOS (Ptz Am1dcnt) ❑ NON-OWNED AUTOS - PROPERTY DAMAGE $ ❑ GARAGEIIABILITY EXCESS LIABILITY EACHOCCURRENCE $ ❑ UMBRELLAFORM AGGREGATE $ ❑ OTHER THAN UMBRELLA FORM STATUTORY LIMITS - X A WORKER'S COMPENSATION EACH ACCMEfTr $500,000 AND UB- 09/26/08 09/26/09 DISEASE-POLICY LIMIT $500,000 0341M556-08 ENIPLOYER'S LIABILITY DISEASE-EACH EMPLOYE: $500,000 OTHER THE PROPRIETOR/PARTNERS/EJCBCUTIVE OFFICERS ARE INCLUDED. DESCRIPTION OF OPERATIONLSJLOCATIONS/VEHICIMISPECIAL I FBLS THE INSURER'S NIA WORKERS COMPENSATION POLICY AND ITS L I]TED MUM STATES INSURANCE KmORSENIENT AUI'HORIZ9S THE PAYNIENT OF BENEFITS FOR CLAIMS MADE BY THE INSURED'S 11L1 EBD'LOYEES IN SPATES OTHP.R THAN NL1.NO AUTHORIZATION LS GI M TO PAY CLAIILS FOR BENEFITS IN ANY SPATE OTHER THAN NU U THE INSURED IRRES.OR HAS HIRED.EAR:LOYEES OUTSIDE OF DL1.T MS POLICY DOES NOT PROVIDE COVERAGE FOR ANY STATE OTHER THAN BLL T NIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CER I WICATE HOLDER AFFECTING WORKERS CODIP COVERAGE ....... ............................. .............. ................................................. TOWN OF BARNSTABLE SHOULD ANY OF THE ABOVE DFSCRIB®POLICIES BE CANCELLED BEFORETHE EXPIRATION DATE T LEmWF.THE LSSU NG COMPANY WILL ENDBAVOR TO 11ul - PO BOX 40 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NA IED TO THE LEFT. HYANNLSMA02601 BUT FAILURE TOBL IL SUCHNOTICESHALL 16D?OSENOOBLIGATIONOR LIABILIPY OF ANY EDO UPON TBE CODBANY,ITS AGENTS OR REPRE�VTATIVES AUIRORIIBDRBPRHSBNIATIVE RRA1fL4 CASMI-OJfIER I .kx Board of•Baildbgg Re9A#p9ns*nd S6ndgnds i t ons"rtaObn S'tWpervnsQr+License 9.766E �Brr@�dafe 6/ /19'5i7, �Fxplr.ala'on�:6?l?011• Tr# 97666 DEAN FRASER � 104 TWINNtV1EW LA EAST FALMO.UTH,IYAlA 02-536 Commiasionet • - a 44 ®ard of e A -b u a $•f®ns and S=audexds ,BOst®.� slice a OM 1301 �I®tee aohtSetts 021 oS •��lL ®JL ga e • FRASE CC)NSTFiUC ts soon. p,0a ®O 1SER TI®l�1 C®. �r��n. p �s C®TU'-r, IWA 02535 A � 2oos 127e2o -- LIPdaft ","I"awroomwAm. C] Lon Card mash&Gion. or � �m 09 � vm dal use TW 92792p ufma ft �Y f®�a�81e$um g., . 4558 FjT� . . oarUrr,MA I�1at - I y.3 Possible Extra-Any rotted or otherwise deteriorated trim boards, plywood sheathing, lead flashing, or other carpentry needing replacement will be done and charged for as an extra at the rate of$55.00 per hour, plus materials, plus 15% overhead mark-up on total extras. FRASER CONSTRUCTION Warranties the labor for 12 years FRASER CONSTRUCTION Warranties the shingles against Blow-Offs for 10 years. GAF Warranties the shingles and labor 100% through the SMART CHOICE Warranty duration. GAF Warranties the shingles to be ALGAE resistant for the duration of the SMARTS CHOICE Warranty depending on the shingle that was purchased. Any deviation or alteration from above specification will be executed upon written orders and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays are beyond our control. Owner should carry fire, tornado and other necessary insurance upon the above work. We, if not accepted within thirty days may withdraw this proposal. FRASER CONSTRUCTION: Carries Workman's Compensation and Public Liability Insurance on the above work. DATE OF ACCEPTANCE: 9' o off / O Homeowner Fraser Con tion A'ssessor's offioe (1st floor): / y 0*TMEt� Assessor's map and lot number .... .7...... ......... �♦� Board of Health (3rd floor): �Q o Sewage Permit number ...........`�.... ....... Z BA"STADLE, Engineering Department (3rd floor): 39 MA �+ House number �if"1 �7 (OI o 39 e i APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ... ? ! .!. ay ... ...`.... L.Cji,.,CCT ?rT,.�N....................................... TYPE OF CONSTRUCTION �1 Af-[ ........................................................................................... N!.7.D-V-�....2.G 10.�. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: `.'a G-7 L A K e El 1 2 A-6 67f4 � ., �1�A(r^V 1I.L 1� L.P�rt� i�.e�_ Location .........................................................................................;..................... ........................................,.................... s Proposed Use 5 l.tG 1..... I r-t 1 L Y I7 5 17 V *c "............................................................................. ............... ............................................ ............. ..........Fire District ' Zoning District R.: ...................................... .. ..D........................................................... Name of Owner � 15C)HAR 9 'Pl LL5 L3U R," ••••Address Z� r�T� v rs�iKcty vS , � �,gu3�; �( . ..... ........^....�..................... ...........................,............ , �a�i�Zii C st(0. t-� ........Address 3a L r�tS..LA . �f%KTG?2,V4LLfE. Name of Builder ...... '........................".........�i .............. Nameof Architect .....................................,.......:....................Address .........................--.-....................................................... Number of Rooms ..:.!.....2-....................... ...........................Foundation ........... ................................................................ Exterior ........ 4:kk S ..................Roofing .....A.`,�- 41(/A!#.r. ..... Z{�?L� S S Q73D1� . ......� '' ....Floors ........... ...........P..............'. �.............Interior .................�j.................. HeatingCr .f.T..??tC Plumbing ... �V .. .. �P. .t�................................ ............ �+ Fireplace ..................................................................................Approximate Cost ..........� a� a..� Y� Definitive Plan Approved by Planning Board ________________________________19-------- . AreaGd Diagram of Lot and Building with Dimensions Fee 0..'........................... SUBJECT TO APPROVAL OF BOARD OF HEALTH ,•y 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 ............................................:...x,�.J:';.`:.�.�.?�:.............. ``Construction Supervisor's License .................................... PILLSBURY, LEONARD A=227-016 30257 Add 2nd Floor No .....:........... Permit for .................................... Single Family Dwelling ......................................................................... Location 367 Lake Elizabeth Drive Centerville ... ............. ... .... Owner Leonard Pillsbury ...................................................... Type of Construction Frame .......................................... ........................................................................... Plot ............................ Lot ................................ Permit Granted ... December 8.,..19 86 ...... ................. .. .. Date of Inspection ....................................19 Date Completed ......................................19 A +D OD 0,,,/gg 'Assessor's offioe (1st floor): ` � SEPTIC SYSTEM MUST BE' ,y Assessor's map and lot number .:.. .7'...1��. ......... ?NET°� Board of Health Ord floor): INSTALLED IN COMPLi Sewage Permit. number � ..f,;r-- 4 WITH TITLE E ' Engineering Department (3rd floor): ENVIRONMENTAL. CODE ' B UIL � ASd9 L ?? ,My � r House number ...41..6 1......�...... /> ' TOWN REG�$laQa°����`� °o 1639. �o Mav a• APPLICATIONS -PROCESSED 8:30-9:30 A.M. and L1:00-2:00 P.M. only TOWN, OF BARNSTABLE BUILDING INSPECTOR APPLICATION .FOR PERMIT TO r�T��I.S.!.!tV��... .......... �'?.f.r............!T(.o b{................................... TYPE OF CONSTRUCTION ll"1..rz ....... .......................................................................................................... • t , .2• ..................19�J1. ` TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: �e,-� L•.A.�e...... L t zA-6V C, Ai �o��. c Location ............................... �. ..... F ........ ......... ................. 5 C , I i 1_f, � FA r-1 1 t,'! l s t 6—c C Proposed Use ............... ........................................... ............................................................................................................. ZoningDistrict ...........:f .3................................................Fire District .......L.: .. ...:........................................................ 1 ' *,ime of Owner .:L..FL.....Kltf..!. ....................... S� 1 .i .. t3tJlb`;............ ... Address ............. �frai'ivfJ ... Name of Builder i !.....:..! 1% i�u (A. b.�1...............:..Address 3P t�l t . 4 �!..KT�i... .. f.L€ Name of Architect ..................................................................Address Numberof Rooms .............?:...................................................Foundation .........,...................:................................................ Exterior ........ �...... ! K� I!t'a: .................... ' (o.. Roofing .....l .IfFlt:r.. .....�!.?�..�?,. . ...$.5................. Floors iv ....'....). .........�..i....t.i...I...............Interior ........4 utom .......p.z......�.. .�............:.............................. Heatin �U� / � a t gT. ?:�: .......................... Plumbing P. Fireplace ...Approximate Cost • r I• Definitive Plan Approved by Planning Board _____________________________19________ ,. Area :............................ Diagram of Lot and Building with Dimensions ��d Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH ITI Ac=k 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 ........................... ....r. r � Construction Supervisor's. License b , 1 P-l'"LLSBURY, LEONARD # 30257 ADD 2nd FLOOR No ................. Permit for Single Family Dwelling .......................................................................... location ... 361 Lake Elizabeth Drive .......................................................... _ { Centerville -, Owner Leonard Pillsbury Type of Construction ......Frame .......... ................................................ - Plot ............................ Lot ................................ Permit Granted December 8 8 6 ......................................19 ' Date of Inspection ...................................:19 _ I ' Date Completed ~ j23 • �+ �w/ IC / r'' Alaw Cr ► • : - • . r �. t Assessor's map and lot numbers OF THE t0 Sewage Permit number t.!!1... .....� BABB9TABLE, i , House number ......... yp NAM . .. ...:.................................... po,1639- 9� 'F0 MPY a\ e TOWN OF BARN'STABLE BUILDING INSPECTOR C OR APPLICATION FOR PERMIT TO ............ ;/[�t' / .. .............................................................. jr - TYPEOF CONSTRUCTION ...........t: : C3 �. .................................................................................................. .. ..... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit `according to the following information: Location ..... n% ,+:1. l .t......� l .. .`�a..!.............. 1.. ? . ..................:........:. Proposed Use j !``1........... / � !..�� .... ,r /... ...........................................I.................... .. Zoning District .............. ................ lLtS. .Fie District .. ..L f �"?. .(�//// / i")f1 �!///,;'.y Name of Owner .: ti Yt �� 0'1 Xi r� t!...:..r S '� . .f�� Address °; r ... ! n i / ..... Name of Builder ',> t s:l2�f(lj! �� :.: � Address .!` �� jrW, t I,Yt. w. ...... .............. i Nameof Architect .............. ?. .. : ............................Address .................................................................................... Number of Rooms .............Foundation - � .......,z ................................... .......... .... ............. ... ... Exlerior ,r!f. 1 /`rJ�` ! ,AI..��! c ...................Roofing .......f ` ....................................... ....... .... ....................... .. �` " NK V) , t Floors 1< -`j `� ................................................................Interior .....:..:...........�........ .................................................... Heating ' ...... ....................................................Plumbing .................................................................................. Fireplace .............................................Approximate Cost ......;,�.;.0 ................?. ... 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. t / ' Name i t'/t�//, �`Y� /. • / I............... 'Di-11sbury, Leonard, A=227-16 A No .......22.4Q7 Permit for .......add..W..fr.=e.... ........... ..............................;................... Location 367 Lake Elizabeth Drive ................................................................ ........................!: .................aigville................................. Owner .........L.e.onar.d..Pill.s.bur.y. ................... .. . ........ .. .... . . . ...... .. Type of Construction ... ..........frame................. ........... .......................................... ..................................... Plot ............................ Lot ................................ Permit Granted .........Augus......t .5...................19 80 Date of Inspection ..../...................................19 Date Completed ......................................19 ro PERMIT REFUSED ................................................. ......... 19 ...................... ... ..................... ...................... ............. .. ....... . �........... . ............... (� . .i.................................. ............................................................................... Approved .......................... .................... 19 ............................................................................... ................11.1........I................ ................................. Assessors map and lot number ,.. ,C�!/` D � F THE t - SEPTIC SYSTEM Sewage Permit number .. .L!kl ... ll..4�- :•(�r�. I� �Gc TILLED IN c B L • House number ...............3.4..: ............................................... t WITH flTL NAB& ENVIR0nen.4rP-T,.,.,, 0MAI r\ TOWN OF BARNSTABLE BUILDING . -INSPECTOR APPLICA TION FOR PERMIT TO ... W - TYPEOF CONSTRUCTION ........... .. .....................................................................:.....................:.......... TO THE INSPECTOR OF BUILDINGS: The undersigne hereby applies for a ,permit accord', g to the following information: Location ...... . .... /, .. !� �V /E.� �•. , . A ....................................... ................................... Proposed Use ... ` ..... ..............IS .................. Q f 2iZoning District , l .�L�$..Ul..�.Fire District .. �e.. . .... . A y, Name of Owner . . �. Y1. ... �t� .. �c .. ddress :.„..... ..... ti. Name of Builder ........Address � . .. ....G.d4 ..:,rl......................... Nameof Architect ..............1PV ni.. ............................Address .................................................................................... rr Number of Rooms ...........Foundation .......6X.C .lam... . ..................................... Exterior ..... ...N ....... /.........CJ/..c P Roofing ....... .. Floors �� 9�-�' ....................................Interior .....(/ !� �' ........................... .. .................................................. Heating ..........6.4.sie ..................................................Plumbing Fi.replace ..................................................................................Approximate Cost ......� 00-1-0.�1................. .......... l Definitive Plan Approved by Planning Board ________________________________19 . AreaC/ Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH ere 4 0 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ` �,�� ..h!!l l.! v.�Y.. .......... L' -- Dury, Leonard No ...22407.... Permit for ......add. .......... we l lizg.................................................... Location 3.67. ...Lake..Eli. . zabeth. ..Dr. .ive. ; .. . . ......... .. . .......... .... .. . ..... Owner Leonard Pillsbury' .......... �. ' frame Type of Construction .......................................... ............................................... ...... Plot ..:...................... . Lot ................................ gu 80 Permit:Granted Au St 5 Date of Inspection ...............�. ... e-4a...19�'' � • Date Completed ......... PERMIT REFUSED 19 . ....... '. ........................... ..................... ......R.+, ...... ............................................:........... _ _ Ile- ..... •�•�•j •......................................................... F # 4 a {-.. f ApP d, ................................................ 19 } Id ' :mot I. ............................ .................`. ..................... ......................................................... /--. ..r..... �..y•_.- .w....... .,...,�,«",,,vr" f'^r.l" i�T-...*..��..^...•.a.'.v"•'^"'..'-_„".--I�.-,.-+.+...S�ti.^r..a-*^rr�...-.-+.�`.^-...^.tJ.-+.-�.^- -.-.. .--..r*.- .+�.-•r;--�.....'ti--.....r�.r.�,. 227-16 4�.� ;zs—71—' Assessor's map and lot number ...................................:...... SEPTIC �SYST � UST BE INSTALLED IN 0YAPKIANCE Sewage Permit number y 4�" # ....�:'1c.�1 � .. Jr WITH ARTICLE I fI 'S A u SAMTa ,.Y COD �PyoStNETo�o TOWN OF BARNSTA ` r Z BASHSTADLL MASL BUILDING INSPECTOR Constrict addition APPLICATIONFOR PERMIT TO ............................................................................................................................. TYPE OF CONSTRUCTION ...............WOOdframe...................................................................................................................... 25 April 75 ................................................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Lake Elizabeth Drive,Craigville Location ....................................................................................................................................................................................... Family room ProposedUse ..............pp.............................................................................................................................................................. Zoning District 1\..C. Centerville ........... .. ................................................Fire Distr�ct ................................:............................................. Rev.Leonard Pillsbury Lake .Elizabeth Drive,Craigville Nameof Owner ......................................................................Address .................................................................................... Name of Builder Carl Brian Olander Address .258..Winter, Hyannis Same Nameof Architect ..................................................Address................ .......................................................:............................ One Concrete Block Numberof Rooms .................................................................Foundation .............................................................................. Vinyl clapboard Asphalt Exterior ....................................................................................Roofing .................................................................................... FloorsCa.r e.t.............................................................Interior ..... Dryw.all.ed........................... ....... .. ..... ....... .... ............................... . Heating .....FOTce.d...ho.t..air.........................................Plumbing ....None ...............................:..................................... .. .. ... .. Fireplace None .....................................Approximate Cost #5000 .......................:..................... .................................................................... Definitive Plan Approved by Planning Board _______________________________19________. Area 224. sq ft Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH N � Ike fG0 v1 ' ` oil Q I � , fj _ _ W V � 41 l8 � 3 I� O I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .:......✓✓.. ................................ ..... . ...................... Asbury, Rev. Leonard a s No „17658 permit for . add to single ............... family dwelling ............................................................................... Location L.ake. ..Elizabeth. . . . ...Drive. ........... .. . .... .. . ...... . ...... ........ . ` C.raig. v.ille. 1 .. . ........ . ....................................... ri Owner ............... Rv......Leon. a.rd. ..Pillsbury. . . . . ...... e... . ........ . .. .. . . ...... . .... Type of Construction frame .............. ............................................................. > i ,,Plot ............................. Lot ................................ , Permit Granted ......,Agx'.1 -25................19 75 i Date of Inspect o .............1.19 Date Completed J.7 .4...........19 s ' i PERMIT REFUSED ............................ ................................ 19 i. ............... .. ff { ....................... c................. . ............................................................................... y�. ............................................................................... ky ' M � � r Approved ................................................ 19 Assessor's map and lot number ............. --1�� ,.- Sewage Permit number ......... Q..r't' ��'.... t CF TH E T� TOWN OF BAR.NSTABLE Z I9HB9TeILE, i "6 BUILDING INSPECTOR o ,. am a• Co strut addition APPLICATION FOR PERMIT TO ............................................................................................................................. v Wood frame TYPE OF CONSTRUCTION ..................................................................................................................................... 25 April . 75 ................................................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: lake Eli"zrlbst<a Drive wr.aigvillo -Location ....................................................................................................................................................................................... Proposed Use Ps � room Zoning District CeAt;erv�13E ................................................Fire District Name of Owner ................................................J3-1f.Leona7ld Fi110bUry Address .LaKe E' iaabet:h Ur1ve,Cr-a1�r11le .... ..................... .,.. Name of Builder Carl .1'rian 01WItAor �5& `�'in.t;er, Ei','AT11't�.s................................ .................................................Address ................................................ Nameof Architect .....t.` ... .................Address....................................... .................................................................................... Number of Rooms or.0 Conar,lte -OCk �s .................................................................Foundation .............................................................................. Exierior Vinyl C"4r_'SbQt�re Asphalt: .............................................................................Roofing ............ ...................................................................... Floors rpc t Interior T1v,walled Heating rorced hot: ;sir one_ - --g _._... ...._......................................................................Plumbing .................................................................................. Fireplace {!t?qz ......Approximate Cost© ............................................................................ .................................................................... Definitive Plan Approved by Planning Board --------------------------------19--------. Area ......��4......... bC� f ..................... Diagram of Lot and Building with Dimensions Fee ' SUBJECT TO APPROVAL OF BOARD OF HEALTH 9 Cb 11-0 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .............................................:�'^r":'..-^::................... Pillsbury, Rev. Leonard I 17658 add to single No ................. Permit for .................................... family dwelling ........................ .......................................... Location V Lake Elizabeth Drive ............................................................... .........................Cra igv�l l e V .... .......... ............. Owner ............... &ev. Lion ard Pil1sbury..................................................... Type of Construction frame Plot ............................. Lot ................................ 1 Permit Granted .......April 25 lq 75 Date of Inspection ....................................19 i Date Completed ........../ PERMIT REFUSED ............................. f, ................................ 19 ..... .. .............................. ....................................... � .................................... 11 ................. .......y� ................. .. .. ..... ... ..... ..... .... . . Approved ................................................ 19 .................................................................. ......... i ..................... ......................................................... i, - ., ,«. .. .. _ ,�-.,.':..:.. r: .. ." . :. - .. ... -.. .� .-u ,. •.. - - ire" a - t r ,4. spar .r. ;t r► ia�e $t a'.; f. .0 »a..�. .< �m ::,, xsta, �� _.- --- -- i I t fi i EKPAN5l0N i N RREA APIWE p ) O l� 1-E o o ��. S-r',N 6 CcSNC. Y cJ\ toOO 1-ecicl. p`,T OrT � \ Yy,�•_ Z r 77 � D D \ i 13t 7� FUTURr £xPArvs,orl io'-q a q �lErS y y iwoma's; ,-rc co',x� SL,�E a � y . _ �.� ... \ � �VA I1GlENT ` C� S= ✓-�J�" .`0 � . ci ..� NO YVAT� t2 �Dy Craps LKIllo 7-1 h/ �N60UNT•EFZ d t OF MAPIP oSTEPHEN G. SEYMOUR i CIVIL r No. 31918 , f