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0609 LUMBERT MILL ROAD
-_- o G Town of Barnstable Building Post,Th15 CartlSo That It as 1/isible;From the Str"eet App;roved,,,Plans Must beReta�ned on J,ob,and this Card Must be Kept ■A2TNSCAISL6: � "::'�.. 'p M" 'osted Untll'Final Inspection Has Been Made � � yam ° W,,herea" ertificate.of;Occa anc. as Re used such Buildm""shall.Not be Occu ied�unt�l?a Final Inspection has been.,made �1 ijjlt ..<.'� z .......o_. "r�"' Permit No. B-20-412 Applicant Narne: Michael McMahon Approvals Date Issued: 02/13/2020 Current Use: Structure Permit Type: Building.-Insulation_•ResidentialExpiration Date: 08/13/2 20 Foundation: Location: 609 LUMBERT MILL ROAD,CENTERVILLE Map/Lot: 147 088 Zoning District: RC Sheathing: � s Owner on Record: HARRIS,KEITH G&CATHERINE R a „- ContractorFName MICHAEL T MCMAHON Framing: 1 ' Address: 7 BACKSTRETCH COURT Contractor License CS 068111 :y 2. ° .Sa SARATOGA SPRINGS NY .12866 _. .wr . Est Project Cost: $3,500.00 : Chimney: Description: Weatherization, AirSealing, Weather StrlPpi,n ,Cel l � PermitFee: $85.00 Fiberglass, R21 Spray Foam " Insulation: Fee Pa , $85.00 z r Final:. Project Review Req: Date 2/13/2020 Plumbing/Gas ' t rp ugh Plumbing:Rough mb'ng: ts This permitshall be deemed abandoned and invalid unless the work authorized by.this permit is commenced within$1XI—onths'afEer Iss an Icia Final Plumbing: All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and structures shallgbe in compliance with the local zoning by laws and codes. Rough Gas: This permit shall be displayed in a location clearly visible from access street�or oad and shall'be maintained open for public Inspection for the entire duration of.the - work until the completion of the same. a � f Final Gas: s 4�' rf The Certificate of Occupancy will not be issued until all applicable slgnatureAs b Ahe Building and,Flre Officials are providecd dhjhispe�rmit. Electrical Minimum of Five Call Inspections Required for All Construction Work 1.Foundation or Footing r f fi s t/ Service: 2.SheathingInspection P � Rough: 3.All Fireplaces must be inspected at the throat level before firest flue;Iming Is Installed, g 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Final: . 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Rough: 7.Final Inspection before Occupancy -Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Low Voltage Final: Work shall not proceed until the Inspector has approved the various stages of construction. Health "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: CW i-T�E v t TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION - Map Parcel Permit# 3� 1 Health Division �� 0 � � J ' Date Issued 9_ woo Conservation Division jUJ Feed Tax Collector %"' - ^F IN C01ULIAI`tCE Treasurer WITH TITLE 5 Planning Dept. `' ENVIRONMENTAL CODE AND TOWN REGULATIONS Date Definitive Plan Approved by Planning Board _• .r Historic-OKH Preservation/Hyannis `" t Project Street Address D l ccz, Z✓L l/lii�` Ic-U/ 4 Village ��, N �(' -e lztl,t4 117 Z. C 2 Owner Q`� c wJLcl Q, mkt Address (Q(� 9 li �r✓L��'. �lD_ Telephone /—FC6 S�l e/�9— 76 S9-Z=-- Permit Request " ' 2 1 J IG t�ZS 22 j(�r�y` V�i v4 S�t'2� -Q IK bC�LI.� - - Square feet: 1st floor: existing SW proposed 2nd floor: existing (.b6 proposed 6ti Total new Valuation 9 Zoning District Flood Plain Groundwater Overlay Construction Type (,_gx Q �ow� Lot Size 4k 14 cvie Grandfathered: ales ❑No If yes, attach supporting documentation. Dwelling Type: Single Family O' Two Family ❑ Multi-Family(#units) Age of Existing Structure w as Historic House: ❑Yes MKo On Old King's Highway: ❑Yes �lo Basement Type: Wlfull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) ® Basement Unfinished Area(sq.ft) Number of Baths: Full: existing _new D [[Half: existing C) new 0 Number of Bedrooms: existing new Total Room Count(not including baths): existing new a First Floor Room Count Heat Type and Fuel: ❑Gas W'Oil ❑ Electric ❑Other Central Air: ❑Yes Q No Fireplaces: Existing New Existing wood/coal stove: ❑Yes Leo 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# 1 I Current Use Proposed Use BUILDER INFORMATION Name k4 ,�— 6,fo Telephone Number !Z9_� d Address IN gitLeLVA'aw ZIP' License# &,!r 7 39 Ll Home Improvement Contractor# 1 I( q5q Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO _ T .-�✓ Gam.�,�;'Uf SIGNATURE DATE FOR OFFICIAL USE ONLY �Y PERMIT NO. (5D ,q DATE ISSUED ` F /PARCEL NO. ` t f F ADDRESS a. VILLAGE �. OWNER: k DATE OF INSPECTION °' `' FOUNDATION FRAME INSULATION FIREPLACE .:. ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH f: FINAL F GAS: ROUGH 3 _, �' FINAL t FINAL BUILDING DATE CLOSED OUT f ASSOCIATION PLAN NO. t r� ��✓die i�o?mvrreoncuea/� o�� �euar,� BOARD OF BUILDING REGULATION! Icense: CONSTRUCTION SUPERVISOR Number: CS 057394 Birthdate 06/02/1962 Expito:06/02/2001 Tr.no: 10345 - Restncted To: 1 G ROBERT G WALSH _ 101 ROSEMARY LN 7V��V CENTERVILLE, MA 02632 Administrator f K` `•';k �� t��(� �Y e��enonwaa�e a`../uii4aac%uae• Ate:•, \ :HOME IMPROVEMENT CONTRACTOR Registrat5 on 4 111434 . r YPe may.48A Expiration 12%29%00 y x ru' HARBORSIDE REMODELING NALSH fs�; z.. . ROSEMARY.LN CENTERVILLE MA 02632 ..t y�ADMINISiRATOR s F..fiezrii^. _ •r�r .�L"-t.�•• .,.ra}+. .- F .. . I.IVIN. G SPACE /} (high end construction �v sq uare feet X S115/sq. foot=92 14N (above average construction) square feet X S96/sq. foot= (average construction) square feet,X$57/sq. foot= GARAGE (UNFINMHED) square feet X S25/sq. foot= PORCH square feet X S20/sq. foot= DECK square feet X SI5/sq. foot= OTHER square feet X S??/sq.foot= Total Estimated Project Cost �a► For Offlce Use Only /nclusionary Affordable Housing Fee ❑ Residential ❑ C ercial** Property Owner's Name Project Location Project Value P t er "Existing Sq. Ft. **P posed New q.Ft. Fee S LAHFORNI 113100 The Town of Barnstable � BARNSfABLE. 9�A "9. Regulatory Services TEo► �' Thomas F. Geiler, Director Building Division Ralph Crossen, Building Commissioner 367 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: '71�wG- Estimated Cost f`�-6 &66' Address of Work: l o Y _, be. _ OW Owner's Name: Lhmd j , 1Q1 Date of Application: /0) 77 Gb(I I hereby certify that: ` Registration is not required for the following reason(s): ❑Work excluded by law []Job Under$1,000 ❑Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR-GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR Date Owner's Name q:forms:Af6dav I70CURAppom j ` . TaWe.ts�(aotfaad) Praaiptive Psek"a for Oae and Two-Fsmay Readmdal BoildbW Hewed with Fad Foal k4miUM AWMIUM Gluing Celiiag Will Floor Haaeormt Slab 1lmtiag/ iiag '(%1) U valuer R VWUL &vdaal 1Gvdu� Wi11 P Fqa E15cit ' Par�case Rrvaitof Brvaiusr 5701 to 6300 Hauto;Desrsa Dade' Q L 12% OA0 1 31 1 13 19 1 10 6 Normal I R 12Y. 0.52 30 1 19 19 to. 6 Normal I S 12% 0.30 3E 1 13 19 All 6 1S AFUE T IS!4 036 3E 13 2S WA WA Normal U ism, 0.46 31 19 19 10 6 Norma! V IS7. 0." 3E !3 2s WA WA UAFUE W I,V. OM 30 19 19 t0 6 E3 AM LZAA1V/.11 al % 0.32 3E 13 23 WA WA Norm 19% OL42 3E 19 2S WA WA Normal 12% 0.42 32 13 19 t0 6 "AFUE I 0.50 30 19 19 10 6 90 AFUE 1. ADDRESS OF PROPERTY: �O 4 a 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: 30. 3. SQUARE FOOTAGE OF ALL GLAZING: 4. %GLAZING AREA(#3 DIVIDED BY#2): S. SELECT PACKAGE(Q—AA-see chart above): NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. BUILDING INSPECTOR APPROVAL: YES: ' NO: y q-forms-t980303a 780 CMR Appendix J Footnotes to Table J5.2.1b: r ' Glazing area is the ratio of the area of the glazing assemblies (including sliding-glass doors, skylights, and basement windows if located in walls that enclose conditioned space, but excluding opaque doors) to the gross wall area, expressed as a percentage. Up to I%of the total glazing area may be excluded from the U-value requirement. For example,3 ft of decorative glass may be excluded from a building design with 300 ft of glazing area. Z After January 1, 1999, glazing U-values must be tested and documented by the manufacturer in accordance with the National Fenestration Rating Council (NFRC) test procedure, or taken from Table J1.5.3a. U-values are for whole units: center-of-glass U-values cannot be used. ' The ceiling R-values do not assume a raised or oversized truss construction. If the insulation achieves the full insulation thickness over the exterior walls without compression, R 30 insulation may be substituted for R-38 insulation and R-38 insulation may be substituted for R49 insulation. Ceiling R-values represent the sum of cavity insulation plus insulating sheathing (if used). For ventilated ceilings, insulating sheathing must be placed between the conditioned space and the ventilated portion of the goof. 'Wall R-values represent the sum of the wall cavity insulation plus insulating sheathing (if used). Do not include exterior siding,structural sheathing,and interior drywall.For example,an R-19 requirement could be met EITHER by R-19 cavity insulation OR R I3 cavity insulation plus R-6 insulating sheathing Wall requirements apply to d-frame or mass con masonry.log)wall constructions,but do not apply to metal-frame construction. woo (concrete, my 'The floor requirements apply to floors over unconditioned spaces(such as unconditioned crawlspaces, basements, or garages).Floors over outside air must meet the ceiling requirements. The entire opaque portion of any individual basement wall with an average depth less than 50%below grade must meet the same R-value requirement as above-grade walls. Windows and sliding glass doors of conditioned basements must be included with the other glazing. Basement doors must meet the door U-value requirement described in Note b. ' 'The R-value requirements are for unheated slabs.Add an additional.R 2'for heated slabs. ' If the building utilizes electric resistance heating use compliance approach 3,4, or 5. If you plan to install more than one piece of heating equipment or more than one piece of cooling equipment, the equipment with the lowest efficiency must meet or exceed the efficiency required by the selected package. 'For Heating Degree Day requirements of the closest city or town see Table J5Mla NOTES: a)Glazing area and U-values are maximum acceptable levels. Insulation R-values are minimum acceptable levels. R-value requirements are for insulation only and do not include structural components. b)Opaque doors in the building envelope must have a U-value no gtin=than 0.35.Door U-values must be tested and documented by the manufacturer in accordance with the NFRC test procedure or taken from the door U-value in Table J1S.3b. If a door contains glass and an aggregate U-value rating for that door is not available, include the glass area of the door with your windows and use the opaque door U-value to determine compliance of the door. One door may.be excluded from this requirement(i.e.,may have a U-value greater than 0.35). c)If a ceiling,wall,floor,basement wall,slab-edge,or crawl space wall component includes.two or more areas with different insulation levels,the component complies if the area-weighted average R-value is greater than or equal to the R-value requirement for that component. Glazing or door components comply if the area-weighted average U- value of all windows or doors is less than or equal to the U-value requirement(035 for doors). 43 The Commonwealth of Massachusetts =* =- Department of Industrial Accidents Office oflosestIONMos 600 Washington Street Boston,Mass. 02111 -- Workers' Co m ensation Insurance Affidavit i name q / , location- city f'L v i phone# QL ❑ I lin a homeowner perfbiming all work myself. am a sole r rietor and have no one workin in any ca aclty %% %%%%%%%%%%%%%%%%%%%%%% %%%%//��%%%//%/%%%%%%%��%%%%%%////G//////%%/G�%/%%%/G%%%%�%%%///%/�////l/%///%%%%%% I am an employer providing workers' compensation for my employees working on this job. :.:: maany name- ; :;::>::>::::»::: ::::.:.......::::...:::... ....... ..........:..::...........:::::::.::::::.::::. address:. cites. insttratitse co :;: olicv# . ❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: X. com an name;:. ...;: :...:: address.:. ..:.... xx Xx ::::.::.: •::::::::::::.'22::::::. wi:•r y... "FEW i$::iiiii:?:}}};:'i ....................: :w:::v:::::.::::::::::::.:.................................................. ?:i:::iii:i:}:vi:v:iiiFi!:v: isv::isiii.':isii i:_::i:::i:::::::i:.'::'.: .......::::::.......{:::::ii:i'.:: t &.x•::: .............................................................................................................................................................. ........................... ..........................................................:.................................................................. r.............. .:„cw,:.ya.:a.. .. :address: ;:. ......................... Fafiure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to S1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. I understand that a COPY of this statement may be forwarded to the Offlce of Investigations of the DIA for coverage verification. I do hereby certify, t e pains and penalties of perjury that the information provided above is&W..and corr et signature Date 1 b l 'Z Print name 4tf, /`S Phone# '/';)/1-4 8c - ofndal use only do not write in this area to be completed by city or town offldid city or town. permittlicense# ❑Building Department ❑Licensing Board ❑checkif immediate response is required ❑Selectmen's Office ❑Health Department contact person: phone#; ❑Other oriind 9195 PJA) Information and Instructions r • . Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", an employee is defined as every person in the service.of another under any contract of hire, express or implied, oral or written. An employer is defined as an individual,partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives,of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. n� 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 maybe 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 r not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if You being requested, ep 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 pi number which will be used as a reference number. The affidavits may be reta6R in- the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents ®ffico of Invesduadons 600 Washington Street Boston,Ma. 02111 fan#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375. QQ ©o/li 9cc 1 Ca sd l r SMOKE DETECTORS O.K. BA (STABLE AUILDING DIEPT. r�Al, CRIV v-,-Iye h e� laclk r� f 1 _ 1/ flwdol lr i rsd��jvo �2 " 1 aj . M I t Qw L�s FL) P r 1 e • RA',,yyF rc = �MO 2S YL YsC{ ', s I 'T- T" r Lr ILL1. If opt Pf— f tLnA�T -t*IRWA) BA7E� .tDD.nwJ Outw;s ,low • — ---. _ ...-_ -. - ------ -_ \\ - � - / — �� _BY slFAsc��.,�s n._w+ 'te..� ��l•e,L7f� .. ._�.: r Frtnwrr o,wo OCAO-a 4'TTW,+- - I�SIBh(-7 LPo7 .3y 79! W G SHru6 Lt S�T.rsa*_ ISf iELY OdE•i CD/L PtY S - .K Ip4f�'CONT. �FFrT VENT IKY T!L/M !X 4 !K 3 2MCE - i If. �x4 c6a'y LVL limbs ((AE6 LD.+o E.a yAto S•rq 7YYLV- oYE/t�G Ox PLY. 7n/0GJ• GiGbC•" 230 rNfoLw Tou ALou.6vrrg,e3+Jr rov*s I - . ., r RCQ,f .J4 AO.LL.D.Ex.UT pORHE2 O�?E2 OR ILK � BLOT "� L r of ./ Nr� Gr NeW,I"to UA *ie Tuk vr• a p �.3oFy l> w . EYxrdD IV P PIA7 YVY .7"9. It Irmlw. it a._ yuac, 3x` N4� mil g ; �? erlbal ;s �raro wsrngs .1 y�� x 0^ eqr W xmt. / D FIoo- .�DS Y S+roe ^ F x Isr. 7 C �h� y /o 1 �G10 LAN.6l Ark A- VMt►L i+.SN 49% L17MQElL yA4ry fft4- �g6r ' _ � r 8 a$s� Wl•JDO«7f • Wl� pAK So��"� else r a T J x.o t Sfd'we R i- Z Z Y SHOE a ' , a . ' 3. ax$a r Z� CRAWL t>OAGG � /o WX✓ ./WUfOf- OoL Pep-cOVE 3�s'G LOL. JTVAr. O+lSTclt Fr'ylLLy V-p^�J/bN�- 8'LotK. Go y G•GWl X )1tLED ^j /.)SEAL Wl/G.XP"GON ,a. ye� ,!� lnAC. Pw eS_ DkM/ CROO= $E LOr.J G DE f04 Al/a= ;£CT ONL �1p7/Vrcl-l]+' UrNDpW.�EKT. VOO,L W# 0ol6 Zw— A- D.. at.7/0. . t / 3 �' 6wT 6 x•�T. i.i� Fvyr• •,wrc Qavy uY. ODautE " •1 � nf�-ra iuvyr 6F '' f.:.. E`fto .q'�_ .•o/ DJ�IO,.OD Rl.1£2 CJ?F(Z o9w µ1A)00 a7, _.G4•l"/SG6 cry.......".. ...._._. V ".` , N �J V..o:Y pb.+fr.Jf• W1c EO,y,Ev • ueN7 PMcoDE w�tit `�0 4 w .uro '� OO1Y 0 E �wu 4N Wgts GnS! a\ /� • b TJ 7Y�ro - 1� �lalo � - Y •� kry e •' Y- G J 3-d7t 6l4t l0 O cr+.- e 1-47 , - -0— X104 CO PAD IRI 8"�oruC. CVAuS. iCd/�!6°xa` T�( f bOt.T DA)4 p 40". F7bt7yP,��Y/Kfi�02 n Y aYarQ �p p� t QDDF &P- ® as 2Yq(, ry a�sc V h l'lATtnu Pt AK) _4trn..�o FL,=R, R_n s„e�� Rcovirt P�wti� t 'rQo . . Z6TC;, Devi D oR 3 �`T f aC. l � tied kfi r►�,: ���� Town of Barnstable ,ER MIT Permit# �'� � E.rp/r - t arthsjrom issue dote T Regulatory Services w g,A'843fAH[L,t.1 dAss U _ Thomas r. Geiler, Director i=z•p /fir l P�C.)r P°1 t�3��• � V Building Division • Tom Perry, CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us - Office: 508-862-4038 Pax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid IPithorrl Rerl X-Press Intprinl Map/parcel Number Property Address 60 L 0IrL� R®. ��Ui�P-01 LLC t'f Residential Value of Work 000 a Clio�t Minimuxm fee of$35,00 for•Work under$6000.00 Owner's Nam e & Address F F G� y —s'�—6 G `-C u s�; (�� 1 �) Contractor's Name 0;err j A Or0 R y Telephone Number C?�- $ ®�t1oZ Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) C -- 64 0_tij J ❑Workman's Compensation Insurance Check one: ® I am a sole proprietor I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp. Policy# Copy of Insurance Compliance Certificate must le Ompany 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 'existingrlayersofroof) ❑ Re-side #of doors Replacement Windows/doors/sliders. U-Value (a 3 (maximum ,35) #of windows *Where required' Issuance of this permit does not exempt compliance with other town deportment regulations, i.e. Historic,Conservation,etc, *"Note:*Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License & Construction Supervisors License is required. SIGNATURE: "fA. �:IWPPILESIFORMSNjilding permit fonns\E.XPRCSS.Joc Revised 072110 T The Carninorni eallb Hof-Massacllusells - --- - Depart'inent of Indusirial.4ccidents Office'of.,nvestlbaioTls r ' 600 Wash'ingfgn S'treel B,oston, 1V4 02111 wtirm rllrlss govldia lVorlcea•s' Compensation Insurance MfidatiZt: B>s triers/iCr)ntr,ictors,/Electric ans/Pl;umbers Applicant Information Please hint LegibIy g ) (I i k,L t A(h, FCC,&'A Name, (Busine�s,'Y1r aui?ahan�rliidi�;iidc>al Address: �972.MFFIL 0 i City/Sta'te zip: 05TER0 I LLF= Phone #.. 50 8' �tV You fill employer?Check the zpproprzate box.: E10 projecY(t equit ed):. 1..❑ I am a employer Leith 4. ❑ I am a general contractor and I * have hired the sub-contractorsew constriction 6- employees(full and/or part=tirrre). �I am a sole proprie=tor or.partner- listed on.the attached sli.eet. emodelingslli and have no errs to pees These sub-contractors haveP P 3 eiuolitionworking for me in any capacity. employees Reid leave Zvarkers'Y ilding addition'[No tuorkers' comp,in llnnce- comp.insurance. .required.] 5. We Fire a corporation and its ectrical repairs or additions officers,have'exercised their3.Q :I am a.homeotivner doing all work rzlbing repairs ar ritldi#mans myself. [No workeas'comp:. right of exemption Per MGLaf repairsimurance:required.]T .c. 152, l(4),andwe have noemployees.'[Noworkers' er 1.0. lJtNpOL05 ' compAnsurauce:required-] *Any apptkaut thatchecks box#1 quit also 511 out the section below showing Their worhes'conTensation policy infonvatiam- Y Hoiueourneers who submit this affidavit indicating they nee doing all work sled then hire autsidc•tontmctors most submit.a new.afdsv of indicating such- =C'c=t cfiors than cbkk this:box mirst stuchesd m additional sheet showing the osme of the sub-cmtr c,=and stsle whether or not those eatit-ses have enrp]oyees. Ifthe sub-c.onlractors:hsve employees,they.nntst provide their workers'comp.policy number. Tant an enipbcr wr that is provrdirig workers':contpen=ion hintrance for rely eniployeas. Eeloiv,is file poi cv relief job site hiformrltiolL Insurance Company Name: Policy#or Self-ins.Lrc.#: Expiration Date.- Job Site Address City/Stage/Zip: Attach a copy of.the wDrkers'compensation,policy dieclaration Page(s,11,611ing the policy'umber and exptr•ttion date). Failure to secure coverage as required under Section 2.5A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1..,500..00 and/or one-year unpiisonment,as well as 6,it penalties in the form of a STOP IWORP ORDER anal a fine of up to$250.00 a day against the violator. Be advised that a copy of this stzatement may:be forwarded to the Office of Investigations of the D.IA for insurance coverage verification. ` I do hemby certify iiF. the paints aild partab es 6fp�ditry tltat tite ittforlrtiTtiart proirided a.bolre is h ita and correct e Signature ,. -Date: 11 ' A0 t Phone#: , Q;�cial itse only. Do not lr,rite iai this area;.fo be conipltrted by rifle or town ofcfal City or Town: Permit/License Issuing Authority(circle one):_ 1.Board of Health ?.Building Department 3. C:ity/To-vvn Clerk '4,Electrical Inspector 5.Plumbilig.Inspector b. Other Contact Person: Phone# s • . r BARNSTABLE, ' "9. s639. Town of Barnstable �0 Regulatory Services, •Thoinas F. G-eiler, Director Building Division Thomas ferry, CBO Y Building Commissioner. ` 200 Main Street,Hyannis; MA 02601 www.town.ba rnsta ble.ma:us Office: 508-862-4038, 508-790-6230 Property: Ow'ner'Must. Con plete And Sign This .Section If Using A Builder I r.. as Owner;of the subJeC.t property, ii �� hereby authorize W 1.4- C v la tri o A 2 7 to act oii my behalf, in all matters relative to work authorized by'•this-:Molding permit application°for:"` mf lid s ' Cev eau"►I lie �1�" . C%4 3 _ ffl' (Add>te'ss of Job) 'CA 1A a z ?A1� Signa re of Owner - Date lJ Print Name If Property Owner is.applying for permit, please complete tlie;Homeowners License Exemption Form,on the, reverse side. Q:\WPFILESIFORMSIbuilding permit formslEXPRESS.doc- •, . °r .s : .,,, ._ � , P .,�� ,< ,,;' Revi.c`r.rl n721 10. . ,: . fHE Town of Barnstable Regulatory Services " SS. Thomas F. Geller Director y Inss. $ `�'ATab;9,. Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnsta ble.ma.us Office: 5�8-862-4038 Fax: 508-790-6230 HOME OWNER,LICENSE EXEMPTION Please Print DATE: 1013 LOCATION: number street village "HOMEOWNI R" name home phone N work phone N CURRENT MAILNG ADDRESS: city/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 Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more thati one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit.to the Building Official on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit (Section 109,1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws, rules and regulations. The undersigned"homeowner".certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements, Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section.127.0 Construction Control, HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the_provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. !n this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible, To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q'\WPFILESIFORMS\building permit forms\EXPRESS.doc Revised 072110 J ✓ -Z!�O'I7Ti132ryIZCIM.IbLldy O ✓I�GQ.40QC92tl.JP - -. tg Office of Consumer Affairs&Bo mess Regulation w, License or registration aLd for mdividul use only HOME CONTRACTOR before the expiration'dafe ;If found return.to: 'Registration ,150807 Type Office of Consumer Affairs.and Business Regulation Expiration 513/2012 Individual 1Q PakPlaza Suite 5170 WI.. AM J.FOGARTY+tE t - Bosfon,lVIA 02116 WILLIAM FOGARTY 1#7j 46 VERMEER COURT � f[ O$TERVILLE,MA 02666 = - s`-� • Undersecretary. e E ot,Vaiid wifhout signature z`'Iassachusetts- Department of Public S:ifet1 Board of Building Rea hitions anti Standardis Construction Supervisor License One-and Two-Family Dwellings. License: Cs 64245 WILLIAM J FOGARTY Ill 46 VERMEER CT 03TERVILLE, MA 02655 , Expiration: 10/28/2012 — Cunmiissioner Tr#• 3978 c e� Tows. of Barnstable *Permit# �o yo ys Expires 6 inonfhs front issue dace Regulatory Services Fee �zs Thomas F.Geiler,Director �3�b6/7"— Building Divisi®n v Tom Perry,CBO, Building Commissioner" PERMIT 200 Main Street, y e Hyannis,MA 02601 www.town.barnstable.ma.us k T5A_79 �q�0 Office: 508-862-4038 01 BARNSTABLE EXPRESS PERMIT APPLICATION - RESIDENTIAL Not Valid wititout Red X-Press Imprint Map/parcel Number_ _ Property Address Residential Value of Work C� Minimum fee of$25.00 for work under $6000.00 Owner's Name&Address C� Telephone Number Contractor's Name Home Improvement Contractor License#(if applicable) d Construction Supervisor's License#(if applicable) &orkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Cornp.Policy# 7 - Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ® Re-roof(stripping old shingles) All construction debris will be taken to Re-roof(not stripping. g Goias over existing layers of roof) ❑ ❑ Re-side ❑ Replacement Windows. U-Va1ue__________ maximum.44) *Where required: Issuance of ttis permit does not exempt compliance with other town department Tegulations,i.e.Historic,Conservation,etc. ***Note: roperty er t signProperty Owner Letter of Permission. . Home Imp eme ontracto ease is required. SIGNATURE: QTomwexpmtrg Revise071405 t ne L arnmonweacrn of lvlussuvnusei& Department oflndustrialAccidents Office of Investigations 600 Washington Street �•' Boston, MA 02111 ' M ° www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/or,ganizationiindividual): _ Address: �� s,) o< `l S City/State/Zip: - 1114 Phone#: Aoo�S-J l'0"5`') Are you an employer? Check the appropriate box: 'Type of project(required): LgI am a employer with '__3 4. ❑ I am a general contractor and I 6 employees(full and/or part-time). have hired the sub-contractors ❑ New construction 2.❑ I am a sole proprietor or p=er- listed on the attached sheet $ 7• ® Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp.insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself.[No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.] t . employees. (No workers' 13.❑ Other comp.insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their worker'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 their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and,pob site information. Insurance Comp any Name: Policy#or Self-ins.Lie. #: / 6 1 Expiration Date: / A Job Site Address: 60 Lyra.��G��O City/State/Zip: _/ Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500..00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA.for insurance coverage verification. I do hereby cerd sus ain a pen o rjury that the information provided above is true and correct. Signature: Date: 3 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 a.Electrical Inspector 5.Numbing Inspector 1 6. Other Contact Person: Phone#: I Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees, Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as "an individual,partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es) and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit 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. Self-insured companies should enter,their self-insurance license number on the appropriate line. City or Town Officials . 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 permMicense number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write."all locations in (city 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 future 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 Investigations would lice 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: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, NIA 02111 Tel. -617-727-4900 ext 406 or 1-877-MASSAFE Fax - 617-727-7749 Revised 5-26-05 w .mass.gov/a wtiv ia T = w � �k �,r � Ti. L� �Q• �t�8. gl.P xi '$+�«' z "s^3�' s�'' 09/27/06 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY PRODUCER AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT:AMEND,EXTEND OR ALTER THE COVERAGE WISE&QUINN INSURANCE AGENCY AFFORDED BY THE POLICIES BELOW. 449 PLEASANT ST BROCKTON,MA 02301 COMPANIES AFFORDING COVERAGE COMPANY A HARTFORD UNDERWRITERS INS CO LETTER COMPANY B LETTER INSURED COMPANY C FRASER CONSTRUCTION LETTER PO BOX 1845 COTUIT,MA 02635 COMPANY D LETTER COMPANY E LETTER THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS;• CO TYPE OF INSURANCE POLICY NUMBER POLICY POLICY LIMITS LTR EFFECTIVE DATE EXPIRATION DATE (MM/DD/YY) D/YY GENERAL LIABILITY GENERAL AGGREGATE $ COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG. $ CLAIMS MADE OCCUR PERSONAL&ADV.INJURY $ OWNER'S&CONTRACTOR'S PROT. EACH OCCURRENCE $ FIRE DAMAGE(Any One Fire) $ MED.EXPENSE(Any one person $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO ALL OWNED AUTOS BODILY INJURY $ (Per Person) SCHEDULED AUTOS HIRED AUTOS BODILY INJURY $ . (Per Accident) NON-OWNED AUTOS GARAGE LIABILITY PROPERTY DAMAGE $ EXCESS LIABILITY UMBRELLA FORM EACH OCCURRENCE $ OTHER THAN UMBRELLA FORM '. AGGREGATE $ STATUTORY LIMITS h 17V OI2iCfiR'S COMPENSATiON EACH.ACCMENT - $i00,000 - AND 6S60UB-794X6191 09/26/06 09/26/07 DISEASE-POLICY LIMIT $500,000 EMPLOYER'S LIABILITY DISEASE-EACH EMPLOYEE $100,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE 75 � T SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE ERASER CONSTRUCTION EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAM 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, PO BOX 1845 - - BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR COTUIT,MA 02635 LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES AUTHORIZED REPRESENTATIVE e fie �arrumaruuea a� ivaelta Board of Building Regulations and Standards License or registration valid for individul use only HOME IM OVEMENT CONTRACTOR befori the expiration date. If found return to: i Beam'of Building Regulations and Standards i Registr _: 12536 One gUhburton Place Rm 1301 2007 Boston,Ma.02108 C '. FRAS.ER CONS r � i DEAN FRASER 71 TARRAGON CIS GG d•' j✓f`^" -- GOTUIT,MA 02635 Administrator Not valid without signature � A. Assessor's map and lot number ........ '1.f..�� !...�.....!. 7 Sewage Permit numbe . 7 ....5 ... ........................ .1 A `{ F 7ME TOWN OF BARNSTABLE ., r O t0� � , •, ` t .BARNSTABLE i 9 j DUhLDING INSPECTOR .t •-'� 0 +'t APPLICATION FOR PERMIT JO .............................................................../... ..................... ' TYPE OFF CONSTRUCTION S^ . l nI f.. .......- A M-t�. 1� 1, ..�:�...?. I. .........?.. .ST v/...y..... t. �i w- 6.. � ....................19�7...i. ........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ?.fi..t2......... .!.1..!.......Q.Q.! t7.....1.......4. 6.T........L�................................................................................ Proposed Use ...... ....................................... ZoningDistrict ... ........................................................Fire District ...�.......�....................................................... Name of Owner ......(A( . Address .......0A �A.A....�.f it t� i, a rr Nameof Builder ....................................................................Address .................................................................................... r, Name of Architect ..:....Address ............. ................................................ �r Number of Rooms Foundation f n <at..... �G,n1 ( (� ,i.... ................................................................. .... ................. A (' 4 t a C1 N 17- C.6 a A Q...................Roofing Exierior ..�.�?.....C, , . .............. . y .. ... ...... � ...................................................... Floors :................................Interior ....�.............. ........... ..i Heating gjfi ............o.,I.t () f ................( P.'.........................................Plumbing .............. J/( .... -/4.,.............................................................. Fireplace ..................................................................................Approximate Cost �Z.1r. Definitive Plan Approved by Planning Board --------------------------------19--------. Area ��.�a../ ...AT f `............ Diagram of Lot and Building with Dimensions Fee 31 'r v SUBJECT TO APPROVAL OF BOARD OF HEALTH `i \ 9 1 xx y n � I I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. V Name p.. .1: Y �r ............... � Tally-lio Farms Inc. Permit Granted ..........N No-v P\ERMIT REFUSED ---------------.-------.—.~— � ^ ' ------------------------'~^'' ' - � `„% TOWN -OF BARNSTABLE Permit No. _------_Z9`22 Building Inspector � rua Cash 16)q. " OCCUPANCY PERMIT Bona �`�� 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 Tally Ho Farms Address lot #2h Lumbert 11-Lll Foad, Centerville t q Wiring Inspector /I r� Inspection date Plumbing Inspector r ._ "�' 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. l / ................ _.:... ...{. ........., J...:_ .........................:.`Building Inspector _...�........._._ F• {• �"r;,n"}AF- :.• '. i - - 5 r? ,.,r0't yl l.. tr,''`! ; :I ' �„^'> 1� .. . ,... 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I r„.., C Assessor's map and lot number .......'... .. ✓�U_ /jJ ;c.l 7 i SEPTIC SYSTEM MUST BE ! {INSTALLED IN COMPLIANCE 1� WITH •ARTICLE 11 STATE " .r, Sewage Permit number ................. ... ...:.................:......... y � .yi j IV SANITARY CODE AND TO y�FTHE T� > TOWN OF BA�R'NS uMLE 4iQ - q 16 "�` 0 UUIL:DIH;G ; INSPECTOR APPLICATIOfij FOR'PERNIlt'-T .....-EL&M.'.. ......... .... ... .................................. .......................... `w TYPE OF CONSTRUCTION J�SL.nL ..i% ,-...... .!.. .... 61ALC --I..4..6..�.....�. S�U�/........ v ............... ....................I 7.. ' TO THE INSPECTOR OF BUILDINGS: { The undersigned hereby applies for a permit according to the following information: Location ... • ProposedUse .. J.N.IraL4,......�.M.13. .......................................................................................................................... 0 ZoningDistrict .../ ........................................................Fire District ... .................................................................... f Name of Owners-���. �.s�.... �,%�ls.......1.1� ......Address .......f..�........ .�t.�:..�.1�:�.........�:�........ ..... Nf Nameof Builder .............................................................:.......Address.....................................I................................................ Name of Architect 9C.�.�..�L ...!a. .Q<�.....1��).1 �.S. ....Address ............. ................................................ • 4 Number of Rooms ....... .................... ..................................Foundation ....�.0,.........." �Il�. , Q........C.Q..�..�-.(�. r 4V r t k�"..........."..Roofng ....... k .................................................Exieriorbs ! Floors 1. (<P.X....:....... . .... ....1d..(Lr(j....1�.:...................Interior .... .......... :...... HeatingIT..W...r......6.1.C.. �- �.............................Plumbing C�:.....(J. {..5. .... ....... ..... .... ........... Fireplace ..............................................'...................................Approximate Cost .......... �p.. .�Rf�.:>............................... Definitive Plan Approved by Planning Board ________________________________19-------- . Area ,.�.6. ..�.� iAt�!........... Diagram of Lot and Building with Dimensions Fee s v SUBJECT TO APPROVAL OF BOARD OF HEALTH Y) - hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above con"struction. Nam .. .... ..... . ............ Taller - •Ho Farms Iac' l , I- �t ¢ �No ....i Permit for ......Dwelling............ ............................. ... ...... ................................ Locat4j'?.i-tm►bext..Mil,lAd.......L t.16........ ...................... en tervil.Ie.................................. Owner, ...Tatly..-...Ho..F,asms...Inc............. .... Type-of Construction .......Frame....................... ` .......... ................................................................. 4 Plot 147-88 9h - r Lot ........ ............... Permit GrantedQ. ....19 77 Date of Inspection . ..::............—.7....-........19 ' Date Completed .� �, /.�r ,,.. --19 Rf PttSflf} � ..r............ .. ........_ .................................. < I• ` . .................................. ..................................... _ M ............ ............................................................... - - - _+t Approved ................................................ 19 r ............................................................................. .................. ......................................................... r - • . ...n. .: :-. - ... .,"'•r'... i:. .. 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