HomeMy WebLinkAbout0049 WHITES LANE�II
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aff To
wn of Barnstable Permit#' "
b[�'7 60, z
A .Expires., om' e date _
Regulatory Services Fee
1659. ��$ Thomas F.Geiler,Director
Building Division
Tom Perry,CBO, Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town barnstable.ma.us
Office: 508-862-403 8 Fax:.508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
of Valid without Red X-Press Imprint
Map/parcel Number A� %y k� ,t 71 �.4f, c,0!41 Z,0.0 0 .2;>,T S
Property Address
[�Residential Value of Work ,�� Minimum fee of$35.00 for work under$6000.00
Owner's Name&Address / � S 610. - .2� 'PS ,4/V C,
Contractor's Name _ Telephone Number
Home Improvement Contractor License#(if applicable)
Construction Supervisor's License#(if applicable)
❑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 accompany each permit.
Permit Re qu st(check box) '* r
Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to�% C' 1 'A,
❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof)
❑ Re-side
#'of doors
❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows
❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. .
Separate Electrical&Fire Permits required.
*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&Construction Supervisors.License.is
required.
SIGNATURE:
S_doc I
1
The Commodwerrlth of Massachuse&
Departnent of ludusbial ccidents
d
OKw--of Investigations
600 Washington Street
Boston,M4 9211.1 ,
avow Y am,54 rvJdia
Workers' Compensation Insurance Affidavit:Bmlders/ContractorvUectricianstPbnmbers
Applicant Information Please mint Legibly
Name
CityfState/Z p-. ® J Phone##_ C3
Are you an employer?Check the appropriate boa: Type of project(required):
1_❑ I am a employer with 4 ❑ I am a general contractor and I 6- ❑Neva o>action
employees(full anNorpart-bme).* havehiredthes;ub-contractors
7 El am a sole gmprietoi or partner-
listed on the attached sheet 7. ❑Remodeling
sbip and have no employees These sub-contractors have g- ❑Demolition
four me-many employees and have w c&ers' Building,addition
workiaa ny sty- 9. ❑ g,
INC wags'�_insurmce C07 p_mettrartr�
5- ❑ We are a corporation and its
1 tl.❑Electrical repairs or additions,
regr a h] officers have exEtr9ced timer 11_ Plumbing airs or additions
3_ I am a homeowner doing all work ❑ l;mP
irght o esenspw per IYfGL
myself [Na worleers'comp. f ti
1?.X Rflof repairs
hmn-ence required.]T c-132, §1(4} and we have no
employ-{No workers' 13-❑Other
camp.insmace required.]
:*Any applicant that cheds box#1 mast also f a cm lire section below showing d udr wodes'compeoszwn policy mfmms am-
I Ho-memnQrs who submit this aft imd-cicatiag they asedowg sa vat lmd then hue outd&cammcton mast submit a new affidavit indicating such'
IConmcmrs that check this boat mast xttached mi sdduia_i sheg showing the comae o#the sub-em ractm aad staff a whether of not moose des have
employee;. If the stsb-caattaana have emplayees,they,—m provide the9r waitere ramp.policy number-
I ton an employer drat ispraoviaYng worirers'compe=Mivn insurancae for aiy empIay Below is the poury md,joh site
ix,�orarrrtror�.
Iusrzrance Company Name:
Policy-or.Self-ins-Lic- Expiration Date:
Job Site Address: City State/Zip-
Attach a copy of the workere compensation policy declaration page(showing the policy munber and expiration date).
Failure to secure coverage as required under Section.25A of MGL cw 152 can lead to the imposition of enminai penalties of a
line up to S1,50000 an&or one-year imprisonmenk as well as civil penalties is the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the viajator. Be advised @sat a copy of this sfaement may be forwarded to the Office of
Instigations of th,e DIA for tomra ce coverage veri catian- '
ado hereby cer*aader thapains ands afpedkty ii?iatthe irformm[i a provided above ig bw- 'and correct a�
-. Phone 9-
Official um only: Do not write in this arts,lobe compIded by citr or tmm oft -
City or Town:. PermitUcense At
Issuing Authority(Circle one): .
1..Boand.of faith 2.Bing Departaunt 3.Ckyfrarwn Clerk 4.Electrical Insperrter S.Ph�bmg Ins}rectar
Oth
er
er.. ..•. :... . : _
A .
OFF ra{y •-
a a
a a
+ BARNSfABLE a
9�, ,�� Town of Barnstable
.. . pTEp MA't A
Regulatory Services
Thomas F. Geiler,Director.
Building Division
Thomas Perry,CBO
Building Commissioner
200 Main.Street, Hyannis,MA 02601
www.town.barnstable.ma.us '
Office: 508-862-4038 Fax: 508-790-6230
Property Owner Must
Complete and Sign This Section
If Using A Builder
l ;as Owner of the subject'.property
hereby authorize to act on my'behalf,
in all matters relative to work authorized by this building permit application for:
(Address of Job)
- Signature of Owner Date
Print Name
If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on,the
reverse side.
QAWPFILESTORMSIbuildin g permit formslEXPRESS.doc ..
Town of Barnstable
ti
Regulatory Services
HARNSTABL$ ' Thomas F. Geller,Director
9� s 9 ���
ATFD 3�A Building Division
Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office:. 508-862-403 8 Fax: 508-790-623 0
HOMEOWNER LICENSE EXEMPTION
�
Please Print
DATE: /�'jj 1�0 ^�All �L
JOB LOCATION: /
number street village
"HOMEOWNER": I.�<3 b.*?
name home phone# work phone#
CURRENT MAILING ADDRESS: �'n✓ � !� q 1"
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-
familydwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one
g� ry
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
I/procedures and requirements and that he/she will comply with said procedures and requirements.
Signature of Homeowner
Approval of Building Official
n
Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code
Section 127.0 Construction Control.
HOMEOWNER'S EXEMPTION
The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section
109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as
supervisor." ,
Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,Rules&Regulations for
Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons.
In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately
responsible. re , .. _ .. .. ..
To ensure that the homeowner is fully awa 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 far use in your community. .
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map .� s - Parcel , i Permit#
Health Division �' ����
Date I sued t—1/
Conservation Division /L Fee- S,a� •'
Tax Collector. '' I �n� �P TIC SYST M- MUST BE
1 . ° 14 TIALLED IN A- COMP ,LlR�I�9
t,u _.
Treasurer ,li) �!!TF!TITLE 5
�` ENVIRON hi ENT ; f
NTID
Presewe ien+lyannis C
'�--
4
Project Stree ddress 49 zlz�e 17-N&IM—el
Village `
Owner . Address
Telephoned _
Permit Request
Square feet: 1 st floor: xisting proposed Y 2nd floor:existing proposed Total new
Estimated Project Cf Zoning District Flood Plain Groundwater Overlay
Construction Type -
Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation.
Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units)
Age of Existing Structure ;, Historic House' ❑Yes ❑No On Old King's Highway: ❑Yes ❑No
Basement Type: ❑Full ❑Crawl - ❑Walkout ❑Other
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft)
Number of Baths: Full: existing new Half:existing new
Number of Bedrooms: existing new
Total Room Count(not including baths):existing new First Floor Room Count
Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other
Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No
Detached garage:❑existing, ❑new size Pool:O 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
BUILDER INFORMATION
Name Telephone Number
Address License#
Home Improvement Contractor#
Worker's Compensation#
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE ✓ �.f/. DATE ���
17
FOR OFFICIAL USE ONLY
PERMIT NO.
DATE ISSUED
MAP/PARCEL NO:+
Ile 4,
' _� '-� '_ym_a * f r l��4 f� • 1 • - ry i ' - • i i •, .,, .5 l � 1
ADDRESS A>> (VILLAGE 4 _ Y• ;
OWNERfI 1;
`ter
DATE OF INSPECT1014. r 1
V Q J
FOUNDATION
_ FRAME - -
INSULATION 3 - i •� ` a
FIREPLACE
ELECTRICAL: ROUGH FINAL
r`
PLUMBING: ROUGH= FINAL'
GAS: '' ROUGH" r' FINAL r • # .
FINAL BUILDING
DATE CLOSED OUT
ASSOCIATION PLAN NO.
t
-
The Town of Barnstable '
jum. �$ Department of Health Safety and Environmental Services
Building D1*VW*Gn
367 Main Stray►Hyannis MA 02601
Ralph Cross=
OfUce: 509-790-= Building Cammissic-:
Fax: 308-790-6?30
For otIIce use only
Permit no.
Oate •
AFFIDAVIT
HOME MOROVEMENT'CONTRACTOR LAW
` SUPPLEMENT TO PERMIT AETUCA77ON
MGL i 142A requires that the "reconstruction, alterations, muovatfon, repair, modermi=tion.
denolItfom, or construction of as atiom to any pre-existing
conversion. improvemieut, removal,
owner occupied building containing at least one but not more than tour 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: -h- Est.Cost
Address of work: i'�vTWzo-' :
Owner's Name
Date of Permit Appiladon: &�
I hereby certify that:
Registration is not required for the following reason(s):
work ezcfuded by law
Job under SI.00L
_But owner-occupied
Owner pulling own pewit
Notice is hereby given s OWNERS pULI.ING THEDZ OWN PERMIT OR DEALING WrM UNREGISTERED
CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE
AC THE THE MOITRA17ON PROGRAM OR GUARANW FUND UNDER MGL c- 142A
SIGNED UNDER PENALIZES OF PE&MY
I hereby apply for a.permit as the agent of the owner.
Date Contractor tie l gistratfon No.
OR
x�
Date
Owners 112me
�� ,
r . The Commonwealth of Massachusetts
..... -�-
. -- - . Department of Industrial Accidents
' _= #met 81/aseS90o ions
— 600 Washington Street
--- � Boston,Mass. 02111
'� Workers' Compensation Insurance davit
i
name: �� 6 � A
oiggaW42�4�
location: !X/d,." �
city m�-'[�[.Gl . c-) phone# 7rn F- '�f
❑ I am a homeowner performing all work myself. -
❑ I am a sole r netor and have no one workin in ca acity
%%%%%%O%% % /%%%%%%%%%%%%%%/%%%%%%%%%%%%% %%%%%/%/ /
❑ I am an employer providing workers'.compensation for my employees working on this job. ::.::::::::::.::::::::::::
::::::a i ::5:"?i z i isi 'i � i !::::i > < ! ` :: ::: 4J'sa 2 [%:`['<ii>i ::::%%%:7::r G i <asi5::i . i?5:: ':............::s i ii i i 2 i ` ii i ..
pit as n m
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.... :.::;::::i,.;::::i::.'.'::'°`'%%!:.::i..o:?,:i:::;'-%1- ... > .. ..............
.. shone
insurance co: .. ..
uli #
...:.:.;,.;:. :;. :.;::::.;:.;:.:.
,::.
%:
❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractomlisted below who
have t
: I
. .
the following workers compensation polices:
....>: :::.>:.:::;>::>:;::;
:<:>::
romnanv:name. : ' ;::::;:::;, ,. ::.. ......:::::
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Fafimro to seem a coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or
one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a
copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification
I do hereby certify e p ' and penalties of perjury that a information provided above is&w- ' coned
f � 2.d—l ---� -
signs ./+ �/� .�� Hate
Print name Phone#
offldal use only do not write in this area to be completed by city or town official .
city or town- permit/license# ❑Bndlding Department
. . ❑Licensing Board
❑checkif immediate response is required ❑Sebxlmen's Office-
❑Health Depattrnent
contact person: phone#, ❑Other
(devised 9195 PW
r
16
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y rM 7 .'•kil Li
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OF lq�
a,�t-'' AI�_ fs }.,�. ,fit e;�``S � t: J0 :. - ^t#{ +;• .•.a•4. .
d4•j1[ i�' '� Y .�0 4 t tr� ''• ��':.:.t ��',. •`'t t ,a.��°:Z1 a�. `• +
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No.22162�0�4.
LEGEND
rya ♦ s • �' •. .
EX ST�NO ;;SPOT ELEVATION 0.0 ' za=;:' CERTIFIED ::': PLOT ,PLAN •
-
kiStINa,. CONTOUR.- - = p
(FINISHEa SPOT ELEVATION
FINISHED CONTOUR 0 � 'S'
'. _.
APPROVE 1 ' 90ARD OF HEA�TH IN •;' .
:DATE... AGENT , ..
°�:' SCALE: 'DATE #40106v1v1//s76
E�L�DTf�EOGE_EN6/N£ER&G' CO. INS j' � f� `
CERTIFY: 'THAT THE a PROPOSED
. '�. �iE REGISTtRED
EGISTE t .JpB N0. _ BUIIDI
�.. ,, : = � G SHOWN ON THIS PLAN
CIVIL LAND s 4 • CONFp
ENGINEER 'SURVEYOR ' DR 9Y , �/'_ RMS TD THE ZONING LAWS ,
p F
r rt• ' :. -----_ � ... 1 - BAR
NSjAB CIE ,. MASS.
MAIN ST ..." . 712 MAIN S.� CHhA9 ,f�D �,.
MOUTH, MAS.,. ._, HYPNNIS, M S,. fI �^ ,2 y/y��swN
f SHEET_ rye OATE:` T REG. r°LAND SURVEYOw
The Town of Barnstable
°FVNE Department of Health Safety and Environmental Services
Building Division
' Brut MASS. " 367 Main Street,Hyannis MA 02601
9 i639. �
�ArED MA'I A .
Office: 508-862-4038 Ralph Crossen
Fax: 508-790-6230 Building Commissioner
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE: a —
JOB LOCATION: �J`�� C/(J rYt
numb r eet village
"HOMEOWNER": 6j LzE /z?, �a3,q
name home phone# work phone#
CURRENT MAILING 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 than one home in a two-year period shall not be considered a homeowner. Such
"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be
responsible for all such work performed under the building permit. (Section 109:1.1)
The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other
applicable codes,bylaws,rules and regulations.
The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department
minimum inspection procedures and requirements and that he/she will comply with said procedures and
requirements.
J 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. In this case,our Board cannot proceed against the unlicensed person as it would
with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible.
To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,
that the homeowner certify that 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 to amend and adopt such a form/certification for use in your community.
Q:FORMS:EXEMPT
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- w ;1�— � Y^KLrw�r^_.. �".Lw.!+1.: ....,�.M ri.. w.•.wN -,.-.-...�+.-r a
Assessor's "ma and lot number .... .............. 1
017.
Sewage Permit number .. ' ...... . .............................. ;
THE
TOWN OE ,, ..BARNSTABLE . j
BAHESTADLE,
9� 1639.
BUILDING lINSPECTOR
1, o rav a
APPLICATION FOR PERMIT TO `
TYPE OF CONSTRUCTION .....
....................................................................................................................................
....l1.............�... .�t?........19...1�....
TO,THE,.INSPECTOR OF BUILDINGS:
The undersigned hereby applies fora permit according to•the.following information:
Location ...1"fl i..f.:. ./S...z All".'ell �n f'z-5,; 0- 9C Ln f Tl s.......:................. '
...........................................................................................
ProposedUse ".7/if;_ ........ ../•I/•/h......... ..............................................................................................
i
Zonirigi District C&*7n•f/.�7`.........`...:.......................Fire'' District ...... /./��7F
........ .. .........
//� ./ //�^P/ii/ 7-ram/ /ri:r./7' •n /i// 7
Name'of Owner .............wif l/// r� . Address .....
,�4
Name of Builder /� t��ri .'�iy �f .a...:.......Address .!l�:'�.!w,�/•�/G�h„ ,�.� /..c/J
.�/. .
Name of Architect ......�•Gt.�.. ...J¢ :Address ) �%�" 401 /i.� K;,Al n.,/i C
Number 'of.Rooms /`' / // :.A..:..:........ Foundation ../ �li.d/L .. '.....................................
Exterior: �G� �S
..... .. n....... ....................:........ Roofing /�;5 ��f"/i
Floors u...�.d?ii�/.�/c......�� ...:.....Interior. .. .. . li .WI/.......... .
Heatin 1�n T i iifs ...:... .. . Plumbing /�crT `• �c.�.. ... ................................
g• .......................
Fireplace .... ! ...... .......................... Approximate. Cost ........................� 71 .................................
.a .. •{.
Definitive Plan Approved by Planning Board —:___ 19__ ___ Area :.........
Diagram of Lot and Building with Dimensions Fee
n�f � �'4 ................................
... ....^... .ice.
SUBJECT TO .APPROVAL •OF BOARD OF HEALTH _ :; . '
n
. 200
. j �.
6 hereby agree to conform to all the Rules and. Regulations,of,the,Town of Barnstable,regarding the above
construction.
Name _. ..................
' White' as om Ar
Th ; 27-4 `[ r
t / .
t 20612 ' 1/2 stor
t [ Permit, for Y....:...No '•
............s family dw ..... ••,,,•.••.•.••
t
1
Location .........White..S...Lame......f....................
Cotuit
. Thomas Wh' / '
t Owner ..... ?Vie..... ..
Type of Construction i
........ ......... ................ ..................... -3 ,;� [ .Y - i -. [. •-r �.
Plot............... ... ... Lo�.. ..:A.......... 1 y
.. r
Permit Granted .......September 25 '--78 - - -- A - - - --
A' Date of Inspection ... ...........19: -
Date Completed ...... ...............19
r r , _
�.
jt � :
i
PRMIT'R USED
..................... ... ............. 19.
........... P..... .................E - .
A .
3
Approved 1. Ii .. .3IS•� ......... _19
..........................:�.....`/ '
/........ ....
l' 206I2
TOWN OF BARNSTABLE Permit No. ___-____--______------_____
1 Building Inspector cash
-----------------------
—
OCCUPANCY PERMIT Bond �-OW
Issued to Thomas White Address
lot 03 49 White's Lane, Cotuit
Wiring Inspector "�� Ins ection date
Plumbing Inspector Inspection date
Gas Inspector � � Inspection date
Department
/
,,Engineering De P Inspection date
`Board of Health Inspection date412117
THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL
SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN
REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE
BUILDING CODE.
/� is a ,�� '...................................._..............., ......__ ...,.... -_ ...�...Building..Inspector ..
- -
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i s -�I" '. f i t x RTIFIED: PLOT P,LAN
1. r t,�
CE.
t a
L O T � 3 5 f/I, f/TE /S .Li4 I , s
NEW: C O Id 3 T R U C T 10 N ".O N LY i t/l/�1�i7-o u�i✓ 6
r tF ,STOP 'OF FOUN®ATION IS. FEtl�ET , ' - r ,i'l`
A®O". ,+ POINT fOF, ADJACENT " 11
Y - AA 'S"T",� ,,,L, , it
� e
ROAD , t
` t.. , .; k F` ' r � SCALE / '' 40 t DATE"� S/3 !7�g�} I
d.� r
L'OREDGE Ei✓C9/NEEl4/AIG'.CO.N41 ,1 CE'RT1FY THd►T THE 10011 /1 U.�7J,0
t .CLIENT` Gt//�/T�
ti i, : - . SHO N ON THIS PLAN IS eL0'CAf I
E®Isl'aERED, REGISTERED 7d/3
CIVIL I LAWO� ': J0®. NO. , . T;HE1 �ROUN4 AS>`IRIQICAT�O /I�DIt
ENGINEER "'SURdEY.®A DR; BYt A- A-'1', :.I,'CONFORMS,'.TO THE ZONIN® L-,- ",�
OF BARNS � FEti.
P . E , �1 8 ;.,. �,;
3 ill
3 NO. MAIN ST i7 2 MAIN`-S . „� �',:-'e�
.SO ,YARMOUTH,_MASS. HYANNIS g MASS,- $HEET�L OF 1�� pATE. `RE® LAN®' $URY.ETO�; ti I
r �oo 71A4
`���� i ��o �tc`J AsM-eor'sma " and lot number ........
IN�� 11vj f�6
Sewage Permit number ........................................................... ;' - S,($
•
LQS
TOWN OF BARN.STABLE
?"THE •
ro�Q yew -
Z BABBSTABLE. i
tees. � ,-
9 ,
1639.
s'' BUILDING." INSPECTOR
�0 MPy
I
APPLICATION FOR PERMIT TO ..............................:..............................................................................................
TYPEOF CONSTRUCTION ...........:.........................................................................................................................
Y.y�.l�%/.:..� .........19..
TO,THE INSPECTOR 9F: �iUILDINGS,
A �A. �..�n w.Y..,..x� i�wk„& '7C`'i!Yvffii,�..as.e:M1ry,:t• ...: _. *�;y�.�:.�> '<Y,...trr,:.�•'.r �YS rw.h.. .A..7,:.:.y.cv'� .,a^"rkYs•.{„a:.4.,:'..,RaA9`:::.."'y.wfs.",%—..,.
The undersigned hereby applies for a permit according to the following information:
Location �..f, JS. e.... A.f// ..0 �� 19 ..... 0.. ..... ....................................
ProposedUse ..... C7�/.5. ...r. .� 1/S�G................................................................................................................
Zoning District ........e.Q..7112 C..z.'.......................................Fire, District ...... .........................................
/� / ¢ Address
Name of Owner . ... .. ..t�/JJ.�/.�..1�1� . .(...�.................. �:'�.':rr..S/........r?..r�.... .�� ..,/...
Name of Builder /1..5?�l?Q ....f��J/.1.... ...........Address Zvct
Name of Architect ......PGc,l...:?!mp.........:.........................Address .... ��111.. ........!.1...zr...... l it,. ...........
w ,p
Numberof Rooms ......................................Foundation .1....4ClI ...................................................
Exterior ......... ..S!A!............................Roofing ...!/ .5��/d.�l�
. .................................................
Floors ... 4?/fll1��- ... ir/� .Fitz.la.�`�.............Interior ..... <1...............................................:.
' ieafii9_ D..;/.... .�!✓ ... .Plumbing . . .. Q .... ..... .....
Fireplace ..............................Approximate Cost � .
Definitive Plan Approved by Planning Board -------------------_-----------19--------. Area (o 2
Diagram of Lot and Building with Dimensions Fee !.......... ... ............................
� / d•
SUBJECT TO APPROVAL OF BOARD OF HEALTH 40��--- -'RAO•
n
j
AP 1 �
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Name .... .d.r... .................
.,White, Thomas
o ....20612 Permit for .....1 112 story
..............................
........single family.. ....................
......................... . . .....
Location ........4q..X1qite.1.s..La.ne......................
........................ ..........................................
Owner ...........T11QMs1,5..XhitJq............................
Type of Construction .............X.rame................
................................................................................
Plot ............................ Lot .............A3...............
Permit Granted ...........September 9 78
......... ...
Date of Inspection ................ ................19
4;..Date C?mp t'd .......... ....19
PERMIT REFUSED
.....................
...... 19
�`
............. . . ...... . ..........................
.... . .... . .......................
....................................
...............................................................................
Approved ................................................ .19
; Approved r o.,
...............................................................................
............................................................................