HomeMy WebLinkAbout0103 WILD WAY
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TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map On Parcel J r Application # (// a L 19
Health Division Date Issued 2 L��S'
Conservation Division � 0,�(AE Application Fee
Planning Dept. - Permit Fee 14--7
Date Definitive Plan Approved by Planning Board
Historic - OKH _ Preservation/Hyannis
, Il
�t Street Address 10 S ll f /0r/
Wei
llzv--alllge
.=Gwner.O/ rJa gos I /Vi' d- 4/fZg ((?I Address /0,-; 04 A
Telephone, '-/ O 6 9,�^6
,Permit Request
ke__-�Wcl e rg 941a ce W
sxwo2 On Iv
Square feet: 1 st floor: existing proposed �2nd floor: existing proposed Total ne-W
Zoning District Flood Plain 41,E Groundwater Overlay
Project Valuation ��QQ� Construction Type
Lot Size 0o y/ a Grandfathered: ❑Yes ❑ No If yes, attach su porting'docur jentation.
Dwelling Type: Single Famil20,
Two Family ❑ Multi-Family (# units)
Age of Existing Structure Historic House: ❑Yes �No On Old Kin 'skghway,,,L] �No
9 9 9
Basement Type: ull ❑ Crawl ❑Walkout ❑Other
Basement Finished Area (sq.ft.) d,9 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: Cas ❑ Oil ❑ Electric ❑ Other
Central Air: ❑Yes No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No
Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new, size _ Barn: ❑ existing ❑ new size_
Attached garage: Kexisting ❑ new size _Shed: ❑ existing ❑ new size _ Other:
Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ -
Commercial ❑Yes �jNo If yes, site plan review #
Current Use / Proposed Use
APPLICANT INFORMATION
(BUILDER OR HOMEOWNER)
�.--Name 1/l� �T dZ ✓6 A?f Telephone Number
Address `9 C� t1 ---T— (� / License # L/4-
t
' Home Improvement Contractor# US
70
Ema ® � ��T� a,W Worker's Compensation # k1C — 5-0(2S 9
ol ,,ALL CONSTRUCTION DEBRIS RE LTIN FROM THIS PROJECT WILL BE TAKEN TO &J
SIGNATURE C—DATE
FOR OFFICIAL USE ONLY
R j
d APPLICATION#
s DATE ISSUED
MAP/PARCEL NO. ,
j ADDRESS VILLAGE
OWNER
DATE OF INSPECTION:
, ,-FOUNDATION
FRAME dl PKAW Pok"'
INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL '
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
FINAL BUILDING
DATE CLOSED OUT
ASSOCIATION PLAN NO.
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/Individu d): /(J�Q/"?!�/� /;C L tC
Address: -
City/State/Zip: (%�I J 026 Phone#: Y r-69 ii OS'
Are you an employer?Check the appropriate box: Type of project(required):
LIPam a employer with 4. ❑ I am a general contractor and I 6. New construction
employees(full and/or part-time).* have hired the sub-contractors
C2-�]: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'
9. ❑Building addition
[No workers'comp. insurance comp.insurance.1
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 ' right of exemption per MGL
Y �o workers comp. 12.0 Roof repairs
insurance required.]t c. 152 n Y
' §1 4 and we have no
13. Other__
employees. [No workers'
comp.insurance required.]
*Any applicant that cbecks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
*Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-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:
_A/1 ;q
Policy#or Self-ins.Lic.#: Re 50123 9 U Expiration Date: D �J
Job Site Addresslog w1/ City/State/Zip:
Attach a copy of the workers' compensatio 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' prisonment,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 vi or. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA f ce coverage verification
I do hereby certify Wd "d penalties ofperjury that the information provided above is true and correct-
Phone#: �
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.EIectrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
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 permit/license 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 bum leaves etc.)said person is NOT required to complete this affidavit,
The Office of Investigations 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:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
Tel. #617-727-4900 ext 406 or 1-877-MASSAFE
Fax#617-727-7749
Revised 4-24-07
w .mass.govfdia
CERTIFICATE OF LIABILITY INSURANCE
r 09/29/la
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE �A CONTRACT .BETWEEN THE ISSUING 01SURER(S),: AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: IF the certificate holder is an ADDITIONAL INSURED, the poBcyfios) must be endorsed- It SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsemerd(s). -
PRODUCER - NAME: PAUL SCHLEGEL .
SCHLEGEL INSURANCE BROKERS INC PHONEI.- 508-771-8381 N,)508-771-0663
34 MAIN STREET ADDRESS: SCHLEGELINSURANCE@GbIAIL.COM
TIDIEST YARMOUTH Mh 02673 BNSUREMI AFFORDING COVERAGE NAIC8
_ DISURERA:NGM=INSURANCE COMPANY 14788
INSURED - ""UNERB:AIN MUTUAL INSURANCE ,
Tuleika Building Company Lle
"- INSURER C:
44 Eaton Court - -
INSURERD:
• INSURER E:
Cotuit, MA 02635 INSURERF:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS..
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
Lm TYPE OF INSURANCE INSR YWD POLICY NUMBER. (MMIODNYYY) (MMIDD[YYYY) LIMITS
A OENEtALLTABILITY MP16593Q 09/30/201309/30/2014 EACH OCCURRENCE s 1,000,000-
g COMMERCIALGENNIMLLASILITY 09/30/201 09/30/2015 PREMISES(Eaaxnnnnen) $ 500,000
cLAeLSAaDE ®OCCUR MFDEYP(NIr—P—) S 10,000
PERSONAL hADV INJURY s 1,000,000
GENERAL AGGREGATE $ 2,000,000
-
GENL AGGREGATE UNIT APPLIES PER: - PRODUCTS-COMPAOPAM s 2,000,000-. •.
PRo-
POLICY JECT LOC s
V
AUTOMOOaE I/ABDJTY - - —..—UE.MII
- ...
- (re accident) _ $
ANYAUTO _ BODILY INJURY(per PI=,I) S
AUTOS OS AUTOS- SCHEDULED
AU BODILY INJURY(Per ndlanU S
`
NON4WNED-
HIRFDAUTOS AUTOS - rau tlenD S .
S
UMBRELLA L1/1a OCCIIN - EACH OCCURNENCE S
EXCESS LmB C AUSSINAOE - AGGREGATE 3
Ow I RETT . S
B MIORI(ERSCOMPENSARON WC-5012398
AND EMPLOYERS'LIABILITY rrw TOW LIMITS ER _
ANY PROPRIETOWPARTNEIMECUTNE 08/25/201408/25/2015 aL FAcwacclDEwr s 100,000
OFFICERAEMBEREMUDFDT ❑. NIA - -
owdatwY in
ItYmAnefibeme E.L.DISEASE-EAEMPLAYEE S 100,000
-
DESCRIPTION OF OPERATIONS beb. El DISEASE-POLICY LIMIT s 500,000 -
DESCRIPTION OF OPERATIONS I LOCATIONS/VENICLES, lllecb ACOAD 151,Atltlitio,elRemnrkT BCMtlule,Rmora epee is lequbaU
VICTAR TULEISA HAS ELECTED TO BE COVERED UlD-ER"HIS CURRENT WORHERS COMPF,NSATION POLICY
CERTIFICATE HOLDER CANCELLATION
NO CERTIFICATE HOLDER ON FILE
- ' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE.
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POUCY PROVISIONS.
AUTHORIM REPRESFRTAIM -
0 19 88-201 0 ACORD CORPORATION.All rights reserved.
ACORD25(2010106) The ACORD name and logo we registered marhaof ACORD
� <Illll�V VL 1�V11JLd111V1 C1LLC111J "11%4 Ll.tJ111v JO 1\vs ulKLly at
,a` 10 Park Plaza Suite 5170
Boston, Massachusetts 02116
Home Improvement Co ay.tor Registration
Registration: 173709
Type: LLC
Expiration: 11/1/2016 Tr# 260787
TULEIKA BUILDING COMPANY LLO
VIKTAR TULEIKA
125 BERKSHIRE TRAIL
W. BARNSTABLE MA 02668
-ram ��� 4,�t•
Update Address and return card.Mark reason for change.
sCA 1 20M-05/11 0 Address Renewal Employment 0 Lost Card
Office of Consumer Affairs&Business Regulation ! License or registration valid for individul use only
ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Wre,jistration 1"j3709 Type: Office of Consumer Affairs and Business Regulation
LLC 10 Park Plaza-Suite 5170
iration i"t/-20`6, Boston,MA 02116
�I
TULEIKA BUILDING OO:fl7PAN L-L'-IF
VIKTAR TULEIKA yr 5 nr
i,1,:f
125 BERKSHIRE TRAIL'";"g
W.BARNSTABLE,MA 026t8 Undersecretary Not VAid th t signature
E
/ <
� 5 a
.KNE cty i 7h aap �7faunkre � �. a
�fI` /v�i iti'tp��� �i,��c���x ? `Y? �.�."�i�y➢ ��I�yg�u�#�" u �
d
f t
J7�� �'l`�#y-''„.�,a�e�p
to �,' t
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map 027 Parcel l3 Application # 1 q0 U000
Health Division n � Date Issued64
Conservation Division 'Q' Application Fee
Planning Dept. Permit FeeQ
eX, r
Date Definitive Plan Approved by Planning Board [gy
a° ,
Historic - OKH _ Preservation/ Hyannis
Project Street Address Ar wi Id Nay
Village /� 0 026
Owner0%;'0nQ1701' 9 � Address
Telephone �/
Permit Request AMz -e// �c/le��/, 2 �it"S
ke klace A fiX1 � Z/aors /419;lalol��i�s, /�e l&Ve,f A 0 lWz eu,
J, &cr 6`1
Square feet: 1 st floor: existing roJ /q g 1 osed
p5-2nd floor: existing proposed al new c�
Zoning District Flood Plain Groundwater Overlay
Project Valuatio `7 mil✓ 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 Plo On Old King's Highway: ❑Yes/w�lo
Basement Type: pl:ull ❑ 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: existin: :new®
Total Room Count (not including baths): existing new First Floor Room Count
Heat Type and Fuel: Gas ❑ Oil ❑ Electric ❑ Other
Central Air: ❑Yes Ylo Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No
Detached garage: xisting .❑ 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 o If yes, site plan review #
Current Use Proposed Use
APPLICANT INFORMATION
- — - (BUILDER OR HOMEOWNER)
Name Ty�e�� �CLLC �f��A'A-� /�l��i�/ Telephone Number
Address ��f =�o`or�1 License #
/e//0` , �, Home Improvement Contractor# 173 7a,/
Worker's Compensation # WC 50103/1
ALL CONSTRUCTION DEBRIS R SU71G FROM THIS PROJECT WILL BE TAKEN TO S 4--V q_k
SIGNATURE DATE
FOR OFFICIAL USE ONLY
r APPLICATION#
DATE ISSUED
MAP/PARCEL NO.
ADDRESS VILLAGE
r
OWNER
t;
4
DATE OF INSPECTION:
r
c'
_ FRAME
Z-,,INSULATION , ,,_
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
FINAL BUILDING
DATE CLOSED OUT
ASSOCIATION PLAN NO.
The Ctr;�s-Moreftwa-Uh of Vassuchusetts
Department o,f lidmstridAccidents
01ce of Imldstigations '
600 Wa_,vhirrgtam Street
Boston,,M102I1I
wnw.masy-gouldia ,
Workers' Compens:atian Insurance Affidavit:filalders/Con"ctors/E;iec.triciansfRumbers ,
Applicant Information J/ Please Print Lefibiy
Name 0usmesdorpnization/individmo: Vyl�hL_
Address: . ��► �� .
CitylStateJZip: d UI?' /Vh` 0& r_ Phone,, 6 9T
Am you an employer?Check dw appropriate box: Type of ie
_ I am a cnnfractar and I � _�oectr J (�' r �4
1r I am a employer with 3 ❑ 6- ❑New won
employees(full and/or part-time).* have hiresl-the sub-contractors
listed on the attached sheet; - ❑Remodeling
2_❑ I am a sore proprietor or partner- .- ,
ship and have no employees These sob-contractors have g_ ❑Demolition
working for pie in any capacity_ eanplayees and have workers 9_ ❑Building addition
[No wofkeIs' comp.insurance comp-insurance.
required] 5-❑ We area corporation and its 1011 electrical repairs or additions
officers have exercised their 11_❑Plumbing n airs or additions
3_❑ I am a homacswner doing all work � ,
myself [No workers'comp- right ofexemption per MGL 12 Roof s
insurance regouEd-]t c_152,§l(4},and.we hrn e no
�
ranc
employees_[No Workers, 13_❑Other
'crr
comp.insurwxe,requirM-]
that*Any appti t at checks boat,91 roust also fill out the section below sharing ffi&vrorkeis'compensation policy inftrrtatior
�Home Ii is who submit this afhdavxt indicatmg they ate doing an vrak sad ihen hire ostside contnrctors aamst 57ib®ii a oeu:s dsvit mX�aiinv Mdi
1Cvat®ctors that check this box must attached sa additions/sheet shaQeing the name of&e sub-oohs and state whether ocnot fhnse moues Have
aWlayees- Ifthe suircontmcfars hire employees,they must provide their workers'comp.policy number_
lam an emplo5,w that isprmiding ir�orkers'conTens Lion irmirarre4!r for rity RmgloyLre s Bdaty is thegoTi}raid job sitar
iniformativn.
Imsurance Company Name: /� / q
Policy#or Self-ins-I��a- -®/2� / t� Expiiatioa Date:
Job Site Address: �7/ Gl/c� City/State/Zip:
&a copy of the workers'compensation policy declaration page(showing the policy number and expn-atiou date):
Failure to secure coverage as required undea Section 25A of MGL c, 152 can lead to the imposition ofcriminal penalties of a
fine up to$1,500.00 and/or one-yearin3prisonment 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 lator_ Be advised that a copy of this statement maybe forwarded to the Office of
Investigations of the D e coverage vwffication_
Ida hereby c,erh,fy ri t ass andponalties ofpe ury that the information praiided re is bun and correct
S.iPnature: ` Date: 9 /
Phone#:
ai lt}:7 rrat�vritai►rffE area,to big camp ed by city-or-town 3
City or Town:. Permit/License#
issuing Anthor4(circle one), x
1.Board of Health 2.Building Department 3.Cityll"owu Clerk d.Electrical Inspector $.Plumbing luspector
6.Other
Contact Person: Phone#:
6
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 Iocal licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the cornrnouwealth,`.or 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 aPPl to your situaion and,if
necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their cer-ficate(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 incuiance coverage. Also be sure to sign and date the affidavit. 'Ilie affidavit should
be returned to the city or town that the application for the permit or license is being requested, not the Deparment 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
e at e affidavit
. Please be sue that the is complete and punted legibly. The Department has provided a spac.,at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant
Please be sure to fill in the permit/license number which will be used as a reference number. In add don,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 Ile 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:
'fhe Goramanwealth of Massachusetts ,
1 �
Department of I&Iustdal Acekd�nts.
€}ffzoe of kvestigattxans
600 Washingtaa Street
Baston,MA 02111
Tel.9 617-727-4}00 ext406 or 1-$77 I AS E
Revised 4-24-07 Fax 4 617-727-7749
www.mas&gov/dia
f
CERTIFICATE OF LIABILITY INSURANCE
09/29/ld
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the polieyges) must be endorsed. If SUBROGATION IS WAIVED. subject to
the terms and conditions of the policy, certain policies may regWre an endorsement A statement on this certificate does not confer rights to the
certificate holder In tieu of such endomemerd(a).
PRODUCER NAmE: PAIL SCHLEGEL
SCHLEGEL INSURANCE BROKERS INC PI�E+¢ 508-771-8381 Iaa,1508-771-0663
34 NA124 STREET ADDRESS: SCHIEGELINSURANCE@GMIkIL.COM
WEST YARMOUTH MA 02673 DnURER(S)AFFORDING COVERAGE ams
_ WSURERA:HGM INSURANCE COMPANY 14788
0MURED onvauts:AIM MUTUAL INSURANCE
TDleika Building Company Llc
DAUBER C
44 Eaton Court
11AUREao:
RA--E:
COtuit, MA 02635 1 INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REOUIREMF-NT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WTH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAM
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GENERAI.AGGREGATE s 2,000,000
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VICTAR TULEIAA HAS ELECTED TO BE COVERED MMER HIS CtHtRENT WORKERS CC2dPENSATI0N POLICY
CERTIFICATE HOLDER CANCELLATION
NO CERTIFICATE HOLDER ON FILE
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCEI19: BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL 8E DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS
AUDIUMM REPRESENTATIVE
0 1 988-201 0 ACORD CORPORATION.AI rights reserved
ACORD 25(2D10105) The ACORO name and logo are registered marks of ACORD
I
? , Town of Barnstsble
�
Regulatory Sera-m
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1'rnnerty Owner Must
Cumpleie and Sign This Section
If U4ing.A.Builder
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cc of Consumer Affairs&Rusidess Regulation License or registration valid for individul use only
OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
egistration: 173709 Type: Office of Consumer Affairs and Business Regulation
piration: 11111M14 LLC 10 Park Plaza-Suite 5170
Boston,MA 02116
ULEIKA BUILDING COMPANY I.I.C.
'IKTAR TULEIKA ,
25 BERKSHIRE TRAIL g.
V. BARNSTABLE, MA 02668 Undersecretary _
Not valid thout signature
Town of Barnstable *Permit# 93 2-
Expires 6 monthsjrqmJsjWda9e
Regulatory
lato Services Fee J
Thomas F.Geiler,Director
Building Division
Tom Perry,CBO, Building Commissiox-PRESS PERMIT
200 Main Street,Hyannis,MA 02601
ww.town.barnstable.ma.us NOV 2 2��5
e
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Office: 508-862-4038 7 0 6230
TOWN OF BAR TX�LE� -
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
Not Valid without Red X-Press Imprint
Map/parcel Number t/,/
Property Address 3 ►`i-
q �
[�Residential Value of Work S/00' Minimum fee of$25.00 for work under$6000.00
Owner's Name&Address A- 1 kO LA 0 S ► N K)A)AIZ0 S
Contractor's Name Telephone Number 77 q_c)s
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 be on file.
Permit Request(check box)
®Re-roof(stripping old shingles) All construction debris will be taken to "1�' Anj Is ockao P�
❑Re-roof(not stripping. Going over existing layers of roof)
❑ Re-side
❑ Replacement Windows. U-Value (maximum.44)
*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.
ome I rovement Contractors License is required.
SIGNATURE:
Q:Forms:expmtrg
Revise071405
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A
JPR 1
Roofing
SHINGLE•SLATE•FLAT
MASONRY•COPPERWORK
17 MERRITT STREET
WEST BRIDGEWATER,MA.02379
Tel: 1-774-259-4054
General Conditions:
MASSACHUSETTS HOME 1WRO.VEMENT CONTRACTOR REGISTRATION:
Registration# 137419
All(Home Improvement)Contractors & Subcontractors engaged in Residential(Home
Improvement)Contracts, unless specifically exempt from registration by provisions of Chapter
142A Of The General Laws, must be registered with the Commonwealth of Massachusetts.
Inquiries about registration and status should be made to the Administrator, State Board of
Building Regulation& Standards.
1. SCHEDULED START &COMPLETION OF WORK VARIATIONS: The actual dates
that construction will commence and be completed may vary due to:the time required to
apply for and obtain necessary permits; delay caused due to necessary inspections; delays
in schedule of work(crews); the presence of hidden conditions or necessary additional
work discovered during construction;,delays in the receipt of equipment and/or materials
which must be ordered and/or delivered to the site;acts of God weather, strike, labor
disputes;and other causes beyond the control of the Contractor.
2. NOTICE OF SCHEDULE CHANGES:The Contractor agrees that when such delays
become known to the Contractor,the Contractor will advise the home owner as soon as it
reasonable.
3. DELAYS IN COMPLETION DUE TO HIDDEN CONDITIONS: The home owner
hereby acknowledges and agrees that in certain remodeling work, the demolition of
portions of the preexisting structure may reveal additional defects, conditions, or the need
for additional work which must be repaired, altered or carried out such in order to
commence or to complete the work described under this Contract. In such case(s)the
home owner agrees that the duration of the work and the scheduled date of completion may
differ from the dates contained in this Contract and that such variation which is not
avoidable by the Contractor shall not be considered to be a violation of the Contract.
4. HIDDEN CONDITIONS&NECESSARY ADDITIONAL WORK:Hidden conditions as
described in item#3 above may require adjustment in the overall price of the necessary
work related to this Contract. In such cases the Contractor shall inform the homeowner of
such conditions forthwith and where necessary a written amendment of this Contract will
be negotiated and executed by the Parties. No Contract for residential(home
improvement)contracting work shall require a down payment(advance deposit)or more.
than 113 of the total Contract price of the total amount of all deposits or payments when
the Contractor must make, in advance to order and/or otherwise obtain delivery of special
order materials&equipment,whichever amount is greater.
5. PERMITS THAT ARE THE RESPONSIBILITY OF THE CONTRACTOR: The
Contractor under provisions of Chapter 14 A f h
ha 2 o The General Laws is required to apply
P p
�l PP Y
for and obtain all construction related permits.
6. OTHER PERMITS/APPROVALS NOT RESPONSIBILITY OF CONTRACTOR:
Certain home improvement work (i.e., additions, garages, porches, etc.)may require other
permits including,but not limited to:Variances and Special Permits under Zoning By-Laws
through the Board of Appeals, Board of Health Permits for expansion of sewage disposal
system, Conservation Commission for an Order of Conditions, etc. Such permits, which
may require non-construction, related engineering,technical of legal representation for
the homeowner, shall be the responsibility of the homeowner.
7. DELAYS IN OBTAINING NECESSARY CONSTRUCTION RELATED PERMITS:
The Contractor shall not be deemed responsible for delays in the work described in this
contract caused by regulatory,permit granting or inspection agencies, authorities or
individuals. If the home owner obtains his own construction related permits for the work
described under this contract,the home owner is hereby advised that in the event of a
dispute,judgment and nonpayment of the contractor, the home owner will not be entitled to
make a claim to or collect from the guaranty fund established by M.G.L. Chapter 142A.
8. CLAIMS IN WRITING: All claims for adjustments, repair or replacement shall be made
by the home owner, in writing, and mailed by postage prepaid first class mail to the
contractor and the contractor's address.
9. COPY OF AGREEMENT MUST BE GIVEN TO HOMEOWNER: This contract is
governed under the Laws of Massachusetts. It is executed in duplicate, and a signed copy
hereof shall be given to the homeowner at the time of execution. This contract may not be
effective or enforceable until the homeowner receives such copy.
SITE PROTECTION: Owner is responsible for attic/interior contents exposed to dust and
debris as well as incidental damage caused by the normal vibrations of the renovations. The
contractor will clean outside property of nails, debris and magnetically broom driveway daily.
The work areas of the house will be covered with a tarp during rook removal. The materials
will be removed from the roof with care, so as to minimize damage to lawn, landscaping,
siding,windows and new/existing roofing. Roofing and related debris to be removed from
site. Your home will be kept in a safe and workmanlike manner during construction.
The following proposal does not include replacement of any defective roof boards that may be
uncovered when the shingles are removed. In the event defective boards are discovered,there
will be and additional charge for wood replacement,not to exceed$5.00 per ft. (Add$3.50 per
ft. for Tongue and Groove wood)for removal and replacement boards. Any additional
structural, carpentry, masonry,roofing will be inspected upon roof/flashing removal. We will
provide any pricing and our proposal at that time.
ICE AND WATER SHIELD: CertainTeed Wintergaurd ice and water shield membrane. A
common roof leak problem in this geographic area is freezing ice in the gutters and along the
cave edge. Under certain conditions this ice may expand up and under the roof shingles where
it may melt when exposed to attic interior warmth resulting in leaks. For double protection
along cave edge it is recommended to fully adhere a 72"CertainTeed Winterguard ice and
water shield membrane which is designed to stop any expanding ice under the roof shingles
from penetrating the deck.
L Nil
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FELT UNDERLAYMENT:Install#15 roofing felt over balance of exposed roof deck.
PERIMITER EDGE FLASHING: Drip Edge provides efficient water shedding at the eave
and rake perimeter edges under shingles and protects the underlying wood from rotting. Install
white aluminum roof flashing to all affected eave and rake edges.
SELF SEAL STARTER COURSE: The lower leading edge of the roof sustains more wear
than any other part.of the roof. Sealing the first course of shingles is critical to the longevity of
the roof. Cut shingles so sealant is positioned along the lowest edge of the starter course.
ASPHALT SHINGLE INSTALLATION: Supply and install CertainTeed Roofing Shingles.
All CertainTeed Asphalt Shingles meet the tough requirements of ASTM D3462 and are
certified by UL(Underwriters Laboratories Inc.) We install CertainTeed to ensure that your
home is protected by a premium product. We will install the CertainTeed Highlights AR or
Landmark Asphalt Shingles that you have selected, with 6"galvanized nails(storm nailing)per
shingle and 5"exposure per manufacture's professional specifications. All installation work to
be performed by closely supervised insured professionals that have been awarded the Master
Shingle Applicator designation.
CHIMNEY FLASHING SYSTEM: Remove existing chimney reglet, step, and base flashing
materials. These flashings provide efficient water shedding and prevent water infiltration as
the chimney penetrates the roof surface. These flashings also protect the underlying wood
from rotting. Cut a 1 '/z "to 2" reglet joints into masonry for counter flashing. Install
aluminum step flashing to roof to chimney juncture. Fabricate and install lead counterflashing
to reglet. Secure counterflashing with lead plug and caulk with high grade Tremco Dynomic
Caulking.
CHIMNEY CAP and MASONRY RENOVATIONS: Grind out 100%of the joints to strong
bondable mortar not to exceed 1 '/2 " in depth. Point with Type S or Acrylic Fortified mortar.
Tool finish all restored joints. Allow rebuilt joints to cure for 72 hours.
CONTRACTOR FL)d(Sot� KLC L DATE
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HOMEOWNER DATE (P 6S
Srt2��. �Nd► R
EntT��2E A0066 36yft 514W31C.5 .
w► P.to�q¢ tlet�t
1 pDO. AU e AT StVt tJ q'' I.%6 �latc�►
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AssesAr's offioe (1st floor): .`
iAssessor's map and lot number ........04 ... ��.� • �.�*THETOE
Board of Health (3rd floor);
Sew.age� Permit` number ..... ............. ...." .............
Z DAUSTAMU, .
Engineering Department (3rd floor): 03 �� �o rasa
t6
House number ...................................................................... o,,�oYpy ale
APPLICATIONS PROCESSED 8:30-9:30 A.M, and 1:00-2:00 P.M. only
TOWN OF BARNSTABLE
BUILDING NSPECT .
IIZ- ^- - _��`
APPLICATIONFOR PERMIT TO .. ..... ............ ..................... ............... .................... ......................................
TYPE OF CONSTRUCTION ........ .. A . . ..... ...... . ... . .... .... . ................................ ...........................
TO THE INSPECTOR OF BUGLDINGS:
The undersigned here applies for a permit according to the following information-
wing
Location ... ... �.e... � �, p'y..U.J. .(� 1.
a
r
ProposedUse ....... ........ . ................ ... ..........................................................................................................................
Zoning District ......... ..... ..... ... . . ...Fire District
6 f (, W 6�4A4`
Nameof ' n ... ....... ... ... ..:...:..... ss ......................!�.................................... . .................
Name of Builder;� -. .'...... .:Address ........ ..................... ..............................
Name of Architect .
..................................................................Address ..... /.... ...!�LIF�'XX.-k ..
Number, ...
of Rooms ....................... . .......................................Foundation ........... ...... . ....................... .. ...
Exterior .... .... ........... Roofing ....
(�tt'?SZ ............... g .................
,r, ,� f... .
Floors .vl.... ......lnterior ................ ................ ...............................................
Heating ...............Ft`T..!!�!................:.................................Plumbing ............ ......�V
...... ......................................................
eft
Puy
...
oFireplace ............. ....................... ..................... ..................Approximate Cost ....... . . .
�is� l� -
Definitive Plan Approved by Planning Board -----1_� d V 119 _ Area
Diagram of Lot and Building with Dimensions Fee .... ........t.
SUBJECT TO APPROVAL OF BOARD OF HEALTH
oS 4
� G
-D?/ d IVV,
� R -
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the Rules and Regulations of the Town of B nstab e r ing he abov
construction.
r
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Name .... ..
Construction upervisor's, License ..
ra •�r
HILARY- LAUREN R. E. TRUST
� C4
7VV �J QS S�}Mlfi',q G'i:9NMr�fp� 4
*' •�` 31386 11 Story .Y. Nca ................. Permit for ......�............................
Single Family Dwelling
_............................................................... .
Location ..Lot...#.5.,......10 3..Wild l.d...VV�::Y'....... � �
Cotult
- r -
Owner Hilarv-Lauren R ' E. 1'rus
- .................. .................................... . ........
" frame '
Type of Construction' ..........................................
...................r...........................................................
Plot ........... ....... Lot .................................. 1
Permit Granted .....,November. 5 , 19 07 r
Date of Inspection -1 .."". ...........19
+� Date Compl ted .,.. � . 5..%. .......19 - a
h
f'
Assessor's offioe (1st floor):
THE
Assessor's map and lot number .......67. ... 5� .�.1� • ..�� tO��
• Q
Board of Health (3rd floor):
Sewage Permit number ........ .+.......!...f......" ...........:. : BA239TADLE, i
Engineering-,Department (3rd floor): /a 3 �J� °o ;'6so.
House.:number ..........................................I........................... o UP
APPLICATIONS PROCESSED 8:30-9:30 A.M. 'and 1:00.2:00 P.M. only
` �r
TOWN OF � BARNSTABLE
BUILDING NSPECTO-R
APPLICATIONFOR PERMIT TO .. ....................................... ........... ......................... .........................................
TYPEOF CONSTRUCTION ......../. ................... ................................... .........................
.......:........... . ... ....0.............
1�9�_...-1
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location ... .... ................ ........ ..................................................................S ........ ..(a.77<1�.. .
t
Proposed Use ........ ...... ............................. ... ................................................... ..................
.................. ........ .................
ZoningDistrict ............... ........ ............................................:.Fire District ............ ... ............................................................
]�,, �e 6e,x 6 g
Name of Owner :.. . ........ ... ./.„�..64��A
..l ddress ................................................................ . .................
Name of Builder ,� .. ddress ................ �
y w.r .......... .. ... f ;. ............................
Nameof Architect ..................................................................Address ....................................................................
Number of Rooms Foundation ........, ............... ......... ... ................. ..............
t
Ik
Exterior .... .. ..... .................. ...._............................Roofing ................�......... .........................................................
...............
n
Floors -"... . ......... .... .. .............
........ ......Interior ................ ............
Heating. ( .. 'w Plumbing .V .�...........
�..
i A roximate Cost .......Fireplace ............ ........................ .:...................................... pp 0 .................................................
Definitive Plan Approved by Planning Board _____ ______Q__V -1_�_19 _ Area :4. 1. �3.....1................
Diagram of Lot and Building with Dimensions Fee
SUBJECT TO APPROVAL OF BOARD OF HEALTH
9
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..l� n -�. . . . ....
Construction upervisor's License .�4.. .` .. ....
PERMITS SENT TO ABINGTON SAVINGS BANK
P 0 Box 2075
Abington, MA 02351
i
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,'TWE TOWN OF Bi4RNSTABLE Permit No. . 8.6
BUILDING DEPARTMENT
1 ' j TOWN OFFICE BUILDING Cash ..
7 ML
6�9• f,
�'touv► HYANNIS,MASS.02601 Bond ..........`�'p
CERTIFICATE OF USE.AND OCCUPANCY
Issued to Nilolaos & Samira Giannaros
Address Lot #5, 103 Wild Way
Cotuit, Massachusetts
USE GROUP FIRE GRADING OCCUPANCY LOAD
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.
June 8, 89
............................ 19......... ....... .......
Buildi Inspector
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+� TOWN OF BARNSTABLE
BUILDING DEPARTMENT
2 VesaIr TOWN OFFICE BUILDING
,631. �� HYANNIS, MASS. 02601
MEMO TO: Town Clerk
FROM: Building Department
DATE: �� g
An Occupancy Permit has"been issued for the Building authorized by
BuildingPermit #....... j: �?� ..... _--%.. ... .... ............ ....._.................. ............_ ...
issued toY,l�/f c .._. .. .... ... _......... _..
Please release the performance bond.
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TO\VN OF BARNSTABLE, MASSACHUSETTS; U I L Da N G pEP
A=,027-135 .
` V DATE *--t ez.Z6ii��7 —19 PERMIT�Y'�-
APPLICANT .�
qapeADDRESS r
I N a.l
S RE P . t, RJO.,' TH,S ���
PERMIT TOMUER OF
2,4M ( STORY( ., L� DWELLLIING UNITS
' IMP 0 E p `py• - �+y+`�"��''TI US
AT (LOCATION) - ZONING
•)• DISTRICT_
BETWEEN AND___
(CROSS STREET) (CROSS STREET)
SUBDIVISION LOT LOT
BLACK SIZE
BUILDING IS TO BE FT. WIDE BY FT. LONG BY
FT, IN HEIGHT AND SHALL CONFORM.IN CON STR UCTION^`
TO TYPE USE GROUP BASEMENT WALLS'OR.FOUNDATION
• (TYPE)
REMARKS: j`FiT.7a JlQ'7 RAA ..
7 R
AREA OR
VOLUME g ''CS f� ESTIMATED ,COST $ 60 , 000
000_.On FEE
(CUBICISOUARE FEET) _ .r� A
OWNER !.�Lla.'� ..
1
ADDRESS BUILDING..DEPT.
BY
` THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY(OR
PERt•�ANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THEBUILDING CODE, MUST .BE.:AP-..
® PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOyATION OF PUBLIC SEWERS MAY BE OBTAINEC'r
{ FROM THE!DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE_APPLICANT,_FROM_THE CONDI_INECF
OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. "
7.1
MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED,ON•JOB AND THIS WHERE APPLICABLE�SEPARATEr<".' t_�_
INSPECTIONS REQUIRED FOR
? ALL CONSTRUCTION WORK: CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOELECTRIR ,;3
I' I- FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- 'MECHANICAL-I STALLATIONB`.�`"``'y�:•,�,
2. PRIOR TO COVERING STRUCTURAL �T
MEMBERS(READY TO LATH). OUIRED,SUCH BUILDING.SHALL NOT BE OCCUPIED UNTIL
3- FINAL INSPECTION BEFORE FINAL INSPECTION HAS BEEN MADE- •`�`�' "�•
'- OCCUPANCY. .q„ a
POST THIS CARD SO AT IS, VISIBLE FROM STREET
BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS •
ELECTRICAL INSPECTION APP 10V•ALS
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9 HEATING INSPECTING APPROVALS REFRIGERATION INSPECTION APPR :ya
E G EERING
OTHER —� -- .. ------------
2
z BOARD OF EA
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WORK SHALL NOT PROCEED UNTIL THE PERMIT WILL 13ECOME NULL AND VOID IF CONSTRUCTION iNSPECTIONS INDICATED ON THIS CARD
INSPECTOR HAS APPROVED THE VARIOUS WORK IS NO?'.'TARTED WITHIN SIX MONTHS OF DATE THE
STAGES OF CONSTRUCTION. CAN BE ARRANGED FOR BY TELEPHONE..PERMIT IS ISSUED AS NOTED ABOVE. OR WRITTEN NOTIFICATION.'..*
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R£F£R£NCE: LOT S _
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SHOWN ON THIS PLAN IS LOCATED ON THE , 4- GEOR y-
GROUND AS SHOWN HEREON AND THAT/T io' . J
DOES CONFORM TO THE ZONING o Q
BY-LAWS OF THE TOWN OF 0P'Sms7-ABt-E
WHEN CONSTRUCTED. su���
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