HomeMy WebLinkAbout0011 GOOSE POINT ROAD /f .Soo.se �o.�f
L-
Town of Barnstable *Permit#
°F'iHE Tph,
P� ti Expires 6 it rttltsjront issue date
Regulatory Services Fee
+ BARNSTABLE, r
y$ MASS, g Thomas F. Geiler, Director
ArFD MP'l0.
�1AY ; ding Division
4 TWVT. erry,CBO, Building Commissioner
r 200 Main Street, Hyannis, MA 02601
; a TA ftEtown.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
J Not Valid without Red X-Press Imprint
Map/parcel Number
ZProp rty Address L
Residential Value of Wort. YO 41 `"� Minimum fee of$25.00 for work under$6000.00
Owne.r's Name & Address � f' iJOrr L�✓I/� �l 1 ��
Contractor's Name 13#Mo s ! ✓1ocy / _ Telephone Number Y01 cp(" Coo
I Ionic Improvement Contractor License# (if applicable)
Construction Supervisor's License# (if applicable)
❑Workman's Compensation Insurance
Check one:
VI
a sole proprietor
the Homeowner
ve Worker's Compensation Insurance
P <
Insurance Company Name 6.e4LLy4l
+:
Workman's Comp. Policy
Copy of Insurance Compliance Certificate must be on tile. � ?
Permit Request(check box) ".
❑ Re-roof(stripping old shingles) All construction debris will be taken to
❑Re-r of(not stripping. Going over existing layers of roof) r,
❑
-side
, f
Replacement Window QIdoorslslide)rs -Value (maximum .44) 14
P ��� ,✓ r
*Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
'Note: Property Owner must sign Property Owner Letter of Permission.
A copy of the Home Improvement Contractors License is required. `t
SIGNATURE:
k
WN-ll.LS% 0RMS\1huilding permit lorms\EXPRESS.doc
Revised 100608
h
,
.w
Customer Name._ litLl?Lgt/ C,� _ :.Year Bttilc:
�— t2ettewal bt Andersen of RI&Cape C d
�1� � t/ C=reSe_ � ,-t Ctummes[I)
xy,a d� S t� eetrlent Address 37 par r I i k East IJ ve
r
+<a. Cin,state,Zip a k- order Number NKroonsockcr,RI U995
�?Y12( CtSetl Phone Homt �77x `t' -C5S�5`�
wtkoow REPL tGEMENT'-n 1 dr. n< ;ipa�y I of e�Krork Ixage ltrease RI 12259'-;kk 1113>3
t l of Datc
Email f�LF� D lQ�rrct
� f6�
fri
: es'
:CTos62
�2> '
5 ! i./ Technical Measurn
ttNtiS J E� i31. GRILLES
Rb
m .�+`',I:a.e n.ak: 5N � m��+ '•�@ rL a3v �.b aE nk_ `• c i ig� v ,:x I _v ya, t b .o
_ o
A .. e fi'O ;r "'V N. .tC.N O E.E T.. '.tiE .4.,. gg _
E Room. H. i-.ate *t.6. . �� �3.rp`a 'dv.a 'zn ::x. «G .a`- .p�; 3:: c2 ed.~ ail a. I .'m`^..w cn . ''ti zs $.PRICE S
pg.: oesmpUon' a . ::,E �xg: �. fib I `o: :' `aC s7g - -' off. _ y y wz:. a N
a -'s« - N Npp` a $ .Ne •�- a - _: N`o l `o - �... o -1,X :^ _u _
H,
l
i
i
l
Pxo osaL Ati of the*,m nt_,�. 't�:;o.:s„bs o.P3 d,cr h nl a.rt src.ez' d,x a .=nc IT,e -hliseel! neous Credirs or Ex cnte_s Sub Total r s"%
P p i�cree Sraicxin i;a Rix lip air rramocoa,'=tcl -- Payfftent Ntethod
P axi1�1.rc�9.m wL.f for'•„days an3 b tt:n c7+•si b to tF to tuner.'I Raua9,1 by Acsdreoen;<tan'grr as : i' R' p' p '" Sub Total tWdu.rasss; ... .
e
Ch ck
f e f
- Sub Total Ias
''C:.CEedit Card .
Cu.¢tOtFteF 11,CCfptailee:Yc,a uc b,ssbc aurhurs d m fu. xti an s9coG•a+Ml dxrs rgwrad e 1 2�9i ' MISG Credits or Expenses +.
egtrou9u.foe w7+ich tzar um{n.4:faed a8;—;v par e,<ar*ai.w sMx d. a.,µ age=rmeat a i u r1,:g ro d:c t .
See Reverse Sidefor'Terms and Conditions of Sale;You,the buyer,may cancel Total a Ci Financing
this transaction at an time. riox.ta zttidttiRht of the Hunt business day after �'
,. ---—
!the date of this transaction Please see attached notice of cancellation for an 5 I s 7ax os a d=a f!eay .
ae
csplanati0 Of thl3 nigh. j r ml?dtxrrllznrotts Cr lits o Pxpczs a
l ii `�^y� /'•+ y p..c..al Orderx Amount addt8cnai ordc Po•9ns Actathod
Acc=pird Y !!Jr/0 r' �.t'xM..LL�-_l r L`.(„l'•LV�'=� c:'�m"bre,coca?ro rvse.uceax npr.�.x cu r u:ignr). Work Permit Cost
a � - _ CpieN uitte nS hn7 RPly4
1 A'"pccd " - - .. .. - ----.... of Agreement I �!?,� a y�ar[nt9y onor .
f _
- IN— Total Am
Dau Rcn c-af by:Sa s>ec Rfanage..S,R. dnK. .: - .-� / /� / .. Deposit Required !l CIlJr3 -1 G' sp 'afty".d—
Arp paa fay,t,.a..ap ai :. - Beaeival by dvde/sgi P.emma tad ri'�,.aSalNn Beau s o to•rx arc unable to bid npairi,x -°' L"f"t� F ._ ...... ..-
rvo papanrq fifth maY dxs a[9+ura-cee un. .. 'of wvrhu ccvc,i: t _ 4A a�L�.t TPl R.,. i, i _7 �ftad Z i t l` 4rd>� Balance true an Completion i/t ,p/� >t♦,
9,sa ry xear do 4T-Navvxr�:fmi -zdama � ...:
Le aee4dencrmcNfnt rn of aagaai nfr,Snv 9akirthe rzs,^,cr�7i;laf ix evcom'ec d;r.?rg as9a.4i mll comp:in /' `IP4 ..
in M1989,ttmenxenlesx mx+nl `r y ^ S9�.,/ I,atak n[na,ea`,s X lhs cnlotM unlc55 ml�iatgs j+w fa'tlic,eWurs cpaR yule ygitavat (3 __.�_ 1.0 Chi T- rice illdcs Iaf,oe,r-9a tia;x:[csixllarl—,
sp.Y.iRwl!y mteC abase. ^�me imQld, -` u0:—ist acted, r:th,ea�ai�ej.yaUm ;i+>^aa:Cebu n:J be
rrmmed aw efxTd—ya,a atwnLdnar9 and- VAIte-Renmaib Andetsrn Ye;iova-ins2xllaL'cn ?.' removal,'xnd di nl n}: mdcx<S r<.Iaceti.
zn
Customer Customer cmtomer ,' ns Homeouaer �' P p
Initiair. t]a,..L, initials;
''.'..'. : : 9i.'�.Ifwa ,:.m'u:3c.iW��w?#Mecim Wp me eukmu6N4,derxa C„pw:.:.6 W5Av!s:w,C+:+P^'�"-M''t1•••rtcmd I"JB.'+rvn#r R iOM
The Commonwealth of Massachusetts
07. 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 Lezibly
/�,
Name(Business/Organization/Individual): �t ooglV _&` :TAIL
Address: &R 1_.`ad OV-Ac
City/State/Zip: CUddN 0�,Iz/,�, Phone.#: 4101— Q . 60
Are y an employer? Check the appropriate bog: Type of project(required):
1. I am a employer with .)� 4. ❑ I am a general contractor and I 6. El New construction
employees(full and/or part-time),* have hired the sub-contractors..2:❑ I am a sole proprietor or partner listed on the attached sheet 7. . emodeling
ship and have no employees These sub-contractors have g.'❑Demolition
workingfor me in an capacity. employees and have workers'
Y P h'• # 9. ❑Building addition
[No workers',comp.-insurance comp.insurance.
required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions
myself. [No workers' comp. right 6f exemption per MGL 12.0 Roof repairs
insurance required.]t c. 152, §1(4),and we have no
employees.[No workers' 13.❑Other
comp.insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensationpolicy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'corgp.policy number.
I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site
information. I
Insurance Company Name: e f,4COA/' !'/U V
Policy#or Self-ins.Lic.M Expiration Date:
Job Site Address: I, 6005'e F7L, City/State/Zip: C`w
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 lip 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 ce under the pains•and penalties of perjury that the information provided above its true and correct.
Si e: — Date: —
Phone CgCV
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 CIerk 4.Electrical 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 engag m atom en ,rpriseinel�the leg represen�atiiTes 6f- deczasezl empiuye�or
receiver or tiustee 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 dweouse
lling h
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 in.��ce
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-contiactor(s)name(s),address(es)andpbone number(s)along with their certificates)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 permit4icense 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
tAwn).".A copy of the affidavit that has been officially stamped or marked by the city or town maybe 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 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:
Tlae Commonwealth of IMassachusetts
Depaxi meat of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
TO. # 617-727-4400 ext-406 or 1-977-MASSAFE
Fax# 617-727-7749
Revised 11-22-06
www.mass-gov/dia
TIr � Town of Barnstable
�. Regulatory Services
9 Mg Thomas F. Geiler,Director
16 Building Division
Tom Perry,Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-403 8 Fax: 508-790-6230
Property Owner Must
Complete and Sign This Section
If Using ABuilder
/CZ. clv ck ek ,as Owner of the subject property
hereby authorize 90-n4t to act on my behalf,
in all matters relative to work authorized by this building permit application for.
(Address of job)
See �- • U-p C'6w T-
Signature of Owner Date
Print N
If Property Owner is applying for permit please complete the
Homeowners License Exemption Form on the reverse side.
O:FORMS:O WNERPERMISSION
Town of Barnstable
THE tp�yT
Regulatory Services
� Rli�AiCTIRi
Thomas F. Geiler,Director
taAs4 . g .
�orED 16 $lli dixig Divisiou
Tom Perry,Building Commissioner
. .200 Main-Strce Hyannis MA 02-601
www.town-barnstable-ma.us
Office: 508-862-403 8 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE:
JOB LOCATION:
number street village
"HOMEOWNER'*
name home phone# work phone#
CURREN-r MAILING ADDRESS:
cityhown state rip code
The =ent exemption for"homeowners"was extended to include owner-occupied dwelling 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.
DEFMMON 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 siructures accessory to such use and/or farm structur6s. 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 Tpwn ofBA=table,BuildingDepartment
minim=inspection procedures and requirements and that he/she will comply with said procedures and
requirements.
Signatirm of Homeowner
Approval of Budding 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 bomeownerr performing work for which a building permit is required shin be exempt from the provisions
of this section(Section 1D9.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such
work,that such Homeowner shall ad as supervisor."
Many homeowners who use this=CMTtion are unaware that they are assuming the responstbtlitics of a supervisor(see Appendix Q.
Rules&Regulations-for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problerns,particularly
when the homeowner hirrs unlicensed persons In this use,our Board cannot proceed against the unlicensed person'as it would with a licensed
Supervisor. The homeowner acting as Supervisor is ultirrmtcly responsible.
To ensure that the bomeawner is fully aware of hivbar r esponnlnlitics,many communities require,as part of the permit application,
that the homcowncr certify that�dshe 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 sucb a formIcertifieation.for use in your community.
Q:forms:homccxcmpt
From:Via wrxna Roble snf>, Hie-tter Ir'tecronce At:Hunter lose ance,In d wdG: To:Dr;nlsa GlOde Date: 19= t t:Id AM ra90> 4 01
_.. _ 1E? ATE fbSAtft?f3trYY="1
5
CERTIFICATE OF LIABILITY INSURANCE ���OP to 09/29/08
f"'faOOMCC- - _ .... _. THI$CERTWICATS IS ISSUED A$A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Hunter Insurance, Xnc. HOLDER.THIS.CERTIFICATE DOES NOT AMEN(),EXTEND OR
389 Old Ri vcz Road, P,0. Box 1 ALTER THE.COVERAGE AFFORDED 6YTItE POLICIES BELOW.
t4auville: R1 02838-0001
t1hone; 401-769-9500 rax:401-769-9502 INSURERS WORDING COVERAGE NAIC#
[4^s:3l1REG th°,�5,"F�"E{G: ��7:dga•t titan . �`rzscaranxw a.A
Moon .Associates Inc,
DBA Outter ;!{e}RTL�t ( S�zRB s.•aaan Lut�•t ivtarar«�ac � __ _-
D5A. Rene al bV�r Andersen: of RT
e met Roofing
11.37 Pagk East Drive
Woonsocket RI 02695
COVERAGES
=T 4�sf.lCf�t C3i-GT'C Lisi 'T fYr:L04E 3tAVE lE.�4 "' .f�'PA'Fi i�fSlX t1MY3 tV.�?F'O£?'1 f: .te.',Y F`a=4iaC3 lhsG+fC.RTc'J iv�?tY4"si'}#'Y&, 34tI�-:r ..
svY MY9.ARENe rT,TENS(1A C x9 T 1:.N OF ANY CCl43TRlk-T OR Q Yt{}9 t.)ZAC�. ''4 W M4 .$KCT TO WHt,!"t Tt 05 f f".fY'i4MATE MAY or 4 ^*0 OR
MAY 4>FMAIN,T)-E 9«"sLP1tF3 X 4T"i3>:%- D w ti iE Y�C14.fC€�3 C�.-"a[:TSIt�:C4# i£7PF is'u"1.w—ct ro AZL."fii TE.rziS .E4CE;Lkf`i ogs AM C101LOat(xis C.)F;DES
POLIC ffn$A-30P OATE LIMT'S SfIO"14 4,,Y i{A14 td r7EC..4t.K;ED a,Y PAID t.'t..A#,S
V45R P t T PTfET+5r x- T1fFti »a.m __ __ ._�-.... ....._ _._ ..
LTR plSR TkPE OF ihlSURAtiz E G4,lC1 fJUA Pt OA�titT�SF03 O4lE f4tl Lot 4TS
a€_rlEW-1LfeZU-rTY CHOCCURRENCE S 1000GOO
Cf ,aEtz u4 G tt 4zat rttr 14PS26619 0911,6108 09/16/09 r tstst af���ccaFw�.e Y 5Ai}D4F1
CUV14 W't r I X 1 LV-u".;A LED EXP V nv thew+) $10 0 0 D _M
AovIN'KRY.._w_._* 1000000
FFC6,NeRA.Ac,0W.CW,1'F _ $2000000
!POLICY
aTrraaoelT.p rx.�r � t _
4:40tfr 611*t.�0,11T $1000000
K (Ea Gfe$14 "dl
A X asNYXJM 81326619 09/16/0� 0s/�6/09
w.. Al t3'sA'T3'."T ALITW
"a'c:t-Ra1dtY7,WTO's Ievr WWII
}
_ ... __ �•errzY f�JArx;
6 fi f 14t1f32STY # AUTO W-Y•EA AMMO $ __
tATFC-ft iAtiM
3 P100 OMY
}}.1EXCESSMP49TLE4.LAL3A84JTY EACH 0000;1 >z $ 1000O00 _
A CtA4,AsWL& CUS26619 09./16/08 09/16/09
Tt'!»Twif,N 310000- $
t".K?ftKDRu C�2fe1F*�'Ri�.JiTYJ4d J.BlE? 6P°�Y t f FfS"`u� C:fi ._,.....
. _.
FAMOvt?ftS•LtttsiLTrt
T 28586 10/O1/08 10/01/09 Et�O�F $500000
,W�er¢�ti2lE r Gfc+FW�"+P+Cf�t:u.C�ttt�t�
EXCL=�€Em E.L.R1SEAGE• Err +fEE $50 0 0 O O
If r .a 5»zits aSrr w
car.C3f c`)V4w wo-o f 'L DISFA4E-P,0 rYLOA t SO0000
s.��'�C�tiP'T^ ��its OT�#�r.TfCs!�L{3t� t uEts�eLE:�t Ixtit4slt ��'� �t�wrr�l.p}24)VI 7=Ot3`3
CERTIFICATE HOLDER CANCELLATION
SUILDIN $H4MXA AW OF TIRE ASOVE D4 SCROF-D POt CIES 86 CANMLLED WORE 7H&EXPfR4n*ff
D.tTR n4EREOF.THE ISSL#JG MU PER t*A.L EPVC-AVOR TO MAR, 10 O-YS V-R Tw
Building Coat. Reg. Board W.
=U TO THS C 'nMATE Ha DER sEa TO TW LEFT.euT FALURE TO QQ SO SHALL
Dept. of Ax4nitxi.s tration 9WO1.6 No L4SUCAT04 OR f.ASLITY OF.AW KIND iJP'x'M THE WSURER.frs Ac'em OR
One: Capitol Hill
Providence RT 02508 EsiGraTaT d.
n .raj. t3 f2Ef!FT�MSEWYI+`f1Y�
ACORD 25(2001108) OACORD CORPORATION 1990
.- �a
License or registration valid for individul use only Board of Building Regulations and Standards
before the expiration date.,If found return to: HOME IMPROVEMENT CONTRACTOR
Board of Building Regulations and Standards Registration: 119535
One Ashburton Place Rm 1301
Boston,Ma.D2108 Expiration: 7/24/2009 Tt# 130189
Type: Private Corporation
MOON ASSOC INC
sAMES MOON
` 1137 PARK EAST DR. �,,C��.•,_
Not valid ithout signature WOONSOCKET,Ri 02895 Administrator
�t:t ,t ht:,itt; i3cit:tt"ttrr�ctt ,If F'ttittsti �.tttfl Restricted to: RF;NS
w tjei,u 11 ut l3Ftilt4i+�� ftt, ttiattllt+• t+��l ,t it�f t;-�6•
IA- 'Masonry only
RF- Roof C(wer€ng
9840 WS-Windows and Siding
to: R WS SF- Solid [duel Burning Devices
DM-Demolition only
,TAMES MOON
48 PAiNE ROAD Failure w possess a current edition of the
CUMBERLAND, R! 02864 1lassachusetts State Building Code
is cattw:for revocation of this license.
Refer to: WWWAN1ass.GovfDP`S
23M♦
C�
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTINO
?. (print or Type)
` TOWN *OF BARNSTABLB QDate qC.� 19
Hyannis. Massachusetts D - Qd perrttit i ! ��
Building Owner's
AT: Location Name
1 Type of Occupancy:
New ❑ Renovation ❑ Replacements
GPlans Submitted Yes ❑ No ❑
e
W w W F o • �' f z to
O
i a IW- K002 . 0 Z 1W-
N O W < Z = 1- b C ■ <
W W q W Z_ tV X K
O F- Z J F- i' H w Y O C > LL f t 1 J H W
s Y O C �MZ1I a ; O 4 J V t > O a H O
$Ua—asMT.
■ASEMENT
IST FLOOR
2ND FLOOR
3ADFLOOR
ITHFLOOR
aTHFLOOR
GTN FLOOR
7TNFLOOR
aTHFLOOR
(Print or Type)
• Check One. Certificate
Installing Company Name 6;orp.
Address 1,77 ❑partnership
❑Firm/Company
Business Telephone�aGj Name of Licensed Plumber or Gasfitter
1 hereby cartllr that aU of the doulls and Information 1 have submitted(or entered)In above application are true end accurate to the beet of Mir
knowledge and 11at all plurnbinS work and YataSathons performed under hrrnll laud for this application wW be In oornp1moo trltll eE purUs"I
prorialons of tJr Nuaadruaalte State Gas 0W@ Ord chapter 142 of Ure General Laws,
I have Informed the owner or his agent that 1 .do not have liability
insurance Including completed operations coverage.
Signature of Owner/Agent
I have a current Its ility Insurance policy to Include completed operations
coverage.
By TYPE LICENSE• ''
P um er
Title Gasfitter Signatyre of Licensed
City/Town: .aster Plumber or Gasfitter
Journeyman1;7-.1414
APPROVED (OFFICE USE ONLY) License ��q•�i/�
BELOW FOR OFFICE USE ONLY
FINAL INSPECTION _ SKETCHES
/� PROGRESS INSPECTION
FEE F 3
NO.
APPLICATION FOR PERMIT TO DO GASFITTING
NAME A TYPE OF BUILDING
#
LOCATION OF BUILDING
PLUMBER OR GASFITTER
LIC. NO.
PERMIT GRANTED
DATE -� 19 SL,
GAS-INSPECTOR \
Qy�FTHEt TOWN OF BARNSTABLE
•
B98HSTLUE, i
"6 9 BUILDING INSPECTOR
o ,,
'FO MPY a'
APPLICATION FOR PERMIT TO .....rt ... .... ................... ............ ............ ........................................ ..........
TYPE OF CONSTRUCTION ...... �.. ............... ........................ ........... .......................................
N.
....1.......C... .1(.................19
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit ccording t the following i o atio :
Location .�.... ' -......... '........s......... :34 �1,� ..............................
ProposedUse ... ,/� .. .. .. ...... .... .......... .............................................................:............................
ZoningDistrict............................ ................. .. .....................Fire District ..............................................`...............................
v
Name of Owner .. .. . .. .... . . . . . ...Address .. / ••.•. ,•,. (....
Nameof Builder ....................................................................Address ............................................................................
OF RC� O
Nameof Architect _....... �� ..����. � �J ...........................................................................
TVAE PR
R SUPPLY' p
Number of Ro IT. W A. Ht �Y.. �' `.z.``'�kundation ..............................................................................
Exterior ...............® ®�K�NA � ��
AN Bl i ABL
,,oV �..OF... ...................................................................................
AL
Floors .BOARD OF HE
....In
Heating ......: ............................t f.........
�...� l l n k.......................
................... ............................
Fireplace ..................................................................................Approximate Cost .............1.. ...V...........................................
Difinitive Plan Approved by Planning Board ________________________________19________.
Diagram of Lot and Building with Dimensions4 tfl�
I
I hereby agree to conform to all the Rules and Regulatio of the Town of Barnstable regardin the above
construction.
Na 51vti�\G / ���
-
Shaw, 0ozxoau fI°
� ��pw~w �
� `����
,
No .... Permit for .........tool...ahed.......
'
—^~-----^^---'—^--^'^^—^^^----`'
�
II Gmoaepoiot Road '
Location ---.—.----------------' .
Centex-viIIm
.—.--.--.—.—..~,—.~------.--~--..
Owner .............Norman,B ...Shaw
~
Type ofConstruction ------.M�—m*tal
—.—.—.—^.—....---.—.---.-------.. / ^
Plot ............................ Lot ................................. �
' v
Permit Granted _..Uotobar..I9____..l9 71
� Date of Inspection .---.. -----'lV
Dote Completed —,��� � .TY---..lg
^
| ^
�
PERMIT REFUSED `
* `
-
.—_..,~—..—...—.-----..-- 19
-
'
-~-------...~—,.....---..— ----. '
.. — / ^
-
..._.--....------.~..--...—'.—.—.—. �
` . .
^
....~._..---~—....—_.....~..—.-.—.--. ^
.---.-.—.-.—.-^...—,^..—.~--.....—~.— .
Approved ................................................. 19 �
' |
-------'--------^^^—~'^'~^^^^~—'
-------`--`----'-----^---^~^^
'
|
�