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Home My WebLink About0061 PINE AVENUE Cv � �t n L, R �� . � TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION R--m l eJ Map `-Parcel l Application # / - S53 Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Sl Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address Village ( k� VX ZA Owner Address jl- Telephone Permit Request if� Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation j 2 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 i 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: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: R1 III DING nF-P Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ MAR 0 6 2017 Commercial ❑Yes 360 If yes, site plan review# OWN OF BARNS?-ABL!. Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name F 4AN Telephone Number `�,�� Address ( V Z44 � License# V` &am-a, — 'ontractor# Home Improvement C Email Worker's Compensation # W0Q0 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJE T WILL BE TAKEN TO SIGNATURE DATE L ,- FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER `t E DATE OF INSPECTION: FOUNDATION L FRAME ti INSULATION 4 FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL ' FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. i . f ' The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 0 Boston, MA 02114-2017 ..' www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILET)WITH THE PERMITTINQALITHORITY. Aimlicant Information Please Print Le ibl Name (Business/Organization/Individual): Il. j(L 6 V`/ Address: I �V OVL GW cI& City/State/Zip:'✓U. GtiV'�l,01�4'I'w► �YI,� Phone#: `%Jb8�`�`��' Ml� Are you an employer?Check the ppropriate box: Type of project(required): l-1 am a employer with ;� employees(full and/or part-time).* 7. New construction 2.[]1 am a sole proprietor or partnership and have no employees working for me in $. Remodeling any capacity.[No workers'comp,insurance required.) 3.0 I am a homeowner doing all work myself.(No workers'comp.insurance required.)t 9. ❑Demolition 4.M I am a homeowner and will be hiring contractors to conduct all work on my property, I will 10 Building addition ensure that all contractors either have workers'compensation insurance or are sole I I.❑ Electrical repairs or additions proprietors with no employees. 12.Q Plumbing repairs or additions S.Q I am a general contractor and I have hired the subcontractors listed on the attached sheet. These sub-contractors have employees and have workers'comp.insurance.1 D.0 Roof repairs 6.0 We are a corporation and its.ofpcers have exercised their right of exemption per MGL c. 14, 0ther 152,§1(4).and we have no employees. [No workers'comp,insurance required.) "Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp,policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site Information, Insurance Company Name: 16 Ckk+A( 1 ✓, Policy#or Self-ins,Lie.#: Cam, Q �j Q Expiration Date: ;,20 i Job Site Address:/ City/State/Zip: !IT , W Attach a copy,of the workers' compensation policy declaration page(showing the policy nu b r and expiration date), Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to $1,500,00 and/or.-one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify un 1 alns and pe alt' s of perjury that the information provided above Is true and correct. Signature: Date: Phone#: Official use only. Do not wrlite in this area, to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2, Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: Massachusetts Oepartment of publlo Saw/ rIt,Oj� Board of t3ttllding Regulations and Standards l.lcense; 08.100M Conatruotlon Supervisor, 4 milW HENRY E CAS-SIDY, 0 SHEO ROW n I WEST YARMOU; H n, I� v01 , �• t �' Expiration; Wnrnissloner 1 111 112 0 1r C / E r' , Office of Consumer Affairs and Business Regulation 10 Park Plaza = Sulte 5170 Boston, Mai, ab usetts 02116 p mA Home Improveme.:: .o••tractor Registration ,M =�^��I,�,•.-•rvf-''.'�� Type; Corporation Cape Cod Insulation, Inc s n• 163687 �'� w Expiration; 12/14/2018 18 Reardon Circle So, Yarmouth, MA 02664 IV �s 0 +i 20M•08111 Update Address and return card. Mark reason for change, 1 ' ^ .. de�'a7rt7�t.___.._,_:,y�Cl/�aaaao% ._.__. ,_._..:_..•___,_.._.6�.Adr,'.rfa'•�a.•.[''lawt:�Cl.tt;F�L_(1�plo��pzetlt_Ca-A.c�.gt C•�r�l.. a�trvea�C/o uoelA• Office of.Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only As,, Corporation before the expiration date. If found return to: j •.•<;': '"' Exnlration Office of Consumer Affairs and Sualne egulation �� 10 Park Plaza•Suite 5170 ! 12/14/2018 i,I Boston,MA 021 Cape Cod insu I t y .f. ,, i, Henry Cassidy lr<; r 18 Reardon Ciro ` ��R.CG•Q�r�-.---. So,Yarmouth,Mj Underaeoretary voffd7 ho 4Agnature i � l i _._.._.................... __.... — -�1 CAPECOD•27 DEATON A`COREY CERTIFICATE OF LIABILITY INSURANCE DATE(MMIODIYYYY) 7/29/2016 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, I V. IMPORTANT; If the certificate holder Is an ADDITIONAL INSURED,the pollcy(les)must be endorsed. If 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 endorsement s PRODUCERTACT Rogera&Gray Insurance Agency,Inc, 434 Rte 134 877 816.2166 South Dennis,MA 02660 IleA16881 CRE mall ro ers ra ,com INSURERS APPORDINO COVERAGE NAIC q INSURER A I Peerless Insurance Company INSURED INSURER 81801f(ItY insurance Company 39464 Cape Cod Insulation,Inc, INSURER c(Endurance American Specialty insurance Company 41718 18 Reardon Circle INSURER oIAtlentic Charter Insurance Company 44326 South Yarmouth,MA 02684 INSURER @ t INSURER P t 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 POLIICY 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, INS AQDr Will L R TYPE OF INSURANCE J=Wa POLICY NUMBER M D M A X COMMERCIAL GENERAL LIABILITY LIMITS EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE M OCCUR C8138263063 04/0112016 0410112017 , $ 100,000 PRE MED EXP(Any one erson $ 6,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERALA05REGATE $ 2,000,000 X POLICY Q INT LOCH" .__ PRODUCTS•COMPIOPAGO $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY FSO.M.21DLIMIT $ 1,000,000 B ANY AUTO 6232707 COM 01 04/01/2016 04/01/2017 BODILY INJURY(Per person) s ALL OWNED X AUCuTOSUIEO BODILY INJURY(Per accident) $ 'X HIRED AUTOS X AUT08WNED $ X UMBRELLA LIAR N OCCUR $ EACH OCCURRENCE $ 2,000,000 C EXCESS LIAR CLAIMS•MADE EXC10006635001 0410112016 04/0112017 AGGREGATE $ DED I X I RE ENTION$ 10,000 WORKERS COMPENSATION Aggregate $ 2,000,000 AND EMPLOYERS'LIABILITY D OFFICERIMEMBER/EXCLUDED?ECUTIV@ Y� NIA WCE00431902 0813012018 0813012017 E.L.EACH ACCIDENT $ 1,000,000 (Mandatory In NH) II Yyes descr vRIer E.L.DISEASE-EA EMPLOYEE $ 1,000,000 DE8 RIPTI OF E T 0 below I IE.L.DISEASE•POLICY LIMIT 111 1,000,000 DESCRIPTION OF OPERATIONS f LOCATIONS f VEHICLES (ACORD 101,Additional Remarks Schedule,maybe Attached If more spoof Is required) Workers Compensation Includes Officers or Proprietors, Additional Insured status Is provided under the General Liability and Auto Liability when required by written contract or agreement with the Certificate Holder, CLEAResuIt,Eversource and National Grid are listed as Additional Insureds on this pollcy on a primary,non-contributory basis, CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVMONS, AUTHORIZED REPRESENTATIVE ®1986.2014 ACORD CORPORATION. ell rinhta raaorvarl 14. The Parties acknowledge that this Agreement.is under seal. It is intended by the Parties that the.Tenant or any successor Tenant is the intended beneficiary of the Agreement and shall have aright of enforcement. A s i� Property Owner's Signature: 4 pate -" r Phone: 4j Address: Tenant Signature Date Agency Approved Weatherization Company GM — jj(�`� Adam T. Incorporated / All Cape Energy / Alternative Weatherization Cape Cod Insulation- Cape Save I Cazeault Frontier Energy Solutions I Lohr Home Improvement I Tupper Construction Agency Signature Date 14. The Parties acknowledge that this Agreement is under seal. It is intended by the Parties that the Tenant or any successor Tenant is the intended beneficiary of the Agreement and shall have a right of enforcement. Property Owner's Signature: Date Phone: Address: Tenant Signature_ U ! I r1,1111 Date4, I Agency Approved Weatherization Com an 9 Y pp p Y Adam T. Incorporated / All Cape Energy / Alternative Weatherization Cape Cod Insulation I Cape Save / Cazeault Frontier Energy Solutions / Lohr Home Improvement. / Tupper Construction Agency Signature Date ...�y....Y'ti,- ,.--,. .�,a.-.;•Ww.,r«7`"...,_, .. ,....1. ..r,. y.., •� `+^✓^"`r-� .�..y..y :.,,..,t'.•-:-.r..,-,.ro..,..• r�y.,A F...N^"""''""'� "'..'r.•.+.....,.� ��1HETp,_O� The Town of Barnstable BARE. Department of Health Safety and Environmental Services N. Building Division 367 Main Street,Hyannis,MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner Inspection Correction Notice Type of Inspection -U�-- Location Permit Number Owner Builder One notice to remain on jobsite, one notice on file in Building Department. The following items need correcting: Air�&CA-� V C-0 V1"N�C�- ok t* O 0-kk- K-c� --- Please call: 508-790-6227 for re-inspection. Inspected by Date � r i °F THE The Town of Barnstable MMSTABIA Department of Health Safety and Environmental Services P `J ArEDMA'�p Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner For office use only Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW _ SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than _four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors, with certain exceptions,along with other requirements. Type of Work: P_W 0V q+"6V 1 Est.Cost of 1 O O O Address of Work: ro I P t rI Owner's Name ALA 6 W W, 6 F— Date of Permit Application: — I ( 9 —7 I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under$1,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contr for Name Registration No. OR Date Owner's Name The Co►nntonivealth of Afassachusetts -W71. Department nt of Industrial Accidents ofice8110yeSM21/ons 600 Nashingt irStreet :►' Buctun7 A1u.vs. (12111 Workers' Compensation Insurance Affidavit Llpplcant information: --~- Please PRINT le�i�l jp "—"""'-'—'•""'�'•��`-•"�•�"—��• — ' name: G, locition: city l' 1S 4- 2i) I ( \ i ( da nhonc# 1 am a homeowner performing all work myself. LV ' am a sole proprietor and have no one working in any capacity • __..:. .,....;--.�-.s-,.,_.......__,,,.,_•.-r,...,,...,-Y.-s,.cry-•-•'�-'n.+r^:..x..-.-..-,.......,�...�..,,...�.:..�,.y..,...�. ,.�.r.�...... ,�-.•,.-...•.--«..,.,�-....____ I am an emplover providing workers' compensation for my employees working on this job. co_mtianv name: address• city: phnnc#- insurance co. policy# . .ar..�. •.+w.wn.w.w..�r�T\rw.f+�+�. ❑ I am a sole proprietor, general contractor, or homeowner(circle one) and have hired the contractors listed below who have the following workers' compensation polices: comnam• name: address- city! _phnnc#• insurance co. nnlicv# ! • T.::•'�:. Yam"-'- - - ._'T':Y•••::"-.•_�_- -- r^:b: �;�iT"1^.'.ww. ..._. ._ .R.—� ��_...._... conspiny nnine: address- Phone#: insurance co, nolicv# Attach additional sheet if nccciiArx =• :r^-=°+ - % ~�'T�"��''�'�"� _� ' w-� r:iilurc to secure coverage as required under Section 25A of AIGL 152 can lead to the imposition of criminal penalties of 2 line up to S1,500.00 andiur one scars' imprisonment as well as civil pcnaitics in the form of a STOP NVORK ORDER and a fine of S100.00 a day against me. 1 understand that a COP) of this statcrueut may be forwarded to the Office of Investigations of the DIA for coverage verification. 1 do herehv cerrij-under the pr 'its and penaUies o perju •that the information provided above is true and correct. Signature ry Date 7 Print name Phone# official use unly do not write in this area to be completed by city or town oli-tcial N. city or town: permit/license# riBuilding Department . [3Liccnsing Board Q check if immediate response is required c3Sclectmcn•s Office f [311ealth Department contact person: phone#: nOther : ..�._._ ..._.. ......�.�...-..�..�.. ----�.�--ter... _.._... . Information and Instructions 2S oni cnsation for the Massachusetts General Laws chapter 15_ section __ requires all employers to provide workers c. p P q P P employees. As quoted from the an etnpl(rree is defined as every person in the service of another under any contract of hire, express or implied. oral or written. An rmph rer is defined as an individual. partnership, association, corporation or other legal entity•, or any two or mor the foregoin- enLa�s 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 th owner of a dwelling house haying not more than three apartments and who resides therein, or the occupant of the duelling house of another who employs persons to do maintenance , construction or repair work on such dwelling he or oil the _rounds or building appurtenant thereto shall not because of such employment be deemed to be an employe MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance of- renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not Produced acceptable evidence of compliance with the insurance coverage required. Additionally, neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public-work until acceptable evidence of compliance with the insurance requirements of this chapter i� been presented to the contracting authority. Applicants Please fill in -tile workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names. address and phone numbers as all affidavits 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 requires to obtain a workers' compensation police, please call the Department at the number listed below. Citv or"lowns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom o- the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Pie: be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned . the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any question please do not hesitate to give us a call. I r..y,v�'•...•_.... ...__..—•-..,....•. .._.._...r.•r....:e�...—..v.._-s.-,w...i__....+.n+.n....++.w•e...,.�wr�+. . w—._...+w.-�r�ao.r�rrr -.E^rn��w..ro.�_' 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 fax #: (617) 727-7749 phone #: (617) 727-4900 ext. 406, 409 or 375 DEPARTMENT OF PUBLIC SAFETY t 8 CONSTRUCTION SUPERVISOR LICENSE r11:l, Number: Expires: Restricted To: 00 DENIS J COLBAIN 282 OLLO MILL RD OSTERVIIIE, MA 02655 I 9 1 R.un ii+- tarp uu.-•1r�Fhl!.f.it of etln al lidRinili•irl1A IhG .ICI j"✓119�++T1�It HOME .IMPROVEMEN7 CONTRACTORS REGISTRATION oard of Building Regulations arid,'Standards j ,One Ashburton Place a'; Room 11301: I Boston , Massachusetts 021Q8 HOME IMPROVEMENT �'GONTRACTOF: f �I� t ii [Boston I --------- ---------- ------------ - '4 � , �I �� N� ,I , , — -- Registrations 117293, Expirata.an' 09/18/98 Type — INDIVIDUALS � � ,•i I ; ,' �� n �� HOME IMPROVEMENT CONTRACTOR Registration 117293 � Type - INDIVIDUAL DENIS J..r,COLBATH ' '� �' t ' �r li .. ., Expiration 09/18/98 � 282 OLD MILL RD 41 � �t � ' OSTERVILLE MA 02655 � j, r1 ' ,h�'It �� j DENIS J.'COLBATH � 1� ►� I 1� '�.� I'� �� 282 OLD MILL RD WRVILLE MA 02655 �If 4 ADMINISTRATOR_, � �I � 1.44;IlAiWikk4I�„I 4��I�Ids �i�Gil,�liJ6:ni,awacwsr•oam.•M� I ° �,—.;._�,_LII 17,� t Engineering � n Dept. (3rd floor) Map p(S Parcel v�&Z&rmit# ter' House# �o%l�& Date Issued p2 — PLIC Bird of Health(3rd floor)(8:15 -9:30/1:00-4:30) �dT��QCONIV OBT , C6 ZNGINEERIp�IV�T PROP] E Conservation Office(4th floor)(8:30- 9:30/1:00-2:00) CONS�Uc']i6A S, ON PRi6li1,0 114E 19 BARMABLE. TOWN OF BARNSTABLE Building Permit Application Project Street Xress . P i rI F_ i"11�44 Village ±' �t1 ti I S Owner Lt YA (A.)W V� Address L4(3 Sic tfih �fi Telephone `7-7 S7 — l 1 `{ G Permit Request R Q,V)0 V T "1 al c v (Z First Floor 3 p b square feet Second Floor 3 0 Q square feet Construction Type W Opp T=a A&I Estimated Project Cost $ 6( 6, 000 Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family Y-" Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes ❑No On Old King's Highway ❑Yes ❑No Basement Type: lull LJ Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft)/ Number of Baths: Full: Existing New Half: Existing V New No. of Bedrooms: Existing v�1 New Total Room Count(not including baths): Existing New First Floor Room Count o� Heat Type and Fuel: ( Gas ❑Oil ❑Electric ❑Other F V4 W Central Air ❑Yes 3* o Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) tZoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use 1 Builder Information Name co Telephone Number C`) Li a 6 3 5 3 �J Address License# d L H c'(a 3 Q S k-p t )t �I t4: Home Improvement Contractor# Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE` 3 (J LA DATE 9 - BUILDING PERMIT DEI A FOR THE FOLLOWING REASON(S) - FOR OFFICIAL USE ONLY PERMIT NO. r Z I Z o3 DATE ISSUED"'. t � MAP/PARCEL NO. + 1 Y. r F a ADDRESS " VILLAGE OWNER r DATE OF INSPECTION: FOUNDATION FRAME_ INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING f DATE CLOSED OUT i ASSOCIATION PLAN NO. i i V A t no I its 3 y G ga..DL IT AVCARC 3inioo`(gz amod) prod ynougr3 Los+•ooLg-gz* 1 spaau Supuiad anoS Ur ao3 gm4u�cl uvglni jagxualuag ..,.... L�,WREWCE READY MIXED CONCRETE CO. 888-8002 TOLL FREE 1-800-633-8889 __ _I �- Lk; Ole _ __1-LL -- ,�- , - � t i SERVING CAPE COD