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Home My WebLink About0203 COTUIT BAY DRIVE y a a3 c-- -O FT any I CJ i S e n V � , i o `Q. 0: F �i 1 I. 1� �d Y 1. tt` F it -3q vl � 4- i J�4 F- /I tg 4� �II F• 13 d . . �: The Town of Barnstable .� Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner February 8,2000 J RE: 203 Cotuit Bay Drive,Cotuit,MA To Whom It May Concern: Enclosed please find the original Street Bond which was posted for the above referenced property. A Certificate of Occupancy was issued for this property on 1/30/98. Therefore the Town of Barnstable has no further interest in any performance bond for this property. It is important that you return this document to the insurance agency who issued it in order to avoid a renewal and fee. Sincerely, Richard Stevens BUILDING INSPECTOR Enclosure /kl q:forms:bondrele k"# it TOWN OF BARNSTABLE CERTIFICATE OF OCCUPANCY PARCEL ID 056 035 GEOBASE ID 3222 ADDRESS 203 COTUIT BAY DRIVE PHONE COTUIT ZIP - LOT 68 BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT CT PERMIT 28636 DESCRIPTION PERMIT TYPE BC00 TITLE CERTIFICATE OF OCCUPANCY CONTRACTORS: Department of Health, Safety ARCHITECTS: and Environmental Services TOTAL FEES: BOND $.00 .CONSTRUCTION COSTS $.00 756 CERTIFICATE OF OCCUPANCY 1 PRIVATE P ® sARxsrAB MASS. i639. D MI►� BUILD BY DATE ISSUED 01/30/1998 EXPIRATION DATE 1 . TOWN OF ]ARNSTABLE CERTIFICATE. OF OCCUPANCY ( PARCEL ID 056 035 GEOBASE ID 3222 . ; ADDRESS 203 COTUIT BAY DRIVE PHONE COTUIT ZIP - LOT 68 BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT CT PERMIT 28636 DESCRIPTION PERMIT TYPE BCOO TITLE CERTIFICATE OF OCCUPANCY CONTRACTORS: Department of Health, Safety ARCHITECTS: and Environmental Services TOTAL FEES: BOND $.00 Oki CONSTRUCTION COSTS $.00 756 CERRTIFICATE OF OCCUPANCY 1 PRIVATE P Q ; + iA�1VSTAEIM ; 039. BUIL BY DATE ISSUED 01/30/1998 EXPIRATION. DATE. • ..�•'nLLCi"VIfI�OC.T.�JfLLC.tV VUf PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: APPROVED PLANS MUST BE RETAINED ON JOB AND WHERE APPLICABLE, SEPARATE 1.FOUNDATIONS OR FOOTINGS THIS CARD KEPT POSTED UNTIL FINAL INSPECTION PERMITS ARE REQUIRED FOR 2. PRIOR TO COVERING STRUCTURAL MEMBERS HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU- ELECTRICAL,PLUMBING AND MECH- (READY TO LATH). PANCY IS REQUIRED,SUCH BUILDING SHALL NOT BE ANICAL INSTALLATIONS. 3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. 4.FINAL INSPECTION-BEFORE OCCUPANCY. POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 0 2 2 � 2 ^ ` d SMeVt� 3 1 MATING INSPECTION APPROVALS ENGINEERING DEPARTMENT Z9 1�30 IG 2 9 9 ;� ARD QF H LTH 42Q. OTHER: SITE PLAN REVIEW APPROVAL WORK SHALL NOT PROCEED UNTIL PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON THIS THE INSPECTOR HAS APPROVED THE STRUCTION WORK IS NOT STARTED WITHIN SIX CARD CAN BE ARRANGED FOR BY VARIOUS STAGES OF CONSTRUC- . MONTHS OF DATE THE PERMIT IS ISSUED AS I[TELEPHO NE OR WRITTEN NOTIFICA- TION. NOTED ABOVE. - TION. TOWN OF �RNSTABLE 4"t CERTIFICATE OF OCCUPANCY . PARCEL ID 056 035 GEOBASE ID 3222 ADDRESS 203 .COTUIT BAY DRIVE PHONE COTUIT ZIP — LOT 68 BLOCK ' "` '' LOT SIZE DBA DEVELOPMENT ' DISTRICT CT _ PERMIT 28636 DESCRIPTION PERMIT TYPE BCOO TITLE CERTIFICATE OF OCCUPANCY CONTRACTORS: Department of Health, Safety ARCHITECTS: and Environmental Services TOTAL FEES.:-.. $.00 Oki CONSTRUCTION COSTS $.00 756 CERTIFICATE OF OCCUPANCY 1 PRIVATE P >'?Ed * ■ABIVSTABLE, # MASS. i639 A� ! BUIL BY DATE ISSUED 01/30/1998 EXPIRATION DATE t TOWN OF BARNSTABLE y TEMPORARY CERTIFICATE OF OCCUPANCY I ( PARCEL ID 056 035 GEOBASE ID 3222 ( ADDRESS ' 203 COTUIT BAY DRIVE PHONE COTUIT. ZIP TOOT 68 BLOCK LOT SIZE IDBA _ .. DEVELOPMENT DISTRICT CT PERMIT 28636 DESCRIPTION 30 DAY,.TEi;1PORARY ( PERMIT TYPE BTC00 TITLE TEMP.-' OCCUPANCY PERMIT CONTRACTORS: Department of Health, Safety ARCHITECTS: and Environmental Services TOTA'BONDL FEES: $.00 Oxj� J CONSTRUCTION COSTS $.00 756 CERTIFICATE OF OCCUPANCY 1 , PRIVATE P + BARNSTABLE, • MASS. 039. BUILD BY DATE ISSUED 01/$n/.1998 -QvPIRATION DATE TOWN .OF BARN4-TABLE �.�;•^ / BUILDING PERMIT PARL`�=3�D 056_�035 GEOBASE ID j3222 ' ` -ADDRESS 203 COTUIT BAY DRIVE PHONE Catuitr, ZIP- LOT 68 '`°"' BLOCK. IOT SIZE DBA DEVtLOrENT DISTRICT CT. PEaMIT 2.4234 DESCRIPTION SINGLEE FAMILY DWELLING ' PERMIT- TYPE BUILD TITLE NEW RES.fDENTIAL BLDG -PMT - 'CONTRACTORS: KENNEY, LAWRENCE- K_ Department of Health, Safety ARCHITECTS: I and Environmental Services TOTAL FEES: $768..80 BOND $.00 THE CONSTRUCTION COSTS $248,000-00 I 161 SINGLE FAM HOME" DETACHED - 1 PRIVATE P:M*')�;L 1 BARNSPABLE, ' �C /Po,B'7 9f-S7FIOI AJ i c -163 9. �.0 �► I OWNER RIXWbij IS ' 2HBN•-W_&_ � ED its ADDRESS 173 COUN'I'RY DR BUILD G F VI I.SON . WESTON MA � � BY - n DATA—ISSUED 07/07/1997 EXPIRATION DATE THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY.EN- # CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR .ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS j S PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: APPROVED PLANS MUST BE RETAINED ON JOB AND WHERE APPLICABLE, SEPARATE 1.FOUNDATIONS OR FOOTINGS THIS CARD KEPT POSTED UNTIL FINAL INSPECTION PERMITS ARE REQUIRED FOR 2. PRIOR TO COVERING STRUCTURAL MEMBERS ' HAS BEEN MADE.WHERE A CERTIFICATE OF.00CU- ELECTRICAL,PLUMBING AND MECH- (READY TO LATH). PANCY IS REQUIRED,SUCH BUILDING SHALL NOT BE ANICAL INSTALLATIONS. 3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. ' 4.FINAL INSPECTION BEFORE OCCUPANCY. i POST THIS CARD SO IT IS i _ OM STREET i BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 2 2,�� `�� 2 ^ i d Srv%eV 3 1 TING INSPECTION APPROVALS ENGINEERING DEPARTMENT I�30 Ic�� 2 � 5 18 ARD OF H LTH OTHER: SITE PLAN REVIEW APPROVAL WORK SHALL NOT PROCEED UNTIL PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS,INDICATED ON THIS THE INSPECTOR HAS APPROVED THE STRUCTION WORK IS NOT STARTED WITHIN SIX CARD CAN BE ARRANGED FOR BY VARIOUS STAGES OF CONSTRUC- . MONTHS OF DATE THE PERMIT IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICA- TION ABOVE. — TION r' BUILDING PER. MIT � 30 a TO (/ �� / ✓ TIME/ '� DATE/: '7 - 1NHILE�YOUiREO, El T � � ❑:Retomed ' Called'to M / your sill: s a you OF [kPleose ❑ aittsto PHONE /, [] Wgstoll []gTou'It MESSAGE { OPERATOR` a '23-024L400 SETS ' 23-027-200 SETS ` 1 [� Parcel 3;7mit# Conservation Offic (4th floor)(8:30-9:30/1:00-2:00) , ate Issued Board of Health(3rd floor)(8:15 -9:30/1:00-4:45) q7 Fee ' '17C Engineering Dept. (3rd floor) House# _ NSTq�� `� 1'^ P - �NV/Rp� 19 To TOWN OF BARNSTABLE ``"d aw4N0 Building Permit Application Pro ct S `et Address 2�3 .� - �i y r f �A �d'i y Village,., c, - -Owner O,8'*/'7 / Address 3 /� .Telephone f 7 7 - o` 6 Permit Request l �U C i First Floor square feet J)h� �_ o�'d /�orc �S Y- r � Second Floor square feet -7 y� Estimated Project Cost $ of (J 00 . 0 Zoning District Flood Plain Water Protection Lot Size /. 0 ;3 a C Grandfathered ? Zoning Board of Appeals Authorization Recorded Current Use Proposed Use Construction Type Commercial Residential Dwelling Type: Single Family 6a oo+ll Two Family Multi-Family Age of Existing Structure Basement Type: Finished Historic House Unfinished ✓ Old King's Highway Number of Baths No.of Bedrooms Total Room Count(not including baths) 7 First Floor Heat Type and Fuel 0 s Central Air • pS o N -e- Fireplaces j Garage: Detached Other Detached Structures: Pool Attached 2 CAr,e- Barn �+ None Sheds Other Builder Information �� Name w t a 4, �'� kle,N ,fJ y Telephone Number 7 Z Address e) A'.r-.P" License# 00 ,S 6 0 9 W,P S / /`-Zo u l `y/ - Home Improvement Contractor# 16 i Worker's Compensation# .JG 02 („ 7.76-0/2- 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 BETAKEN TO I at, L SIGNATUR n�LDATE A BUILOWN 3 �•��;;� ' � tits FO LOWI ON(S) 1p • PERMIT KIP FOR OFFICIAL USE ONLY P MIT NO. ; sow D ISSUED 4 q' i P/PARCEL NO. vm RESS VILLAGE NER DATE OF INSPECTION: I i FOUNDATION i FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: UGH FINAL GAS: F ROUGH FINAL FINAL BUILD!Ngmv. r DATE CLOSED OUT ASSOCIATION PLAN,NO. , c O' I ' I l( �_ s-4�YY i 3'f,c v 60. 18 �l'I•�¢ i ;o N r0 r-4 r �e�bJv. 99�. 00 ' �O � •00 N ' r •✓ r n . r� �s r. rm r i • r i r . i r 170.00 CERTIFIED. PLOT PLAN FOR LOT 68 COTUIT BAY DR, COTUIT, MA. PLAN BOOK 292 PAGE 26 I CERTIFY THAT THE FOUNDATION SHOWN ON THIS PLAN IS LOCATED ON THE PREPARED FOR GROUND AS SHOWN HEREON AND THAT IT CONFORMS TO THE MINIMUM SETBACK ROBERT BALL REQUIREMENTS OF THE TOWN OF BARNSTABLE. SCALE: V = 50' AUGUST 12, 1997 oSTEMU RUMBA WELLER &'ASSOCIATESr a : . ,fz;t s°q"� i y• a. ,r. �� A"..- - v i..y+ .S[ !• ;"�. , +,.t{, y1� sty Rk 3 y ,}1645 FALMOUT ... +.. RD.? CENTERVII.LE,MA. 02632(50 + •�1 s+ A .. �i t •( .t} ! 1. , + 2,• t+j ��,j 'S:�r j �•' �� . . � S .� 1+•{ �. x•xl •�( •��3' } e .g jEt 4 f�is� r +n� � � , i 7-�3AI -f o_ '*� 4y,. 37 -ate \ 7�k / o s �a - �2 �.= ems „• �o ,� •. -• .. ' sE,Q�� ,yihl. / 3Z zs 07 l08 a a O'll OF RZol% % `�Oi sr. N P �7 U DANIFL 1. �y \ AN" BNAMAN 'A - g�i. CIVIL �y No.77686C• ' d,! CiSTEP ,'•vEy�1 � oy,�� _ TEST HOLE LOG DATE:,MRRc+f i997 SOIL EVALUATOR: TN WIESS: ..•/ �?uti�vivr,— PERC RATE: c Z tifiv�i.�Cy Q #/ z • � o� �9��q o rl '� � �;NX 3 • C �-�.��-- � � G` 6 Lo.o....y y � c wA.o . ♦ �o4 i /oyzsa y,�,3 gLJow...y w.vo t SA JA ' S. Z.Sye Al GoT GS --�p svA7C,2 E•u cac��,TE�Q.O �, DESIGN DATA DAELY FLOW:(f')BDRMS.z 110 GPD �CPD SEPTIC TANK:SSo GPD:200%-//oo GFD USE:/S-b GALLON PRECAST SEPTIC TANK LEACHINq FACHdTY: I USE: -Cy s'x a s''X z' Csoo) SCE' _-_.. 4='02 CAPACITY: y�G•`�^J dit= SIDEWALL:-//o- 2't -0,?Y- J6Z.e BOTTOM:_/3'!c.f/z'x p,7Y�, �1%: 'rF•�15 p'R Lb��S N� l..l cr, t�l�t� TOTAL:- .S`G. �N OF�y� 9 DANIEL E. CG BRAMAN N NOTES: �1 ,S 1.ALL PIPE TO BE 4"DUL SCH 40 PVC. 0�1 2.PIPE TO BE LAID LEVEL FOR 2'OUT OF DISTRIBUTION O S06VE�� BOX. -L7�97 5 0-47 3.RAISE ALL APPLICABLE MANHOLE COVERS TO WITHIN 6"OF FINISH GRADE. ►■' 4.SEPTIC SYSTEM IS NOT DESIGNED FOR THE USE OF A GARBAGE DISPOSAL , S.SEPTIC TANK AND DISTRIBUTION BOX TO BE INSTALLED ON A 6"LAYER OF STONE. 6.INSTALL GAS BAFFLE IN OUTLET TEL r IAwE or Im 1•wTONc owl ]N•.E VP WASM STOK9 ALL AMUM TOP OF FOUND. 3S a ®EL. Y,9•o / I,* u- 8s�> \i�.ffl 3 32.ZS 3B,o0 SEPTIC SYSTEM PROFILE • ir. SITE SEWAGE PLAN GENERAL NOTES FOR 1,CON TRACTOR TO BE RESPONSIBLE FOR THE LOCATION OF ALL unlr IE3,ABOVE AND UNDERGROUND,PRIOR LD T G a CO TV/T B.�yD,e� G oTUi T- TO ANY EXCAVATION OR CONSTRUCSON. L SEPTIC SY6fEM TO BE INSTALLED IN COMPL ANCE WM PREPARED FOR 310 CMR 1S,CDs TITLE V. D�srsam�PW�n�,m�a uasD FOR rn0�mr tnra DATE: _�IAY•/;r SCALE: / 3v'.. L ALL DISTURBED ARBAR TO LOAMED AND SUDEQ 1:, S CONTRACTORTOPROVME24 HOUR NOTICEFORANY REQUIRED VISPECiIONS W� WELLER& ASSOCIATES 1645 FALMOUTH ROAD CENTERVII.LE,MA.. 02632 TEL.(SOS)77S-073S FAX: (508)7754754 Lr.4 APPROVED BY: ; -P4/EE7 / of 2 �s�/rFrc- The Town of Barnstable 619KAB& e$ Department of Health Safety and Environmental Services BuiIding Division 367 Main Strut,Hyannis MA 02601 508 790-6227 Ralph Cms Office: FFax508 775-3344 r Building Commissio 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-Odsting Owner '0=10ed building containing at least one but not more than four dwelling units or to stroc=s which are adjacent to such residence or building be done by registered contractors,with certain exceptions, along with other requirements. Type of Work: /VF&t> Est.Cost-I 0 0 0 , Address of Work: C o A` J Owner.Name: /")L7 Date of Permit Application:_,-d 1 197 I hereby certify that: Registration is not required for the following reason(s): Work cccluded by law Job under S1,000 Building not owner-ooarpied Owner pulling own permit Notice is hereby green that: CONTRACTORS OWNERS PULLING THEIR OWN PERMIT OR DEALING WiTKUNREGISTED FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO TIC ARBITRATION PROGRAM OR GUARANTY FUND UNDER MCI-c 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner. GtJ A, Registration No. Bate Contractor name OR The Commonll'ealtlt of Massachusetts -- ' •hl _ ��..�,� Department of Industrial Accidents �� ;i ==�� - OIBCeoI/oYest/gal/oas �,� =r•;-a` 111) 11ashbigpon Sircet Bosion.Mass. 02111 Workers' Compensation Insurance.AlTidavit 'cant ntormation� Ile-se PRINT le 1y �'�'"�` ' -T _ _)._... ... _...... name• L,��GtJ A a Otic ee Al ['/v/vim 1/ r Ittcation• city Woo/ �/%l�h I�OV�� / !�_ phone# ❑ I am a homeowner performing all wort:myself. ❑ I am a sole proprietor and have no one working in any capacity __. _.� ...,.<._ :_-7 1 —1 am an entplover providing workers compensation for my employees working on this job. corn 2nVnnMe- A&NJ,,,eI 13 1 J- , nddr so I UC)-11 54/; iL . � Wes / hh t e-6c�I� / �/.�, phonef!• 2 Z_S` ' 37f � f 5 st noli .q ❑ 1 am a sole proprietor, general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: company name- address: eih•• phone#* ineurnncc co nplicvll �T'_.: .«.< - -- ... - - �-:�..s.—S.r,-,.�5•:�•.Re.F�G�;, _ _ •TJ9f�i'�,;,...• .S7A/•-�!!- ,.en3Tr.Y••-•=#S ctim am•name: address: city: phone 0, insur•roce co. •' op ficv� .• Ik ;Attach additional'aheet if tieeeisa �Y:-'yam - +'_�-•++ Failure to secure coverage as required under Section 25A of h1GL 152 can lead to the imposition of criminal pettdties of:,line up to$1.500.00 and/or one%cars'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and aline of S100.00 a day against me. 1 understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. l do herebtr certij• •r the pains and penalties oj*pe aq•that the informadon pmv ded above is truerd correct Signature ate �V 2 Z9 Print name A AJ A,e/U Phonc# 7 Z:- 4 ifs oRcial use oniv do not write in this area to be completed by city or town official city or town: permit/license p rnBuilding Department C3Licensing Board check if immediate response is required (3Seleetmen's Office' Dlieaith Department contact person: phone t1;. rJOther tren,sed3.n4 r:A: -Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", an emplgvee is dcfined as every person in the service of another under any contract of hire, express or implied. oral or written. An einplmyer is defined as an individual, partnership,association. corporation or other :L-gal entity, or any two or more o the fore-, engaged in a joint enterprise, and including the legal representatives of a deceased cmplover, 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 1.52 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonn•ealth for any applicant who has not produced acceptable evidence of compliance with the in 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 hay been presented to the contracting authority. 77 ♦ 1a.1 :1::•<, t y •f:i:.. i ,.... .1:aw- .y:r .�% i'J:V•I:4•p ; U�•+.1:.•:IY:^:� J"�{.`.:i'. .. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying-company names, address and phone numbers 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 required to obtain a workers' compensation policy, please call the Department at the number listed below. ,Mwrrser�,s,. ., ,,m,..R7n...•,.o••.ew,+vr!+�: _ .;�:: _ :...:� L6:�-.T'`p"._ _�:4� �.:��•w,,..,�.: _ �. ... ..:.:�,•, •".....•... .. ........ :.��.. q_.*•: .;•'.:'.'t:. _7."i:.'•.'..Y� _ "`�r,::'>y9rwr+•-s.:.Rii;li��.:}3:zI?{'�jir...• �•; + City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions, please do not hesitate to give us a call. T�„T�.,_,+�.,wwrw.w.""f!�s� =:i :i...�.. h-_. •adne% .wc.v.r.�•.rY h.e7. �ir:�� • s-�.►+ ..�7ir: :wrj�:•'%r- � 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) 7274900 ext. 406, 409 or 375 +." j.-.—• - � ��.u,....w...c.�•�.-.,..__......_..,�w;a: S1�fR�7w.::...a._.r...._..—..�..._,...rai.�.t'6Lw�dW'+"R1+.ict'r...•w.+'r'.Lh,.,:.hl!A a'Yc1.+.�rs...�.�___..._�..a.v.9 = MEMO= Ae -� A.... DEPARTMENT OF PUB IC SAFETY.,,, ONE 4SHBURTON PLACE , RMI10 o : j BOSTON , MA 02108-1614' r' j 'tom• [ CONSTRUCTION SUPERVISOR LICENSE Number: Expires: r Restricted To. 00 gyp '�oZI _ r , r LAWRENCE K KENNEY Detach bottom, fold sign on 100 SULLIVAN RD " - . back, and laminate license card. - W YARMOUTH, MA 02673 keep top for receipt and change of address notification. f t —�.�, �•— --:. _:., �\ t 'is P \��•_'�� .�_'_" . w - i l � , y ( — � t E ' , i } LIP 77 t , _ ; _ } r l s �iY ._...<._-n �.. 4. _-. ...,.,r-.i zr-* ..'.^.:-aim:. ��"�".�.+-i—. � __ -. _.. -__ _ ,_ \�-'^•�\`.,.... -- - ,_ — : f r' r ; f - , , ji-- i � i ,�T _ _--? � T_�-__r' t-=r;..+•_+�-,� � i , '� i--r'=? �r�-- i (� (� .__... { t—� Ji _. - -- - - _ •. ..._ __ �� !_. ;� 1. � + - - I{I r i I 11 L_J { I f I .-. t} _.,ts:'-�-t_�.m�.r..v'v�c�•..-..-t `p ; -.-al_fr��a�-ni-+c.: - , iz e e _ � _..: -._.. ._ .. 1R.-.:. ...__ -,1. _.._.._.... -._.. -.._......_...__...,._.._ .__.., .��". - -_. .. .. _ ...- .,..,.._... ,. .. _ .... rrr,.,..,u-- ..., � .,, n „_ .. _ � ..s of ...e• � �' k%^. .. ✓ .^-^�' __. ...r Y _ r _ "t •.,.,� L..,.r' t.<..F ,�i ; (... t o� t\ } �i,,.i -^^�...t �_.______. DATE: i REVISED V� A UL G � , � DONALD I. MEYER r z Professional Building Designer P.O. &-ix 532 W So Yarmouth,NIA 01€�btt jj DR 4etN.;NUMBER ��t1 a _ k f F - i 1 E t k ,{ , i � � • d j ~ , 4 , k , j ...;..«,...-.__.,..:-......�...�..,....,..,.�....+•..�....,,...»..r...�...e....�,+,..<+... .- ...._. 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Yarmouth, MA 026E+4 _ J • DRA` Nv. JMf3ER °U (508)344-5246