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HomeMy WebLinkAbout0710 WAKEBY ROAD �� /0 h��9� -_ 1 ,� i �i ,� , I �' �F A d 0 1 � e k i x - .._�,..cfu�hi � .. �,� .,.. :. ' ,':' ^ ._ y. r.- ...' w n :., _. r �:.Ir-.'Im.•r C.. '!,: i Town of Barnstable UF BARNS[ABLE Regulatory Services �0 Thomas F.Geiler,Director .. 2009 FEB —5 Am 1 1: 04 BARNSTABLE ; Building Division v MASS $ Tom Perry,Building Commissioner,�jDrEp Nay►�� 200 Main Street, Hyannis,MA 02601 �� �_ f0� Office: 508-862-4038 Fax: 508-790-6230 Approved: Permit#: )�I � HOME OCCUPATION REGISTRATION Date: C1_)ZQ O Name: 41 6 Al-4 Phone M. I�OQ� l� ��J` �Z Address: z//l - lil/A�f�� Village: /✓�iQ2U�/�/ /��S — 0 (5, Name of Business: /? 4- C664,//,'V 5 C927RICM G CIAIA C 44NV T Type of Business: CCEi9.r//N Mapaot: CJ i9a INTENT-. It is the.intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling. there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;. increase in traffic above normal residential volumes; and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space; • There are no external alterations to the dwelling which are not customary in residential buildings, and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does trot involve the production of offensive noise,vibration,smoke,dust or other particular matter,' odors,electrical disturbance,heat,glare,humidity or other objectionable effects. . • There is no-storage'or use of toxic or-hazardous materials,or flammable or explosive materials,in excess of normal household quantities. . • Any need for parking generated by such use shall be met.on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment • There is no commercial vehicles related to the Customary Home Occupation, other than one van or one p p ty,and one trailer not to exceed 20 feet in length and•not to pick- -t uek-not-tonexceed•one•tom.ca aci —_ exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit . I,the undersigned,have read and agree with the above restrictions for my home occupation I am registering. Applicant' zL f A� Date: YOU WISH TO OPEN A BUSINESS? For Your Information: Business Certificates cost $30.00 for 4 years. A Business Certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L. - it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, 1' FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) and 200 Main Street Offices at the Licensing counter. DATE: =Y Fill in please: ;ham APPLICANT'S YOUR NAME: -4, R X it/ g— K� BUSINESS YOUR HOME ADDRESS: _Z of TELEPHONE # Home Telephone Number: ,2 NAME OF NEW BUSINESS ,/— . 2M &1A ,,1L,_,,jTYPE OF BUSINESS IS THIS A HOME OCCUPATION? YES NO Have you been given approval from the'`buil rb'g Iivis n? S IVO-, ADDRESS OF BUSINESS '710 _ ww*6 1-7 AV.0,26 4 MAP/PARCEL NUMBER 0 � � �U> co-S When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. — (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses requiretl-to eg N operate your business in this town. 1 . BUILDING COMMISSIONER'S OF CE This individual h en info ed of any permit requirements that pertain to this type of business. MUST COMPLY WITH HOME OCCUPATION thorized Signatdre* COMMENTS: v RULES AND REGULATIONS' FAILURE TO 2. BOARD OF HEALTH This individu h inford of it requirements that pertain to this type of business. tIr�1ST SLY WITH ALL Authorized Signature** HWIRDOUS MATERIALS REGULATIONS COMMENTS: 3. CONSUMER AFFAIRS (LICENSING.AUTHOR[ ] This individual een inf- �h ' e in ,� uirements that pertain to this type of business. Authorized Signature* COMMENTS: ^, TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map' �Parce`I C QD,5 Permit# Health-Division ' Date Issued ��a1`�lei " l o�� Fee 4?0. 0 o Conservation ivisionn D �az,Collector� ,.,:,..;_-Treasurer_ SEPTIC SYSTEM 10U V a ,5 3 INSTALLED IN CC6&qFL! r Planning Dept. pp��eeR® nWITHp��TnniTL'—" _ ENVIRONMENTAL IPi®i�➢��9\i 9(r9� ai�a i IL Al l Date Definitive Plan Approved by Planning Board TOWN) RECULA1 9C4�3J Historic-OKH Preservation/Hyannis Project Street Address /�� ����/���/> - me4c,ZaAl 5 Village�1LS�T;4,1y Owner 7'n4F 6- G CIZZ4 6;4 Address 7/O • D 71,i ,5/;9,&-H1�} Telephone �C�D�� V 7 4� 0.- d, d, ,z Permit Request E. C Square feet: 1 st floor: existing Z 6L)I—Pproposed 2nd floor: existing proposed Total new Valuation 1, S- y or, Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family fZf /,T/w���o///F/�amily ❑ Multi-Family(#units) Age of Existing Structure _� � Historic House: Cl Yes ❑No On Old King's Highway: ❑,Yes ❑ No Basement Type: I Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing_ new Total Room Count(not including baths): existing _5 new First Floor Room Count Heat Type and Fuel: VGas ❑Oil El Electric ❑Other Central Air: ❑Yes �[No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage:Cl existing ❑new size Pool: O existing ❑new size Barn:O existing ❑new size Attached garage:❑existing Cl new size Shed�(existing ❑new size Other: - _n� P P11 P, H M P nn Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ AUG 2'3 2001 Commercial ❑Yes ❑ No If yes, site plan review# By Current Use _ Proposed Use BUILDER INFORMATION Name Z7esZ` Ll�.►�T�� Telephone Number (• � G/.Z(,��L/ Address Aft M O14-',/ ei :/? License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE �� o� — O l i Y e FOR OFFICIAL USE ONLY; PERMIT NO. DATE ISSUED _. MAP/PARCEL NO,, 0 ADDRESS VILLAGE OWNER a DATE.OF INSPECTION: r'y FOUNDATION FRAME z INSULATION 1 FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH'- . . ,__ FINAL GAS: ROUGH -» `' FINAL FINAL BUILDING'. DATE CLOSED OUT ASSOCIATION PLAN NO. y it i E t F 1HE Tp� , The Town of Barnstable BnaxsrABLL 9� MASS, �0g Regulatory Services 'OlEp59.(A Thomas F. Geiler, Director Building Division Peter F. DiMatteo, Building Commissioner 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax: 508-790-6230 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. II// Type of Work: /0 C r` Estimated Cost Address of Work: 2/11) LNA&C_h Owner's Name: 70CC6 i Date of Application: �' _ 0/ 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: Registration No. Date Contractor Name Re g OR Date Owner' e q:forms:Affidav:rev-070601 The Commonwealth of Massachusetts sj Department of Industrial Accidents '= — exce oflOYBstigBt/ODs 600 Washington Street Boston,Mass. 02111 Workers' Com ensation Insurance davit i name: location: -7119 S hone# I am a homeorowpnner performing all work myself. I am a sole vctor and have%%/%///%/////%/////////l�////�/////,lll", 61��/ �0%� citv � / ����//� 0 %0%%//O%//%////%/O/%%/%%/%%%//G/%/Ol/i%/////ll////%%%%%/.,': din workers' compensation for my employees working on this job.:;:: :: '; I am emp .P.................:. : .... : :::.:::::::...:::::::.::::....:::::X. ::::::.::. .camX. ------------- A. �s;ce<'aca g of i❑ I am a sole proprietor,general contractor, or homeowner(circle on and have hired the contractors listed below who have ' compensation polices: o workers comp p .;:.;:.;::::.::::;. .....:;.i:.:.:>::,.. the following ..................:::: ...:::::......::...:.:::::::::::...:::::.::.:.. m m ..co ........... :.:................. ................... ....::... s.. ............ .:...............:.:..............:v...........................•....................................v...r.:}.{:::•:�:?........ ..... ...raw.:.r......................................, ....n....• .........r......... ..Y...r.r....... S. .......... ........... ............ .............. ................ ...?......rr........... .......r.•.v ....... ..........w::::L;:;n;;.}w:•:::::::w:::::.v:::�:4::.v::•.v:::•.v:::::..:...... ... ... ..................:. X.:::v...........................w::.v::::vv::::•.v::::.- �v::w.v:::::::::n:i}:?}i{is;{{Ji:•:;{4:{v................ ..............::.v:•......' .................n.. ...................... v.. ..... iif:•}}:isi}ii::•:ii}:{•}:}ir:?:}:j:?;•:•}`}i:•X;:y?$•ii:{?v>:4;iii:j;:::{;::?:'::::i:•:4'v;•iii'}:;Ji:;'}:v:::i}i:;•::v::' . .......................................:::::::::::...............:w:.i;ry;}:{�::.::•.}}}:i44i:•}}'{}:::.J::9i;}:}it,.•�•i.:::4}:4:•i}:4::}}}':;;• ...... ........ .............. ..........................x r. ... ... ....... ...... ..... ...........<•}:•}:.i•:4:i}ir•;::x:.y:{:vv.,v-}•:{;0;;}:;}:J'^::......vi:4::{•;::•:::w;•:. .. N. .16nmricer ::........................................::::::::::::.::..::.::::.:........................ ......:................:..... .,tam :.:.:::::....::..;;........:.:......::..;............:......... a tidies ..:........ . ...:::...: 0 ne ............................. under Section 2SA of MGL 152 can lead to the imposition of criminal p or enalties of a fine rap to SI,S00.00 and/ Faflrn a to secure coverage requited one yam,imprisonment as wen as civil penalties in the form of a STOP WORK ORDER and a fine of 5100.00 a day against me. I�dersRaDd ths<a copy of this statement may be forwarded to the office of Investigations of the DIA for coverage verification 1 do hereby certify wider the pans and penalties of perjury that the information provided above is true and cooled Date - e Signature G Phone# Print name fe ot8cial use only do not write in this area to be completed by city or town official peradtNcense# ❑Branding Department city or town: ❑Licensing Board ❑Selectt+ten'sOtIIce , chccicif immediate response V required ❑Health Department contact person phone#; - ❑other UTA"a 9/95 P1N Information and Instructions Laws chapter 152 section 25 requires all employers to provide workers compensation fortheir Massachusetts General "law", P �� , employees. As quoted from the law , an employee is defined as every person in the service of another and ntract of hire, express or implied, oral or written. defined as an individual, partnership, association, corporation or other legal entity; o over or the receiver or. y two or more of An employer the legal representatives of a deceased employer,, the foregoing engaged in a joint enterprise, and including lo, employees. However the owner of a trustee of an individual, partnership, association or other legal entity, emp vhouse of dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling 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 section 25 also states that every state.or local licensing agency shall withhold the issuanceapplicant nt who has �� of a license or permit to operate a business or to construct buildings in the commonwealth for any pp produced acceptable evidence of-comp with the insurance coverage require1dfo ce u,blin c wor until not pr contract for the commonwealth nor any of its political subdivision shall eater into any chapterof this have been presented to the contracting acceptable evidence of compliance with the insurance authority. Applicants ' eosatioui affidavit completely,by checking the box that applies to your situation and Please fill in .he workers comp hone numbers along with a certificate of insurance as all affidavits may be . suPP1Yu�company��' addres and phone � of insurance coverage. Also be sure to sign and submitted to the Department of or town that the application for the permit or lime is date the affidavit: The affidavit should be rationed to the should you.have any h questions regarding the'law"or if you big requested, not the Department of Industrial Acci lease the Department at the number listed below. are required to obtain a workers' compensation policy,p M City or Towns rinsed legibly. The.Department has provided a space at the bottom of the Please be sure that the affidavit is complete and p ons has'to contact you regarding the applicant. Please affidavit for you to fill out in the event the Office of Iavestigati be retmn�to be sure to fill in the peimitllicease number which will be us��been made.arence number. The affidavits may the Department by mail or FAX unless other arrangements e Office of Investigations would lie to thank you in advance for you cooperation and should you have any questions' Th please do not hesitate to give us a call. MENNEWN The Department's address,telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents Me of I11iestl9ations 600.Washington Street Boston, Ma. 02111 fax#: (6L7) 727-7749 phone #: (617) 7274900 ext. 406, 409 or 375 °PIKE T The Town of Barnstable : MUWSTABLL . . : MASS, Regulatory Services 1659. Thomas F. Geiler, Director Building Division Peter F.DiMatteo, Building.Commissioner 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION /i 7 Please Print DATE: K — JOB LOCATION: / number street village "HOMEOWNER": SOS Cy" �l//U� .72 y � , time home phone# work phone# CURRENT MAILING ADDRESS: city/town state rip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,2rovided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Sipe true of ifomeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction.Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors):provided that if the homeowner engages a person(s)for hire to do such work.that such Homeowner shall act as supervisor." responsibilities of a supervisor(see Many homeowners who use this exemption are unaware that they are assuming the res P P Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require.as part of the permit application.that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:FORMS:EXEMPTN 11 , V NEW ENGLAND TELEPHONE y & TELEGRAPH COMPANY EASEMENT 9 4 \ LOT 5 \ a L � � Q O L a.- W a 1 33.1 9 16.81 WAKEBY ROAD MORTGAGE LOAN INSPECTION ML11085 SAGAMORE SURVEY ASSOCIATES SCALE: 1 IN.= 80 FT. laocr�q P.O. BOX 28 DATE: APRIL 13, 1998 SAGAMORE BEACH, MA. 02562 � THOMQS gGpp (508) 888 8667 / "�-- c. . I CERTIFY TO p POWTBRIANO coo THAT THE LOCATION OF THE BUILDING SHOWN HEREON CONFORMS u No.3o314 TO THE ZONING OF THE TOWN OF BARNSTABLE (MARSTONS MILLS) � t�°��sg,o�'Pv I CERTIFY THAT LOCUS DOES NOT LIE WITHIN THE FLOOD HAZARD ZONE AS DELINIATED ON MAP 0015C COMMUNITY NO. 250001 PLAN REFERENCE: BARNSTABLE REGISTRY OF DEEDS REGISTRY OWNER: BOOK/PAGE: LC NO 37518-8` LOT NO.: 5 PLAN BY: BSC/CAPE COD SURVEY CONSULTANTS BUYER: DATED: JUNE 18, 1986 THIS INSPECTION NOT MADE FROM AN INSTRUMENT SURVEY AND IS NOT TO BE USED FOR FENCES, HEDGES OR TO ESTABLISH LOT LINES. FOR USE OF BANK ONLY. / \ \ \� o_ 6 A T F. \X\ •L,aT 4 \t \\ CB/OH F HEL D 43, 568 S. F. C- LOT 5 4 3' 563 t S.F. ti a� /. dDA� ti � g �a,v N/F a a GQRY W GIFFORD ^� 3156176 ^�0 P B• 27,7166 _ op \10 >> S ED 6,9 - gSj_. — /pH FND.- ` �3 HELD FND.�S / rj ?vi • 6p��� 50 - �, r 3•'.�'Yf`,.�e C'•yyM1' �F 4�"w .'p. ,.•at 4�$T"*3 "%� �:,�`iF.+..'3' 1:k• �° "'_ E re. . jY�-1Ca�WNT STABLE LOCATION SEWAGE # -I VILLAGE ASSESSOR'S MAP & LOT 13.-0 61- 00 s INSTALLER'S NAME&PHONE N SEPTIC TANK CAPACITY �_ • LEACHING FACILITY: (type) L L1 (size) X 3 V NO.OF BEDROOMS �/� h` BUILDER OR OWNER �_K!i PERMITDATE: 1 Z�, -.COMPLIANCE DATE: Separation Distance Between•the::. Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water'Su 1 Welland Leachiin Facili fan wells exist . PP Y Leaching'Facility (I Y - on site or within 200 feet.of leaching facility) Feet Edge of Wetland and Leaching Facility,(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by cc; r�� i 2 x Pr 5"r'�P u 13 E e a G . '17 o VT ►1-� 5 �r �ram► 1�'°�'G )jv� . s-rA I N t�s� �T�`C.s t—A G fiVIA�Jb= Co ARS ZL( w I 1 1 1 i i f 1 10 PT -T7 o -A I-AG P-jDl---T-S 5 i's 1 1 ; . 10 . i TOWN OF 13ARNSTABLE BUILDING PERMIT APPLICATION Map ()I Q-f 0 3U0 Parcel Permit# t�5S3 ( I;L `Health-Division Date Issued �'O'� l o-( Conservation Division Fee (00 Tax Collector. d a S SEPTIC SYSTEM MUST'SE INSTALLED IN COMPLIAN*C._ `Treasurer 0&& WITH TITLE 5 Planning Dept. fw ENVIRONMENTAL CODE AND TOWN REGULATIONS., Date Definitive Plan Approved by Planning Board ' 'r Historic-OKH Preservation/Hyannis Project Street Address _7/0 11V,6 k (4 Le=0 Village 111P764Z�T"Al A-17 I e6l 21 c 6l r Owner 3r S6 Ly t// 7 Address S4A1-) Telephone r S o 8�) Permit Request SNFn o /o '-x IbI l� Qti. Cr_Mf_A•Z�CCPg Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Valuation ,�/ 2 Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfatfiered: ❑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 0/Basement Type: Full ❑Crawl Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) l 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: VGas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes VNo' Fireplaces: Existing A10 New Existing wood/coal stove: ❑Yes VNo Detached garage:❑existing ❑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 Eli ,Yes I� No If yes, site plan review# Current Use _�— -^—�` """^" "`' u�-Propos d Use ". - ��2E BUILDER INF019MATION Name- f �11CA01 "i0 &2)DaCTSTelephone Number ��O � �� (l n Address � � Q M���i7 �7,�_ License# �6(5 Home Improvement Contractor# � �T Worker's Compensation# 1 � ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE a4 DATE FOR OFFICIAL USE ONLY PERMIT NO. — 4 i DATE ISSUED �e MAP/PARCEL NW ' ADDRESS " VILLAGE OWNER ; 4 ' DATE OF INSPECTION: r — k FOUNDATION } FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL 4G PLUMBING: ROUGH: FINAL GAS: ROUGH FINAL x FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. K, i i i . Board of BuiOding'R uiatons -- One Ash burton Place. 1301 Boston, Ma 02108-1618 License: CONSTRUCTION SUPERVISOR LICENSE Shthdate: 03114M970 Number CS 013855' Expires:03/14/2002 Restricted To: I JAME•S R MCGRA-Tfl ,n WINTERGREEN LANE BREWSTER. MA 02631 Tr.no: 73865 Keep Lop for n and orange of address notific8don. 4 -- - Board of Building Reguia ions and Standards 4 "_ One Ashburton Place - Room 1301 Boston, Massachusetts 02 108 Home Improvement Contractor Registration Registration: 122935 Type: Private Cz poration Expiration. -0/3112002 McGRATH POST & BEAM CO. JAMES MCGRATH -- __._.._........_... 259 QUEEN ANNE RD. HARWICH, MA 02645 - ' -- . ---- Update Address and return card.}lark reason for chanage Address ' Renewal Employment .— Lost Car a .;7i.: i:r.�N.iacirarq►/// r . /'[fi::r7�i��Lr�l' Buard or Building iteytulations rmd Standar'iis License or registration vaiid for individui use only ' HOME PAPROVEME NT CONTRACTOR before the aspiration date. 1f found return to: Registration' 132935 Board of Building Regulations and Standards Expiration: 1=1=2 One AAhurton Place 11m 1301 Boston,.Ma.02108 Type: Mr.GRATH POST&BEAM CO. AME EN ANN ANNE E �� rav� ! __ 259 QUEEN EEN RD. 1-;k HARWICH.NIA 02645 Adminisrator Not valid without Signature t i r Suggested Affidavit for Home Improvement Contractor Permit Application For omee the Only NAME OF CITY/rOWN Permit No. Date AIFMAVI T Home Improvement Contractor Um Supplement to Permit Application MGL c.142A requites that then wonaruetiom alteration,renovation.mmir,atodernintim conversion,in .removal,demolition. or construction of an addition to anv ore adaint ownerooeanied building containint at test one but not more than fottrdwellint units.—or to structurts which are aftwent to such rtsidwor or building be dtwe by registaed amumciam with certain cwc;boos,along with othts tequirt:metus. Type of Work: eD 15', V ch o n of Pcni t ea--en� Est. Cost/ Address of Work. Owner Name Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): _Work excluded by law _Job under S1.000 _Building not owncr-occupied _Owner pulling own permit _Other (specify) Noticc 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 aec t r. Date tractor a c Registration No. OR: vh'fu_�' r . , Notwithstanding the above notice. I hereby apply for a permit as the owner of the above property. Datc Owner lame The Camatonwrallu nl juuAau«��•�'•�.. Dt pgrtment of Indswrial Acddeats . . ti t• i 01�eallomli�thms • 609 if aWngtnn Stuff •r ••�� •. ' ; Bnvan.Maxi. 0311! `'M:.'•' NvorL•ets•Compensation tofalrataet Atfda�it _�' _. .— -• _ i 1MIl •�itc . 1 am a homeowner eU performing all work mys 1 am a sole proprietor and have no one walking is my eapaY i - ion for lm empioy/ees work--- an this�o 1 am an�t1lpl�yer proridmg tnrati:ers' �Q�LC/r �..L rnm �nr m �/ N/ /� �C/t/ i 3 rn f Td l " Due �� _a���7G . T.; Jj� ` Li n r� 0�7 � //'. nheer tf• rlrt•: Y Vf � (� - _ 1 am a sole proprietor,et nt rrl eoatractor,or homeoaaer(circle one)and have hired the Imrltradors listed below who ha�•r o tllc follo%ving workers' compensation polices: rt%MT13n imr: a r1,1 rr cc: . 1 N. :nlnrnnrr co. _ .. +ir•'S i.'.1^r,�yOr,- 7 _i:,r. _ •�•. - .���� rohni k- Atincti idditLtul shcdif nctiess_a!}": --- ail i:rc iu.rcorc cn.era;c as regoired under Section 25ll1 or AIGL IM can lead to Ike imposition ct erttntttal penalties of a pine up to St�00.110 anJillr ,Inc pearl itpltjison spell as tril prnolties in th!form of a STor\\outz ORDER and a fah of SIC0.tM•tla�a;aiwst ac. 1 swderstalul that a CUP!earsof .utr 1nt mar fun.ardtd to the ottice or In "�atioes c Dt.♦forcottrapc arificatRem. ::o I,crri,t r ijr t r noias,a .� i rl•/ 1/1 afOlR�fton prrrrtdt:d e..4mv is four an-4 MrrtfL <:enaturc Phone 0 Vrint na l' --11 E oGcia!n.r na11 du auk.bite in thn arcs to he completed Ir-city or town official `1 peroviAcrow k nitoildir;Ilcpartment 1. citl or Inan: t Olicce..itr;IlwrJ ;: OSnc�ttwrn'>Offirr 0 rhrrL it ilnulydlatc.c>lunl>c i•required 011ealta Urpartlnrut l: pMouc k; nc lthcr t. contan pcl.ua: i un.1a�:•••1.1:1� THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) Im ^�c� C DAA&TA r r COITS'n. +CTION SJP'r VISOR FORM PRINT l' JOB LOC"ALTION - - _ 30_ RT'I OWITER -- CC:IS=R_ JCTI02i SJF= LVISOR sS 3n -'isE NUNS=�� 5 073 PHONE - - S D A TY) - p= C' 1=CE A _C_=. «S r10 LG_ - - - _-- r- - _- -e:C._SG __Gl-r c_..:-c__....r - - -- - r - �C' - -- -- --- - - _-=-- =--- CCc= --- "-_-_- - Wr me G_-Z^.__GcL=CIl= ^_o- r'_ CE-Gj_-_C:: c� __^• i c=EC Gv SeC==C c- -_-- -- r G=- r - - - - - _e - -EC-:_.:_Ore . Tr Of - - - - SG_c c_ zzte c " C==S= L•:.�._� c Su ccessor license holder is _ ' E=_-_- i'! T'E5.^.C:'_5�= undo ate i d i cc E7"_ read cr C L= - -- i c�=^:'_S =C•= -_- = --a c:--e COG' T l;--'i SeC:_OYl 109 O_ -E-z Bu-: it iaC-. amec-=-C =-:S�eCG_0::= ES - _r- - Q=-_C--- - /� r "TCZ il CONS•'-LC'�'T�`I JU^__=__ -Ziv2l 1_1•� I / PLOT PLAN FOR LOT f Indicate location of g agc ar acc==y buii i--,— Additiow witb dashed lima -- Ser,rcage dismal(CaMmool) 1 ----------------fL rear fbutt='r OVOL Lot' iC- I Res: Yard �yl �sN�p �, r is c ce--v tct, --_•'- '.::. i - writ L cf , I —.arc ! -r,• I c:._. ^c... I 4I 4 ................. I ' ; I (L-C.....................L. wage) J / (14=rue of reet) L-rforr<:atioa 1 Supplied by °F tME rqt, Vie- f .� The Town of Barnstable • MASSg Regulatory Services �A t639' � Thomas F. Geiler, Director Building Division Peter F. DiMatteo, Building Commissioner 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax: 508-790-6230 E 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: f0 Estimated Cos 4 Address of Work: Owner's Name: 62- LZ/X1l4 J Date of Application: I hereby certify that: i Registration is not required for the following reason(s). i ❑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 E 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: Contractor Name Registration No. Date OR Date Owner's Name q:forms:Affidav:re v-070601 wy �r + RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings,Additions $50.00 Alterations/Renovations $25.00SrL.�• Building Permit Amendment $25.00 FEE VALUE WORKSHEET LIVING SPACE square feet x$96/sq.foot= x .0031= plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet x$64/sq. foot= x .0031= plus from below(if applicable) ACCESSORY STRUCTURE>120 sq.ft. >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= x.0031= STAND ALONE PERMITS Open Porch x$30.00= (number) Deck x$30.00= (number) Fireplace/Chimney x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool . $25.00 Relocation/Moving $150.00 . (plus above if applicable) Permit Fee . projcost ir�-��r � } �: � I �� � � /� � eTi �L i 7 �/C/� ��/ �Vv ��, � �%x i�/r"���i I i • 1 39 \ LD7- o ¢3� �► h . �SZ EX/JT/�t/G �Ifi Ic ,� ! j 1 i Z //E,eEBY �E.eT/�Y 2Z07- T/�E A'/S77N-6 FDUNDATIGYV O. S 1 CONFa,&VS TD 7716 Z41VIl /G SYG.914/S Dvz' T/� ?Oh/N a, �'Ielv-:5 NBle� �AsE� a✓ AN AG771.4L /itlST,Pl1iyFNT SIJRf�Ey_ C�27/F/ED FDdNLL977oN ,ols�it/ T Jtk 0F JOHN 9�s M/C�A�L `/TzpAT.e/C.K P. No, 7io )11^W651 .'019.6 IAI DOYLE,III H p//,Q1V-57X 6 z I e!F� M-9. No.33589 SC9LE%��Ste' FE,B. 7J /9 9�o 9 �0 S U RV�J O� 6,e.9PN/C SG9GE /N FEET D -50 /oo II �7�12 AfCk \ BOLA-2n tj - — NG - I I NCO►* CA6r BLOCK , I rj - A LL S E DS I+A v6 G A(SCE f N O LOUYl RS c�� T1 E S 1 a x y" LNW- Sfrow N� X y Tv A PI ATE y �,, Zxv' PU�L�►�S i S I i j IOx1C� ' e • • 30 ,� e Q 3'IDOL� I-cu all blo � � t4s 4.3 :0. r +'r:F V, a 0176, 315 1 T.0 3-r'Vd -11 9 3soc ZBVEOZ0809 0£::80 T.00ZI8T180 WM -71 ssor's Office(1st floor) Map 0 Parcel CCR,13b5 Permit# f a 5 1 Conservation Office(4th floor)(8:30-9:30/1:00-2:00) Z $ Date Issued 94 Board //of Health(3rd floor)(8:15 -9:30/1:00-4:45) Fee F �3T 1, Engineering Dept. (3rd floor) House# IKE Planning Dept.(1st floor/School Admin..Bldg.) a�--1-�-�a `r �, k��( , -LAN(Z ►J c '� �•; e.aKA Definit' Zanproved by Planning Board 19 TOWN OF BARNSTABLE fi Building Permit Application aw dress Village ,/Owner Z -r ,T u, —Address Telephone L /ermit Request ✓First Floor square feet Aecond Floor b 70 square feet Estimated Project Cost $ �U , 6,u U / Zoning District Flood Plain Water Protection Lot Size_�l3 s� 5-7 th. Grandfathered ? Zoning Board of Appeals Authorization Recorded Current Use Proposed Use Construction Type Commercial Residential r/Dwelling Type: Single Family Two Family Multi-Family Age of Existing Structure Basement Type: Finished Historic House Unfinished Old King's Highway Number of Baths 2 No. of Bedrooms Total Room Count(not including baths) S First Floor J7 Heat Type and Fuel�/J(,� - �j Central Air di l Fireplaces /I�artR Garage: Detached Other Detached Structures: Pool ,�f.�- Attached Barn �,- None Sheds Other Builder Information /Name z a )el( `C - Telephone Number'�Uf -?Ina /Address 0 e k e f C• License# l =/Home Improvement Contractor# "J/3?T S -,""Worker's Compensation# 4Z C I 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 DAB �' f BUILDING PERMIT DENIED FOR T FOLLOWING REASON(S) FOR OFFICIAL USE ONLY / ��� PERMIT NO. . DATE ISSUED . MAP/PARCEL NO. ADDRESS G VILLAGE ; OWNER DATE OF INSPECTION.: � FOUNDATION �` Q FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL ' GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT t ASSOCIATION PLAN NO. y TOWN OF BARNSTABLE CERTIFICATE OF OCCUPANCY PARCEL ID 012 003 005 'GEOBASE ID 40127 ADDRESS 710 WAKEBY ROAD PHONE Marstons Mills ZIP 02648- © I LOT 5 BLOCK LOT SIZE DBA DEVELOPMENT j DISTRICT CO PERMIT 14257 DESCRIPTION single family dwelling ' PERMIT TYPE BCOO TITLE CERTIFICATE OF OCCUPANCY Department of Health, Safety CONTRACTORS: and Environmental Services ARCHITECTS: � TOTAL FEES: Ox BOND $.00 CONSTRUCTION COSTS $.00 756 CERTIFICATE OF OCCUPANCY ` BARNSTAB LF, i639. A� OWNER FITZPATRICK HOMEBUILDING CO. ,INC. , E� ADDRESS BUILDIN' D V. S ONP 0 BOX 154 FORESTDALE, MA BY� I DATE ISSUED 04/03/1996 EXPIRATION DATE THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) m A DATA ' �:" ��;)' .'l• l ;� 'lam`—t< 7� � � :� � �S)'.-' �,1_?V:,✓.7:' ,cv1 i !°. 1.; 17„ \' \'Y" .. 1�7�n�_'r f?i i.. _•1 illisiS ��-iltCl::�i,r.ii.a„�•. � - 'd�1.L�.+.� ,.� t�2,•w�ti.+'•. .S;.Ti•a;�Y:s%�`��:.:'Si:-.:.,_+...:. :.._:_..t.��.a�2 l�<� 9.%.i .' • r' 7t:�, ,.� �.• I� t,l L�� !(r<r 1� .• !�.;e�*�C1:- J! -`WSJ.i.<'�? .. T�1_I1I i MTT_IT! ;Yi'/1{,_.,'.s 1..�!�� L.�):_,•'•i (n'^ -i-'?., . i�7. _ i"ti .� i /.,,1: ! y. �c� �� Department of Health,'Safety and Environmental Services • t ! •' .... ,N '.Ill�(_ r }, 1- PRIM, I • BARNSTABM + l a;. .: f :. 'BUILDING DIVISION BY ' is.r1 I' !;'3C1•_.�.�.1., �J ! _I:.�. .,"J.:L.: 1.1 <`M4 fl�Sr.:.,4< !/' •`r , ..... -- <. 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 UNDERTHE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROMTHE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLESUBDIVISION RESTRICTIONS. ; MINIMUM OF FOUR CALL INSPECTIONS REQUIRED APPROVED PLANS MUST BE RETAINED ON JOB AND FOR ALL CONSTRUCTION WORK: 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 BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 0o0 �� (IVo7nGC .d�ix�, ? 2 "Vifl�/ d�r� Gcv 2 �e 3 1 HEATING INSPECTION40PROVALS ENGINEERING DEPARTMENT 01 jr 2 BOARD OF HEAL IeI17 , —cr-'br- - - OTHER, SIT P N REVIEW APP L -p� f F0 WORK SHALL NOT PROCEED UNTIL ' PERMIT WILL BECOME,NULL AND V616 1F:CON•, INSPECTIONS)NDICATILD-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. NOTED ABOVE. TION. /Ll� ;��l i 3IS, LOT /</D. ✓� SB� yC3� S63 S F, r� 43 � ti 38� I 53� � � h i /52 Est'/SST/�t/G w GOA/C,eETE .8 o 4 ! I Z .yE,eEBY �E.2T/FY T7f,9T 4--,,V,,ST/11,6 DN LOT /✓D- S G'QrVGO4V,5 TD 771E SYL.9h/s D� , T/fZ� TOh/N O� B9�STg'B�3 B/IsEv 6W AN AG7zG4L //t/ST,P!/��iVT St�Rf�Ey_ I' f { CST/F/FD FDdNLL9J70N ,oL.�Jit/ -B1//LT `N OF 1 O�� JOHN gLti M/Gf�fi��L `/TzpAT.e/cr { P. DOYLE,I11 No.389 71 19 9�0 GfSTER�y�Q� S'GyLE /N FEET SUR' D 5D /co i �M 38� h /SZ w GD�►/C.eETE � w �Ot/N1�TlD�t/ f i f I Z yE,e�BY �.'E.2T/FY 7W7- T� AW3771Vry FDl1NDi9TlGY1/ .dF�/G7Z=1D DN LOT AV, S i i CONGO,eMS TD 771�5 S�T89GK TNT OVIV/jVLO 8yz-4,4/s Dl'= T� TOhIiV O� E �/�/S%h'BG,E� F s�l� CW AN .9GT iL //1LST,P11ry�iVT SIJR�Ej! i CST/F/c�1� FDdNG29J7D/✓ ,oGA�t/ s t �c�J,�H �f A9gsJq �O,e i JOHN cy� /�//Cf�f��L `/TZpAT.�/C•K I LE,111 /•�� rJy���y /N DOY No.33589 Bf/�STA,BL��, MA, �q'pFCIST 1)O� SCyGE.% SO' FB,B 75 /9?6 S u, G ge Ze /N FEET 2_7-1 0 50 /oo "/p//W P d 4 YG e� P. L, S ti `OptME TOE The Town of Barnstable . O� BARNSTABLE.p• Department of Health Safety and Environmental Services 9 MASS. 0 �p 1679. �0 TEGMP�4 Building Division 367 Main Street,Hyannis, MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner Inspection Correction Notice j Type of Inspection F V-1 Location �.� Permit Number� ^ Owner Builder A- A"O (7 One notice to remain on jobsite, one notice on file in Building Department. The following items need correcting: G� 1 _ - e 1.�At LE, CZ) '� ,-vq ni,�A 3i )1,g 70 YL y - Please call: 508-790-6227 for reeinspection. Inspected by , .� Date I r ' _ The Conunon►1'edith of Atassaclrasetts De art»rent of Inditstria/Accidents p :i office 8110 11121lotts �-`� '.';�:': •r•,�' 61111 A'ashin,,,tun Street Boston;Alas. 02111 Workers' Compensation Insurance Affidavit Applicant tntormation: name: location: city rhone# I am a homeowner performing all work myself. I am�eaa sole proprietor and have no one working in any capacity A�w L...•_�__ i•.�IT� .tY :Oa�ur•a -__ :'A:-.:� ,w.y:i_...e�ie1'. .4.- —- _ .:.R. '�• ., :""'ii"L!"•4_-.•TM��+,Y,til�'11!1•••y�f.Y�Vy� 0 lam ari employer providing workers' compensation for my employees working on this job. cnnJnany name: address: city: phone#• insurance co polio•# ,,. .,,.. .:,..:.,:....,�.:•.-:.. ...._,.._•,...,,;.�r,;•-.. ..�,,•:••.�.«,.�.�r.,. •- .;•....ter,;..•.-,.�»;_.......�,,.. 1 am a sole proprieto , contractor homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: � II Cool •an name• �C•2 /GlL VLt2 ' —G r Id res incurnnceco. / it 11olicy# — a�� L'.:.:.� __.�.� _ ..,ycnr:r.-• •:r�roe-asry?• �;�s .i z^, .T .=R.:T,,. .�rr,•tn,,,,,. .,,ate.'.. c6mpanv name: address: city: phone#• insurance co, policy# :Attach additiorial'sheet if tieces '� "� rL �r;.;s: a:,>f;w a i :v.[,• nw•.. ��' 7:"Z ^ E, uc'�` Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to 51.500.00 and/ur one years'imprisonment as well as civil penalties in the form of a STOP NVORK ORDER and a fine of 5100.00 a day against me. 1 understand that a cope of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. 1 do herehr certij•t d r tke i r nd nalties ojperjun•that rite information provided above is true and co MY.Si_natur Date`" n' C Print name G ►� I� Phone 6 — 5G 7ofrcia, nly do not write in this area to be completed by city or town official permit/license# rlBuilding Department OLicensing Board 0 check if immediate response is required Selectmen's Office [3I1ealth Department contact person: phone#; nOther V'n-�.,,�•., r,- lam .T,. .r ri: -- - --- - - - .er.�.,..-sr....a..�•, (revised 3;95 P1A) -.::..._• ••. � STY. 1 ''' - - COMMONWEALTH DEPARTMENT 4F PUBLIC-SAFETY OF ONE ASHBORTON PLACE a a aairaat MASSACHUSETTS BOSTON,MA 02108 Fallo►oto po!los �laaaaohaa+na state�NIOInC aa�tN rowoatton EXPIRATION DATE CONSTRLISUPERV.ISOR 09/07/1 996 EFFECTIVE DATE LIC-NO. FOR PROTECTION AGAINST RESTRICTIONS THEFT, PUT RIGHT THUMB , NONE 0*6/3 0/19 9 4 0 4 c 416 ' _ PRINT IN APPROPRIATE ~1 o MICHAEL T FITZPATRI.CK ,� x PO BOX 75 7 SS p 034-55-0370 z. f UZZARDS BAY MA 02532 ;,t �.� US TINDE ATO m PHOTO(BLASTING OPR ONLY) FE 00.00 0 'NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY HEIGHT: STAMPED-OR-SIGNATURE OF THE COMMISSIONER ' DOB: 000, 09/07/196 D.P.S. THIS DOCUMENT MUST E t IN LL ABOVE SIGNATURE LINE CARRIEDON THE PERSON(' SIG TORE OF LICENSEE THE HOLDER WHEN E- OTHERS•RIGHT THUMB PRINT GAGEDINTHISOCCUPATIO: i "NP4UlT bNINCiLlS �('••�'Ir _.KlalM:w-ITt8 •)iY IDWEL 7,taG INSEA.. 't1w1A INEtA. ' 2i.t�IKSIti�C; 1vM1t[.ClIHR Yi1N(,LE1':..... ''• .wKOCtinAR:bHN4LEf K U..Ib ItlSIA''. KIl(A1E1•f.U6CM'[._. -.11 ) _ -.t .1 ._i ,.I•. G1.Q.N•"._.._. EX1f:OPT�1.. "'111 i., '.:'',' �' fll + -2�rY.'IMSU�'-:. 4-1 _ r o evIin' cogrlghF,Q•1887°_-.. • �;,� %?il.'i-• Yih1r.:v':.,.::.•y,.:ut `i141NiUL'�_ .. 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