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TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map P. �7�Parcel � Permit#
Health Division ?'Gib 7 �,,-O,<- Date Issued �7
Conservation Division `7 /�i Fee02 �qo
Tax Collector \
Treasurer • �.c i b� a,Q SEPTIC SYSTEM MUST BE
Planning Dept. INSTALLED IN COMPLIANCE
WITH TITLE 5
Date Definitive Plan Approved by Planning Board .V A— �' ENVIRONMENTAL CODE AND
Historic-OKH Preservation/Hyannis TOWN REGULATIONS
Project Street Address
Village ��i. i5�✓th 5 ����-'
Owner &4 � %G�/G �� Address � �/G�/
Telephone �� - 3 G Z - /3/6
Permit Request /
�6 r VU� o w
Square feet: 1st floor:existing &0 proposed 2nd floor: existing 3M- proposed Total new
Estimated Project Cost /, ' o — Zoning District Plain —11-6 Groundwater Overlay
Construction Type 1* &o F
Lot Size Grandfathered: ❑Yes ❑No If yes,attach supporting documentation.
Dwelling Type: Single Family .a Two Family ❑ Multi-Family(#units) /
Age of Existing Structure Historic House: ❑Yes o On Old King's Highway: eC�'Y s ❑ No
Basement Type: a ull ❑Crawl ❑Walkout ❑Other yy
Basement Finished Area(sq.ft.) �/l5,��`i Basement Unfinished Area(sq.ft) 1/4y
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: UGas ❑Oil ❑Electric ❑Other
Central Air: Erles ❑No Fireplaces: Existing �_ New Existing wood/coal stove:- ❑Yes
Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:Cl existing ❑new size- -
Attached garage:d-e-x—isting ❑new size Shed:Ming ❑new size `---Other:
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
.Commercial ❑Yes ❑No If yes, site plan review#
Current Use Proposed Use
/ `�, BUILDER INFORMATION p �/g
Name .>O/Y/1/ �G-i�ICQ�J�-- Telephone Number �U — Z177 v15l"/
Address /h � License# (05�0�
UZ oll Home Improvement Contractor# 3
Worker's Compensation# GUl C9 S��
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATU DATE y/�7 Id y
FOR OFFICIAL USE ONLY
PERMIT NO.
DATE ISSUED
MAP/PARCEL NO.
ADDRESS VILLAGE
OWNER
DATE OF INSPECTION:
FOUNDATION
FRAME
INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
GAS: ROUGH «l FINAL
FINAL BUILDING
DATE CLOSED OUT r fir.
ASSOCIATION PLAN NO.', tax
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'TO THE BEST OF MY KNOWLEDGE THE PLOT PLAN OF LAND
FOUNDATION SHOWN ON THIS PLAN IS AS LOCATED IN
rT ACTUALL Y EXISTS AND CONFORMS TO THE ZONING REGULA TIONS rN BA RNS TA BL E — MASS.
JT' lb1Vl .OF
BARNSTABL& REGARDING YARD- WTBAClfs• '.. PREPARED FOR
DA TE.•DEC.1. 1997 = ``
A GPI COLA CONSTRUCTION
q;'L';'S, :E DATE.•DEC. 1. 1997 SCALE.- 1'-50 FT.
CAPE 6° ISLANDS ENGINEERING
FLOOD ZONE C
f)-61 . 24c "�,, .,�!':•" MA SHPEE — MASS.
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HOME IMPROVEMENT CONTRACTORS REGTSTRAiION
Board of Building Regulations and Standards
F One Ashburton Place - Room 1301
Boston . Massachusetts 021.08
IWME IMPROVEMENT CONTRACTOR
Registration 110033 Expiration 10/02/00
w Type - PRIVATE CORPORATION
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AGRICOLA COIJSTRUCTION CO _ INC .
rn
JOHN P . AGRICOLA
P _O .BOX 765/19 PUNKHORN POINT RD
%,I� {�`,r„emoc4 eatdi r f{ossacoell3 MASHPEE MA 02649
BOARD OF BINLDING REGULATIONS _
Lloense: rOONSTRUCTION SUPERVISOR 1,
Number.-CS O40642 s
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Tr.no: 7632
d 00
7 JOHN P AGRICOLA
PO BOX 765 HOME IMPROVEMENT CONTRACTOR
� _
MASHPEE. MA OL2649 AdminiVra[or y = Il. RegiStlatlon 110033
� \ Type PRIVATE R'PORAT ON
i° ACRICOCA COWRUCTION CO. IN(
Q� 10 P. AGRICOLA
-- BOX 765/19 PUNKHORN POINT
,— K:AWIESIHAKO+
MASHPEE MA 02649
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04/27/2000 12:11 617-749-1354 VINI ST PIERRE PAGE 02
Deparrment•ojiadustrial Accidents
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-_ 600 Washington Street
Boston,Mass 02111
=" Workers' Com ensatlon Insurance A�Ytdavit
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ESTIMATED PROJECT COST WORKSHEET
Value
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LIVING SPACE square feet X S55/sq. foot=
GARAGE (UNFINISHED) square feet X S251sq. foot=
PORCH square feet X S20/sq. foot=
DECK. square feet X S15/sq:foot=
OTHER 5/*4-1f �1iCJJr- ��, square feet X S??/sq. foot=
Total Estimated Project Cost �S°�d6
_9 915b
L6 S 51 *17'50-E.
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B0.09 A-71. 13
N 50'49'25"W R.203.g1
HIGH STREET
'TO THE BEST OF MY KNOWLEDGE. THE PLOT PLAN OF LAND
FOUNDATION SHOWN ON THIS PLAN IS AS LOCH TED IN
I T ACTUALL Y EXISTS AND CONFORMS TO BA RNS TA BL E - MASS.
THE ZONING REGULATIONS IN TlTVIlF,Of-
BARNSTABLEE, REGARDING YARQ•`�WT9ACKS.' PREPARED FOR
DA TE.•DEC. 1. 1997
A GPI COLA CONSTRUCTION
OATE.•DEC. 1. 1997 SCALE. 1"-50 FT.
CAPE 6. ISLANDS ENGINEERING
FLOOD ZONE C (NON-HAZARD)
D-61 324C MASHPEE - MASS.
Application to
Old Kings Highway Regional Historic District Committee
in the Town of Barnstable for a
CERTIFICATE OF APPROPRIATENESS
Application is hereby made, irf triplicate, for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470.
Acts and Resolves of Massachusetts,.1973. for proposed work as described below and on plans, drawings or photographs
accompanying this application for:
CHECK CATEGORIES THAT APPLY:
1..Exterior Building Construction: ❑ New_ Building ❑ Addition �lteration'
Indicate type of building: House ❑ Garage ❑ Commercial- ❑ Other. .�
2 Exterior Painting: ❑`
3. Signs or Billboards: ❑ New sign ❑ Existing sign ❑ Repainting existing sign
4. Structure: ❑ Fence: ❑ Wall ❑ Flagpole ❑ Other
(Please read other side for explanation and requirements). N ,
TYPE OR PRINT LEGIBLY N DATE1���LGy U
ADDRESS OF PROPOSED WORK ��
ASSESSORS MAP NO.
OWNER & llzj4 �G ASSESSORS LOT NO.
HOME ADDRESS TEL NO. -3""2
FULL NAMES AND ADDRESSES OF ABUTTING OWNERS. Include name of adjacent property owners across any public
street or way.. f Attach additional sheet ifnecessary). `
fit
rl
AGENT OR CONTRACTOR Z'9 Q�/'1f?,4? TEL N0.
ADDRESS
DETAILED DESCRIPTIQN OF PROPOSED WORK: Give all particulars of work to be done(see No.8,other side), including
materials to be used, if specifications do not accompany plans. In the case of signs,give locations of existing signs and proposed
locations of new signs. (Attach additional sheet, if necessary). D D
Signed
Spam below lint for Committee use.
O
ate a Certifi to is hereby Date
ime* 2 0 c
�w�ixQ
WNOFB �i
HIGHWAY
Approved ❑ IMPORTA If Certificate Isa proved,approval Is subject to the 10 day appeal period
provided In the Act.
Disapproved 0
Town of Barnstable
Old King's Highway Historic District Committee
SPEC SHEET
FOUNDATION
SIDING TYPE S�j,Y X-61e5 COLOR_ if/L
CHIMNEY TYPE /r/O !?G`� COLOR --
ROOF MATERIAL COLOR Z�� Z( eeV 1H /f 9 P77)
PITCH �!
WINDOWS COLOR 11 azE 'Olt
TRIM COLOR 6 / bac-O CO / 97A D d D
DOORS 10,47 t COLORS 9'
SHUTTERS COLORS
GUTTERS f70 h P COLORS
DECKS 17 or `1 -e MATERIALS
GARAGE DOORS A41`j -P COLORS
SKYLIGHTS SIZE COLORS �—
SIGNS COLORS
�� -�
FENCE �! COLOR '
NOTES: Pill out completely, including measurements and materials/colors to be used. Pour copies of this
form are required for submittal of an application, along.with Pour copies of the plot plan, landscape
plan and elevation plane, when applicable.
SPECSHT
Revised 11198
.:�.�:APP16tion to
a Old Kings Highway Regional Historic District Committee
in the Town of Barnstable for a - - ---- -�'
CERTIFICATE OF APPROPRIATENESS
Application Is hereby made, id triplicate. for the issuance of a Certificate bf Appropriateness under Section 6 of Chapter 470.
Acts. and Resolves of Massachusetts, 1973. for proposed work as described below and on plans, drawings or photographs
accompanying this application for:
ECK CATEGORI ES THAT APPLY:
1. Exterior Building Construction: I New Building ❑ Addition ❑ Alteration
Indicate type of building: ❑ House ❑ Garage ❑ Commercial ❑ Other,
'I Exterior Painting: ❑
a Signs or Billboards: ❑ New sign ❑ Existing sign ❑ Repainting existing sign
4. Structure: ❑ Fence Wall ❑ Flagpole ❑ Other
(Please read other side for explanation and requirements).
TYPE OR PRINT LEGIBLY DATE
ADDRESS OF PROPOSED WORK 2-2��/�w '-� ASSESSORS MAP NO. `
OWNER Jbi A PUM / //Ie /04FZ— ASSESSORS LOT NO.���
HOME ADDRESS �Z /�IG/� �'1� /.l✓-�� �d�i�/.�'�' TEL NO� C�"
FULL NAMES AND ADDRESSES OF ABUTTING OWNERS. Include name of adjacent property.owners across any public
street or way. (Attach additional sheet if necessary) �
(ySlEizv.//�,i19,f4—
�S1f�� 14t,)10- 36V #/r-# s0- UJ. b4W
AGENT OR CONTRACTOR d(� h �% TEL NCe5 2- e
ADDRESS �,Y k4-&-::A 5-1- t42'
DETAILED DESCRIPTION OF PROPOSED WORK: Give'all particulars of work to be done(see No.8,other side).induding
materials to be used, if specifications do not accompany plans. In the case of signs,give locations of existing signs and proposed
locations of new signs. (Attach additional sheet, if necessary).
A,0',JLj
fry-� -' ,
7
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• w -
Contractor-Agent '
Space below line for Committee use.
Received by H.D.C.
J
itee r� �'� a Cert 'cate is hereby V 4 E Z C E Date1 Ti
m �
UV i I,�7
TOWN INF BARg'SI'STABLE '
IMPORTANT: If Certificate is approved,approval'is subject to the 10 day appeal period
provided In the Act.
Town of Barnstable
Old King's Highway Historic District Committee
SPEC SHEET
FOUNDATION
SIDING TYPE_
CHIMNEY TYPE �f��~ COLOR
ROOF MATERIAL COLOR �� ��� �S •Q1J t /
PITCH
�.,-
WINDOW � 1 y GW COLOR Ql�� SIZE X Z /
TRIM COLOR /�' G�j��/!� �/ L
1
r 1 '
'DOORS GS O •%Z'► c COLORS
SHUTTERS COLORS
GUTTERS � "7 G`� COLORS
DECKS MATERIALS
GARAGE DOORS < Vj £ COLORS
SKYLIGHTS /V C� G SIZE COLORS
SIGNS O(9 C� COLORS
APPROVED�
FENCE��� L/Lo �i COLOR
NOTES: Fill out completely. including meamureaents and materials/colors to be used. Your copies of this
form are required for subaittal of an application, along with Four copies of the plot plan, landscape
t
plan and elevation plans, when applicable.
Sp3CSHS
Reviaed 11/98
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HIGH S TREE T
"TO THE BEST OF MY KNOWLEDGE, THE PLOT PLAN OF LAND
FOUNDATION SHOWN ON THIS PLAN IS AS L OCA TED IN
IT ACTUALLY EXISTS AND CONFORMS TO BA PNS TA BL E - MA SS .
THE ZONING REGULATIONS IN TH,6`*W—.OF
BARNSTABLE, REGARDING YARD•`SETBACKS" PREPARED FOP
DA TE.' DEC. 1, 1997
A GPI COLA CONS TPUC TION
�• - _ } _ __��r_ . , R:L•.S. ` DATE: DEC. 1, 1997 SCALE.' 1 "=50 FT.
CAPE 6 ISLANDS ENGINEERING
FLOOD ZONE C (NON—HAZARD)';.
D-61 324C MA SHPEE — MASS.
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Town of Barnstable g7(al
Approved Regulatory Services
Fee Thomas F.Geiler,Director
Building Division
Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
I O fficd: 508-862-4038 Fax: 508-790-6230
Home Occupation Registration
Date: � ef-'�> �
II
Name:�� /14 �C Phone#: PS S �5
Address: �- r J s� _Village: U • [3c,( n Sy,7 L-<_
II
Name of Business: J_st ,
M`r'r�1��+-� �� r J f C-e—
Type ofBusiness:C"edJ Card 'Q" Map/Lot: �� 0
Zoning District Zoning Districts RF and RC-1 require Special Permit from Zoning Board of Appeals.
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;no 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 not 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 nonnal 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
pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to
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 re a and agree with the above restrictions for my home occupation I am registering.
Applicant• Date:
Homeoc.doc
TO ALL NEW BUSINESS OWNERS. 0
DATE:
Fill in please:
APPLICANT'S YOUR NAME: iQ_ jIc
BUSINESS ?. L —he
YOUR HOME ADDRESS: S
TELEPHONE - Telephone Number Home - 6 �X-- P1 3 3
NAME OF NEW BUSINESS
�f"✓_ Ce TYPE OF BJSINESS��cc�,4- aze�{ Oe'oe •
IS THIS A FiO.ME OCCUPATION? N0 _
i Have you been given approval from the building division? YES NO
ADDRESS OF BUSINESS 3a `t - `H� 11 a- _ r1,J • Q,-„ �-Jh Jr: MAP/PARCEL NUMBER
When starting a new business there are several things you must do in order to be in compliance with the :,ides and regulations of the Town
of Barnstable. This form is intended to assist you in obtaining the information you may need. Once you have obtained t:":e required
signatures, listed below, you may apply for a business certificate at the Tov;n Clerk's Office (Ist floor - To%-,,n Hall) or if you get the business
certificate first you MUST go to the following office to make sure yo,- have ',lie required permits and lice-.ses..
GO TO 200 Main St. - (corner.of Yarmouth Rd. & Main Street) and .you will find the following,. offices:
1. BUILDING COMMISSIONER' OFFICE
This individual ha inform of any permit requirements that pertain to this type of business.
Auth ized Signature"
COMMENTS: ,00O .v v �(o -J -l��-e_ O /itTY�ti /�P r��.f-Tro •!
2. BOARD OF HEALTH
This individual has been informed of the permit requirements that pertain to this tyre of business.
Authorized Signature" .
COMMENTS: .
3. CONSUMER AFFAIRS (LICENSING AUTHORITY)
This individual has been informer of the licensing requirements that pertain to this type of business.
Authorized Signature""
COMMENTS:
Business certificates (cost $20.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in the town (which you rust
do by M.G.L. - It does not give you permission to operate - you must get that throug''i completion of the processes from the various departments involved.
"SIGNIFIES APPROVAL FOR A BUSINESS CERTIFICATE ONLY.
Town of Barnstable
of Ero Regulatory Services fit' It1 Or EARNSTABLE
do Thomas F.Geiler,Director 20014 JAN'30 PP 2: Q
snreNsrest�,
Building Division ?�,
M"M $ Tom Perry,Building Commissioner
163.9 .�
1°rEo ,t6k 200 Main Street, Hyannis,MA 02601 �-
. pi 4'IS10�1
Office: 508-862-4038 Fax: 508-790-6230
Approved:
Pee: L 0 .
Permit#:
HOME OCCUPATION REGISTRATION
D�p1 �o o y
Name: (/mil C VIDE KJ —L J-1 Phone# •S'S�/y
Address: 3-'�y
Name of Business:
i
Typei'af Business:_G(e-a V1 I n C Map/Lot: — a
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;no 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 not 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
pick-up-ttuek-not•to,exceed•one..ton:.capacity,and one trailer not to exceed 20 feet in length and not to
excg-ed 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 'th the above re ons y home occupation I am registering.
Applicant Date O
Homeoc.doc Rev.5/30/03
TO ALL NEW BUSINESS OWNERS
DATE: 3P o9 w
"i
Fill in please: ,.s;;GGs �a r;� ,Qx s_ UR NAME:
c�4el
APPLICANT'S 1, YO
YOUR HOME ADDRESS:
BUSINESS :
Telephone Number Home
TELEPHONE.. � ,.:,.::. ... .: ..:.„. ,
NAME OF NEW BUSINESS M mon Wc01 f e� ' I ti TYPE OF BUSINESS h ►^
IS THIS A HOME OCCUPATION? YES N
Have you been given approval from the building division? YES NO `!/ _ o�8
ADDRESS OF BUSINESS Via- G S�- • ��s ! a Zi�z(AIIAP/PARCEL NUMBER .
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. Once you have obtained the required signatures, listed
below,you may apply for a business certificate at the.Town Clerk's Office (Ist floor-Town Hall) or if you get the business certificate first you MUST go to
the following office to make sure you have all the required permits and licenses..
GO TO 200 Main St.7 (co er f Yarmouth Rd. Mai Street) and you will find the following offices:
1. BUILDING C,pMM19SIO ER'S
This individual as b epr info ed o req irements that pertain to this type of business.
tho i ed Si nature**
COMMENTS:
2. BOARD OF HEALN
This individual has b inform th per ents that pertain to this type of business.
t orized Signatur *
COMMENTS:
3. CONSUMER AFFAIRS (LICENSING AUTHORITY)
This individual has Min infor ed,of the li ns' r irements that pertain to this type of business.
Authorize Signature*
COMMENTS:
Business certificates (cost$30.00.for 4 years). A business certificate ONLY REGISTERS YOUR NAME in the town (which you must do by M.G.L.
-it does not give you permission to operate-you must get that through completion of the processes from the various departments involved.
**SIGNIFIES APPRO VAL FORA BUSINESS CERT/F/CATEONL Y.
�j
_ TO OF J13ARNSTABLE
CERTIFICATE OF OCCUPANCY
PARCEL ID 111 0.28 G OBASE ID 5428
ADDRESS 324 HIGH STREET .F PHONE
W BARNSTABLE ZIP -
LOT - ?'LOCK -LOT SIZE _--
DBA DEVELOPMENT DISTRICT WB
PERMIT 29636 DESCRIPTION SINGLE FAMILY DWELLING (PMT-026637 )
PERMIT TYPE BC00 TITLE CERTIFICATE OF OCCUPANCY
CONTRACTORS: Department, of Health, Safety
ARCHITECTS: •and Environmental Services
TOTAL FEES: ' i
THE
BOND
CONSTRUCTION COSTS $.00
756 CERTIFICATE OF OCCUPANCY
__�_ __� -•-- -- ��__- - --.___. __._.____.. _--_ -_- .-------- -_ -- * .BARNgrABLE.
�039.
Fp�A
BUIL '. W S OWN
BY./�DATE ISSUED ISSUED .03/23/1998 EXPIRATION DATE
TD N OF BARNSTABLE
Jf -- V-1:1 MLDING PERMIT
PARCEL ID 111 028 GEOBASE ID. 5428
ADDRESS 324 HIGH STREET PHONE
W BARNSTABLE ZIP -
LOT 2 BLOCK LOT SIZE
DBA DEVELOPMENT DISTRICT WB
PERMIT 26637 DXSCRIPT.T.ON 3BP/2 1/2 BATH/2CAR ATTACH./COW CAPE(SP97"611
PERMIT TYPE BUILD TITLE NEW RESIDENTIAL BLDG PMT
Department of Health' Safety
CONTRACTORS: AGRICOLA, JOHN
ARCHITECTS: - and Environmental Services
TOTAL FEES: $434-00 OxI�
BOND $.00
CONSTRUCTION COSTS $140,000-00
101 i SINGLE FAM HOME DETACHED 1 PRIVATE P. &Z'R 'ABLE, '
MASS.
BUI DD G DI SOON I
BY
;i w,TE ISSUED 10/29/199-1 EXPIRATION DATR-
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
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.
VISIBLEPOST THIS CARD SO IT IS
BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTIO APPROV LS
3 1 EAING INSPEC N APPROVALS NGIN)INCjDEPAqTMENT
2 BOARD OF HE LTH
J'A.
OTHER: -F-1 P, SITE P REVIEW APPROVAL
-NJ,v L
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. NOTED ABOVE. TION.
• � 4
! �i
4
L6 S 51 '17'50"E
53.21 94.40
L7
LOT 2
1. 1 ACRES
W48-t ".00 3
EXISTING =
FOUNDATION
Qu
ti
O O �� $
2 ie.o0
- 13
80.09 A=71. 13
N 50'49'25"/y ga203.81
HIGH STREET
"TO THE BEST OF MY KNOWLEDGE, THE PLOT PLAN OF LAND
FOUNDATION SHOWN ON THIS PLAN IS AS L OCA TED IN
IT ACTUALLY EXISTS AND CONFORMS TO BA RNS TA BL E - MA SS.
THE ZONING REGULATIONS IN TH --.OF
BARNSTABLE. REGARDING YAR0-JET9AiC95i-."I i.,; 'PREPARED FOR
DA TE.'DEC. 1. 1997
A SPI COLA CONSTRUCTION
q;L';'S ii :,� DATE.'DEC. 1. 1997 SCALE.• 1"=50 FT.
CAPE 6 ISL A NDS ENGINEERING
FLOOD ZONE C (NON—HAZARD);".��; _;:;'',.;•"r.''
MASS.
D-61 324Co. fs, MA SHPEE —
f
IA
Engineering Dept. (3rd floor) Map i f Parcel n Permit#
House# I ate ssued 1.O . 2-9
Board of Health Ord floor)(8:15 -9:30/1:00-4:30) �0c�')`
Conservation Office(4th floor)(8:30-9:30/1:00-2:00) m&Y/�1- I -
Planning Dept. (1st floor/School Admin. Bldg.) ryu$T BE
Definitive Plan Approved by Planning Board u 19 LIANCE
NSTALL
0 ODE AND
TOWN OF BARN TABLEEwIRON
Building Permit Application TOWN RE(�lld.�+T96SNS
Project Street Address 3a9 �t19�1 Ist .air 0-c-L 1 l
Village ezrT -k--2�AaA . n
Owner 1 l I i A-M 1 gJ1,(-NcA Address Jai► Agq
Telephone ";OR- Ufa,�'- a?a 9
Permit Request A/e Li C 0^3-'-VXQc%i�.rN 3 -Be 0 R aoy►•
First Floor tJ�O'7 square feet Second Floor square feet
Construction Type �Npo� �2A-Me
Estimated Project Cost $ l,Y6 000
Zoning District Flood Plain Water Protection
Lot Size I e 10 (AC- Grandfathered ❑Yes ❑No
Dwelling Type: Single Family p/ Two Family p Multi-Family(#units)
Age of Existing Structure Historic House Ll Yes ❑No On Old King's Highway f(Yes ❑No
Basement Type: (Full ❑Crawl ❑Walkout ❑Other
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Z.4
Number of Baths: Full: Existing New Half: Existing New
No. of Bedrooms: Existing New 3
Total Room Count(not including baths): Existing c•--- New First Floor Room Count �p
Heat Type and Fuel: UeGas ❑Oil ❑Electric ❑Other Foac,,,Q / csT A l2
Central Air @/Yes ❑No Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No
Garage: ❑Detached(size) Other Detached Structures: p Pool(size)
Attached(size) sa 8 aye ddZ) ❑Barn(size)
❑None ❑Shed(size)
❑Other(size)
Zoning Board of Appeals Authorization Ll Appeal# Recorded❑
Commercial ❑Yes GJA io If yes, site plan review#
Current Use R Psw L A,X�, Proposed Use e S J e,-n A 4C1 n.e
Builder Information t�
Name t-� a��o\ct c�-aS�/L,�c t�en.� �„r c- Telephone Number �08' I�7- S-4 �7
AddressM O o-K 7&S License# CS - 6 Yot.
QA3 Home Improvement Contractor#
Worker's Compensation# W C
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 DATE ��- �S' 97
BUILD N ]P O ING REASON(S)
FOR OFFICIAL USE ONLY
t
PERMIT NO. M
DATE ISSUED
MAP/PARCEL NO.
ADDRESS VILLAGE
OWNER
s r _
DATE OF INSPECTION:
i FOUNDATION-
FRAME -a2 4 I
INSULATION
FIREPLACE
ELECTRICAL: ' ROUGH FINAL ;
PLUMBING: ROUGH FINAL
GAS: RO%H f. FINAL -
FINAL BUILDING S
`%'DATE CLOSED OU_T!w
ASSOCIATION PLlgpO. C
m0 Q '
m t
The Colllilloll ivealth of l fassachmcff
:-._, :_ Department Of 111dllstrial Accidents
it WOffice OflavesUgalfotts
• hUfl !f'asliitr;;tun Street
;tom Boston. Ma.u. 02111
Workers' Compensation Insurance Affidavit
li :intinformati�n': Plcise PRINTIe�
name* -4— J
cat' n- /41,� St
city W eSQ B Ate^ `T CA phone
1 am a homeowner performing all work myself.
C] I am a sole proprietor and have no one working in any capacity
I am an entplo_ver providin` workers* compensation for my employees working on this job.
coot tangy• name: A (,\� �s ��y�3�j(L.�G�1ctViJ C
�ddress: c
1"1,A"A\01C AA 0 nhnne 6 SY
insurance cn. "qCCJ lt2- 0 C o S 1
f—i I am a sole prop rieto , general contractor. or homeowner(circle o»e) and have hired the contractors listed below who have
the following %vorkers compensa on polices: n Q //��
emmnatty nnmc• 4C J \eJ
address:
cin: phnne M-
insurancc rn. nniict t!
cmmnnn%, nnrne:
atldresc:
rite: phnne ft•
insurance co nniiey 0
Attach additional sheet if neccsiary•• ""_:%_ -_ + --+:_ _ _ __ ''=`� ::►._. ����
Failure to secure coverage as required under Section:SA of AIGL 153 can lead to the imposition of criminal penalties of a line up to 51.500.U0 andiur
unc wears' imprisonment as weil as civil penalties in the form of a STOP NVORK ORDER and a fine of 5100.00 a dap against me. 1 understand that a
Copy of this.cttcntcut may be forwarded to the Office of Investigations of the DIA fur coverage verification.
1 do hereby Certify rrnr r t/i aims atr mollies of perjury that the information provided above is true and correct.
Si_naturc Date 97
Print name
V O�W A Phone>* 5��8-Y.7.7-
' official use unit' do not write in this area to be completed b}•cin•or town official `
ciq or town: permit/license if rnlluilding Department
C3Uccnsing Hoard
i]check if immediate response is required C3Seleetmen's Office 1
(:311c2lth Department .
contact person: phone N: rJUther
• i.
Information and Instructions
Massacrfusd.ts General Laws chapter 152 section 25 requires all employers to provide workers' compensation forth
employees. As quoted from the "law'% an enlploree is defined as every person in the service of another under an%
contract of hire. express or implied. oral or written.
An emp/urer is defined as an individual. partnership, association. corporation or other legal entity. or any two or me
the foreuoina en�ga�ged 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,;
owner of a dwelling house having not more than three apartments and who resides therein. or the occupant of the
dw-clling house of another who employs persons to do maintenance , construction or repair work on such dwelling he
or on tiie grounds or building appurtenant thereto shall not because of such employment be deemed to be an empioyt
MGL chapter 152 section 25 also states that even• state or local licensing agenc,% shall ��ithholJ the issuance or
rencival of a license or permit to operate a business or to construct buildings in the commonwealth for uny
applicant ,who has not produced acceptable evidence of compliance with the insurance covera;e 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
been preseiued to the contracting authority.
,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 coyera`e. 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 require.
to obtain a workers' compensation policy. please call the Department at the number listed below.
City or Towns
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Pit
be sure to full 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 questic
please do not hesitate to :give us a ca11. . .
The Department's address. telephone and fax number.
The Commonwealth Of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 «'ashinbton Street
Boston,Ma. 02111
fax #: (617) 727-7749
(41',) 777-49011 r%vt. a116. 409 or 375
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Application to
�p JF.aF`�oP�Jtr, i
d Y 0P_P, �1JEPt 5 NP E`�W'
Old Kings Highway Regional Historic District Committee
in the Town of Barnstable for a
CERTIFICATE OF APPROPRIATENESS
Application is hereby made, in triplicate, for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470,
Acts and Resolves of Massachusetts, 1973, for proposed work as. described below and on plans, drawings or photographs
accompanying this application for:
ECK CATEGORIES THAT APPLY:
1. Exterior Building Construction: ew Building ❑ Addition ❑ Alteration
Indicate type of buildin House ❑ Garage ❑ Commercial ❑ Other
2. Exterior.Painting:
3. Signs or Billboards: ❑ New sign ❑ Existing sign ❑ Repainting existing sign
4. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Other
(Please read other side for explanation and requirements).
TYPE OR PRINT LEGIBLY DATE n,
ADDRESS OF PROPOSED WORK �f�Gf/ �% �'�..���.!/,13A���s�a�`� ASSESSORS,MAP NO.
OWNER �1L11 4 wt If 12Gk,gs>�i�— f�i e gia,6-7-Z ASSESSORS LOT N0.
HOME ADDRESS10,4(;C,aST /A/. .f'.G/�`/ 0J53'I TEL. NO.a2l) SYS-7,11715"
FULL NAMES AND ADDRESSES OF ABUTTING OWNERS. Include name of adjacent property owners across any public
street or way. (Attach additional sheet if necessary).
AGENT OR CONTRACTOR TEL.TEL. NO. (6��� r ����s��
ADDRESS / .Jo�i.� i'(,f�i k Rh �n, n - �Ji4 Sh ���>° . /J�i� q 9
DETAILED DESCRIPTION OF PROPOSED WORK: Give all particulars of work to be done (see No.-8, other side), including
materials to be used, if specifications do not accompany plans. In the case of signs, give locations of existing signs and proposed
locations of new signs. (Attach additional sheet, if necessary).
�t _ --._
OyLfie�-Contractor-Agent
Space below myttee use.
R RivdTy r ®
Date The ertificat�is hereby Da
AUG - 1 1997 `
Time
70\-Y D.n�c WIG."n ALY V
Approved ❑ IMPORTANT: If Certificate is approved, approval is subject to the 10 day appeal period
provided in the Act.
Disapprovpd ❑
Town of Barnstable
Old King's Highway Historic District Committee
SPEC SHEET
FOUNDATION evil
SIDING TYPE ,S,0&5 e .D,ock : 1<i14/ef' COLOR
CHIMNEY TYPE lG COLOR
ROOF MATERIAL 1Q5,&-/ALT��,�CAree f-i,r��JCOLOR !�/,44t!!�/) S141
PITCH
WINDOW 2 ��. l���e P�l,-�— 'SIZE
TRIM COLOR Ali'l;q6zWhY
V
f
DOORS COLOR
SHUTTERS 1 f O N l�l COLORt
GUTTERS /�-�j <a. < <i « /�fQisr /�rJ 7z i Ctj�oiC
DECK e
GARAGE DOORS CUM t�ri ''ih � lf7 n,_ COLOR ,
p , �:�
SIGNS N COLORS
dI
Cr
FENCE /y COLOR
NOTES: Fill out completely, including measurements and materials/colors to be used. Three copies of this
form are required for submittal of an application, along with three copies each of the plot plan,
landscape plan and elevation plans, when applicable. Site plan should show all structures on the lot
to scale.
SPECSHT
s f
• •' GIQ w j1 ;
flog
r 1 'z O
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w •
x L . • �
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EL.__o__
FINSSH GRADE 9 2
Rota FSNSSH 6RADE OVER
�Oe` SEPTIC TANK_
v'v �
12" MAX.
:a°.pe:i a'... -;: .•a.,'4;.. 'e'::a.,yP's•'-�.:i'n.pe�:: . . ..•�., .
.o•.o.p 0 ..ib
•
P •: , 3•
,• eb', ,� C.I. OR PVC TEES '
;b.�,•de i 4�
BSMT FL.
GALLON 4:
?•, 'c ', to: �
PRECAST CONCRE
pe TE '.
H— /0 REINFORCED
ADAM
or
SEPTIC TANK
INSTALL ON LEVEL BASE
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2. An
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PLOT PLAN
SCALE,*!
DAiAPRWT ,i,i •d I'80 Eb:ii z6, zi gnu
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?1
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��e Cnri�•iiraiuuen�(�. of._ �ll�.:�.c�lrnL/.;
i.
doom.� OEPARTMENT OF PUBLIC SAFETY
i
CONSTRUCTION SUPERVISOR LICENSE
Nuiber: Expires:
Restricted To: 00
JOHN P AGRICOLA
::;.� PO BOX 765
MASHPEE, MA 02649
........................... .....................
................ ....... ..... .........................................
..............
DATE(MM/DDIYY
10 0 7 9 7
..........
................
........................ ...... LIN JR
AC
11 ff
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
OLDS CAPE COD INS AGENCY, INC. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
435 MAIN STREET COMPANIES AFFORDING COVERAGE
HYANNIS MA 02601 COMPANY
A WORCESTER INSURANCE CO
INSURED COMPANY
AGRICOLA CONSTRUCTION B
COMPANY, INC. COMPANY
P 0 BOX 765 C
fvLASHPEE MA 02649 COMPANY
D
COVERAG .................... ........ ..................... ........ ...
............. ..............
. ................
............................ ..... ........................................................
............. ........
.......................................... ...........................
......................
.... ...........................%............. ..........
....... .... : ::
-X-:-:-:-` ........... . ..............%.............
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LCO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION
TR DATE(MM/DDIYY) DATE(MMfDDNY) LIMITS
GENERAL LIABILITY GENERAL AGGREGATE $
17COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG $
CLAIMS MADE r_—]OCCUR PERSONAL&ADV INJURY $
Fl:ow',ER'S&CONTRACTOR'S PROT EACH OCCURRENCE $
II
FIRE DAMAGE(Any one fire) $
MED EXP(Any one Person) S
j AUTOMOBILE LIABILITY
FIANY AUTO COMBINED SINGLE LIMIT $
ALL OWNED AUTOS BODILY INJURY
SCHEDULED AUTOS (Per person) $
HIRED AUTOS BODILY INJURY $
1,7 NON-OWNED AUTOS (Per accident)
,-7
17— PROPERTY DAMAGE $
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $
pANY AUTO OTHER THAN AUTO ONLY:
i EACH ACCIDENT S
17 AGGREGATE $
EXCESS LABILITY EACH OCCURRENCE $
UMBRELLA FORM
AGGREGATE $
OTHER THAN UMBRELLA FORM $
WORKERS COMPENSATION AND WC810518 6/01/97 6/01/98 XTTw5_yST LIMITS j JOE-R
-
EMPLOYERS'LIABILITY EL EACH ACCIDENT $ 100 , 000
THE PROPRIETOR/ INCL EL DISEASE-POLICY LIMIT $ 500 , 000
PARTNERS/EXECUTIVE
OFFICERS ARE: EXCL, EL DISEASE-EA EMPLOYEE $ 100, 000
OTHER
DESCRIPTION OF OPERATIONSfLOCATIONSIVEHICLES/SPECIAL ITEMS
............P
................. ........................ .......
....................... ......... .......... ......
.................... ........
................Y............... ...........:d d
g�R FICAT ................. A- EU�"ON........ ..
n .....
......................
.... ................................. . .... ................
...... .... ........... .......
................. ........
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
TOWN OF FALMOUTH EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
P 0 BOX 765 BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
MASH PEE MA 02649 OF ANY KIND UPON THE COMPANY, ITS AGE IM OR REPRESENTATIVES.
AUTH EP E VE ya
M ind MB A
. .. . .......................... .........
.................... ............. ......................................... ............... ..... ..
.................. . l......................... ..... ........... ... .................
.. :::::. ..........................................
.......... -:. .......... ........... .. . . . . ...
. ............................
........................................................................ ..............
............................................ ............
.......... .. ...........X . .. ......................... .... ............... CO.RP..G.RAT. x
• Agricola Construction Co Inc .
List of contractors for Workman' s Comp.
Wilcox Enterprises Inc .
6 Wagon Trail Road
West Barnstable, Ma. 02668
508-362-9298
American International - AIG #WC6156501
R J Bevilacqua Construction Co. Inc .
P 0 Box 628
Forestdale, Ma 02644
508-833-4899
CIGNA C42154246
Mechancial Advantage Inc .
15 Main Street
Plymouth, Ma 02360
508-747-6300
Eastern Casulity #WC95772011
Chaffee Plumbing
161 Route 6A
, Sandwich, Ma 02563
508-888-4715
Eastern Casulity #WCTBI
Anderson Insulation
P 0 Box 2003
Abington, Ma 02351
617-857-1000
Crum & Forester #WC0330220
Gardner Brothers
P 0 Box 98
Monument Beach, Ma 02553
508-759-5630
Hartford Insurance Co. #77WZNB8878
RWC Masonary
P 0 Box 5
Mansfield, Ma
508-339-7580
Kemper #3BY 002112-00
Bortolotti Construction Inc .
P 0 Box 704
Marston Mills, Ma 02648
508-771-9399
Travelers Insurance Co. #DTOOB912K006697