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MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston,Massachusetts 02108-1904
(617)723-3800 Ma Only(800)392-6108, FAX(800)851-8424
a 8/30/2016
Form of Notice of Casualty Loss to Building
Under Mass.Gen.Laws;Ch.139,Sec.313
Id;Y\ �e .
200 l�rn;�h Sir.
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Re: Insured: MARY DUNDAS HAYDEN
Property Address: 140 FULLER ROAD,CENTERVILLE, MA 02632-
Policy Number: ` 0955965
Type Loss: Water Damage:.All Other Water Damage
Date of Loss: 08/26/2016
Claim Number: 408715
4
Claim has been made involving loss,damage or destruction of the above captioned property,which may either
exceed$1000.00 or cause Massachusetts General Laws,Chapter 143,section to be applicable. If any
-notice under Massachusetts General Laws,Chapter 139,Section 3B is appropriate,please direct it to.the
attention of the writer and include a reference to the captioned insured,location, policy number,date of loss
and claim or file number. -
MPIUA Claims Division
r
CMA00021
TOWN OF BARNSTABLE
NA"STULE,
MU&
1639-
M BUILDIRG INSPECTOR
APPLICATIONFOR PERMIT TO ... .....................................................................................................
Y .....................................................................................
TYPE OF CONSTRUCTION ..... . .........
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location
. . ....................... ............................................................................
Proposed Use ..... ...................
;K......................................................................
, // .........................
Zoning District ......RA6....................................................Fire District ,� .
Name of Owner .4.11')I.Address .... 1..............
V -11Y.R.
Nameof Builder ...........,q...)n...........................................Address ....................................................................................
Nameof Architect ..................................................................Address ........................................
Number of Rooms ...............................................
...................Foundation .... .. .................................................
Exterior .................................................Roofing ............................................
Floorsx . .. ..............................................Interior 5 0 Heating ...........................Plumbing
Fireplace ....�.........................................................................Approximate Cost ........
..........
Difinitive Plan Approved by Planning Board --------------------------------19--------- ioQ s�
Diagram of Lot and Building with Dimensions SO
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Agree,*�'—*to conform to all �Rule;, ,�,ndRe�,I here y La es and Regulations of the Town of Barnstable regarding the above
construction.
Name ....... ...... ............... . ....................................
� Jdsar������
DEC ,
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No —.������� Permit for -------..�y--..
---.-.........—...........�..................w...................... ,
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Locohon .r �~��.rI�m� .
.------------.--------.. /
_______Cuoto ___--------
Owner ---Jooeo�. �.. ...................... .
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Type of Construction ...........f r.ame,------.
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-----.--------------------.. �
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Plot ............................ Lot ..........#7.................
Permit Granted —&uoJzat �� lg 7I
' —................... .
Date of Inspection ---.]Q
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Date Completed ...................................... `
. �
PERMIT REFUSED . ~
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.----.---.------------,. 19 '
....................................... ' ~
~'—~--------~------------~''
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Approved ........................................ lg �
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