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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
k . 1/23/2013
Form of Notice of Casualty;Loss to Building
Under Mass.Gen.Laws,Ch.139,Sec.3B
BARNSTABLE BUILDING COMMISSIONER
367 MAIN STREET -
367 MAIN STREET
HYANNIS MA 02601
Re: Insured: EDWARD&MARILOU DASHNER.
Property Address:. 16 PEARL RD,CENTERVILLE,MA 02632
Policy Number: 1164.112
Type Loss: Fire(including Fire caused by Lightning
Date of Loss: .01/22/2013 `
Claim Number: 309285 y
Claim has been made involving loss,damage or destruction of the above captioned propert,which may either
exceed$1000.00 or cause Massachusetts General Laws,Chapter 143,section 6 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 otrUs
and claim or file number.
t MPIUA Claims Divisiont �
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CMA00021
Town of Barnstable
Regulatory Services
• .Thomas R Geer,Director
II suuvsTns , : 7
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s6 Bung Division `
3 9. 10� Building .
' �erED MA'S► � � _�.
Tom Perry,Building Commissioner - .
200 Main Street, Hyannis,MA 02601 oa '
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Office: 508-862-4038
Fax 5�08-790-6230
-PERMIT# Y 6 3 ®D
FEE: $ J
4-14 AA 111�/Xgl-/o
SHED REGISTRATION
120 square feet or less
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Location of shed(address) Village
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Property owner's name Telephone number
Size of Shed Map/Parcel#
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Signature D
• Date r
Hyannis Main Street Waterfront Historic District?
Old King's Highway Historic District Commission jurisdiction?
Conservation Commission(signature required) /a /
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PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE
COMMISSIONS,THERE MAYBE A REVIEW PROCESS AND APPLICATION FEE.
PLEASE SEE.THE APPROPRIATE COMMISSION FOR DETAILS.
THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN
-LOT 4
LOT 3
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LOT 1 ����,
LOT 2
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40 DO' LOT 3
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RES. ZONE- ORB This MORTGAGE INSP CTION Plan is For FLOOD ZONE- "C"
Bank...Use Only
REGISTRY OWNER: R __&_,TV_P1TIi A.- _BZ4LCHA1Ni
DEED REF: -OWI-241— _ - -BUYER: _7LWARD_B-_1MSHNER - - - - - - - - - - - -
DATE: _11ZW_02- — — — _ — _ PLAN REF: _V-6 86— _ _ _ _ _SCALE:1" RO F
I HEREBY CERTIFY TO _ _L914 I YK—&__________
-TRUST COMPANY —THAT_ ___ _ _THAT THE BUILDING tN Of YANKEE SURVE'
SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS PAUL
CONSULTANTS
SHOWN AND THAT ITS POSITION DOES ____ CONFORM A
TO THE ZONING LAW SETBACK REQUIREMENTS OF THE MERITNEW 40B INDUSTRY RO.AI
TOWN OF ---BA8A1,SL1LE-------------AND THAT Nam MARSTONS MILLS, MA. 02E
IT DOES- 1VOT- LIE WITHIN THE SPECIAL FLOOD HAZARD TEL 428-0055
AREA AS SHOWN ON THE H.U.D. MAP DATED'7,/ / __ M,u FAX 420-5553
250001 0008 D
THIS PLAN NOT MADE FROMAN INST MENT .. .
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' •""> TOWN OF BARNSTABLE _ Permit .No.
---_ 99�5
Building Inspector 4
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°„. �Paul Leo'nar !)
OCCUPANCY- PERMIT
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"No building nor structure shall be erected, and riio land, building'or.structure shall be,
used fora new, different, changed-, :or enlarged use`'without a..-Building, Permit therefor
first.having been obtained from the Building Inspector,No building-shall'be occupied until a
' uldn 'Inspetor "certificate of .occupancy- has been,issued.by the Bii ' c
Issued to. Fer 'one f�SSOC2�^a.tes Address _
lot jr2 '.16 Pearl.'Road,•'Cenverville:
Wiring Inspector i.--'. �- inspection date "`R ;
Plumbing Inspector Inspection.date
Gas_ Inspecto ! �;Jr' /� 1 fib` Inspectiondate
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Engineering Department `Inspection date -�
THIS PERMIT WILE'NOT' BE VALID AR' THE BUILDING SHALL ,NOT BE OCCUPIED (UNTIL
SIGNED BY THE .BUILDING INSPECTOR UPON- SATISFACTORY. COMPLIANCE .:WITH TOWN
REQUIREMENTS. t
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Aes�r's map and lot number ....................................... L(�1�� '►Jfy �o,.F,.,..
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' Sewage L-Permit number
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`O� BARiLE'Alr%TOWN • �l;,
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1�39'a<�� :; �v, BURDIHG,, , INSPECTOR
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APPLICATION FOR PERMIT TO '` ... s..........................:.............. .......................................�
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TYPE OF CONSTRUCTION ........... Ar.,.........:.......................................................:..
......................... ...19.1
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:J
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Location ..... .................................................................................. '
......... ..... �.. .... ..... ....... . ...........
ProposedUse ................. ... ....... .............. .......... ... .......... ..................................................................................................
ZoningDistrict ........... �. .................................................Fire District ......... .....: .....................................
Name of Owner .. .. d.: ...... .... .. .... ... . .............Address .... . , ... ....!( . .fir-.. .... .... .........
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Nameof Builder ....................................................................Address ....................................................................................
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Nameof Architect ................ ....Address............................................... ....................................................................................
Numberof Rooms .................5..............................................Foundation .... . ....................................................:..................
Exlerior ( (
................. . �....i................0 .../. .............Roofing .....................W.:'.........................................................
Floors ................................................Interior ...........
Heating ....Plumbing �.
Fireplace .....................................................Approximate Cost ....... .e.................................................
Definitive Plan Approved by Planning Board ________________________________19 Area !...�. .
Diagram of Lot and Building with Dimensions Fee
SUBJECT TO APPROVAL OF BOARD OF HEALTH CASH AGO. 6
Return to:
Paul Leonard
(� -Box-�-2-U, Hyannis, MA
L�2601
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I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Name ......................
D.M.L. TRUST
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one ot�ry \ � '
............. Permit for ....................... —�...... '
m1nmlm family dwelling '
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Location ------
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Centerville
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Owner ° °
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Type of Construction —. --.______. �r '
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Plot ............................ Lot ........��------
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re,nn' Granted 78
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--- of Inspection_
Date � �
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PERMIT REFUSED '
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