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0349 LITTLE RIVER ROAD
_ .�-- � �, �. :� y� �, , r ,� ,�� .✓ } ,� ' � y � 1 a �� i 7 j�l C y 1 �� r Town of Barnstable *Permit# Expires 6 months from issue date Regulatory Services Fee snaxsraatAMAW f � 1 Thomas F.Geiler,Director 0►Bp 3 �' Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number ,33 O P/ l70 Property Address ❑Residential Value of Work ck-0 Minimum fee of$35..0-0 for work under$6000.00 Owner's Name&Address Contractor's Name Telephone Number �Tj d Home Improvement Contractor License#(if applicable) l�, Construction Supervisor's License#(if applicable) C S Ji �� --PRESS PERMIT, [ Woikman's Compensation Insurance AU Check one: ❑ I am a sole proprietor . ElI am the Homeowner TOWN OF BARNSTA5l F, I have Worker's Compensation Insurance Insurance Company Name ��r Gil- /,-��;J `,�, �C �v(r�� J' i-,U ' Workman's Comp. Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) i — �Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken too ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side " #of doors ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows *Where required: Issuance of tins permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is requ' ed. ,g SIGNATURE: y C:\Users\decoM\AppData\Local\Mcroso \Windows\Temporary Internet Files\ContentOutlook\DDV87AAZ\EXPRESS.doc Revised 072110 -62 Office of Consumer Affairs and usiness Regulation 10 Park Plaza - Suite 5170 Boston; Massac setts 02116 ;Home Immovement tractor Registration Registration: 167739 Type: LLC Expiration: 10/25/2012 Tr# 205252 NORTHERN COLONY.BUILDERS DANIEL GALLAGHER. 1694 FALMOUTH RD. #135 - CENTERVILLE, MA 02632 _ — - Update Address and return card. Mark reason for change. Address n Renewal Employment ::_! Lost Card OPS-CM 0 5OM-04/04-G10O�11216 ��/� 0fF,ce�f , ;�m�emr airs us�ines` ss"�ea a License or,registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 167739 Type: Office of Consumer Affairs and Business Regulation '' 10 Park Plaza-Suite 5170 -` Expiration: <:1�/,2,,5l,2012 LLC Boston,MA 02116 N ERN COLONY BUJ D-ERS..LC. DANIEL GALLAGHER?...= 'r ah 1 180 HIGH ST W. BARN, MA 02668'0: r y of v , atureLnierseireary +� Massachusetts- Departntciit of Public Sa 't(N Board of Buildin t Rcoulations and St.inditrds Construction Supervisor License License: CS 53638 F_, Restricted to 00 M MiTa + � DANIEL J GALLAGHER ',PO BOX -q1g W BARNSTABLE;.MA 02668 , : i .. Expiration: 10/27/2011, Commissioner. Tr#: 9773 a .*�. Massachusetts - (Deportment of Public Sa?'ate Board of Building; Regulations and Standards Construction Supervisor License License: CS 53638 Y, Restricted to: 00 DANIEL J-GALLAGHER } v PO BOX 471, W BARNSTABLE,;MA 02668 " I Expiration: 10/27/2011 ('ummissiuner Tr#: 9773 The iGa!tr morrfveal la.ofMa ,h elf, Dep�nnt�ad�int sfI�afaisl��Acci � . 0Kce.00mestioadons" 600 Washington Street Boston 02111' .. N'+tni;:rrris�govlrlira::. Werkers� Compensation Insurance Affidavit. Auil&rs/ retractors/EIectrycaoaslPlumb"ers Applicant Information i Piea�se>Priimt Legibly Name(Businesdoqani ationadEviduaD_ LKk7rkA C A-j � (7 1 O).r:i ,Address__12 y C ca.e ( I k_ G q/A Ciq,/State/Zip: C' phone#€_ 5 07 - :Ire.yrou_an employer''Cheek the appropriate bos. Type of project(required : ,AlE;am a employer with t 4 ❑ I am a:general contractor and I a leave:hired the sub-contractors 6.: ❑Neiv construction . employees`(full and/or pant-time): 7 Resiodelin listed on the•attached bheeE. 1":ama sole.proprietor - ❑-.❑ or s amd'have as to g - Tbese sub-contractors1mre �P 3ees" S. ❑Demolition working,forme.in any capacity. enrplogTes and'ha��e,warkers' 9._ Building addition [No xvodbere.comlr insatanc , ct p.iasurauce.$ ❑ 5... We.are..a co oration:and its.. 10.0 Electrical repairs.or.additions r�ec�uired:J . ❑ rp 3.❑ I:ama:l eownerdoing;all+wk. officers have'exerc iedtheir . 11:.❑Plumbing repa s oradrlations myself[No workers'COW. iigbt.:of exemption per MGL rs i.sura„ce d:,�` c."15?, 1 4i; d .haNT'no; 1;�-�Roof rtspai employees:iNo workers�; 13.❑Other comp..;insuranca required-] ''Amy appli;=iha¢che&s box#1 m aLsco.fiIl•oua tbesecfson baton,sbowing;Sh&.vmTkers'compensation policy infbnmatdaa. :Homema inn otho.submet this sf5dzVftJi eb,S#g ihy.ate,doimg ail":ur is and u:b¢e outsidezmnuactgrs mutst;sulom a:sam: da:lt.indieati¢g sacYti lcoataactars that chat&thistm must&hatched am addidonsl shed showing the nume of the sub-cuium aors and stare whether ar:not those ewetin l>m empioyee5. Iftl?e soft saatracmrs'Ehav-e effiplac s,they mim.pnwide tMr-morken,,comp.palicy number., I am.an emp&.yw that is prmIdting"vrhers'cooWensatkn insoraniry for arty en apJ R.Below is:,thepolicy gRdlJob.site, Inforufal rt 3nsiaranee CorupaajIName 0 v�� Y -�``s,(�.� �—�!S LJ IQ (J� Policy#or Self-ins.Lic,.it: n Expiration,Date: Job Site Address:��(� L : ct L..5:-� i�; i-Li i4�\7 CitylstatetZip: 0 ,6 5 F Attach a ropy":of the worlrere compensation-policy declaration page-(3howing the polic�°,number and;espiration slat ). Failiare.to"secure co:aer�age.asxequired:under Section 25A"of MGL c_1.52 can lead to the imoositiofl of crizn�al.penaNes,of al fine up to•$1,540 UO'andfof one-Fear imprisonment,as cell as chin penalties in he:form:of s STOPMC7RK ORDER and.a sae: of,up to:$250:.Ofl a...aay:against.the.violator.. Be ad%ised that a cm.—of this.statement may be forwarded to the{Office of i estigatio is Hof the.DU for insurance coverage verification. I dry her Ne �certtA,trader theg rrirts andpenaLdes� 4? perj..uly.that.tJte hy*rmratiare�prmzrf al'abm�e as true:andi co.rrecL J� Date: - Phone Offleial use only., Da not write in tltis.aarea to.be completed ky citp.dtr town t�+ cggt City or Town: PermittLLicense Issuing Authority (curcte one): 1.Boa aid.ofwealth Z;.Builtlix►gDepartment. .itytfoN�nCUrk: 4.Electrical Inspector 5..Pltambing..Inspector- 6.Other ontactPcrson::. Phone#i -6 a s w BA tNSTAI= 9 39. Town of Barnstable Regulatory Services Thomas F.Geiler,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstablema.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder c ►j �� \ S l-� J� , as Owner of the subject property hereby authorize _� �. - to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signatt e of Owner Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Intemet Files\ContentOutlook\DDV87AAZ\EXPRESS.doc Revised 072110 ALuiiu 201 �Mr�TIFICATE OF LIABILITY INSURANC9°' 8149 P. /23/2011) J. 08/23/2011 ODUCER 508.997.6061 FAX 508.990.2731 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION outhsastern Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR f4.39 State Rd. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 79398 North Dartmouth, MA 02747 INSURERS AFFORDING COVERAGE NAIC# INSURED Northern Colony Building Co LLC INSURER A: Central Insurance Companies 20230 1694 Falmouth Road #135 INSURERB.' Merchants Insurance Group Centerville, MA 02632 INSURERC: INSURER D: INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR D' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR NSR DATE MIDD DATE MIDD GENERAL LIABILITY CLP7997489 07/08/2011 07/08/2012 EACH OCCURRENCE $ 1,000,000 UAMAUL IQ RLIN ILL) X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $ 300,000 CLAIMS MADE T OCCUR MED EXP(Any one person) $ 5,000 A PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY JPE4 LOC AUTOMOBILE LIABILITY MCA7013965 01/05/2011 01/05/2012 COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ 1,000,000 ALL OWNED AUTOS BODILY INJURY X SCHEDULED AUTOS (Per person) $ B HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER TFtAf� EA ACC::-$ AUTO ONL''"Y° f AGG--$ EXCESS 1 UMBRELLA LIABILITY EACH OCCURRENCE OCCUR CLAIMS MADE AGGREGATE $ > $ 'L3 DEDUCTIBLE $ o RETENTION $ $ f WORKERS COMPENSATION WC799749014 07/08/2011 07/08/2012 X WC S A U o H- ..1 AND EMPLOYERS'LIABILITY TORY LI ITS E. ANY PROPRIETOR/PARTNER/EXECUTIVE Y❑ E.L.EACH ACCIDENT r, $ 100,000 A OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ CTi 100,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS roject Location: Fisher, 349 Little River Rd. , Cotuit MA 02635 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN Town of Barnstable NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Attn: Building Dept. IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 200 Main St REPRESENTATIVES. Hyannis, MA 02601 AUTHORIZED REPRESENTATIVE Karen Bernier ACORD 25(2009/01) FAX: 508.790.6230 ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD MN �•:: :^:'i';':iy{<'•?:.itiiii�iiSC'-<� ..... i?vi`y:;•`•v; .vx:w.vivri•.xvvi•:i .xxxxvvw:::::nvv vv:v.::::vw.vvw:::.:•.vvw::nw::nvw::nvvvv:::nvvn:vv;•:ti;•r:v:L;•:4:::ui•:;•ri•:itix•.w:::.:xv '�iiiii:.yr:v,•::nv::::;.rryr:::::•.y. .:.::. ... •" .' :rr�r:-r�r ter:- .,,•::...: .: .:r:::r:r:. 687: « B ILD N RV ....................... ..............:....:.:...::::::..:..:...... .............................................. ...... k-xixIBUILDING :.:.;.:...........:......:..... . . .. .........:..::.. Mae, . :.: :':2:•. MAC EA HERN ::::::::v;.v,•.v:.,:i,•rrr:•:;•.:..,....,....:..:..........vv.,,;•r:•r:•r':;.:;'•i::::rr:.::.r::or:•:.r:•r....:::.... ,:...,:,.•...::..:..:::.. r.:.:.:... �Kj R�•. i;ri.r: E RIVER::RO,«. �:.. x» : 7 .vM1:•;:::::.>•-;;•r�.:;;.:iii:.�:.:,;;;:;::.:;;�;;:::•.::.r:c•:ii•.ii;::::isv:;.�:::::::ti;:::::;:.x:•:.r;::;;r:•tirr:•:;•rr:•>:•r;>:•rr:•rr:•:;r:•:;;t M.A�..,eT„` S MILLSe! �••r:•rrrrrrr r;.rrrrrr;.r:r:::;;:?::::::�::.^•.t�::::;r;?::rr>:;;>::;;rr:•r:•rrr:•r:•rrrr:-rrrrrr:•rr:•r:•r:•rrr:•rrrrr:•rr:•rr:-rrr�:•r:.;•.,:•r:•r:•r:•r:•rrrrr: N :•r»rr:•r:•rrrr:rirrrr:•r:•r: •.:• ...:............... .`.: '.i.`..,".t'iy:y';;.:-:arrr''l.•.•.-'''~•.•••:�••. %.•.':•:+.fi':: ??':2`•``.•`: +':•`::: :`M1M1:':;:'M1;<t.'`ti::i::':'::•`::': `% ::;` '::................. Y': •`:•``.: :+�: .; ;`. ;`:;`: :'t' •,`. <:<: .. .«•:•;••r::•r:•r:•r:•r:•r:;;;•rrrrrrrr;;:....:::::..:.::.:.:.. r.ri:}.:;:•r:•r:•r:•r:;•r:;is•;�::... ZON-ING PAPER r` .a:•r:•r:•rrrr:•r„ ..... .:... ..v:::::: •:;•:isi•.,•r:•r:;•r:•:_r:•:r:.rrx;:•.i•: i.:•:rtlF:...t. .,r:::.:.:rr:•:::::r::••:::•:::...;:..;•r:•r:•r:•r:•r:•:�r:•r:•r;;r:•r:;•::•:ar:-rr{}r: .......................................................... ..... w:;;•>:•r:•r: -LEGAL???????????? r- MARSTONS MILLS: in v"- t 1convenient - a e to ev e 9rY ; s thin 650 in lu II il- 9 c des a ut i pets. sti . 1 last, security. No _ et . 428-4 4 message. s 8 95 essa e. XX XX >. .: rC SEARCH ......................... H ........................... X. xi :, .............. .,,.::::::::::rra:;;;•r:;ai«•>rrrrrrrrrr:<�•::•::••.,,•::::;y:»>..::�::;;:;:.;;; - PARTIALLY VISIBLE DIRT WAY C. 2650���/ ice/ T3s� .B w C,E. o 0 � 160 1p0 LOT 19 w 0 5 ON �+ 'ca � 3753 LOT 20 FLOOD ZONE "C"_ FO UNDA TION CERTIFICATION RES ZONE. "RF" TO WN:COTUIT SCALE.-1 "=50' PL.REF-17287E ELE U N/A I CERTIFY THAT THE ABOVE YANKEE SURVEY CONSULTANTS FOUNDATION IS LOCATED ON P. 0. BOX 265 t THE GROUND AS SHOWN, AND ��a-N OF UNIT 5, 40B INDUSTRY ROAD IT'S POSITION DOES MEPAULA R THEW m MARSTONS MILLS, MASS. 02648 CONFORM TO THE ZONING LAW SETBACK REQUIREMENTS OF " No. TEL: 428-0055 BAR_NSTABLE� A�' P�" FAX 420-5553 JOB PAUL A. MERITHEW DATE 1 1 95 NUMBER5078OFND r G G f , G n u G G Western Surety n n a n 9 ` _ 9 F LICENSE AND PERMIT BOND G For County,City,Town or Village Only-Not Valid for BondsRequired by the State.Not Valid for Contract, Performance,Maintenance,Subdivision,Agent to Sell Hunting and Fishing Licenses or Utility Guarantee Bond. G F KNOW ALL MEN DONALD THESE MACEACHERNPRESENTS: & DEBORAH SCHILLIN BOND No. L&P•4 2�5 0 6A3 01' That G we y of the of BARNSTABLE , State of __ MASSACHUSETTS , as Principal, and WESTERN SURETY COMPANY, a Corporation duly licensed to do business in the State of MASSACHUSETTS , as Surety, are held and firmly bound unto the TOWN of BARNSTABLE , State of -MASSACHUSETTS - ,Obligee, in.the amount (Valid only when a County,City,Town or Village is named as Obligee) of ONE THOUSAND DOLLARS ($ 1 , 000. 00 ), (NOT VALID FOR MORE THAN$25,000) lawful money of the United States, to be paid to the said Obligee, for which payment well and truly to be made, we bind ourselves and our legal representatives,jointly and severally. THE CONDITION OF THIS OBLIGATION 'IS SF1CH, That whereas, the Principal. has been licensed STREET PERMIT BOND LOT 1 LIT AD COTUIT, MA 0263b by the Obligee. NOW THEREFORE, if the Principal shall faithfully perform the duties and comply with the laws and ordinances (including all amendments), pertaining to the license or permit, then this obligation to be void, othe � � ++ ain in full force and effect for a period commencing on the 1 1 TH day of a I '�i 1995 , and ending on the 1 1 TH day off` .-�3'I;P i� 1 9 9 6 , unless renewed by continuation certificate. n +. - �rminated at any time by the Surety upon sending notice in writing to the Obligee and to fiEfTincipal, in a* the Obligee or at such other address as the Surety deems reasonable, and at the expira- bf#irty-five days from the mailing of notice or as soon thereafter as permitted by applicable law, evetsatx;` bond shall terminate and the Surety shall be relieved from any liability for any subsequent a he Principal. J 1 TH day of SEPTEMBER _1 995 Principal Principal G Counter e - WESTERN U Y COMPANY G G G r r By _ By G Resident Agent President ACKNOWLEDGMENT OF SU E_TY F STATE OF SOUTH DAKOTA l ss (Corporate Officer) n County of Minnehaha f F On this day of ,before me, the undersigned officer,personally appeared Joe P.Kirby ,who acknowledged himself to be the aforesaid officer of WESTERN ; F SURETY COMPANY,a corporation,and that he as such officer,being authorized so to do,executed the foregoing instrument for the purpose therein contained,by signing the name of the corporation by himself as such officer. R IN WITNESS WHEREOF, I have hereunto set my hand and official seal. f +�J�J��i�:'qC�iC�44iGGe4�l:s;i,4f7CiL+ � 9 G S. BARNES h G r� NOTARY PUBLIC ,p Notary Public, South Dakota n SAL SOUTH DAKOTA SF�'AL ;C n My Commission Expires 1-22.99 Western Surety Company G Form 849—8-93 1-605-336-0850 t l F G G u r u ACKNOWLEDGMENT OF PRINCIPAL G (Individual or Partners) U F STATE OF G F ss F F County of F u F On this day of ,before me personally appeared ^ tl F F F , G D r � r r. F � known to me to be theindividual°= described in and who executed the foregoing instrument and f F L acknowledged to me that_he_ executed the same. My commission expires _ } < Notary Public ACKNOWLEDGMENT OF PRINCIPAL (Corporate Officer) STATE OF ss County of On this day of ,before me, personally appeared , who acknowledged himself to be the of , a corporation, and that he as such officer being authorized so to do, executed the foregoing instrument for the pur- poses therein contained by signing the name of the corporation by himself as such officer. My commission expires Notary Public F F F F F r , l r F F � F G � ^ G F Q ¢, rn6 °D z4-4 O F� zi y' F F V1 U 4-4 n F F MCI O D W F a O r n L i ��Pe9p,at I �iaas's r /Assessor s Office(1st floor) Map 0 Lot / Permit# Conservation Office(4th floor) Date`// 3 Date Issued-zl Board of Health(3rd floor)(8:30-9:30/1:00-2:00) , = � . zngineering Dept.(3rd floor) House#1 `, 4 BE V Plannin Dept. 1st floor School Admin. Bldg.) INSTALLED � � Definitive Plan Approved by Planning Board (,, 0 '19 7 54WER0N E AND TOV & BA &STABLE Building Permit Application Project Street Addre s � Lj 77LL Village g C6 fi?O l'r Owner D J Zr- Af�F f A/ Address go. Af�€k2r,f /Ayll- Telephone /�ermit Request 9 L/I 21LT�:(-f -s 8 .V Total 1 Story Area(include 1 story garages&decks) : �'square feet ,Total 2 Story Area(total of 1st&2nd stories) g4fkre feet Estimated Project Cost $ /*7d, 4-LID Zoning District 2 r Flood Plain Water Protection Lot Size Grandfathered ? Zoning Board of Appeals Authorization Recorded Current Use Proposed Use Construction Type U-XS-Ob l=� Commercial Residential Dwelling Type: Single Family o/ Two Family Multi-Family Age of Existing Structure Basement Type: Finished Historic House Unfinished Old King's Highway /\1 A' Number of Baths No. of Bedrooms Total Room Count(not including baths) First Floor Heat Type and Fuel Central Air Fireplaces Garage: Detached. Other Detached Structures: Pool Attached Barn None Sheds Other Builder Information a/ Name Telephone Number Address / License# Home Improvement Contractor# Worker's Compensation# �/� NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DDEE RES LT G FROM THIS PROJECT WILL BE TAKEN TO a SIGNATUR � DATE BUILDING PERMIT DENIED FOR'`FHE FOLLOWING REASON(S) a FOR OFFICIAL USE ONLY � PERMIT NO. 10258 ` E DATE ISSUED 9/11/9 5 r ! r MAP/PARCELNO...038 071 001 i ADDRESS 349 Little River Road 7 ' f '` Cotuit I VILLAGE ' Anne G. Gould OWNER DATE`OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING ROUGH FINAL GAS: r: `ROUGH FINAL FINAL BUILDING DATE CLOSED OUT, ASSOCIATION PLAN NO.: ' ' f t. The Commonwealth of 4fassachusetts -Ia Department of Industrial Accidents 1� OJficeoJ/nvestigations - ��' 600 Washington Street Boston, Alas. 02111 �.�. .,. Workers' Compensation Insurance Affidavit li 'tn tnt rn i n• n m location: 2 rz1 city e:jhone# ❑ I am a homeowner performing all work myself. m a sole proprietor and have no one working in any capacity t w { x� �ar�^ •s X' ,:.z"�¢Y z s•aras's�"e w" �S ,�';„.. -'�.�"�"{, 'i*5^+'a.'�fa s*., ;:3-iP�sxs. + .. ...ran ;;'w'"+a.+*.-�a:Sf.r7�'^'w'Trrc^t x van-��r. ..s... .: .�,...:.....t:�.:..�u�m�,�:�.«...�a.�„�.��.u.tri. ,:.e,^ .a'SF z."° .. �`�.,�.+a:.,...�:'isL,�,:.gut.Esc•�:.-...a.«z'�i «.,ward.d.Cw..::;w..::�.s..::,,a.::,�;�:;..,t.,v......_......:.-.c::,.:1 am an employer providing workers' compensation for my employees working on this job. company name: address: cite: phone#: insurance co. Policy# :. ..: ..t, u w+.. 9'�xg-a Mwavfeacywrsvr .qy axwr,;rze{s. 9A'^. .a,ws,. v+•> ,a ..- :.,,3, �...:�,, Jsiu�sr»ssz.��r •., a..�. '... .:_: am a sole propneto ,general contracto or homeowner(circle one)and have hired the contractors listed below who have f the following workers' compensation po ices: con any name address: cih: (�r /4'/_CR-/sJ Lt✓/ //t phone#: 3 (o Z insurance co. C��G R//9' policy# 01 ArJ ` � 4 - Y' .:: H'�:xi::C.'r::i•; M'�vt4;:nr.w..}:-^.{t:s i•^T: x..,�+�"�.. .�.sY'^�..;4. ,?�v�'4r�?P,!`"S: `l4:. h `-?".�..'a'*' �°ti:.: '�^'.''_':--�?'. company name: address: cih•: phone#: insurance co. - police# ;Attach additions!sheet tf necessa :�~� t"sF.1z{�.Fss"' e,--.' �pA: ' r m t�'�-.'�r.".'a •�'i "t'� ' "a;i".�'�'�`• Failure to secure coverage as required under Section 25A of NIGL 152 can lead to the imposition of criminal penalties of a Tine up toS1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP NVORI:ORDER and a Tine of S100.00 a day against me. I understand that a cope of this statement may be warded t t Office of Investigations of the DIA for coverage verification. I do lrerehr certij it r c purrr ennities ojperjurt'that t information provided above is true and correct Signature Date �J J, Print name e2 6 ,4t tle, 3 Phone# �2 r -:r V0Mcial use on1v do not write in this area to be completed by city or town official city or town: permit/license# r(Building Department ]Licensin,,Board O check if immediate response is required QSelectmen's Office Y' 011calth Department contact person: phone Other r 'i^^ -+ _-� raxaaa�+ae+s.�+t- ,va.�;asrxx ..., fr.r`•. :re"sed„es PIA) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", an e►np/ovee is defined as every person in the service of another under aiy contract of hire, express or implied, oral or written. An enrpl( tver is defined as an individual, partnership, association, corporation or other legal entity, or any two or more of the fore�_oing engaged 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 the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance , construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant,who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally, neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. .,7 dr $ i7°t. p Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. s F .ram-.•. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. Tile affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions, please do not hesitate to give us a call. r+swe ec„•s- -'*�ntr�.. ss�r c•r-r,r +w �., .,v.,.w ea�� .r�ruarrgro vsvy�? ..m4gsz .:. zk=r77-7 rray=s wra q'�s Tzf rt-ea+!sc+s mcr a»sa mwr+q- The Department's address, telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations w. 600 Washington Street Boston,Ma. 02111 _.. fax#: (617) 727-7749 " phone #: (617) 727-4900 ext. 406, 409 or 375 �lte eomvmowa eaIa ol—AwaaWmzma DEPARTMENT OF PUBLIC SAFETY i CONSTRUCTION SUPERVISOR LICENSE MU�ber - Expires: ,,,Restricted 1a• .aG ' Q t r TWAS P DAMELIO :y68 DORY CIRCLE MARSTONS MILLS, MA 02648 - �:?'1' :ra �.ti, .•,_S. Y �iw a •r, F ..r,,b3r` �i it�.aar- jy:. 1 I R.. - Y ".l• `4q•.J f fS er f:.„ ], Y:•. •�. \S. e k "X :a..• s :f.. L„ 4c.:i.,rY. f,.tP�....ai. 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TOWN OF BARNSTABLE CERTIFICATE OF .000UPANCY PARCEL ID 038 071 001 ' GEOBASE ID ADDRESS 349 LITTLE RIVER ROAD 'PHONE (508)428-49: Cotuit ZIP 02635- LOT 19 BLOCK � ;°'' :,.LOT SIZE _ DBA DEVELOPMENT :DISTRICT CT PERMIT 13798 DESCRIPTION SINGLE FAMILY DWELLING PERMIT TYPE -BCOO TITLE --CERTIFICATE OF OCCUPANCY CONTRACTORS: Department of Health, S4et3 ARCHITECTS: and Environmental Services TOTAL FEES: BOND $_00 CONSTRUCTION COSTS $.00 756 CERTIFICATE OF OCCUPANCY RNS,l•A BIA OWNER MACEACHERN, DONALD J. , ADDRESS 225 OLD FALMOUTH ROAD ED INIr►� MARSTONS MILLS, MA BUIL, IN D BY DATE ISSUED 03/15/1996 EXPIRATION DATE THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY-a'1TiEEi;ALLEY UH bIDEWALK7urV Alin-MMI-ntcncvl,crrncrv-rcmrvnnr— �.-.. ... .,-,..::- 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 APPLICABLESUBDIVISION 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. 0 Rolle] BUI PINQA INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS *:.. �6�i1c.2-duin u•.A7acme� 3 1 OWING INSPECTION APPROVALS / ENGINEERING DER NT Cw- 2 BOARD OF HEALTH Y �£ V OTHER: SITE PLAN REVIEW APPROVAL 7i (4 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. 508-790-6227 i37q� ' s TOWN OF BARNSTABLE CERTIFICATE OF OCCUPANCY PARCEL ID 038 071 001 GEOBASE ID 42014 ADDRESS 349 LITTLE RIVER ROAD PHONE (508)428-4954 CQtuit ZIP 02635— LOT 19 BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT CT PERMIT 13798 DESCRIPTION SINGLE FAMILY DWELLING � PRMIT TYPE BCOO TITLE CERTIFICATE OF OCCUPANCY CONTRACTORS: Department of Health, Safety i ARCHITECTS: and Environmental Services .<- TOTAL FEES: BOND , $.00 CONSTRUCTION COSTS $.00 756 CERTIFICATE OF OCCUPANCY * 1E►IiNSTABi.E, MASS. OWNER MACEACHERN, DONALD J. i639' A� ADDRESS 225 OLD FALMOUTH ROAD MARSTONS MILLS, MA BUILDING DISI N BY DATE ISSUED 03/15/1996 EXPIRATION DATE v i i `'OWN OF BARNSTABLE >' .-'BUILDING PER MIT I':' 1 PARCEL Ili 038 071 001 GROBASE ID 4,2014 ADDRESS 349 LITTLE RIVE:R'RC7AD DUNE Cotuit - ,2ip - �LOT 19 .. BLOCK z LOT SIZE DBA DEVELOPMENT DISTRICT CT PERMIT 10258 DESCRIPTION SINGLE FAMILY DWELLING PERMIT TYPE BUILD TITLE NEV RES/COMIC BLD D�plifttnent of Health, Safety CONTRACTORS: DAMELIO, THOMAS P: and Environmental Services ARCHITECTS: TdTAL FEES: .... $44�.68 BOND .00 � CONSTRUCTION COSTS $170,000.00 QA 10.1 SINGLE FAM HOME DETACHED 1 PRIVATE P MAS& 039. �1 OWNER COULD, ANNE -G E� ADDR.Ea:j P 0 BOX 161 , COTUIT MA BUILD S11O' DATE ISSUED' 08/ 1%1995 E:XP.IRATIG�IY DATE BIV 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 OFTHIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLESUBDIVISION RESTRICTIONS. MINIMUM OF FOUR CALL INSPECTIONS REQUIRED W 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. ` BU*PINQ INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS .�_�.✓ -o 2 �G�u tZ-Z c• r �PW 2 1 q 3 1 ING INSPECTION APPROVALS ENGINEERING DER NT ter_Mwo' 2 BOARD OF HEALTH OTHER: SITE P N REVIEW APPROVAL w. 5F Y. I1. F_ WORK SHALL NOT PROCEED UNTIL PERMIT WILL BECOME NULL-AND VOID IF CON- INSPECTIONS INDICATED ON THIS THE INSPECTOR HAS APPROVEDTHE 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. 508-790-6227 i SHED REGISTRATION L K rv6t, le-,0- location of shed(address) property owner's name � pia size of shed signature date Old King's Highway Historic District Commission jurisdiction? THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN shed 120 Great Western Road (508)760-4500 P.O. Box 708 Fax (508)760-4930 South Dennis,MA 02660 �D PRO Toll Free 1 (800)368-SHED 7433 58550 DEPARTMENT OF PUBLIC SAFETY 58550 ONE ASHBURTON PLACE, RH 1301 ,, BOSTON; HA 02108-1618 CONSTRUCTION SUPERVISOR LICENSE Number: Expires: : _ Restricted To: iG O, DO JAHES D HCGRATH Detach bottom,, fold , sign on PO BOX 708 � �° � `back, and laminate license card. S DENNIS, HA 02660 Keep top for receipt and change of address notification. (� 7eowwworw�aa�d�c�,�aesaaEuraA'o �\ HOME IMPROVEMENT CONTRACTOR Registration 109374 Type - INDIVIDUAL Expiration 09/11/98 PINE HARBOR BUILDING CO.,INC. JAMES D. Mc6RATH 708/120 GT_WESTERN RD Am,'IsTRaDR S DENNIS MA 02660 . � r _ The Contrnonwealth of t Iassachusetts Department of Industrial Accidents lxL - Office vllnyesUgations <<- 600 Washington Street Boston, Mass. 02111 , Workers' Compensation Insurance Affidavit f nnlicanti'mformafion: 7Please.:PRiNT•le?i}ilvKr:r name: t )D1,/4 Q) f• MC_JcACdMiU location: t TTL6e— P,( rza r /� ,/C� • city c Or(/e r"I P7,4, oa-(a phoned I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an emplo ter providing, compensation for my employees working on this job. i con any name: . c "1.. address• city: phone#: insurance co. afI H 1 AL, ✓y policy. a" )a D ) I am a sole proprietor, general contractor,or homeowner(circle one) and have hired the contractors listed below who have the following workers compensation polices: company name: address c(t-v: - phone#: insurance co. policy# 7,7 77 - -M - company name. address. city: phone#: insurance co_ policy# . Attach additional sheet if necessan Failure to secure coverage as required under Section 25A of NIGL 152 can lead to the imposition of criminal penalties of a fine up.to 51,500.00 and/or one years'imprisonment ns well as civil penalties in the form of a STOP WORK ORDER and a fine ofS100.00 a day against me. I understand that a copy of this statement may he forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under t pai n ant' erjury that the information provided above.is true and correct G� Signature Date Print name C ��r Phone official use only do not write in this area to be completed by city or town official -� cih or town: permit/license# nBuilding Department Licensing Board p check if immediate response is required: OSdectmen's Office ❑Health Department contact person: 6 phone rOther I Suggested Affidavit for Home Improvement Contractor Permit Application For Office Use Only NAME OF CITY/TOWN. Permit No Date AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application MGL c.142A requires that the"reconstruction,alteration,renovation,repair,modernization,conversion,inprovement,removal,demolition, or construction of an addition to any pre-e+dsting 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. /� ,,, z Type of Work: CJ0 IS�Cfi 0() � P�`J� f ee-em 4�.Est. Cost Address of Workv 3 "t 1 I TLL Cc) I r Owner Name' 7 A)k �t �'l 14 LL&[AIL R AO 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 owner-occupied _Owner pulling own permit _Other (specify) 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 age t �t n r: � 7�J Date tractor Na a Registration No. OR: Notwithstanding the above notice, I,hereby apply for a-perminas the owner of the above property: Date Owner Name CONSTRUCTION SUPERVISOR FORM PLEASE PRINT DATE JOB LOCATION 3 _ 1 LL z > C Tvf-T PROPERTY OWNER �)/✓►4L _ 191A 41 CONSTRUCTION SUPERVISOR �S CO`< LICENSE NUMBER PHONr. -760-y ADDRESS �j _-5 f ch n 1,s. LICENSED DESIGNEE (IF ANY) 2 . 15 Responsibility of each license holder.: 2 . 15 . 1 The license holder- shall be fully and compie-elv reszonsible for all work for which. he i s supervising. He shall be responsible for seeing that all work is done pursuant to the Sta-e Building Code and the drawings as ap-croved by the Buildisc Official . - - 2 . 15 . 2 The license holder shall be resronsible to supervise t e construction, reconstruction; alteration, repair, re-!oval or de-;ol-iti on involvinc the structural elements ,of buildings and structures only pursuant to ' the State Bu=lding Code and all otter acol_cabie Laws of the Commonwealth even though - he, the license ho..der, is not tho permit holder but only a subcontractor or contractor to the per:nit holder . 2 . 15 . 3 The license holder shall Lm-nediate1y notify the buy ldi_c of=icial in writing of .the discovery. of any violations which are covered by the building permit. 2 . 15 . 4 Any licensee who - shall willfully violate. Subsections 2 . 15 . 1 , 2 . 15 . 2 or 2 . 15 . 3 or any other sections of theses rules .and regulations and any procedures as amended, shall be subjecb to revocation or suspension of the license by the Board. 2 . 16 All building per: it applications shallcontain the name, S_c.lature and license numbe of- the construction ;supervisor who is to Supervise those engaged in construction, .: reconSli._uc': _O ,. alteration, repair, removal or dem:�olit-ion as regulated by 'Section 109 . 1 . 1 of the Code an these rules and regulations . In the eve^- tha- such licensee is ..no longer supervising said persons , the wor-k. s11Gll immediately , cease' until. a `successor license holder is substituted on the records . of the. building debartment. I have read and understand; my res-ons ibil i ties under the `rules anal regulations for licensing construction super-risors in- attendance witz Section 109 . 1 . 1 of the State Building Code . I understand t e construction inspection procedures and 5.Ne sn_ ecifi c ;inspec-,.or_s ..a.s called for by the building official ; LICENSED CONSTRUCTION`. SUPERVISOR I � n PLOT PLAN FOR LOT I 3 g f, (Do 4 la.dicate location of garage or accessory building Additions with dashed lines---------- -- Sewerage disposal(cesspool) Well I I (Lot.......o�.L.�.�........fr- rear) Abuttor's Abuttar's Nance� QLLt I" Name I/i[4,4m L,,4nip T6L✓ST � f'lv9��on/ N � Lot/ Rear Yard Lot 3 9/0 Qa� ..• o� . .iL li this is a a .W ` 9: � If this is v i GCS:S]Gr last, cc-'ne• lot, wr'te in na=e of tame c! o best eet. SiZevarc' HOUSE Sideyard tithe: rc_t. - .. ba Set Baa& ........�.Sd. ..fit 1 , (Lot. /. . .........ft. L^oatage) ±Q- ---------------------- / (Natne of street) / \ Wormatioa _ Supplied byPU / Mark North Point coo � � ^.'•��....�, f O-N )oo •3t,� OfgG / _ I -�' ► .v+ J VO 10.0 16-0 94 :) �O g / r CD ruo oa CD c1 0 +-a °� � �. � • �G9 �D� ail I � � os ,I,N%Il1,7�1 Ind -- -- — -- ,lQ-- -- -- -- — - - - — — -- — SOXI �111V,111 f 85. ,2 �5 R=60.00, BENCHMARK. `C TOP OF CONC. BOUND 00 ELEV-=100.0(ASSUMED) B. 6 E PLAN REF• 1728 7E rjP� N71 \\ �� �~ �' �l �- \ // \ 3// i \�-� 1,00/91 i a I B� \ / \ / I \ \ 6a/ \\ RES. ZONE' RF I / I \ o I \ ASSESSORS MAP 3 IL I I I \ I 52 Q ' \ o I \ TO WN WATER_A VAI L 0-0 N O 99}gTO / . L w I LOT 19 I \ I I AREA=62,881 S.F.j I \ \ \ \oIJ cG0. t 0 tom\\ \ \ O Q I \ �g /g�E \ \ \ c N #2 n J \ 98}6 ERA/ \ PROJECT L OCA TION 41.\\ % I \ \ \ \ \ \ \ I ( LOT 19 LITTLE RIVER ROAD to COTUIT, MA. \ \ \ \ \ 8 35 — — - APPLICANT' Ma cEACHERN & SCHILLING 51 co cp 00 YANKEE SURVEY CONSULTANTS LOT 20 \ \ \ v UNIT 1, 40B INDUSTRY ROAD 09oFEsso�P Q. P. 0. BOX 265 I IgNO �y� MARSTONS MILLS, MASS. 02648 TEL• 428-0055 FAX 428-5553 BRUCE G. MURPHY R.S. ENVIRONMENTAL CONSULTANT GRAPHIC SCALE 77 SPUR LANE OAS MILLS MA. 40 20 40 80 160 MARPH. (508)428 3358 2648 SCALE. 1"=,4 0'= FDA TE.• 7/28/95 ( IN FEET ) 1 inch = 40 ft. REV. REV.• 8114195 LJ08 NO. 50780 SHEET 1 OF 2 •j