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Thomas F.Geller Director p�E 659. Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 - R F�_�n7 Office: 508-862-4038 DEG 2 9 2003 per: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENT uI BARS- ��� Not Valid without Red I Press Imprint Map/parcel Number�sZ507 a 7 Prope Address ��i e Value of Work_, 8®0 Db Residential c Owner's Name&Address Contractor's Name /� c .f� /r°/�/� Telephone Number z.n22— ` Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) f_1VYozkman's C mpensation Insurance Che one: I am a sole proprietor 1a ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Woikman's Comp.Policy# Permit Request(check box) 2"Re-roof(stripping old shingles) All construction debris will be taken to ,— d�✓�` �' ❑.Re-roof(not stripping. Going over existing layers of roof) Re-side' ❑ Replacement Windows. U-Value (maximum.44) *where required: Issuance of this 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. Improvement Contrac ors Licensq is pequired. Signature Q:Forms:expmtrg Revi053003 ' a m '''�� t' Jfie i�onvyno�ztuea�b��aauc�zuael�a;` Board�A�•.8�ildirg3te�uiaf�o�s�n'a�fYa�iYl" jM0ME IMPROVEMENT CONfMAdfd Reg(stc�atfo,�i� 119983 °3 ED 1 5 Pe-a- E13 SHON A S 81 REPI ARMO �5.'PQR�R10 I W i I t } Scott Schofield 500-775-6255 p. 2 oET rod Town of Barnstable M� Regulatory Services f Thomas F.Geller,Director �oPre ►`� JBualWng Division Tom Perry, Building CommMoner 200 Main Sttect, Hymnis,MA 02601 Office: 508-862-4038 Fax: 508 750-6230\• Property Owner Must Complefe and Sign This:Section If Using A Builder �1_�0 `t --'..;as.C4vrues.Af the.subject psoe .. ...... ...,.. ._ hereby authorize �f a`%/i�, . to.act on snp..behalf,. . is all mattets telatise to work au;.hoiized bp.this building permit-epplicatioa•for: (Address of Job) 3 ► — a3 c tote of Qwaez ]7at Print�,rn.e - 72 Assessor's Office Pst floor) Map a.S- - Parcel .0 l Permit# S 7 Conservation Office(4th floor)(8:30- 9:30/1:00" 2:00) 6- 1.Jjcf( 01,i Date Issued m — 9 Board of Health(3rd floor)(8:15 -9:30/1:00-4:45) / 7 � Fee' Engineering Dept.(3rd floor) House# J) �� d.ME ~ r Planning Dept.(1st floor/School Admin. Bldg.) `�E.IC,SYS finite Plan Approved by Planning Board 19 -INSTALLED i 10E CICO S"r F� TOWN OF BARNSTAHMONPOPAL CODE AND ' Building Permit Application TOWN REGUTMON"r, Jectet Address a�./ 41 Village -,Owner /�/%�''�.�� ��.3"ter✓pll J`/� Address 1/Z/ Telephone Permit Request /�� �//�%/��� /.�n liks� - ' First Floor square feet Second.Floor square feet Jeftk Estimated Project Cost $ �00. Zoning District Flood Plain Water Protection Lot Size Grandfathered ? I Zoning Board of Appeals Authorization Recorded Current Use Proposed Use Construction Type Commercial Residential 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 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 l Name ,*111-� a���/� Telephone Number Address License# 22 92 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 DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO/fi0!,A11 U/ell, SIGNATURE DATE BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS y { VILLAGE 'r OWNER _ �, "'. � • j, _ a I f --; •• N a I S 4;r �� 1 � f r, e a f 1 t , • ` DATE OF INSPECTION: FOUNDATION - FRAME' a i INSULATION FIREPLACE a I i ELECTRICAL: ROUGH •FINAL PLUMBING: I(o GBH FINAL ' , GAS: ' R - t6 ° /FINAL 0 FINAL BUILDING �� 4 �. �a - 4 DATE CLOSED OUT n + ASSOCIATION PLAN NO � ! a t i y The Cumnizan>,•calM-of Atassachusetts •«7• ----=i,v Department of Industrial Accidents AMC V01M*sllgalloos - t - . 600 Wasltitr�,tun Street Bu ton,A1am 02111 �• Workers' Compensation Insurance Affidavit �i7/4,, /-O�" � Inaltion- city 1/r���1f'�:.�i phone 1! Q 1 am a homeowner performing all work myself. j I am a sole proprietor and have no one working in any capacity Q I am an employer providing workers' compensation for my employees working on this job. cmmnam•nnme- r,dress• - thong±fh ittsttr�nce�� noiic��# Q 1 am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who the following workers' compensation polices: CD-Many nntne! address: city. phone#* iacurnnce ce neiicv# �: -�c , .. ... --. K +r-.•.ate-anr•►s:1+nNsrw�y - -- -- -- .�Q�'.1r�C7!!O► - �-...�,..r� _ _- - comn�m•name• address city. phonein,tur #s ---- co- veiicr# .Attach additidnafsheet iCtiieeisar �r w�D^ - ^TM—"'• ^'�'-.::•: :""'•" `��"" Failure io secure corcrage as required under Section:SA of AIGL 152 an lad to the impaaition otcrimi=petuddes of a fine up to S1.500A0 anti une years,imprisonment as Weil as civil penaities in the form of a STOP WORK ORDER and a fine ofS100.00 a day against mts I understand tha! copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verifleation. I do hereby t ertif}}• der re p ' UP aloes equ, at the infonnwion provided above is true and correct Signatu � Print name /' � one otiicial uae oniv do not write in this area to be completed by city or town official city or town: permit4lccwe#1 nSnilding Department C3Uccnsing Huard Q check ifimmediate response is required pSdattoeo'a Ofntx (3tieaith Department phone#tt nOtber. - contact person: � Information and Instructions 9 Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for t employees. As quoted from the "law", an emph ree is defined as every person in the service of another under any contract of hire, express or implied. oral or written. An empinrer is defined as an individual. partnership,association, corporation or other legal entity, or any two or rr. the fore�_oing enga�=cd in a joint enterprise, and including the legal representatives of a deceased employer, or the rccei+•er or trustee of an individual , partnership. association or other legal entity, employing employees. However owner of a d++-cilinL house haying not more than three apartments and who resides therein, or the occupant of the dwclling house of another who employs persons to do maintenance, construction or repair work on such dwelling or on the ;,_rounds or building appurtenant thereto shall not because of such employment be deemed to be an emplo MGL chapter 152 section 25 also states that even.state or local licensing agency shall withhold the issuance or renewal of:r 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 in requirements of this chapte been presented to the contracting authority. '.�.•��. .. •14:f.,i _ .�T.�'. ... ='Y•..r•`FSK. •tS�:a.:^�' .'h ��•::. :.��•q;i� 777 Y" :�:.•ay . •:u.. Applicants Please `;161 in the workers' compensation affidavit completely, by checking the box that applies to your situation an 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 mquir to obtain a workers' compensation policy, please call the Department at the number listed below. �. r....�.•.w.+e.rn...+r-� ..•.•�P..n-.-�.•� „'�.� .�._ 7 '77 W �t• ^^'.r•.7.��.r ai iM.•:... . City or Towns Please be sure that the affidavit is complete and printed legibly. Mie Department has provided a space at the bottorr. the aflidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. P be sure to fill in the permit/license number which will be used as a reference number. 'The affidavits may be mturne 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 quest; please do not hesitate to give us a call. , rw._,• .:� . •�.:, ;sue: 7. The Department's address. telephone and fax number. om inonwealth Of Massachusetts The C .. Department of Industrial Accidents office of Investigations 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 The Town of Barnstable KPALP Department of Health Safety and Environmental Services .e Budding Division 367 Main Street,Hyannis MA 0=1 Ralph Ctt= OTI= 509-790-6227 Building C0n= F= 5M-775-3344 For office use only permit no. Date AFFIDAVIT HOME II4i3'RO Tv'EMENTMO ARppLCCAZ'IONw SUPPLEMENT cxion,alterations;rtnovation,�moderauatzOII,0D�°II' MGL a I42A requires that the"reco:ustru ownered uaprQvement,.=Ma%-1, demolition. or construction of an addition tom Bch' =adjacentbuilding g at least one but not more than four&MIing units oM along with other to such residence or building be done by rzgistercd aonttactors;with=M'n�ti =quin==tL Type of Work: /? ids Est. Address of Worn:, Zl , /� 4S Date of Permit Application: I hertb}'certify that: Registration is not rcquired for the following rrason(s): Work caduded by law _ ob under SL,000 Building not owner-occupied Owner pulling own pm= Notice is hereby gh=that: CONTRACTORS PULLING'T�R OWN PERMIT OR DORICG DO NOTEHAVE ACCESS TO THEFOR APPLICABLE HOVE RAPROVMAEN L- ARBrrRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER MN OF PERMY I b=by 'iy for a /the gent of the -Z 1 Comm=na Regisration No. me OR ' 1S93 3' � W>:�?u nQu ET 1eacE `� II � gzi5?tl,� Woc 6,N ' 1xX K N'I�N��D f3 Ee�M co F G!ALvAN IZED p,QE `r_ \ fll X �IARD L, � lwcRyAgG�f � � � 50aR�5, 2757 W, OSAL W6, WALNUT' CA�9:K, C.&LlF g45q�' 0 yo � I�YGN4 H, LA.rIMER v5 133 NucKfPS N5CW J'��EE�1'' MULcc�oN-�Lt�woRz-+� AWENWLYN MULPOoN TOAN M U LDt�>4N O U K I,4 L21 MUCK I NS NECK Fio,&D Gi✓hIt�IZVI LLB M/�Sg, Oz-G32 �r 1? 80� 0 20um Mom. 40 14UGKIM6 N&GK R04D ��,�; I � D7dCEUr Rop.-9'TY Ow lE25 >LI i lyeD DUBK i0 �Dw�tD L. PL&O VI 9W W"u�,GzuE� LvK� M ,oRtr( SaN MU LDA�N•( Ll.sWoR�N C EW -,g RV!LLj� 50 P,�h 121 µUGKIOS NI✓GK CAOLD � u.1�L, LAtIM�t�, G1:M�RVILL�., Mays, 02G3z S�E�'1' dG 2 1.25-q3 , 5 1,----- 10 4 "A' 01411 — g,4 .� 8sj�rs �� a 8 rX Engineering Dept. (3rd floor) Map Parcel Permit#Qt / � House# Date Issued _ l61/111-7Z Board of Health(3rd floor)(8:15 -9:30/1:00-4:30) ^`l/ Fee ( )( ) S ���� 5�� � rim Conservation Office 4th floor 8:30-9:30/1:00-2:00 0 0 �l� �,,,,, W LLED 1 � MPUA�iZa- wisisaiwg) (t r�r � 1 /+. 19 9Cildkid 61671� RNSTAB ,DE �MV 7M'A6 �tEO TOWN OF BARNSTABLE Building Permit Applicat ion Project Street Address Village R-" Owner -.;P?,00%e724z& ��.51✓®rT1.1 Address /elrl _S Telephone Permit Request /- 1` �- �A T� 21- 0A1 square feet �Second Floor �/ square�feel � Construction Type l i Estimated Project Cost $ y.S"oW. — Ze istrict Flood Plain Water Protection Lasize- // Grandfathered ❑Yes ❑No ily ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure .3 Historic House ❑Yes No On Old King's Highway ❑Yes ANo Basement Type: ❑Full ❑Crawl ,�Walkout ❑Other Sac mPi�d Area(sq.ft.) Basement Unfinished Area(sq.ft) Numbn-4-Fall sts: Full: Existing New Half: Existing New Existing New Tote ou not including baths): Existing New First Floor Room Count Home sm 4— --@ Gas ❑Oil ❑Electric ❑Other CentraLAa;;-S4es ❑No Fireplaces: Existing New Ex ting wood/coal stove ❑Yes ❑No G size) Other Detached Structures: Pool(size) ❑Attached(size) Barn(size) ❑None Shed(size) Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ?1N0 If yes, site plan review# Current Use Proposed Use Builder Information Name �/ �_ A-/ Telephone Number` Address ")S� r�!//ASp/�S /t�,7-11 License# Z 2 Home Improvement Contractor# 0 Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS. PROPOSED STRUCTURES ON THE LOT. ALL ONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) ry - > � � w..�vf�":ri�f e ; r-� s+ ._'�Y S"�"�rir.",aY°'S1??� T ,�^,`� �' se 1 .> .�- ...� � � - s�� � a c The Town of Barnstable $ 'Department of Health Safety and Environmental Services Building Division 367 Main SUcet,Hyannis MA 02601 Ralph Crosses Ofrj= 508-790-6u7 Building Ca= F= 508 775-3344 For office use only Permit no._ Date AFFIDAVIT ROME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. I42A requires that the"reconstruction,altemdmM renovation,repair,modernization,conversion, improvement.mmo%-4 demolition. or construction of an addition to any PVC-edsting owner 0°cupi� building containing at least one but not more than four dwelling traits or to sUuctm=which arc adjacent to such residence or building be done by registered cmaactom with certain C=eptions,along with other teguitraaeats. Type of work: 61C4i 0.1 Est.Cost Address of Work: -s 0wner.Nainc: 4, Date of Permit Application: I herein certify that: Registration is not required for the following rrason(s): Work cvduded by law Job trader S1.000 Building not owner-0ocupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UN CONTRACTORS FOR APPLICABLE HO1V4E IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL r I42A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: zi9 o� Date Contractor name Registration No. OR ' n,,e Owner's name • +` The Commonwealth oj4fassachusetty • ' u;i� -=_==�;_� De partntent of Industrial Accidents 8=9 fif1110 lfOMONs 600 ff ashinrton Street Boston,Alas. 02111 Workers' Compensation Insurance Affidavit l to rn t . . � . .. ti. Ic s 1 am a homeowner performing all work myself. I am a sole proprietor and have no one worl.tn�, in any capacity es.:•^bane.!�r•+!+..riser..;.,7!..-µ":,et7.'7�:.^lFlKaw'+.rw�1V ss�7�'�D+".�•7Nf'!oa*..'....7'�* _ :: _-. .. _..:.. _•....�. �M!�?r"r7"��'y..,'.T{'.��-....•.v•w. � I am an employer providing workers' compensation for my employees working on this job. company name: -- address• city: phone#- insurance co policy# lam ole proprietor, general contractor, or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: company name: address: city' done#• insurance co noliey# 'zm- __ •:..re• vr- -rJ��r.r.+w�.•.•-...fir•:_ 7....; .-. company name: -address: city: phone#• inur•ance co policy# -- :Attach additional sheet if necessary ±._::;f^s:�." a,.. Jr csf,_er��.ass.:'::;.t..�1 .. •tr..•e.+.riii�a'w.....,• �.sM-iSi�� �=��:surc�:�`�,�u��� w: 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 S1.500.00 an one years'imprisonment as wcll as civil penalties in the form of a STOP N1.ORK ORDER and it fine of S100.00 a day against me. 1 understand that a copy of this statement may garde the Office of Investigations of the DIA for coverage verification. I do herehr certify it er is is and halt' o un fit.the information provided above is true and correct. Sienature Date Print name Phone# a*ofticial use only do not pyrite in this area to be completed by city or town official city or town: permit/license# Mudding Departmcnt OLicensing Board I]check if immediate response is required OSeleetmen's Once E311caith Department contact person: phone#; nOther s Ire%ised 3l95 P)A) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation !or their the service of :ll other under a employees. As quoted from the la��•", an cn1p1t{t ee is defined as every person in contract of hire, express or implied. oral or written. .r An eiytplotrcr is defined as an individual, partnership, association. corporation or other legal entity, or ail-,-two or more the foregoing enLaged in a joint enterprise, and including the le al representatives of a decease emplover. or the rccei\'er or trustee of an individual , partnership, association or other legal entity, employing employees. However the owner of a dwellina, house having not more than three apartments and who resides therein, or the occupant of the d\\,cllin�,, house of another who employs persons to do maintenance , construction or repair work on such dwelling hour or oil the urounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chanter 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 ha' been presented to the contracting authority. Applicants Please fill in tine 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. Tile 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. .. City or,ro-wns Please be sure that the affidavit is complete and printed legibly. Tile Department has provided a space at the bottom of tine affidavit for you to fill out in tine event the Office of Investigations has to contact you regarding the applicant. Pleas be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. Tile 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. ►^-aNv-r+.- .....-. .--.�.+.a.••r+w•v-...v.... .r.�t�.!.. .....T.r w •�waTY'evrJNtt!C7!',•,'T.Y*!�•1+wswea.,.,-.c The Department's address. telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,Ma. 02111 fax #: (617) 727-7749 phone #: (617) 727-4900 ext. 406, 409 or 375 d' R1 v 7D w va m aas a _ �7 Z f••.O � Off H _� 10 C7 C .9 4-1 m m oa PC C In N N � N m m LOCUS N4� Nh Ko UAOUET �� 3 1-1/2 X 1-112^ 1�"-TERS LAkE SS`l I r -CIF-- ♦' -low � f{�i L t {• +, /' �. _ r I ONO. POND 1 M + �Rf' j . I I f pRr)F It c SECTION i s c ASSESSORS MAP 252, LOT 18 N/F 90 -"A POWALK DETAIL HAL F.L. LATIMER OLT.& i S 86'19'10" E � P�JSTS 128.00' \ \ WOODED AREA 1 r r / SECTION-8 s x O POST SECTION-A WE Q U A Q U T N , SUPPORT NET O dp TOP VIEW I LAKE RACK LINE x x x m _q HAYBALE COUPLER 4'-0" Irr, SILTATION FENCE B PROPOSED HA'113ALE DIKE 1, FLOW Y � AND SILT FENCE ��' _ x ASSESSORS — 1 1<o _ 1_± MAP 252. LOT 17 N BACKFILL x , X EXISTING LAWN C 16 . - SECTION—A ± SECTION-8_ _ �, _ I N EXISTING TREE �''� oo10 t � 1 / PROPOSED WOODEN DECK i APPROX. LOCATION I NATIVE SOIL F.F. EL-- OF EXISTING WOODEN DECKS� TOE-IN METHODS JOINING SECTIONS OF ENVIROFENCE cp - XISTING DOCK-- PP,OPOS ` 56.65 E �. STAIRS 1 NEEDED 1 a' SILTATION FEN 8c HAYBALL DETAIL NUT TO SCALE) I PROPOSED • ` n ,o --�-, 4' WIDE WOOD 0 BOARDWALK (TYP) x f a a - �, EXISTING ✓ PARKING O I 10.04, I 13. 1 WOODED AREA ✓ I E�: TO WATER N 86'19'10" W 1. ALL DIMENSIONS ARE PERPENDICULAR TO THE PROPERTY LINES. I 128.00 2. ANY CHANGE TO THIS PLAN MUST BE APPROVED BY THE CONSERVATION COMMISSION 1 AND DESIGN ENGINEER. 3. ENTIRE PARCEL SHOWN ON PLAN IS ZONED RD-1 PER THE TOWN OF BARNSTABLE ZONING ASSESSORS MAP 252, LOT 16 MAP, LAST REVISED MAY 7, 1988. N/F 4. TOPO AS SHOWN BASED ON FIELD SURVEY PERFORMED BY ATLANTIC DESIGN ENGINEERS, INC. I EDWARD L. SOARES 5. PROPERTY IS LOCATED IN FLOOD ZONE C PER 250001 0005C LAST REVISED AUGUST 19, 1985 6. ALL ELEVATIONS ARE NGVD 1929 FtLE 1506 Designed by SCALE ----- - — -- --- _ �' �� WRY � DL CK AND BOARDWALK PLAN Sheet 01 Drown by _ ---- -- -- J A N F T M tJ h.-.D tO ON — I t-- L--:� ''�'v O R T N FOR R INC. Checked by SCALE _ o -- _ --- -- -- t NUCKINS NECK ROAD _ aDESIGN ENGINEERS, � c f k JE �;� ���� L+k�VE Joe NUMBER Field survey ch by _ JULY 23, 1996 L�� Y508. 0 ENTERVILLE MA Box 1051 `.sandwich, MA 02563 (5(j8) 888 9282 Approved by : � , l — I _ —__— _�----._-- C ` _ T 06070 -1 � JC' ATE PEVISI 'N