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HomeMy WebLinkAbout0129 WHITMAR ROAD /�`� ��; maw -��., f. � _ � ti 0 i Assessor's office(1st Floor): - SEPTIC SYSTEM MUST BE Assessor's map and lot umber ��� _ 0 6 S^ _ INSTALLED IN COMPLIANCE Conservation WITH TITLE 5 °•► Board of Health( rd floor): ENVIRONMENTAL CODE AND j PAR13TAML Sewage Permit number ��lAilnw �'�'P;�����'I®�� 'oo ,e q. d' Engineering.Department(3rd floor): y a 3 House number Definitive Plan Approved by Planning Board 19S APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2-00 P.M.only 19 TOWN OF BARNSTAB LE BUILDING INSPECTOR APPLICATION FOR PERMIT TO �U/ /UFI,u `-�'��r� j/y r y TYPE OF CONSTRUCTION 19 J TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location % 6 rc / l Proposed Usedv �S/lIC?r/7`�r3/ Zoning District /_ Fire District � -v tT — I� yJr �/�/rcuAy Name of Owner j�Ni7 6 /--yT-' Address 1157195,Y4� *T Name of Builder� i9/�9�C�/�LGsPS �z��l C9oli0NAddress__ Name of Architect !/)/�l/ li,5)tm az2�&/ Address Number of Rooms /�9 Foundation Exterior /-�� ✓�/'�oNl 4*)`l //5"'//f2"Roofing Floors J�f.�IiPVG�l�a1� —L4iPA��{r �iL rP/' Interior �5�5.� �aC✓�f J�a �� �,P 3T��s Heating �/qs 1'f'.�� T � Plumbing f OJUE �TC/l�i� Fireplace �/'�C� Approximate Cost d ®-� Area - �� Diagram o Lo and Building with Dimensions Fee r- OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS ' I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construct' n. Name Construction Supervisor's License EAGLE POND REALTY TRUST No 35122 permit For BUILD DWELLING ti 'Single Family Dwelling r i Location 129 Whitmar Road R Cotuit r , Owner. _Eagle Pond Realty Trust. —•c Type of Construction Wood Frame , r ` Plot Lot { Permit Granted June'�12` 19 q2 Date of Inspection /o� 19 , ;DatComaleted 1©/�r 19 7`-7 ..! �, ; ; I HEREBY CERTIFY THAT THIS FOUNDATION IS LOCATED ON THE LOT AS SHOWN AND k CONFORMED TO THE TOWN OF ' BARNSTABLE ZONING EGULATI NS, REGARDING SETBACKS FROM STREET LINES AND LOT L N E IT W CONSTRUCTED. r' JUNE 10, 1992 -RABER E. R ND, P.L.S. DATE N 22054'05'W 152.84 - I I , 43560sf, I PARCEL 67 4N, r y.�.. I ` I Im 'N 0 � I NO - N � I '4 N f0 I N Cu ID 6G Z I EXIST. FOOTING EXISTING FOUNDATION 42rt I ol . , 152.80 S 23'30'59"E WHITMAR ROAD 40 20 0 40 80 120 SCALE IN FEET THIS PLOT PLAN WAS MADE FROM AN INSTRUMENT 'SURVEY AND IS -FOR 'THE USE -OF T-HE BANK"ONLY. UNDER NO CIRCUMSTANCES ARE OFFSETS TO BE USED . FOR FENCES, WALLS, HEDGES, etc. AI FOUNDATION LOCATION PL_A,N VSN OF blpsnCs --- ROBERT PARCEL 67 WHITMAR ROAD `t%, LL E. CQTUIT (BARNSTABLE) Ma. RAYMOND r 9Q No.21583� ARO ENGINEERING INC. FLOOD ZONE L "�J�J'�y 39 STRIPER LANE COMM. No. 250001 0018 C E. FALMOUTH, MA. 02536 r 1992, EFFECTIVE DATrAUGUST 19, 1985 o.,�s _ J SCALE I"=40' DATE JUNE IO COMMONWEALTH OF . MASSACHUSETTS EXPIRATION DATE --,,RESTRICTIONS . I , ........ . '•, PHOTO(BLASTING OPR ONLY) 'FEEsI•LC`(I •4 1(: .� - - r' HEIGHT: i l [Ni . - THIS DOCUMENT.MUST BE , .CARR6D-ON TNET+EASON OF . THE''HOLDER"WMEN ENGAG- OT�ERS-RIGHT THUMB PRINT ED IN THIS. OCCUPATION.' "1010:2.8%61429 { 9 { i .. p DEPARTMENT IF C SAF�y 4010 COMMONWEALTH AVE. q BOSTON,MASS.02215 'IF f;:'� ;L_ii''FfR:VIs';I:iF . EFFECTIVE DATE LIC NO. 0,17489 C'If`I' Nii'F_f: w1(a 4.51 w ;1 NOT VALID UNTIL SIGNED By LICENSEE AND OFFICIALLY" '�- STAMPED-OR-SIGNATURE OF THE COMMISSION .SIG RE OF LICENSEE " :.r�F='b''I-ii f`�! -:, _I _ T ►f1' g19B1(717i1�-. 4 1 k 't �l ii '-31 q. I i • of i4 'rs ;e I; I I = f I ,v[atz_CF YJC.Swlw;LE[ I ---_T Q.{:14]suat• I lroCt_GL n..C. 1 17 _-- 5508.428.6191 ct�tiRawNS�s— 1` I` (gevi i n ign_ r ' des s ,w E-LCOVE Copyright Q 1992 All ghti R L' TMFI _ Res ght 74�2t 1MSl.�, SEA ( I �i �u.utw�ltaH I ' - �.LLy..r.r'r•��:�4•)�� �1-� -'.��LTJHf�SL'21a11_��T- -f�'� � ... I i ved -��.�Ln'..cLl„lC.curl5onnnS�l �� —;.— j�il ��� ~ �• � { i _ I I C _ . r � �ROI`I�T-F��dTIC�-I:L '�• "� � "'`• '�'� '.�+ ' ���s - � -. � Prebmrnary plans and layouts by DC Dare for the use 01 [Heir customus only.Any o[her use is strictly proniDne �-� r I 1 ' ! 1 } ._� sstZM cvna47t5-- _ - I i I I T MOLM 2�24swSLL. s... .���{lustl.. •__�_ 4 508.428.6191 u sutr+G rvst sHOL_ I T @ustom 1 T--,i _.� 4- — Qesigns �%tu All R,g ts Reserve[® 99 . _ Li—r1��� ... d, L"Z{ 2 7A , 1 i • - Pr N,min9ry plans and layouts by D.C.D.a,e for the use of [neu tus[ome.1 only.Any other use�s i[nC[ly Pronibne t I I I . i I i • .._. HnS-rcMR"'�Lttlurlytj—..� 7LLIC�—�- A Ob . � ¢[DAL vrw ;Isis �ivarl2S�l5-• � eb ''j � sLwc�y-c4tt)= I .—V41,11TL w S CLOWL SNC.LL ill'I 7JF:2q lHl j' .. Mrtt MUWOV.' II�I�; j' JE3 508.428.6191 t: u o�eviin @Ustom designs - .. 7yJ PiL MulLp1Y�_= copyright®J99I -vr�rrn.p�_ All Rights Res ewed i Ptellminary plans and layouts by DC.D-are lot the use of their customers only.Any other use�s it nCtly ptO D:te I I, j Q;al'`fr4ep�y1`q'�1L. 117UitfL'"_vl ...._.__...___--._�._......Zsr ..... SIAS d � b p Z I LLYrr''r-CTltj ` o I li 508.428.6191 Coaeviin N ii. o g @ustom s -:_.•=r� s�aj a ° '' i tesigns cogri9ht®1991 All R.9htt US L> m _gIRDSAyoCxlTCTrP) rltsOt •. - OZ . � —_ _ld••__ - = 1'^1_- ':7LL_1ev-r-nr,n=—__ 4! __O:h_.IO'AN�I-' - - 1''7� � l �+ l • .. ncL\wtitti?-B=zslx. _t:-ti^TtM-.sata� � � � . . . i� , ! i. '_Sd+1G.C2e�:CAW.-211-171V.rtlitSlfi < '. .... -7 Pf Niminary nnly prom orte plans and layouts by OC.O.are for the use of their customers only.Any"other use rs fl — . I I I n _.A t 31L1frM'�RY,DVIR C�+4«) iO - - �O O N 00 1 p .._x� ---- I' I I ._ 0• YmafS GiChCAnd__.—__: 508 428.6191 t ze Z CA ,y j'I f •4 .-'tr MtN.s.ouc,stnw.� I . c• M _c•u�acrnawna--' ! a evl i n _.eau7aY sd- 'Irrcm: O @ustom � N designs copyright®1991 All Rights Reserved a .. r IL I l a• 4•:d.. �. t:.cf ..ancf. : .:.�.t;. .... �. :. . .zr-:. :.a•,d. ,... r.'.o•. _ ,r•o`_ d•o' So•_-- i - •< AS 1 j FlctsT FLOCXF Preliminary plans and layouts by DC D.are lot the use of their customers only.Any other use rs St .City ProneDrte - .u.u..o.r.,x..,..r,ay.,a.ro :. ^-._.. .. .-..,--._,:,r..-.y.:..c. ..cc�.•�„w•'r,.>;..._ - :.. .. .. .._ ...._ .. 1 I i 1 .I • ' i 4 i • 1 •. � � i III I.n1i... i .- 508.448.6191 19 `? _ MASTE R'SCU 1TE.— M ev i i n — �«.o :• - -- @ustom designs copyright Q 1992 y 2' All R.gh[s 0 � !i I SKf,�1�7I�31.�LI— �-Ll F'„r:e•'� _ y - •• - I Preliminary plant ano layouts by pC.D.Ali fnl the•Ulf of`•Bert Cy)tc,mrl{O^IY,^^Y,O(hr1 uSF!S 311�[tl)r p1Ohi Dilr I �' ___...._......_._.__. _ _...._._.._._..___..__...--.__-- _._....... f{ .J O i s i I _— I; TOWN OF BARNSTABLE, MASSACHUSETTSe e: A=056--067 DATE June 12, 92 y* 9 ± 19 PERMIT NO. �¢ _ _ APPLICANT-_ Dream Developers ADDRESS1S1 . Rti J 551 Bld,' �18sia 7 (NO.) (STREET) •t ICON,6'S LICEI:SE.. 'PERMIT TO. Build Dwelling ( 2 ) STORY_Single -Family Dwelling NUMBF� OF (PROPOSED USE) - (TYPE OF.IMPROVEMENT) NO. DWELLING UNI TS '- AT (LOCATION) 129 Whitmar Road, Cotui ZONING' (NO.) (STREET) DISTR ICT_NE—_____...__. it(' d l BETW EEN AND (CROSS STREET) (CROSS--STREE ) - SUBDIVISION LOT BLOCK SIZE BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT, IN HEIGHT AND SHALL CONFORM IN CONSTRUCT; 4 . It f , TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION REMARKS: #92-'182 ITYPrI -- r I 1 I' AREA OR A A qq VOLUME 1844 sc�• .�t• ESTIMATED COST: �OO,VOa•00.' FEEMIT Q ,fs7. .. C� (CUBIC/,SO DARE FEET) _ �P �. OWNER Edgle, Paftd Reaj.ty 'rust f ADDRESS 45 Fairway Lane, . 1` ashpee BUILDING DEPT. ` �I BY THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHE R..TEMPORARILY.( ® PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER .THE BUILDING CODE, MUST BE P PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAIN[ FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT�FROM OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. .THE CONDITIO MINIMUM OF .THREE CALL 'APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE INSPECTIONS REgUIREO FOR ALL CONSTRUCTION WORK: CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN ELECTRICAL* PL PERMITS ARE REQUIRED FOR I. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF. OCCUPANCY IS RE- MECHANICAL,INSTALBLIATIONS.D • 2,. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL-NOT BE OCCURIED UNTIL ey FINALI INSPECTION TO BEFORE FINAL INSPECTION HAS BEEN MADE, 't 4 3. FINAL�INSPECTION BEFORE OCCUPANCY. POST THIS CAR® SO IT IS VISIBLE FROM STREET;. BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ^ ELECTRICAL INSPECTION APPROVALS aA"'0, yf 3-HEATING INSPECTION APPROVALS' 1 ENG EE FIN yyDEP RT ENT 2 0 - 8- 9 BOARD OF HEALTH .0 ,Q�C. ,tea. ,"L OTHER _ SITE PLAN REVIEW APPROVAL Awls WORK SHALL NOT PROCEED UNTIL THE INSPF.C- PERMIT 'W!LL BECOME NULL AND VOID IF CONSTRUCTION TGR HAS APPROVED THE VARIODUS STAGES OF WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE INSPECTIONS INDICATED EP THIS CARD GAN RIT CONSTRUCTION, PERMIT IS ISSUED AS NOTED ABOVE. ARRANGED FOR BY TELEPHONE OR VVRITT 6 NOTIFICATION. i , w. e o*1wv TOWN OF BARNSTABLE Permit No. . 3,5122 BUILDING DEPARTMENT 4 ' TOWN OFFICE BUILDING Cash .ML� HYANNIS.MASS.02601 Bond .......X....... CERTIFICATE OF USE AND OCCUPANCY Issued to Eagle Pond Realty Trust Address 129 Whitmar Road Cotuit, Mass. USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID. .AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. October 16, . I9.....9........... .. ... .. .. ... .. .. ..... �uil?ingnspector r s , .YN�r pT r � LT.U4ySb.;INf1itYR_. 4e4IiN D-FA Va. .�O RJ2•VULT x- _.....U;Rt. Sid un[fL MAIN I�tL1�M5 ImL u4t,lo''�PJJVE GhnnE7K I Pl I CEMMI{t'iLE ,� f f N 3 Bl.{LS l2"O+G. RApiug..... .i it .: .•Y1t�G�4J.p.W'..:t`s.PE':T`UTO.U�tit�R: : '�' LT.li4m%f IlAiriuiR_. LIkE:. ;OLNMFNVLT.@ORd2wmT - sum;-.Uwa i - i 0 f :31 Q .,MnIz�T: ienl ry -, i cc, P1.Ulv`t31N�, SGNF��t�TlC5.. N.T.S. LI ALL 5�GTION.; — 12"O'G _ / (if w �- b„49841 h �qEC�Sf D N:L`CPl'Tt:+TO.E1llG a,' 4 LINE. i R5 RtJ St�!Miai_ �. .. s - Ii :3; aj ...ti�nsiy:'agelry .. Lcc � F. Srt�t Eta KEtLtN �uvRW+•., PLUM6INC, .SGI-4EMATIC5 N-T.s- 1) evn co ig Air igrres e:; _. Reserved j 77­ • V Map Parcel 6.7 - Permit# ' t j 1 House# Date Issued Board of Health(3rd floor)(8:15 -9:30/1:00-�4.3D) ee r Conservation Office(4th floor)(8:30- 9:30/1:00=2:00) 6_SATEEki1L_1_-111.,,,; 3, Planning Dept. (1st floor/School Admin. Bldg.) , ,oNSTALLE PUANCE Definitive Plan Approved by Planning Board 19 ENV9�®N E. - ®E AND t T� 9N . t IONS TOWN OF BARNSTABLE Building Permit Application ; Project Street Address Village L j— Owne t;--i 6,_,s z J QAA X Address Telephone0`2.6- Permit Request o� 7 p First Floor square feet Second Floor square feet Construction Type - Estimated Project Cost $ —1-P IV el Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No -Dwelling Type: Single Family �4' Two Family ❑ Multi-Family(#units) Age of Existing Structure P,o 0 Historic House ❑Yes WNo On Old King's Highway ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) &,o Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing _ New Half. Existing New No.of Bedrooms: Existing New Total Room Count(not including baths):Existing New First Floor Room Count Heat Type and Fuel:X Gas ❑Oil ❑Electric ❑Other Central Air ;W Yes ❑No Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) 0 14 Attached(size) ❑Barn(size) ❑None ❑Shed(size) t� ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes PNo If yes, site plan review# Current Use Proposed Use / Builder Information Name a Telephone Number Address License# 6,�3 Home Improvement Contractor# //C��r1 r3 Worker's Compensation#&LP-o o/-3 6—.3 6 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 T�� n,s21A—_ _ SIGNATURE ADATE BUILDING PERMIT DENIED FOR`THE FOLLO ING REASON(S) �a (Iatlec+n V, i �: 11 4L " - - FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO.all ADDRESS VILLAGE QWNER z -..z DATE OF-I_NSPEGTION: ' FOUNDATION t .4 FRAME ,r INSULATION', FIREPLACE F + ELECTRICAL: ROUGH FINAL t PLUMBING: _ROUGH FINAL - - GAS:'t --ROUGH- FINAL FINAL BUILDG . :.. , + DATE CLOSED Ours ; i c' fu C _ . i ASSOCIATION PEAN NO S at Z/ l4ow , The Town of Barnstable 9� 1059. epartment of Health Safety and Environmental Services .erED �, Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner For office use only Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW, SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing 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. Type of Work: d Est. Cost r Address of Work: Jc�-9 �i(�i�}�/�%A.Q ?� y Owner's Name Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under$1,000. Building not owner-occupied Owner pulling own permit 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 fora permit as t e agent of the owner: Date Contractor Name Registration No. OR Y Date Owner's Name r The Commonwealth of Massachusetts p "!� Department of Industrial Accidents oxce of/nsestigatieffs 600 Washington Street Boston,Mass. 02111 Workers' Co m ensation Insurance Affidavit name: & location: al, / 6a /P city phone# '7«d 1o0-A _ ❑ I am a omeowner performing all work myselfP0 neto and have no one kil I am an employer providing workers' compensation for my employees working on this job. v me.:comaan na f? � � 1? � � — ? address. f lid `' " :. citys phone insurance ca. .QS/ei� ... ✓4Sp 7 ? ohcv# �� 6lI / 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: . comnanv name: - - address:. _: - _ city: :.: .. ., tneorance ca ohcv# . I cambanv:name: :.: .. . address: city: phone# ansarance co.< olicv Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a tine up to S1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a tine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certi under th p and penalties of perjury that the information provided above is truo and correct: Simatur �1 Date Print name S 141 A R A. �"s Phone# oi$ciat use only do not write in this area to be completed by city or town official city or town: permit/license# ❑Building Department ❑Licensing Board ❑checkif immediate response is required ❑Selectmen's Office ❑Health Department contact person: phone#; ❑Other (wised 9/95 PJA) ' - r 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 employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An employer is defined as an individual,partnership, association, corporation or other legal entity, or any two or more of the foregoing 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. Applicants r r 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 along with a certificate of insurance 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. 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 peimit/license number which will be used as a reference number. The affidavits may be returned io 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. 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 I..I.-1.�... ..-.I iL�-..:I,.-.11:.,.,.:...�.,.-'....-.-...I:.1.'%1. ` � I.-,�-�!I,,-.,,-.I,,.-,I,--".I.I v..-,-.I.1"-..:1I",!-,.�-m..�--�.��--,.�.,�..�I;.v:0m���I�:..�0��,i.,�,�.%:-....1,.L....t,,....-��,�..,D.�.�..f.1. 1 `. 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EEO AESKARIS " ,at1 ttteando?� N OESKARAIS � . r z.•;'`p a '... .:,... .A # �DMItJISTRATOR S .BOX t881/4 NNI TIER'S NAY KASHPEE NA 01649 K t' � tin �e �' a. •'( i.� .' - _ � .�.- ti.a -.. z stranon valid for in,V uat - N License oT Tegi iratton'd"ate if .found' use only beforeP Place Rm±1301 h to:One Ashburton : t:a , return Boston IA 02108 � . r