HomeMy WebLinkAbout0017 CLAMSHELL POINT LANE lot—
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Weat her ization & I.nlsuIation
4io Grove St.Fall Rivet Ma 02723
Insulatersave.net l
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April 12, 2013
Town Of Barnstable
Thomas Perry, CBO
200 Main Street
Hyannis,MA.02601
RE: 17 Clamshell Point Lane
Dear Mr. Perry,
This Affidavit is to certify that all work completed at 17 Clamshell Point Laipe has been
BPI Inspector. R14; R35 Cellulose was added to the attic. All Work Performed Meets or exceeds Federal and certified
State Requirements.
Sincerely, t
w
z.
Roland Langevin
Insulate 2 Save,Inc
President
CSL 103861
HIC 166311 -77
t
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TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
MapM -0— Parcel Application t
Health Division Date Issued
Conservation Division Application Fee :0
Planning Dept. Permit Fee
Date Definitive Plan Approved by Planning Board
Historic - OKH Preservation/ Hyannis
Project Street Address
Village 02)
Owners _YV\D)Vv-_-N Address
Telephone •LA 1
Permit Request
AO
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuation �1�1 d�i Construction Type
Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units)
Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No
Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft)
Number of Baths: Full: existing new Half: existing nCD
ew
Number of Bedrooms: existing _new
Total Room Count (not including baths): existing new First Floor Room Count-0
tl uJ
Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other
Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stover❑Yds, ❑ No
Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing 0-newt size_
Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other:
Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑
Commercial ❑Yes ❑ No If yes, site plan review#
Current Use Proposed Use
APPLICANT INFORMATION
(BUILDER OR HOMEOWNER)
Name Telephone Number ( t,(0 �T
Address- License #
Home Improvement Contractor#
Worker's Compensation # cl_,471u I
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
N(4Ak ��,A 0 A-1L (S
SIGNATURE DATE I
FOR OFFICIAL USE ONLY -
APPLICATION#
DATE ISSUED '
j; MAP/PARCEL NO. :
t
ADDRESS VILLAGE
' OWNER
.DATE OF INSPECTION: 1
1
FOUNDATION I
FRAME
INSULATION
s FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
GAS: ROUGH i FINAL
FINAL BUILDING
ICCL" r I
DATE CLOSED OUT'
LAN IN
ASSOCIATION"`P :"
i
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Organization/Individual): IAt cA 9,1
Address: I D
City/State/Zip: Phone.#: t u .ul o u
1.
Are ou an employer?Check the appropriate box: Type of project(required):
I am a employer with 1 C) 4. ❑ I am a general contractor and I
employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling
ship and have no employees These sub-contractors have g• ❑ Demolition
workingfor me in an capacity. employees and have workers'
Y P tY• 9. ❑ Building addition
[No workers' comp. insurance comp. insurance.$
required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself. [No workers'comp. right of exemption per MGL 12.❑ Roof repairs
insurance required.] t c. 152, §1(4),and we have no
employees. [No workers' 13.4 Other)
comp.insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
(Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information. '
Insurance Company Name
Policy#or Self-ins. Lic. #: 1 Expiration Date: o[ V a
Job Site Address: f City/State/Zip: CQ�
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. i52 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of
Investil;ations of the DIA for insurance coverage verification.
I do hereby certi under the pains and penalties of perjury that the information provide above 's true and correct
Signature: Date:
Phone#:
Official use only. Do not write in this area,to be completed by city or town official,
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
i
CERTIFICATE
THIS CERTIFlCATE Is ISSUED As A OF LIABILITY INSURANCEOP ID: HG
CERTIFICATE DOS NOT AFFIRMATIVELYMATTER OF INFORMATION ONLY =DIATEyyrnBELOW. OR NEGA AND CONFERS NO RIGHTS UPON 2
REPTHIS CERTIFICATE OF INSURANCE DOES IVELY AMEND.
E A CONTRACT
ENTATNE OR PRODUCE EXTEND OR ALTER THE CERTIFICATE HOLDER.THIS
IMPORT R,AND THE CERTIFICATE HOLDER. gETVI►EEN OVERAGE AFFRESORDED BY
ANT: If the cert,l-cate holder is an THE ISSUING INSURE THE POLICIES
the terms and conditionsADDITIONAL INSURED, IN-SURER AUTHORIZED
certificate holder in lieu Policy'certai^ the policy(ies) muy�p�� Of such endorseme policies may require an endo be endorsed. If SUBR
s. rSement A statement on thisOGATION IS WAIVED Partners Ins•Mizher.Division 508-675-0308 CowrACT certificate does not r subject to
560 Wilbur Ave. 508.675-0006 P"o'E Helen Ga ne 9�to the Swansea,MA02777 No .508-491-0174
Stephen Long�Wansea AEDDRLES$' InPRODucER:h a artnersins Ilc.com FAX NO:508491-0108
Insulate 2 c STO1"� INSUL-1
Roland Langevinnc INSU
INSURER A:SCO n S AFFORDING COyF,pAGE
536 Eastern Ave. ttsdale Insurance Com Nac 0
MA 02723
Fall River INSURER B:Travelers of Massachusetts
INSURER C:
INSURER D:
COVERAGES INSURER E:
THIS IS TO CERTIFY CERTIFICATE NUMBER: INSURER F
INDICATED, NO THAT TME POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEO TO THE INSURED NAM
CERTIFICATE TWiTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF REVISION NUMBER:
MAY O ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED H
EXCLUSIONS AND CONDITIONS OF SUCH POLICIESNCE .LIMITS SHOWN MAY HAVE BEEN REDUCED gY p Ell)
COVE FOR THE POLICY PERIOD
ANY CONTRACT pR OTHER DOCUMENT WITH RESPECT TO
IN
G 7Y� AID CLAIMS. HEREIN IS SUBJECT TO ALL THECH THIS
TERMS,
ENERAL LIABILITY POLICY NUMBER MM/p�EFF P0�pp,
A X COMMERCIAL GENE
RAL LIABILITY LIMITSCPS1366499
CLAIMS-MADE a]OCCUR 06/12/11 O6/12112 EACHRF1uhOCCURRENCE $ 1,000,0
�
°°cu"a^ce $ 50,0
MED EXP(Any a,,pew) $
PERSONAL&ADV INJURY 0,0
0EN1 AGGREGATE LIMIT APPLIES PER: PERSONAL 1,000,00
POLICY PRO LOC REGATE GENERAL AGG $ 2A00,00
AUTOMOBILE U ABU y PRODUCTS-COMII AGG S 1,000,00
ANY AUTO $
(Ea COMBINED SINGLE LIMB $
ALL OWNED AUTOS )
SCHEDULED AUTOS BODILY INJURY(Per per) S
HIRED AUTOS BODILY INJURY OW ) S
NON-OWNEO AUTOS PROPERTY DAMAGE
(Peraca0em) $
X UMBRELLA OCCUR
UAB S
S
X EXCESS LIAM
A CLAIMS-MADE DEDUCTIBLEON $ 10,000 UBS0001144 EACH OCCURRENCE $ 11000,00
X 06/12/11 06/12/12 AGGREGATE $ 1,000100
RETENnoN
AND EM $
B ANY PROPRIETORIPARfNER � YIN 70P25111 WC STATu OTM-
OFKERIMEMSER EXCLUDED? NIA 12/10/11
(Mandatory In NH) 12/10/12 EL EACH ACCIDENT
D I�I N OF OPERATONS below $ 500,00
E.L.DISEASE.EA EMpLO $ SDD,QO
EL DISEASE-POLICY LIMB $ 500,E
DESCRIPTION OF OPERATIONS!LOCATIONS/VEHICLES(AttWh ACORD 101,Addidoul Remarks Schedule,If more space is required)
Honeywell International Inc,its subsidaries and its and their respective
officers,directors,shareholders,employees and agents as additional
insureds in respect to general liability.
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED ED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHOR ZED REPRESENTATIVE
ACORD 26(2009/Qg) The ACORD name and logo are registered marks 2of ACORD ACORD CORPORATION. All rights reserved,
, 1
c�
AXe
Office of Consumer Affairs and gusiness Regulation'
10 Park Plaza - Suite 5170*
Boston, Massachusetts 02116
Home Improvement `a�tor Registration
i— Registration: 166311
Type: DBA
Expiration: 5/11/2014 Tr# 222532
INSULATE 2 SAVE
ROLAND LANGEVIN f;,
410 GROVE STREET
FALL RIVER, MA 02720
�•i,— �b :i Update Address and return card.Mark reason for change.
DPS-CAI it SOM-04/04-G101216 •
-~ [� Address Renewal Employment [],Lost Card
Office�tonm�erAf}arr�s gi�sioe s`�Retr'"o License or registration valid for individul use only
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Registration: ,A, 6311 Type: Office of Consumer Affairs and Business Regulation
Expiration: 51.1�1.�,014 DBA 10 Park Plaza-Suite 5170
Boston
IN TE 2 SAVEr, ,MA 02116
ROLAND LANGEWN
536 EASTERN AVEi,;` `'< ?
• FALL RIVER,MA 02T• / secre _
�' Undersecretary
=1 Not valid without signature
Nlassachu..ett%- Department of Public Safety
Board of Building Regulations and Standard%
Construction Supervisor License
License: CS 103861
Restricted.to:, 00
ROLAND L=ANGEVIN
536 EASTERN AVE,
FALL RIVER,MA 02123
Expiration: 8124=13
(' nunixiva r Tr#: 103861
i
OWNER AUTHORIZATION FORM
(Owner's Name)
i
owner of the property located at
C L4vvske It
(Property Address)
off.k oZ6 3�—
(Property Address)
i
hereby authorize ( Jam— -2. �A
(Subcontractor)
an authorized subcontractor for RISE Engineering,to act on my behalf to obtain a building
permit and to perform work on my property.
Owner's Signature
Date
��ypT TM[tp``Oa
TOWN OF BARNSTABLE
t sasaerAEL ?
'oo "6 9. MASSACHUSETTS
Solid Fuel Stove Permit
DATE OF APPLICATION ................. ...1��2............................. FIRE DEPT. ISSUING PERMIT ............................................................
NAME (owner) �� NAME (Installer) l�d.�.�. ....-CQ.n. �? �t?!s'...............
CG/,IN1 SN€�L �T U✓ coTvs�T `
ADDRESS17................................/......................................................'......................... ADDRESS ..............��� sXo,....I.....................{.....�1.�......
STOVE TYPE . ..... .. f......:r.... .. .. ..:.... ... ... ................ CHIMNEY: NEW ........................ EXISTING ........................
Manufacturer 2 CHIMNEY: Masonry 41"P-! 1r� b:...............„ (, ... ..tc
...........
Mass. Approval ............................./�.(... ................................................. CHIMNEY: Metal ...................................................................................................
This is to certify that the above installer.has permission to stal
soli el burning appliance at the listed
address in accordance with an application on file with the .. ... ..................... ...............................................................
and subject to the provisions of the Commonwealth of Massachusetts State Building Code and regulations made
under the authority thereof.
Issued B Title Date
is
y: ............ . ................. ......................................... .............
Permit to install expires 60 days after issue date
Stove ............................. .........................................................................................:....................................................................................................................................................................
StoveClearance ...... ....................................................................................................................................................................................................................................................
Floor .........................1 ...................................................................................................................................................................................................................................................................
SmokePipe ............ ...............................................................................................................................................................................................................................................................
SmokePipe Clearance ........ ..................................................................................................................................................................................................................................
Chimneyv.......................................................................................................................................................................................................................................................................
SmokeDetector ................................ ..............................................................................................................................................................................................................................................
The undersigned hereby certif s tat the installation of solid fuel burning stove and equipment made under au-
thority of permit dated .. ....���.y ............... has been made in accordance with provisions of the Commonwealth
of Massachusetts State Building Code now currently in effect and pertaining thereto .
Installer
?LA
INSTALLATION APPROVED .....�.....�,� ....9 ................... By:.............. ....................... ................................................ Title: "fi`"":.. `"'�""""'.....
ate
WHITE: FIRE DEPARTMENT — CANARY: BUILDING INSPECTOR — PINK: APPLICANT
-6%TX E Tp�`
TOWN OF BARNSTABLE
DAUSTABL i -
'�, r679. �P MASSACHUSETTS
Solid Fuel Stove Permit
DATE OF APPLICATION? .................: FIRE DEPT. ISSUIN PERMIT ............................................................
NAME (owner) ` �11AMJrK, NAME (Installer) S oiJ — fa, }�.�q„c ?
` ADDRESS �7.....dZAA4�N,E1_4_ . .:..U✓'.....(207L DDR•ESS ..............✓�lt.�.sXo�t.�•!...... c�%zl' A.�oopl
STOVE'.TYPE .......e e5.. .�........... e-1 z KA ............ CHIMNEY: NEW ........................ EXISTING ...... ...... _
Manufacturer ..�!.�.1 ..'..� !/ /,�/�'`��c�C�/�!......... CHIMNEY: Masonry ... .... .0 ��- c.�.....
..l...f.......... ..... ...............................
Mass. Approval ............................i........ ........... ......... ........ ......... CHIMNEY: Metal .M.... ........................................
This is to certify that the above installer has permission t , instal a. soli el burning appliance at the listed
address in accordance with an application on file with the ../. .... ..................................]}ir-eDepartnrent,
and subject to the provisions of the Commonwealth of Massachusetts State Building Code and regulations made
under the authority thereof.
r .
Issued By .��
................�!......!...........................................................................................Title ...........:............ ..`.'." ......................:...... Date ......... .......................
Permit to install expires 60 days after issue date
Stove ............................ .............................................................................................................................................................................................................................................................:.
StoveClearance ........-......................................................................................................................................................................................................................................................
Floor .........................`-..................................................................................... ::........ ....................................................................................................................................
SmokePipe ............ .......................................................................................................................................................................................................................................................................
_Smoke Pipe Clearance `..--'—.. .. .. .. . . .
Chimney .v..................................................................................................................:....................................................................................................................................................
SmokeDetector .........................././444.................................................................................................................................................................................................................................
v
The undersigned hereby. certif'•es t'at the installation of solid fuel burning stove and equipment made under au-
thorit of permit dated ../��.� has been made in accordance with rovisions of the Commonwealth
Y P ..............,.....y../...................... p
of Massachusetts State BuildingCode now currently in effect and pertaining thereto .............................................
Y p g
Installer
/ � !�� �W Ao/
INSTALLATION APPROVED .,... ......gate/.................... By...................................!.................................................. Title. ......... ..................`..............
WHITE: FIRE DEPARTMENT - CANARY: BUILDING INSPECTOR - PINK: APPLICANT
7&
Assi-s*sor's map and lot number .. . ..... ..................
INSTALLED IN CIOK'%IANC�`= THE toySewage Permit number ...S Y';;.> - - . - ,WITH TITLE 5... . .......................... � /1 8
ENVIRONMENTAL CODE AK✓ i 33A]UST&BLE,
House number ... ....................../7......................................... TOWN REGULATIONS 11AS&
14 r- 1639-
TOWN OF BARNSTABLE
BUILDING INSPECTOR
L
APPLICATION FOR PERMIT TO .......3. C*...................... .................
TYPE OF CONSTRUCTION ................... N.C.. ...... ...... . ...........................................
2
............ .. . .........................
19. 1
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information.
hA*
Location .............. 8......cmo fi)iof , C-1) ....
................................................. ......4. ...........................................................
ProposedUse ...............................................................................................................................!.............................................
ZoningDistrict ........................................................................Fire'District ..............................................................................
Name of Owner ...... nf��..Aciclress..................................... ...5
........................................................ .....
Nameof Builder" ......................OWP�Y�............................Address ....................................................................................
L)r,(Z
Name of Architect ....................OW......................................
Address .......... .............................?...........................................
Number of Rooms ..................................................................Foundation ...............................
Exterior ............ t7...... .....................Roofing_....... ........................................................
Floors .........OP06...:t .4.!2A)72 (.Z. ......f. . .................................... Interior;•..........................ka C-
...........................................................
-Heafing ..... .............................................:.................I...........Plumbing ........ ...........................
.. . ....................... ............. ........................ .......
Fireplace .......=.21.......................................................................Approximate Cost ...... ..00...........................
Definitive Plan Approved by Planning Board --------------------------------19 'Area.
............
6d
Diagram of Lot and Building with Dimensions
Fee ......... ..........................
SUBJECT TO APPROVAL OF BOARD OF HEALTH
4. OL
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the Rules and Regulations of the Town ofarnstable regarding the above.
construction.
2S
Name ........ ..................................
THOMAS, PAUL J. & LILLIAN
One & 1/2 Story
N,a ...Z3P.49.. Permit for ....................................
Single Family Dwelling
...............................................................................
Location ,Lot....#.1.9......1.7....C.1a.m.s.h.e.1.1...Point Ln.
Cotuit
...............................................................................
Paul J. & Lillian Thomas
Owner ..................................................................
Type of Construction .......Frame
...................................
................................................................................
Plot ............................ Lot ................................
March 2. ..............19 82
Permit Granted ..........................
Date of lnspection!-!9!��'?�.'2 ...............19
.....................
Date Completed ....... .. ...........................19
Assessor's map and lot number
Sewage Permit 'number
ON
TOWN OF 'BARNSTABLE
^
BUILDING
INSPECTOR
-
APPLICATION /~APPLICATIONFOR PERMIT TO ............7� ��.�'�—.. 'J-''�''/''/A///----'---------'—'-'
TYPE OF CONSTRUCTION .................... � __ . ./
/ 'L/1-7 /
--.—,—./--.--.,----lR.��..
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for o permit according to the following information:
��
Location ----. '/°� ��� —.. ............... f_ _./���r'/7__________________.
Proposed Use -------------------.�-----------------------------_—_______
-
Zoning District -----------.------------.Rve District _-----------_____________~.
� Nome of Owner ......f? ` --.�.-"J^�*J�[� �'--�' ' ����".�A66,e» .��..���.��.�\..�� .�l`�\"�—�lfy�s_.
�
Nome of 8oi|6e,' �8����R� A66nss ``
� -------� ----------- --------------------.-------..
/
Nona of Architect ------.����/.c�.� ��---------A66,es ............................
Number of Rooms ----------------------Foun6ohon ...
Ex/ehor ..........&0,0v\_ L~ //�__~f.�_�ru��+�!�� . ___ 6�___________________
Floors ___ ....... -----------`.|nt��r --- . ...........................................
Heating ....v�.—...--------------'---'R0m6ind ----- ---------'--------
�7
Fireplace —'."���-----------------------`Approximote [ost .....x/\...............................................................
/
Definitive Plan Approved by Planning Board lg----' Area ...... ...................................
Diagram of Lot and Building with Dimensions Fee ___~ -�� � ���...................
� SUBJECT TO APPROVAL OF BOARD OF HEALTH
`
-
^ � \
e �
\\�
. �
�
^(7 '
~/
�
, !�
-
`
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
| ' �
| hereby agree to conform to all the Rules an Regulations of, Town
construction. - � /
Nome ...................................... ------------'~'—
- - |
THOMAS, PAUL J. & LILLIAN A=6-73
�0
1/2 Story ,
No Permit for &.....................
Single Family Dwelling
...............................................................................
Location ,Lot #19. 17 Clamshell Point Ln.
............. .................................................
Cotuit
...............................................................................
Owner .Paul...J. &....Lillian i.an...Tho.mas.... ....... ... . .. . .. .... .. .. ....... .. ....
Type of Construction ... .........................
................................................................................
Plot ............................ Lot ................................
Permit Granted ...March....2....................19 82
..... ..
Date of Inspection ....................................19
Date Completed ......................................19
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Iwsre��+c=t.lr guc:•i�Y -TtAc: UFc�F--T�i 514"Ji-a APPt_I GA.h1T 1
L I'l-r V.r ur.cn T.► r)ePczmlNk- L'Or - t_IN •� PAUL \FA Q5
•TM . TOWN OF BARNSTABLE Permit No. :_2 3 8 4
}
Building Inspector
Cash --•------_—__-- ---
OCCUPANCY PERMIT Bond
Issued to Paul & Lillian Thomas Address
f
Lot 19, �r17 Clamshell Point bane, Cotuit
Wiring Inspector !f/�J �, /���� _ Inspection date -
Plumbing Inspector/7,-,-,,„� Inspection date
!_ r-
Gas Inspector J -J// / Inspection date
Y Engineering Department fill f��� 1� Inspection date'
Board of Healthy-y�,,, /9 Inspection date
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. /
. L
Buildin `Inspector
Y -