HomeMy WebLinkAbout0035 CONTENT LANE f
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Town of Barnstable Budding
Post This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept
enxnsnABL& * p j
M"S $ Posted Until Final Inspection Has Been Made. Permit
Where a Certificate of Occupancy is Required,such Building shall Not be'Occupied until a Final Inspection has been made. '
Permit No. B-20-1976 Applicant Name: Michael DiBuono
Approvals
Date Issued: 07/30/2020 Current Use: Structure
Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 01/30/2021 Foundation:
Location: 35 CONTENT LANE,COTUIT Map/Lot: 040-044 Zoning District: RF Sheathing:
Owner on Record: DIBUONO, MICHAEL Contractor Name: HOMEOWNER IS APPLICANT Framing: 1
Address: 35 Content Lane Contractor License: EXEMPT 2
Cotu.it, MA 02673 Est. Project Cost: $4,800.00 Chimney:
Description: Replace roof shingles/Trim Permit Fee: $35.00
Insulation:
Project Review Req: Fee Paid: $35.00
Date: 7/30/2020 Final:
Plumbing/Gas
Rough Plumbing:
Building Official Final Plumbing:
This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance.
All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. Rough Gas:
All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes.
This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the Final Gas:
work until the completion of the same.
Electrical
The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Service:
Minimum of Five Call Inspections Required for All Construction Work:
1.Foundation or Footing
Rough:
2.Sheathing Inspection
3.All Fireplaces must be inspected atthe throat level before firest flue lining is installed Final:
4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection
5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough:
6.Insulation
7.Final Inspection before Occupancy Low Voltage Final:
Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health
Work shall not proceed until the Inspector has approved the various stages of construction.
Final:
"Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A).
Fire Department
Building plans are to be available on site
Final:
All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT {
i ��
Anderson, Robin
From: Carter, Jeff
Sent: Friday, August 10, 2018 4:40 PM
To: Anderson, Robin
Subject: 35 Content Lane, Cotuit
On 8/10/181 performed a site visit as well as spoke to the property own by phone. The property owner, Michael
Dibuono, he stated that he owns a commercial company but stores his equipment at another location. He has
purchased this property within the last year and it is his primary residence. Due to the condition of the property when
he purchased it he has been doing work on the landscape by removing trees and stumps, bringing in and spreading
loam for a new lawn. He states this as the reason for having certain pieces of equipment on his property at certain times
depending on the work he is doing. He also said that he still has more to do with removing additional stumps. His
statement corresponds with what I was able to see during my site visit which showed recently spread loam in the front
yard with a sprinkler trying to establish new grass.
I did not discuss the snowplow in the driveway but will follow up with the owner to recommend a better placement
and/or storage offsite.
Jeff Carter
Local Inspector
Building Department
Town of Barnstable
200 Main Street
Hyannis, MA 02601
508 862-4035
1
Date: August 10, 2018
To: Building File
RE: Run-off not retained on site/vehicles blocking public access
Address:' 35 Content Lane, Cotuit
Owner: Michael Dibuono, 69 Joshua Barker Rd,W Yarmouth 02673
Dibuono Sewer& Drain Cleaning 508-364-9587
4650 Falmouth Rd, Cotuit
Originator: 1,nKOW 111
Complaint: Commercial activity impeding public access and wash-out onto sidewalk and road
Enforcement Process Steps
Q 1. Initiate local investigation: RA
Q 2. Document/enter into system Yes
Q 3. Contact
Q 4. Property Owner Unknown
® 5. Seek access to subject property
6. Seek administrative warrant (if necessary) NA
Z Notify state authorities of findings NA
0 8. Document conclusion OPEN
Q 9. Referred Bldg/Jeff Carter/BC
Property—040-044
Property is developed (1973) with a 1 story SF dwelling containing 3 bedrooms and 2 full baths on 0.51
acre in the RF zoning district.
08/08/2018
Caller advised that heavy equipment(dump truck/bull dozer)on site and hasn't moved. Operating
business (Septic?). This is a residential zone—should not see heavy equipment on site.
a
) Map 0 L Parcel -d Permit#
House# Cd N r L. Date Issued r
,
Board of Health(3rd floor)(8:15 -9:30/1:00-4-94) - Fee' ,
Conservation Office(4th floor)(8:30- 9:30/ 1:00-2:00)�
Planning Dept. (1st floor/School Admin. Bldg.)
Definitive Plan Approved by Planning Board 19
BARNSTAR LE.
u. TOWN OF BARNSTABLEF°�'p��
JBuilding Permit Application"
Project Street Address 3 Q Aj 4- t—to L
Village > u � -� )
Owner c.� �� D �Nn� C f. S Address 3 S G�ILA_ C A-)
Telephone
-Permit Request Q U
First Floor square feet Second Floor square feet
Construction Type
Estimated Project Cost $ (Too
Zoning District Flood Plain Water Protection
Lot Size Grandfathered ❑Yes ❑No
Dwelling Type: Single Family Two Family ❑ Multi-Family(#units)
Age of Existing Structure Z-( Historic House ❑Yes JJPNo On Old King's Highway ❑Yes ❑No
Basement Type: ull ❑Crawl ❑Walkout ❑Other
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft)
Number of Baths: Full: Existing 2, New Half: Existing New
No.of Bedrooms: Existing_f New
Total Room Count(not including baths): Existing c-) New First Floor Room Count c5
Heat Type and Fuel: dGas ❑Oil ❑Electric ❑Other
Central Air Yes ❑No Fireplaces: Existing New Existing wood/coal stove ❑Yes I�-Pd'6
Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size)
Attached(size) ❑Barn(size) !•
❑None /❑Shed(size)
❑Other(size)
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial ❑Yes ❑No If yes, site plan review#
Current Use Proposed Use
Builder Information
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 DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE DATE
BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S)
...;:r
.�, ` I
� I
.. FOR OFFICIAL USE ONLY
PERMIT NO.
DATE ISSUED
IYIAP/PARCEL NO. ,
ADDRESS VILLAGE
OWNER ,
•DATE OF INSPECTION: ,
FOUNDATION { `
FRAME
INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL;.
• t
GAS:' - ROUGH FINAL
c 1 I
FINAL BUILDING
DATE CLOSED OUT
ASSOCIATION PLAN NO.
I
The Town of Barnstable
Department of Health Safety and Environmental Services
���• BuiIding Division
367 Main Street,Hyannis MA 02601
Office: 508-790-6227 Ralph Crossen
Fax: 508-790-6230 BuiIding Commissione
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: !/. o�e —PEst.Cost
:/ Address of Work: 5� d Al
Owner's Name
Date of Permit Application: s ���I
I hereby certify that:
Registration is not required for the following reason(s):
Work excluded by law
Job under S1,000.
+ uilding 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 for a.permit as the agent of the owner.
. Contractor Name Registration No.
Date
O
Date Owner's Name
The Commonwealth of Massachusetts
Department of Industrial Accidents W ..... ......
Office 91111yesif9l"faffs
600 Washington Street
Boston,Mass. 02111
Workers"CoT,pensation insurance Affidavit
'Ap
VNEZZOW,r1l
�J IL J��7t
.�/11.�afion*:� IL phone
tv
L) f NA
homeowner performing all work mvself
am a proprietor and have n one working n any c achy r t 0 f b
so
com any name:
o
providing
g vor rs C compensation
or Y
a an employerovidin workers' mpensa employees working o s i
address:
Citv. phone
........................ polin,0
insurance 11 1 1 :':':-
. ....
am a sole proprietor, general contractor, or homeowner(circle one) and have hired the contractors listed below who
have
the following workers' compensation polices:
camyanv name
address:
phone
dtr. ......
. .............nolkV
insurnnc-
........... ---------
....
MOM-0/m/m/w/w/11
companv name-
..........
address:
CitV. .. . . .. .hone 0 ....
. .. . ..............
...... ....
011Cv a
................ .......... --- ----------
Fa lure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a One up to S1,500.00 and/or
one vex" imprisonment as well"civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against Mr- I understand that a
copy of thiS statement
tattMrnt may be forwarded to the OMce of investigations of the DIA for coverage verification.
I do hereby certify th pains and penalties perjury that the information provided above is tru,,and correct
Signatore -
Print name Phone#
^JUCW use only do not mite in this area to be completed by city or town official
permit/license 0 Mudding Department
city or town: ULAcensmg Board
Melectmen's Office
check if immediate response is required C3
CHealth Department
contact person: phone#-, (-]Other_
...................
(m-vLsea9,9$PJA)
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 a
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 of 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 renews
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
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 permit/license number which will be used as a reference number. The affidavits may be retmned 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.
The Department's address,telephone and fax number:
The Commonwealth Of Massachusetts
Department of Industrial Accidents
0111ce of Iwestlgatlons
600 Washington Street
Boston,Ma. 02111 T'
fax#: (617) 727-7749 _
phone#: (617) 727-4900 eat. 406, 409 or 375
TOWN OF BARNSTABLE
BUILDING DEPARTMENT
HOMEOWNER LICENSE EXEMPTION
Please print.
c-IDATE d ...:
� � I
✓JOB. LOCATION �� �� I� c9 +v '
Number Street address Section of town
"HOMEOWNER" ,
Name Home phone Work phon
PRESENT MAILING ADDRESS
City town State Zip code
The current exemption for "homeowners" was extended to include owner-occupied
dwellings of six units or less and to allow such homeowners to engage an in-
dividual for hire who does not possess a license, provided that the owner
acts as supervisor.
DEFINITION OF HOMEOWNER:
Persons) who owns a parcel of land on which he/she resides or intends to re-
side, on which there is, or is intended to be, a one or two family dwelling,
attached or detached structures accessory to such use and/or farm structures.
A person who constructs more than one home in a two-year period shall not be
considered a homeowner. Such "homeowner" shall submit to the Building Offici,
on a form acceptable to the Building Official, that he/she shall be responsib'
for all such work performed under the building permit. (Section 109. 1. 1)
The undersigned "homeowner" assumes responsibility for compliance with the Stz
Building Code and other applicable codes, by-laws, rules and regulations.
The undersigned "homeowner" certifies that he/she understands . the Town of
Barnstable Building Department mini inspec 'o procedures and requirements
and that he/she will comply s ' d proced es and quirements.
HOMEOWNER'S SI
GNATURE
APPROVAL OF BUILDING OFFICIAL
Note: Three family dwellings 35, 000 cubic feet, or larger, will be required
to comply with State Building Code Section 127. 0, Construction Control.
HOME OWNER'S EXEMPTION
The code state that: "Any Home Owner performing work for which a�'building
permit is required shall be exempt from the provisions of this section
(Section 109. 1. 1 - Licensing of Construction Supervisors) ; provided that if
Home Owner engages a person(s) for hire to do such work, that such Home OwnE
shall act as supervisor. "
Many Home; Owners who use this exemption -are unaware that they are assuming
:.,the responsibilities of a supervisor (see Appendix Q, Rules and Regulations-
for . licensing Construction Supervisors, Section 2. 15) . This lack of awarene
often results in serious problems, particularly when the Home Owner hires
unlicensed persons. In this case our Board cannot ,proceed -against the
,inlicensed person as it would with licensed Supervisor.- The Home " wner-' act-
as supervisor is ultimately responsible.
To ensure that the Home Owner is fully aware of his/tier responsibilities, ma
communities require, as part of the permit application, that the Home Owner
certify that he/she understands the 'responsibilities of a supervisor. On the
last page of this issue is a form currently used by several towns. You may
care to amend and adopt such a form/certification for use in your community.
y �
Assessor's map and lot number ...�j//�.....J.. . ........ THE
j' Sewage Permit number
?A, � EAR33TADLE. i
i House number .... 51..!! ................................................... 90C _.MAO .
Q YAY-
TOWN OF BARN`STABLE
BUILDING INSPECTOR
APPLICATION FOR PERMIT TO ...... I C�.O...t..........s.4.4f . ........................................
P.
TYPE OF CONSTRUCTION ..............w.0.0.J..............F. .A.M.E...............................................................
................................................19........
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location ................... . .............Co.I. .... .............L..N....................................................................................................
ProposedUse ....................... ...`...........S..VI ..........4.........�J.�.�..��..n.�..��.........................................................
ZoningDistrict ........................................................................Fire District ..............................................................................
Name of Owner 1 Koyk1 ... Address .......... ....... N .......... ....n.......................
Name of Builder T.hokAs......F►.sK.E............................Address ........3,57.... .4.N.T.. .!` .T..............4:N.....................
j-- Name of Architect ...............VIA.............................................Address .......................... ...............................................
Number of Rooms �................................................Foundation .......�E//E.NT lock
................. /.............................. ..................................
5� / N l6
Exterior .........�...../:7/%..... ..... 5.�/.. ej./&.........................Roofing .................. �Z.......................................................
/ .v O.v
Floors ...........�"�.......o.�Y..�.......................:.......................Interior ....................................................................................
.v t
Heating ...ti.�ti.E...........................................:....Plumbing ..................ti...........................................................
Fireplace �tJ D iV�................................................Approximate. Cost ............. ?. .:. .�................. ..........
................................
Definitive Plan:Approved by Planning Board -------------------_-----------19--------. Area �
Diagram of Lot and Building with Dimensions Fee ...........• ...®......................
SUBJECT TO APPROVAL OF BOARD OF HEALTH
f
65
I t9
- \ I Ci
It
32
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regar ' g the above
construction.
Name .f�...... . �. ......... ...�r . ..............
A Construction Supervisor's License .....................................(
Y
FISKE,-�TROMAS W. IDABELLE A-40-44
24590 ADDITION
No ................. Permit for .....................................
Tool Shed & Garage
. ..................................................; ...........................
Location .....3.5...Co.nte. L nt....Lane. ......................
. .. ..... ....... .... .... .. ..
Cotuit
...............................................................................
Owner ...Thomas W. & Idabelle Fiske.
..............................................................
Type of 'Construction ......................
. .,.Frame
.......................................................................... ......
Plot ............................ Lot ..................... ..........
Permit Granted ... November 29......... .............. ...19 82
- Inspection ....................................19
/Date Compl d .........ple .............................19
m e�
1
Assessor's map and lot number �.. ................ '� �/ //73
SEPTIC SYSTEM MAST BE-.
INSTALLED IN COMPLIANCE
Sewage Permit number ............J�........`�.................................. WITH AOTICLE 11 STATE
SA?,,'ITARY CODE AND TOWN
`114E.T°�o v TOWN OF B ARN STAIM E-
BAHBSTSDL$ i
639. . BUILDING INSPECTOR
�l8M p'
��I
APPLICATION FOR PERMIT TO .... A....... .............�.......................... ........................................
TYPE OF CONSTRUCTION ..............ROVVAA�..........................................................................................
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location ....... ®........... ! a ems. ....... !.. .! .�` .::.:........................:...................................................
•
ProposedUse ........�. e-jo..y!Rz..........F.0'A!.. .., ....... .....0.40.s:.'.�...........................................:............................
Zoning District ......................... .....................................Fire District .......�w.. !.l...v.��...................................
Name of Owner .II IR�Ao.......P"1 :77c, —On.......Address ..... X......VS. ............1 a
Nameof Builder ....................................................................Address ....................................................................................
Name of Architect Cjkj4jlb.....Fit..... a4Address ........... ° ..........................................
Number of Rooms ..............:�.....�....'.....................................Foundation ........ C.4X"re.......................
Exierior ..........9.4. ..........4.4.0.0 ..........Rcofing ....../7.�.1�.� II � �..... . �Z . ..
Floors ...........0
..............................................Interior .... !1/ .�....................................
Hearin .......................Plumbing .... r... ....................
g ........� ., ..:......7� Ars ► ........... o.....
Fireplace 40- \ .........•....•••Approximate Cost Q�:....................... z..�.. ............. t.............
Definitive Plan Approved by Planning Board -----------_____—-----------19_______. Area ......./... .
Diagram,of Lot and Building with Dimensions a ,
i ..ov..... .
SUBJECT TO APPROVAL OF' BOARD OF HEALTH
10
ISO
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Name ....... ........... ..................
ABORN.& PROCTOR, INC.
No :1a 521.... Permit_for ..QAQ..Wt/.Q=..............
,
amil
.... ..d ........................!.
Location ..Q=te t.laba.................. ......... k
Cotuit' Massachusetts
born & Proctor"` Inc:
Owner ........a.............................
Type of Construction J.FkmQ.............................
................................................................................. j �+
Plot ............................ Lot ................................
Permit Granted .AMVWt..2 7....... ... 1973
�..... ? ........Date of Inspectori .... � -
.... . 19Dw t' .
Date Completed /V .... .1...........19
PERMIT REFUSED
................................................................ 19R
...............................................................................
j
...........................................................................
d
...............................................................................
Approved
...............................................................................
Assessor's map and lot 'number ...y .....-.y. ... '
-- ... �.0
,j-"�` ........Sewage Permit number ........
2
33MSTAXLE._ Z i
i7 vt,�
�fHOUSe number ..............'./<!/ ................................................... - 9�p 16399 e0�
0 MOX Or
t
TOWN OF BARNSTA,L oft ...
INSTALLED M CC WITH T111
BV I L D I N G I.N S P E C T®01RONMENT40
TOWN RVEC"'
APPLICATION FOR PERMIT TO ..... �.R.Q..I.. .....5. ..........................................................................
TYPE OF CONSTRUCTION ..............�O oA..............E��..A)V E...............................................................
...................�.....�'...................19........
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit!raccording
, to the following information:
Location ...........................................3 +�N r 4 N............. ..... .............. ... .....................................................................................................
ProposedUse ............. ...........S..Vl.4`'.j..........4.......... .�?..1=n.�.E................................. .........................
ZoningDistrict ........................................................................Fire District ..............................................................................
of Owner Q t s... :.. �' bell P.....F4 G...Address .......... C o 1v-r 6-
Name ,v
Name of Builder FsK.67............................Address ........ 45....c.4N...T.. .N..T............7/......................
Nameof Architect ........... '`..............................................Address .............................. ...............................................
Number of Rooms ...............�................................................Foundation .....:.����N T.........
lock
..................... ..................................
Exierior .........—..� //...... . 5. /. r. E........................Roofng ............ u I E
.................................................
/(r D N E
Floors �`:0.......�(.h.:f..................................:...........Interior ....................................................................................
................
Heatingti.�ti.....................................................Plumbing ..................N. .......t:.............................................
itJ O N E................................................Approximate Cost �o O O ,d 0
Fireplace .................................. pp .......................................`............... .�...........
Definitive Plan Approved by Planning Board -----------_____—-----------19_______ . Area /7 v S'......................... ................
Diagram of Lot and Building with Dimensions Fee ............ .............................
SUBJECT TO APPROVAL OF BOARD OF HEALTH
Lo-i I-40,y- 160/ I
t N l
a �
u"
3Z _
A-p
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
Thereby agree to conform to all the Rules and Regulations of the Town of Barnstable regar ' g the above
construction. Name' .1/...../
. Z.4........ ... `. ..............
Construction Supervisor's License .....� ..........
1
FISKE, THOMAS W. & IDABELLE
24590 ADDITION
No ................. Permit for ....................................
TOOL SHED & GARAGE
...............................................................................
Location .3.5...Content........Lane
.... .........................
. .. .. .. ....
Cotuit
.................... ................ .........................................
Owner ..Thomas 1K. & Idabelle Fiske
............................................................
Type of Co'ns'truction ..°.Frame........................
...............................................................................
Plot ............................ Lot ................................
November 29, 8 2 jz
Permit Granted ........................................19
Date of Inspection ....................................19
Date tompleted ...................
............19