HomeMy WebLinkAbout0048 SECOND AVENUE 70 Q
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[ ] [R116 063 . ] •
LOC] 0048 SECOND AV*r E CTY] 11 TDS] 300 CO KEY] 56414
----MAILING ADDRESS------- PCA] 1091 PCS] 00 YR] 93 PARENT] 0
BRACKETT, PATRICIA G MAP] AREA127BC JV1278513 MTG12012
48 SECOND AVE SP1] SP21 SP31
UT11 UT21 . 60 SQ FT] 822
OSTERVILLE MA 02655 AYB11930 EYB11950 OBS] CONST]
0000 LAND 95800 IMP 34000 OTHER
----LEGAL DESCRIPTION---- TRUE MKT 129800 REA CLASSIFIED
#LAND 1 95, 800 ASD LND 95800 ASD IMP 34000 ASD OTH
#BLDG (S) -CARD-1 1 19, 600 DESCRIPTION TAX YR CURRENT EXEMPT TAXABLE
#BLDG(S) -CARD-2 1 14, 400 TAX EXEMPT
#PL 48 SECOND AVE OST RESIDENT' L 129800 129800 129800
#RR 1463 0141 OPEN -SPACE
COMMERCIAL
INDUSTRIAL
EXEMPTIONS
SALE] 09/93 PRICE] 1 ORB] 8770/271 AFD] I A
LAST ACTIVITY] 01/24/94 PCR] Y
- _ T
R116 063 . P P R A I S A L D A T • KEY 56414
BRACKETT, PATRICIA G
LAND BLD/FEATURES BUILDINGS NUMBER ZN/FL=RC
95, 800 34, 000 2 A-COST 129, 800
B-MKT
BY 00/ BY /00 C-INCOME
PCA=1091 PCS=00 SIZE= 822 JUST-VAL 129, 800
LEV=300 CONST-C 0
----COMPARISON TO CONTROL AREA 27BC -- --MAY NOT BE COMPARABLE--
NEIGHBORHOOD 27BC OSTERVILLE
PARCEL CONTROL AREA TREND STANDARD
101 10 LAND-TYPE
958001 LAND-MEAN +0*
1298001 127105 IMPROVED-MEAN -7306 2506
] FRONT-FT
] 100 DEPTH/ACRES TABLE 02
10001 LOCATION-ADJ APPLY-VAL-STAT 1
LNR] LAND LFT/IMP]ADJS/SB/FEAT STR] STRUCTURE ARR]AREA-MEASUREMENTS NOR] NOTES
COM] MARKET INC] INCOME PMR] PERMITS GRR] GRAPHIC
FUNCTION- [ ] STRUCTURE-CARD NO- [000] DATA- ( ] XMT [?]
R116 063 . • P E R M I T [PMT] ACT* [R] CARD [000] KEY 56414
000000001
PERMIT-NO MO YR TYPE VALUE CK-BY MO YR .CMP NEW/DEMO COMMENT
TOWN OF 3A33NSTABLE
REPORT PLEWENTART/COMWl"II ON.REPORT
NAME (LASTZPST, NIDDLE) DIVISION /of ?
1
OL
NOSE DETAILS i OBS TIONS-ITEMIZE EVIDENCE, SERIAL IS ETC. 3�
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-p(v3
` LA-
�— I
1
I
i
J
30PERTY ADDRESS I I ZONING (DISTRICT CODE SP-DISTS.I DATE PRINTED(STATE I PCS I NBHDUMBER
CLASS KEY NO.
0048 SECOND AVENUE 11 RC 300 11C0 07/09/95 1091 OJ 27BC R116 063. 56414
LAND/OTHER FEATURES DESCRIPTION i ADJUSTMENT FACTORS IT
Y UNIT ADJ'D.UNIT
ESRACKE'TT.LanO By/Dale Size D�men.tDn LOC.IYR.SPEC.CLASS ADJ. COND. P PCE ACRES/UNITS VALUE Doxriplion
RI PATRICIA G MAP-
/ CD. FFDe InlAcres PRICE
kL A N D 1 9 5 i 8OO —
1G 18LUG.S.IT 1 x _6i =10 133 CARDS IN ACCOUNT
119999.9 15959998 60 95300 g9LDG. _ (S)—CARD-1 1 19,600 01 OF 02
rYBLDG(S)—CARD-2 1 14,400
BATHS 1 _0 U x D= 100 2700.0 2700.00 1.00 1 2700 ,-j 4PL 48 SECOND AVE OST ARKET
r .3k 1463 0141 INCONC7
q10 SE
DI PPRAISED VALUE
JII I DARCEL SUMMARY
OG
S 3LDGS 3400E
-AND 95800
T
M
IMPS
TIOTAL 12980E
Ni �i CivST
DEED REFERENCE Type DATE
I RIOp YEAR VALUEBook Pape Incl. MO. Yr,D stale.Price A 1N D 95800
S .77101271, 109/9.3 R—dod A 1 LDLS 340GG
7473If037YE1�03/91 86000 rOTAL 129800
3.322/280: 0/00
BUILDING PERMIT
Number Dale Type Amount
LAND LAND-ADJ INCOIMF SE SP-BLDS FEATURES HLD-ADDS UNITS
95300 1 2700
Class C:Dn51 TOIaI ga-Rate Atll.Rate 'B I AI'. Norm. Ob%v
Units Vnls - A I p D.7, COntl. CND LOc %R.G ROD( Co51 Naw Atll RLDI Value S10I19! Herphl ROonrs Rm! Btalh! •Fii. I P.rtywtall Fec.
01 + 000 100 100 51.85 .51.85 30 50 44 3.81 100 38 51.573 1960U 1_0 4 2 1.0 4.0
"noon Rate square Feet ReDI,Cost MKT.INDEX: 1 e D V IMP BY/DATE: / SCALE: 1/0 0.63 ELEMENTS CODE CONSTRUCTION DETAIL
100 51 .85 780 40443 aTIVGt- ;M j :,J
F.EP b5 33.70 192 6470 N. *-7-* 3 T Y L E 09COTTAGE 0.>
n
liSF 90 46.67 42 1960 *------26--*FSF* ESTGIsi-A1)-JMT GO-------------------
! ' -XT-Z-R.J-XL S-- -i)T4DVU-FR-iVME-------
U.-O
! ' i EAT/AC-TYPE 04 Il----------------U:O
! ' NTc17:FTNrSH- -00 ------------------U.O
! ' I R7cT:LAYOOT- J2 ------------------U.-O
! ! I(G7c-R.QUti:TY J2 S AT4'E-A7S--EXTER'.--V.-O
30 8ASE 30 F CJ'.7R STRJCT -Jv-------------------TU-:G
D I 19 ! + E -LJJ-R CDV'E;l ,JC- -------------------0-.0
J I I
E TDlal ArcaS Aug . Be- . 2 2 - -
' =L£ TRIC-A-L--- -OL -------------------0-.-0
T DUI!DING DIMENSIONS -
U We < S �rU3 w ! + -b:iv-DATl-O-N--- -00 -----------------99-.-9
A BAS w02 N30 E26 FSF N06 W07 S06 + + -------------- -- --------------------------
I EU7 . . SAS S30 .. *------24-------x -----14EIGlrR0RH D 2-7-9C- O�TERV-I-LtE----
L 8 8
LAND TOTAL MARKET
! FEP ! PARCEL 9.5800 129800
_------24------*
AREA 9141
VARIANCE +0 +1320
STANDARD 25
COPE RTV ADDRESS I ZONING (DISTRICT CODE SP-DISTS.I DATE PRINTED I CSTATE
LASS I PCS I NBHD PAACFLJ12FNTIFICATION NUMBER KEY NO.
0043 SECOND AVENUE 11 RC 300 11C0 07/09/95 1091 0J 276C R116 063. 56414
LAND/OTHER FEATURES DESCRIPTION ADJUSTMENT FACTORS
Lane By/Dale FF apt nc n LOC./VR.SPEC.CLASS ADJ. COND. vP PRIICE IT ADPRICENIT 5 R A C K E T T.
I CD. FFDr. I Acres ACRES/UNITS VALUE oeacripllon PATRICIA G M P.P-
CARDSIN ACCOUNT —
BATHS 1 .0 U x D= 100 2700.0 2700.00 1 .00 2700 J 02 OF 02
- NO 63MT 3 x I D= 100 7.2 5.61 888 .500.0-3L U 5 T 12vguu-
MARKET
INCGME
A i I USE
D APPRAISED VALUE
J
129,800
U
PARCEL SUMMARY
AND 95800
T I LDGS 34000
M 0-IMPS
DOTAL 129800
E
' CNS7
N DEED REFERENCE1 Type DATE Rxawa 'PRIOR YEAR VALUE
7 Booh P.Q. Insl. MO. Yr.DI Sales Pr c. AND 9 5 D 0 U
S .,LDGS .34000.
I
OTAL 129800
BUILDING PERMIT
Number LAND LAND-ADJ INCOME tJSE SP-BLDS FEATURES EILD-ADJS U:AITS Dele Typ. Amount
2300-
Class Consl. Total r B Il Noerm. Obsv.
UnnS Units Base RDIC ADI Rale J/I I AID D Dr. Cona. CND LOo 4E R G Repl Cosl New Atll RBDI Value $ton Heiehl RDoma Rms Belha a Fis. P.nywell Fac.
010 000 100 100 47. 55 47.5.5 A00 50 44 3^8 95 100 36.1 39924 1440J 1 .Oa 4• 2 1.0 4.0
p 17. R.I. Square Feet Repl.Cost MKT.INDEX: 1 e 00 IMP.BY/DATE. / SCALE: 1/U 1.0 G ELEMENTS CODE CONSTRUCTION DETAIL
100 47.5.5 888 42224 Sty L)WELLING CNS7 GP:'
•-----------------36----------------+ STYLE: 09 OTTAGE 0.0
-AOJ-- :50 ------------------ i).0
• cSiGN MT
8 ! cATcfF:aALLS Q1 OOD "FAME 0.0
! ! AFA_T_/AC-7YPE -02 AS----------------U:O
' 6— ! IN'fc`R:FINfSH 00 ------------------0.0
' ! INTcR:CAYO0T_ _UT - -----------------U.O
! ! INTt,1:0U-FLTY- -023 KE-AS-EX7ER_ -U.O
! ! FCUJR STROCT- -Jp ------------------J.O '
w ' BASE 28 E L7)_UR_CUVER-- -OG---------- -----------0=0
368 ! ----------------
E plat Areas Baae. 2 D-J Y-T Y F J L' U=0
20 ry
BUILDING DIMENSIONS C C L T R 11.A L UG -----------------
T
BAS N2U w06 NUS E36 S28 'a30 A 0UY6ATI0-N - -00------------------9V-9
_ !
! ! -------------- --- ----------------------
--- ---------- --------------------------
LAND TOTAL MARKET
! ! PARCEL
X--------------30-------------•
AREA
VARIANCE +0 +0
STANDARD
FOUNDATION BSMT. & ATTIC PLUMBING PRICING .
LAND COST �
pnc.Walls Fin.Bsmt.Area 0 Bath Room Base /21 r-/ O.0 BLDG. COST
pnc.Blk.Walls Bsmt. Rec.Room St. Shower Bathh1-1 / Bsmt. — /0 /0 '
PURCH. DATE
Inc. Slab Bsmt.Garage St. Shower Ext.
Walls PORCH. PRICE.
lick Walls Attic Fl. &Stairs Q Toilet Room o
Roof RENT
one Wells Fin.Attic J Two Fixt. Bath
Floors — a
Ott INTERIOR FINISH Lavatory Extra
imt. F 1• 2 3 Sink
1 1/2 r/4 Plaster Water Clo. Extra Attie
. . . . . . . . . . . . . . . . . . . .
EXTERIOR WALLS J -PineMATt Water Only r� G 30
ruble Siding Plywood No Plumbing Bsmt. Fin.
ngle-Sidding Plasterboard Int.Fin. — /7 y� b
JQe !_Shingles W / TILING Al
inc. Blk. G F P Bath Fl. Heat 2 S' •
ire Birk.On Int.Layout Bath Fl.&Wains. Auto Ht.Unit 8y�
Veneer Int.Cond. Bath Fl.&Walls Fireplace
im.Brk.On HEATING Toilet Rm.Fl. Plumbing
slid Com.Brk. Hot Air Toilet Rm.Fl.&Wains.
Tiling
Steam .Toilet Rm.Fl.&Walls
lanket Ins. Q Hot Water St. Shower
lof Ins. Q Air Cond. Tub Area Total ,
Floor Furn.
ROOFING COMPUTATIONS
6ph. Shingle — Pill Furn. 8 t/OS.F. /.2 .2Q
$od Shingle No Heat / /I/ S.F. S. 90 11,271
kbs. Shingle Oil Burner S.F.
late Coal Stoker S F
Ile Gas S. F. OUTBUILDINGS
ROOF TYPE ElectricI - -able Flat S.F. 1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6 7 8 9 10 MEASURED i
lip Mansard FIREPLACES S.F. Pier Found. Floor
iambrel Fireplace Stack el Wall Found. 0.H.Door LISTED
FLO RS Fireplace Sill Sdg. Roll Roofing
onc. LIGHTING
_ Dble.Sdg. Shingle Root
arth No Elect. DATE
Shingle Wells Plumbing
line
lardwood ROOMS Cement Blk. Electric
isph.Tile Bsmt. 1st TOTAL /a //-L/ Brick Int.Finish P _D
{ingle 2nd 3rd FACTOR 2, ;2,p
REPLACEMENT 13 U G / /- �-`
OCCUPANCY CONSTRUCTION SIZE AREA CLASS AGE REMOD. COND. REPL. VAL. Phy.Dep. PHYS. VALUE Funct.Dep• ACTUAL VAL.
)WLG.C"•77 / s ,c s/� !ST600
1
2
3
4
5 \
6
B
9 w
10
TOTAL
V
g� 16RESIDENTIAL PROPERTY
MAP NO. i LOT NO. FIRE DISTRICT
STREET SUMMARY
48 Second Ave. Osterville LAND
116 63 C-0 BLDGS.
OWNER TOTAL
LAND
RECORD OF TRANSFER DATE BK PG I.R.S. REMARKS:
BLDGS.
David & Lois A. 10 27 65 1316 68 B
TOTAL
LAND
�B U� P ✓ oa.G.ss �, BLDGS.
TOTAL
LAND
0) BLDGS.
TOTAL
LAND
a) BLDGS.
TOTAL
LAND
BLDGS.
TOTAL
LAND
BLDGS.
Cl
TOTAL
LAND
INTERIOR INSPECTED: BLDGS.
TOTAL
DATE: j /
". LAND
EAGE COMPUTATIONS BLDGS.
D TYPE # OF ACRES PRICE TOTAL -"'DEPR. VALUE TOTAL
HOUSE LOT LAND
CLEARED FRONT BLDGS.
REAR TOTAL
WOODS&SPROUT FRONT LAND
REAR Q! BLDGS.
WASTE FRONT TOTAL
REAR LAND
BLDGS.
TOTAL
LAND
O1
BLDGS.
LOT COMPUTATIONS LAND FACTORS TOTAL
FRONT DEPTH STREET PRICE DEPTH% FRONT FT.PRICE TOTAL DEPR. COR. INF. VALUE HILLY TOWN SEWER LAND
ROUGH TOWN WATER BLDGS.
HIGH GRAVEL RD. TOTAL
LOW DIRT RD. LAND
CW.1 V OI Ann
_ LAND COST
ne.Wells Fin.rBsmt.Area 0 Bath Room / Base / BLDG. COST Zkl �•
ne.Blk.Wells Bsmt. Rec.Room Q St.Shower Bath Bsmt. — (o 0 PURCH. DATE
Inc.Slab Bsmt.Garage n St. Shower Ext. Walls
PURCH. PRICE
lick Walls Attic Fl.b Stairs Toilet Room Roof RENT r ,
lone Wells Fin.Attie 0 Two Fixt. Bath
Floors _ �� •
rs INTERIOR FINISH Lavatory Extra
mt. F f 2 3 Sink /7
= y4 Plaster Water CID. Extra Attic ya
XTERIOR WALLS Knotty Pine Water Only 2 G
ble Siding Plywood I No Plumbing Bsmt. Fin.
gle Siding Plasterboard Int.Fin.
oo Shingles TILING 10 790
c. Blk. G F P Bath Fl. Heat -f Q30 ,
e Brk.On Int.Layout Bath Fl.b Wains. Auto Ht.Unit
Veneer Int.Cond. Bath Fl. b Walls Fireplace
Brk.On HEATING Toilet Rm. Fl.
Plumbing ,
id Cam.Brk. Hot Air Toilet Rm.Fl.b Wains.
Tiling z
Steam 9 Toilet Rm. Fl.b Walls
nket Ins. Hot Water St.Shower /9,Z
f Ins. 0.. Air Cond. Tub Area Total ,
Floor Furn.
ROOFING r -6�� COMPUTATIONS '
h. Shingle Pipeless Furn. 790 S.F. /S(o /
od Shingle No Heat ?,2 S.F. 63
bs. Shingle Oil Burner y S.F• /D• 30 `/3 `/ _
to Coal Stoker S.F. /Y O A%r/
e Gas
S.F. OUTBUILDINGS
ROOF TYPE Electric
/ S.F. 1 2 3 4 5 6 7 8 9 10 1 2 31415 6 71819110 MEASURED
ble Flat
�p Mansard FIREPLACES S.F. Pier Found. Floor C•c
lmbrel Fireplace Stack V Well Found. 0.H.Door LISTED
FLOORS Fireplace Sgla.Sdg. Roll Roofing r
inc. LIGHTING Dble.Sdg. Shingle Roof DATE
firth No Elect. Shingle Walls Plumbing
no
Cement Blk. Electric Y
iph.Tile Bsmt. 1st TOTAL /;77 Brick Int.Finish P D
ngle 2nd 3rd FACTOR p d'
REPLACEMENT Inc 7 -
OCCUPANCY CONSTRUCTION SIZE AREA CLASS AGE REMOD. COND. REPL. VAL. Phy.Dep. PHYS. VALUE Funet.DeP. ACTUAL VAL.
WLG. C, / - s / .f.c - 77L - F16 7O /O0
1
2
3
4
5
6
7
6
9
10
TOTAL
I
C RESIDENTIAL PROPERTY
MAP NO. LOT NO. FIRE DISTRICT SUMMARY
116 63 STREET 48 ' Second Ave. Ostervill,e C_O
WTOTAL .Ag
S p
73 7 0 C--)
i 0)
OWNER /t ,�_r.••.1/ /12[.� t•4tr SSD
i
RECORD OF TRANSFER DATE BK PG I.R.S. REMARKS LAND:
BLDGS.
TOTAL
LAND
Murray, i A _ _ 792 BLDGS.
m DR I v e /�o. o Ma,
David — TOTAL
� _ Sao D� LAND
BLDGS.
_
TOTAL
LAND
�• BLDGS.
TOTAL
LAND
BLDGS.
TOTAL
LAND
BLDGS.
TOTAL
LAND
INT BLDGS.
ERIOR INSPECTED: rn
TOTAL
DATE: _ — ' ;i� LAND
CREAGE COMPUTATIONS BLDGS.
ND TYPE # OF ACRES PRICE TOTAL DEPR. VALUE TOTAL
HOUSE �7 /D GU Oi�U %! S(>. LAND
CLEARED FRONT BLDGS.
0)
REAR TOTAL
WOODS&SPROUT FRONT LAND
REAR
BLDGS.
WASTE FRONT TOTAL
REAR LAND
BLDGS.
TOTAL
LAND
JL BLDGS.
LOT COMPUTATIONS LAND FACTORS TOTAL
FRONT DEPTH STREET PRICE DEPTH% FRONT FT. PRICE TOTAL DEPR. COR. INF. VALUE HILLY TOWN SEWER LAND
ROUGH TOWN WATER BLDGS.
HIGH GRAVEL RD. TOTAL
LOW DIRT RD. LAND
SWAMPY NO RD. BLDGS.
APPLICATION FOR PERMIT TO INSTALL AND RE�I
4T ;1
FOR ELECTRICAL SERVICE �
actor of Wires y�AkA�!��r✓ 1 '6(o ✓ Wiring"Permit #� COM/Electric # �t6 7 4 97
'
R, ,4Town of LLe ` Massachusetts 1 Building Permit # Date °� 3
Customer: A---r-k-� on (Street #) +�
Lot # in the village f c(_ utility pole number or underground number 3
Customer's billing address �1` GOWD Pry LL F Ej '
Temporary Ne istallation Change of service 1-1 Starting date
Job description C—_ I Cf a C-[-t S L(4E�:_
Service entrap a voltage ��( Amperage / Phase
Wire size cu)or al.) r Conductor per phase
Number of"meteA Z Water heater Off peak: Yes—No
Estimated load: Electric heat kw, lights F kw, Range dryer Motors, H.P. & Phase
Ready for first inspection 'Ato Jhj Ready for final inspection N
Electrical Contractor %A,F Lic. # 6�5 Telephone # / o-2L,0,10
Address ` �, / L n /�,
Additional Remarks: A1.� K["7�t�V &Al-L 77 /A70 k/ 21,y6- 1N/PeC�i>'Z- A/ft C L /N-70
-» Do Not Write Below This Line
ELECTRICAL WIRING INSPECTION CERTIFICATE
INSPECTOR OF WIRES
INSPECTIONS DATE FEE CHARGE
Temporary Service
Roughing in
Service and Meter (1
Off Peak Meter
Final Approval
Disapproved`
`For the following reasons - -���7Z/-G,- iG /r`edoti/s+G>✓> o/k�✓C'o�i�i��d0��
Gain• Giii% ini s>a//.�i.9C, S G-,�n!s7��
CERTIFICATE OF INSPECTION
Date
To the COMMONWEALTH ELECTRIC COMPANY. The installation described above has been completed and has this day been inspected and approval
granted for connection to.your service.
s nspector of Wires
WIRING INSPECTOR TO BE NOTIFIED WHEN WORK IS READY FOR INSPECTION
Permit?Good For One Year From Date df Jssue
CA 46
INSPECTOR'S NOTICE
i
j\ Office Use Only
The CommonJoth of Alassachusetis
` Department of Public Safety Occupancy&Fee Chedwd
' BOARD OF FIRE PREVENTION REGULATIONS S27 CMR 1Z.00 3N0 (leaveblm*)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All nvrk to be periormed In accordance%41h the Massachusetts Electrical Code. 527 CMR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date /Z-(7- oy
TOWN OF BARNSTABLE To the Inspector of Wires:
The undersigned applies for a perm/iitt t�o1 pet-form the electrical work described below.
Location (Street & Number) `f"� I - 5�-b n y E r55 f F� Q (LL& LIA
0.rer Tenant ��—
Owner's
Is this permit in conjunction with a building permit: Yes ❑ No 21*" (Check Appropriate Box)
Purpose of Building s (� �•�� _Utility Authorization NO.
Existing Service p Amps 120 / L�SZVolts Overhead Er-Undgrd❑ No. of Meters /
New Service Amps / Volts Overhead ❑ Undgrd❑ No. of Meters
Number of Feeders and Ampacity 6 D
Location and Nature of Proposed Electr cal Work (�f{Z,E ey-1
No. of Lighting Outlets /?j No. of Hot Tubs No. of Transformers Total
KVA
No. of Lighting Fixtures SwimmingPool Above In-
grnd. ❑ grnd. ❑ Generators KVA
No. of Receptacle Outlets No. of Oil Burners No. of Emergency LightingBattery Units
No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones
Total No. of Detection and
No. of Ranges No. of Air Cond. tons Initiating Devices
No. of Disposals No. of Pumps
Total Total Tons KW No. of Sounding Devices
No. of Dishwashers Space/Area Heating KW No. of Self Contained
Detection/Sounding Devices
No.. of Dryers Heating Devices KW Local ElMunicipal ❑Other
Connection
No. of Water Heaters KW No, of o.—0= Low Voltage
Signs Ballasts Wiring
No. Hydro Massage Tubs No. of Motors Total HP
OTHER:
INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws
I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial
equivalent. YES NO[] I have submitted valid proof of same to this office. YES ff NO
If you have checked YES, please indicate the type of coverage by checking the appropriate box.
INSURANCE ❑ BOND ❑ OTHER❑ (Please Specify)
Expiration ate
Estimated Value of Electrical Work S 3 0i)
Work to Start' SAYIiF 'M"EInspection Date Requested: Rough Final 1 ^ f3
Signed under th penalties of perjury:
FIRM NAME_ G LIC. :VO� _.CL "
Licensee i- � �`-) Signatu LIC. NO.
G Bus. Tel. No. d -7 0 D
Address (O 0 Pl4Q-(r=-��CL__. �11 -y( LLB —Alt. Tel. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or is sub-
stantial equivalent as required by Massachusetts General Laws, that my signature on this permit
application waives this requirement. Owner Agent (Please check one)
Telephone No. . PERMIT FEE S
Signature of Owner or Agent