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REGISTRATION AND CERTIFICATION FORM P
FOR FORECLOSING/FORECLOSED PROPERTY
Thank you for registering in accordance with Town of Barnstable Code chapter 224
sections 224-3 and 224-4. Please complete one form for each property in foreclosure
(section 224-3) or already foreclosed for which possession has been taken(section 224-
4). Please file the original with the Building Commissioner and a copy with the Chief of, �
the Fire.District in which the property-is located.. `—`
If you claim you are exempt from registering under Massachusetts law,pleas, ate the
reason(s) and complete section 1 (property information)and the.first paragraAAD f Z.
section 2 (foreclosing party, court, etc. and foreclosing party representative,but of other,
representatives and attorney) so that the Town can review the exemption and update its ' e
records: N/A
Section.1 Property Information
Property Address: 20 BACON ROAD, HYANNIS, MA, 02601
Assessors Map#:_ 309 . Parcel#:. 158
Land area and description 11,761 s q ft
Building(s) description and contents Single-Family Residential
Occupied: Yes Occupant(s)(if borrowers so state and include name(s)) Unknown
888-349-8964. Property.Reg istration@spservici com
Phone: email: ot�er.
Vacant: No:.. Date: N/A Anticipated_Length of Vacancy:. N/A
Last occupants) )(if borrowers so state and include name(s)) Unknown
Property.Registration@spservicing.com
Phone: 888-349-8964 - email: other: -Has possession been taken No If so,please explain and complete and file the
maintenance:and security plan form(unless exempt as stated above)
Section 2—Toreclosi ng Party Information
Foreclosing Party(full name/title) US Bank NA c/o Select Portfolio Servicing
Foreclosure Case Court: Unavailable Docket# Unknown
0.013687603-Property.Registration_71408 . . .
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Date filed: 08/15/2016 Current Status: In Foreclosure
Foreclosing Party's representative(s) for property (entry, management,repair,
etc)(name, title,): Safeguard Properties
Company(if different from foreclosing party): Safeguard.Properties
Address: 7887 Safeguard Circle.,Valley View, OH 44125
877-340-0060 CodeViolations@spservicing.co
Phone: email: other:
If an exemption is claimed,please do not complete the remainder.
Other representative(s) (if foregoing representative is primarily responsible for
property and/or foreclosure and is most likely to be able to address town matters
concerning the property and/or-foreclosure,please so state and do,not complete
contact information(i. e.."none" or"see above")).
Name,title, other: Safeguard Properties
Company(if different from foreclosing_party):
Safeguard Properties
Address: 7887 Safeguard Circle, Valley View, OH 44125
877-340-0060 CodeViolations@spservicing.com
Phone(s)-. email(s): other:
Name, title, other: N/A
Company(if different:from foreclosing party): N/A
Address: N/A
Phone: N/A email: N/A. _ . .. other: N/A.. .
Attorney representing foreclosing party N/A
Firm name(if-different from attorney's name): N/A
Address: N/A
Phone(s): N/A email(s): N/A other: N/A
1 acknowledge that the information provided is accurate and correct. I also understand,
that any inaccurate information will,result in non-compliance with section 224-3 of
chapter 224 of the.Code of:tlie,Town:of Barnstable.
Date: 08/15/2016
Name: Katie Lewis
Title:
Authorized-Agent of SP.S
I hereby certify that the above-named foreclosing party is in compliance with the
provisions of section 224-3 of chapter 224 of the Code of the Town of Barnstable.
Date:
Building Commissioner, Town;of.Barnstable
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION A,
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Map Parcel Permit# vr� 6x
Health Division Date Issued
Conservation Division Feet
Tax Collector
Application Fee _
Treasurer
Planning Dept. Checked in By
Date Definitive Plan Approved by Planning Board Approved By
Historic-OKH Preservation/Hyannis
Project Street Address A 6 &9ro.*1t, R&
Village ly� /y1 S
Owner /��/�, j�C{ 1 c__4�2 gem lC 5tL Address
Telephone "
Permit Request /`l��- - , �ts+2G�'�-�� >a�C�!
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed , Total!hew
Valuation 00 6 Zoning District Flood Plain Ground ater Overlay F
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 &10 Historic House:. ❑Yes O'klo On Old King's Highway: ❑Yes O No
Basement Type: U Full ❑Crawl alkout ❑Other
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft)
Number of Baths: Full: existing new Half:existing new
Number of Bedrooms: existing_ new
Total,Room Count(not including baths): existing 44 new First Floor Room Count g y -:
Heat Type and Fuel: Gas ❑Oil ❑ Electric ❑Other _ f
Central Air: ❑Yes ff No Fireplaces: Existing New Existing wood/c'al stove: 0 Yes Flo
Detached garage: ❑existing ❑new size Pool:❑existing ❑new size Barn: ❑ xisting C,ll,new size
Attached garage: ❑existing Cl new size Shed:El"e5oxisting ❑new sized Other: h
Zoning Board of Appeals Authorization '❑ Appeal# Recorded❑
Commercial ❑Yes ❑ No If yes,site plan review#
Current Use Proposed Use
BUILDER INFORMATION
NameAle-1-114&�_ Telephone Number J�l
Address r70 IJA-1,-r/xl,_ y/g/li/vZ�p n'/.4icense# ��Fo/ !v
_ _ Home Improvement Contractor#
Worker's Compensation#
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Ilk"ol /0
SIGNATURE DATE
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FOR OFFICIAL USE ONLY
t
PERMIT NO. {
DATE ISSUED ' 1
MAP/PARCEL NO. _
ADDRESS VILLAGE ;
OWNER
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DATE OF INSPECTION:
FOUNDATION
FRAME
INSULATION
i
FIREPLACE
ELECTRICAL: ---ROUGH FINAL
PLUMBING: ROUGH FINAL,
f,
GAS: ROUGH FINAL r,
FINAL BUILDING a '
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DATE CLOSED OUT or, ,
ASSOCIATION PLAN NO.
Town of Barnstable
Regulatory Services
BARNSTABM Thomas F.Geiler,Director
9 MASS
1639• p�m Building Division
lf�MAC Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE:
JOB LOCATION:
nummbber //^ street age T
"HOMEOWNER": //�' dr (C��� 2��(��� Lyo 7 7�G�y/
name home phone# work phone#
CURRENT MAILING ADDRESS:
ity/town state zip code
The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and
to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as
supervisor.
DEFINITION OF HOMEOWNER
Person(s)who owns a parcel of land on which he/she resides or intends to reside, 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 Official on a form acceptable to the Building Official, that he/she shall be
responsible for' all such work performed under the building permit. (Section 109.1.1)
A
The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other
applicable codes,bylaws,rules and regulations.
The undersigned"homeowner"certifies that he'she understands-the—Town afBnrnstabje-B�lrling$eparimeat
minimum inspection procedures an equirements and that he/she will comply with said procedures and
reqWFqRen j
Signature of Homeowner
Approval of Building Official
Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the
State Building Code Section 127.0 Construction Control. .
HOMEOWNER'S EXEMPTION
The Code states that: "Any homeowner 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 the homeowner engages a person(s)for hire to do such
work,that such Homeowner shall act as supervisor."
Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,
Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly
when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed
Supervisor. The homeowner acting as Supervisor is ultimately responsible.
To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,
that the homeowner 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 t amend and adopt such a form/certification for use in your community.
Q:forms:homeexempt
A
E. Town of Barnstable
Regulatory Services
Thomas F.Geiler,Director
Building Division
Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable,ma.us
Office: 508-862-4038 Fax: 508-790-6230
Permit no. Q Date i:. x a7
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 Wank: Estimated Cost 6 -evo
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Address of Work: �
Owner's Name
Date of Application:
--
I hereby certify that:
Registration is not required for the following reason(s):
[]Work excluded by law
[]Job Under$1,000
[]Building not owner-occupied
gowner pulling own permit
Notice is hereby given that:
OWNERS PULLING THEIR OWN PERMIT OR DEALING WTi'H.UNREGISTERED
CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE
ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A.
SIGNED UNDER PENALTIES OF PERJURY
I hereby a for7ait as th f t`he o r:
Date �Q Contractor Name Registration No.
OR
Date Owner's Name
Q:forms1omeaffidav
\ A VJ LIIKJJK�.IIKJGI.�J
Department oflndustrial Accidents
Office.of Investigations' ' .
600 Washington Street
�< Boston,MA 02111
5. www.massgov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plunabers
Applicant Information Please Print LeLribly
AL j5V
Name (Business/Orp=ationdhdividual)- ;> G
Address:
City/State/Zip: S one W 57
Are you an employer? Check the-appropriate box:. Type of project(required):
1.ElI am a employer with 4. ❑ I am a general contractor and I
6. ❑New construction
employees (full and/or part-time).* have hired the sub-contractors
2.❑ I am a sole proprietor or partner- listed on the attached sheet 1 7. ❑ Remodeling
ship and have no employees These sub-contractors have 8. ❑ Demolition
working forme in any capacity. workers' comp. insurance. 9. ❑ Building addition
[No comp. insurance 5• ❑ We are a corporation and its
officers have exercised their
10.❑ Electrical repairs or.additions
3.DI am a homeowner doing all work right of exemption per MGL 1 11.0 Plumbing repairs or additions
myself. [No workers' comp. C. 152, §1(4), and we have no 12.❑ Roofrepairs
insurance required.]t employees.[No workers 13.❑ Other s�
comp.insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information:
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new a$idavit indicating such
tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy information.
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.#: Expiration Date:,
Job Site Address: City/State/Zip:
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. 152 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
Investigations of the DIA for insurance coverage verification.
I do hereby ce nder h ains d e Ides of ' ry that the information provided above is t e and correct:
Simafore:. Date:*.
Phone#:
Official use only. Do not write in this area,to be completed.by city,or town official.
City or Town: PermitUcense#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/'Y'owu Clerk 4..Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute, 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 ap�-.ap indivi¢ual,.:paMership�: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. Howev..er:the-
havin not more than three apartments and who resides therein,or.the occupant of the
owner of a dwelling house g construction or-repair workbn such dwelling house
dwelling house of another who employs persons to do maintenance,
of because of such employment be deemed to bean employer"
din appurtenant thereto shall n �P .
or on the grounds or building app .
MGL chapter 152, §25C(6)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,MGL chapter 152, §25C(7)states"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 ofthis chapter have been presented to the contracting authority.
Applicants
Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contractors)name(s), address(es) and phone number(s)along with their certificate(s)of
to
insurance. Limited Liability Companies(I,LC)or Limited Liability no employees other than thety Partnerships(LLP) .y .
members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees, a policy is required. Be advised that this affidavit 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.. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials .
Please be sure that the affidavit is complete and printed legibly. The Department has provideda 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
number which will be used as a reference number. In addition, an applicant
Please be sure to fill in the permit/license
that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"'the applicant should write"all locations in (city or.
town)."A copy of the-affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for.future permits or licenses..A new affidavit must be filled out.each
year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance for your 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
Offce of Investigations
r 600-Washington Street .
Boston,MA 02111..
Tel.#617-727-4900 ext 406 or-1m877-MASSAFE
Fax#617-727-7749
Revised 5-26-05 www.mass.gov/dia
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Town of Barnstable a '
-? �FTNE Regulatory Services
. Thomas F.,Geiler,Director
+ BABNsTABIE * }�: �
9 MAm. . Building Division --- --�_
0
MAC Tom Perry,Building Commissioner "'
2 0 Main Street, H annis,MA 02601
Office: 508-862-4038
Fax: 508-790-6230
PERMIT# FEE: $ S
SHED REGISTRATION
120 square feet or less
'Location of shed(address) V lage.
Rt 73i--1
Property owner's name Telephone number
/ A- l9-
S Map/Parcel#
Size of Shed
)ature Date .
Hyannis Main Street Waterfront Historic District?
Old King's Highway Historic District Commission jurisdiction?
Conservation Commission(signature required) �� ®y
PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE
COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE.
PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS.
THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN
Q-forms-shedreg
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ssessor's map and lot number .
. ....................:.......................
OF THE
Sewage Permit number /7brIL..i . . �:..� SI;P3'IG SYSTEM M
House number ....o�.Q....... � ........... :.... INSTALLED IN Cf�M LE' '
............. ......... .
WITH TITLE, 5 °°",�o 39.a�e�'
TOWN OF BA R N S T>9IV
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BUILDING.. . INSPECTOR
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APPLICATION FOR PERMIT TO ....'�. ...:.1, ,:r.` ..... v ``t .........................................................:..
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TYPE OF CONSTRUCTION 64,1•C)0 �r .c...................................... .........:..................................
r . ... . . .�.2...................... .19...
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for annpermit according to the following information:
Location ............ .D.....IJCO .......K. `.....#at. (.!1 �1o.......mC7:....................................................................................
ProposedUse ...... ............................... .................................................................................................
ZoningDistrict ............... .... 7............................................Fire District ......J ................................................
Name of Owner .. � �1..f.L.l.!1. �f....DF.4�. Y3��1//?t'lAddress ......P�. .... rc.G ......l�Z ..........1� ``.`.�........
Name of Builder ...... .e.10 2.:.....!74.� , ... .. .......�, Address ... 3.. �. 1".�4rrf....... � .....1?`� ........
Name of Architect � '��'.r_ ..Address ........
.. ...............................................
Number of Rooms .................. ..............................................Foundation 96�
16,
........ ...................................................
Exterior .............. .........................Roofing
.......�. T.......................Floors dQ.�................................................Interior .................. .�+ :. c �...N...oc....................................
Heating AC .... .LS�I '� ......./r.-4/................Plumbing ......................s�....�.... ...................................................
Fireplace ........................ P.0................................................Approximate Cost .. *.�1... -o U
4.....................................
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Definitive Plan Approved by Planning Board -----------_------_-----------19________. Area ...... �.0.. .......................
4T do
Diagram of Lot and Building with Dimensions Fee .....
SUBJECT TO APPROVAL OF BOARD OF HEALTH
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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
construction.
i
Name ... ..... . ........... .... .. ....... ..............................
^� Construction Supervisor's License eM 4
DIJERONIMO, JOHN & LINDA �
No 25422 Permit for Build„Add t.],Qn s `
Single..Family...DWp.a ...
IL
Location 20 Bacon..Road.......................... {
-? .. ............... yannis..........................................
_
Owner,' John...&...Linda..1?. b��Qn.i:mo `"� �,; .: r *el
Type of Construction EKATRa........................
Plot ....... ........... Lot ................................ 1
r Permit Granted ...` ugus t� i 2,/ ....:19 83 F'• { _ .. _ -
Date•of.Inspection 19 �
` Date Completed ..................`............".......t19
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Assessor's map and lot number ............................................ �OF?"Er0
Sewage Permit numbert r?..;•J1.Pr3;�5�....... :,.. :.2.�..... �`� o,�
13AUSTABLE. i
House number ............%�........n.:..........?:a.. ........................... :o rasa
ip s639. 9�
a NIX
TOWN OF BARNSTABLE
BUILDING INSPECTOR
APPLICATION FOR PERMIT TO ..... .f:'/ ......� .:..�. '�"
TYPE OF CONSTRUCTION .......... .U d. .... l 'ir t ....................................................................................
/.......................................
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location C .....��...O.� 4`.G� v u 4` ur S r •...................................................................................
__.zz. ....... . .........�. ....E.............. �..,....
ProposedUse ......%., rn c: )ZOO.^`..................................................................................................................................
Zoning District ..................... District .....................................
Name of Owner ... !1..:1�.:.L ..... .....�.v.... cc c .......4d.......... ;i t.`.`:5........
i
Name of Builder S /T� ' ' Address ��',� 'c .... !,
�: .¢ �;
.............. .�. ......... .
z� /'-
Name of Architect ........... .t-
................::.....................................Address .....................�..............................................................
" Number of Rooms .................................................................F.oundation ............../.:'...:......... ...........................................
[ e ..........Exterior �; r....... ...............Roofng .............. �C'ir .�.......k..F..�...................................................
Floors ........a....................................Interior ................... "..r.� °C .� ...........................
Heating ... .... ! ''. 5........r. P' ..../.................Plumbing ...........
............ .. ...... ....
Fireplace ......................... ��..................................................Approximate Cost .�� � ....,�,;1&.............` ...............
.,.. ......
'F
Definitive Plan Approved by Planning Board -----------_____-_-----------19--------. Area y
......... ..........................
.- p 9
Diagram of Lot and Building with Dimensions Fee .
SUBJECT TO APPROVAL OF BOARD OF HEALTH
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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
construction.
Name ........,..... ...,............ .... .�....... ...............................
"C66it ction Supervisor's License
DIS/ERONIMO, JOHN & LINDA
2 5:4 92 2 Build Addition
No ........ ..... .Permit for ....................................
Single Family.. ............
Single„.....................
Location ...20 Bacon Road
............................................................
.................... ..............................................
Owner ....John...n.....&....Linda...Dilberonimo
............ ............................
Type of Construction ....Frame........................
................................................................................
Plot ............................ Lot ................................
Permit Granted ....August' 12............1983
.......... .
Date of Inspection ....................................19
Date Completed ......................................19
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