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HomeMy WebLinkAbout0455 BISHOPS TERRACE N55 3,vr,�r Teracc J;- - --� _ � ' \ y" ;:.. }..or.-^.: r. ....:.�.:. t, ..,,,�.....,.��..��,yR..'+ ,.. ��- �...t Vrs-�";'-•,.-�','.-j'yw..r.rs .,a,,,wir+c::";':�n.vn..r•w, .wr ..�_.�„�.,.s I & ,FTHE TOWN OF BARNSTABLE 32104 ` . � Permit No. .. BUILDING DEPARTMENT TOWN OFFICE BUILDING Cash �9 .6Tq• V '�tgrnr HYANNIS,MASS.02601 Bond A CERTIFICATE OF USE AND OCCUPANCY Issued to Bayside Affordable Home Division, Inc. Address Lot #2, 455 Bishop' s Terrace Hvannis , Massachusetts USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND.IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. October 25 88 ��.-- •�--�► ........... ..........!..... 19................. ........ ................ Building Inspector TOWN OF BARNSTABLE BUILDING DEPARTMENT t aaaaer : TOWN OFFICE BUILDING MYl HYANNIS, MASS. 02601 4 MEMO TO: Town Clerk FROM: Building Department DATE: / J , An Occupancy Permit has been issued for the building authorized by Building Permit $k. / 7� _ ...... r................... ....... .........._... .... ......._........ issued to .....Y:�... /��'?�' Please release the performance bond. DATE CONTINUATION OF ROAD BOND BUILDING PERMIT I The undersigned owner/co ntracto- hereby aq"---e 'to frz?jl road �, i.- .� bond in force until the folk-wing worl arecoign' -.: satisfaction of the Engineering- Sec-,6-lon o-,;. the 'OP-Par"Mert, ?,Jb ;-I : 14orks. loam and se--dshouldars as soon IS weather permits. other (explain) S'IGII W. /'(Own J7 Contra ctor ElfGINEE G AUTHOR ZATIO14 TOWN OF BARNSTABLE, MASSACHUSETTS BUILDING "'PERMIT s : 19 iu,y a DATE 19 PERMIT NO. tbL APPLICANT C)vm er ADDRESS 005645 - INO.) (STREET) (CONTR'S LICENSE) PERMIT TO Build l.iweill.iT?g ( l.�) STORY sign le zatailt, dWfFLlij NUMBER OF � DWELLING UNITS (TYPE OF IMPROVEMENT) NO. (PROPOSED USE) ZONING AT (LOCATION) .iot. 7tL 475 iiishop's Terrace, Hyannis DISTRICT 'Rc (NO.) (STREET) BETWEEN AND (CROSS STREET) (CROSS STREET) LOT SUBDIVISION LOT BLOCK SIZE BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION (TYPE) To m selie .WZ316 REMARKS: -? 11 AREA OR 766 sq. ft. - I66,400 PERMIT 61.50 VOLUME ESTIMATED COST $ FEE (CUBIC/SQUARE FEET) ua *s34_ .0 orcLibic 41ioine Division, inc. OWNER `-' Lr.SiL;.' Ls, Tz�i 1).034 BUILDING DEPT. ADDRESS By ../7�+!''� = 1`I'/� ;`!rrti<�• f r i THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF. EITHER TEMPORARILY OR PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE AP- PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE INSPECTIONS REQUIRED FOR PERMITS ARE REQUIRED FOR ALL CONSTRUCTION WORK: CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN ELECTRICAL, PLUMBING AND 1. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS. 2. PRIOR TO COVERING STRUCTURAL OUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL MEMBERS E TO LATH). FINAL INSPECTION HAS BEEN MADE. 3. FINAL INSPECTION BEFOREE OCCUPANCY. POST THIS CAR® SO IT IS VISIBLE FROM STREET BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 2 2 2 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT Sc/ LZT 7a Gvga 1/C�1'l_ 05 OTH BOARD OF HEALTH i; I s WORK SHALL NOT PROCEED UNTIL THE INSPEC- + PERMIT 'N!LL BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS INDICATED ON THIS CARD CAN BE TOR HAS APPROVED THE VA.RI000S STAGES OF WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE ARRANGED FOR BY TELEPHONE OR WRITTEN CONSTRUCTION. I PERMIT IS ISSUED AS NOTED ABOVE. NOTIFICATION. a'�y�•�. TOWN OF BARNSTABLE _ BUILDING DEPARTMENT = SAId0sAIM TOWN OFFICE BUILDING M"O. - g t639. HYANNIS,MASS. 02601 MEMO TO: Town Clerk FROM: Building Department DATE: An Occupancy Permit has been issued for the'.building authorized by BuildingPermit #........................................3�/�x_....................................................................... .................................._................................_.. . issued to 4- f/z ° �!...1! ✓ � .F � e...... Please release the performance bond. vo TOWN OF BARNSTABLE BUILDING DEPARTMENT = aeaaS so TOWN OFFICE BUILDING � a. g�01uY►�� HYANNIS, MASS. 02601 MEMO TO: Town Clerk FROM: Building Department DATE: r ti h... An Occupancy Permit has been issued for the`-building authorized by Building Permit $k.........// r, ...........................:...................................... .. .. �................/..................... ......._.................._.................. miie: issued to 5?.e, ,„ a'/>i' ��/�,� 7'.r e c {.v.....Lo �✓ 5r/✓%Sf�� 3/rr Please release the performance bond. N- F� Z;oc�l -oc�sG _ o T 150 Tempo,. Z•�� �Q��J� 83.00 1�• '�� N ^ Q 1 Ld -t� ti 1 ! + ! ,U w I 0-4 w j o T � 3 O Ln j8.96 o C�.eT/F/E-D PLOT �L�4ti/ P)e E PA)a E D Fo R: ,eEFE.ecvc�: ZS4.. 2 i-/Ee�BY CECT/FY TNAT T.�./E 6CJ/Ln/.VG SHON/.L/ O.V T///S PL AN /-5 LOCATED OA./ TA,/- yeOc%vD f7S --SAO'C)W.\/ /WZ7Cn1AL7:ZXe-"S TO V'rC �i((C.Dtrc. c2rrc�a tE�[7's ii�c EF �� �� o� A-T Tr{ TrMC G�CDafSc"�LtCT�onl /���� r !off ARMED cocun canoe cn9inecrir�9 OJALA ci�/i� EwGiti/EE�3 C � �`• �OCJTE GA^-`/�"�.E'N10(JT!-/� M�7S�. DATC- Q�G. L Rio sci¢v�eYOB -.r;1� ..:..,. -.,. - -. ...___ n „-ems>. 4_.. ,ya..r ,.ne!.�- . �,e i..�...•r.w.ww,M;7rur-ar�`4-!S�- cQ r EROF BARNSTABLE, MASSACHUSETTS BUILDING �P Mil A i5U—U66 .July r. DATE 19 88 PERMIT NO.N9 It i� 4' APPLICANT � '4'r ADDRESS 005645 (N0.) '' (STREET) (CON7R'S LICENSE) Build (!,PERMIT TO ( 4 STORY .�1(!.k,lt'. t�.ilJli�; c�wE�1li4t ; NUMBER OF (TYPE OF IMPROVEMENT) DWELLING UNITS NO. (PROPOSED USE) AT (LOCATION) 455 �`i:.;httiy •.: i�t+ l?r7:i:1.(_i?y R}'<3>"LIlfs -ZONING 'i�+`+ ' (NO.) (STREET) DISTRICT BETWEEN AND (CROSS STREET) (CROSS STREET) SUBDIVISION LOT LOT BLOCK SIZE BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTI TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION (TYPE) Town scarf'_;; ;t_:31fi REMARKS: AREA OR 766 sq. BONDlt. �6,400 i VOLUME ESTIMATED COST $ PERMIT s , 61•50 ' (CUBIC/SQUARE FEET.) FEE .7 d /�� �} i_y 7 /t 1S@lju'1LLf_ fi11U1c1�ib�tOili<? LrivlCiJGi2� 1i1C. OWNER • • box �Jt .E1i (@I� Ce t'+ � G BUILDING DEPT. ADDRESS - BY - I THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY C PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE A PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF IC SEWERS MAY BE OBT AINE ANT FROM THE CONDITIOI FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT REL PUBL • OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. EASE THE APPLIC MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE INSPECTIONS REQUIRED FOR PERMITS ARE REQUIRED SEPARATE FOR ALL CONSTRUCTION WORK: CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN ELECTRICAL, PLUMBING AND 1. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS. 2. PRIOR.TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL MINAL IN IRE INSPECTION TO BEFORE FINAL INSPECTION HAS BEEN MADE. 3. FINAL INSPECTION BEFORE OCCUPANCY. POST THIS CARD SO IT IS VISIBLE FROM STREET ,, BUILDING INSPECTION APPROVALS �Q PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS D I ,P HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT ' Sc/ AZT 7a vc��l/c>YL I OTH BOARD OF HEALTH WORK SHALL NOT I;HOCEED UNTIL THE INS'EC- -P_ERMI.T. ',v!L-L BECOME NULL AND VOID IF CONSTRUCTION TOR HAS APPROVED THE VARIODUS STAGES OF WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE INSPECTIONS INDICATED ON THI$-CARD CAN , CONSTRUCTION. PERMIT IS ISSUED AS NOTED ABOVE. ARRANGED FOR BY TELEPHONE OR WRITi NOTIFICATION. 1,15 9 -1 r PLANNING BOARD rs d S L Lp 75 ' Q ,.,.o 1-2 o i ��-0-7s Pg E PA 1e E D Fo R 7-8 ,e EFE.ec vc�: Fj 4� D S LI I L-T -�ZZ3oco c-LP�nc�c � -2 s-/FeEBY CECT�FY �TNi4T�T.�/Ee`6(J/L.Dia/G SHOIV.t/ O.t/�Td-//S PL�i.�/ /5 LOCATEa O.V T/�E ' :yeOu../n AS -29NOW.V HEeEO�V P`«+ Of o� ARNE G i H. o�own canoe en9ineerir�9 aALA ,OocuTE Gq^-7�Z—Af0 JT'f-/, M,455, D/9TE- e�`G. .va sutv�r�oe • sses"or offioe (1st floor): �j- Assessof's map and lot number .... S ..P..0&.t��. ....., Q�oF THE Tod` Board of Health (3rd floor): ��/ Sewage Permit number ............................ MUST CONNECT T = BABd9TeDLE• MMa Engineering Department (3rd-floor): �i /5—�- f���' TQwN S Housenumber ................:....................................................... MAI d' APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00•2:00 P.M. only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ...C. 'I .......4.........Sl � ........ �I`; ........ G TYPE OF CONSTRUCTION .. ......%Z ............................, .................................................. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location � z G�.J..... ISf aH�OiiG' /. .......................................................... r ProposedUse .............f /. .................................................................................................................................:........ Zoning District ..... (..................................... /t//-S Fire District ... .. .. .. !Y..............................................._......... Name of Owner ...Address .6:....s �.X..... Name of Builder ............... ............................Address .............�4�!!.[f", ................................................ Name of Architect `7....... 5�E�..........................Address .. $.%.. f.......,��? .0 ................... Number of 'Rooms 6..........................................Foundationve� ......... ............................................... � r� ...Roofng �....Exterior �...Yr............ . ............. ....................................... Floors .......... .. .... .. .........4 1 �.... ..............................Interior .... ...... /�S ... ............................. Heating ............... .....................................Plumbing .......... ....... ......................... Fireplace ......................................Approximate Cost �(F6 00 Definitive Plan Approved by'PfanninglBoard --- ' �---------------19 1 ---- • ...S Area ....... ... ......j-• .......... .� Diagram of Lot and Building with Dimensions /.Y Fee ..........�1.............................. SUBJECT TO APPROVAL OF BOARD OF HEALTH 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 .............`... ....... ....... .. ................................... . Construct'g6n\ Supervisor's License ......qos-z�.K) - ,;`BA3�SIDE--IAF-'FORDABLE--HOM DIVISION, INC. ' 32104 l.l.. Stors i •. No .:..... ..:._.._.. Permit for ...... � ............�........... Single,..Family.,Dwelling........ Lot ... ,2.,....;.. 5:5 ?.B:isYi.o ' s.`.T.e�-dce'!! Location p. f. .. ... ..Hyannis............................ _...._..........._ ' , ,' f Owner Ba .side e H Division .-Affordabl . Home ,:Inc'. , ....'.... ........ _ .. - Type of Construction ..Frame....:........ .. .................. ........................................................... ,R ` Plot ........... Lot 72.2--, .......n 19 88 Permit Granted ...1 July _,_.; 'R Date of Inspection �.. Date ComVxe . s.9.,j............... ; .19 o f r71 . - C-> , Assessor's offioe (1st floor): y � (".r� G ��THE TO Assessor's map and lot number ............................:...... ...... .. o ` Board,- of Health (3rd floor): Sewaget Permit number � � �.... Engineering Department (3rd floor): t6 a `e House number '7 ........ b. °0 79 i' APPLICATIONS PROCESSED.8:30-9:30 A.M. and 1:00-2:00 P.M. only TOWN OF BARNSTABLE �. BUILDING INSPECTOR ' APPLICATION FOR PERMIT TO ...( ..... .......�'// '�i.......................... �. ....... ..Y... . � l TYPE OF CONSTRUCTION ..G� V`' ..:..................... .......:.................:. `\ ................................................... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location GENT ' as• GG' /.Sf�D1�J' � .1,..'r7............................. ................ . ....................... !. ... ........... ...... ..... 71> ..Proposed Use ........................................................................................................................................................................... ............Zoning District ..... ..... `•_./.:.............................................Fire District . ..... ............. Sew / ??1t / lS/� �� Address d......an Name of Owner ..... . ... r............... . .. Name of Builder .......... ����.............................Address .............(.5.. ................................................ ............... . Name of Architect .?........` ...!!!..5 ..........................Address © 1.+'.. $j. -G ,'.........r`J �T................. Number of Rooms .!!!!�.........................................Foundation f / �,-Q 19f S /- Exterior .(�.1 ��CZ'/�`� �J .. S ...Roofing y. ............. Floors ...L'.... ' ?! ......."A... .............................Interior ................................ Heating — . .... -� c Fireplace ..............................1!4�/, ......................................Approximate Cost - y Definitive Plan Approved by4ng Board --- ----!� 19 Area .......� .p.....sre ......... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH l 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.- 4 Name1 ...... ....... .. .................................... Construction Supervisor's License ....OaCM J ' u BAYSID;E,ARFO;RDABLE. HOME DIVISION, INC,.- A=250-066 3:21 o 1 z Story No ...'2.'........ Permit for .................................... Single Family Dwelling Location .. :0 # - ...... .5 �:B' .S S?:p.'..5 ::T.1 ace . �iS ......................Hy ann i.s....................................... Owner Inc.. Type of Construction Frame ` ............................................................................... Plot ............................ Lot ................................ f Permit Granted ..............J..Uly....�D, ......19 88 Date of Inspection ....................................19 j v 1 / r Date Completed ......................................19 I % ro Town of Barnstable *Pernut 0; o Expires 6 months from issue d e ag- - Ory Services Fee � P Thomas . eiler,Director 7 2006BUilding Division TOWN Q BO, Building Commissioner 20 ai eet,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERAUT APPLICATION - RESIDENTIAL ONLY r Not Valid without Red X-Press Imprint ap/parcel Number operty Address US c e R re � i 5 d2�0 Residential Value of Work ®PAC) Minimum fee of$25.00 for work under$6000.00 AU 1i vner's Name&Address 0 /V -eK S P r•5A 6P5 _777_�,qA14C tjNje. 6 t mtractor's Name f° AyVI Telephone Number ome Improvement Contractor License#(if applicable) visul's Li: tr app able) Workman's ompensation Insurance Ch one: I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance surance Company Name tbeefV dtdAI orkman's Comp.Policy# OCR Z "' 315 3 2 Y'L z6 opy of Insurance Compliance Certificate must be on file. .rmit Request(c ck box) a Re-roof(stripping old shingles) All construction debris will betaken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders. U-Value (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. VIP A copy of the Home Improvement Contractors License is required. :GNATURE: Forms:expmtrg .4se061306 ✓ P o{Building Regulations and Standards. License;or registration date If founds return to�ltly '. .. Board before the p Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR on °150950 One Ashburton Registrati Place Rm]301 . 5/8l20.08 Boston,Ma.02108 Expiration Types DBA PETER J.SMITH HQMMPROVEMENT E I PETER SMITH 3925 MAIN ST. ''`:i Notva d ithoutsignature Deputy Administrator CUMMAQUID,MA 02637 Department of-Industrial Accidents Office of Investigations ' d 600 Washington Street Boston,MA 02111 www.mas&gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plu><nbers knplicant Information Please Print Legibly p 1 Tame (Business/Organization/Individual): ti-v- 'ad&ess- 3�2 5 r"I I l- 1S-0a6k G 'ity/State/Zip: C d M k d D e-� �:��3�Phone #: d k 3 �2 3 yo P . re you an employer? Checkthe-appropriate box:. . . Type of project(required): I am a employer with 4. ❑ I am a general contractor and I 6. ❑ New construction loyees (full and/or part-time).* have hired the sub-contractors 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 for me in any capacity. workers' comp. in 9. ❑ Building addition [No workers' comp. insurance... . 5. ❑ We are a corporation and its required.] . officers have.exercised their. 10.[] Electrical repairs or additions I am a homeowner doing all work --- -right of-exemption per MGL II.❑ Plumbing repairs or additions myself [No workers'. comp. - c._152, §1(4),and we have no 12:❑ Roof repairs insurance required.] t employees. [No workers - -3.[:] Other comp. insurance required.] ;y applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information: )meowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such ntractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy inforrriatim m an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site Ormation. urance Company Name: icy#or Self-ins.Lic. #: W G2—3 Expiration Date: a Site Address: S5 A bDt S le 9 _ City/State/Zip: N W N 1 .ach a copy of the workers' compensation policy declaration page(showing the policy numb r and expiration date). lure to secure coverage as required under&ction 25A of MGL c:J 52 can lead to the imposition of criminal penalties of a e up to$1,500,.00_and/or one-year imprisonment; asvell-as-civil penalties inthe form of a STOP WORK-ORDER and a fine zp to$250.00 a..day against the violator.- Be advised that a copy of this statementmaybe forwarded to the Of'e* of . estigations of the DIA for insurance coverage verification. hereby lfflffy der the pains and penalties of perjury that the information provided above i true and correct nature: ADate: me#: JU Official use only. Do not write in this area,to be completed by city,or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town,Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: i i Town of Barnstable Regulatory Services SAMSTABv ''E$` Thomas F.Geiler,Director 1639�A�ED Mai&�0 Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-8624038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, IJP a o�P , as Owner of the subject property hereby authorize �N'L f' L to act on my behalf, in all matters relative to work authorized by this building permit application for: �166p' Apmce . Ai iS (Address of Job) f/'LZL i ature of Owner .Date � 6bv Print Name i Q:FORM&OWNERPERMISSION