HomeMy WebLinkAbout0270 CASTLEWOOD CIRCLE f
Engineering Dept. (3rd floor) Map v?7,? Paicel , o� = Permit# /�a2-6
House# 07�� B D to Issued
Board of Health(3rd floor)(8:15 -9:30/1:00 4 ,. ) m ' .
Conservation Office(4th floor)(8:30- 9:30/1:00,=2:00)
Planning Dept. (1st floor/School Admin. Bldg.) YST tNE►p;-
�N 1�
Definitive Plan Approved by Planning Board 19 ft"S TALL�p
N WITtf �•
TOWN OF BARNSTABI 7w1Y
ME RE G z
Building Permit Application
Project Street A o2�®
Village Nl - ,
Owner IJV�4 �7 A�pe � Address o270 C TG dt/G' C/BL
Telephone -77LS-, 74/9
-Permit Request ���7 ` it�'«,��il.�Zc�c ?Z" ltD/L A71•4)
®71/� A Z /
First Floor square feet Second Floor ;,, square feet
Construction Type
Estimated Project Cost $ /9O�
Zoning District Flood Plain Water Protection
Lot Size Grandfathered ❑Yes ❑No
Dwelling Type: Single Family 0"" 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 New
No.of Bedrooms: Existing New
Total Room Count(not including baths): Existing New First Floor Room Count
Heat Type and Fuel: ❑Gas ❑Oil 10il, Electric ❑Other
Central Air ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No
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 & i�o If yes, site plan review#. -
Current Use Proposed Use
Builder Information
Name Telephone Number 49� ,95%ha
Address lb-11 License# aS-77 03 7—
f 076- Home Improvement Contractor#- IDO 74,40
Worker's Compensation#4V6 A113s32 .2g2_Z
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
/yld�/J7/
SIGNATURE DATE /09— ya® J
BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S)
FOR OFFICIAL USE ONLY
} •"PERMIT NO. Nx
ell
DATE ISSUED
MAP/PARCEL NO. r
ADDRESS VILLAGE.
OWNER '
DATE OF'.INSPECTION:
FOUNDATION r `
FRAME .:
INSULATION,
FIREPLACE•. -
ELECTRICAL:' ROUGH•, FINAL
...
PLUMBING: ROUG1 L: FINAL
GAS: C FINAL`
FINAL BUILDING
ta
DATE CLOSED OUT V v
ASSOCIATION PLAN NO.
V
e
�G r� It I , I/36a,aaJ Xilly
r
CAPIZZI' HOME IMPROVEMENT INC . rA
SPECIFICATIONS AND ESTIMATES PAGE 1 OF 3 ftU
CAPIZZI HOME IMPROVEMENT PROPOSAL
Established 1976 , Serving the Cape for 22 Years
1645 Newtown Road '
Cotuit , Massachusetts 02635
508-428-9518 1-800-262-5060 Fax 508-428-1547 Date :
==—===sse6==a
Name : ir1i�, t- Iti.A"I �Cr-tRAWP ■ -# a7`- A ��
■ Job Address :
Address : ■ Town : wi . .7�'► lIS
City : ■ Home Phone : #aie-- 9��t
■ Other Phone :
MC< ■ Estimator : 4
■ Job No . : '57 (
We hereby submit=specifications and estimates @tosf=rnish=and install=new
roofing as follows : 0 N FAcNr T-�u Rce + t 1 5;de 6- +CAC-E
a . Strip existing roofing and remove debris . Calculated layer - 1 la er
2 layers , 3 layers . Anymore layers of roofing needed to be stripped will
be additional .
b . Check all flashing , on cheeks (if applicable) .
C . Install aluminum drip edge .
d . Apply shingle underlayment (felt paper) . ^+
e . Includes new flashing around all boot stacks .
f . Includes Ice & Water Shield to be adhered to roof under lead of chimney
and roof valleys , around skylights , and roof stack (if applicable) .
Where roof meets side wall , at least l ' on each exposure -- only if side
wall area is exposed with job .
g . [6] six nails per shingle to be used on all asphalt shingle jobs .
h . Caulk all lead flashings together around chimney with Dymonic caulk.
This is not a guarantee but a maintenance procedure .
i . Dumpster will be sent to job site . Please note any special requests for
location : =_s--=.=ma========a====ss—s===a=--=
Touch-up painting may be required and is not included in this proposal . Any
unforeseen rot or loose boarding that may be uncovered during construction
will be repaired at $40 .00 per man hour plus materials .
We cannot guarantee chimney from leakage with roof job only . See chimney
proposal if applicable . We cannot guarantee existing skylights or venting
units unless we replace them with new ones .
B .P . Company Organic Asphalt Shingles with 5-year 100% labor and materials
warranty and duration of warranty is prorated labor and materials for the life
of the shingle (see warranty) .
Citadel 20-year warranty 7 <'-� LABOR & MATERIALS $
PRO Standard 25-year warranty LABOR & MATERIALS $ � 7�
Tradition 30-year warranty LABOR & MATERIALS $ _
Super Eclipse Architectural Style 35-year warranty LABOR & MATERIALS
ACCEPTED BY .....
______ __. c
___ __.....__.... ... DATE
THIS 'PAGE IS PART OFANDIN CONFORMANCE.WITH PROPOSAL S#-----
CAPIZZI HOME IMPROVEMENT INC .
SPECIFICATIONS AND ESTIMATES PAGE 2 OF 3
RIDGE VENT:
Furnish and install continuous ridge ventilation system along entire roof of
house after cutting approximately 1 1/2" on both sides of ridge board for air
exhaust .
PbJ 0111� LABOR & MATERIALS $ 5
VENTILATED : !!
Furnish and install ventilated aluminum soffit buttons along entire eave line
of roof for air intake . ,
a,V 6AITII& LABOR & MATERIALS $ 7(.�
MANUFACTURERS STATE THAT THE WARRANTY MAY BE VOID IF PROPER VENTILATION IS NOT
IN PLACE .
OPTION : Ice and Water Shield 3 ' in width along entire eave length of house to
prevent snow and ice build-up . Also 18" along all rake edges .
t
LABOR & MATERIALS $ ^ashing
SIDE WALL CHEEK FLASHING : (No guaranty against future leakage unless f
is replaced . )
a . Replace all side wall on cheek areas where roof meets siding with
Ice & Water Shield 1 ' on roof and siding exposure and step flashing and
Tyvek Housewrap .
LABOR & MATERIALS $
b . OR just strip side wall up just enough to install Ice & Water Shield, step
flashing and replace shingles as needed .
LABOR & MATERIALS $
C . OR leave side wall as is and install Ice & Water Shield on roof deck and
under step flashing and nail step flashing down tight , and black jack
shingles together .
LABOR & MATERIALS $
Job is estimated to commence 4 to 5 weeks after deposit received unless
otherwise noted here : a=�aa s----s-S6=�s
Any work above and beyond the specifications outlined in this proposal will be
performed at $4#. 00 per man hour plus materials or priced on request . All
additional work , including travel time and lumberyard runs , will be subject to
extra charge . In the event of rot repairs , roof repairs or any related work
requiring immediate attention , 'we will proceed without customer approval .
There will be no refund for special-order windows , doors or any other
nonstocked materials after three days from approved proposal .
Owner to move all personal objects , furniture , etc . , from work area . All items
against walls should be considered for removal during any exterior siding jobs ,
additions , etc . , to guard against damage . In the case of any roofing and ridge
venting , dust and debris should be expected and any items in the attic should be
removed .
ACCEPTED BY ____ ____ _ ________sa-@=.. DATE ..........=
( 0.21 � THIS PAGE IS......
PART¢OF AND INCONFORMANCE WITH PROPOSA #m-«¢
w r..
1 �Y� Ls �N Sv�GII�lOK �7L' h1Pr7T
v W e-4r Rake `7)3 OZ b..
6=L,ti n C cno �«„ ��ee� �- �. 5
5Felrcco:-cam /ap le m_ e'_.
13«-k 05., ,CAPIZZI HOME IMPROVEMENT INC . / 6
�tVpk e:;>' 4- ?i,SvlaTiL SPECIFICATIONS AND ESTIMATES PAGE 3 OF 3
�l�yer c:el�ySP
We look forward to working with you ; please call if you have any questions .
Sincerely ,
CAPIZZI HOME IMPROVEMENT
The job site will be kept clean and orderly at all times .
All products installed by Capizzi Home Improvement Inc . will be to manufacturer
specifications or better .
All workmanship is warranted for the warranty life of the product (s) by Capizzi
Home Improvement and will be replaced at no labor cost if due to faulty
installation or workmanship .
All material is guaranteed to be as specified , and the above work to be
performed in accordance with the drawings and/or specifications submitted for
above work and completed . in a substantial workmanlike manner .
Any alteration or deviation from above specifications involving extra costs will
be executed only upon written orders , and will become an extra charge over and
above the estimate . All agreements contingent upon strikes , accidents or delays
beyond our control . Owner to carry fire , tornado and other necessary insurance
upon above work . Workmen ' s Compensation and Public Liability Insurance on above
work to be taken out by Capizzi Home Improvement .
This Contract not valid unless signed by corporate officer ..._---ss--G-----
Acceptance of Estimate
The above prices , specifications and conditions are satisfactory and are hereby
accepted . Capizzi Home Improvement is authorized to do the work as specified .
Payment will be made as such : 1/3 DEPOSIT, 1/3 WHEN 1/2 COMPLETE, 1/3 AT
COMPLETION . ALL PROGRESS AND FINAL PAYMENTS TO BE MADE TO FOREMAN AT
APPROPRIATE TIME . IF ANY CONCERNS , FOREMAN TO CALL OFFICE.
Da —_ —=-----
Signature (s )�
Note : You , the buyer , may cancel this transaction at any time prior to
midnight of the third business day after the day of this transaction . See the
attached notice of cancellation form for an explanation of this right .
ACCEPTED BY __a___ ........ __ ___ DATE s---
THIS PAGE. TS�PART¢OF AND IN=CONFORMANCE.WITH PROPOSALa$
HOME IMPROVMIENT
1645 .
Newtown Road -
Cotuit, Massachusetts 02635
- 508-428-9518 1-800-262-5060 ';
ROOFING STOCK ORDER LIST "`''
HISTORICALLvoi
Y~ t.
,G PERMIT YES / NO
TOTAL SQUARES: v
ASBESTOS SHINGLES YES NO : /
I -r--
LAYERS TO STRIPED 1, 2 3 I COLONIAL:
HIP:
WOOD ASPT ./ RUBBER: RANCH:
NA,nE GARRISON:
t1 VICTORIAN:
ISALT BOX:
PUMP STAGINGS YES:.
V L N0:
1 ��N I I •�i�v�C 7 STORY .
STORY 3 STORY
TOTAL ICE &• WATER SH ILD:
.II ,� �3 MISCELLANOUS NOTES:
TOTAL BLACK JACK:
TOTAL DRIP EDGE: II
(
TOTAL EAD: !��
OT ,
TOT' LN
TOTAL BONDING ADF-�ESIVE: `
TOTAL TERMINATION II
. ION BAR: I
TOTAI, LAp SE ALA'tiiT:
TOTAL STRUCTODEK 1 �I
T' T' R N /2 OR 3/8
TOTAL VENTED DRIP D t _
TOTAL 0 �L
TOTAL ROOF GUN NAILS: I I �
CALL CUSTOMER BEFORE STARTING JOB: YES / NO
CUSTOMER RATING: 1 2 3 4 5 6
DATE: TIME:
i
v•� v �e.��'[.GIgOIZ%I�iI�G,OF,GLa
! i
E HOME IMPROVEMENT CONTRACTORS REGISTRATION
Board of Building Regulations and Standards i
One Ashburton Place — Room 1301
Boston , Massachusetts 02108
I
HOME IMPROVEMENT CONTRACTOR ------------------------------
I �
Registration 100740 Expiration 06/23/00 I ��
Type — PRIVATE CORPORATION I
j HOME IMPROVEMENT CONTRACTOR
?b
I Registration 100740
CAPIZZI HOME IMPROVEMENT , INC . 6 Type - PRIVATE CORPORATION
Thomas Capizzi , Sr . I Expiration 06/23/00
1645 Newton Rd . i
Cotuit MA 02635 CAPIZZI HOME IMPROVEMENT, INC
��hh9�ias Capizzi, Sr.
1645 Newton Rd.
ADMINISTRATOR
Cotuit MA 02635
sue. •` _
_ DEPARTMENT OF PUBLIC SAFETY
CONSTRUCTION SUPEP.VIs0R. LICENSE
NuEDEr: Expires:
Restricted To: It
THONAS I WI1ZI JR
181 PERCIVAL OR
:. .'
. � � U BAPkSTA2lE, N"
::::::::.DA
..:::.........::::::..........
::.::...;.:.:.:;<,t::; ::<::;:::::::is;:::::::?::z��:;::::2::::::;:;::}::..::::::::: :::�:::`i:: TE ...........::.:>:::
:::::: . : :::::::::::::
:::::::.........................................:.. 04/09/98
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
NORCROSS & LEIGHTON INC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
HTTP : //WWW.NLINS.COM ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
437 STATION AVE COMPANIES AFFORDING COVERAGE
S YARMOUTH MA 02664 COMPANY
A MARYLAND INS GROUP
INSURED - COMPANY
CAPIZZI HOME IMPROVEMENT INC B THE HARTFORD
COMPANY
1645 NEWTOWN RD C
COTUIT MA 02635 COMPANY
I D
COVERAGES ^<:;;r»;;>; ::<::.:.:::.;:.::.:............:.::.: ,.:.:;:..::::
i .... . HAVE BEEN i :::UED:T::.TM::::.................... ...AB..VE.F..R:TMPOLICY
U Y
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE L STIED BE O SS O E INSURED NAMED O O E 0 C PERIOD
INDICATED, NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POUCIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
COI TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
LTR I DATE(MM/DD/YY) DATE(MM/DD/YY)
GENERAL LIABILrrY RGP 2 819 2 8 2 2 04/01/98 4/01/99 GENERAL AGGREGATE S 2, 0 0 0, 0 0 0
X l COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG S2, 0 0 0, 000
CLAIMS MADE a OCCUR PERSONAL 6 ADV INJURY I S 1, 0 0 0, 000
OWNER'S 6 CONTRACTOR'S PROT EACH OCCURRENCE S1, 0 0 0, 000
FIRE DAMAGE(Any one fire) S 50 , 000
MED EXP(Any one person) $ 10, 000
AUTOMOBILE LIABILITY 08MCP399948 04/01/98 4/01/99
ANY AUTO COMBINED SINGLE LIMIT S
ALL OWNED AUTOS BODILY INJURY
X SCHEDULED AUTOS (Per parson) $1, 0 0 0 , 000
HIRED AUTOS BODILY INJURY
X NON-OWNED AUTOS (Per accident) S 1, 000, 000
PROPERTY DAMAGE $ 500, 000
GARAGE LIABILITY I AUTO ONLY-EA ACCIDENT S
ANY AUTO OTHER THAN AUTO ONLY:
EACH ACCIDENT S
AGGREGATE IS
EXCESS LIABILITY EACH OCCURRENCE $
1HUMBRELLA FORM AGGREGATE S
OTHER THAN UMBRELLA FORM 8
WORKERS COMPENSATION AND ( 08WBEZ2826 04/01/98 4/01/99 X !TORYLIMITS! ER
EMPLOYERS'LIABILITY
EL EACH ACCIDENT Is 100, 000
THE PROPRIETOR/ INCL I EL DISEASE-POLICY LIMB S 5 0 0 , 000
PARTNERS/EXECUTIVE I
OFFICERS ARE: REXCL EL DISEASE-EA EMPLOYEE S 100, 000
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS/VEMCLESISPECIAL ITEMS
FOR VARIOUS CONTRACTED JOBS
CEITlFCA... ..C}OLDEEi:::,::........:..::::............:.............................:...:.:.:.::::::::::::.::.::: :::..:A.:.........................:.:.::.:.::::................ :........::.::...:.....:::::::::::::.......::...............:.:.:::..::.::::::.:
............................................
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
ALTTHORG= REPRESENTATIVE
Michelle Connors MM C
:..>:.:s...::<..::.>:.::...::::.:...:...:<.:::..:....:..... . ..:»>:>.
.............. .. : : >.........>.>:> >: .......... R:..::
�::.. 39OR:> » : :.
The ConniJurilt'calth of:lfassachusctts
Department of Inds srrial Accideirts
OfficPoflnyeS11ga110J7S
600 !f'uslrhigiun Sirccr
Workers' Compensation Insurance Affidavit-
Ai
liitn inf rm itin. PI �' -'v
----.----• .^_-------------- -- -
locnrion• 1
rite. e:5�771// "/54r"' e% 6 c� nhone 4 / ��—�✓ /O
0 1 am a homeowner performing all work myself.
I am a sole proprietor and have no one working in any capacity
[1 I am an employer providing workers' compensation for my employees working on this job.
cmmmanv n•amc-
atiriress�
city nhnnc#-
in-mrance c-n =Z= / f/ I�Zf noticr ii elxe ti36 Z -azg 24
[1 I am a sole proprietor. general contractor. or homeowner(circle arc) and have hired the contractors listed beiow who hz%e
the following workers' compensation polices:
comonriv nimc• -
� adrirccc-
cin•- nhnnc a•
incur^ncc rn
.-..._._ .. ... ._�._-..._. -+..�r�r..�._ �-.ter-.-.-r- - ___— __ .��'• � _ _ _ -� 1
cnninlny narny.. - - -
addresc-
tin nhnnc¢'
incur•tnce co
Attach additional sheet if necessa_ry--- _.,;,.:......- -. .. .. . :.- _._�, "_.�.. _�_-•::.�. :,:
Failure io secure coverage as required under section:.SA of NIGL 152 can lead to the imposition of criminal penalties of a line up to SIS00.00 andiur
une�cars'imprisonment as 1%4:11 as cis•il penalties in the form of a STOP wonK ORDER and a fine of S100.00 a day against me. I understand that a
copy of this statement ma}" be rurwnrcicd to the Oflicc of Invcsti;:ations of the DIA for coverage verification.
1 do herchl•ccrtifr under the ptrins and pett�a dices oofperjun-that the information provided above is true and correct.
Si_naturc � �1J Date �� 40
Print name � ��—01� Phone 9
' official use univ do not write in dtis area to be completed by city or town official `
L city or town: permit/license d r.Building Department
(:,Ucensin_Board C
C:checi:it imrncdiatc response is required Q
Seicetmen's Office t
Cticalth Department
contact pennon- phone#: r'Other r
The Town of Barnstable
9MAS&
�� Department of Health Safety and Environmental Services
rE1659. Building Division
367 Main Street,Hyannis MA 02601
Office: 508-790-6227 Ralph Crossen
Fax: 508-790-6230 Building Commissioner
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.
o�-
Type of Work Est. Cost
Address of Work: � �61 G �;� �� ZgLe Ina
Owner's Name Wi-w a CJG`>2T/I�iU�
Date of Permit Application:
I hereby certify that:
Registration is not required for the following reason(s):
Work excluded by law
Job under S1,000.
Building 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:
J �44'
Date N ems - Registration No.
OR
Date Owners Name
The Town ®f Barnstable
KASM& Department of Health Safety and Environmental Services
P Building Division
367 Main Street,Hyannis MA 02601
Office: 508-862-4038 Ralph Crossen
Fax: 508-790-6230 Building Commissioner
SHED REGISTRATION .
�Z � SNAv2�ol
Location of shed(address) Villa e
Property owner's name Telephone number
o 2�3�2�
Size of Shed Map/Parcel#
Slinature Date
Hyannis Main Street Waterfront Historic District?
Old King's Highway Historic District Commission jurisdiction?.
Conservation Commission(signature required)
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
PLOT PLAN
FOR LOT
;pdiL-Le lOC3QOA of$ange
Cr acc ==y buildias
Additions with dashed lines-----
Sewerage disposal (cesspool)
Well
..................ft. rear)
Abutter's
�
I Name
s�.,,etotIs
Na=e
Lot N
Rear Yard
Lot/
...............fL
a If this is
4W
� e:ornt! 10L,
v _ MT1iC in
C=er lot, 'C �• Lame C.,
write to
other SQcet.
name of - HOUSE Sideyard
other street- S i d ey art 1t.
• h- A.
ly Set Bade
.................f
4V- -'
(Lot.....................ft. iroatage)
+\
-----_ - ----- --
-_----------------------(Name of eaeeL) ---------
—? �— Worrrtation
/ _.
Supplied ba
Fnir.!
The Town of Barnstable
dp t1+E tb,,_ Permit# 2 Co, G R-0
, ' "�{►�, Massachusetts
BARNS BIUL = Date (0 3 �l
KAB& SOLID FUEL STOVE PERMIT
Fee
y"
This constitutes an official stove permit after inspection and approval by the building inspector.
Owner ,b- � ti�yw�G AlVdIU&j5 Telephone no. W) 74 1 g
Address of Property QP CO,6," Village lftm.4t15
Ll
Location and Stove Type a OV�
Bate:
Building Inspector
The solid fuel burning stove at the above location passed: failed; inspection.'