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CERTIFY THAT THE
uNDAT/ON
SHOWN ON THIS PLAN IS %G `+c�
CLIENT ��P / PAUL A. 0
LOCATED ON THE GROU
JOB N0. /39e LEVY
AS INDICATED u No. 10617, y
DR.BY: 14 SL Z 2 . o
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CHKD.BY:
SHEET_OF 21 7 b
9
DATE RE.GI T RED LAND- SURy OR
LEVYtELpREDG 8 WAGNER ASSOCIATS,INC. PLOT PLAN
ENGINEERS - LANDSCAPE ARCHITECTS
PLANNERS - LAND SURVEYORS LaT 3 / kLKo2�
- _ IN
889 WEST MAIN STREET
CENTERVILLE, MA. 02632 SCALE '¢O L DATE: Z /T b
Assessor's office (1st Boor):
Assessor's map and lot number ......... ...... ... . ��f?
N E T�
" Board) of Health Ord floor):
Sewage Permit ,number .........�;.... `....
Z 13MU BLE, i
Engineering Department (3rd floor): rasa
�p 1639-
House ,number ........ ' aye
g. ......... .. ...
11 ._ YPY
Definitive Plan Approved by Planning' Board _____________ ------_ _____19_ ______ .
} Y
! APPLICATIONS .PROCESSED '8:30-9:30 A.M. -and 1:00.2:00, P.M.,only.
} TOWN.. -,-,OF BARNSTABLE ,
BU:ILDIN INSPECTOR
APPLICATION FOR PERMIT TO
,4 0 o �w ��� �✓
.... ........
w00� '�
TYPEOF CONSTRUCTION .......::......_........,............:.......,..................................:::.............:....................................
................ .............:.................19......--
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby'applies for a permit acco ding to the following information:
40,
/
Location /........ ......... ,........ ...... .............., ....... /......................................_.........................................
ProposedUse .............................................................................................................................
ZoningDistrict ............... ............. ...................... .....::..............Fire District .................................................
: r n �7
/ �. /,6X 710 `ErvTE7ZvlLG�
.Name of Owner .:........Addr.ess
. S,ohcr .s"� S�iti Lr
Nameof Builder ....................................................................Address ................................................................................,...
Name of Architect .:.......:..............................~........................ Address' ........ ...........................
Number of Rooms ........... ...........................Foundation '........ ..9u,ze.. Co ve.-FrF........................
Exle io! ......� c 4OR . Si�ln/G �� - :c E��/�/` f
..........................................Roo n As / .
Floors .......:.............................................:.................:...............Interior .................... . .
�/PA ................... .....Plumbin ..........^�1/¢
Heating ........... ...................................... g ... , ...... ........ ............
04
Fireplace ..................................................................................Approximate Cost .............. 1.1..!!.�..5 ..... ......:.:......................
Area Q
Diagram of.Lot and Building with Dimensions
g 9 Fee ............. ,
d .
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
L. I hereby agree to conform to all'•the Rules and Regulations of jheTown of Barnstable regarding the above
construction:
Name .............. ...........................................
Construction Supervisor's License QQ�3G
GREENBRIER CORP.
No 3649 Permit for Build Addition
.......................
4��Single Family Dwelling - r
. ......7. � ..........................................
x` Location Lot . ..1, 5 Kilkore .Drive s F r
` �HXanni s.................... .....°. ......... ;. =t
�} Owner Greenbrier Corp
....: ................_........� f
Type of Constr-uetion „Frame =
........ •y a
>i _ ............. ...................... .. • ..........
n ,
Plot .............................. Lot ................................
.. � .
I f .
February 21 89
Permit Gran,ed '...................:................19 .-
Date;of Inspection ...............................19
„x Date, Completed ...:.. ...... !.19
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Assessor's office.0st floor): n n ?
! oC J 7 N
Assessor's timap and lot number .................................. . Q
Boa?d.of Health (3rd floor): `O
Sewage Permit number ........................................................"""""4ry2'7 It B9Bd9TODLL, i
Engineering Department (3rd floor): 'moo r1639.
House number �+
`e
.................................�...��.�:....................... RFD ray a�
Definitive Plan Approved by Planning Board ________________________________19-------- .
APPLICATIONS PROCESSED 8:30-9:30 A.M. and. 1:00-2:00 P.M. only -/
r TOWN OF BARNSTABLE
BUILDING INSPECTOR
/1 /) 0 T o
APPLICATION FOR PERMIT TO ........................... .
TYPE OF CONSTRUCTION L" °o/*)
........................................................................................................................:...........
-? • _-:;) / b-17
................................................19........
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
ie
Location ...........�...r........... .........../.. .....` .F.......... ..`........`...... �;1.. ''...v.`..5.................................................................
ProposedUse .............................................................................................................................................................................
ZoningDistrict ........................................................................Fire District ..............................................................................
/l ,T ft��.•.. ij I>.v........��G X >/6, �C`i..�t ite.t ff
Nameof Owner .......... .............................................l/...........Address ........... .................r..........................................
P
` Name of Builder ....................................................................Address ....................................................................................
Nameof Architect ..................................................................Address ....................................................................................
Number of Rooms ..................................Foundation .........?uv.r
c /, /tiL (( - C � t)/7A / —r , -T" I .6 (/
Exterior ......... fl......,�.5 5 �..,�............................................................Roofing ...............I. it .!............................................................
Floors ......................................................................................Interior ....................................................................................
Heating .........V.....................................................................Plumbing ...........^!� ...................................
,o � `-.�--•��1�
Fireplace ..................................................................................Approximate Cost .................!/, p..V........
AreaU....................
v
Diagram of Lot and Building with Dimensions Fee _s0 -"""`
. ........................... .................
�J
i
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 .../t ......... ......t..... l.................
..............................
Construction Supervisor's License
....................................
GREENBRIER CORP. A-271-236 :,
No ..��`264.9.. Permit for ..Build..Addition
; Single Family Dwelling..........
Location ....Lot 31 ........5...Kilkore Drive
...................HyaRai S..........................................
Owner ...Greenbrier..Corp......................
Type of Construction ..........F..r...a.me.....................
...............................................................................
Plot ............................ Lot ................................
j
F•
Permit Granted February 21, 89
.......................................19
Date of Inspection ....................................19
Date Completed ......................................19
PERMIT COMPLETED 1/1/-
CAMPBELL
RISES
BUILDING•REMODELING
625 Race Lane, Marstons Mills,MA 02648
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TOWN OF BARNSTABLE
BUILDING DEPARTMENT
HOMEOWNER LICENSE EXEMPTION
Please print.
DATE
JOB LOCATION
Number Street address Section of town
"HOMEOWNER" A� f-UN y 7`7iL. ,r !T l 7
Name Home phone Work phone
PRESENT MAILING ADDRESS
pZ_67 c
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:
Person (s) 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 to six 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)
The undersigned "homeowner" assumes responsibility for compliance with the Stat
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 minimum inspection procedures and requirements
and that he/she will comply with said procedures and- requirements.
HOMEOWNER'S SIGNATURE �^
APPROVAL OF BUILDING OFFICIAL
Note: ' Three family dwellings 35, OOO cubic 'feet, 'or larger, will be required
to comply with State Building Code Section 127. O, Construction Control.
I--
HOME OWNER'S EXEMPTIO
N
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 the
inlicensed person as it would with licensed Supervisor. ThegHometOwner actir
as supervisor is ultimately responsible.
To ensure that the Home Owner is fully aware of his/her responsibilities, mar.
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.
A
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lAssessor's office(1st Floor): /
Assessor's map and lot number — 3� cf TN a to`
Board of Health(3rd floor): C ♦w
Sewage Permit number �O/ o
Engineering Department(3rd floor): r - /il3L � ;DAHdSfADtt !
rus
House number � S /��'� ' °o i639.
Definitive Plan Approved by Planning Board 19
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 e /(jS 73?—0C-7 16 5,-/6 �tv►�/LY 12��
TYPE OF CONSTRUCTION
19
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location .57 kf r ►V �V
Proposed Use "7`'�1y�� /may
Zoning District Fire District 14`a'.4 &_1V I.S
Name of Owner AiV77-(¢JN Y Wit+ (N 1 T. Address
Name of Builder •A
- �� Address
Name of Architect IV. A. Address A4 0 ,
Number of Rooms OD Ovr Foundation A" P r-w j 46V
Exterior C��' !946&4rl F Roofing .A:Kn 7' 5ff/wc=Ce
Floors � Interior
Heating 471E2-K<C_ Plumbing 04104UF
Fireplace /Vo A/ Approximate Cost �zn "
Area /b X / 6
Diagram of Lot and Building with Dimensions Fee 7
Lod- 3f�
L O i ( rJ
is 045' s_ N
S 7,73
G '
M
ku
_ p
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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 regardi g the ab truction.
Name
Construction Supervisor's License
FULGINITI, ANTHONY
No 34103 Permit For Build Addition
'Single Family Dwelling _
`s Location 5 Kilkore Drive
Hyannis
Owner Anthony Fulginit 3
Type of Construction Frame
i
Plot Lot
Permit Granted December 12 , . 19 90
Date of Inspection' _ 19
Date Completed ����y�/� -19' ,
f
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Ass.essor's.office(1st Floor): ,�
Assessor's map and lot number v cf.INE To``
Board of Health(3rd floor):
Sewage Permit number.
Engineer.in Department 3rd floor): t DAHsSTSDtL
House number S /��I2i ... co ia}q.
Definitive Plan Approved by Planning Board 19
r 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 j!�VS jX UC7 16 Se 16
TYPE OF CONSTRUCTION wap- c� E ( f G I
i7�Z . lZ 19 90
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies fora permit according to the follow'ng information:
Location 57 k'(L
Proposed Use 'f'�-yLt (L
Zoning District / I _.Fire District 14S'��vyt S
Name of Owner -W IJ Y r N l 7- Address S K1"((_KncE-F �2
Name of Builder Address _6—��row--tea =r� s
Name of Architect IV, A. Address AA
Number of Rooms Oar foundation S° P.fx�i2 C07-j
Exterior CFT),� c1-f�iv+�r Roofing
Floors elte Qom" Interior
Heating Plumbing r242avX'
Fireplace NO a�,� Approximate roximate Cost Z_ C�'�
P
` . Area /6 X
Diagram of Lot and Building with Dimensions Fee
L0T 3�
is OQs S.
2
lor Z t 0�
o r N
M
ku
_ Q
' J
OCCUPANCY PERMITS REOUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the Rules and-Regulations of the Town of Barnstable regar ing the abpye coonnstr ctior
Name -
Construction Supervisor's License /� .�
FULGINITI, ANTHONY A=271-236
No 34103 permit For Build Addition
Single Family dwelling -
Location 5 Kilkore Drive
Hyannis t -
Owner. Anthony Fulginiti '
Type of Construction Frame
E
Plot Lot
Permit Granted December 1.2., —1.9 90
Date of Inspection - ( 19
Date Completed 19
A/s //9r
PERMIT COMPLETED
L Rol
,fTM�>o TOWN OF BARNSTAB.LE Permit No. .32453
BUILDING DEPARTMENT
I ""n TOWN OFFICE BUILDING Cash
7 •Yl
639•
9''r9wr► HYANNIS,MASS.02501 Bond .........
CERTIFICATE OF USE AND OCCUPANCY
Issued to Greenbrier Corp.
Address Lot #31, 5 KilK"ore Drive
}
Hyannis, Mass. T
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.
Mdre.h 22,. 19 89 ..
Building Inspector.
i
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:.. ( -.:" ,e. r .1 �H.a.'...
j�.. TOWN OF BARNSTABLE, ML SSACHUSETTS B U j,_•
�Am271-236 Novo c:>'b lfi R'•�'T�!
DATE • 19 86 PERMIT-NO.„'0 324
;APPLICANT
r Owner AODRE!rS
INO.1 - (STREET) (CONTR'S LICENSE)
I4 PERMIT TO ' Build dwelling ( L ) STORY_ Silig' jalTlily c1We111.7i}! NUMBER OF l
(TYPE OF IMPROVEMENT) Np, £ DWELLING UNITS
O (PROPOSED USE)
AT.(LOCATION) lot f131 5 Kilkore Di.—VC? ��j2dliT1B ZONING
(NO.) (STREET) DISTRICT_
BETWEEN AND r
(CROSS STREET) (CROSS STREET)
SUBDIVISION LCT• BLOCK SIZE -
1.,.
BUILDING IS TO BE FT, WIDE BY FT. LONG, By FT, IN HEIGHT AND SHALL CONFORM IN'CONSTRUCTI
y
TO TYPE USE GROUP 84SEMENT WALLS OR FOUNDATION
(.TYPE-)
REMARKS: Town Sewer #3081
�U�1D
.. AREA OR 768 B ft.
'VOLUME. �' 50,000, ' .FEEM.IT....� 7.Z.•OO
ESTIMATED COST
r (CUBIC/SQUARE FEET)
OWNER Greenbrier Corp
ADDRESS P.O. BOX 510 Centerville NIA BUILDING DEPT.
BY i ✓ � n
.i OF ANY APPLICABLE SUBDIVISION
RESTRICTIONS. c � rrL�LAn I r'rcoM THE CONUITI-Ol
f MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE
INSPECTIONS REQUIRED FOR
ALL CONSTRUCTION WORK: CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR
I ELECTRICAL, PLUMBING AND
1 I. FOUNDATIONS OR,F OOTINGS. MADE. WHERE A CERTIFJCATE OF OCCUPANCY IS RE— MECHANICAL INSTALLATIONS.
I 2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL
MEMBI FINAL INSPECTION
TI TO LATH)BEFORE
FINAL INSPECTION HAS BEEN MADE, _
3. FINAL INSPECTION BEFORE
OCCUPANCY.
a POST THIS CARD SO IT IS VISIBLE FROM' STREET
I
BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS
ELECTRICAL INSPECTION APPROVALS
Ii
i 1 1 J?_Q� r 1
1
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i 2
2 t Z
rm Cih^ �• 'cC,�
3 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT
IV o K /l
{ 3
— vi31FcT IU R
OTHER BOARD OF HEALTH
WORK SHALL NOT PROCEED UNTIL THE INSPEC- PERMIT W!L L BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS INDICATED ON THIS CARD CAN
TOR HAS APPROVED THE VARIODUS STAGES OF WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE ARRANGED FOR BY TELEPHONE OR WRITT
CONSTRUCTION. PERMIT IS ISSUED AS NOTED ABOVE. NOTIFICATION.
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CERTIFY THAT THE
yr.1 DA T1 o,rJ �p`t µ o M
SI-i(�i��i�I .Q�V THIS PLAN IS l� \
CLIENT 6e P- F° PAUL q y�
LOCATED O;N THE GROUND 0 LEVY 1
J48 NO. 4. a._ AS INDICATED No. 10617,
DR.BY: H(-T- <
Srj�VF�
SHEETIOF- Aa
LEVY`Fl VIl Ga '�,� Xl r� LT
Y Y a1
E.NG,!VEERS - LANDSCAPE AfftHITECTS
PLANNERS - LAND StJRVEY.OR S LET 31
889 WEST MAIN STREET IrL�1 MA
CENTERVILLE, MA. 02632 SCALE : ti® o 'DATE: alzill
% Assess�r s office Ost floor): /
r�
Assessor's m9p and lot number ./Q: ./ ...,v ..,.. � Qp�*MEtoy`o
(3rd floor):
Sewage 'Permit number ................��F. /. ,.:
.. i�'r Z B6B39TODLE, i
Engineering Department (3rd''floor): � '� �0b 9•
House number . "'
'°o
Definitive Plan Approved, by Planning Board -_______q ~__ __._ r_tl9 -_ ----
APPLICATIONS ..PROCESSED, 8:30--9:30'A:M, .and 1:00-2:00 P.M. only
TOWN - OF BARNSTABLE
BUILDING - 1N ECT0.R
c �APPLICATION FOR,PERMIT TO .... `:............. ... .1....,
TYPE OF CONSTRUCTION ...... ............... ......... .W... . .. .... .:.........:.......:...........................:.
............/:V. w Ff 7./....
t•
TO THE INSPECTOR..OF BUILDINGS:
The undersig ed.-hereby applies for a permit according to the ,following information:
Oar
4-1
Location '........ :`..�.......... ................ 3f... ...... ..`................................... /Y. .....:.:..
" 4
Proposed Use .....,.... � . � ... y / ....... ........ ..........................
... '... ......
Zoning District 4....... . c.. 1...: . .....:.. ..Fire District .:.. ............ ..
Name of Owner... ®'IE�l....w1>tE� ............... .Address .......:. Q.: ,...... ........o..... ........... .....
Name of Builder' ................................ ........Address .. ... ..... ........
Name of Architect .......:..... ...Address
Number, of Rooms ... ...... .......... .6.f.............................. ......Foundation
Exterior ...... ................. ...`.`.:"�j��(.... ...... ..(f .. .Roofing /�... Z ....
s
Floors ........ `.�.t ..:*:.....V...r. . ... ..................... nYerior ( T:. .. ............:...:.:.......:...
__`Heating`_" _ (!1/�f:..k..: :. .....................Plumbing /��. .. ............. . ....._....
Fireplace ...............:................................................................:....Approximate Cost .....:.:............ .Q. .C./..t�.. .........
. . • Area ................ .�. .................
Diagram of Lot and -Building with Dimensions Fee'.. �7
OCCUPANCY 'PERMITS REQUIRED-FOR NEW DWELLINGS Y..
,At.,
I hereby 'agr'ee to conform to all the''Rules and Regu lotions of the Town'of. a.rns e e r" ing the above
construction: '
' Name ......
.Construction Supervisor's License ........ ...................
GREENBRIER CORP. i
s' No 32453.. Permit for ..Two...Story........... _.
4 Sin lr
t. . g. . ...k' I11j.1•y....Dwell.i.ng....... '
Location-'' , Lot ,#,31 , 5 Kilkore .Drive
Sj .7...................................
"H e ...... - .' .a'• _, _. _ _ s..
yannis
.. .................................. •. ......... ............... f ^�; • '1 �fr
Greenbrier - r k
Owner .... ............................C...Q p.,................ +�
Type of Construction ...Frame.......
...............................................................q ..... ......... �. . .
....... .... Lot.................................
�r er 18j s
Permit Granted Novemb A-
....................
Permit 88 J+
' Date of Inspection
Date Com leted .........:.. �r..�`......19y/
is a F' _ /.'Y � ram. �. f'f • '� - v`� �.' ,e '� { } " .. ^�- `r
G
Assessor's office (1st floor):. ✓r f !� /r / 7 �FTHETo
Assessor's .map and lot number .�7.........� ..(........
Boardmof=HMa W (3rd floor):- ,�i `O�Q ♦�
Sewage Permit numbers..............`'.... .. Z 9ARISTADLE, i
Engineering Department (3rd floor): S rasa
00,0,1639-- \e0
Housenumber .........................................................:........y... •Fp YFY d
Definitive Plan Approved by Planning Board ________ --------------------- __�
APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only
TOWN OF BARNSTABLE
BUILDING INSPECTOR
r'
�,f I/
APPLICATION FOR PERMIT TO
P-1c
............. ....
W
TYPE OF CONSTRUCTION .............................................D...O..dl........................FMB.: .`....................................................
�U(✓ 1 <
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location .........................................:....... I'm................... .................................................................................................................
ProposedUse . ....................y.Y-16./............... ..........................
/
r' Zoning District .......� ................................................:.................................................Fire District .....................
c
Nameof Owner .................................. .................................Address ......................
Name of Builder I ...................................Address
Name of Architect ..................................................................Address ................................................
....
.....................
..:.:,.�
Number of Rooms ....................... ......................................Foundation .................P... ,,4 !G':G[t/�
............................. ................
Exterior ................... ......./ "..`,t:/ ....7L Ce .. ........Roofing ..................i !. . ...!-. ��....... :. ....f................
.................Floors ..................// .. 1 /v/ Interior .......................1./7"„T... ...1.. .................:.............
.�. .........f..... ..�...... .(..
rl'eating .:.........................................................Plumbing ....................
Fireplace ...................................................................................Approximate Cost ....................
. .... . ........................
it
Area ......................p...................
-Diagram of Lot and Building with Dimensions Fee 71..a...............................
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 ........................................... ...../..........:................
Construction Supervisor's License
GREENBRIER ,CORP. A=271-236 ,
No .32453 . Permit for ...,Two Stou
i
Single Family Dwelling
....
Location ...Lot #31 , 5 Kilkore Drive
.............................................
.....................yann i...................................I.........
Owner Greenbrier Cori......... ....
Type of Construction Frame
............... ............................................................ M
Plot ............................ Lot ................................
Permit Granted ....NOvember'...1.8.......19 88
1
Date of Inspection ....................................19
Date Completed ......................................19