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HomeMy WebLinkAbout0094 QUAKER ROAD �jQ -� c7® �� TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map ` Parcel Application # Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee a� Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address "1 Fy1,�� Villageti� Owner 4&"CJ&A4 , Address Telephonew�` Permit Request Square feet:.1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay .Project Valuation �� Construction Type' Lot Size Grandfathered: ❑Yes ❑ No If yes, attach suppi.A" documentati.9n.g Dwelling Type: Single Family -0/ Two Family ❑ Multi-Family (# units) ` r, Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's H§)I, y, ❑Yes t.,No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) —i ao Number of Baths: Full: existing new Half: existing new:``=' Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No ` Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes UN o If yes, site plan review# Current Use Proposed Use i APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name OA Telephone hone Number Address v14uVh U License # Home Improvement Contractor# Worker's Compensation # W �0 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PRO11a WI BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION# r DATE ISSUED t MAP/,PARCEL NO. t. ADDRESS VILLAGE ` ,€ OWNER DATE OF INSPECTION: 6 ' f. uAFO.UNDATI.ON)DI it i�.aFU'Lf'4D il FRAME — — — - — — INSULATION s",— FIREPLACE k } ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING ' DATE CLOSED OUT ASSOCIATION PLAN NO. w Massachusetts - Department.of Public Safety ...:Board of Building Regulations and Standards Construction Super iscir License: CS-100988., HENRY E CASSII)V 8 SHED ROW } WEST YARMOUfiH 13 ✓,�. " '`� \ Expiration Commissioner 11/11/2015 a Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 153567 Type: Private Corporation Expiration: 1 211 5/2 01 6 Tr# 259188 CAPE COD INSULATION, INC HENRY CASSIDY ----- 18 REARDON CIRCLE -- ---- SO, YARMOUTH, MA 02664 Update Address and return card. Mark reason for change. :CAI Co 20M•05111 [] Address [] Renewal Employment E] Lost Ca,(I die ar�h�zaruue���C/n�'C�/�/G��Wdac/ueeCti C-\ Office of Consumer Affairs& Business Regulation License or.registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistratlon: '1.53567 Type: Office of Consumer Affairs and Business Regulation xpiratlon:, •.121:15/201..6 Private Corporation 10 Park Plaza -Suite 5170 B68'ton,MA 02116 :,APE COD INSULATI;b:N;'.INC'.{.``;:` 1ENRY CASSIDY 18 REARDON CIRCLE-.:. so,YARMOUTH,MA 026 Undersecretar —— — Y qNvnlid wi s Lit sign e i The Commonwealth of Massachusetts Department of IndustrialAccidents W Office of Investigations a d 1 Congress Street, Suite 100 Boston, MA 02114-2017 C6 yV www,mass,gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leydbly Name (Business/Or 'zation/Individua � Address; �6, V .�VL l); V City/State/Zip; �Vkn '10L Phone #; W Are you an employer? Check he appropriate box: i 1.5;�I am a employer with 4, ❑ I am a general contractor and I Type of project (required); employees (full and/or part-time),* have hired the sub-contractors 6, ❑ New construction . 2.❑ I am a sole proprietor or partner- listed on the attached sheet, 7, ❑ Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity, employees and have workers' [No workers' comp, insurance comp, insurance,► 9, ❑ Building addition required,) 5, ❑ We are a corporation and its 10,❑ Electrical repass ot`additions 3,❑ I am a homeowner doingall work officers have exercised their 11.0 Plumbing repairs or additions myself, [No workers' comp, right of exemption per MGL insurance required.] t c. 152, §1(4), and we have no 12,❑ Roof repairs employees, [No workers' 13,[ Other 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 thisuffidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such =Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities leave employees. If the sub-contractors have employees,they must provide their workers'comp,policy number. I am an employer that isproviding workers' compensation Insurance for my employees, Below is the policy and job site „,. .Information, Insurance Company Name; Policy# or Self-ins, Lic. Expiration Date: 1�f Job Site Address; City/State/Zip: V/7 �•�— Attach a copy of the workers' compensation policy declaration page (showing the policy nurnbe 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 may be forwarded to the Office of Investigations of the DIA for insurance'coverage verification, I do hereby cert(o: n r pains and penaltles of perfury that the Information provided abov Is true and correct, Si nature: Date: l�/ Phone 8: Of flclal 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 4: CAPECOD-27 KLIGETT CERTIFICATE OF LIABILITY INSURANCE 76/13/2014 E(MMIDD/YYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Rogers&Gray Insurance Agency, Inc. PHONE Barbara DeLawrence 434 Rte 134 Fax CAM o E t AIC No: (877) 816-2156 South Dennis,MA 02660 ADDRESS: bdelawrence@rogersg ray.corn _ INSURERS AFFORDING COVERAGE _ NAIC p' NSURER A:Peerless Insurance Company INSURED INSURER 8:COMMERCE INSURANCE COMPANY Cape Cod Insulation Inc INSURER C:Evanston Insurance Company 18 Reardon Circle INSURER D;ATLANTIC CHARTER INSURANCE GROUP South Yarmouth, MA 02664 _ INSURER E INSURER F CO ERAGES CERTIFICATE NUMBER: REVISION NUMBER: T IS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD IN ICATED. 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 POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LiR TYPE OF INSURANCE INSDADD R POLICY NUMBER MM/DDYEYY MOLIC M%DDY E YY LIMITS A X COMMERCIAL GENERAL LIABILITY i CLAIMS•MADE OCCUR CBP8263063 EACH OCCURRENCE $ 1,000,000 04/01/2014 04/01/2015 PREMISES(Ea occurrence) $ 100,000 MED EXP(Any one person) $ 5,000 NXEN' PERSONAL&ADV INJURY $ 1,000,000 LAGGREGATE LIMIT APPLIES PER:POLICY❑PRO ❑LOC GENERAL AGGREGATE $ _2,000,000 JECT PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: --------- AUTOMOBILE LIABILITY $COMBINED SINGLE LIMIT $ 1,000,000 B Ea accident) ANY AUTO 14MMBCKVMK 04/01/2014 04/01/2015 BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ 'X HIRED AUTOS X AUTOS NON-OWNED PROPERTY DAMAGE --`--""-AUTOS Per accident $ X UMBRELLA LIAR X OCCUR -- C EXCESS LIAR 1 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE XONJ453614 04/01/2014 04/01/2015 AGGREGATE_ $ DED X RETENTION$ 10,000 Aggregate $ 1,000,000 ORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER __ D NY PROPRIETOR/PARTNER/EXECUTIVE Y/N WCA00525904 06/30/2014 06/30/2015 FFICER/MEMBER EXCLUDED? ❑ N/A E.L.EACH ACCIDENT $ 1,000,000 Mandatory In NH) ---- f yes,describe under E.L.DISEASE-EA EMPLOYEE $ 1,000,000 10 ESCRIPTN OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Workers Compensation Includes Officers or Proprietors. Additional Insured status Is provided under the General Liability and Auto Liability when required by written contract or agreement with the Certificate Holder. CER 'IFICATE HOLDER CANCELLATION__._ ELATION ., -- 460 West Main Street Hyannis, MA 02601-3698 Tel: (508)77.1-5400 Fax(508)775-7434) TTY on all lines Zam...F Wealtheri )n ' Your tenant has requested and is eligible for weatherization of your rental home through the Weatherization program at Hoeing.Assistance Corporation. An avera9e weatherization job is worth $4,500 and these services are provided at no cost:to you. The following weatherization measures are applied to the typical job. air scaling in the attic and 17a �i"df�E6.i, lih5'.U..af or !rl the attic, �61�tticiBieti[ cai.ld U4�r~9I��, v1iC:Ci�ll�B3t(Pping tau 1s. Bath fans may be installed if necessary. We will test the efficiency of the :refrigerator. All work is professionally done by licensed and experienced :contractors. HAC will conduct a final Inspection to make sure that all work is completed in compliance with quality work standards. Prior to the work being done you will receive a letter from HAC showing the actual measures that will be.in and the total,dollar value of the work. To confirm your ownership of the property, we will pull the appropriate towns assessor report. It necessary, we may ask for a, copy of your tax bill or deed to prove ownership. The work on your rental property will begin when we receive the signed copy of the attached Agreement. - If we do not receive• the Agreement, HAC will conduct an energy audit but- no weatherization work can be done- without the signed Agreement. During the energy audit we will install enerav efficlent light b.ktl s and kivill test the efficiency of the refrigerator. If you have any questions. please contact Suzanne Smith at 508-771-5400, ext. 123 or ssmith @ haconcapecod.org. ®ion®• ( Litol 1 .a-'r ?,t,.a i r't TEN to �6�'J kl, email. V1O-k -D khZ Z)VI - CG'r, email: PHONE:(home). '4"c>8i c790 -Cow PHONE: (home) (Coll) S b 0 v e-. (Collj f • PROPERTY OWNER/TENANT WEATHERIZATION AGREEMENT 1. The Parties to this Agreement are the following: 2. y ; •.ky �� `` �:• (hereafter known as Tenant), - d (print your tenant's name) (hereafter known as Property Owner) (print your'�me) and Housing Assistance Corporation (hereafter known as Agency). In consideration of the mutual.promises - hereafter stated,the Parties agree as follows: 3. The date of Agency's signature will be the effective date of this Agreement. 4. Property Owner and Tenant consent and agree that the Agency may do the following with respect to the property located at("street,town) q,q 0t r�`fir t '"�`f. ? w...% .`= ,unit , and currently leased or rented to the Tenant: a) Enter the premises for the purpose of performing a Weatherization Inspection. b.) Enter the premises to perform Weatherization.work which the Agency determines in its discretion is necessary and appropriate as a result of the Agency's inspection of the property and.in accordance with the appropriate priority list for the type of dwelling. The Agency and the Agency's contractors may also enter the appropriate common areas.of the building for the purpose of accomplishing the Weatherization work.. The Agency and representatives of the Commonwealth of Massachusetts,Department of Housing &. Community Development (DHCD) may further enter the property to inspect any and all work hereunder. The Agency will provide reasonable notice of the timing of the Weatherization work and inspections. The Weatherization work will be performed in accordance with the Property Owner's consent as further specified below: **:.IIVMAL ONLY ONE OF TIME 11FOLLOWING V/ I consent to performance by the.Agency and its contractors of any Weatherization work determined necessary and appropriate by the Agency as'a result of.its inspection.of the property, I understand that the Agency will provide.a detailed statement of 4he actual work performed and the associated value at the.completion of work. I will provide a separate consent to performance by the Agency and its contractors of Weatherization Work following my receipt of the Agency's inspection report and a statement of the estimated work:and associated value. This additional consent will be sent under separate cover as Attachment: A. I understand that the Agency will' provide a detailed statement of the actual work performed and the associated value at,the completion of the work. 5. The Property Owner understands and agrees that any and all work, including .related repairs for which the Property may also be eligible,will be performed at the Agency's discretion. The Agency estimated completion of the Weatherization work by the end of 2014/2015. 6. If the Property Owner is required to make repairs to the property prior to the commencement of Weatherization work by the Agency,.the Property Owner will be notified by the Agency and will be required to make the repairs as soon as possible. Except where the Property Owner receives a written extension from the Agency,time is of the essence in the.performance of.repairs by the Property Owner. 7. The Property Owner and Tenant authorize.the Agency to receive a statement from the fuel:supplier/utility supplier as to the:quantity of fuel/utilities,used.at the above:address:in.each of the past:three years and the future three years. The information is to be used only to determine the cost effectiveness of the Weatherization improvements. B. The Property Owner agrees that the rent for the dwelling unit will not be raised because of any increase in the value thereof due solely to the Weatherization work performed. i 9. In consideration of.the Weatherization work hereunder,the Property Owner further agrees,that upon the effective date of.this Agreement and during a.period extending.through 2014/2015, approximately one year from the time the work'is completed, a) The.present rent$. per month will not be raised. (The rent amount must be filled in). Heat included in:rent?Yeses Now However,this Paragraph (8a)will.be waned by the Agency.in wriiting.if,and only if.,the premises are leased under a state or federal rent subsidy program, in which case the actual rent charged byths Owner shall conform to the standards of the rent'subsidy program. Please state �jwhich Housing Subsidy program your tenant is on and through which.-Agency: b) The Property Owner will not institute any summary process action for possession:except.in the case.of non-payment of rent or other good.cause related to the Tenant(or any successor Tenant). P.i.:, t'2..... Owl 1.--.7 r... -fl .W.:. .. rrpp..a,' ��••11 "4 n11.nnw+.r!.:. 'a(� .. c li) I(i?trle GVa,m hia y ro slly 11,iIr is ivtGo"lV Scn �ilc pii:+i.i..ial.a,-r lyp,c.o-.y� "uh, .r s,iaV.s.V11[jp'yY x'r hl Jlic\oi _ the two requirements below'; -The Property Owner shall not sell the premises unless.the buyer agrees(with a copy forwarded to the Agency). in writing prior to sale to assume all obligations of the Property Owner set out in this Agreement;or The Property Owner shall pay the Agency an amount equal to the cost,as certified by the Agency, of the Weatherrzation materials installed and labor performed in the premises as of the,date of sale. Said amount shall be paid to the Agency immediately upon sale. 10. (Applicable only if.Ten nt's heat is.included In rental payment and blanks are filled in) At the end of the period.set forth in Paragraph 8 above,the rent shall not be raised more than % per for an additional period of one year, and the provisions of 8b and 86 .above shall continue in effect for such period. However, the rent provisions of this Paragraph 9 may be Waived by the Agency in writing ifi, and only if, the premises are leased under a state or federal.rent subsidy program., in which case the actual rent charged by the Owner shall conform to the standards of-the rent subsidy program. 11. The Parties agree that the terms of this Agreement are incorporated into any other lease or:agreement between the Property Owner and the Tenant, and between the Property Owner and any successor Tenant., and'rf there is any conflict between the provisions of this Agreement and the provisions of such other lease or agreement, the provisions.of this Agreement shall govern. However, if'such other lease.or agreement, including without limitation a lease or agreement under state or federal rent subsidy program,contains stronger protections for the Tenant, such stronger protections shall apply, 12. For breach of this Agreement by the Property. Owner, the Property Owner shall reimburse the Agency in an amount equal to the cost, as certified by the Agency, of the Weatherization materials installed and labor performed on the premises,.as well as attorney's fee and court costs. The Property Owner may also be liable for damages to the.Tenant in accordance with applicable law; in such instance,the Property Owner shall reimburse the Tenant for attomey's fees and court costs. Without limiting the foregoing, the Agency may at Its option terminate'this Agreement,by providing.written notice to the Property Owner and Tenant, in the event of breach by the Property Owner or Tenant. is. Performance of the Weatherization work hereunder by the Agency is contingent upon the availability of funds to the Agency from the commonwealth.of Massachusetts and the federal.government,as-well as.the eligibility of the Tenant under WAP program requirements. The Agency may terminate this Agreement, by providing written notice to.the Property Owner and Tenant,if the Agency determines that the unavailability of funds or ineligibility of the Tenant warrants termination. 14. The Parties acknowledge that.this Agreement is under seal. It is intended by the Parties that the Tenant or any successor.Tenant is the intended beneficiary of the Agreement and shall have a right of enforcement. Property owner's Signature. Date Phone; Address: `> 'W 2.. Tenant Signatures a4n; date Agency Approved Weatherization Company C(o t�se�� _ Adam T. Incor orated/ All Cape Energy / Alternative Weatherization / Building Science, Construction ape Cod lnsulatia`� Cape Save / Frontier Energy Solutions. / Lohr Home Improvement Resolution Energy / Tupper Construction Agency Signature / Date `� I Town of Barnstable Regulatory Services TC 81RNS j:,s Richard V. Scali, PH 701 Director, STAB Building Division s `0�'' Tom Perry,Building Commissioner '°>Fp Mpl a 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us D tp ; Office`. 508-862-4038 Fax: 508-790-6230 Approved: Fee: Permit#: ' (Lf 3 HOME OCCUPATION REGISTRATION Date: Name: Ck y La Phone#: .3q 0/ .30 Ff6 Address:—Tj ucAk e t c` Village: Name of Business: e t Type of Business: c I�eGc hllg!l 1SC 1 Al Ce Map/Lot:c '5( i IN TENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes; and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 406 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter, odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There are.no commercial vehicles related to the Customary Home Occupation,other than one van or one. pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • - No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. I,the undersigned,have read and agree /with the above restrictions for my home occupation I am registering. Applicant:/e- Date ( , Homeoc.doc Rev.103113 YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates [cost$40.00 for 4 years]. A business certificate ONLY REGISTERS YOUR NAME in town ( hic wh you must do by M.G.L.- it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St_, Hyannis. Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get,the Business Certificate that is required by law. - DATE: ( / Fill in please: APPLICANT'S YOUR NAME/S: Y1,1 L4 [ a,- BUSINESS YOUR HOME ADDRESS:�14 C�c eu I<r r d1 �2 ��n n i - y TELEPHONE_# Home Telephone Number NAME OF CORPORATION: l eui7& NAME OF NEW.BUSINESS_',-) / ° TYPE OF BUSINESS C [ec�.n c.e IS THIS A HOME OCCUPATION? YES NO ADDRESS OF BUSINESS - '- k l (A MAP PA C� / RCEL NUMBER �(.6 (Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of. ' Barnstable, This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. -.[corner of Yarmouth • Rd. & Main Street to] . make sure you have the appropriate.permits and licenses required,to legally operate your business in this town. 1. BUILDING COM ISSIO ER'5 OF ICE MUST COMPLY WITH HOME OCCUPATION This individu I h s n�infor, d o."'ape mit requirements that pertain to this type of I REGULATIONS.. FAILURE TO. u oriz-1 Si natu **. COMPLY MAY R 1,JLT IN SINES. OMMENTS. 2. BOARD ❑F EALTH This individual has,been informed of the permit requirements that pertain to this type of business, . Authorized Signature COMMENTS: 3. CONSUMER AFFAIRS [LICENSING AUTHORITY] This.individual has been informed of.the licensing requirements that pertain to this type of,business. Authorized Signature*.*` COMMENTS: — o Assessor's map and lot number 3 '� `3�D Q/� C — —//— 77 " SEOTIC SYSTEN4 MUST BE •� .....; � -:. ;«- I.�':`31:'a- s ��...Y -Fg � a�i't�f 2�._?f:3 N"�.+F,n ' ,: Sewage; permr number ....... N "�I i i', is %':V 'Y YN E TOE T® 11 N- O BARN\ S "L� 4 B•. E fw L EBHBBTULK 3q• M9 s � RUIL IV INSPECTOR a 00 6 \00 � • C; ILI APPLICATION- FOR PERMIT TO ...:.. r TYPE OF CONSTRUCTION . ...../..... r.....� ...... .. ...� ....................................................... .... .... .... .d.,4'x. ...... ......... .....19� j c: TO THE INSPECTOR OF BUILDINGS: P, The undersigned hereby applies for a permit according to the following information: Location .... �.��..... '1�+et✓'I,........ ..................................................... ProposedUse ...� ............................................................................................................................... Zoning District ............................................. .........................Fire District .. /J1 s '✓.........Address .��� .. ... vr! ..�� ................... Name of Owner 6...i1... ........ ..... ..+..... - ..... .. .. ....... r �h f 1 Nameof Builder .. �. .... .....Address .................................................................................... �� ►...............................�� Name of Architect .:........... Address Number of Rooms .........................Foundation .x/d..... ..�.. ...... . ! .! .................... .... ......... Exierior ........... ...................................Roofing_ ...... .. ;........ /AO Floors .. . Interior -�` ... I . . ................ ... .... . . ... ..... .. .,� . ' 7 ^ .Heating . ..).q.. .!�!!....... ......... E. ......Plumbing ...P,V. ..e.... ....� ,.... .................. Fireplace ...... .............................Approximate Cost . {%mho !/ Definitive Plan Approved by Planning Board ________________________________19--------. Area ... 3 ...5 Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH 0 3 �. d ` 35 ® b - L/ y�` I / by 0 / I hereby agree to conform to all the Rules and Regulations of the Tow_n of Barnstable regarding the above construction. / Name .. �rL w ...... .. - <I T Johnson, Nancy L. A " 19097 one story ' No .................: Permit for .................................... x!zgJmx1zm*#xdxz*:k*Kg duplex dwelling.................q ..Quaker Road............................. � location .....:...........................:.............................. Hyannis C/. ............................................................................... Nancy L. Johnson Owner .................................................................. j frame Type of Construction .......................................... t..........:..................................................................... -Plot ............................ Lot ...................::........... \ i • 'Permit Granted Aril 11 _,-19 77 Date of Inspection ` Date Completed PERMIT REFUSED ................................................................ 19 ............................................................. ......... , .... .i..................................................................`�; .... ................................................................ ..�•^'a.' ......................................................................+........• ✓ A Approved 19 3 •• ........................................................... _........................................................................... Assessor's map and lot number ...':n.................................. d,//, �� ��°'��- ��-f/- ? 71 Sewage Permit number .....................f':` .......................... OFTHErO t w TOWN OF BARNSTABLE bQr O,w r, Z BASBSTAIILE, i - ~= 39 DUItDING INSPECTOR 'Ea MA,(A, �IVI f7!� S .r c APPLICATION FOR PERMIT TO ............................... /M!N TYPE OF CONSTRUCTION / /4 ..:?!?.......::........ ..................................................................... .....................................19.. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: t r� { Location .. .. .'�t r► _�.� 1! \-' v ! in ..�,n .,, 1' .;�; .'?: ..................................................... Proposed Use t/a_,.!�l .... .... ....... ...�r. . ..... ........................ .................... ............................................ P .. ZoningDistrict ..............................................7.........................Fire District .../.. .. .c .?. ..,............................................... ,t'� � r • Name of Owner �i ".. �`-�................. +!! '�-�..........Addressfi " ..L--N ........ ........ Name of Builder ..:... ..;:!.......�►; .......�:.....:r''.,._�!• '.'.�:-;e:''..Address .................................................................................... 1 l 1► �� Name of Architect ........Address Number of Rooms Foundation � Y;--��-��� ................................................................. 1%%... j} Exterior ...Roofing .....1 fi?.n �a< ............................................... ........... .............................. Floors f! . r"�1 Interior ....�J.. ' 't� 4 i ;.,.c-..f+ �}, b' �x .,s,r ........ .... ..... 1( i- J .� Heating /����r..n 1�' (lvf . :".... *+ Plumbing .. �. s1, . ,r Sri !s.t.?:........................ ....... ...... . .... .... .... . . Fireplace ^'� .............................Approximate Cost fin")............:. ..................... .............. Definitive Plan Approved by Planning Board ________________________________19-------- . Area ... - f�............................... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH r 5 1. , i h 1 rt Py r1��1• a� �j • t tk I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .. !'�/.!.i ...... .................................................1, Johnson, Nancy L. A=3l ' ` . No .l�q27—.. Permit for ..\���.. ---.. dooleo 6vwsll1og ' ---~-------._-------~----- ' . . Locotionq.-K. . ^k H is ------..���e��...----__________ Ovvne, ........ .C�.. _____'_. . . . ^ Type of Construction ........fama......................... ----- �--------------------' . ' . Plot ............................ Lot ................................. . . . - April ll 77 � Permit Granted ----.---------lg , Date of Inspection -----------']q � Dote Completed ...................................... ^ . ` ' ^ 'PERMIT REFUSED . ^ -------^--.---------- 19 . ---.. .. ' . . ' // ~ . / , ---...,"�.��--�—.^---�--:.�^�—����—. ' ---~----------.—.~---------. / . � ----.----~--------.,-----.—. . � Approved ------'--------- lg _ --------.------------.-----.. ^ -----------------r--'^—^--'`' . . . 4i P. 1 Commun i cat ion Result. Report' ( Nov. 7. 2007 10: 36AM ) . 1) 2) Date/Time : Nov. 7. 2007 10: 35AM File Page No, Mode Destination Pg (s) Result Not Sent ---------------------------------------------------------------------------------------------------- 2598 Memory TX 950877,89312 P. 1 OK Reason for error E. 1). Hang up o r 1 i ne fa i 1 E. 2) Busy E. 3) No answer E. 4) No facsimile connection E. 5) Exceeded max. E-ma i t s i ze ZONING VERIFICATION i✓�C%A� TO: Linda Edson FROM: Kim M.Gomez-Leased Housing Coordinator > Legal Rental Unit Verification Date: // fir�4l�1L/L_ w Gt?`I Address: �(/9�/�11Rl1�� — Village: h A ED unit T_ ` f BedtpomSize: Map&Parcel No.:. The owner of the above listed property is enteric;into a contract with us for the - - . rental of the property as listed above. Please verify by gigging below that the unit is legal and meets all zoning requirements for a rental in the town of Batastable.if it does not,please list reason . here T7miskyop for your lg this matter. I ` ign re Frintiname ' Date VSAFAX 790-6230 1 eStvP seam g Rev.V06 I 0 J,ML) ZONING VERIFICATION TO: Linda Edson FROM: Kim M. Gomez - Leased Housing Coordinator RE: Legal Rental Unit Verification ! - J Date: -�, Address: y Village: L Unit Tv : : Bedroom Size: Map & Parcel No.: The owner of the above listed property is entering into a contract with us for the rental of the property as listed above. Please verify by signing belowthat the unit is legal and meets all zoning requirements for a rental in the town of Barnstable. If it does not, please list reason here: Thank .you for your s ee in this matter. Sign re PrintIname Date I. VIA FAX: 790-623'0 I AZRVp Section 8 I Rev. 8/06 I I 'd 21668LLBOST uog4nd 2uisnoH 91ge4suueH eLls :Bo Lo 90 Al TOWN OF BARNSTABLE 019097 Permit No. ------------------------ 1 »n.tt Building Inspector cash 4/11/77 . .Y` -________ ° OCCUPANCY PERMIT Bond "No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to Nancy L. Johnson Address 235 Parker Rd. ,W.Barnstable Quaker Road, Hyannis Wiring Inspector '''� Inspection dater/n� Plumbing Inspectr?" t1 ( Inspection date Gras Inspector �- � Inspection date Engineering Department N/A Inspection date 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. V t _ Building Inspector ti ti c 1/19097 o,•�},�,►�, TOWN OF BARNSTABLE Permit No. ___________________ __---- Building Inspector 4/11/77 saarr.n Cash -------------- ------- '►+or�r►` OCCUPANCY PERMIT Bond No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to lv'ancy L. Johnson Address 235 Parker Rd.,W.Barnstable Ouakor Road, Hyannis Wiring Inspector ` -�- Inspection date Plumbing Inspector Inspection date, ' ! 7x� rP Gas Inspector r Inspection date Engineering Department N/A Inspection date 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. �7 .............. . ..�.. ................, ............ 40................_........ :Building Inspector .._ s=?ty t-1 1.tT} Ar jwa7-:)1.. Q 0.1 CSZS;I 39 AeON -Lt-qb7 i-►ddb mr�or►s S1 S J.�O =3r�1 t. nznS rr»vr n2�5r►I "55IVYY n ha t" 0 Ci�S`o'9 :on SI r-iv-Ica SIH1 5-210 �2nS a?y�? QaZ=-U :. rI M o 1 117, .:'T-r7C� Cl�l �H1 �O 51t�t?yv�2}►C�b�2� 71�v�ai�s <ONV =ter.=_��.��2i t`+d�d1 r,mor+st-��►�_raa��'�'-� ��►1 .s.drf ����r�� 1 r S inr►v/� r� t�011 V7O, -..0'1 d Q 1-:i1.1213- t iA k ` 4A. `G VY 1 cs� ;a MAR-88-2000 15:09 SARNSTABLE HOUSING 15087789312 P.81 (S- 0 r Barnstable Tdcphow 1108)771.7222 Fax(508) 77;s-931' Leased Koine Dept. (508) 771-7292 'P Housin Authority 146 South Street •'iyannis•:Mas ._Q'?ht)! ZONING VERIFICATION TO: Gloria Urenas FROM: Robert Hooper, leased Housing Coordinator RE: Legal Rental Unit Verification Date: 3/i/00 ---------------- Address: y Q N Ap,• Village: .� Unit Type: n1 �� Bedroom Size: ,3 ' Map & Parcel No.: The owner of the above listed property is entering into a contract with us for the rental of the property as listed above. Please verify by signing below. that the unit is legal and meets. all toning requirements for a rental in the town of Barnstable. If it does not, please list reason here: — ----....,....,.... --.,..----__---__._......_..._.W.--__----- Than ou f our assistance in this m er. ___�_� �_o .-- — - _ S natur Gf_e-- --- -- rant name Date-------------------�-_ ' VIA FAX: 790-6230 MRVP Section a Rev. 9198 Equa) Housing i)rhnrtun tY Agency I TOTAL P.01 IL-_. [ ] [R310 300 . ] a LOC] 0094 QUAKER ROAD CTY] 07 TDS] 400 KEY] 228603 ----MAILING ADDRESS------- PCA] 1041 PCS] 00 YR] 00 PARENT] 0 i JOHNSON, NANCY L TRUSTEE & MAP] AREA163AD JV] MTG10000 WENTZEL, JENNIE M TR SP1] SP21 SP31 P O BOX 342 UT11 UT21 .33 SQ FT] 1300 HYANNIS MA 02601 AYB11977 EYB11977 OBS] CONST] 0000 LAND 20100 IMP 52900 OTHER ----LEGAL DESCRIPTION---- TRUE MKT 73000 REA CLASSIFIED #LAND 1 20, 100 ASD LND 20100 ASD IMP 52900 ASD OTH #BLDG (S) —CARD-1 1 52, 900 DESCRIPTION TAX YR CURRENT EXEMPT TAXABLE #PL 94 QUAKER RD TAX EXEMPT #DL LOT 35 RESIDENT'L 73000 73000 73000 #RR 1337 0103 OPEN SPACE COMMERCIAL INDUSTRIAL EXEMPTIONS SALE] 12/76 PRICE] ORB] C69370 AFD] LAST ACTIVITY112/14/93 PCR] Y �i �j r .j R310 300 . , P P R A I S A L D A T KEY 228603 JOHNSON, NANCY L TRUSTEE & LAND BLD/FEATURES BUILDINGS NUMBER ZN/FL=RB 20, 100 52, 900 1 A-COST 73 , 000 B-MKT 83 , 600 BY 00/ BY ML 8/87 C-INCOME PCA=1041 PCS=00 SIZE= 1300 JUST-VAL 73, 000 LEV=400 CONST-C 0 ----COMPARISON TO CONTROL AREA 63AD ----------------------------- NEIGHBORHOOD 63AD HYANNIS . PARCEL CONTROL AREA TREND STANDARD 101 10 LAND-TYPE 201001 LAND-MEAN +0% 730001 54197 IMPROVED-MEAN -20 250 ] 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- [0 0 0] DATA- [ ] XMT [?] i t j R310 300 . P E R M I T [PMT] ACT*[R] CARD [000] KEY 228603 000000001 r PERMIT-NO MO YR TYPE VALUE CK-BY MO YR %CMP NEW/DEMO COMMENT a [ J [ J [ lJ [ J ^ J [ J [ J [ J [ J [ J [ ] 1 [ J [ J [ J [ J ^ J [ J [ J [ J r J [ J [ J [ J [ J [ J [ J ^ J [ J [ J [ J [ J [ J [ J [ J [ J [ J [ J ^ J [ J [ J [ J [ J [ J [ J [ J [ J [ J [ J ^ J [ J [ J [ J [ J [ J [ J [ J [ J [ J [ J ^ J [ J [ J [ J [ J [ J [ J [ J [ J [ J [ J ^ J [ J [ J [ J [ J [ J [ J [ J [ J [ J [ J ^ J [ J [ J [ J [ J [ J [ J [ J [ l [ ] [ J J [ J [ J [ ] [ l [ J [ J i 1162J�RECYCLfpcp�Z IIII 5F UPC 68021 ' No. SF11 SA 'o OpST COtiSJFn� HASTINGS, MN r II RESIDENTIAL PROPERTY . .MAP NO. LOT NO. FIRE DISTRICT SUMMARY +'w STREET Quaker Rd. ax>nis •73 LAND x: _. - � BLDGS. 300 OWNER TOTAL y c. - -- 7 LAND. RECORD OF TRANSFER DATE B►c PG I.R.S. REMARKS: Zo 3� BLDGS. E^; TOTAL 3 2- • 44 / -- � LAND .-49— BLDGS. 2_ • • • US TOTAL Z.7 QS{„) Wentzel Jennie-M. & Johnson Nancy, L. Trs.112-217 Ctf. 9370 ' 5 200 LAND C/d lo'R 1 N Q FI e 1 .N o BLDGS. TOTAL 3 1 P' 1 M2. LAND BLDGS. TOTAL IO'17 GOra , i 7j LAND ' BLDGS. S R- 01 TOTAL LAND BLDGS. TOTAL LAND BLDGS. INTERIOR INSPECTED: with �G/Yti�1'r TOTAL DATE: S//Zl�J� LAND --- ACREAGE COMPUTATIONS -- of BLDGS. LAND TYPE # OF ACRES PRICE TOTAL DEPR. VALUE ^ TOTAL HOUSE LOT S.7 7, 33 LAND CLEARED FRONT 5 Too BLDGS. REAR TOTAL WOODS 8 SPROUT FRONT LAND REAR TOTAL BLDGS. WASTE FRONT - LAND REAR --- BLDGS. TOTAL LAND m - BLOGS. LOT COMPUTATIONS LAND FACTORS TOTAL FRONT DEPTH STREET PRICE DEPTH yo' FRONT FT.PRICE TOTAL DEPR. COR. INF. VALUE HILLY TOWN SEWER LAND ROUGH TOWN WATER BLDGS. { HIGH GRAVEL RD. TOTAL' LOW DIRT RD. LAND LOGS. SWAMPY NO RD. B cone.Wells Fin.Bsmt.Area Bath Room �/ Base bB�Q L BDG.COST Cons.BIk.Walls y-" Bsmt.Rec.Room St. Shower Bath Bsmt. /13 fy ' PURCH. DATE _ - Cone.-W- — PlasterBsmt.Garage St.Shower Ext. Wells Brick Attic FI. &Stairs _ Toilet Room PORCH.PRICE. Roof RENT Stone Fin.Attic Two Fizt.Bath vh4. 1 Y Floors Z qG M?•O%'t f 2 \ . Prera, INTERIOR FINISH Lavatory Extra ? Bsmt.: 1 2 3 SinkN uc. t 7 . ' . s� Water Cie. Extra Attic EXTERIOR'WALLS Knotty Pine Water Only Double SidirCe-,. Plywood No Plumbing Bsmt. Fin. Single Siding Plasterboard Int.Fin. Shingles TILING Cr* Mbl t/ Cone Blk. G F P Bath Ff. Heat 10- �.5'40 Face Brk:On Int.Layout Bath FI.&Wains. Auto Ht.Unit r 3 yQ Z 4 Veneer, Int.Cond. Bath Ff.&Walls Fireplace Com.Brk._On HEATING Toilet Rm.Ff. plumbing t 8lo D S Solid Com.Brk. ,. Hot Air. Toilet Rm.Ff.&Wains. ' Tiling Steam Toilet Rm.Ff.&Walls /Blanket) Hot Water J3 B //v ✓ St. Shower Roof Ins.: Air Cond. Tub Area Z ,/ Total Floor Furn. ROOFING Z, Z�A/ !/ COMPUTATIONS ' Asph.Shingle A0.1 Pipeless Furn. Q S. F. Wood Shingle No Heat S.F. Asbs.Shingle Oil Burner S.F. Slats" Coal Stoker S. F. -Tile . Gas S.F. OUTBUILDINGS ROOF TYPE Electric Gable Flat S.F. 1 2 3 4 5 6 7 8 9 10 1 2131 4 5 8 7 819110 MEASURED Hip Mansard FIREPLACES S.F. Pier Found. Floor Gambrel Fireplace Stack Well Found. 0.H.Door LISTED FLOORS Fireplace Sgle.Sdg. Roll Roofing �J��'�f� Cone. LIGHTING Dble.Sdg. Shingle Roof Earth No Elect. DATE Shingle Walls Plumbing Pine ( Hardwood 000 ROOMS Cement Blk. Electric /2- 7 I Asph.Till Bsmt. 1st TOTAL ` Brick Int. Finish PRICED 'Single 2nd 3rd FACTOR —10 _±L1 1-14 1 FTI REPLACEMENT Z,Z,,pQs 24 6 •� Z 1 OCCUPANCY CONSTTRUCTIONp SIZE AREA CLASS /AGE REMOD. COND. REPL. VAL. Phy.Dep. PHYS. VALUE Funct.Dep. ACTUAL VAL. DWLG'QV 10-x I S 413 F", S A I7 77 ��}.•. 2 ._,.3 - .. 4 6 17 — B 9' — 10 TOTAL' r - it �I III - 'i' ROPERTY ADDRESS I ZONING DISTRICT CODE SP-DISTS.I DATE PRINTEDI STATE CLASS I PCS I NBHD KEY No. 1 0094 QUAKER ROAD 07 RB 400 07HY 07/09/95 1041 00 63AD �R310 300. A 228603 LAND/OTHER FEATURES DESCRIPTION ADJUSTMENT FACTORS TY UNIT ADJ'D.UNIT L—d By/Dale s Dlmens�on ACRES/UNITS VALUE 0—ipliion J O H N S ON i N A N C Y L TRUSTEE P MAP- "'CD. FFOe m/Acres_BLOC./YR.SPEC.CLASS ADJ. COND. PE PRICE PRICE #LAND 1 20 i 1 OO CARDS IN ACCOUNT — 10 16LDG.SIT 1 X .3i =10 203 29999.9 60399.9 ..33 20100 #3LDG(S)-CARD-1 1 52.900 01 OF C1 €1PL 94 QUAKER RD __7379UU— J BATHS 2.0 U X i C= 1001 7000-OC 7000.00 1.00 7000 3 49L LOT 35 MARKET 83600 - � EIS MT s x i C= 100 6_3 6.3 1300 8200-3 Jt3R 1337 0103 OME A USE APPRAISED VALUE J j (A 73P000 PARCEL SUMMARY r AND 20100 la Ti LDGS 5290C T S MI TOTAL 73000 E - N CNST - N DEED REFERENCE Type DATE R—.,d D P R I O R YEAR VALUE Inst. Sal—Price ',� T eppk Page Mo. Yr.Di AND 20100 S C69370 112/76 BLDGS 52900 TOTAL 730013 ii BUILDING PERMIT I Number Dete Type Amount }. LAND LAND—ADJ INC IME SE SP—BLDS FEATURES BLD—ADJS UINITS 4 20100 1200 Glass Cons,. Tolai B Norm. ODsv. p� Units L'ni,s Base Ra,e A.,Rare rAr a Age Depr. Contl. CNO Loc 9q R G Rep, Co.,New I A., Repl Velue $toriec MeigDl Rooms r Rme Bane 1 Fm PMywell F. 02C- 000 100 100 56.70 56.70 77 77 17 8.3 90 73 72510 52900 1 .0 9 5 2.0 8.0 scru,:on Ra,e Spuare Feet Repl.Cos, MI:T.INDEX' 1 00 IMP.BY/DATE: ML 8/8 7 SCALE: 1/0 0.9C ELEMENTS CODE CONSTR:JCTION DIET AIL 100 56.70 1300 73710GROSS AREA 1300Li ' *---------------------50--------------------* STYLI 17DUPLEX 0.0 r ! ' ESTGN-AVJMT_ -00-------------------- 3 ! ! EXILR=WATLS_- -13 --1=1-1------------- .-O H EA-f/AC-TYPE- -J7 A-S=RDT-WAT-ER----U.-0 ! ' I NT R:FZNISH- -04 RYWAL_L----------- ! INTER:LAY00T- -1-2'VER:7NURMA_ ---_9_O 26 BASE 26 1 NTER:QUA­LTY- -J2 SAWE AS--EXTER:"--9-O 7t L-0-O-R-STUCT- -J2 Jti-JOIST/9EAM _9_0 W! ! E F L'J7R-CT7VER__. -01 -ARDW0700'---------'J.-0 0 1 300 ! ! ROOF-TYPE' - JT UAT3tE=A-SPH-TH Total Areas Aug � Base E BUILDING DIMENSIONS ! ! LELTRI-C-A"L 01AV-ER A6E U.0 T W N 6 E 5 U S 2 6 F 0"0ATIVN- -01 UIJREA--CONC----------- A ! ------------- - ------------------- *---------------------50--------------------X -----N€3G*t80R JD -53AD-7fiYANNTS------- L LAND TOTAL MARKET PARCEL 20100 73000 AREA 3871 VARIANCE +0 +1786 STANDARD 25 I s �IIII^�� �.gECYCCfpC 116 UPC 68021 ' i No. SF11 SA 'o p�ST•CONSJ��� HASTING.S, MN TOWN OF BARNSTABLE REPORTS 7'3MI3NTABY/CONTINUATI REPORT �ql , ±f= , - NAME (LAST, PIRST, MIDDLE) ``\ r� /cu-Rin!1 DIVISION /Q1�Tw��� NOTE DETAILS i OBSERVATIONS-ITEMIZE EVIDENCE, SERIAL SS ETC- LILL I f�22� � PAGES SUBMITTED BY 116 Iwo JX gl CLSOc2 z oz UPC 68021 No. SF11 SA °osT.co HASTINGS, MN