HomeMy WebLinkAbout0052 SAINT JOSEPH STREET a � ����
Application number
o .� �..
3� •-7v -
AUGU 8 2919 Fee ..................................:................... .............. .......
NAM
BLE Building Inspectors Initials. . : .
t634.
h Date Issued.:.....-R—....l....
Map/Parcel.... r.. :l.. ...................
TOWN OF BARNSTABLE
EXPEDITED PERMIT APPLICATION:
ROOF/SIDING/WINDO WS/DOORS/TENTS/STOVES/WEATHERIZATION
PROPERTY INFORMATION
Address of Project: cJ /&4- Joseix
NUMBER STREET VILLAGE
Owner's Name: -147g0!=` ,1.4Z.4/20 d/ Phone Number 00,''
Email Address: Cell Phone Number �66 APL
Project cost$ GrO _ Check one Residential !/ Commercial
OWNER'S AUTHORIZATION
As owner of the above property.I hereby authorize
to make application for a building permit in accordance with 780 CMR
{
Owner Signature: Date:
TYPE OF WORK
Siding Windows (no header change) # El Insulation/Weatherization
Doors(no headerchange)#_L_ Commercial Doors require an inspector's review
Roof(not applying more than 1 layer of shingles)
Construction Debris will-be going to
CONTRACTOR'S INFORMATION
Contractor's name
Home Improvement Contractors Registration(if applicable)# - (attach copy)
Construction Supervisor's License# CJ-Ila ,(attach copy)
Email of Contractor one number ��
ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN
A uicTnRtr n1.CTRIrT_ vn1I Ml L4T nRTAIN HLSTnRIr APPRnVA1-,RFFnRF A.PERMIT rAN RF I.q.V 1Fn_
4 -
APPLICATION NUMBER............................................................
*For Tents Only*
Date Tent(s)will be erected Removed on number of tents total
Does the tent have sides? Yes No (If yes please attach floor plan with exits marked)
Dimensions of each Tent X X X
Additional tent dimensions can be attached on a separate piece of paper.
Purpose of Event
Check one: this event is a: for profit non-profit event
Check one: Food served Yes No
Flame Spread Sheet of each tent must be attached. Provide a site plan withlthe location(s)of each tent
Fuel source being used LP tank 201bs. or>Yes No___,if yes, a gas permit is required.
Natural Gas Yes No , if yes,a gas permit is required.
If food is being served at your event please obtain a Health Department approval between the hours
of 8:00am-9:30 am or 3:30 pm-4.30pm. Commercial events may require.Fire Department approval.
*WOOD/COAL/PELLET STOVES
Manufacturer# Model/I.D.
Fuel Type Testing Lab
Offsets from combustibles: front back left side right side
HOMEOWNER'S LICENSE EXEMPTION
Homeowner's Name:
Telephone Number Cell or Work number
I understand my responsibilities under the rules and regulations for Licensed Construction
Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand
the construction inspection procedures,specific inspections and documentation required by 780
CMR and the Town of Barnstable.
Signature Date
APPLICANT'S SIGNATURE
Signature Date
All permit applications are subject to a building official's approval prior to issuance.
I
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual):
Address:
City/State/Zip: P T A4 (9,.-A6-?F_P hone#: �
Are you an employer?Check the appropriate box:• Type of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and I
�/�mployees.(full.and/or part-time).* have hired the sub-contractors 6. ❑New construction
2.U 1 am a sole.proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees „ These sub-contractors have 8. ❑Demolition
working for in an capacity. employees and have workers'
g Y P ty 9. ❑Building addition
[No workers' comp.insurance comp.insurance.#
required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their I L❑Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL '12.❑Roof repairs
insurance required.]t c. 152, §1(4),and we have no
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 this affidavit 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 have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. .
I am an employer that is providing workers'compensation insurance for my employees. Below is.the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lic.#: Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
..Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insuran overage verification.
I do hereby certify u e ins and penalties of perjury that the information provided above is true and correct ,
Signature: Date: ® PJ
Phone#:
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#:
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees.
Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire,
express or implied,oral or written."
An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to bean employer."
MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address,telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington.Street
Boston,MA 02111
Tel.#617-727-4900 ext 406 or 1-877-MASSAFE
Revised 4-24-07 Fax#61.7-727-7749
www.mass.gov/dia
�W Town of Barnstable
Regulatory Services
'" Richard V.Scab,D re0or
Building D' ision.
Paul Roma,Building Commissioner
200 Main Street,Hyannis,MA 02601
l
www.town.barnstable.maus
Office: 509-862-403 8 Fax: 508-790-6230
l
Property Owner Must
Complete and Sign This Section
If Using A Builder
as Owner of the subject property
hereby authorize n,,� l'L.> D o b to act on my behal f
in all matters relative to work authorized by this building permit application for:
(Address o ob)
**Pool fences and alarms are the responsibility of the applicant Pools
are not to be filled or utilized befort fence is installed and all final
inspe ns are performed and accepted.
Signature of`Owner 1 of pplicant
Print Name Print Name.
Of/0, �
Date
QYORMS:OWNERPERMISSIONPOOLS
.Tip �.�w,�r.�-�.�a�✓//G�a����i
Office of Consumer Affairs&Business Regulation
7. HOME IMPROVEMENT CONTRACTOR
TYPE:Individual
ReoistYation Expiration
418762r1�" 05/03/2021
KRASIMIR KIRlav=
D/B/A THA HAP40*AN, CAPE COD
KRASIMIR A.KIR,6 4� V JJ
18 KIMBERLY WAYw, a
COTUIT,'MA 02635 Undersecretary
i
Massach,usetts,DPnartment of Public S -,r.-
$oard of Building Regulations and Standards
r License: CS-110796
Construction Supervisor
.ate S
KRASIMIR KIROV "
18 KIMBERLY WAY a •` '
COTUIT MA 02635
�, !t��w' �����•� Expiration:
r COmmssloner 04J17/2020
�F7NEt� TOWN OF BAR \ STABLE
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Z B9BBSTABLE, i �
"6 9 p . BUILDINGINSPECT
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APPLICATION FOR PERMIT TO .......... n�/ ( ...............................................
TYPE OF CONSTRUCTION ................................ .........................:...................
a . .........cam.�.................. .197s..
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information: c�
Location ....may! �.......S.r... . .. ...... .........................4.....2 ? — .a:�.. ..
ProposedUse ....�..61.eg� C.Krl .J.. .................................................. ....... ......................................
Zoning District .....Fire District .,1� �QrLnilr
„ .......................... ............................................
Name of Owner .... /�aTI�.. G� ......................Address ...`. .....- ..!!..1.. ...A�:.v►,!�.
Nameof Builder ........ .I......................:...... ................:..:.:..Address ......./�................1..�.................:................................
Nameof Architect ..... ..................................:...................Address .........��..:.................../.r......................��..................
Number of Rooms :....... ..../*�............................................Foundation ... . ` !� ...............
Exterior ... ..... ..... . ....... ...............................................Roofing ........... .. ....................................................
Floors ... �... .. ..... . ... .. .\ ..........Interior .. ....................................
Heating ...........................Plumbing :...:
t...... .. . .. S✓....................................................................
Fireplace //.......................... Approximate Cost .... . . ........................................................
Definitive Plan Approved by Planning Board ________________________________19
Diagram of Lot and Building with Dimensions �' 00
SUBJECT TO APPROVAL OF BOARD OF HEALTH
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I hereby agree to conform to all the Rules nd Regulations of the Town of Barnstable regarding the above
construction.
Nam .. . 1 '. .. .........
Drouin Corp.
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No . _.�Permit
' i. for __mzmo..............................o�cmr� .
single z� i��.__. .. z� _______. '
St~ St.
----..~. ---'----------------- �
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Hyannis
.....................''..,'''................................................'
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Irt»uin Corp. � ^
Owner ----------..-----------'
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Type of Construction ........... '
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Permit Granted --Feb'���---~ lA ^~
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Dote of Inspection ---- . lA
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CAPS et-STE
PERMIT REFUSED
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Approved ,'--------------- 19 | �
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TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
• 5
Map 2.1,1 • Parcel Permit# 70
+th-B+vfsae+� r Date Issued �0
session t-Fee
E r
.`
1 Tax Collector cue y/f/
Treasurer
Na=WgDapt a
Date-13 #t pproyed by,Planning Board
_ Preservation/Hyannis
r
Project Street Address
Village
Owner Sew.�:.� J��u�.e,\�.Q S��o� ` Address t .Swami
Telephone �S'0�� 1' 08X0.
Permit Request 50 ._Oe,�
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new
Estimated Project Cost ' r10 0 Zoning District Flood Plain Groundwater Overlay
Construction Type --//
Lot Size Grandfathered: ❑Yes ®No If yes, attach supporting"documentation.
Dwelling Type: Single Family 1 Two Family Lf Multi-Family(#units)
Age of Existing Structure 'IF'h11, Historic House: ❑Yes VNo On Old King's Highway: ❑Yes O No
Basement Type: M Full ❑Crawl ❑Walkout ❑Other v\A-
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft)
Number of Baths: Full;existing new -,6' Half: existing new -c�'
Number of Bedrooms: existing 3 new 0/
Total Room Count(not including baths):existing new P/ First Floor Room Count
Heat Type and Fuel: &dGas ❑Oil ❑Electric ❑Other
Central Air: El Yes 6i No Fireplaces: Existing I New Existing wood/coal stove: ❑Yes 3* to
Detached garage:❑existing ❑new size . d1& Pool:❑existing ❑new size Barn:❑existing ❑new size //�,4-
Attached garage:❑existing ❑new size Shed:O(existing ❑new size Other: j
F
Zoning Board of Appeals Authorization ❑ Appeal# Recorded O
-Commercial ❑Yes - ❑No If yes,site plan review#
Current Use Proposed Use
BUILDER INFORMATION Name [2':�sY C�� n �h �� Telephone Number 3 7 7I 0 8 C-y�
Address _ 2 �1 J� �- . License#
t. 6q' Home Improvement Contractor#
Worker's Compensation#
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO '._'k J
/ SIGNATURE `'-� ATE 7 2-0 �q,�
_ _ r FOR OFFICIAL.USE ONLY
PERMIT NO.
DATE ISS[7ED*t � * `_ <s . :. , - s' f ,j • t • _ " Q A .,. t ,
14
MAP/PARCEL•NO.
<71
ADDRESS W - ,VILLAGE _
OWNER
DATE OF INSPECTION
FOUNDATION
FRAME
INSULATION s -
FIREPLACE - t _
x ELECTRICAL: ROUGH FINAL r ,t �
71
PLUMBING: ROUGH - FINAL
GAS: ROUGH FINAL
FINAL BUILDING' ='
` DATE CLOSED OUT
r
ASSOCIATION-PLAN NO.
} ' a `
The CommonweaUft of massas;;4usem
— - Department of Industrial Accidents
Office offarestlgatfoos
600 Washington Street �-
��,;' - Boston,Mass. 02111
Workers' Compensation Insurance Affidavit
name:
location 2-
0
'7 /��
hone# /
city
1 am a homeowner performing all work myself.
❑ I sole rietor an:21d have no one woriQri in any acity
am a s
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insurnnce co.
❑ I am a sole proprietor,general contractor, or homeowner(circle arse)and have hired the contractors listed below who
have
the following. llowln workers compensatt... .pohces:
.....................:._.................:::.�::::... .... ...:............::::::.......
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a aired under Section 25A of MGL IM can lead to the lrnpositioa of erludOai penalties of a Bne ail to 51,500.00 and/or
Failure to secure cove rag as re4
ronment as wen as civil penalties in the form of a STOP WORK ORDER suui a th►e of 5100.00 a day agsitut me. I understand a
one years'imP P e veclII�on.
eopy of this staten►ent may be forwarded to the Once of Investigations of the DIA for covers;
1 do hereby certify under the pains and penedties of pert ury thai the information provided above iset�tw.and eorreea
Date 1 /
Sipature Sic? 7 7/ �
Priest name �l;/�///d'1 !A1,f Phame i1
ofticisi use only do not write in this area to be completed by city or town ofac sl
permit/license# Munding Department
city or town: DT tag Board
❑sdecbnen's omee
checkif immediate response is requited ❑Health Department
contact person: phone#; Other
(renew 9195 P1A)
Information and Instructions
Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their
employees. As quoted from the "law",an employee is defined as every person in the service of another under any come-
of hire, express or implied, oral or written.
An employer is defined as an individual,partnership, association, corporation or other legal entity, or any two or more of
the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver
trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a
dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of
another who employs persons to do maintenance, construction or repair work an such dwelling house or on the grounds c
building appurtenant thereto shall not because of such employment be deemed to be an employer.
MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renew
of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who h,
not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the
commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until
acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting
authority.
Applicants
Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and
supplying company names,address and phone numbers along with a certificate of insurance as all affidavits may be
submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and
date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is
being requested,not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if yo•.
are required to obtain a workers' compensation policy, please call the Department at the number listed below.
City or Towns
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of tt
affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please
be sure to,fill in the permit/licease number which will be used as a reference number. The affidavits may be rcwm ed io
the Department by mail or FAX unless other arrang ements have been made.
The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions.
please do not hesitate to give us a call.
The Department's address,telephone and fax number:
The Commonwealt
h Of Massachusetts
Department of Industrial Accidents
Me of Iltllestl0adolls
600 Washington Street
• Boston,Ma. 02111
fax#: (617) 727-7749
phone#: (617) 727-4900 eat 406, 409 or 375
f
The Town of Barnstable
s aA$81BrA8rF. •
N Department of Health Safety and Environmental Services
Building Division -
367 Main Street,Hyannis MA 02601
Office: 508-862-4038 Ralph Crossen
Fax: 508-790-6230 Building Commissioner
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 pie-existing owner-occupied
building containing at least one but not more than four dwelling units or to structures which are adjacent to
such residence or building be done by registered contractors,with certain exceptions,along with other
requirements.
Type of Work: -
d s Estimated Cost � o 0
'C�. � °
Address of Work: Z S '
Owner's Name: mow•�.•
Date of Application: 7 S0 eta
I hereby certify that:
Registration is not required for the following reason(s):
Work excluded by law
13Job Under$1,000
OBuilding not owner-occupied
tOwner 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.
Date Contractor Name Registration No.
OR
Date Owner's Mike
q:forms:Affidav
Department of Health Safety and Environmental Services
Building Division
367 Main Strack Hyannis MA 02601
�a1
Office: 508-862-4038 Ralph Cnossen
Fax: 508-790-6230 Building Commission
HOMEOWNER LU32M EXEMTION
far,
1'leasa Ptimt
DATE
JOB LOCATION: .'�- � 22 10 e4
tame hears phone# work phome d
CURRE r MA=G ADDRESS: \—\ c to $1A^ .
aityAmm state sip code
The current exemption for was extended to include ed dwellino of sic units or less
and to allow homeowners to engage as individual for hire who does not possess a 11case,=3ged that the mm
a�ervis
DEFIIUrMN OFHOMEOWNER
Person(s)who owns a parcel of land on which hdshe resides or intends to reside,on which there is,or is ittended to
be,a one or two-famrly dwelt&attached or detached sfr===accessary to such use and/or farm structures. A
person who consou=more than one home in a two-year period shall not be considered a homeowner. Such
."homeowner"shall submit to the Building Off ciai an a form acceptable to the Building Official,that!+rlffie shall be
Mj raffle fbr all such work Section 109.1.1)
The undersigned"homeorovne:"ages responsiibilk'y for compliance with the State Burg Code and other
applicable codes,bylaws,rules and regulations.
'flu undersigned"homeowner"cx ffm that he/she understands the Town of Barnstable Building Department
minimum inspection procedures and requirements and that he/she will comply with said procedures and
sipson of
Appmmat of wi ft O>$cid
Now Three-family dwellings contaiaing 35,000 cubic feet or larger will be required to comply with the
State Building Code Section 127.0 Constnudon Control.
HOMEOwNFB'S FXEMPTON
The Code stars etas 'Any homeowner paboaming vodc fwvddch a budit patent is eegoieed shall be euanpt feom the
of dds seedoa(Secdom lo91.1-Limning of coon Supatisoar ptvvided that if the hameowOlf argages a pason(s)for
Mm to dos=*work.that smdt Hom owaes shall mu supervisor."
MWY hOWWWnN2 who rota this es®I.. nee emawaa th9dWY ate as:umiog the of a anpaviwr(sa Appaedix Q.
Rules tit Regdatiam fort iomsiagCotem xd=Supervimm Swdon2.15) 'fleas tackofawaamess oRmresults in sauna ptohlm
patdmlady when the homeowner bins emiiomsed pet m la this eas4 ota Boned cumot peooeed agauat the tmlixased pasom as it would
wilt a Ucaesed Sgmrrisas: The homeowner=ft as Snpavisar is ultitIaty
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