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HomeMy WebLinkAbout0306 STRAIGHTWAY TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION S.. �VMap Parcel L � Permit# "T 0 10 Health Division Date Issued /g to 0 Conservation Division Fee Tax Collector Treasurer J CUA `!(n ZMbb Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis , Project Street XAdress a'/ fffTW 7M U ST Village 6 ' vl S y �J Owner cG /�4-46 J('m Address 3T2 T� 2 d&mW Telephone Permit Request �S SIDS &Z zw1 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Valuatickp of , tin Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: Cl Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑Crawl Cl Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) 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: 0 Yes ❑No Detached garage:0 existing ❑new size Pool:0 existing ❑new size Barn:0 existing ❑new size Attached garage:O existing ❑new size Shed:0 existing ❑new size Other: Zoning Board of Appeals Authorization 0 Appeal# Recorded 0 Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name Telephone Number Address l u Geim'if � �• �• License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 117p, SIGNATURE /G' DATE rl� • FOR OFFICIAL USE ONLY ` PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER) ���-`~_< - � • , DATE OF INSPECTION " FOUNDATION FRAME - INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL S � GAS: ROUGH FINAL FINAL BUILDING.• l DATE CLOSED OUT ASSOCIATION PLAN NO. r �^� :zr esu$ativ�rs � -_ 600 Washington Street 4r ' Boston,Mass. 02111Ce davit ��,, Workers COIIi CIISSt10IITIIS[1t�II -- ///%/ �///%/7// /�%�////�%% %//%�i WMIRI Ann 1l�:211T 1IIi"SS �GC�L1Gn' hane 0 cir" iR woikmySCLf* %_ I am a nomeawnet p is I am a sole== . Job. ,,,;;,,,,;, f woriaIIg an this J ;:.;... �r�,////%/%/%%///� pafor ny emPio A,.,J.,,•.?:•?. workers comp ;:...:...:...:.:::.::.... :'Kv: ..,,.M� , D Pam... ....v,,,.. ...�:�.. ....r... :}:.n..:,v.}�• .i:::.}:•}:.::::::::. ...,:.:•..'::- I am an .........�......t.,:.....: .,.:.............. .... .:... ......}�.... :.:{.}y::::...........r.. C ..A.,{.:.... 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IV. • -_.• or.I 1 ll • • i• • • r+ • •Y•• •11 •• • 1 • /• a .11 • • 1 11 • • .1/ r 1.1 • • / r•• •�••:1• •11 .11• / •1 • • • . 1 1 11 11 1 1 I • � �'' 1 • •11 1 1 1 1 • M I 1 \ I 1 11 1 1 1 1 11 ' / 1 • LJ 1 1 1 I • . 1 1111 ' • • ' Il • 11 1 ' 1 The Town of Barnstable mina Department of Health Safety and EnnII ronmental Services Building D><v>ts 367 Main Street,Hyannis MA 02601 Ralph Crossen Office: 508-862-4038 Building Commissioner Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,moons'renovation'repair'modernization,conversion, improvement,removal,demolition,or construction of an addition to my pre-existing owner-occupied building containing at least one but not more than four dwelling units or to struc=w which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other ` requirements. n r �L( 4 of Work: / 1l AI" Estimiated Cost Z Type AM Address of Work: (��71 S Owner's Name: G � l Date of Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law C]Job Under S1,000 Building not owner-occupied ❑owner pulling own p=aft Notice is hereby given that: WITHEGIS. OWNERS PULLING THEM OWN PERMIT OR DEALINGWORK DO NOT HAVE ERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT PLINK UNDER MGL c. 142A. ACCESS TO THE ARBITRATION PROGRAM OR GU.� SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a i e agen of the owner. D Con r Name Registration No. Date OR Date Owner's Name q:forM5:Affidav HOME MPROVEMENT CONTRACTORS REGISTRATION - (= Board of Building Regulations and Standards ` One Ashburton Place - Room 1301 Eoston , Massachusetts 02108 HOME IMPROVEMENT CONTRACTOR - Registration 120456 Expiration 1 /01 /01 Type - PRIVATE CORPORATION 8IL-RA`( ALUM _ SIDING CORP JOHN O 'NE7L 40 ELMONT RD ELMONT NY 11003 MAY-16-00 TUE 11 :27 EVANS INTERNATIONAL INC FAX NO. 5165962001 P. 02 .. � .. .��?tiM!T+�yP�'P�/+.ey"Q'A4lvDlM:QN,/y,'yy)rk•Mri 1' � Y ` .. �"�MS'4N��l�6�„ � . � .' tl•l 60 •. >>{ g ,,�. ;. "k1R:'tSe*tefi�Rt!Ye'�'^:!'.•� �'S y� DATE(NlplD6N1/j #�'1 ,.,:.aroxji>�a.. X.�.+r ra><3 •,wRd.� viiaxf•a v>: P' ::iL...A..t!LK•!9!1D39.. 0 .tl• '. !Y•'�' "� h,,' •fir•'''� I 05/15/200D PkcD<'rEN " FAX (516)596-Z001 THIS CERTIFICATI�1S ISSUED AS A MATTER of INFORMATION - 'vans Inte rrtati onal ONLY AND CONFl=1iS No RIGHTS UPpN 7HE GF.PiTIFICATE F>tOt.DER.TMlS CERTIFICATE DOES NOT AMEND,IXTEND OR 10 P,>.ni nsul a Bl Vd. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Lynhr'oa k, NY 11563-2464 COMPANIES AFFORDING COVERAGE COMPANY AdIn ral rns Cc Aftn. Robert Seide Ext: 104 A iiti.iiaca .QRG:,.,7he..g............................................................................................... _..American. ..... . ......................... . . ................... i -Ray Group, etal COMPANY Home 40 Elmont Road B :...:.............................. .................................. Elmvnt, NY 11003 i COMPANY RL ns C ........................................... ... E COMPANY D ,,,�,L('1 �:.s�•..; �d s`<E a":;rib Y Y►M�' r. :?.s'aa a—.• y���'`y�l; ip�^r'3'<f �' <s <+6 5s�' #¢ u•`� <�--'.✓v"'rY��,����yy u��8/iY'• `' ;F«alp !' s? �T�.��w��)��as.+„e!e+.npyS+,..,_5,�(.ty,• >>>m '•>97: ..N'.(0.1��1F`M.INFO'4w;"Ki tiYANr O .Oj116P')S�:AA�W t 1i.3%IPJi:�iw -IOTi.i�s.h+�'•' 9i i' , t MVrV �<' w,.a w' �tvi1"'�fi Y�T�f':JF.. •:i"rY.,.Je e� ti\< jj� � '�^l n iIS IS TO CERTIFY TUAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED A13OVE FOR THE POLICY PERIOD IaD1cA1'E0,NOTW Ij'msl-ANPINc ANY RFgXREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS MRI IIICATL-11MY BE ISSUED OR MAY PERTAIN,THE IN$LIPAANCE AFFORDED 13Y THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS ARID CONDITIONS OF SUCH POLICIES.LMTS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. . ................... �.O TYPL•'or imswuNcE POLICY NUMBER '•POLICY EFFECTIVE i POLICY EXPIRATION L DATEIMMIDalm DATE(MWOD LJb111'8 ?YY) OISIdtBLAL LUIUWTY ' GENERAL AOCNEGATE ;`5 2 QQQ QQQ X COMMERCIAL e3mmAL LIABILITY i PRO S + . ......... ?. ..... i ..._DUCT -C(mPIOP AOG S 1,Q 0,Q CLAINISMAOE X OCCUR s > Q' A :."s F ? ! PERSONAL S AOV INJURY "'• ...as AOOAC03651 : 05/14/2000 ' 05/14/Z001 : •••••�• :s 1,000. OOa OWNrJra a CONTIaACTOWS PNOT: EACH OCCURRENCE y s•••••.. 1,000,Q00 ..............................I... ? FIR6 OAMADe(Any one Me) •s 501060 IVIED EXP(My one p ) •8 _ Q AUTOMIbMILE LIADILITY APJYAUTO :COMSINELI SINGLE LIMIT s AL L OWWED AUTOS .................. ....................... ..................... BODILY INJURY s 3CI(GDULED A1R05 (Pe?(Oeron) IHIRrD AUr05 1300iLY INJURY NON-OWNEDAUTOB ( �r,ccidontl i PROPERTY DAMAGE s 6ARAm:uAsiLrrY AUTO ONLY-EAACCIUENT 5- — - OTHERTNM1dUtO ONLY. ..ruiA„C.tBr'.y' ANY AUTO 0 L... ..................... ... . ........ 12:'2�'.i•'"s.'':'...i'.a•'•••'','..:.:.4.j�w EACH Acr.U?ENY s •,___. __ — AGGREGATE.5 LtAnnJTY EACHOCGLNiRENCE s 5,000,000 C UMCRL:UAFORM JtXL 0252717 05/14/2000 05/14/Z001 AGGREGATE S 5)QQQ,QQQ X_C_THCR DIAN UMI ke LLA FORM i S — WJR&RsCOMF'CWBATIONAND ky �•'^'n' ,;.��f: ,aSr RMPLOVERN LIABILITY i .......:TORY•LUIIT$,;••• ER ;r;>:. .o!+.S:rTn�!a�'iw,.;�°;Q• B 'WC6520150 05/14/2000 05/14/2001 :��'CHAc`'IOE�•• '• •s 500�000 TILE VROPRIE1CNy : EL DISEASE-POLICr LIMB s .PARINER.^.lE7-.=VE .•X•••MCL i 500 00U ...... oaFtCues ARE _+r+ :FJ(CL EL DISEASE-EA EMPLOYEE'-i 500,000 (7f.fi4lRUrr d OF Or+LkJ1I IUNWL(]L' K7NSri/pFIK%L PECIAL IT • enevi Contractors Tor Home ImprovemeEMSnts rkers Compensation, in NY,GA,CT,MA,NC,NH,PA, & RI .•. { Y'*i+. .vy�.�•{'s?:'y2•'r<�>>Ti,+`s o.. > n �: Y R. x —<�e• •T%�°�'.hr!',° r.. •, ? n+ j�, �ps; � �.%: �,<,., ,I:.s�'j�•�. :..<....a".u, .. A �eiSel•,?�s�•.s�KiPd�.�n'f4?S% HtN'k��J�<t1°K:�'f?:�15''`I�"i�'���ib ,. oif$' �l'� ^'''T�7���'�A<.��`o„!•k•'r��.�..�.�.<6'?'�.6'.�.=.'1^.�•"''�<R'. SHOULDANY OF THEABOYEDESCRIDED POLICIES DE CANCEL LED BEFORE TKG PU(PIRATION DATE THEREOF,THE ISANO COMPANY WALL ENDEAVOR TO MAIL 10 WRITTEN NOTICE T E CERTIFwATE HOLDER NAMED TO THC I Fr T. l3RG: The Bil-Ray Group BUTEAILURE oMatLSUC NoT SHaI.LrMr�OSENOOWIGATIGNDA[IADILrrr 40 El man_t Road OF ` KwO 6 poMP IT3 AGENTS OR REPRraENTATIVES. E1nKlnt, NY 11003 AUTH TATNE t 1` ;} � 't'f'ti, u� ,'},✓Zi'' ,YY'y"�Y�°3>::.a° i�6'Y""sr'.Sit'h� t' �oyS !"'e',i :!7 '!3�: ,:.2: e4 ''<r�'<•..Y'�ceyi"`�n'G', 4 is2:••a r:<<a��Tr•r .�' "9 AsS Y ` 4'•;' i;'Nr.irs'rrs"r1i.'` • >...'sNl_ _ ..' 1eY•xrt.4 >ai�.�tr:•r.•A :�;lHu`...�i:.us:2 r :r§y.fv Y. A �•T. ...�Y,.•si9rf;t', 1�,.. ...?: 7 TOWN OF BARNSTABLE 33AR33TAJBLE, 1639.Ar BUILDING INSPECTOR APPLICATION FOR PERMIT TO ........ .................................................... TYPE OF CONSTRUCTION ......... ....... .......... ... .. ..............00111e4q..W...... I ... ........................................ ........... 9 6.9 TO THE INSPECTOR OF BUILDINGS: The undersigned .4hherby applies for a' pbrmit according to`--the following information: Location ........Z!5�..... ..;4. ..... ... ................. .. ....................................................................................................................... ProposedUse ...I.... ........... ..................... ... ................................................................................................................................ ZoningDistrict ........................ ... Ei,re District .............................................................................. AO ame of Owner .44 N* 41.1......... Nameof Builder ....................................................................Address .................................................................................... Ile Nameof Architect ..................................................................Address .................................... ..... ......... er o Room .... A, 4c, Numb f R . ....... ........ 'r -Foundation ...... oofing .../.,... . ..... ............................. ... ......4....... Exterior Floors ....................................................Interior ... ...... .... ..... ...... .... .. .... ...... ell Heating ...........................................................Plumbing ...... ........ ..... ...... . ....... Fireplace ....... .........Approximate Cost .. .......... ..........Cie. 42,v 0 ................................................. Difinitive Plan Approved by Planning Board ________________----------------19--------- 1,-111 DIS POSAL Diagram of Lot and Building with Dimensions -rKE PROPOS:-D SANITARY ,"ATER )�'ED AND DRAINAGE IS al, fir P- WN OF BARNSTABLE, 11T11 BOARD OF HEALTH A LICENSED INSTALLER MUST P OBTAIN SEWAGE �RMIFT.; AND INSTALL'��YsTEMJ -7 6 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name . ...... ... ............... ,W .4 . .. ............. ) � \ Hudspeth, William ' '��� �� | . . . No —����.�.. Penni�J���.,�.���Y��������—.. r _ .......... .................... mr | ---� ----------~ ..........~^---....... | ^ ` \ .........................,.—............................................... ' � Owner ..........�������.��������______.. ( Type of Construction ----..�r..a..gN�-----.. ----'---------------------- Plot ��' .�� �~.. Lot .........4�o................ _ Permit Granted -- .26----.]g 69 Dote of Inspection .. ----..47 �-� � ' �'7cr ' Dote Completed ...................................... t |�> |� PERMIT REFUSED 9 -----_--------------.. 19 � » ` ( --.~.-------.--------------.. . / ^--^—~---------------------'' ` � ..---_.---.------------.—.---.. � � � —.-------.----.------.-----.— � k + } � Approved lV _,-------------.. / . ^ , -------.----------.-------.. ' ---------------------^^^^^^^'' � � �� _ Town ®f Barnstable *Permit-# k3 ? ? � o ' •n Esphvs 6 monda from issue dale t saaxsrnMAS&sr.E, *' Refit®It'd �Cr'V1CeS Fee25 , Thomas F.Geiler,Director BuRding Division - Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 -PRE t3 m Office: 508-8624038 Fax: 508-790-6230 p� �vr 7�y �7��yr� y / A rg.� �7 . APR 2 8 2005 EXPRESS JC"EHilY r "PLI .ATIOl� /�I71NmYraP ii'CI V tI {F'tB LE Not Valid without Red X-Press hnprint Map/parcel Number_ Property Address 36 G S+M t' C,` a Y)h 1 s EA Residential Value of Work 3 50 G U Owner's Name&Address i'QL r SI't'i CA 2�bos- Contractor's Name /v t (i k f_(3 o-t J U vk.� YGc l h Telephone Number SdY` a N G" 3 ej 4-1 Home Improvement.Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance' Insurance Company Name L I e f T (,t 4 t Workman's Comp.Policy# .IIC 2 �. Permit Request(check box) " CX Re-roof(strippii g o d shingles) All construction debris will be taken to 14� 7 l l bio)I vl ��✓> `► ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side' Replacement Windows. U Value maxim( um.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc: ***Note: Property Owner must sign Property Owner Letter of Permission. Home Improvement t^ntmotm T i ensg is requked. Signature_ I Q:Forms:expmtrg Revise053003 Tale Comrnonweakk Of e Della DePmlll ofladvS&WAccidents 680 WaddaVon Strom a 0211-1 3a�( Q [am a horneowrrw peaf¢bming mill viliuk myself- 0 i Rm a Sole Proprietor aid have no cme work-mgany l sut aaa employer providing wa&=a compensatim for€any employ working an this job. L,r� tit��u �,►��e - c Z -3 is - 3��i� a -G3y ® l atra a sole proprietor,general cotgtractaar,Or lttatatt ot�+€ter(drde one)and have hied the contractors lined below who e;a.. the following warcers'c ompemition polices: �tfo��tss•. City: ®itarne s isagttr flee sitatee to seeatre coverage as required ulft 025A of 4f�3.152 can i to€€e i •_ of cr'anasa�5 pm aBf a e tsar tag St.'�ii�_tg£!xass�rn: one years,imgrisoametat as aveii as cMl Penalties'n tip f�uraat Gf s STOP WGRIC ORDER and a live of Stfti 00 a day against rae. i understand that a copy of this statement mny be fa-wardcd to the Office of faveAk2tial of the DLA fer zovamge vearificatimL do hereby certify sander the pries and pens ties of f erl rh ar the aafearaam6on provided above is true rasr/d correm signature"��� .--� t3ate 7 �C`J Jr r Print nameja'15 r. /l 1 e t.krio c # 'hone S2 zefcia6 use pair do not write in this saes to be ecoeaafatetcd by citx or govsrc 9WKiai h " city or tarrvmm• met enitf€ieeaist folding Deparmsent � Ot.iceming B.srd check if immediate rg�Wnse is Mqjl OHCaitb YDepartmeat crost8$ti�tt3;a;: pnr�; f1Q2t#acr 1r—ited IM P)p t Boari�o �iied, Z�iegu'1�tiiyfis afilf 1>'d3f�fl g g License or registration valid for individul use only ` HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 133851 Board of Building Regulations and Standards One Ashburton Place Rm 1301 Expiration: 8/17/2005 Boston,Ma.02108 Type: Private Corporation NICKERSON HOME IMPROVEMENT MARK NICKERSON 12 COMMERE DRIVE : . ,�r�u✓ •— ORLEANS, MA 02653 Administrator Not valid without signature T Liberty Mutual Group ` Liberty IoWmutua'l. lb;l r`y PO Box 7202 Portsmouth,NH 03802-7202 Telephone(800)653-7893 Fax(603)431-5693 November 11. 2004 TOWN OF BARNSTABLE BLDG DEPT 367 MAIN ST HYANNIS,MA 02601- RE: Certificate of Workers Compensation Insurance Insured: NICKERSON HOME RvfPROVEMENT INC PO BOX 2476 ORLEANS,MA 02653 . Policy Number: WC2-31S-318102-034 Effective: 11/6/2004 Expiration: 11/6/2005 Coverage afforded under Workers Compensation Law of the following state(s): MA Employers Liability: Bodily Injury By Accident: $ 1.000,000 Each Accident Bodily Injury by Disease: $ 1,000,000 Each Person- Bodily Injury by Disease: $ 1,000,000 Policy Limits As of this date,the above-referenced policyholder is insured by Liberty Mutual Fire Insurance Co under the policy listed above. The insurance afforded by the listed policy is subject to all the terms, exclusions and conditions,and is not altered by any requirement,term or condition of any or other documents with respect to which this certificate may be issued. This certificate is issued as a matter of information only and confers no right upon you,the certificate holder. This certificate is not an insurance policy and does not amend, extend, or alter the coverage afforded by the policy listed above. If this policy is cancelled before the stated expiration date,Liberty Mutual will endeavor to notifi you of such cancellation. AUTHORIZED REPRESENTATIVE LIBERTY MUTUAL INSURANCE GROUP This Certificate is executed by LMERTY IMU rUAL INSMANCE GROUP as mpects such insurance as is afforded by those comp mies. cc: Insured: Producer of Record: NICKERSON HOME IMPROVEMENT INC PIKE INSURANCE AGCY INC PO BOX 2476 PO BOX 1658 ORLEANS, MA 02653 ORLEANS. MA 02653 i of Page Ma... j .. 2 NICKERSON HOME IMPROVEMENT, INC. 1243�99 P 0' Box 2476 :; q. HYANNIS, MA 02601 a , (508) 790 5880 Fax (508).255-5107 PHONE DATE T© Richard Smith 510-632-0313411/Zoos 3874 Fairway Ave JOB:NAM �L �Tt�t Oakland CA:94605 306 Straight Way Hyans afl a Eitlfvlt3EPPHONE 508=7 04 Step slmigies off front half of roof only Renail all loose sheathing - Install 8"white aluminum drip edge on all lower edges -_- - Alf Install ice &water shield on all lower edges and around all openings t2���''`� Install black underhtyment felt paper on supped area C A,re- Install new flanges around vent pipes Install 25 year 3 tab Seal King algae resistant shingles on stripped area G ovv�, i r�f�7-1 All trash and debris will be removed and disposed of properly Ail labor, materials and debris removal$ s PLEASE INDICATE SHINGLE COLOR ON RETURNED PROPOSAL Repair rotted wood at :per man hour pluse cost:Of�� Strip shingles off_cc mete re roof as listed above 25 ear 3 30 year Architectural add 4. - T%' �J6 �. emove and replace chimney flashing WE PROPOSE hereby to furnish material and tabor—complete in accordance with the above specifications,for the sum of: Cont'd dollars fS Confd —1 Payment to be made as follows: -` =Y deposit upon signing g�a� es balance upon completion All material is guaranteed to be as specified. tAit work to be completed in a professional manner according to standard practices. Any alteration or deviation from above specifica- Authorized tions involving extra costs will be executed only upon written orders, and till become an Signature extra charge over and above the estimate. All agreements contingent upon strikes,accidents or delays beyond our control. Owner to carry:ire,tornado,and other necessary insurance.Our {Vote: is proposal may be workers are fully covered by t ior::er's Compensation Insurance. withdrawn by us if not accepted within 30 days. ACCEPTANCE OF PROPOSAL—The above prices,specifications and conditions are satisfactory and are hereby accepted. You are authorized Signature to do the work as specified. Payment will be made as outlined above. Date of Acceptance: (O Ds Signature 04/19/05 20:13 FAX 15106386550 Q 01 h - r - mum � 'Thomas F.Getlar,DI B111-Id ag UIVISIon Tom Parry, Building Con=1m6oaec 2001r =Slmek Hyrano;jL.MA Ma I Offc= 5094MU 40B Fa= SOB 7904230 Property Owner Must Complete and Sign This Section If Using A Builder as Own=of&0 B*ect prvprstp AMC ��•`to sect M my behax is all muum mixtive to week audumized by this badiag pest apphectioa f= 1 (Address ajo, Zor Paas Nsase QFoseeg: x L'd LOl !N VHHW 4t-u BO 6i add