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CAPS ►� ► BAR HE
INSULATION
26 1413- 2 1
FN
h�1
1-800-696-6
lIYI4 OlAii StgmtC53 SpPA!lDAA1 fy3ptNPtO
\AI(i GVIIf43 INSVtAIION CN41NOf
1
Fown of Barnstable
I.;egulatory Services
Building Division
200 Main St
Flyaruus, NtA. 02601
Date:
Dear Building Inspector
Please accept this Affidavit as documentation that Cape Cod lnsulation; Inc: performed &
completed the insulation and weatherization work at the property listed below. Cape Cod
Insulation did this in accordance to the specifications listed on the building permit
application. All work has been inspected by a certified Building Performance Institute
(BPI) inspector. All work preformed meets or exceeds Federal & State Requirements.
Property Owner Property Address Village
all
Insulation Installed: Fiberglass Cellulose R-Value Restricted Uruestricted
Slopes /►'►t��!( 06 (PC) ( )
Moors
Walls
V t ,
Sincerely
He y E C• sidy J , President
Cape Cod nsillation, Inc.
1
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map Parcel 1 Application #
Health Division Date Issued
Conservation Division Application Fee
Planning Dept. Permit Fee u>
Date Definitive Plan Approved by Planning Board
Historic - OKH _ Preservation/Hyannis ( 7/l?
Project Street Address (O l,LGGt,l�
Village C444vik
Owner Address
Telephone '1 Z 5—
h.Permit Request 1 - ra'e&v
. YL14o. 0--39 ha4l'iV, 1/444 'Z
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new.
Zoning District Flood Plain Groundwater Overlay
Project Valuation Construction Type ' 14I cs +
Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family a/ Two Family ❑ Multi-Family (# units)
Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No
Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other
Basement Finished Area(sq.ft.) Basement Unfinished Area (sq
Number of Baths: Full: existing new Half: existing new,21
Number of Bedrooms: existing _news
Total Room Count (not including bath-,): existing new First Floor Room C unt
Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other
Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal s ove: ❑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 340 If yes, site plan review #
Current Use Proposed Use
._APPLICANT INFORMATION
(BUILDER OR HOMEOWNER)
Name ;6PU Telephone Number Awl
Address fm V&WAX License # /0 0 / t t
02M Home Improvement Contractor
Worker's Compensation #
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE DATE 2 3
FOR OFFICIAL USE ONLY
r -APPLICATION#
D ,
DATE ISSUED
F MAP/PARCEL N0. f �.
ADDRESS VILLAGE
OWNER -
e f ,
DATE OF INSPECTION:
FOUNDATION °
FRAME -
INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL ,
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL -
FINAL BUILDING
.^ f
r DATE CLOSED OUT -
ASSOCIATION PLAN NO. ,
_ e• rrr
Nlxssachusetts - DepartUnent pit'Public SafetN
Board of Building Regulations and standards
Construe-tion Supervisor License
Licen CS. 100988
HENRY CASSIDY
8 SHED ROW ,t
WESfT IEARMOUTH, MA 02673
Expiration: 11/11/2013
(luuuiissiuncr Tr#: 7620
��-= l.�• cvyniy�z�nc�ecr.%;f�l, a� � 1;1ac 7�1����1,�
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: 12/15/2b14 Tr# 233831
CAPE COD INSULATION, INC
HENRY CASSIDY - ---- ----- - _.
18 REARDON CIRCLE
SO. YARMOUTH, MA 02664
Update Address and return card. Marls reason for change.
(� Address ❑ Renewal lfmployment I Lost Card
.GA ,:i 2UbLU.'i�1 1
��nrnriur-rtarscxlrr rcl<r/C
_ \ Office of Consumer Affairs& Business Regulation License or registration valid for individul use only
IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
(' egistration: 153567 Type: Office of Consumer Affairs and Business Regulation
< xpiration: 12/15/2014 Private Corporation 10 Park Plaza-,Suite 5170
Boston,MA 02116
i
CAPE COD INS ULATION,':INC:,
HENRY CASSIDY
18 REARDON CIRCLE
SO..YARMOUTH, MA 02664 ------
Undersecretary of vah witho t nat re
The Commonwealth of Massachusetts Print Form
Department of Industrial Accidents ,
Office of Investigations
' I 1 Congress Street, Suite 100
f Boston, MA 02114-2017
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information f Please Print Le ibl
Narne (Business/Organization/Individual): a
Address: yd4�. e4yArbi
City/State/Gip: NVA&K1(/ WA' Phone #: J2_0 1Z 1 _
Are you an employer? Check t1le appropriate box: Type of project(required):
I.Q I am a employer with �10 4• ❑ 1 am a general contractor and 1 -
employees (full and/fir part-time).* have hired the sub-contractors 6. ❑ New construction
'.❑ I am a sole proprietor or partner-- listed on the attached sheet. 7. ❑ Remodeling
shipand have no employees' These sub-contractors have
• 8. ❑ Demolition
working for the in any capacity. employees and have workers' 9 ❑ Building addition
No workers' comp.insurance comp. insurance.
required.] 5. ❑ We area corporation and its 10.❑ Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.❑ Roof r11 e a'rs
insurance required.] .t c. 152, i;1(4), and we have no ��
employees. [No workers' ' 11 Other , rk('�I Z(,i ho
comp, insurance required.]
'Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information.
f Ilomeowners 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. Ifthe sub-contractors have employees,they must provide their workers'comp.policy number.
I ant an employer that is providing workers'compensation insurance for my employees.. Below is the policy and job site
information.
Insurance Company Natne:
Policy #or Self ins. Lic. #: UX A QO 2Vj
'/ Expiration Date:
Job Site address: l � � City/State/Zip:CIW
Attach a copy of the workers' com ensation 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
tine 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 cer f� n)ler the painsAnd enalties of er'ury that the information provided above is true and correct.
Date:. 2 /.
Phone #: ( /%
Official use only. Do not write in this area, to be completed by city or town official
City or Town: Permit/License# j
Issuing Authority (circle one):
L Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
f. Other
Contact Person: Phone#:
OWNER AUTHORIZATION FORM
(Owner's Na )
owner of the property located at
42,
Prope ddress)
1+ � � � -
,
(Property Address)
c7l '
e
hereby authorize + Cod �La� a. o j ,
(Subcontrac
an authorized subcontractor for.RISE Engineering, to act ommy behalf to obtain a building
permit and:to perform work on:my property.
-24 a::
(Owner's-Signature
'0 1 3
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map IM Parcel -'' Application #
Health Division Date Issued l4 ( l
Conservation Division w� Application Fee v
Planning Dept. ' Permit Fee
Date Definitive Plan Approved by Planning Board
Historic - OKH _ Preservation/Hyannis
Project St r et Address ,el
Village AA
Owner �arh Address Ukt,
6 �Z
Telephone''
Permit Request ii �� �� k& f' 26V
Square feet: 1 st floor: existing proposed 2nd floor: existing -proposed Total new
Zoning District Flood Plain f Groundwater Overlay
Project Valuation 56®ol ®® Construction Type .Iy lul"ll�ti
Lot Size Grandfathered: 0 Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family .1d/ Two Family ❑ Multi-Family (# units)
Age of Existing Structure Historic House: ❑Yes 8'�o On Old King's Highway: ❑Yes Cr No
Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other
Basement Finished Area (sq.ft.) Basement Unfinished Area (sq fit)! ~ " Q
Number of Baths: Full: existing new Half: existing krIp news'
Number of Bedrooms: existing _new c0 `.
Total Room Count not including baths): existing new( g ) g e First Floor Room Count
Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other
� v7
Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No
Detached garage: L) existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_
Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other:
Zoning Board of Aeals A orization ❑ Appeal # Recorded ❑
Commercial ❑Yespp No If yes, site plan review#
Current Use Proposed Use
APPLICANT INFORMATION
(BUILDER OR IIOMEOA'NER)
Name ��-' Telephone Number ed 7?5`�2f
Address License# ®�
Home Improvement Contractor# I h 3 56 Z
Worker's Compensation #
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
-tram
SIGNATURE DATE U Z
} . .
\ f
* ` : FOR OFFICIAL USE ONLY
\ :
/ APPLICATION#
} ! !DA}E ISSUED
/ -MAP/PARC L O.».
}
ADDRESS VILLAGE. . . _ y
$ 2 .
{ . OWNER
( .
! .
} . DATE OF INSPECTION:
\ , .
{ FOUNDA$I§Ly _
\ � . _ � . . . . . .
FRAME
} . . .
[ w W&ULAT ON2a a
FIREPLACE
k ELECTRICAL: ROUGH FINAL . . .
fPLUMBING: ROUGH FINAL `
\ .
FINAL--GAS: ROUGH
C� a, r�a; „ �
\ . ,FINAL BUILDING c� : . ,may„
, .
\ cDATE.CLOSED OUT' -
ASSOCIATION PLAN NO. •
\ . .
f -
The Commonwealth of Massachusetts
c .Department of Industrial Accidents
Office,of Investigations
1"
600 Washington Street
t l Boston, MA 02111
wwl-u.rn ass.go v/dia
Workers' Compensation insurance Affidavit: Builders/Contractors/Electl-icians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): � 0,71
Address: r
City/State/Zip: 3 Phone M so ? 7
Are you an employer? Checic th appropriate box: Type of project(required):
1.[ } I am a employer with��_ 4, ❑ I am a general contractor and I 6. ❑New construction
eiiiployees(full and/or putt-time). have hired the sub-contractors..
❑
listed on the attached sheet. 7. ❑ Remodeling
2. I azn a sole proprietor.or partner-
ship and have no employees These sub-contractors have g, � Demolition
working for me in any capacity. employees and have workers' q Building addition
[No workers' comp. insurance comp. insurance.
S. We are a corporation and its 10.❑Electrical repairs or additions
required.]
3.F1 I am a bomeowner.doing all work
officers have exercised their 1 1.❑ Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs
insurance required.] t c. 152,`§1(4),and we have no
employees.jNo workers
13.❑ Other 612eg.1 Al2At 104
comp:insurance requued j .
"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.
lContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
cmployccs. If.thc 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, Li;c. (,�)��Q O(� 'Zs O Expiration Date:
City/State/zip. Ilte m14 PA 7,
Job Site Address: _
Attach a copy of the.workers' compensation policy declaration page (showing the policy numUer 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,
pa' and penalties of perjury that the information provided above is true andcorrect.
I.do hereby certify it e
e: - D
Signature: Dat
l CL
Phone#:
Official use only.;Do�not write,in this.area., to be completed by city-or towii officigl e
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#:
. .. .•.• :Ki�q rt l'S..k hL'd
Vv,
Client#'. 4597 Aco 1 CERTIFIC CCINSOL
ATE OF LIABILITY INSUI NC17 OAII tYMIbUIYY Y,I
1Ii1S 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 Arz
DDITIONAL INSURED,the and cond{lions policy(ies)must UI:endorsed.If SUEIROGATION IS WAIVED,subject to
the ter'rriu of lhr,policy, Certain policies may require an andorsament.A statement on this certificate does not confer rights tp the
cclUilcat"hold".in lieu Of SUCK endorsement(s).
r)an)ucek
Royura a Gray Ins. Su. Dennia CUNrAc
Margaret Young
;31 Ruutc 134
508-760-4602
HA ._�FA -
C'N� 508 258 102
E IL — S— _ I_—.__ _
N i) box 1601 ADDRess youngma@rpgersgray'COIn
�uutttUennls. NIA 02660-160'1 PROIIIICE — >_---
CUSfOM�E H ID 8:
R 12 __ NAI q
INSURES)AFF001NG CDVkf2AGLi
Cape Cod Insulation Ir1C INSURER A:Peerless Insurance _ _._.0_ _
INSURSRB:Ohio Casualty Insurance Company
18333
4�5 Yarmouth Road _
Hyannis, IVIA 02601 INSURER CI Atlantic Charter Insurance -- —�—`
INSUftERo'.Commerce Insurance Company
- INSUtttR E'. .a
i:UVEI<A(TcJ ,INSURERP: ."—"""'
CERTIFICATE NUMBER: REVISION NUMBER:
`;I`:I'i)laFt f1:=1' rl-iAT l'I-iE pOLiC•IES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE PQLiGY PERITo
uh:.'ilc:7 IVUI Yv1 Qi,,l KNDIING ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACTOR O'rHER DOCUMENT WITH RESPECT TO WHICH THIS
IIrIi;ATt MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
is l..LUSICIW-AND CONDI PIONS OF SUCH POLICIES.LIMIT
AS S SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
R
1IN _II PE OF INSuttANuts OLICYEf+ POLICY l=)(P SR D POLICY NUMBCR MMIOU/YYYI M LIUOIYYYY LIIN115
A VtNE11`11.I ILJrY
CBP8263063 OVID112011 04/011201 en'ri ot,hUwtNC(- $1,000 000'.
X ,uhu11C \ u vt(Nt(Q,L Llrlttll.I iy UAMAGETO RENTED
PRCMI9L a orowwwl _ a'100�000-_--
'
' • mEU tahP(NIY OIIq pottionj $5.000
—
` PERSONA4tI,r'.OVINJURY $1,000,000
GENERAL AGGREGATE yZ,DQQ,QQQ
I 'hEl AI F lhl1
n�ooucfs a-2,000,000 —
r'\'I t'•r - LOG --
S
D IAulorti)Bu.I uABLnY 11MMBCKVMK 04/01/2011 04J01)201'2 COMBINED SINGLE LIMIT
lN' ri111C1 .. (Ea aGG4Jni) 1�Q00 QQQ
I it `:wvLD AUTOS I BODILY INJURY pr,a-r
�__A 7i:'PR•Ut1..t;U AV I'Og _ BODILY INJURY(I ar uu.W4nl) $ ^--
as PROPERTY DAMAGE ^��---
VX NON --
r ...__..__ ......_
B urmntLLA uAb X Occ�l; 0001254514645 41Q112011 041011201 EACI-I_ 0CCURRr'NC(- 0 0Q0 OOQ
' .
... -. '_ AGGRECA1C $1 __
. OQQ,Q00
.
I Alto-lrrn�nly 10DU0 - ,
C NUHY.LIi5 CUhIPENSATION � �'
Arb ENIrLGYERS UAt3ILn'Y - WCA00525902 - 6/3012011 06/30/201 2 X 4Y�YTATU- OTH
Nvl i'RUI'ti t l OH/PAR I NEV2/t:AkCUTIVE YIN S-
.'rrn;twn+l-nlpER Exr:Lugt;O? N NIA « - F L.EACH ACCIDENT- .` 1;500'000
If ,-----
I..4acutury In NN) .. "._ .
wo u0amoor EJJ-DIStA,—EAI°MPLCIY[E $50Q 000
III ,'File rlt HV i t i)PEHATIi)Nti' elnw - --._—. ,._
E.I..DISEASI=•POLICY unan $500,000
u aCn)rlluN Ur UrtrtAI'IUNS 1 LUCATIUNa I VEHICLES(Attach ACORD Itl1,Additional Rerni;ms Scriadula,a Moro spacr is rpquircd)
Workbrs Comp Information Ihclu Officers Or Proprietors
(Sea Attached Oast riptians)
CERTIFICATE HOLDER CANCELLATION 10 Day s for Non-Payment
SHOULD ANY OF THE ABOVE DESCRIBED POLICIFS BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH•THE POLICY PRO
S' VISIONS.
_
AUTHORI:.ED REPRESENTATIVE -
�_ ✓ACO A01988-20o9 ACQRD CORPORATION.All rights ieserved,
(tD (Y00 I68 1 of 2 Tha ACORD name and logo are registered marks of ACORD
1tb68575/NI68179
MEY
fowl
C � C
10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement"Ctractor Registration,,
5 Registration 153567
Type: Private Corporation
Expiration: 12/15/2012 Tr# 206433
CAPE COD INSULATION, INC � ��
HENRY CASSIDY
455 YARMOUTH RD. 4 FF t
HYANNIS; MA 02601
pdate Address and return card.Mark reason for change.
b y 4 i Address Renewal .,Employment Lost Card
DPS-CAI %r 50M-04/04-G101216
Office mer Affairs us ne ReguI tion License or registration valid for individu!use cn!;
R &QNfffft& before the expiration date. If found return to:
Registration: 153567 Type: Office of Consumer Affairs and Business Regulation
Expiration: 2/15/2012 Private Corporation .. 10 Park Plaza-Suite 5170
Boston,MA 02116
D INSULATION`INC .,
Vio
a
HENRY CASSIDYf
455 YARMOUTH
HYANNIS,MA 02607 t s. Undersecretary' t alia ith t si ture
Mitssachusetts- Department of Public Satoh
Board of Building Regulations and Standards
Construction Supervisor License
License: CS 100988
HENRY CASSIDY ..
- 8 SHED ROWS;;:
WEST YARMOUTH,,MA 02673
Expiration: 11/11/2013 "
('rrnmrisiuner' Tr##: 7620
�.
OWNER AUTHORIZATION-FORM_
(Owner's Name) y
owner of the property located at 1
y l
(Property Addre )
(Property Address)
hereb Y authorize UA /o( 'YN
Su ntractor
an authorized subcontractor for RISE Engineering,to act on my behalf to obtain a building
permit and to perform work on my property.
i
Owner's Signature -
Date
' ^
r���]����,7�T �l&�� �� �� r�� �� �� l� �7
' TOWN�� l`� �-��� BARN STABLE,
]� ^����� ]����|,
.' `
SAUSTABLL
-
'
' BUILDING
INSPECTOR
��NN0 �~�� 0 �� ��-- - -- ~~
-- _ - `
TYPE OF CONSTRUCTION
TO THE INSPECTOR OF BUILDI�GS:
The undersigned hereby applies for o permit according to the followin ion:
Location '--.�°..��./—.. — —_----. ........ ----------
°�
Proposed Use --��..���Q--.. -----------..----.'------^---------`-----
Zoning District --- -..-----------..Fivo District --'
NompofOwner --. " ----'Address
' —^��y� .
... ............k....��e
Nome of Builder —.� —��� ----.Ad6rex _—'—.--_-------------.--------
ol
Name of Architect —1 . --.V —'----'AJdre» ................ . ---
Nvm6er of Rooms ......--------------------Foon6o/i -----.
^
Emerio, ' --------------'Ronfing — ..................................
Floors —. ---- . ------.|nte,ior —
Heating ������—&��������.r =�����...................... ...Plumbing .................... .��.--_--___________
~
Rnep|oco ------------.�--------------'/\pproximo�p Cos ..'�7.^^..� —.�...................................
_.
DhGnNve Plan Approved by Planning Board l9--------.
Diagram of Lot and Building with Dimensions � ������ �� x-0
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| hereby agree to conform to all the Rules and Regulations of the Town of
' Barnstable regarding the above
construction.
Nome . ._�]..
o-
/ ' '
Renzi, Carlo
. '
No ...lll44 . Permit ..������—&---..�����.. �
b reozen«ay_____,.,____,_..~__..
681 Bay Lane
'
_.____..
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�u _
Centerville
`
----.--.------------------... �
Carlo Ieocol
Owner ..................................................................
'
�ra�o
Type uf [ono�uc�on --------------
,
.
----'—^---^-----'-----------'
�
Plot �� '
---''-----'' --'-------' |
�
| � '
I Permit Gran*e6 .........Ju]Y..3..................lg Av
. } �
Date of Inspection ..|v ,
x�
Dote Completed —.������.=-----.]g�^�
| �
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' PERMIT
�REFUSED
/
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----'`-----~---------''
.......................................
--_----_..—.—`-------.—~.---..
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'----^^^--'---~--~--~—^^—'~--' `
.-----...--------..--..—..~---..'
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Approved .......................................... lV
' . .
----~---------------~~~^—`—
_________________.._. ,. i |
—~—. —.—.,
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