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HomeMy WebLinkAbout0195 KNOTTY PINE LANE v` � ��.� .. �� � ©. �� �. �i�a Ze. .. _ - �_ f ., �.. H. � ,. P 0 0 _. e ��.6 e � e f 2foh 10 )1',- 6, A Town of Barnstable *Permit � arti Expires 6 months fr m d to Q Regulatory Services Fee BAIMTABLE, + _ 9� MASS' p Richard V.Scali,Director ' 163% ® TO Building Division g SAP���12 `Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601rn C7 `� www.town.bastable.ma.us Office ��\\8b2-4 038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number v` Property Address �.S /� ��'NQ �a C G ( t l.L ❑Residential Value of Work$ 0/qoj Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address keWrl I3fow/1 / S' knolk Dine 1a+t Contractor's Name Awk /Vlodww Telephone Number Jv D b U -o`sv Home Improvement Contractor License#(if applicable) V S7GyJ Email: Zorkman's n Supervisor's License#(if applicable) A b 61t Compensation Insurance Check one: ❑ I am sole proprietor ❑ m the Homeowner I have Worker's Compensation Insurance Insurance Company Name 8iill-1 sVl LA / Workman'sComp.Policy# Z D SdQ " tot -ZV --q b" Copy of Insurance Compliance Certificate must accompany each permit. Permit Requ (check box) Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to CC gAvzvp ef�O�Lo Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) `e ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows �. 0. #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: (je,q oqired.' er must sign Property Owner Letter of Permission. c Home Improvement Contractors License&Construction Supervisors License is SIGNATURE: (z' C:\Users\Decollik\AppDataU,ocal\Ivlicrosoft\Windows\Temporary Internet Files\Content.OUtlook\2PI01 DHR\EXPRESS.doc Revised 040215 I�— f POWER-1 OP ID:EL ACORO" CERTIFICATE OF LIABILITY INSURANCE D (MMIDD/YYYY) 09 /11/2015 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 Lacher&Associates Ins Agency NAME` Lacher Insurance Group 9 y IHO No Ex :215-723-4378 FAX No: 215-723-8604 632 E Broad St P O Box 64398 EMAIL Souderton,PA 18964 ADDRESS: Chad Lacher INSURERS AFFORDING COVERAGE NAIC# INSURERA:Harleysville Preferred Ins.Co 35696 INSURED Power Home Remodeling Group, INSURER B,Harleysville Worcester Ins Co 26182 LLC INSURER c:Nationwide Mutual Ins Company 23787 2601 Seaport Drive Ste B110 Chester,PA 19013 -INSURER D:Pennsylvania Manufacturers 12262 . INSURER E: - .. .. INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP - LTR .POLICY NUMBER MM/DDIYYYY) IMM/DDNYYYJ LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS-MADE Fx-1 OCCUR MOA00000089793N 10/01/2015 10/01/2016 PREM SES Ea occurrence) $ 1,000,000 MED EXP(Any one person) $ 15,00 PERSONAL&ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 POLICY� PRO ❑ " JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY EOM�B�NdEDtSINGLE LIMIT $ 1,000,00 B X ANY AUTO BA00000089796N 1 010112 01 5 '10101/2016 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident)AUTOS AUTOS ( ) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAB X OCCUR - EACH OCCURRENCE $ - 5,000,00 C X EXCESS LIAB CLAIMS-MADE CMB00000089794N 16/01/2015 10/01/2016 AGGREGATE $ 5,000,00 DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N X STATUTE ER D ANY PROPRIETOR/PARTNER/EXECUTIVE 201500-66-20-96-7 10/01/2015 10/01/2016 E.L.EACH ACCIDENT $ 1,000,00 OFFICER/MEMBER EXCLUDED? Ff] NIA, - (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,00 If yes,describe under DESCRIPTION OF OPERATIONS belowE.L.DISEASE-POLICY LIMIT $ 1,000,00 B Mass Auto BA 00000018227P 10/01/2015 10/01/2016 Auto Liab 1,000,00 B NY Auto BA 00000074849R 10/01/2015 1 010112 01 6 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) - CERTIFICATE HOLDER CANCELLATION BARNSTA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of Barnstable 200 Main St AUTHORIZED REPRESENTATIVE - Hyannis,MA 02601 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD about:blank F , • Nabonal Heamutlttirs - SandtaCrowell and gcv�)df;wn 2501 Seaport Drive,orvauer,PA 10013 it-02= eae•73e$335 R'3f13e'2da 1 WWW.POWERHRG.COM y ;w3lnGfs:Welq ;•�- CUSTOM REMODELING AND IMPROVEMENT AGREEMENT BUY"*)'Information and Description of the Propertyt Project Number:81-92538 AAsroh Z&2016 Sandra Crowell t>dau i(evin Brown ( )73i 4329 tS{indro s colq kgbsactt)114i1inrlLtcrrl 195 Knotty Pine Lone (tWe)TBtI t06(Homo) c ' Centemilo,MA.02632 ,..(50)241-00"ftvin Is COP) r) , County:Barnstable 6U I/ /u(/ C�� Township: 3 I Buyer(s)listed above hereby jointly and severally agrees.to purchase the goods and/or-services of Power Horne Rernodaling Group and Its vendors(Contractor)in accordance with the paces and terms described itn this 6 page document and ttw Product Specifications,which are incorporated as part of the Agreement(collectively,this"Agreeme01: This Agreement represents a cash sate of goods and services. 8uyet{s)agrees to pay the-t,•pst of the goods and servicres purchased as described herein;regaidtess of timing or approval of any financing Buyer(s)may,saek for their purchase-' Purchase Pr-e: $91M.85 ' °_ Pie lnstaltation In60t lion Aattss: Down Payment: s.0.007tiu Orr beiwearl0 30a and rtooa Balance Due on ' r ' Estimated Project Start:3 to 4 weeks $9,258:05 Substantial Completion: . Estimated Project-Completion;t'to 2 flays Method of Payment: Other eWW6);Adaawieti9e uun a dtsfktltc stint an f COMOWW dates am NM of the mane.'Delays i 6wacmt1s mntrot not inckWedin cakuwIng-tnta tames.$ae OttlgyAMhnwm Ccneitlon� euyer(s)hereby acknowledges receipt of a copy of'the pamphlet,'The Lead-Safe Certified Guide to Renovate Right";inforining Buyer(s)of the potential risk of lead hazard exposure from renovation activity to be performed to or at 8uyer(s)'Property,at the adOress written above.Buyer(s)received this pamphlet on the.date of this Agreement;before commencement of work. , Buyer(s)'Initials. This Agreement constitutes the entire agreement and understanding between?the parties,and this Agreement replaces'any and'ell prior negotiations.representations,or agreements,either written oi.o*a No amendment;,modification or waiver of this Agreement shall be valid or effective unless to writing and signed by both parties. Buyers)hereby acknowledges that Buyer{s)1)_has read the . entire Agreement and has received a completed,signed',and"dated copy of this Agreement,°including the two ecoompaitytng Notice ior of Cancellation forms,omthe°date first written above and 2)was orally irtmed of hisTherrigM to canesl vita transaction.; Buyer(s)also agrees and understands that ff Buyer(s)finances the work with a third-party,the terms of that'financing will be contained on se rate pa documents,including any finance dlarge Future;promotions not applicable, 1 DO NOT SIGN THIS AGREEMENT IF THERE ARE ANY.BLANK SPACES *w< • ' �' ' „� *�4� �s� its��ro� tr � M r ^. II i } t 1!taws read and receivetl each page of this 6 page agresreeM,.; Power Hotfi'e�emodelldg Group• Buyer(s){°' ' Buyer(O • Signature of Remodeling Consultant, Signature Signature - Steven Baillargeon -Sa4dra Cratrelly„ -k = Kevin Brown.' YOU,THE BUYER(S),MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO,MIDNIG1 T O.F THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION. SEETHE ATTACHED NOTICE OF.CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT March 26,2016 1134 - : �III �U� I[� IUI i `Page 1 oft! 1 of 1 4/6/2016 1:08 PM i K° 9a:a.;x advaext,!aa:-d".rir r��•B�xF`resa�gd.,H"'t's ,1}F:@ Of Ct16TSi.Bn@P Aff:SFPS 641 Business]R@n[2Y1Qi�n License or i registr'atiorY valid for emdividu[use orFib i GfIE IMPROVENEN7 CONTRACTOR before the cipiration elate. If found return to: Registration: 165056 Off'sce of Consumer Affairs and Business Regulation s yet.," 10 F2F Fa2a-Suite 5170 ~ Expiration-. 31'EJ207 Sugplemeni :ard t Bo-"o19 A-0116 PCVJER HOME REMODEUNG CROUP LLC. � r s d MARK MCTRDINI 2501.SEAPORT DRIVE STE B1 10 CHESTER,PA 19013 11 �r� �derse@s@a�Ty 10ot valid without signature Wassachusetts Department of Public SaT$ety BvVmoard ti#Bu ldir ugg Regulations and Standards License.CS-057645 ; Construction Supervisor a p' MARK E MORDINR` r' 18 NEWELL DR � N!ATTLE>BOfft� :r I Expiration: Commissioner 0911812,017 _ � �: . �\ The Commonwealth of Massachusetts C �J Department/of lndustriadAccidents 1 Congress Street, Suite 100 ' Boston,MA 02114-2017 www mass.gov/dia 'Workers'Cornpensation Insurance Affidavit:Builders/Contraetors/Electrici�ns/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. ' A j3plicant Information Please Print Leaibh Name(Business/Organization/Individual):Power Home Remodeling Group Address:2501 Seaport Drive City/State/Zip:Chester PA 1913 Phone#:508-280-0156 Are you an employer?Check the appropriate box: Type of project(required): 1.Q 1 am s employer with 15 employees(full wworpan-time).0 7. New construction 2.[31 am a sole propnetor or partnership and have no employees working for me in $. Remodeling any capacity.[No workers`comp.insurance required.] 3.[:]1 am a homeowner doing all work myseL.[No workers'comp.insurance required.]r 9. ❑Demolition 4.0 1 am a honremvner and evil]be hiring mnnactors to conduct all work on my property. I will 10[]Building addition ensue that all contractors either have workers•compensation insurance or are sole I I.Q Electrical repairs or additions Proprietors with no employees 12.❑Plumbing repairs or additions 5.❑1 am a general contractor and I have hired the sub-contractors listed on the attached sheet-' 13.❑Roof repairs These subcontractors have employees and have workers'comp.insurance.: . 6,❑we area corporation and its officers have exercised their right of exemption per.MGL c. 14.❑Other 152,§1(4),and we have Ito employees.[No workers'comp.insurance required.) *Any applicant that checks box 41 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. 1Contractors 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 ant an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:Harleysville Worcester Insurance Company Policy#or Self-ins.Lic.»;201500-66-20-96-7 ) Expiration Date:1011/2016 ? Job Site Address: AO /the /49 CitylState'Zip: *i� Ile aa�✓� Attach a copy of the workers'compeagation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punisbable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verifi 'on. I do hereby u r e poi led penalties of perjury that the informatiom provided above Is true and correct. Signature: Date: Phone#:508-280-0156 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 S.Plumbing Inspector 6.Other Contact Person: Phone#: Auto Detailing Appointments I Cape Maintenance Page 1 of 1 Cape Maintenance - Automotive Detailing Services (508) 292-9358 A Higher Level In Auto Detailing Service — •��, :�I"�-AND SERVICE AREA AUTO DETAILING APPOINTMENTS Falmouth to Truro Area of Detailing service. Call 508 292-9358 Today to Schedule Your Next Auto Detailing Service with d r Cape Maintenance Auto Detailing... }'. r a !. You can also fill out our easy contact form: Interest Luxury Wash I "Thank you for your Name« - interest in Cape f Robin Anderson .-_._,_ !. Maintenance Auto _ - E-Mall Address Detailing" obin anderson@town.bamstbale.ma us _ - Phone Further Information:.*,� I have received a complaint about the sign) Front of the-property located at 195-Knotty Pine- _ "Lane This•is_a single family residential area.1. a ou may not_advertise a business at this locatioUZI '., nor perform detailing Services here. Please call F'` Submit Completed Form W.Kyle Axtell Sr.(Owner) Home Luxury Wash Express Detailing Complete Reconditioning About Us Gift Certificates Contact Us Cape Cod Auto Detailing -Servicing Cape Cod- Cape Maintenance Auto Detailing Services On-Location Barnstable*Osterville*Centerville«Dennis*Chatham Orleans Social Networking Connections Leather Cleaning/Conditioning r Cape Maintenance Auto Headlight Lens Restoration Detailing Service = Buffing/Wef-Sanding .�.° 9 Auto Reconditioning eA Higher Level in Auto Maintenance Wash "z" Detalhngrr r� Hand Wash&Wax • Linked. Ysg ,,,,� W.Kyle Axtell Sr.(Owner) Carpet Cleaning Unit H-5,1815 Falmouth Rd. Touch Up Paint { Centerville,MA.02632 Stereo Installation Monday-Saturday Home I All Rights Reserved® 2010 AxtellArt - We are proud to provide the following services: Auto Detailing,Car Detailing,Auto Cleaning,Car Cleaning,Mobile Auto Car Cleaning,Car Waxing,Car Buffing,Car Polishing,Car Compounding,Paint Sealant,Vehicle Protection,Mobile Detailing,Car Carpet Cleaning Steam Cleaning,Seat Shampoo,Steam Cleaning, Stain Removal,Floor Matt shampoo,Full Detail,Mini Detail,Car Wash,Mobile Car Wash,Tar Removal,Overspray removal,wheel cleaning,Swirt Mark Removal,tree.sap removal,leather cleaning,leather conditioning,pet hair dog cat removal,fabric protection,Mobile • Detailing,Detail,Interior Detailing,Exterior Detailing,Light Medium Scratch Removal,Odor Removal. 1 http://www.capemaintenance.com/schedule-detailing-service-at-home.php 7/13/2012 Cape Maintenance Auto Detailing Info Car Cleaning Cape Cod Page 1 of 1 Cape Maintenance - Automotive Detailing Services (5m) 292-9358 A Higher Level In Auto Detailing Service ' '�' _ • �- • SERVICE AREA CAPE COD'S PREMIER AUTO DETAILING COMPANY Falmouth to Truro 'd Area of Detailing Service. z < Complete Auto Detailing & Reconditioning Services Locally on Cape Cod.. Cape Maintenance Auto Detailing Information �Cape:Maintenance is based in.Centerville,MA and:ready to service any make or model:fcdm Falmouth3o Truro I� _ - Y .� �have;over a decade in experience detailing cars trudks�suvs'motorcycles'and.boats My'backgfound ih the •'; glassarade,_dealerships;and:previous mobile.delailing company,',The Automolrve Appearance Company puts-- �< �, us-a rtotch abovelhe rest.More impodantly I love what I do.Call today and treat yourselfbr a loved arse to the= +� highest level m-auto detailing-service:-Save hmeand�money withCape Mainteriance.`��" � c o W.Kyle Axtell Sr.(Owner) Home Luxury Wash Express Detailing' Complete Reconditioning About Us Gift Certificates • Contact Us Cape Cod Auto Detailing Servicing Cape Cod- Cape Maintenance Auto Detailing Services On-Location Barnstable*Osterville*Centerville*Dennis*Chatham*Orleans Social Networking Connections Leather Cleaning/Conditioning Cape Maintenance Auto Headlight Lens Restoration 6utrng/Wet-sanding Detailing Service Auto Reconditioning "A Higher Level in Auto ' Maintenance Wash Detailing" Hand Wash&Wax - - i, W.Kyle Axtell Sr.(Owner) L'n ® yotiRiJdv Carpet Cleaning �! Unit H-5,1815 Falmouth Rd. Touch Up Paint Centerville,MA.02632 Stereo Installation Monday-Saturday Home I All Rights Reserved® 2010 AxtellArt http://www.capemaintenance.com/mobile-detailing-cape-cod.php 7/13/2012 r. a 2 July 9, 2012 Dear Ms.Anderson, As a resident of Knotty Pine Lane in Center¢ill I pass by the house on 195 Knott y_Pine_Lane,frequently and have noticed that most recently, a sign on their lawn advertising maintenance and car detailing services. Before the most recent sign, there was another one for Dan Brown—Handyman Services that was there for approximately one year. As a resident, I do not want to look at commercial signs in my neighborhood and have found out that they are not, permitted in residential areas. I know that people have to make a living, and hate to complain but it is an annoyance. I wish to remain anonymous and hope that you can send a message to the people living there that if they wish to run a business to do it in an area zoned for such. Thank you for listening. A10 ; ? r If i Fri t gas' 5} LLlf7 21 01 Robin Anderson Zoning Enforcement Officer 200 Main St. . Hyannis, MA 02601 �.. i \ / `�. i _,- . ''� •� \ i \\ �-: -, Town of Barnstable *Permit# 2-- Expires 6 months from issue date , (vim Regulatory Services Fee o Thomas F.Geiler,Director Building Division .;vq 7 Tom Perry,CBO, Building Commissioner Lg 200 Main Street,Hyannis,MA 02601 . www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY L� gip' Not Yalid-vithout Red X-Press Imprint ap/parcel Number operty Address �l'Y O `,� �1 N N �� . C60 r-k y i U E esidential Value of Work 00O Minimum fee of$25.00 for work under$6000.00 wam's Name&Address SA 02 490 Cf 0 yyr 4 L, 9 5 )",la7Tv l', �, CiN7-FtRvJ 1/6 ontractor's Name D b 0 S—T S a i ki S Telephone Number OZ,-3G,2-2-1$'/Q .ome Improvement Contractor License#(if applicable) Q c! S� 'sor`s->rit; -rl`a iieabie- li 7sastiu�ti�'�pervi �• FP ) . ..... �Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ am the Homeowner I have Worker's Compensation Insurance asurance Company Name Ge a tj i J STAR, -TivS U EANGt �0 Vorkman's Comp.Policy#_ \jj c, 279 -5'3 "S y ;opy of Insurance Compliance Certificate must be on file. .ermit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) 2'<e-side ❑*Replacement Windows/doors/sliders. U-Value (maxi?nurn.44) 'Where required: issuance of this permit does not exempt compliance with other town departmentregulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property.Owner.Letter of Permission. A copy of the Home Improvement Contractors License is required. ;IGNATLTRE: 1:Forms:expmtrg .evise061306 OP ID S DATE(MM/DDIYYYY) ACORD CERTIFICATE OF LIABILITY INSURANCE SPRIR03 04 24 07 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HUB International New England HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 437 Station Ave ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. So.Yarmouth MA 02664 Phone: 508-394-0946 Fax:508-760-1407 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: National Grange Mutual Ins. Co INSURER B: Robert J. Springer INSURERC: 75 Indian Pond Road INSURER D: W Dennis MA 02670 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY EFFECTIVE POLICY EXPIRATION LTR INSR TYPE OF INSURANCE POLICY NUMBER DATE MM/DD/YY DATE MM/DD/YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 300000 A X COMMERCIAL GENERAL LIABILITY MPS13411 05/19/06 05/19/07 PREMISES(Ea occurence) $500000 CLAIMS MADE OCCUR MED EXP(Any one person) $ 10000 PERSONAL&ADV INJURY $300000 GENERAL AGGREGATE $ 600000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ 600000 POLICY PROJECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ TH- WORKERS COMPENSATION AND TORY LIMITS ER EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Workers compensation coverage in place- certificate to come directly from carrier. CERTIFICATE HOLDER CANCELLATION ------1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Town of Barnstable IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 200 Main Street Hyannis MA 02601 REPRESENTATIVES. AU D RE TA ACORD 25(2001/08) ©ACORD CORPORATION 1988 �FZHE, y Town of Barnstable Regulatory Services 9B''R'V ssU �� ' ns $ Thomas F.Geiler,Director ATfD MA'S A' Building]Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A.Builder I, S ft"C1-'Q'-4 CROW e l t , as Owner of the subject property hereby authorize � r',r-S R)Nam,F P- to act on my behalf, in all matters relative to.work authorized by this building permit application for: .. (Address of Job) �y D Signature of Owner - _ ate Print Name Q TO RM S:0 W NERP ERM IS S ION BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 003262 �G 7. Ekpires:07/29/2007 Tr.no: 14260 Restricted: 00 ROBERT J SPRINGER` 75 INDIAN POND RD G— W DENNIS, MA 02670 Commissioner ✓1ze �om�reanuecrl',l� a��[�LaaArcfeudelL .f , _ Board of:;,:II,Iiag License or registration valid for individul use oniy HOME IM1IPR.CV[MENT COdTR. '•. `'�".i before the expiration date. If found return to: ! Board of Building Regulations and Standards Registration: 109258 One Ashburton Place Rm 1301 Expiration: 9/8/2006 Boston,Ma.02108 Type: Individual t RC'.,ERT J.SPRINGER { i f3cuart Springer 75 Indian Pond RdLallidw'�6olut's Va'.Dennis,MA 02670 ,r. Not nature .---------- _._ I the c,'ommonweauh olmassachusens Department of Industrial Accidents _ Office of Investigations . ?: d 600 Washington Street Boston,MA 02111 www.mass.gov/dia ' Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information cc�� Please Print Leeibly Name(Business/Organizationadividual): . �o bE6,r Z-gm FS J,m I gtr'i•M Address: d I"anet nog City/State/Zip: VV. DtN^7/5 �►9 Phone:#: 50 fS I Are you an employer? Check the'appropriate boa: Type of project(required):. . 1.Q I am a employer with � 4. � I am a general contractor and I 'employees (full and/or part-time).* have hired the sub contractors 6. ❑New construction . 2.L I am a'sole proprietor or partner- listed on the-attached sheet. 7. ❑Remodeling ship md,hive no employees These sub-contractors have g, Demolition working for me in any capacity. employees and have workers' 9. []Building addition [No workers' comp,insurance comp.insurance. ' d.uire req ] 5. Vve are a corporation and its 10.0 Electrical repairs or additions officers have exercised their 3.❑ I am a homeowner doing.all work 11.❑Plumbing repairs or additions myself. o workers' co right of exemption per MGL Y � �• - 12.❑Roof repairs § insurance required.]t c 152. , 1(4),and we have no . 13: ner S'1 cU n •�- Q�e . employees. [No workers' 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 anew a$idavitindicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether ornot 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: �(Zf}i,1��� J� t3� tJS+12w1►�/CC Cp Policy#or Self-ins.Lic,#:_ .SL} Expiration Date: i O 0 7 lob Site Address: 19S- ?�N.o-► i 191 Ner O?d City/State/Zip:_ C7?UTt R%J 196, i/Y69 0LXZ,-,- Attach a copy of the workers' compensation policy declaration page'(showing the policy number and expiration date). Failurejo. 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 maybe forwarded to the OfFi ce of Investigations of the DIA£or insurance coverage verification. I-do hereby certify under the pains and penalties of perjury that the information provided above is true and.correct, Si afore: Date: 4_q, Phone##: 5-dr 91 FOther only,. Do not write in this area, to be completed by city or town offrciaL n: PermitlLicense# hority(circle one): II Health 2.Building Department 3. City/Town CIerk 4.Electrical Inspector 5,Plumbing Inspector rson: Phone#: ,N t 11 e ao d,v c s.- Corn p r9-go N 1+j 011)5 r Information' and Instr°ucti®ns y 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 =eeei:y=or=.tee•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 be an employer." MCTL chapter 152, §25C(6)also states that"every state or.Iocal 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 complizrice with the in.�nce 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-cont=actor(s)name(s),address(es)and phone number(s) along with their certificate(s)of insurance. Limited Liability Companies'(LLC)of 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. B.e 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-of-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"lob Site Address"the applicant should write"all•locatious'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 bum 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: Tbe,CozmouwWth of Mazsach=tts Depa_rtmmt of Mustrial Aoci.d nts Office of In-ves ga ons • ��Q�'ashi��o.� �tr�et Boston,MA G-2111 Tel, #617-727-00.()ext 406 ar 1-977-MASSAFB Revised 11-2206- Fax-4 617-727-7`-4R • wvw.mass.gov/dia . Results Page 1 of 1 Home Improvement Contractor Look Up Enter Search terms separated by spaces. Search terms can be Town/City,Name, or License number Select Search type: (F�, AND C) OR Search Search Results Reg. No. Applicant Street ICity State Zip Name Title Expiration 109256 ROBERT J. SPRINGER 75 Indian Pond Rd W. Dennis®02670 Springer, Robert Owner 9/8/2008 Total of 1 Records matched. Back to Home Page BBRS Privacy Statement http://db.state.ma.us/bbrs/hic.pl t; '' 4/24/2007 Y f� Town of Barnstable THE Regulatory Services pU Tp� 'bo Thomas F.Geiler,Director Building Division EAMSTABM i v� MASS. ,erg Tom Perry,Building Commissioner 039. '•rFp p�p2l A 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Approved: I Fee: c5 D Permit#: HOME OCCUPATION REGISTRATION Date: V- , 2 lG \ OL4— Name: Lt')-mu=AN. Phone#:ac)s) �O-�CoRfp Address: �� ��No'�Y �z�1� �3J_ Village: Name of Business: Type of Business: CTPmL_k.M Map/Lot: 1 -1 I ® °J K. INTENT: 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 t 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 400 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 is 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. • Ifthe 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 a ee with the above restrictions for my home occupation I am registering. Applicant: _ Date: /'1/W /mil C Homeoc.doc Rev.5/30/03 TO ALL NEW BUSINESS OWNERS DATE: gag, 19�%O`� 3 Fill in please: APPLICANT'S YOUR NAME: z��p� BUSINESS YOUR HOME ADDRESS: I-q5 , ©cam CTELEPHONE Telephone Number Home S NAME OF NEW BUSINESS T trsanl.co-['zvt Ate' TYPE OF BUSINESS hk0z� o IHIS A HOME OCCUPATION? YES S T 1 NO Have you been given approval from the builtlmg drvision� YES NO 63� q13 RESS OF BUSINESS; 145 K�►a ~ram 5' 1 � vt G ' MAP/PARCEL IV_UMBER 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. Once you have obtained the required signatures, listed below, you may apply for a business certificate at the Town Clerk's Office (Ist floor- Town Hall) or if you get the business certificate first you MUST go to the following office to make sure you have all the required permits and licenses.. GO TO 200 Main St. — (corner of Yarmouth Rd. & Main Street) and you will find the following offices: 1. BUILDING COMMISSIONER'S OFFICE This individual been i o med of any permit requirements that pertain to this type of business. yrAUihorized Signatu COMMENTS: 2. BOAR OF HEALTH 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"k"k COMMENTS: Business certificates (cost $30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in the town (which you must do by M.G.L. - it does not give you permission to operate -you must get that through completion of the processes from the various departments involved. "SIGNIFIES APPROVAL FOR A BUSINESS CERTIFICATE ONLY. i Assessor's rfiap and lot number ..f.9�. .... :./ ..., : FT E�' CP Sewage Permit number .Q.� ...[. .......................................' 4 / 9� // i_' 13ARNSTAM LE.O ................ C.� X49 MA88 House n tuber ..................... �t"1 4Tgs 'oco,i639. TOWN OF BARN-STN'REJ AND r BUILDING IHSPE.CT R - � { APPLICATION FOR PERMIT TO �'✓ .. b '� ...� '!'n .. . ' ( ...... /�,�Q TYPE OF CONSTRUCTION G� ..r��.... .��.I.}............�. L . .�..........r�..............19..Yd TO THE INSPECTOR OF BUILDINGS: The undersigned hereby sapp1ies for a permit according to the following information: �/ Location ........�..�...�<�. .. ......h/.l.. �. i .. :..... ..1(! ../.....'.i ..... Proposed Use .... i✓! .. ... . i9 °..... ...... .. ..... /../! ......................... Zoning District ... .... �....... ,?.. ..... :. . . ...Fire istrict :..... .................. Name of Owner .. .... ... .`a!. ... v�� f .... . ...'...Address ... + .� .....................x .............. 6 Name of Builder ..... �J "r . ..................................:Address ,�� .�.. ....... ........... ................... . Name of Architect ... ..:. dQl'✓... . ..... .. .....................Address .. L�. ... ......................................_ pol. Number of Rooms ......... .............................................t undation ................ t ........v` ...1701d.Roofing ... .: .............. Exterior �. ... ......... .... .... . r� Floors ....... � D. f' .....G.....,... ....... .....Interior .....1..2...... 1 ...... . .....� >r .., �a .. .Plumbing � ..Heating ....... ... , ......................................... ............. .... .. :....... - Fireplace ...................................................... .........Approximate Cost ...j .... ............. ..................................... Definitive Plan Approved by Planning Board _______ _ _ E'�G� �---------19 Area ...................�2,t..L>��:.....� Diagram of Lot and Building with Dimensions ..... .Fee . '�. ... ....... ........................... SUBJECT TO APPROVAL OF BOARD OF HEALTH V ` '2-'7� 3Y I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name. S' ...... ... ..... ............ BAYSIDE BUILDING CO. 24122 One 1/2 Story No ................. Permit for .................................... Single Family Dwelling .............. Location L.ot....#.1.9B....1.9.5...Knott y...Pine L a n e .. .... . .. .... ..... .... .. Centerville ............................................................. Owner Bayside Buildinc :Co.-� ... ................. ..... . ...................... Type of Construction• .....Frame...................................... ............. .................................................................. Plot ..........I.,............... Lot ................................. L Permit Grari ecl .......June...I.... .7....................19 82 Date of Inspection ....................................19 Date Completed ........ -Pell 4 PERMIT REFUSED ................................................................ 19 ...... .......................................................................... . ............ ......................................... .................... ............................................................................ ................................................................................. Approved ............................................ ... 19 1'0 ............................................................................... 9 Assessors map and lot number, ... �f .. ....... TFIE • � � yoF rod e�Q ♦�wage Permit number C,9,12.o.�� ^.r 9 Z.. NASB9T1lDLE. House number ........................�......i.9.�S......! '...........:... yo 11"& O,o,1639.. \0� �f0 NO a' TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ' TYPE OF CONSTRUCTION .......��a��.....�!) 7J.............. .. . ...19....C.I. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information Location ..... /��'�'.`:... !...o .... / i !..:�l. .l!:.�.. .... -/1 :..... r�r.� y. ..j.�� .../....:.9.: ..... .... . ..... .... .. Proposed Use ... !. .!P...�. � :."�- .....'.,� ..-c P.lr.f ./.?. ................................................ Zoning District .Al ......Z,?..�)...... ! ..Fire District :..... ................................... Name of Owner �1Si, .....4. 6:7...! I ......Address 1aA4......................................................... Name of Builder . ?. ....... ..................Address ...y...... ,/z.... .1��- ............................................. Name of Architect�' 1/: ,-4—W-I,/,,.5 /t..............................Address .. L t. ... ............................. Number of Rooms ........... ....................._...... Foundation /........l ✓vim �..��!....... Exterior l f 1 ......... ? '�'l ./, C,�X"oofing ... ..C�. ` ....: .�...`...1 .................... Floors r� :, i'�,1 1i?u .. ( .../` , / ..Interior ...... ........'laotl ?•..... . �.....<...�/�',../ ✓.�z Heating ... /v ..6.4�.• .. ............................................Plumbing ............... /r.................. Fireplace .. ........................ .............................. ......................... . ......Approximate Cost/. ...!%� ��.................................. Definitive Plan Approved by Planning Board __ ________:'_________19_ /). Area �U _ r. .U. Diagram of Lot and Building with Dimensions Fee il�.................................... SUBJECT TO APPROVAL OF BOARD OF HEALTH 1 ` 1 I t � 1 27' 3y V I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. BAYSIDII BUILDING CO. A=191-88 ll" Story No -__--. Pern�i� for -....---------.. � ' Si�gIe Family Dwelling ----+=------.------------- = �ot #l9B l95 � ot I,i�e Lane � Location -----------------��--' Centerville � ' --------..-------------.---- , - ^ ` B ide 8 il��i C C�vner -..���-.---l�--..���-..o..---.. ' �. i Type of. Construction -...F.�!a..�....---'..---. ............. ................................................................... . . Plot ............................ Lot .................................. ' � ' June 7, 82 > ' Permit Granted -------------]9 ' ` . Date of Inspection ------------lg .' ^ � Do** Completed ...................................... . � | ' ` , PERMIT REFUSED | ............... .......... 19 ----'1 -------'�---------' . ' { -------'--'-----------~----' . . ~ '---'-'--'~-----~----~--^----` --------`'^-----^'---'--'----- ` . � Approved ---------------- lg .....................'..............................'...` ........,.........' � � -------`--`----------^---^-' \ TOWN OF BARNSTABLE * ``, •o Permit No. Building Inspector A Ilia 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 i.—rc-;de P-,;l ding Address Wiring Inspector �,r ' Ile— Inspection date Plumbing Inspector l Inspection date Gas Inspector / Inspection date Engineering Department - , , j �•,� ,,. ;r*� ,- 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. , .....................................................1 19............ ...................................................................»............_................»........_.» Building Inspector OA 57B.�;> o a b `(f Al. pcwoo'G No a ' o-�- rn / sg x. 3 r 9 � ZcD� l E Ir L oT icy � 12 OFM,�ssq CERTIFIED PLOT PLAN NEW . CONSTRUCTI.ON ONLY : 3 cp ti CL � !. t_{ -TOP -OF !FOUNDATION ` IS �'8 FE ems» C IN a vow LOW POINT :F ADJACENT ®ISTEa��� a ��)� � �� ASS# ROAD. Ho sutcv� .,o SCALE: / ''=40 DATE: 6 //,?'z LD EDGE ENGINEERING COIN Q�►.�`si�� I CERTIFY THAT THE�ov�r�daToN CLIENT SHOWN ON THIS PLAN IS LOCATED "REGISTERED REGISTERED JOB N0. � � � CIVIL I LAND ON THE GROUND AS INDICATED AND ENGINEER SURVEYOR DR.BY, A CONFORMS TO THE ZONING LAWS OF BARNSTABI E MASS. 712 MAIN STREET --- �— CFI.'BY l H Y A N A 1 S, M A$.$. b 3•$� z;...:��., ,.�,__�,..__c'._�—� SHEET/OF DATE G. LAND SURVEYOR