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TOWN OF-BARNST-ABL-E--- EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDO W S/DOORS/TENTS/STO VES/WEATHERIZATION PROPERTY INFORMATION Address of Project: � �IwAll t'e.�, x L12 4t0 Ile. dJo2 f NUMBER STREET VILLAGE Owner's Name: g� eriC C' Phone Number Email Address: Cell'Phone Number ' J�� Project cost$ , 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 0 Windows (no header change)# 0 Insulation/Weatherization ❑ Doors(no header change)# Commercial Doors require an inspector's review EglEoof(not applying more than I layer of shingles) Construction Debris will be going to i,✓,✓ ,�,,.�✓�Z awl CONTRACTOR'S INFORMATION Contractor's name .� 3 Home Improvement Contractors Registration(if applicable)# / 1� 2 (attach copy) Construction-Supervisor's License (attach copy) J ll Email of Contractor Oa t�rEe e r w !J� !•.N ''`'(P hone number �5A X� 117Y ALL PROPERTIES THAT HAVE STRUCTU S OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION NUMBER............................................................ ' *For Tents Only* Date Tent(s) will be erected - Removed on number of tents total r 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 with the location(s)of each tent Fuel source being used LP tank 20 lbs. 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 apytiLtions are subject to a building official's approval prior to issuance. AC� DATE(MM/DDIYYY`O® �. CERTIFICATE OF LIABILITY INSURANCE 04/30/2019. 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 islan ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endors4d. 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 fhe certificate holder in lieu of such endorsements. PRODUCER CONTACT 'Jt n DBMS + ME: Mark Sylvia Insurance Agency,LLC PHONE 508 957-2125 FAC o• (508)957-2781 404 Main Street E"MAIL mark@marksylviainsurance.com Centerville,MA 02632 INSURERIM AFFORDING COVERAGE NAIC# 1 INSURERA: Farm Family Casualty Insurance INSURED j INSURER B:- - Thomas Home Improvements�LC INSURERC, PO Box 177 1 INSURER D: Centerville,MA 02632 INSURER e: i I INSURER F• COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE 13EEN 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 ADD/SUER POLICY NUMBER MM/D�Y EFF f POLL D1 EXP LIMITS LTR X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DGE TO CLAIMS-MADE �OCCUR I PREM SES Ea occurrence) $ 100,000 i MED EXP(Any oneperson) $ 5,000 A N N 20OIX1416 5/01/2019 5/01/2020 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: i GENERAL AGGREGATE $ 2,000,000 X POLICY JET F Wt, i PRODUCTS-COMPlOPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY i COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE i AGGREGATE $ DIED RETENTION$ $ WORKERS COMPENSATION STATUTE ER H AND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE Y/N I E.L.EACH ACCIDENT $ 1,000,000 A OFFICERIMEMBER EXCLUDEDI ❑Y 0 N 2001 WB053 5/01/2019 5/01/2020 (Mandatory In NH) I E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 I DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICL.FIIS(ACORD 101,Additional Remade Schedule,may be attached If more space Is required) Carpentry I i Insurance coverage is limited to the terms,gonditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived or extended the coverage provided by the policy provisions. I CERTIFICATE HOLDER I CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Barnstable Building[)apt ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street . AUTHORIZED REPRESENTATIVE I ` I Hyannis MA 02601' Fax: Email: 1 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD I - , " J l'O?7L777,0�/2LCt6CLGl�O�LJ�j .... Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR a TYPE Corporation Re istra Registration 9 tion vale ion d for —�—� Expiration before the ex individualtifoun a only 185422 06/08/2020 .' i expiration date. If found return ta: TROY THOMAS HOME Office of Consumer Affairs and Business Regulation E�IMPROVEMENTS,INC, One Ashburton Place- z Boson,MA on Pl Suite 1301 TROY THOM.AS 499 NOTTINGHAM DRc r CENTERVILLE ` MA 0 2 6 -3 2 Undersecretary __ NOt al d wi}ho:ut signature Jau01ssiwwo0 Y'Z£910 vim 3l"IIA2131N30 3A(Hd W`dklJNlj..LON 6V ti as SdWONI Ell t £L 6660 1! tT0113R UOO /�}lei°ads jos-1-1 h _s`. !n8 10 pJeos f :.:splepuelS Pue suo!1elnl;aa 6wp1 a�nsuaorl leuo!ssalwd 10 uols'A!(] uowwoD s11asn4�esse1N 10 411ea^^ - ti;,; p In the event that while stripping-the roof we find rot that needs to be reptaced,the homeowner i then has to agree and authorize any replacement or restoration. Then in addition to the above contract price,the homeowner agrees to compensate the contractor for any repairs or restoration at the hourly rate of$65.00 for a carpenter and$45.00 for a carpenter's laborer, plus the cost of materials. -,Roof to be stripped and cleaned of all old shingles and debris 7ftofto be:paperedwfth Wp#her watch(eak barrier,Synthetic roof.underlayment,and installed with GAF architectural shingles using galvanized nails (Storm nailed) 78"d-rip edge.&.new-pipe collars to.be-.installed Timbertex premium ridge cap to be installed -A 10-yard dump trailer will be needed on site& removed upon completion -Contractor will be responsible for all building permits needed at the property NOTICE REQUIRED BY LAND With the agreement of the contract$500.00 of estimate is due.' Further payments under this contract are as follows: 1/2 of the estimate due at the start; and remainder due at completion of the job. Balance of.alt natedals.and tabor stwil lze payWe in.fi4t upott coftipiettogo€.:work desicribed:trr, th"is contract.'f�ayment'asnagreed upon shaiI be made wt en due.,'Any payments which are ` delayed shall be subject to a finance charge of 1.5% per month. The contractor warranties the workmanship completed under this contract for a period'.- of ten years from the date of completion. During the stated warranty period,the contractor shall be responsible for the service of the repair or adjustment, but the contractor shall not be responsible for the normal maintenance,repair du.e o:+a4use, rraas se,:ar d. r,oflr, af,wear.aacl teia w� xo er:b f �a n Afl warranties for'the matefi"a s supphedbV thb bohtractor.shalrbi passed directly to the homeowner. The homeowner may be required to register or mail in such warranty card or evidence of ownership in order to activate such warranties. Homeowner failure shall not create any responsiebi% for the contractor under the warranty provisions;the choice of repair of replacement shall be at the discretion of the contractor. The homeowner acknowledges that the form,content, and notices contained in this contract are�nte,ncled;.to_co.pip�y with.the app4abje portlws of the K. Ceagrat Law Chapter 142A, and"regulationspromuigatedIhere-under. 1n`the event.ofIany instance`of non-comptiance,'onlysuch portion shall be invalid and the remainder of this.contract shall be in full force effect. ,In.addition, any. such-portion not into mpWance shall be e d and interpreted so as to`have its.in#en8ed meaning to the maximum extent allowed under such law and regulation. Signed as a sealed instrument on this date: D=atV. f Homeowner Contractor t 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): f Z224Y"4u'M Address: �� ,l Z _ - City/State/Zip: 17 L 14 Phone#: /z<73 Are you an employer?Check the app opriate box: Type of project(required): 1.[;Kam a employer with _ 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑Demolition workingfor me in an capacity. employees and have workers' Y P tY• t 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 1 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.El 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. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp:policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. .� Insurance Company Name: Policy#or Self-ins.`Lic.#: r G1 �a�/�4$J Expiration Date: y20 Job Site Address: / i4 City/State/Zipa,4L'/" , 0 Atx& 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 insurance coverage verification. I do hereby certify under the pains an enalties of perjury that the information provided above is true and correct Si ature: Date: Phone ZIP 4�1' 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' compens on for their employees. Pursuant to this statute,an employee is defined as"...every person in the service/th r der any contract of hire, express implied,oral or written." An emplo r is .efined as"an individual,partnership,association,corporation gal entity,or any two or more of the foreg ing engaged in a joint enterprise,and including the legal represent deceased employer,or the receiver or ee.of an individual,partnership,association or other legal entityg employees. However the owner of a dw ing house having not more than three apartments and who resi ,or the occupant of the dwelling house f another who employs persons to do maintenance,constructio work on such dwelling house or on the grounds r building appurtenant thereto shall not because of such em e deemed to be an employer." MGL chapter 152, § 5C(6)also states that"every state or local licensing ency shall withhold the issuance or renewal of a license permit to operate a business or to-construct bu'dings in the commonwealth for any applicant who has not roduced acceptable evidence of compliance th the insurance coverage required." Additionally,MGL chap 152, §25C(7)states"Neither the common w alth nor any of its political subdivisions shall enter into any contract for a performance of public work until accep ble evidence of compliance with the insurance requirements of this chapter ave been presented to the contracting thority." Applicants Please fill out the workers' co\approprnia ion affidavit /esure ly y checking the boxes that apply to your situation and,if necessary,supply sub-contracte(s),address(es) one number(s)along with their certificate(s)of insurance. Limited Liability Ces(I LC)or L ' bility Partnerships(LLP)with no employees other than the members or partners,are not recant'workerisation insurance. If an LLC or LLP does have employees,a policy is required 'sed that thiit may be submitted to the Department of Industrial Accidents for confirmation of ie verage. sure to sign and date the affidavit. The affidavit should be returned to the city or town app 'cation fmit or license is being requested,not the Department of Industrial Accidents. Should y any uestioning the law or if you are required to obtain a workers' compensation policy,please caepartm t at er listed below. Self-insured companies should enter their self-insurance license number ppropria lin City or Town Officials Please be sure that the affidavit is complete and p d legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the ffic of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license numb which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applic ions in given year,need only submit one affidavit indicating current policy information(if necessary)and under"Jo Site Addr s"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been o cially stamp or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on fi for future pe its or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtain g a license or pe it not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc. said person is NO equired to complete this affidavit. The Office of Investigations would like to tha you in advance for y 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 Mass ac efts Department of Industrial Acciden Office of Investigations 600 Washington,Street Boston,MA 02111 Tel.#617-727-4900 east 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 4-24-07 wvw.mass.gavfdia i �� D neering Dept; �3rd floor) Map ,/ Parcel GGzc Permit# House# Date Issued Board of Health(3rd floor)-(8:15 -9:30/1:00-4:30) 2 Fee � l . 40 7) Conservation Office(4th floor)(8:30-9:30/1:00-2:00) q PTIC 3YS'tEM E Planning Dept.(1st floor/School Admin. Bldg.) ��a�T�LLE YS E Definitive Plan Approved by Planning Board 19 WITH TIT ��NVIRONMENTAL R BLE ' TOWN OF BARNSTABN REGUL Building Permit Ap lication Project Street Address 9 7 Village �L= Owner , a, ,qn� Address192 / GvG Telephone "7 7c9 Z ' Permit Request ) �✓�S,t� i ®d�' First Floor square feet Second Floor square feet Construction Type a6 Estimated Project Cost $ _ �,©ac Zoning,District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family W"' 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.ft) Number of Baths: Full: Existing New Half- Existing New No.of Bedrooms: Existing New Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other • Central Air ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No - Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ZNo If yes, site plan review# - Current Use Proposed Use Builder Information Name y:'J Telephone Number Address' -7&17— License# G9M::93'2- Home Improvement Contractor# /dO71d Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE e P DATE �— '�_:Z BU ,o T I1E 0 E FOLLOWING REASON(S) r. FOR OFFICIAL USE ONLY y p_ PERMIT NO. 7Z D�TE ISSUED' MAP/PARCEL NO. ADDRESS VILLAGEr € OWNER r. DATE OF INSPECTION:: a FOUNDATION _ FRAME INSULATION _ FIREPLACE_ ELECTRICAL F DOUGH�" FINAL PLUMBING: ROUGH FINAL • _ , GAS:. 4UGH ' FINAL t FINAL BUILDING DATE CLOSED OUT.; ASSOCIATION PLAN NO. M WE T� The Town of Barns table 9 'AS& Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 F Ralph Crossen Fax: 508-790-6230 Building Commissioner For office use only Permit no. Date "-9 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 pre-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. s"7'R ifs � Type of Work: r Est. Cost t Address of Work: /97 ,, oO ^Z /77�'C Zg C-7 Owner's Name ��7yliSyJ Date of Permit Application: V --9-7 I hereby certify that: Registration is not required for the following reason(s): Work excluded bylaw Job under S1,000. Building not owner-occupied Owner 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: 7,51-q7 Date atractor Name Registration No. OR Date Owner's Name Assessor's map and lot number ...... ................... ..... C 6TSTEN MUST BE INSTAILLED IN COMPLIANCE V ITH Ai`TX`wL�; H STATE Sewage Permit number ..........g .. .. SANITARY CODE AND TOWN REGULATI . ` FtNErO�o TOWN OF :BARNSTABLE ' t r ice',., • � � �' � ' b BARNSTABLE. a Y'a:•� BUILD-ING ' INSPECTOR APPLICATION FOR PERMIT TO ..... .......................... .........../-...... .......................... .................................... LIC r � TYPEOF CONSTRUCTION ............ ........... . .. 5, ................ .. �. ........................................ s ............................19........ I TO THE INSPECTOR OF BUILDINGS: The undersigned herebg applies for a permit accor din g to the fo�lowin information: Location ........ .. ..�- ........ .. .....1XV.......... . ............ ..... ........................................... ProposedUse 0/..... . .... .............................. ... ......................... Zoning District ....... TJ� ...Fire District .../Aoz�- ............. ......... ............. .... ............ .... A Name of Owner ..,�L� Address f�?.... .%.... fj e �............I...........Address .........L Name of Builder .................................:....... ........................................................................... Cr Nameof Architect ..................................................................Address ....................................................................................... ow 0 Number of Rooms ..................................................................Foundation .1�.8 ,.. �j ... ��.�1 .... Exterior ... ... L..................Roofing ... . ............................................... Floors ..... ..... .........Interior ................... .......................................................... Heating ........... ........ ......... Plumbing .........:Q.................................................................... Fireplace .............. :...............................................................Approximate Cost .............:1...�... ......................... Definitive Plan Approved by Planning Board _ _ ------/� � d . ..._______197__/ Area .....1.....?. .... ........... Diagram of Lot and Building with Dimen- ' ns Fee ��(..`..�....................... SUBJECT TO APPROVAL OF BOARD OF HEALTH 1 ; l I g i cN.l a.3` Via' 1 hereby agree to conform to all the Rules and Regulations of the Town ofzukn ble regarding the above construction. t' 9 Name ............... ..... .................................... William Dacey Jr. No .17241 ..... p m if--f c;r ....House r`""�.�, *� j w` br ................................ Locafion Centerville ............................................................................... William Dacey Jr. Owner .............................................. Type of construction ......Wood........................... ................................................................................ Plot ........ Lot ...... ...................... 11914 0 ermit Granted' Au gust 1 # i 11)le Date of Inspection Date Completed ........41 AV PERMIT REFUSED 19....................................................... ..... ................................................................................ . ................................................................................ . ............. ........................................I.............. .......................:....................................................... ,-Approved ................................................ 19 ............................................................................... 100, ............................................................................... Q �? J. QTj '•' �� r�l� ( ror 6 CERTIFIED PLOT PLAN iLOCAT9QN SCALE DATE ✓•1/4 t PLAN REFERENCE I'c r� i"' aC✓'-r T?10M.p3xai.9.Lt•.Y C 0 r �� i..:afd,l rp. i . r �il�`��! i/ �.../Qi',s }C1JaD P)Rsb}: C��ri���'!r�� (V'. .';���' i�,�.:'✓. fl lr ":�.,. 1_` ;,;4 12 r 1p I CERTIFY THAT IHE :� ?uri,/ar�r7,c1�,/, : SHOWN g ON THIS PLAN 15 LOCATED ON THE GROUND !^✓✓�!//l.ti'd ,'. j /c"%=t ' /, ' AS SHOWN HEREON AND THAT IT CONFORMS TO �. .0A 'f'v" THE ZONING LAWS OE`T.HE TOWN QE �� � T /L�r{/, J .✓.a/J+I rn WHEN (:^vr�altUCIED, ;�q �o1//� , yi DATE `��Jr-?' ''r•� JX, r--,• ', ., F' iT1C 11"R ; REG. LAND SURVEYOR