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HomeMy WebLinkAbout0017 DOGWOOD LANE SHED REGISTRATION .0062&)00 d kiql\16. - o-ty I t location of shed(address) n property owner's nakne size of shed sin re date Old King's Highway Historic District Commission jurisdiction? THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN shed r �S CLIENT: Attorney Robert Cutler FILE # DEED.-REF: Bk 8606/236 GRANTOR: Robert J Marks , Jr 97551 PLAN REF: Bk 282/27 GRANTEE:John W & Gayle E Jowett NO NCOWHE TATION' RFECOW4EN0 AN INSTRUMEN l S► RVD: BE MADE TO ACCURATELY LOCATE' PROPERTY LIKS, ` I IZZ o e t fvj n I i N (0 .I-3'r01Z•i V1/00D D UJ 1-L L!'..1.. i 1 IZS . 00 ,0 O rD I_ !1 KJ jH of VKIJAM R. I401 19417 "Nis MORTGAGE INSPECTION PLAN OF LAND IN B n 2 N 7- a r` E PAY COLONY GROUP, INC., FOXBOROUGH, MA SCALE 1" DATE: Tu i (99 I hereby certify to the above named client that to the best of my professional knowledge, information and belief that the location of the dwelling as shown hereon either was in compliance with the local Zoning By—Laws in effect when the dwelling was constructed (with respect to structural setback requirements only), or is exempt from violation enforcement action under Mass. G.L. Title VII, Chapter 40A, Section 7, and that the dwelling shown lies in ZONE _C'� as designated on the F.E.M.A. Flood Insurance Rate Mops. NOTE: This plan was prepared for BANK USE ONLY and is not to be recorded, or construed as on instrument survey, or to be used to construct fences or other structures. BUILDING INSPECTORS shall not use this as a building , permit plan. It should be further understood that if an instrument survey is accomplished at a later date we will not be responsible for any changes that occur. I 1 a 1 r- t t �e ® 6.Y}.\2 is '[ t•8 � ! - - .!✓.4 - f �•V-.\i. �•II S.YI): � ` ...c - _�..+.Yt 2 -:x;Y.i- `fe "Ifi - � T! .t a.�.!it.�i}i � a!• � '?: ;tt t..ay.9ss � Y t 3ta• � � it" _f:�t�T K•i Y tea! 3 t Y_f i'T: _ '- t I OMIT N - �' ,s-:-d, ®alarm -� Y4L% i Y. i� m`..•833fi+3:8Yi. � S�a%ti:o...-T _.yss �' _.6 .8: O'8tf9. _.4+' t:�Yt.!"t T1 �Y.a9s• _ a >,.9ii �?s=,.,qi,,, ,Ts`\ Se�IL:LS�� r.r �dhodl� � �c9a/ . 'l�re.o,� 4:9� c z -Ate, _�, i a we n./2sxsno�L4� Ti Section 6—Pr*a S 0 Wiring Oil Tank Storage E] Smoke Detectors wing ❑ Gas ` Fire SWsion . Q Heat Sys D Masonry Cry D AAdlielocoe.beftm Water supply- Q Public D Private. {se�ge: sai . � ❑ Municipal - � II on Sim • Historic.District ❑ Hyannis Historic Disaid Debris aal Fae i . spQ ty:_ u-dC ��`c�_r I qm a crane Yes.:.�. a a XA o Section 7-Flood Zt Flood Zone Designation Within or adjacent to a wetland,coastal bank? Yes No Q Section 8—zoning ' ZomngDishict a Proposed Use i Lot.Area .Ft. Totalt+ontage!�e of Lot Coverage i #of DwelgIs .sue) Setbacks Frobt Yard Required_Propq ed , 1�Yard Required Propq ed. Sidi Yard Requiredpolio s t� relief Pram the 4ning.Board ia.te.past? Yes o i Section 9—.CznstraC# w..Stow. Acme ay, ��ii a P��✓L Teiepi ,Numba 629 P--,f67-G:7O �i. .. . . O 6h D(/e LIB Clty 1�La// yer^ SM —� .Lk.ee -Number License Type Date . I my x %2i ies underto;rules,ad r far Li emd CAR ate StyBuflft Code. I uadmsMd the d by 784 Md R and the Town of$ar 3e.A ach a: of Soobw i4-Home a Tekphone a IF-1.1516?, 2e o ve:-f�' City_ ZAA ZPJ' Rp0r4w Nt nber ��025�� EVhation Date I ray-re.S.PWs�iiities under the rules and regnla=for e c ' Catthe a oem ,Bu&dmg.Code. I mkierstod the doc }by MOM a afyoaar ILLC». Dieter/� Date Sece�a 1I'—Rome. Hmer�.Name• e � HSo n Te w Number 610 -e _L-_Cell or W I d>Py re*=es.0 Eer the r re ous.for Licea�sed di the t Stye Big Code. I�the ICY 780 CMR and the Town of Bwastable, e ' ' C r o r S tc (crap v ,s?e i* ed< ` Itlir.Dent Zoning Board(if required) ❑ Historic District ❑ Site P Review(if requined) '❑ Fi ire ardent Conservation ❑ FQr.cocjd world pkae takeY0.1 1� . n 13-Ownees as Ownerthe ject authorize L hereby to act on m n�a ers relative to work au ho • by b y.b� in all - €catc�n fog: �� D e a. Klae (Address of job) Si of Owner � date ✓'o n Print� e DocuSign Envelope ID:F4740E2D-E463-49BA-BC5A-5F6E56894DC1 - Page 1 of 1 Customer Name:Jeremy Mcpherson CON I Rf1.CT Email:bm1501@yahoo,com Phone:508-284'1789 Premise Address:17 Dogwood Lane,Cotuit,MA 02635 Project ID:3338065 Date:Dec.11,2017 EN 'EERING F orffie'sey Energized: RISE-Engineering 5 Dupont Avenue,Suite 2 South Yarmouth;MA,02664 Job Description AIR SEALING 10 hr $800:00 WEATHERSTRIP DOOR&ADD SWEEP 3 each $240:00 $0.00 ATTIC FLAT-10"OPEN R-37 CELLULOSE 1012 SF $1,578.72 $394.69 4 x 16"SOFFIT VENTS '22 each $636.02 $159.0.1 VENTILATION CHUTES 70 each $244.30 $6.1.07 PULL-DOWN'STAIR:THERMADOME,BUILT-UP 1 each $237.65 $5'0 41. VENT BATH FAN THRU ROOF. " 2 each $237.50 $59.37 ATTIC DAMMING-R-38 FIBERGLASS 60 SF $147.60. $36.90 OVERHANG R-13.FG&RIGID BOARD 28 SF $1-47.00 $36.75 INSULATE BULKHEAD DOOR 1 each $1.10;00 $27:50 .ATTIC FLAT 14"OPEN R-49 CELLULOSE 28 SF $50.40 $1.2.60 _ Total: $4;429. 9 PrPgrani;Incent v.e $3,581.891 customer Total: $847:3.0 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***Eight Hundred And Forty-Seven And 30/10.0:Dollars $,847.30 UPON FINAL INSPECTION AND APPROVAL BY RISE ENGINEERING.CUSTOMER AGREES TO REMIT`AMOUNT DUE IN FULL.INTEREST,OF 1%WILL BE CHARGED MONTHLY.ON ANY.UNPAID.BALANCE AFTER 30 DAYS:SEE REVERSE'FQR IMPORTANT.INFORMATION ON GUARANT 'ES,RIGHTS OF RECISION,SCHEDULING;AND CONTRACTOR REGISTRATION. DO IOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES h'o'"" sRed by. ,�: + t ,YSDIA. 'ISE:Represe. 8/14/2018 1 8.201AM EDT. Sign Date NOTE THIS CONTRACT MAY B WITHD WN BY US IF NOTn ACCEPTANCE OF.CONTRACT-THE ABOVE PRICES; EXECUTED WITHIN 30 DAYS SPECIFICATIONS AND CONDITIONS ARE SATISFACTORY TO.US AND ARE HEREBY ACC€P.TED.YOU ARE AUTHORIZED TO DO THE WORK AS:SPECIFIED.PAYMENT-WILL BE.MADE AS''OUTL'INED,: ABOVE Dmusign Envelope ID:.F4740E2D-E463-49BA-BC5A-5F6E56894DC1 ortM x For Si*#d;,3310826 f, :tatrler:.}eremy Mcpherson Jermey Mcaherson 10, over Qf tl ie tlici t t•`. ltlwnePs Atame,Rfi ,1.7 D.ogwood Lane Cotuit, MA D2635 (Rrapeay Sue.et Xd�iressj. thy} 17Et8�lj�� tiZ��f?��SSSBKE�E3[t7E:;�tii?i;gj(:$8[YiCe5��3ti:12155}�#1i��a�iCi� �� L'�ii`:�1 .. ` he€rxw t ;aet o #> al c>'f-obta a b�ir ttg per�ri to F fcrm #a r a #Qt• rea##e i y�o�©i�mkt�Pe�Y• oocusigned by: - 5* ` . 21Fcgsgsos7440E... . 8/14/2018 1 8:20 AM EDT mo FO�:;fl�E,< :Qt�CY �� a Fa �ntir g bl"$SeteAome iergyr S r the abcnce.a. bMpce proms:: + a� i�aritlractar' : _ Name: RISE Engineering Phone: 401;784-3700 Erna t: Reu 1 The Commonwealth of Massachusetts: Department ref Industrial Accidents 1 Congress Street,Suite.100 ;t Boston,MA 02114-2.017 www.mass.govldla Workers,Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILER WITH THE PERMITTING AUTHORITY. Applicant Information Please.Print Legibly Name(Business/Organizati6h/tndividual).: Insulate2Save Inc. Address:410 Grove Street City/State/Zip: Fall River MA 02720, Phone#: 508-567-6706 Are you an employer?Cheek the appropriate box: Type of project(required): 1, t am a employer with 20 cmpioyces(full and/or part-timc)* 7, New construction, 2.Q l am a sole proprietor or partnership.and have no.employces working for me in _ 8, Remodeling any capacity.[No workers'comp:insurance required.l 3Q t am a homeowner doing all work mysel ,[No workers'comp.insurance required_]t 9. ❑Demolition f 4.r.71 1.air a homeowner and will be hiring contractors to conduct all work on my property. t will Ion Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.[]Electrical repairs or additions proprietors with no employees. 12.:Q Plumbing repairs or additions S, l am a general contractor and t have hired the sub-contractors listed on the attached sheet: These sub-eontractors have employees,and have workers'comp,imurance.t 1 •�R00f repairs 6,Q We area corporation and its officers have exercised their right of exemption per MOL c. 14,[�x Other Insulation i 52;.§1(4),and I we have no employees.[No workers'comp:insurance requited.) *Any applicant that checks box#I 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 trust submii 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 trust 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 Comparty Name: Liberty Mutual Insurance Policy#or Self-ins.Lic.#: XWS 56418741 Expiration Date: 12/10/2018 .lob Site Addres.�-7_�i6�vo Z•et41 e— City/StatefL Attach a copy of the work page jfOftc,Y taec rtrr A;ion page(showing the policy number an&&p_irahon dace)* - y� Failure to secure coverage as required under MGL c. 1.52,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,;as well as civitpenalties 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 verification: I do hereby certify under the s air e trey ref perjxtry that the information provided above is true and correct, Signature: Date, Phone#: 508-567-6706 Official use candy bra 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 I City/Town.Cleirk. 4.Electrical Inspector 5.Plumbing Inspector 6:Other Contact Person: Phone#: a ,.... W Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Bo%on, Ma .< usetts 021.16 Nome Improvem WQ tractor Registration Type: corporation Registration: 180747 INSULATE 2 SAVE , INC. Expiration: 1212t312fl1i3 410 Grove St 1-0 Fallriver, MA 02720 `�� Update Address and return card. Mark reason for change, �. p iCA i a"5>11 . 0 20M-.. ®ddri ene�nrai;QEtnp1nerit O Lost Card _........... , .. office of consumer Afteirs&Business Aegulation' diOMEIMPROVEMENT CONTRACTOR Registration vaddd for intdividue d use only before.the a iraetion date. If found return to: TYPE:Corporation � Office of donsurner Affairs and:Business Regulation Exglratlan 12/28/2018 10 Park Plaza,-Suite 5120 a ,: Boston,MA 02116 INSULATE 2 Roland,Lange 410 drove st Fallriver,MA 62 UndersecretM. Not valid without signature Comvonweaitft of Massachusetts Division oi Pt0feSSi0ft0l Licensuft I Board of Building N uiations and 5tandwds cony rvst�i c`S-tiJ:t861 irss,fl83 �'0 t 9 ROLANDzLANQEVt �.. i�E' RE� � ss� s1ri FALL RdvElt frill ii i l Commission T - t cm' FCATE OfWARM ��aO�ES!�T C��STiFFF€E%k ACT w c ..tt eetd abe. OlderAftow Sri;feu oE; 1 lr►ee .. pip a ,A. wins t 23aYe;kbr. 41Q C :iSt. Hi5lA�;G: Fv# AtAsW2D' d h O{ i WT7pW— u i S7 BEf HAVE, fS TOT - Ras";7fl 40RCCll�ffftlfON0' Y{ RRCtOfiE3 pt MAYaR'btAY PERTq�ts TtE H�StfRAMGEAFFO%3EDSY,}}iEPt SCfBTTOALE.FE DCLYAL�1D C�NflFlfOPkS OF Sif�Ft PQf fCtES f3R {S SHOVIE�i IfAAI:HAVE 8E$E D SY;3 �iER��c ilggfLtiY ,... i L�fS. g.00CLR A Y Y BKS S64l8741 aae uEc s nij WAPPLIESPBt t2HQd17 12tftTll8 S AN�AtiffC - � A Y Y S + , Y Y .6AA"56418741 12N8J17 12f W8 Y: rE�raodde Cj s 'AETfOSOI�Y %' AS3TOS;CD&.Y $ X OCCk1R i aa�tsaraoe .Y Y US0:564'#8741 12MOM7 ::YIN ' ' Q N/A XlA L5"18741 l2I1Gd17 1211 s 18 �b*W- EU flSE EkEfl�6 f — S DE � 1 ( 4Ql. Sd+ewe,m�rb6ddtaz(feddmorrsyaeeJc.�e�teed) '801fYAE r - .DAilY OF AS01tE Prod of kourance : The AC.Oft a td: a� G6 .- - �° arcs a� 3" Asse ors- rwap and lot number ... .......... . .fl......... ; Sewage Permit number .........ra.��^.. �/.1........................... 6`� r� 33ARESTAIILE. i House number ........l..l.....11Yj.. ....... iaI (�gn� �� 039. t,, MPY TOWN OF BARN�`,, TX Tv .EGO BUILDING 11SPECTOR Construct APPLICATION FOR PERMIT TO ................................................ Wood Frame Residential TYPEOF CONSTRUCTION ..................................................................................................................................... November 18.....................19.....82 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location Lot 6 Dogwood I ne, Cotuit, Ma.,,.. .... Proposed Use ...,residential ........................................................................................................................................................... Zoning District .......... ............................Fire District .......:........... Name of Owner Cedar..Acres Realty..Trust.................Address ....24.. 1 Qa .. QF .. ...�...5....y4=.dt.I...M?,... ................ Nameof Builder ................same...........................................Address .................................................................................... Nameof Architect .............nla.:..................:........ ...............Address .................................................................................... Number of Rooms ..............6...................................................Foundation ....PQ1dXQd..GOX1Gxet9......................................... Exterior .,cedar„shingle ....................................................Roofing ........�SRY�t..S11J.Cl91�.......................................... Floors .....Pled.................................................................Interior ...........Sh.Ot~t ock..................................................... ... Heating. •-5i Cj. g.t'.��.... �5.............................................................Plumbin ........1! .hrai1i5.................................:...................... Fireplace .One..,........................................................................Approximate Cost ...25,00tr1.............................. ............ ....... AA u Definitive Plan Approved by. Planning Board Sept-2-1--------------19_78___ . Area ...1...1. .......`S.......`........ o Diagram of Lot and.Building with Dimensions Fee . '.................................... SUBJECT TO APPROVAL OF BOARD OF HEALTH G� OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name . c! _/+ ....... Construction Supervisor's License ...O/V/.V/..el....... CEDAR ACRES REALTY TRUST 246-98. One Story "No ................. Permit for .................................... Single Family Dwelling .......................................................................... ref Location ...Lot....#.6......1.7...D.oq..w...00.....d.......L.ane........ u otit .................C.............................................................. Owner Cedar.. . ...A.cr.e.s....Re.a.1t.y. ...T.r.us.t .. .... .. .. .. .... .. . .... .. .... .. .. .. .... Type of Can— Frame Construction .......................................... ............................................................................... Plot .......................... Lot ................................. Permit Granted January 6 , 83....................:...................19 Do I te of Inspection ....................................19 Date Completed ...........19 Assessor's map and lot,onumber ..../...�."�..., ......�l:c . cy�k ,p,��, /1 a6 dz rNE � yo Sewage Permit number r� ,, Z MAWSTADLE, i House number ........1./...:.!!C!.. ............................................... 9�oe�MA �0 ?� 'FO NAY a\� TOWN OF BARNSTABLE BUILDING INSPECTOR Construct APPLICATION FOR PERMIT TO ........................ ..................................................................................................... TYPE OF CONSTRUCTION ........1"Tood..sari. Residential............................................................................ Nmrenber:'.1$,....................19.....8.2 iT0 rTHE INSPECTOR OF BUILDINGS: The undersigned hereby applies �for a permit according to the following information: Loca'fion f 3.o .. L..""c pd..lane,..COtuitl..P�1c1................................................................. ................................... residential ProposedUse ....re...................................................................................................................................................................... Zoning District .............Fire District .............................................................................. .......... C...................................... Name of Owner Cedar._Acres Realty„Trust ............Address ....24. C'reat,Pond Dr...l...S.,,YaYTCtauthe.. :... Nameof Builder ................same............................I..............Address .................................................................................... Nameof Architect .............Z?la.............................;,: .............Address ......................................................................... Number of Rooms ..............6..................................W..............Foundation ....PQLIX:BCI..C;T!9K9,'tE........................................ Exterior ...Cedar shlilgle .............Roofin ash?halt.. h 14':.......................................... g ............ Floors .....P4.WOOd..................................................................Interior ...........5heP.tQ.(*.................................... ................. Heating FW.77..0-9.................................. ..........................Plumbing .:.......1.L1>.1>�A-1119........................................................ Fireplace =.e..........................................................................Approximate Cost ...25,Q00..........................................44....... Definitive Plan Approved by Planning Board Se�2t4__2-______________19.73___. Area `.....1.. ...... ....................... 7 40— Diagram of Lot and Building with Dimensions p Fee '............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH i , �1 r� OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name r'�_,� r..... ...fir A �' G�° ... . .......... Construction Supervisor's License ... > .. j......... CEDAR ACRES REALTY TRUST A-40-74 { 24698 One Story . No ................. Permit for .................................... Single Family Dwelling Location „Lot #6 17 Dogwood Lane I, ................................................ Cotuit ............................................................................... Owner Cedar Acres Realty Trust ................................................................ i_ Type of Construction ...,Frame ............................... . ................................................................................ xPlot ............................ Lot ................................ Permit Granted ,,,,January 6, 19 83 Date of Inspection ....................................19 Date Completed ......................................19 j `i «, ., ; 1 _ _ .- r � �s' -, r.�-• .�? .sr i. 'f 4 iY F-" L'A."ht ,�..i r '"a e, 2 .='r ;+ a`:±ems. '� t.-, ,.• ^-:. 49sr,,�.. W. . N Af � riv � Q R/ PLAN SHOWING �N FOUNDATION LOCATION wio 00 MASS. wl�o -� o�-U'w OWNED BY: G1�5224A?- .14C,e..S "p1dWzzy , g o 0 3 LL 4=42 it SCALE / '� ,¢Q DATE' 0 0 w NORMAN GROSSMAN t---——=REGISTERED LAND SURVEYOR 3 w 0 F a�ZIL s W o LL U I HEREBY CERTIFY THAT THIS FOUNDATION /S LOCATED ON THE` LOT AS SHOWN AN N a�� �F Mqs� n I �a D CONFORMS. TO THE .TOWN y��. 3 OF 6?,wA, r7;-g81�-ZONING REGULATIONS REGARDING °� t�phMAN =0 W U id SETBACI6S FROM STREET LINES AND LOT LINES . �►aczssf�st"`" _z u tdn.12 715 n f z LL W NORMAN GROSSMAN R.L.S. } TOWN OF BARNSTABLE Permit No. Building Inspector cash OCCUPANCY PERMIT Bond Issued to Ar-rx�s u Address Wiring Inspector Inspection date Plumbing Inspector Inspection date Gas Inspector Inspection date Engineering Department Inspection date Board of Health 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 AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. ....................................................... 19......._... ......................,................................................................ -----......__.......... Building Inspector - - FROM - -� TOWN F BARNSTABLE BUILDING DEPARTMENT � Mr. Francis Lahteine 367 MAIN STREET HYANNIS,_MA 02M 1 Town Clerk Phone: 775-1124 SUBJECT: FOLD HERE - DATE - December 7, 1.198 M E S S A GE Mork has •been completed under'Building hermit #26456 & #24698 (Cedar Acres Realty/Dennis Star Construction). . Please release Bonds. SIGNED DATE REPLY SIGNED , +• N87-RMf , - - 'RECIPIENT`.RETAIN WHITE COPY-,RETURN PINK COPY PRINTED IN U.S.A. - SENDER: SNAP.OUT YELLOW COPY ONLY.SEND WHITE AND PINK COPIES WITH CARBON INTACT. MASSAGHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) TOWN OF BARNSTABLE Date y 19 Hynnnise Massachusetta Permit Building /X/vOwner 'a AT: Location / Name .� _ Type of Occupancy: New ❑ Renovation [] Replacement GPlans Submitted Yes ❑ No ❑ q q W q q Y Z i 19 M Z q ! VO Z q WWj q YZI H V r ~ � i q O _ < 3 Z ; O F' YZf O i O O Z 1- O q O W < Z = H g 0 W ! < W W W q j Z ``O W ►' W F" = q Z q`` r O Z WZ O q Z sus—ssYT. NAiEMENT isT FLOOR 2NOFLOOR iR0 FLOOR ITNFLOOR aTlf FLOOR aTNFLOOR TTNFLOOR $TN FLOOR (Print or Type) Check one- Certificate Installing Company Name orp. Address ❑partnership ❑Firm/Company Business Telephone ilf— j, ?— Name of Licensed Plumber or Gasfitter I hereby outify that all of the detalis*ad)nfOun@tbn I have wbmltted(of entered)In above applfatlen tea true and @=wrote to the bet of wr knowledge and that all plumbing work and Instalotlons performed under hrmll'faatred (of this eprOatlon wW be In oompWa@ with as/ePoaeat prO.Wonr of the Waaeeehurtu Stan Gu Cade sad Ompter 142 of W Cnaeral laws, I have Informed the owner or his agent that 1 .do not have liability Insurance Including completed operations coverage. gnature of OwneriAgent I have a current 11a Ility Insurance policy to Include completed operations coverage. s. gy TYPE LICENSE• ' Title P um er Gasfitter Signatyre of Licensed .aster Plumber or Gasfitter City/Town: l - Journeyman 20 4// 'N ' APPROVED (OFFICE usE ONLY) License 14UMbbX7 ` _ BELOW FOR OFFICE USE ONLY FINAL INSPECTION _ SKETCHES PROGRESS INSPECTION �O FEE NO. / b/ APPLICATION FOR PERMIT TO DO GASFITTING NAME i TYPE OF.BUILDING LOCATION OF BUILDING PLUMBER OR GASFITTER - 0 LIC. NO. PERMIT GRANTED DATE 19 GAS INSPECTOR,,