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0096 PRUDENCE LANE
9G �.k G�. � i V Cape Save Inc. 7-D Huntington Avenue South Yarmouth, MA 02664 Tel: 508-398-0398 Fax: 508-398-0399 11/10/2014 Thomas Perry CBO Town of Barnstable Building Division 200 Main St. Hyannis,MA 02601 RE: Insulation Permits Dear Mr. Perry µ This affidavit is to certify that.all work completed for 96 Prudence Lane(#201308837) has been, inspected by a third party Certified Building Performance Institute(BPI)Inspector. All work performed meets or exceeds Federal and State Requirements. Sincerely, E William McCluskey, OISIAI it 1i Z! W'd L 1 ii r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application 7 Health Division Date Issued Conservation Division Application Fee k c Planning Dept. Permit Fee V 22 2? �S Date Definitive Plan Approved by Planning Board 2/4 h 3 Historic - OKH _ Preservation/ Hyannis Project Street Address t^V, 1.4 c am e c Village �C Owner L �i,c� Address Telephone ��� �� CO a Permitl,Request /y'� ✓ S�u`> w �k �!��%,✓( �� C� lS C i�llcL -Se (u/ i_ %�tS c,Ta re a /f,-C 4c , Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District r� Flood Plain Groundwater Overlay Project Valuation 90 v ^ Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family 2.-' 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 C7 Basement Finished Area(sq.ft.) Basement Unfinished Area (VQ. t) Number of Baths: Full: existing new Half: existing riew Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count:' -�' Heat Typ and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Others Central A*r: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name k1M 4&3ke 1('-we'Cave � Telephone Number C Address C quk�i �� C I License # l®�'176 —fD Q-A O W k Home Improvement Contractor# /�✓v 0 Worker's Compensation #TkIC 3�S_3 Qvl-U . ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO SIGNATURE DATE `G b 6 v i ,r FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED y MAP/PARCEL NO. { ADDRESS VILLAGE r" { OWNER s L DATE OF INSPECTION:- { FRAME k. k iINSULATION- FIREPLACE k ELECTRICAL:, ROUGH FINAL PLUMBING: ROUGH FINAL . '. GAS: ROUGH FINAL FINAL BUILDING 3 . E _ r .DATE CLOSED OUT ASSOCIATION PLAN NO. i nnt For"m` '� The Commonwealth of Massachusetts L�--�P— Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Cape Save,Inc. Address: 7D Huntington Avenue City/State/Zip: South Yarmouth, MA 02664 Phone#: 508-398-0398 Are you an employer?Check the appropriate box: Type of project(required): 1. ✓❑ I am a employer with 17 4. ❑ 1 am a general contractor and I 6.. ❑New construction employees(full and/or part-time).* - have hired the sub-contractors listed on the attached sheet. 7. ❑ Remodeling 2.❑ I am a sole proprietor or partner- . These sub-contractors have ship and have no employees employees Building 9 8. ❑ Demolition working for me in any capacity. loyees and have workers' addition : ❑ g o workers' com insurance comp. insurance.? p' 5. ❑ We are a corporation and its . 10.❑Electrical repairs or additions required.] ❑ officers have exercised their 11.❑ Plumbing repairs or additions 3. I am a homeowner doing all work myself. [No workers comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no 13 ❑ Other Insulation 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. fi Homeowners who submit this affidavit indicating they are doing all wort: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. . Technology Insurance Company Insurance Company Name: TWC 3353968 Expiration Date: 04/09/2014 Policy#or Self-ins.Lic.#: 1 City/State/Zip. Job Site Address: `t; \ 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 cert under the ains and enalties o eri t at the information provided above is true and correct �l of St ature: ---- _--- -- ---- - - - - - - Date -- - ---_ _.._; Phone#: 508-398-0398 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 Phone#: Contact Person: •�ACORD® `.� CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 10/22/2013 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 pollcy(les) must be endorsed: If SUBROGATION IS WAIVED, subject to the terns and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer fights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME: Colleen Crowley Risk Strategies Company PHONE (781)986-4400 FAX (781)963-4420 1S Pacella Park Drive MA c No: Suite 240 - INSURER(S)AFFORDING COVERAGE NAIL INSUREDURED P # R h M 02368 INSURER :Selective Ins. , of America INSURERB:Safet Insurance Company 3618 Cape Save, Inc INSURERC:Technolo Insurance an 7 D Huntington Ave INSURERD: INSURER E South Yazmouth NA 02664 11INSURERF: COVERAGES CERTIFICATE NUMBER:CL13102268490 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 LTR TYPE OF INSURANCE D POLICY NUMBER MMIDOCY EFF MPMOj ICY E P LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO PREMISES occurrence) $ 100,000 A CLAIMS-MADE a OCCUR 1994480 0/16/2013 0/16/2014 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,0001000 GENERAL AGGREGATE $ 2,000,000 [�'L AGGREGATE LIMIT APPLIES PER:POLICY FX PRODUCTS-COMP/OP AGG $ 2,000,000 PRO- X LOC $ AUTOMOBILE LIABILITY Ea accident I LIMrf 1,000,000 8 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED E ULED 1/6/2013 1/6/2014 AUTOS X AUTOS 208200 BODILY INJURY(Per accident) $ X HIRED AUTOS X AUTOS NON-OWNED PROPERTY DAMAGE AUTOS Peracadent $ X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS�v1ADE AGGREGATE $ 1,000,000 DED RETENTION$ Bit S1994480 0/16/2013 0/16/2014 $ C WORKERS COMPENSATION Officers Included for WCSTATU- OTH- AND EMPLOYERS'LIABILITY YIN X R ANY PROPRIETOR/PARTNER/EXECUTIVE overage OFFICER/MEMBER EXCLUDED? Ni NIA E.L.EACH ACCIDENT $ 500000 (Mandatory in NH) 3353968 /9/2013 /9/2014 E.L.,DISEASE-EA EMPLOY $ 500 000 Iles describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) Weatherization Specialists GL: Blnkt AI, Blnkt PNC, Blnkt WOS, Per Proj Agg, Per Loc Agg / GL Exclusions: Snow & Ice Removal/OCIP/Wrap Ups CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE �Iichael Christian/CLC ACORD 25(2010105) O 19W2010 ACORD CORPORATION. All rights reserved. INS025(201005).01 The ACORD name and logo are registered marks of ACORD 4 Massach use-s -Depar mem of'public Safety Board o�Building Regulations ar,d Standards Construction supen-isur specialn" icense: CSSL-102776 WILLIAM J MC CLUSKEY._. r 37 NAUSET ROAD West Yarmouth NA 02673 f Commissioner 06/28/2015 `�-In, a � Office of Consumer Affairs and 2USiness Regulation ci 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration = Registration: 171380 Type: Corporation Expiration: 3/14/2014. Tr# 222184 CAPE SAVE INC. WILLIAM McCLUSKEY 7=D HUNTINGTON AVENUE- SOUTH YARMOUTH, MA 02664 Update Address and return card.Mark reason for change. OPS-CAI"0 sor.4-o4/os-oiot2ts ? i Address ?� Renewal � Employment .1 Lost Card ✓1ze Loow»zoozcaea�� cj.'�•j�aaacdi' Office of Consumer Affairs&Business Regulation License or registration valid for individul use only A ! I' HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: f- , Registration: 171380 Type: of Consumer Affairs and Business Regulation �re: O 10 Park Plaza-Suite 5170 Expiration: =3l14/2014 Corporation fl -: - -_ Boston,MA 02116 ep�W SAVE INC.. WILLIAM McCLUSKEY \ 7-D HUNTINGTON AVENUE SOUTH YARMOUTH MA:026Ei4 Undersecretary Not valid wit o signs Building Permit Authorization I, Roland Stutsky as owner hereby give my permission to Cape Save, Inc. 7-D Huntington Avenue South Yarmouth, MA 02664 Office: 508-398-0398 to take all necessary steps to obtain a building permit to perform work at my property located at 96 Prudence Lane Cotuit, MA 02635 Signed Date x Y Assessor's offioe (1st floor):- CF TN E TO Assessor's map.,and lot number ....�....�...........0.....�...... ----' Board of Health •(3rd floor): a Sewage Permit number ........................................................ 1 MAUSTADLE, i Engineering Department (3rd floor): oo MABIL \0� Housenumber ........................................................................ APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only TOWN OF BARNSTABLE . r BUILDING INSPECTOR APPLICATION FOR PERMIT TO ........... ..... ....... ..... // L �!( ................................................ TYPEOF CONSTRUCTION .................s/ ........Q...... ........ ............................................................... ................... .......... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies applies for a permit according to the following information: Location Location e%v N- ,i (!r. P....V(. .. '...:........!'�.-n........................ .,1..../.1�. ....................................................... Proposed Use .................... Zoning District ........................................................................Fire District Nome\of Owner J'/E� .H....(2>-:.........�.�..klA..............Address &.:....Prucf.,_"_ c _.J. .- '�.�. r)��.�.............. .... ............ .... Name of Builder .a .(fit+ .!..!l..ta ......�..0.?!.:5 ........Address .. .. .4C�1. .�... .h......f '�4./r .<........ per- {� �, J.---- Name of Architect .t r. ... ..^�,.. �'►1ro . ....:...........Address ./ ... .L @ C...... :;...... :.......... i Number of Rooms �,3........................................Foundation ....C,Q.?.M!:;:..f':`eA!1;k,. r C `� O ��� `�-ret`Gc tih 1 Exierio. - !....... ......�........ .... ` ................ ..... Roofing .....C - fJ.....C ...�'. ..w�..i e.$........................... Floors Af..7t�rn......?dy W_C1.?r�...................................Interior ......... ! !/�i��G___ d.... ....... . .......................................................... Heating .�..�.�.�'.:1.11.'.!.6�.......................................................Plumbing ..........kg 7-77 Fireplace ......................�.......................................................Approximate Cost ...... O'00c .............................. .. Definitive Plan Approved by Planning Board ________________________________19-------- . Area ...1.�/... ....................... Diagram of Lot and Building with Dimensions Fee ..........!............... SUBJECT TO APPROVAL OF BOARD OF HEALTH ti Fr f a i 1 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 (:Y/! iLl�...... � ...................... . , Construction Supervisor's License ................ PINA, HELEN G. A=040-049 No ..29748.... Permit for ...Build Addition .............. Single Family Dwelling...................... Location .....96. PrudenCe..La.ne Cotuit ............................................................................... Owner ....Helen._G.. Pina . . . ................................. Type of Construction ..Frame ............................................................................... Plot ............................ Lot ................................ Permit Granted ....August_,5..................19 86 Date of Inspection ....................................19 Date Completed ......................................19 Assessor's offioe (1st floor): �.-.8. ��'d:, l sessor's map and lot number IN C0MPLl o;+.� ..� ` Board of Health ,Qrd floor): WITH TITLE 5 Sewage ,Permit number .... 1 ENTAL CODE Au Z BAHd9TODLL, Engineering Department (3rd floor): i ����LATI� 01 +�6S9. Housenumber ........................................................................ '°�oraYa. APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only TOWN OF BARNSTABLE BUILDING INSPECTOR �APPLICATION FOR PERMIT TO . �......k '.....:5.:�.!.✓!^. `.� ./�.�. G.4>....�........ .. V....... . .......................... TYPE OF CONSTRUCTION ..�2.. . �7.T>til.� ���` ,�!!ld Otj/ ............ ............19 k? TO THE INSPECTOR OF BUILDINGS: The undersigned he applies for a permit according to the following information: .. C �� , Location ....?1 UQi/.'f _ iv�s,.r....................�.7-�./...�............................................................... .............................. Proposed Use ...1. .�2 !C1 .... ..7rd .... .....�d .l....................................... Zoning District ��F...........................................Fi District ...............� /-.. Name of Owner J ......7..j ��-................Address ................ Nome of 0.. dress ...4... ->D��1�. J/l�':..f! 1 .0...��,l.F.�� Nameof Architect ..................................................................Address .............. ..................................................................... Numberof Rooms ..................................................................Foundation .............................................................................. Exterior ....................................................................................Roofing .................................................................................... Floors ......................................................................................Interior .................................................................................... Heating ..................................................................................Plumbing ......................... ................................................... Fireplace ....................................................................Approximate Cost .......... / Definitive Plan Approved by Planning Board ------------------------ ____19 ____ -- . Are .......67.f .. .......... cc,, Diagram of Lot and Building with Dimensions Fee ,,.. .! .....v...a.......................... SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable reg rding th above construction. Name ............. ... ......... .. Construction Supervisor tense .. ...oz 9<..(�..... PINA, EDWARD t ' l I . 1 � I "o 31163.. Permit for .,,Swimming Poc;i ...................... „l. 'in ie Family. Dweiliny.............. m ....� ....................... Location .....`9.6 Prudence Lane . ................................................. Cotuit ............................................................................... Owner .......Edward. ...P.ina. .. ..... .. . .. ................................ Type of Construction .....,,Gunite ............................................................................... Plot ............................ Lot .................. :............ Permit Granted ............�...'...... S e t 8.!.............19 87 Date of Inspection ....................................19 19 Date Completed ..........yy/... �........... ::.... � r i Assessor's offioe (1st floor): FtNET Assessor's map and lot number 0..".8 .�.... ±.......� �o o�♦ P Board of Health (3rd floor): Sewage Permit number ..77.n..`..ate. :..D .......?........... Z NARBSTODLE, i Engineering Department (3rld floor): 'oo,s�MAGIL 1639- House number. ....................... ...?.............................................. �Ea Nrl W. APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00�-^2:00 P.M. only\ TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT-TO b�.�.�b.....,5`J r Y /"` , 1 ...... �>.v....!...... TYPE OF CONSTRUCTION ✓ r ... .. ��!V. /./... . .. ...... .. ti........................................ ..-.. ` �...... 19- TO' THE INSPECTOR OF BUILDINGS: The undersigned hereby applies fordo permiaccordtng xto.the (following mformabon:- 'i f � . �v�e,cJe� ... T i'Yl..I4 . a Location ... . ... ...... ................. ......... ......... ...... .... Proposed Use ......� 1 1.L.. !./ �d .......................... ZoningDistrict ........................................................................Fire District ................................................... ............+........... �(�GtJ /11�......T"lK� ...... Name of Owner ....... ...... .......... ddress .. ..............................'%............... .. . ............... Name of Builded 1PGL .:wlUlT ......!. ......Address C� /C-Pjw / ....��/�/d /�///f.C� Name of Architect .:...Address Numberof Rooms ..................................................................Foundation ....`........................................................................ 6 IExlerior ....................................................................................Roofing .................................................................................... t 7 t Floorsi.......................................................................................Interior .................................................................................... Heating ............ ............................ ...........................................Plumbing ...................... ................... .................................. . Fireplace .........................Approximate Cost ........../.....�... d .... Definitive Plana Approvedby Planning Board - r ,�- , . ,--- ., --19 _ Area. ,-. � � ... � Diagram of Lot and Building with Dimensions "`ti Feely .- SUBJECT TO APPROVAL OF BOARD Of HEALTH f i� f �I �f R:M r° OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS 1 hereby agree to conform to all the. Rules and Regulations'of-the-Town of Barnstable reg-rding the above t construction. r , Name ....... . ........... 9g Construction Supervisor icense .......................l..k....... a PINA,. EDWARD A=040-049 A , No 31163 Permit for ....Swimming Pool Single Family Dwelling Location ....9.6 ..Prudence Lane . . ............................................. Cotuit , .....................................................................I......... Owner ..,Edward Pina . ....................................................... Type of Construction .. Guni.te Plot ............................ Lot ................................ Permit Granted ..... ...19 37> Date of Inspection ....................................19 Date Completed ......................................19 r r 1 I�� - 4 5 A a -a e 1 ` Assessor's offioe (1st floor): V Xssessw's= map and lot number .... �oF "E>o�♦ Board of Health (3rd floor): Q *� Sewage Permit number ..............................1.... cl......... =. Z BARMT&BLE. • Engineering Department (3rd floor): 'o MASL 0' O1639. 9 Housenumber ......................................................................... 'EaViv APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00.2:00 P.M. only TOWN `OF ,BARNSTABLE B.UILD.IHG INSPECTOR . i n APPLICATION FOR PERMIT TO ...... TYPE OF CONSTRUCTION ..................( .� p..... ............................................................... ..................... .... .........19 1.. TO•THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: t /' Location ....... ( ....... G1�+.(�4 .Y.(.G.-P.:.......�..! 1..:.....................��1/l�......... ................... L7 Proposed Use ................. ................................................................................................. Zoning District ..............?.. .........................................:.....:......Fire District ............... t � .................................. Name of Owner (!�.......... L. .........Address ...7. ....... .... U. :!'�(.4 Name of Builder ... . ►1.l7 1ti f �- .. . .l... .�........ . . ........Address -.�...�J...�i1.".:k ...... ........ Name of Architect .. r3...� 1" ...............Address ...c `� .(<�.'D.�-... ..... .. •......,.., ' Number of Rooms ..................................................................Foundation .....CD.4N—c-.i^ . Exie ior ....... ,. i. Roofing ..... ..��.h. .��,$........................... Floors ......:...........................Interior ......... 1 //f/,Imo. �F �..................................... - Heating . .eG' :.Y:L.(. ...........................`.................:.........Plumbing ....... ..... Fireplace ............................................................................:.....Approximate Cost ........0... ................ . . Definitive Plan Approved by Planning Board --------------------------------19-------- . Area ... ....................... Diagram of Lot and Building with Dimensions Fee �� SUBJECT TO APPROVAL OF BOARD OF HEALTH 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. F Name ZALI. Construction Supervisor's License .6v.. .. ................ PINA, HELEN G. No Permit for i:ion ......................... Single..Fa1q.i.lv..Dw.e.11in.g..................... Location 96 Prudence Lane................................ ............................... Cotuit ............................................................................ Owner Helen G. Pina .................................................................. Frame Type of Construction .......................................... .............................................................................. Plot ............................ Lot ................................ August� T&,- Permit Granted ........................5.,.................19 86 Date of Inspection ..............19 Date Completed ... ........................19 oa. ,Q 47 40 4.1 ''1 I - R i � I S70 P ------ I � j � j I Sr tL rTc ( lb I i �-� _ I i 1 I L-� EI � " i F y t 7 CC I !'. AAPRaV D BY $GALE: r +Q DRAWN BY�y j • DARE: DRAWING NUMBER n' 4- r a + mope- , 1 r- - 2f11-ram '�1-© � , -{ ,i I _. 1 1 '1 f xo V71---Z _�_-_-fi11 i - 7 j 44 i { i C.�� �t`t GJh'�rnpr•1s SCALE: r'Q„ AP►P10VED9v im"mar G3Z) BATE: AMMNO M111IIMEl1