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HomeMy WebLinkAbout0640 SANTUIT ROAD i 1. U I :3 iF. d.'r f oil IOU 00 • � 4udk6 u61" �� � �� t i k i ,'. Town ®f Barnstable Permit: Regulatory Services Date: * 00HE rod Thomas F. Geiler, Director Fee: Building Division * BARNSTABLE, # Tom Perry, Building Commissioner 16:59. ��� 200 Main Street, Hyannis,MA 02601 'IFnMA+a www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 TOWN OF BARNST'ABLE SOLID FUEL STOVE PERMIT Owner: R 0 Phone: �G '�r� Z/ Lp k Install at: >-) J G/ 1 X Village: (�oJ G f 7— Map/Parcel: ejQ 6 L677 4 0- 9 Date: tp- �' U Stove b,f�pS'p36a,��/ A. PNene/ Used `� e))&>�P B. : Radian Circulating , C. Manufacturer: _ - y ar,l: Lego tab. NO.&L_ 3 9_._ ,r 3,t1 — 23e'< � l D. Model No.: 3 s f T L %7 Chimney A. ee /Existing (If existing, please note date of'last cleaning) B. Flue Size C. Are other appliances attached to Flue? '416 D. Pre-fab Type and Manufacturer 0 (1 IZ A P-4 61 9 415' 0 S/M� s_�/VAA�T /A)C E. Masonry: fined lnlined Hearth A. Materials: c�,i/� ,�� r,�� 79A ^—7 B. Sub Floor Construction: Installer Name: Address: -ri Phone: rr Location of Installation: -X , H.I.0 Registration # Er z;, Construction Supervisor# " OR-.check tiHomeowner Installing, no license required APPLICANTS SIGNATURE ✓2%� APPROVED BY: c m /®c Please make checks payable to the Town of Barnstable *This constitutes an official stove permit after inspection, photographed, and approved by the Building Inspector Q:forms:stove Rcv 103107 f Town of Barnstable �oF SHe rp�� Regulatory Services Thomas F.Geiler,Director BARNSTABLE, - MAM Building Division PIED ' a Tom Perry,Building Commissioner . 200 Main Street, Hyannis, MA 02601 www.town.barnsiable.ma.us Office: 508-862-4038 Fax: 5.08-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: n number street villag e "HOMEOWNER": l ,�70/1 "3 name home phone# work phone# CURRENT MAILING ADDRESS: -sue-/-I,!f city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is,or is intended to be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner } Approval of Building Official Note: Three-family dwellings containing 35,000 cubic.feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a persons)for hire to do such work,that such Homeowner shall act as supervisor.,. Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors;Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. r OpIKEt Town of Barnstable Regulatory Services =" ". E8; Thomas F. Geiler,Director qjA i639. �� jFo3ra 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 as Owner of the subject property hereby authorize to act on my Behalf, in all.matters relative to work authorized by this building permit application for: (Address of Job) Signature of Owner Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. PERMIT.,PAA NT RECEIPT TOWN OF BARNSTABLE BUILDING DEPARTMENT 200 MAIN STREET -HYANNIS, MA 02601 YDATE: 09/19/06 TIME: 10:06 : -----------------TOTALS------------------ ' PERMIT $ PAID 25.00 , AMT TENDERED: 25.00 'CHANGEPLIED: 25.00 f APPLICATION NUMBER: 200805231 PAYMENT METH: CHECK PAYMENT REF: 1396 r) Ma Parcel p G 6 ,� � " Permit# �� ,� 0' I House# (o l Date I��*Q_ w�Board of Health(3rd floor)(8:15 -9:30/,1:00- - Fee 1 P4ST r EJ`O , � _ J!9 !d Conservation Office(4th floor)(8:30-9:30/1:00-2:00) �� � � elvvin 17.j1 T.PIN ��PUA1Vice 0JVJWMum 15 - ) TEE 9 i and , 19 ®�AIVD /� S^h �vJ I C�vt I AP... ) i BARNSTABLE. ••.-. — F � 9 l 1 Vl A V 9 Y1 - MASS. I J Al6 ��EA MAC a` TOWN OYBARNSTABLE. . Building" Permit Application 4K 4�0 Y,4 Al T e `i- � l� Project Street A d �' , _ W� Village Owner L. /': d N /z 19. l 10f 2,2'_T.$) Address 6-V® I v 7- & 12 Telephone 1' -Permit Request ' A-7 1-/ 0 0 '-1 � �� i �� /�� 11� � �P���llz !� ���� f cl c 17� CL� ZT.,S 9 f eA 7 I2 R e i 9179 41�70 /Z)�- - Z,02C E' gea-Y 3.%%>.?G- First Floor a41 square feet Second Floor y1+/d square feet Construction Type Estimated Project Cost $ Zoning District A: A S Flood Plain D Water Protection Lot Size AM ,,A eg-' Grandfathered a-Ye's ❑No Dwelling Type: Single Family [9® Two Family ❑ Multi-Family(#units) Age of Existing Structure C j PZCA 11?J'D Historic House ❑Yes M,110 On Old King's Highway ❑Yes (f1le0 Basement Type: [lull ❑Crawl lkout ❑Other Basement Finished Area(sq.ft.) / a o® Basement Unfinished Area(sq.ft) Alo A)f- Number of Baths: Full: Existing New / Half: Existing New No.of Bedrooms: Existing New Total Room Count(not including baths): Existing New S First Floor Room Count J Heat Type and Fuel: ❑Gas Mr(Ill ❑Electric ❑Other Central Air ❑Yes 2,Ko Fireplaces: Existing i/ New Existing wood/coal stove ❑Yes ISO Garage: etached size r g ®'D ( ) � '� � a 5 Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use lit. Builder Information Name .4 A /Z 0 7-ie J_--;-! / Telephone Number Address !�o vp ro I % A P License# I!y N)5 re,70 7 7 /17 )1- --ems 2 G 3s Home Improvement Contractor# 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 L SIGNATURE DATE BUILDING PERMIT DENIED FOR THE ROLLOWING REASON(S) FOR OFFICIAL USE ONLY ' .PERMIT NO. DATE ISSUED ti MAP/PARCEL NO. L t �Z ADDRESS c VILLAGE OWNER I a J DATE,OFjNSPECTION FOUNDATION FRAME INSULATION r FIREPLACE' ' ELECTRICAL: t ROUGH ; �r FINAL �' f Y PLUMBING: 0 ROUGH FINAL , y GAS: ` ' t ROUGH ! FINAL _~ F FINAL'BUILDING DATE CLOSEDOUT +, ro ASSOCIATION PLAN NO. - t _ t Bain Louise From: Giangregodo Robin To: Bain Louise Subject: RE: tax check Date: Thursday, July 02, 1998 4:12PM All of these properties are ok. From: Bain Louise To: Giangregorio Robin Subject:tax check Date: Thursday, July 02, 1998 3:41 PM Priority: High r0100.1-- - 790 Falmouth Rd, Hyannis- Parkside Senior Services, Ltd. 144/003/001 -24 Falling Leaf, Osterville- McShane Constr. 278/058 - 94 Old Jail Ln., Bamstable-James Antiposti 120/078 - 5 Oldham Road, Osterville- Susan M. Rogers 172/137 - 128 Cedric Rd., Centerville- Barbara Swimm 006/029 -640 Santuit Road, Cotuit- Leonard & Lempi Petit J Robin -very sorry that there are so many to check-our staff is quite depleted today and didn't get a chance to send this until just now. 3 0 wc*) Page 1 Ueparrmentui inuusrriactitcctue.u� :-:- Office of/oyesuffations 600 Washington Street +r 1' Boston,Mass. 0211r.?���V,, f Workers compensation Insurance Affidavit / name location D TCy ) f 2Z o hone# o city am a homeowner performing all work myself. ❑ I am a sole proprietor and have no one working in any capacity //%/G%%% %/%%/%/%%%%%///%/%%///////%%/// ❑ I am an employer providing workers' compensation for my employees working on this job. com anv name• address: ... .. city insurance co. I RolicV#,: ❑ I am a sole proprietor, general contractor, or homeowner(circle one) and have hired the contractors listed below who have the following workers' compensation polices: i com anv name: :. address: hone#: olicv,# insurance co. company name: address: city hone#: ollev# insurance co Failure to secure coverage as required under Section 25A of MGM 152 can lead to the imposition of criminal penalties of a fine up to S1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S 100.00 a day against me. I understand that a copy of this statement may be forwarded to the Ofltce of Investigations of the DIA for coverage verincation. I do hereby eery under the pain penalties of rju the information provided above is true and correct �y Date d d _ Signa e---- Print name eJ 72 > � / ® Phone# C/ 2- J' official use only do not write in this area to be completed by city or town official city or town: permit/license# ❑Building Department ❑Licensing Board ❑Selectmen's Office ❑check if immediate response is required ❑Health Department contact person: phone#; ❑Other (nosed 9/95 PJA) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", an employee is defined as every person in the service of another under any co= 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 o: the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receive:. trustee of an individual , partnership, association or other legal entity, emploving 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 ofb another who employs persons to do maintenance , construction or repair work on such dwelling house or on the grounds building appurtenant thereto shall not b..,,.....,., of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or reneN- of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who h: not produced acceptable evidence of compliance with the insurance coverage required. Additionally, neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance as all affidavits 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"or if yo,. a are required to obtain a workers' compensation policy, please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of thi 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. The affidavits may be retuned io the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you 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 Massachusetts Department of Industrial Accidents r�r 0mce of Imles"gallons 600 Washington Street Boston, Ma. 02111 fax#: (617) 727-7749 phone #: (617) 727-4900 ext. 406, 409 or 375 780CURAppcwft, Table JS2.1b(continued) Prescriptive Packages for One and Two-Fmoily Residential Buildings Heated with Frill Fuels MAXIMUM MINIMUM Glazing Glazing Ceiling Wall Floor Basement Slab HeatirijCooling Area' •/•) U-values R-value' R-value R value' Wall Paimew Equipment Efficiency' Package R va ue° R value' 5701 to 6500 Heating Degree Days' Q 121'a 0.40 38 13 19 t0 6 Normal R 12% 0.52 30 19 19 10 6 Normal S 125's 0.50 38 13 19 10 6 85 AFUE T 15% 0.36 38 13 25 N/A N/A Normal U IS% 0.46 38 19 19 10 6 Normal V 15•/. 0.44 38 13 2S N/A N/A 83 AFUE LAA 15% 0.52 30 19 19 10 6 85 AFUE 18•/. 0.32 38 13 25 N/A N/A Nominal 18% 0.42 38 19 23 N/A N/A Nommal 18% 0.42 38 13 19 10 6 90 AFUE 18% 0.50 30 19 19 10 6 90 ARM 1. ADDRESS OF PROPERTY: Y D S'/A �l TG 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: /)- 2 Cf 3. SQUARE FOOTAGE OF ALL GLAZING: 4. %GLAZING AREA(#3 DIVIDED BY#2): 3 5. SELECT PACKAGE(Q--AA-see chart above): NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. BUILDING INSPECTOR APPROVAL: YES: NO: q-fortes-f980303a 780 CMR Appendix J Footnotes to Table J5.2.1 b: Glazing area is the ratio of the area of the glazing assemblies (including sliding-glass doors, skylights, and basement windows if located in walls that enclose conditioned space, but excluding opaque doors)to the gross wall area,expressed as a percentage. Up to 1%of the total glazing area may be excluded from the U-value requirement. For example,3 ft'of decorative glass may be excluded from a building design with 300 ft'of glazing area. 'After January 1, 1999, glazing U-values must be tested and documented by the manufacturer in accordance with the National Fenestration Rating Council (NFRC) test procedure, or taken from Table J1.5.3a. U-values are for whole units: center-of-glass U-values cannot be used. ' The ceiling R-values do not assume a raised or oversized truss construction. If the insulation achieves the full insulation thickness over the exterior walls without compression, R-30 insulation may be substituted for R-38 insulation and R-38 insulation may be substituted for R-49 insulation. Ceiling R-values represent the sum of cavity insulation plus insulating sheathing (if used). For ventilated ceilings, insulating sheathing must be placed between the conditioned space and the ventilated portion of the roof. 'Wall R-values represent the sum of the wall cavity insulation plus insulating sheathing (if used). Do not include exterior siding, structural sheathing, and interior drywall. For example, an R-19 requirement could be met EITHER by R-19 cavity insulation OR R-13 cavity insulation plus R-6 insulating sheathing. Wall requirements apply to wood-frame or mass(concrete,masonry, log)wall constructions,but do not apply to metal-frame construction. 6 The floor requirements apply to floors over unconditioned spaces(such as unconditioned crawlspaces, basements, or garages).Floors over outside air must meet the ceiling requirements. `The entire opaque portion of any individual basement wall with an average depth less than 50%below grade must meet the same R-value requirement as above-grade walls. Windows and sliding glass doors of conditioned basements must be included with the other glazing. Basement doors must meet the door U-value requirement described in Note b. 'The R-value requirements are for unheated slabs.Add an additional R-2 for heated slabs. ` If the building utilizes electric resistance heating use compliance approach 3, 4, or 5. If you plan to install more than on --piece_..of..heating equipment or more than one piece of cooling equipment, the equipment with the lowest efficiency must meet or exceed the efficiency required by the selected package. 'For Heating Degree Day requirements of the closest city or town see Table J5.2.1 a NOTES: ' a)Glazing areas and U-values are maximum acceptable levels. Insulation R-values are minimum acceptable levels. R-value requirements are for insulation only and do not include structural components. b)Opaque doors in the building envelope must have a U-value no greater than 0.35. Door U-values must be tested and documented by the manufacturer in accordance with the NFRC test procedure or taken from the door U-value in Table J1.5.3b. If a door contains glass and an aggregate U-value rating for that door is not available, include the glass area of the door with your windows and use the opaque door U-value to determine compliance of the door. One door may be excluded from this requirement(i.e.,may have a U-value greater than 0.35). c) If a ceiling,wall,floor,basement wall,slab-edge,or crawl space wall component includes two or more areas with different insulation levels,the component complies if the area-weighted average R-value is greater than or equal to the R-value requirement for that component. Glazing or door components comply if the area-weighted average U- value of all windows or doors is less than or equal to the U-value requirement(0.35 for doors). 43 �THE The Town of Barnstable NAM ,$ Department of Health Safety and Environmental Services &" 6 BuiIding Division 367 Main Street,Hyannis MA 02601 Ralph Crosser Office: 508•790-6227 BuiIding Commission: Fax: 508-790-6Z30 For otrice use only Permit no. Date 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. Type of Work: -N IM- " .n.,!Z 7]d 1) Est.Cost Address of Work: 1 cry 5,A-.eJ T� l Owner's Name —CJ Al P a YJ Date of Permit Application: a I hereby certify that: Registration is not required for the following renson(s): Work excluded by law Job under SI,000. BuiIding not owner-occupied I-, Owner pulling own permit Notice is hereby given that: OWNERS PULLING 171M OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGZAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner. Contractor Name Registration No. Date OR 9 LI �� J Date Owners Name I Appt rit,-- Peru- Of 4X-WertY= CUM.rt f . .5 antr Pwa I- ." 189. 47 T 54*t tto. 640 tj I story dwellix �s , -dot 86 w �s Lor 76 ,Area = 46, 200±s. 275. 18 ,Lot 77 tM OF ref $15 / 128 Mood Panel:250001 00211) f00& Z0rW- r� L moo' PAUL 4N hereby Certify �t ttus mortgage in5pectfon was-pr�zrei-for GROVE l ne, Woodwo -tth. 47Tvarts 10 611eonard and MI 1Petiv- ,► o TW dwelling shown.. hereon,does � in a special . {�,00d IST +o� hazar& area with am eRctLve date of 7-2 -92 and. edw locaftbr/ oP the dwelling does'-_/r cmn rro flu local ,gaping 60ws im ef*v wt'the tune oF-con.struaion Wi t, respect to horisontrd di iona Scale: 1" - 80 setback requ t s or is ennVr{rm. Vtolaht n. ert oMet�ttietlr' Date: 4 15 . 98 "tt,otti under Mass. GeneraL Laws Chapter4oX-_Seett'ory 7. File No. 9s.2as8 PLEASE NOTE:,The structures as shown on this plot plan are approximate only. An actual survey is necessary for a precise determination of the building location and encroachments. if any exist, either way across property lines. This plan must not be used for. recording purposes or for use in preparing deed descriptions and must not be used for variance or building plan purposes. This plan must not be used to locate property lines. Verification of building locations, property line dimensions, fences or lot configuration can only be accomplished by an accurate instrument survey which may reflect different information than what is shown hereon. Please note that this is "NOT A BOUNDARY SURVEY" and is "FOR MORTGAGE PURPOSES ONLY". W COLONIAL LAND SURVEYING COMPANY,lu INC. Y 269 Hanover Street • Hanover, Mass. .02339 • Phone: 781-826-7186 Fax: 781-826-4823 r TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please print. DATE 3 a JOB LOCATION 4; If G -S A A) %!v 7 /h Number Street address Section of town i "HOMEOWNER" � �O i�✓a (z /� �� /��� ���- y 1�_P'y Name Home phone Work phone - PRESENT MAILING ADDRESS (� � �,� 70 City town State Zip code The current exemption for "homeowners" was extended to include owner-occupied dwellings of six units or less and to allow such homeowners to engage an in- dividual for hire who does not possess a license, provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER: Person (s)• who owns a parcel of land on which he/she resides or intends to re- side, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Officia. on a form acceptable to the Building Official, :.that he/she shall be responsibly for all such work performed under the building permit. (Section 109. 1. 1) The undersigned "homeowner" assumes . responsibility for compliance with the Sta4, Building Code and other applicable codes, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedu d requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL Note: Three family dwellings 35, 000 cubic feet, or larger, will be required to comply with State Building Code Section 127. 0, Construction Control. HOME OWNER'S EXEMPTION The code state that: "Any Home Owner performing work for which a building permit is required shall be exempt from the provisions of this section (Section 109. 1. 1 - Licensing of Construction Supervisors) ; provided that if < Home Owner engages a person(s) for hire to do such work, that such Home Owne: shall act as supervisor. " Many Home Owners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q, Rules and Regulations for , licensing Construction Supervisors, Section 2. 15) . This lack of awarene: often results in serious problems, particularly when the Home Owner hires unlicensed persons. In ,,this case our Board cannot proceed against the inlicensed person as it would with licensed Supervisor. The Home "dwner actir as supervisor is ultimately responsible. To ensure that the Home Owner is fully aware of his/leer responsibilities, mar communities require, as part of the permit application, that the Home Owner certify that he/she understands the responsibilities of a supervisor. On the last page of this issue is a form currently used b You care to amend and adopt such a form/certification for euse aint your�community. _— n r -_- - -- — IxZ IK9 E. , 't .- �..,.� �. .-- _— 1 _- .. I a Y'ti• _ 3 ao I'�u S. x��"••h^"r 1 r.�; - - I r- lT.'_= -,tX4•tY1N..- { 14: .i. "`'c 1' 7ri k:l1L- ___ _,� E.. 'I F E � •'�. ks._) 3 Aar �£ �� _ - - -¢w cct-_rw ts4� r, <�. n•�s 1.�Z, t r Y - -� r � ,� ,�. .. I P�.Je 2't•_eis P-Z— '7- a<.&tV qj _ _ j = -I - -- - - 99cEr nN ulu1L;rx 4pp{{v�o -244ry .244� _ Wki ic. R_/,.1 'P�' �I�E. 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