HomeMy WebLinkAbout0076 TROUT BROOK ROAD TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map ! 6a- Parcel. ®7 'Application # y 010 M3
Health Division 'Date Issued
Conservation Division Application Fee
Planning Dept. Permit Fee
Date Definitive Plan Approved by Planning Board N
Historic - OKH _ Preservation/Hyannis
Project Street"Address :76 7t&u-f Oct&k 2.oW9
Village 0
Owner W Q' ` /14, Address
Telephone �-- �-f���_ C�S�
Permit Request jC t ` Z
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new.
Zoning District Flood Plain Groundwater Overlay
Project Valuation v" L' 0 a Construction Type
Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family Two Family ❑ Multi-Family (# units)
Age of Existing Structure '63 , 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) K00
Number of Baths: Full: existing !✓ new Half: existing new_
R o
Number of Bedrooms: .3 existing _new
Total Room Count (not including baths): existing new First Floor q&p Count G
Heat Type and Fuel: Gas ❑ Oil ❑ Electric ❑ Other ` R`, 0-
Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove❑Yet ❑ No
Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size — Barn: ❑existing ZewPsize_
Attached garage: �l 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 61 t+,t14_c 1 (," � ��� � Telephone Number
d
Address LL < < � / �/ � License # C r
u Home Improvement Contractor#
Worker's Compensation #
ALL CONSTRUCTIONZRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
DATE SIGNATURE r�
` FOR OFFICIAL USE ONLY
-APPLICATION#
DATE ISSUED
MAP/PARCEL N0.
ADDRESS VILLAGE ,
OWNER
DATE OF INSPECTION:
FOUNDATION w
FRAME S b c
INSULATIONS
FIREPLACE
;k
ELECTRICAL: ROUGH FINAL r
PLUMBING: ROUGH FINAL
GAS: ROUGH / FINAL
FINAL BUILDING ,�F SG o0 o`S �o �L�-� ;,c„¢� /Lbr � cry ®F,�
DATE CLOSED OUT
ASSOCIATION PLAN NO.
AN The Commonwealth of Massachusetts
Department of Industrial Accidents
1 ' Office of Investigations
600 Washington Street
l� Aly Boston, MA 02111
y% www,mass.gov/dia
Workers' Compensation insurance Affidavit: Builders/Contractors/Electricians/Plumber
Applicant Information please Print Legi_bl
Naive (Business/Organization/Individual):
Address: G
City/State/Zip; G '�.I �' Phone #: 4 —.
Are you an employer? Check the appropriate box: Type of project(required):
1.❑'I am a employer with 4. 0 Lam a general contractor and I
employees (full and/or part-time).* have hired the sub-contractors
6. ❑ New construction
listed on the attached sheet. 7. ❑ Remodeling
2. I am a sole proprietor or partner-
ship and have no employees These sub-contractors have g, ❑ Demolition
working for me in any capacity. employees and have workers' 9 ❑ Building addition
' comp. insurance comp. insurance.$,
o workers repairs or addil
p 5. ❑ We are a corporation and its lo.❑ Electrical r p
required.]
3 am a homeowner doing at] work officers have exercised their l I.❑ Plumbing repairs,or addil
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.❑ Other
comp,insurance required,]
*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 must submit a new affidavit indicating such.
tContractors 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, Lie.#: Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration dat
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties o:
fine up to $1,500.00 and/or one-year irnprisonmen`., as well as civil penalties io the form of a STOP WORK ORDER and a
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 r insurance coverage verification.
I do hereby cerlify tin er the pains nd penal i.es perjury that the information provided above is trice and correc4
Signature: Date:
Phone.#: 60
Official use only. Do not write in this area, to be completed by city or town of
City or Town: Permit/License #
Issuing Authority(circle one): `
1. Board of Health .2. Building Department 3. City/Town Clerk 4. Electrical Inspector S. Plumbing Inspector
6. Other
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire,
express or implied, oral or written." .
An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more
of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the
receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the
dwelling house of another.who employs.persons to do maintenance, constriction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed.to be an employer."
MGL chapter 152, §25C(6) also states that"every state or local licensing agency shall withhold the issuance or
renewal of a.license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required." ..
Additionally,MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if
necessary, supply sub-contractor(s)name(s), address(es) and phone numbers) along with their certificates) of
insurance. Limited Liability Companies (LLC) or Limited Li4bility Partnerships (LLP) with no employees other than the
members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit.. The affidavit should
be returned to the city or town that the application for the pen-nit or license is being requested,not the Department of
Industrial Accidents. 'Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy, please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided.a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current
policy information(if necessary) and under"Job Site Address" the applicant should.write"all locations in (city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. Anew affidavit must be filled out each
citizen is obtaining a license or permit not related to any business or commercial venture
year. Where a home owner or it g p
(i.e, a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit,
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address, telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
Tel. # 617.-727-4900 ext 406 or 1-877-MASSAFE
Fax # 617-727-7749
Revised 4-24-07
ww.w.mass.gov/dia
ENE-p C,'� CONSERVATION APPLICATION FORM FOR ENERGY EFFICICIENCY FOR
ONE- AND T O-FA.MM Y DETA.C=D �SIDENTTAL COi`1S) RCJCTTON (7ao cm 51.00)
Applicant Name: YalaxTowa:
S c Address:
. •print u'l
Applicant Phone: c 1
Date of A
Applicant Signature: � _ PPlicatio.n: -3
NEW CONSTRUCTION: chops NE of the follo)vin tWD'o tions
r.780 CMR TABLE 6107.1
RESCRIPTXVE ENVELOPE COMPONENT CRITERIA- FOR
NEW ONE- AND TWO-FAIM Y BUILDINGS
MA)QMU2Jf MINM[JM ;
Ceiling or Slab
❑ Option 1: Basement
Fenestration exposed, Wall Floor Wall Perimeter A_FUF_ HSPF
U-factor floors R-•Value R-Value R-Value R Value
R:Value and De th
_. National Appllancc-E
R-10, Consrxyation Act(N.?.35 R•-3 8 R.-19 R-19 R-10 4 ft.- 1997 as amcndcd,mii
rater as applictibir,
Note: This form is notrcquired if you choose either ofthc twov. ersions ofREScheckas fisted below.
El -Option 2: R.EScheck Version 4.1.2 or later variant software analysis must be completed
780 CMR 6107.3.2
R.EScheck--Web which can be accessed at http•//VMW Cnergycodes oy/rescht,6
UT�Z OriS 0 '�ERA�XO1`'S,T0 EXSS ZTN B ULG]�XN
a GS'- .'.n S YEARS OLD*
*buildings under 5 years old must usa option#1 or#2 in New Construction section above,
Complete the following formula to determine the o of glazing:
(a) Gross Wall & Ceiling Axea equals Formula: (100 x b a) '
SF 100 x ZUS 7_7 2,0% of glazing
a e �C ��SP �' a
(b) Glazing are quals Y�s' �.? 2 ,Cl.
If 'lazin is<'4D%.use the chart be10 If lazing is } 40 % rqc ed to "SUNROOM" section
. 780 CNNCR'X'ABLE 61O1.3
PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA ADDITIONS TO EXISTING.
LOW RISE RESIDET TS41 BUILDMGS
r-i MAXIMUM MQNMUNI
• ling and Slab Per
Cei
Fenestration .. E floors.. 'Wall Floor Basement Wall R-Va
xpli
U-factor R-Value R-value R-Value and D
R-Value
.39 R-37 a R-13 . R-19 R-10 R-10,
EL R-30 ceiling insulation may be used in place of R-37 if the insulation achieves the full R-value over the entire ceiling
area i,c, not corn rCSSed Dyer exterior Walls, and includingan access o rn s .
SUNROOM—An addition or alteration to an existing building/dwelling unit where the to
❑ glazing area of said addition exceeds 40% of the combined gross wall and ceiling area of
addition.
Note: Owner to fill out ConS'1 MErbl ormation.Form found in APPcndix 120,P
pF Vf r ti Taw of B arns t ab-T e
°^ Regulatory Services
M
sAxHsusr • Thomas F Geiler, Director
WARS-
q� t
Building Division
Totti Perry, Building Commissioner
200 Main Strcet, Hyannis,.MA 02601
tvww.t0wr1.barnstab1e.m2•us
Office: 508-862-4038 Fax: SOS-'
Property Oder Must
Complete and Sign This Section
If Using A Builder
as Owner of the subject.property
hereby authorize ���,2i2�°`�� ��� to act 6a my 6ehaff,
in all,matters relative to work authorized by this building permit application for.
(Address ofrob)
Signature of er Date
Print Name
If Property-Q-wner zs-applying fog-p ertnzt please complete the
Homeowners License Exemption Form on the reverse •s'Yde.
Town of Barnstable :
• Hof YrtE r�2 •
o Regulatory Services
-
Thomas F, Geiler, Director
iAxrrsrkst.e
Building Division
�prEO �h Tom Perry,Building Commissioner:
200 Maid.Str.5_t,.-Hy annis,MA. 026.01
)-iwsv.town.barnstable.ma,us
r
Fax: 508-790-6230
Office: 508-862-4038
ETms0.WNER LICENSE EXEMPTION
Please Print
DATE:
IOB LOCATION: v lla'gc
number
street
.`HOM$OWNER": work. one#
name home phone# >
CURRENT MAILING ADDRESS:
state rip code
ci ty/town ,
The current exemption for"homeowners" was extended to include owner-occupied dwcllings of six units or less and
to allow hpxn.eowners to engage an individual for hire who does not possess a license,provided that the owner acts_as
supervisor. •
DESK-MON OF Eo)Y1 M';'NER
Pcrsou(s) who owns a parcel of lamd on which he/she resides of intends to reside, on which thcre is, or is intended to'
bc, a one or two-family dwclling, 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 homeoner, Such
"homeowner"shall submit to theutlding Official on.a form acccptablc to the Building official, that he/she shall be
responsible for all such work performed under the buildipg permit. (Section 109.1.1)
The undcrsigncd"homeowner"assumes responsibility for compliance with the State Building Codc and other
applicable codes, bylaws,rules and regulations.
The undersigned"homeowner"certifies fl at.he/sbc understands the Town of Barnstable Building Dcpartrpcnt
minimum inspection procedures an4 requirements and that be/she will comply with said procedtrccs and
m
rcquixcmcn ts.
Signalurc of Homcowncr
Approval of Building Official
Note: Thrce-family dwellings containing 35,000 cubic fret or larger vtill be required to comply with the
State Building Code Section 127.0 Construction Control.
HOMEDW"NER'S EXEMPTION
The Code stairs that "Any homeowner performing work for which a building pcmr t is required shall be cxcmpt from the provisions
of this scelion,(Secdorn l D9.1.1 -Licensing of eonstructio❑supervisors);provided that if the homcowncr engages a pcson(s)for hire to do such
wor% that such Homcowna shall act as svprrvisor."
Many homeowners who use this rxmvr oon arc unaware that they arc assvming the responn'bilities of a supervisor(sec Appendix Q.
Rules&Regulations for Licensing conshuetion Supervisors,Section 2.15) This lack of awarcncss'often resides in serious probles,particularly
when the homeowner hires unlicensed parsons. In this case,our Board cannot proceed against the unlicensed person as i mt would with a licensed
Svperviser. The homeowner acting as supervisor is ultimately responsible.
7o ensure that the homcowncP is fully aware of his/her responsibilities,ma ommunitics inquire,Al part of the permit application,
that the homcovmer eerta t that he/she understands the responnb0ities of a Supervisor.'�m4hc last page of this issue is A.form currently used by
several towns. 'You may care t amrnd and adopt such a forrr)cervfiealion for use in your eot%mwnity.
Massachusetts- Department of Public'S.itet*
Board of Building* Regulations and Standards
Construction Supervisor License
License. CS
16029 .
Restricted to: 00
DARRELL H CHAPMAN
PO BOX 694
MASHPEE, MA 02649
Expiration: 7/3/2011.
Tr#: 18687
. .. .• •i �Board°B ilding Re
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tMPROVEA1 S and Standar
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OA MAN CONST r P�j ate Corpor T ?8jg58
PO RRELL CHAPUCTjON CARP atio�
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Assessor's map;and lot number '... a. .......(/./..4.. . n
....�r� *THE
t0
SEPTIC SYSTEM MUST
a:.Sewage Permit''-number ......... ..7.�....':...�.�. .. K....C..
��S INSTALLED IN COMPLIAN • BasasTsnLE, i
House number ........ .... ........................:...............I............ nea 0a
WITH TITLE 5 1639• �0
ENVIRONMENTAL CODE AN
TOWN OF' .BARN9gA ONS
BUILDING , INSPECTOR
/✓��+
APPLICATION FOR PERMIT TO ............ ........�....�.�.... ......C... ...�1./�:.......:.....................................:
TYPE OF CONSTRUCTION .......:...........W6 ..........................................................................
................................................19........
TO THE INSPECTOR OF BUILDINGS: '
The undersigned hereby applies for
/aa permit according to the following information:
Location ............./..` ...... !J�tCX'i ........ ......... .7V/............4 or.... :�!t.............................................
e
ProposedUse .�.�....................... .............................................................................................................................................
ZoningDistrict ....... .............. —...........................................Fire District ...........� �'.�.1.. ........................................
V l�i i�r,2 .�
Name of Owner gA<-j'�l.........!.!F. .....................Address ...(� �/'fJ(,Tr/ � vCZI
......................... ...........�.
Name of Builder .S K4m ....A s.....A1tb-0..V.1...................Address ...... ....!`} ... !`�VL................................
Nameof Architect ................... ...................................Address ....... 1. ..............................................I...................
Number of Rooms ............../.................................................Foundation ........�(��e /
. ............. .........................................
���� [f / Q
Exterior ...�V.. J...�%..L�. . ..G ......��!!.!�.�/.l.�-5 .................Roofing ........ ./... '. .` ................................................
Floors B irk Interior ......s-4 P ....20(dC...........................................
Heating ............. ........... .....................................Plumbin ...............1................................................................
Fireplace .................N A......................................................Approximate Cost :.. ..l1L? 1.............................. . ........
Definitive Plan Approved by Planning Board -------------------_-----------19--------. Area V`3� f'�.......................... ...............
S�
Diagram of Lot and Building with Dimensions Fee ............................
SUBJECT TO APPROVAL OF BOARD OF HEALTH
1
k--30 -�
e o f
E P5 TI O Q,
N vu S E 09,e ge6"
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 .. .... . .. . .........................
Construction Supervisor's License ....................................
28613 Addition
No ................. Permit for .................................... .
'
' Single Family Dwelling
� _-- .....................................................................
Lo�o�on —�76—Iroutbroo.k..Duu6______`.
.
\' Cotuit
----..---------------.---'--- '
.
� Victor� 6 Jackie Mastro
Owner, ----.--. ----------.. — -- �
� . � .. . .
^ ^
' FRame
. , Type of ..........................................
-
' --------------------�------
. ` .
Plot ---------. Lot ----------'
.
. .
'
October 30, 85
Permit Granted -------------]P ~
^ . .
Date of Inspection ...---lA
~ - ,
Dote Completed ---' ----lA �
'
^ '
`
^ '
'
` .
`
Assessor's map and lot number ........j TN E
TO
OK Q Qy
-
Sewage Permit number .............3...........I.. .................
33AR35TAEL
House number ........................................................................ s MAM
1639.
Ar.
TOWN OF BARNSTABLE
BUILDING I N S P ECT-0-11
APPLICATION FOR PERMIT TO ....... . ..... ..................................................
TYPEOF CONSTRUCTION ...................k05........ .....................................................................
................................................19........
J,
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location ............ ........ ........ ..... Jr.....-- ",.................................................
ProposedUse .............................................................................................................................................................................
10!:5
ZoningDistrict .......................4 - r.... ....................................Fire District .......... .....................................................
c—io ie
Name of Ownerl.&( k...............M-e. ..............................Address 67...../..7
Name of Builder ...... ..................Address ......:�..Aq�nq.....6t. f\.ej?).0.V 4��................................
.... ... ... ....
Name of Architect ...................IV
...................................Address .......��/ ...................................................................
Number of Rooms .............. .......................:.........................Foundation ........ .C.6!( ........—../................................ ....
Exierio, X�e:4�1 r�..le..5.................Roofing ........ 1�5 77
......................................................
oe
Floors ...........r�� t..............................................................Interior ..... .. ............. ...........................................
A-
Heating ...r.......... . ............. .....................................Plumbing ....... .............................................................
•
Fireplace ..... ........... .....................................................Approximate Cost ... ..............................
Definitive Plan Approved by Planning Board --------------------------------19-------- -
Area .... . ....I...........
Diagram of Lot and Building with Dimensions Fee ...... ............................
SUBJECT TO APPROVAL OF BOARD OF HEALTH
Pic
1Y
q0
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.
Na .. . ..................
'me .
Construction Supervisor's License ....................................
MASTRO, VICTOR & JACKIE A=022-072
No 28613 permit for ,, Addition
...............
Single Family Dwelling
...............................................................................
Location .....76 Troutbrook Road
..........................................................
Cotuit
Owner Victor & Jackie Mastro
.. ..............
Type of Construction Frame
...............................................................................
Plot ............................ Lot ................................
Permit Granted .......Qctobex...3Q.a.........19 85
Date of Inspection ....................................19 i
Date Completed ......................................19
LA
Assessor's map and lot number ........... ) "0C
n� /*
SEPTIC SYSTEM MUST SE
_ S N ._LED: IN COM,11ANCE
Sew*-a a WPe mit number .............................. ..........//..+`.... IT
I TR"
4' g 1�'ITH P'TiCLE i4 SIATE
°'
5 ..�'IT.�'tv Co E AND TQW�!
/O Q�Of T E TOE TOWN - O F B AR N S T �J`tS aL" .
BARA9TADLE. i
jDUILDING IN
`T ,.• _i
r Construct New Dwelling
APPLICATIONFOR `PERMIT TO ...................... *...................................... ...........................................................
f
TYPEOF CONSTRUCTION ..................Frame.......................................... ........................................................
March...3.!
............191T.
-"TO-THE INSPECTOR OF BUILDINGS:--
The undersigned hereby applies for a permit according to the following information:
Lot 3A Trout Brook Lane-"HILLCREST" in Cotuit, Barnstable
Location ........................................................................... ..................................... ........................................................................
ProposedUse ..........Dwelling................................................................. ............................................................ ........
RD-2 Cotuit
ZoningDistrict ........................................................................Fire District ..............................................................................
Name of Owner Sea-Lake Corporation Address ,Route 6A & Tupper Rd. ,Sandwich,Ma.
.............. ... .............. ......................................................................
Name of Builder Sea—Lake Corporation •.Address ...••,;Same as above
Nameof Architect ..................................................................Address .................................................................................... -
Five "Walls Poured crete '-4."
Numberof Rooms ..................................................................Foundation 10................1.......................Con..............7........ .............Pour..
Exierior�te Cedar Shingles-All sides Roofng235# Self-Sealing AsJ�halt Shingles
...................................................... ....
t&Bath-Vin l/all others hardwood ?" Sheetrock
FloorsX..: .........................................................Interior
rieating ...Gas- Warm Aix ....................................Plumbing COPP.er..SuPP1Y...-..PVC.....Drain
Fireplace. Yes ............................................................Approximate Cost ....$.211.000.................................................
Definitive Plan Approved by Planning 1-15 73
. .................... Board
-------------=-------- 9 - Area ................�.::-::.:....���
Diagram of Lot and Building with Dimensions Fee ..... ..3........
SUBJECT TO APPROVAL OF BOARD OF HEALTH
I hereby agree to conform to all the Rules and Regulations of the To n o a s ab a egar the abo. e
construction.
Name ...................... ... ... ............ .....................................
Sea-Lake Corp. ,
2 y y
i `
No .....19069. Permit-for ...........1.......s..............
single fatnfly dwelling
` .............eiamp:......................................................
n Trout Brook L�
. .................................
1
Location �4!........ .... - -
Cotuit
............................................................................... i
Owner ............Sea-Lake Corp........... ... .....
Type of Construction ,,,,,,,,.frame
.......... ....................................
Plot ...... Lot .........#3A..
Permit Granted April 1 _ ,; 19 77
.
.......... .... .. fr_ _ - -
. r i
Date oft Inspection ........ ................::!.....:'.19
Date Completed ... .a.. ....... .......19
PERMIT REFUSED 't -
i ..................... ............................. 19 _ c.
................................... t
`r `h ................................... ..................................
..................... . ..............................................
r: 1 t,
.... ... .... .......
Li Cl
Approved . . ....................................... 19
.....................................................................F'.. ~�
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