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Richard V.Scali,Director 39• �� RFD MA't A Building Division mp � Tom Perry,CBO,Building Commissioner Maw 200 Main Street,Hyannis,MA 02601 MAR 2 9 ZU1S www.town.barnstable.ma.us- Office: 508-862-4038 ®wN OF BAR� EE 790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL V I Map/parcel Number Not Valid without Red X-Press Imprint Property Address % �f� t lI residential Value of Work$ 36 WE Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address f t�� A W tub )- C C.44,4j ""Illy,A % Contractor's Name l/(Ai1/d fa(AA -ef COkAl t,L&A',l Telephone Number f—539 J Home Improvement Contractor License#(if applicable) ] ✓ Email: At saUyey,/ ,,MC& ,/t 1° Construction Supervisor's License#(if applicable) 0 / �lf s- NIVVorkman's Compensation Insurance Check one: -`N I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance tt�� Insurance Company Name EiLt�... "G)w d4Y1d , Workman's Comp.Policy# 0 00( 4)(a 48(�a Copy of Insurance Compliance Certificate must accompany each permit. Permit Rtequest heck box) e-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. copy of a Home Improvement Contractors License&Construction Supervisors License is require z C SIGNATURE: C:\Users\Decollik\A ata\Local ..soft\ indowffemporary Internet Files\Content.Outlook\2PIOIDHR\EXPRESS.doc Revised 040215 cn�cw.7ww yr uvrvn�nry�w�■ revvc POLICY NO 2001W6406 RENEWAL OF NO. 2001W6406 EFFECTIVE 3/05/15 FARM FAMILY CASUALTY INSURANCE COMPANY 17-& - 3/�j� NCCI COMPANY NO. 16721 Auto- pf(-4 -4 ISSUED TO: (/ DAVID SAWYER DBA SAWYER CONSTRUCTION _ .. ...................................._..................-............:.:........4..._...................._... ........................................._._.......... i Office of Consumer Affairs and Business Regulation / 10 Park Plaza - Suite=5170 Boston;Massachusefts 02116 Home Improvement Contractor Registration Registration: 134313 - Type: DBA _ Expiration: 10/24/2017 Tr#"270759 �! DAVID SAWYER CONSTRUCTION DAVID SAWYER 318 MEIGGS BACKUS RD. ± _ ., SANDWICH, MA 02563 'Update Address and return card.Mark reason for change. Address Renewal 0 Employment Lost Card scA 1 % 20M-osi1 I C �1 Vlu (�omr�naa2useall�a�Vl�Cu�el�b Oil ee of Consumer Affairs&Business Regulation License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to-. istration: 134313 Type: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 iration A99. , l- ..7T DBA Boston,MA 02116 DAVID SAWYER CONSTRUCTION; C DAVID SAWYER 318 MEIGGS BACKUS RQ, SANDWICH.MA 02563 Undersecretary valid w" out signature Massa husetts department; f Public Safety Board-of Build►eilg Regulations;and Si andaru's - � = 1.l7nst1[itt3Vn Sltpe1'6'I]Ur JIJCli2f1CV License: CSSL-098859 DAVID R SAWYE i. 318 MEIGGS SANDWICH MA7025' y i J ,vy_.irit�?A Expiration Commissioner . 01/27/2017 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY EXTENSION OF INFORMATION PAGE " w F POLICY NO 2001WS406 RENEWAL OF NO. 2001WB406 EFFECTIVE 3/05/15 FARM FAMILY CASUALTY INSURANCE COMPANY NCCI COMPANY NO. 16721 ISSUED TO: DAVID SAWYER DBA SAWYER CONSTRUCTION Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston;Massachusetts 02116 Home Improvement Contractor Registration Registration: 134313 Type: DBA Expiration: 10/24/2017 Tr#'270759 DAVID SAWYER CONSTRUCTION = DAVID SAWYER .-318 MEIGGS BACKUS RD. SANDWICH,'MA 02563 Update Address and return card.Mark reason for change. Address Renewal Fj Employment Lost Card SCA 1 0 20M-W11 - �lae COa7tcmeor2ufealff a�Vl��resetf6 - - ffice of Consumer Affairs&Business Regulation ENT or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: = gistration• 134343 Type: Office of Consumer Affairs and Business Regulation xpiration 10l24l2017. DBA 10 Park Plaza-Suite 5170 v. ,: Boston MA 02116 DAVID SAWYER CONSTRUCTION; DAVID SAWYER 318 MEIGGS BACKUS RD � o SANDWICH,MA 02563 Undersecretary 'Z4vafidw- out signature LUOZILZ/I� J8uo1ss1wwo0 . uoijefldx3 SZO=YNi IDIMCWS . I Yfl S99IMNi 8I£ � y��AMYS 2I QLAdQ WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY ' INFORMATION PAGE AGENT NO 3020 OFFICE NO 3020 MARK SYLVIA INSURANCE AGENCY L.LC L 404 MAIN ST CENTERVILLE MA 02632-2916 FARM FAMILY CASUALTY INSURANCE COMPANY 508-428-040 NCCI COMPANY NO. 16721 POLICY No 2001W6406 >1 3 INSURED AND MAILING ADDRESS: RENEWAL OF NO. 2001W6406 EFFECTIVE 3/05/16 DAVID SAWYER OBA SAWYER CONSTRUCTION 318 MEIGGS BACKUS RD SANDWICH, MA 02563-3131 THE INSURED IS INDIVIDUAL F Workplaces covered by this policy: ST WP NO. ADDRESS OF WORKPLACE RTG.BUR NO. INTRASTATE NO. MA 01 318 MEIGGS BACKUS RD 210677 SANDWICH MA The policy--period-is from 3/05/16 to 3/05/17 12:01 A.M. Standard Time at the insured's mailing address. A.Workers.Compensation".Insurance: Part One of the policy applies to the Workers Compensation Law of the state listed here: MA B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in item 3.A. The limits of our liability under Part Two are: Bodily Injury By Accident Bodily Injury By Disease Bodily Injury By Disease $ 100,000 each accident $ 500,000 policy limit $ 100,000 each employee C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: All states except the states designated in item 3.A. of the information page and ND, OH, WA, and WY D. This policy includes these endorsements and schedules: WC 00 00 00C WC 00 00 01B WC 00 03 15 WC 00 04 14 WC 00 04 228 WC 20 03 01 WC 20 03 02A WC 20 03 03D WC 20 04 05 WC 20 06.01A xti Copyright 1997 National Council INSURE®COPY PROCESSED 02/01/16 on Compensation Insurance we 00 00 01 13 Issuinn Office - PO Box M 9 ALBANY. NEW YORK 12201-0656 77te Coninrouwealtli of Massachusetts Department of Industrial Accidents O,free of Investigations l 600 Washington Street Boston,MA 02111vtt,wimamg;ov/dia Workers' Compensation insurance Affidavit:Bu lders/CaimtractorsMectricivm/Plumbers Applicant information r Please Paint if Name(SusinessfogMizationftndividual): Address: 31 0 1/ clCiS IJ�.Ct� 1M city/state/zip: " Phone##_ 5�� 3G1 Gl Cl 2� Are you an employer?Check the appropriate bow. Type of project(re quired}: I_❑ I am a employer ezth 4_ ❑ I am ageneral contractor and I 6. 0 New construction employees(fu11 and/or part-time)." have hired the sub-coatractaas 2 jam a sole proprietor or partzxT- listed on the attached sheet 7- ❑Remodeling ship and have no employees sub-contractorshave 8- ❑Demolition a for me in employees and have waikers' 9_ Budding addition m'� ffiY��Y- ❑ g [No workers'comp"insurance comp.msurance.1 required] 5. ❑ We are a corporation and its ME]Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11_❑Plumbing repairs or additions myseM o workers'cam right of exemption per MGL e wed]g c.152,§1(4),and we have no 12. of repairs tnattrtmrP 13_❑Other employe_[No workers' comp-insurance required-] *Any applicant that dhecks box#1 most also fal out the section below showing their motets'c�p®mtion policy itdaam a atio ?Ebmemners who submit dos affidavit indicating they ate doing an wink and then hire oatsidecoanacon must submit a new affidavit indicating such_ tContrwans deaf check this box mint attached an additional sit sbawing the name of ihe sub-comiac rots and state whether or nat those entities have employee:;. Ifthe sub-conuwots bade employees,they must provide their warkene'eo®p.policy mnaber. I am an employer that is pm idirtg workers'caongmnsation insurance for my enipih y es. Below is tltepoficy and f ob site information ( Insurance Company Name: Policy#or Self-ins.Lie.A: 07(DO 1W��I �1 �(J Expirat oaDate: A-// T Job Scott;Address: City/State/Zip: ( 0 ,M411— Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiation 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$1,50D 00 and/or one-year imprisonment,as well as civil penalties in the forma of a STOP WORK ORDER and a fine i of up to$250.00 a day a the violator- Be advised that a copy of this statement may be forwarded to the Office of Investigations pf the DIA ce coverage verification_ I do hereby rhfy under pains d)w abies of perjury that the information prodded above is/true and correct Signature, Date: Phone#- OBicial use only. Do not wrfie in this area,to be completed by city or town oft" City or Town: PermitUcense# Inning Authority(circle one): 1.Board of Health 2.I nilding Department 3.CitylTown Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: 6 i I- -I f- David Sawyer Construction 318 Meiggs Backus Road Sandwich,MA 02563 508-539-1992 Proposal Submitted To: . Work Address: Arnold Schertzer Same 7 Garth Court Centerville,MA 02632 508-375-8681 Worked to be Performed: *Strip Front 2 Layer Roo l of House--Replace with Certainteed AR Architect Shingles Color-Sunset Brick *Nail Plywood as needed *Clean Gutters as needed *Install: White Aluminum Drip Edge Ice&Water barrier on all edges of roof and chimney Underlayment Paper System Hurricane nail shingles - *Add 1x3 Rake Boards--2°d member--pre primed pine,paint pine -$200-included below *Clean&Remove all debris from workplace,-take to landfill Total Labor&Investment$3,375.00 three thousand three hundred seventy five dollars All materials guaranteed to be as specific,and work to be performed as stated above in a workmanlike manner. Please remove and/or secure any fragile household items. Not responsible for broken or damage to household items. Five year Labor Warranty/Plus annfactures arranty. Contract may be with drawn if not accepted within.' days. ease see back or additional terms. Respectfully Submitted Acceptance Of Proposal The above prices,specifications and conditions are satisfactory and hereby accepted. You are authorized to do the work. a t is due in f t job completion. Ones[g atn e 4Fx / i TERMS AND CONDITIONS CHANGE IN THE WORK Any alteration.or deviation from the work specifieat ons'involving extra costs will be executed only upon written order,and will become an extra charge over and above the estimate. - DELAYS Contractor agrees to start and diligently pursue work through to completion,but shall not be responsible for delays. All agreements contingent upon strikes,accidents or delays beyond our control: COMPILANCE WITH LAWS Contactor shall be licensed and Insured. In connection with the performance by Contractor of duties pursuant to this Agreement, Contractor shall obtain and pay for all permits and comply with all federal,state,county' and local laws,ordinances and regulations. ARBITRATION,VALIDITY,AND DAMAGES Any controversy or claim arising out of or related to this contract,or the breach thereof, shall be settled by arbitration in accordance with the Construction Industry Arbitration Rules of the American Arbitration Association,and judgment upon the award rendered by Arbitrator(s)may be entered in any court-having jurisdiction thereof. ATTORNEY FEES In the event legal action or arbitration instituted for the enforcement of any term or condition of this contract,the prevailing party shall be entitled to an award of reasonable attorneys fees in said action or arbitration,in addition to costs and reasonable expenses incurred in the prosecution or defense of said action or arbitration. ASBESTOS AND HAZARDOUS WASTE If contractor encounters.such substances stated above,Contractor will stop work and allow, , the owner to obtain a duly qualified asbestos and/or hazardous material contractor,to perform the work. .nature Page 2 , war YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L. - it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. DATE -� Fill in please: v APPLICANT'S YOUR NAME/S: � r r BUSINESS YOUR HOME RE o v r -2 TELEPHONE # Home Telephone Number --2 :7 �o NAME OF CORPORATION- NAME OF NEW BUSINESS eaX I q -,---(-kv TYPE OF BUSINESS r c lI IS THIS A HOME OCCUPATION? YES NO ADDRESS OF BUSINESS ( 02 !L MAP/PARCEL NUMBER �� S� (Assessing) �a 3z When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COM SSIO ER'S OF C This individu a n-infor f n pe m't requirements that.pertain to this type of business.MUST COMPLY WITH HOME OCCUPATION RULES AND REGULATIONS. FAILURE TO Au - -rized ignata e** COMPLY MAY RESULT IN FINES. MMENTS: r �— 2. BOARD OF LTH This individual has been informed of the permit requirements that pertain to this type of business. Authorized Signature** COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature* COMMENTS: " 7 s"e Regulatory Services oF t� . P� Thomas F.Geiler,Director • Building Division MSs g Tom Perry,Building Commissioner .9 0.1� A act 200 Main Street, Hyannis,MA 02601 www.town:barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230, Approve d: Fee: Permit#: HOME OCCUPATION REGISTRATION Date: dZ Name: ! f OG Phone#: 0 7 Address: r Village.0 r �U C Name of Business: ! Mac� Type of Business apt. IlV'I'ENT: It is the intent of this section to allow the.residents of the Town of Barnstable to operate a home occupation widnin single family dwellings,subject to the provisions of Section 44.4 of the Zoning ordinance;provided that the activity shall not be discernible.from outside die dwelling. there shall be no increase in noise or odor,no visual alteration to die premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes; and no increase in air or groundwater pollution After registration with the Building Inspector,a customary.home occupation shall be permitted as of right subject to the following conditions: • The activity is camed.on by the permanent resident of a single family residential dwelling unit,located nvithui that dwelling unit. • Such use occupies no more than 400 square feet of space, • There are no external alterations to die dwelling which are:not customary in residential buildings,and there is no outside evidence of such use.` • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive.noise,vibration,smoke,dust or other particular matter, odors, electrical disturbance,heat,glare,humidity,or other objectionable effects. • There is no storage or use of toxic or hazardous materials,.or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use.shall be met on the same lot containing the Customary Home Occupation,and notwithin the required front yard. . o There is no exterior storage or display of materials or equipment. • There are no commercial velucles.reh ted to.the Customary Home Occupation,other than one wm or one pick-up truck not to exceed one ton capacity,and one,.trailer not to exceed.20 feet in length and not-to, exceed 4 tires,parked on,the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. the Customary Home'Occupahon,is listed or advertised as a busin d. ess,the street address shall not be include • No person shall be employed in die Customary Home Occupation who is.not a.permanent resident of the dwelling unit. I,the urnders' / have read and' e with th ove restrictions`for my home occupation I am regist Applicant. Date: S o s - I Homeoc.doc Rev.01/3/08 The Town of Barnstable Department of Health, Safety and Environmental Services &MMABIA Building Division Mnea. i619. ,0�' 367 Main Street,Hyannis MA 02601 tFD IAA't A Office: 508-790-6227 Ralph M.Crossen Fax: 508-790-6230 Building Commissioner Home Occupation Registration Date: La L#Jt1 h � Name: �.�SCt✓' I�U� 0� Phone#:f�� Address: J eMap/Lot: Type of Business: ��JIICGce�� ./U�S ��oUeU INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling. there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal ' residential volumes;and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter,odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There is no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. I,the undersigned,h e read and agree with the above restrictions for my home occupation I am registering. Applicant: Date:�7 Homeoc.doc G -7 Assessor's map and:lot +number ......... ....... ..:...... Sewage Permit number ........................ f F`TNErO�o TOWN ', OF BARNSTABEE 1i 139HB4TODLE. SAM 9 SUI.LDING i INSPECTOR `a MPY r APPLICATION FOR PERMIT TO c' /,!l.Tit // .....� �..(�.../.:�rf_.- ....................................... TYPE OF CONSTRUCTION .... f -► ' .. f-' ;r;.?^..... ..................................................... ................. '-f.....;................................19........ i TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies... fora permit according to the following information: Location .........s i...:�....'.t. ?........ �:c L4i..:...... . f ....... r. . f...;;t:; ..`.'.:-?..................................................... Proposed Use r�... .... ` rr, �, i f%� f ... ................................................. ......... •, ...... Zoning District ........ ...�......................................................Fire District`............. ....... ................ J !1Vr .o /Name of Owner - , �i:!(. r /��.... .f:....Address .`� -'??.... T:. '�.. �.: !......................... ...::<�L 2' r.... Nameof Builder ...................................................... ..........Address ...:............................................................................ Nameof Architect .......... .......................................•...............Address .................................................................................... Number of Rooms ..........................Foundation Exterior ...f... ........!.............................................Roofing ........................ ............................................... r Floors �" r <? Interior �? �.. L ............ .`.. .. ............................... ....... ............................................................................ Heating ....................... ..................................Plumbing ............:. Fireplace Approximate Cost .._ ......................................................................... .................. .. ............................................. Definitive Plan Approved by Planning Board _____: - c'12<l19 !K: Area � y`S Z j................}.-..........^...�.... Diagram of Lot and Building with Dimensions Fee .¢ ....... ..�\.......... SUBJECT TO APPROVAL OF BOARD OF HEALTH 71 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Nam /// ��L.....'........................................... L ' . .— ' a1rgle family dWelling ' ----.--------.—'--------.---. ` Location .......... ~~~^......— ...... --°' Centerville ' .-------------------.------. Capew1de Davel � ' ' ' Owner --------------.��__—. ' ' frame ' Type of Construction .......................................... ' . ' —~--.---..-----^--------..�-- ` ` Plot ............................ ' ^ ' Permit Granted - ' Date of Inspection ^ Date Completed . --- . . � - ` , . PERMIT REFUS D . � ^ x.� ^ .. � / ' ' ' G �7—~ ' - ........... ................. -----' . . . ' � � ' ' Approved . ' � � � . . ------------- —'---'' ' ' . . ` .......................................................... --,, � '=~ y -71 sessor's ma 'and lot number L/g ( AKA SEPTIC SYSTEM MUST BE` � INSTALLED IN COMPLIANCE: /�".'. Sewage Permit number .. ;. WITH ARTICLE II STATE SANITARY CODE AND TOWN tMETo�y TOWN OF BARNSORNBLE - j BJHH9TSFILL i 4 f? , r � 1oMASL Y 4URDING INSPECTOR. q OD 639 \00 u - {►• `{. is C: APPLICATIONi:.•FOR PERMIT(TO .... .. .. ... . ........ ..................................... ...................................... • TYPE OF 'CONSTRUCTION. ....�...Q r$ Z� ............' ...... ....... • ..... .............................. ................`...................197�a.. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the folI wing informati n: Location ........�:.. ... l i. .. . . .. .. ..................................................... ProposedUse ... .. ... `.(�'.. .. ....... ........ .. . . ................................................................. -Zoning District ....... ...�,,.......................:... ......................Fire District ........1 .......� .............................. Name of Owner .. ... .. .piL �r�-G�-Qr...�"` :... .... ....Address ......I ..... . .. ..........IZ.�C• ( �( Nameof Builder ....................................................................Address .................................................................................... Name of Architect ................Address ................................. Number of Rooms ..Foundation Exierior ... .......... .................................Roofing ..... ............................................................. r Floors ......................................... ..............Interior ....A Heating ......... ..Q ...............................................................Plumbing ........Z..................................................�. Fireplace .......................1.........................................................Approximate Cost ......... ...Z' (/�71T� ................................. Definitive Plan Approved by Planning Board ______12_ __________ _19 Area .................................Z Diagram of Lot and Building with Dimensions Fee ........................ SUBJECT TO APPROVAL OF BOARD OF HEALTH o / G 570 w I hereby agree to conform to all the Rules and Regulations of the ,6wn of Barnstable regarding th above construction. 2 Nam .................. .. ....... . V• Capewide Development Corp. 18336 one story, N a ..................Permit for ...................................... i-s �le famil d,4elling 0 n � y ...................................^......... ri Location ..........Cada.lipEk*a ....... . ......j.............................. Centerville . ............................................................................... .4— i Owner ............ r ..��ide...Deve...opm.ent..Co...p. ........ ....... ...... .... Type of Construction ......f.rame.......................... .......................... ..................................................... #40 Plot .................. ......... Lot .................................. April 26- 76 d ........................................ Permit Grante 19 A / ......... ........19 Date of Inspection Date Completed .................19 'PERMI T REFUSED ...... 19 .......................................................... t . ............... ........I......................................................... ............................................................................... . ................................................................................ Ir Approved .............................................. 19 ................................................................................. ................. ........................................................ S ' - 46 f t J ,.t /C/•. 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