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HomeMy WebLinkAbout3220 MAIN STREET s 0 *We ir - • C9 • i) .� Town of Barnstable Building Th�s:Car..d So That rt>:is Visible From the Sheet A rovedrPlans Must�be.Retarned.on JobMand thissCardy.Must$beKe L ,1 ABLE' � �.d Until`Final�lns ecion HaBeeri�Matl�e 3� �; �� �� � F � � � � �. , 1 ; '� �>�: ,�'�. �. �'� �._ • Poste 1kt . oa .1639. Permit ° Where aC.ertificou a c >sRe caredsuchBuidmg=shall Not be Oil�aFinal Inspection has beenmade <. er ;.=s: pq . . .w ._ „,z, , .. > Permit No. B-18-398 Applicant Name: MICHAEL S MEAGHER,JR Approvals Date Issued: 02/23/2018 Current Use: Structure Expiration Date: 08/23/2018 Foundation: Permit Type: Building-Alteration INTERIOR Work Only- Commercial SPLIT Sheathing: Map/Lot: 300-010 Zoning Distrir_.t: Location: 3220 MAIN ST./RTE 6A(BARN.), BARNSTABLE l'I '' k ... Contractor Narne. -;-;, L S MEAGHER,JR Framing: 1 Owner on Record: 3220 MAIN STREET LLC C tractor License CS;4,102260 Address: C/O TURTLE ROCK LLC s ' --.. .�, r - k �ProJect Cost $20,000.00 Chimney: YARMOUTHPORT, MA 02675 Permit Fee: . $282.00 Description: CREATE OPENING FOR NEW OFFICE.CREATE OPENINGFROM 2ND l Insulation: Free Paid':: $282.00 FLOOR LOFT TO ADJACENT OFFICE UP GRADEI$MOKES & Date 2/23/2018 Final: Project Review Req: ` 'i Fi. Plumbing/Gas f i t' ','4' I NT"1A- t''- i'":-f;i'';;;,t" Rough Plumbing . _ � Building Official �` Final-Plumbing: This permit shall be deemed abandoned and invalid unless the work auth oriz x m ed by this permit is commenced within sionths•after issuance. Rough Gas: All work authorized by this permit shall conform to the approved applitiond the approved construction documents for which this permit has been granted. 1ijI' ` Final Gas: All construction,alterations and changes of use of any building and structuresahall be in compliance with the local zoning laws and codes can a . This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public(mspection for the entire duration of the work until the completion of the same. t Electrical i �i 3 � Y The Certificate of Occupancy will not be issued until all applicable signatures by thelBuildmg and Fire Officials are provided on this permit. Service: Minimum of Five Call Inspections Required for All Construction Work: _ r� ' 1.Foundation or Footing ' Rough: 2.Sheathing Inspection Final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department - '%� Building plans are to be available on site Final. \�% All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION ' Map Parcel 0 ( 0 ®Fpi- Application # v[.7'/ �6 C3Q 0-1 B Ith Division r ���O8 2o/ Date Issued �/YC 'R!t14- Ow Conservation Division NOP44.4isT� Application Fee Planning Dept. 84F Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/ Hyannis xciWiT- Project S Address 3&c kc - 5t-cLQd12 .. 6 Ott , Village it,� Cam_ Owner 3&Dc (f ar-�A-- L L Cc, Address 031 , / S14' • Telephone 6(S ' 5c (( - E 73 . a am-' fob- 4 Q. Permit Request eilstotive_ Cpy-12AitIncok hea_... ILLtA-tcoop;cst.,, i 6...A.toLS-4._ 1 op.t.ALL..k` ox ifiurryyk Qk -9406,01 Lels 4- -t . cloiAel- 666.;-c_c,_ , 00 a_ S-rn b 1o2_. -ec4-0,12S° o Square fe- : 1st floor: existing proposed 2nd floor: existing proposed Total new 1 ( Zoning District V 13-14 R Flood Plain oundwater Overlay Project Valuation L 'QoK Construction Type W Lot Size ® --1(0 Grandfathered: ❑Yeslo If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) sc)S,. l a Age of Existing Structure I?.5® Historic House: ❑Yes AMClo On Old King's Highway: es ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑Other Central Air: ❑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 es ❑ No If yes, site plan review# Current Use 8-c-C482.-Spae..-12._ Proposed Use (43fc-i �. S?3-0---k... APPLICANT INFORMATION (BUILDER OIL HOMEOWNER) - 0 Namei)1 0� L fug.. --r-t JO L. Telephone Number Y� c( o't J 11 A•,-: -,,s �? ii,s\---_,‘ \ License # c s - !� o o LHome Im rovement Contractor# l l� D c 2E p(t9 Ne . c 0►1AWorker's Compensation #`.c c�� �J ry IA-- ALL CONSTRUCTION DEBRIS R LTI FROM T IS PROJECT WILL BE TAKEN TO 0111 • .4 ,!: ,_. J i SIGNATURE DATE c-iS I r ;r 14. • FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED • MAP/ PARCEL NO. ADDRESS VILLAGE ' OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL • GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. Mass. Corporations, external master page Page 1 of 2 AlV-41 g Wiliam Francis Galvin ., f Secretary of the Commonwealth of Massachusetts I . Corporations Division Business Entity Summary ID Number: 001285408 Request certificate New search Summary for: 3220 MAIN STREET, LLC The exact name of the Foreign Limited Liability Company (LLC): 3220 MAIN STREET, LLC Entity type: Foreign Limited Liability Company (LLC) Identification Number: 001285408 Date of Registration in Massachusetts: 08-04-2017 Last date certain: Organized under the laws of: State: DE Country: USA on: 08-03-2017 The location of the Principal Office: Address: 231 WILLOW STREET City or town, State, Zip code, YARMOUTH PORT, MA 02675 USA Country: The location of the Massachusetts office, if any: Address: C/O TURTLE ROCK BUKLDING 231 WILLOW STREET City or town, State, Zip code, YARMOUTH PORT, MA 02675 USA Country: The name and address of the Resident Agent: Name: JEFFREY D. BILEZIKIAN Address: C/O TURTLE ROCK BUILDING 231 WILLOW STREET City or town, State, Zip code, YARMOUTH PORT, MA 02675 USA Country: The name and business address of each Manager: Title Individual name Address MANAGER JEFFREY D. BILEZIKIAN 231 WILLOW STREET YARMOUTH PORT, MA 02675 USA The name and business address of the person(s) authorized to execute, acknowledge, deliver, and record any recordable instrument purporting to affect an interest in real property: Title Individual name Address http://corp.sec.state.ma.us/CorpWeb/CorpSearch/CorpSummary.aspx?FEIN=001285408&S... 2/8/2018 Mass. Corporations, external master page Page 2 of 2 REAL PROPERTY 'JEFFREY D. BILEZIKIAN 1231 WILLOW STREET YARMOUTH PORT, MA 02675 USA LIConfidential i.._i Merger Consent Data Allowed Manufacturing View filings for this business entity: Annual Report e Annual Report - Professional • Application For Registration i Certificate of Amendment View filings Comments or notes associated with this business entity: { New search • http://corp.sec.state.rna.us/CorpWeb/CorpSearch/CorpSummary.aspx?FEIN=001285408&S... 2/8/2018 02/08/2018 02:41 5086810415 SOUTHERN COMFORTS PAGE 01 eMqCwr Gcnsrurv:lion Inc. 150342E10529 PAGE, li 1 Town of Benistabie Regulatory Services mashed v.son,nutevr mtwois Pr/.COO Orilkise CONflosiknar ' ?Oa arad,Kraft%KA OM erofttormtsrotittilie.eatia 041161.3044044011 Poi£41,790.030 Propeny Ofoffier Mu Complete awl Sign MIS Seed= If trein$A&Older LY /5/LE - KM fs?1,6(twint tiva si4bItat ropirty r /link sithodolli-etk,114&,,. to,lookquv,bafte, $1,4 mItøas relogita *OAO2&by esinOt peva Oftatiaa for 0.144:ersilito "."110.4witickiV raso .301 ""4! Ato 14,a4-1 1,4" jeFq7.,6Y I CA.V.&/1141_, vric—rati—no &oft*Mt corlyit4 for petentt#pinto 1410711116 ihe ittglIOSSel 146VOIA tomparom brin ati rovegeileta (10041.0016Aivag.i.doratcrAtaiWroGooluray imintoirWounsktoaoltiftwaiakuPfint,fts WI+.law MIS • • Massachusetts Department of Public Safety Board of Building Regulations and Standards r Construction Supervisor License: CS-102260 Restricted to: Unrestricted-Buildings of any use group which contain Construction Supervisor V ° ` R less than 35,000 cubic feet(991 cubic meters)of enclosed space. MICHAEL S MEAGHER JR • 97 EMERALD LANE - ,s k MARSTONS MILLS MA°`02648 vim--- Expiration: Failure to possess a current edition of the Massachusetts • Commissioner 11/06/2018 State Building Code is cause for revocation of this license. DPS Licensing information visit:WWW.MASS.GOV/DPS • I%(m1rrnuMead f r`, fr.taar4ic/6 Office of Consumer Affairs&Business Regulation Gl ,fib HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only ( � TYPE:Individual before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation . 4• 9162938 04/26/2019 10 Park PI -Suite 5170 MEAGHER CONSTRUCTION;INC. Boston, 02116 l , MICHAEL MEAGHER JR.. 6 - 776 MAIN STREET OSTERVILLE,MA 02655 - t valid without signature Undersecretary The Commonwealth of Massachusetts Department of Industrial Accidents "v ,��4 Office of Investigations .� tw.- 600 Washington Street \ A� Boston,MA 02111 a ' ii ww.mass.got/din Workers' Compensation Insurance Affidavit BuildersiContractorsiElectriciansiPlumbers Applicant Information Please Print Legi ' b Name( SnessfOrganimimandivictue f\leo,.\:=4%.6.0 C)le, Tcst-i ak ...iY.O- C leY YAddress: ` S City/Stamp: [Le-- Phone#- 6 C q u Are an employer?Check the appropriate box: Type of project(required): 1.L"1 t am a employer with 3 4 0 l am a generalcon for and I b. ❑New consunrtion employees(full andlor part-time).* have hired the sub-contractors listed on the attached sheet: 7. 2.❑ I am a sole proprietor or partner- These sub-contractors have S. 0 Demolition Valsdeling working for me in any capacity- ship and havee noemployees employees and have workers' 9 Building addition. [No workers'comp.insurance camp.insurance.: ❑ 5. 0 we are a carpasratian and its 10.❑Electrical ors or actions required] oeers have exercised their' 11.0 Plumbing repairs or additions - 3.❑ I am a homeowner doing all wattleracersper t of vas MCA,myself[No workers'ramp. 12.0 Roof repairs - c.152,§1(4),and we have no empinsurance Via)= 1 o workers' 13.0 Other comp.insurance required.) 'Any applies that checks hat#1 most also fill out the section below showing Muir warkers'COIllpenstation policy information. I Homeowners who submit this affidavit indicating they ere doing all work end then hire outside coottactors most submit a now affidavit indicating such. 7:Connsastors that check this box mast attached an additional skeet showing the name of the sub-camtrectms and state whetter or not those entities hove employ. If the sub cotattactors have employees,they roast provide their wow'comp.policy number. I am an employer that is providing workers'compensation n insnrwwe for my employees. Below is the policy , •i b site information. AC Insurance Company Name: . s k ,• ., Policy#or Seif-ins.Lic.#: CO C-2) 14 Expiration D e: 1 a 1 1 ea-0 t Job Site Address: '3 * ;A-Sa-- City/'State/Zip: ). �� (showing the page policy m�mber Attach a copy of the workers'compensation policy declaration p a and expiration date): Failure to secure coverage as required under Section 25A of NIGL 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$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. __ I do hereby cert&and a pains and peas s of airy that the information provided above is tea d eared. Signature: - Date: Phone#: Y Official are only: Do not write in this area,to be completed by city or town of caL City or Town: PermitiLicease ii Lssuing Authority(circle one): 1.Board of Health 2,Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector d.Other Contact Person: Phone#: T.. r-.. — ._-4.. , ti Client#! 16665 2MEAGHERCO YYY) /DDIY TE(MM ACORD CERTIFICATE OF LIABILITY INSURANCE DA TE(MM207 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder Is an ADDITIONAL INSURED,the pollcy(les)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT Dowing&O'Neil Dowling&O'Neil Insurance Agency �a""$,N1,Ext):508 775-1620 FAX 973 lyannough Road (NC,No): 5087781218 lY E-MAIL g ADDRESS: coi�doins.com P.O.Box 1990 INSURER(S)AFFORDING COVERAGE NAIC# Hyannis,MA 02601 INSURER A Penn-America Insurance Company 32859 INSURED INSURER B:Associated Employers Insurance Company 11104 Meagher Construction Inc. Timothy Meagher INSURER C 776 Main Street INSURER D Osterville,MA 02655 INSURER E • INSURER F: COVERAGES CERTIFICATE NUMBER: 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. INSRT TYPE OF INSURANCE INSR WVp POLICY NUMBER R POLICY EFF PMIDXDY EXP LIMITS (MM DDlYYYY) (M I D/YYYY) A GENERAL LIABILITY PAV0146331 10/16/2017 10/16/2018 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES(Ea oxurrence) $50,000 CLAIMS-MADE X OCCUR MED EXP(Any one person) $5,000 X BIIPD Ded:500 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 7 POLICY jE 7 LOC $ • AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED - SCHEDULED BODILY INJURY(Per acddent) $ AUTOS AUTOS HIRED AUTOS AUTOS NON-OWNED (Pe acddentDAMAGE • UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ _ $ B WORKERS COMPENSATION WCC50050054422017A 06/23/2017 06/23/2018 X TORY OMITS 2RH AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y I N E.L.EACH ACCIDENT $100,000 OFFICER/MEMBER EXCLUDED'? N N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,It more space Is required) Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived,or extended the coverage provided by the policy provisions. CERTIFICATE HOLDER CANCELLATION Town of Barnstable AU: Building SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Inspector ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE a'7o r =; ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S199934/M199933 CBD X.-PRESS PIT . Commonwealth of Massachusetts APR.16 2014 • Sheet Metal Permit Map Parcel TOWN OF BARNSTABLE Date: 41 lc l Permit# a di o) 3 S Estimated.Job.Cost:'$ ( .L '� .. Permit Fee: $ 'c / ‘6' Plans Submitted: YES NO b Plus Reviewed: YES NO Business License# Applicant License Business Information: Property / ob Location Inf• •:on: Name:1�1e c,�i� A)CN .Inc- Name: LDS Q. ae q y wNErcs P Street: N`--1 o jc k\;y\ .t2 d Street: Dtaci tk j r' 3* City/Town: benr\3 _ _ City/Town: Cirly*r,t h(Q Telephone: 1vB- Q —ci e\(; ' _ Telephone: Photo LD,required/Copy of Photo I.D. attached: YES. J NO ,)6 Staff Initial ' J 1/M-1-unrestricted license J-2/M-2-restricted to dwellings 3-stories or less and commercial up to 10,000 sq. ft./2-stories or less Residential: 1-2 family - Multi-family Condo/Townhouses Other ' Commercial: Office L Retail Industrial Educational i Fire Dept.Approval i Institutional_ Other Square Footage: under 10,000 sq.ft. ✓ over 10,000 sq.ft. Number of Stories: Sheet metal work to be completed: New Work:z_ Renovation: HVACk__ Metal Watershed Roofing Kitchen Exhaust System Metal Chimney/Vents j Air Balancing Provide detaile description of work to be done: • INSURANCE COVERAGE: • - I have a current liability Insurance policy or its equivalent which meets the requirements of M.G.L.Ch.112 YesikNo If you have checked As.indicete the type'of coverage by checking the appropriate box below: A liability insitrance policy Other type of indemnity Bond OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 112 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement Check One Only OwnerD Agent Signature of Owner or Owner's Agent By checking this boxia I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my Imowiedge and that all sheet metal work and installations performed under the permit issued for this application will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Duct inspection required prior to insulation installation:YES. NO Progress Inspections Date Comments • Final Inspection Date Comments Type.of License: ay_ ik:n..!aster rdie Master-Restricted • ::ity/Town ' DJoumeyperson Signature of Licensee Dermtft OJoumewerson-Restricted License Number 2 :es$ Check at www.mass.govidpi • nspector Signathre of Permit Approval 1111 • Commonwealth of Massachusetts Sheet Metal Permit Map Parcel Date: .Permit## J Estimated.Job.Cost: $. Permit Fee: $ Plans Submitted: YES . NO Puns Reviewed: YES NO Business License## Applicant License# Business Information: Property Owner•/Job.Location.Information: Name: Name: Street: Street City/Town: City/Town: Telephone: Telephone: Photo I.D.required/Copy of Photo I.D. attached: YES. NO Staff Initial 3-1/M-i-unrestricted license. J-2/M-2-restricted to dwellings 3-stories or less and commercial up to 10,000 sq. ft./2-stories or less Residential: 1-2 family Multi-family Condo/Townhouses Other Commercial: Office Retail Industrial Educational Fire Dept Approval Institutional_ Other Square Footage:. tinder 10,000 sq.ft. over.10,000 sq.ft. Number of Stories: Sheet metal work to be completed: New Work: Renovation: HVAC ' Metal NJatershed Roofing Kitchen Exhaust System Metal Chimney/Vents Air Balancing Provide detailed description of work to be done: • it `�ri X `cJ 1 S �l L _ 1x ti f ,'_ k4 t }tn 'f 0_1 G` 'S- t"F-y � �. T f a f } R 4 Y 40 �r14 4`'k FEtillY 1 t F Vi.Y t .gs - :- �n'x73iR g4.14F_ n'+rr. f4 k 1 4 f 5c-az41 ff Y v.fw :..-yif�. i w ..3 - .. { 'P K' i. e -, �4dfk:.4 '- S T Z A yW-Y CONTROL# �o° LL ` r k g IMPORTANT' �l ?- If your license Is lost,damaged or destroyed;is inaccurate;or needs to be corrected,visit our web site at mass.gov/dpl for instructions to ensure the proper mailing of your Renewal Application and any other correspondence. kikt,44.f.--At',...i.n,-.,::,.4,5.;-,,,-.,....-..,:.,:,-,,...,,,,, • t . This license is subject to Massachusetts General Laws and 4`1-itt regulations.Your license is a privilege,and cannot be lent or i-sZ� s` assigned to any person or entity under penalty of law. Keep this 4., license on your person or posted as required by law and/or zL regulations. x '�}rc aa rir - g. ? t ,4i ,} s..Frfi a <„C x i k S}yy r k t _9� L • GOMMONWE�kLTH OF M% `1I = p� DIVISIONOFPROFESSIQNALi•L'I:c:,1,...:,,N.,..7..4;U„.F.3Erti. flE SHEET IORKE .. k I SSUJES.;THEW FOe]LL`OW f,[ :II, EPI E, ;; .4-' ,RICHARD P OLSEN TF3E: HOKUM ROCK CORD ,.f `= 357 HQi u RACK RQ PO BQX 2Q25 E NIS MA, O263$ ,25�t1 522 .°01 1/16 185487 . ,i:,.:'.::. Irr ayawwafon!•i r+a. —`�I7Ssx�Ti7.ti�T.rfw, -�Vyt1h�1�1III t!l !I i