HomeMy WebLinkAboutBLD-90-640 . ,c-diii;t=cij, ---1 MC,/ 90,--- riC -74- 4/f90
/4l .4Tr,0 el 'Cr, TOWN OF YARMOUTH oWF ; iolvili°
OSTEO
VaMlAT}M. oEES 0 i I I plication for a Permit to Build No. fo//0
UPON FINAL APPROVAL MAP o . LOT a 5-1/
FEE MUST ACCOMPANY THIS APPLICATION. DATE /6/261990
The undersigned hereby applies for a permit to build /946/6
according to the following specifications <�/i�t A
1. Name of property owner old S. Zc1b1W CE/770-ie Tel:sa8 nes i f t9
Address 33 �fAA✓CAAcf (N. f t<AtJY
2.Name of Architect(if any) a7A�iXlas / Tela
3. Name of builder j= .•• +A- - F •.•dress
4. License No. Tel. 7469" 39 ZZ
5. Name s%Rich& CJ.- ins/ . t?o. 105-Address LJ3 ea.' 5 , Ma.
6. License No. 09.g/05 Tel. nto--738'S
7. Construction address 33 P&iWc- Kd 'V1. > °J✓'y
Flood District
8. Date of subdivision Approval plain zone R"/I- LAG . Ia.. Zone 2`2
R�Mod t /d DO NOT WRITE IN THIS SPACE
9. Private dwelling l . Estimated Cost
d2s sF Type of room No.
10. Multi family 0 j(74 070 FGA / ,is
11. Commercial 0 ) 30) /L{. ' '� 13
O Kitchen
12. Other 0 Q� cr
Pae 04-, u ' Dining Rm.
wr p_s g , 3 a Living Rm.
13. No. of stories
Pa.,g7- P 1Eft* f?- 1:, ° Bed Rm. 3
14. Foundation — Full 0 Half 0 Crawl IC Slab 13r AtrsCc 3 z 3 ,30 Bath /
15. Materials — Woodg Cementg Other 0 Deck
16. Type of heat — Oil 0 Gases, Electric 0 Other 0 Closed porch
17. Garage — 1 0 2 ❑ Family Rm.
Sun room
18. Swimming pool - Size" Garage
19. Storage shed — Size Shed
20. Stove — Wood 0 Coal ❑ Alterations ,e
21. Size of lot: No. of feet front No. of feet rear No. of feet deep '
22. Size of building: No. of feet front No. of feet side No. of feet rear
23. Distance from nearest building: Front Ft.side Ft. side Rear
24. Distance back from line or street From rear lot line Side line
LOT RELEASED BY Signature s. AII .I
PLANNING BOARD Address // 7 fA(,1/4 0I S C
Date fr t i Li ' 0a//
BUILDING F,RHIT APPLICATION
•
APPLICANT:`, ii/ab t s. ,QC.y7-/rg-t< BUILDING PERMIT #:
ADDRESS: 33 j ,�'cg /��. [hV/ 74:41,r,1411. TEL.NO.:a3 7 —//4'7 DATE FILED:
BLDG. SITE LOCATION: 33 P(ZI)c (Zd Wk.sr ) c. idl1, MAP #: LOT #: 4/7
The following information outlines the procedural steps required to obtain a Permit to BUILD - ALTER - or ADD TO
structure within the Town of Yarmouth. The Building Department will determine compliance to the following (A) ZO
REQUIREMENTS (B) HISTORICAL DISTRICTS (C) FLOOD PLAINS ZONING. The Building Department will be responsible for assis
the applicant through the following departments:
RESIDENTIAL AND/OR COMMERCIAL BUILDING
WATER DEPARTMENT: Determines Compliance of Water Availability.
ENGINEERING DEPARTMENT: Determines Compliance for Parking and Drainage.
CONSERVATION COMMISSION: Determines Compliance to Wetlands Acts, i.e.: If lot(s) border any type of Wetlands, Streams,
Ponds, Rivers, Oceans, Bogs, Bays, Marsh Lands, etc.
HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations, i.e.: Requirements for Septage Disposal
and other Public Health activities.
FIRE DEPARTMENT: Determines compliance to State and Town Requirements for Personal Safety, Property Protection,
i.e.: Smoke Detectors, Sprinkler Systems, etc.
The following departments must sign off, in the respective order, prior to Building Inspector issuing the required
Building Permit:
REVIEWED BY:
1. WATER DEPARTMENT: G � GJ���� DATE: /a — syr— 2 d N/A._
•
2. ENGINEERING DEPARTMENT: DATE: N/A:_•
3. CONSERVATION: 4,3_�.. _ v G DATE: 7 -2 Y fD N/A:_
4. HEALTH DEPARTMENT:`J3 , -� l DATE: . nit C) N/A:__
INDUSTRIAL AND/OR COMMERCIAL PERMITS
5. WIRING INSPECTOR: DATE: N/A:_
6. PLUMBING INSPECTOR: DATE: N/A:_
7. FIRE DEPARTMENT: DATE: N/A:_
PLEASE NOTE
ALL STUMPS AND/OR BRUSH MUST BE DISPOSED OF AT AN APPROVED SITE. A SIGNED RECEIPT FROM THE DISPOSAL SITE MUST BE SUBMI
TO THE BUILDING DEPARTMENT PRIOR TO ISSUANCE OF THE BUILDING PERMIT. �^�y
COMMENTS: S (AAA". S "1 l &NV%•s r V ?rale � i f I r!"b )
Ilea-17N• 7P, RMI Thf r toe issued r�rr�7
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• TOWN OF YARMOUTH
BUILDING DEPARTMENT
HOMEOWNER LICENSE EXEMPTION
•
Please print.
DATE P.ec,. /6J ( % g •
JOB LOCATION ,3 b°44)C 4- 41
Nur1oer Street aadress Section or town
•
"HOMEOWNER" ,A*;,Ln.7 C7 A L538 -77.571/t/7 /1//
Name Home pnone Work pnone
PRESENT MAILING ADDRESS J/7 / .,, a, / S
City/town state tip coa..
The current exemption for "homeowners" was extended to include owner-occupied
dwellings of six units or less ano to allow such homeowners to engage an in-
aiviauai for hire who does not possess a license, provided that the owner
acts as supervisor. (State Building Code Section 109. 1 . 1 )
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 to six 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, by-laws, rules and regulations.
The undersigned "homeowner" certifies that he/she understands the Town of
YARMOUTH Building Department minimum inspection procedures and requirements •
and that he/she will comply with said procedures and requirements. • .
HOMEOWNER'S SIGNATURa 0.eQ
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 .
8
FRONT ELEVATION
• G.W.A. elle, s.ft<
' 'OP
CEILING ASSEMBLY
TOTAL R=31.6,7 WINDOWS:
SURFACE U= ++
=0.61 x031(0
9" FIBERGLASS .
•
I=3ULATION
R=30
inIAnAAnl
\_SHEETROCK DOORS:
' ar R= 0.45 ap j,f;
5 —BOTTOM SURFACE
• R= 0.61
1/2"PLYWOOD INSIDE SURFACE WALL ASSEMBLY
REAR ELEVATION
R= 0.62 R= 0.68 TOTAL R={3,747 G.W.A.52j`j&p dj,f_
WOOD }" SHEETROCK U
SHINGLES f_R= 0.45 073
R= 0.87 WINDOWS:
OUTSIDE ` 3}" FIBERGLASS 5(0�.
—
SURFACE INSULATION
R= 0.17 R=11
OP =SURFACE RESISTANCE
1 R= 0.61
Pr FLOOR ASSEMBLY DOORS:
PP •- FINISH FLOOR TOTAL R= 23:1E; ' 263 S.
R= 0.91 U= �„yr
I�/T�o •
}, PLYWOOD RIGHT SIDE ELEVATION
re SUBFLOOR
R= 0.62 //
_ 1CJ
G.W.A. le5 T
SURFACE `� `
V L - V UeA U/%/U)
R= 0.17 ♦ � /'Zoi'.
WINDOWS:
'�' FIBERGLASS rat -5_ .
�� INSULATION FOUNDATION
CONCRETE R= 19 WALL ASSEMBLY
FOUNDATION ' (may be used instead DOORS:
I
WALL SURFACE RESISTANCE of floor insulation) 42
R= 0.61
R= TOTAL R=
f U- LEFT SIDE ELEVATION
i, tG.W.A. CIO •S . ,,
INSIDE SURFACE
, ' 7—R= 0.68
3/8" SHEETROCK WINDOWS: i
• 1;
I 7 R= 0.32 0057,1::r
. �1" STYROFOAM
� ij DOORS:
• / l ��+•
• ,. t . •.. d i . • 1 I ; l .. A 4 ..••t 3 .l
NOTES: ` (.�j�� ,y�
PERMANENTLY INSTALLED STORM H'tcF•••�/ 4 g
WINDOWSRTO BE USED Lot- 4A , 1, ` �,
GROSS WALL AREA= 3D78 h.�, N.-� �//�
WINDOW AREA= 1� 4j j . W W . 1M24(400t14
/ M f
DOOR AREA= 3@7 apt Q f,n[� / `{
% FENESTRATION= Z � ' I • `�B•! ' i
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• . CERTIFIED PLOT PLAN
--£4 —/,4 ___ _ �_1
�� ' -,� LOCATIONrF.+.`.T le14407g. e I
• 1 .A 1 SCALE ./.e &k. t aATE G •2,7� .r
• `^a Id.Q p�p�� A� �r'(� '
lHcy\(AS E.KELLLI CO. \,ir S. PLAN R:, ERENCE i r+� ..e.,1 .
soINEEFS —SL:`i:YORS - �• .e//'
0•d746 LONG FOND PRI%E J•4 --......4%SOUTH YARMOUTH.MASS...I (•) . •• � �• ••O � x � /p
aL
' o • . ,TETT• ':. c • • 59./1$ac .`4. •. S
• . '444ca• •C'Gt 7104. . /% t. . Karin TM 1 4,•t /•A' $S
�j an �+ . SHOWN ON II LDCATED ON THE GROUND •'
• trt:
f 17,7/iCr4,/, "j/// .. rT LLEY j AS OIWW }', •
•
. . s� �►q IIRi DATE (.Q�� ��� i.
PETITIONER: . • . 6
ISTERED LAND SURVE R
BOOK 6 912 PAGE 281 51535 •
IForm 5 DEQEFile No. I SE 83 - 1002
• • (To be proviced by 0E0E)
(;.a Commonwealth •
ciry,Town• YARMOUTH
t`f CA of Massachusetts Harold Cutter
I_ — Applicant
•
• •Order of•Conditions
Massachusetts Wetlands Protection Act ,
• G.L. c. 131 , §40
• and the Town of Yarmouth Wetland Bylaw
From TOWN OF YARMOUTH CONSERVATION COMMISSION
To Harold (Uttar Sable
(Name of Applicant) (Name of property owner)
Address17 Hammond St. , Chestnut Hill, MA Address Saar
•
This Crder is issued and delivered as follows: •
0 by hand deliver/to asplic.nt cr representative en
(date)
.� e2L /917 (date) '
C•fby certified mail, return receipt requested on i
This project is located at 33 Prince Road, West Yarmouth
•
The prc:erty is recorded•at the Registry of EARN STABLE
Sock • 1507 Page 66
f
r• ate registered)
The Notice of Intent for this -rc'ec:was tiled on
August 22. 1989 !da:z)
The :__:ie hearing was Clos=e Cn September 7, 1989 (ca:e)
Fincings
The Town of Yc.—cuth C..•.__A c'icn Cc rrn._- Cn has reviewer the ac_ve-rnf=:en:Ec Nc::ca :
Intent ant :tans arc has heic a :u_,ic :fearing on the :.:;ect. Esse:: on the info..rma:cn ava is::e :c the
me. the • COMM' SSA has cetern•nec that
C��"�dIS�iON at:his ;,, ._
the area on wn:c^ the :rCCCsec work is to _e e is s ^.Ific:r:to the to:lowing interests in aC:_rcance with
•'-:rt -
the ?resurhottn5 of Sion ic:nos set`cr;h in the re,_s::ons for non Area Sut;ect to Protect.:n Unser
the
Act ;caecx as a:ors:r:ate1:
,—/ Fico 1--1-ars: sne:Ifisn
.—,,irT/ Sr-'• d ma:s ^rove^tion C'� F seer:es
L... rr:va:e water zu:: :•! • "' ' r
CyCrc..., Na. . :..:! r FrevenC ;cilu:Ion LrPr •ec• n _ tifz
. _-
:...
5•;
• BOOK G912PAGE 282
Therefore. the COMMISSION hereby finds that the following conditions are
necessary,in accordance with the Performance Standards set forth in the regulations,to protect those inter-
ests checked above. The COMMISSION orders that all work shall be performed
in accordance with said conditions and with the Notice of Intent referenced above.To the extent that the fol-
lowing conditions modify or differ from the plans, specifications or other proposals submitted with the Notice
of Intent.the conditions shall control. ,
•
•
General Conditions •
.•
, 1. Failure to comply with all conditions stated herein.end with all related statutes and other regulatory meas-
ures,shall be deemed cause to revoke or modify this Order. ,
2. This Order does not grant any property rights or any exclusive privileges:it does not authorize any injury
to private property or invasion of private rights. -
3. This Order does not relieve the permittee or any other person of the necessity of complying with all '
other applicable federal,state or local statutes, ordinances, by-laws or regulations.
4. The work authorized hereunder shall be completed within three years from the date of this Order unless
either of the following apply:
(a) the work is a maintenance dredging project as provided for in the Act:or
(b) the time for completion has been extended to a specified date more than three years. but less than
five years, from the date of issuance and both that date and the special circumstances warranting
the extended time period are sbt forth in this Order.
5. This Order may be extended by the issuing authority for one or more periods of up to three years each
upon application to the issuing authority at least 30 days prior to the expiration date of the Order.- •
6. Any fill used in connection with this project shall be clean fill,containing no trash,refuse. rubbish or de-
bris.including but not limited to lumber,bricks, plaster,wire, lath,paper,cardboard.pipe, tires.ashes,
refrigerators.Motor vehicles or parts of any of the foregoing.
7. No work shall be undertaken until all administrative appeal periods from this Order have elapsed or, if
such an appeal has been filed, until all proceedings before the Department have been completed.
8. No work shall be undertaken until the Final Order has been recorded in the Registry of Deeds or the Land•
Y' -
Court for the district in which the land is located.within the chain of title of the affected property.In the
case of recorded land,the Final Order shall also be noted in the Registry's Grantor Index under the name
of the owner of the land upon which the proposed work is to be done.In the case of registered land,the
Final Order shall also be noted on the Land Court Certificate of Title of the owner of the land upon which
the proposed work is to be done. The recording information shall be submitted to the COMM ISSI ON
on the form at the end of this Order prior to commencement of the work.
•
9. A sign shall be displayed at the site not less than two square feet or more than three square feet in size
bearing the words. "Massachusetts Department of Environmental Quality Engineering.
File Number SE 83 — 1002
10. Where the Department of Environmental Quality Engineering is requested to make a determination and
to issue a Superseding Order, the Conservation Commission shall be a party to all agency proceedings
and hearings before the Department.
11. Uporrcompletion of the work described herein, the applicant shall forthwith request in writing that a
Certificate of Compliance be issued stating that the work has been satisfactorily completed.
12. The work shall conform to the following plans and special conditions:
5-2
•
•1
... .
BOOK 6 912 PAGE 283
Plans: .
Title Dated Signed and Stamped by: On File with:
Revised
Plan Accompanying 8/24/89 Robin W. Wilcox & Con. Can. office
Petition T. A. Dumas
' 1
Special Conditions(use additional paper if necessary)?
•
13. The applicant shall be held responsible to advise the contractor of all
these orders of conditions.
14. The Conservation Officer shall be notified at least 48 hours prior to
the commencement of the proposed work. Tel.#398-2231 Ext. 284.
15. These orders of conditions shall apply to any successor in interest or
successor in control.
16. Any fill required, (see General Order #6. ) shall be clean sand and
contain no material over twelve (12) inches in diameter.
17. Any area proposed for the removal of vegetation for a period of more
than seven (7) days, shall be nulched or otherwise treated to prevent
erosion.
18. The cesspool is to be pimped dry, the connection broken, and filled
with clean sand.
19. The applicant shall be responsible for having a copy of the Orders of
Conditions on the job site at all times. Failure to do so could
possibly result in a revocation of the Order of Conditions, or a fine,
or both.
20. Upon ccnpletion of the project a Certificate of Carpliance shall be
requested. This Order shall be considered incatplete until the
Certificate of Ccnpliance is recorded.
(Leave Space(Blank)
5.38
• .... BOOK 6912PAGE 284 C'irrE2
Issued By , TI Wk OF YARMOUTH Conservation Commission
• i
Signature ' �4 ' / � , pt -_ '
• J
ii:taiviir e,,,,, i . ,. . . " .
i __
t ......Y
•
This Order must be signed by a majority of the Conservation Commission.' s
On this / y of ,' 19 O /� before me'
personalty appea red ' tome known to be the
p, i rid25cr4tiiifytrF.pod who executed the foregoing instrument and acknowledged that he/she executed
ik�e saMr • s � @e� 2 and deed.
c•% ...._ :, - ;,.4.2.-Apr *Chats' Was Norte RlMti '
•
? ,ota b'1Ryic .;$4.4 / My commission expires
*/.0.-01/471
The aaptiWgt,;ha owner,any person aggrieved by this Order,any owner of land abutting the land upon which the proposed work is 10 be
done or any ten residents of the city or town in wnich such land is located are hereby notified of their right to request the Department of
Environmental Quality Engineering to issue a Superseding Order,providing the request is made by certified mail or hand delivery to the
Department,with the appropriate filing fee and Fee Transmittal Form as provided in 310 CMR 10.03(7).within ten days from the date of
issuance of this Order.A copy of the request shall at the same time be sent by certified mail or hand delivery to me Conservation
Commission and the applicant.
•
nLLUUirS CCI 10 69
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^
'JAMES E. EGAN. P.E. AREA CODE 508
385-2044
. ggeacon engtheer KM/2day, clan
•
STRUCTURAL ENGINEERS
585 MAIN STREET, BOX 642 RQ�`d 6 0//(�1 b
DENNIS, MASS. 02638
Jan. 25, 1991
Town of Yarmouth
Building Dep' t
Re: Cutter Residence
Prince Rd.
W. Yarmouth, MA.
Dear Sirs,
I request that work be allowed to proceed on the work
above the foundation until a review of foundation
depth requirements can be determined.
I anticipate submitting a report to you in
approximately three weeks for your approval of
foundation requirements.
I also request that interior footings be allowed to
proceed according to plan.
V y truly yours,
i)et.,,,,_
James E. Egan
g JAMES E. N
,s EGAN
STRUCTURAL w
� .I . v, '„ No.22691
�/0?5 // J A9or AfCISTERE��""
//AA7'" FSSIONAL F--0
5 \I 'S‘\c\• •^.� No. ..1'� t7 —‘ l
Py\''a Application for a Permit to Build a�.2&/G/
Fee must accompany this application
Yarmouth • J 2 19 o
TO THE BOARD OF SELECTMEN:
The undersigned hereby applies forua permit to build, according to the following specifications:pe�
1. Name of Owner L��CCP/YL v/ )`Cad Address c/�a � - 2 2�4n�i�
2. Name of Architect (if any)
3. Name of Builder •$C ac QeG[cle-7/ / z __ ,
4 Precinct No. Lot No. 444
Plan: Name or No. $o-n. 6c - Ptkf 3
• 5. Name of Street 6Zccc c..e R 4?
8. Purpose of Building & .-C EL/. " •
7. Material
Com [' • 1/-5
8. Estimated cost of building 2 CW-Z" .
•
9. Dwelling
. 10. Cottage // •
11. Heat 0, lryt.c�alitt.Lc,•- .c� :441. c,/
4'
12. Basement 21.e la,
13. Garage 72-G2cA.
14. Store A
15. Shop X
18. No. of stories /nit.(
17. Is there to be a store.in lower story? 4
18. Size of lot. No. of feet front ....1..7C / No. of feet rear `;/ No. of feet deep .....7.g..0
/2 r+iL9 '
19. Size of building. No. of feet front 'Ca # No. of feet side No. of feet rear So
20. Distance from nearest buildings: Front 21`/ . ft.de 6 Q # It; side ft; rear h';"4t-7- • ft.
21. Distance bath from line or street -.' 1 , from rear lot line -re . , side line 44C'
Show by diagram the location of proposed building with relation to distances from adjoining lots, on reverse side.
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0 _ 49.1 PLUMBING PERMIT
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• Office of the Inspector of Plumbing, South Yarmoutil fikat4 c 7 194 a
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has permission to .......„-24(g.......zoi............ cy-
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in building on le.-...4417.Cne..1.4.1.ia fe Street, Village of 4Z-C,...e.i.",;(24a.rSilX
in accordance with an application on file in this offic and sulfect to the provisions of the Ordinances
relating to Plumbing in the Town of Yarznouth
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No. .72
Fee $ 9•Oa ,/ • '
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TOWN OF YARMOUTH
BUILDING DEPARTMENT
CONSTRUCTION SUPERVISOR FORM
PLEASE PRINT: Pbyd
JOB LOCATION: 33 U p RI NC5 R44), /#c2 '//
aUT/V
NUMBER STREET VILLAGE .
OWNER OF PROPERTY: 702A9t, tb C �u7T.R •
CONSTRUCTION SUPERVISOR: �.ci �C� o 8983_ ??6 - 73 of
NAME / LICENSE NO. • PHONE NO.
ADDRESS: e . 0 . &X 1 'a.3 5 to, >PW/J 15 UI'LA O o`t i '70
LICENSED DESIGNEE:
(IF OTHER THAN SUPERVISOR) NAME LICENSE NO.
2.15 RESPONSIBILITY OF EACH LICENSE HOLDER:
2.15.1 THE LICENSE HOLDER SHALL BE FULLY AND COMPLETELY RESPONSIBLE FOR ALL WORK FOR WHICH HE
IS SUPERVISING. HE SHALL BE RESPONSIBLE FOR SEEING THAT ALL WORK IS DONE PURSUANT TO THE STATE
BUILDING CODE AND THE DRAWINGS AS APPROVED BY THE BUILDING OFFICIAL
2.15.2 THE LICENSE HOLDER SHALL BE RESPONSIBLE TO SUPERVISE THE CONSTRUCTION, RECONSTRUCTION,
ALTERATION, REPAIR, REMOVAL OR DEMOLITION INVOLVING THE STRUCTURAL ELEMENTS OF BUILDING
AND STRUCTURES ONLY PURSUANT TO THE STATE BUILDING CODE AND ALL OTHER APPLICABLE LAWS OF THE
COMMONWEALTH, EVEN THOUGH HE, THE LICENSE HOLDER, IS NOT THE PERMIT HOLDER BUT ONLY A SUB-
CONTRACTOR OR CONTRACTOR TO THE PERMIT HOLDER.
2.15.3 THE LICENSE HOLDER SHALL IMMEDIATELY NOTIFY THE BUILDING OFFICIAL IN WRITING OF THE
DISCOVERY OF ANY VIOLATIONS WHICH ARE COVERED BY THE BUILDING PERMIT.
2.15.4 ANY LICENSEE WHO SHALL WILLFULLY VIOLATE SUBSECTIONS 2.15.1, 2.15.2 OR 2.15.3 OR ANY
OTHER SECTION OF THESE RULES AND REGULATIONS AND ANY PROCEDURES, AS AMENDED, SHALL BE SUBJECT
TO REVOCATION OR SUSPENSION OF LICENSE BY THE BOARD.
2.16. ALL BUILDING PERMIT APPLICATIONS SHALL CONTAIN THE NAME, SIGNATURE AND LICENSE NUMBER 0:
THE CONSTRUCTION SUPERVISOR WHO IS TO SUPERVISE THOSE PERSONS ENGAGED IN CONSTRUCTION, RECON-
STRUCTION, ALTERATION, REPAIR, REMOVAL OF DEMOLITION AS REGULATED BY SECTION 109.1.1 OF THE
CODE AND THESE RULES AND REGULATIONS. IN THE EVENT THAT SUCH LICENSEE IS NO LONGER SUPERVISI:
SAID PERSONS, THE WORK SHALL IMMEDIATELY CEASE UNTIL A SUCCESSOR LICENSE HOLDER IS SUBSTITUTE
ON THE RECORDS OF THE BUILDING DEPARTMENT.
I HAVE READ AND UNDERSTAND MY RESPONSIBILITIES UNDER THE RULES AND REGULATIONS FOR LICENSING
STRUCTION SUPERVISORS IN ACCORDANCE WITH SECTION 109.1.1 OF THE STATE BUILDING CODE. I UNDERS
THE CONSTRUCTION INSPECTION PROCEDURES AND THE SPECIFIC INSPECTION AS CALLED FOR BY THE BUILD
OFFICIAL.
SIGNATURE: R cy
BUILDING OFFICIAL APPROVAL: