HomeMy WebLinkAboutBLD-22-006586 (2) i
/
pU 1) )ci/22
ONE & TWO FAMILY ONLY- BUILDING PERMIT
® Town of Yarmouth Building Department
R C E 1 V 1146 Route 28, South Yarmouth,MA 02664-4492 ,_
508 398 2231 ext. 1261 Fax 508-398-0836
AY 1 12UU2 Massachusetts State Building Code,780 CMR W ,ii
Buildi rnzitApplication To Construct, Repair, Renovate Or Demolish
. WENT a One-or Two-Family Dwelling
6111LI7t
riv This Section For Official Use Only
Building Permit Number: Li...)' -OD(p,S'$-(p Date Applied:
Building Official(Print Name) ignature Date
SECTION 1:SITE INFORMATION
1.1 Proper Address: 1.2 Assessors Map&Parcel Numbers
a Uhl-, ( 7o /13
1.1 a Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required J Provided Required Provided Required Provided
36 /YZ- av /‘. s ace , /1-6
1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public Private❑ Zone: Outside Flood Zone? Municipal 0 On site disposal system 4
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 jclit er'11yof Recordc�� 02 V CA, a & �,� r/fr
Name(P nt) %/'� City,State,ZIP / ���� �/T v`/
02 `f 10 d I- 3 77/ 99a 7 "i Afj/v*40m - am
No.and Street Telephone Emailddress
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction 0 I Existing Building 1711 Owner-Occupied 0 I Repairs(s) 0 Alteration(s)A I Addition %
Demolition 0 Accessory Bldg. ❑ Number of Units / Other ❑ Specify:
Brief Description of Proposed Work': (1:6-19 I i41 ,,21 'e—ite -/ .a sit 1// 17e0J
/OW 1 , /
SECTION 4: ESTIMATED CONSTRUCTION COSTS.
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ ��/�U�' 1. Building Permit Fee:$1().6 Indicate how fee is determined:
2.Electrical $ � . '®Standard City/Town Application Fee
0 Total Project Costa(Item 6)x multiplier . x
3.Plumbing $ 0/ i3`0 D 2. Other Fees: $_1444(.41 - ' tfr
_
4.Mechanical (HVAC) $ 6V Ate List: iGLO
5.Mechanical (Fire '�
Suppression) $ .94 Total All Fees:$ O
,---Check No. Check Amount: Cash mint:6.Total Project Cost: $ 0 Paid in Full ZI Outstanding Balance D e: 10 64. V[m
(o( I -\ /
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
hil. 3-:/�l� dY1ls' 0//3 q '9.,-/4'-2
License Number Expiration Date
Name of CSL Holder ' /
.2 Cl Gvhl A List CSL Type(see below) L/
No.and Street '1. , 1 Description
y/,' 'l07/i A,70 D2d6 / C 1 Unrestricted(Buildings up to 35,000 cu.ft.)
City/Town,State,ZIP R I Restricted 1&2 Family Dwelling
Ivt Masonry
•
RC 1 Roofing Covering
WS Window and Siding
`'/-77/ 7 ���10 � SF Insulation
Fuel Burning Appliances
"G � ��'d�'� I lnsufation
Telephone EMail address D I Demolition
5.2 Re inter d A)Home Improvement Contractor CHIC)
HIC Com N or Re ' trant Name HIC Registration Number Expiration Date
a. Street f �//� / `t°C /r!J✓YJd//D' LA1Yi
y iStreet 6'"r ff'/' o.- e26)`/ Email address
City/Town, State,ZIP Telephone
SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L. e.152.§ 25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide
this affidavit will result in the denial of the Issuance of the building permit.
Signed Affidavit Attached? Yes No 0
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize 4 e"4/1-0.-/ ,V/j-4.40d1'/5
to act on my behalf,in all matters relative to work authorized by this building permit application.
4, 4-6.X.5 m 5--te r Zz
Print Owner's N e(Electronic Signature) Date
• 1 SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
contained in this application is true and accurate to the best of my knowledge and understanding.
Aly e 44-v'/ A/44.0-r i ar —to— ZZ--
Print Owner's or Authorized Agent's Name(Electronic Signature) Date
NOTES:
1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration
program or guaranty fund under M.G.L.c. 142A. Other important information on the HIC Program can be found at
www.mass.eov/oca Information on the Construction Supervisor License can be found at www.mass.4ov/dps
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) <2/6 6 (including garage,finished basement/attics, decks or porch)
Gross living area(sq.ft.) /yyv Habitable room count
Number of fireplaces C) Number of bedrooms
Number of bathrooms Number of half/baths O
Type of heating system it) Number of decks/porches /
Type of cooling system .- ' Enclosed b Open (
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
' The Commonwealth of Massachusetts
,, Department of IndustrialAccidents
1 Congress Street, Suite 100
i Boston,MA 02114-2017
�..°"'y www. a0v/dia
v/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY,
A Iicant Information
I'Iease Print Leoibl
Name (Business/Organization/Individual): ill. ', ,SY1 6 /� �y?G
C.i l�n�tp
y- L e
Address: ( )ii 14-e$ '))
•
City/State/Zip: S, ARM. Mil- OZ•60 Phone#: ,sos 7 71 —60 )7
Are you an employer?Check the appropriate box:
I. 1 am a employer with Type of project(required):
employees(full and/or part-time).*
2.0 I am a sole proprietor or partnership and have no employees working for me in ❑New construction
any capacity.[No workers'comp.insurance required.] 8. Remodeling .
3. I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. Demolition
4.E I am a homeowner and will be hiring contractors to conduct all work on my property. I will 1 O BuIldirlg addition
ensure that all contractors either have workers'compensation insurance or are sole
11•t]�Electrical repairs or additions
proprietors with no employees.
5.—I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 12. I Plumbing repairs or additions
These sub-contractors have employees and have workers'comp.insurance.i 13, Roof repairs
6.0 We are a corporation and its officers have exercised their right of exemption per iMGL c. 14.0 Other
I52,§I(4),and we have no employees.[No workers'comp.insurance required.]
*Any applicant that checks box Ail 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,
1Contractors 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: 4 1 i'4 muter —. i 4 S do
Policy or Self-ins.Lic.the..- god - 70 3y mi„ o260,f
4 Expiration Date: 3— 1 Z—oZc)
Job Site Address:
Attach a copy of the workers' compensation policy declaration page(showing hetpoicy number and expiratio�e),Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by 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. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby cert(f untie the pains and penalties of perjury that the infornudion provided above is true and correct.
Signature:
Phone 4-:: Date: 3'=/b—2Z.
—77/ —474-1--I
Official use only. Do not write in this area, to be completed by city or town official.
City or Town:
Permit/License R.
Issuing Authority(circle one):
I. Board of Health 2. Building Department 3. Cityrfovvn Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person:
Phone#:
§TOWN OF YARMOUTH
1146 Route 28, South Yarmouth, MA 02664
508-398-223!1 ext.-1261 Fax 508-398-0836
Office of the Building Commissioner
BUILDING DEPARTMENT
DEMOLITION DEBRIS DISPOSAL AFFIDAVIT
Pursuant to M.G.L. Ch. 40, §54 and 780 CMR- Section 105.3.1. #4.
I hereby certify that the debris resulting from the proposed work/demolition to be
conducted at o2 o///kr ej L
7
Work Address
Is to be dis osed of oat the followinglocation: m/ Z -
p
(-
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Ch. 111, §150A.
Sin re of Application Date
Permit No.
Office of Consumer.Affairs and Business Regulation
1000 Washington Street-Suite 710
Boston,Massachusetts 02118
Home Improvement Contractor Registration
Type: LLC
M J WHITES E CARPENTRY LLC. Registration: 135887
299 WHITES PATH Expiration: 08/14/2022
SOUTH YARMOUTH,MA D2664
, Update Address and Return Card.
ORIH.o1Cons IMPROVEMENT
S Rosin...CONTRACTOR
HOMEROVEME CONTRACTOR before
Valld date.
Iualus.only
TYPE:LLC b the expirationdate.a found return to:
Re13588 ion Etrairatiog Office of hi Consumer Affairs and Business Regulation
136867 06f142022 L 1000 Washington Street-Salle 710
JNAR00NE CARPENTRY LLC. Boston.MA 02118
•
CHAEL J.NARDONE .-
9 WHITES PATH ;Me/xx.4.
IUTH YARMOUTH,MA 02664 UnOersecielary Not id without signature
Commonwealth of Massachusetts
Division of Professional Licensure
Board of Building Regulations and Standards
Constwj t t�...p�T isor
11
CS-081139 ;5' 4<< spires:09/16/202:
MICHAEL J Ist,AR 19 4r4
299 WHITES4TH
SOUTH YARM9UTI4
Q
Commissioner diaeG i ,
f� _
•
•
Bk 34985 Pg157 #14413
03-18-2022 @ 02 : 13p
{i` - _ p , TOWN OF YARMOUTH
t''' - i`t ' BOARD OF APPEALS
I� ,� DECISION
!A COI'
FILED WITH TOWN CLERK: February 25, 2022
PETITION NO: 4938
HEARING DATE: February 10,2022
PETITIONER: The Amy MacIsaac Rev. Trust, Amy MacIsaac
PROPERTY: 24 CharIes Street, South Yarmouth, MA
Map 70, Parcel 113
Zoning District: R-40
Title: Book 32826,Page 156
MEMBERS PRESENT AND VOTING: Chairman Steven DeYoung, Mr. Igoe,Mr. Fraprie
and Mr. Martin
Notice of the hearing has been given by sending notice thereof to the Petitioner and all those owners
of property as required by law, and to the public by posting notice of the hearing and publishing in
The Cape Cod Times, the hearing opened and held on the date stated above.
The Petitioner is The Amy MacIsaac Revocable Trust by Amy MacIsaac, It's Trustee. The
Petition was well-presented by Kieran Healy of the BSC Group. Both the Petitioner and Mr.
Healy explained that the need for the relief sought (in the alternative a Special Permit or a
Variance) was to allow the increase by 2 feet of the existing building and deck. The Petition had
been vetted by the Conservation Commission, which voted to approve the deck"per Site Plan of
Land, 24 Charles St. in South Yarmouth, Amended Order of Conditions, Kieran Healy PLS,
BSC Group dated 12/3/21 and New Foundation of Existing Structure MacIsaac Property Plan
and Notes, Scott Orlowski of Apex Engineering dated 12/16/21".
David Bennett, Licensed Site Professional, appeared in support of the Petition, and another
abutter, Debora Leahy of 28 Charles Street, appeared with questions regarding the grade of the
land, which were answered by the Petitioner/Mr. Healy. No one appeared in opposition to the
Petition. No exhibits were received.
It was reported to the Board that an oil spill had been detected at the location of the existing
structure, which needed to be cleaned up. As part of the work for the cleanup, the Petitioner
seeks to relocate the building and allow for the cleanup together with an addition of 2 feet in
height of the foundation area. The footprint of the home will remain the same. The 2 additional
feet will allow for the basement area to have a much greater utility than it currently does.
A TRUE COPY ATTEST:
1 ��L��-1
MAR 1 8 2022 CMMC CMC I TOWN CLERK
Bk 34985 Pg158 #14413
The Board agreed that the grant of the requested relief for a Special Permit would not result in
any undue nuisance, hazard, or congestion, and the changes to the existing structure will not
cause substantial harm to the established or future character of the neighborhood nor of the town.
Accordingly, a motion was made by Mr. Fraprie, seconded by Mr. Martin to approve the
Petitioner for relief of a Special Permit with the assurance that the request for the Variance
would be asked to be withdrawn, without prejudice. On this motion, a roll call vote was taken
with the following results:
- Chairman DeYoung: AYE
- Mr. Igoe: AYE
- Mr. Fraprie: AYE
- Mr. Martin: AYE
The Board voted 4-0 in favor and the Special Permit was therefore granted, without conditions.
As to the requested Variance, the request was made by the Petitioner to allow for the relief to be
withdrawn, without prejudice. A motion was made by Mr. Martin, seconded by Mr. Fraprie and a
roll call vote was taken with the following results:
- Chairman DeYoung: AYE
- Mr. Igoe: AYE
- Mr. Fraprie: AYE
- Mr. Martin: AYE
The Board voted unanimously (4-0) to allow the withdrawal of the requested relief, without
prejudice.
No permit shall issue until 20 days from the filing of this decision with the Town Clerk. Appeals
from this decision shall be made pursuant to MGL C40A section 17 and must be filed within 20
days after filing of this notice/decision with the Town Clerk. Unless otherwise provided herein,the
Special Permit shall lapse if a substantial use thereof has not begun within 24 months. (See bylaw
§103.2.5, MGL C40A §9)
Steven DeYoung, Chairman
A TRUE COPY ATTEST:
2
ffifigt,i44
MAR 1 8 2022 CMMC CMC i TOWN CLERK
Bk 34985 Pg159 #14413
CERTIFICATION OF TOWN CLERK
I, Mary A. Maslowski, Town Clerk, Town of Yarmouth, do hereby certify that 20 days have
elapsed since the filing with me of the above Board of Appeals Decision# 4938 that no notice of
appeal of said decision has been filed with me, or, if such appeal has been filed it has been
dismissed or denied. All appeals have been exhausted.
t4e),Ital•MiV4141
Mary A. Maslowski, Town Clerk
MAR 1 8 2022
A TRUE COPY ATTEST:
3 •FIZA(4364
MAR 1 8 2022 CMMC MC I TOWN CLERK
Bk 34985 Pg160 #14413
- •Yik 4
COMMONWEALTH OF MASSACHUSETTS
TOWN OF YARMOUTH
,t'l - -if-�. BOARD OF APPEALS
Petition#: 4938 Date: March 18,2022
Certificate of Granting of a Special Permit
(General Laws Chapter 40A, Section 11)
The Board of Appeals of the Town of Yarmouth Massachusetts hereby certifies that a Special Permit has been
granted to:
The Amy MacIsaac Rev. Trust,Amy MacIsaac
24 Charles Street
South Yarmouth, MA 02664
Affecting the rights of the owner with respect to land or buildings at: 24 Charles Street, South Yarmouth, MA;
Map #: 70; Parcel #: 113; Zoning District: R-40; Book/Page: 32826/156 and the said Board of Appeals
further certifies that the decision attached hereto is a true and correct copy of its decision granting said Special
Permit, and copies of said decision, and of all plans referred to in the decision, have been filed.
The Board of Appeals also calls to the attention of the owner or applicant that General Laws, Chapter 40A,
Section 11 (last paragraph) and Section 13, provides that no Special Permit, or any extension, modification or
renewal thereof, shall take effect until a copy of the decision bearing the certification of the Town Clerk that
twenty (20) days have elapsed after the decision has been filed in the office of the Town Clerk and no appeal
has been filed or that, if such appeal has been filed, that it has been dismissed or denied, is recorded in the
Registry of Deeds for the county and district in which the land is located and indexed in the grantor index under
the name of the owner of record or is recorded and noted on the owner's certificate of title. The fee for such
recording or registering shall be paid by the owner or applicant.
"i. a...,,SB144.,
Steven S. DeYoung, Chairman
A TRUE COPY ATTEST:
•
MAR 1 8 2022 �dt�4a
LM� /CN�C I TOWN CLCftit
JOHN F. MEADE, REGISTER
BARNSTABLE COUNTY REGISTRY OF DEEDS
• Yr�MA�
n,.
$ 9
. :;� .. „
r(xV',N OF YAR.AWW I I i
to WATER DEPARTMENT
0•5" a " ,y. Ott Buc Road
Yarrnuuth. MA O C t
•� r . IcicHlw.ty -1--921 • Fat: `,Otis --1- 1 lti
BUILDING PERMIT APPLICATION FOR
WATER DEPARTMENT SIGN OFF
TRANSMITTAL FORM
BUILDING SITE LOCATION: (>2 V L3/
PROPOSED WORK: C 17la- f �� ` ///C` �f ,�' 1t U f 'l,' 5/( -1 (
APPLICANT:
ADDRESS: 6Vt ' /1: •
TELPHONE: 63/
RESIDENTIAL AND OR COM\IER('IAl. BUILDING ,4// -Q4 4(J/ ''uCe . C-ervvk
Water Department: Determines Compliance of Water Availability and or existing location
Engineering Department: Determines Compliance for Parking and Drainage
Conservation Commission: Determines Compliance to Wetlands Act: i.e. lt'lot(s►border any type of
etlands. streams. ponds. rivers, ocean, bogs, boys, marshland. ETC...
Health Department: Determines Compliance to State and Town Regulations, i.e.
requirements for Septage Disposal and other Public Health Activites
Fire Department: Determines Compliance to State and'[own Requirements for Personal
Safety, Property Protections. i.e. Smoke Detectors,Sprinkler Systems,etc
APPLICANT SI NAT TRE DATE
OFFICE USE: COM. IENTS ON PERNIIT APPROVAL OR DENIAL.
RENI5i.. 'EDB kV �� Z7i
1 ATER DIVISION(SIGNATURE)
ATE
•
\ N
\�
L An
4pN. -J r 1 • 0 w - .</
W O
OO<
• ^h•, vases \ tis t
\ r 4.4, 4 'to o 0 �'
•
•�00 vy y o kJ 4
\- ,o f
// \ \ Dc
a lg
.\ a v h nmo
o4)9 - �``� �o - o �oz�
\ ; Q. • \ O��, �rcii
. />'
d� i pr�N
\ \/'`rye .ry00 0°
\f 4.2a \b�db
= f•,i, -00•'DLO
�,, Oy .�d'rd
Ss 41,
f. o " W I
yN
O
Sears, Tim
From: Sears, Tim
Sent: Friday,June 10, 2022 10:46 AM
To: 'mike@mjnardone.com'
Subject: 24 Charles St
Mike,
I am reviewing the plans and there is a detail on page A5 B showing the deck ledger attached to the overhang. Section
R507.2.2 requires"Band joists attached by a ledger in accordance with Section R507.2 shall be fully supported by a wall
or sill plate below."
Please advise,
Timothy Sears CBO
Deputy Building Commissioner
Town of Yarmouth
508-398-2231 Ext. 1259
mailto:tsears@varmouth.ma.us
1
Sears, Tim
From: Sears,Tim
Sent: Tuesday, May24, 2022 8:22AK4
To: 'nnike@p jnaodone.comn'
Subject: 24 Charles St
Mike,
| h addition/renovations and there are some items needed.
Health Department sign off
Conservation sign off
Please submit these items for review
Tinnnthy Sears [BO
Deputy Building Commissioner
TovvnofYarnnouth
�08'398-22]1 Ext. 1259
lnaKt[dtse§Is(@Yarmouth.rna.uo
1
oF%x`�R
, Conservation Office
it
o . . y: sTown of Yarmouth
Y kcrantCa�varmouth.ma.us
*. y,\M T^" $s, ' Conservation Commission
Building Permit Sign-off Application RECEIVED
TO BE FILLED OUT BY BUILDING PERMIT APPLICANT": JUN 0 6 2022
Building Site Location: ta_til r,kotAlts si _---
RIJILDING DEPARTMPKIT
Map# /� Lot(s) # / By
Property Owner: 441 ki - Date filed: eri--"3-- 2
*Applicant: + �� /tAlft.041,1/tr
Applicant Address: c - "9 4✓4 le (>jy 4-6
, ,
Email: /W, ti 0 7l ,4441 At , `7 Telephone: 7../ 92 7
Please note:by submitting this apcation,the applicant grants permission to the Conservation Office to enter the location to conduct a site visit(if needed).
Proposed Project Description: '� w� Ozer, .owl
a $M4-(( - s %66 2e_��
I k. .i WO-Lk
Site Plan Title/Date: Site plan dated 12/3/2021;New Foundation for Existing Structure Plan dated 11/29/2021; Mass
DEP Release Amendment Form dated 12/14/2021
TO BE FILLED OUT BY CONSERVATION ADMINISTRATOR:
Does the proposed project require a permit? ir--
Refer to: SE83-111,4j?j or DOA permit
Comments from Conservatio
n Commission: Approved -TCotionallyApproved Rejected
-
The work proposed in this Building Permit is governed by an Order of Conditions issued by the Conservation
Commission for MA DEP file# SE83-2253. Please have the contractor and any sub-contractors review the
Order of Conditions, approved plans, and requirements that must be satisfied before the start of work. All
special Conditions in the Order of Conditions must be followed.
Conservation Commission Sign-off Signature:4L4 Date:4
(.¢ I(e l Za ZZ
*TO APPLICANT:
All work-related debris shall be taken offsite or disposed in a legal upland location. At the end of each
day, the area shall be clean and no debris shall be in the Resource Area.
If work is permitted under an Order of Conditions, please arrange a pre-construction site visit with the
Conservation Administrator. At the time of site visit, the MassDEP n
along with the erosion control/work-limit line. A copy of the Order Fof Condile itions er g ustur t be installed,
during construction. Please refer to the Order of Conditions for further details. remain on-site
r __
0c: .k TOWN OF YARMOUTH
' °.t
HEALTH DEPARTMENT
,.
,..tt
',�• ` . ;.r
' PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant:
Building Site Location: , 0/
V
Proposed Improvement: (1 ? (z, k WV / APi,"D4, ,,, G'r7/7
Applicant: 4"l 1 r`"(/l iC L)O'/ ,, Tel. No.: d e.-g)(--c ,
Address: c„)-ciq /4,4 (7,„. I-,,-, y. ( /
.Date Filed: >" //-,1
**If you would like e-mail notification of sign off,please provide e-mail address:
Owner Name: 4ii/ fP4'G7q f2
Owner Address: a I( , '41,,-z-6 J Owner Tel. No. )Wk")7/ <;Z
RESIDENTIAL AND/OR COMMERCIAL BUILDING
HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements
For Septage Disposal and other Public Health Activities.
Please submit three (3) copies of plans, to include:
(1.) Site Plan showing existing buildings, water line location,
and septic system location;
(2.) Floor plan labeling ALL rooms within building
(all existing and proposed) — I
Note:Floor plans not required for decks,sheds, windows, roofing;
(3.) If necessary,Title 5 application signed by licensed installer
with fee.
REVIEWED BY:
DATE: — ; —
COMMENTS/CONDITIONS: PLEASE NOTE
I
G�cf,;cvC v- Le U e L--- _
3etvc�c 1'E'
t
pic c i Ai t-(0c (22 09,, f z,e, J. ✓o c"Nk rc
/Z.0 CAA"- 5e II-Et �. y J3P�,.C,