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HomeMy WebLinkAboutBLD-23-001102 ell)( \\? ,Z..3 \-)11T/ 3 ONE & TWO FAMILY ONLY- BUILDING PERMIT Town of Yarmouth Building Department 1146 Route 28, South Yarmouth,MA 02664-4492 :�•t 508-398-2231 ext. 1261 Fax 508-398-0836 Massachusetts State Building Code, 780 CMR Building Permit Application To Construct, Repair, Renovate Or Demolish \ .. a One-or Two-FamilyDwelling \"" '"I. t� g T,h s,$ictin y ZFor Official Use Only E D Building Permit Number: g(��—2 3 uti t l I Date Applied: r7Y p� a AUG 2 4 2022 BuildingOfficial , _ _(Print Name) Signature , titi iiINci D=PARTMENT Li 3 v SECTION 1:SITE INFORMATION _--- 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 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 Provided Required 4 Provided Required Provided 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public Private 0 Zone: — Outside Flood Zone? Check if yes❑ Municipal 0 On site disposal system SECTION 2: PROPERTY OWNERSHIP' 2.1 Ownej'o Record: Name(Print) City,State,ZIP 7 Seni►Arett Yr. sac 5% i/v 7S No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction{ Existing Building 0 Owner-Occupied Al Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition Accessory Bldg. 0 Number of Units Brief Description of P posed Work'`: �y Other ❑ Specify: i4mD 601) / &'` 1zJ1i if Ae SECTION 4: ESTIMATED CONSTRUCTION COSTS. Item Estimated Costs: (Labor and Materials) Official Use Only 1.Building $ 3 06644 1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ .---______—\ 0 Standard City/Town Application Fee 3.Plumbing 0 Total Project Cost3(Item 6)x multiplier x 4.Mechanical (HVAC) $ �' 2. Other Fees: $ 166 List: e ' a-- 5.Mechanical (Fire $ Su..ression) Total All Fees:$ - 6.Total Project Cost: $ Check No. Check Amount: Cash Amount: coact, • 0 Paid in Full 0 Outstanding Balance Due: T SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) vArrkin 1.,A, ��c1r Csb6 5©3 �r z5 Name y of CSL Holder , P License Number E/xpiiration Date `�/� j�i�{x'� we List CSL Type(see below) V No.and Street Type Description l fm!?g,di Z20 U Unrestricted(Buildings up to 35,000 Cu. ft.) City/Town,State,Z R Restricted 1&2 Family Dwelling. M Masonry RC Roofing Coverin WS Window and Sidin• 4j Q'37 '3 ir�+SS.1c�'4/e�?6.01A�/eiysi IF Solid Fuel Burning Appliances Telephone Insulation Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) ' HIC CompanyName or C egistrant Name HIC Registration Number xpiratio Date pgc No.and Street u!� n, ',P eo nth t 41) �j 637 66 Email address City/Town, State,ZIP Telephone SECTION 6: WORKERS' COMPENSATION H tSURANCE AFFIDAVIT(111.G.L. c.152.§ 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide 1 this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes .i' No 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 to act on my behalf, in all matters relative to work authorized by this building permit application. e-iz - Z Z Print Owner's Name(Electronic Signature) Date • SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION By entering ., n•me below,I hereby attest under the pains and penalties of perjury that all of the information conta'•-d in thi .pplication is true and accurate to the best of m-knowledge and understanding. _� y � Prm or Authorized Agent's Name(Electronic Signature) :2( e r Date NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner(not registered in the Home Improvement Contractorw whoye access to the hires an unregistered contractor program or guaranty find under M.G.L. c. 142A. Otheeimportant information on the HIC P ogram arbitration can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/d s 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) '-'----` � (including garage, finished basement/att_ic_s^decks or porch) Gross living area(sq.ft.) Number of fireplaces — Habitable room count Number of bathrooms Number of bedrooms ''—� Number of half/baths Type of heating system Type of cooling system Number of decks/porches Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost' I ► `� The Commonwealth of Massachusetts ' ► Department of Industrial Accidents IU= 41 Congress Street, Suite 100 ,��f� Boston, MA 02114-2017 _ ,, www.mass.aov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. A licant Information Name (Business/Organization/Individual): iork ,1,1 Please Print LeQibl eJ Address: eNe City/State/Zip: /fitnieb4e6 %►1/ _ � 027d� Phone #: Qj /6663 Are you an employer?Check the appropriate box: 1.0 I am a employer with employees(full and/or pan-time).* T e Of Yp project(required): 7•1tNew construction 21am a sole proprietor or partnership and have no employees working for me in any capacity.[No workers'comp. insurance required.] 3.❑I am a homeowner doingall8. ,remodeling , work myself [No workers'comp, insurance required.]t 4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I will 9. "" Demolition ensure that all contractors either have workers'compensation insurance or are sole 10 � Building addition proprietors with no employees. Electrical repairs or additions 11.[] 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. These sub-contractors have employees and have workers'comp. insurance.t 12.0 Plumbing repairs Or additions 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.0 Roof repairs 152,§I(4),and we have no employees. [No workers'comp. insurance required.] 1 ❑Other *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. T Homeowners who submit this affidavit indicating they are doingall work tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not employees. If the sub-contractors have employees,they must provide their workers'ctom .re .polisidecy contractors must submit a new affidavit indicating such. I am an employer that is providing p p•Policy number. those entities have information, p workers compensation insurance for my employees. Below is the policy and job site Insurance Company Name: Policy#or Self-ins.Lic. #: Expiration Date: Job Site Address: t Attach a copy of the workers' compensation policy declaration page(showing thepo is ninn Failure to secure coverage as required under MGL c. 152s Y a ber and expiration date).criminal and/or one-year imprisonment, as well as civil penalties in the form of STOP WORKn punishable andy a fine up upo to$500.00 day against the violator, A copy ORDER a fine of $250.00 a coverage verification. of this statement may be forwarded to the Office of Investigations of the DIA for insurance I do hereby certify zznd r the p ' sand p fP J penalties o perjury in that the information n provided above is true and correct. 1 a Signature:Phone#: //Q! 037 4:4,&3 Date: e!� /b C Official use only. Do not write in this area, to be completed by eh);or town official. City or Town: Issuing Authori Permit/License# ty(circle one): 1. Boardher of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5, P . Bo Plumbing Inspector Contact Person: Phone#: 01' TOWN OF YAR MOUTH o o BUILDING DEPARTMENT MATTACMECSE'�'/r� 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1261 PLEASE PRINT: HOMEOWNER LICENSE EXEMPTION DA rE: JOB LOCATION: BeigloAR d Tr. AME STREET ADDRESS SECTION OF TOWN "HOMFOWNER" e D&e .1v08 _j 9% '4' NAME HOME PHONE WORK PHONE PRESENT MAILING ADDRESS 5. "i€ 4/3aVe CITY OR TOWN STALL, ZIP CODE The current exemption for 'Homeowner' was extended to include owner—occupied dwellines of one or two units and to allow such homeowners to engage an individual for hire who does not possess a license,provided that such homeowner shall act as supervisor. (State Building Code Section 110 R5.1.3.1) Definition of Homeowner: Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is or is intended to be, a one or two family attached or detached structure assessory 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 perfouned under the building permit. (Section 110 R5.1.3.1) 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 SIGNATURE ��10 APPROVAL OF BUILDING OFFICIAL INSURANCE COVERAGE: I have a current ility insurance policy or its substantial equivalent, which meets the requirements of MGL Ch.142. No drIf ou have checked yes, please indicate the type coverage by checking the appropriate box. ability insurance policy Y Other type of indemnity Bond OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws and that my signature on this permit application waives this requirement. Sign ture of Owner or Owner's Agent Check one: g Owner Agent h:homeownrlicexemp • f TOWN OF YARMOUTH 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1261 Fax 508-398-0836 Office of the Building Commissioner BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to M.G. L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 111/5 I hereby certify that the debris resu ting from the proposed work/demolition to be conducted at 7 &jeibia 5 J . So me ,9. Work Address Is to be disposed of at the following location: , 7, iVO G'7%1 aorip Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. ' 6° - 1 g /6 Z. Signature of Applicant Date Permit No. 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, co oration or other legal enti or of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer,ty, or any t /o or the more 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, construction 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 number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC)or Limited Liability 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 retuned to the city or town that the application for the permit 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. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-NIASSAFE Fax # 617-727-7749 Revised 02-23-15 www.mass.gov/dia Sears, Tim From: Sears, Tim Sent: Thursday, September 1, 2022 4:22 PM To: 'ken58active@gmail.com' Subject: 7 Bernard St Ken, I have reviewed your application for the deck addition, and you are going to need a plot plan stamped by a land surveyor showing the setbacks to the proposed addition. Please submit this for review. This email is considered a written denial of your permit application per Section 105.3.1 of the Massachusetts State Building Code. Section 105.3.2 states in part that "an application fora permit for any proposed work shall be deemed to have been abandoned 180 days after the date of filing, unless such application has been pursued in good faith" You may appeal this denial to the Building Code Appeals Board in accordance with M.G.L. c. 143 §100, within 45 days of this notice. Timothy Sears CBG Deputy Building Commissioner Town of Yarmouth 503-398-2231 Ext. 1259 mailto:tsears@varmouth.ma.us 1 ONE or TWO FAMILY- BULDING PERMIT APPLICATION REGULATORY APPROVALS NOTICE Address of Proposed Work: 7 /3egio Ad 57; 5c _' /7,6 CZ_ /-j .A Scope of Proposed Work: e c(CCe C I p�, �c i L /i7em , J5�.,�C---Rare 4We D E.Cli °)r. i? r ✓ Date: 4jez- Based on the scope of work described above, the applicant is required to obtain approval sign- offs from the following departments as checked-of below: 'fr Health Dept. —508-398-2231 ext. 1241 Conservation —508-398-2231 ext. 1288 /Water Dept. —99 Buck Island Road, 508-771-7921 Old Kings HWY. Hist. Comm. —508-398-22631 ext. 1292 Engineering Dept. —508-398-2231 ext. 1250 Fire Dept. — Kevin Huck/Matt Bearse, 96 Old Main Street, SY Note: Please call Fire Department for an appointment. 508-398-2212 Other Appropriate plans and/or application shall be provided to each departments checked-off above. Each of these regulatory authorities has their own requirements outside the jurisdiction of the Building Department. All applicable approvals shall be obtained prior to submitting a building permit application to the Building Dept. Thank you for your cooperation. gR ce' t Ackno �_wledge nt: — g 4/2z-_ p licant's Signature Date Rev. March 2022 litCommonwealth of Massachusetts [��/ Division of Professional Licensure Board of Building Re ulations and Standards Consi l i�(S{prvisor CS-064503 N3pires:01/24/2023 KENNETH A,g'APRADE 100 SPRUCE .ANE V ATTLEBORO-MA 02703 O Commissioner daeG K. Y&„h., .a.00/./Xa saa bsel i ,, .Tie �einin~iie , Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR 1 TYPE:Individual R@fli5_ t 17 F d1 n 12l4 07/29/2021 KENNETH A. Yi.: 1; I,; i7v'I I 2"- tf.3 t --. f.. KENNETH A.LAPRAs J f l� 100 SPRUCE LN s "� `'� � ATTLEBORO,MA 02703 Undersecretary 0N-=,Y4,k TOWN OF YARMOUTH sV rr k.:5 HEALTH DEPARTMENT PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET 1 To he completed by Applicant: Building Site Location: '7 ,& ,CA,i4 ',D 5- 1' so, /y, ' iek./7/"( Proposed Improvement: /74 O i 2 )Cre.,.J5T 0 i0 ex/S T/0 0 Pr =AFT w.- , Applicant: )<;'1,.1 tie, , Pp-MVP Tel. No.: o/ .,-.1 Address: IV $/3 fle-( .4 C1 f 7 71 ', G Y "'l.1 (VI' d?7d3 Date Filed: l`TIze I **If you would like e-mail notification of sign off please provide e-mail address Owner Name: 7I Owner Address: 7 1 t ,etJ$ 56. tQ, 'trioU -Al Owner Tel. No: ' t ' 7s 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. ft- 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) — Note: Floor plans not required for decks, sheds, windows, roofing; J b (3.) If necessary, Title 5 application signed by licensed installer with fee. REVIEWED BY: (?-17DATE: r--� °� S ��'- , PLEASE NOTE COMMENTS/CONDITIONS: { C., 76- e• c..4.:( Z.1 if-, 6.4 -'4,_ Li 1•4 ..I.T..,,>l'). ---- C'--- Z .- -- . ----,6 - I Fi _ , t, .... .. 1 . , - x Z7 Li\ .. - — ------ -i-- 1 F.... •...- k , . I‘.---7 ---- r 1- - ---7 -A ---- . I ' 9..... sacj ----7 ::::,. ----------4, Ctt At 5/14 rs1 14 79 ~1 -- 'cl --r c. 0 ' CI .%:,•1 .-- _ ' •<., 1 '''' .. c ' , • a .09..--- Jii-,fe . 1 .---1 _K (:). q r ,_, .>•._ ztZe Tqs.. Nt . . , t: i if_.... tl C p.L .si...._..._ . .N.1, ‘,..4- 4 ,),. •;..\ , --01--J,„v, _A., f•(A ,,.,, -,) , , ,. ......, ,. ,„..,, , N N ' r, (v--.. - h--- iz•;,1 ,1 '..' 0. , -4 c4{ °c) •,.. 0., LAI g • -......4-14 t•-. ei -.Z)•-• ,16. C:N- "Zt' t\• • 11 7% ....--, ,-) ••'uu fl I-L. • •z> . Na ro (-76--- -•,_ vl i d O. � t.00LA I I %fin FcuIti • n 6 ,3 r (Nkj HIC Registration Complaints Registration 121468 Registrant KENNETH A. LAPRADE Name KENNETH LAP ADE Address 100 SPRUCE L.N. City, State ATTLEBORO, MA 02703 Zip Expiration 03/01/2024 Date Complaints Details No complaints found for this registrant,. You can also view arbitration and Guaranty Fund history. Back To Search Z1 , 4 a � p . 'ji1"-•_"7-7• "_"''._.—',a'>.c...„rRlX. Q1 \.,,)t.•... 41 __. ._ ___ - . ,I—qf.*\i..7._--..'..—..(..'./'.'.‘'..".,..V,--,„— kA%.,. r, � ") _ �l Wit' * * _ .o r 1— iq r . 0. . ' ' . : ' , _ ,. k ag ' ,, i 1,, . ..., 4,,,, it, , ..—....----a rb sc- 0 1:7) ? . gig o b : itt ° 3.1, i 1 ti • • K\ ...1 .0, l 1 �j T p n4 . ) z S, .� ro . T IIII� - C _a );III) 0r•, r :--1 "J 'i'' . o 7 '1 • 0 ate' y N A Q • c 6 Q; S (1.""e �toz Vlo , \141 - '-- '''''''' ---•^L1 . • "":? \ ri - .... -- N ._ L.Q. 4.- 1r ___ ,- sifii!L, cf4 ,'-‘ az.,f_ ..1 a ts , \c . . /1‘ )1/4 ?Is 74.N tu , ..z.%_--., Cil- r ` ' . F\ . ii , . .., t":4- sj 'c, i Q 1• • ,\, , . _ 1 L._ 1 . . \______, _ . z. • T. \ _ ,.. i,--.:,) • . ci • >4 -4 '1` ? 1 ' ---, 'III; r 1n a) 111111 . 4i. • Q ®F Y1 TOW'1'NOFY R SOtJSt1 ° 4 WATER DEPARTMENT s. fir';\ jr�y. 99 Buck Wand Road eV .r�x�sc�� lN�st'a ir.aaoiatli �tl�dt2ta �6j; TiAephone %DFi ; 1 7921 • S a'c_ 15081 7 71-'<J`. kieiJorpczeeeci) a Ode? BUILDING PERMIT APPLICATION FOR WATER DEPARTMENT SIGN OFF TRANSMITTAL FORM BUILDING SITE LOCATION: 7 66reig/geo PROPOSED WOE RK: novaid 'mod el1,5 /A- ,1 ecalC , C APPLICANT: AJP4d .,042 ,.2„4,...e4cle (_.,p Y 1114 z'76-3 ADDRESS; /QC� . '�rJQL ��' TELPI)ONE: ._ ! g 37 , RESIDENTIAL AND:OR COMMERCIAL BUILDING Water Department: Determines Compliance of Water A‘ailabilit and or existing location Engineering Department Determines Compliance for Parking and Drainage Conservation Commission: Determines Compliance to Wetlands Act: i-e. If lot(s)border any type of wetlands,streams,ponds,rix`ers,ocean, bog,.boys,marshland, ETC, I fealth Department: Determines Compliance to State and`I ow n Regulations, i.e requirements for Scptage I)isposail and other Public I lealih Actix tics Fire Iepartment: I)etcnmines Compliance to State and Town Requirements for Personal Safety,Property Protections,i.e Smoke Detectors,Sprinkler Systems,etc ‘1:: -V/r)14f4da— jff OZ— APPLICANT SIGNATURE I):. 7 E OFFICE USE: COMMENTS ON PERMIT APPROVAL OR DENIAL. ..41v.e St 7774,22.----- REVIEW D BY WATER DIVISION(SIGNATURE) DATE r.-- ., ' rs• 7-- Z LT\ 1;2'2,,z,..- 41,: :',,''. •(''\ ,4 / (4) \\\ , a< .„ \ t, t c-- '44,< _,,,A .... ,_1 W < tt a 17 11 i °I - 11 '4t, 0 N' 1 0 'i°•*-- ,--- f'sl V N -4 44 - , <, .,' -, s ' '- v- C.,., i 7 Xst .„ - •Z'''.-4 '14 ‘,3r _..„._<,... ....„1 _ 4---)i — i 4.............,, 1'> Vci .•, — — —— - \ , ..3 -c-A------ •"I tki ...... - 0 _ 3) 01 H . -.) 0 ,)Q \ r, ...i-eOleirZ j _ i I ) I j ( , ...s.,,,, , , ,....... ,......., 1 ( , >7,1 'z,,,. ,:s, ''' ,... C) it,7 --- —r• — -- /44 r°,,,,T, '0:4c-NI -:)".: ,.;',',•%''''' **4 - l• rtt ` '',:„,„*. 'C4,. 4--. c":4‘''' >, .„,,,,,"- --i 171 ''''„. et i reli m CD 0 k cl% t rri 4-,' Loci 5 6959-19 James E Deneen NAME ro ST•,,'EET Af VILLAGr // / SERVICE NO 6 ';", METER NO it-9-41.4, rtzi ex-41( f. Aqe) „ tio (142,4,0It, ,s1).cib .0 /Jew