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BP-229 . : LDI PER T Dartmouth I3ui/din. Department partarextt P?_.af :hie 400 81ar. um Road-P. O, Box 9399 I Lot ('3 7i ' ,artm month, MA ¢P� Dar e �1 t 1 Lot [ .w srvl T September 1St ` -,�€' {ey r n:t) Permit tit Issued Date: _ ,3 ref C? .:rt:., i>-§:• /' Pro_aect Lec at inn s 1 3: eoc cla.i Subdi v on Wade as Nearest Eros Streets - Aipnt i cant!Agent `�,�an Y i_Eextr t.cSdri a 2 _9 -,:?_ °e t t e,: ri., ITgrtob PI1-rt atedtt,tI _ !7.1W OT 7-1 r.. ln';r act Person Phone f$: (508. 9O52 E'a55_.- :ype of LiC7eT5a.:.t Owner: f.$) Con5t. Supery.y t s. epst:Y' Arch'itec.=t t Engineer: t tithers Proposed os€d Use: Resin. uttigst_.. __.at .. 10an8.Ct. aeye Caerlsi. in4asarkp as,w, Pore t a -,,stied Tot flint 1.q n tr t s- zon T.9s 7eG•^ar ase5k, :ah'+ S,tta^, kb, wn41., _as,. .,aa9fAara, ; Iluaeaa➢a ,na. nA` sae.oa;9 mn,9 anAFr"rtr[a and a4hgn a•,ucai i rov`o kr ocof sibn "to i g (1'G'! 4C !'ka Cost of Con irk• $+60 eu 5t—Other C:on t. z TOVAL EEL: i1 Own Own e sa „f Record. Mane£-f Lr i! r ACdres Esc a,5 B.e° .c1 RRoarJ,...`,4itd,tt_Pa itt. '!}„e rv.. 't :'% .fit-- [ Al 1. work she comply with zee Ci4% :.et4F Ed. itSC-L Chap. 4-iff) ant, aoy other applicable Mass. Laws or cOdea and p i 'wz on ftie- r hereby hertitb that the proposed work z author r:e+:; by the steer of „__e d z d 1 have been authorized by the owner to make tins aeptk at ion as his agent and `.:ir r nceivc- thii permit., 'E further understand other age--_i tray have reason to °'ITttP wing if items under their juti Witt ton are not met ; out; withstanding ttit' of this buitdirq\Zsninai Permit: Y saature of 0wrsaerr fluent : . ,:' t ! €idp tr R s n i , **- **ii-Ar -&Ri=-A re A***.***-4dTk *. . *,t� .„.„. oTa n# ,-** ##)t+J****.0 t<01a*-% *a Eipnaturr . , r _.:-u. ed. Io 'led Bya:. 3oe- s S.: Reed., Title 75uii n rrfl _tts potato t 1 S 1.F,T. . `Nf.L-OSr PPS PERtIJI CARD SO TWAT i I .`.:,� VI- 1,t BJ.i_ l PO9 __.-. _... T*it E f€#EY_; a , .aa. RECEIPT FOR PERMIT � TOWN OF DARTMOUTH - PERMI N . b No �'ts Date ! -/ 3 6 Received From ht---T<1,a r�,P.er Owner* .4-,-v2 t c i Location _ / a 3 .0-P-�..C_.. &It. . Type a _r/,, t .�_ 6 0• Amount Paid.-- ci Received By s'L%- ��, ,_ �� -`�—_ RECEIPT FOR PERMIT u`x. TOWN OF DARTMOUTH CP 69/ m PERMIT NO O Date 9 Received From i T. j Owner 1 �, _ t Location �� GR � AY Type ��70 ..7 `C�"" J�✓'if Amount Paid $p?..5 'L 12-0 Received By /" �/...-- _TOWN OF DARTMOUTH BUILDING DEPARTMENT TELEPHONE 508-999-0720 FAX 508-999-0738 APPLICATION FOR ZONING AND BUILDING PERMIT Instructions The applicant shall complete this application to the best of their ability prior to submission.leaving no item unanswered.The Department staff will he available during regular business hours to assist as necessary.N(AKshould be inserted for those sections which do not apply.A properly completed application will help avoid unnecessary delays. Net fig Seek not nth (for office me only) �7,, Application fee S/?'`, U received by 41 Date (9/ 2M Total Permit Fee $ Permit# //j, /5CL.0 100 LOCATION OF PROJECT' i . a , CURRENT ACCESSORS' PLAT / LOT?. ZONING DISTRICT SIB Q^yQ THER ZONING OVERLAY DISTRICTS , if applicable V NUM1BER & STREET .. / a a R - D RD '(0. bar% ,n u &&t. 0o2741 7 NEAREST CROSS STREET SUBDIVISION NAME & LOT# or BUSINESS NAME PREVIOUS TENANT ; OWNER 200 RESIDENTIAL - PROPOSED PROJECT - one & two family residence only = THIS SECTION NOT APPLICABLE Single family - number bedrooms number baths - Two family - number bedrooms unit I number baths unit 1 number bedrooms unit 2 _ number baths unit 2 - _ Accessory apartment Total gross sq. ft. - Accessory structure ▪ Garage - detached - attached to dwelling, dimensions L W i — Carport - detached - attached to dwelling, dig'ensions L W W D ▪ Shed - dimensions L /0 V/( - Gazebo - dimensions L W _ _ Swimming-pool above ground in-ground Size total square feet _ Chimney -#of flues 1 _ G Woodstove - used(will require inspection prior to installation), new (provide manufacturers instructions). Location(s) (list) C' Fireplace(s) -(includes flue) List location(s) C Game Court-describe(include overall dimensions) C Tent, Trailer(Mobile Home) or Other-describe 300 COMMERCIAL-PROPOSED PROJECT/USE-INCLUDING THREE FAMILY OR MORE AND EXEMPT USES C. THIS SECTION NOT APPLICABLE (The following descriptions are based on the Massachusetts State Building Code Article 3,AS NOTED) (See the Code) C Assembly - restaurant, lounge, theater, school, etc. (see Code Section 302.0) Describe C Business - office, assembly with less than 50 occupants - indicate Medical or other professional (see Code Section 303.0) C Educational-structure for training including child day care for those over 2 years 9 months(see Code Section 304.0) C Factory / Industrial - (see Code Section 305.0) C. High Hazard - (see Code Section 306.0) Institutional - hospital, nursing home, infant day care (see Code Section 307.0) C Mercantile - retail stores (see Code 308.0) C Residential - three or more family, hotel (see Code Section 309.0) C Storage - includes garages (see Code Section 309.0) , C Utility & Miscellaneous Structures - includes tents and agricultural structures (see Code Section 311.0) C New tenant for any of the above, indicate above (see Code Section 119.0 and Zoning By-law section 35) C. Tent or Trailer - temporary purpose? C Other Describe the proposal briefly,INCLUDE number of dwelling units and bedrooms or occupant load as applicable, also existing condition 400 TYPE OF CONSTRUCTION OR WORK TO BE PERFORMED ='New Construction and/or Addition - total gross square feet (For commercial only total gross cubic feet) -indicate It will be considered new construction if there an increase in square footage in addition to any alteration(s). If project is an addition to existing structure - Total gross square feet of existing C FOR COMMERCIAL ONLY Will this project be subject to CONSTRUCTION CONTROL(over 35,000 cu.ft.) __Yes No. (If yes see Code section 127.0). Designer to submit Code Synopsis. Will this project require Peer review(over 400,000 cu.ft.) Yes _ No (see Code Appendix I) APPLICANT TO PROVIDE _ Alteration of existing, no increase in gross square feet. A separate Refuse Disposal Declaration required. 7. Demolition - describe structure Number of dwelling units Number of bedrooms A separate Refuse Disposal Declaration required. Moving- (Provide copy of D.P.W. moving license) Type of structure from where (plat/lot or address) to where (plat/lot or address) , Number of dwelling units Number of bedrooms per dwelling unit Re-roofing - (for existing only, is included in new construction) Number of square feet Number of layers already existing Number of layers when complete A separate disposal declaration REQUIRED - Replacement doors and windows - (for existing only) (only where doors and windows exist and will not be enlarged) EGRESS dimensions must he maintained. Enlarged or new windows in an existing dwelling will be considered as an Alteration, otherwise will he included in new construction. (see Code section 3401.10 for residential and Article 8 for commercial) ▪ Temporary structure- includes when allowed, trailers, tents and the like and only for limited periods of time. Describe 500 CONSTRUCTION PLANS None submitted. Why? (/ - Submitted, usually three sets required. Four sets for food service\uses. Number of sets submitted 600 SITE PLAN ❑ Not required, why? _ Submitted When? - Previously, date _ With this application 700 UTILrTIES Water supply - required_ yes_ no, public ? _yes _ no, on site well? yes _ no, existing? _yes _ no If required and not existing have necessary permits been issued? _no _yes, date (M.G.L. Chapter 40, section 54 provides that no building permit may be issued unless a water supply, when required, is available. See Code 780 CMR section 114.1.2) Sewage disposal- required_ yes no, public sewer_yes_ no private septic - on-site _yes _ no. Submit copy of permit as soon as available. 1 ■ 800 MECD:ANICALS & PRIMARY FUEL Furnace(hot air) - Fuel gas (natural or propane), fuel oil, electricity, other(specify) Boiler(heating)- Fuel gas (natural or propane), fuel oil, electricity, other (specify) HVAC (combined unit) - Primary fuel, natural gas, propane, electricity, other(specify) Air conditioning - (separate unit) T. None of the above to be provided Hot Water Gas Electric Fuel Oil Other 900 SPRINKLERS - FOR STRUCTURES OVER 7500 SQUARE FEET and certain multifamily residential — Required, =plans provided, =plans not provided, why? _ Not required, not to be installed, Why? 1000 REQUIRED OFF-STREET PARKING - for ZONING & Architectural Access NOT APPLICABLE T. Parking Plan submitted To = Building Department = Planning Board Date submitted Number of spaces - indoors outside total provided Handicap spaces - required_ yes_no. If yes, how many as a part of the total required number. Is Route 6 (State Road) Entrance permit required? yes = no =. If yes has it been issued yes T. no =- Submit copy of application and/or permit as soon as available. 1100 IDENTIFICATION i print or type except as noted) Current owner- name fr/gA7/2 e( eft c� address //A ,3,2 n ec 1 �/{� 72 /: phone# 99.E 2 yT L.J v �v .eJ If corporation. officer in charge (J �f Architect/Engineer- for overall design Company name Address Phone number Certified by State of Massachusetts as Certification number NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originals and not reproductions. `f' Architect/Engineer-project supervision and reports Company name Address Phone number Certified by State of Massachusetts as Certification number .• NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originals and not reproductions. General Contractor(if Homeowner, state homeowner here then complete section 1300) Company name Address • Phone number Construction Supervisors license number NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originals and not reproductions. *****xitititiilYt*****iY•iFl******************iii#ii******Y% s******ttiVittifii******iittifi ki 1200 FOR RESIDENTIAL REMODEL WORK ONLY Are you a Home Improvement Contractor subject to(780CMR -6) ? Yes_No_If no go to next section! Are you claiming exemption from the requirement? Yes _No If yes, submit the required affidavit! Remodel contractor name (please print) Address /J 3 3 A'G /y1 Registration number(if none state'none) Phone number PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTEE FUND! QUESTIONS OR COMPLAINTS call or write: Home Improvement Contractors Registration One Ashburton Place - Room 1301 Boston,:MA 02108 (617) 727-8598 Owners name (print) M Uk E 1 l P Signature�/ u e Date • /'42' / 6 1300 OWNER SIGN - OFF I, the undersigned.am the owner of record or authorized lessee(provide documentation) and I have reviewed the application herein submitted. I state that to the best of my knowledge and belief that the information provided in this application is true and correct and that the permit requested he issued. Further I understand that the permit will expire in six months, from the date of issue, if no work is begun or six months after the last inspection if work has begun and that the permit may be extended for six months if no work is anticipated if I request such an extension in writing. I understand that the permit may be extended only three times by 5 written request.I understand that once the permit expires a new application may be required,including fees and current other requirements (including Zoning). Name J.C/fl�uet. (.,� C..� `• Signature :� 44' -f •. ^(['' The above signa is my voluntary act Sfid issigned under the pains and penalties of perjury. Date //��/y� Who is authorized to pickup the permit at the Building Department? I please Prinn 3/9/Q 'C. Address Phone 1400 HOMEOWNER EXEMPTION - ONE &TWO FAMILY ONLY FOR HOME OWNERS WHO INTEND TO PERFORM AND BE RESPONSIBLE FOR THEIR OWN PROJECT 109.1.1 Licensing of Construction Supervisors:Except for those structures governed by Construction Control in Section 127.0. effective July 1, 1982, no individual shall be engaged in directly supervising persons engaged in construction. reconstruction, alteration, repair, removal or demolition involving the structural elements of buildings or structures, unless he or she is licensed in accordance with the rules and regulations promulgated by the BBRS entitled Rules and Regulations for Licensing Construction Supervisors. Exception:Any Home Owner performing work for which a Building Permit is required shall be exempt from the provisions of this section: provides that if a Home Owner engages a person(s) for hire to do such work ,that such Home Owner shall act as supervisor. - _ For the purposes of this section only,a"Home Owncr" is defined as 4ollows: Persons)who owns a parcel of land on which he.-she resides or intends to reside. on which there is, or is intended to he,a one or two family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in two-year period shall not be considered a Home Owner. If you are applying under this section sign below: Signature Your signature carries certain responsibilities, including hut not necessarily limited to, general liability NOTICE TO LICENSED CONTRACTORS: The Building Code provides in the Rules and Regulations section that any licensed Construction Supervisor, whether or not they have taken the permit are responsible for code compliance. (see 2.15.2 of section 51 iStsfltitstFt****Sta**SSSS*t*tt**SStt***S****S*$tfl*,*fl*SS*flt**S*fsfltttt*SSS***s******t***t**t******* 1500 COST Cost of Improvement 5 Items to he installed but not included in the above cost: Electrical 5 Plumbing HVAC Other TOTAL $ b The following section for official use only. INSPECTORS' REVIEW Date plan reviewed 30 days to review period expires i = OK to issue date 0 .= OK to issue subject to requested submittals (see project review worksheet) date DEN®see project review worksheet date HOLD reason date - HOLD Subject to Zoning Board of Appeals action Comments Inspectors signature Date Applicant informed of above - Date time_staff (fax, phone, in person) Over six months since approved for issue - DEEMED abandoned! Advise applicant. Hold 90 days for return then dispose if not picked up. Inspector Date Advised applicant Date Time staff_(by phone, fax or in person) ssxssssxssssssssssssssssssssssssss::xrsssssxsssssasssssssesssssssssssss**sssssssssssa sssssas:ssssssa:* OFFICEHNSPECCORS NOTES TOTAL FEE S O n Gross area - new construction _ (>00 Total Sq. Ft. alteration Total Sq. Ft. Permit is issued to 7 � Comments/notes on permit /0 x/ 2-0 • 'maw arri lyaL Date of Application submission 9/(2/7 C P Plat _=Lot !/ Street / �f 3, 7 7 ry Aquifer Zone__ '�J�� lJ 9 Owner � Gt-'✓Z.“-.4 / c ( • Owner mail address Owner phone f{ 7C 1: (('' OTHER INVOLVED AGENCIES -The following agencies require separate jurisdictional permits or approval for your proposed project. CONTACT THEM FOR REQUIRED SUBMISSIONS. ❑ TAX COLLECTOR _ Approved _ HOLD By e x. Date �' / -94. • Conservation Comm _ Approved By Date --� ��\��\ ❑a D.P.W. water - Approved By Date ❑ D.P.W. sewer = Approved By Date ❑ D.P.W. cross connection _ Approved Date ❑ D.P.W. engineering _ Approved Date i ' ❑ Board of Health well _ Approved Date Board of Health septic _ Approved — Date ❑ Board of Health food service _ Approved Date ® FIRE DISTRICT(I - II- III) _ Approved Date ❑ Planning Dept _ Approved Date Other _ Approved - Date Other _ Approved Date (•nmments Project summary new constructions alterationrdemo sewage disposal - publiciprivate [A1ter:add interior walls) [add rooms) [add footprint] water supply - publiciprivate well [pool] [garage/shed] [game court) [foodf service) Describe /6,k ,1 ,,C�Y/L.�--- To the various departments: This notice has been forwarded to you for your information and any appropriate action. Should you have any questions please advise. If any reason to withhold the requested permit is found, please advise. Your assistance and cooperation is appreciated. The Building Departmentv ��/� By U%.//f Date sent for review 8 L .61 S'f�Ft� o tiV FILE COPY vs " TOWN OF D RTMOUTH R D RECORD PLAN A Copy Of This Endorsed Plan Must Be Kept On Site Date Dur Cpr g ion Date of Application submission 2/7 _plat (G F, Lot Street /O2 3 - r 7'_rejet, Aquifer Zone /11yw Owner l Owner mail address Owner phone# 76 ca 1il OTHER INVOLVED AGENCIES -The following agencies require separate jurisdictional permits or approval for your proposed project. CONTACT TDEM FOR REQUIRED SUBMISSIONS. COLLECTOR = Approv _ HOLD By Date �/ � > <r `` �]\ Enservation Comm pproved By Date -7— d - 6 ` ❑ D.P.W. water = Approved By Date ❑ D.P.W. sewer = Approved By Date ❑ D.P.W. cross connection = Approved Date ❑ D.P.W. engineering = Approved Date iand❑ B1 of Health well = Approved Date ❑ ¢oard of Health septic = Approved • Date _ �❑/Board of Health food service _ Approved Date ® FIRE DISTRICT(I - II - III) = Approved Date ❑ Planning Dept = Approved Date Other = Approved Date Other = Approved Date Unrnments Project summary new construction/ alteration/demo sewage disposal - public/private (.alter:add interior walls] [add rooms] [add footprint] water supply - publiciprivate well ]pool] [garage;sshhed)) [game court]! [food service] Describe /v be /S 74 l�-�/�`--•/(---- To the various departments: This notice has been forwarded to you for your information and any appropriate action. Should you have any questions please advise. If any reason to withhold the requested permit is found. please advise. Your assistance and cooperation is appreciated. The Building Department [/�/7 Date sent for review f/2/94 By 1 8 Date of Application submission yi2/' C --Plat Q CO Lot'7/' Street /J3 j7,f7/ A' Aquifer Zoneel‘ _ -4\ /0 Owner Halt-41_4 lOwner mail address Owner phone# 7 6;21.0 OTHER INVOLVED AGENCIES -The following agencies require separate jurisdictional permits or approval for your proposed project. CONTACT THEM FOR REODIRED SUBMISSIONS. ❑ TAX COLLECTOR Z. Approved = HOLD By Date CConservation Comm = Approved By Date ❑ D.P.SV. water = Approved By Date ❑ D.P.W. sewer = Approved By Date ❑ D.P.W. cross connection = Approved Date ❑ D.P.W. engineering = Approved Date ❑ B and of Health well _ Approved /�� //�/`l nx .� Date �[ �� hoard of Health septic _ Approved L� • Date �1 1 ❑ Board of Health food service = Approved Date ie FIRE DISTRICT(I - II- IIII = Approved Date ❑ Planning Dept _ Approved Date Other Approved - Date Other = Approved Date U.,mments Project summary new construction/ alteration/demo sewage disposal - public/private [Alter:add interior walls] [add roomsj [add footprintj water supply - publiciprivate well jpoolj [garage;sshh'ed]✓ [game court] [food service] Describe /V be /S Z To the various departments: This notice has been forwarded to you for your information and any appropriate action. Should you have any questions please advise. If any reason to withhold the requested permit is found, please advise. Your assistance and cooperation is appreciated. The Building Department [///� Date sent for review f/Z/9, 4 By 4 • 8 • . _ to 1,„ch WO S • THE COLLECTOR 'S OFFICE DATE: Va ai • TO: BDTLDSG DEPARTMENT FROM: COLLECTOR'S OFFI' RE: PAYMENT OF PASS' DOE TASES PLEASE BE ADVISED TEAT DAY 3 J ' T8E TaXL:^a FOE PROPERTY LOCATED 0111 33 - a7. , e PAIKKCEZ. # ‘6-ZZ SAVE BEES PAID. TEE NBICS BAS SEEM 273QUE TED MAy RE ISSUED. IF YOU HAVE ANY QUESTIONS CONCTRNING TB.IS pizazz CArL- cc:DEBORA/I L. P_TT7A ' ^ L.: � ...r,yyua.au/u-�j�bIDlsiloil �f /2 ' Aquifer /C_� Plat Lot !! Street /aC -3 . it � EXts�<�,d lt��((1< rr Owner fu Owner mail address Owner phone# L 0 OTHER INVOLVED AGENCIES -The following agencies require separate jurisdictional permits or approval for your proposed project CONTACT THEM FOR REQUIRED SOBMISSIONS. ® TAX COLLECTOR = Approved C HOLD By 1 Date-_ i ❑ .Conservation Comm Z. Approved By Date ❑ D.P.SV. water = Approved By Date ❑ D.P.W. sewer C Approved By Date ❑ D.P.W. cross connection _Approved Date a D.P.W. engineering _ Approved Date (// ❑ Bard of Health well = Approved 4 Date ❑ oard of Health septic = Approved Date _ C Board of Health food service C Approved Date le FIRE DISTRICT(I - II- III1 C Approved Date ❑ Planning Dept = Approved Date Other _ Approved Date Other _ Approved Date (*,,mments Project summary new construction/ alteration/demo sewage disposal - public/private [.Alter:add interior walls) [add rooms] [add footprint) water supply - PP Pubiicrprivate well IPooll [garage:shedj [game court) [food service) Describe /t/)(7. / _._ i� To the various departments: This notice has been forwarded to you for your information and any appropriate action. Should you have any questions please advise. If any reason to withhold the requested permit is found. please advise. Your assistance and cooperation is appreciated. The Building Department /�? By .,�J yyy/// '7 Date sent for review 9/z// `�/ (�{ 8 G�7/ BUILDING PERMIT FIELD INSPECTION Dartmouth Building Department Plat: 66 400 Slocum Road P.O. Box 9399 Lot(s) : 71 Dartmouth, MA 02747 Lot Size: 40, 152 Telephone (508) 999-0720 Zone Dist. : SRB Issued Date: 09/13 /96 Permit No: 229 Project Location: 1233 Reed Road Number Street Subdivision Name: Nearest Cross Street: Applicant/Agent: Manuel Leite Contact Person Phone #: (508) 995-2855 Proposed Use: Residential Residential, Commercial, Industrial,etc. Permit Issued To: New Construction Type of Improvement,Add,Alter,New Coast.,Demo,Land/Move,etc. 10 ' x 20 ' shed (200 sa. ft. ) Indiuste no of bedrooms and bathrooms and other rooms Owner( s) of Record: Manuel Leite Address: 1233 Reed Road, North Dartmouth, MA 02747 DATE TIME TYPE OF INSPECTION REMARKS INITIAL /—'/— // a-7 .-4 a;r7sta- ,ar BUILDING PERMIT Dartmouth Building Department ( Plat :66 400 Slocum Road-P. O. 3c. 9399 _ot (s) : 1 02747PaY.Dartmouth, MA Lot ot u•i.e :44:, 15c' 1 Telephone 508-999-0720 Zoning Dist. :ERB September 13, 1996 (typed) Permit =io. : Issued Date: /-f�/ y� Clerk . BAS • Project Location : 1233 Reed Road Nuaber Street Subdivision Name: Nearest Cross Street : _T� . ----- Applicant/Agent : Manuel Leite Address : 1233 Reed Road, North Dartmouth. MA 02747 Contact Person Phone # : (508) 995-2855 Type of License : Owner: (x ) Const. Superv. License #: ( Architect : ( ) Engineer: ( ) Other: ( Proposed Use : Residential ieeldenttei. Commercial, Industrial. etc, 1 --Permit Issued-To-1 l:e W (f e41 C.t Y'i_t ctifln Type of :aproaaent. Pat. Alter, Noe Zonst.. Deed, Land/Proe. etc. 10' x 20' shed Indicate no. of bedrooas and bathroom end other rooms Gross Area of Const. : 200 sq, ft . Cost of Const . $600. 00 Cost-Other Const. : TOTAL FEE: $ 50. 00 Owner (=_ ) of Record: Manuel Leite Address : 1233 Reed Road, North Dartmouth, MA 02747 All work shall comply with 780 CMR 5th Ed. (MGL Chap. 142) and any other applicable Mass. Laws or codes and plans on fil-e. I hereby certify that the proposed work is authorized by the owner of record and I have been authorized by the owner to make this application as his agent and to receive this permit, I further understand other agencies may have reason to STOP WORK if items under their jurisdiction are not met; not withstanding the issuance of this Building\Zoning Permit. ,C(' Signature of Owner/Agent : / a-n(.� Address : / ((( *******************-* - *** *** -***. ***** ****x*-a-zea->F* z*********>f*- Signature : • Approved/Issued By ' oel S. Reed, Title Building Inspector COMMENTS: PLEASE DST PERMIT CARD SD THA IT IS VISIBLE FROM THE STREET U ORIGINAL 0 APPLICANT c ASSESSORS 0 CLERK r` COPY