Loading...
23D-013 (2) 4 NONOTUCK ST BP-2007-0177 GIS#: COMMONWEALTH OF MASSACHUSETTS d Vlap:Block:23D-013 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: BUILDING PERMIT Permit# BP-2007-0177 Project# JS-2007-000267 Est. Cost: $3000.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: M H MASONRY Lot Size(sq. ft.): 10672.20 Owner: SPONGBERG JANET L&CHRISTOPHE Zoning: URB Applicant: M H MASONRY AT: 4 NONOTUCK ST Applicant Address: Phone: Insurance: 9 LIBERTY ST (413) 540-0078 HOLYOKEMA01040 ISSUED ON:8/16/2006 0:00:00 TO PERFORM THE FOLLOWING WORK:REB U I LD CHIMNEY POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 8/16/2006 0:00:00 $25.00MO 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo Department use only City of Northampton Status of Permit: ��\ Building Department Curb Cut/Driveway Permit \` ) 212 Main Street Sewer/Septic Availability ``� O0� �' Room 100 Water/Well Availability 16 �' >Northampton, MA 01060 Two Sets of Structural Plans 0 phone"413-587-1240 Fax 413-587-1272 Plot/Site Plans Other Specify APE'i:1CATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION /.1 Property Address: ` This section to be completed by office J 1/ f (3 _�j/uG `.�] Map Lot Unit � Zone Overlay District Elm St.District. CB District SECTION 2 PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Lk r i S 6f2 ` SG r—) 1 / ir)0 f cic.. - �- { Name(Print) Current Mailing Address: Telephone 5� 4-0‘e Signature 2.2 Authorized Agent: Ili tic /T 1/6/1at/ ///l e1\ / 7/o1 i1S4 Name(Print) Current Mailing Address: Z't/('Li 7.,./24-/) ------ 7..? cg 67,6' ignature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building (a)Building Permit Fee 066 2. Electrical / (b)Estimated Total Cost of Construction from(6) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) -/ C Check Number Ol o I -5'- This Section For Official Use Only Building Permit Number. Is e Isssuedd : Signature: Building Commissioner/Inspector of Buildings Date • r Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department ' Lot Size Frontage . i Setbacks Front 1 1 Side L: R: ( L: 1 R: 1 1.__.,..,.1 I Rear Building Height Bldg. Square Footage Open Space Footage i (Lot area minus bldg&paved parking) #of Parking Spaces ' Fill: i i' (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DON'T KNOW 0 YES 0 IF YES, date issued:1 IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW 0 YES 0 IF YES: enter Book: Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? ' Needs to be obtained 0 Obtained Date Issued: C. Do any signs exist on the property? YES 0 NO 0 IF YES, describe size, type and location: i l D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO Q IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre or is it part'of a common plan that will disturb over 1 acre? YES 0 NO 0 IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) l i Roofing n Or Doors Cl Accessory Bldg. E Demolition ❑ New Signs [O] Decks [p Siding[0] Other[0] Brief Description of Proposed Work: �_ j 1 G�1 W11V'h'I Alteration of existing bedroom Yes No Adding new droom Yes No Attached Narrative Renovating unfi ished basement Yes No Plans Attached Roll -Sheet sa 4IfNea lh iii n:i nalira f e cis In kciii iii omt tetet a oTiouunaq: a. Use of building: One Family Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft.of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No. I. Septic Tank City Sewer Private well City water Supply SECTION 7a-OWNER AUTHORIZATION.—TO BE COMPLETED WHEN OWNERS.AGENT OR'C"ONTRACTOR-APPLIES FOR„BOLDING 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. Signature of Owner Date 01 C I lac ( T' ``cG L f Cl✓ 1 6 , as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. - Signed under the pains and penalties of perjury. i cl e1- T';c 'tI��o Pri ame 72 n % , �, (60c Signa ure of Owner/Agent Date SECTION 8 CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable 0 Name of License Holder: License Number Address Expiration Date Signature Telephone p Qr =Rest sterei4orr°ttmprouemen>:�orrtr Ct :,_, _4y �.:__y x'. ;i No Applicable .❑ )2.7:**----" �T 1" Company Nameegistration Number . nfr flaw; Ad ress /� �n xpiration Date I f iat r7 JM/60_, r 1► Telephone G( 6 D SECTION 10 WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.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 0 No 0 The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)families and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor.CMR 780, Sixth Edition Section 108.3.5.1. Definition of Homeowner: Person(s)who own 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 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 be/she shall be responsible for all such work performed under the building permit. As acting Construction Supervisor your presence on the job site will be required from time to time,during and upon completion of the work for which this permit is issued. Also be advised that with reference to Chapter I52(Workers'Compensation) and Chapter 153 (Liability of Employers to Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,you may be liable for person(s) you hire to perform work for you under this permit. The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of Northampton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature • • V.J-f -(1y (rii ) of P[trfl etltt tntt 1 _• _ AJ E �ZasaRcl)nsctla' _ irpool s • i DEP ARTMEl•rr OP BUILDING INSPECTIONS • 212 Main Street. ' Municipal Building Northampton, Mass. 01060 r'r \YORER'S COMTENSATION iNSrJRANCE AI'FIDA • \ • (li ctnsxJpermi ttcc) with a principal place of business/residence at: (phone) . (su-=„t/ci ty/statdzi p) do hereby certify, under the pains and penalties of perjury:; hat ( ) I am an employer providing the followine worker's compensation coverage for my • employees worldng on this job: g (Insu•rantw Con (PcLic: Number) (Expiration Date) ( ) I am a sole proprietor, general contractor or homeowner (ci cie one) and have hired the corm-actors listed below wbo h.ave the following worker's coopen anon pe>icies: (Name of Cont^cior) (Insurance Cotnolrr}'i?o Nut:Dcy:7) (-Exptrauon. Date) • (Name of Conmctor) (lnsuranc:. Compa.ay Po!ic Ntl.olc-r) (EN-pin-Mon Date) (Name of Coto-actor) (Ln uranee Company/Policy Nutobu) (Expirtioo Date) • (Name of Contrac la ra tor) (Insunca Comny/PoLicy Number) (Expiation Date). (sa�e'l1`-,:td"i="=1=boot.lf DCG' ry tv ratio&taformaJOo pertaining to all mCtT-corn) • • ( I am a sole rhave proprietor and La e no one wog for me. ( ) I arn,a home owner performing all the work myself. NOTE:pl,—.c be aorzrc tax �.'1Jc 6emcow cry woo cxtptay pc—too to tf_i r• > tv-=.;eiva a rc,-nuw orx ram.d..c1Lz of cot caocc th a t11ir_=ts in which the bomoawocr ride or an the p-ounen xppurteasrs the-C.o arc ooc ooa:dard to be eirpioyc-r oar the kui:da r--rp,---Loa Act(GL152.xn 1(5)).:-pplintioo by n botneowve far a G -cc{,�,un tr<y e.'ideoc+c the lepl rta.�u of as crzployoc under ttro W odec,' GompoaxLioa Act I undesxaad the x copy of thi.mttmem m.y be forxerd.d to tbo pcgart.toccrt of 1 •rriJ Axcdratz'OfSoo or 4a+r'eo+for th. cove-' euoa o td th;u f ilt.TL to scant tovcryse txnda soczio0 25A of NOL 152 an lad to the i"r+t ioo orcizoiAxl pcnsltia coceisng of a fine or up to S 1.500.00.rtd/ociaxprizocracat of up to ooc year and avil pea.tio a Sc form of.Stop Wore Orde and I _ fun 0(5100.00 t day awing coo. For 4Ga.rtm ''e only - Permit Number Map" Lot Sizpaatun of LiacnscrJPcrrniucc gate •\ a ¢'St1AMPi, . ;� (rzfp of Northampton z =_ �r•ti J;+ Fly ,. 8s5AClt usett9 '- DEPARTMENT OF BUILDING INSPECTIONS , _'•. r2- /; INSPECTOR 212 Main Street • Municipal Building % Northampton, MA 01060 . e HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction sup,_,: Hsor. The state defines "Homeowner" as, " Person(s) who owns a parcel on which he/she resides or intends to be, 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 a two-year period shall not be considered a home owner." The building department for the City of Northampton wants any person(s) who seek to use the home owner exemption, to act as their own construction supervisor, to be aware that by doing so you become responsible for compliance with state building codes and regulations. The inspection process requires that the building department be called to inspect work at various stages, which include foundation/footings (before backfill), sonotube holes (before pour), a rough building inspection (before work is concealed), insulation inspection (if required) and a final building inspection. The building department requires these inspections before the work is concealed, failure to secure these inspections can result in failure to obtain a certificate of occupancy until the work can be inspected. If the homeowner hires other trades to perform work(electrical, plumbing & gas) the homeowner will be responsible to make sure that the trades hired secure their proper permits in conjunction to the building permit issued, and that they get their required inspections. Failure of the individual trades to secure the permits and inspections as required can DELAY the project until such time as the proper permits and inspections are made I, understand the above. (Home owner/resident's signature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. Date Address of work location ROPOSAL-----....,,-"-- PROPOSAL NO. SHEET NO. r DATE, IF C / PROPOSAA.SUBMITTED TitL1 e _ r WORK TO BE P RFORMED AT: iiiE Wil I� WA! ADDRESS ADD' cliSiMirIAIIIIIII -:F DATE OF PLANS %fW1 , '1/(0 - 5 rCVO PHONE NO. .✓ ARCHITECT We hereby prop e to f nish th aterials perfor the lab r yecpssary for the completio of mac! ir,. .j;1-ef"-.//e,e' -",_ ,, 7,, i je; • , ,s- IT/ r ,t7 -cr lei ig "?/.4 r o S-114 CE' "i7e7i-7' e6- -- ---r-r/e 74-I AFLe 7 eft,, 0he G) i e_4) ei,s 4 , (-, qe,h,vizz.7-7-' _ cs-',G-r /7iC k ---,.) r ', /47 #c)(///fe_ ,04- -,1._ S7,60-, 7_Zeq° - P -,- ,7 i? -../ %,-,e , 2.722. (, ) p".11 -A r._)(41/th 2.40' ,, ,,474.1 . - ei.-iir-i-- -.2--iiiAS-- , tn-7 -7 0 MAoo& o42 /�I'2fI P4, 79"6- 7:,___ All material is guaranteed to be as specified, and the above work to be performed in accordance with the ddrrawi r>.gs and specifications submitted for ab e work, and completed a substantial work like man er for the sum of 7e L d' �l -4/ 2e e ,)� � ,C19 Ce 4-7rl,e1 Dollars ($ 32C62' ) with payments o be made as follows: 0 ,_ Respectfully submitted ' r Any alteration or deviation from above specifications involving extra costs will be executed only upon written order, and will become an extra charge Per over and above the estimate. All agreements contingent upon strikes, ac- cidents,or delays beyond our control. Note - This proposal may be withdrawn by us if not accepted within days. ACCEPTANCE OF PROPOSAL The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payments will be made as outlined above. 2 7 Signature / Date (J — (5-- OC Signature .-- 1.4ST kr",6V D8118 .PROPOSAL adarta MADE IN US � e.:7 9 O(Al f3 42evs- 4 — 3 3 a'/33 • D i;n,u . ,t r., c--i.. nerd:atioss QreCt Stancar&s � � 1 as *oration No-: r- r-__ -3 � � � f 'Horne Improvement Contractor F-gr�-trztion Frc.�m -, Urre Ashbnrtoa Face,Room I_0I „'"i Easton,MA 02I0S �,-eCtn'e Date: r ram= 47 - Application for Registration zs 2 Home Improverrrent Expiration Late: Contractor or Subrontrarior 44 GL Chapter I42A:7R8 CMP.R6 (PLEASE READ BOTH PAGES CAREFULLY) Date Prx?sled- } 1. BUSINESS NAME: �: ! Print the name in which the applicant i ducth g bt*sness (SEE IN 1 . CT}ONNJS) Z Mal-firm Addy_,,. 9 L I be,t- 't ( `1 3 ) `C) - 00 7g �[ y/J�f /' Arm Code Telephone N'um'v-_- 3_ City: t l� oi`�Q_. _ 5 t-_ ( !t 1 C1 • Zip: .0 4: Street_Atisa-ss(if difia-nt . • . � ,(fit street nzne and auto=,a P.O.Box is not acceptable for adzes)City State Ztp 5. Applimirt type: • ® 1n5ividtral 9 DBA © Pa.II.�.I ip 9 Trust 9 Private Corporation et Public Corporation 9 1._fi t Liability Pa-tn ip 9 Limed Liability Corporation -C a (See insYeu ions re^.a$urug end a duty Dr town reti.st:ation una D3A or' itituus name taw-M;t c t 7t,9 5 t 5) ' 6. So al S ity or Federal ID Norther: Q i C)1G Of 0 (sec ba_l,) 7. Numb of Employ I q (See .-tr iau=tiaras) S. Have you r-zist�ed previously tm t :au? I�/0 . If so,tm vrtiat? Narrm Registration Ns: . y 9. Indivitrtsa'f r:sponsrolc for i-iorm I.:rrs:or,.,.r-_it Contest t LI I t (.4 Yl e) f h c V t o t ( - 0R^7 t 'i o''� (St atst tr-tittrs) List i rst )✓1 Sinn]S alty N. 10. Title of individual rsporsrole.for Horn I.t.Ip,csv.,ll r_i a.Contra' . MCA 0 t• I I1. DO=the aPnh 1 or 4 .,.able ineirviaal bold any of=cor=ocitro el rated smote, ty,town b me r. t—zi c r *tars? 0 Y= V No • Type Of frrstse Dr t t?r>L eu'on .:�->teetf 3y I e or Expiration Date Name of Li-.=- t Fiolde t Y.i�L a5on:number . • • I • • 1. .1 • 1 • 12. List all pa<try s,i est_.__; ornces,air- ms and major own (IC%or at.:. of nership)of an cspii ±zt partnbrip or corpo:ation below. Use atidi+sortal paper if r._.... y. (See in.,.b u..tiors bans)•Cliva here ifYou'vt-i>'�r to re eire n app`ntation for ad&itionat ID -Lis fa:key r�S�Oa6,.. 0 ( - - f.. Last i Frst f addle f.1II� hie in Ari*art Bushnt 1 ..Dwae r • { —_ . . 1 13. Is the applicant clai-rang ezcrrption from the.117. .1t.4.ion izc?(See iastrutttohs) - _ • BY= I No 14.- Prow fee=closed S /( s f 0 (sec note r l,of irSstra:.tions) a.._...1.f y Fund fee ct_lose±S la.i.00 (see note ,of it nr_iota If nay,include two separate r..rtified ate-.•s or goner orders-one rze -d"Re fln Fee";one rr ±e4'YGLa,diey F um ". See .in>-trz cm3 for the fee=mum Wak:all—rif rl:.Ie-.;,1_,or money Drd- payable to"Comtaoavr t.ir of Ma iiz tts". F,..-7 QL.OR KISIN=CHECKS w'TT.T DE ACL.ra r_i)EIIT WILL REQUIRE AN 4DJITION AF.,TEN(IP)DAYS TO PROCE..SS F'tirst:ant to Massat t set G.-JD-ter-4 Lz'rs C7r-pter o",C g 49A,L -cif}txsd-_�r ate pee tiee of p m-jury that I, o my ....,. F�r� _' c and I r i f zz-= :al_tereturns ztsd paid zli>.zt_..ram retrthre:.1 pa ' Sisats=of a1,pii.,d..or a rime.t s:_p. .tat :art✓had w t :pprr:actt 'Er:G • - . A f: arises to any cst.i cs .tn in this zppi'imt o e n vsstFtats a oux:ft for ste a p- eio or rcro.�tios of the appp-. :_c.L.cr ,Int's ow_ • INSTRUCTIONS FOR COMPLETION OF APPLICATION FOR REGISTRATION AS A HOME IMPROVEMENT CONTRACTOR OR SUBCONTRACTOR ITEM 1. Name:The name must he the nave in whirl you do or plan to do business.It cannot be a different name than used for previous reoistr350n 3. Applicant type:If applicant is not a corporation and at least the surname of the principal or one of the partners is not included tin tne corn;,an) name(dba name),•a copy of the'fr,:tiuot.s name'ce iri sate filed with the city of town clerk must be included with the application. 6. Applicant partnerships and corporations must show a Federal ID number.Applicant individuals should show a Federal ID number if they hav employees in addition to the owner. 7. Number of employees For t ie p� ,srrlses of the application and 73aC1C's R6,the number of employees-fiat n uda all mrstnrdion related erppbyees who worked 20 or more hours on the payroll in the weekly pay period.prior to the fling of this renewal form. 9. Re ponsible iniivictuat If the name in O eSStion 1 is other than an indbV QCal,(Le.,a corporation,pa -ship,-etl )the narne cif f•P i divi3aat person•respons7ole far the home improvement contracting work of the entity must be entered-hers. If the person so named holdu a construct- sup.erisor bcanse and owns l a%or more of the applicart enff ty,the applicant entity is exempt form tie re stavon fee.ate-license and . owrneer hip'data in Question 11 and'12 and dhed;Nee in Question 13. 72. Corporations or partrt�..i'Ships-rnt* ;plo:[ any'ofca1 dcsrnerlt,which Ests the required information,Suci as pernnaant rectos.of t e A-1C of incorporation,currant Annual Report, e jc�L ation as a foreign corporation as filed wrlh the MA_meta y of State,o r a copy of the current pal e shir►agreemmt in lieu of listing the required info.nation on nay of pa thers,trustees,othcets,directors and ran jor oiir •s, CA yar i a5ans other, than core aru.ts must sulrntt copies of any b=..brie.em ccrrticatees filed in cities or towns pursuant to MG Chapter 110, Section 5_(Aar lctown as th&D3A or ILL'iii,Jus.name`law)_ 13. if 41 .,af tt or responsible inarvnc ai s a lice:se c :Auction war under MGL C_t43,S_94(i)or a registe ed:motor v e e repairshop op afar and is dairrii ng e,ampn`on form the renewal fee,died:yes on`auestion 11 and"i nclude a copy of the currenticenseh tag anon tin We this application.(See ins'ructions of Question 9 above) • 14. Endose a mrMed check or money order far the registration fee cite a llc rat s not.ex—rapt)and a sepa-e ed deck or money ord:: or the Guaranty.rund((n y,see beiar).Make checks and money orders:payable to the Cot.ui rpnweatth of Me>,a I,x ts. :EL APPUCAh S MUST PAY TI-E GUAR YFUND-ram EVal IF FROMTrIE REGa?.AT ION FEE WaR completed appm..ation form,required dorarmen'ation and certified cl-tec-(s)or money orceer(s)tic_ • 3BRS-Horne improvement Program One Ashbturton.Pace,Room 1301 3oston, WA 02103 •- _ • •�•:: ApplicaSons are not processed on a walk-in s . Please allow up to 30 Jays for ---• - - - R_•eytl 4tio. Fee: SI DD(Rmle^walale e ery two years) { Note f inaTvidtat Lr ear- Carstni an Supern rs in goad&'-annbg-trrder Cheer 143,Sec orn 94,who re ter es err tom ua!ores Jn rcafed In cistn tfans to Oues in 9 above and izxiiiedtat marrorrepa,r s hops e .e,,in trdan WET C t 1GtaA,Sambn.2,are exempt fn>trrfrnera ratbn fee Dr�fy T _qLa r AYE*exams a r;the appli--Ji`rnt s;.heck yes'kt Crues5on T2 ands-U-5re wiTh this appiiffon a coy curr;art Trcnse or reg:...Lt rn. ce uric ode which straws the ezpi dam„ate - - Garanty.Fiord Contriution • -Zero to threeenm1oye- - 7100- . - 4 to 10 m npksyees - S24-0_0* - ZI to Mt em eyee 530€LO0 - - - More&air S �z c ;� r c Fri'vc?f? i��:line a:a `ix =z 5��?.'"i=c.Ter✓i-3�Fi'Fi�r�,�"x:�tt'3i r ram:rrL?:;.�i�F?"��r.�a v"'2s'.,c,..� ri<.>u..r r✓tee,aI're?''"r.::�r3"1 D-_'' . etzs- -sed far an ado-Zane'can ribufarl ri ac dame w 73'3a€??a and MGL c ;424 -ALLAPPLCAY.I3S MUST SJ3Arr i;i=GtlRA hTr:,;ND r'r - - V5+ - -*1/4,.' *MK. '''.J." :: Cm: rillii efc 10 -4T7 NK ;...'t, ., ,ivI N .c., g 6 - f J._ pro r D RSk bu r ttr P\laL eco rn /3 1 Eosfakr\ f rnii 09, k08 UN/TEDSTATES - 0. . �AOST/�L SERVICE, I'O S TAT, IIQNEY ODDER i3 8oa \ \ � SERIAL '�111Mf3rR y\\ \ \ \I41\. *:‘, t''',\H")s\t‘\ .\\..\,.\\\ \, i, \\\<\;\\\\ @�\\\ \r; \u\\��oti\\t\i\u\\gip\\\\1�\\\\\���\\\\\, ��\���\\\ '�4 �. �' , \«\\�\\�.o\\\\q\ \�\ \.\\\\�\\Rmc�wnm\\\a�\A�mneiah\��Ft•\� \Avro � '\k, �\� \\\\� \ � ���`��` -��.� #er�\,\r�\\�`�r> >\l\\\\ �rO�e`•Sl�l,^�•5.1\�a,��, a v \ w ���� '��(f,'�y/�)� L/�`//J�� C/� n Av\\VA a� \A � ['/p� �L��\,A\\ \�wv aA.vra��w �A�A \\�. \WDDR ES IAA (4 / [ri C.t.� d ail& ` \\\\N `\0' L.fit�\\\`\ r / \\i\\\\\�\\�y �,`\\' ��\\\\\\\\\\�\\\ •1•A,`` k\,!,0t \ k „ \A_ Ov\\ 0\k,4\ \\ J �Eq FOR / \\ \� 11 �C." � t V aQ l/ � V Ay v y V �� ` v ; > w\ AAyvy' ��� w �� \fi� \ �, r r ' UNITEL3 ST/�TES is-eo>3" �POSTAL.SERVICE® POSTAL MONEY ORDEt�. 000 SERIAL �V^� A�\\�� \� \\ �����\ v,09553993 v yvv� v y:�� yv '' 4 �' y` \\\� \� \� \. ,, �` ' \\ ' \ h�M ,\,-admmtnmmmm\i \\ \,�` AMOUNT �''\\�\\1\�\\\,\ \\\\ \\a\d\\i.\\R�\tmCF�uZraau\ u,\\\\\\l\q\\i \a\ ill.oam\\vc>\q zap \c�\ua\q\w�gUHeC Ri�\VaA\\!.r /^y^r•try^jam j � 0'�0� r�\° yr`CO\��t\\i = h� r \ rA\fi. 1 S4\r>cep\\�1\ \1PAV TO .�' I "' V 9`t :V N. \ @ r 1�� \ r`rr,+ �\ ��\l\\\\ ADORES r /� FRO �� '� 1 ':. • ,''\�1 :ADD-RE5\\ F Y b..\`�13�\�\\l\\ �AAL ,, � `. �G o.o.No.OR, v r v r ` v = 1�'\vqA\@ V� ' v • v �q v MSED FOR , `� i 54��\\A�\ aAv. e� A r q� -