fl 1 MAR 0 9 2015 Department of Consumer and Regulatory ......MAR 1 • 2015 u BY:.----Date: March...

13
Government of the District of Columbia Department of Consumer and Regulatory Affairs Permit Operations Division 1100 4th Street SW Washington DC 20024 Tel. (202) 442- 4589 Fax (202) 442- 4862 TO SCHEDULE INSPECTIONS PLEASE CALL (202) 442 9557 1 ecEIVEn fl MAR 0 9 2015 u BY:--,._-- Date: February 24, 2015 Cap ld: R1500066 D.C. Historic Preservation Office 1100 4th Street S.W., Rm E650 Washington, DC 20024 Re : Request for clearance of premises subject to razing operations An application to raze the structure identified below, located in the District of Columbia, was fil ed on this date with the Permit Operations Division. Our records do not reveal any kind of conservation holds on this property. We are hereby requesting confirmation from yo ur oftice, in order to release the subject pe1mit. Address: 129 VARNlll\1 ST NW LOT: 0011 SQUARE: 3321 TYPE: VACANT: No Please notify our office of the satisfactory completion of your in spection of the premises, by filling out the clearance section below and returning this form to the D.C. R.A. Permit Operations Division, II 00 4th StrP.P.t S.W .. n. l.. 20024 . CLEARANCE This is to inform you that we researched our records concerning the structure identified above and we have no objections to proceeding with the proposed razing of said structure. Date: Signature: ---------------------------------------- Name of releasing HPO Official. (print) Page 9 of 13

Transcript of fl 1 MAR 0 9 2015 Department of Consumer and Regulatory ......MAR 1 • 2015 u BY:.----Date: March...

Page 1: fl 1 MAR 0 9 2015 Department of Consumer and Regulatory ......MAR 1 • 2015 u BY:.----Date: March 11, 2015 Cap ld: R1500072 D.C. Historic Preservation Office 1100 4th Street S.W.,

Government of the District of Columbia Department of Consumer and Regulatory Affairs

Permit Operations Division

1100 4th Street SW

Washington DC 20024

Tel. (202) 442- 4589 Fax (202) 442- 4862 TO SCHEDULE INSPECTIONS PLEASE CALL (202) 442 9557

1ecEIVEn fl MAR 0 9 2015 u BY:--,._--

Date: February 24, 2015 Cap ld: R1500066

D.C. Historic Preservation Office 1100 4th Street S.W., Rm E650

Washington, DC 20024

Re : Request for clearance of premises subject to razing operations

An application to raze the structure identified below, located in the District of Columbia, was fil ed on

this date with the Permit Operations Division. Our records do not reveal any kind of conservation holds

on this property. We are hereby requesting confirmation from your oftice, in order to release the subject

pe1mit.

Address:

129 VARNlll\1 ST NW

LOT: 0011 SQUARE: 3321 TYPE: VACANT: No

Please notify our office of the satisfactory completion of your inspection of the premises, by filling out

the clearance section below and returning this form to the D.C. R.A. Permit Operations Division, II 00 4th StrP.P.t S.W .. W<~shinPion n .l.. 20024.

CLEARANCE

This is to inform you that we researched our records concerning the structure identified above and we

have no objections to proceeding with the proposed razing of said structure.

Date: Signature: ----------------------------------------

Name of releasing HPO Official. (print)

Page 9 of 13

Page 2: fl 1 MAR 0 9 2015 Department of Consumer and Regulatory ......MAR 1 • 2015 u BY:.----Date: March 11, 2015 Cap ld: R1500072 D.C. Historic Preservation Office 1100 4th Street S.W.,

Government of the District of Columbia :: :: I I I : : :: I I I :: :: : :: :: C I I I :! !I I I I :: ll : ::

:: I I I I :: I I :: :: I I :: APPLICATION FOR RAZE PERMIT D£1ARTM!NT Of CONSUM£1l" 1\lClliATORY AffAIR.I

1plication can be downloaded and is tillable except for signature area. If not filling out on computer, please type or print legibly 10 ink. Please provide detailed informatioiL Write N/ A (non-applicable) for items that do not apply. Erasing. crossing out, whiting out, or otherwise altering any entered information will void this application. The owner of record must sign the application with an original signature.

Applicable code sections are in the 2008 DC Building Code Supplement Chapter I§ 105.1.7. 105.1.7.1, 105.1.7.1.1_ 105.1.7.1.2, 105.1.7.2, and Section 155A.

Al~aco G&

4. DESCRIPTION OF BUILDING 15. Description of Building to be Razed (e.g., two story brick single family dwelling) 16. Existing Number of Stories of Bldg:

IIAt>t=>'··~~ ~n~ io JlcAlt: k -cX,,>n~,,._.t;,.l·-~t-l·'v hl\.t.<:.~ II ~ 17. Use(s) of ProP.ertY (specifically indicate if any use is residential.) 18. Materials of Building (brick, wood, etc.)

I ~$\AGY\\i~ II ~r\~)< 19. Bldg Length (ft) 20. Bldg Width (ft) 21 . Bldg Height (ft) 22. Bldg Volume (cu ft) (L x W x H)

I ~8.oo II '2b.00 II ~o, ot> II ) ({.,ho, 0<1 .. - - -·

OFFICIAL USE ONLY CONOmONS/ COMMENTS:

L ------------ - --------------- - ---- ------- - ------- -

I I I

REVU/11

Page 1 of 5 Effective April 9, 2009

Page 3: fl 1 MAR 0 9 2015 Department of Consumer and Regulatory ......MAR 1 • 2015 u BY:.----Date: March 11, 2015 Cap ld: R1500072 D.C. Historic Preservation Office 1100 4th Street S.W.,

* * * ~ oc Government ofthe District of Columbia Department of Consumer and Regulatory Affairs

Permit Operations Division 1100 4th Street SW

Washington DC 20024

Tel. (202) 442- 4589 Fax (202) 442- 4862 TO SCHEDULE INSPECTIONS PLEASE CALL (202) 442 9557

Date: March 04, 2015

D.C. Historic Preservation Office 1100 4th Street S.W., Rm E650

Washington, DC 20024

Re: Request for clearance of premises subject to razing operations

Cap ld: R1500068

0Ece•ven n MAR D 6 2015 u BY~·----

An application to raze the structure identified below, located in the District of Columbia, was filed on

this date with the Permit Operations Division. Our records do not reveal any kind of conservation holds

on this property. We are hereby requesting confirmation from your office, in order to release the subject

permit.

Address:

2800 8TH ST NE

LOT: 0822 SQUARE: 3643 TYPE: VACANT: Yes

Please notify our office of the satisfactory completion of your inspection of the premises, by filling out

the clearance section below and returning this form to the D.C.R.A. Permit Operations Division, II 00

4th Street S.W .. Wa~hinl?tnn D.\. . 20024.

CLEARANCE

This is to inform you that we researched our records concerning the structure identified above and we

have no objections to proceeding with the proposed razing of said structure.

Date: --------------------- Signature: --------------------------------------

Name of releasing HPO Official. (print)

Page 9 of 13

Page 4: fl 1 MAR 0 9 2015 Department of Consumer and Regulatory ......MAR 1 • 2015 u BY:.----Date: March 11, 2015 Cap ld: R1500072 D.C. Historic Preservation Office 1100 4th Street S.W.,

Government of the District of Columbia Print Form J

~

APPLICATION· FOR RAZE PERMIT

Application can be downloaded and is fillable except for signature area. If not filling out on computer, please type or print legibly in ink. Please provide detailed information. Write N/ A (non-applicable) for items that do not apply. Erasing. crossing out, whiting out, or otherwise altering any entered information will void this application. The owner of record must sign the application with an original signature.

!Applicable code sections are in the 2008 DC Building Code Supplement Chapter I§ 105.1.7, 105.1.7.1, 105.1.7.1.1, 105.1.7.1.2, 1 05.1.7.2, and Section 155A. · · ·

r-. 1~- Ooo 6 8 Sob ::ft Application Date: I I 1. INFORMATION ON PROPERTY

1. Address of Proposed Work 2. Quad 3. Ward 4a. Square 4b. Suffix s·. Lot

12800 8th Street - I EJ EJ 13643 ... II_ 11822 J 2. APPLICANT INFORMATION

6. Property Owner 7. Complete mailing address (indude zip) I 8. Phone Number(s)

2800 8th Street Partners LLC

10. AgenVContractor for Owner (if applicable)

0 Ra.:e Permit

J· . 4. DESCRIPTION OF BUILDING 15. Description of Building to be Razed (e.g., two story brick single family dweHing} · 16_1~ting ~~be7~t &ori~~~f Bldg:' '

Garage space and small office str .1cture

17. Use(s) of Property (specifically ind:cate if any use is residential.) 18. Materials of Building (brick, wood, etc.)

garage, storage, and office space Brick and wood ·] 19. Bldg Length (ft) I 20. Bldg Width (ft) 21. Bldg Height (ft) 22. Bldg Volume (cu ft) (L x W x H)

161.9 1![ 40 11[20

CONDITIONS/ COMMENTS:

REV l.l/11

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Page 5: fl 1 MAR 0 9 2015 Department of Consumer and Regulatory ......MAR 1 • 2015 u BY:.----Date: March 11, 2015 Cap ld: R1500072 D.C. Historic Preservation Office 1100 4th Street S.W.,

23. Raze Contractor's Name

Eo 26. Historic District?

27. CFA?

28. Raze Entire Building?

29. Building Condemned?

30a. Party Wall?

31 . Building Vacant?

32. Public Space Vault?

33. Plumber's Name

(rso

SECTION A. RAZE PERMIT 24 . Contractor's Address (including zip code) 25. Contractor's Phone

II[ OYes~No

DYesiEJ No

IE]YesD No

DYesJEINo

OYesiEJNo

IE)YesDNo

DYes IE] No

Ill 33. Raze Contractor Signature

34. Property Owner Signature

30b. If yes, adjacent property owner signature is required .

30c. Any raze permit application for a building(s) involving party walls must be include 2 copies of a plan that show how the party wall(s) will be protected.

Building must be vacant before Raze Permit issuance.

Official Use Only Fee By I Date

34. Plumber's License Number

II[ 1. You must submit a Certificate oflnsurance covering the raze operatiOn/contractor-'·unless the building you plan to raze is an acces59ry building .500 ''

square feet or less ln area and not more than. one story, wholly detached from any other building on the same or adjoining premises. ; ·. . . . .. ' 2.TheCe~fibate~h~u)~ : · ; . c, .. ~. ' ·' .~;~·';1:.... ' ~:~[,\"' .; \~:~:. • · _.· ;;'·

• Show the·frOider of the insurance as: Deputy Director, Permit Oivision, 1100 4th St SW, Washington, DC 20024 ,, . ~· ,: .• !i:: •. , "· _J.; ·• •· • Include a 30-day advance notice cancellation 'clause. .,;,f' ~· . . . · ' · ·~ . . ' ~.;.: • .,

~ . >:::'< -· • ' ':: ,;:_. . ,.~.....,.... ~

! ·; • .- ' • Include these amounts of. insurance coverage: Bodily Injury, $100,000; Aggregate, $3QO,OOO; and Property Damage •. $100,QOO. · ". -~; ... , I •,: ; -~ <• . State that the insurance covers "Razing Operations in the District of Columbia,. if the. Scope of th~ insurance .is for blanket coverage, ..

' • If the insu.rance i~ for ~-ne· specific address only, state that, "Razing O~tlons at ·· . . ' , . · " •

[

· (address of raze operation) .· ,;

36. Insurance Company

39. Asbestos in Building? If yes, indicate location:

37. Policy or Certificate No.

DYes IE] No

Fee By

38. Expiration Date

Official Use Only

Date

REV 1l/ll

Page 2 of 5 Effective April 9, 2009

Page 6: fl 1 MAR 0 9 2015 Department of Consumer and Regulatory ......MAR 1 • 2015 u BY:.----Date: March 11, 2015 Cap ld: R1500072 D.C. Historic Preservation Office 1100 4th Street S.W.,

* * * ~ oc Government of the District of Columbia Department of Consumer and Regulatory Affairs

Permit Operations Division

1100 4th Street SW

Washington DC 20024

Tel. (202) 442 - 4589 Fax (202) 442- 4862 TO SCHEDULE INSPECTIONS PLEASE CALL (202) 442 9557

0Ece•ven n MAR 1 • 2015 u BY:.----

Date: March 11, 2015 Cap ld : R1500072

D.C. Historic Preservation Office 1100 4th Street S.W., Rm E650

Washington, DC 20024

Re: Request for clearance of premises subject to razing operations

An application to raze the structure identified below, located in the District of Co lumbia, was filed on

this date with the Permit Operations Division. Our records do not reveal any kind of conservation holds

on this property. We are hereby requesting confirmation from your office, in order to release the subject

permit.

Address:

125 OSTSE

LOT: 0805 SQUARE: 0744 TYPE: VACANT: Yes

Please notify our office of the satisfactory completion of your inspection of the premises, by filling oul

the clearance section below and returning this form to the D.C.R.A. Permit Operations Division, II 00

4th Street S.W .. Wac;hinPion n.r.. 20024.

CLEARANCE

This is to inform you that we researched our records concerning the structure identified above and we

have no objections to proceeding with the proposed razing of said structure.

Date: Signature: ----------------------------------------

Name of releasing HPO Official. (print)

Page 9 of 13

Page 7: fl 1 MAR 0 9 2015 Department of Consumer and Regulatory ......MAR 1 • 2015 u BY:.----Date: March 11, 2015 Cap ld: R1500072 D.C. Historic Preservation Office 1100 4th Street S.W.,

Print Form

:: :s Ill ::: c lll:: a r: u 1: 1 Ill !': 1 Ill :: 1 c :: •=I ••• ::1 fl~ " =•liD

fllr~RTII[\T(lf CO~Ili\IIR & R!GlllATORY MIAIRI

Government of the District of Columbia

APPLICATION FOR RAZE PERMIT I//S70;t<iC

Application can be downloaded and is fillable except for signature area. If not filling out on computer, please type or print legibly in ink Please provide detailed information. Write N fA (non-applicable) for items that do not apply. Erasing, crossing out, whiting out, or otherwise altering any entered information will void this application. The owner of record must sign the application with an original signature.

Applicable code sections are in the 2008 DC Building Code Supplement Chapter I§ 105.1. 7, 105.1.7.1, 105.1.7.1.1, 105.1.7.1.2, 105.1.7.2, and Section 155A.

~~~-(){X) 11- Application Date: 13/11/2015 I 1. INFORMATION ON PROPERTY

1. Address of Proposed Work 2. Quad 3. Ward 4a. Square 4b. Suffix 5. Lot

11 25 0 Street 'IEJ EJ 10744 :jlss I 'I 0801 I I

2. APPLICANT INFORMATION 6. Property Owner 7. Complete mailing address (include zip) I 8. Phone Number(s) 9. Email

I DC Water [email protected]

10. Agent/Contractor for Owner (if applicable)

IE] Raze Permit

4. DESCRIPTION OF BUILDING 15. Description of Building to be Razed (e.g., two story brick single family dwelling) 16. Existing Number of Stories of Bldg:

I One story brick storage shed /~pilQ ~eeij eRe i~Ell?''""eeEI 'bfild; ~ QQ' P¥~e~el iiRtfiiiJIJil :111 ; 1; n/a I 17. Use(s) of Property (specifically indicate if any use is residential.) 18. Materials of Building (brick, wood, etc.)

I Storage; Abandoned; Abandoned J I Brick w/steel roof framing; Wood; Metal ·I 19. Bldg Length (ft) 20. Bldg Width (ft) 21 . Bldg Height (ft) 22. Bldg Volume (cu ft) (L x W x H)

r~ 12; 2 ·1 [911 ; 2 'lfij15;100 1 ~87~ 1980, 400 I '

OFFICIAL USE ONLY CONDITIONS/ COMMENTS:

~~ ~41 "U? ~ 00,0').,0 01.-F-r. ....-,. ~~ ~* -· G .. L -P+ -l~ l' (i j. l6 ·;:?!- ( l i bO WtJOb ~~D

--rt\1~ ~o.,J ~ fb~ ~ t3U0C, ool:j

REVll/11

Page 1 of 5 Effective April 9, 2009

Page 8: fl 1 MAR 0 9 2015 Department of Consumer and Regulatory ......MAR 1 • 2015 u BY:.----Date: March 11, 2015 Cap ld: R1500072 D.C. Historic Preservation Office 1100 4th Street S.W.,

I SECTION A. RAZE PERMIT 23. Raze Contractor's Name 24. Contractor's Address (including zip code) 25. Contractor's Phone

lceltic Demolition Inc ~ 2050 Ballenger Ave Suite 200 Alexandria~ 1(703) 739-9103 I 26. Historic District? DYesiE)No 33. Raze Contractor Signature

27. CFA? IE]YesD No

28. Raze Entire Building? IE]YesDNo 34. Property Owner Signature

29. Building Condemned? DYes IE] No

30a. Party Wall? DYes IE] No 30b. If yes, adjacent property owner signature is required.

30c. Any raze permit application for a building(s) involving party walls must be include 2 copies of a plan that show how the oartv wallis) will be protected.

31. Building Vacant? IE]YesDNo Building must be vacant before Raze Permit issuance.

32. Public Space Vault? DYes IE] No Official Use Onlv Fee By Date

I

i

••• 33. Plumber's Name 34. Plumber's License Number 35. Raze Method (ball , bulldozer. by hand, etc.)

In/a :II n/a I excavator, bulldozer I 1. You must submit a Certificate of Insurance covering the raze operation/contractor- unless the building you plan to raze is an accessory building 500

square feet or less in area and not more than one story, wholly detached from any other building on the same or adjoining premises. 2. The Certificate should:

• Show the holder of the insurance as: Deputy Director, Permit Division, 1100 4th St SW, Washington, DC 20024 • Include a 30-day advance notice cancellation clause .

• Include these amounts of insurance coverage: Bodily Injury, $100,000; Aggregate, $300,000; and Property Damage, $100,000 . • State that the insurance covers "Razing Operations in the District of Columbia," if the scope of the insurance is for blanket coverage .

• If the insurance is for one specific address only, state that, "Razing Operations at " (address of raze operation)

36. Insurance Company 37. Policy or Certificate No. 38. Expiration Date

llnsurance Associates Inc 'I NY14CGL 1164601( ~ 110-1-15 I 39. Asbestos in Building? IIE]YesONo Official Use Only If yes, indicate location:

Fee By Date

---- -- -

REV1.1,111

Page 2 of 5 Effective April 9, 2009

Page 9: fl 1 MAR 0 9 2015 Department of Consumer and Regulatory ......MAR 1 • 2015 u BY:.----Date: March 11, 2015 Cap ld: R1500072 D.C. Historic Preservation Office 1100 4th Street S.W.,

* * * ~ oc Government of the District of Columbia Department of Consumer and Regulatory Affairs

Permit Operations Division

1100 4th Street SW

Washington DC 20024

Tel. (202) 442- 4589 Fax (202) 442- 4862 TO SCHEDULE INSPECTIONS PLEASE CALL {2021 442 9557

~Ec~w~ .·e~ ... _;:~ ;,, ·· ···~ ;:, .,_! ·'

MAi1 1 t 2015

BY:_......;.._ __

Date: March 11, 2015 Cap ld: R1500073

D.C. Historic Preservation Office 1100 4th Street S.W., Rm E650

Washington, DC 20024

Re: Request for clearance of premises subject to razing operations

An application to raze the structure identified below, located in the District of Columbia, was filed on

this date with the Permit Operations Division. Our records do not reveal any kind of conservation holds

on this property. We are hereby requesting confirmation from your office, in order to release the subject

permit.

Address :

125 0 ST SE

LOT: 0805 SQUARE: 0744 TYPE: VACANT: Yes

Please notify our office of the satisfactory completion of your inspection of the premises, by fi lling out

the clearance section below and returning th is form to the D.C.R.A. Permit Operations Division, II 00

4th Street S. W .. Wa~hinl!tnn D.l.. 20024.

CLEARANCE

This is to inform you that we researched our records concerning the structure identified above and we

have no objections to proceeding with the proposed razing of said structure.

Date: Signature: -------------------

Name of releasing HPO Official. (print)

Page 9 of 13

Page 10: fl 1 MAR 0 9 2015 Department of Consumer and Regulatory ......MAR 1 • 2015 u BY:.----Date: March 11, 2015 Cap ld: R1500072 D.C. Historic Preservation Office 1100 4th Street S.W.,

Government of the District of Columbia . :: :l I I I ::

:: ; I ~ ·: :~ OEPARTMli'IT Of CON~UMl& & RIGULATORY AHAlltl

APPLICATION FOR RAZE PERMIT H\ )fo(t t ~

Application can be downloaded and is fillable except for signature area. If not filling out on computer, please type or· print legibly in ink Please provide detailed information. Write N I A (non-applicable) for items that do not apply. Erasing, crossing out, whiting out, or otherwise altering any entered information will void this application. The owner of record must sign the application with an original signature. ·

Applicable code sections are in the 2008 DC Building Code Supplement Chapter I§ 105.1.7, 105.1.7.1, 105.1.7.1.1, 105.1.7.1.2, 105.1.7.2, and Section 155A. ·

1. Address of Proposed Work 2. Quad I 3. Ward 4a. Square 4b. Suffix 5. Lot

t1- 'S 0 S-rt"Lee-1 ~E I 1 Ol-44 ~s 6~o\

2. APPLICANT INFORMATION 6. Property Owner 7. Complete mailing address (include zip) 8. Phone Number(s) 9. Email

DC WA'ff-5o c:. o Ow.d~c. \e. ~"~ 1 SW ~o1) Jfjf7- 2o(Q. c;; ... s. f><l>J.@d(,.vcc..\-ec. \olt..'>hlN~"io~ 1)L Cc~

10. AgenUContractor for Owner (if applicable) 11 . Complete mailing address (include zip) 12. Phone Number(s) 13. Email

SAM/\~A. A>>-a '-if)lc \<E':;. rt:.. lc~'t..f f(o~k~N S.'-r1 ~2~ 1o~-Cth- 37\\ <SJo..v\~e_~"""-k"'-Q.re,.h, 'f/M'\L ~ Jc1. 1/ /lr z t ()to c..o~

~ •naJmwn~ 4. DESCRIPTION OF BUILDING

15. Description of Building to be Razed (e.g. , two story brick single family dwelling) I 16. Existing Number of Stories of Bldg :

\dooo ~o 1 t 17. Use(s) of Property (specifically indicate if any use is residential.) 18. Materials of Building (brick, wood, etc.)

~~1:.. ~oO 19. Bldg Length (ft)

,~, 20. Bldg Width (ft~

l \ 21 . Bldg Height (ft)

\S' 22. Bldg Volume (cu ft) (L x W x ~-

II 4 !;o ~~ 1-f

REVll/11

Page 1 of 5 Effective April 9, 2009

Page 11: fl 1 MAR 0 9 2015 Department of Consumer and Regulatory ......MAR 1 • 2015 u BY:.----Date: March 11, 2015 Cap ld: R1500072 D.C. Historic Preservation Office 1100 4th Street S.W.,

SECTION A. RAZE PERMIT 23. Raze Contractor's Name 24. Contractor's Address (including zip code) 25. Contractor's Phone

26. Historic District? 10"Yes D No 33. Raze Contractor Signature

27. CFA? DYes ~No

28. Raze Entire Building? es D No 34. Property Owner Signature

29. Building Condemned? DYes~o

30a. Party Wall? DYes 0 30b. If yes, adjacent property owner signature is required.

31. Building Vacant? Building must be vacant before Raze Permit issuance.

32. Public Space Vault? No Official Use Onl Fee By Date

33. Plumber's Name 34. Plumber's License Number 35. Raze Method (ball, bulldozer, by hand, etc.)

1. You must submit a Certificate ,of lffsur~npe covering the rpze 'oper,ation/contract9r~ Uf1.less tne building Y,QU plan.to r.aze.isian 'access'ocy,building 500

:, '. ,~ .. ,,, ' s6ciw the:•h'Diaer'ot:m~·insurance as: beputy !Director;' Pe~nnit• Division, 11 bo 4th St SW; Washington, oc'2ob24:; ,· .!:~-): . .. . . . i1,.);~'~r. li)'clude'ia '3o7,~~19v~n1qe ·.r1oti2~ fan~ellationi' ~l~~se :,. i:·::t~,:\.1;1.; ,, ,,,:~· •• ,:·; ··.4~~[·,." ": '~ • • t .·~.· L" · ·:r •·• .,,, ·.( R~'''~. • .,

· ·;; · . Include these amoimtspf insurance coverage: :sodliYinjUiy; $1 00,000; Aggregate, $300,000; and Property Damage,' $1 00,.0'00 . . . ~\: ,~tate',tbat th.i{insur~hte savers "R¥ing Ope.rations:lf1Jhe.,D,istrict oJColum~ia." if the scope ot.the insu"rance.is for blanket c;overage .. .

!; ;. ... :•,• ~l; .! r ' t"':~!:' '' i·d~ · ... ,~, ' I ': · ' , ·;;:;;;;. ,. ,,·, ')_ !'f:.:• I

. ~ ,. lf,tpe iQsuranee is fp'rone specific address only, state tha~ ~Razing,:Qperati9ns at----,-------'---::-------,----,-----'-

36. Insurance Company

39. Asbestos in Building? If ves, indicate location:

37. Policy or Certificate No.

Fee By

38. Expiration Date

Official Use Only

Date

REVl:I,IU

Page 2 of 5 Effective April 9, 2009

Page 12: fl 1 MAR 0 9 2015 Department of Consumer and Regulatory ......MAR 1 • 2015 u BY:.----Date: March 11, 2015 Cap ld: R1500072 D.C. Historic Preservation Office 1100 4th Street S.W.,

3321 0011 129 Varnum Street NW

2800 g th Street NE (both structures

shown)

125 0 Street SE ( one story brick storage

shed)

Page 13: fl 1 MAR 0 9 2015 Department of Consumer and Regulatory ......MAR 1 • 2015 u BY:.----Date: March 11, 2015 Cap ld: R1500072 D.C. Historic Preservation Office 1100 4th Street S.W.,

125 0 Street SE (small wood storage

shed)