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TOWN OF BARNSTABLE Permit No. ..34.gg5.....
BUILDING DEPARTMENT
I 'Aurr I Cash
TOWN OFFICE BUILDING
L1M�
�� a6S9• t
HYANNIS.MASS.02601 Bond .....x.........
CERTIFICATE OF USE AND OCCUPANCY
Issued to Greenbrier Homes, Inc.
Address Lot #14, 49 Weathervane Way
Dlarstons Mills.
USE GROUP FIRE GRADING OCCUPANCY LOAD
THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL
SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN
REQUIREMENTS AND.IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE
BUILDING CODE.
..... Apr i 1..3......... , 19....9..2......... ......... ...... .....
Building spector
-'�+,+r..�•;�-a.•^�"....�Z,.,,�,,. -,.. �. .. .r..w :„,,...�.y� „��.•:.., ..:.---....T-i*.`:�T^"?^.-I.T.^.`:+}': .;�'
j. 'BUILDINGTOWN-'OF:BARNSTABLE, MASSACHUSETTS
P��fVll
A=14 7 0.4'2
• f. ' DATE }'(..,b ui,.?'"--3- 19 92 P RMI6 NO NO � �4815
APPLICANT Greenbl 1C r flames, Zf1i;. ADt Ss 0�-51� (:ent7e-i v 13
f
IN-) (STREET) � � (CONTR'S�L I,C,E N$EI
PERMIT TO Build Dwelling ( 1 I STORY °S' .lgiL' i'amily DwellincUMBER OF
(-TYPE OF IMPROVEMENT) NO, WELLING UNITS
(PROPOSED USE)
AT (LOCAT,ON) Lot #14, 49 Weathenjaiie 6;ay, ilarstons Mills ZONING ;Rk,
IN0.) (STREET) DISTRICT--
BETWEEN AND
` (CROSS STREET) (CROSS, STREET.) f+.'i:,r•'I' SUBDIVISION LOT LOT '
BLOCK SIZE
BUILDING IS TO BE FT. WIDE Blk:' FT. LONG BY FT. IN HEIGHT AND.SHALL CONFORM jN'CON`STRUCTI
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
I Sewage #9 2-a;G (TYPE)
I�I REMARKS:
fond
AREA! VOLUME 1368 sq. Ft. � A SL000 .00 � "PERMITESTIMATED COST FEE(CUBIC/SQUARE FEET) $:6;8j�.
.50
I oWNEs Greenbrier. Hornesi Inc.
� .
ADDRESS p. 0. Box 510, CenterVili�'. BUILDING DEPT.
BY
x'f3CS [5E'IYX1`K1 NT F PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES FROM THE 4OND1T10
OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. NOT RELEASE THE APPLICANT
MINIMUM OF THREE CALL -APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE
INSPECTIONS REQUIRED FOR
ALL CONSTRUCTION WORK: CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR
I. FOUNDATIONS OR FOOTINGS. ELECTRICAL, PLUMBING AND
MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS.
Z. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL
MINAL INSPECTION
TI TO BEFORE
FINAL INSPECTION HAS BEEN MADE.
3. FINAL INSPECTION BEFORE
OCCUPANCY.
POST THIS CARD SO IT IS VISIBLE FROM STREET
BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS
1
fI Lr
a�
2 —
2 -.
3 �� 1 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT
3 + B04ggpFHEALTri
OTHER SITE PLAN REVIEW APPR A
i
WORK SHALL NOT PROCEED UNTIL THE INSPEC• PERMIT W;LL BECOME NULL AND VOID IF CONSTRUCTION
TOR HAS APPROVED THE VARIODUS STAGES OF WORK-IS NOT STARTED WITHIN INSPECTIONS INDICATED ON THIS CARD CAN
SIX MONTHS OF DATE THE CONSTRUCTION. I PERMIT IS ISSUED AS NOTED ABOVE. ARRANGED FOR BY TELEPHONE OR WRITTI
NOTIFICATION.
1
\ ^1Y
1
148-82
4 \
148-83
JI
\ Lot 14 Lot 15
43,561 sq.ft.f
00
0.
TOF Elev. = 97.6
R = 25.00'
�o o L = 6.18'
0
N '
0
g Y _ Lot 17
THIS PLAN IS NEITHER INTENDED ' I/2s/9z INMAL ISSUE elk
N0. DATE DESCRIPTION BY
FOR, NOR SHALL IT BE USED FOR AS—BUILT FOUNDATION PLAN—LOT 14
MORTGAGE LOAN PURPOSES. WEATHERVANE WAY
w
BARNSTABLE, MASSACHUSETTS
FOR
GREENBRIER DEVELOPMENT CORP.
HDt ��' SCALE: 1" = 40' JOB N0. 1599 1599osb
I CERTIFY THAT THE FOUNDATION �`` �'c
SHOWN 0 PLAN IS OC TED ° PAUL A. 0 40 80
' EVY
ON THE G U D S I I T D. ` u NoLIC517 I
1/213/92 -LEVY, ELDREDGE & WAGNER ASSOCIATES INC.
DATE R GI ERED LAND SURVEYOR <3 Sr��tiY�4%. ENGINEERS WOCAPEARCf07M PLANM I,ANDSURPEYOFS
889 WEST MAIN STREET CENTERVILLE, MA 02632
• t •,t
.... ....;:,... ..,a?E�,•.• -'r}g2Sk>;�,�.,:•I�.r,r.�2fY�hitriht5.t?Jt!tka:ENt.9k.5{{d 2321k'kE3kL:
.- .. .. .d...i -a:r i'r:. ::rlrii2});?� i';2i:U?:h! :J%:•,:41jii:• `
/ I
COMMONWEALTH DEPARTMENT OF PUBLIC SAFETY
, i OF 1010 COMMONWEALTH AVE. ,
MASSACHUSETTS BOSTON,MASS.02215 �
ENCLOSE CHECK OR MONEY ORDER
LICENSE FOR REQUIRED FEE,
EXPIRATION DATE CONSTR. SUPERVISOR
06/30/1993 MADE PAYABLE TO
RESTRICTIONS o EFFECTIVE DATE LIC NO. 6
NONE o 06/30/1991 001397 0 "COMMISSIONER OF PUBLIC SAFETY"
o n
WILLIAM E DAC EY m (DO NOT SEND CASH).
290 GREEN DUNES DR PO B
WEST HYANNISPORT MA 02P EASE NOTE FEE INCREASE
PHOTO(BLASTING OPR ONLYI FEE:
100.00 E FECTIVE FEB. '1, 1989
HEIGHT; NOT VALID UNTIL NED BY LICENSEE AND OFFICIALLY
STAMPED -O SIGNATURE OF THE COMMISSIONER
D NOT DETACH LICENSE STUB
THIS DOCUMENT MUST BE SIGN NAME IN FULL-ABOVE SIGNATURE LINE
CARRIED ON THE PERSON OF •-SIG NATURE OF LICENSEE
THE HOLDER WHEN ENGAG.
OTHERS RIGHT THUMB PRINT EO IN THIS OCCUPATION. COMMISSIONER
JOGGED RANCH APPpoyED
NOTE H NGES THE GREENBRIER
• _ CORPORATION
02 1550 Route 28
TG V�� ®F BARNSTABLE 10 Center Place
P.O.Box 510
Building 1nspeCuOe Department Centerville,MA 02632
(508)771-3616
Irlr _
/ FHi r r I
SUNDECK
12.X 10
Q
MASTER BEDROOM
15X 10 KITCHEN-DINING ROOM
18 X 10
OPTL.GARAGE
CL. CL. 14 X 22
CL. LIVING ROOM
18 X 14
BEDROOM BEDROOM
12X 10-6 12X 10-6
CL.
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b. r A'ssessor's office (1st floor):
�
� THE T
Assessor's map and lot number ...........1.. -..a.y ...G-C__g TIC SYSTEM. MUST BE
Board of Health (3rd floor): �j INSTALLED IN COMPLIANCE e
Sewage Permit number ...........•.t• •'•• `�•• .........• WITH TITLE 5 2 Baarasa LE
EngineeringDepartment (3rd floor): /`� ,/�__ �o m0
House nmber ` ,JtSl'/� ENVBF�®BdfliiENTAL CODE AND ��0 YPV
.................................... .... ... ......... .............
Definitive Plan Approved by' Planning Board :__ _------19T EIGULATICNS
APPLICATIONS PROCESSED 8:30-9:30 A.M. an ldv .0 00 'P.M. only �,^•
TOWN OF BARNST `
BUILDING INSPEC "0�'''"'"r
APPLICATION FOR PERMIT TO .............. s;iL..:c .- 7<�,E«siv(r
TYPE OF CONSTRUCTION ..... ....... ..
................................. .7...19..`..
TO THE INSPECTOR OF BUILDINGS:
• .F
The undersigned hereby applies for a permit according to the following information:
Location �o,— lL / fiJtrr..o ... .............�j, JcGs..........................................
G
SlnrG c �..t [ �6.. .
Proposed Use ......... ...... ...�......... ......................................................................................................
ZoningDistrict ..............�.. ...�..........................................Fire District .................... .�.. . . ... .
Name of-Owner 6rc— gasE?Z.. KEs - ...........Address G 3Qf.... !�.: ��....-E e vs<CE .....................
Nameof Builder .........5 �&` ..................................................Address ..............°' cc .................................................
Nameof Architect .................../......................................Address ............ .....................................................................
.Number of Rooms .................�.............................................Foundation ...P.O.v!' �� Cpn!'r��e
...................-......................................
Cl� �JaAieCeda�..°'..!!'." �le 5�: leS .9-5akal>
Exterior .......�.. .. . .y... }.................�........Roofing ............1......................................................................
s i
Floors 4'ar .....lV..!n.b..�................................................Interior ......5.!�t�f woe
Heating ... ....a.�...................................................Plumbing ......1..�7......h
Fireplace •..................................................................................Approximate Cost ............................................. ....... .......... .
Area •�Pr� .
Diagram of Lot and Building with Dimensions Fee ...........
1040
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the Rules and Regulations od..
a nstable regarding the above
construction.
Name ..... ... ......................................................
Construction Super v is License QU��S7
r' GREENBRIER HOMES , 'INC.
No ..3.4. .15... Permit for ....One :Story......,.
Single Family Dwelling........
Location ...Lot #14, 49 Weathervane- Way
K Marstons Mills
. ........................................................
Owner Greenbrier• Ho mq. .,.,..JT>G......
Type of Construction ....kx:ame.........................
r ..............................................................................
Plot ............................ Lot ................................
r ebruar 3.r......19, 92
Permit Granted ...................... ........
Date of Inspection ....................................19
Date mplet .. .........19 \
` 1, _
°
4 '
6�s
�ptME , G DEPT• Application number................................................
�✓ � � J,N'' �► Fee �S
o ..........................................................
NAM
Building Inspectors Initials....%.B...................
TQON OF BARNSTABLE �/ _ ��
Date Issued.......�.........1..................l ..................
Map/Parcel...I.�. ......:..:........................................
TOWN OF BARNSTABLE SCANNED
EXPEDITED PERMIT APPLICATION: MAR 0 4 2020
ROOF/SIDING/WINDOW S/DOORS/TENTS/STOVES/WEATHERIZATION
PROPERTY INFORMATION
Address of Project: 5 fir kl.,-i / , ( Is
NUMBER STREET VILLAGE
Owner's Name: �,,, Phone Number Cal; -,Xo-G I i y
Email Address: Cell Phone Numbe
Project cost $ Check one Residential Commercial
OWNER'S AUTHORIZATION
As owner of the above property I hereby authorize �A, I-J-4-,i
to make application for a building permit in accordance with 780 CMR
Owner Signature: �c ��.„4 Date:
TYPE OF WORK
❑ Siding ❑ Windows (no header change) # ❑ Doors (no header change)#
EInsulation/Weatherization ❑ Roof(not applying more than 1 layer of shingles)
❑ Commercial Doors require an inspector's review
Construction Debris will be going to
❑ Certificate of occupancy with no construction(complete below)
Occupant/family relationship or business name
or Existing amnesty apartment(attach a copy of recorded comprehensive permit)
CONTRACTOR'S INFORMATION
Mike McCarthy Construction
Contractor's name pe Ham2
Home Improvement Contractors Registration(if applicable)# West Dennis, MA opy)
Cell (508) 880-6964
Construction Supervisor's License# CSL-5 h g-169393
Email of Contractor Phone number
ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN
A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED.
i
APPLICATION NUMBER............................................................
*For Tents Only* `
Date Tent(s)will be erected Removed on number of tents total
Does the tent have sides? Yes No (If yes please attach floor plan with exits marked)
Dimensions of each Tent X X X
Additional tent dimensions can be attached on a separate piece of paper.
Purpose of Event
i�111'Check one: this event is a: for profit non-profit event
Check one: Food.served Yes No
Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent
Fuel source being used LP tank 201bs. or> Yes No , if yes, a gas permit is required.
Natural Gas Yes No , if yes, a gas permit is required.
If food is being served at your event please obtain a Health Department approval between the hours
of 8:00am-9:30 am or 3.30 pm-4:30pm. Commercial events may require Fire Department approval,
*WOOD/COAL/PELLET STOVES
Manufacturer# Model/I.D.
Fuel Type Testing Lab
Offsets from combustibles: front back left side right side
HOMEOWNER'S LICENSE EXEMPTION
Homeowner's Name:
Telephone Number Cell or Work number
I understand my responsibilities under the rules and regulations for Licensed Construction
Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand
the construction inspection procedures, specific inspections and documentation required by 780
CMR and the Town of Barnstable.
Signature Date
APPLICANT'S SIGNATURE
Signature Date
All permit applications are subject to a building official's approval prior to issuance.
The Commonwealth of Massachusetts
z, Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
www mass.gov/dia ;
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Organization/Individual):
Address:
City/State/Zip: Phone#:
Are you an employer?Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and I
employees(full and/or part-time).* have hired the sub-contractors 6. []New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling
ship and have no employees These sub-contractors have 8. ❑Demolition
workingfor me in an capacity. employees and have workers'
Y P tY• 9. ❑Building addition
[No workers' comp.insurance comp. insurance.t
required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their I I. Plumbing repairs or additions
myself. [No workers'comp. right of exemption per MGL 12.❑ Roof repairs
insurance required.]t c. 152, §1(4),and we have no
employees. [No workers' 13.❑Other
comp. insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
$Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lie.#: Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
Signature: Date:
Phone#:
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
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,corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the
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-contractors)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 returned 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
I
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 permittlicense 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 Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address,telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington.Street
Boston,MA 02111
Tel.#617-727-4900 ext 406 or 1-877-MASSAFE
Revised 4-24-07 Fax#617-727-7749
www.mass.gov/dia
I � .
.. The Commonwealth of Massachusetts
Department oflndustrialAccidents
I Congress Street,Suite 100
Boston,•MA 02114-2017
www.massgov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Llectricians/Plumbers.
TO BE FILED WITH THE PE$MITTING AUTHORITY.
Applicant Information /� Please Print Legibly
Name{Business/OrganizatiotJindividual): JWC®g@� CC"Arth
Address: PO Box 52
City/State/Zip: west PTionel - 02670
Are you an employer?Check the approprlate box: Type of project(required)'
1.EJ I em a employer with ! employees(full and/or part time).• 7. ❑New construction
2. am tole propretor o partnership and have no employees working for me in
❑I al i f
• any capacity.(No workers'comp.insurance required.] ❑Remodeling required.]• ,
3. . I am a homeowner doin all work myself, ] 9. ❑Demolition
❑ g Y (No workers'comp.insurance required t
4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will
10❑Building addition
ensure that all contractors either have workers'compensation insurance or ere sole 11.0 Electrical repairs or additions
proprietors with no employees. 12.❑Plumbing repairs or additions
S.Q I am.a general contractor and I have hired the sub-contractors listed on the attached shut 13.❑Roof repairs
7bese subcontractors have employees and have workers'comp.insurance t
6.❑We are a corporation and its officers have exercised their right of exemption per MOL c. M C26ther Sr�/�•I+.
152,11(4),and we have no employees.(No workers'comp.insurance required.]
$Any applicant that checks box#1 must also rdl out the section below showing their workers'compensation policy infommetion.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such.
tContractors that cheek this box musts- an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the subcontractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation Insurance for my employees Below is the pbUcy and f ob site
Information:
Insurance Company Name: Li c,L bv +
Policy#or Self-ins.Lic.# ✓ wC v 33 Expiration Date:_ ).2.)1) a
Job Site Address: City/StateMim
Attach?copy of the workers'compensation policy declaration page(showing the policy.number and expiration date).
Failure to secure coverage as required under MGL c.152,§23A is a criminal violation punishable bya fine up to$1,500.00
and/or one-year imprisonment;as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a
day against the violator.A copy of this statement maybe forwarded to'the Office of Investigations of the DIA for insurance .
coverage verification.
I do hereby certify and t e Its enalties ojperJury that the Information provided above Is true and correct
Signature; Date: I X I of-IN f
Phone#: CS60 af<u-6 S6,/
OfJlctal use only. Do not write In this area,to he completed by city or town offldaL
City or Town: Permit(License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Cleric 4.Electrical Inspector S.Plumbing Inspector
6.Other
Contact Person: Phone#:
Office of Consumer Affairs and Business Regulation
1000 Washington Street- Suite 710
Boston, Massachusetts 02118
Home Improvem ftpC gtractor Registration
Type: Individual
MICHAEL MCCARTHY 'r:- +. ,' Registration: 169393
P.O.BOX - - ;-, Expiration: 06/15/2021
h. qt:,
WEST DENNIS,MA 02670
Update Address and Return Card.
SCA 1 O 20M-05/17
Office of Consumer Affairs&Business Regulation
HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only
TY,FA:Individual before the expiration date. If found return to:
giglsti*cl ft galration Office of Consumer Affairs and Business Regulation
rr i939e3—, 06/15/2021 1000 Washington Street -.Suite 710
MICHAEL MCC # _?r r' Boston,MA.021It
MICHAEL F.MCCA `-6
r l �. �GGfossck'
6 RANGLEY LN. v;_;: '
SOUTH DENNIS,MA Og660 Undersecretary Not val out signature
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Town of Barnstable
RARN BLUE, ; Building Department Services
9�p 11639. �0 Brian Florence,CBO
ArFD Mai a' Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
Property Owner Must
Complete and Sign This Section
If Using A Builder
I, Brian Wallace , as Owner of the subject property
hereby authorize `l` ��,�- to act on my behalf,
in all matters relative to work authorized by this building permit application for:
49 Weathervane Way Marstons Mills
(Address of Job)
Signature of Owner Signature of Applicant
Print Name Print Name
Date