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HomeMy WebLinkAbout0043 ANGELL ROAD e-k .�' OF BARNSTAB F CAPE COD INSULATION m�, � 7)' 'I� IISIR 01137 3[lMllSf SPRAY FOAM SUSPIND[D -a4a Slii! 0UiTIR3 INSUS131ON lIISINOS DIVISION Ii I�'y`N 1-800-696-6611 Town of Barnstable Regulatory Services Building Division 200 Main St Hyan1nis, MA 02601 Date: Dear Building Inspector Please accept this Affidavit as documentation that Cape Cod Insulation, Inc.Iperformed & completed the insulation and weatherization work at the property listed below. Cape Cod Insulation did this in accordance to the specifications listed on the building permit application. All work has been inspected by a certified Building Performance :Institute '(BPI) inspector. All work preformed meets or exceeds Federal & State Requirements. Property Owner Property Address Village Chin 1e, -I M F-qn:fie V 3 Alulz?e-ll Insulation Installed: Fiberglass Cellulose R-Value Restricted Unrestricted Ceilings ( ) ( ) ( ) ( ) 0 Slopes ( ) ( ( ) ( ) Floors ( ) ( ) ( ) ( ) ( ) Walls (V—) �i t r, (vo r /��r),ro r,41 Sincerely 2ryHE ssi r, President Ins ation, Inc. SI —1- - I TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map' ; Parcel Application # ��/SOo CDnS Health Division Date Issued a—to —I� PQ Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Stre utAddress Village �6 Owner (JA&IM0 V 4 Address Telephone � v KV5 Permit Request W W Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation �,c��° Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count _4 Heat Type and Fuel: ❑ Gas ❑Oil ❑ Electric ❑ Other _, Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wo %coal stover ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing 0 new,-3size_ ,-Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: j � Ul)� Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes �No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION 1AVI/bW ca�j( (BUILDER OR HOMEOWNER) ( W-g la Telephone Name hone Number p Address ( V��/ License # Home Improvement Contractor# Email Worker's Compensation # W-�C b 1�?i 6 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PRJEC WILL BE TAKEN TO { r'/ SIGNATURE ` DATE Sib �� t FOR OFFICIAL USE ONLY { APPLICATION# DATE.ISSUED f* ' l MAR/PARCEL NO. ADDRESS VILLAGE '. OWNER n 4 DATE OF INSPECTION: k } FOUNDATION Y t FRAME INSULATION - —- FIREPLACES ELECTRICAL: ROUGH FINAL 1. a PLUMBING: ROUGH FINAL GAS: ROUGH FINAL t' FINAL BUILDING-. DATE:CLOSED OUT ASSOCIATION PLAN NO. Massachusetts - Department-of public Safety :.Board of Building Regulations and Standards Construction Supervisor License: CS-100988., HENRY E CASSIDO' 8 SHED ROW WEST YARMOiFTH t3 Expiration Commissioner 11/11/2015 f/J Pi� Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 153567 Type: Private Corporation Expiration: 12/15/2016 Tr# 259188 CAPE COD INSULATION, INC HENRY CASSIDY 18 REARDON CIRCLE -- SO, YARMOUTH, MA 02664 Update Address and return card.Mark reason for change. scA1 di 20M•05/11 Address Renewal ❑ Employment 0 Lost Card �e t0ar mi&oracoeo,.ZM n19411daccc/uaeM Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date, If found return to: egistration: '153567 Type: Office of Consumer Affairs and Business Regulation xpiration:::,..121115/20:1.6 Private Corporation 10 Park Plaza-Suite 5170 y Boston,MA 02116 CAPE COD INSULATI;Q:N;;;`INC'. HENRY CASSIDY 18 REARDON CIRCLE" 30.YARMOUTH, MA 02664 Undersecretary N valid wi tit sign e The Commonwealth of Massachusetts Department of Industrial Accidenis Office of Investigations a I Congress Street, Suite 100 Boston, MA 02114-2017 www,mass,gov/dia Workers' Compensation Insurance Affidavit; Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl C7AName (Business/Or zation/Individual); Address; 60V City/State/Zip; 1,�GV � � � Phone #; 17G� ''�� r ?j l� Are you an employer? Check he appropriate box: I I am a employer with ' 4. ❑ I am a general contractor and I Type of project (required): 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 g. Demolition working for me in any capacity, employees and have workers' o workers' comp, comp, insurance,t 9, ❑ Building addition [N p, insurance P� 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 11,❑ Plumbing repairs or additions myself, [No workers' comp, right of exemption per MGL i 12 insurance required,] t c, 152, §1(4), and we have no ❑ Roof repairs employees, [No workers' 13,[ Other �( comp, insurance required,] // J *Any applicant that checks box#I must also flll'out the section below showing their workers'compensation policy information. t Homeowners who submit thisV idavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such, tContractors 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 subcontractors have employees,they must provide their workers'comp,policy number. I am an employer that Is providing workers' compensation Insurance—Information, for my employees, Below Is the policy and job site Insurance Company Nam l,'�G e; QVp'.4y Policy# or Self-ins, Lic, Expiration Date: v f�f Job Site Address; City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy numbe and expiration date). Failure to secure coverage as required under Section 25A of MGL c, 152 can lead to the imposition o criminal penalties of a fine up to$1,500,00 and/or one-year imprisonment, as well as civil penalties hi 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 lnsurance"coverage verification, I do hereby certify n r pains and penaltles of per/ury that the Information provided« ove Is true and correct, Signature: Phone#: Official use only, Do not write In this area, to be completed by city or town offlclal, 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#t I � I r I •�.�'®I�L�'" CAPECOD-27 KLIGETT �...�- CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) THIS CERTIFICATE IS ISSUED AS A MA CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.MATTER OF INFORMATION ONLY AND 13/2014 CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the pollCy(les)must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in Ileu of such endorsement(s). PRODUCER CONTACT Rogers&Gray Insurance Agency, Inc. NAME: Barbara DeLawrence 434 Rte 134 PHONE _ South Dennis,MA 02660 EMAIL A/c No: (877 816-2156 ADDRESS: bdelawrence@rogersgray.com INSURERS AFFORDING COVERAGE s _ NAIC N INSURED INSURER A:Peerless Insurance Company INSURERs:COMMERCE INSURANCE COMPANY Cape Cod Insulation Inc INSURER C:Evanston Insurance Company 18 Reardon Circle South Yarmouth, MA 02664 JNSURER D:ATLANTIC CHARTER INSURANCE GROUP INSURER E --- CO ERAGES CERTIFICATE NUMBER: T IS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NIA O D ABOVE FOR THE POLICY PERI.OD IN ICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. .I1R TYPE OF INSURANCE n n POLICY EFF POLICY EXP X COMMERCIAL GENERAL LIABILITY POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS i CLAIMS-MADE X� OCCUR CBP8263063 EACH OCCURRENCE $ 1,000,000 04/01/2014 04l0112015 PREMISES(Ea occurrence) $ _ 100,000 MED EXP(Any one person) $ _ 5,000 GEN'LAGGREGATE LIMIT APPLIES PER: PERSONAL&ADV INJURY $ 1,000,000 X POLICY❑ PRO- JECT LOC GENERAL AGGREGATE $ 2,000,000 OTHER: PRODUCTS-COMP/OP AGG $ 2,000,000 AUTOMOBILE LIABILITY $ I COMBINED SINGLE LIMIT ANY AUTO 14MMBCKVMK (Ea accident) $ _ 11000,000 ALL OWNED X SCHEDULED 04/01/2014 04/01/2015 BODILY INJURY $AUTOS AUTOS X HIRED AUTOS X NOWOWNEO BODILY INJURY(Per accident) $ AUTOS PROPERTY-DAMAGE ------- -- Per accident $ X UMBRELLALIAB• X OCCUR $ EXCESS LIAR CLAIMS-MADE 1 XONJ4$3614 OCCURRENCE $ 1,000,000 DED X RETENTION 10,000 04/01/2014!06/3012* GATE ORKERSCOMPENSATION gate $ 1,000,OOU ND EMPLOYERS'LIABILITY ER NY PROPRIETOR/PARTNER/EXECUTIVE Y/N TATUTE OTH• FFICER/MEMBER EXCLUDED? ❑ N/A WCA00525904 06/30/2014ERMandatory In NH) CH ACCIDENT $ 1,000,000 fyes,describe underEASE-EA EMPLOYEE $ 1,000,000ESCRIPTION OF OPERATIONS belowEASE•POLICY LIMIT $ 1,000,000 SCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be atta )rkers Compensation I v ched I p Includes Officers or Proprietors, 1 more space Is roqulred) ditional Insured status Is provided under the General Liability and Auto Liability when required by written contract or agreement with the Certificate Holder. :R IFICATE HOLDER CANCFI I ATIr)N s ell% OWNER AUTHORIZATION FORM I,- CLAes 11 . % A�&Je (Owner's Name) owner of the property located at `13 � �w5e11• �. (Property Address) AYC,V%t4 A A , O �L G6 f (Property Address) hereby authorize. (Subcontractor) an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my property. Owner's Signature Date TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel li do #1 ` P Health Division Date Issued f?--2'Z-14 f f"7 Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address A►- ;e 1/ a. Village Owner Address s.►-� Telephone egi 17 Permit Request �_A1c��11-.«z��.�., �- )� ec)l,," 4, Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach S,�orting &cur4tation. Dwelling Type: Single Family 9�' Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's f highway:LO Yet❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other cCn Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # 'Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Mike McCarthy Construction Telephone Number PO Box 52 Address west Dennis, M�02670 License # Cell (508) 280-6964 �c�,_�86 3 8✓1�69393 Home Improvement Contractor# Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO J SIGNATURE DATE J2,/S'f�y FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED r MAP/PARCEL NO. C t. K 4 ADDRESS VILLAGE OWNER- DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL ` GAS: ROUGH FINAL a FINAL BUILDING `{ DATE°.CLOSED OUT c ASSOCIATION PLAN NO. .5 Massachusetts -Department of Public Safety Board of Building Regulations and Standards C'unstructiun Supervisor License: CS-058633 MICHAEL J MCCAR PO BOX 52 W DENNIS MA 167 - L ` Expiration Commissioner 04/10/2016 ��� Office of Consumer Affairs and Business Regulation r` 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 169393 Type: Individual Expiration: 6/16/2015 Tr# 238121 MICHAEL MCCARTHY MICHAEL MCCARTHY ---------. --- ------ P.O. BOX 52 ------ -------- ------- WEST DENNIS MA 02670 -------------.--.-.--- -- ✓' Update Address and return card.Mark reason for change. SCA 1 20M-05/11 Address RenewalEmployment Lost Card i;r `•.�'// n � �� _.........----.._.._._....__._.___.__..__..,__...,,_....___..-------. Ilk r The Commonwealth of Massachusetts Department oflndustrW Accidents Office of Investigations 600 Washington Street Boston,MA 02111 lip omnass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print egibly ` Mike McCarthy Construction Name(Business/Organization/lndividuai):. PO BOX 52 Address: West Dennis, MA 02670 City/State/Zip: CS1pMQ.3 HIC-169393 Are u an employer?Checkthe appropriate box: Type of project(required): 1.&I am a employer with�1 4, El I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole propridtor or partner- listed on the attached sheet,t 7. []Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity, workers'comp.insurance. 9. E]Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its ME]Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL I L[]Plumbing repairs or additions myself.[No workers'comp. c.02,§I(4),'and we have no 12.[]R f repairs Insurance required.]t employees.[No workers' comp,insurance required.] 13. they *Any applicant that checks box A must also fill out the section below showing their workers'wmpmatinn policy information. t Homeowners v6o submit this afftdad indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractors that check this box must attached an additional sheet showing the name of the subcontractors and their workers'comp,policy Information. lam an employer that is providing workers'compensai<on hisurmice for my employees Bdoip is the policy and job site irrforniadon, Insurance Company Name: Policy 9 or Self ins.Lie.#: VWL 1w-(�d tjG Expiration Date: Job Site Address: t 77 -1 r 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 ofMGL c.152 can lead to the Imposition of criminal pemalties 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 3 s 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 i Investigations of the DIA for Insurance coverage verification. I do hereby cerfo rf d e pa a enalties ofperjury that lire Information provided above is true and correct Si ature: Date: )1 Y- Phone M. E Offleial use only. Do not iprite in this area,to be completed by city or town of}iclaL f} City or Town; Permlt/Ltcense# ! Issuing Authority(eircle one): 1.Board of Health 2,Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone 9. AC40R& CERTIFICATE OF LIABILITY INSURANCE °ATE`MM/ 07/10/2°01414 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE.OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: if the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER 01962-001 NRaJACT Bryden&Sullivan Ins Agcy of Dennis Inc )J8,JFo,Et): (508)398-6060 ,No,: (508)394-2267 PO Box 1497 �S{}t So Dennis,MA 02660 INSURER(SI AFFORDING COVERA _NAICB IN RE A: A.I.M.Mutual Insurance Company 26158 INSURED INSURER B: Michael McCarthy Construction Inc -- IN E C• P O BOX 52 INSURER D• West Dennis,MA 02670 --- INS RE E: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NG i WITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WI.11CH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NR TYPE OF INSURANCE I sP � POLICY NUMBER AM AW LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DRAMA T ERENTE Da occurnce $PEMISES _ L—�CLAIMS-MADE OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ �— -F PRO- Ir—�OC CT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accide t ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS )—AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS P accide $ $ UMBRELLA LIAR HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS MADE AGGREGATE $ yyp I DDEERDg ppMM RETENTION $ y�g7p7� TH $ gANNyD ERM�PpL�O�YEETRpsR��pUgARBTILNIETY X X TORY LIMITs OR A i OFFICER/MEMBER EXCLUD�?ECUTNE Y� N/A VWC-100-6017656-2014A 7/17/2014 7/17/2016 E.L.EACH ACCIDENT $ 500,000.00 `(Mandatory In NH) E.L DISEASE-EA EMPLOYEE $ 500,000.00 (WCA N OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000.00 I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) Workers Compensation Coverage applies to MA employees only. CERTIFICATE HOLDER CANCELLATION Thielsch Engineering 195 Francis Avenue SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cranston,RI 02910 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE & a ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD f 99�_1S�-7a y� � • • OWNER AUTHORIZATION FORM I, C• S ` P� F (Owner's.Name) T - owner of the property located at (Property Address) { AA (Property.Address) . •ti hereby authorize '1 (Subcontractor), an authorized subcontractor for RISE Engineering, to..act on my behalf to obtain a building• permit and to perform work.on my,property. : ` Owner's Signature E 4 /VI i Date