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0004 ARROWHEAD DRIVE
�{C�+au��roA �o. Town of Barnstable Egufl&ng esaaiss,v •'. t .PP .., . this Card Must be Kept x Post This Card So That it�s Visible From the Street A . roved Plans Must be Retained on Job and Posted Until Final Inspection Has Been Made r � x '��r�y{/��, e Where a Certificate of Occupancy!s Required,such Buildinghall Not:be Occupied until a.Final Inspection:has been made Permit No. B-20-1850 Applicant Name: Michae silva Approvals Date Issued: 07/16/2020 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 01/16/2021 Foundation: Location: 4 ARROWHEAD DRIVE, HYANNIS Map/Lot: 271-049-001 _ Zoning District: RB Sheathing: Owner on Record: GOMES;JOANNA L Contractor Na a - k Framing: 1 Contractor Licenser Address: 4 ARROWHEAD DR 2 -- -- Es • ,ct Cost: $480000 , . HYANNIS, MA 02601 t Pro ie, Chimney: .00 35 Permit Fee: Description: Remove old roof new 30 year landmarks by certainty Perm $ Fee Paid:) $35.00 Insulation: Project Review Req: Date: 7/16/2020 Final: Plumbing/Gas Rough Plumbing: \Building Official -�,, �, This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced withinsix months aftersissuance. Final Plumbing: All work authorized by this permit shall conform to the approved application and the approved construction documenis.for which fhi�s permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall b. in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the Final Gas: work until the completion of the same. d Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are.provided on this,permit. Minimum of Five Call Inspections Required for All Construction Work: Service: 1.Foundation or Footing IX 2.Sheathing Inspection x Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lirnng is installed'" 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Final: 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Health "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: 0 NSF L�v- il�L ,S IE�T TOWN OF BARNSTABLE Permit No. 26521 - - - Building Inspector s,on % Cash s,a � OCCUPANCY PERMIT Bond __— Issued to Bamstable Holding Co. , lnc. Address West Main St., Hyannis �- t=�r�-rtre,etrh .yes L�7�nrc.�- r lot *lA Arrowhead Drive, Hvannis Wiring Inspector Inspection date r. Plumbing Inspector ` Inspection date Gas Inspector Inspection date Engineering Department ` i':�/r/ / '/.� rlr� � Inspection date Board of Health Inspection date 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. ..... -� �,........�_................. 19 � z+ J /`�F r�,•�a�• __ _ fir` Building'Inspector FROM - IF f"` a TOWN OF BARNSTABLE BUILDING DEPARTMENT Town Clerk Francis Lahte ne 867 MAI STREET ' HYANNIS,. AMA 02WI • To - Phone: "n5-1120 SUBJECT: FOLD HERE DATE - - - -- - - October `Ifs, 1984 1; MESSAGE Work has been c<impleted under Build ng.Permit #2652-1 & #26522 (Barntable Hold Company). , Please teleaee Bonds T. DATE - REPLY SIGNED - b} 'Nei-RMI RECIPIENT:RETAIN WHITE COPY,RETURN PINK COPY - PRINTED IN U.S.A. - SENDER: SNAP OUT YELLOW COPY ONLY.SEND WHITE AND PINK COPIES WITH CARBON INTACT. . r G o7 /A 000,� 3 3 5, IV Fr.. , NM -T r 7 7 1; o SKI a,l � , �/-��� Gc-u�•�-�. �w_ Fes,,,, I��,�'c� u-r �c..�� .�-�, c�s�•=ta�S 1 cn I ri�ii PLOTr Foa^w" r- FLAN /O 000 r o� F�4SS %- / o volE -y� Yam-, r'/�:; l�, EL ED IN C1 +sTE yo SCALE o / 30 ' DATE , A, . S MGE E1VGlI�EE�INQ I CERTIFY THAT THE _ CLIENT ��v �vU�v_n r.�.,. ©ISTEREt) REGISTERED SHOWN ON THIS FLAN IS L.00ATQLQ CIVIL LAND J0� �10� 8-- = ON THE GROUND a9 INUICAI Ep al`6G �`NGLI EE�t _ . SU!?yEYOR_ t Y� �4.f1,��. CONFORMS TO THE Z014 hg LAWS . eCH,�Y VP' 6A_RNSTAr�.LE MA8.5 'fi r j 712 MAIN STREET i R �'�' �' / i •�• ..� y , MASS. 18HEET-LOF-L— DATE_ REO. L AN6 SURVEYOR ssessqr's map and lot number ....�.21....... THE Sewage Permit number ...... ......... .3e.1 ......................... Mus Lrr IN CoAr 7, STABLE, Housenumber ................ ......... . ...................................... TITLE t639-- Ar, TOWN OF BARNSTABLE" BUILDING INSPECTOR APPLICATION FOR PERMIT TO ...... ............./...... 00,TYPE OF CONSTRUCTION ..... 0..a...... . .................................................................... ........... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: 6�9 of !a pt Location ....... f........./..........00............... .............. Proposed Use ...... .... .. .4.0# ...................................... .... ......................... ........... /.......................... istict ............. ... . . ........ .. . ............................. t Zoning District ......... . .... ..................................................Fire (� 4j. A C_ 10' �S4 Name of Owner .... .. .. ..... .2 I'PAd.... . . ..Addr Z�e....... ..... ...... . .. . ................... ........... I ILI Name of Builder ...... . A.&:Z Address .......Z1.A�......... 07.4. 0114e9 4�1� Name of Architect Address 0.X'Z.^..........5 . .. ...... ......... 0 . .... ......... .. ;101 Number of Rooms ......... ...................................................Foundation zeo..........enonnaze, ........ Exterior Roofing z.......... 4//,00�z ......................Interior Interior ... ............. ),&4eA"4V_z............... Floors ... ......................z0a..........0 ,��ee�e_ A,,7 -e- Heating ................................ .................................................Plumbing .......e.0......................................................................... Fireplace .(A6,ovxF........................................................Approximate Cost ........ ......................... ...� *.'7.,.*.*.*.*.*.*.* Definitive Plan Approved by Planning Board ------------------------------19-------- Area .........% .. S.-. . 3 Diagram of Lot and Building with Dimensions Fee ................. ....................... SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. No Construction Supervisor's License ...4..�d.,op ,----, U ,,- old - I- - y- W'. Q004ja - ;�.,-I,- -.-,-c". , - , � � ?"-�,,-,�, .,--,, -, T, • - M ,�,,.M , ,, , , , , ;1�r: . T, - � .. .. I - ,•, , ." - �- ,,--- , - �,� �5 , . - ,,, -�l .41 , ',i': , ,.-,---,,.'; -',�; 'i-, . � , , —% —.�—'. ' .--,,. , -, I ,-, - !",I,, c • . .1-,�- " ,-��;,. 4' - - --�-,� --,� - - - I . , -� '6" , !11 k '�...- - .� - , -:`5:;-;.,,-,?-,�-'.�r.� ."',�,"-- I �I:j,�, � . . - 11.����, tr , I ,1� �- . -. . , .��-MANNSA"BL-EAMO WN , ` ,,,.,- -7,�",-' .. ,-,��i , �, . 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I " I . . -- � � .-,- -,- ;:�� ,,, , .�� ., 7 . �I., - ,j - , - I , - ,f", -��': -, - . 1 -4. , f, ". ;-ir--1..,-- ,-1- - -,,--I- - . I .. .- 1. , :,%'." I � -" /I - -, 0 1- ��. �, -- ',. I�-*-' ; -�- I -,�.�'. , . - , , .. p - , ,; 6,!-( .V� ' . , , .-. , - . � . ' - "- - - 1"'..,,,�� - "'I".. ': �: tt. � , , , . I.:--; . - ':.: ''i- -1-. .- "'.1 � .- . , '. . -" . .. ,t & , � , .. C��tc -'-- t, -it"", *,."11", 1-�-� -1� r . , ,' .�,� I�T- - . . - , . . - " ,�. , � ;7 -� -.;� - . . : ; ,�, � - . .. 1�11 44�,4; � � -�,,!�:,�--- �--- --'-,-',---"`� . - !-.--, . � .. � , . 1 � , �I& - -- '�',�,:��t�--' ,;- , ?: --, �11,"I-. -- - . ., - N.-.�. -;-.rh I -, -"I. . . , '. ", ,.,, - ,. . , - . , '. 't -:"- , � �- ,- -, I - -, , I ` .. - - -�. - T kp , .'- -` - , :-, - --:, -�� - � - � , '-� -- ` , ",, - -,��l .;I-�--!,-I�),-----;�,vt`-, --�, , : . ,-, ��-` --,.��.,'Sl--:: ,%----:-"� -� .., .) ��, -,.,. , , --�- ,:��11-11,:,. , -,,;, . " �, .1 - ,�f, -,-, . . . .1 ,,�..-.., -� ..,, ,-"r- - . -77��, V, " , ..�Q,.,, , ,,��,,. ..' , , ;. .� ���y -110, -,� . - � I - ----�-`L , ,, , .:�!�-- - A..-",- -,p , . .S -e� , ;. - A 0 1 a S -! -3 ,,---- . , .I-., , ,� , , -, t , . -" "'i" 'r - - -,k �, - ��, -� ... --,---,, -: ,-%, L�� � ;,- , ,,, � ,-.5.�, -�-,-�--,; -- .'-., s 7 - �-- - - - - - -, ---,� ,-� � ,- -� - ; , , .;7 " ,-,,-,-� ,�, ; ",---.--,.,��� �,A4,� .., �� - " I .�w 1�,,,� . -" -�, ,� , .I-:i �!.�Q - -,� ,��,:, .- .�1. ��:'1.111��11 - . - ".'r�-,, ;,�rL . ,� , �t" -, .,-,.I - . ,�, -�, !� in�_,�0 v _ _ 0 IN r eRI Et't CAPE 0 SAVE . .. r Weatherization 508-398--0398 December 14,2011 Town of Barnstable Thomas Perry CBO Building Commissioner 200 Main St. Hyannis,MA 02601 RE: Building Permits Dear Mr. Perry, This affidavit is to certify that all work completed for permit application#201100830, Status A, Parcel 271049001 at 4 Arrowhead Drive, Hyannis, Permit type: RADD, and issued on 2/24/2011 has been inspected by a certified Building Performance Institute (BPI) Inspector. R-30 Cellulose insulation was added to the attic.All work performed meets or exceeds Federal and State Requirements. Sincerely, William McCluskey Cape Save 7 Huntington Avenue Suite C, South Yarmouth,MA 02664 t TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 2,T k Parcel L( Application 1. i M9, Health Division Date Issued a' k Conservation Division Application Fee �r Planning Dept. Permit Fee 7 Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis (/ Project Street Address Village ktumY S Owner -,�pk4v (y Ac (COM& Address sA-VV4_e, Telephone J 0g J5-3L4 0(1 25� Permit Request bwum , Ili Q C-L1_(A LOSE t& r::,L(7C'Aip®k) Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 4660 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 Kind's Highway O Ye 3 ❑ No ZZ Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area(sq.T 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 E/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 W(I1 o m f% c C I kW Telephone Number 9,3 Address -7 Ci License #i �A&Mo LAT1,$- mA tDZ.�i(oq Home Improvement Contractor# I (1,q q 3 2-- Worker's Compensation # uJ C- 0� 1 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE s s FOR OFFICIAL USE ONLY !. APPLICATION# DATE'ISSUED MAP/PARCEL NO. i ADDRESS VILLAGE r OWNER ti , DATE OF INSPECTION: FOUNDATION FRAME I , INSULATION I t ` FIREPLACE ELECTRICAL: ROUGH FINAL. , PLUMBING: ROUGH FINAL GAS: ROUGH FINAL t FINAL BUILDING ' ,y DATE CLOSED OUT r ASSOCIATION PLAN NO. f - x y U,ffice ofInvestigadons i 600 Washington Street Boston,MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Aoulicant Information Please Print LWbl_v Name(Business/Organintion/Mvidual):- I UACL ��� �1[' -1 -- bi6jp, C ,SAVE Address: Ci /State/Zi : d'v�o Phone#: C(2 - OSO Are you an employer?Check the appropriate box: ❑. I am a general Type of project(required): 1. I am a employer with 4 _ g 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 g, ❑ Demolition working for me in any capacity. employees and have workers' (No workers'comp. insurance comp.insurance.t g• ❑Building addition required:] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doingall work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152,§1(4),and we have no 3a.❑ I am a homeowner acting as a employees.(No workers' 13:(,a'Other , S�t L i�d�►�( - general contractor(refer to#4) comp,insurance required,] *Any applicant that checks box#1 must also Sll out the section below showing their workers'compenawodiioh'cy 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. rContractors that check this box must attached an additional sheet showing the name of the sub-eoatt�and state why or not those entities have employee. If the sub-contractors have employees,they must provide their workers'c l' meA.policy number. 1 an an employer that is providing workers'compensation insurance for my errip/oyees Below is thepollcy d job sfte informadon. Insurance Company Name: ra+A P—T 15 (�J S u AApJ cs= Policy#or Self-ins. Lic.#: UP. [A - -t Expiration Date: 7 Job Site Address: `1 I�RdLc7u1�+t /1-12� City/State/Zip: i 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 herby certify under the Palm and pe of perjury that the information provided above is ftt and correct i lr Phone#• .'SGf'-. � -15" �� OfflC&I use only. Do not write in this area,to be completed by city or town ojj'lcia[ I . City or Town: Permit/License# Issuing Authority(circle one): L Board of Health 2. Building Department 3.CltylTown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: CERTIFICATE OF LIABILITY INSURANCE 1T/1/201410.<DATE(M(d/ Y) 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 I NAMEACT Shannon Sperrazza Risk Strategies Company PHONE (781)986-4400 � �:(761}963-4420 ' 15 Patella Park Drive E-MAIL ss errazza@risk-strata ies.com ADDRESS: p g Suite 240 PRODUCER 00018476 Randolph MA 02368. INSURERS AFFORDING COVERAGE i NA}C#_ INSURED INSURERA:Seneca Specialty Insurance Cc INSURER B.Keating Group Ins Services i .Michael McCloskey, DBA: Cape Save INsuRERC:Chartis Insurance 7 C Huntington Ave ; — INSURER D: INSURER E: South Yarmouth MA 02644 INSURERF: COVERAGES CERTIFICATE NUMBER:CL1011132675 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. 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, j EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR j POLICY EFF POLICY EXP LTR TYPE OF INSURANCE !N ! POLICY NUMBER I MM/DD MM/DDIYYYY LIMITS ��-G-E-NERAL LIABILITY I EACH OCCURRENCE !$ 1,000,000 l X i COMMERCIAL GENERAL LIABILITY I I' { DAMAGE TO RENTED f t j i X i PREMISES(Ea occurrence ;$ 50,000 A i CLAIMS-MADE OCCUR AG1002608 i10/16/2010110/16/2012 ( )- ;$ 10,000 i f MED EXP An one PERSONAL&ADV INJURY 1$ 1,000,000 GENERAL AGGREGATE j$ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG '$ 11000,000 X POLICY i PRO- LOC i -- $AUTOMOBILE LIABILITY 1 COMBINED SINGLE LIMIT $ 1,000,000 I 16208200 '111/6/2010 -11/6/2011 (Eaaccidenq I�ANY AUTO ' + BODILY INJURY(Per person) $ I i ALL OWNED AUTOS I I f►XI I ( BODILY INJURY(Per accident);$ 'SCHEDULED AUTOS - }--? � I E i PROPERTY DAMAGE j I X i HIRED AUTOS i $ I I i(Per accident) it X NON-OWNED AUTOS is X ':.UMBRELLA LIAR OCCUR I i ' EACH OCCURRENCE ;$ 1,OOO,O0O EXCESS LIAB CLAIMS-MADE I AGGREGATE $ 1,000,000 DEDUCTIBLE is B I (RETENTION $ i i023578601 i10/16/2010 10/16/2011 I$ C WORKERS COMPENSATION j )tq I + AND EMPLOYERS'LIAINLITY Y/N I jr is McCloskey i { i X i TORY IMITS I I ANY PROPRIETORJPARTNER/EXECUTIVE i s excluded from coverage' I OFFICER/MEMBER EXCLUDED? I N J A I E.L.EACH ACCIDENT $ 500,000 i(Mandatory in NH) 1 9930951 110/21/2010 10/21/2011; E.L.DISEASE-EAEMPLOYEQ$ 500 000 If yyes,describe under i I DESCRIPTION OF OPERATIONS below i i E.L.DISEASE-POLICY LIMIT $ 500,000 I � I } DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Issued as evidence of insurance. Contractors-Executive Supervisors or .Executive Superintendents. 1 CERTIFICATE HOLDER CANCELLATION (508)790-2425 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Housing Assistance Corp ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Ruth 460 West Main Street AUTHORIZED REPRESENTATIVE Hyannis, MA 02601-3698 Michael Christian/SMS % ==="- ACORD 26(2009/09) 01988-2009 ACORD CORPORATION. All rights reserved. INS025(2oosog) The ACORD name and logo are registered marks of ACORD -' Office of Consumer Affai s and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 164432 Type: Supplement Card Expiration: 10/6/2011 CAPE SAVE WILLIAM MUCCLUSLEY 8201 S. HOURD CT CHAPEL HILL, NC 27516 Update Address and return card.Mark reason for change. Address -? Renewal ! Employment t___ Lost Card Office of Consumer Affairs&Business Regulation License or registration valid for individul use only x before the expiration date. If found return to: `SHONE Ii1APROVEMENT CONTRACTOR x rd Office of Consumer Affairs and Business Regulation Registration: ''164432 Type: 10 Park Plaza-Suite 5170 Expiration `10/6l2011 Supplement Card Boston,MA 02116 CAPE SAVE . ti. WILLIAM MUCCLUSLEY: 7C HUNTING AVE. � ---- S.YARMOUTH,MA 02664 Undersecretary Not valid wit ou signature Department M'1 oblic• Saic°ts T Board ol, Ruildirr r Re,a"I 16(pos ar!!1 � Andards bcense: CS SL 102776 s=Restricted to. IC " ty f ) WIL•OAM MC CLUSKY q 37 NAUSET ROAD WEST YARMOUTH, MA 02673 �-�--—� Expiration: 6/28/2013 f :utn�i-�t.xtr r Tr#: 10277,6 ' r OFIKE r� Town of Barnstable le Regulatory Services WANSrAaLE, ' Thomas F.Geiler.,Director WAM Building Division Tom Perry,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 Z p C S ,as Owner of the subject property 1�� :� , hereby authorize `w � 1 , ' to act on my behalf, in all matters relative to work authorized by this building permit application for. r"Co-I e4::IA SX- W/il%4 V3 1 9�' (Address of Job) nature of Owner Date yj no' Ce!�w, e- :5 Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the.reverse side. Q:F0RMS:0WNERPERMISSI0N .