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Home My WebLink About0105 DUNN'S POND ROAD Town ,of Barnstable Building Department Brien Florence, CBO Building Commissioner. MUST COMPLY WITH HOME OCCUPATION 200 Main Street,Hyannis, MA 026CRULES AND REGULATIONS. FAILURE TO www.town bamstable.ma as COMPLY MAY RESULT IN FINES. Pre-application for Business Certificate p • Date Map .Parcel Applicant Information Applicants Name j>0 P(GLL Appli cants-Address. nnalAddress 21 Telephone Nnmbea 516 cam - S I/ Listed❑ Unlisted ❑ Business Information New Business? ---------------------------------------- Yes No Business isaregisteredcorporation7 ________________________... .Yes If yes Name of Corporation Does business operate under the registered corporate none? Yes ( .No 0 Is the business a sole proprietorship or home occupation?'_--_-----� . No If yes then a Homeroccupation Regisstrat on is regaaed—See Building Division Staff Nmme of Business A r"1j orms 9+' u CP bA Business Address (05 X013 O �S Type of Business ✓/� C1 T Bmlding Commissio er Office Use Only Conditi Building Commis Date Clerk Office Use Only Town of Barnstable Building Department MUST .COMPLY WITH E RE OCLC ATO N �oFTHE rOky Brian Florence,CBO RULES.AND REGULATIONS. Building Commissioner COMPLY MAY RESULT IN FINES. 200 Main Street,Hyannis,MA 02601 suss.i639- •� www.town.barnstable.ma.us � QED MA'1� Office: 508-862-403 8. Fax: 508-790-6230 Approved: Fee: Permit#: HOME OCCUPATION RkGISTRATION Date: ��l�/ Phone#: t� I sea Name• Address: QS \I V 440 69 t Village: Name of Business: (I-F('t6 Type of Business: Gl`'f Map/Lot: �l"l—' 0 INTENT: It is the intent of this section to al ow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1 A of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: The activity is carried on by the permanent resident of a single family residential dwelling unit,located " within that dwelling unit. Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular .matter,odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • , Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. - There is no exterior storage or display of materials or equipment. • There are no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity, and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. I,the undersigned,have read.and agree wiih the above restrictions for my home occupation I am registering. Applicant: Date: Homeoc.doc Rev.10/17 Town of Barnstable Building Department 4 Brian Florence, CBO Building Commissioner 200 Main Street,Hyannis, MA 02601 www.town.barnstable.ma.us Pre-application for Business Certificate Date 1'6 Map,:; Parcel Applicant Information Applicants Name Applicants Address Email Address IiDaW1 L _V>q _pi 2`1 gL�u41{QO -GOB Telephone Number 2q2 9 2.J']- Listed ❑ Unlisted ❑ Business Information NewBusuress. � � `��J� --------------° Y s No Business is a registered corporation? ------------------------- Yes \o If yes Name of Corporation Does business operate under the registered corporate name? Yes `- N Is the business a sole proprietorship or home occupation? - ---___`Ye _ No If yes then a Home Occupation Registration is required—See Building Division Staff Name of Business 7uc,_L'4 or-- E6EBJ Business Address kn` 644060,14 0=0 [t 4 'Acly wl'S W 4- O'Z 6 K10 � Type of Business L=Auke-AP f,zq CC'n t TV Build Commissioner.O ice Use Only jxl_�� C Condit io s - fLh Al U 1l von Building Comnislnei ^ no / F1__LU -Date Clerk Office Use Only Town of Barnstable Building Department oFt►+e lam.`, Brian Florence,CBQ O,* r r Building Commissioner * snxxsTna , * 200 Main Street,Hyannis,MA 02601 y MASS. g 1639• www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Approved: Fee: Permit#: HOME OCCUPATION REGISTRATION Date: Name: � Phone#: 0%' - 2.7-2- o24,`j Address:_ ew 41�1A9e ��91t4 121� fl,,tA-& JS L( dillage: Name of Business: k 6UC LJ ``K` Type of Business: Lt4 pj Map/Lot: c),42 _ I INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter,odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials, or flammable or explosive materials, in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There are no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. _ • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Custom Home Occupation who is not a permanent resident of the P �' P dwelling unit. I,the undersigned, ave read and agree with the above restrictions for my home occupation I am registering. Applicant: �, Date: S 0. MUST COMPLY WITH HOME OCCUPATION Homeoc.doc Rev. 10i17 RULES AND REGULATIONS. FAILURE TO comm..Y MAY RESULT IN FINES. Town of Barnstable v Building Department Brian Florence, CBO Building Commissioner 200 Main Street,Hyannis, MA 02601 www.town.barnstable.ma.us Pre-application for Business Certificate Date c `< Map Parcel Applicant Information Applicants Name _Od 1 ilSC Applicants Address OQAW� L LQ Email Address n tU9Q C1_SUkP pS 12_*j LlAL{tzo -CO Telephone Number SQ�K 242 9 24: Listed ❑ Unlisted ❑ Business Information New Business? En�� _C�__�F_� -0 Y�s No Business is a registered corporation? ________________________. Yes �10 If yes Name of Corporation Does business operate under the registered corporate name? Yes Is the business a sole proprietorship or home occupation? _________`Yesr-� No If yes then a Horne Occupation Registration is required—See Building Division Staff Name of Business 4�f4_L'4 Business Address <<U�-� AG31j ®4�('�`1 F{;. i L (p t, ¢`Z 6L Type of Business L"hw OP t�.5q' 'PiUk a` J . BuiLdi Commissioner O fice Use Only Conditio s I' } V p�� l Building Comssi�nei — ate mi �j Clerk Office Use Only Town of Barnstable Building Department OFTHE l Brian Florence,CB0 Building Commissioner * BARNST ABA. ' 200 Main Street,Hyannis,MA 02601 y MASS. 1 .39• �� www.town.barnstable.ma.us alEO�,1 a Office: 508-862-4038 Fax: 508-790-6230 Approved: Fee: Permit#: HOME OCCUPATION REGISTRATION Date: Name: �ti((�t,7�� `�w9(; Phone#: Address: ti5 J fA 0a(rtt d (Lo fl"tktllQ5 illage: Name of Business: k e)(4 C j4 a l=t1l f1} (� Type of Business: 1. Abe l AeiA t,)L gq Map/Lot: INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal- residential volumes;and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings, and there is no outside evidence of such use. x • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration, smoke,dust or other particular matter,odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials, or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home , Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There are no commercial vehicles related to the Customary Home Occupation, other than one van or one pick-up truck not to exceed one ton capacity, and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as'a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. 4 - I,the undersigned,bave read and agree with the above restrictions for my home occupation I am registering. Applicant A Date:_9 S F MUST COMPLY WITH HOME OCCUPATION Homeoc.doc Rev. 10/1: RULES AND REGULATIONS. FAILURE TO CONAPI:Y MAY RESULT IN FINES. fi dO . f r E f 11/14/14 Thomas Perry, CBO Town of Barnstable Building Division 200 Main St Hyannis, MA 02601 RE: Insulation Permits Dear Mr. Perry, This affidavit is to certify that all work completed for insulation work at 105 Dunn's Pond Road (application#201406361) has been inspected by a certified Building Performance Institute(BPI) Inspector. Al worts performed meets or exceeds federal and State requirements. Sincerely, Conor McInerney ConserVision Energy ` co 4.1 to- 376 ROUTE 130,SUITE C SANDWICH,MA 02563 508-833-8384 WWW.CONSERVTODAY.COM TOWN OF BARNSTABLE BUILDINGPERMIT''APPLICATION ( � Map -�y� Parcel \o\ Application # 7 `i 6(43(01 Health Division tjt C : ? , E POD94 Issued 9-ZG /c/ 1�c Conservation Division Application J "°"'m"""" �° �Planning Dept.- Permit FeeD I V.iS I oq Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address Village Owner ,��,,.C, .� —� ►a cm Address jog a ��S �eN� Telephone sn,. zc,-L bZ.c,-4 04 u Uzi .s , -•_.a gD Permit Request �,.a y e.�yn�_� ,t ate.n+-s �� :Z. t. �ay..w� e�v �•-'�D Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation i.soo . Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family 0�-' Two Family ❑ Multi-Family (# units) Age of Existing Structure \c%3 o Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: dFull ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing Z 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 UrOil ❑ 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 Telephone Number ruin•, Address -"q% License # xo sa,�-�.,.> �.b+ , v---•A oza'b3 Home Improvement Contractor# _ky.t.31 Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO - �"e9...s...� 6 e- ��O vim.V fm �.P►►--��.. .. .,.�_ SIGNATURE DATE N FOR OFFICIAL USE ONLY „< APPLICATION# DATE ISSUED MAP/PARCEL NO. ' r` ADDRESS a VILLAGE OWNER e "K � r it '• .. ..., DATE OF INSPECTION: n. rE j Z *'• r m •cr` rra. a r+ S^r f I`w, ] a ' FRAME , INSULATION •• <A FIREPLACE ELECTRICAL: ROUGH FINAL • S 9 `r PLUMBING: ROUGH FINALr k r GAS: ROUGH FINAL'. ' FINAL BUILDING DATE CLOSED OUT `; ASSOCIATION PLAN NO. Massachusetts -Department of Public Safety Board of Building Regulations and Standards ConstructiMn.Sulwn i or Sl e6olt), Licenser CSSL-10Z778 t CONOR 1)MCINI MNEX 39 SIASCONSE'P�RI6 M SAGAMORE BEACH.Dl41 462;m Expiration Gorr rriissivaer 08/19/2016 Office of Consumer affairs&Business Regulation License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:. 14agiistration: 171251 Type: Office of Consumer Affairs and business Regulation xpiration: 3/1/2016 Partnership 10,Park Plaza-Suite 5170 Boston,ll'fiA 021.16 CON-SERVE,ENERGY CONOR MGINERNE`( 376 ROUTE 130 SUITE C � �__ SANDWICH,MA 02563 Undersecretary Not.valid without signature The Contntonivealth of.119assachusetts kvDepartrnerrt of I dunrial Accidents Ofttce o f hj vestlgatFons 600 Washington Street Boston. MA 02.1,11 'I t�'al vv.►Dt tss.l;ll t'/tl i(t Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lej ibly Name(Cosiness/or�)anizat'iotitlndividueil): ConserVision Energy Address: 376 Route 130 Suite C City/State/Zip: Sandwich, MA 02563 Phone g: 50&833-8384 Are you an employer?Check the appropriate box;: Type of project(required). 1,ER I am a employer with 8 4. ❑ 1 am a genera I a on:uirctor araeI i I I f, ❑.Nest*cottstrnctior: employees(full and/or part-time).* have hired the,sub-contractors 2.❑ i.am a sole proprietor or partner- listed on the attached sheet. 1. ❑ Remade{ing ship and have no employees 'i'hese sub-contractors have 8. ❑ Demolition working for mein an ca ac ity. workers' comp. insurance. b y p ' y, ❑ Building addition [No workers' coop. insurance 5. ❑ we are a corporation and its required,] officers have exercised their 10.❑ Electrical relators or ulditions :.❑ 1 am a homeowner doing all worl-. right or exemption per MGL I LEI Plumbing repairs or additions myself. [No workers' comp. c. 152, §l(4), and we heave.no 1.2.❑ Rtiof repairs insurance:required: employees. [No workers' II[A Other Weatherization comp. insurance required] - -- — Any applicant.that checks box 41 mutt also till out the section help showing,their workers'cunapeni;ation poliev inforn'tat on„ t 13uineo+vneis whet statamn this zatiidavitiodieaiting they arse ddiug all Work and then hire oulside contarctorm must sutatnit a new ttllidavit indteating much., tContractors that check this box must attached an addit.ionat street showing the name v.i'thv sub-cortiraclors aced their workers'colnp.policy inforn alioti. am an employer that it providing workers t otnpensaturn insurance for my employees. Below is the police rind job site information. Insurance Company Name: CS&S/WORKCOMPONE Policy#or Self::ins. Llc, '�6011316340 CxpiratrvnDntc 03/11/2015 Job Site Address: City/Statr/Zip: Attach ra copy of the workers'corripensation policy declaration.page(shoving the policy number and expiration date): I'a lure to se.cure.coverage as required tinder Section 25A of MGL c, 1.52 can lead to the.imposition of c.rinunal petaalties of,a tine up to S1,500.00 and/or one-year imprisonment,as well as civil penalties in the.forin of a sm.P wok.i,MDLtt and a fine of tip to.$250,00 a day against the violator: BPI advised that a copy of thus statement may be torwardc d to the Office of ' investigations of the DiA for insurance,coverage verification: T rlrr hereb ;fj, der th,p 'ns rnd Penalties qfperjury that the information provided above is trite and,currect ------ Date: r \y. !Official use only. Dr not write in this area,to be completed hit cityt or town oflirial. City or Town.: PermitlLicense Issuing Authority(circle one): I. Board of Health 2.Buildi.ng Department 3.Citvfl own Clerk 4-Electrical Inspector 5-Plumbing Inspector 6:Other Contact Persons Phone#: �•:+, nATE.tRaM/Ggh'YYY) :. AC<> CERTIFICATE OF LIABILITY,INSURANCE 03/17/2014 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 T11E CERT4FICATE HDLDE•R. IMPORTANT: if the certificate holder is an ADDITIONAL INSURED,the polky(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 an this certificate does not confer rights to the certificate holor.ip,lieu of such endarsementls). CONTPCT. PRODUCER - E-MAIL�.. '. ID" NAME: CS&SIWORKCOMPONE PRONE FAx PO BOX 946580 (A)C,No Exl)a (AIC„Na. MAITLAND,FL 32794-6580 ADDRESS: Phone-877-7244669 FaX-8TT-T63-51 ZZ INSURER(S)AFFORDING COVERAGE NAIL 4 INSURER on Ctinental Casualty Compan 20443 y t A r- _ INSURED .INSURER.IL. - - CONSERVISION ENERGY 376 ROUT 10 INSURER C Continental Casualty Company INSURER o; y p y 20443 SUITE C SANDWICH,MA 02563 INSURERS Continental Casualty Company 20443 INSURER F COVERAGES CERTIFICATE PLUMBER; REVISION NUMBER: THIS IS TO CERTIFYT1-iAT THE POLICIES OF INSURANCE LISTED BELOW!HAVE BEEN ISSUED TO THE,INSURED NAQ4EO ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REOUIREWENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WIThf RESPECT TO WHICH THIS CERTIFICATE MAY BE WVED OR MAY PERTAIN,THE IINSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUC4i POLICIES,LIMITS SHOWN SAY HAVE BEEN REDUCED BY PAID -CLAIMS.INS RADDL SUSR F8LiCYEFFOL LTR TYPE OF INSURANCE INSR: WVD. POLICY NUMBER MMNooIYYYY) - mwDU LIMITS GENERAL LIABILITY •. EACH-OCCURRENCE � $9,000f000 i COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $300 000 PREMISES(Ea occnnRnce). v CLAUA&MADE ®CICCUR. $10 000 q Y N 6011316335 031i 1l2014 03h I. 15 MED ExP tAn,Ora P«rdn PEaSbNAL6 ADVINJURY. $1,000 000 GENERAL AGGREGATE $21000000 GEN'L AGGRlE—G•—AI.E LIMIT APPLIES PER: PRODUCTS•COMPiOP AGG 5;2,000,000 LI,y t ]e O 1.0^ . .. ... COMBINED SINGLE LIMtT- si.000,000 AUTOMOBILE LIABILITY tEa accid"l) ,,.. ANY AU 10 _ BODILY INJURY(Par pwwj •;-• t ALL OWNED- SCHEDULEi). � A AUTOS � AUTOS N N" 601131IBM 0311112014 0311112015 t3001LY INJURY tees aCUtlOigl a , -HIRED AUTOS NON-OwNeu. P!40MR7Y 0AMAGe _ AUTOS- (par arsrdent) UMBRELLA LIAR OCCUR EACH OCCURRENCE - _,000,000 - .. D EXCESS LiAB CLAIMS+MADE N N 6011,316352 0311'112014 03/11/2015 AGcaEGATE• $1,000,000 DEDRE_TeN1ION S 10,000PENSATION WORKERS COMPENSATION WC ST'Aa'U- OTH- TORYLIMITS -ER AND EMPLOYERS'LIABILITY - - •• `i ANY PROPRIETOR,PARTNER/EAECUTIVE YIN - E.L.EACH ACCIDENT $1,00,000 f OFFICERIMEMBER EXCLUDED? N N 6011316349 03111l2014 03/1112015 (Mandatary in NMI. E,L DISEASE-EA EMPLOYEE $1'00,000 it yes,desuitai ender $500,000 DESCRIPTION OF OPERATIONS t>o,,Ww E.L.DISEASE.,,POLICY LIMIT n£SCRiPTION OF OPERATIONS I LOCATIONS IVEHICLES(AIaChh ACURG tot,Aiiiiii6 l Re arks SU etlule,it mo a space is ra"reti) Certificate Holder is added as an additional insured as provided in the blanket additional insured endorsement. CERTIFICATE HOLDER CANCELLATION - ---- _ ; Ise'- ngginee tng SHOULD ANY OF THE ABOVE DESCRIBED POLICIES SE CANCELLED BEFORE 1341 Elmwood Ave. THE EXPIRATION DATE,THEREOF,NOTICE WILL BE DELIVERED IN Cranston,RI 02910 ACCORDANCE WITH THE POLICY PROVISIONS. IIII AUTHORIZED REPRESENTATIVE Cc71988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 f20101051 The,ACORD name and logo are registered marks of ACORD cpc4955. ConserVision :< e n e r. 9 y OWNER AUTHORIZATION FORM I, Desmond Irving Owner of property located at 105 Dunns Pond Road Hyannis, MA 02601 hereby authorize ConserVision Energy, to act on my behalf to obtain a building permit to perform work on my property. Owner Signature Date