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Home My WebLink About0132 SPRING STREET 132_ �j n�5 Si-. - - /Ssessor's offioe (1st floor): INEr . :.....0.... ` Assessor's map and lot number ....... ..... �.Q,,,,, o�♦ /�oard of Health (3rd floor): VSewage Permit number .....`3.' %$..�., ... * �., .��zMIST CONNECT TO TOWN SEWER i B�9TSDLL, Engineering Department (3rd floor): +oo 0e 9• House number .I Z— 7 �0 V!�4 APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P,M. only TOWN OF BARNSTABLE BUILDING . INSPECT APPLICATION FOR PERMIT TO ...�t .....I......Y.��`'�..:......... .............................. TYPE OF CONSTRUCTION ... !o r✓�!m.0................................................................................................ tY►c,✓G�'1......4 ..............19..$:I TO THE INSPECTOR OF BUILDINGS: The undersigned hereby app for a permit ac ring to he following information: Location ....(.�� ... .. .. . .. , ...:......�/....... ......... ..G.:�1�/JX.................................................................... ProposedUse .... . ... .. . . . ... .... ...................... ...................................................... ........................................................ ZoningDistrict .................................................... ...................Fire District .......... .:........ ..... .................................. � � r �me of Owner ..... .QS�...........1.YY1.( ..........................Address Q.�....rbl.. ... le� V�. ameof Builder .... .. ......... ............... ..................................Address ... ........................ .................................. VName of Architect ..................................................................Address ................... . .............................................................. Number of Rooms ....! .........................................................Foundation ........ Exierior ...... :^......... ...... ..... .. . . .....................................Roofing Floors .... ..............PAr �y..............................................Interior/.. .i........................ .................................... Heating ... .................................................................Plumbing ...... ... Fireplace .....0.6..................................................................Approximate Cost . ...` .. Ibw- ........ Definitive Plan Approved by Planning Board __________________________ 9 Are .........J.(.�....................... Diagram of Lot and Building with Dimensions Fee " SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS 1 hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name �44"........:........4..... .. Construction Supervisor's License ......... LIMA,_ JOSE No 31726 Permit for .,Add...Do.rme.r....... .... ....... .. Single Family Dwelling Location ..132...Spring..Street................. . ........................H annis...................................... Jose ' Lima Owner ..................................................... .............. Type of v `Construction ........................... ............................................................................... Plot ..................... Lot ................................ "branted .......M.a.r.c.h...2 1..' 88 .. . .......... Permit 19 Date of Inspection ....................................19 Date Cor-fipleted ......................................19 C;) �As essor's offioe-(1st floor)- AssesAssessor's sor's map and lot number N�......... C—�, ••��ETOo`....... ............. ....... VBoard of Health (3rd floor): Sewage Permit number .....��.' .......... .l"�. ..�.<. '� .. r..�/z-7/7� Z BAS39TAX i Engineering Department (3rd floor): ` ° °o 0b 9• e� House number .............................................. ..: .. --............... �n Mpr APPLICATIONS PROCESSED 8:30-9:30; A.M, and 1:00-2:00-'P.M. only' TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ...rt ..... .......r'e�.n..:.........6.11 ...... ....... ...........:Y.. lu o 0 1=✓c.�m TYPE OF CONSTRUCTION ............. ..................CW...................................................................:............................. ✓C.��...-..- ...--..........19.-$ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby apples for a permit accordirig to the following information: Location ....(.. ....... ...... . i.. /!r!. . ..... ........... .................. ... 2.�!J ...............�....... Proposed Use / �.r... < ....... ....................... ...............................................:...... ........................................................ Zoning District ......... ...................Fire District .......... .......... .......... vQ.................................. 1/Name of Owner ......... .Qf�e......... krn.er..........................Address ..... ,..\..... 1 �1��. . ..Address 'Name of Builder ....... ..... J ....................G� _.��........................... Name of Architect ......... ..........Address .......... . Number of Rooms ....� .......................................................Foundation , ' /..� - . Exterior ....... .................... ...... .. . . .....................................Roofing .. / ... .............................. Floors ............................._..................................................Interior/.4.1P,1Cf0 . ......................1!........................ Heatin g Plumbing ......,/r.. �, ................... Fireplace' ..... -_1.........................................`�.�.....................Approximate Cost . ...�..: .>....X. .,�� ........... ..... i Definitive Plan Approved by Planning Board --------- -----------------19 ------ . Area U C VO Diagram of Lot and Building with Di''mensions Fee a SUBJECT TO APPROVAL OF BOARD OF HEALTH I� f . \ 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. Name .... � .............. . 1.............................. 6 f Construction Supervisor's License ��1 /... .......... LIMA, JOSE ' A=328-080 No ... Permit for ..,%dd, Dqrmer 5ing.j!EA..EATiji1 f Dwelliag........ ........ ...... .....y;.................. Location iRcStreet .... . ... . . ................. .....................Hydnni.$............................. ............. Owner ...Jose '. ......Lima..................................... Type of Construction ......Fr.am..e........................ .... ..... ............................................................................... Plot ............................ Lot ................................ Permit Granted .....Ma.r...c..h....2.1...............19 88 ..... .. Date of Inspection ....................................19 Date Completed ......................................19 06? p� v . TOWN OF BARNSTABLE INSULATION 213 141 A R 1 :3 AM 8. 0 MAR g1A>i S{AMtGy SYPA{IOAAI {yPPINq{q IAM Gy11IPP IHigwmm S{IUI{q{ 1-800-696-6611 ' Rk7e; Town of Barnstable D��- PF 3—1 3 _/3 Plegulatory Services Building Division 200 Main St Hyaiuiis, N>A. 02601 Date: Dear Buildin g g Inspector ector Please accept this Affidavit as documentation that Cape Cod Insulation, Inc. performed & completed the insulation and weather12ation wort: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 insulation Installed: Fiberglass Cellulose R-Value Restricted Unrestricted Ceilings Slopes 1 4( ) ( ) ( ) ( ) ( ) Floors (�O ( ) ( ��) ( ') walls 1 OW411 )nt QA) C36) C Av Sincerely He y E C, sidy J , President Cape Lod nsulation, Inc. YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town [which you. must do by M.G.L.-it does not give you permission'to operate.] You must first obtain the necessary signatures on this form 'at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office,.1st FI., 367 Main St., Hyannis, MA 02601 (Town'Hall) and get the Business Certificate that is required by law. �DATE: " J 0 J Fill in please: APPLICANT'S YOUR NAME S: 1 C� ��0 �h7EZE-S AA Q2Cr�V✓ G �1 f E r � BUSINESS YOUR. HOME ADDRESS: I.3oZ S P-i G �7' t-1�/ (y ll�i /lil.lq . DR 60 e6f �vk r,,• 5 % I �°�y,+ � {�,��' -� r erg��, �0�'�15'b3'6� r .. • TELEPHONE( � # Home Telephone Number r tits;�;,'-d 844r aj,�$bv ,.rc�.:,,A - • .. NANIE`OF CORPORATION. •.. NAME'OF NEVI!BUSINESS,;::. 111/. ..1: : ;;. .-,; . 1�: i 1� . TYPE OF.BUSINESS AI '1- IS';'THIS:A E.HOM OC N CUPATIDIV� YES D e. L \ r •: ADDRESS OF B1351NESS...: .).•�J. '.l 3 :'. . f .;. MAP/PARGEL;NUIVIBER; [Assessing) . r When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street) to ke sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING C MISS( ER'S Di= E MUST COMPLY WITH HOME OCCUPATION This indivi ual e n i R ed of n p r t requirements that pertain to this type of business. RULES AND REGULATIONS, FAILURE T0_ COMPLY MAY RESOLT IN PINES: . . A thorize i atPre *' O ME 1 ,s 2. BOARD OF HEATH This individual has been informed of the permit requirements that pertain to this type of business. Authorized Signature** COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: Town of Barnstable ire r Regulatory Services c Richard V. 5cali,Director Building Division nnaxsrn ,E.sr M^� g Tom Perry,Building Commissioner iOTfo�hp2l a 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us E Office: 508-862-4038 ax<50 790-6230 � Approved: - Fee: 3 S Permit#: :P?Fc�- HOME OCCUPATION REGISTRATION Date: A �K q ry,,E� - - _ Name��1Me O w 26 ` e0pJ Phone#: Address: 13,1 6f A N61 S- Village: to *fN>-15 Name of Business: ALL -PA 11��^�� Type of Business: 1 Vo I` e' Map/Lot: m6 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 excee&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 undersignedJ,,7e read and agree with the above restrictions for my home occupation I am registering. Applicant: Date: Homeoc.doc Rev.103113 w TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel AppIicatio,,,t19/7R`71 Health Division Date Issued i Z 1 Conservation Division Application F Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _Preservation / Hyannis Project Street A.dress Z Village `' . �2 p/ Owner -Address Telephone .60 0 0 5 0 Permit Request 1�G�`�l �� ' 6C�?� f 2 Mal l%11 l � Go /Zi v G?� t�l c C /r 5 S � ef Ce :� oqaee ' ?? e . � in proposed Toal"r�ew Zoning District Flood Plain /Groundwater Overlay Project Valuation ov, a Construction Type Lo'rtt lG�.�"td-1 ' Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family .-2' Two Family ❑ Multi-Family (# units) R Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: Ij Yes c0 No CID Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other = r, Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) =- n 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 ❑,Jo If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name �� C'� /. /u/ Telephone Number `,s,f 7.7L5_1-Z /4 Address /o' f1 License # /a D 9 E e a,W,w,/ Home Improvement Contractor# J—e Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 0- ,er2a SIGNATURE DATE /%�- Z-a/Z FOR OFFICIAL USE ONLY R APPLICATION# DATE ISSUED MAP/PARCEL NO. ,l C ADDRESS VILLAGE "t OWNER � s ` DATE OF INSPECTION: FOUNDATION i FRAME INSULATION FIREPLACE Ir ELECTRICAL: ROUGH FINAL L , PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING _ DATE CLOSED OUT 'i IP ASSOCIATION PLAN NO. E s r:t a� The Commonwealth of Massachusetts :Briniv,,Forfirl Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): e; l a Address: �8 &Idat. City/State/Zip: V a IM�}' Phone #: BOO— 1 ' - 1Z 1 Are you an employer? Check t e appropriate box: Type of project(required): l. I am a employer with 20 4. [] I am a general contractor and I ❑ employees(full anor part-time). * have hired the sub-contractors 6. New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub-contractors have 8. F1 Demolition. working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance. $ 9. Building addition required.] 5. FJ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I LE] Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof re a' s insurance required.] t c. 152, §1(4), and we have no �j '119 / employees. [No workers' 13Y Other W ft Tl comp. insurance required.] *Any applicant that checks box 41 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: AaAc- C Av v 10%vao 6i & Policy#or Self ins. Lic. #: WGA OD 22 q 01 Expiration Date: (�- Job Site Address: ' -32, J V l Ur. City/State/Zip: lka j7141,j, I'7lk uz&— r Attach a copy of the workers' compeLation policy declaration page(showing the policy num er 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cer n er the pains i/ enalties o er'ury that the in ormation provided above is true and correct. Si nature: =DateF77 '_'-_)_ Phone#: ' Official use only. Do not write.in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: No, I6U5 N. l y Client#:4597 CCINSUL ACORD., CERTIFICATE OF UABILITY INSURANCE DATE(Mh11DD/YYYy)F IS CERTIFICATE IS ISSUEO AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER`TIQS2 RTIFICATE DOES N01'AFFIRMATIVELY OR NEGATIVELY ANiL Np,EXTEND OR ALTER THE COVLFtAGE AFFORDED BY THE POLICIES LOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTIT UTE A CONTRACT BETWEEN THE IS$UING INSURER(S),AUTIIUR(ZLL) PRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If li cerll(lcft holder ie an AbpITIDNAL INSURi:U,tile).1014(ies)IlIUBt be endorsed.If SUBROGATION 13 WAIVEp,xu�ljur.I lu (IIC(CIIIIS.Ufld COIldlu On`J Ut tf1C POI ICY,"11aIn P011C106 IIIay 1'gl♦UhU all ondortia rllallt.A 5ta to(,,ell,on this CBrtiIT4Nte(I oetl nul CUI1Itl1'rllf Illy tU(IIC Curtlf(catu holder in Ii*u(:If such nndursoment(s). PRUDUCER Gray Ins. -:30. Df11'Ini$ NAME: Mar al'et Y_dull -- ----- PHONE 434 Kauta 134 Arc No Ex1: .156 508 7ti0 4602 rAX—'-- ____.^ EMAIL C N ._B// 1G-2 SDuth UDnnia, MA 426GG-964'I bob 390-/900 I1`10URIU0)AFFORDING COVENA13C NAIL;N •"� INSURER A:Peerless Insurance INS11RkU — -- -,-- Cape Cod Insulation {nc INSURER Evanston Insulance Cnrr►p�lny 455 YarinouLt, RUap wsur.ERc:Atlantic Charter InsLlinnCe 1`Iytuulia, MA 0.G01 INJURERD Commerce Insurance Company -- INSURFRF: ----.—_.__.- ------ _ If I vL 1tgc;ES CERTIFICATE NUMBER: HIS 13 Td CERYF-Y rHAT 'IHL POLICIES OF INSURANCE LI$ o ; I_;,— REVISION NUIV(UER: UI(AILU. NOIWITI-ISTANDING ANY RttOUIREMENT, TERM OR CONDITION IOFEANY CONTRACTOR BEEN ISSUED TO I HOTHER DOCUMENT WIE INSU NAMED TH RESPECT TO wrU VE FOR 'FIE H Mils CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCIf A[I BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL. THE..TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN II HAV9 OCEN RLDUCED BY PAID CLAIMS. IN H AOOL SUER lTR YYPk OF INSURANGE POLICY EFF POLICY EHp POLICY Nvn+well mmiti YYYY mmA)DNYYY LIMJT1: .._- q <,ENLRAL uaalLll r CBP8263063 410112012 04/011201• EACH occuRRenlc 1 ODU UIIU _X_C_0_MMENCIAL GENERAL LIABILITY p Lq 77- ENrEE _I CLAIMS-MADE n OCCUR F��AIISS �«=�<0 91 UU UUD N1CD ExP(Ally and pof80o) $5 0Q0 POR6QNIAL&ADVINJURY T 11L000.000 GENERAL ACTQrzEL3__ nTE $2.000,U_U4 (vL Au;HCOAI k LIMIT APNLIELt PER: PRODUCTS-COMPILIF,AGG s 2,000 Ut1U POLICY�,- Nrtn- ,.L04' 1 --- p AurunloalLkuRawrY 12MMBCKVNih 4/0112012 p4l01/201; COMFl11VE6SINGLEIIMITI AI1Y AUTll E�au:IdePl _^._ 11040,040-_ -"- BODILY IN.IURY(Pc, ) (; ALLOWNED X SCHEI)UL6D. AUTOS __ N0AU'2O - - BODILY INJURY(Pa,i"won,) S X HIRED AUTOo X NON-OWNED PROPERTY OAMAIIk -- AUT09 s H X umeRkLLA UAe _ OCCUR XONJ453512— 4101/2012 04/01/201 -ch ocCURRENCF4.1 � -^-- tNGEti�"LIAk3 �1.000,QQQ AGGREGATE F1 VVU VUV ulu l XI REIr N 1U040NrIO --L—�----- _.L��- 6/3012012 UGI301201 X - � WURKtRti rPMPENtlATIUN --- AND EMPLOYERS'LIABILITY WCA005259U1 l --- ANYPROPWE�Oµ1y.(-17�Dr��PCUTIVk Y)N .-L-......L __ OfFICER/MFM 6 YC L N 1 A C-.L.EwON ACCInkN1' NIL1y_QU QQQ-- (hlnnduWry i„ - It ynn,(Id xC oa ilndnr E.L.DISEASE-EA Cl IPLOY66 •I 004 4U(1 _._-_DESCRIPTION OF OPLIlP,I'IONS Uelaw - E.L.DISEASE-POLICY LIMIT 0 QU0,000 — UC CNII11(ON OF OPERATIONS 1 L0CA(I DNS 1 VLHICLES(A Ll ah ACORU I01,AddI I-I R,, 4Ch@quhl,II M9fo 8pgC8 10 f0pUl18 G) Workers GOrrl()Information++ IIICluddd Officers or Proprietors Certificate Holder is included as an additional insurod unL1Ur Gunaral Liapitity wiloiT squired fay Written contract or agreement. CERTIFICATE HOLDER CANCELLATION -- - --- Cape Cod hwula-tion,Irlc SHOULD ANY OF THE ABOVE DESCRIBED POLICIF-$JAE(;ANI;kLLII RkfURL THE EXPIRATION DATE THEREOF, NOTICI= WILL bE OFLIVEkEU 1N ACCORDANCE WITH THE POLICY PROVNIONS. AUTHORIZED REPRESENI ATIVE ��------ - 20IU1 (I 180 -2010 ACORD CORPORATION,Ali riyht9 resaryiu(. ACuN)zh( V5) 1 of 1 the ACORD name and 1090 aru ra0lstarad(parks ofACORD 9$83840/M83848 MAY Massachusetts - Department of Public Safeth Board'-of-Building Regulations and Standards; (;,onstruption Supervisor License aye• -. Licence: CS. 100988 , HENRY CASSIDY 8 SHED ROW = WEST.`JARMOUTR, MA 02673 Expiration: 11/11/2013 ('rnun issiner Tr#: 7620 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: 12/15/2t14 Tr# 233831 CAPE COD INSULATION, INC HENRY CASSIDY — -- - - --- . 18 REARDON CIRCLE t SO. YARMOUTH, MA 02664 -- -- -- --------- •l- "':;,•,...'` `Update Address and return card.Mark reason for change. Address Renewal Employment Lost Card sCA 1 Co 20M-05/11 �., �`,��r�anrneorau�ecrlC�a�C�/��,cx�:lnc�use 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: 453567 Type: Office of Consumer Affairs and Business Regulation xpiration:, .12I1°5/2014 Private Corporation 10 Park Plaza-Suite 5170 ` Boston,MA 02116 CAPE COD INSULATIOWIN •,,..-- HENRY CASSIDY j:',%~ 18 REARDON CIRCLE SO.YARMOUTH,MA 02664 Undersecretary 400tvalfiho t�natre OWNER AUTHORIZATION FORM e Z e^, , (Owner's Name) owner of the property located at 3Z (Prope y Address) &I � s A74 Gz60 (Property Address) hereby authorize � �� • C� �/ �� (Subcontra'c or) an authorized subcontractor for RISE Engineering, to act on mybehalf to obtain a building permit and to perform work on my property. ' Owner's SignatGr Date _ D _