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200 Main Street, Hyannis MA 02601 508-862-4038
Application for Building Permit '
Application No: TB-17-721 Date Recieved: 3/17/2017
Job Location: 135 LAKE ELIZABETH DRIVE,CENTERVILLE
Permit For: Building-Insulation_Residential
Contractor's Name: WILLIAM J MCCLUSKEY State Lic. No: CSSL-102776
Address: , West Yarmouth, MA 02673 Applicant Phone: (508)398-0398
(Home)Owner's Name: PARKE,AVIS-ANN S. Phone: (508)771-8298
(Home)Owner's Address: 135 LAKE ELIZABETH DRIVE, CENTERVILLE,MA 02632
Work Description: Add 2" rigid insulation to the basement.Air seal the basement with expanding foam.
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Total Value Of Work To Be Performed: �� -$3,600.00
Structure Size: 0.00 0.00 0.00 a
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I hereby swear and attest that I will require proof of workers'compensation insurance for every contractor,subwntVactor,or other wo4Z before
he/she engages in work on the above property in accordance with the Workers' Compensation Act(Chapter 568). A r�
I understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by
filing a waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage unless he files his intent to
accept coverage.
I hereby certify that I am the owner of the property which is the subject.of this application or the authorized agent of the property owner and have--
been authorized to make this application. I understand that when a permit is issued;it is a permit to proceed and grants no right to violate the
Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and
specifications. All information contained within is true and accurate to the best of my knowledge and belief.
All permits approved are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24
hours in advance.
Signed: William McCluskey 3/17/2017 (508)398-0398
Applicant Date Telephone No.
Estimated Construction Costs/Permit Fees
Total Project Cost: $3,600.00 Date Paid Amount Paid Check#or CC# Pay Type
Total Permit Fee: $85.00 ' 3/17/2017 $85.00 XXXX_XXXX_X}XX- Credit Card
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Total Permit Fee Paid: $85.00
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