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HomeMy WebLinkAbout0081 NICKERSON DRIVE .p/J 7 `#`MCCARTxY '...n"�E k .. 0 = RUCTION C O. esid -fd -1 and Commensal Builder . a r 77 October 21, 2014 Town of Barnstable Thomas Perry CBO `-mobCa Building Commissioner 200 Main Stret Hyannis, MA 02601 cr RE: Insulation Permits Dear Mr. Perry, This affidavit is to certify that all work completed for permit application#201406294 at 81 NICKERSON ROAD has been inspected by a certified Building Performance Institute(BPI) inspector.All work performed meets or exceed Federal and State requirements Sincerely, Michael McCarthy McCarthy Construction TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map V Parcel OR Application # V Health.Division Date Issued 2 Aq -Conservation Division Application Fe Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/ Hyannis Project Street Address C_1_<<s� . Village Owner C Address,'--"- s•rti Telephone $- Permit Request •-.,Yc 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 supporting documentation. Dwelling Type: Single Family LY" 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.ffz Number of Baths: Full: existing new Half: existing never . Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Roo Count = Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: 0 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 DA*ke McCarthy Construction Telephone Number PO Box 52 Address guest Dennis, M A 02670 License# Cell (508) 280-6964 .-S 586 z HIC ,6®.39.3 Home Improvement Contractor# ii�OV�T�rrc rv� Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Yrr.. SIGNATURE DATE ��� (�'r FOR OFFICIAL USE ONLY APPLICATION# DAME ISSUED r MAP/PARCEL NO. ADDRESS VILLAGE '• �• ;." OWNER e DATE OF INSPECTION: i r :R�FOUNDATION>_;}�-r.=�: • �.�t� a��•� ,..s=:�- - FRAME •{ INS-ULATION_• 4. M=.•� �• • . . FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL / t GAS: ROUGH FINAL FINAL BUILDING` r DATE CLOSED:OUT ASSOCIATION PLAN NO. OWNER AUTHORIZATION FORM ' (Owner's Na ) owner of the property located at R (Property Address) YM S (Property Address) a hereby authorize C I e , (Subcon actor) an authorized subcontractor for RISE Engineering, o act on my behalf to obtain a building permit and to perform work on my property. Owner's Signature Date i 1 F� !J Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction super)isur License: CS-058633 I Is MICHAEL J MCC AR PO BOX 52 ; W DENNIS MA 0267� Expiration Commissioner 04/10/2016 Office of Consumer Affairs and Business Regulation 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. (.•'/ ❑ Address Renewal (J`Employment Lost Card SCA 1 Ei 20M-05/11 .._._._..----__ ...- - - ---- --- - -- l' ' t The Commonwealth of Massachusetts Department oflndustrialAccidents Office of Investigations 600 Washington Street Boston,MA 02111 www.rnass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Blectricions/Plumbers `. Applicant Information Please Print Le ' I Mike c arthy Construction Name(Business/Organization/Individual):_ PO BOX 52 Address: - West Dennis, AIA 02670 City/State/Zip: CSIC ##3 HIC-169393 Are u an employer?Checkthe appropriate box: Type of project(required): 1. I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).• have hired the sub-contractors listed on the attached sheet t 7. ❑Remodeling f 2. am a t: ❑ I a sole prapnetor or partner ship and have no employees Theso sub-contractors have 8. ❑Demolition working for me in any capacity, workers'comp.insurance- 9. ❑Building addition [No workers'comp.insurance S. ❑ We are a corporation and its 10. required] officers have exwolsed their ❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself.[No workers'comp, a 152,§I(4),'and we have no 12,('"I g�fnp n insurance required.]t employees.[No workers' 13. ther comp.insurance required.] *Any appiieml that ehedirs box 91 most also fill out the section bdowshowing their workers'compeasadon policy hdbrmadon. t Homeowners who submit this affidavit indicating they am doing all work and then hire oulside contractors most submit a new oAdavit indicating such. ICoatractors that check this box must attached an additional sheet showing the name of the subcontractors and their workers'camp.policy irfirmadon, lam an employer that Is providing workers'compensatlon Insurance for my employees Below Ia the polky and fob site Information. aInsurance Company Name: P •n• •/��•-� Policy#or Self ins.Mr.ff: VW(- Iclo-tP lxy-" -10 1`1A ExphationDate: Job Site Address: �1�14_&e r s� .., �� City/Stats/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 ofcritninal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as Ctvll 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 DU for insurance coverage verification. Ik I do hereby certo N e a enallin ofpeduiy that the i"r{formadon provided above Is true and correct. ! SigNture: Date: Phone#: Offlktal rise onry. Do not write In this area,to be completed by city or town officiaL t City or Town Permiffleense# : i Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector j 6.Other Contact Person: Phone#. AC40Ro 07/101 CERTIFICATE OF LIABILITY INSURANCE DATE DD/YYYY) OTI10/2014 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 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 Ileu of such endorsement(s). PRODUCER 01962-001 hROJACT Bryden&Sullivan ins Agcy of Dennis Inc � ,,E.: (508)398-6060 ,No,: (508)394-2267 PO Box 1497 �Sss: So Dennis,MA 02660 Dff0_QQYEFAGE _ AIC A SURER A: A.I.M.Mutual Insurance Company 26158 _ INSURED INSURERS Michael McCarthy Construction Inc P 0 Box 52 51 West Dennis,MA 02670 41 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. NOiJViTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO 'AI-ITCH 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. IN TYPE OF INSURANCE INSR POLICY NUMBER LIMITS GENERAL LIABILITY EACH OCCURRENCE S COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTEDPREMISES(Ea ocwtrence) $ CLAIMS-MADE OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES(PER: PRODUCTS-COMP/OP AGG $ __�OLICY F RC0j ��OC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ i ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS ) HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS - UMBRELLA LIAR OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS MADE AGGREGATE $ DED RETENTION $ $ ET oPp/Cpr �l4EfR4/ X TS�t,W, -s °R- A OFFICER/MEMBER EXCLUDED?ECUTIVE NIA VWC-100-6017656-2014A 7/17/2014 7/17/2016 E.L.EACH ACCIDENT $ 500,000.00 (Mandatory In NH) EXCLUDED T E.L.DISEASE-EA EMPLOYEE $ 500,000.00 69MI PT A II&ERATIONS t low E.L.DISEASE-POLICY LIMIT $ 500,000.00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,H 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,,RI02910 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/06) The ACORD name and logo are registered marks of ACORD 01 Expires 6 tl s fro n isoK ReguRato ry Services Fee * BARNSTABLE, MASS.1639. Thomas F.Geiler,Director Building DivisI®In. 6� 7/ Tom Perry,CBO, Building Com23)1 missioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number U 1$ (O 25 2— Property Address [residential Nalue of Work$ �2 �� �O Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address =� -V G A'j2_ N CG Contractor's Name VPcL L- S e_A?_t5AU .- 4- S oi-j.a, Telephone Number Home Improvement Contractor License#(if applicable) .'63`� i 9 Email:' G @_�A 2c�1-vC,T, CO Nj Construction Supervisor's License#(if applicable) ❑Workman's Compensation.Insurance PERMIT Check one: ❑ I am a sole proprietor ❑ am the Homeowner Whave'Worker's Compensation Insurance JLL •2 F 2 2014, Insurance Company Name Workman's Comp.Policy# bi c 3-' 3) S' - -S.a 66�C5 _O / WN®EMNSTABLE Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) � . �Re-roof hurricane nailed (stripping old shingles) All construction debris will be taken to v� N1DU LAlJt7Fl�L. ( ),( PP g g. ) / ❑Re-roof(hurricane nailed)(not stripping. Goinb over existing layers of roof), ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum .35)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red'S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.:Historic,Conservation,etc. 'Note: Property Owner must sign Property' Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: G C:\Users\decollik\AppData\Local\Microso8\Windows\Temporary Internet Files\Content.Outlook\8R76BDVA\EXPRESS.d6c Revised 061313 0 PAUL boom & SONS 11111111 Property Owner Must Complete & Sign This Form If Using a Roofer / Builder. I (print) lick YaE Lr„- , as Owner / Agent of the subject property hereby authorizes Paul J. Cazeault & Sons Roofing Inc. to act on my behalf, in all matters relative to work authorized by this building permit application for: Address of Job V Al[c�<C 5o Al I�P. C-d�T D 6-3 > Signature of Owner Mailing Address of Owner �r/r _!< Zs�,✓ (�� , n 37 Telephone # �r�``f Date Please return this form to Paul J. Cazeault Roofing along with your signed contract. It is needed for us to obtain the building permit required by your town to complete your roofing project fax#508-420-4555 office@cazeault.com M?tCoNnin®mweacltla ofMacssa8chusetts Department of Ilendustrid Accidents Office of Investigations s 600 Waslaington Street Boston,MA 02111 www.manss gov/disc Workers'Compensation IInsuairance Afffndavi$: Builders/Conaraetolrs/IElectffncnaans/Pgumlbei-s ApHlicant Information Please Print Legibly d � Name(Business/Organization/individual): Address: EG 31 /0filr/9/ CitylState/Zip:&k��,����� �,� �,1 Phone#: � ®��77 Are u an employer?Check the appropriate boa: Hype of project(required): 1.Are a employer wi 4. 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 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'' 9. Building addition . [No workers'comp,insurance, comp.insurance) required-] 5. We are a corporation and its t0:❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their i LEI Plumbing repairs or additions myself.[No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c.152,§1(4),and we have no � �` employees.[No workers' 1:;.aOther j�. 6� comp.insurance required.] *Any applicant that checks box#1 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 mist attached an additional sheet showing the name of the sub-contractots and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. lam an employer that is providing workers'compensation insurance for any employees Below is the policy and job site information. Insurance Company Name: ,_ U go wee Policy#or Self-ins.Lic.#: d/106-3 f 3 r 4 70- Od Expiration Date:_ /® Lam/ Job Site Address: 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 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. 1 do hereby certify_underrtthe pains and penalties Qofpperrj t -ury that the information provided above is true and correct. Signature: G '� �� fL� �!`-� Date: 7 220, y _ Phone#: 5��'y // 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 S.Plumbing Inspector: 6.Other Contact Person Phone#: f Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervi%or License:.CS-026325 PAUL J CAZEAUJr`r .. 1031 MAIN ST OSTERVILLE MA 02655�1 ✓f Expiration Commissioner 1012012015 fl n I Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration .. ` Registration: 103714 Type: Private Corporation "t Expiration: 7/9/2016 Trlf 254237 PAUL J. CAZEAULT& SONS, INC ._ ,_ s Paul Cazeault 1031 MAIN ST OSTERVILLE, MA 02658 Update Address and:return card.Mark reason for change. Address Renewal Employment Lost Card SCA 1 ES 20M-05/11 V l& (Yih7lllx/�1pBCl�l�Cf�/IJGCGJJClC1000.iBIIJ h- Office of Consumer Affairs&Business Regulation License or registration valid for individul use only DOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: rr _�egistration 103714 Type: Office of Consumer Affairs and Business Regulation Expiration 7/9/2016 Private Corporation 10 Park Plaza-Suite 5170 z Boston,MA 02116 PAUL J.CAZEAULT&SONS I,NG F, " Paul CazeaultiL ' 1031 MAIN ST OSTERVILLE,MA 02658 Undersecretar /1 Y Not valid withou gnature /lb/'LU1.J b:W):U!1 ADI UbT (16111•—U) CKUf•T: 1000U0—'1'U: L0Uog4ugD:JJ cayc. a va t. CERTIFICATE ®F LIA ILITY:1 SURA11`M'%C!#" :. "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 C E'OF'INSURANCE DOES NOT CONSTITUTE A.CONTRACT:BETWEEN THE ISSUING INSURER.(S)i AUTHORIZED BELOW.: THIS-CERTIFE AT" 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, subjectto the terms And•c6nditions of the policy,certain policies may require an endorsement: A statement,*n.th is.certificate does.not"conferrights to the . certificate holder in lieu of such endorsements." " PRODUCER.DOWLING &O'NEIL INSURANCE AGENCY,INC CONTACT NAME: 973."IYANNOUGH RD PHONE fAIC,No.Exit! FAX We.qo: PO BOX 1990 HYANN IS, MA 02601 EMAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIL 0 INS URER A: LMjn5urance CorpoWtion INSURED INSURER 8: .. PAUL J CAZEAULT&SONS ROOFING INC 1031 MAIN STREET iNSURERC: OSTERVILLE.MA 02655 INSURERD: INSURER E: .. ' .. - .... INSURERF: _ COVERAGES CERTIFICATE NUMBER: 17327850 . REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE.LISTED BELOW HAVE BEEN ISSUED.TO.THE INSURED NAMED ABOVE FOR THE:FOI CY PERIt7b INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR:OTHER.DOCUM.ENT WITH.RESPECT TO,WHICH THIS. CERTIFICATE MAYBE ISSUED"OR MAY PERTAIN, THE INSURANCE AFFORAED 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. " INSR YYPEOFINSURANCE ADDLSUBR POLICYEFF:': .POLICYEXP LTR INSR WVD POLICY.NUMBER- ... MMIDD MMIDDIYYYY LL14iTS GENERAL LIABILITY _ EACH OCCURRENCE COMMERCIAL GENERAL LIABILITY DAE4 (E RENTED RER41 ESES PIIa a a rren� 5 CLAIMS-MADE OCCUR MEO EXP(Any one person) $ PERSONAL&ADVINJURY $ GENERAL AGGREGATE " S GEN'L AGGREGATE LIMIT APPLIES PER:" PRODUCTS•CCPAP1OP AGG S. POLICY M PRO- LOC $ ED AUTOMOBILE LIABILITY (Ee a�Ndenlj INGLE GIMIT._ g". ANYAUTO BODILY INJURY(Per person) $ .: ALLOWNED SCHEDULED BODILY INJURY(Per accident) g AUTOS R AUTOS HIRED AUTOSNON-014NED 1pe0r erME AMAGE. S AUTOS S UMBRELLA LIAB OCCUR EACH OCCURRENCE S" EXCESS LIAR CLAIMS-MADE AGGREGATE ' $ DED RETENTIONS $ 5 S A WORKERS COMPENSATION WC5 31 S 386fi70-013 $(10120.13 8/10/2014 / T rRv L Marrs AND EMPLOYERS'LIABILITY ANY FROPRIETORIPARTNERIEXECUTiVE YIN E.L EACH ACCIDENT g 1000000 . OFFICEirMEMSER EXCLUDED? N NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1000000 If yes,d escrbe under DESCRIPTION OF OPERATIONS Fielovr E.L DISEASE-POLICY.LIMIT 5 . .,1.000000, DESCRIPTION OF OPERATIONS f LOCATIONS!VEHICLES(Attach ACORDiIll,Additional Remarks Schedule,if more,space is required) Workers Compensation insurance coverage applies only to the Workers compensation laws of the state of MA CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVdSIONS, AUTHORIZED REPRESENTATIVE UCL Jef€Eldrid e ©1988-2010 ACORD CORPORATION. Ali rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD RF NO.: 1732 850 CLIENT C DE: 1614182 Anne Chandle 8/16/2013 8:03:3.3 AH P ge 1 of•1 ' �fFhis certificate cance�s and supersedes .AL�L previously issue certificates. i - To Date Time WP ILE Ylpp WERE OUT of Phone,:20i Area Code Number Extension TELEPHONED PLEASE CALL CALLED TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU •URGENT RETURNED YOUR CALL Message pe or AMPAD 23-021 -200 SETS EFF I CIENCY® 23-421 -400 SR CARBONLESS r Town of Barnstable Building Department ComplainyInquiry Report Date: Z - G —9 Rec'd by: Assessor's No.:�a Complaint Name: /L Location 1�2 Address: M/P Originator Natne: Street: // lC_: C/ Village: State:. Zip: Telephone: D/Ir '�� I Complaint a . Description: Inquiry 0 J f Description: For Office Use Only Inspector's Action/Comments Date: ��`��� Inspector. Follow-up hf Action 6 a a9 A CAz4z��-, Additional Info. Attaclied Copy Distribution: vu ite-Department File I'ellocv-Inspector Pkk-Inspector(Return to Office Manager) Q - C7/ -74l/ 03