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HomeMy WebLinkAboutBLD-19-002575 • +e ONE & TWO FAMILY ONLY— BUILDING PERMIT r S . C 'APPLICATION TO CONSTRUCT,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING A • ; • Town of Yarmouth Building Department p���_ � / • c��,,,'7 ,,, 1146 Route 28 • South Yarmouth,MA 02664-4492 `��r l/ /��/fib 508-398-2231 ext. 1261 Fax 508-398-0836 Bc Ote Use Only r� Planning Board Information Assessom Department Information: Permit N6-4019-4/03- Plan Type / Map to Permit Fee $ Endorsement Date [ / lit Recording Dan New Deposit Recd. $.3-5Other7f Date_ an Plan pa 1.4 Property Dimensions: ® ^ Net Due $ \\ o Lot Area(1) Frontage(tt) Lot Coverage .. Mit Section for Orta Use Only_ . Bttitdthg Permit thimbei"a• ;;.;::'.,r- ; (Darfl�isstiettt.•.. • . •.f . • •. __ Win`,. `t� It nn�• . r: Seict10ft t-Site Infy:neat r Use Group:R-4 Type:5-B 1.1 Property Address: 1.2 Zoning Intormaeort 3 e MO, (Y )IuE ST C. 6060 peg . • Zoning District Proposed Use 1.3 Butiding Setbacks(It) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided • 1�. 1.4 Maur Sriph(41-0J- .q,L c.40.554) 1.5 Flood flue Irdeonsdore, Catrsnaree. • ' . Public Private rant We . . O Seals Z'- Property ONmerahip/AWlorizedggent) W 21 Owner of Record' . > - MIN-SL( W e-V& N Igo mouverveQwa floe- etiThavcc Name(print)w Ee�� boo- -7g 840 -6Sly "� Signature s: V u • Telephone • Email Addres MI • C' 1' (17 A Reita 1s-cc cat). ZZ , .�-, lc r Vr/13-Mgt-. n Name(print) Mailing Addres! e\ •.- _.. ����3r7V V97og37 sr&- 740 99Cr a Signature Telephone Fax I NUV Ub MU Seaton 9-Construction Services 1 y — _f S`17 3.1 licensed Construction soLL NC BER44T r1 Supervisor! �Y No al _ G!_� 122_ / ,,z s 7 faaws s»x, ,ie A- 0163 ( License Number AddressCS-07Y. 22.8 775, W7DrS 7 Expiration Date Sgnature Telephone Email Address: `lam -2-a 32 Registered Home Improvement Contractor: I Company Raine ( leo g:esloR..4a.I retvr2.aj: Not Applicable ❑ Address ,�7Email Address: �Z y�y !/fes . • ` / 7[ilI- 7 0 1/3 7 ,E:p6aeon Date Signature Telephone • 7-24 —1-Cj 1 ort ( OVER Sectiort4sWorkeisfComjleitdtinbitlritbrarciiAffidavit(tAtiktet SM*(Mil • Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure - • to provide this affidavit will result In the denial of the Issuance of the building permit. Signed Affidavit Attached Yes . No section a:-Desai•, of Pro.1,;,:a; • WWI(check el ) New Constnlctlon ❑ No.of Bedrooms No.of Bat rooms Existing Bldg. ❑ E=Ia Alteration ❑ Addition 0 Accessory Bldg. 0 Type . Demolition Specify: A D E jf.17 Enitil eke ,f CPA>Q S 7D Azon/T cAntoPA., 0 xoote ol>o( 0 W UEfLaftr Nr-- '6/9Ai AS ter i `vn e t-A/4 V 0b✓ ( T ,e - . (AX-€O ' ��._r / , o�lete-S 0444-6 itJ��R' 110 I ' V Section S- Estimated Cdnstrucdon Castel 13 Item Estimated Cost(Dollan)to be Check Below completed by perms applicant 1. Building 6. 0 ConservatklrrCommbebnFlMg 2.Electrical -4{6r3' (s applicable) 3.Plumbing/Gas 4-Mechanical(HVAC) ❑ Old Kings Hiway �rical ProtectionS.Fire Protection 200 • • Commission e.Total.(t 2+3*4*5) 3axv (s appocabiet IT. Total Square FL Inn has taddle* Sectfott-711•Owner Authddzencet-Rs b.Completed When • Owner's Agent or Contractor Applies for Btillding Permit I. ,as owner of the subject property hereby authorize to act on , my behalf, In aft matters relative to work authorized by this building permit application. sign:urea a Owner Date Section 7b-Oaner/Auth'orrized,A(g�en`t 0 'I \ 1 i��� u)` V.�WKV1YN ��K ��SS , as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Print name Pts---------r /958 / S: Signifies*at OwnalAgent Date 9- IS-99 2 at 2 • The Commonwealth of Massachusetts Department of Industrie:Accidents • Congress Street,Satre 100 • ?=g L.g 3 Boston,M402114-2017 `v www.mass.gov/die Workers'Compensation Insurance Affidavit!Bapders/CantractorslElectrIelans/Plumbers TO BE FILED WITH THE PERMITTING AUTHORITY. Applicantlnfermatlon • Piens Print Legibly Name(Buskess/Orgegratic llnd{vidn), Whalen Restoration Services Address: 22 American Way City/State/Zip:_ South Dennis, MA 02660 Rom if: 508 760 1911 Are yon an employer?Cheek the appropriate bon Type of project(required): • 1.®lamaemployerwith 25 employees Mill andforpurmlnm).• 7. 0 New construction 2.01amasole proprietororpartnership end have noemployees working forme In 8. Remodeling adcepuity.Nowark:me comp.Serene required.] ❑ 3.0Iama homeowner doing ali work myselt tele workers'comp.insure=required)t 9. ❑Demoldon - 4.0!emabomaovmaradwill beMasa comma toconduct aliwent anew property.twin 100 Bâlidlng addition ensure thsten cot tutors either have workers'compensation Insurance oeero sole 11.0 Electrical repairs or additions pftprlatarswftb no employees. , 12.0Plumbing repairs or additions 1.0 lam a genus!ecaaaateert mpl yeesanthealxonhaotemlistedout s attached sheet 13❑ ire These sub contamonhave employees end huewodtem'comp.Immune paha • 6.QWeeraacaspomdonand Its oibcemhave examimdthabrigbtofexempnonperMGL o. 14.00ther 132,gl(4hanewehave no employees,lNo workers'comp.tremeoeotegokcd] *Any applicantthat cheeks box 01 must also tin out the rattan below showing theirworkom'componsadon porky lnfbrma on. tHoreeewaemwho submit alb @Mdavnindlcaenatheywedoing ea work end thenhim outside contra mow rubmiea nowefndavklndiondngsuch tcontreoWrsthetobeoktbis boxrmrstattaohedan additional sheet showing the mune oft suboontreotommd One have employees.If the subronaamors have employees,they must provide their workers'comp.policynumber. lain r matlasloyerthaltsprotddrngworkers'con(pensatloninsuraneefornyeniployeei: Beim itlhepalleyaudjobsiteinffi Insult/co company Name: Ace American Insurance Company Policy#or Self-ins.IA 6S62UB5B89454217 Expiration Date 4/1/19 Job Site Address; Ito P,u C, City/State/Zip; Attache copy of tbe workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MOL o.152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-yeerimprisomnent,as well as civil penalties in the farm of a STOP WORSORDER end a fine of up to$250.00 a day againstthe violator.A copy oasis statement may be forwarded to the Office oflnvesfigations of tho DIA for insurance coverage verification. No herebycenlj,under the pains andpemal fat ofperjuy that thehp/ormadonprovidedaboveistrueandcorrect Skater r/`" Data: "?! SeprvB •Phone#: 77d{ 4K7 —W3 � ' Official use only. Do not write hi thIs o'ez to be conMedby cIty or(mm City or Town: Permit/License# Issuing Authority(circle one)? 1.Board of Health 2.BuildIng Department S.City/TownClerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person! Phone#: vs. aTOWN OF YARMOUTH i BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR� " FORM > Location: ocatiASE n: ( -PC 5-�- � (dam ,` bur- Job Location:— iti Number Owner of Property: �I art IkAC-Okre Village . Construction Supervisor. kiDA\tA-"'L b \ iJ Ci "us 0 79 q2 g 7 71`- y87_pv37 Name License No. Phone No. • Address: I Z-7--- {jvt>, .51-• $eThasi ;e-, Licensed Designee: vbkV1/4 41. 3pkytts ' CS — 06 cg7/ (If other than Supervisor) Name License No. 2.15 Responsibility of each license holden 2.15.1 The license holder shall be fully and completely responsible for all work for which he is supervising. He shall be responsible for seeing that all work is done pursuant to the state building code and the drawings as approved by the building official. 2.15.2 The license holder shall be responsible to supervise the construction, reconstruction, alteration, repair,removal or demolition involving the structural elements of building and structures only pursuant to the state building code and all other applicable laws of the commonwealth, even though he, the license holder, is not the permit holder but only a subcontractor or contractor to the permit holder. 2.15.3 The license holder shall immediately notify the building official in writing of the discovery of any violations which are covered by the building permit. 2.15.4 Any licensee who shall willfullyviolate subsections 2.15.1,2.15.2 or 2.15.3 oranyother section of these rules and regulations and any procedures, as amended, shall be subject to revocation or suspension of license by the board. 2.16 All building permit applications shall contain the name, signature and license number of the construction supervisor who is to supervise those persons engaged in construction, reconstruction, alteration, repair, removal of demolition as regulated by section 109.1.1 of the code and these rules and regulations. In the event that such licensee is no longer supervising said persons,the work shall immediately cease until a successor license holder is substituted on the records of the building department. 2.17 The license holder shall be responsible for requesting all required inspections. Failure to do so may be deemed a violation of the permit conditions. I have read and understand my responsibilities under the rules and regulations for licensing construction supervisors in accordance with section 109.1.1 of the state building code. I understand the construction inspection procedures and the specific inspection as called for by the building official. • INSURANCE COVERAGE I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch.152 Yes jar-- No \0 C_/ If you have checked yes,please indicate the type coverage by checking the appropriate box. A liability Insurance policy [a Other type of Indemnity Ca Bond Ij OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 152 of the Mass.General Laws,and that my signature on this permit application waives this requirement �.----- -�� Check one: signature of Owner or Owners Agent Owner 1] Agent a"------ S i gna ture: "-----_Signature: Building Official Approval: Main L evl S • I L I►UE s-r ifrQ1✓r . A (3a - o LukrEe 1) Mu*&E t— 31' 1" I_ Fri 8'5" X6'4"--115, Q 1, pR'i,/,lhl( 7 N44• Bathroom CoI ' Q O Kitchen Area ^ I N- N Rear Left Bedroom 2 i 'v " 3'2" 1-,..... � o Foot=• q 314- 3'!• O / Co Closet (t) (VI VD l allwa 7 I I En 4'4„�_4' 1„ rn¢��, 18'8" N k N Clos 'lose[ (1) 3'4"—+ ��vjML 1`jNq �J. s;e.Flopezig, Livin°S'ia��m� f.° S 1 (V 11St/4-1400 pp 13" Front Le bedroom ,,,, 0 0 Al 18'4" 0 r..--LI 18' 8" 11'9"• I-• N M t 12'5" a flUaxt Main Level MCNALLY_EMS 10/19/2018 Page: 1 o=• '' ') TOWN OF YARMOUTH ' BUILDING DEPARTMENT now.vg y 1146 Route 28,South Yarmouth,MA 02664 . . 508-398-2231 ext. 1261 Fax 508-398-0836 cri, BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to M.G.L Chapter 40,Section 54 and 780 CMR, Chapter 1,Section 1 115, I hereby certify that thedebrisresulting from the proposed work/demolition to be UPconducted at I;�P 1 ewe— Sr- Work r-Work Address Is to be disposed of at the following location: lI flog-14j Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. a /9 Tlo Signature of Application Date Permit No. ke.......--"" 07/12/2018 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 polfcy(fes)must have ADDITIONAL INSURED provisions or be endorsed. .If SUISROGATION 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 License M 1780862 NoAcr John Powers HUB International New England PHM E>,c (508)945.7866 I FAX . 265 Orleans Road 1 a h (ac,No): North Chatham,MA 02650 PADonass:John.Powers@hubIntemationai.com INSURER(S)AFFORDING COVERAGE NAIL A INSURER A:Arbelia Protection Insurance Company 41360 INSURED INSURER B: • Whalen Restoration Services Inc. INSURER C) Whalen Services Inc. 22 American Way INSURER 0: — South Dennis,MA 02660 INSURER E: INSURER F: 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. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR 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, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SURF; POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD IMM/DD/YYYTI (MMIDDIYYW) . A X COMMERCIAL GENERAL LIABILITY ° EACH OCCURRENCE _ $ 1.000,000 CLAIMS4MADE El OCCUR PPK1799951 04/01/2018 04101/2019 oAMAGero RENTED 100,006 PREMISES IEeawxreneol f — • MED EXP law one Person) $ 5,000 - PERSONAL 5ADV INJURY f 1'000'000 GEM.AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 n 'POLICY0 jTEY 0 LOG PRODUCTS-COMP/OP AGO _S 2,000,000 �1I OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea acddentl $ — ANY AUTO BODILY INJURY(Per person) S OWNED SCHEDULED _ AUTOS1E� ONLY _ AUTOS BODILY BBpO�DILY INJURYpp (Per accident) $ . _ AURTOS ONLY _ AUTOSONLV (PerraCItJmlr lAGE $ • S UMBRELLA UAB H OCCUR SACH OCCURRENCE 3 _ EXCESS UAB II I CLAIMS-MADE • AGGREGATE $ DED RETENTIONS $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN PER IER" AQN�Y�P`ROPRIETORIPARTNERIEXECUTNE U EL,EACH ACCIDENT f . (Manda1ROM/an NES EXCLUDED] N/A E.L.DISEASE-EA EMPLOYEE S 1If yes,demote under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT f DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Addlllonel Remarks Schedule,may be attached If mere space Is required) • CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Ma McNally THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN N y ACCORDANCE WITH THE POLICY PROVISIONS. 16 Pine Street Yarmouthport,MA 02675 AUTHORIZED REPRESENTATIVE I ACORD 25(2016/03) 01988.2015'ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD r A CERTIFICATE OF LIABILITY INSURANCE / DATE(MMIDDIYYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE H07/12/2 OLDER01THIS 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) bjctto the terms and conditions of the policy,certain policies may require an endorsement A statement endorse . If SUROGATION IS on this certificate does not cAIVED on errightsto the certificate holder in lieu of such endorsement s. PRODUCER Eggier HUB INTERNATIONAL NEW ENGLAND LLC ' PHONE . 500945-0448 800 LONG WATER DRIVEeill .., �tlAsl�n� NORWELL INSURED MA 02081 INSURER A' ACE AMERICAN INSURANCE CO WHALEN RESTORATION SERVICES INC 2M 22 AMERICAN WAY - SOUTH DENNIS — MA 02660 _ CERTIFICATE NUMBER: 290830 11111.1111COVERAGES EVISION 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, I�EXCLUSIONS AND CONDITIONS OF SUCH PO�n�L�II+tCIE®®S.LBEEN IMITS SHOWN MAY HAVE REDUCED BY PAID CLAIMS. _R:Ff RIR POLIO F POLICYE%P ■ COMMERCIAL GENERAL LIABILITY MIOD TA :■CLAIMS-MADE OOCCUR EACH OCCURRENCE ran DANA E • 'EN rT . MED EXP An one.:non IMIEMMINIIIME GENT AGGREGATE LIMIT APPLIES PER: PERSONAL 9 ADV INJURY POLICY❑JELOT LOC GENERAL AGGREGATE raIIIIIIIIIIIII I II I. OTHER; PRODUCTS•COMP/OP AGO AUTOMOBILE LIABILITY 11111 ANY AUTO �✓e•I��7-� ■AUTOS ■ AUTOSOIAEDIllallin BODILY INJURY Per Person) ,,,,mmmummimmi HIRED AUTOS 1111 :A AUTOS PROPS- NON-OWNED BODILY INJURY(Per accident)Ian. J PTY AMAGE I:UMBRELLA LIAR 1111 main E%CESS LIAR III,CLAIMS-MADE„ EACH OCCURRENCE • IIII1 COMPENSATION ON ■■AGGREGATE ANDWORKERSEMPLOYERS' YERS.LIABILITY -_ [��, SI AND EMPLOYERS'LIABILITY I ANYPR111 OFFICE T1EMHRIPARTNOED? CUTNE CV" /N © lJ ■IIR;�IUMEMEMIEM - (MandER/MEMNERE%CLUOED7 6S62UBSB89454218 (Mandatory In NH) 04/01/2018 04/01/2019 EL EACH ACCIDENT 5 1,000,000 II yes,describe Under lianaDESCRIPTION OF OPERATIONS below EL.DISEASE•EA EMPLOYE 5 1,000,000 E.L.DISEASE-POLICY LIMIT S 1,000,000 ■ DESCRIPTION OF OPERATIONS/LOCAnON$/VEHICLES(ACORD tot,Additional pemeAe Schedule,may be attached It more epees Is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B.no authorization Is given to pay claims for benefits to employees In slates other than Massachusetts if the Insured hires,or has hired those employees outside of Massachusetts. This certificate of Insurance shows the policy In force on the date that this certificate was Issued(unless the expiration date on the above policy Issue date of this certificate of Insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage- g Search tool at www.mass.govAwd/workers-compensatlonflnvestlgations/. P cY precedes the 9 Coverage Verification CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Mary McNall THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 16 Pine Street y ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Yarmoulhport Da G4-0 MA 02675 Daniel M.C e , Y CPCU,Vice President—Residual Market—WCRIBMA0 1988-2014 ORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered maks of ACORD 07.06.2818 11:33 RB fR%21 PUBLIC FR% SERVICE Foo: To: 5087609995 Page 1 07/06/2018 10:47 0216 PAGE 01 • 1:41. , moo f71t NWLV1194'FiII PAWN* ,,// p 0:91.V/t1 r W60 I !! :patsy Ado*a l01d!aoai edpeiMowpe(Gm) • 13OIAa3$ NGUYLO11131i N31VHM 0;ssoi s!yl w e geogdde slyeueq syi u6lsse (ono)I lueple Mil at PUS JI1om sWt Bulop Ja1'sisllepads uJlep v2ueinsul'83Ouwas Lulea'oossy pun au'ddwd nun Auadwo383UCHNlad u oAW> IP pun ezu n SaLLO# daylne(GM))#I 'ucgeldwo5 u0dn gawked.q A lµgisuodsnJ visomi PNe 1VoM s!4%uuoyed 01 83OIAb13S NOILYIlOLS3a NB1YHM azuotane Agsa9q(em) I-JVom'w azpoy{n(lsnw(m )i 4044 Pue)sJopun(em I 'Riaedojd s14I 10(s)Jeumo eV 'Wm Ai pasnea a®ewep J(edel oi'919Sd YIN 149noluJ?A 19e11S eu!d 911e P0111301d 1$ e<uer f lam w+oyled w Y3.IAIMS NOILYMOJS3V N31YHM ozuolq t(ai ) I auo36sanbab loaau(y Ionia pun uolumpowny'maay Pfuusnvnf9 VQA Dv—'wlw 0zfl wld u k!zijipadg aou?Mewawy • Yonel!floed • SWAM., 1fl5113g oongMUDIj P1011 711MA ups'noat5•'F J •3UI 833WaS uageic lsaU • • • • • • --- t. Commonwealth of Massachusetts Ce tiommosrreenU/e o/'OIZauae%ractb i Division of Professional Licensure Office of Consumer Affairs a Business Regulations Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Constrl&t8rftpervisor TYPE:Coroorallon nea7stretion Fxniratlon CS-074928r �71�lires:08/1012020 129244 07129/2(179 t R HALEN RESTORATION SERVICES INC. 7 t . , & ' F4 r%. , WILLIAM WHALEN V E^ • y 122 POND STREET;• r ' F BREWSTER MA1,2631 1 �, NT' ; • WILLIAM WHALEN �'°�" `I()1057-10�, 22 AMERICAN WAYa SOUTH DENNIS,MA 02660 UnderseCretar - n Q '` • Commissioner• Vjs, • • • • Registration valid for Individual use only before the expiration date. H found return to: Construction Supervisor • Office of Consumer Affairsand Business Regulation Unrestricted-Buildings of any use group which contain 10 Park Plaza-Suite 5170 less than 35,000 cubic feet(991 cubic meters)of enclosed Boston,MA 02116 space. ••. 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