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HomeMy WebLinkAboutBld-20-002744 ¢`office Use Only pT'Y4 I .'�� --`�' 'Permit# Ou �' H; Amount" — d Permit expires 180 days from 1 issue date EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yarmouth, MA 02664 (508)398-2231 Ext. 1261 CONSTRUCTION ADDRESS: 300 Buck Island Road Unit 13L ASSESSOR'S INFORMATION: Map:47 Parcel:97 OWNER: Sandra Nelson same 508-790-9232 NAME PRESENT ADDRESS TEL. # CONTRACTOR:William McCluskey/Cape Save 7-D Huntington Ave, S. Yarmouth 508-398-0398 NAME MAILING ADDRESS TEL.# ■Residential 0 Commercial Est.Cost of Construction$ 2200 Home Improvement Contractor Lic.# 171380 Construction Supervisor Lie.# IC 102776 Workman's Compensation Insurance: (check one) ❑ I am the homeowner ❑ I am the sole proprietor ■ I have Worker's Compensation Insurance Insurance Company Name: Employers Mutual Casualty Company Worker's Comp.Policy# 5D77852 WORK TO BE PERFORMED Tent Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares Replacement windows:# Replacement doors: # Roofing: #of Squares ( )Remove existing*(max.2 layers) Insulation X Old Kings Highway/Historic Dist. ( )Replacing like for like Pool fencing "The debris will be disposed of at: Yarmouth Location of Facility I declare under penalties of perjury that the statements herein contained are true and correct to the best of my knowledge and belief. I understand that any false answer(s) will be just cause for denial r re Lion of my license and for prosecution under M.G.L.Ch.268,Section 1. Applicant's Signature: \ Date: 11/7/19 Owners Signature(or attachmea attached Date: Approved By: . — Date: //`— �--/� Building Official(or d ' ee) EMAIL ADDRES Zoning District: Historical District: G Yes '11, No Flood Plain Zone: ❑ Yes 0 No iV i i if i i r'F Water Resource Protection District: Within 100 ft.of Wetlands: ' C r44,-, cj,( ❑ Yes 0 No El' Yes 0No `� DJ ' i The Commonwealth of Massachusetts ►'—* ._.!t Department of Industrial Accidents __:lei 1 Congress Street,Suite 100 ;;I•}= Boston,MA 02114-2017 Y `=* ww».massgov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/Individual):Cape Save Inc Address:7-D Huntington Avenue City/State/Zip:South Yarmouth, MA 02664 Phone#:508-398-0398 Are you an employer?Check the appropriate box: Type of project(required): I.a✓ I am a employer with 20 employees(full and/orpart-time).* 7. 0 New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in 8. 0 Remodeling any capacity.[No workers'comp.insurance required.] 3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required.]' 9. ❑Demolition 4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 0 Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.0 Roof repairs These sub-contractors have employees and have workers'comp.insurance.: 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.['Other Insulation 152,§1(4),and we have no employees.[No workers'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 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: Employers Mutual Casualty Company Policy#or Self-ins.Lie.#: 5D77852 Expiration Date: 10/16/2020 Job Site Address: 300 Buck Island Road Unit 13L City/State/Zip:West Yarmouth Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under th pains and penalties of perjury that the information provided above is true and correct. Signature: Date: 11/7/19 Phone#:508-398-0398 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#: _.------"'1 CAPESAV-01 HWOODS ACOROT CERTIFICATE OF LIABILITY INSURANCE DATE(MMIONLYYYY) 4.........--- 10/2/2019 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(les)must have ADDITIONAL INSURED provisions or 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 lieu of such endorsement(s). PRODUCEREWT RogersGray,Inc. PHONE 434 Rte 134 (A/C,No,Eat):(800)553-1801 I WC,Nc):(877)816-2156 South Dennis,MA 02660 lists.,mail®rogersgray.com INSURERS)AFFORDING COVERAGE NAIC# INSURER A:Employers Mutual Casualty Company 21415 INSURED INSURER B:Union Insurance Company of Providence 21423 Cape Save,Inc INSURER C: 7 D Huntington Ave INSURER D: South Yarmouth,MA 02664 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 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, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADM SUER POLICY NUMBER POLICY EFF POLICY EXP LTR INSD WVD ,(MMIDOIYYYY) (MM/DD/YYYY1 UMITS _ A X COMMERCIAL GENERAL LABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR 5D7785220 10/16/2019 10/16/2020 ISEg E ,oe) $ 500,000 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: EBL AGGREGATE $ 2,000,000 A AUTOMOBILE LABILITY COMBINED a acddentlSINGLE LIMIT $ 1,000,000 X ANY AUTO 5Z7785220 10/16/2019 10/16/2020 BODILY INJURY(Per person) $ OWNED SCHEDULED _ AUTOS�Ep ONLY _ AAUUTNOSSy p pBODILY RIINJUpRY(Per accident), $ AUTOS ONLY AUTOS ONLY (P ra t)AMAGE , $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 EXCESS UAB CLAIMS-MADE 5J7785220 10/16/2019 10/16/2020 AGGREGATE $ 2,000,000 DEC X RETENTION$ 10,000 B WORKERS ND EMPLOYERS'UABIUTY YIN ENSATION X STATUTE ER ANYQF �PREOR�PMRIETgOERR/PARTNEWEXECUTIVE 6H7785220 10/16/2019 10/16/2020 500,000 (MendatorMFgNH)EXCLUDED? N N/A E L EACH ACCIDENT $ 600,000 ((IMyyeess describe under EL DISEASE-EA EMPLOYEE $ IDESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Cape Light Compact Joint Powers Entity are included as Additional Insured for General Liability,Automobile Liability&Excess as required by a signed written contract or agreement with the Named Insured. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cape Light Compact Joint Powers Entity THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 261 White's Path,Unit 4 South Yarmouth,MA 02664 AUTHORIZED REPRESENTATIVE I 4 :):07-04/T41 7/116444.A.—."---------- ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD gJ Ae (6 G i1G // Office of Consumer Affairs and Business Regulation One Ashburton Place- Suite 1301 Boston, Massachusetts 02108 Home Improvement Contractor Registration Type: Corporation CAPE SAVE INC. Registration: 171380 7-D HUNTINGTON AVENUE 03/13/2020 SOUTH YARMOUTH,MA 02664 Update Address and Return Card. SCA1 0 20M-05/17 2e' or/en/arane,/a i( '/irwacAe, .'. Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Corporation before the expiration date. If found return to: Expiration Office of Consumer Affairs and Business Regulation 171380 03/13/2020 One Ashburton Place-Suite 1301 CAPE SAVE INC. Boston,MA 02108 WILLIAM MCCLUSKEY CGQ �-- 7-D HUNTINGTON AVENUE SOUTH YARMOUTH,MA 02664 Undersecretary Not valid :+`/ =ignature Commonwealth of Massachusetts Division of Professional Licensure Construction Supervisor Specialty '~ Restricted to: Board of Building Regulations and Standards CSSL-IC-Insulation Contractor Construction5t p4 ispr Specialty CSSL-102776 Ecaires:06/28/2021 WILLIAM J M CLU f. 37 NAUSET ROAD WEST YARMOUTH 3 -- 47,. �� 1. Failure to possess a current edition of the Massachusetts Commissioner A,/.•, State Building Code is cause for revocation of this license. DPS Licensing information visit: WWW.MASS.GOV/DPS r _ Luiiding Permit Authorization I, Sandra Nelson , as owner hereby eive my oermissiori c Cape sa—, 7-D Huntington Avenue '_'" h Yarmouth. MA 02664 508-398-0398 to take all necessary steps to obtain a building permit to perform work at my property located at 300 Buck Island Road - Unit 1�L W. Yarmouth, MA 02673 Signed lAgito.. Q }&11t4) Date 10)2(A (C‘ of•Y44 Office Use Only 4.' 0 ,Permit# O - z r Amount ✓ S u ` 4' r".n c Permit expires 180 days from issue date PiD-20--ag43 EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yarmouth,MA 02664 (508)398-2231 Ext. 1261 CONSTRUCTION ADDRESS: 300 Buck Island Road Unit 8A ASSESSOR'S INFORMATION: Map:47 Parcel:97 OWNER: Karen Lilly same 774-368-0551 NAME PRESENT ADDRESS TEL. # CONTRACTOR:William McCluskey/Cape Save 7-D Huntington Ave, S. Yarmouth 508-398-0398 NAME MAILING ADDRESS TEL.# ■Residential ❑Commercial Est.Cost of Construction$ 2200 Home Improvement Contractor Lic.# 171380 Construction Supervisor Lic.# IC 102776 Workman's Compensation Insurance: (check one) ❑ I am the homeowner ❑ I am the sole proprietor ■ I have Worker's Compensation Insurance Insurance Company Name: Employers Mutual Casualty Company Worker's Comp.Policy# 5D77852 WORK TO BE PERFORMED Tent Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares Replacement windows:# Replacement doors: # Roofing: #of Squares ( )Remove existing*(max.2 layers) Insulation X Old Kings Highway/Historic Dist. ( )Replacing like for like Pool fencing *The debris will be disposed of at: Yarmouth Location of Facility I declare under penalties of perjury that the statements herein contained are true and correct to the best of my knowledge and belief. I understand that any false answer(s) will be just cause for denial r re 'on of my license and for prosecution under M.G.L.Ch.268,Section 1. Applicant's Signature: Date: 11/7/19 Owners Signature(or attachmen attached Date: /� Approved By: Z' Date; // ^'/2— —7/ Building Official(or d EMAIL ADD t Zoning District: j r Historical District ❑ Yes ri No Flood Plain Zone: Yes L No Water Resource Protection District: Within 100 ft.of Wetlands: Yes ri No ❑ Yes DI No I 1 G1 ql _, The Commonwealth of Massachusetts ►� * Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 ww».massgov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/organization/individual):Cape Save Inc Address:7-D Huntington Avenue City/State/Zip:South Yarmouth, MA 02664 Phone#:508-398-0398 Are you an employer?Check the appropriate box: Type of project(required): LEI I am a employer with 20 employees(full and/orpart-time).* 7. 0 New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in 8. El Remodeling any capacity.[No workers'comp.insurance required.] 9. CI Demolition 3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required] 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 Q Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.* 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑✓ Other Insulation 152,*1(4),and we have no employees.[No workers'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 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 site information. Insurance Company Name: Employers Mutual Casualty Company Policy#or Self-ins.Lic.#: 5D77852 Expiration Date: 10/16/2020 Job Site Address: 300 Buck Island Road Unit 8A City/State/Zip:West Yarmouth Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under th pains and penalties of petjury that the information provided above is true and correct. Signature: \\\ Date: 11/7/19 Phone#:508-398-0398 Official use only. Do not write in this area,to be completed by city or town officiaL City or Town; Permit/License i# 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#: ""1 CAPESAV-01 HWOODS ,a►CORO" CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDWYYYY) 4.----- 10/2/2019 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 poiicy(les)must have ADDITIONAL INSURED provisions or 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 lieu of such endorsement(s). PRODUCER C �ACT ROgersGr ,Inc. PHONE 434 Rte 134 WC,No,Est):(800)553-1801 I jam,No):(877)816-2156 South Dennis,MA 02660 Ate;mail@rogersgray.com INSURER(S)AFFORDING COVERAGE NAIL# INSURER A:Employers Mutual Casualty Company 21415 INSURED INSURER B:Union Insurance Company of Providence 21423 Cape Save,Inc INSURER C: 7 D Huntington Ave INSURER D: South Yarmouth,MA 02664 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 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, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR (MOMILIDCO�Y► POUCHY» LIMITS LTR INSD,DOL POLICY NUMBER POLICY A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR 5D7785220 10/16/2019 10/16/2020 S(�E ) $ 500,000 MED EXP(Any one person) $ 10,000 PERSONAL a ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIM�IT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 JECT POLICY X LOC PRODUCTS-COMP/OP AGG $ 2,000,000 Off; EBL AGGREGATE $ 2,000,000 A AUTOMOBILE LIABILITY (COMBINEDEa �SINGLE LIMIT $ 1,000,000 X ANY AUTO — 5Z7785220 10/16/2019 10/16/2020 BODILY INJURY(Per person) $ OWNED SCHEDULED _ AUTOSR�p ONLY _ AUTOS �p PBOODILY INJURYp (Per accident) $ AUTOS ONLY _ AUTOS ONLY (per a t) GE $ $ A X UMBRELLA UAB X OCCUR EACH OCCURRENCE $ 2,000,000 EXCESS LIAB CLAIMS-MADE 5,17785220 10/16/2019 10/16/2020 AGGREGATE 2,000,000 DED X RETENTION$ 10,000 $ B AND EEMMPLOYER'LIAABIIUTY Y/N X STATUTE ERH ANY PROPRIETORIPARTNERIEXECUTIVE SH7785220 10/18/2019 10/16/2020 EL EACH ACCIDENT $ 500,000 QEFn EMBER EXCLUDED? N N/A 600,000 (PMyes storyIdescribe under EL DISEASE-EA EMPLOYEE $ DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space la required Cape Light Compact Joint Powers Entity are Included as Additional Insured for General Liability,Automobile Liability&Excess as required by a signed written contract or agreement with the Named Insured. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CapeLight Compact Joint Powers EntityTHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN g ACCORDANCE WITH THE POLICY PROVISIONS. 261 White's Path,Unit 4 South Yarmouth,MA 02664 AUTHORIZED REPRESENTATIVE I ir -..---)r—OiNzei 7/4e1(444A*--...------- ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD c./ Vo4re/i2witwectitA �� Office of Consumer Affairs and Business Regulation One Ashburton Place- Suite 1301 , Boston, Massachusetts 02108 Home Improvement Contractor Registration Type: Corporation CAPE SAVE INC. Registration: 171380 7-D HUNTINGTON AVENUE Expiration: 03/13/2020 SOUTH YARMOUTH,MA 02664 SCA A soh os�n Update Address and Return Card. <`%L.( rrf.ntoneve,//A n1 ?i'laakac. aetta Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Corooration before the expiration date. If found return to: Registration glarstwo Office of Consumer Affairs and Business Regulation 171380 03/13/2020 One Ashburton Place-Suite 1301 CAPE SAVE INC. Boston,MA 02108 WILLIAM MCCLUSKEY \IZ.CC'/' `' 7-D HUNTINGTON AVENUE (� SOUTH YARMOUTH,MA 02664 Undersecretary Not valid w _,, ,i =ignature ---_____---._...-- Commonwealth of Massachusetts 11,1 Division of Professional Licensure Res Restricted tn: Supervisor Specialty Board of Building Regulations and Standards SInsulation -IC-Insulation Contractor Constructiotr.S 4Vispr Specialty CSSL-102776 - Otpires:06/28/2021 WILLIAM J M, CLU r. 37 NAUSET ROAD _ WEST YARMOUTH 3 -- 4, i,,„, I i�}\1 Failure to possess a current edition of the Massachusetts Commissioner A,/,• reli ""l--- State Building Code is cause for revocation of this license. DPS Licensing information visit: WWW.MASS.GOV/DPS r� - Building Permit Authorization I, Karen Lilly , as owner hereby give my permission to Cape Save, Inc. 7-D Huntington Avenue South Yarmouth, MA 02664 Office: 508-398-0398 to take all necessary steps to obtain a building permit to perform work at my property located at 300 Buck Island Road - Unit 8A West Yarmouth, MA 02673 Signed Date '' /4%�