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0219 COTUIT BAY DRIVE
�� � �� ,� �. �. „ ' .. o- �'' ry �' ..,, i � i� ,� a. ,. ��� n n �� l "' � .�� �� q � � i �,►� Town of Barnstable *Permit# 16— 33q� Expires 6 months from issue date Regulatory Services Fee . E ARrrsrasi e, MAC'1639. Richard V.Scali,Director Building Division Tom Perry, CBO,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Map/parcel Number d 7` O!11 Not Valid without Red X-Press Imprint Property Address °Z/ Ca�JI 6,4 y �yl°J� loTv� [residential Value of Work$ 2 000,vo Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address 61z-kkem r'e!e Contractor's Name G 4 1?y Telephone Number Home Improvement Contractor License# (if applicable) / Email: '- elf Construction Supervisor's License# (if applicable) e5 �t/ y� y' rwo.—,.._ r ❑Workman's Compensation Insurance t Check one: NOV ❑ I am a sole proprietor �'��� 1 7?016 W am the Homeowner ng have Worker's Compensation Insurance C'�p,Vs Insurance Company Name 4 1 k4iq 1�f 4oV,*N� �/l7 �'/l�`� Workman's Comp. Policy# -?Z IV C G 6' "2 0 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 ❑Re-roof(hurricane nailed) (not stripping. Going over existing layers of roof) Re-side 0_2-5 Lec✓ Je Replacement W' dows/doors/sliders.U-Valued (maximum.32) #of windows &/4-R/ ,46 '0 00,61e, !F/&eAM- #of doors: AA ee.10 c Yov Je& j Cv#6F CA y ❑ 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 equ' ed. SIGNATURE: C:\User.s\Decollik\AppMta\L6cal\Microsofl\Windows\Teniporary lntemef Fi1es\Content.0u11ook\2P101 DFIMEXPRESS.doc Revised 040215 Page 7 of 7 Capizzi Home Improvement Inc. Specifications and Estimates STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT I WE, fln�. �'�''' , OWN THE PROPERTY LOCATED AT IN MASSACHUSETTS. I HAVE AUTHORIZED CAPIZZI HOME IMPROVEMENT TO ACT AS MY AGENT TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. I GIVE MY PERMISSION TO LESSEE TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CO SIGNATURE OF OWNER: OWNER'S ADDRESS: OWNER'S TELEPHONE: LESSEE'S SIGNATURE: LESSEE'S ADDRESS: LESSEE'S TELEPHONE: APLLICANT'S SIGNATURE: APPLICANT'S ADDRESS: 1645 Newtown Rd., Cotuit, MA 02635 APPLICANT'S TELEPHONE: 508-428-9518 RESPONSIBLE OFFICER: RESPONSIBLE OFFICER ADDRESS: RESPONSIBLE OFFICER TELEPHONE: 'li.ii,ir<riurrxr///rrir/rr�r(li j Mee of Consumer Affairs&Business Regulation j OME IMPROVEMENT CONTRACTOR Registration: 160740 Type: License or registration valid for indi'Oidul use only Expiration: 6/23/2018 Supplement Card before the expiration date. If found return to: CAPIZZI HOME IMPROVEMENT,INC. Office of Consumer Affairs and.Business Regulation: , 10 Park Plaza-Suite 5170 d GARY GUSTAFSON .Boston,MA,02116 1645 Newton Rd. �..,_. `•.�>,—— Cotuft,MA 02635 Undersecretary f Tot v�%vithout signature ' o (D S. a W y �- D "' CA m0) to c w 4� y = E 0 S• Cda am- C9 . C � � �. f.p� _ k � - 4 �• G fU o O is O C N CL �J y — c .✓� �m t �i v ( nL m I ' TE Aco d CERTIFICATE OF LIABILITY INSURANCEF12/29/201 " °A 5 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 CERTIFICATEINSURANCE DOES NOT AND THE CERTIFICATE HOLDER.CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, IMPORTANT-. If the certificate holder is an ADDITIONAL INSURED,the policy(tes)must be endorsed. ff SUBROGATION IS WAIVED, his to to the terns 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 endorsemen s. PRODUCER i ROGERS&GRAY INSURANCE AGENCY,INC. FAX PHONE No. 434 Route 134INSU S AFFORDING COVERAGE NAIC fISouth Dennis MA 02660 : ArnGUARD Insu ce Com an 2390 INSURED BCAPIZZI HOME IMPROVEMENT INC C:1645 NEWTOWN ROAD D:E:COTUIT MA 02635 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. ILTR POLICY EFF POLICY EXP LIMITS TYPE OF INSURANCE POLICY NUMBER MM/D MMIDD EACH OCCURRENCE $ GENERAL LIABILITY � S DAMAGE TO REMTU- COMMERCIAL GENERAL LIABILITY PREMISES(Ea CLAIMS MADE FI OCCUR MED EXP one S PERSONALBADVINJURY $ GENERAL AGGREGATE $ PRODUCTS-COMPIOPAGG $ GEN'L AGGREGATE LIMIT APPLIES PER: $ POLICY PRO LOC AUTOMOBILE LIABILITY IL INN BODILY INJURY(perperaon) $ ANY AUTO BODILY INJURY(Per accident) S AAUTpg OWNED AUTOS NON-OWNED 1pa, lent) AGE $ HIREDAUTOS AUTOS $ UMBREl1A LJAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS-MADE $ DED RETENTION$ WC STATU OTH. WORKERS COMPENSATION R2WC655250 12/25/2015 2/25/2016 A AND EMPLOYERS'LIABILITY YIN E.L.EACH ACCIDENT $ 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE NIA OFFICER/MEMBER EXCLUDED? N E.L.DISEASE-EA EMPLOYE $ 1 000 000 (Mandatory In NH) E.L.DISEASE-POLICY LIMIT $ 11000100 IDfEeSsCRPON rOaFdOPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Afbch ACORD 101,Additional Remark;Schedule,If more space to required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town Of Barnstable THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis, MA 02601 AUTHORIZED*�' ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 26(2010105) The ACORD name and logo are registered marks of ACORD �c....w..u�w[..►f...as+rv,:a.a..uvw.►woaa..v- _ •- _ ,: .. Depw*nent ofIndarialAeddents 1 Congress S&e4&Ue 100 Boston,MA 02114=2017 www men.gov/dla Workers'Compensat on I ummee Affidavit:BuIlderdConhwWrallE IdandPiumbers. TO BE FILED VflM THE PEBN nTMG AUTHO$=, AmintLntm on Please P1dnt_I;esfh_y1 Name •CAPIM HOME IMPROVEMENT INC Add=s:160 NEWTOWN ROAD - atyaweatp:COTUIT,MA 02635 phone#:508-428-8518 areyou an e R c 1he appeoprlse bo=: Type Of profed( : 1.®I am a employarwi&40 employees(fall andkrpatGthmp 7. ❑New Doti 20lama sole ymprletosor pmtn s*andbaveno amplayM vWddp9 for=3n & ❑Remodeling any awky [NO wadwe CMP rename Nwh&I 9. ❑Demolition 3.0I am ahameamw daft al waft myNZ[No watlosa'Damp.betasucemgWMQ t 4QI am ah=ww=&ad wMbe hhft ooatWW to camdnct aII vM&W MY VmPady.IwID 10 Q Building addiSan eas=do an oo9srima ewer have worioem'canTumadon bw mme or are sole 11.0 Bison W repairs cr additlons V t nD 6MP1oYW8• 12.Q Plumbing repaim or ad8itlons saIamagenialforandlevehimddw slWWontheamdwdsheaf 13 fr�us These havaemplayaea andbavewodoW env.bumsams C 6.Qweamaacrpa�lanandkeo�ImAea�Jsadthetrri�tofonperlldt$.a 14• lf4t/ [� M§1(41,mtdwehavenDemployfas.[Nowaaa'comp imp mmrequh &I tv lax GAJ *Any tlmt dmbbox#1 mnst also fiD aatthe w&owinga t*wo*W ampoodnpolicym an. t Homeoxseas who sabres ft affidavithxUcatmg dWare dohtg eU vwk end than hhe ouaft songs tmm eab®ft a nawaT1avf hd 8D& tCanhacDoastimt�cthls baxmastattachedanadditlonal sha�ttmwingdta tame oftha s andstate oraotthosee have _ =P1pyg• If*vsub aEhwwbaveampl=thaym=tPEe&w wado couqLPa1mi'm=bvt I am an eaployer Md tr prurotdYnW tvor*M'co WM9allon ursurum fnr trg+w9ftm Below Is thepo&7 and fob I& WOMW ML insurance CompmW Name:AmGUARD INSURANCE COMPANY Policy#or Sel us.Lie.#:R2WC527200 gym Dam 12/ 12018 Job Site Address• a C y CU U6'f� �j pd!`A. = 6�J/I YP Attech a copy of the workers'compensation policy declaration page(showft the policy number and eaphvtion date). Failure to wane coverage as required under Mtn,a.152,§25A is a aftin d violation punishable by a Ems up to$1,500.00 and/or oneym imp&onment as well as civil peaaftlas in the form of a STOP WORK ORDM and afire of up to$250.00 a day against the violator.A cxngp ofdtis staftment may be forwarded to The Office of hmwdgadm ofthe DIA for hLwranw ooverage verificatton. I dohereby epatticf ondpenoffid 4lpwjury t1UdMebtfomodonp added abowIs wand cvrr>et .D Z !7 4 Phone#• 18 ,f Q 7"use m . Do nottarlte in 0&and to be mWZ% d by d&or town o fdaL CHy or Town: Pgrn*ffAeem# ImIngAntho ty(rlrele one): 1.Board of Health 2.BaU tg Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION -Map -/Parcel Permit# ?1296 i7 1'1 S Il wD o3rsME Health Division - Date Issued Conservation Division ! i z R3 i;O P ' 6 Application Fee iy Tax Collector Permit Fee Treasurer Oju�� _ ���;`-- SEPTIC OYETEM MUST SE U, . ISfOfd Planning Dept. INSTALLED IN COMPLIANCO Date Definitive Plan Approved b Planning Board WITH TITLE 5 PP Y 9 ENVIRONMENTAL CODE AN[ Historic-OKH Preservation/Hyannis TOM REQUI.C.IONS Project Street Address Village c I y( ""%Owner �GL��I i1/� �� Address z 1 q ez I l f Dom, Telephone Lii �' Permit Request 1 Z �(�' rUD m GdckffibVL iy) olau ( Eex-(3fim _ Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new J� Zoning District Flood Plain Groundwater Overlay Project Valuation $ ZS 9 5-7 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes,attach supporting documentation. J Dwelling Type: Single Family ::�- Two Family O Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes On Old King's Highway: ❑Yes @446— Basement Type: O'Full O Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) 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 . I Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other Central Air: O Yes O No Fireplaces: Existing New Existing wood/coal stove:' O Yes ❑No Detached garage:0 existing ❑new size Pool: 0 existing ❑new size Barn:O existing O new size Attached garage:O existing 0 new size Shed:0 existing ❑new size Other: Zoning Board of Appeals Authorization 0 Appeal# Recorded❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use- Proposed Use BUILDER INFORMATION / q Name D as Zi y-• Telephone Number Address q V�— WA License#. (fS D 5-7 Home Improvement Contractor# f()b7 y6 Worker's Compensation# (f A-WCYOMY3 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO — UbS sj- --S�` SIGNATURE �1U �N DATE < < V FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. u - ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION ; , — ^ i �a FRAME INSULATION o) Zb2loy,w FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL 3 >" GAS: ROUGH `__, FINAL t. FINAL BUILDING 'y J "` �l�`' A6j-- IS DATE CLOSED OUT ASSOCIATION PLAN,NO. S� T� t • U GP\ ' `x b n n�cK 1� a 68 e h�a.ti p� �i 69 1 . 0 70 AC . 0' WIDE EASEMENT (APR X. LOC. FROM PLAN) 119.41— 71 72 MORTGAGE LOAN INSPECTION BON MLI898 SAGAMORE SURVEY ASSOCIATES SCALE: 1 IN.= 50 FT. P.O. BOX 28 DATE: MAY 15, 199 SAGAMORE BEACH, MA. 02562 ;;;' rala„rA,, ;;.\. (508) 888 8667 roNTI.m.ANa I CERTIFY TO N°.ans1n THAT THE LOCATION OF THE BUILDING SHOWN HEREON CONFORMS1� �, TO THE ZONING OF THE TOWN OF BARNSTABLE (COTUIT) }'' °Frss!% " lf.� Q elt.CVf•.{./.a I CERTIFY THAT LOCUS DOES NOT LIE WITHIN THE FLOOD HAZARD y�..+d:rart7:i.+nr ZONE AS DELINIATED ON MAP 0018C COMMUNITY NO. 250001 PLAN REFERENCE: BARNSTABLE REGISTRY OF DEEDS REGISTRY OWNER: BOOK/PAGE: PLAN BOOK 292, PAGE 026 LOT NO.: 69 BUYER: PLAN BY: GARCIA, HANACK & RICHARD DATED: JAN. 3, 1975 BE THIS INSPECTIONFOR FENCES, HEDGOES ORDTOFES ESTABLISH LOTULIINES.SUFORYUSEDOF BANK ONLY. USED f ENERGY CONSERVATION r41PLICATIOIN FORM FOR .. LOW-RISE R.GSIDENTIAL NEW CONSTRUCTION and ADDITIONS 780 CMR Appendix 1 (eflective 3/1/98) Applicant Name: Site Address: . Applicant Address: '/�;��ot/�z/ .f City/Town: Use Group: Date of Application: Applicant Phone: _ y��fl'-�y`—�� Applicant Signature: Compliance Path(check one): Ej Prescriptive Package(Lindled to I-or 2-family wood frame buildings healed with fossil fuels only) Package(A through KK from Table J5.2.1b): Heating Degree Days(MDej) from Table J5.2.la: (For items d. through i., till in all values that apply from Table J5.2.I b:) : a. Gross Wall Area sq-11 f. Wall R-valu' d R- f b. Glazing Area' sq.R. g. Floor R-value R. c30 c. Glazing%(100 x b+a) % h. Basement wall R- d. Glazing U-value U- i. Slab Perimeter R- /U e. Ceiling R-value � j. Healing AFUE E] Component, Performance: "Manual Trade-OtP'(Limited to wood or metal framed buildings only) Climate Zone(from Figure J6.2.2) [] Zone 12 [] Zone 13 0 Zone 14 Attach Trade-Off Worksheet from Appendix J, land HVAC Trade-Off IVorkslieet, if applicable] (� ALMScheck Software Attach Compliance Report and Inspection Checklist printouts. (] Systems Analysis OR (] Renewable Energy Sources Attach Mass Registered Architect or Engineer Analysis ALTERNATIVE FOR ADDITIONS ONLY: a.Gto s Wall +Ceiling Area r qJ1. b.Glazing Area��p_sq.R. c.Glazing%(too x b+a) % ADDITION with Glazing % (c.) up to 40% may use 780 CMR Table J 1.1.2.3.1 below: MAXIMUM U-value - MINtMVM R-Va ues Fenestration .eilio Wall I Floor I Basement Wall I Slab Perimeter,Depth 0.39 1 R-37 I R-13 I R-19 1 R-10 I R-10,4 It [] "SUNRO.OM"addition(greater than 40% glazing-lo-wall and celling gross area) Attach"Consumer Infonnation Fortn" from 780 CMR Appendix 0. Official's Name: Official's Signature: Application Approved [] Denied [] Dale of Approval/Denial: Reason(s) for Denial: (provide additional details as needed on back side) t Glazing Arta may be either Rough Opening or Unit dimensions. netts 06112NI f T/te Contntorrlveallh ofMassachr,serls Ueparlinenl of Itidustrial Accidents .= 011fce 011nyesd9JUMS 600 Washington Street _—���•. Boston, Mass. 02111 Workers' Compensation Insurance Affidavit �bl�►�t2S L�l��� location: city phone N k7 I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers compensation for my employees working on this job. Co vany nanic Pro L �Laf,r S11Y' Al-, �� 0tone He f R• � ���t� po i y N L ^ I am a sole proprietor, general contractor, or homeowner(circle one) and have hired the contractors listed below who Ila-- the following workers'compensation polices: company name: address•. cry: ,hone N. Durance:cd: Pplicv N fzllna_ny name: .........:::.. . address: city: phone N• insurance,co. policy N Failure to secure coverage as required under Section 25A of 111GL 152 can lead to the imposition of criminal penalties of a fine up to S1.500.00 andim one years'Imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. 1 understand that a copy of this statement may be forwarded to the Office of Investigations of(lie DIA for coverage verification. t do hereby certify under the pains and penalties of perjury that the information provided above is true a d corr/eea Signature l�(�< �ZU V ° Date t Print nano ` ! Phonc N 1/0? Y �EI official use only do not write in this area to be completed by city or town official city or town: permit/license ff f—lBuilding Department I OLicensing Board check if immediate response is required oSeleetmen's Office F. 0I1ealth Department is contact person: phone H, flOther prwimd V95 PJA1 .S" ��I; 'V/09J74ltOftllJCIlIA/L 0���.Qd1Q�tl16CQO . lionrd of ISuilding Regulallons and Standards I; pp HOME IMPROVEMENT CONTRACTOR J1 Registration: 100740 Expiration: 6/23/2004 Type: Private Corporation CAPIZZI HOME IMPROVEMENT, 91romas Capizzi,jr. 1645 Newton Rd. -,��,�u✓ Coluit, MA 02635 Administrator OTI. l)OF BUILDING REGULATIONS BOAR License: C10NSTRU.CTION SUPERVISOR ` Numbers 057032 Blrthdate Q9/26/1963 Tres 0912'**"' ' 5 Tr.no: 7171.0 i THOMAS X CAPIZZI=JR' 1645 NEWTOWN RD. COTUIT, MA 02635 Administrator C!J/Lb/LCICJ:J 1J.L1 :�elti I bYJ14YJ/ I`IUKl;KU55 & LL1UH I LIN I"Aut ul ACORD_ CERTIFICATE OF LIABILITY INSURANCF�g�i °�o/` 26 03 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER 5PTNFORMATION Norcross C Leig}iton Cape Loc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE C.J.Mocarthy ins.Agency,Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 437 station Ave ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. So.Yarmouth WA 02664 INSURERS AFFORDING COVERAGE 1Phono: 50B-394-0946 lax:509-760-1407 INSURED INSURER A: fttiOnal Gran a Wutual Ins. Ce INSURER B: Bafety Insurance C AA C�3t z i Home wrovement Inc. INSUREnc Guard Insurance GromR 11 7 e�vt0� R� INSURER D Gotui !Q1► OY6 INSURER ' COVERAGES THE POLICIES OF INSURANCE LISTEO 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.AGGREGATE LIPATS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE POLICY NUIMER m9uwAE -WRAWrLIMITS oeNERAL LIABILITY EACH OCCURRENCE f 1000000 A X COMMERCIAL GENERAL LIABILITY MPS02733 04/01/03 04/01/04 RIREDAMAGE(Anyomfim) f 300000 CLAIMS MADE 1 OCCUR MED ExP(AgYPn.P.naen) 010000 PERSONAL L ADV INJURY f 1000000 OENERALAGGREGATE f 2000000 OWL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/oPAGD f 2000000 POLICY JEECT 0LOC AUTOMOBILE LIABILITY BICOMBINED SINGLE LIMIT f B ANY AUTO 1601064 04/01/03 04/01/04 ALL OWNED AUTO$ BODILY INJURY $1000000 X SCHEDULED AUTOS (P«pMon) X HIRED AUTOS ROOILY INJURY S 1000000 X NOWUMFI)AUTOS .ak�nq PROPERT/DAMAGE 1500000 a'w wddonq GARAGE LIMILITY AUTO ONLY.GA ACCIDENT f ANY AUTO Tl♦AN SA ACC f NLY:M% AGO S Excess LIABILITY EACH OCCURRENCE f OCCUR CLAIMS MADE A00REOATE f f DEDL=RLE S RETENTION f f wORKrR5COMPENRATIONAND X NMI C EM►LOYERV LIABILITY CANC401043 01/01/03 01/01/04 E.L.EACH ACCIDENT f 100000 LL.DISEASE,FAEMPLo S 100000 LL,DISEASE•POLICY LIMB I f 500000 OTHER DEBCRIFTIoN OF TIONM.00ATION&YEHICLES/EX UgONb ADDED BY ENDORSEMENTfSPECULL►ROYfO S CERTIFICATE HOLDER 114 1 ADDITIONAL INSURED;INSURER LETTER: CANCELLATION CWWLD ANY OP THE ABOVE DISCRIBEo FVLK7IES EE CANCELLED BEFORE THE EXPIRATION • • . • . • . DATE THEREOF,THE ISEUDNO MsURER WILL eNOEAVOR TO MAIL ,1 D DAYS WRITTEN NOTICE TO TN■CBATIPICATE HOLDER NAMED TO THE LEFT.BUT FAILURE TO DO 30 SHALL ' IMPOSE ND OBLIGATION OR LIMILITY OF ANY KIND UPON THE INSURER.ITS AGENTS OR REPResENTATNBS. AM, SWCTAT ACORD 25-6(7/97) CACORDCORPORATION INS #,?76411 CAPIZZI HOME IMPROVEMENT INC . SPECIFICATIONS AND ESTIMATES PAGE 11 OF 12 STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT I, OWN THE PROPERTY LOCATED AT IN MASSACHUSETTS. I HAVE AUTHORIZED �� �-��` Ae e � ✓®"e �� TO ACT AS MY AGENT TO APPLY FOR A BUILDING PERMIT IN A CORDANCE WITH 780 CMR, THE MASSACHUSTTS STATE BUILDING CODE. I GIVE MY PREMISSION TO LESSEE TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. SIGNATURE OF OWNER: n OWNER'S ADDRESS: L®�Li T OWNER'S TELEPHONE: Z LESSEE'S SIGNATURE: LESSEE'S ADDRESS: I LESSEE'S TELEPHONE: APLLICANT'S SIGNATURE: APPLICANT'S ADDRESS: 1645 NEWTOWN RD. , COTUIT, MA 02635 APPLICANT'S TELEPHONE: 5081428-9518 RESPONSIBLE OFFICER: RESPONSIBLE OFFICER ADDRESS: RESPONSIBLE OFFICER TELEPHONE: ACCEPTED BY DATE THIS PAGE IS PART OF AND IN CONFORMANCE WITH PROPOSAL #27641 � a I RESIDENTIAL BUILDING PERNHT FEES APPLICATION FEE New Buildings,Additions $50.00 Alterations/Renovations $25.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE 19.1 square feet x$96/sq.foot= 19 4 3 x.0031= plus from below(if applicable) ALTERATIONSMENOVATIONS OF EXISTING SPACE square feet x$64/sq.foot= x.0031= plus frombelow. (if applicable) GARAGES(attached&detached) square feet x$32/sq.ft.= x.0031= ACCESSORY STRUCTURE>120 sq.ft. >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= x.0031= STAND ALONE PERTYMS Open Porch x$30.00= (number) Deck x$30.00= (number) Fireplace/Chimney x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 I Relocation/Moving $150.00 (plus above if applicable) Permit Fee '�$7 L I D C-ti 57 A 11 i),VW,j -A)k 4-T CA) off aPvf 91-7- la o 7-H 7'.4#Q Y?-3 No bTDIZ.4A '7,cA!,0 fi-r-C&I /'IT fATYl 514cp G16- t7'OJP Ljx.& -1 y A A DJu5r 0 1 1�0-A m)A) LZ 2m!mll our cr Cipe-,,jEP- 7-D 5"—>I Q-7' & DH A Y'16-s Di of 5/L)E W1,J00--j (-.LV.L.oVG2 H-9 -7*-/I/r MA.-V 6i;ALc' r. F,00 T V L- J T' �J 7 r'F J w-r A L U i.') - 6 v-rT'-E " P6 U 7- 8 1A.2 kA,W- 7i;t\ -1 pjyUi.A.-Flo N P-3 0 t- L e !i \ - � \ o(Q /3 c,-)A 3'1-M,,,j �,)DlAjC� I.P vl'i q, T-.-r4,j,t F -fD F-A 1 E CL&, 4 A) 7-P-I/--1 0/A.)DO Lj I I AJ 7 E RJ 0 OZ. L.&I A L L A--Iv iE>cA A-'6 Doo rz 3 p)<q v 1 140 L-Dc R tVALL L TkIIA c9X Y 7D 1x S FA�ciA f-- t,< iaSDr-Fl 7- - i X w SN r K . I 'T LL toj,T--a)c tt)/ B-ED 14L,D e.. I CL6.-o'WALCf ku CN V-�1�VC '91 AIA11.5-1- tbqo�j 4 E)e 15T- 6tuet- VAIL PT: on) -6:'1 D) ' ' Lf A 7-: - L 0.1 O.E QA)p4e�p' ATOP- "05 /I � -7V/2 /,p. S,,O.tJ A TV FRA A.4 j G 5-�r-rj o Af- E /I/ i I 1 QQ st Ta P t i I 3 Lo1,J 3 3 �_--- /S w4 X � _ — �O`Y.- /1V0/�w,n_•�ac'1. <��� -- f0!/1tJDA7-7nti1 t A i E or- GRoc,.vo =� a j r/A) N----- -----_---I I L ' --- rL VM 3Efc�l�t�n—�`—�Do�c �jcHe DU(£ � ie/ TBT/GT......,.. I " _ ---- l'-- y�I pN — �u h D DN �8Y9x3 —.:— -- ---- --- — I v/A)V L 5f ,n1G f�5 �x6 cndf -- F. 0 r . i� i N IL k� h A-R 'g=LE V,q 77 D&Z i� r 'i ITFI �1 U 3/a VE —� 7 L•1'/ re: a o yt JI ._�.117'(Onl5- �5 oP). d RGAr VL CL,iPPjl°Ar;'n 5/17"A'L- UJ7t1C1;:J2 - k+ise'n IuAtL -� These drawings wero4irepaled by Capizzi Home ! - Improvement for the use of Cepizzl Home Improvement employees and subcontractors. Anyone using these drewi tiq,::: 411:*-i1:Id verity all existing conditions, din'len:,irr> :In •n:^.unity to Icrat and state building -..raa�_R_+'I codes^rt:`th":ridequacy of(hose drawings. Capiui Home SCALE:�I�I'—r' n., APPROVED BY: TRAwmeY�AI;eny respol�sibility for qny end ell -- pi li;_: ]$',:' ICl l nr152 from the use Of these drawings by DATE: /p- ISED i,r;yr:na elt.r,:then employees&subcontractors of Ca,I_7i ii,,rilr !n;;:..rvement. �llsl l=o�_M.�1(?u e- Y6 ii Al e,J -7?X 6eC ;7 S PERMIT Town of Barnstable =>�e�-mit4: O� Expires 6 mortthsjrom issue date 4 ® 015Regulatory Services Fee � ttzsraB •>4 'KAM V.�Scali,Interim Director BARNSTABL chard Building Division TOM Perry,CBO,Building Commissioner 200 Main Street Hyannis,MA 02601 •MN1111.town.bamstable.ma.us Office: 508-862-4038 Fax:508-790-6230 MRESS PERMT APPLMC-A MON - RESIDENTIAL ONLY ^� Not Valid withow Red X-Press imprnv Map/parcel Number W(o J`7 Property`Address_ -Z /Q// 809V LR(Ue Residential Value of Work S S&p Minimum fee of S35.00 for work under$6000.00 Owner's Name&Address. -21q dEu4-T 0AL3s, Contractor's Name-��n aj,C ,�}• S / �; �t 1E6n i sn(g Telephone NumberUC,1)) Home Improvement Contractor License_(if applicable) /7 3 y S� Email: Construction Supervisor's License s(if applicable) O 5 7 0 [9Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I-am the Homeowner I have Worker's Compensation Insurance Insurance Company Name A e n G uT _Lns u tg Yt ce— Worlanan's Comp.Policy b�lG q Z_$p ti 43 3�S2 3 q y - 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 ❑ Re-roof(hurricane nailed)(not stripping Going over _ existing layers ofroof) ❑ Re-side Replacement Windows/doors/sliders.U Value l3 y (maximum 35)f of windoti T of doors: - ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. 'When required- issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. *"`Note: Property,SJwner must sign Property Orner Letter of Permission. A copy o�the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: \ Q A1.k1PFILESIF0n1S1building permit fortnAWRESS.doc Revised 061313 . n�wal'. U;�a,OTS . de1Sal RE\TEmTAL .BY ANDERSEN TU "�"7 " fi tcctac rG60jan vrsew nrsm�l aniw�. 26.Albion goad • 1 ipn ,ft i 02565 ins t 9�a a Lab> RB ne W-563.2•!9S•Fax 401-633,6602 SswAttn Kev*End:Windows,LLC d/bla P,rj rralbyAmdersesof Sawiitre New England CUSTOM:WINDMA1v'D DOOR REMODELING AGItBEME."i r Zbpe,r"�SafeeAAtn�.�ij'SfrAac®.�C.b®t�QBoc —ZI �A �tU� "�t • fa-�r BuyeeA hereb j Ioicdy and te%-*99M to put& a the peoduca and or seraiocs of gouthetn Yew England 14:utdows,ILC dfbl k FA*&;21 by Andersen of Soujhcrn New fmgkmd17Coowectorj.in emcarrsnce with the tume mad omdi*ms dexzNd 48,the£r=.and the rrvem of ffids agmer-leat and aaa the attu led spedi'icauon shee0.gr(cailsc>g.*d ia'*p�eem="). 'M 1fstorlc.0 Condo ❑110A? i Toml)ob Wetounc �f? Eadmated SU dog thy-- I �1Gftd a€PWM--,t: ;fleck s a,h O Rrened o ft P ecrivoa tlllik - Credt Curtis.r e>o fort ddcpoosR«,y-re®ci�xum rD of ago Wince at Stm of a�e1LD Prvlesc cost.¢Pk�c sx eredx Ca d tbrmcrst r«Rn1 ha 1�f3 cweptntan oma a i AV "M ada-owioago tha the&dtnm.g San d fob and die i Balm=on S clap _ Balame an Stalls tm"Co roction of Job mnsot be m de ty ertdt Gcmpretlon of�b 7 cord and mutt;be nude bY peraonel d+eak brntt&A-&.or Buyer(&)allpxees and uaderstaads that this AVrefemalent eomsdtu um the entire andmMamdleg,between the parties,and that 9% are fw verbal usderuftntrial vhxagl6&my of An terms at thhs AprcemenL Swyer{a}acinmdedgea ttia!Beyer{s} (1)has read:th1s.Agreement,ijadcrstno&the term of this Agreement,and has recelba4 at completed,aigned,and dated. eapyof thIsAgreemenzi induffiattlic,two attached Notices at CLancel adann,mnthe date fintwritten abogm and(21 waa.rally tsformed of buyero right to cancet this Agreemen.DO NOT SIGN THIS CONTRACT IF 77ME ARE ANy BIANKSYACES. (Made fafaadSQlra thy)Xotice to Buger.(1)Do not Ago,ibis Aareesneatif say of the"Cos intended far the agreed termE to the esttnt or then avitilabte Whnnadon asvJ.BLlaak.(2)You are®titled to a ropy.of d d ASnSnm t Atthe.dme ymop it.(S)L Yam may at may payoff rho No maid babmoe due under fh6ftreemmt,and into cluing lm mrsy be eadd,,d to, rteeivt:a paetiall rebate of CbO fnamee eyed ins--ch—g—(4)The seller Lan uo rigt tto unlawrmljy enter ppaasatr premig as or eommft any brteacdt of*0 Peace W goods pasc6ased under this.Agreement:(,S)You nkuy unreel thisApva>aao it tf it has.sot beea slgm eel at the aim of fee or a bzmach al�ice of the uellen provided you notify&a a "h6 or hen swain vice or branch office show-in the AV--at hY a ate:ed or—tMedmuf,wtacb shanbe posted cot later than midaaW of the d drd ealeadeu day ofter`dw day onwhich the bsy*C signs the Agreement,emaluding Sunday and any l ko&!d ky on which regobw nasil deliver*&are not dudt.Seee the neconfpanying nation of cascellation farm in an eatplaeug4on of b-pert.rights.. Buyerorecchmd the cansucnatedueadonmsaee P-A(edblrttCB*dt_XibndCooteacGo�wRegierca MBoard. (Bl &LiQ Rwww-tlby orUutbem New England Bwer(s) Bu.yec(s) & Mtasarger � ��[l�i��ltk$te SEt�atse Peii►fName Epupducthfana�c t FiiffutNttmte PrtntName YOUf'THE.B1;1M(s), m, "vAhu . THIS TRANSAMON AT ANY TIM MOR TO m[D\3GEU jDy THE THIRD BaDsmssnAFAF=TmWEOFImsT-BANSA=ON.SEE.THEATTAC MDydl 4=OFCk%.vGBLLATIO.-4fQRMj S FORAM SSPIA ATtONOtTINSIUMM, 1 A, s� - - - - - - - -- - - - - - sac- - - - -- - - - - - -- X r` - - -- - - - R&ICls of calmr teTtntss Dace of Transneden you MartattoeI I Date of Tratined'on Yant malt autcet this trarwau don,Wltbo6t n hapdott.Within t this UVW9010N Widtottt any Penalty or obliffn6ortt wid" thr three Minos Con dar 1tm,the abaya date,if you &noel,arty► MY t rmkd K anY 122" rb made by year sander the p property traded n,any Py+n�ado• by yota undue tM aeract or Sate,acid wny.ht2gottWe instruanertt wosc 6W p antract a or Site;and. w noRqtlabls Ittrtrurnent caceeuced by you wlli he returned wrtf is ten husinest dap foRawfng p-I yF you will be returned within'can butlttats d*f&Aowlta rw@rpt by the SgIW of your eaneellMon nodea.and achy p ricdpt by duce Seller of youar=rtcerlhation notice,and ua security Wtereut arising sue Of tha trans Qnl will be. 1, setueitY tr+cereit arhft Out Of the traonsaetion will be e%nceletl',Hyyvvuucmcetyounuistntakeavaila6feto the Seller caftceled.ifyoucanc9.yYrooumustmatnarallablato the getter a&your rgMsace,in svbat andally as good evndltien as when p wA your reaidsravv,rut subatantiallyr as good condition as when received,any goods delivcwct to you under this Contract or I rt&Ned,any godih delivered to you under this.Cana-act or Sato;or You may;If you wish,cam vd*the Instructions of I Sala:our You may,l46R%l?!A,cornpry with the fnn�uctions of -ds.Sdwr.rugaptR.-am re�pmM of the good's at the` tA''r Seim rvq j*d'' ""retuirrtf nKr*cif the goo&at t1w Svller<a ennpernse o ride If ybu do make:the Ovaffafiln SeKor"i etsAF If you do nab the govd:avarlable to the Seiler,and the leper does•not pick them up within to the rand the:Seller dons rwt pick tixm tip"Idin twenty days elf tha date of cancelFatiott,you may rewin or p iweau ce y days of the dam of eancelisson.you nuw retain or dispose of three goods witkut airy fin�cfw obltgstioen.If you I di sv of the geoid without M4 further obligation.If a furl bo ntakse the goods avoibble to the Seller,or Ef you agree I fan=make the goods available to the Seller,or if you agree 0 return jim Vpoxh to the firer and fall co,do so,tkern your to ratio m the goods to the Se1kr and fail to do In,theA you rernaln IWUe&w parfwmanca,of all obfiiV36w s under the r remain fa rvm liable for orfeanea of an obllgadona wWer the . canerart.Tb cancel tltl9 uw-ction,:nairi ae delhw'a sf&ed ContramTo iW. i anss tee:Mn N. Mail or deriver a rhj�ted and: dated copy of this cancelladon notice or mW other r and dah d c " of this caocelladon notlee or any other written notiiceorsend'atele2ramttr Renewal byAmdermnof F wrtttennatice,orsmd'ate-le amtoRrnewWbyAndersmof Sout}gm NaWy Worel at 26 Alblon S therm:New Expand PA 26 Atbian Road,Lhxaln,tii WM4 (NDOT�)LATER THdN MIDNtQHT OF . F (Mar)LATER THAN MIDNICI{T' qp f HEMEBY CA NCELTHISTRANSACTION. p d HEif®Y CANCELTHISTRANSACTICK asvywA vo an" rr4u N0f1N o>W 7[ a+m►b s Prw Mime Data %hA Copy:Who Guyer Coplr.YeAmw Guyer Copp Pack Southern New England Windows d.b.a Renewal by Andersen of SNE Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supen•isor License: CS4)95707 BRIAN D DBNN7; N 7 I.ANIW FOND sL'IIt Charhon MA 0150'7 f Expiration Commissioner 09/08/2016 r Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Boston,Massachusetts 02116 Home Improvement..Contractor Registration Registfation: 173245 Type: Supplement Card SOUTHERN NEW ENGLAND WINDOWS LL1' Expiration: 911912016 DENNISON BRIAN 1 26 ALBION RD — LINCOLN,RI 02865 Update Address and return card.Mark reason for change. su 1 p 2AKSM Address C Renewal 0 Employment 0 Lost Card �iEo rOnavno�sam/G�c1fA'�amaair�+elle Rler of Conse4R=Altair @ Badness Resalatloa License or registration valid for lodividui use only IMPROVEMENT CONTRACTOR before the expiration date lif found return to: Office of Cons" Affairs and Business Regulation e0180113" : 173245 TYPO- 10 Park Plaza-Suits 5170 Expiration: 0f19,2016 Supplemard•.ard Boston,MA 02116 SOUTHERN NEW ENGLAND WINDOWS I.I.C. RENEWAL BY ANDERSON DENNISON BRIAN + 26 ALBION RD LINCOW,RI 02865 Underaeeretary Not valid without signature The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations ' Q I Congress Street, Suite 100 Boston, MA 02114 2017 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): SOUTHERN NEW ENGLAND WINDOWS Address:26 Albion Rd City/State/Zip:Lincoln, RI 02865 Phone #:401-228-9800 Are yolk an employer? Check the appropriate box: . Type of project(required): 1.9 I a a employer with 20+ 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 t required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I I.❑ 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 � 1 employees. [No workers' 13. Other w[IV f)W comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. y 1 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:ARGONAUT INS. CO. Policy#or Self-ins. Lic. #:WC 928058352394 Expiration Date:8/21/2016 Job Site Address: &M,% ��"`� yJ City/State/Zip: &u,r In l 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'UfMGL 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' urance coverage verification. I do hereby cerdA under the and penalties of perjury that the information provided above is true and correct c � _ Sianature: Date: Phone#: 4012289800 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Pernut[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#: SOUTNEW-01 SHETTYSHT CERTIFICATE OF LIABILITY INSURANCE DAT1912Dn'YYY) 8119/2015 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 lieu of such endorsement(s). PRODUCER CONTACT NAME: Willis Certificate Center Willis of New Jersey,Inc. PHONE 877 945-7378 FAX ( ) c/o 26 Century Blvd E-MAIL No Ext:( ) a No): 888 467-2378 P.O.Box 305191 ADDRESS:certificates@willis.com Nashville,TN 37230-5191 INSURERS AFFORDING COVERAGE NAIC# INSURER A:Selective Insurance Company of Southeast 39926 INSURED INSURER B:OneBeacon Insurance Company 21970 Southern New England Windows LLC INSURER C:Argonaut Insurance Company 19801 D/B/A Renewal by Andersen INSURERD: 26 Albion Road Lincoln,RI 02865 INSURERE: 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 POLICY EFF POLICY EXP L� INSD INVO POLICY NUMBER MM/D MMfDD LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE ❑X OCCUR S 2029459 08/10/2015 08/10/2016 PREMISES Ea occurrence) $ 100,000 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 POLICY a JET T LOC PRODUCTS-COMP/OP AGG $ 3,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 A X ANY AUTO S 2029459 08/10/2015 08/10/2016 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED (BODILY INJURY Per accident)AUTOS AUTOS ) $ NON-OWNED PROPERTY DAMAGE X HIREDAUTOS X AUTOS Peracddent $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 A _4EXCESS LIAB CLAIMS-MADE S 2029459 08/10/2015 08/10/2016 AGGREGATE $ 5,000,000 DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LABILITY TY X STATUTE I ER B ANY PROPRIETOR/PARTNER/EXECUTIVE YIN 0000068028 08/21/2015 08/21/2016 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N❑ N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yas,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 C Workers Compensation WC928058352394 0812l/2015 08/21/2016 See Attached DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) 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 PROVISIONS. AUTHORIZED REPRESENTATIVE Evidence of Insurance 1-14 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION ., 1 U-77 -Z Map 0 S6 Parcel �3 `� Application .0 C� I l Health Division Date Issued Conservation Division L Application Fee Planning Dept. Permit Fee L-2 D Date Definitive Plan Approved by Planning Board Historic - OKH Preservation / Hyannis Project Street Address 1 9 GO-'L)i-r $Ay 9OV Village G Owner t�2'�"�1-(�U Pevyy Address .219 COToi�- SAY 'R0 <vrve+,*4 Telephone Sod Permit Request PuxNiJ4 auo wJr*11 Neul Dzclt ,Al ZXi. 4-r tf6,ty off' X owe. -fZefr/F ee xa orlw6 s (tio c,y,�yAe 7e �ol�tTioes GI/ 001'191i1 ) U/000 UecKi is ei/i-�I A7!�,L ee e ;Y /IAiZ/�Vd Jk,1Te,.& - ,Square feet: 1 st floor: existing proposed O 2nd floor: existing proposed O Total new . Zoning District T r Flood Plain Groundwater Overlay Project Valuation 2/000104 Construction Type W 00D C/Zq ne nLot Size i •0 3 Ay P0v Grandfathered: ❑Yes Wd No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) // Age of Existing Structure I R�y Historic House: ❑Yes 41//o On Old King's Highway: ❑Yes LV<O Basement Type: WrIFull ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) ® Basement Unfinished Area (sq.ft) 1 i 3 Number of Baths: Full: existing new Half: existing 1 new Cj Number of Bedrooms: J existing v new Total Room Count (not including bath:,): existing new O First Floor Room Coupb 3 --♦ Heat Type and Fuel: ❑ Gas Coil ❑ Electric ❑ Other ujj Central Air: ❑Yes I2/No Fireplaces: Existing New Existing woodkcoal stovpe: ❑Y6s ❑ No Detached garage: O'existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ [xisting ❑ nev.l size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size Other: a Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Ri D eAliAl Proposed Use Re sid e t ftw 4_ APPLICANT INFORMATION (BUILDER OR HOMEOWNER) - Name 6AZy Telephone Number soy Address q5 Al"W"1-°LOA` Rl� License # G S 0 ri Y6 V o C67-Ul:j- i Mq o 9_6 3r Home Improvement Contractor# 10 07Y0' Worker's Compensation # w e C S06 J-0 t o rV7Z013,4 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO d Ulti. Or 8,00r4 SIGNATURE DATE FOR OFFICIAL USE ONLY 4 APPLICATION# r • DATE ISSUED r` MAP/PARCEL NO. J ADDRESS VILLAGE OWNER y . t _ DATE OF INSPECTION: w=FOUNDATION: 4 SoaoS -(a W L•3) Y FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL s PLUMBING: ROUGH FINAL . GAS: ROUGH FINAL FINAL BUILDING '0 ., , DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of Massachusetts Department of IndustrialAccidents 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): Capizzi Home Improvement Inc Address: 1645 Newtown Road City/State/Zip:Cotuit, MA 02635 Phone #:508-428-9518 Are you an employer? Check the appropriate box: Type of project(required): 1.❑■ I am a employer with 40+ 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling 'PECK ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.t 9. ❑ Building addition required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions -3-.•❑ I am a homeowner doing all-work- officers have,..exercised_their._...... . ....11.❑ 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' 13.0 Other 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. tContractors 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:Associated Employers Insurance Co. Policy#or Self-ins.-Lic. #:WCC500501054772013A Expiration Date: 12-25-2014 Job Site Address: a'I Cd �'47 V rt�Y& City/State/Zip: aTo/r/ IV-4 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 f r ins ance coverage verification. I do hereby certify unde tli and e s-of perjury that the information provided above is true and correct. Si ature: Date: JOG 20 1 Phone#: 508-42 -951 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#: CAPIHOM-01 APEL L ACO p" DATE(MMIDONYYY) CERTIFICATE OF LIABILITY INSURANCE 61412014 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 terns 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 CONTACT NAME Rogers&Gray Insurance Agency,Inc. PHONE FAX 434 Rte 134 AIC N Fed: A/C No):(877)816-2156 South Dennis,MA 02660 no aORFss: INSURER(S)AFFORDING COVERAGE NAIC 0 INSURER A:Main Street America Assurance Co. INSURED INSURER B:Associated Employers Insurance Co. 11104 Capmi Home Improvement,Inc. NSURE1C: Capb7i Enterprises,Inc. 1645 Newtown Road wsuREl o Cotuit,MA 02635 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. LTR TYPE OF INSURANCE AODL SU POLICY NUMBER POLICY EFF POLICY YY YI LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS-MADE OCCUR MPB1075H 06/08/2014 06l08f2015 DAMAGE TO RENTED PREMISES a occurrence) S 500,0 MED EXP(Any one person) $ 10,0 PERSONAL&ADV INJURY $ 1,000,00 GEML AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 POLICY a EECTT LOC PRODUCTS-COMPIOPAGG S 2,000,0 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 5 a accident A ANY AUTO Mi M28044 06/08/2014 06/`08/2015 BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BODILY INJURY(Per accident) S 500 0 AUTOS AUTOS r X X NONdWNED PROPERTY DAMAGE y HIREDAUTOS AUTOS eracciderd S X UMBRELLA LIAB rd OCCUR EACH OCCURRENCE $ 5,000,00 A EXCESS LIAB CLAIMS-MADE CUB1076H 06/08/2014 06M=015 AGGREGATE $ DED I X I RETENTIONS 10,000 Pers&Adv Inj $ 5,000,00 WORKERS COMPENSATION X PER OTH.- AND EMPLOYERS'LIABILITY STATUTE ER B ANY PROPRIETORIPARTNERIEXECUTIVE YIN N CC500501 OS472013A 12/2S12013 12/25/2014 EL EACH ACCIDENT $ 1,000,00 OFFICERMIEMBER EXCLUDEDT N❑N I A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,00 If yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Barnstable EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis,MA 02601-0000 AUTHOR®REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD s of any use group which Unrestricted -wilding . contain less than 35,000 cubic feet(991xn3)of enclosed space- 9W�78, Massachusetts -Department of Public fSafety Board of Building Regulations and Standards Construction Supervisor t ` : License: 074640 ��•:r rx possess a current edition of-the Massachusetts Failure top state Building Code is cause for revocation of this license. GARY�USIAIF�Q�T For DPS Licensing information visit: wvdw.Mass.Gov/DPS �Qp2$6� ,{ SANDWICH P�fi A �.�4jj _._._..__ . ..._. J )1-110 O Expiration 6 11/29/2014 Commissioner Cc�parrea�ea�eruerr�t/a�0�lrusrrc%�uettr ffice of Consumer Affairs&c Business Regulation License or registration valid for individul use only before the expiration date. If found return to: ME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Regulation egistration: 100740 Type: 10 Park-Plaza-Suite 5170 Expiration: 6123/2016 Supplement Card Boston, VIA 02116 CAPIZZI HOME IMPROVEMENT,INC. GARY GUSTAFSON g -7� - 1645 Newton Rd. No-valid wit out signature Cotuit,MA 02635 Undersecretary — " 2,1 rut C a ' ° I. I G� ti°1 i i/�� i x r 68 69 1 6 AC , 70 0` WIDE EASEMENT (APR X. LOC. FROM PLAN) 119.41_ i 72 ' I 71 I I ►ALIB98 '1� I ! E LOAN INSPECTE® � pp SCALE: 1 IN. 1 99 ,i .. S SURVEY ASSOCIATES DATE: MAY 15, ' ^ Illo"��`' SAGAMORE ?,-' ' FONTI;RIAND BOX 28 SAGAMORE BEACH, MA. 02562 :� No.3431h r (508) 888 8667 :F:1 �,� + " of, ape', ' I CERTIFY TO OF THE BUo�I gARNS�ABLE (COTUI WN HEREON jONFOR rt\\ THAT THE LOCATION FLOOD HAZARD TO THE ZONING OF THE TOWN 250001 COMMUNITY N0 I CERTIFY THAT L�Ep ON MAP 001 gCIE WITHFND DEEDS REGISTRY OWNER: ZONE AS DELINIA PLAN REFEEENPLANBBOOK 292, PAGES026 0 BOOK/PAG BUYER: LOT NO.: 69 USED PLAN BY: GARCIA, HANACK & RICHARD ' DATED: JAN. 3, 1975 FOR USE OF BANONLY. :,...-- DE FROM AN INSTRUMINES SURVEY AND IS NOT TO B THIS INSPECTI HEDG�S OR TOE TA --�T""'"°" � FOR FENCES HE G 1 Page 7 of 7 Capizzi Home Improvement Inc. Specifications and Estimates STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLE'FOR A BUILDDING PERMIT 2f I, , OWN THE PROPERTY LOCATED AT IN , MASSACHUSETTS. . I HAVE AUTHORIZED CAPIZZI HOME IMPROVEMENT TO ACT AS MY AGENT TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. I GIVE MY PERMISSION TO LESSEE TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING C SIGNATURE OF OWNER: �'�-, � OWNER'S ADDRESS: OWNER'S TELEPHONE: LESSEE'S SIGNATURE: LESSEE'S ADDRESS: LESSEE'S TELEPHONE: APLLICANT'S SIGNATURE: APPLICANT'S ADDRESS: 1645 Newtown Rd., Cotuit, MA 02635 APPLICANT'S TELEPHONE: 508-428-9518 RESPONSIBLE OFFICER: RESPONSIBLE OFFICER ADDRESS., RESPONSIBLE OFFICER TELEPHONE: , o ® � a _ . . ..... . .' �-•- --� -- � �...-.,.<.-...ate.. NO _ f J. r ` m v . .... . .. NA �� y I • . i i I � � I � r �r I k ' • � aC' ` I � ' NN �I I CQ �. ewFT `b � . � �'• I i � I I 4 ��' I 1 � 1 t i E a y. PERMIT Town of Barnstable *Permit 4 �dZ�� '� fl 4 200� Expires 6 months from ' e dote • � BARNSrABLE, Regulatory Services Fee y MASS.. Off' BN$TLEThomas F.Geiler,Director Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid witJiout Red X--Press Imprint Map/parcel Number � �,'rj � Q Property Address 1 . T � .brkue XResidential Value of Work Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address �'�'� Z1 CUB kt P� �.Q �SJT L� Contractor's Name 1 Telephone Number 42 GS L p) Home Improvement Contractor License#(if applicable) ` V—14 . Construction Supervisor's License#(if applicable) '"l 0 ❑Workman's Compensation Insurance Check one: _ ❑ I am a sole proprietor I am the'Homeowner I have Worker's Compensation Insurance Insurance Company Name Gtf 0::---,Ctn Workma.n's Comp.Policy# I ( J . "1y :) Copy of Insurance Compliance Certificate must be on file. ?ermit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) El- �bco 0-LED ❑ Replacement Windows. U-Value (maximum.44) *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. Home Improvement Contractors License is required. ignature :Forms:expmtrg -vise063004 Clisnt?:47298 CAPIHOPA AOORD„ CERTIFICATE OF LIABILITY INSURANCE DATE(1VMeLD(YYYY) _ 0 1 r09rT)7 -RODucEP THIS CERTIFICATE IS tSSUE;AS A MATTER OF INFORMATION Rogers&Gray Ins. Agency,lnc. ONLYAND CONFERS NO RIGHTS UPON THE CERTIFICATE 434 Reuse 134 HOLDER.TNIS CERTIFICATE DOES NOT AMEND,EMEND OR P. O. Box 1601 ALTE THE COVERAGE AFFCRDEO 3Y THE POLICIES BELOW. South Dennis,MA 02660-1601 INSURERS AFFORDING COVERAGE I NAIL INsuRED Capizzi Home Improvsment,ine. UasJR£R National Grange Mutual Ins: Cc. Capizzi Entarprises, Inc. INS:JRERs; American Intemational Gr f1645 Newtown Road INSURER M CGtUIt, MA 02635 INSURER0: COVERAGES INSURER THE PCLICIES CF INSURANCE LISTED cD BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ASOL==0R THE POLICY PERIOD INDICAT ED.NOTidI T HSTANDMG ANY RSQUIR=A4ENT,TERM OR CONDri ION OF ANY CONTRACT OR OTHER DOCUMENT YVrrH RESPECT TO WHICH THIS C=P.7IFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALI THE TERPAS.EXCLUSIONS AND CONDITIONS OF SUCH PCLIC:ES.AGGREGA i cc L r,,Ir S SH.6WV MAY HAVE 5ESN REDUCED BY PAID CLAIMS. In LTR r' TYPE GF INSURANCE ?OLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION AT W ! Y AT=:NILNI ;YY I 'LIMITS A I ILXZ4MERCLAL GL LIABILITY MP010707 06/08/06 106108f07 EAOH,OCCURRENCE $i 000.000 GENE:-AL LIABILITY DAMAGE TO Rc'P:TEO CLAIMS MACE OCCUR P.- .I - ;� j500 QOQ I I MED EXF(Any:ne pers:n! $1 Q 000 PERSONAL d AOV NV VRY 0,000,000 GENER AL AGGRECA.TE s2,000 000 GEM+AGGREGATE LIMIT APPLIES r=Er� I POLICY -R�' I PRODUCTS-COMPICP AGO $2,000 000 IECi LG� 'AU7'OMO8;LE LIABIUTY ANY AUTO -M-MBI EDSI SINGLE LIMITjEa S ALL OWNED ALTOS I BODILY INJURY j SCHEOULEDAUTCS fperperson) HIRED AUTOS ' NON-OWNED AUTOS BODILY INJURY S 1. !P--r a=Ezra) PROPERTY DAL^.AG E I S (F-f nc Cf.") GARAGE LIA91lRY AUTO ONLY.EA ACGDEN7 $ ANY AUTO OTF-ER THAN EA ACC S 1 AUTD ONLY: GO j I EXCESSIUMBRE LLA LIABILRv ,A jEACH OCCURRENCE S OCCUR �CLA!MS MADE ! j . AGGREGATE I RETENTI.^,N B WORKERSCOMPENSATION AND 1764953lr STATU- GTH- S EMPLOYERS'LIABILITY i?125t'O6 �12-125/07TORN LIMITS - AAY PROPRIETORIPARTNERlEXECLrTIVE £.L.EACH ACCIOEi1T s500,000 OFFICc"'YRAMt 6ER EXCLUDED- i If yca,desc`x unGc E.L.DISEASE.EA EMPLOrYEE $500,000 SPECIAL P40VISIGN5 to cw OTHER £.L DISEASE•POUCY UAIrT j5Q0,QOQ. DESCRIPTION OF OPERATIONS;LOCATIONS 1 VEHICLES!EXCLUSIONS ADDED BY ENDORSEMENT)SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED PCLIC;ES SE CANCELLED BEFORE THE EXPtR.AnoN DATE THERSOF,THE ISSUING INSURER WILL ENDEAVOR TO NAiI . III DAYS WRITTEN NOTICE TO T'HE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO So SHALL IMPOSE NO OBLIGATION OR UA31LI TY OF ANY KIND UPON THE INSURER,ITS AG EN T S OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001iC8) 1 Of 2 #2643S (� DPr1W-� 0 ACORO CORPORATION 1988 \ 1 ne L ommonwealln of ivassaenusetts Department of Industrial Accidents - !` Office of Investigations ` 600 Washington Street Boston, AM 02111 www.mass.gov/dia Workers' .Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (BusmesJOrganization/Individual): Address: 3 645 Newtown Road 4/1 ��535 City/State/Zip: Tel. 428 9518�#-onu I .50fiU OITe fir: e .ou an employer? Check the•appropriate bog: Type of project(required): I am a employer with _ 4. ❑ I ain a general contractor and I 6_ New coiistiiiction e Io ees full and/or art-time . &ve hired.the sub`contractors �. .y . ( P ) 2.❑ i an_i a.sole proprietor or partner- listed.on the attached sheet.$ y D Remodeling ship., have no employees These subontiactgrs have S. ❑ Demolition `vo.9.for nZe in any capacity. workers' eo p-. nc„rance. g ❑ Bwlding addition jNo workers' coap. msurance 5: We are a corporat�bn and its requaed] offices have egerciseii their .10-� Electrical repairs or additions 3.❑ I ant a homeowner doing ail work right'of exemption pet MGL _ 1 1.❑PInnzbmg repam or additions fnyseif jNo wb=kers':comp. c. i52,.§1(4),an ':wefiaveno 12�Roofiepairs msuiance required t •.en?ploy�es,;.{No wo3�zis' c? insivancer' tired] .13 T,..er n?Pq.._ *?:riy applicmmt that chec3cs.boa#1 must also fill:butffie section below:shogiing Ytieii wor2ceis'co on ltc.iafom�ation' :,. .. . . t Homeowners who submitflii's afficiavat inSicaj Hieyste.domg aIl woik and fi�en lore oatside com n c ois m submit anew aiE3avit indicating sack Contractors 8�at cfieck this boa giust slfscheet a.n addifional sheet sfidiving e name oEthe sab coritracfors:arid ffieir.woFkers .comp pol�cymfor orl : .,. 1 am do employer i3u ispr.oyiding workers',compensatron:iiisuraizce foriny em�Iayees $e�oyv is flze poliiy'�rd>olri-site information_ 7 •: ,��:^ .T'.,;;jj j� Policy##or Self-is. Lic. #: 1 �7 q� .E tion Date:•/ _ o xp P /0C ' Job Site Address;. City/State/Zip: tEach a copy of the workers' compensation policy declaration page(showingthe;policy number and egpirat ort date). ?aihire to secure coverage as required under Section 25A ofMGL c. 152 can lead to the imposition bf crhninal penalties of.a zne.:up to$i,5o0.00 and/or'one-year imprisonment, as well as civil:penaIties in the foim of a STOP WORK ORDER and -fine )f $250_00 a:.c3ay againstthe;�ioiator. Be.aclvisecl that a copy ofthis statement may be for;varded to tlie,Office of nvestigations of the;DlA for ir,cm-arice coverage verificafioiL do hereby.ce. .• 4.iderthepains arcdpenalties gfpe ry.tlr dthe.i grin provided above is true and correct is _ �' atuze` Date: 'hone#: — 1 Official use only. Do not write in this area,to be completed by city or town official. City or ToWn: Permit/Licease Issuing Authority (circle one): 1. Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5. Plumbing fInspector]6. Other .._.. ��ie '[�a�rvrnaruueall� o�✓Gla�sac�uaeCta Board of Building Regulations and Standards Construction Supervisor License License: CS 74640 Birthdate: t1/29/1975 Expiration: 11/29/2008 Trta 6430 Restriction: 00 GARY GUSTAFSON 8 SHORT WAY SANDWICH,MA 02563 Commissioner i V 6/7- Board of Building Regulations and Standards License or registration valid for indivldul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registrati'&K`100740 Board of Building Regulations and Standards Ezpication 6 3/2008 One Ashburton Place Rm 1301 Boston,Ma.02108 ype=Supplement Card r - Ems! - CAPIZZI HOME IMPROVEMENT:t UARY GUSTAFSON — 7 1645 Newton Rd. Cotuit, MA 02635 Administrator t valid with t Sig ture Board of Building Regula ions and Standards One Ashburton Place - Room 1301 Boston, Mass..achusetts 02108 Home Improvements�) i. ontractor.Registration . Registration: 100740 ' l Type: Supplement Card j � Expiration: 6/23/2008 IV CAPIZZI HOME IM PROVE MENT,'f"N,C." ri GARY GUSTAFSONUP �� 1645 Newton Rd. Cotuit, MA 02635 ';`4 Update Address'and return card.Mark reason for change. )PS-CA1 C, 5OM-04105-PC8698 Address ❑ Renewal ❑ Employment. Lost Card 1 GAP IZZ Home f Improvement Inc. I, Gary Gustafson, Production manager Of Capizzi Home Improvement, hereby authorize Lisa Haworth, to sign on my behalf for permit applications filed through the town. Signed: Gary G stafso Date: Qis #rChaW—"--� Date: i 1645 Newtown Road Cotuit, MA 02635 (508) 428-9518 (800) 262-5060 FAX (508) 428-1547 ngineering Dept. (3rd floor) Map Parcel Permit#' lp House#- �;i L S FJS Date Issued Board of Health.(3rd floor)(8:15 v-9:30/1:00-4:30) Fee ��J i � � "I" dA.11�� Conservation Office (4th floor)(8:30-9:30/1:00.2:00) Planning Dept. (1st floor/School Admin. Bldg.) . Definitive Plan Appro d by Planning Board 19 • BARNSKE. MA f 1639. TOWN OFF BARNSTABLE r Building Permit Application Project St ee dress (� L-V J4(, Village Owner ', c.'l C.�J� L y�l Address -Telephone Permit Request • 3� --First Floor squar6 feet Second Floor square feet Construction Type Estimated Project Cost $ 'IOCk ) — Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family ❑ 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.ft) Number of Baths: Full: Existing New Half: Existing New No.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 Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) - ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use i Builder Information Name Telephone Number r Address .1"/( j�9�c`�00,1 �'(� License# C_ 0 -C� Home Improvement Contractor# Worker's Compensation#U'/3i,S 3h30/6 NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATUR DATE /l /G ' 7 BUILDING PERMIT DENIED FOR E FOLLOWING REASON(S) FOR OFFICIAL USE ONLY PERMIT NO. 2,6 �' U s DATE ISSUED "w MAP/PARCEL NO. ADDRESS 3 VILLAGE OWNER - ; DATE'OF INSPECTION: i FOUNDATION _ FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS•, ROUGH FINAL FINAL BUILDING DATE CLOSED OUT al 1t ASSOCIATION PLAN NO. ' 4 CA- 1"E A ` The Town of Barnstable Department of Health Safety and Environmental Services ���• $ll1ICIIIIg DIYiSIOII 367 Main Street,Hyannis MA 02601 i •• Ralph Crossen Office: 508-790-6227 Fax: 508-790-6230 Building Commis: For office use only Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization. conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors, with certain exceptions,along with other requirements. Type of Work• 6/&W Est.Cost —7000 �- Address of Work:- / Owner's Name Date of Permit Application: J1 'le X�7 1 hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under S1,000. _Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as th=Contrac er. sme Registration NO- Doe lob y Tlrc• CUt11111Ut111'Calrlr of Massachusctty Department of ludusrrial Accidents OfficraalIff,v9 fgatfans 600 if ax1thi►►tun Street Btustan.lll=x 0111 Workers' Compensation Insurance Al davit ;kEloi t inforntatinn• name, Incmion• _Z/ Z29 170-CGY C/l Litt• �C J C(C�C /!'/i/ mhont: [1 I am a homeowner performing all wort:myself. 1 am a sole proprietor and have no one working in any capacity I am an entplover providing workers o pensatian for m% employees wort-ing on this job. emmVinnt• nnmc• &Uag. -I e-A �T7Lc 1C 7YC�l atlrlrrcc• citt nhnne t!• incornncc ••n rT( �t/(�[ �, nniirt•d C.i t .1 Sf<'e"5a, I am a sole proprietor. ;cneral contractor, or homeo�v�ner(circle one) and have hired the contractors listed below who :: the �ollowin= workers' compensation polices: cnmrrinA, nntnc• — �tirlrrc�� cin nhnne�• in,ornnrr rn rimier•0 emmn my mine: atirlrrcc• rity- nhnne>+• incurnnrc cn nnliet• _77 Attach additional sheet if neceisar-v .�' - _';�.iiv+� ��r•��`��� .a.i� ru ti Failure to secure cut•craec as required un cr jectton-A of NIGL 152 can lead to the imposition of criminal Penalties of a line up to S1S00.UU andiur uric cars' imprisonment as well as cis-if pen21lic3 in the form of a STOP WORK ORDER and a fine of 5100.00 a day against me. I understand Main Copy of this matemcttt mat be furivnrded to the Once of Investigations of the D1A for coverage t•eriGcation. /do irerent c ri► turtle r/r r 'rrs ar err !tics ojperjun•tlrar the irrjormariorr prorided above is true and correct. sicnature Datc 7/U/S 7 ['tint namePhone official rise unit do not trrite in this area to be mtedy �®rwnta [ city or town: permit/license# rlltluilding Department ❑Ucensing hoard L check if immediate respunse is required ❑ Jcleetmen'N Uttcc r 1'. ❑health Department L contact person- phone fr; —'Hier. r. ':x+.t - r'i,.,1 �;1 (��-t r9s'�a .".��' e�+,' sz�. ,�,.a'�:. Af '�'�.",+ r,t5r.: �. ��,� �. .7; � �:4., t r ^>*;, �r ^K t'�-` ;3.: § ^��. �. .a+ "�> � �•t v?;: U��q. ' .�,v. ?7• .. 3. , .. t1 ✓: t,q•y��:y$5.�F p,wivyl.Zr,4,t. ,J _-r�. rSw t�a' .,' •,;9 12r f't' .5., .3y .Ftk: 11,, t,b qQe$';� a A-•na�.'S;+, { f�...4 ' :>�t .•;j'ra.�� .���t�uv '+i't ?�• ti't.*k: �r1 .r• +�4' er?i��i.' a':'... .,yt.� k:.at;•'i 1'dt'�•i� "1';-s' ee '� •, '? `i� t � (.. ,4L'!" i 'S / E� ,� Pw' 7.. '��t t MT y�k tn'4 rr Y.t{ .f �44. tG d 6 � a r E. 3, :nkr 4. � G,{eA �, \ T:-..�is} e'�`k + �`•" �,i1'„ �. f ".� '$, s` .. _6��� C.�.. to.� � ';••. •�+�.:/?7GG'.'V ;;} �• ��*'a k��i>� �1 �A>_ti>; t E��;N"`i,� �vC��' 1a4�„�,�°•�`1,t� z�5„,v-Eo- f��q? a >� �..�:�r.,l!^4,.cv x >r<a -x, s._ •.y. r,, s; �yj-°+7��� �'S:�. r n'1•�t t14;S°� 3,- ����[[ r ' to S�` .. J.�.. T3 „! 4"�..F�. 1�f`" •�?� Q'�� �$,..#'L� �'.••'J ��}?' + �{.� f .iY.. 'H'+:v J; ;ssS,....f•,r'+ts:4 �.v.rr .�' :lt• 1v_,,i,, �Y`� ,r,�k�'•ar�`$ti'�.�:1'. .i.� 4!, [��� t-Y$��t-'r h^v'�= �� �''C�'..,�`•,�e�+"�}-'.A3'�4� '9�k..r,�b y ^��S�: � F .> "t k' ,r .L ;7t', "-.;st'�'''.'-a'.. 2Y'"y, "�.` :. ,,. q .)f-v.•«r7• -.�i ySwJ �}3c,7 r.g? a r I, .L-1 aty cy1 Fi.7•.�. e `�'�s +✓ a'S;L tit?r� �'-••1f- •,. �h,�s'JL'rL+•�,y �..��..+U-�''r7' 7"s cti.t''.:a�' , '' r 3' v {• .l R r"+i T a n ¢ � HO . k': t '%' �,.,��: � ,ME,, IMPROVEMEN�yr'CpNTRACTORS;:�REG;ISTRATI:ON j," sta : -t. .SY.:.at`�r a. .q<�,t•, `_t:; ,;a;y.• ;� 'sa. 1�.5,�s '�a. �1N'Kit''ntfkr-W''s,C fr.w ��:,yr.i' t�.;'-'+Zk (: ,. ,. 7'w.. _.3 .le� ti4 tc'S: t k '4. ;,F`rU'. t S�>S` . r{& Board�:of.` BU'lldltn :rd t 1�' vs� r�/ C_a �s t sf� + , s ,f2egUlta�tlo:ns andl St YdgF 7 x'� a lKe t a ,� J��t �.yi,? e,' S;�,.N'._Taa.-.a'a�.7"N, ��[y` t'0' 7' -}r M 'F' ,�hi<` �•r s.;'.Eti?u �Y � w� Ashbur:"t rVfPl-ace,� .Room.:1301 ,,i j �f .:;.M!'. n ! ..F. .�.•L.. l4i bu.. ,t1'{., w., ...i^s' y .r`Y,'.. ,,•'7�Fs' ,J -- P .t .:`v't,x '"t� E+'��,� -t.� '} ,-++' ..1t•- rkt �tt'c+ t�7`',.�1• ° .rY �$ • -'tP�n`+'P!'. :.'5"• t 'MP;,7§-r-+E'.•w.;; " ;S [ .ti �;�`§ emu,.?, i ,{ ..i,.,^�zM' y'.''y cat'1.`i'.,.'i. .Bost.on: Massa {{ a.. ! ;t,. `s,r a z s. s ,a v7. .t^z s' Clyt' Set t'S s 021:08$r av k4t'd. 7• .iH " : 5 d } •.Y sFfL"ar' '; ..,r.,s;�".!1r•`;•�i.:;4 zrr., •,z•s•••1;.,.V,.. ao.+:'R�w. sd: ..e,.}. �J .,�, Y •'^;:rfi� .<Ml a. r y`:t. .�{,+ ti ,9•`- 'ti' t. " a y. - a •6 , 'S. pyf �;'i;'i.. .f.. (g, t 'y. p't•a?c -7?C+? <kt� hr. i • � SYs u '( a Y5'7 ,.J' �k.��;�.�`M1e• 4... .4�.�.N,. F.y. '.YW: .l+Y '{s'ix�: �,��' .:ry' tJ ;`{;. �• s. �iµ• `5 'y r r l K .' '•r .d C' syii } 3C d�,.r�:::-.t :.�...t. s..,..t?�. .,..a:., . t ',� ' , :�*,.'••FiCi k',' ,�3�: rr. `-�.,"• +2. v, 7 rLl -�,�r,rc,.el i f{A €c i i. •�;:. � � a1-:4 _ . ,4+t� . rr:� r mot. -;:e 2�r -a��2cs�+'•,-'�--::•.i '. t1'.�a�+c HOME ('IMPROVEMENT. CONTRA TORS, e � 5- ?}. -,� "c•I. <•a. ,,<x} �.+,•[�,.: ••1 T. �r�:(,;,{`iN � r.fHF'Yp. k _t..�1(. 6,et•t�..�r• .si�}r d7^ti Ali.r4r ,\ - t #' i - � �` ..l 9 .•' < 1- _•�.' :. L :k'i;..:•)i,:Sy'. `S-i« Y�,.•ct�..; a .x P .4•ti';?irte�'' 'i1,r�"�.t #>Y5'+'S'.c,�tC.+ iTi 3� ";r^p 'J'�..t. :.'.is„`•'�' . Regitratlon 1',12536.1EExp <�r:ati,on04/06Y99 r -F�'S .r,r >y' .n e;" -� :.a ',� r 'd .'hk��C k ' ems! •,�S•' } arse cY ZEOC 't(7I tp . . S o `. ��✓iee TD+oomswoert' :v9L� ^` a�, . Y71>r � i N § , F tv00,11ih s Y y_ 4 }HOME�IMPROVEMENT,"CONTRACTOR,, " w' !§,a 't•:y W. i a. ��;.r i. i:p i 2�•}i . ¢�_�y., . M., ,Registration f? � •a- x- .r..��''NOW .',, a . ,,;rp m{d- L� -.a:' �q3'• ?.-;i •t,�,.:t17.., �.. lvt �f RASER CONSTRUCT ION. r ,•. {� , f�> �t,j�¢�; . �:. :r r T e.- 4 t, w, IIt• v yr..r= 1 fly. p. » 4f'S?.,.f'r^t� :.'�-4�i` 7.��L ;Etyi+��,: i: �;�>.\.S( YP y r e?.DBAr A:SER e4 � rr n�?R 4« � �v sn ' €` ' a .a Expiration;.." :y04/06L§99. t k.:9 . }n i AtEk-vIM: 5 t 15(• .��5'�•.w. l .�x..t,r� '.Yhd . :;*t�.' 3+r, ,Rf j s•,- �'` �i �`%. ,ii _ -'fy > i^I 1:.. bt�ti :. v'•. Y4!`"• Y F' 1':4�. r :y:7 - T ,1 �,'. -�t R�`! t>• � .. •4h >' ') 1:. )> .k„f:. ' .:F!.TA` '.k'! 1. _ •�S�r 1 J••�•i•f� N'0 ;..t f✓ 1.i.. 1S�j'7�,r�1: � <, f'�. �t.St. 6 .5'."Li ' COTUIaT MA 02:635 a' K y. ;t. , 1. " ''a• r� f ss }4' FRASER� CONSTRUCTION r r ,' o�yAtatitc. �ajy�- {r. 'r .`,�s"kr9 g7,t�F'rry'.,r.r...y,..71' Iw%� �r,�'• ttt{d}•y.�, u+Io. V„ �1 ^ +� ,>�?;K'+ .�' �t�iN�.�f4F' Va,�1 �a",: �' hi' AI.,. �i� �'3.lr•• .lA-..1•'hV'i`A.�� ��..tl'a x:•:{�' f�j^' l Ali„I.Y��!rl1YS i'tk •.t' -�,. .�` � .,,,., >nY. * t•F �' M+, a."w rt, ! �� -,l,Nxo ." :• e. ._'y^ ! '�P� °?k Y• :Y,; 4 _,.} ?w f ! ..�t lj a �:� � ,,.F >�'�'�,� e'• �; .'.-h ':��; "" �,k v p�,q' •�.�k . t � b � '�;�' f,: -'C: ERASER •+��'�:;rr; �,1t' 'o". } 5 ' •F, x. .ay w,�.y FC P '7. s F' t? g �,. 3Y' , r x F. iyq�X^� .COSH dO � _ 'f�' rf- —- --- •- _.E" -�.. rc. s4{-h`,t -� , [, `d. ':Y> t'y. ySy`*sm?} _&r: , ,-yy.,v...ay, #•a•" .-,,, r ;y`}-r.: .,,`,•,'f.� - �.y: }. {: t�- �� .;:, � ,��•, ,,-+�:;�=� ,.>+;� rr.��,>,� ,�,t, � � ,t�_ �E��` �� �.�o,��t; .:;:•,� '1��}TARRA60N CIR:a:: t}t�'. ,;?�. ln+u a. yh o r � x � ^� � _1"{l ltu.l 4 sa u<:! .,>,� .:1'.•�' +- '�`e� .,$ r�ADMINISTRATOR,•S�� -r :.;� -��'.S:.dsr �F� :�?�F st}j,...f dr } 4 t�,si-if.8: .�'.r �E'.-.s'_ ?,r,. 1 :r• �it�tn, 7*F�t,�.'�{+C'1p�•ra.�1�. -1�3 t wt� ;j.'. �,R c�`4 .�, ,��� �.� ,�' tf.tKa� ��r<:�� t �- ��ra �t r 'a y �.�' dx �•Y �� s���`, t COTUIT#MA 02635 • y r„r d bVSTEM MUST Sewage Permit n THE TOWN OF BARNSTABLE BUILDING INSPECTOR . TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Name of Builder —~�\* ' . .........Address ....... �ap......^�................................ ' Name of Architect —^ —����^�`^�e/�----A66re� '^������� —.��»��..�--------___.. Number of Rooms --' ----------------Foun6ohon -- . Ex|eho, '^�^�'' .� ' AS —_--'Roofing -- A!—y......................... Floors ..... ...... —|n^e,io, ..... —__..�__.__________.` ° Heating . --^9V �-------------..P1um6ing —. — _______________ / p Fireplace .�������--'eff??!-A.........................................Approximate Cost~-.. ............................................. Definitive'Plan Approved by Planning Board ^� 19 ' Area .................... / Diagram of Lot and Building with Dimensions Fee ......gle --- - SUBJECT TO APPROVAL OF BOARD OF HEALTH | ���� . � ` ' ~ . � OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS | hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. ::)Nome . . ................... Construction Supervisor's License ......... 0 WALSH, THOMAS N. 25984 ne tory -No ................. Permit for ..... ....... ...................... Single Family Dw ing Location Lot 69, 219 Cotuit Bay Dr. Cotuit Y ............................................................................... E Owner .........Thomas....................... Walsh................. Frame Type of Construction ............ ; ............................. Plot ............................ Lot ................................ Permit Granted-..J14R' 4W.Y...IS...........T9 84 Date of Inspection ....................................19 Date Completed ...... .. ' :. .......19 I 'r f E _ r t Assessor's map and lot number .�. 6.. 3 THE y...... e. t. Sewage Permit number ....../J, ....�....y.: :.............. Z 33ARESTADLL i . qoo OS YaYaHouse number .......................:....�.� 39 AP �6 TOWN OF BAR.NSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ..... 4?fv S T� Q l ��0 use- ......................TYPE OF CONSTRUCTION ........ .•. ..................................................................................... i3. ...ag.....................19.. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .........✓UT 4.9...........nGZ:. ....... .... ......7� ili�=......'............�6T0i7 ...` '`�f�02 S Proposed Use �5i viral•,,,,,,• 'q�''�V .......... y.......................................................................................................................... Zoning District .................................Fire District ...no�ui'7 ........� ..................... ............................................................... Name of Owner �'�' ��a�'3S Lt.��4,5 e! i•7�''L � :..........................................•:.C!'.........Address .............. .................................. ............. Name of Builder • .....Address ...... c.........— n %'iy ............................ Name of Architect Gu'gC rP� f/' !.�°Pra it,e� ...Address ����'�97�U't/ /n�................................ ............:................................... Number of Rooms ......... � .................................................Foundation .. oGk'Ph 1ll4�✓r -e te-,,S— Exterior ..C.� (T,Q r�Pl�i9-`... 'ti'.�! --5................Roofin i,2t %f!9�r �5��%t�4• �:.5'.......................... .......... ........ .... g ........... Floors ,�L�.P Pr/ :'�4+....e7e.le T....... .v%!!F�r9 ...l nterior ..... ���Vu! 1. .................................................... g �`fi�! Did �...�a Heatin ...,,.,,,,,,A.......... .....:..............................................Plumbing ..... Fireplace 4(! ........................................Approximate Cos....W..�..I.®o a Definitive Plan/Approved by Planning Board _----------- --- -------19_,-3. Area Diagram of Lot and Building with Dimensions Fee . SUBJECT TO APPROVAL OF BOARD OF HEALTH i �S f� 'e 'Q y-r•�q l�� �o�a r �o c� ^- -a. F _ OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS i I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the.above 3 construction. Name ....... C,y'�_ ,,.•.� �lll.GriO,... .................... Construction Supervisor's License .52- ?4s:i s :` ............ WALSH, THOMAS N. A=56-34 14.:&6-3 No 2.5.9.8.4... Permit for One S torX........... .......S.i.ng.le...Fam.i.l.y.... .....Dw.e.1.1.in.g.............. .. .. .... ..... ....... .. . .. . .. .... Location Lot...694 Bay Drive. ...... ..... ...... ..... Cotuit ............................................................................... Owner ..Thomas N. Walsh ................................................................ Type of Construction .Frame............................ .. .... .... ............................................... ................................ Plot ............................ Lot ................................ Permit Granted ......January .....19 84 ............I........... Date of Inspection ....................................19 Date Completed .......................................19 p-v ``�o•�; .� TOWN OF BARNSTABLE Permit No. _-_25984 NAUWAX � Building Inspector cash -a OCCUPANCY PERMIT Bond' --------_K__ i Issued to Address Lot 69, `a2191Cotuit Bay Drive, Cotuit Wiring Inspector Y 'or—.Inspection date v Plumbing Inspector - r .� :� Inspection date Gas Inspector ` �/�/ �' Inspection date XEngineering Department -T; " Inspection date�'�G/ Board of Health �� jl��,�/�� Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE.4 ............ . .....:.................r....., ......�.... ............................................................ ...............�.............� ................... l r Bui ing, Inspector FROM - TOWN OF BARNSTABLE BUILDING DEPARTMENT Mr. ,�,F�r/amis- -Lahteine 367 MAIN STREET HYANNIS, MA 02M • iV11Y11 �r�.�wL''.�. '••i:.,•.a 1-r.+ -.rar•v�.q•+►a,.•�t ro4 i.rw s'arm�►.•y . 'in+jryi'i,r•Mer., .,,,,,�,,..,.�,.,w. �nw - Phone: 775-1120 SUBJECT: FOLDHERE DATE July 24,' 19814 MESSAGE 1 under,,.Permit #25984 ��hce:�s .. y II- Walsh iFV V'j'i i/iav-•9b'?•s oM�+h`+!�M�Sr S.Y 1•Pa-+r �a..� �y- w1.►}.. � Please release Bond. 'r'4��..N+ls.�r-a aF M.r,�.p,ria w=ca.w it x••.a.a.,s..+}e+�:•a.'.,a..t�Mswy+P-Ab!•s'aF . •� -� .` - .. .. SIGN - `DATE, R E P-L Y SIGNED Ne7-RmI RECIPIENT:,RETAIN WHITE COPY;RETURN PINK COPY 'PRINTED INU.S.A" SENDER: SNAP,OUT YELLOW COPY ONLY.SEND WHITE AND PINK COPIES WITH CARBON INTACT.' V . 9G In AN ei lop01 o #•�. \ •t•s l V T � �' r PIT _ ;.} k•� f, qt . .. 1 �.. f r .. •C' � � � �� -gyp. � t, �'� e09 • { 4 �j i •` f nn� RICHARD �, F I A. W. 4 r 4W SAXTER 29 u JOKES r No.2•:48 { 0. 2111 t alaye hp SURV I 1 • • ��..• �'�pro'.,. _ . �: • .� ,Ay / '• 4 4'• ht l 1 -a, 1. - { •, ., x F .1 f°• Jr .J/.ri4N Y.O IV .n 7 a P Fuso�y� 114 Xi•3;; t 33Q G, . �P GTPNK3'$3Axi5a ��lFG. � "� � , k us ' Al_"F. -��'$US1r.: 1vP0~GAL'. • `.�_' D�WA L' ARCA•.� 'So5 F., ' . ' I L Co CC 1VIT a �''BOTTO/K f AR ��;�SQL $� .;X ,1"� � � �'�; � �" ` • ';,.,'1 .�;.'1 :;F'E=2G;�?� l►Tlo "arA1E I. IN 2MIN o�L>~5S .- i i`��'�"{1'a"+fir' � t iy,.ew�fi+•_� _� T :'r - - � '. •) i x t f i4 .�•LfN,ti� '�P`11�' �,y�,� f Y �+ } �� ��� 7 � � 'RlCHARD G t, O A6hN` r_.'• v'f� t t NoR 24NS � � !o. 21 1{1 k • ,GAD 511 .�t� ��'��onn E./ ' �,�.` 3 .=M: 4. TOP FN�s�017 4mP� '�� INv.9 I � Z, 016T. INY. CA PTiG LElaLI{� INV. INV. PIT A. .Mop.. �_...� i/ q• . L _ .. �:. .. T C1_2TlFiGD PL P1..At.1 Z 10 �• 12 .' No SGP.LE ScA�E ! REF E61ZEN.GE' Ii.. C E°RT 1.G•Y f'.T HAT 'r H f� kpAT',o/� 5No µ!N '- I� NESZ�or.1 GOMPL�(5 YJITN'CHE S1oEL�NE LOTS /i_r7 " .i r_; AWD SET5ACX 2F,Gtv�S t • 11J T�E GLoaD P�.ta.IN AND gar -1v"20ty i.=��;�..'.} °. p LOGp.TED MIT DAT 1✓ �3" x Gt BAXTE iZ rc W Y 5 w c.2 . E!�oe5 li-�. .-�--+ • - -•- � - � _ . . , REG t S"T EQ6U 1.A►.1 D u ..., . . , OSTELZVILLE- Ss• �� ?u15 PLo.N 15 Nam' 4n5c�D cb AN INc�--R�JM6NT 5v2vE`( -TNE orFSETS Suou►,� ' NoT DE V5EoT0 DETEFCI^INE L.cT �_I►"1E�j APP�-ICAr� r