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HomeMy WebLinkAbout0016 WAKEBY ROAD i� �'� -: � �^. , I �/carr�h� 1 of r Town of Barnstable *Permit 3 Zl4q6 34 Expires 6 mon t f m jssue d to d Regulatory Services Fee 6 • RAMSUBM MASS. Thomas F.Geiler,Director 163q. �0 QED MA'l A Building Division Tom Perry,CBO, Building Commissioner ®r 200 Main Street,Hyannis,MA.02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY •Map/parcel Number 0/P / V MaP Not Valid without Red X--Press Imprint �O Property Address [Residential Value of Work Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address �Q IjL lZT C !l/y J Li 11 Z Contractor's Name N i Lz/ u,�u� .Zf?? Yt't/Z ou��/f ZNG r � Telephone Number Home Improvement Contractor License#(if applicable) / 0 41 V 0 Construction Supervisor's License#(if applicable) La S J 06111131 D�® ❑Workman's Compensation Insurance �+t Check one: JUN ❑ I am a sole proprietor Z012 ❑ I am the Homeowner [}I�I have Worker's Compensation Insurance T ,Vv iv� OF BARNSTgg . 'Insurance Company Name /'� y LE Workman's Comp.Policy# 0lV /�� `� l 3�� 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 / l�rGftJI�C J � J 130 #of doors ( Replacement Windows/d�.U-Value (maximum.35)#of windows—i 02 o6!p e h i.�f *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. <� SIGNATURE: C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.0utlook\DDV87AAZ\EXPRESS.doc Revised 072110 ' Page 7 of 7 Capizzi Home Improvement Inc. Specifications and Estimates STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT a 124-A/�q- / I, 016 � � CJtO�, OWN THE PROPERTY LOCATED AT c, IN �/�. - �'1 / , 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 CODE. 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: Client#:47298 CAPIHOM ACORD,. CERTIFICATE OF LIABILITY INSURANCE DATED/YYYY) 12/28/228/2011 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 Karen A Walther,CISR Rogers&Gray Ins.-So. Dennis PHONE 508.760.4630 FAX 877.816.2156 A/C'No Ext: A/C No 434 Route 134 E-MAIL ADDRESS: South Dennis, MA 02660-1601 INSURERS AFFORDING COVERAGE NAIC# 508 398-7980 INSURER A:National Grange Insurance Co. INSURED INSURER B:Associated Employers Insurance Capizzi Home Improvement,Inc. CNA Insurance Companies INSURER C: P Capizzi Enterprises,Inc. INSURER D 1645 Newtown Road 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDEQ_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 SUER POLICY EFF POLICY EXP LIMITS LTR I S WVD POLICY NUMBER MM/DD/YYYY MM/DDIYYYY A GENERAL LIABILITY MPB1075H 06/08/2011 06108/2012 EACHOEECCC7URRENCE $1 000 000 X COMMERCIAL GENERAL LIABILITY PREMISESOEa o.ence $50O OOO CLAIMS-MADE F—R OCCUR MED EXP(Any one person) $1 O 000 PERSONAL&ADV INJURY $1 000 000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000 000 POLICY j CT LOC $ A AUTOMOBILE LIABILITY M1 M28044 06/08/2011 06/08/2012 COMBINED SINGLE LIMIT 500,000 Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS X NON-OWNED PROPERTY PERT accident) $ AUTOS A X UMBRELLALIAB X OCCUR CUB1076H 06/08/2011 06/08/2012 EACH OCCURRENCE $5 000 000 EXCESS LIAB CLAIMS-MADE AGGREGATE s5,000,000 DED I X RETENTION$ 1 O 000 $ B WORKERS COMPENSATION QQ130221321 12/25/2011 12/25/201 X TO Y LIMIT ER OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $1 OOO 000 OFFICER/MEMBER EXCLUDED? a N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1 000 000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 C Surety Bond 70011607 11/28/2011 11128/2012 $25,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) Carpentry. CERTIFICATE HOLDER CANCELLATION Town of Barnstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis, MA 02601 AUTHORIZED REPRESENTATIVE ©198 -2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S75543/M75539 KW i The Commonwealth of Massachusetts Department of Industrial Accidents Office of Invesdgations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information ,f Please Print Legibly Name(Business/Organization/Individual): ���,z Z�• !� �'�t{� t� � �IUIi✓¢ 1NG Address: i l eul-Al Al RIP City/State/Zip: �&A A14 Phone#: y17 1/ AFy an employer?Check the appropriate box: Type of project(required): 1. m a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'comp.insurance comp. insurance. $ required.] 5. ❑ We are a corporation and its 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 12.0 Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13. Other +����� �0 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 isproviding workers'compensation insurance for my employees. Below is the policy and job site information. fie,,' Insurance Company Name: Sf 0C<� � ��/Uxfg(z f" ' Policy#or Self-ins.Lic.#: l ?j Q ,9 9-(3 ;L Expiration Date: Job Site Address: �tl �g y Rp City/State/Zip: if �t '��1#4 1/ Attach a co of the workers'compensation policy declaration page(showing the policy number and expiration date ,4)-'6 r F . PY P P Y P g ( g P Y xP ) Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature: AV� Date ��'�l t•"z d` Phone#: 7 wvll Official use only. Do not write in this area,to be completed by city or town official i 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#: i (fee wl neoauuealL10191ffaa:raC11uaeffd - Office of Consumer Affairs&Business Regulation License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration:-.10,0740...-, Office of Consumer Affairs and Business Re ulation _ Type 10 Park Plaza-Suite 5.170 g VExPlrat'Ofl,.�-6l23/2014:• Supplement Card Boston,MA 02116 CAPIZZI HOME IMPRO_VEMENT',INC. ROBERT ELLSWORTH, 1645 Newton Rd. e::a Cotuit,MA 02635 Undersecretary Not valid without signature Massachusetts-Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License:CS-061438 ROBERT T ELWORTH . .I 69 PALMERAD MASHPEE*A 0264 z Y •t . . o..�y J���f,.tfl�a Commissioner Expiration10/15/2013 y 4,fv ,IJ /t�///' - r� J r Op INE r Town of Barnstable do " Regulatory Services r SAMSrA MASM sI E Thomas F.Geiler,Director 16 39. � Building Division Peter F.DiMatteo,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 PERMIT#3'S�o� FEE: $ C7 C2 SHED REGISTRATION 120 square feet or less 16 W0.u�l� ✓Z�G ar .t'/nytr Location of shed(address) Village Property owner's name Telephone number J OCR 0 0 ' Size of Shed Map/Parcel Signature Date Hyannis Main Street Waterfront Historic District? Old King's Highway Historic District Commission jurisdiction? Conservation Commission(signature required) I64 Zx OG'lX PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN Q-forms-shedreg REV:121901 v L ON IC3F ELRO PE TY LINES A'Y NOT, BE ACCU TE STANDARD LEGEND • 83 . 3 NOTE:not all symbols will appear an a map4=Zia) GOLF COURSE FAIRWAY , ryy-rr EDGE Of DECIDUOUS TREES • � EDGE OF BRUSH ORCHARD OR NURSERY , T-V-" EDGE OF CONIFEROUS TREES MARSH AREA • \ / —••-— EDGE OF WATER 8108 0 -= DIRT ROAD DRIVEWAY PARIONGLOT V�51 PAVED ROAD 1 it ----•---• DRAINAGE DITCH ` ------ PATH/TRAIL PARCEL LINE** MAPtIo a-----MAP# 21 , PARCEL NUMBER \ / #law HOUSE NUMBER /'\ 850 2 FOOT CONTOUR LINE 16 - 10 FOOT CONTOUR LINE Elevation based on NGVD29 4.9 SPOT ELEVATION STONE WALL � X—X- FENCE RETAINING WALL MAP 60 -+-�-i-1- RAIL ROAD TRACK 1 \ / STONE JETTY 85 . 7 SWIMMING POOL 30 / \ \, , PORCH/DECK / n ] U BUILDING/STRUCTURE 2J/ DOCK/PIER / � Q HYDRANT o 3G ` A VALVE A MANHOLE .7 / / , , p POST p`P RAG POLE r ' 1 O W N O F B A R N S T A B L E O E O O R A P N 1 C I N F O R M A T I O N S Y S T E M S U N I T o SIGN ® STORM DRAIN PRINTED *NOTE:Thh map h an enlargement of a **NOTE:The parcel lines are only graphic representations DATA SOURCES:Planimefia(man-made features)were Interpreted from 1995 aerial phoographs by The lames o TOWER 1"=100'scale map and may NOT meet of propeAy boundaries They are not true ba tons,and W.Sevmll Company.Topography and vegetation were Interpreted from 1989 aerial photographs by GEOD o UTILITY POLE 0 20 40 National Ma Acaracy Standards ai the do not represent WWI relationships to physical objects Corporation.Planhnetdq topography,and vegetation were mapped ro meet N�Hanal Mop Ac urmy Standards T INOI=40 FEET* enlarged scl on the map. at o safe of 1°=100'. Paroel Urres were digitved from 2001 Town of Bamstable Assessor's tax mops. 4 UGHf POLE O ElE(TRIC BOX -A f w_ TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 6 Parcel d >b Permit# 22 2 Health Division Date Issued 2 Z Conservation Division Fee �& a�✓ 99'7`L Tax Collectors • '��` ~ �� ` Treasurer Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address A w 19 L e a!A. R ' Village i(kS A Owner Y3y P�S� S Address Telephone Permit Request jth� ,Pcti2-� _ v-e� 17 Square feet: 1st floor: existing proposed 2nd floor:existing proposed Total new Estimated Project Cost 350-7) Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family 6 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 Number 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 Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑ No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Name FRASER CONSTRUCTION Telephone Number Address 71 TARAGON CIR. License# COTUIT MA 02635 Home Improvement Contractor# 503 428-2292 Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Ycc,? 4taVA4 SIGNATURE DATE �' 7 - _ FOR OFFICIAL USE ONLY - t - PERMIT NO. DATE ISSUED .' co MAP/PARCEL NO. ADDRESS yr� VILLAGE ; �' Z. :Ali .. a5 OWNER. W �c - DATE OF INSPECTI�I: FOUNDATION FRAME r - INSULATION ? FIREPLACE ELECTRICAL: ROUGH FINAL r PLUMBING: ROUGH FINAL • ; GAS: ROUGH FINAL - FINAL BUILDING DATE CLOSED:OUT v'+� ASSOCIATION PLAN NO. f t• 1 HOME IMPROVEMENT CONTRACTORS REGISTRATION oard of Building Regulations and Standards One Ashburton Place - Room 1301 Boston, Massachusetts 02108 HOME IMPROVEMENT CONTRACTOR Registration 112536 Expiration 04/06/01 - --- - ---=-- TYPe - DBA OL \ t HOME IMPROVEMENT CONTRACTOR FRASER CONSTRUCTION co Registration 112536 DEAN C . FRASER Type - DBA ---- - 71 TARRAGON C I R - ---- --- --"-- - - a ion �— ------- -- COTUIT MA 02635 f FRASER CONSTRUCTION co DEAN C. FRASER -7fTARRAGON CIR ADMINISTRATOR *TUIT MA 02635 T The Common>woaM of M=wk Dopm"Wat of Ind AaddON 60o w �.e Som.04 Msoa Rill -IF A Woriosrs' Iawrasies Af�ldavit DAGCD ICONSTRUCTION 71 T RAGON CIR. i oty Lama 1 am a sole mmhaw no one is aor N, I am as maP-o-ya, for my omplo m ww*Wg an tMs job. N GIN IT MA t' `• x '��>orV: ..+�dr l.: '� ..:.)•.r I\?., :vf•.r2.p:a: •. ,;�;�.�"`��;k.','::.. • v .• r,/ 8) 428-2292 ,t >„;.•. .. ,,� t::. 1 I am a sole prop*m.owdcosoeaetor.or hem miiw(dlmk av#and Law tilted the condors!!sled below who haw the tbllaMas workm'omjwWdw polIM' ........ WdMal Jim tua 'HK,87Sa•: �+'r.y,.�••r r.v,' •'Si:.tOPjh�.� ` '1•.At•. � Xi' i ,:f.•;j(� , .Yt'nt'•.n;'. ...•yv•`\ •.�v\Aw_ h�•. ••,1�.. r� �.. r\\)4•. n.S •i'^":�""\n.•N'• , i �), �. n• rI.\p �ay �r ,.{y!��.�,,�tp a .�N' >.< '�' '.d. jM�.. "•'ff•f'•"�!•.w.. \ii'O.•�sI•i?h'S• ••.i.it�.22F�91�i ' ' ..�"• r ABC`/ yp•..• %.7G: dlel.�B'I11.elBi " '�h • ;vr•' •4••wy `!'��•t,... v •.w• a�-•• 951:• ^� � a ' , .. .. '. u: �ttiwfli�+aodwiJe�'a:.•.. .V. •�, m a �a����1bxy���• tt��r..�Sn• •. .. '>, �:avt��e t�tpt'• ice•• :.15.. :�x r•' ���,�ay''n. .. Y.. ••6"'�•:\'•ljj/yV�7YNw�i \t;. •S�`�•rd a.::i�'�• .•%Nx1�:":Y�^,Bi.�7lallowNV..S��• .lA''��••%wf4tl�A,'�f•ifb�?•''•" �,r' tie.a rangy�r .�����i11.f MOL 10 wis Iri r W���dYr�red�l�wrMM�.�a�a f1.s0�ee..�or or�eN l M r wdl wi dd Pwam r ds hm fro s'rOt OfTIiR W•��rlte60e•d0' w� �u�Mn tlrt• eop�.tlW�wiq►M An��N tM OAa�r��rA�Dti1►�rrwrp rrltiwdM I do hffeb► sRo ejperjxrp&wAw graftprop 6&m wdcount PtWmm BSA9,:: .• .maWarr�bt baoew�lbl�tlYws�MrwrW�bd�'�ra��ltii� do orBUM O dadclrt�riW.rw�ww��dea+ stl�t'sottla Elf"Depiumm I i " ~�= The Town of Barnstable Department of Health Safety and Environmental Services - '�� Building Division 367 Main Street,Hyannis MA 02601 Office: 508-8624038 Ralph Crossen Fax: 508-790-6230 Building'Commissioner 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: a Estimated Cost 3 SZrp Address of Work: &,(4 Owner's Name: 66 �lt/Z Spyt.O Date of Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law [3Job Under$1,000 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 the agent of the owner. Date Contractor Name Registration No. OR Date Owner's Name q:fortns:Affidav