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HomeMy WebLinkAbout0139 MEADOW LANE UPC 12543 No.5�R HRSTINCS,YN TOWN OF BARNSTABLE BUILDING PERMIT.APPLICATION y� Map t31-} Parcel. ,O M. Application # C, Health Division "Date Issued Conservation Division ` Appl.cation Fe Planning.Dept: :,Permit Fee S Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/Hyannis Project Street Address VaR MAcQW �.Tl. Village OwnerVo&IC4,M 4 Address\3D1 Telephone Permit Request i C e �?p :` �a ZM�4 � Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District, Flood Plain. Groundwater Overlay Project Valuation�s C Construction Type QRMQk- Lot Size �"�• Grandfathered: 0 Yes ❑ No If yes, attach supporting documentation. 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.) nn Basement Unfinished Area (sq.ft) Number of Baths: Full: existing oC new Half: existing new Number of Bedrooms: 4 existing —new Total Room Count (not including baths): existing _new First Floor Room Count Heat Type and Fuel: ❑ Gas 'Qil ❑ Electric ❑ Other Central Air: ❑Yes *0 Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage:Aexisting 0 new size _Shed: ❑ existing ❑ new size _ Other: E f Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ cj Commercial ❑Yes jJo If yes, site plan review# N w Co Current Use Proposed Use oret } r> APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number5L70�"'lU►�'�J�� Addressk %.,.1�145'1.1 V_4A. License # O Home Improvement Contractor# WAIAO I, Worker's Compensation # We(s 2000 ALL CONSTRUCTION EBRIS RESULTING FROM T S PROJECT WILL BE TAKEN TO 11 SIGNATURE DATE 40o FOR OFFICIAL USE ONLY J APPLICATION# G DATE ISSUED •' s a; MAP/PARCEL N0. ADDRESS VILLAGE OWNER DATE OF INSPECTION: _ F FOUNDATION FRAME �6t INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL . ' PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT,- ASSOCIATION PLAN NO. S z Page 7 of 7 CAPIZZI HOME RVIPROVEMENT INC. SPECIFICATIONS AND ESTIMATES STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT I, nn 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 ERMIT IN ACCORDANCE Wffff 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: , 67, Board of Building Regulations and Standards License or registration valid for individul use only .~HOME,IMP•R,OVEMENTaCONTR•AC•TOR=>,,.. ,;,,Y be-fomthte expirationtl•at•e-.-Mfo tin cLreturn,to. . �. ,,;•>.,-�.:.:....r: Regtst0 7p��t.; 100740 Board of Building Regulations and Standards I@fflg,f n�=fz 23/2010 One Ashburton Place Rm 1301 Boston,Ma.02108 plement Card CAPIZZI HOME NARY GUSTAFS(DIy;,�: . 1645 Newton Rd. Cotuit, MA 02635 _ — --..-_.. .-- -.-- •-- Administrator N7ova itho. nature :Ma..�achusetts- Dej)a1,1171 ut of Public safest — Baird of Buildin- Ro"elation and statsdards -� Construction Supervisor License License: CS 74640 Re.stricied to: GARY :GUSTAFSON t �: 8 SHORT WAY SANDWICH,.MA 02563 cxpiraiji n: 11/29/2010 {' r,,itd,e +trn:cd' it 7755 04/17/2009 00:25 5087785731 CAPE COD INSULATION PAGE 01 Proposal Cape Cad 11asulafion, Inc. 455 Yarmouth Rd. Hyannis,AAA 02601 508-775-1214 Fax-508-778-5735 DATE ESTIMATE No. FInaron,Gutb9M Suspended Celi tt s 4/13P2004 6055 capecodinsulatlon.com SUBMITTED TO JOB LOCATION Capizzi Home Improvement 645 Newtown Rd. Fisk Residence Cotult,Ma_02635 Fax.508420-2164 JOB SPECIFICATIONS PRICE Cr'W1 space insulated with 4" R-27.2 Closed cel spray foam insulation. CONTRACT PRICE $0_04 chrlsicgt�v�izon.ttct Proposal is good for 30 days unless otherwise nm and oted.Owrua is to keW jobsitc clear of any work hawdv.,Any alteration or daviati��,,,�above specific�ia. covered Wotkyna�ss Oomp Iasar�alce and a�wd fmtiisb ll a ents co ingent apon stn'kes,accidents or delays am beyond our control. Our wOtl M are fully copy Won your request.Owner to carry any other ttrnat�t invoiced upon receipt Im'oias unpaid der 30 des will be subject to a 1 1!2°i6 monthly intemst c Y due for the incw'rod nfur the oppOMmly to bid an ym project. We do not wmwet against and shall n0t be liable fog any amage ury,incls resporaffle for ryudfn but not collection celirtu�tad to mold t Acomftnca Slanature 04/17/2009 00:59 5087785731 CAPE COD INSULATION PAGE 01 Proposal Cape Cod Insulation, Inc. 455 Yarmouth Rd Hyannis,MA 02601 508-775-1214 Fax-508-778-5735 DATE ES MATE NO. 1-3 96-6611 Ir1111,11W016 Guth,Suspended Ceilings 4/13/2009 6055 capecodinsulation.com SUISM171-7ED TO JOB LOCATION Capi=�dome ftwrovetment 645 Newtown Rd. Fisk Residence Cotuit,Ma. 02635 Fax-508-420-2164 JOB SPECIFICATIONS PRICE Crawl space floor&foundation walls insulated with 4"R 27.2 Closed eel spray foam insulation. CONTRACT PRICE $0.00 Chrisle9ctc@v1erdzonnat Proposal is good for 30 days unless otharwise rate&owner is to kM jobsite clear of work c��vlee+eed by Wmkme o.,er mea-bode dro axt;maey All assg y cMftM up strikes, aMs a delays am beyo d o wn Our v s aMve ��ae�fi,lly amount invoiced a and we will furnish you a copy upon your rMeSt owner m�& �ne��� Pent is due for the upon reoaipt lnvoiM unpaid after 30 days will be subject to a l 1/2%monthly interest charge. Customer is incurred. Thank you for the opportunity to bid on your projeet we do not warrant against and shall ttot be liab. cu �ongwe far any collection ooetg to mold acmmulation. any dernac or injury.including but not limited Awantanm Sionalure The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street . <V Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual). L\�t \ac1ini Address: \LoAS KlTl�(7_su s u 9 A City/State/Zip0 pt \11c`a er�w-'a Phone.#:�`��, Are you an employer?Check the appropriate box: Type of project(required):. 1qI am a employer with_ 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 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' ME]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 insurance required.] t c. 152, §1(4),and we have no 12.[]Roof repairs [Na.workers'.__.­. 13,.El Other _ comp. insurance required.] 3~ "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. 1Contractors 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:\�(� 1`1 Policy#or Self-ins. Lic.#: Expiration Date: ' InG 1 � Job Site Address:Q_9t '0�i& , City/State/Zip:l9.) kiok,1) C W R, 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 tip 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$256.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the for insurance c era a verification. I-do-hereby-ser-ti- r- e-p fald perjury-that-the-infor-mation-provided-above-is-tr-ue-and-corr-ec4 Si ature: Date: Phone#: 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#: ACORDTM _ - •,V••• CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YY11� PRODUCER 12/30/08 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Rdgers&Gray Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE ~- 434 Route 134 HOLDER:THIS CERTIFICATE DOES NOT AMEND,EXTEND OR P. O, Box 1601 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. South Dennis,MA 02660-1601 INSURERS AFFORDING COVERAGE INSURED NAIC# Capizzi•Home Improvement,Inc. INSURERA: NGM Insurance Company INSURER B: American Home Assurance Capizzi Enterprises,Inc. 1645 Newtown Road INSURER C: COtuit, MA 02635 INSURER D: COVERAGES INSURER E: . 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION DATE MM/DD DATE MM/DD LIMITS A GENERAL LIABILITY MPB1075H 06/08/08 06/08/09 EACH OCCURRENCE X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENT s1ED occurrence) $1, 000 000 000 CLAIMS MADE �OCCUR MED EXP(Any y one person) s5 000 PERSONAL&ADV INJURY $1 000 000 GENERAL AGGREGATE $2 000 000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- El LOC PRODUCTS-COMP/OP AGG E2 OOO 000 A AUTOMOBILE LIABILITY M1 M28044 06/08/08 06/08/09 ANYAUTO COMBINED SINGLE LIMIT (Ea accident) $500,000 ALL OWNED AUTOS X SCHEDULED AUTOS BODILY INJURY $ (Per person) X HIREDAUTOS X NON-OWNED AUTOS BODILY INJURY S ' (Per accident) X Drive Other Car PROPERTY DAMAGE $ (Peraccident) GARAGE LIABILITY ANY AUTO AUTO ONLY-EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGG $ A EXCESS/UMBRELLA LIABILITY CUB1076H 06/08/08 06/08/09 EACH OCCURRENCE SS OOO OOO X OCCUR CLAIMS MADE AGGREGATE S5 000 00O DEDUCTIBLE S X RETENTION $10000 $ B WORKERS COMPENSATION AND $ WC6957000 12/25/08 12/25/09 X WC STJQRY A�- oTH- EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT s5OO OOO OFFICER/MEMBER EXCLUDED7 If yes,describe under fi - E.L.DISEASE-EA EMPLOYEE $500,000 SPECIAL PROVISIONS below - OTHER - E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Carpentry CERTIFICATE HOLDER CANCELLATION TN ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Town Of Barnstable EREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL n DAYS WRITTEN 200 Main Street TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Hyannis, MA 02601 NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE • t ACORD 25(2001/08)1 of 2 #S40650/M40647 I(yy o ACORD CORPORATION 1988 SEPTIC SYSTEM MUST BE Ass ioe.(1st floor)- `;. //�° [� [-NSTALLED IN COMPLIANC �`TNEtO Asse , is map'and lot number ......,�/V.../.... v WITH TITLE 5 = Board of Health (3rd floor): �/ ' "- � ONMENTAL CODE A - Sewage Permit number t.��.. �G�Q.�^...�: .'. : BasasTsnte, Engineering Department (3rd floor): / a L� OWN REGULATIONS �o rb a House number .......... ..(...1.. :. ,:. o�orpY `e APPLICATIONS PROCESSED .8:30-9:30 A.M, and 1:00-2:00 P.M. only TOWN OF . 'f BARNSTABLE BUILDING.. `INSPECTOR APPLICATION FOR PERMIT TO ...........,�� ./.. ...... TYPE OF CONSTRUCTION .............Gc1Id..,f �yl c ................................................................................ ....11../.....................190..R TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: ... . •...................Location ........li� T. ...�� .5/ 's��- .....-115 . ��! !fw..� :. ProposedUse ...........aro ...................................................................................................................... ZoningDistrict ......... (.r.......................................................Fire District ............................................................................... Name of Owner ....... ........Address ..¢ '� E....:....................................................... Name of Builder .... .............Address Nameof Architect ............ Address ...... ....................................................................... Number of Rooms ..................................................................Foundation ....... Exlerior .......� �........................................Roofing ........ / !?7" ................................................ Floors .......C . . . .............Interior ....... .. t'/ ............................. Heating ......A001six.'..............................................................Plumbing ..... ............................................................... Fireplace ........./. l-01-4..................... ......................................Approximate Cost ....�.0�� Definitive Plan Approved by Planning Board ________________________________19________ . Area ..C;z o..o. '. ...... ............. Diagram of Lot and Building with Dimensions Fee / SUBJECT TO APPROVAL OF BOARD OF HEALTH 6 OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS 1 I hereby agree to conform to all the Rules and Regulations of the Town of Barn le the above construction. Name . . ... .............. ....... .. . ................................ Q.a.Construction Supervisor's License .... ..� v...!...... Fiskej William .... Permit for ......:NRKU.e............... ........................................................................ Location .............. ................. ............................. ................... Owner ..... ........Will iam,...Fisk.e............................ ........ . Type of'C6nstruction ................XTAM9............... ............................................................................... Plot .............................. Lot ................................ Permit Granted .....November...2.4 19 86 ...... .......... A Date of Inspection . ........ ........:19 Date Completed ............ ./,7 19 XT it 4 ti• ' -,'r.�r' �� .a r ' n - +. _ 2. .Y -2 . c.�r 4y• ao­41J� +y.i.f a .7 ` .' 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( 3 a� 6,4 � „• wL 26k 71 vt 06 xw" .1-_0 'Wit p 43"- Town of Barnstable Old King's Highway Historic District Committee $ 200 Main Street,Hyannis, Massachusetts 02601 ° o (508) 862-4787 Fax(508) 862-4784 CERTIFICATE OF EXEMPTION Application is hereby made,with four(4)complete sets,for the issuance of a Certificate of Exemption under Section 6 and 7 of Chapter 470,Acts and Resolves of Massachusetts,1973,as amended,for proposed work as described below and on plans,drawings,or photographs accompanying this application: Date %�f '�Y/ '+ L�J� Address of Proposed work, Assessor's Map and lot# 131 011 House# ! 3! Street 14CAV C"C; L_-4N'E Village: ' e5f Z-41'WV4'r,4 13`e- Thhiiss application is for an exemption of the proposed construction on the grounds that work: L/ Will not be visible from any way or public place ❑ Is within a category declared exempt by the Old Kings Highway Regional Historic District Commission ❑ Other V"• C f; -f d t Description of Proposed Work: ��� f' `P 00e f✓`14 1✓ i L'1''ir•ec . ►'1 �Li',� CLVe c;��,�r. VI-4-114 ti� aPred eWtn� ih/� � Hoy ; It,�iflF�a� � �=re Fdt,-If- t l C e,4i�l 'koji 1�116'n'd - ID4�Li^i q�i) shad �i;'`;ki.1 `it 4 11C,31 XCY 41j I,`eAL iR w kee (4v 1ZPOIA/lAr 9J 0 1 /114 CJ 1�`io Kldl/11?� S L�%�Efit2 ��� ���iV�amt�% ro 17'�!�/a'0 �•�/`c'✓ �''�= P1€OJp"/d¢S Ll�'1 he^i�� Agent or contractor(please print): 6 19i ZZ1 d V'MC •b McVC:>2 i�,eNt Tel.no. 50 t1 XP `LI T/k Address i� i Id�ii}4I4'vlB;l/ •�VA0 f V ii YEA 0 .� Owner(please print): W'd iA rn 0,41) 14 A/41 r i 5 Tel no. T C.`6' 3 0 X Owners mailing address: Pi,, &IL G I s' N j J3 AAIV J;r'4 g jo ! to 4 � 2 ulsF Signed,Owner/Contractor/Agent�,1.w�/l ��% LAW `''!�>Z?/ l�c i►►c' �l�'iya/�G�Z�L.fiist¢, �A/i o ee This Certificate is here Approve enied Date: Committee Members Si 0,.�ei of bal hstabie piv Kmra s t.t,ghway ` Goy 6rr,jttee Y.T _. i Any condition approv C:IDocnments and SetangsldecollikV ocal SettingslTemporary Internet FilesIOLKI DKH Exemption Form 07.doc .,..jJ Town of Barnstable Geographic Information System August 26, 2011 / �. 00 Sm7th Creek o - >. J. J 0 85 Feet 14. --LT- DISCLAIMERS:This map is for planning purposes only. It is not adequate for legal Map:134 Parcel:017 � (� boundary determination or regulatory interpretation. Enlargements beyond a scale of Owner:FISKE,WILLIAM P&MARY E Total Assessed Value:$976400 Selected Parcel T=100'may not meet established map accuracy standards. The parcel lines an this map �.:,' i-.€ are only graphic representations of Assessor's tax parcels. They are not true property Co-Owner: Acreage:4.52 acres Abutters boundaries and do not represent accurate relationships to physical features on the map Location:139 MEADOW LANE suct.as building locations. Buffer � v - �'�• Zvi. -tia���'.i. l,ilj `r �hlrki•..}.. t Al .,�. -•�-•,(, r,�}�t�iy-F �j t /��e1`3�'� J,tT'. i"}•{ t�;�•,�•'l T �.�: '—^I - -- �... v-> E , ,�4�`'.rt��• .1 �-�.✓~rl-`,:ham � ty�°;)•P �,., , .ice m � 1R•"""""� .� •'�t •w• � ,j • /_ fit. +.�2��x r ( l , •/ , 1 1 ' �i� „rs ,� y i.�a� y "fa•A•_ ryi y`�'s r \S^•` � !1 ' �� _ ��a��•�?i �r•"'��j-,'•''Yl••F17)+a„tl . Y �`� �-y��:e`` � �' •aJir ''11 ti�.^�y` 1i '•'I tbfar "ti •.fil' ■ ,'� ,�;�,�_ ter' AT Cium '. r. 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To _ �O0 T� iV G ,- - � arp e LTAI,-:�-tA1 —z — n 1 7 /O X / © 16 Ts PO R IV 7- -On �co/v �A..T�# C 6 IF PERAv Town of Barnstable Permit# VC Expires 6 months from Mate ate iRNS.TABLE Regulatory Services Fee Tp Thomas F.Geiler,Director Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamst�ble.ma.us Office: 508-8624038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address i 3 /1 Ii�4 D O W L A] W. S A a/g,m e I e Residential Value of Work OO 0, 0 6 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address rj S k, Contractor's Name .J y /p S �y��`� Telephone Number / "V 6�Q /rl Home Improvement Contractor License#(if applicable) ` 06-1 L 6 Construction'Supervisor's License#(if applicable) - �4' �, 11 4orkmah's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I i dI have Worker's Compensation Insurance f 45300 ,, I Insurance Company Name 4 S S 0l t ,fe IL 9/11 f p o �/��l RAAl N C O M 4 A) Workman's Comp.Policy# W G G �UdSO j S Y 2 0 13 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) I � VRe-side Le GA 6/z of-- Vtle d 0 Of me& f/?K ul Cj #of doors ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows ! *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. p SIGNATURE: :: 0hA1 cJ-f/ PMSX C:\Users\decollik\AppD t \Local\Microsoft\Windows\'temporary Internet Files\Content.Outlook\DDV87AA2\EXPRESS.doc Revised 072110 . J The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations 1 Congress Street,Suite 100 Boston,MA 02114-2017 wwx.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): 1.9 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 ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.: 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.❑ Plum.bing-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 13.[lOther sf //✓G, employees. [No workers' comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:Associated Employers Insurance Co. Policy#or Self-ins.-Lic. #:WCC50050105472013A Expiration Date: 12-25-2014 Job Site Address: 13 1 M QU d a) b cty City/State/Zip: M,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 DP for insurance coverage verification. I do hereby certify de the pains n nalties of perjury that formation provided above is true and correct Si ature: Date: Phone#: 50 -428-9518` 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 APELL A QRQ' CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDONYYY(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 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 Rogers&Gray Insurance Agency,Inc. PHONE Fax 43d Rte 134 A/C N E,d: No):(877)816-2156 South Dennis,MA 02660 EDDR ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC I INSURER A:Main Street America Assurance Co. INSURED INSURER B:Associated Employers Insurance Co. 11104 Capmi Home Improvement,Inc INSURER C: Capmi Enterprises,Inc 1645 Newtown Road INSURER D: Coturt,MA 02635 INSURER E: NSURERF: 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. NSR TYPE OF INSURANCE ADDL SU POLICY EFF POLICY EXP LTR POLICY NUMBER UNITS A X COMMERCIAL GENERALUABILRY EACH OCCURRENCE E 1,000,00 CLAIMS-MADE N OCCUR MPB1075H 06/08/2014 06/08/2015 PREMISES ocasrence $ 500,004 MED EXP(Any one person) E 10,0 PERSONAL&ADV INJURY E 1,000,0 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 POLICY��o- N LOC PRODUCTS-COMPIOP AGG $ 2,000,00 OTHER: $ AUTOMOBILE LIABILITY COMBNccidaRED SINGLE LIMIT = aa A ANY AUTO M1 M28044 06/08/2014 06108/2016 BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BODILY INJURY(Per accident) $ 600,000 AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS eracadent E X UMBRELLA UAB X OCCUR EACH OCCURRENCE $ 5,000,00 A I EXCESS UAB CLAIMS-MADE CUB1076H OW0812014 06108@015 AGGREGATE $ DED I X I RETENTION$ 10,000 Pers&A&Inj $ 5,000,0 WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER B ANY PROPRIETORIPARTNERIEXECUTIVE YIN N❑ CC500501OS472013A 12/25/2013 12/2512014 E-L EACH ACCIDENT $ 1,000,00 OFFICERIMEMBER EXCLUDED] N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE 5 1,000,0 If yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT b 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 THE 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 26(2014101) The ACORD name and logo are registered marks of ACORD ,,rs Paae 7 of 7 Capizzi Home Improvement Inc. Specifications and Estimates l j STATE OF MASSACHUSETTS I LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT I, W b if Ark rid ,fie , OWN THE PROPERTY LOCATED AT 131 M E'�0 0W r IN WQS {' 3&NJTA`j- , MASSACHUSETTS. . f 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. II I GIVE MY PERMISSION TO LESSEE TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING COD . k SIGNAT'URE OF OWNER: ( M F OWNER'S ADDRESS: i OWNER'S TELEPHONE: 3 LESSEE'S SIGNATURE: I LESSEE'S ADDRESS: r 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: U/te (�iv�r�by�ao7uverclf�a�Vv�trdJ�cc�rrJe� • ffice of Consumer Affairs&Business Regulation License or registration valid for individul use only �ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:' Office of Consumer Affairs and Business Regulation Registration: 100740 Type: 10 Park Plaza-Suite 5170 Expiration: 6/23/2016 Supplement Gard Boston,MA 02116 CAPIZZI HOME IMPROVEMENT,INC. j JOHN STRUMSKI 1645 Newton Rd. - — Cotuit, MA 02635 Undersecretary rzot valid without signature t Massachusetts -Department of Public Safety Board of Building Regulations and Standards i Construction Supenisor License: CS-064817 p, JOHN T STRUMSjd Buzzards Bay Mk 02532� i t Expiration Commissioner 06/18/2016 i i I i I FRIEDLINE& CARTER ADJUSTMENT, INC. 436 Main Street, P. O. Box 338 Hyannis, Massachusetts 02601 Tel. (508) 771-3232 AX (508) 790-2344 TO: ( Building Commissioner or Inspector of Buildings ( ) Board of Health or Board of Selectmen ( ) Fire Department TOWN OF BARNSTABLE TOWN HALL BARNSTABLE, MA RE: Insured: FISKE, William P. & Mary E. Property Address: 0:39 Meadow L-ane �W:113amstabl-q—,4 Policy Number: H0360686 Type of Loss: Lightning Date of Loss: 7/20/2008 File#: 107980 Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or cause Mass. General Laws, Chapter 143, Section 6 to be applicable. If any notice under MGL, Ch. 139, Sec. 3B is appropriate, please direct it to the attention of this writer and include a reference to the captioned insured, location, policy number, date of loss and file number. On this date, I caused copies of this notice to be sent to the persons named above at the addresses indicated above by First Class Mail. d C� c <' P. J. PARECE r Adjuster co 8/13/2008 g y i . s. P oFtNt ro Town of Barnstable * 7/ � rcrmil #�Qt� Ol (p7/ T Expires 6 mora7is from issue date " SARN6rABLE MASS. Fee — �A 1639. 10�' Thomas F.Geiler,Director �3 rF0 MAt p (�)rj ,2S nO Building Divisiono� Tom Perry, Building Comnussioner Office: 508-862-4038 200 Main Street, Hyannis,MA 02601 / XpPRESS PERMIT Fax: 508-790-6230 E DEC ® 3 2007 'RCSS.PERMIT APPLICATION - RESTDLNTLAL Not voJsd URhout Rea X-Presshnprujt OF BARNSTABLE Map/parcel Number_ 1:5 14 ZL f Property Address f 3 G(' MgA O LA) �*=a: Residential Value of Work Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address (il)/Q-1AM7c,/5 KE S h'1�9 b0 UU z AA-) F1 Contractor's Name_ Telephone Number 361 1;L Home Improvement Contractor License#(if applicable) ADO 7 d construction Supervisor's License#(if applicable) f 4/G//6 1]Work0='..s Compensation Insane Check one: ❑ I am a sole proprietor I am the Homeowner .I have Worker's Compensation Insurance Lsurance Company Named 6 pLn I Iorkman's Comp.Policy# 'opy of Insurance Compliance Certificate tntist be on file. 1 :mvt Request(check box) ❑ Re-roof(stripping old shingles) All construction deb ris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side Replacement P W44de%w. U-Value #1 (maximum.44) 7 4- /cLS S *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. nature ,rms:expmtrg se063004 Or, Page 7 of 7 CAPIZZI HOME IMPROVEMENT INC. SPECIFICATIONS AND ESTIMATES STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT OWN THE PROPERTY LOCATED AT /--31I m 6A D d 1JV .L N IN BARnX7-A 64-!6 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 ERMIT IN ACCORDANCE 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: 3 xi The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 ki www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leeibly Name(Business/Organization/individual): _ rani yi Home Improvement Inc 1645 Newtown Road Address: ��toit, Mil A�66�� Tel. 428.9518 jk800-2#2-5060 City/State/Zip: one Are you an employer?Check the appropriate box: Type of project(required): 1. I am a employer er with a' 3 4. ❑ 6.I am a general contractor and I ❑ • have hired the sub-contractors New construction employees(full and/or part-time). 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑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 ME]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 13.❑Other employees.[No workers' comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 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'corm.policy number. lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. � Insurance Company Name:�a 4�/e S A Y//XA q e"/�5 • A 4 41!�AIC 4V - Policy#or Self-ins.Lic.M Expiration Date: 4 Job Site Address: .City/State/Zip; -__..:----..._.... _..._._. --........_. ....- ;._.:.__.. Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct: Si attire: Phone 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#: Date, 10/4/2007 Time: 12:26 PM To: @ 9,1,508-420-0318 REG Ins. AQay. Paget 001 Client#:47298 CAPIHOM ACORD. CERTIFICATE OF LIABILITY INSURANCE o8;3 07"' PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Rogers&Gray Ins.-So.Dennis ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 434 Route 134 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.0.Box 1601 South Dennis,MA 02660-1601 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: National Grange Mutual Ins.Co. Capizzi Home Improvement,Inc. INSURER B: American Home Assurance Capizzi Enterprises,Inc. INSURERC: 1645 Newtown Road INSURER D: Cotuit,MA 02635 INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION DATE MWDD DATE(MM1DDfYY1 UMITS A GENERAL LIABILITY MP010707 06/08/07 06/08/08 EACH OCCURRENCE $1 000 000 X COMMERCIAL GENERAL LIABILITY DAMAGMISE TO RENTED $500 000 CLAIMS MADE 51 OCCUR MED EXP(Any one person) $1 O 000 PERSONAL 8 ADV INJURY $1 OOO 000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG i2,000,000 El POLICY PRO- JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea acddent) $ ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Par accident) $ PROPERTY DAMAGE $ (Paracddenp ` GARAGE UABRITY AUTO ONLY-EA ACCIDENT $ ANY AUTO EA ACC $ OTHER THAN AUTO ONLY: AGG $ EXCESSAIMBRELLALIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ B WORKERS COMPENSATION AND WC1764953 12/25/06 12/25/07 wcsTATT 1111 OTH- EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNERIEXECUTME E.L.EACH ACCIDENT $500,000 OFFICERIMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $500 000 If yas,desodbe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $500 000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS "Supplemental Name** First Supplemental Name applies to all policies-Capizzi Home Improvement Inc&Thomas Capizzi,Jr. Policy#MP010707-:Thomas Capizzi,Jr. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Town of Barnstable DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAR 10 DAYS WRITTEN 200 Main Street NOTICE TOTHE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE To DO SO SHALL Hyannis,MA 02601 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001/08)1 of 2 #S30375/M30374 DD o ACORD CORPORATION 1988 ✓ka e m^, /l- r�✓G�sa�ueeQa Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Board of Building Regulations and Standards Registration: 100740•Ez One Ashburton Place Rm 1301 ' Piration:,�6/23/2008 •Type:-°Supplement Card. Boston,Ma.02108 CAPIZZI HOME IMPROVEMENT, I d RY GUSTAFSON 1645 Newton Rd. t • Administrator dtv Vvi —,A &vlv��� Board of Building Regula ions and Standards One Ashburton Place - Room •1301 .. .:.:.:..... •::..:.:. .....:...,..:Boston, Massachusetts '02108 .- : Home Im rovement�.Contractor;.Re` stx�aton :.:..:;. - •::_f�'-_:.: ,..:�:_,...:'•_..tc,,.rz..._.;..•,..pw.:..�...^ Ci'r-..r_.h.yn...n + .. -T:.. L. .''�.':y�r :i::' L. " .: = Type: Supplement Card Expiration: 6/23/2008 CAPI77-I WOME IMPRO-VEMENT, INC' GARY GUSTAFSON 1645 Newton Rd. = CotU It, MA 02635 Update Address and return card.Mark reason for change, _.- Address Renewal ❑ Employment ❑ Lost Card ✓/e 'tiomvmo�ruvea`l�i c�✓�icuetla � :.�tr`,'<�.�}"�'y,y_/:S _ :..�:._-w•.-C`} '_C.a,,35'� aT`to T " k]'g,D uu•A�<�•,a.i:'o_*ns.j�..ac!,.r�.zdnr sSect_a _n d:a�9r a�Fd P`srJ• : fioard.o uilding:Re _i_e. . .Y t _-+.°.,,�tyS•.`��•�y M��• ramFt`cS_+}v1.;;-f ce 9M1`t=c '��uonlso. ._' ,-,3' .-pie •u:a:t:^r'i.''�.� rr h., .. e..,r•:.,x �.. h .tYy -.'• ,. 64,0?� ' ti+g`kx .t,e`t Y '"a�Gi•�s .r^�.;y?o- i .a.` ti 1v,z�-Jr °•7.;t sr ,- + e} �. -..a Epp �:_:w' „� a, r ' Ex•E t s{. License 'CS•Gs�7 .�c.� � Er*.�(�eys�. 5��?'ti i'r3� r ��x•mr„ey�d ,Fj'.�`5 `;' y�!, ;y�e.n !1 �Jyf-JS C �t�i9ua.� +� �.f't t ,1 29.975. '�` ,� :r �' b i xk t t a Sirthda e wx e� f N r - {x„ 1 '�,-.r�c�•„r:�;.,re �c•$(;.,u t,.. i1�. ,4 'XQu'S�"c' �y ]'�.k� ,r S s�- r sash n� qf + + •rEi4�'J �'+"•g?+ei,. .�yr:aN•' ' �'ikT •�V '� „3 C 5` . .: '', ` �`S' i ] K v t �{.a .2=�} v'C' '.,5 : t �i X u a..,e.J"" I -Erp ^:.r- h 4, J,P -bF-Cf�� ]i. l:. ( ld N t�t iAJti� JT:riL Expiration �11 9/2008e `'Tr# 630�>n"x; l �vv, T 7� k �'�z' € s , u 1azal—b`.` •`Q 'l'-q aye�ms-1fc�' tIw`"•-r r•Ylt,R'`�.';'5°-.:s�sr -t'.'S3 Ca'�'iY.�,.. vT KRis �-•�22L `7% .a i j`4`?c - M� c.l .3°•3—•)3.aS.a.Si°nr�;5�3g 4u x'�]�„��t54 qx- e••-f'r,+} J1 �Fk ,•.+,s-�F ,sG N- ]�.•` yC�l {.ni,Y . i1:':4'r,5'^'' '. :.,:n-:.._. �i"Y-•'r ,T ''.'1f'. - .. .. o �'t'.i Gl."h l GARY GUSTAFSO, Y. _ C °< 8.SHORT 0256 siSANDWICH;MA soner. c a , �' _..3wK 3} M•S..M�",.� ;3`_w1 a2"- M" :'fir- .YL,,."♦ �9 :h... F _1Y'i, ,.:.jr.-.._ - ,S mil. _ 'L 2 •,•,.,'ly S�' _ •t _. _,{,"'•. G tT } HOME IMPROVEMENT I,Gary Gustafson,Production Manager of Capizzi Home Improvement,Inc.,hereby authorize Jan Donnelly to sign on my behalf for permit applications filed through the town. I Signed: /Gary Gwofs ate an Donnelly Date Ll1645 Newtown Road, Cotuit, Massachusetts 02635.• Tel. (508) 428-9518 • Toll Free (800) 262-5060 Fax. (508) 428-1547 • Email: chi@capecod.net e Website: www.capizzillome.cotn Print Page Page 2 of 4 • Sales History-Map/Block/Lot: 134/017/-Use Code: 1010 I History: Owner: Sale Date Book/Page: Sale Price: FISKE, WILLIAM P & MARY E 1984-07-02 4166/260 $0 BIRDSEY, CHARLES J 1982-06-18 3501/265 $0 • Photos 134/017/-Use Code: 1010 T • Sketches -Map/Block/Lot: 134/017/-Use Code: 1010 DK 49, 0 PRG 40 QO 3 SPE 4,C40WD $ 11.1 10 30 '&AR' ' ..:38, .,...__ .4 24 FAT 7 6, FUS4 1:3 • , 6 PR 38r, 18 As Built Cards:Click card#to view: Card #1 • Constructions Details -Map/Block/Lot: 134/017/-Use Code: 1010 Building Details Land Building value $ 195,400 Bedrooms 4 Bedrooms USE CODE 1010 Replacement Cost $232,568 Bathrooms 2 Full+ 114 Lot Size 4.52 (Acres) Model Residential Total Rooms 8 Rooms Appraised $ Value 404,500 http://www.townofbamstable.us/Assessing/printl5.asp?ap=0&searchparcel=134017 9/1/2015 - �r h Assessor's map and of number .....f 3 ! l �` ` ` G'/! . . /�s 3� ;zi /E!/ �✓G G,s•l f�� ..... ............ �F THE O Sewage, Permit number `........................................................ d Z IM3 STLBLE. i House number ...........� . s Maas TOWN OF. BARNSTABLE. BUILDING . INSPECTOR APPLICATION FOR PERMIT TO ...................... ......!ZC"�i\-G Nr?;C I! ..... t.a �: ....................... TYPE OF CONSTRUCTION .....................u-.v ..0 IS ................................................ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location 1���....M 1 .....i..�. .... .............................................................................?.. ... ................................... Proposed'Use ...........\ `> C! ..................................................................................................................................... Zoning District ............ ...................................................Fire District ......1....!.....` �r ^. � r �.,�,lys Name of Owner ............. .:G........... . �.� ?:�' ......Address ...........................�.........................................................` Ci � - R J� . � ^� U. Name of Builder. .................0 ...(���,u� -`� ......Address .................................................................................... Nameof Architect ....I..............................................................Address .................................................................................... Number of Rooms ...`.. � �Q�. ��V('Sl_:...Foundation .......��� e nq— 4 ............................. .u.. ........!........................�"............................. Exierior ..........�� +A bvr �lCl... �..L06 ..CCc�C�f!5�;�c�C�SR T.�."".... .� ^� a. ,.;� oofing .......... ,;:'..:. t i .Floors .............�-........... : ..... .��.....................................................Interior .............' ................................................................. - Heating 1c�C�32 .........Plumbing ' Fireplace ..................................................................................Approximate Cost ............. ....................................................... Definitive Plan Approved by Planning Board ---------------____-----------19________. Area ..... ...:.. .:...:.°...'..... ``) Ya Diagram of Lot and Building with Dimensions Fee A ° �...................... ...................... SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. a Name ...C- ."..`.:k:`..`..........: 1 :° � ...................... BIRDSEY, CHARLES A=134-17 No .................23931 permit for ....Build Garage ................. Accessory to Dwelling ............................................................................... Location ..,,139 Meadow Lane ......................................... West Barnstable ............................................................................... Owner Charles Birdsey .................................................................. Frame Type of Construction .......................................... • ................................................................................ Plot ............................ Lot ................................ April 2, 82 Permit Granted .:......................................19 Date of Inspection ....................................1-9 Date Completed ......................................19 � OC> TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel 6[. Application # " 656 Health Division Date Issued o� Conservation Division Application Fee Planning Dept. Permit Fee W Date Definitive Plan Approved by Planning Board f Historic - OKH Preservation / Hyannis o Project Street Address 1 3 l'04.0 4V We Tr S A2Nsl-,4J!e Village W egr R)AMMS iAS !e, Owner WO/Ain CLV?D MAR!/ f Zd Address 'POU 13 e/X <At �' Telephone 56 1 34 a- 4 a,.S'�. ,� 0 a Permit Request �J �! �� �'6 V,ered iF W.4 Y U/V o f L-4iJT_114 r/d4/1f Ua®r 11414i S 04 IX4#0 51A19Y co/OmovS ®/ xW Square feet: 1 st floor: existing proposed 2nd floor: existing pro (d ed Total news aocy/,, Zoning District Flood Plain as Groundwater Overlay . A)'(-?1 -- ::E49�"��e U�ct :n C Project Valuation / Construction Type Wovp �- Lot Size ' e Grandfathered: ❑Yes ❑ No If yes, attach supporting docum'Intation. Dwelling Type: Single Family a Two Family ❑ Multi-Family (# units) 'i I q?D Age of Existing Structure Historic House: ❑Yes ®'No On Old King's!,Highway*3 'gs ❑ No Basement Type: t"Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing 0 new Half: existing new Number of Bedrooms: `V existing d new Total Room Count (not including baths): existing e new First Floor Room Count Heat Type and Fuel: ❑ Gas YOil ❑ Electric 0 Other Central Air: ❑Yes ENo Fireplaces: Existing I New 0 Existing wood/coal stove: ❑Yes ❑ No Detached garage: grexisting ❑ 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 S'D.eMA L S't ns it r�4ftr�y Proposed Use ��fE°p��✓f/�� S�S !e t�dn,�(y APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name 16kAl 7-JAPPIN14i Telephone Number YZ 9,f/.1 C4pi2ti vM e err, j,o v pX e1V-1 Address eftar /Z J License # S d' 1, e o'V/'�'j �� 3 �^ Home Improvement Contractor# l 60-7 Y 6 Worker's Compensation # Al UJ C c YJ-d� -?z0,;- ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 7�Vh 0 SIGNATURE DATE 1 FOR OFFICIAL USE ONLY - APPLICATION# DATE ISSUED c _ MAP/PARCEL NO. h ADDRESS - VILLAGE OWNER DATE OF INSPECTION: - FOUNDATION ' FRAME - I, INSULATION FIREPLACE ' ELECTRICAL: ROUGH FINAL; o� PLUMBING: ROUGH FINAL _ GAS: ROUGH FINAL: 14, FINAL BUILDING 1 DATE CLOSED OUT ASSOCIATION PLAN NO. - r - l The Commonwealth of Massachusetts ,U�VDepartment of Industrial Accidents ' Ogee of Investigations 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit:BuHders/Contractors/Electricians/Plumbers Applicant Information ]� Please Print Legibly Name(Business/Organization/individual):��T f Z.Zt r� ®+'9►t' -L r)7 JP k-.-7 Je(-"en!-/ . tV C Address: S' Al t ul4—,h W,., jZ fn City/State)-Zip: C 0 MA 61 3S Phone 1�! Are you an employer?Check the appropriate box: 1.�am a employer with Li !- 4. ❑ I am a general contractor and I Type of project(required}: employees(full and/or part-time). have hired the subcontractors b. ❑N construction 2.❑ I am a sole proprietor or partner. listed on the attached sheet. 7.' modeling shipand have no a to These sub-contractors have mp Y� 8. ❑Demolition working forme in any capacity. employees and have workers' insurance t 4. Building addition [No workers'comp.insurance comp. required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doingall work officers have exercised their i L Plumbing re❑ g pairs or additions myself.(No workers'comp. tight of exemption per MGL 12.❑Roof repairs instrance required.]t c. 152,§1(4),and we have no employees.(No workers' I3.❑Other comp.insurance required.] 'My applicant that checks box 01 must also fill out the section below showing their workers'compensation policy information. t liommwnets who submit-this affidavit indicating they are doing all work and then lure outside contractors must submit anew affidavit indicating such. ZContmctocs that ehxk this box must attached an additional sheet showing the acme of the sub contractors and state whether or not those entities have.,. employees. If the sub-contractors have eerrtployees,they must provide their workers'comp.policy number. 1 am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: ACE p✓a P-e pzlr Y 4 il D C 4 Su4 L4 C C Z}5 z1 3 L!?� y Policy#or Self-ins.Lic.#: /1t �j Expiration Date: i 2 / S 2©Z/ Job Site Address: t 3 / '" " ��' Q vi Ut City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to S 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 5250.00 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 under the pains and penalti f perjury that the Information provided above is true and correct �- of Si-anature: Date: C� 3 t� P LO v Phone#: O, cial use only. Do not write in this area,to be completed by city or town ogeiai City or Town: Permit/License# Issuing Authority.(circle one): 1.Board of Health 2.Building Department 3.City/Town Cleric 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person' Phone#' Client#:47298 CAPIHOM ACORDn. , CERTIFICATE OF LIABILITY INSURANCE D6/02/011 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 NAMNT E: Karen Walther Rogers&Gray Ins.-So.Dennis PHONE 508-760-4630 F 508-258-2230 A/C No Ext: A/C,No 434 Route 134 E-MAIL @ers ra k lth waera o ADDRESS: g g ycom P.O.BOX 1601 ROD CER South Dennis,MA 02660-1601 CUSTOMER ID#: INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A:National Grange Insurance CO. Capiui Home Improvement,Inc.Capia ACE Pro i Enterprises,Inc. INSURERB: perry&Casualty Ins.Co 1645 Newtown Road INSURER C: Cotult,MA 02635 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DL UBR POLICY EFF POLICY EXP L TYPE OF INSURANCE g POLICY NUMBER MMIDD MMIDD LIMITS A GENERAL LIABILITY MPB1075H 06/08/2011 06/08/201 EACH OCCURRENCE $1 000 000 X COMMERCIAL GENERAL LIABILITY DAMAGES(RENTED PREMISES Ea occurrence $500 000 CLAIMS-MADE I I OCCUR MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GENE RALAGGREGATE $2,000,000 GEN4.AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY PRO- LOC $ A AUTOMOBILE LIABILITY M1 M280" 06/08/2011 06/08/2012 COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $500000 BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ X SCHEDULED AUTOS PROPERTY DAMAGE $ . X HIRED AUTOS (Per accident) X NON-OWNED AUTOS $ X1 Drive Other Car $ A UMBRELLA LIAR X OCCUR CUB1076H 06/08/2011 06/08/201 EACH OCCURRENCE s5,000,000 EXCESS LIAR CLAIMS-MADE AGGREGATE $5 00O 000 DEDUCTIBLE $ X RETENTION 10000 $ B WORKERS COMPENSATION NWCC45843208 12/25/2010 12/25/2011 X WC STATU- OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE -N E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N NIA (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT $1 000 000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) Additional insured status is provided under the general liability when required by a written contract with the certificate holder CERTIFICATE HOLDER CANCELLATION 10 Days for Non-Payment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Town of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE i 0198 -2009 ACORD CORPORATION.All rights reserved. ACORD 25(2009109) 1 of 1 The ACORD name and logo are registered marks of ACORD #S675371M67480 MEE ITEM 10: ELECTRICAL(This section is limited to the items listed below. Customer to meet with electrician and sign off on all details of needed work.) _ City: Item: — Qty: IItem: Qty: IItem: I I Openings(Plugs) Cable Outlets �_ Phone Outlets I - - -- - - _ Openings(Switches) Exterior Plugs _ —_F Fan Controls ` - - - - , i I Exterior Lights—__- _. _1._._ ' Compactor Ckt -_— Under Cabinet Lights -- -- Hot Water Heater Ckt i Recessed Cans Bath Ckts Central Air Wiring j ) Bath Fan Light J. Refrigerator Ckt Disposal Ckt Washer Ckt Range Ckt i Burner Ckt I Dryer Ckts Microwave Ckt Gas Heatalators Dishwasher Ckt Bath Fan Heat ' Well Pump Wiring _ Shower Recessed Door Bell Closet Lights Jacuzzi Tub Wiring I Central Vac Outlets Puck Lights Central Vac System _ J Double Flood Sets 100 AMP U/G Service_ 1200 AMP O/H Service_ 200 AMP U/G Service Circuit(s)added to existing panel;additional circuits needed to be quoted by electrician. o Electric demo includes hours using a$ allowance on electrician's invoice. • Smoke Detector:— Not included. ITEM 11: HVAC • Heating,forced hot wost , si g $( allowance. • Heating,forced hot ag allowance. • Electric heat, using aa a • Ventilation, using a$ llowance. • A/C,using a$ allowance. ITEM 12: MISCELLANEOUS o These proposed specifications supersede any and all plans associated with this project o Install owner-supplied bath amenities-toothbrush holder,towel racks, paper dispenser,etc. © Exterior painting: Two[2]finish oats on: Location: o Caulk seams with PhNeas d d �Ie o Prime-all bare wood tio Putty all nail holes.o Apply finish paint tor ,windo casings,door casings,doors,sliders,and shingled siding. • Interior painting: Two[2]finish coats over primer on: Location: o Caulk all seams. o Set and fill all nail h•les. o Sand between ea coat of p ' t. o Fix/patch/repair iou de e s w II a ceiling surfaces as viewed 6 ft.from area. o Prime patched/r aired ar a of II a d ceilings. o Apply one[1]co o fi is aint o il' o Apply two [2]co is o finish paint to all trim,walls,door casings;doors,window casings,and window sashes. Accepte By: Date: ---`L THIS PAGE IS PART OF AND IN CONFORMANCE WITH PROPOSAL# 33-'b:- P '- -'---------'-e-------•- ---C- 1 V61JU4UV11 Y-iU 1Vl 1)IUIYILL41 U.):,Ullly 'HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and:Business Regulation Registration: 00740 Type: 10 Park Plaza-Suite 5170 Expiration _6l23�2012 Su leinent Card PP Boston,MA 02116 CAPIZZI HOME'IMP.ROVEMENT;INC. JACK STRUNSKI 1645 Newton Rd. __ g Cotuit, MA 02635 Undersecretary Not valid without signature i Massachusetts- Department of Public Safetj- Board of Buildin�u Reg ,.mlutions and Standards Construction Supervisor License. ., 'License: CS 64817 OHN T tSRUKIMSKI _ , .:.PO BOX 861sr BUZZARDS'BAYptMA 02532 Expiration: 6/18>2012 Tr,-: '1�0573 i i ! i I I i t ; �, 1 a L�•L i `. a ,Y fk o y S aa r� ' l a 1 I oe Assessor's map and lot number .....,....... .1....l.............. le I;EFTIC SYS T,EM/MUS � INSTALLED IN COMPLIA BE1 ,tiCE Sewage Permit number � .s.......................... WITH ARTICLE II STATE F SANITARY CODE 'A'AND TO ypF THE r0� O F B A ` "'�'A L 'J �,;h t C TOW yo STA �ABIL,LS,O I ��h Wd-t_j i639 BUILDING INSPECTOR �� O �0 {� APPLICATION FOR PERMIT TO ............�.�.., 1.4.1 A........................................:....................................................... TYPE OF CONSTRUCTION .....S- -e Q. !�.....T.r?V�l ?.....�. 'r.I.l<<?.. .........::................... .............; ..,.... .........19.7 .. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location �Y ���y CW. L Q / '�`�'�`� � • Proposed Use ........+.Q.f:. aw_,........ .............1�. .. :...�?` .. n. , Zoning District ................�.f..................................... .........Fire District .......... ........... Name of Owner ......... 41\ �,5... ....�..��.A SC'. Address .! ......... .. �� Name of Builder ......... ' r 1 0 \\ Address .��o ' ...Gx. ...C �!ve................................ . anlelT..`�..... ).C.10'. ................... (j Name of Architect ......... /bru r..Q z...�3.�puu•R.<..................Address .............erne,..Gt,A.... .............................. Number of Rooms dne'.........................................Foundation ..... OCt'C' ................ O.` '."` .c�.......... ............................ 1 Exterior ............V U�.yot�:C3......C. �ee.. ..y........Roofing ...... ................. d Floors ...............CC.'.t`(1 Interior Heating .............f*'�Qne.....................................................flumbing. .....................:n.0(?............................................... Fireplace ..............k,-. ............................................................Approximate Cost ..........................Jr O O .......................... .... . ..... 8o s.�' Definitive Plan Approved by Planning Board -----------_------_-----------19_______. Area .......� ..........0...................... Diagram of Lot and Building with Dimensions Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH �pM2 / ZO wed p i : v s- I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .. .... .. .. ... . ` .............................. Birdsey, Charles J. 16320 storage No ................... Permit for ....................................... shed A7mc~ 7D #00.1w ............................................................................... Meadow Lane Location ................................................................ West Barnstable ..................................................................I............. Charles J. Birdsey Owner .................................................................. frame Type of Construction .......................................... .................................................................................. Plot ............................ Lot ................................ Permit Granted ........Jilne...18..................19 73 ........ .... Date of Inspection .............. .......... ........19 Date Completed W IL)A�rljAj dAky' PERMIT REFUSED .. ................................................................ 19 ............................................................................... 'b ................................................................................ ............................................................................... ............................................................................... J\ti Approved ................................................. 19 ............................................................................... ............................................................................... oF�HE T Town of Barnstable *Kermit# 07 yQy 1'� Expires 6 months Jroin issue date " SARNSfABLE, Regulatory Services Fee + � r MAC' Thomas F.Geiler,Director s639• �0 pIEDMP'+" 40 Blllld)1lg Division Awftels Tom Perry, Building Commissioner PERA 200 Main Street, Hyatuus,MA 02601 2 Office: 508-862-4038 ZOOS Fax: 508-790-6230 ® � EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid is,ithout Red -Press Imprint Map/parcel Number O Property Address m iko w LAU i Wm. km UAO / Residential Value of Work 4 i/� Minimum fee of$25.00 for:work under$6000.00 Owner's Name&Address �� � Contractor's Nameflmma_�_ ,1, � Telephone Number I � Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) �� ����� 0Workman's Compensation Insurance t' Check one: ❑ I am a sole proprietor I am the Homeowner I have Worker's Compensation Insurance r� Insurance Company Name ` � W W orkman's Comp. Policy# C Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) % lDie.�aGr( ,��'1 ►VIu1( l �U "`� ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-sideol ❑ Replacement Windows. U-Value (maximum.44) w , 0 I *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. Signature Can' V1 r k, Q:Foims:expmtrg Revise063004 y� :C 11 Lic. osion- M as -juset 0') 1 OS D qapl 1" 1-10MC 1D1PT0VCn1CDt �c►Dtrad-OT RX'MStratjoll Registration: 100740 Type: Private Corporation Expiration: 6123120016 CAPIZZI HOME IMPROVEMENT, INC_ ThomasCapizzi, jr. 1645 Newton Rd. Cotuit, MA 02635 Update Address and return card.N12rk reason for orange. Fj Address Ej Rencm,21 [] Employment Lost Car 0 Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Board ofBuilding Regul2tiODS and Standards Expiration: r.123120C)B One Ashl)urton P12ce Rm 1301 'i Boston,h1a.102108 Type: Private Corporatio CAPIZZI HOME IMPRO %omas Capizzi,jr. 1645 Newton Rd. Cotuil.,IVIA 02635 Not valid without out BOARD OF BUILDING REGULATIONS License' ONSTRUCIbN —41a be C§, 09 S 963 B. E"-'*-- X R 0 .C :7 TIJIOMA .'CA Pl_ IF 1045 NLV�_ COTUIT, MA 026 C6MT i.si:: _ iorer 7 FISK F aim #,3Jb6Y CAPIZZI HOME IMPROVEMENT INC . SPECIFICATIONS AND ESTIMATES PAGE 6 OF 6 STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT 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 W 0 CMR, THE MASSACHUSETTS STATE BUILDING CODE. • 1 y '. 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: ACCEPTED BY DATE THIS PAGE IS •PART OF AND IN CONFORMANCE WITH PROPOSAL # 11/04/2002, 12:48 915087906230 PAGE 01 Application to Old Kings Highway Regional Historic District Committee in the Town of 6amstab)e for e CERTIFICATION OF EXEMPTION Application is hereby made, in triplicate,for the issuance of a certlflote of exemption under Section 8 and 7 of Chapter 470, Acts and Resolves of Massachusetts, 1973, as amended for proposed work as described below and on pions,drawings,or photo. graphs accompanying this application. TYPE OR PRINT LEGIBLY DATE D 121 iO� ADDRESS OF PROPOSED WORK W ASSESSORS MAP NO. OWNER W1 1,116 ASSESSORS LOT NO. -- HOME ADDRESS ` VW I �U �w QEL,.NO. 11Y AGENT OR CONTRACTOR NA OVAt + ADDRESSI TEL N0. � 06)9 Thisapplication is for exemption of proposed exterior construction on the ground-that: (1) It will not be visible from any way or public place. (2) It is within a category declared entitled to exemption by Old King's Highway Regional Historic District Commisslon, (Check applicable box) PROPOSED WORK: Describe and furnish plan of proposed work,showing location on lot,and,if an addition Is Involved,show• ing location of existing building, V/ 1 i�� (�( � YYtiC Si SIGNED TyAsVt ! ' Space below line for Commtttga use. Owner.Contr rApent Received by H.D.-C. The Certif[cete is hereb Data —A gOi ir. Time By vote 16 L2,�a OL Approved ❑ The categories of work entitled to exemption are listed on Disapproved ❑ the back Of this form. l ;I :'r'r.t1El:•+.•u1F :ar D+tG�: � 0� �IETLetw � �\ t l eR'•: tJ'+ r.n���Y Go,� is < GFInRLE� __ CH I ROES f�IKc-sEY C 4 � j; �� \� ��� �`fib k * ..:,�k. .•.� i2; � /F(EXI 1� �� � _"F�b�tr��'Fovcr&�� lkTlr�Jt� .-�5�� . • 91 10 � i I 41 Y i ` J • ^ t/ �.i'�Ohl,�l,`f C✓E=n�D�iri G,•bL'�.ht;�Et I:_l.-i:F V ('_-':,1, L i'/tL C'.irtJ .Y:..'- r:sv`. _•L, �,. �; �LIi�YC+1� . L • �k P C% C% m � co (D Q C it � 6 LE LE C± t4 A O U C)� o jP V0�6m D 0 m o X= A e: x i rn:U D pQfto n� nprn .a P N ® N W A (b 6'O ni W -1 V S E iv ,,"C3, a� CN zoOpUl -'genv� - - - - . . . . . . . . . -{U = r" C7 N N v° SMOCPrn �_ yO M p j N 0 2 o U s m . _ p Y A m m 3 3 LP rF'. FTTIFMI O M r o J M z - u f M O ® k:. " (\ Fort® o - II O t w , o S ,p 1 l O z M r2 4--0" - Z J I \ sam II ' 7✓1 cn �I - - HUD N ( 5'-0" d s o l7 � I o rn Ali I !�� Ir F. 5o � z U3 � Cr CID CD � a U1 s Wm z � n 70. N CD CI S d-6 O (D N'Q =Al (\ 1. M O m zQP CD Cn CD —3 o O 70 II boo z3 ! o < N D• �- 303o Or- CID (n m z C\ : co NO o• aq rrnno o o m CD CD = W z -• 0 = N a W Scale:as noted Capizzi Home Improvement M o :. n� co (when printed on 11x11 sheets) _ FIBKE RE5IDENCE 1645 Newtown Road v 3 139 Meadow Lane cotuit, Massachusetts 02645 `" Covered Ent www.capizzihome.com ® �^ West Barnstable Massachusetts nJ Irv;-• ._.--------—._...._.._. .. . .__ , �(. .� o` J=1f :„ _ •1t,, l,�:a -,s,;r� ICI •{r-%:,.� �'1.3;C.',':�I���rl�'fdq.9 !�=;�J,ap�l.� S7�\"�,ICiI-!:o %\ r � ..i \�_��\ \ (��j 7 rj_ILL::•.7:I'%'.�: 3 \ \ a i I 1Z ' I\,'irss,!n•v•: ;a'':1:cn7a° >b / \ -s�-_ A I r g�Ss, a�hr11'sg1 a!e •��o�/ • `�"'. � .off' nosski y' .::X Ism lee 131. �': crlvY�hhl �0 �lii.l ;i:: a{n•^,r�U+.�.: i aria a�19 iY1j�� r l t 4 I; ..NG osIS -STA k .i.,N. axisI Ow• itLl Q '- _ ,_ � I I • -.. ..___• --- .. ... I 1. - - � ��--3, I..—.__ , ._ —_ }—�� I➢ F� ' ' f `; t i ;y t w--�r--3• 11.-•-�a�-_ ,r.V )-ZPV/ • —_._ _. --.. r ff[/ate_ .ly_fr'� !V/ �y , . . ;_ - . -- _ .�-� � - --� - ..tea©-�- 1--- .�._ •.. f` to -o N E C1 l6 yON s 1:12 PITCH - >S 1` N E O O S t 24 RAFTERS®16 OC N ozU) M Simpson H25A dips to beam _In M 7eAsUng fro door 2/2x10 BEAM deligh Nhang Q exlsdng wall ain as Iwith HU46 han � V, _ Simpson ACE4 postcap T 4x4 PT POST with 11"VIA I ' TAPERED FG WRAPPED COLUMN , 3-0 high railing I ( ( I to 3-0 HIGH RAILING I ' N N ABU44 POST BASE L DRILL&GROUT 5/5" L THREADED ROD IN TO " X a . EXISTING BRICK STEP C: .�— 0 W Note:add approx 1-0 to T-5" U) O depth of existing brick landing; °° M O add new brill:step °° pj - L PLAN OF NEW ENTRY scale: 1/4"=1'-0" a O SECTION Q NEW ENTRY scale: 1/4"=1'-0" 3 � v 'r S i • U) U) W IZ— ewsmly wwlerl z US LU -1 U) A 3 � - - w � � Mewcovenev exnlr �.♦f^/� �.., to Date: % 6-12-11 1 Revisions: 4 " b-30-11 LEFT SIDE ELEVATION scale: 1/8"=1'-0" Final Plans: FRONT ELEVATION scale: 1/8"=1'-0" BUILDER TO CONFIRM ALL CONDITIONS AND DIMEN51ON5 ON 51TE Accepted by: Date: Note:These plans are for the sole purpose and use of Capizzi Home Improvement and are not to be distributed or used for construction other • Accepted by: Date: than by Capizzi Home Improvement.