Loading...
HomeMy WebLinkAbout0048 SCORTON HILL ROAD S(-'OZTO N ILL rCb UPC 12543 No. o$��ST•CONSJ�,�� HASTINGS, RIN C 3 DEC. \Q/2,Z� A NI ssessor's offioe (1st floor): Q�d • " ;" !+ ` T d1 :• Assessors map and lot number ..... Ne Board of-Health (3rd floor): p `n ' 5 Sewage Permit number ........./...nA .?.%:7—q......... ............... �p BAH9TGD LE00.&EN AL OIE Engineering Department. (3rd floor): �� -M R GULAMON3 "639. House number �i'Fa mo M1. APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO�M1(e11G1 � 4�19W1Iky...AiP✓?.F.GJ:t'1!�1. $f4> f.. 0....L4��►�tQ�Qf� TYPE OF. CONSTRUCTION . . .�'LrkQ1L•lc.�.��d•'�� .. - ....................... ... ......Z4......1 �.. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby plis fora permit according to .the following information: Location ...... ......./. .. h... .. ........ .....(N ).............................................................. n �9:t Proposed Use .af .. .. �Ye!(..' .Ck✓LG............................................. Zoning District ... .............................................................Fire District V�.....•f••'••••••4'..... 0 Wes Name of Owner� " - ( l.............................................Address ctk. Name of BuilderCIS. ! J . .,A ...... ........Address .. .Yr9' .A..ZL( .y Nameof Architect ...)AUC..... .............................Address .................................................................................... Number of Rooms .....I..............�..........................................Foundation ... �....�J.(466................................ Exterior .. ... .!!�......................Roofmg ....!�SY'.kl?e -.. Floors ^...C.l1.... r' t ..........................Interior ....... �0 ..... .z�... ,� Heating �............................................................Plumbing .... .. ........�... .......... .............................................. Fireplace ....../�1 +! .....Z�<re... Q1�.KP�T✓... . . .Approximate Cost ........... Definitive Plan Approved by Planning Board ------- 7____ _________19 _]!__ . A !}T .dx,z ,,,....�4z �Z�Q �ar+aru�ov�. r Diagram of Lot and Building with Dimensions Fee��!.�.. SUBJECT TO APPROVAL OF BOARD OF HEALTH e to T �20' 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. Name .. ... .. .. .... ... ...................................... Construction Supervisor's License o3n..1.51........... Bauckman, Ted & Joanne No ....31216.. Permit for .........build arape ...... ...... . . I d addition ..................................................................... Location .............48...S.c.o r.t.o.n..H.i.1.1...Road....... West...Barnstable .............i....................... ......r..n................................ Ted & Joann' Bauckman Owner ................................... ............................. Type of_Construction .........frame....................... ............................................................................... Plot ............................. Lot ................................ Permit GraA*ed ........5!29.t�'.a. AK..2.2......19 87 Date of Inspection ....... ........19 Date Completed ....... 19 Town of Barnstable *Permit l2o 1�b k95 `y�' p Expires 6 mor hsfron issu dale �T Regulatory Services Fee !�- • a►xxsTnBi.s. M"SM 1659. Thomas F.Geiler,Director �0 �D MP't A Building Division. �✓ Tom Perry,CBO, Building Commissioner . �;, 200 Main Street,Hyannis,MA 02601 �- www.town.barnstable.ma us Office: 508-862-4038 !Fax:508-790-623Q EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number III 6 x 0 Property.Address y J C relt dill /+a -W 134,CAVi4,6 A 4.4 [Residential . Value of Work. 3 U V 0 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address M ple /2-Nl y � S Cud�'��1, 1 i// R�� W. �3�/lA'✓141318 N4 It 41 ' 1 �`/�la� 11 CA.. Ilf Contractor's Nam e t`/� f / Telephone Number 5-0-j—qY �JW Home Improvement Contractor License#(if applicable) ©� 7 CZorla lion Supervisor's License#(if applicable) C S ��✓ , man's Compensation Insurance RR P PERMIT Check one: ❑ I am a sole proprietor NOV .y 2 011 ❑ tfam the Homeowner . [ have Worker's Compensation Insurance ��'Ol��ii� OF SARiVSTABL Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit ReeR(ue (check b ox) -roof(hurricane nailed (strippingold shin es All construction debris will be taken to V xoed j e ) ) elli1iie, 76 ❑Re-roof(hurricane nailed)(not stripping. Going.over existing layers of roof) fit Lj 0 u,j 1. &4 ❑ Re-side #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. copy of the Home provement tractors License&Construction Supervisors License is equ' SIGNATURE: C:\Users\decollik\A ta\Local\icrosoft\Windows\Temporary Internet Files\Content OuUook\DDV87.AAZ\EXPRESS.doc' Revised 072110 r 1-4 Page 7 of 7 Capizzi Home Improvement Inc. Specifications and Estimates STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT b,&4/P'-0'7 I, 1 VNN THE PROPERTY LOCATED AT ��cv-d���s-� Ito o'er 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 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: �—� Office of Consumer Affairs&Business Regulation License or registration valid for individul use only 7iOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and--Business Regulation ?egistration :100740 Type: 10 Park Plaza-Suite 5170 Expiration:::6/23/2012 Supplement Card Boston,MA 02116 -=t CAP!ZZI HOME'IMPROVEMENT;.`INC. JACK STRUNSKI.'. = `•. 1645 Newton Rd. Cotuit,MA 02635 Undersecretary Not valid without signature �-` Massachusetts- Department of Public Safety Board of Building Reg=ulatians and Standards CanstrvctiDn Supervisor License 4.iceiise: CS 64817 _JOHN`T i5 UM Kr ' ;.PO BOX 8 ,. ._ 86,1:, BUZZARDS.;tBAYiMA 02532 ... ,;,, ... y .,�•� COST dl Expiration: &A 8/2012 ` ('onSmiioriei Tr : 10573 i • i i • i i • I Client#:47298 CAPIHOM ACORD. CERTIFICATE OF LIABILITY INSURANCE FD TE(M o�;m) 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 Walther NAME: Rogers&Gray Ins.-So.Dennis PHONE 508-760-4630 F 508-258-2230 (A/C,No Eat): A/C,No 434 Route 134 ADDRESS: waltherka@rogersgray.com P.O.Box 1601 PRODUCER South Dennis,MA 02660-1601 CUSTOMER ID 0: INSURER(S)AFFORDING COVERAGE NAIC# INSURED Capiai Home Improvement,Inc. INSURER A:National Grange Insurance Co. Capiai Enterprises,Inc. INSURERB:ACE Property&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 TYPE OF INSURANCE D UBR POLICY NUMBER MM/DD POLICY EFF MMlDD OLICY YYM EXP LIMITS A GENERAL LIABILITY MPB1075H 06/08/2011 06/08/2012 EACH OCCURRENCE $1 000 000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $500 000 CLAIMS-MADE Ex-1 OCCUR MED EXP(Any one person) $10,000 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 PRO- LOC $ A AUTOMOBILE LIABILITY M1 M280" 06/08/2011 06/08/2012,COMBINED SINGLE LIMIT $ c ANY AUTO i (Ea accident) 500 000 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 $ X Drive Other Car $ A UMBRELLA LIAB X OCCUR CUB1076H 06/08/2011 06/08/2012 EACH OCCURRENCE s5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $S 000 000 DEDUCTIBLE $ X RETENTION 10000 $ B WORKERS COMPENSATION NWCC45843208 12/25/2010 12/25/2011 X TO Y LIMITS I ER AND EMPLOYERS'LIABILITY IN ANY PROPRIETOR/PARTNERIEXECUTIVEF—NI NIA E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? (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 OOO 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 ©198 -2009 ACORD CORPORATION.All rights reserved. ACORD 25(2009/09) 1 of 1 The ACORD name and logo are registered marks of ACORD #S67537/M67480 MEE The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant.Information r )J Please Print Legibly . Name(Business/organizadon/individual): {� C zz, 4C?+'b a Mf 1/o ueene'J� 71y L Address: S� /V t t tl �w g P City/State/Zip: C �+t 62 0 3S Phone#: .J 6,f-.y.Z C- 5 s l Are you an employer?Check the appropriate box: Type of project(required): 1.t31!t am a employer with 40. -i— 4. [] I am a general contractor and I 5 �New construction employees(full and/oi part-time).' have hired the sub-contractors 2.0 I am a sole proprietor or partner. Listed on the attached sheet. 7. ❑Remodeling shipand have no employees ees These sub-contractors have P Y 8. ❑Demolition working for ate in any capacity. employees and have workers' [No workers'comp.insurance comp.insu ce.i 9 ❑Building addition a" required] 5. [] We are a corporation and its 10.0 Electrical repairs or additions officers have exercised their 3.❑ I am.a homeowner doing all work I l.❑P bing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.anoof repairs insurance required.]t c. 152,§10),and we have no employees.[No workers' 13.❑Other comp.insurance required.] ;Any applicant that checks box 41 most also fill out the section below showing their workers'compensation policy information. lfomeowuers who submit this affidavit indicating they are doing all work and rhea hire outside contractors must submit anew affidavit indicating such. �Coniractors that check this box must attached an additional sheet showing the mime 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 infonrtation. Insurance Company Name: ACC P"P-e P-T Y 4 N v C A Su4 L�y Policy#or Self-ins.Lie.#: A/ A/ CC q S� q 3 Z0� Expiration Date: / �j� Job Site Address: City/State/Zip: �� ,�� 3 le A* Attach a copy of the workers'corn pensation 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 weft as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 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 � Sianature: Date: Phone#: Official use only. Do not unite in this area,to be completed by city or town orcial City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Towa Cleric 4.Electrical Inspector 5.Plumbing Inspector 6.Othei Contact Person: Phone#: Client#:47298 CAPIHOM ACORD. CERTIFICATE OF LIABILITY INSURANCE DsE(MMID;Y'") 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 NAME: Karen Walther Rogers 8, Gray Ins.-So.Dennis PHONE 508-760-4630 F 508-258-2230 434 Route 134 F--n(AIeap Alc'Na: ADDRESS: waltherka@_rogersgray.com P.O.Box 1601 PRODUCER South.Dennis,MA 02660-1601 CUSTOMER ID#: INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A:National Grange Insurance Co. Capiai Home Improvement,Inc. Capiai Enterprises,Inc. INSURERB:ACE Property&Casualty Ins.Co INSURER C: 1645 Newtown Road ('iotult,MA 02635 INSURERD: 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 LTR TYPE OF INSURANCE NSR INVO POLICY NUMBER MM/DDIYYYY) (MMIDOfYYM LIMITS A GENERAL LIABILITY MPB1075H 06/08/2011 06/08/2012 EACH OCCURRENCE $1 000 000 DAMAGE TO X COMMERCIAL GENERAL LIABILITY PREMISES EaENTED occurrence $500 000 CLAIMS-MADE 5XI OCCUR MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMITAPPLIES PER: PRODUCTS-COMP/01?AGG $2,000,000 POLICY PROT - LOCI I $ A AUTOMOBILE LIABILITY a M1 M28044 06/08/2011 06/08/2012 COMBINED SINGLE LIMN (Ea accident) :Y $500 000 ANY AUTO 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 LIAB X OCCUR CUB1076H 06/08/2011 06/08/2012 EACH OCCURRENCE $5 000 000 EXCESS LIAB CLAIMS-MADE AGGREGATE $5 00O 000 DEDUCTIBLE $ X RETENTION 10000 - $ B WORKERS COMPENSATION NWCC45843208 12/25/2010 12/25/2011 X I WC STATU- OTH-AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? NIA (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 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(2009/09) 1 of 1 The ACORD name and logo are registered marks of ACORD #S67537/M67480 MEE .. .. .. .. otoved by' Pionn,ng Boar- ---------------- am-,of'Lot:.and Building with Dimensions �- i 44 . i . 20 O Q Lei U O s . Z � J C' rr .147 i tv .. GLL o i� —j —j J. GrG a � I:t Y C, hereby agree to conform to all, the Rules and Regulations of the Town of Barnstable regarding-the above construction.. '� .............. .. �•JL Name ...,f..�-` -1��...., ............ • i i . e