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0074 WILLIAMS PATH
oxkxcr NO. 1521/3 ORA MAW N FSUL?F �"a Town of Barnstable Building Post This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept ' Posted Until Final Inspection Has Been Made. Permit Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made. Permit No. B-20-1630 Applicant Name: Thomas Capizzi Approvals Date Issued: 07/01/2020 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 01/01/2021 Foundation: Location: 74 WILLIAMS PATH,WEST BARNSTABLE Map/Lot: 111-038 Zoning District: RF Sheathing: Owner on Record: LOWENTHAL,ABRAHAM F&JAQUETTE,� Contractor Name: CAPIZZI HOME IMPROVEMENT Framing: 1 INC. Address: 74 WILLIAMS PATH \ 2 Contractor License: 1007,40 WEST BARNSTABLE, MA 02668 � Chimney: Description: REPLACE ROOF WINDOW IN BATHROOM NOT BE SEEN FROM Est. Project Cost: $3,500.00 A WAY OR ROAD.)ACTIVE LEAK Permit Fee: $35.00 Insulation: Project Review Req: Fee Paid $35.00 Final: Dater 7/1/2020 Plumbing/Gas Rough Plumbing: Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. Rough Gas: All work authorized by this permit shall conform to the approved application and theiapproved construction documents for which this permit has been granted. M r Final Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. t Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Service: Minimum of Five Call Inspections Required for All Construction Work: Rough: 1.Foundation or Footing 2.Sheathing Inspection Final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Final: Versl on ng with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT . f �tNE T� ... Town of Barnstable *Permit# � '� 551T Regulatory Services Fees 6,t hs fiom issue date sawvsrneLe. M"SA Richard V.Scali Interim Director �014 ' i°lEG.Mp'�a Building Division Tom Perry,CBO,Building Commissioner i MILL 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid witkout Red X-Press Imprint Map/parcel Numberg Property Address `7� (�t I,�)q S t'cc{(/I C CU "�'�z��� l AA CT2(9("q Residential Value of Work$ `�� 9 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address '�L� ctvt a yatav�� .1 '-7 l t]t Contractor's Named �.�InQ Z Telephone Number 5--a , /V/ Home Improvement Contractor License#(if applicable) /Z4.1 4 9 3 Email: ll�lu✓LCZ3�Co�UCeL9� frt¢� Construction Supervisor's License#(if applicable) 0(o!j&-,tO ❑Workman's Compensation Insurance Check one: am a sole proprietor I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name (S&m T'&M co. \ adgnan'c r=p,Poliel# F p dS-(( � .1 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 "Replacement Windows/doors/sliders.U-Value d, o► (maximum.35)#of windows #of doors:_L__*nJessttA PW-V Wla �1 t171v,� ass ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. &A— 1-0 SIGNATURE: ' T:\KEVIN MBuilding Changes\EXPRESS PERMITREXPRESS. c Revised 061313 oFtr+E rp� • saxrasraete, , "6;S, Town of Barnstable Regulatory Services Richard V.Scali,Interim Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder �n I, � 4L[Q ��CtPA 1 n � , as Owner of the subject property hereby authorize AsGO ��tiene_� to act on my behalf, in all matters relative to work authorized by this building permit application for: U - ►� ��e ��' (Address of Job) z — zo Signature of Owner Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. TAKEWN D\Building ChangesEXPRESS PERMITEEXPRESS.doc Revised 061313 The Comtttonivealth of Massachusetts Deparhttent of Industrial Accidents Office of Investigations vi 600 Washington Street Boston,MA 02111 www.tnass.gov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information V SCO NUNEZ Please Print Legibly 79 Mayfair Rd. Name(Business/O,ganizatiowaidivi(w:S01 UN DENNIS Ml102660 Address: City/State/Zip: Phone#: 6-0 8 3 018 / 5-1 Are you an employer?Check the appropriate box: Type of project(required): L❑ I 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. am a sole proprietor or partner- listed on the attached sheet: 7. ❑Remodeling ship and have no employees These contractors have 8. ❑Demolition working for me in any capacity_ employees and have wodcers' 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.❑Roof repairs insurance required.]i c.152,§1(4),and we have no employees.[No workers' 13_ ther O-� comp.insurance required.] I •Any applicsIIt that checks box#1 mast also fill out the section below showing their wockers'compensation policy information t Homeowners who submit this affidavit indicating they are doing all workk and then hue outside contractors must submit a new affidavit indicating smcb_ tContracmrs that check this box must attached an additional sheet showing the name of the sub-conmacmts and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. lain an employer that isproviding workers'compensation insurance for uty employees. Below is the policy and job site information. AA tt 1 Insurance.Company Name: Policy it or Self-ins.Lic.#: � (Z,`S l (�`� Expiration Date: ! " 2— 21J Job Site Address: l'(I q lM S h l-�'► City/State/Zip: I l I, ` t 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 ce fy' under the pain and penalties of perjury that the information protdded above is true and correct Si tore: Date: 6 — Z — Za t Phone#: '/S/ Official use only. Do not write in this area,to be completed by city or town official. City or Town: PermitUcense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: 6 Client#:647900 2NUNF_7VA ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDNYYY) 01/20/2014 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 Dowling&O'Neil PN ONE F Insurance Agency E WAtL EM:508 775-1620 A/c,No): 5087781218 973 lyannough Rd., PO Box 1990 ADO ` INSURER(S)AFFORDING COVERAGE NAIL S Hyannis,MA 02601 INSURER A:National Grange Mutual Insuranc INSURED Vasco E.Nunez Ail DB/A INSURER 8:Citation Insurance Company V.E.Nunez Carpentry INSURER C: 79 Mayfair Road INSURERD: South Dennis,MA 02660 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 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. L°TR TYPE OF INSURANCE DDLW POLICY EFF POLICY EXP IN SR POLICY NUMBER MMO MWDD LIMBS A GENERAL LIABILITY MPOS117J D911212013 09/12/201 -EACH OCCURRENCE s2.000000 X COMMERCIAL GENERAL LIABILITY PREMISES Es NTED nee $500 000 CLAIMS MADE OCCUR MED EXP(My one person) $1 O 000 PERSONAL&ADV INJURY s2,000,000 GENERAL AGGREGATE S4,000,000 GEHL AGGREGATE LIMIT APPLIES PER:, PRODUCTS-COMPlOP AGG S4,000,000 POLICY J CT PRO LOC $ B AUTOMOBtLE LIABILITY 13MMBBWC51 7/18/2013 07/18/201 (CFO,accidentSINGIE LIMB S ANY AUTO BODILY INJURY(Per person) $250,000 ALL OWNED SCHEDULED AUTOS X AUTOS BODILY INJURY(Per accident) $500,000 IXHIRED AUTOS X NON-SWNED PROPERTY DAMAGE S300,000 S UMBRELLA LIAB HOCCUR EACH OCCURRENCE S EXCESS LIAR CLAIMS-MADE AGGREGATE $ DEO I I RETENTION S S WORKERS COMPENSATION WC STATU- OTtf AND EMPLOYERS'LIABILITY - YL[MS ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDEDT N/A (Mandatory In HH)It yes EL.DISEASE-EA EMPLOYEE S DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS!VEHICLES(Attach ACORD 101,Additional Remarks Schodute,if more space is required) Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived,or extended the coverage provided by the policy provisions. 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 AUTHORMED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.A�I rights reserved. ACORD 25(2010105) 1 Of 1 The ACORD name and logo are registered marks of ACORD 44123476IM123475 KKM 77r li . . '•:. :. c.: .:. .�.��`(�'i�/[r.•�r(rynrrN4lttucc6l(�n/�G'rrTIfJJr�CI(No/td ,, N . ( � Massachusetts Department of Public Safety .q�(Ico;oFbonilumcc:Affglrs& usincae;RcgutdHon I �J Board of Building Regulations and Standards ME IMPROVEMENT CONTRACTpR• egistratlon 124793 Type:' I. � Cunvtructinu Super�•isor i&2 Family f "" •x (_'ration:':8/26/2016 individual I License:CSFA-0 -m-si 0 1 Vasco.E. Nunez, III ' j YASaCO E NtJ1VEZ tQ �P. i' —�- j 79 MAYF'AIIt • j I ,i South Dennis MC 02660 T I Vasco Nunez,Iil� � ;;• ' ' '•�r•> 79 Mayfair Rd. { $:Dennis,MA 02660 Undarsecrotnry Expiration I' 10/03/2014 Commissioner .......................:......:.................................... ..... � ! a ,jeu�.s;.3.q.o. 3lA�• en o ' ' �,--- o vt- •.. 9L'1rZ0.1r•�1I''uo#sag _ ' OLiS a3ln's:-rozera}r�gtI�'OT . uoliein2ag.ssaulsn�,pugsake,{;yao,wgsuo 3oa ,p :of ujntsa:puno3dI 'a3P'halie�!ixQ OiI�.B'?P304 ,fluo eon Inp]Alhul JoJ•!plisA u01301;Si2du•.to asuAolrl . I �r PROPOSAL 505 w°eZ caA 79 Mayfair Rd.: South Dennis, MA 02660 MA Lic. #069680 capecodwindows.com H.I.C. #124793 (866) 398-1511 • Toll Free (508) 398-1511 • Dennis, MA PHONE DATE TO: Mrs. Jane Jaquette 508-375-9373 5/28/2014 74 Williams Path JOB NAME/LOCATION West Barnstable MA 02668 Andersen Gliding Door JOB NUMBER JOB PHONE 9373/Gliding SAME We hereby submit specifications and estimates for: 1. Remove one older model Andersen gliding door from master bedroom and replace/install with one new Andersen PermaShield gliding door in same location. * New Andersen PermaShield gliding door will have a white vinyl clad exterior with a white vinyl clad interior, white Tribeca hardware, gliding screen, no grilles, Low-E4 argon gas filled insulated glass, and a white auxiliary foot lock. The handing or gliding movement of the operating door/panel will be the opposite of the existing door/panel, ( from inside the door will move from right to left ) . 2. Remove external storm shutter from this door and not to be re-installed. 3. Supply interior/exterior trim and framing materials. New exterior trim will be lx8 rough sawn barn board, and the new interior trim will be either 2 1/2" or 3 1/2" primed reversed clamshell casing. 4 . Insulate the cavity of the new door. 5. Take old door, storm shutter and any debris from this job to the town landfill. 6. Make arrangement for delivery of new door. 7. Supply town of Barnstable building permit. * This proposal does not include any other work not described above. * All Andersen products described above will be prepaid by the home owner. * Any changes to this proposal must be done in writing and accepted by both parties. ** If this proposal is satisfactory, please sign the YELLOW copy and return with payment schedule. ** Please make a check payable to Vasco Nunez Carpentry in the amount of $ 1, 339. 11 for your new Andersen products described above, and please include this check with your signed proposal. Allow 3-4 weeks for delivery. We Propose hereby to furnish material and labor—complete in accordance with the above specifications,for the sum of: Two Thousand Six Hundred Nineteen and 1 /1 00 Dollars dollars($ Payment to be made as follows: Labor: Payment in full upon completion at time of completion. . . . . . . . . . . . . . . . . . . .$ 1, 280.00 All material is guaranteed to be as specified.All work to be completed in a professional manner according to standard practices.Any alteration or deviation from above specifications Authorized involving extra costs will be executed only upon written orders,and will become an extra Signature G j�" -2 P. 2_0! — charge over and above the estimate.All agreements contingent upon strikes,accidents or delays beyond our control.Owner to carry fire,tornado,and other necessary insurance.Our Note:This proposal may be workers are fully covered by Worker's Compensation insurance. withdrawn by us if not accepted within days. 30 Acceptance of Proposal—The above prices,specifications and con- ditions are satisfactory and are hereby accepted.You are authorized to do the work as /. specified.Payment will be made as outlined above. Sig re �' !/ ��, Signatu / C� Date of Accep L��1 �, Z 0 PROODUCT 1312BG USE WITH 771C ENVELOPE Deluxe For Business 1-80D-225-6380 or www.nebs.com PRINTED IN U.S.A. ,A f TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION IN � �-( Map Parcel. A ication"# Lf q� Health Division Date Issued Conservation Division �%�-� _ ''. Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address 7 y We ll iA ryr s PR'T+l ' W. 9 A AAJJ7 t Village /f.�tE _ i Owner '4 '` 441441V Z d MFIVA U L Acidres;�—" • +""'�ti '��z: - Telephone foS 375"` 13Ole 09 Fier it equest• VS e " JA hL/ f��W �' ' Ile//'f�6� iy euJ Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District ? r Flood Plain Groundwater Overlay Project Valuation d,OOG. DU Construction Type 10191/ Lot Size �' y ✓� Grandfathered:. ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure f y Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: L Full ❑ Crawl ❑ Walkout ❑ Other Basement Finished Area(sq.ft.) - Basement-Unfinished Area(sq.ft) Number of Baths: Full: existing Z new Half: existing new Number of Bedrooms: 10 existing _new Total Room Count (not including baths): existing 7- new First Floor Room Count Heat Type and Fuel: ❑ Gas UXI ❑ Electric ❑ Other Central Air: ❑Yes Oslo Fireplaces: Existing / New Existing wood/coal stove: ❑-Yes ❑-M6 Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑existing D;newc-5�ize_ v Attached garage: C✓existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: p Zoning Board of Appeals Authorization) ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # r Current Use Proposed Use 177 APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name f Z�� I 'B MEA171- Telephone Number 'f OW yo?d,- sw At e Address T Ile1,V '0UJA/ AD License# 0 O f y3d, p �`d®7�/ Home Improvement Contractor# Worker's Compensation # WCC_ S 10-rk ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO X SIGNATURE DATE �G � — } FOR OFFICIAL USE ONLY APPLICATION# -, DATE ISSUED , MAP/PARCEL N0. ADDRESS VILLAGE OWNER DATE OF INSPECTION: i FOUNDATION FRAME �FQWI o� 4�o f/r z ("?►��9� INSULATION S FIREPLACE ELECTRICAL: ROUGH FINAL s PLUMBING: ROUGH 'FINAL GAS: ROUGH FINAL FINAL BUILDING - E DATE CLOSED,OUT ASSOCIATION PLAN NO. i �THEr T6?vTr of Barhstable ; . -Regulatory Eervzces - r Thomas.F. Geler,Director Building Divuion , a0mas Perrpl CB OJ BuzJding Corn,,,i.c-ei over 20o Maih Stu HyEa2 i ,MA D260I' . �.Eown.har�tta6le.ma_us - - . Offices 508-862-4-038 508-79M230• PLAID RE Wtzo (-,I-� -7`f;' Owncr. •project Addmss 7 Builder- The faITow?ng items were nofed.on tev-iewJng: �F Gc%N,a0 w . - .o v C-�'fj C.�� ����• o �� �s cad.��. Repiewed by: i The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeLyibly Name(Business/Organization/Individual): i,�Z! �0 l� .L�7 �'DJe'►&VJ- ,-jy G Address: ! '/.' A/Pul- blind W 0 City/State/Zip: Co-&1 - M,Q OZ63S Phone#: -rdd' Aree an employer?Check the appropriate box: Type of project(required): 1.L71 I am a employer with © 'f' 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 8. ❑Demolition working for me in any capacity. employees and have workers' insurance.t 9. ❑Building addition comp.[No workers'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.❑Roof repairs /' insurance required.]t c. 152, §1(4),and we have no 13.[� Other 4J el)d al T employees. [No workers' comp.insurance required.] Q O I! *Any applicant that checks box#I 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. t ontractors 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. Insurance Company Name: WAY a Ll,�ffd /�1����fv Pam/ =/�/�Ei®',���Q e_ Policy#or Self-ins.Lic.M Wc-L y 701 Tea!� Expiration Date:_ 1A/a sl Job Site Address: 20�ll`SIN'I A47M City/State/Zip: W- 941M,11,491 e 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 hepainsand enalties of perjury that the information provided above is true and correct. Signature: � Date: ��/ e/2_ ` s�°�� I 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#• Client#:47298 CAPIHOM ACORD,. CERTIFICATE OF LIABILITY INSURANCE DATEDIYYYY) 12/281228/2011 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 8r 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 INSURER(S)AFFORDING COVERAGE NAIC# 508 398-7980 INSURER A:Nationalrang 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 INSURER E: Cotuit,MA 02635 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 AFFORDED,BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE'BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INS INSR WVD POLICY NUMBER MM/DD/YYW MMIDDIYYYY A GENERAL LIABILITY MPB1075H 06/08/2011 06/08/201 EACH OCCURRENCE $1 OOO 000 X COMMERCIAL GENERAL LIABILITY PREMISES(ERENTED r nce) $500 000 CLAIMS-MADE 51 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 PROJECT LOC $ A AUTOMOBILE LIABILITY M1 M28044 06/08/2011 06/08/201 EOMa.l.id.DISINGLE LIMIT 500,000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS Ix AUTOS X HIRED AUTOS NON-OWNED Per OPERTntDAMAGE $ AUTOS A X UMBRELLA LIAB X OCCUR. CUB1076H 06/08/2011 06108/2012 EACH OCCURRENCE s5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE s5,000,000 DED I X RETENTION$ 1 O 060 $ B WORKERS COMPENSATION QQ130221321 12/25/2011 12/25/201 X WC STATU- OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $1 OOO 000 OFFICER/MEMBER EXCLUDED? � N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1 00O 000 If yes,describe under f PTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 y 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 #S755431M75539 KW �e epa�n�naarecueaCC�o�C�a:rac�uveCGt ... . -. 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: e istration:.. Office of Consumer Affairs and Business Regulation _ 9 100740.:..., Type.* 10 Park Plaza-Suite 5470 Expiratio-!-, 23/2014 Supplement Card Boston,MA 02116 o CAPIZZI HOME IMPROVEMENT;INC. ROBERT ELLSWORTH• u 1645 Newton Rd. •� . ����_ C������ Cotuit,MA 02635 ' Undersecretary Not valid without signature fI Massachusetts -Department of Public Safety i �WW'' Board of Building Regulations and Standards Construction Supervisor License: CS-061438 r`± �uSC rA\s Uti I ROBERT T EL WORTH 69 PALMERI2D Q MASHPEE#A 021i4,f i Expiration Commissioner 10/15/2013 I 4 Page 7 of 7 Capizzi Home Improvement Inc. Specifications and Estimates STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT WE,ABE& JANE LOWENTHAL, OWN THE PROPERTY LOCATED AT 74 WILLIAMS PATH IN WEST BARNSTABLE,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: 925 YALE ST, SANTA MONICA, CA 90403 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: yx`f ow LIU CTYP) IZ" PLY rn Icy �� Town of Barnstable . Old King's Highway Historic District Committee 200 Main Street,Hyannis,Massachusetts 02601 ► ' (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 (7 6 .y Address of Proposed work, Assessor's Map and lot# �1 �® 3r House# Street t'V Q��l �'1'i $ 747# Village: C 5 r B 411W.1 fV6 /a This application is.for an exemption of the proposed construction on the grounds that work: Gd Will not be visible from any way or public place (lA//lq p0W J dIs within a category declared exempt by the Old Kings Highway Regional Historic District Commission ❑ Other Description of Proposed Work: �/ ^fd j�[�'r., 0 &Ljae 1--4 C. /07 ; 0ops (A'4 le i14 Al t-L41 Ct 10 � C 4 le. m i'�/� '�i10 F� r' 71 Agent or contractor(please print): C �`��'�f U Me. j=j?�Tel.no. Address 14e cer Iv-e-al-l-car4 tr Givd Owner(please print): 4 I to C�q 4 o a 1, y cif,►AG�4 I Tel no. "r—r. ' * �z-¢T+� Owners mailing address: �,{� (�; �/� �, ��{ _W' 154121 `/�,4 B le- /W Signed,Owner/Contractor/Agent 1 ,w F e v 1 10 If For Committee Use Only This Certificate is hereby Approved/Denied Date:-Ma- Committee Members Signatures: APPROVES A&jt-1 "AUG 2,2 2012 Town of Barnstable Old King's Highway Committee Any conditions of approval: C:(Documents and SettingsldecollikV ocal SettingslTemporary Internet FilesIOLK110KHExemption Form 07.doc Town of$arnstable Geographic Information System U IvaT" Ll 1,4,5 le GM 4N August 17, 2012 6v A/c V00pi I.' All 1NOoVJ Lovil ............. f l" tr' 0 48 Fe4111 f; DISCLAIMERS:This map is for planning purposes only. It is not adequate for legal Map:111 Parcel:038 N boundary determination or regulatory interpretation. Enlargements beyond a scale of Owner:LOWENTHAL,ABRAHAM F Total Assessed Value:$413600 Selected Parcel 1"=100'may not meet established map accuracy standards. The parcel lines on this map E are only graphic representations of Assessor's tax parcels. They are not true property Co-Owner:JAQUETTE,JANE S Acreage:1.17 acres Abutters boundaries and do not represent accurate relationships to physical features on the map Location:74 WILLIAMS PATH such as building locations. Buffer x 'Apr t -'' - •r �"�"�-�♦ ,C'. � ).:.l ra•. _ s i ,•�K.E,•. w,J. „'r y✓• i:. ��i. � v., f���_ •� ,G�' �( ;�.• w rye%. � � � �F. L�� ;.� � .� ;'•�� � � ;�5 ►'r,�`f'f f's�;_ ��. s y `• r'. -tT�G .1`�`-_� - r .e-' .�. �Y1 S f' 'f�'`�. ' ems. 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' fit, • •�' ! `- � ~� '� �;.�..r= -•'•• ��,," _ _ � _ .......- --,• � =may" -• __• e��. dal+.,�•„ ++.,�-� !' `�, • AAA u,a�.t' ','.' �.iyF�l�� �{,1a,t\S - ,'!t" • d t��, �'y}•t�, .. .. r� r- r�. C�& OSZ Town of Barnstable *Permit# 7 Expires 6 months f m issu�E.&te Regulatory Services Fee • anansrnsM 9� erase.1 639. Thomas F.Geiler,Director �0 QED MA'1 A Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 . www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY y Not Valid without Red X-Press Imprint Map/parcel Number Property Address ?A 7f11 Residential Value of Work ,!"Fn9, 614 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address A N,t z 1.4/4 fl"-- J 4 dyl-ia M0,1VI f4 I OY aW Contractor's Name Ito a'e yr C-11Y we P rF/ Telephone Number Home Improvement Contractor License#(if applicable) lJ0�7 y0 Construction Supervisor's License#(if applicable) -5 G Y-3 1 A-P [�4orkman's Compensation Insurance RESS " E ,MIT Check one: ❑ I am a sole proprietor AUG 2 ❑ I am the Homeowner 4 1012 ❑ I have Worker's Compensation Insurance Insurance Company Name d,� �foi/ TOwN pF gARNSTA6LE Workman's Comp.Policy# c G rid l ,0 -5-y 7 0/ Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side , / f C,/Replacement !2 Ie'�✓p� r�l/�ev #of doors ❑ Windows/doors/sliders.U-Value I Z (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. SIGNATURE: C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\DDV87AAZ\EXPPESS.doc Revised 072110 Y Page 7 of 7 Capizzi Home Improvement Inc. Specifications and Estimates i STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT WE,ABE&JANE LOWENTHAL, OWN THE PROPERTY LOCATED AT 74 WILLIAMS PATH IN WEST BARNSTABLE, 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 CUR, THE MASSACHUSETTS STATE-BUILDING CODE. SIGNATURE OF OWNER: OWNER'S ADDRESS: 925 YALE ST, SANTA MONICA, CA 90403 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: i RESPONSIBLE OFFICER TELEPHONE: i Client#:47298 CAPIHOM 812011 Ad 5^ MIDD/YORD. CERTIFICATE OF LIABILITY INSURANCE YYY) 12/2 DATE(MM/DD/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 CONTACT Karen A Walther,CISR Rogers 8r Gray Ins.-So. Dennis Pn"rc"N Ext:508.760.4630 ac No): 877.816.2156 434 Route 134 E-MAIL South Dennis,MA 02660-1601 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# 508 398-7980 INSURER A:National Grange Insurance Co. INSURED INSURER B:Associated Employers Insurance Capizzi Home Improvement,Inc. CNA Insurance Com anies Capizzi Enterprises, Inc. INSURER C: p 1645 Newtown Road INSURER D: COtult,MA 02635 INSURERE: INSURER F.: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR 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'*3EEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE INSR SWVBD POLICY NUMBER MWDDY EFF POLICY EXP LIMITS A GENERALLIABILITY MPB'1075H 06/08/2011 06/08/201 X EACHOCCURR OCCURRENCE $1 000000 COMMERCIAL GENERAL LIABILITY PRESECaoTueMI E . ne $50U 000 CLAIMS-MADE a 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/OPAGG $2,000,000 POLICY jRa LOC $ A AUTOMOBILE LIABILITY M1 M28044 06/08/2011 06/08/201 COEaMBINED ccident SINGLE LIMIT a 500,000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS X NON-OWNED PROPERTYDAMAGE $ AUTOS Per accident $ A X UMBRELLA LIAB X OCCUR CUB1076H 06/08/2011 0610812012 EACH OCCURRENCE $5 000 000 EXCESS LIAB CLAIMS-MADE AGGREGATE $5 00O 000 DE D X RETENTION$ 10 000 $ B WORKERS COMPENSATION QQ130221321 12/25/2011 12/25/2012 X WC STATU- OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $1 00O 000 OFFICER/MEMBER EXCLUDED? a N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1 000 000 It yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 C Surety Bond 70011607 11/28/2011 11/28/2012 $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 an�c �rnn�cca� ___ KW w:► 1 �e rpa�nirnaiacuea,CG�e a�C�ac�zccaeGiit ._-_ ...... 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: e9 istration:;.l Ot)740. Office of Consumer Affairs and Business Regulation ;:., Type. 10 Park Plaza-Suite 5170 Expiratiori ..6%23j20 k4 Boston,MA 02116 Supplement Card CAPIZZI HOME IMPROVEMENT;iNC. ROBERT ELLSWORTN;: 4 1645 Newton Rd, Cotuit,MA 02635 • Undersecretary Not valid without signature S f Massachusetts-Department of Public Safety "kv—v Board of Building Regulations and Standards :. Construction Supervisor License:CS-061438 �USCTTS I ROBERT T ELWORTH _ 69 PALMERAD 3 MASHPEE 1 jjA 02 49' r-, oe IF Expiration Commissioner 10/15/2013 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 Please Print Legibly Name(Business/Organizationdndividual): �/ijZ2>R /7 C e -2 !�I��lar/ewElyr -r/y G Address: i 'Kr Aleal- Wll W o City/State/Zip: Co � M'4 "Z63S Phone#: AVain u an employer?Check the appropriate box: Type of project(required): 1. a employer with Ll© 4-1 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 8. ❑Demolition working for me in any capacity. employees and have workers' [No workers'comp.insurance comp.insurance.l 9. ❑Building addition required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doingall work officers have exercised their 11. Plumbing❑ g repairs or additions myself. [No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 13.0�0ther 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: f7 SfOLl��fd_ jF01lL4fyPe1 /la®',0411-Q (� Policy#or Self-ins.Lic.#: WC 701 x-0!1 Expiration Date:_ 1A15 Job Site Address: 7 � '1 ?47 City/State/Zip: 14/* 4116*J�'9 <e 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 a pains and enaI *,s of perju that the information provided above is true +and correct Signature: Date: � C/r0/,2D/2' 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#• 111. 038 APPLICATION FOR PERMIT TO INSTALL AND REQUESTGary// 00/� FOR ELECTRICAL SERVICE � � W X--,4- b -51 d Inspector of ires Wiring Permit # COM/Electric # 311493 Town of /)PyS�*Al3L�Massachusetts _ _ Building Permit # Date Customer: �.//J .. ice i.� A!� � # r Lot# in the village of IiJ' ,1��JiPA/S/ QN� utility pole number or underground number ��0 Customer's billing address 416 d V Temporary New installation Change of service A/ Starting date Job description 7 0 D A!7/2 Ua;2 p d 1YA-1 .fit as.i Service entrance voltage 1 o A Y.0 Amperage ;Z,n d Phase Wire size(cu-or al.) 'Y 6 ALZ Conductor per phase Number of meters -Water heater Off peak: Yes No— Estimated load:Electric heat kw,lights kw,Range dryer Motors, H.P.&Phase Ready for first inspection Ready for final inspection I--n Electrical Contractor A&.d- L le P1 e!fo Lic. # ,,.6 d-?y/ Telephone# Address -?a.- .S rL' Al.&Aj S STrt r,&� ���AJ.41Z Additional Remarks: Do Not Write Below This Line �D ELECTRICAL WIRING INSPECTION CERTIFI T�� INSPECTOR OF WIRES INSPECTIONS D FEE CHARGE Temporary Service Roughing in Service and Meter Off Peak Meter Final Approval fig? At Disapproved' ? 24 `For the following reasons— CERTIFICATE OF INSPECTION Date To the COMMONWEALTH ELECTRIC COMPANY.The installation described above has been completed and has this day been inspected and approval granted for connection to your service 'IEs_p; ctor of Wires WIRING INSPECTOR TO BE NOTIFIED WHEN WORK IS READY FOR INSPECTION Permit Good For One Year From Date Of Issue CA 46 INSPECTOR'S NOTICE The Commonwealth of Massachusetts Pettnit No. Offim Use Only Dcpct: , crlf of Public Scfcy O=upancy a Fes Chatted BOARD OF FIRE PREVENTION REGULATIONS s27 CmR 1200 Vo Cleaveblanit) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All Work to be performed In accordance with the Mauachusects Electrical Code. 527 CMR 12:00 (PLEASE PRINT IN = OR TYPE ALL INFORIfA=ON) Date TOWN OF BARNSTABLE To the Inspector of Wires: The undersigned applies for a pe:zic to perform the electrical work described below. Location (Street b Number) � rJor Ienant /Owner Is Address ry y`- As A0&iv14-^ Is this permit in conjunction with a building permit: Yes ❑ No ❑ (L'heck Appropriate Box) Purpose of Building Utility Authorization NO. Existing Service �Q_,d_Amps J-2 6 Voles Overhead ❑ Undg±d K No. of Meters New Se;-rice dp Amps f1y / �'7�� Voles Overhead ❑ Undgrd No. of Ykters N=ber of Feeders and Aapaeity Location and Nature of Proposed Electrical Work �, O r / No. of Lighting Outlets INo. of Hoc Tubs No. of Transformers Toca1 \ KVA No. of Lighting Fixtures Swimming Pool Above ❑ In- ❑ grnd. gnd. (Generators KVA No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. local No. of Detection and tons Initiating Devices No. of Disposals INo, of Hear local local Po Purees Tons KW No. of Sounding Devices No. of Dishwashers ( Space/Area Heating K No. of Self Contained W Detection/Sounding Devices No. of Dryers Heating Devices KW Local❑ Municipal Other Connection[] No. of Water Heaters KIj No, of No. or Lev Voltage Signs Ballasts Wirin No. Hydro Massage Tubs No. of Motors Loral HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General "we I have a current L abilit Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES NO I have submitted valid proof of same to this office. YESLRI NO ❑ If you have.checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE BOND ❑ OrM ❑ (Please Specify) (Expiration ace Estimated Value of Electrical Work S / Work to Start Inspection Date Requested: Rough Final V Signed under the penalties of perjury: FIRM NAME .d ,(1� /� C id-/ / LIC..io_ e&L-2. Licensee Signature LIC. N0. Address "AJ-S S t- f iu/r/fS h,1 Bus. Tel. No. Alt. Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Lice see does not have the insurance coverage or its sub- cantial equivalent as required by Massachusetts General Laws, and that my signature on this permit appllcacion waives this requirement. Owner Agent (Please check one) r Telephone No. - PERMIT FEE S Signature of Owner or Agencl i Assessor's map and lot, numb D ze--77 SEPTIC MAST BE INSTALLEi COMPLIANCE Sewage Vermit number ....... ........ . .,f......................... WITH ART[ STATE THE LL, SANITARY CO D TOWN �oF , >�� 6 TOWN OF B A R�N �ioB�s ' 39B9TODLE, BUILDING INSPECTOR . ;may C' `7 oe APPLICATION FOR' PERMIT TO ..:......... ............................... .................................................. a n TYPE OF CONSTRUCTION ..........:...........!!(/�X/C .:.... ., IGcM�t. ....... ' 0 6, �s ...........0 ......2 .................19..`�.� TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the f o ll owing information: / Location V l W ` ProposedUse .................. - !i!?�ii....... ..........1 .G.- ( ................................................................................. Zoning District .....................R......4- .......... . .....................Fire District ...... ...... ..! ��.;.,.,,,.. ..!. � Name of Owner O l� r / Name of Builder .......... . ...... Address (. ..... .............:.1. P?... .....:e:............... ffww 14 Name of Architect /G .........Address .. .............. .... `1..... ..�L ...�1.....w...... Numberof Rooms .....................1.(........................................Foundation .......a-tl.. ........................................... Exterior ....... ....... .. ......... -!(. ......G7.......... .. ......Roofing ....... �i . ............................................................ Floors .. .. ..........t.... .5. ........Interior ........... ......... ... ...........:.................... ..... Heating .......... ...................................Plumbing ........ .7 - p ... 7.Fire lace � ......................................................Approximate Cost .......... .�rf. ' ..'................................ Definitive Plan Approved by Planning Board -----------__ ^ IV ---- - 9 ----• �Area ... ri................. Diagram of Lot and Building with Dimensions Fee ........ ................ ... SUBJECT TO APPf1d.66 OF BOARD OF HEALTH C 00 o. . � 1 � 2 . 5 � � a I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name D // ram...... .........44.! ................. Chase, Francis 19684 one story No ................. Permit for .................................... single family dwelling=garage ............................................................................... Location .......................William Path ......................................... Welt Barnstable ............................................................................... Francis Chase Owner .................................................................. Type of Construction ...........frame............................... ............................................................................... Plot ............................. Lot ................................ October 24 77 Permit Granted ............... ........19 , I Date of Inspection /../.............19 Date Co npleted ....n . . ... .............19 PERMIT REFUSED ................................................................. 19 ............................................................................... ................................................................................ ............................................................................... ............................................................... Approved ................................................ 19 ............................................................................... ................. ....................................................... ' - STNE TOWN OF BARNSTABLE 1639* a M BUILDING INSPECTOR TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Zoning District ....................../� �, ",4 # ;�:64,1C."-4/j/,, 0 1"no�, //) 5 (,O-t 1"134," Diagram of Lot and Building with Dimensions Fee ............ ............ SUBJECT TO APPROVAL OF BOARD OF HEALTH | hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Noma ..------.,.��..��.�.:�—..L...= .................. . � � Chase, Francis A=111-38 E. No ................. .Permit 19 6 84 for ....................................on e story single-family dwelling ............................................................................... Locati on TA...Wil.1.i.ams...Path........................... ...... . . ...... ........ West Barnstable ....................... ................................................ Francis Chase Owner .................................................................. Type of Construction .................... frame...................... .............................................................................. Plot ............................ Lot .................... ........... Odibber 24 77. Permit Granted..........................................19 Date of Inspection ......................................19 Date Completed ...............;.........................19 PERMIT REFUSED ................................................................ 19 ..................... ..... .......... I......... �. .f......... ...... . . . .. . ..... ........... ................. ... .... .. .......... . . ...... ...................... 19 Approved ........ ...... .... ................................................................................ ............................................................................... >` . F. _ so.00' TYPICAL SYSTEM PROFILE AREA PLAN FDN TOP FINISH GRADE=-4 •o-j NOT TO SCALE FINISH SCALE : I "_ =� FINISH GRADE OVER TANK= '_3•�� i GRADE OVER PIT=_1-0O LC�T-4 ' W L j A !V)- �, a T N 5 O �O g S . F. RESIDENCE O BAFFLES OR 39 6� O O 1 1 •� • • . • 1 1 C. I. TEES ` 39,33' 1 • . • • 1 • • 10 9,540.00 BSMT 0 .. . ' / 1 1 1 FLR='OU' IOOO GAL. 4" 1 1 1 1 1 • • / • 1 1 { REINFORCED IfDIST. BOX lot e 1 , • • • • 1 e 1 1 CONCRETE 8 TO BE INSTALLED ON / 1 1 1 1 • • • • 1 • 1 ' A LEVEL STABLE BASE 1 1 e • ' 0 1 1 I —� ':be:o.'•jo,.io': ;�•, .e' 'ro�.b o.:�,a. '.'a5 • • / 1 • i 1 1 1 • • • • • 1 e 1 e SEPTIC TANK f / • 1 1 1 • -• • • 1 e So 35 - TO BE INSTALLED ON A 1 1 • • 1 • 1 1 1 'r �l LEVEL . STABLE BASE ': • 1 1 • . • i . / • • 1 1 Ib IA9 2"-11/8" 1/2 "WASHED PEASTONE ALL * ' ' ' ' • • • ' • ' • ' s: BRICK a MORTAR COURSES AS AROUND FREE OF IRONS FINES ' ' • ' •' • • • • 1 1 e ` REQUIRED TO BRING COVER TO GRADE 'AND DUST IN PLACE 111 � ,. LEACHING PIT 24 C.I. MANHOLE COVER a 3/4 TO 1-1/2 WASHED CRUSHED FRAME - SEE DETAIL STONE ALL AROUND FREE OF BASE TO BE LEVEL +( IRONS, FINES AND DUST IN - ' FOR FIN. GRADE PLACE C 1 R`EC•�D.) o� ( SEE SYSTEM PROFILE SOIL AND PERCOLATION . _. PRECAST CONCRETE LEACHING 4„ II- p PtT-•,I REQD,NOW-�SEE DATA T H - 1 ry DETAIL AND PROfl t-E CANCQETE D15TI21 BIJT'10 N C30X.., Q1 /I1.00 9EE PRo-F-II.E. ---- -- -- - P#2+3836' 8„ PERC. RATE : 2 MIN. IN. 1 x?T P. 1 , foo GAL, PRECAST CONC2 l39� ' 2.l6 ETE SEPTIC, FOR INV.ELEV SEERE5ERVE PIT AREl1. INSTA ► ANK--5EE PROF'ILk THIS S}IEET _/4 ° ' LL r� Io SYSTEM PROFILE ° 6�� TAKEN BY : C. D. SPOHR i TNIS PIT SOME TIME IN THE � �� -I2.00' L LET -�- - FUTURE SHOULD THIS Bf. Z �32 k O,c� - NE1 . .. Y. .B, N •MR. PAUL. MUR , �+ E� �� .� NOTE: {BASEMENT WALK-OUT , ° o OPENINGS W/4-1/8" „o '°N ° `,` WITNESSED B RA`I` B NECE55APY, 3 DIAS. OR 49,00' A S O� k 4,1 2f AT GRADE IN RF,AR--"GRADE : 0 OUTER DIA. a 1-3/4 0 DATE. i 5 SEPT, i�77 31 G CTR,TO CTR. MINIMUM D r- ,3 ROp. 6� ti 4' ' �CCORL?►NGLY. 7 _ �. , ° 0 INSIDE DIA. TEST PIT-GNO ELEV. +3�3. 25 (TH �* {) r3D ,6 TOTAL LEACH1NGp 0 ` �UVS ,9Q� ?F , ;°: o ° AREA Pt T o '3 , . LOAM E� E G a `�'g9.00' D e V NO RUST I-EDGE- 1 tip` `b _ �9.007 0284 .53 S.F.o 0 0 ' " ``` SUB— SC) I L. OR WATER 0 0 ', .p 0 o D o 0 0 0 0- CLEAN [30Y. OF PERC, "0t_1= ° 00000 0 0 0 ° 2 6 6 DIA. 2 53.00' i 101 G EFFECTIVE DIA. :. 173'4(FRONT) LEACHING PIT - SECTION 144 LOCATION OF EXISTING ' �' j +5°1.08 NO SCALE `•�' DESIGN DATA : APPI�oYED 2" DRIvEN W�.LL• �,iT NOTE: DO NOT RUN HEAVY EQUIPMENT OVER SYSTEM 3 J NO. OF BEDROOMS +5184' \ J`!� i NO DISPOSAL ;w in-i 0 .6��t� LEACHING PIT NOTES: EST. TOTAL DAILY EFFLUENT 3�� 7 t . 5 2 00, GALS. UNDERGROUND ELECTP-IC, IBOX 5?.00 i' . Z I . CONC. TO BE 4000 P.S.I a 28 DAYS. SEPTIC TANK I�GAL. _ 4 TELEPHONE.4'h.A' (20NCRETE +51.94'``•� ;, 2. REINF, W 6 " x 6 6 GA. W. W. M. LEACHING AREA_SQ.FT/GAL= 22 SQ.FT. COVER S.E. C_0p_QI=2 @ ^kO;., 3. 2 'AND 4 SECTIONS ARE AVAILABLE FOR ASSU►�IEo ELEV. +5p,00' GREATER DEPTH REQUIREMENTS GENERAL NOTES 1 . ALL SYSTEM COMPONENTS SHALL BE INSTALLED IN ` NOTE: 160.000. -+51.7,1EXCAVATE TO ELEV. L9'fl4OR LOWER AS ACCORDANCE WITH ART. XI OF THE STATE SANITARY CODE I- N 50`- •40-30"W aAPPLICABLE. DATED AUG 1511966 a ANY LOCAL RULES +509 MATERIAL BENEATH PET. REPLACE EXCAVATED MATERIAL AND CLAY CONTAINING 2. A 0 ANY CHANGE T THIS PLAN MUST BE APPRD BY THE . �'U� L L AY'! J ` ,AT 1 � .` _ }. 4'+ �I�� R,O:W� WITH CLEAN,CLAY FREE GRAVEL, MECHANICALLY BD- OF HEALTH. COMPACTED IN PLACE. .3. WHEN CONSTRUCTION IS COMPLETED, PRIOR TO BACKFILLING, PAY EA W IDTH W IrH Ear- NOTIFY BD. OF HEALTH FOR INSPECTION. 4. FOUNDATION ELEV. MUST BE CHECKED WHEN COMPLETED. `k 5. THESE ELEVS. MUST NOT BE CHANGED WITHOUT BOARD OF HEALTH APPROVAL. LEGEND 6. BOARD OF HEALTH INSPECTION READ. WHEN EXCAVATED. LL.�� r\ ' + 50.0' EXIST. GROUND ELEV. U. M. NOTE : �,N��E�� • 50.0' FINISH GROUND ELEV."UNDERLINED" ALL EL1=VS. vEV. DATE 4 DESCRIPTION BASED ON S.E.ECORNER MR, F_ MRS. FR,ANC15 CHASE 47 50 PIPE INVERT. ELEV. OE �' x �' : CONCRETE ELECTRIC COVER PF-tiNNEY'� L,�N p TEST PIT LOCATION SEWAGE DISPOSAL SYSTEM @ ASSUMED 1=l.EV. 5ca.00' CENTERVIL.LF—, MR. 55 . I ,{t� C FOR P`j 0 o SEPTIC TANK �4'I�. T M :J. f R I V C ) S A CHASE «-�•..✓� -` �°4 ❑ DISTRIBUTION BOX I MA L_OT G ��11 L L I S 'PAT Of MAs qc� ��"1^-dam Q w.o 4 C. I . PIPE A PA H ,3��`f/ ' '�' �3 d-�t-•-rr0 , 4' B1T. FIBER - � Charle'D. 1 v\ Y`IET 1. i'1� NSTA L� E, MASS. -i-ttttttt-i- B ER PIPE -TIGHT G HT J OI N TS Charles D, � � � SPOHR $POT�R n r No 74G8 `•, P IF - --- PROPERTY 'LINE �� F� i `� DESIGNED: C.D,SPOHR DATE:IS SEPT• '77 DRAWING No. P No. 7468 0 �W W Esc,nr�,/ DRAWN: C.S. SCALE:ASSHOWN MIN. CODE DISTANCE _ 5 CHECKED: C. D. S . ' -9 -7 - -----------------