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HomeMy WebLinkAbout0032 ANGELL ROAD `� J _ _ _ _ - -- - �- - - i i 4� �+. t i 1 �r1 r � � � r �� ��. { �\( I � ��. �t F � .� � .. � v � \ � ' . O ;N v r r Town of Barnstable *Permit P'EUR11 p��1f Fapirec 6monUssfront date n6 egulatOly Services Fee E NLM MMMB> t 28 2014 9e� Thomas F.Geiler,Director ®F BARNSTABLE Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstableana us Office: 508-862-4038 Fax:508-790-6230 EXPRESS PERNUT APPLICATION - RESIDENTIAL ONLY Not.Vigid without Red X-Press Imprint Map/parcel Number D q I Property Address J Z 14N6e f/ 7?.04 d 1 jVAA1,Vl'j Of [Residential . Value of WorkZ/ 0 0 D [� d Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Eb1 44t3e9- y!D 3z AWell ko dy W/Vd/ M4 Pz4a Contractor's Name_Joh', Telephone Number_ (00 Home Improvement Contractor License#(if applicable) 1007 V d Construction Supervisor's License#(if applicable) C S- V V 11 4? I 2/Workman s Compensation Insurance • Check one: ❑ I am a sole proprietor ❑�,�am the Homeowner L1/I have Worker's Compensation Insurance --- Insurance Comparry Name Workman's Comp.Policy# G S�OyD 1Q SCSIj/ 4 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 #of doors ��'�r�/✓�/ly �] 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. h, copy of the Home provement tractors License&Construction Supervisors License is equ' SIGNATURE: kA, C:\Users\decollik\A 1LocalNicroso8\WindowsWemporary Internet Files\Content Outlook\DDV87AAZ\EXPRESS.doc Revised 072110 -_ pO' CAPINOM-01 APELL co" _A_.CORI DATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 6/4/2014 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 endorsemen(s). PRODUCER CONTACT NAME Rogers&Gray Insurance Agency,Inc. PHONE FAX 434 We 134 N Ed: No):(877)816-2166 M South Dennis, A 02660 ED ADDRESS: INSUREMS)AFFORDING COVERAGE NAILS INSURER A:Main Street America Assurance Co. INSURED INSURERB:Associated Employers Insurance Co. 11104 Capri Home Improvement,Inc. INSURER c: Capri Enterprises,Inc. 1645 Newtown Road INSURERD' Cotult,MA 02636 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. 0L R TYPE OF INSURANCE ADDL SU POLICY NUMBER YPOLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL uAei TTY EACH OCCURRENCE $ 1,000,00 CLAIMS-MADE N OCCUR MPB1075H 06/08Pl014 06=12015 PREMISES aENTEoccu ence $ 500,004 MED EXP(Airy one person) $ 10,0 PERSONAL&ADV INJURY $ 1,000,0 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,0 POLICY��O N LOC PRODUCTS-COMP/OP AGG $ 2,000,00 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ a acddent A ANY AUTO MIM28044 06/08/2014 06/08/2015 BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BODILY INJURY(Per accident) $ 500,0 AUTOS AUTOS X X NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident) $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,0 A EXCESS LIAB CLAIMS-MADE CUB1076H 06/08/2014 0610IM15 AGGREGATE $ DED I X I RETENTION$ 10,000 Pens&Adv IN $ 5,000,00 WORKERS COMPENSATION X PER OH AND EMPLOYERS'LIABUM STATUTE ER B ANY PROPRIETORIPARTNERIEXECUTIVE YIN CC50050106472013A 12125=13 12/26/2014 E.L.EACH ACCIDENT $ 1,000,00 OFFICERddEMBER EXCLUDED? N❑N/A (Mandatory in NH) - E.L DISEASE-EA EMPLOYEd$ 1,000,0 If yes,describe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS 1 LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Sehedtde,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 VIIILL BE DELIVERED IN IM 200 Main Street ACCORDANCE TH THE POLICY PROVISIONS. Hyannis,MA 02601-0000 AUTHOR®REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Department of Industrial Accidents w Office of Investigations ' d I Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Capizzi Home Improvement Inc Address: 1645 Newtown Road City/State/Zip:Cotuit, MA 02635 Phone #:508-428-9518 Are you an employer?Check the appropriate box: Type of project(required): 1.0 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.❑ 1 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. Buildingaddition [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......,...: . _l l.❑ Plumbing-repairs-or-additions= • - . myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *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. $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. #:WCC500`5r0105472013A Expiration Date: 12-25-2014 Job Site Address:___ 3 2. A N ��/ City/State/Zip: b Z G 0 / 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 cer ' under the pains and penalties of perjury that the information provided above 's true and correct. Signature: Date: 't T Phone#: -428-951 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: ��,• � �le�pc�ria7reo�rcaetclf�n��tuJan�ufe 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(.;ard' : Boston,MA 02116 CAPIZZI HOME IMPROVEMENT,INC. j JOHN STRUMSKI i 1645 Newton Rd. Cotuit, MA 02635 Undersecretary Not valid without signature 1 Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-064817 - JOYIN T STRUMS Id r ; r 18 ALDEN AVE Buzzards day NM 02532� ✓. ire„ Expiration Commissioner 06/18/2016 i Page 7 of 7 Capizzi Home Improvement Inc. Specifications and Estimates STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING.PERMIT I, ELIZABETH HAROLD, OWN THE PROPERTY LOCATED AT 32 ANGELL ROAD IN HYANNIS, MASSACHUSETTS. I HAVE AUTHORIZED CAPIZZI HOME IMPROVEMENT: TO ACT AS MY AGENT TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR,THE MASSACHUSETTS STATE BUILDING CODE. I GIVE MY PERMISSION TO: - LESSEE TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING C E. SIGNATURE OF OWNER: '/ / � •' ' OWNER'S ADDRESS:. 32 Angell Rd., Hyannis,MA 02601 -- OWNER'S TELEPHONE: 508-775-M05 LESSEE'S SIGNATURE: LESSEE'S ADDRESS: LESSEE'S TELEPHONE: I 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: - - i Assessor's Office(1st floor) Map 0 Lot 9/ Permit# Conservation Office(4th floor) " Date Issued Board of Health(3rd floor)(8:30-9:30/1:00- 2:00) Y Fee Engineering Dept. (3rdrfloor) House#1 Ge� Planning Dept.(1st floor/School Admin. Bldg.) �^ AR Definitive PI ro 'd by Planning Board 19 s AppldC . M S& ASEWEE CONNECTIObFROM TOWN Off'.BARNSTABLE co ° �0 TO Building Permit Application Project Stre ss , 3.2— A/V � , Village �V Owner.'19�-je ��/ .l,< 0�1� Address Telephone 7j,5"—3 8©g- Permit Request; UL1ei/�Sf�f' 'M XV-4 C44W& LV/ G'�D�4�Sid/N�G� &IV / F� Total 1 Story Area(include 1 story garages&decks) square feet Total 2 Story Area(total of 1st&2nd stories) square feet Estimated Project Cost $ C5� 000 Zoning District ' Flood Plain Water Protection Lot Size Grandfathered? Zoning Board of Appeals Authorization Recorded Current Use Proposed Use Construction Type fy �G'�j1� _Sif—li✓c e,g Commercial Residential t/ Dwelling Type: Single Family ✓ Two Family Multi-Family Age of Existing Structure Basement Type: Finished Historic House W� )D Unfinished Old King's Highway /Nd Number of Baths No.of Bedrooms Total Room Count(not including baths) First Floor Heat Type and Fuel Central Air Fireplaces Garage: Detached Other Detached Structures: Pool Attached Barn None Sheds Other �� Builder Information Name J�W/�� igllo� Telephone Number 2 e,5?S;W Address 4W License# Q' 6 /,99 4/�/2zj AA �aA&-zVkma Home Improvement Contractor# /676-7,4eo Worker's Compensation# p f3 WA=B AI gU V'A 7-7- 0�� NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE e --P— S BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) t FOR OFFICIAL USE ONLY PERMIT NO. 9589 DATE ISSUED 8/9/-9 5 ' !; } MAP/PARCEL NO. 13 0 6 0'91'' - ADDRESS 32 Angell Road ,, VILLAGE Hyannis - - OWNER Charles Harold DATE OF INSPECTION: FOUNDATION r ! i . FRAME INSULATION FIREPLACE % ELECTRICAL: ROUGH ,FINAL PLUMBING: ROUGH FINAL _ GAS: ROUGH2�5 FINAL r to*ERA � FINAL BUILDING � "1�� r rillDATE CLOSED OUT ASSOCIATION PLAN NO 0 i The Town- of Barnstable u�►iuvsrnarE. � � Department of Health Safety and Environmental Services i639. Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-775-3344 Building Commissioner For office use only Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions, along with other requirements. Type of Work:, , &6" Ally egi Est. Cost 9,5)vea Address of Work:. 6-2 r— In Owner Name:i e &fteLJ1ff�'7 Date of Permit Application: I heretn•certifv that: Registration is not required for the following reason(s): Work excluded by law Job under$1,000 Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owacr: Date Contracto/rfiamc Registration No. OR Date Owner's name s'l ' I I ; HOME IMPROVEMENT CONTRACTORS REGISTRATION I I oard of Building Regulations and Standards i ( . One Ashburton Place — Room .1301 8oston, Massachusetts 021.08 I I • HOME IMPROVEMENT CONTRACTOR --------------------- ---- 'Registration 100740 Expiration 06/23/96 r Type — PRIVATE CORPORATION I I HOME IMPROVEMENT CONTRACTOR...., �.2"Istfatiom 400740 I Capiz�i Home •Improvement , Inc. Type -. PRIVATE CORPORATION- ( . � • Thomas -Capizzi , Sr . I tiphation • 16/23/96 1 1645 Newton Rd. I CIPIZZI Home Improve eat, Inc Cotuit MA 02635 j Thomas Capizli, Sr. G� �o f± 4.6A3 Newton Rd. I -Cotult MA 02635 i GQeeao4isaeGe Restricted to: 10 1EPARTMENT IF PUBLIC SAFE11 lug CONSTRUCTION SUPERVISOR LICENSE I t 10 - lost Luber: . .Expires: lirtldete: 1A - usoerr oily tS 141119 10/29/1996 10/29/1948 16 - 1 1 2 141ill,Nous Restricted To: /0 4X-L. OAVIO N IEBB CoaMasarme 100 PLUM NOLLOV RO i E FALMOUTH, 1A 12536 Commonwea Lh of Xas3ackz3etb .1.1e arfnte�o�J�tdtclfria�Jdcc�� .�� 600 WadLV foa Street ' - i oefo►c, Vajsac�. tb 02 f f f James J.Campbell -� -_ Commrssiwer Workers' Compensation Insurance Affidavit - I ZZ cauea/permiccee) with a principal place of business at: 7 r�iGvp.� (acy/Salce/Zip) do hereby certify under the pains and penalties of perjury, that: Q/ I am an employer providing workers' compensation coverage for my employees working on this job. Insurance Company Polity Number O I am a sole proprietor and have no one working for me in any capacity. () 1 am a sole proprietor, general contractor or homeowner (circle*one) and have hired the contractors listed below who have the following workers' compensation policies: Contractor y Insurance Company/Policy Number Contractor Insurance Company/Policy Number Contractor Insurance Company/Policy Number O 1 am a homeowner performing all the work myself. I understand that a copy of this statement will be forwarded to the Office of Investigations of the DIA for coverage verification and that failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposidon of criminal penalties consisting of a fine of up to S 1,500.00 and/or ene years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S)00.00 a day against me. Signed this day of Licensee/Permittee Building Department Licensing Board Selectmen Office' Health Department - TO VERIFY COVERAGE INFORMATION--CALL: 617-727-4900 X403, 404, 405, 4.09, 37S