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HomeMy WebLinkAbout0029 ATWOOD AVENUE Pc I� i 17 5 Town of Barnstable *Permit# Expires 6 nw fro is ue date Regulatory Services Fee MASS. Richard V.Scali,Director ED Nlpt� Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town barnstable.ma us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERAUT APPLICATION - RESIDENTIAL ONLY Z c6q ., �,1 Not Valid without Red X-Press Imprint Map/parcel Number*� (/ I (�"� Property Address �� � E Residential Value of Work$ :Z 3 7 2 0-0 Minimum fee of$35.00 for work under$6000.00, Owner's Name&Address pR UD 4 RAS K 1 N,5 zq 4Tov 6fl d o 1 Contractor's Name'Di,00 cz 5 FOR v7 c Telephone Number'�� 77 Home Improvement Contractor License#(if applicable) /6 � Email: A 4 ro S a7 Co un c a g j, /7 2?' Construction Supervisor's License#(if applicable) CS ­C)] i11 L I) Workman's Compensation Insurance o�Check one: S& PERMIT 9 I am a sole proprietor - ❑ I am the Homeowner OCT 2 3 2015 ❑ I have Worker's Compensation Insurance Insurance Company Name TOWN OF BARNSTABLEr Workman's Comp.Policy# 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 (maximum.32)#of windows #of doors: ❑ 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 ome Improvement Co trajts;License&Construction Supervisors License is required. SIGNATURE: :\WPFILESTORMS�buildin permit forrns�EXPRESS.doc ; i .Q gP , Revised 040215 " ' 7 f 17ze Commoinvealth o+,f- assachusetts • f 3 Deptvhnerzt o,frndustrialAcciderais '. fly`rr-e of Ime'tigatiens. ' 600 Washington Street Baston,MA 02111, f6'ym masS��TF)VIdia '"Turers' Campensation Iii n ce Affidavit:Affidavit:Bmlders k lCantradurslEIecfricianslPlumhers Applicant Inf4rmafran Please Frint I&gffi v - 1�x1-hrw� exzas - Name(BasaaemforganQaGionauffvidaalYALC Add I�8 ����pr IMPS t �� Gityls!aW_ Pli�ne g- 7b= af) a Are you an employer?Checkthe app opriate.box. Type of project(required): I_❑ I am a employer with 4 ❑I am a general contractor and I * liar=e hired the sub-contractors 6. New co construction Ioyees(full antlfor part�ime). 2, a sale proprietor arpartner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees. , These sub-contractors have g-'0 Demolition wading for mein any capacity: employees and have workers' 9. Bunting addition.' . [No vrorlmn,camp.insurance: comp-insurance required-] 5. 0 We are a corporation and its 14❑Electrical repairs or additions 3111 am a homeoumer doing all work of iceas have exercised their 11_Q Plumbing repairs or additions myself[No workers'camp- right of exemption per MGL 12-0 Roofrepairs insurance required.]1 c.152, §1(4X andwe have no employees.[No workers' comp-insurance required-] 1AUY appEicsut ff3ac cbedm box#1 most alai fU"the sectionbgaw shmvin-g then wodeW can3penm&.xzpoficy in5madc a Homeowners wbo Saba rit this affid2MI ind5xadug they ne doing zU vrat=1 then him outside connxctors rmLst submit a new affidavit indiF4�sacIL ZUntiactars this rhea This boat mast attactsed�as addiliaosl sheet showing the name of the sub-co�cfiots and state whether or not those entities bay employees.ifthenib-cont�rshzceemplayee%theymnsrpmvidetheir workm'camp.paiicynumber. I ant art enipLapr tliat is prniding ivorkes'congwisatian irtseirance-for eery*entpFvj ees BeIoty is giLq policy and job site ittfbrmation , Insurance Company'Liam: Policy,44 or Self--ins.Lie_ E�cpiratioa Date: Job Site Address: CifylStaferttp: Attach at copy of the workers'compensation policy ded'aration 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$UOD 00 and/or oney e-'arimprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a F= of up to$250-00 a day against the violator- Be advised that a copy of this statement maybe fkviaraled to the Office of Investigations of the DIAL.for insurance coverage yerffication I do k¢reiiy cp Wajrdsr the pants ed prilaNes ofperjury that goo ireformatiarrprmided abmw is true and arrrect ' Simature11 I?ate: Phone be c Y. er ompkied by city artetcn O fficiat O at use 671E.'Do exit svrfte trl,this area,t C4' or Town: PermitUcense Bm Authority(circle one): L Board of Health 3.BuffTmg Department 3.f.'ltp Town Qerk 4.Electrical Inspector 5.Plumbing Inspector S.Other Contact Person: Phone it: ormation and Las coons Massachusetts General Laws chapter 152 reqaires all employers to provide workers'compensation far their employees- - P -b,this statute,an is defined as-"_.every person in the service of another under any coi>fract ofhire, express or implied,oral or wr>t tcn An,emplyer is defined as'°an individual,partncrship,association,corpora ion or other legal entity,or any two or more of the foregoing=gaged m a joint enterprise,aad including the Legal sepresent±ives of a deceased employer,or the receiver or trastee of as mdividA partnPasbip,association or other legal entity,employing employees- However-the owner of a.dwelling house having not more than three apartments and who resides therein,or the occapant of the - dwelling house of another who employs persons to do maintenance,construction or repair work.on such dwelling house or oa the gz-oimds or building appzrttnzn±thereto shall notbecanse of such employment be deemed to be an employer." MGL chapter 152,§25C(t7 also states that"every state or local licensing agency shall withhold the issuance or renewal of a Iicerxse.or permit to operate a business or to construct buildings in the cornmDnwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,M(H-chapter 152, §25C(7)states"Neither the commonwealth nor ray ofits political subdivisions shall enter into any contract for the perfounance ofpublic work untd acceptable evidence of complia.mce with the insures ce, regzlrerments of this chapter have been presented to the contracting MdhOzity-" Applicants - Please fill out the w P,orkers'compensation.ensation.affidavit coin letely,by checkiog the boxes ffiat apply to your situation and,if necessary,supply snb-contractor(s)name(s), address(es)and phone numbers) along with their certificates) of inuance. Limited Liability Companies(LLC)or LimitedLiabi ityPartaeiships(LLP)with no employees oi cn her than the members or partners,are not required to carry walkers' compensation insaraam If an LLC or LLP does have employees,a policy isrmpa-ed. BeadvisedthatthisaftidavitmaybesubmittedtotheDepadmentofIndustrial Accidents for confamation of insurance coverage Also be sure to sign and date the affidavit The affidavit should be retied to ffie city or town that the application for the peanit or license is being requested,not the D ep artmeat of LndmsftiHl.A ccid=fs. Shouldyou have a:ay questions regarding the law or ifyou are required to obtain a workers' compensation policy,please call the Department at the number listed below_ Self-insured companies should enter their self-msur&nce Iiceilse number an the appropriate line. City or Town Of Please be sure that the affidavit is complete andprkited legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the pent/license,number which will be used as a reference number. In addition,an applicant that must sabmt multiple pen itllicense applications in any given year,need only submit one affidavit indicating=cent p olicy infomation Cif necessary)and under"Job Site Address"the applicant should write"all locations in (city or. town)."A copy of the affidavit that has been officially stamped or marked by the city or town maybe provided to the " applicant as proof fiat a valid affidavit is on file for fate perm or licenses- A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial v6nt IM (Le. a dog license or permit to bum leaves etc.)said person is NOT requi and to complete this affidavit The Of of Investigations would h1e.to thank you in.advance for your cooperation and should you have any questions, please do not hesitate to give us a call- The-Department's address,telephone and fax number_ '1he CGnM�MWealth of MaS.ch�tts D ent cif Indnit J Accidents Of of lvestigatio= �Q��ashm�an Street $os�Gn=11'fA E1�111 Tc,-1.4 617' -4 �t 4-06 Or 1-M MA SAS Fax;ff 617-727 7749 lZevised.4-24-07 ma -gavld a The Coznnomweakh of-Wassadrusetts DeparbxeFztaf1nd=tridAcdder s - - - Orke 00MV51i9atiaas , 600 Wastiuzgtoa Street Baston,MA 62111 mmv mass. dra Workers' Campensafnon Insurance davit:Bmilders/C,nntr•actars!'EI cians(Phu nbers APPEcautInfcxrmafzag Please Print CityfS t l N I 01_ Phone Are you an employer?Check the appropriate box: `T f ' r FPeo project( egnu ed): 1.❑ I am a employes with 4. ❑I am a general contractor and I 6..❑New construction ' etngloyees(fish andfor part-time)-* have hired the sub-contractors 2.OKI am a sole proprietor orpartner- listed on the attached sheet. 7- ❑Remodeling ship and Have no employees These sub-connractam have g- ❑Demolition ' wodeing forme in any cape cifj` fo aizdh ve�va�ers a 9. ❑Building additioa tt JNo orlams' comp.insurance comp- l¢umnc1+# .' 5_,❑ We are a corporation and its 10❑Electrical repairs or addni'ons 3_❑ I am a homeowner doing all work officers have exercised their 11_❑Plumbingrepairs Qr a'ddititms myu-If p4rs workers' right of esempfion per MGL�F c.152, I andwe have�0 12. Roofrepairs _ ;nsuzance required-]t t § { ' 1.3_[tther comp-insurance rrqdire&] #Any W ic=&2tc5edrsbox K west alsa fMo=theurfion below shUW!Vz dmkvm&eW campenm&n Porky infncm UML Homemnm Who submit dais affidm d nuffCat 3kz they are doing slf waak=4 then hire auMde contRctom—st submit anew affidavit mdif-I&M Ss,rF FCanizactnas liner d--2 this bm must attached an atldthaaaf sheet sboxing d aname of the sub-caatixscros and state Whether ar not those eafitiesbzm employees.If the snb-=t zctm have employees,theymaut pmuide their aarkers'v=p.poli y number lam ECTO v is theptrlicy imd jab site , Insurance Company Nam- 4,1.or Seff izrs Tic_ Expiration Date: Job Site Address y ' CitylStaWztp. • ' Attach a copy of the work-ere coanpensationpolicy declaration gaga(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$1,50D 00 andror or e-yearimpiisonraeut,as well as civil penalties in the form of a STOP WORK ORDERand a fine of up to$250_00 a dap against the violator. Be adsdsed that a copy of this stahnnect may be funded to the Of of 1mvesfigajpw,oQthe DIA R F insurance coverage verification_ tla Ffj� gder • s and psnas at�ety�aty fhat flie iafarwua€ioa pirotRded abuts is tars artd arrrect Date_ Phone 9�- M L`�O Lp . Offlad use only. Do not wrde in this area,to be cvmpfeted by diF ortatrn official City or Town: PerffitlLieeEtse Issuing Authority(circle one): 1.Board of Hrdth 1 Building Department 3.Cftylrown Clerk. 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: U' Phone#: " 6 ormation and Instructions 7 fassac umtts Cenea T awe chaps I52 regaaes an employes'to prov2dew06£e&C;MIPMsation fortbeir eozployees- Parsnantto this sfatrfe,an.elrrpinyW is defied as.�.every person in ffie sea-vice of der under any confrart ofhire, eaprew or implied,oral or written." An Moyer is defined as"air mdividnal,pmtaersb3p,associlti on,corporation or other legal entity,or any two or more of the foregoing=gaged is a Joint ,and including tie legal relaesca afives of a deceased employes,ar the receiYer or trustee of an individual,partnership,association or other legal entity,employes employees. However the i artmeats and who resides therein,or the occupant of the - owner of a dwelling house having not more�three ap - dWeIIing house of anodiw Who mapkys pmssans tD do mafitmm=,rnncfruction or repair woik on such dweIliilg house or on the grounds or bmldmg appurtzaantiiiereto shaIlnot because of such employment be deemed to be an employer_" MGL chapter 152,§25C(b)also states thA'every state or local Iicrosing agency shall withhold the issuance or renew-al of a license.or permit to operate a business or to consfract btufldkV in the commonwealth for any applicantwho has notproduced acceptable evidence of cdmpfiance with the hgrance.coveragereqused." Addhionally,M H_chapter 152, §25C(7)states fiNeiferthe cowcawcalth nor my ofifs political subdivisions shall enter into any contract for the pmformancz ofpublic wolkmntl acceptable evidence of compliancewith the ins rranrz.. requirements of this chapter have Been presented to the confrarimg anihoz>ty_" A.ppTicazb- Please tip oirt the workers'compensation affidavit completely,by diecldag the boxes that apply to your situation and,if necessaiy,supply sob-cont ractor(s)nauie(s), addresses)and phone-r— er(s)along whit their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships CLU)withno employees other titan tine members or partue-s,are not rued to cagy wm±ers'compensation msormm If an LLC or LLP does have employees,'policy is required. Be advisedihatthis affdavitmay be submit ed to the Department of Industrial Accidents for com of msoranoe coverage. Also be sure to st a and date the affidaYit The affidavit should �m � be returned to the city or town that the application for the permit or license is being requested,not the Department of b,dn b i a1 Accidents. sloaId you have any questions regm-ding the law or ifyou are requited to obtam a workers' compensation policy,please can the Deparb ent at the nurnber listed below, Self-inscaed companies should enter their self-msurance license number an. appropriate lime. City or Town 0Mcials . T - Please be sc re that the afdavit is complete and pried legibly. 'Ihe Departmeat has provided a space at the bottom of the affidavit for you to fM out in the event the Office of Juvesfigations has to coact you regarding the applicant Please be sure to Ell in the pen lI cease number which will be used as a ref=mce number. In addition,an applicant that must sabmit multiple p=itiUcense applications in.any green year',need only sabmit one affidavit indicating cnsent policy infoanation Cif necessary)and under`Job Site A_ddre&*the applicant should vute'all locations in (city or town)."A copy of the-affidavit that has been officially stamped or marked bythe city or town may be provided to the ' applicant as proof that a valid affidavit is on file fur f AM pe=i#s or licenses A new affidavit must be filed out each year.Where a home owner or citizen is obtaining a license or permit not related in any business or commm vial 4eniiae Cie. a dog license or p=it to bum leaves eft.)said person is NOT reqaired to complete this affidavit: The Of of Investigations would like to thank you in advance for your coopmafion and should you have any questions, please do not hesitate to give us a call. The Departments address,telephone and fax rtnlnbm- ' ' Depa�ent cif�'ndm-�aal A�d.�nt� as o-ns MA O�111 Tf,-L 14 6617 -49QO cit 4€6 w 1-977-MASSAE Fax It 617-727 7M Revised 4-24-07 m� .gig fdia a r y Town of Barnstable Regulatory Services 4 Richard V.Seali,Director Building Division Tom Perry,Bu ldmg Commissioner 200 Main.Street;Hyanais,MA 02601 www.town Barnstable maxs Office: 508-862-4038, F Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder - as r of the subject property hereby authorize act on my behalf, in all matters relative to work authorized bydh s building pe=it application for. -/JC to � 4:11" (Address of job) 'Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or ufflized before fence is installed and all final' inspections_are performed and accepted. - r lure of Owner Signature of Applicant y i riot Name Print Name are . Q:F0RMS:0 VnMPERMISSIONPOOLS Massachusetts -Department of Public Safety Board of Building Regulations and Standards a,Y1II�LI UlLlll 11 :7UpC I,Y nm - �w License:'CS-074816 KATHRYN R HE4} S 188 QUAKER M19E E It E SANDWICH Na I Expiration Commissioner 06/16/2017 q w ��e�paryur�aarauseall�a��Taaaccc�iicae� Office of Consumer Affairs&Business Regulation OME IMPROVEMENT.CONTRACTOR {j egistratYop 166839 Tylw.' t Expiration 7 i41201.6 DBA" ALL IN ONE REMODELING SERVICES gg- DINO HERAS t ti 188 QUAKER MEETING HOUSE R -PAST SANDWICH, MA 02537 Uuderkeretary j' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map a 9 : Parcel Application #00 I� o Health,Division Date Issued 10""1$`"' Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address Rmp Village #L4/UAJa'S 2J Owner yi�mg a Alc//Efo - l-14s k//V3 Address wa0U 1r0 f'�/✓�//r �-9 ®ode/ Telephone 0gt 17/— Permit Request �f'�/y�c/ /Cy/ /�i��,C' W,#// 2�r/�o t/e s/o��� >� /�d tit l� g�/b R E�/�c� /�' ✓g me U��Hi ivy .Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 'tall OU Construction Type W 10P FX4Mt Lot Size °/� Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family l/ Two Family ❑ Multi-Family (# units) Age of Existing Structure / 9�� Historic House: ❑Yes Colo On Old King's Highway: ❑Yes lJ0 Basement Type: W(Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft:) - - Basement Unfinished Area (sq:ft) --- Number of Baths: Full: existing 04 new 0 Half: existing new Number of Bedrooms: existing 0 new Total Room Count (not including bathe): existing 5 new d First Floor Room Count Heat Type and Fuel: ❑ Gas L Oil ❑ Electric ❑ Other Central Air: ❑Yes C/No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No I' Detached garage: ❑existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing �g neW_ size Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other:, "`' VE ' 9�+•B i es'G. V Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes W(No If yes, site plan review# , -- Current Use of O-✓%o-eN i-4 /' 6' � Proposed Use ��J/� '��`/•9L S•/' 'g rill APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name G 41 y MHI AM u Telephone Number Woof e �? ro t/e /y?c/V� ZN(-. Address T� �� i7EOazo ��,. License # C �y� 1/0 a�ri/ / /elf (0y'-r Home Improvement Contractor# I Worker's Compensation # WC C Sa/0 a la?o/2, ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE a 6 z 1 Z U 3 1 ti FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS - VILLAGE OWNER DATE OF INSPECTION: -FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING _ DATE CLOSED OUT ASSOCIATION PLAN NO. Department oflndustrialAccidents . Office of Investigations. _ I Congress Street,Suite 100 Boston,MA 02114--2017 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers AP Plicant Information PIease Print Legibly Name(Business/Organization/Individual):Capizzi Home Improvement Address:1645 Newtown Road City/State/Zip:Cotuit, MA-02648 Phone#:508-428-9518 Are you an employer?Check the appropriate box: Type of project(required): 1.❑✓ I am a employer with 40+ 4. ❑ I am a general contractor and I p q ): 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 shipand have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' comp.insurance.t 9. ❑Building.addition [No workers' comp.insurance P• required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions g officers have exercised their ❑3.❑ I am a homeowner Join all work 11. Plumbing-repairs or additions right e of exemption per .myself [No workers comp. �. p p MGL 12.❑ oofrepairs. insurance required.]t c. 152, §1(4),and we have to employees. [Na workers? 13. & .Other b 14 P d al-J comp.insurance required.] Any applicant that cheWdC box#1 must also fill out the section below shovflg their workers'.yzompensation policy informations" t Homeowners who submit this i davit indicatin the are do' all work g Y � �then hire outside contractors must :submit anew affida s-s.mchcating such. $Contractors that check this box must attached an additional sheet showingbthe name of the sub-contractors and state whether or riot those entities have employees. If the sub�eon tractors have employees,they must provide their workers comp,policy oli number. lam an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance CompanyName.Associated Employers Insurance Company Y Policy.#or Self-ins.Lie.#:WCC5010 547012011 12/25/201 Expiration.Date: .Job Site Address:-2 6 IN-Wo aU Rr i City/State/Zip: /����/�i f l4 o ZICd/ 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 c. q an lead to the,imposition of cr iminal runinal penalties of a foie 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 cert�under the ains and penalties of perjury that the information provided above is true and correct Si ature: Date: f 0 // ;L 0/3 Phone#. 508-428- 518 Of 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#• r �...,. CAPIHOM-01 CBENISCH ,a►co,e>o CERTIFICATE OF LIABILITY INSURANCE UAT /YYYY, 6112/201D12/23 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: Chris Benisch Rogers&Gray Ins.-Dennis Branch PHONE 508 398-7980 FAX ( ) 434 Rte 134 AJC No,�:( ) (ac No: 877 816-2156 South Dennis,MA 02660 ADD lEss:cbenisch@rogersgray.com INSURER(S)AFFORDING COVERAGE NAIC q INSURER A:Main Street America Assurance Co. INSURED INSURER B:Associated Employers Insurance Co. CapizZi Home Improvement,Inc. INSURER C: Capizzi Enterprises,Inc. 1645 Newtown Road INSURER D Cotuit,MA 02635 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY 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 ADDL SUBR POLICY EFF POLICY EXP '.LIMITS LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER _(MlW@MNYYY) (MMIDD/YYYY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY - MPB1075H 6/8/2013 6/8/2014 PREMISES(Ea occurrence) $ 500,000 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 JECT LOC $ COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY Ea accident $ A ANY AUTO M1111128044 6/8/2013 6/8/2014 BODILY INJURY(Per person) $ ALL OWNED LX SCHEDULED BODILY INJURY(Per accident) $ 500,000 AUTOS AUTOS X HIREDAUTOS NON-OWNED. . pERACTYDAMAGE '- $ AUTOS X UMBRELLA LJAB OCCUR EACH OCCURRENCE $ 5,000,000 A EXCESSLIAB HCLAIMS-MADE CUB1076H 6/8/2013 6/8/2014 AGGREGATE $ DED I X RETENTION$ 10,000 $ 5'000'000 WORKERS COMPENSATION WC STATU- X OTH- AND EMPLOYERS'LIABILITY - TORY LIMITS ER _ B ANY PROPRIETORIPARTNERIEXECUTIVE YIN WCC5010547012012 12/25/2012 12/25/2013 E.L.EACH ACCIDENT. $ 1,000,000 OFFICER/MEMBER EXCLUDED? � N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under ''- 1,000 DESCRIPTION OF OPERATIONS below - E1..DISEASE-POLICY LIMIT $ ,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,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 ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street' Hyannis,MA 02601-0000 AUTHORIZED RE/PRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010106) The ACORD name and logo are registered marks of ACORD r. i Unrestricted -Buildings of any use group which contain less than 35,000 cubic feet(991m3)of enclosed space. Massachusetts -Department of Public Safety i Board of Building Regulations and Standards Construction Supervisor Failure to possess a current edition of the Massachusetts License: CS-074640 State Building Code is cause for revocation of this license. GAR1,GUSTAFSQN 1 " For DPS Licensing information visit: www.Mass.Gov/DPS g SHORT WAY _ SANDWICH MA;0256,3' � J,• 1 Jy Expiration commissioner 11/29/2014 f ✓fze �aorinzazureall� °� i .... ' Office of Consumer Affairs&Business �Ucenz.:or r .st Afton va?td for 3X drddiul t'•"`e 0aly mix bofora the e-tiration date. If found refer to: OME IMPROVEMENT CONTRACTOR C1fce ofC'onsunier-Ai zrs and Ensines'9 ReVliltfon. Registration: 100740 Type, IQ rark.P12xa»Sixite 5I/4 _ Expiration:;:&%237... Supplement c o y CAPIZZI HOME IMPROVEMENT`;INC. . GARY GUSTAFSON 1645 Newton Rd. Cotuit, MA 02635 Undersecretary r c� Page 7 of 7 Capizzi Home Improvement Inc. Specifications and Estimates STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT I, &c�m I' S t-IAO , OWN THE PROPERTY LOCATED AT 9 D IN Nn/13 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 FORA 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: 508428-9518 ' RESPONSIBLE OFFICER: . RESPONSIBLE OFFICER ADDRESS: , RESPONSIBLE OFFICER TELEPHONE: 'auawanadwl au.+oH Inlde7 hq uoq; :21ecl • Jay;o uol37ruy9uoo Jo;pasn to paVilAslp aq 03 IOU ale pue}uawano.Idwl awoH lzzlde,:)4o Ben pue asodlnd aloe aq lo;ale sueld asayl:aaoN 3119 NO SNOISN3WI0 ON d :2}eQ _ o SNOIlI0N07 ' 1W WNUN07 Ol Nadine :sueld leUld _ EL-I-b :8UOl8lAa?J DNIISIX3 DAM NIISIX3 DNIISIX3 ONIISIX3 / 'aced - DNIISIX3 \ / • � - - ' mm o mm 6SbZZbn to - C MQN9llSlEfft2Ql DNIISIX3X3 DNIISIX3 '�DNLL81X3- / 3 "DNIl81X3' U 9NIN3d0 03SYO (..Ob Ol ZE HOSZO 039'SYIN3 >y ®N30d3H @XZ/Z OOd HF. b30 1S 0.9 d0 37Vld NI MOONIM M3N OOd:WOONNns lb' IIYMAYMNId1S NO 513N19` O a3dd(1 00'd an_ A-,L 39 Ol WOOJNf1S Ol NI 9NIN3d0 (N'dld SIHl NI 0300d 39 Ol dO1J31Nf107 aOd 033N ON 3JOd3J3Hl) a01d?J391TJd3a d0ld3 i Ol lINf AN.LNdd IM Ol a-1d Zb 00'd 11 3n09d12NIGYV 0NYNO.LYN39lN=JaN 21YV019N 3TdId NI NlYkGN eeos d32J 3Hl?J3AO 3NO 3H11d37X3 S13NI9b'7 9NI1SIX3 lld R InOAY-1 N H711>1 0390JONci 7C 3.rs 3 a ro o _ 3 X N p a a 84X..Zb®lINf13?Jfll7l4i l - I 1N3W3SYSOl At,X.,bZ@S9NnH'190i; � <0 �s :9NIN3d0 9NIlSIX3 _ Fd L�A 3 SMOONIM M3N 00d J301'1S„0-.B 3nOW3TJ oee oeeeM aealM S?J3ddf1 M3N b 30 Nl ClY3H BXZ/Z 00d DNIN3d0301M..9-.L�I '" Z/l L-.OL -,�Z-.9 II N .,G-,OZ m� g v c i - m F p� � i ' m 3 �, IX3 0 NIISIX3 DNIISIX3 DNIISIX3 ` 4B,mn O cgcg 3 _ woe DNII81X3 DNIISIX3 IISI%31 I ONIlSI%3 DNIISIX3 a ONI I%3 p� < I . N C 3 - DNIISI%3 NI'dW32J M0M 01 MOM'X3 X3 3nOW3a r 3'191SSOd dl SNOOCI 301E-39NIH 39NYH7 w �• � �._ a.._ ask t r r> I k 4A't 4 b A , _ Y x m w i �.Ilk l, Y` o. v Ono VA - :�.�....._.,� - - a^r• .- - ... _ �. �oWME�I^Nr�M�rvhrtlt h � ` S� 1. V y } '' '✓' L 5 w ti.rf a,ty" ' i."' i" i�.fe"'- 1� q, o ` `" � 7, k j Il 4, r. r, , S.41 „ " „y 4to Y Al v �`t 1 ,;�,. _ ti k � *� f t (y x ,t I ws v � x i r � Town of BarnstablePen-nit: 7 �1ME Regulatory Services ate: gVC_/G jV o; Thomas F.Geiler,Director * s AM Building Division ee: �Qv M � nss. s639� ,0�,erEo�ra Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-79 -0 6230 TOWN OF BARNSTABLE SOLID FUEL STOVE PERMIT Owner: Phone: f Install at: a �_\4�� � Village: - Map/Parcel: tQ 9 1?I a. Date: /`',I l # Stov New Used f B. Type: Radirt/Circulating C. Manufacturer: E M V I Lab. No. D. Model No.: Chimney A.&'"/Existing (If existing,please note date of last cleaning) B. Flue Size If it C. Are other appliances attached to Flue? �h D. Pre-fab Type and M facturer E. Masonry: ine nlined Hearth A. Materials: � B. Sub Floor Construction: Installer Name: ACM) ( � Q Address: ` � Phone: S-98 --2-7 l q7 c7 9 W Location of Installation: a APPROVED BY: Please make checks payable to the Town of Barnstable *This constitutes an official stove permit after inspection,photographed, and approved by the Building Inspector Q:forms:stove Rev122801