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HomeMy WebLinkAbout0104 BRANT WAYPip 1 is t5� Application number...—...../lplQ �. ., . ' 1 DUe Issued.............�F.11.L11s................................. Building Inspectors In SFP 12 20rS fil/ .................... trt� _ ����III!! � � ry rr,, f�/1 p/Parcel........62 el ....... /�'� RNS Trl�L. Z - 3S TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDO WS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: 0 Oy `RANr'WA`� N�ANN� S NUMBER ' STREET VILLAGE Owner's Name: ?-?_+t✓- _KP.N7A I I Phone Number 30t 1'7(J S5s"g o .Email Address: �e-1'e��`�Nip/-�11 1 Z � (,KR-r/. -Cell Phone Number s � � L 5 5"r C Project cost $ �/a �1. 0 d. Check one Residential Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize C�/°� ZZi �� �`l/!✓e!/e f't to make application fora building permit in accordance with 780 CMR Z)V Owner Signature: f �'¢G c d _ Date: 0 ti I 1! TYPE OF WORK -2 -Dovr31& 141Vi✓!. ' ! P«i/✓c. ❑ Siding lid Windows no header change)# � .Insulation/Weatherization' . 0 Doors (no header change)# Commercial Doors require an inspector's review 0 Roof(not applying more than I layer of shingles) Construction Debris will be going to CONTRACTOR'S INFORMATION Contractor's name Jl o k a/%• 5fil/tjr1/Yl. 1 27i 140d e 1 Ile Home Improvement Contractors Registration(if applicable) (attach copy) Construction Supervisor's License# l (attach copy) �-e V Ka e. e AV iWiz; Ron 6, c 0M G `�� 15 '�� Email of Contractor --�A C,lC e- C A ZT o M e. C Ott phone number ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION NUMBER ............................................................ 1 f *For Tents Only* Date Tent (s).will be erected Removed on number of tents total Does the tent have sides? Yes No (If yes please attach floor plan with exits marked) Dimensions of each TeKttached X X Additional tent dimensittached on separate piece of paper. Check one: this event ist non-profit event Check one: Food served Flame Spread Sheet of st attached. Provide a site plan with the location(s) of each tent If food is being served t please o tain a Health Department approval between the hoursof8:00am-9:30am',or0pm. Commercial events may require Fire Department approval, *WOOD/COAL/PEL T STOVES Manufacturer# Model/I.D. Fuel Type i esting Lab Offsets from combustibles: fr t back left side right side HOMEOWNER'S LICENSE EXEMPTION 1 Homeowner's Name: 1 T__ Telephone Number - - Cell or-Work number . I.understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLI T'S SIGNATURE S G Ile Signature Date All permit applications are subject to a building official's approval prior to issuance. ilocuSign Envelope ID:AD10D1 D8-AHA-48FC-BE64-9595878EM04 Page 6 of 6 Capizzi Home Improvement Inc. Specifications and Estimates STATE OF MASSACI USETTS , LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT I,PETER RANDALL, OWN THE PROPERTY LOCATED AT 104 BRANT WAY 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 CODE. --Dbcu5igned by: SIGNATURE OF OWNER: ukr KWOU 8543DD8653BE415... OWNER'S ADDRESS: 104 BRANT WAY, HYANNIS MA 02601 OWNER'S TELEPHONE: 508-776-5559 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: sCA 1 0 20M-05117 r j//,r+ .�iurr=.unry !."o ^!�r trralr lation Registration valid for individual use only officeonsumer rs Business eg HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:Regulation TYPE:Supplement Card o office of Consumer Affairs and Business Reg w n one Our Place-Suite 1301. 100740 06122=0 ,MA 02108 4 CAPIZZI HOME IMPROVEMENT,INC. r " z JACK STRUNSKI - "- r Mnt Val without signature 1645 NEWTON RD. COTUIT,MA 02M Undersecretary ' ' . .,,oy..,..:y ..�..-.«..>.-:TM1. -.,;:.*,eww:,v�r+4e .•. :k.�4 :a!f4h;gb'Syy€s, .., • Construction Supervisor Commonwealth of Massachusetts Unrestricted-Buildings of any use group which contain ® Division of Professional Licensure less than 36,000 cubic feet(991 cubic teeters)of enclosed Board of Building Regulations and Standards space. • Constrrltli�Stitrvisor _ CS-064817- �� E-pir es:06/181202C JOHN T STRUMSKIkLa 18 ALDEN AVEBUZZARDS BAWMA02532: Failure to possess a current edition of the Massachusetts y ;Ya 3)S�.T_1i�11� State Building Code is cause for revocation of this license. For information about this license , !,� i .aco CERTIFICATE OF LIABILITY INSURANCE °ATE`MM/°°"YYY' 12/27/2017 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(iss) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT - NAME, Rogers and Gray Processing ROGERS &GRAY INSURANCE AGENCY INC IPA_N o FAX EXt: (508)398-7980 Al.,No: E-MAIL ADDRESS: mail@rogersgray.com 434 ROUTE 134 _INSURERS AFFORDING COVERAGE NAIC{i SOUTH DENNIS MA 02660 INSURERA: AMGUARD INSURANCE CO 42390 INSURED INSURER B: CAPIM HOME IMPROVEMENT INC INSURERC: INSURER D: 1645 NEWTOWN ROAD INSURER E: COTUIT MA 02635 INSURERF: COVERAGES CERTIFICATE NUMBER: 225463 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUER EXP LTR POLICY NUMBER MM/DDfYYYY MM/DDI LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE FIOCCUR PREMISES Ba occurrence $ MED FRCP(Any one person) $ N/A PERSONAL&ADVINJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ POLICY JECOT- LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILEUABIUTY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS N/A BODILY INJURY(Per accident) $ AUTOS NON-OWNED PROPERTY DAMAGE $ HIREDAUTOS AUTOS Per accident ' $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS MADE N/A AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION - AND EMPLOYERS'LIABILITY YIN - ..PTATUTE EERH ANYPROPRIETOR/PARTNERIEXECUTIVE n E.L.EACH ACCIDENT $ 1,000,000 A OFFICER/M EMBER EXCLUDED? I NIA1 WA WA R2WC863728. 12/25/2017 12/25/2018 (Mandatory in NH) E.L. ISEASE-EA EMPLOYEE $:.1,000,000 If yes,describe under ' DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ 1,000,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/lwd/workers-compensationAnvestigations/. CERTIFICATE HOLDER CANCELLATION 4 r f SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Daniel M.Cr ey,CPCU,Vice President—Residual Market—WCRIBMA @ 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD CAPIHOM=01 CLEDDUKg CERTIFICATE OF LIABILITY INSURANCE DATE 06128120177) Ofi/28/2017 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, EXPEND OR ALTER THE COVERAGE AFFORDEDA3Y 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 have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WANED, subject to the terms and conditions of the policy,certain policies may require an endorsement Astatement on this certificate does not confer rights to the certificate ho&der in lieu of such endorsements). CONTAC7 PRODUCER NAME: Rogers&Gray Insurance Agency,Inc. PHONE FAX No:877 816-2156 434 Rte 134 Arc,IL Extl: I ) South Dennis,MA 02560 a oA1Ess:mail@rogersgray.com INSURERS AFFORDING COVERAGE NAIC 9 INSURERA:Arbella Protection Insurance CorripanV,Inc, 41360 INSURED -INSURERS: Capizzi Home Improvement,Inc. INSURERC: Capiai Enterprises,Inc. 1645 Newtown Road INsuRER D Cotuit,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, TEEM 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. IL SR ADDL UBR POLICYEFF POLICY EXP LIMITS. TYPE OF INSURANCE TR IN D WVD POLICYMUMBER prrnlyl) A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,Oflfl,0fl0 CLAIMS-MADE FRI OCCUR 8500067380 06/08/2017 U610812018 DAMAISE50 oRENTED ce $ 500,000 MED EXP(Am one erson $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEML AGGREGATE UMITAPPUES'PER: GENERAL AGGREGATE 2,000,000 POLICY�%,Q� �LOC PRODUCTS-COMPIOPAGG $ 2,000,D00 OTHER: S A AUTOMOBILE LIABILITY (Eaa�INEDSINGLEUMrr $ 1,flfl0,00fl ANYAUTO 1020D64960 06/08/2017 0610812D18 BODILYINJURY Per erson S __ OV+ItIIED FXX SCHEDULEDBODILY INJURY Peracddent S AUTOS ONLY AUUTTOSIryry 7yXA R0.S ONLY AUTOS ONLY PeO,exgirleitfDAMAGE $ $ A X UMBRELLA L1AB X OCCUR 'EACH OCCURRENCE 3 2,000,000 EXCESS LIAB CLAIMS40DE 600067381 0610812017 06/08/2018 AGGREGATE $ 2,000,000 DED I X I RETEN-noNs 10,000 $ WORKERS COMPENSATION PER OER TIi- AND EMPLOYERS'LIABILITY AANNYPRRO/PPJETOERRIPARTNER/EXECU71VE Y-I EL EACH ACCIDENT $ {MandEPJ,M MBEf-)EXCLUDED? N/A E.L DISEASE-EA EMPLOYE $ If yes,dascriba under E L DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS!VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached If more space is required) WORK COMP CERTIFICATE TO BE ISSUED DIRECTLY BY THE CARRIER CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Evidence of Insurance ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25(2016103) @ 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD I ' 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 Annlicant Information Please Print Legibly Name musiness/Organization/Individual): CAPIZZI HOME IMPROVEMENT Address: 1645 NEWTOWN ROAD City/State/Zip: COTUIT MA 02635 Phone#: 608428-9518 Are you an employer?Check the appropriate box: Type of project(required): 1. ✓ I am a employer with 40+ 4. 1 am a general contractor and I employees(full and/or part-time). * have hired the sub-contractors 6. New construction listed on the attached sheet. 7. Remodeling 2. I am a sole proprietor or partner- ship and have no employees These sub-contractors have g• Demolition workingfor in an capacity. employees and have workers'. Y Pa h' t 9. Building addition [No workers'comp.insurance comp.insurance. required-] 5. We are a corporation and its 10. Electrical repairs or additions re 3. I qu a homeowner doing all work k officers have exercised their 11. Plumbing repairs or additions am myself.[No workers'comp. right of exemption per MGL c. Roof repairs . insurance required.]t c. 152,§1(4),and we have no ° employees.[No workers' 13. Other W 1 n 1yow S 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: AMGUARD INSURANCE COMPANY Policy#or Self-ins.Lic.#:R2wrc863728 Expiration Date: 12/25/2018 Job Site Address: a� -F3_9RAJ4 Why City/State/Zip: �-IjaNWi d, M4 02-601 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 th IA for insurance coverage verification. I do hereby c fy nde a pains and penalties of perjury that the information provided above is true and correct Si tune: Date: 02/0612018 Phone#: 508-648-0269 Of trial 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.Bulling Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Comact Person: Phone#: } 4 Town of Barnstable *Permit# po Expires 6 months from issue date Regulatory Services Fee Thomas F.Geiler,Director 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 PERMIT APPLICATION - RESIDENTIAL ONLY tt Not Valid without Red X-Press Imprint Map/parcel Number I a` 5 Prop er-ty.Address Itiv r .0 esidential Value of Work ©.6ff/►,L_ Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address /". , ?us j! Contractor's Name 04 a v Ls /In 1N V Telephone Number 7 75X*,aL4 Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) orkman's Compensation Insurance ^ �±S PERMIT � �S Check one: ❑ I am a sole proprietor JUL 2 2007 ❑ I am the Homeowner ave Yorker's Compensation Insurance TOWN OF BARNSTABLE Insurance Company Name T V?11 sa .a v S Workman's Comp.Policy# it �'�5—�'7-Id Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) [�e-roof(stripping old shingles) All construction debris will be taken to S2 ..� LU t k ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders. U-Value (maximum.44) . *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Histon�;C—e/,,yation,etc. ***Note: Property Owner must si&m2 Property Owner Letter of Permission. A co e Ho e p vement Contractors License is required. SIGNATURE: i. Q:Forms:expmtrg Revise061306 COREY f 3jT COREY . ,9`rhq�� Roof 0, r-r-S 9141 1694 Falmouth Rd. #115, Centerville, MA 02632 CERTABNTEED LANDfly:AR / :° OOD > sAPE 3 AR ARCHITEC,TURAL STYLE REoR ® ® F N0 P+ RQG 0SALIB, July 2, 2007 SHIRLEY BAUSCH INSTALLATION ADDRESS: 41 KENT DRIVE 104 BRANT WAY HUDSON,MA 01749 HYANNIS, MA Phone: 1-978=562-5369 Phone: 1-508-778-4967 COREY & COREY hereby proposes to perform the following services in a neat and professional manner and in accordance with the manufacturers specifications and local building codes. Remove and Haul Away All of the Old Asphalt Roofing Shingles. Supply and Install CERTAINTEED LANDMARK/WOODSCAPE AR 30: 30 YEAR WARRANTY, 10 YEAR SURE START PROTECTION, CLASS A FIRE RATED, ALGAE RESISTANT, 245 POUND EXTRA HEAVY WEIGHT, SELF-SEALING, 70 MPH WIND WARRANTY, MULTI-LAYERED, LAMINATED ARCHITECTURAL STYLE, FIBERGLASS BASED ASPHALT SHINGLE with New England's exclusive COP:PER/CERAMIC STONES with a FULL 10 YEAR WARRANTY AGAINST ALGAE CONTAMINENT COLOR:_ S' zE Supply and Install CERTAINTEED WINTER-GUARD ( lee & Water Shield ) WATERPROOF UNDERLAYMENT SYSTEM on Roof Eaves, Valleys& Under the Step Flashing on the Skylights, Chimney and Gabel Walls. Supply and Install ALPHA PRO-TECH-SUL SYNTHETIC UNDERLAYMENT Supply and Install AIR VENT S.HfNGLE VENT H RIDGE VENT on the Four Main Ridges. Supply and Install COPPER & NEOPRENE SOIL PIPE FLASHINGS Clean and Remove Debris from work area after job is completed. r d j,. r R E Y 0 R TOTAL INVESTMENT ®- $ 9975.00 POSSIBLE EXTRA CARPENTRY: Any Rotted or Otherwise Deteriorated Trim Boards,Plywood Sheathing,Missing Metal Flashing, Side Walling or Any Other Carpentry Needing Replacement will be done and charged for as an Extra: Materials Plus Labor at the Rate of$ 60.00 per Hour. PAYMENT SCHEDULE: A Deposit of One Half is due at the Signing of this Roof Proposal and the Final Payment for the Balance is Due Immediately Upon Completion. WORD SCHEDULE: All Roof Work is Normally Scheduled for Completion Within 30 Days of Acceptance and Receipt of Deposit providing the Materials are Available. Please Make Checks Payable to: C ARLES C. REY COREY & COREY Warrants the Shingles and Labor for 5 years. CERTAINTEED Warrants the Shingles up to a 70 MPH WIND WARRANTY. CERTAINTEED Warrants the Shingles to be Algae Resistant for a Full 10 Years. CERTAINTEED Warranties the shingles 100% for the First 5 Years and then on a pro-rated basis for 30 Years Total if the shingles becomes defective. Any alteration or deviation from above specifications,will be executed only upon written orders and will become an extra 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 upon the above work.. This proposal may be withdrawn by us if not accepted within thirty days. COREY & COREY carries Workman's Co pensation and Public Liability Insurance on the above work DATE OF ACCEPTANCE: ACCEPTED BY: SUBMITTED BY: JR. SHIR EY BAIISCH CHARLES CORM HOMEOWNER COREY & CO 4 °lam Pomvrreawreai a�./�aaaar/u�ael- 4 f �.a —- - Board of Building Regulations and Standards License or registration valid for individul use Only HOME IMPI2,OVEMENT CONTRACTOR, ., before the expiration date. If found return to: Registrafior% 36066 Board of Building Regulations and Standards Expiratron6/2008 One Ashburton Place Rm 1301 = -- L./� Boston,Ma.02108 V� ehype .D A >, COREY&CORE` OMIMPROVEMENTS ,�V c O CHARLES COREYi t 1684 FALMOUTH -- CENTERVILLE,MA 02632. Deputy.Administrator valid without signature r ACORD CERTIFICATE OF LIABILITY INSURANCE vw 104/09/2007 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION SCHI-2-GEL INSURANCE ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 34 2Q12N ST HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. WEST. YARNOME, MA 02673 INSURERS AFFORDING COVERAGE NAtC# RvsuRED INSURER A NORTBI.AND INSURANCE Paul Buckmill®r WgURER B:•TRAVELERS DBA BUCIMIXER ROOFING INSURER C INSURER D. Hyannis, MA 02601 INSURERE:' COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR MYSRD TYPE OF INSURANCE l POLICY NUMBER DATE LIMITS A GENNERALUABIUTY CP46859503 05/15/2006 05/15/2007 EACH OCCURRENCE $1,000,000 % COMMERCIAL GENERAL LIABILITY PREMISES(Eyct-4—) $50,000 CLAIMS LIeAOE. % WUR__ s-=CLUDED _. PERSONAL&ADV INJURY 111,000,000 GENERAL AGGREGATE 52,000,000 GENT.AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG , $2,000,000 POLICY PRO- . JECT LOC AUTOMOBILE LL48R Y . COMBINED SINGLE LIMIT $ ANY AUTO (Ea aoddeM) . ALL OWNED AUTOS - BODILY INJURY• $ SCHEDULED AUTOS (Par Pam-) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Par acmem) PROPERTY DAMAGE $ (Per aoeWai . OARAGE LIABILITY AUTO ONLY-EA ACCIDENT S ANY AUTO OTHER THAN EA ACC $ -- AUTO ONLY: AGG S EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE E OCCUR ❑CLAIMS MADE AGGREGATE' S DEDUCTIBLE 9 RETENTION $ $ WORIMS COMPENSATION AND.. 7PJDB-743OA7-06 04/11/2007 04/11/2606 5TAT,L EMP EIW LIABILITY O . ER ANY PROPRtETORPARTNEIEECUTVE E.L.EACH ACCIDENT $100,000 OFFICERIMEMBEA EXCLUDED? .._ - . .... ._. _-.___-_...-.-_. E.L EE DISEASE'=£REMPCOY ...'-`-3-1'0O-OO-0..._. SPECIAL PROVISIONS 61.1 `4 -- _�.._^._..._ .__. - E.L.DISEASE-POLICY LIMIT i 500,000 0171ER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS PAUL BUCKWLLttR IS B=UDED FROM HIS NORIURS COMPENSATION 'ERTIFICATE HOLDER CANCELLATION lGREY & CORRY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 1694 FALLOUT$ RD DATE TNEREOF, THE ISSUING INSURER WILL ENDEAvoR TO MAIL 21 DAYS WRITTEN '..ENTERVILLE, MA 02632 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF 70 UPON THE INSURER, ITS AGENTS OR _ RFPRESENTA AUTIORU"REPRESE11�6111% WORD 25(2tt01l08) a 0 ACORD CORPORATION 1988 ti 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 Le 'bl Name(Business/Organization/Individual):. ch2 r Av� �6ft Address: City/State/Zip: Phone.#: '`77��`R�l/rl Are you an employer? Check the appropriate box: Type of project(required):. I.❑ I am a employer with 4. a general contractor and I 6. ❑New construction . employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a'sole proprietor or partner- listed on the-attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition workingfor me in an capacity. employees and have workers' Y P tY• $. 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 l l.❑Plumbing repairs or additions myself [No workers' comp. right 6f exemption per MGL 12.U5,Koof repairs insurance required.]t c. 152, §1(4),and we have no employees.[No workers' . 43.❑ Other comp. insurance required.] . *Any applicant that checks box#1 must also fin 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: f� V2 Out, v 5 Policy#or Self-ins.Lic.#: �1��[� -7� �7�0 ExpirationDate: Job Site Address:1W B 1;, Kt�t City/State/Zip: LS Xirt 1 S Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure,to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine tip to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$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 c he pains-and penalties ofperjury that the information provided above is true and eorrect. Si mature: Date: 7 .147 Phone#: Official use only. Do not write in this area,tb 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/Towu Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: L Informnation and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two.or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer,or the receiver or trustee-of an individual,partnership,,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 occupant of the' dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to'operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for,the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented'to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-cont=actor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies'(LLC) or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. 'The affidavit should be returned to the city or town that the application for the-permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete'and printed 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 permit/license number which will be used as a reference number. Iuaddition,an applicant that must submit.multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if 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 may be provided to the applicant as proof that a valid affidavit is on file for future permits 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 venture (i.e. a dog license or permit to bum leaves-etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like 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:. The eommonwoalth of Massachusetts Department of Industrial Acoidcnts Office of Investigations 600 Washingtori Street Boston, MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax## 617-727-7749 Revised 11-22-06 www.mass.gov/dia { yoiTNE.>o TOWN OF BARNSTABLE Permit No. ..P4$A BUILDING DEPARTMENT TOWN OFFICE BUILDING Cash ;. . °'rnav HYANNIS,MASS.02601 Bond ........... `x "' CERTIFICATE OF USE AND OCCUPANCY Issued to Capricorn Realty. Trust Address Lot #19 , 104 Brant Way Hyannis, Massachunattms USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL.NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. June 25,e. I9..... .Z....... ........ ! ...... .. .. Building Inspector 0 Y. o'fy�•�: TOWN OF BARNSTABLE _ BUILDING DEPARTMENT 76837TAM TOWN OFFICE BUILDING rua '639' . HYANNIS, MASS. 02601 MEMO TO: Town Clerk FROM: Building Department DATE: 2� 1u tj 2 7 4 An Occupancy Permit has been issued for the building authorized by BuildingPermit $ ..... " f����.`.........................-..-.............../.......................................................... _ .... _. »_ _. issued to (......:... ............. !� ,�C,,,,`. .....A„ .,,........F '., ..... /'D,r✓' /c." �.!5z!v.�._.. _ ` Please release the performance bond. APPLICANT °j'+"' •' (NO.), (STREET) (CONTR'S LICENSE) PERMIT 70 STORY .,•S NUMBER OF (TYPE OF IMPROVEMENT) N t �OWELI_ING UNITS • .(PROPOSED USE) AT (LOCATION) Fi.�,� I ZONING (NO.) - (STREET) DISTRICT BETWEEN AND (CROSS STREET) (CROSS STREET) SUBDIVISION LOT LOT BLOCK SIZE BUILDING IS TO BE FT. WIDE BY FT..LONG BY FT, IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION - (TYPE) REMARKS: - - AREA OR VOLUME ' -'- ESTIMATED COST `��' `)I•��' PERMIT $ - (CUOIC/SQUARE FEET) FEE OWNER ADDRESS ``' BUILDING DEPT. BY 1 - HIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF. EITHER TEMPORARILY OR PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE AP- PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR I. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALPLUMBING IATIONS.D 2. PRIOR 70 COVERING STRUCTURALIQUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL MEMBERS(READY TO LATH). 3. FINAL INSPECTION BEFORE FINAL INSPECTION HAS BEEN MADE. OCCUPANCY. POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTION APPROVALS PLUMBING INSPECTION.APPROVALS .) ELECTRICAL INSPECTION APPROVALS _ 6 7Z� !mil 3 C HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT 1 OTHE ------ -------- 'w "f- -'r(',-, BOARD OEHEALTI-I In a cC) 7 ,I WORK SHALL NOT PROCEED UNTIL THE INSPEC- PERMIT W!LL BECOME NULL AND VOID IF CONSTRUCTION TOR HAS APPROVED THE VARIODUS STAGES OFLWORK IS N0T STARTED W T INSPECTIONS INDICATED ON THIS CARD CAN BE 7�UC710N < - NTHS OF DATE THEI HIN SI MO� RMIT:A.S ISSUED.AS NOTED ABOVE.__,. OR BY TELEPHONE OR WRITTEN ._-... __ NOTIFICATION. ARRANGED _ $ / �oz '6/7/6� p /�. ......,. THE Assessors ma and lot numbe �.�:' Sewage Permit number BARNSTAALE, i House number ..................... ...... .... :... IO ..." 9o M A8s po,1639• p MAI TOWN ',OF • BA-RNSTABLE BUILDING .IhNSP4ECT0R APPLICATION-FOR PERMIT TO Construct Single Family Dwelling • � Wood •Frame.. .. F... � .. ... ,. .. .Y. ...<� ./.� ., TYPE OF CONSTRUCTION .....:.... . ......................................................... September 1 G F •••.19856 TO THE -INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit'according;to the following.information: Location a ...f��anri i s:..I4IA. ..... ............ .... .....� r Proposed Use .............................,.. .........'............................................................................ :.... , ' !ry Zoning District R... ..�....... .......................................... ...Fire District H,Y,amilg: `.......... a Name of Owne $1?X� �O 'Y) £s' .'�yL..TY'i1S.t..:::_.....:.:.Address7.65.:�!'f.4IMO.. th.Road.=-H3xu13,8 :.:.N1a i � . Y ,tie. - Name of Buid;�aYlCO...R211 ES�.e D.�Y.:t.�0.�.i.lnR.�..Address ......:....Sam@..:.....,............,,... i Nameof Architect .............:................................................:....Address .................................................................................... , ............ Foundation ..... .. ' Number of Rooms ..S.r.�.....:.............................. ..... P C '. , I Exterior C1a bgaxd.:.... dr..Shl.nl HB.....:....*... ...Roofin p... , g ..........p sphi .--Zh ngies......................�,..... ; Floors ........................Interior ........... ................... ... HeatingG..> ......-..... '. .Ws�t.•................................................Plumbing ........T-wo.....,.......Goppel,................. t'. a� FireplaceNOn@.:.................................. .......................Approximate. Cost ...$•Q*-000-.DQ...::A.... ...... .. Definitive Plan Approved by Planning Board /� / ----------------------------19-------- . Area .t ......r ' Diagram of Lot and Building with Dimensions Fee ......'...... . .. .......... SUBJECT TO APPROVAL.OF BOARD OF HEALTH y ` ydd ' ~ A f i OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS ? I hereby agree to conform to all the Rules and Regulations.of the Town of Barnstable regarding the above construction. Name . ........ ..... ..... ... .... . Ares: Construction Supervisor's License 00..... •••,•,•••••••.••••• CAPRICORN REALTY TRUST r Not.3 0 4 8"$... Permit for ....One....................../ ...One.....t ...... v........ Single Family Dwelling ..... .................................................................. _ 'r< location ."• Lot #19 ," 104 Brant Way ` Hyannis ..................................................... Capricorn Realty- Trust - Owner , ' Type of Construction` ".•••Frame ..;' ........................................................ i IPlot ............................ Lot ................................ , Permit Granted &�X.Qh... ... - Date of. Inspection .......19 Date Comple e :.........a ... . ............+19 7 CA Assessor's map and lot numb r .�_% .�. .; ...........�J. . Sewage Permit number .................�:........ ...�. ��/ , . J Z BJBBSTADLE, : i House number. ........... ........................... ................/mod-...... ro Maas � O 039• 90 �EpMA-f TOWN OF BARNSTABLE - _-BUILDING INSPECTOR APPLI. ._ > �'"�� k�� C T ......... ............... ... ... ....... .-.•••.. TYPE OF CONSTRUCTION ......WOOd Fram@................ = 0 19815 y .... - "- ----TO THE INSPECTOR OF BUILDINGS: _ The undersigned hereby applies. for a permit according to the following information: Lot. # 19. Br. .ant: i4 ... a.y Iiyannis. . tlA. t Location .... ............ ....... .. .... ....:............. .......... .. .........................................................:.................:...................................... ProposedUse RR.................................................................................................................................... Zoning DistrictR.C-1- Fire District ' ............................................... ..... . arM- 1a.................:......:............................. t , Name of OwnPapr oarn-Re.alty..Trust...............Addres!76.5..Fa]-muth..Ro•ad-i...Hyanniff...M.19 • Name of BuX Q... ...Address ......,,..cv8:t1`le..................... ..................... Nameof Architect ..................................................................Address ................................................... ::............................ Numberof Rooms .SJ,? ............................................:............Foundation ....P.,O.................................................................. Exieriorq!?LP:WArd..And/or..,Sh1,r1gles....................Roofing .........�� h;31t .rS�IYY]g r P 2.e.e. .......................... Floors .pArpe.t. .Interior ......... $hue'�ro-ak.................................................. Hea'tinc *a$.... .F. w g�. .. ...................................................Plumbin Two...... ......c pp ........ FireplaMoRe...........:. ........Approximate. Cost*, $40-j-000.:•©-0.....0....................... Definitive Plan Approved by Planning Board ----------------------------------19._-______ . Area 1Q6...g .;.... t • Diagram of Lot and Building with Dimensions Fee SIJBJECT TO APPROVAL OF BOARD OF HEALTH h r tomji, 'i > ' Y C� OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS R I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. i t j Name ! Pres. ...... Construction Supervisor's License .................................... _: 000985 CAPRICORN REALTY TRUST A=272-3 No ... .048.g. Permit for .,,One ......... S..... Fami1X..Dwelling........... Location ....,Lot #19 r,.... 104 Brant Way ...... ..... ...... H .a nn i.s Owner Capricorn Realty Trust ........ Type of Construction .........Frame... .............................. Plot ............................ Lot ...:............................ Permit Granted ......March. . . ... ................ 6 19 87 .. .... .. .. .. . Date of Inspection ....................................19 Date Completed ......................................19 p N Sal , V V ti Q N j 0 N 0 � 32f z (5.ov Q ►� Q N) 3 9.9.5 2.3v Z-0T / 4 I �L�✓. �S. SO N.G.V. . ' TOWN OF BARNSTABLE ZONING �tw of M BY—LAWS DATED FEBRUARY 1986 PAUL q`y ZONE: RC- 1 2 RRLL SETBACKS A No. � 9 y� FRONT = 30' DS'�NAL LA'�3 SIDE = 15' . D. . r° REAR = 15' I PROPERTY LINES SHOWN HEREON WERE COMPILED FROM PLANS OF RECORD AND 00 NOT REPRESENT PROJECT NO. �-1348-05 AN ACTUAL SURVEY ON THE GROUND. THE STRUCTURE` DEPICTED ON THIS PLAN WAS LOCATED PLOT PLAN ON THE GROUND BY SURVEY ON MARCH 5 1987 in AND EXISTS AS SHOWN AS OF THE DATE OF LOCATION. BARNSTABLE MASS . THIS PLAN IS FOR PLOT PLAN PURPOSES ONLY AND SCALE: 1" = 20' MARCH 6 1987 SHOULD NOT BE USED FOR ANY OTHER PURPOSE. --- - ---- BSC / CAPE COO SURVEY CONSULTANTS i _��2� __.. 3261 MAIN STREET f 0 E_' PROFESSIONA j L LAND VE pR BARNSTABLE. VILLAGE, MA.M02630 (617) 362-8133 j