HomeMy WebLinkAbout0006 BROOKSHIRE ROAD eeases�reE za .
- - -- --
�7HEfr y Town of Barnstable *Permit# -7
Expires 6 months from issue date
BAMSTABLE, » Regulatory Services Fee
y MASS.
gjpl i6g9• _ ,_. ... Thomas F.Geiier,Director
� IT Building Division
NOV 2 1 2006 Tom Perry, Building Commissioner
Of 200 Main Street, Hyannis,MA 02601
fic R038:yy;i%�STABLE
Fax: 5 e0§90-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
Not Valid without Red X-Press Imprint
Aap/parcel Number 4' 1�, _ ��
?roperty Address4 ,^
Residential Value of Work Minimum fee of$25.00 for work under$6000.00
)wner's Name&Address_ m((DTI AR..,) "-PA 4 i oz.)a j
r �I C f'1 t S
:ontractor's Name , �ZZ�
1- Telephone Number a
[ome Improvement Contractor License#(if applicable) 16�
'onstruction Supervisor's License#(if applicable)
]Workman's Compensation Insurance
Check one:
❑ I am a sole proprietor
❑ I am the Homeowner
I have Worker's Compensation Insurance
surance Company Name
'orkman's Comp.Policy
spy of insurance Compliance Certificate must be on file.
.rmit Request(check box)
❑ Re-roof(stripping old shingles) All construction debris will be taken to
❑Re-roof(not stripping. Going over existing layers of roof)
❑ Re-side
❑ Replacement Windows. U-Value ( mximum.44M
*Where required: issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,, onK
***Note: Property Owner must sign Property Owner Letter of Permission. O No2
me Improvement Contracto
Hrss License is required.
nature
mns:expmtrg
ae063004
I
G � PIZ
Homo-
Improvement21
Inc.
I, Thomas Capizzi'Jr., owner of Capizzi Home Improvement, hereby authorize Lisa
Haworth,to sign on my behalf for permit applications filed through the town.
Signed:
4 6 L,
Thomas apizzi, r. Date:
aworth Date:
1645 Newtown Road Cotuit, MA 02635 (508) 428-9518 (800) 262-5060 FAX (508) 428-1547
±: Date: 6/13/2006 Time: 8:40 AM TO: @ 9,1,5084281547 RAG Ins. Agcy. Page: 035
Client#:47298 CAPIHOM
k ACORD. CERTIFICATE OF LIABILITY INSURANCE 0613106
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Rogers&Gray Ins.Agency,Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR,
434 Route 134 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P.O. Box 1601
-1601 DING COVERAGE NAIC#
A 02660 ERS AFFOR
South Dennis, INUUR B
INSURED INSURER A National Grange Mutual Ins.CO. '
Capizzi Home Improvement,Ina,' INSURERB:-GUARD Insurance Group
Capizzi Enterprises,Inc. INSURERC
1645 Newtown Road INSURERD:
Cotult, MA 02635 IN
SURER
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 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
r - POLICY EFFECTIVE POLICY EXPIRATION : :LIMITS -
LTR NS TYPE OFINSURANCE POLICY NUMBER DATE MMIDD DATE MMIDD
A GENERAL LIABILITY MP010707 06/08106 06108107. EACH OCCURRENCE ' $1 OOO OOO
Ly X COMMERCIAL GENERAL LIABILITY PREMI ES[Ea RENTED Ce $500 OOO
i I: CLAIMS MADE a OCCUR MED EXP(Any one person) $1 Q ODO
- PERSONAL&ADV INJURY $1 000 000
GENERAL AGGREGATE $2 000,000,
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG $2000000
I POLICY JPERCT O LOC
A AUTOMOBILE LIABILITY M1010707 06/08106 06108107 COMBINED SINGLE LIMIT $5OO OOO
(Ea accident) ,
y, ANY AUTO
ALL OWNED AUTOS BODILY INJURY
t (Per person)
X SCHEDULED AUTOS a
X HIRED AUTOS BODILY INJURY $ '
X NON-OWNED AUTOS (Per accident), � �
X Drive Other Car r PROPERTY DAMAGE
(Per accident)
GARAGELU161LITY AUTO ONLY-EA ACCIDENT $ '
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
A EXCESSIUMBRELLA LIABILITY CU010707 06108/06 06/08107 EACH OCCURRENCE $5 OOO 000
X OCCUR CLAIMS MADE, AGGREGATE s5,000,000
DEDUCTIBLE $
t X RETENTION $10000 OTH- $
I B WORKERS COMPENSATION AND CAWC702365. 12125I05 12/25I06 X WCSTATU- -
EMPLOYERS'LIABILITY E.L.EACH ACCIDENT 000,000
s ANY PROPRIETORIPARTNER/EXECUTIVE - -- - E.L.DISEASE-EA EMPLOYEE $500,000
i
OFFICERIMEMBEREXCLUDED?
i If yyes,dasaibe under E.L.DISEASE-POLICY LIMIT $SOO,000
SPECIAL PROVISIONS below p`
OTHER
r`
DESCRIPTION OF OPERATIONS/LOCATIONS 1 VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
= 3 n
;r
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL In DAYS WRITTEN
,. NOTICE TOTHE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL
VA,1011:• J IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR
- REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
ACORD 25(2001108)1 of 2 #M22681 MEE 0 ACORD CORPORATION 1988
J
O�li� hj1'r.•�Yi�iliiUh,ti'
r ,•' .I r U/0 f'i ClSlilifl f<!11 i�Il'�;P.�
C;c3 ]XISDr-;aMe Affidnvil_ 3��ilc3cr;lC�z��3 rir�7 sJ i; cc.�.z-i� �x�slX'I��z 1:►c:z;
'ai01 )xt Y 1 Iv
DTJC; (3313siy)cSS�Ua'?ariixaii.t>13�3id� dual): Capin! Home lmprove.'Ment Inc.
^5—KJe% rlwn
�d7'C;SS: Cotult, MA 026-3 r
Tel 42E9518 I J 800-262-5O6Q
trzz ail emp)oyer7 check lie a}�}�roprlat,e box-
Type of�xo,�ecl.(required): .
aaxa a ear lloyea mill _ 9. El am a gtl3ml con acioimd T .
�ar�o ogees andJoz apt-ti�e).�' havc bin--d fbo snb-cmindors e,)v cons coo
aua'a sold Pr OprietorozparLDCT- listed on tic attacbed short 7_ El R MOd.Cing
ship'and"re no•employees Tb6se sob-coDtaaciors 8. bemolaiion
VA'orjZh3,g for arse jo airy capacity. �e7orls eas' comp.insarrance.
[NQ -roTkers' coaii�l_•in�;rran $_ 9. [ D�ldiag nddidoA' .
E �c a1-c a coTporatioD aad iIs -
r I�ia j officers have cmercised tli6y ID-❑ D-I&bical repays or arldiiio-
I nTll a b9meowner doing all wotL, rigbi Of eaeaaapiion per MGL ILEI I'P Inmbzrag repairs or additions
r_pyself No Worbeis, corms>_ ' c:352,§1(4),and x rehaveno
sur ce equar j i 12-El Roofrepairs .
ez�aplo3rees_ �No7orliers' 1.3- Oilier
'comp-msm -act T:NnizeLj
c3�ecl s 1?0�.,i must also 03 oriiilie _scoii ,on i�e�oV,slio cig iiie v rozkers -
ozamcas V16h (--I-f i h s risY*st dicai g Y e* doing uli r,+o'I-mmd fuea 1we'oxsisdeoo i rs mLlsi.sUb it exv zdavzt iadicaing sue?
ciozs s�1$Y ec7 f�tis i�o�mrisl clJecl sa add iionsl slaeei slaor ing•be 53ame of flic sulb-mairaciors end i.1pir cones_policy informaiion.•
r�rz7��oy�r-tlzcrt xs,�r-o��zc�ilz���orl�ers',cnlr�p.exzs�iorx z�rszrxzzrzce�oa-mp exz�•p�p��.ees_ �n.�nn��s�ie�.�;lic}>>arxr�'�v�i sr�e .
CAW C-7
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race Coxo�a���I*T.arue. �- �a r(d.. I ���CI�.Jb�, - . •
a-3 b5. Expiration Dale: !oO k�lI -
:e
—� - t_----- CiLylStaielZip:
a c Py ofthe orl+exs'+compe sat ola o is dcetara�iQra pace�(.S�o' g policy namber a)ad e:q3 c►la dal-4-
to
jCol
SeCLL�e re c as re
o 'q u'red Iandex Secdon 2-5A ofIAGL c_ 152 canlead In l e imposi-domL of climmal penalises,of n ,.
to 1, 00_ D aradlor flrae year n'OPziSonment,as-i=ell as c eoa7tiesza-Ene.form of a STOR-WORK.ORDER_aid a_f e
a day against:floe violator, :13e advised ibat a copy of bats sbtemmt ]�13e for riled to#sae Office of
galiozis Gf�ae Dl.for Msorance CON?-0mge jredficatinaa-
sof,�ez, x ,�r��ilr# x�pro?
x�rdr7 emu! zsXauerrzzdorr �. .••.
Ire: lei
Ar:
ase onlj>_ DO not Ypres in this area tfo' e coo
. b .� j '� vr•�ottYXa xl�cici�.
stag A'tWixori.�, �clx clue��aej:
oax-d of)aeattt� Z_�rtildiug�epa�`t•naet�i 3.�>-L�71'1r o���.C�exk �_l�ieci.�cat�.n.spect.oz• �_�Xtrxlabing�xaspecloX�fiiea- .
-tact pemou.
' rote 3Y_
Board of Building Regulations and Standards
-< d One Ashburton Place - Room 1301
" Boston, Massachusetts 02108
Home Improvement Contractor Registration
•
Registration: 100740
Type: Private Corporation
Expiration: 6/23/2008
CAPIZZI HOME IMPROVEMENT,.INC.,
Thomas Capizzi, Jr.
1645 Newton Rd. — —
Cotuit, MA 02635
Update Address and return card.Mark reason for change.
DPS-CA1 a 5oon-04i05-PC8698 � Ej Address ❑ Renewal Employment ❑ Lost Card
9XI -e.w-2u J6a&1, O�✓!/G2J0(LGfZLIJP. b
Board of Building Regulations and Standards
- IJr a License or registration valid for individul use only
_I HOME IMPROVEMENT CONTRACTOR before the expiration date. if found return to:
J' Registration: 100740 Board of Building Regulations and Standards
Expiration:" One Ashburton Place Rm 1,301
Type Private Corporation
Boston,Ma.02108
CAPIZZI HOME IMPROVEMENT, INC.
Thomas Capizzi 1r �--- __
1645 Newton Rd
Cotuit, MA 02635 Deputy Administrator Not valid without signatw a—�
_ OAR
A r,2; oBUI
LDING
R G'.UR 40iSf
-icense. '�CONSTRJCTION S•
Aumb
j -
CS, 057032
Ex ires�'0j2fi12bD7
' l THOMASX
CAPI
i 1645 W ,_
COTi11T, MA 063 " `f,
COhlrnissi6rier f
oFSNE T Town of Barnstable *Permit:q .() 76j/,)-o.
Expires b montJis from 'sue date
• BArtN6TADLl
Regulatory,
Services Fee
9 ass.
$A Y6g9. Thomas F.Geiler,DirectorrED MAt a p
Building Diviisioxi I
Tom Perry, Building Commissioner
200 Main Street, Hyannis,MA 02601 IT
Office: 508-862-4038
Fait: 508-790-6230 JAN 9 - 2007
EXPRESS PERMIT APPLICATION - RESIDENTIAL N OF SARNSTABLE
Not Valid without Red X Press hiprt,i
Map/parcel,Number?a� d 3
Property Address Lann l S
Residential Value of Work Oq A inimum fee of$25.00 for work under,$6000.00
owner's Name&Address keze LPLb21
contractor's NameC)04�j�����
Telephone Number
Some Improvement Contractor License;r#(if applicable)_ � -o--7 ` 4 n
construction Supervisor's License#.(if applicable) U��
-1Workmain's Compensation Insurance
Check one:
E] i am a.sole proprietor
I an the Homeowner
I`have '.
Worker s Compensation Insurance
nsurance Company Name nnt� C .
Vorkana.n's Comp.Policy#L / 7(ul-I q �
= .py of insurance Compliance Certificate must be on file.
'ermit Request(check box)
�u( 1
Re-roof(stripping old shingles) All construction debris will be taken to � .
Re-roof(not stripping. Going over existing layers of roof)
[� Re-side
[] Replacement Windows. -Val
ue
(maxinnum.44) I
*Where required: Issuance of this permit does not exempt compliance with other lovm dep"nent regulations,i.e.Historic,Conservation,etc.
***Note: Property Owner-must sign Property Owner Letter of Permission.
Home Improvement Contract rs License is required.
ignature
:rorms:expmtrg
,vise063004
-------------
Client*47298 CAPIHOM
AC®R®,. CERTIFICATE OF LIABILITY INSURANCE DATE(MO7DIYYYY)
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Rogers&Gray Ins.Agency,inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
434 Route 134 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
P.0.Box 1601 ALTER THE COVERAGE AFFORDED SYTHE POLICIES BELOW.
South Dennis,MA 02660-1601 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER.4: National Grange Mutual Ins,Co.
Capizzi Home Improvement,Inc.Capiizi Enterprises, Inc. INSURER B: American International Gr
1645 Newtown Road INSURER 0:
rrotuit,MA 02635 INSURER D:
" INSURER E
COVERAGES
THE PCLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABO'r/E FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING
ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CEF.TIFICATE 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
POLICES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INISK AUDIPOLICY EFFECTIVE POLICY EXPIRATION
LTR TYPE OF INSURANCE POLICY NUMBER AT T r 'YLIMIT9
A GENERAL LIABILITY MP010707 06/08/06 106/08/07 EACH OCCURRENCE $1 000.000
)( COMMERCIAL GENERAL LIABILITY DANt4GE 70 RENTED
PREMISE rr. $600 000
Ij I CLAIMS MADE OCCUR 101ED EXF(Anyone person) $10 0OO
r!•-��� PERSONAL d ADV INJURY $1 000 000
I I GENERALAGGREGA.TE $2,000 000
GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS•COMP/OP AGG JECT $2,000 000
?OLiC.Y PRO- LOC ..
�
i AUTOMOBILE LIABILITY
I •=MBINF.D SINGLE LIMIT
ANY AUTO Ea accident) $
.ALL OMEDALTOS - BODILY INJURY
SCHEDULED AUTOS (Perperson) $
HIRED AUTOS
BODILY IN lUR1' $
NON-OWNED AUTOS (Per accdent)
. PROPERTY DAMAGE $
(Pa-as dent)
GARAGE LIABILITY A1,70 ONLY•EA ACCIDENT $
.ANY AUTO
DTI-ER THAN EA ACC y
AUTO ONLY: AG $
I EXCESSiUMBRELLA LIABILITY EACH OCCURRENCE $
j -OCCUR ❑CLAWS MADE AGGREGATE $ .
I 3
OHDUCTISLE $
RETENTION $ I $
B WORKERS COMPENSATION I NI T AND 1764953 12125/06 12125/O7 WC SLIMIT 6TH.
EMPLOYERS'LUABILITY
ANY PROPRIETORiPARTNERlEXE6,UTI4E. I E.L.EACH ACCIDENT $500,000
I m,d scr be u de EY.CIUDECd -'e.L.DISEASE-EA EMPLOYEE $500,000
Il Yes,descr he under SFECLAL PROVISIONS to cw E.L.DISEASE-POLICY LIMB $500,000
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS!VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT i SPECIAL PROVISIONS
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
Town of Barnstable DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 1n DAYS WRITTEN
200 Main Street NOTICE TO THE CERTIFICATE H OLDER NAMED TO THE LEFT,BUT FAILURE TO 00 SO SHALL
Hyannis,MA 02601 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,iTS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
4 y
ACORD 25(2001MS)1 of 2 Q6435 pMyy ACORD CORPORATION 1988
P� P I Z
G 21
Home
Improvement
Inc.
I, Thomas Capizzi Jr., owner of Capizzi Home Improvement, hereby authorize Lisa
Haworth,to sign on my behalf for permit applications filed through the town.
Signed:.
Thomas apizzi, r. Date:
aworth Date:
1645 Newtown Road Cotuit, MA 02635 (508) 428-9518 (800) 262-5060 FAX (508) 428-1547
CAPIZZI'HOME IMPROVEMENT INC.
SPECIFICATIONS AND ESTIMATES -
r
-x
STATE OF NiASSACHi7SETTS
a n-t
LETTER OF AUTHORIZATION TO APPLYFOR A BUILDING PERMIT
' y., - .w-a�.,+�+an-,.w4-ro,,..:'»� ....-<-a-�r+a'k�.. ..-hex'....- s�. _�'�.,p�, .,...t.,.,,�,a,.,:n.-cw.«.p.�<.�- ...,.:st4.��_'r..p,.;s..•....:..+.—. =-,-.^ +-.K..-.,
� ::-.•F�,i:r ...r .�".'Ed'� we..�•e�. w4�-a,s. s..�E �h. xT4 -s-....r ..C-.ws.aT hi+q- w_,..^.r- w ..<+
'OWN THE
MASSACHUSETTS' `
y a x s
u �: a s � y
•$��
I HAVE AUTHORIZED » CAPIZA.HOME YIVIPROVEMENT TO ACT AS�MY AGENT-TO APPLY FOR
A BUILDING PERMIT IN ACCORDANCE WITH 780 CMF, THE MASSACHUSETTS STATE BUILDING'
CODE: >. r
i
I GIVE MY'PE RMISSIONTO
LESSEE
x 4�
ABUILNG PERMIT ICCONCEW0CTO APPLY FOR M , MAS,SACHU.SETTS.
r
STATE BUILDING CODE 4
'� .• N.• 4t ..^e Si4`xu � y, M w, - *T e.F
SIGNATURE OF OWNERS) _
OWNER'=S DD ARESS
OWNER'S TELEPHONE a � � � ` }
LESSEE'S SIGNATURE
LESSEE'S ADDRESS
..IV
s. t
S �
P
a 3 iH qr
4 � 4
APLLICAN URE
T'S'SICNAT f
f APPLICANT'S"ADDRESS 164 e�vt®wn IZd;donut;IVIA�02635 "" �
�.
APPLICANT'S TELEPHONE 1 508 428 9518
RESPONSIB
LE;OFFICER
RESPONSIBLE OFFICER-ADDRESS
70
:
RESPONSIBLE`OFFICER TELEPHONE
The.Commonwealth of Massachusetts
Department of Industrial Accidents
r _ Dice of Investigations
600 Washington Street
-oston 'MA 02111
www.mas&govldla
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Letibly
Name (Businessoganization/individual): :.: vement
Address: 1645 Newtown Road
.06t6.�� .
Cl /State/Zl Tel. 428-9518 800.262.5060
ty p �hone#:
employer?Check he appropriate bog TM* 3
with general Type of proleet(regmred):
Are ou an
I am a employer _* 4. ❑ I am a' contractor and I [7.6. ❑New con triictlon
employees(full and/or part-time): :have hued the sub=contractors
2.❑;I am a sole proprietor or partner- listed'on the-aftached sheeO 9,R emodeling
ship-:and have no employees These•sub-contractors-have 8. [] Deniohtion
working for me in any capacity. .. workers' comp. insurance. 9; ❑ Building addition
(No workers' comp. insurance 5. ❑'We are a corporation and its
required] officers have exercised their 10.❑ Electrical repairs or-additions
3.❑ I am xhomeowner doing all.work right of exemption per MGL l I.❑ Pluinbing'iepairs or additions
myself [No workers''co c'.152, 1 4 :and we fiave no
comp.- § O� 12:❑ Roofrepaus
insurance.required] t employees Mo workers'
, 13.❑ Other'
comp. insurance required.]
*Any applicant that'checks box-#1 must also fill out the section below-showing their workers'compensation pohcy infoirnation:
t Homeowners who submit this affidavit indicating they are doing all work and then lure'outside contractors must submit a new affidavit indicating such.
tcontractors that check this box must attached an additional sheet showing.the name ofthe sub-contractors and their workeis'comp,policy i ifoi47iatibn.
I am an employer that is providing workers compensation:insurance formy.employees-Below is the policy.andPb.site
information._
Insurance Company Name: �—
//
Policy#or Self-ins Lic #. tionDate:
Job Site Address: City/State/Zp:
. _ _� _...
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-upto$1,500.00 and/or one ear. , t,y unprisonmen as well as civil.penalties in the form of a STOP WORK ORDER'and a fine__.
of up 0$250.00:a day-against the violator.* Be advised that a copy of this statement may forwarded to the Office of
Investigations of the DIA for insurance coverage verification:
I do hereby f etW#under the pains and penalties ofpe17 ry that:the information provided above is true and correct
Si ature: Date:
Phone#:
0f,1acial use only. Do not write in'this:area,to be completed by city or town official
City or Town: Permit/License#
Issuiiig`Authority(circle one)
1. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
- : Board of Building Regulations and Standards
k One Ashburton Place - Room 1301
. ; h
Boston. Massachusetts 02108
Home Improvement Contractor Registration
Registration: 100740
1 Type:. Private Corporation
CAPIZZI iHOME IMPROVEMENT, INC. Expiration: 6/23/2008
I Thomas �Capizzi,jr.
1645 Newton Rd.
Cotu it, MA 02635
1 Update Address and return card.Mark reason for change.
DPS CAi ca sonn 04ros-pcesse Address Renewal E] Employment- Lost Card
r
{
zoo 1�DOJ��izo4ztu p�✓�tadQaoltttQeffd
Board of Bufiding Regulations and Standards License or registration valid for individul use only
WOMI=IMPROVEMENT CONTRACTOR .
before the expiration date. If found return to:
lReglstration: 100740 Board of Building Regulations and Standards
I Expiration:' e/23/2008 One Ashburton PIace Rm 130I
Type: Private Corporation Boston,Ma:02108
CAPIZZI HOME IMPROVEMENT, INC.
Thomas Capizzi,Jr.
1645 Newton Rd. �
Cotuit, MA 02635 Deputy Administrator Not valid without signature
i
i
t
t
BOARD OF SU1LDING Rice
i_icense: ,�f7NSTRUCTION S 5 ONS
i Numb' :GS 057032
i B Ii3i e3 { } }
i THOMAS X CAP14NN
} COTUIT, IVIA urt;3
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I Coiiirnt:c�v�,;w , _