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HomeMy WebLinkAbout0074 CHASE STREET nL I ' Town of Barnstable Final Inspection Affidavit Date: 3�c Building Division 200 Mair(Street Hyannis, MA 02601 RE: Insulation Permits Dear This affidavit ' certify that all work completed at: Street: ' � Village: has been in ected by a certified Building Performance Institute (BPI) Inspector. All work performed meets or exceeds federal and state requirements. Permit applicati n n ber: g`�� _ 5 Issue date: 3� Sincerely, a Francis Sheehan President Frontier Energy Solutions, Inc. 502 Harwich Road Brewster, MA 02631 Office: 774-237-0410 Email: fssfrontierenergy@gmail.com ��v f /19/2018 12:09PH FAX 7742370410 FRONTIER 3100 1?10001/0001 / E2 '6 CA— ::E Frontier Energy Solutions, Inc. ? 502 Harwich Rd ( � 00 Brewster, MA 02631 I tn 3/19/2018 -- � Brian Florence, Building Commissioner -� 200 Main Street Hyannis, MA 02601 Dear Brian Florence, 1 am requesting an extension for Permit 8-17-3015.74 Chase Street. The client had to reschedule the insulation work due to animals in her attic. I just realized that the permit expired on 3/18/2018.This job has been rescheduled for the middle of April. Thank you Megan Mulhern Administrative Assistant Frontier Energy Solutions, Inc 774-237-0410 mmulhern@frontiercapecod.com 10127/)7 Barnstable *Permit# - ? -Town of s ble P rm 3 ( 6 7� F ,eessrnonthsfromissuedate/1,R C Regulatory Services * easxarast's KAM i Richard V.Scab,Director6J11 .06k � e SP ! '1� -- . Building Division 6. Paul Roma,Building Commissioner QCT 18 201� 200 Main Street,Hyannis,MA 02601 www.town.barnstablc.ma.us Office: 508-862-4038 TO���� Fax:508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Map/parcel Ntttrtber 3 09 — 2 3 2_.� Not Valid without Red X-Press Lnprint -7 `t C44/-1s� S-�"ree � ��1Ati�,; s Property Address Residential Value of Work$ / OOd` U� Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address E-1 a Z<I 6.2711'4 Fe i L 7 C 144J E r-f= 14\/A,v ai J / M,4 if 2e a ! Contractor's Name G A19� "Cl-- 'AFJC)n Telephone Number Home Improvement Contractor License#(if applicable) 106 7 Y d Email: GA(I-y e Zorkman's etion Supervisor's License#(if applicable)____-C s 0 7 y 6 Compensation Insurance Check one: V11have am a sole proprietor am the Homeowner Worker's Compensation Insurance Insurance Company Name All (° 0it V b -I�IJ Cd"JAM Y Workman's Camp.Polley#.__.._._� Copy of Insurance Compliance Certificate must accompany each permit ) e e?1,4IA/feeo Permit Request(check box) Who/.e f o u J e l A tiD t'1Aj 1-�1jv e,ae 8114ek) C e a fA/1J�-ee d []YRe-roof(hurricane nailed)(stripping old shingles) All construction.debris will be taken to N8 W,4Y r15 c%ftJD w/ c*1rf4 ❑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: *Where required: Issuance oFthis permit does not exempt compliance with other to%Nn department regulations.i.e.Historic.Conservation.etc. ***Note: Property Owner must sign Property Owner Letter of Permission. (Xee .4 dA44 A copy of the Home Improvement Contractors License&Construction Supervisors License is r eq uVed. SIGNATURE: C kUsers:demllik',AppData%LocatNicrosoWt Windo%vslNciCache�Content.Outlook'L7U69Lt21EXPRESS(2).doc o IP-5117 F r ' no L"m1f mx em se,*md Of ht&w&WAeddeHU We g HA 02111 wwwmmgov/db berg WoftW Compe>stion Iwar="Affidavtj:BOderalContractc►r�1��r1d�lPlu�► fl . Name(B-9nms Adw&d1 ): CAPI?ZI HOME IMPROVEMENT INC Ad�� I$45 NEW'E'aWN ROAD .. Phone#:FT 5a8.428�518 p �inplayef!'G'hcckthe bom 4• I am a getrrarral coa�ador and b• New a� a:employdr wi& 40+ hw lied*s snb-ooasrecbaim ($�Umd/argW*w)•'` onto 7. Remodeling 2. I sm aso116-p p 'or p These D=OWM ship �uplo3rees and ha�re wodwe 9 BWiftgaddition Vod&9 Sor me in ate c 13'- •,e t i0. Ejectiggrepsimoraddidow [Nod com*bwsncc5. We are a omVmzdm and r 11. ar ad 3. I bomeowno'doing Il warkTw of onpf•MOL 12.1/ i£`tNo warps 0010P- a 152,$1(4),andwehave no 13. Oi�+sr t maploy"L[NO wortew LW- �A�y: tbs2s�ox#��ate��ltantft � sbmh �tltimo�}da =esstwwdav8 wwwog w+. VMS t �finsu�t� ��' �Sn�of� �s�tea��8� bave s�chedea a+es'oam�P • Yf11te ecva +ta .B $ ,and jb X mnan aserdem brprovfd�g workds �!F A11AaUARD p4SURANCE COMPANY CMP 12125=17 R2WCT75328 oa Policy#4- Shcfins.:Lic#: Z 4✓� City/stamlzIp: Job SttaAddmr— nem�r cam po,, ra*,1Ep{d m Pow of a oitherro�r i I . won ofsaft* llnselt a cppF u mgWmd wuUr hdctian 25A of MCI<L a 152 as lead to the Fem9a 130 as well as-civil penaltieahi the Same €a STOP WORK ORDER and a fins onmdsrt, be�Iaote Offiae of >, f ip 3,500 0Q aaidh r onaY of this�my di violaw. Be advind a cagy ofup ta�'t50 aYcan. ivNlin oot a, #yyartown t ►erT { )' C*j'ownCldrk 4.L1jupedwPar Construction Supervisor =' Massachusetts Department of Public Safety Restricted to: yy group Board of Building Regulations and Standards less than 35,000 Buildings feet a(991scub o meters)of contain enclosed space. License: CS-074640 irof�otr�a+c:lc�o Durvir x GARY GUSTAFSON 8 SHORTWAY SANDWICH MA 0=3 't " Fa ilure to possess a current edition of the Massachusetts state Building Code is cause for revocation of this license. / � aW rl -- Expiration: CPS Licensing information visit:yyy� MASS.GOV/CPS _ Commissio er .11/29/2019 • i T .3 '.Jh,• t•rvr•ri,r•J��rert//!r r�C'lttr�.irrrltJirr/lJ � . 4M• ntmtlon 1 tnce of Conearuer AfY'aire&Buslners 'w` ME IMPROVEMENT CONTRACTOR ' 'r Reglstmdon: 100740 Type. >Lteense of ragbtmdon valid for Indtddal nee 0* S ` Supplement Card before the expiration dater. If ffonnd relater to: .,�: Explyddon: e12312018 f CAPIZZI HOME IMPROVEMENT,INC. i�Ce of Cotisuaea'�saire and D®ell itatton� . lt0�°erlt�iru�-Salta aA70 Boston.,WA WhI6 GARY GUSTAFSON 164E Neon Rd. •� ..�ws°^~ Cotuft,MA 02635 Undersecretary . w Not d•Gvitho01:8100mre ..,_ I ' DATE(MMIDDIYYY1f) �►Co v® CERTIFICATE OF LIABILITY INSURANCE 12130/2016 THI� DOES NOTUAFFARMATNELYEOR NEGATiVELYR OF OAMEND, EXTEND OR ALTER N ONLY AND CONFERS NO �THE COVERAGE AFFORGHTS UPON THE DED BY THE POLICIICATE HOLDER- ES CERTIFICATE 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 ceRificate holder is an ADDITIONAL INSURED,the policy(Iasi must be endorsed. fi SUBROGATION ISIiii WAIVED,subject to the IMPORTANT: terinis 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 endorseme s. 0ONYAcT Rogers and GrayProcessing. PRODUCER NAME: PHONE (508 398 7980 FAX No: ROGERS&GRAY INSURANCE AGENCY INC MAIL mail@mgersgra .con► ADDRESS: INSURE S AFFORDING COVERAGE N2ICi 434 ROUTE 134 42390 SOUTH DENNIS MA 02660 INSURERA: AMGUARD INSURANCE CO INSURER B INSURED CAPIZZI HOME IMPROVEMENT INC INSURERc: INSURER D 1645 NEVJTOVVN ROAD INSURERE: COTUIT MA 02635 INsuRER F: REVISION NUMBER: COVERAGES CERTIFICATE NUMBER: 114654 R THE ITHIS IS TONDICATED.CNOTNITTHAT THEHSTAND NOTWITHSTANDING ALNY ICIES REQUIREMENT,TERM OR CONDITION OF ANY CONTOF INSUNCE LISTED BE BEENERACTT OR OTHER DOTO E INSURED CUMENT WITH RESPECT TOL 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 RED UCED BY LICY EFF PAOLICC EXPLAIMS. LIMITS INSR ADDLSUSR POLICYNUMBER M /Do MMIDD LTR TYPE OF INSURANCE EACH OCCURRENCE $ COMMERCIAL GENERALLIABRM TOE $ PREMISES Ea occune oa CLAIMS-MADE OCCUR MED EXP(Any one person $ WA PERSONAL&ADV INJURY s GENERAL AGGREGATE $ GEN'LAGGREGATE UMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY❑JECOTT ❑LOC $ OTHER: C a e EDtSINGLE LIMIT $ don AUTOMOBILE LIABILITY BODILY INJURY(per person) $ ANYAUTO BODILY INJURY(per accident) $ UW ED SCHEDULED NIA PROPERTY DAMAGE $ Nuo WWNED Peracddent HIREDAUTOS AUTOS $ EACH OCCURRENCE $ UMBRELLA UAB OCCUR NIA AGGREGATE $ EXCESS LIAB CLAIMS-MADE $ OT DED RETENTIONS X STATUTE ER WORKERS COMPENSATION 1,000,000 AND EMPLOYERS'LIABILITY Y 1 N E.L.EACH ACCIDENT $ ANYPROPRIETOR/PARTNER/DCECUTNE NIA NIA NIA R2WC775326 12/25/2016 12/25/2017 E.L.DISEASE-EA EMPLOYEE $ 11000,000 A ( ryi EXCLUDEEXCLUDED?CDED? ea E.L DISEASE-POLICY OMIT $ 1 000, If y desaibe under 000 DESCRIPTION OF OPERATIONS below N/A DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be allaehed R more space is wired) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authortwtlon is given to pay s other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts claims for benefits to employees in state • ess the rat This Certificate o�Sf�ttifit�shows the of insurance).iI The status of this coverage canbe monitoredicate was ldaily bssued y accessing the l proof of Coverage on date on the bCov ove policy precedes rification e Issue date Search tool at www.mass.govllwdhNorkers-compensadonrinvestigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POUCY PROVISIONS. Town of Bamstabie 200 Main Street AUTHORIZED REPRESENTATIVE M. C Hyannis MA 02601 Daniel M. y,CPCU,Vice President—Residual Martcet—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD a Page 7 of 7 Capizzi Home Improvement Inc. Specifications and Estimates STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT I/WE, ELt y` Ls!` , OWN THE PROPERTY LOCATED AT 7Y CIA41'ell. IN � f�ivT/� l . ,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 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: 508-428-9518 RESPONSIBLE OFFICER: RESPONSIBLE OFFICER ADDRESS: RESPONSIBLE OFFICER TELEPHONE: zr 1 Town of Barnstable ' f - { f Bulldin ,e, „:' �.z .Y.:;: n�•.. .. ,•` �'s „s ._„ tr`,' gv', . �•�: :. Retained.on�J.ob,and..th�s:CardfMust".be�Ke t� h ,.Str et•-:A roved'Pianust be. er hat.t e.. p ost Tfi�s Card.So-T pP ya. .. .. . , ., m ,w • _« . ..1 ., r3 . ..._.L�s mac.. t�l•Final.Ins p�t�on�as Been Made � � xPosted p � �, � .� �. .., 3, r s y. . , r ., a Occu ied unt�I a,Fnallns ectionhaszbeen,made 1t Cert�ficate=of Occu anc is.Re ►aired,sgelp Q iJding shall Nat:b p „p a may Where a w p Y q -. ..-moo Permit No B-17=3015 Applicant Name: FRONTIER ENERGY SOLUTIONS Approvals Date Issued: 09/18/2017 Current Use Structure Permit-Type: Building=Insulation-Residential Expiration Date" 03/18/2018 Foundation: Location: 74.CHASE STREET,HYANNIS Map/Lot: 308-232 Zoning District: RB Sheathing: .... Owner on Record: FEIL,ELIZABETH C&JANET ELIZABETH � _ Contractor Name FRONTIER ENERGY Framing: 1 < r SOLUTIONS 2 Address: 74 CHASE STREET HYANNIS,MA 02601 -.4 Contractor License 160854 Chimney: Description: Weatherization Est Project Cost: $3,100.00 Insulation: Permit Fee: $85.00 Project Review Req: Weatherization Fee Pal:d: $85.00• Final: D to 9/18/2017 Plumbing/Gas . r .t e�ay Rough Plumbing: s �z Final Plumbing: s Building Official Rough Gas: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced withi il months after issuance. All work authorized by this permit shall conform to the approved appl'ica'6' d the approved construction documents for wh ch'this permit has been granted. Final Gas: All construction,alterations and changes of use of any building and stebctures.shall be in compliance with the local zoning by laws and codes. This permit shall be displayed in a location clearly visible.from:access street or.road a d shall be maintained open for public nspectio for the entire duration of the Electrical work until the completion of the same. ..' Service: The Certificate of Occupancy will not be issued until all applicable signaturOW the Building and Fire',®fficials are provided on his permit. Minimum of Five Call Inspections Required for All Construction Work: Rough: 1.Foundation or Footing ,_, F.<.. _ ,� „• _. ^,. 2.Sheathing Inspection Final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) ;nsulation Low Voltage Final: !.Final Inspection before Occupancy Health WJhere a pplicable;sepa.rate.permits are required for Electrical,Plumbing,and Mechanical Installations. Final: Work-shall notproceed until the Inspector has approved the various stages of construction. _ . i ent .: :. : s � {� F're Departm .P,ersons contracting.:with°unregistered:contractors;do.not•have access to tFie guaranfy fund (as set forth;in MGL c.142A). Final: Building plans are to be available on site _ All.Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION BUILDING 0EP7 r 2 Map Parcel C Z t, k Application —! �J 0 Health Division AUG 3 12017 Date Issued Conservation Division TOWN Oi:PARNIS-r V.SL Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address -74 JIASC7 S—FOLF Village► } f �CJo Owner Cam —i Address Telephone 7 L1 C aL D/ Permit Request J �� �`�\rS9D 0 ® 0 ijutL l 4-6 0 fba -kik Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes 0 No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.)' Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes 0'No If yes, site plan review# Current Use 1?�i � . Jl Proposed Use ', APPLICANT INFORMATION (BUILDER OR HOMEOWNER) _ Name Telephone Number Address (kt License # �� -a�G Home Improvement Contractor# Email _ *ekes pensVtion CC'_ �O(STS[` D07,- ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO I?A ( ldln a"'JAAMMA SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. 5 ADDRESS VILLAGE ,r OWNER DATE OF INSPECTION: FOUNDATION i FRAME ti INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. I ra Town of Barnstable Regulatory Services *". .BAR�fS 'AALE, " ' Richard V. Scali,Director MASS:`- °0 109""-el.�� Building Division Paul Roma Building Commissioner 200 Main Street,Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section I, ELIZABETH. FEIL , as Owner of the subject property hereby authorize Frontier Energy to act on my behalf, in all matters relative to work authorized by this building permit application for: 74 Chase Street Hyannis, MA 02601 (Address of Job) y9 A Signature of Owner Date C Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form. C:\Users\decollik\AppData\Loca]\Microsoft\Windows\rNetCache\Content.Outlook\L7U69LF2\EXPRESS(2).doc 01/25/17 The:C"ornria ngealth of It a stzehriselts ' ;�. �'� Dep'artrrterxt.of'ltirlr�strirrl.:�E:ccitleirts t�l �� 1'C'ang�ess Street,Suite ;l"t?C1 Boston, MA,d ?0.1".? w►ut?xrurss. av/ditr, �Z Qr1re;rs' C o i pcnc7"fiuµo lasut once itfl#rlavtt:-.i3 ttldcrslCuntracEdrsiElectrtcza as/Tiumber§: '110,AE}'litM WITtI VIE-TERmrt ,INN- ACtTl tt}t11"Y r�l nTicanf lnCortnat an Please Punt LejjhL �3CIl�(}3tts"inessiC+rgan'zatiortllnr�tvailua.i}:�� '� o (�.t�f �,�,,�L't�E�i G,�i� ��(_. dciress- C1 _ fr'suer • Y _ . C►tvfState/71 �+ C,2 S ' fire-you an,em.pioytr'C_firc4..t#c`atpraprtaie bot:' T C Uit'etl`. j YP u"[pled Greg }- i E T:xm a eri gy.er with f : empioy�ces tful�,umti 9r punt=Mlcl:' 7. ❑New'costru 6iin 2 f am a>oIe p oprietor or partnership and ha-n no'cmptovetes wtii ctng-;i� meat 0 $:`�,R�modelin any capasiry [fito worker"comp anyuran re�uirel;j hom�awmcrddi7e a'I wt31K my sett,(Va uo<kzrti comp s i,uranee;cyuired.j ❑"Derraal"ition t0 0 Luildi'ng ailtion t Q am rt°hnthcowrzet an3 w rll be#irr ng eonuacmrs to eon iuct a i ibork on my grope t.,d.vi{! ensure that ail ontra tors uithet havo wo kcrS'e'omjiensatlor,in arance ware"aolc I,I;;Q EleCtCiCal rcpalCS;Or additlans: propnetocs with n(rcmploytes; i?;.Q PE.unihiirgtepatrs=n�additions 3 Q i am gene-al coniiaraor nrd i have h re'.3 efts,uo-eontractois tist�l on the. ttauhed sf ear 7hes sua ceantractors hsve empioYces andavc worker> Comp tr sura=ce 0Y2ai7f Ce[lairs o: c arua;comr rat otiAn. its af.te ers Itayc ccertiscti LSeii,eighi..or:e.mmp ton per ytts[.y c> `I52;g't`(4) ,ma xe=leave=no employees [her cork fs'cahtp.inse}anee'r�qtiired j' F4;y apptictint tNt t.hccU tiir :#t mtiu aim tttf out the se0on taeloiv showt,peth it workers"iompcnsation pol"icy i,nfrirmation Hur cowners who,s+bruit'this at`idavir tndtcn:i'ig they-are doing al worF an I,the here ouside epni actors musi sihmit a"-neax az7triav';-ia 3icatingsueh. *Goltcpcutts<{ha chaek t}tis:box m st'a:tache 1.tif aildiFianal;shErt sboevt tg the me of;thc stiE'co itrdcuxs artei stfte t ltitlier or"nai hose entities ave. ernnioyees lf•.tftc->uh cesnvactois'havc;cmployc ,they mttsrprovtdC riieir workers comp;policv ntts. 1 um-'an.errrtyer ticitrs.p'ra.vtircg.wprkcrs'campensalian irisrirance far my ernptayec�s: Below Ys ll:e policy rsnrl joh`site infotncation, -[ S x;l u. `C:. fi `1^ .21 Cr C ompany ylame 1 r� `� ,A� m . ^ -'f f y Pojey#"or-Self ins Gil rt..� C .: jj p:� � C:[ Fiepirarionlate" id.� Join Site,Addtess_ C it,/statcf s� Attu¢!t a copy uI the worl.crs'".''camp t u�ti ptiUcv tleclaratt+�ri page-(shutrtno tlic polio n i er and ecpirat' Failure to secure coverage as-rt y'tfired under MOL c, I]2 751A is a.criminal vtolatiOn"punisttabie°by.a.fine up to and/or;one-year imptis�nment as weji.a5 t,vtl,.iaenajtics iti the for n.of a STQP'"Wf1R.K-(),RDG[t andaa tine of zp`to 23(!QG;'a day:against the vi6lator A.cPpv cif this staterrietit;titay'fie'-fc warded to t ee t�ffice o.€inseari�aUons of the DIA'for-utsurarce coveGau��rtfc��on,, �.. .,. � ..� fP 1��+�� .� � • I da It gm'b c�rtt u►rrfer tlxe"duns rr ties a; er rr tltnt t J:e"ire v"rrrtutibn pr i4d:-d rtb ve ' true ' ticarrect- St nature:,. _ [date: Off.: lose on-!v. Do not tt+rrte in this arek,'ti�h'e compl.rterl by ctty or totun affclrrt , t ity or Town: Per.mit/Lice.nse:#-. .- . Issttint;"'k-A ritj�'(circic t►:ne) 1 i:`Board iliNeaith.2.Bt it lsng.i)epartmenf 3 t<ity;Mdwn Mrk 4.Flettrkal faspec tar 5.P9u'mhinb inspector b:"Outer. I 1 Goutict ersaa;. "lions : .Y ( f,.A�'"EXi't A7€r��flX.rilflf �."Fi1 .Tlr✓Jtd..(.tF,i' LlCense.br registration valid for indiwdual use only 2�, Office,nf Consumer Affairs.S Business Regnlationt ! before the expiration date. If found return to ' = HOME IMPROVEMENT CONTRACTOR p Ce of Consumer�Xf6irs and Business Regulation Registration!.,,.- 1A60854 Type: 10!ParkPlaza-Suite 51 i0 Expiration 94/2018 LLC € Boston,'Nl, 02136 t " FRONTIER ENERGY SOLUTIONS'" �D 1 FRANCIS SHEEHAN t 502 HARWICH RD s ,, BREWSTER;MA 02&31 t?ndcrsecnetary N t vaI �:ithou signature 3 Construction Supervisor Specialty _. Restricted to: lvtassachusetts De'partrient€f Pu'btic Safety CSSL-IC-Insulation Contractor Bo'rd of B€�.sideng,kegu€ations and Standards License C99L-105041 onst uctepn Supervisor"SpeciM,ty y s FRANCIS S SHEEHAN 802 HARWI,CHWRO DREW$TER MA 0201` �g °,. Failure to;possess a currentedition ofthe Massachusetts State Building Code is causelor revocation of this,license. DPS Licensing information visit: WLNW,MASS:GO1t/DPSoissaoner 02117/2018 1 { x 1 DATE(MMIDO/YYYY) ACC) CERTIFICATE OF LIABILITY INSURANCE 03116/2017 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(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 CONTNAME: Rogers and Gray Processing ROGERS &GRAY INSURANCE AGENCY INC AICDN No. Ext: (508)398-7980 ac No: ADORess: mail@rogersgray.com 434 ROUTE 134 - INSURERS AFFORDING COVERAGE NAIC# SOUTH DENNIS MA 02660 INSURERA: AIM MUTUAL INS CO 33758 INSURED INSURER B: FRONTIER ENERGY SOLUTIONS INC INSURERC: INSURER D: 502 HARWICH ROAD INSURER E: BREWSTER MA 02631 INSURER F: COVERAGES CERTIFICATE NUMBER: 134675 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. IICY EXP LTR R ADDLITYPE OF INSURANCE INSO WVD SUER POLICY NUMBER MMIDDPOLICYIYYYY EFF MMIDDIYYYY LIMITS LT COMMERCIAL GENERAL LIABILITY - EACH OCCURRENCE $ DAMAGE 111 CLAIMS-MADE OCCUR PREMISES Ea occur ante $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident - ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED N/A BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED per accident) PROPERTY DAMAGE $ HIRED AUTOS AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE N/A AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION X STATUTE ER H AND EMPLOYERS'LIABILITY " ANYPROPRIETOR/PARTNER/EXECUTIVE Y/NF--1 E.L.EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBER EXCLUDED? I N/Al NIA N/A VWC10060153152017A 03/14/2017 03/14/2018 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 N/A DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be 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-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Frontier Energy Solutions Inc. - 502 Harwich Road AUTHORIZED REPRESENTATIVE . Brewster MA 02631 Daniel M.Crgw�y,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Ali 91,417 Town f Barnstable o ermit# -��-11 f of o o1 months from issue date �.� Regulatory Services B►xNSrABM /'� tttass. Richard V.Scali,Director AUG�9 Vf�, D 39. Building Division 1044 Paul Roma,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 0 d 2-3 Z Not Valid without Red X-Press Impiint Map/parcel Number c� �Property Address 6 a f E J:21- ` //�C t/ I-11JA11 Y residential Value of Work$ 10 p 0 OU-- Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address 7 Y ( AW e. Jf I�yW VAII/ AIA e, 2�4 0/ G Contractor's Name G,0 U[J✓�i��Ja�j 4YiZ2e 900-e Telephone Number 0 Ado yfl�yrl�pry C'� i z Zi f�eeYe-�a�l Home Improvement Contractor License#(if applicable) /00'1 y" Email: / f Construction Supervisor's License#(if applicable) e L 6Workman's Compensation Insurance Check one: ❑ I am a sole proprietor I am.the Homeowner I have Worker's Compensation Insurance Insurance Company Name /��'d Grl ® Z,41✓• Workman's Comp.Policy# a W C y7r3Z� 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 ❑ e-roof(hurricane nailed not stripping. Going over existing layers of roof) r 7 Re-side �' ��to 1• �'tJ d Replacement Windows/doors/sliders. U-Value (maximum .32)#of windows #of doors: *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic.Conservation,etc. ***Note: Property Owner must Sian Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is qu' ed. SIGNATURE: C:\Users\decollik\AppData\Local\Microsoft\Windo%vs\lNetCache\Content.OulloolaL7U69LF2\EXPRESS(2).doe 01/25/17 Page 7 of 7 I Capizzi Home Improvement Inc. Specifications and Estimates STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT UWE, /t-- , OWN THE PROPERTY LOCATED AT '�y �1T�T� IN MASSACHUSETTS. I HAVE AUTHORIZED CAPIZZI HOME IMPROVEMENT TO ACT AS MY AGENT TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. I GIVE MY PERMISSION TO LESSEE TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. SIGNATURE OF OWNER: OWNER'S ADDRESS: OWNER'S TELEPHONE: LESSEE'S SIGNATURE: LESSEE'S ADDRESS: LESSEE'S TELEPHONE: APLLICANT'S SIGNATURE: APPLICANT'S ADDRESS: 1645 Newtown Rd., Cotuit,MA 02635 APPLICANT'S TELEPHONE: 508-428-9518 RESPONSIBLE OFFICER: RESPONSIBLE OFFICER ADDRESS: RESPONSIBLE OFFICER TELEPHONE: j1 { Construction Supervisor Restricted to: Massachusetts Department of Public Safety Unrestricted-Buildings of any use group which contain I less than 35,000 cubic feet(991 cubic meters)of k9 Board of Building Regulations and Standards enclosed space. License: CS-074640 Construction Supervisor GARY GUSTAFSON t� 1 8 SHORT WAY SANDWICH MA 02563 1 Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. a . 3 DPS Licensing information visit: VAVW.MASS.GOV/DPS �,� ✓ /��� — � Expiration: \�.____..— -- ... — .--� -- -------------.—. 1Commissio er 11/29/2018 Y v � of Consumer Affairs&Business ltegn➢ation - z_4 R- })IOME IMPROVEMENT CONTRACTOR Registration: 100740 Type: License oe registration valid for iendliidul use only Expiration: 6/23/2018 Supplement Card before the enpiration slate. Uffouand return to: CAP1771 HOME IMPROVEMENT,INC. Office of Consumer Affairs and Basin;ess Regulation: x 10]Park]Pln=-Suite 5170 GARY GUSTAFSON Boston,MA 0211.E 1645 Nevdon Rd. "'— Cotuit,MA 02635 Undersecretary Not v Itlnonut Signature , The Cor»raonweakh of Massachusetts .Deparhnent of Indus&WAcddents Office of Investigations s , . 600 WMkINgton Sheet Boston,MA 02111 wwwm0sgvv1dia Workers' Compensation Insurance 'vft:Builders l�adstraetars/Electri����� li Info 'o Nam mustness/pMIL-Maonandhidusl): CAPiZZi HOME IMPROVEMENT INC Address. 1645 NEWTOWN ROAD C' I'Stawn 3. CaTUIT MA 02635 Phme#; 5Q$-42&9598 Are youer?Check*9 appropriate boa: contractor and I TYPe of proleet{ ): an employ 4. I am a general i,✓ I mm a employer with 40+ 6. New cotzstruction ees fulland/orpart time).* have hired**sub-ors7. Remodeling employees{ er' listed on the attached sheet. 2. I am a sole proprietor or partn These sub-contractors have L12. Roof ition ship and have no employees employes and have workers' g addition W-Wft for me in any caPaci't - camp. net al repay or additions [No workers'camp•inwarwe 5. We are a corporation and its require Lj officers have 6i6dsed their ng sepaim or additions 3. I am a homeowner doingall work r of exemption per MOL mysei£[No workers'damp' 0.152,§1(4),and we have no insurance 1 t employees.[No workers' instu'eace required• shy pp nttiu<t I mac also flit oat flm secion.bedow showing dt*wO&f compasa&a Policy khnnafim all w0&ad V►enbiw outsdde Wit= m most sobndt anew 8ffi" t such t H0tWv M who submit this aft 1h the name of*e M�ad staff wbethec or note have 3ContcaoM*Adwk*s box mustatta Was wotkere'comp PoboS' �. i Vthe eub�ao aaWn;bove emptayeea.tlu�Y �° a ee& Below is the poltCj'andjob site er the is dig�'k'�penmdon warmee for n4V employ I am me e�ploy P�'l Insurance WOMWORL Nam: AMOUARD INSURANCE COMPANY , 1�1IC?75328 �on�. 42I25/201T Policy#or elf-ins.Lie. �� . v211" e 94 j e tatty/Statelzip: Job Site Address: - number and�pfat�n date). asatw.policy declaration page(showing the polic9 . . enals of a Attach a OUpy of the workers'compe osmon of p FaOiae:m,sure.eoe as r�uired under Section 25A of MGL c.152 can lead to die imp imprisonment,as well as eivd penalties in the£arm of a STOP WORK ORDER and a fine fine ug in$I',540.00 and/or cme-y�r imp' of this statement may be forwarded to die Office of of ug $250.00 a day the violator. Be advised that a copy ce coverage veriiactian. " ¢pails ondpena&tes ofper &e hform0npr°n'ided aWe is&ue rand y Idol ; �-7 a 9518 n e in thfs ruses,to be co*1ded by c*or town mouse only" vt. i Anthorlh►{circle one), ant 3 Cityl'i M.Clark 4.Ethical IaspecWr 5.pinmbl�Insp r }.Bo�rt1 of Heatdi 2.�pding Dept (,Other Phone#: :con perMon: � 7 ®A`�o CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 12/30/2016 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). CONTACT PRODUCER NAME: Rogers and Gray Processing ROGERS&GR_AY INSURANCE AGENCY INC PHC.N Etl: (508)398-7980 FAA/C No: ADDARESS: . mail@rogersgray.com 434 ROUTE 134 INSURER(S)AFFORDING COVERAGE NAIC# SOUTH DENNIS MA 02660 INSURER : AMGUARD INSURANCE CO 42390 INSURED INSURER B: CAPIZZI HOME IMPROVEMENT INC INSURERC: INSURER D: 1645 NEWfOWN ROAD INSURERE: COTUIT MA 02635 INSURER F: COVERAGES CERTIFICATE NUMBER: 114654 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 I TYPE OF INSURANCE AODLSUBR POLICYNUMBER MMIDD EFF LICY MMIDD EXP LIMITS LTR COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES Ea occurrence $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ POLICY❑PRO LOC PRODUCTS-COMPIOP AGG $ JECT OTHER: COMBINED AUTOMOBILE LIABILITY Ea accident) SINGLE LIMIT $ BODILY INJURY(Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS N/A BODILY INJURY(Per accident) $ AUTOS NON-OWNED (Per accident)PROPERTY DAMAGE $ HIRED AUTOS AUTOS $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE WA AGGREGATE $ DED I I RETENTION$ _ $ wORKERsCOMPENSATION X STATUTE ERH AND EMPLOYERS'LIABILITY YIN ANYPROPRIETOPJPARTNERIEXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 A OFFICERIMEMBER EXCLUDED N/A N/A NIA R2WC775326 12/25/2016 12/25/2017 E.L.DISEASE-EA EMPLOYEEI$ 1,000,000 (Mandatory In NH) If yes,describe under E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS below N/A DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be 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-compensaton/nvestgations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of Bamstable 200 Main Street AUTHORIZED REPRESENTATIVE Hyannis MA 02601 Daniel MCC lney,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 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map - Parcel 2. Permit# Health Division _,�V `/4 ,r1� .�i� L�Y� '.�/s Date Issued Conservation Division S J `� vd Fee02� Tax Coll or /Ila0 Treasurer A SEwp MPLICANT MUST OBTAIN Planning D t CpNNECTIO�PLR�IION Pg10RT0 ENG1NEElZ1`id D1VI5 Date Definitive Plan Approved by Planning Board cgNSTucTION. Historic-OKH Preservation/Hyannis ' Project Street Address Village Owner J tit l > VV 1 L L 1 14 1M,S' Address 79 CDJ A i X S!, 14 YA A)N IJ Telephone '� 1 -2-9 1ZA m -3 6 2-- OG Permit Request pD i4G l;F a Ur;gte- 1 J' A) 'k QifUC- Square feet: 1 st floor:existing proposed 2nd floor: existing proposed Total new Estimated Project Cost ��a�� UU Zoning District Flood Plain Groundwater Overlay Construction Type 6)OD19 944MK- Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family 0 Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑No Basement Type: ❑ Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full:existing new Half:existing new Number of Bedrooms: existing new ;Total Room Count(not including baths): existing new First Floor Room Count =,Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes ❑No Fireplaces:Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:Cl existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION l.J � C2 7�Name ('f Telephone Number tf-JgF- 7/3 Address 1�� �YL�Y-00 l', License# �.S a 0 1 S� S&A 4 k De_/m ij l/�I� . Home Improvement Contractor# /6 7,3 9.3 Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO lzwiii L l,)io ri cz; SIGNATUR �� DATE - 02 i t : FOR OFFICIAL USE ONLY PERMIT NO. � DATE ISSUED MAP/PARCEL NO. _ ADDRESS VILLAGE OWNER .. . _ DATE OF INSPECTION _ FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL _ t , - �; GAS: ROUGH r. FINAL ' FINAL BUILDING, OD DATE CLOSED OUT ASSOCIATION PLAN NO. Department of'Industrial Accidents 24: :3 ; OfIfCC Of/OYBSlfg8ll'O/IS "- — 600 Washington Street Boston,Mass. 02111 Workers' Compensation Insurance Afridavit name 6t[U location -1 t ,l�l(�'�C' d'T G ✓1►�Rf U''I�- city ❑ jam homeowner performing all work myself. I am a soler, lover dln workers worlds on this 'o con�ensatioa for my employees:::.:::,:;.::...... b. I am an emp ......Provi $ : •.:' ::::::.:..; a con anv name: ss. ....... ........................... :..... .. . city:.... ���`on nsuranc co. 1 e ` -------------- ❑ I am a sole proprietor,general contractor,or homeowner(&de one)and have hired the contractors listed below who have c..o.:..P:.e:.,n.:..:s.:.:a.,:tio.:...:n... o.::li:...c.:.:e...:wthe following wokr .::...:.: : :.....:.::.<:,..;::::«::.:.::.::.:.:::.<:::::::::?::;.:..;::::;.::::.;<.}:::.?.?:..<:.:::::,:::.<:::::>.:;::::::<::;:::::.>:::::<::.::::>:.:::<:::::::{:.:..>;..>:..::..;.;:;.>:.;.;::.,;:::?::.::::,::.:.:...>..,.: comoanviame. are :>ss:: <== :v .. ... .... ..: ..:...:...:....:... ... .. . ......:.......... .............. ..... .... .... ...... ................ .....:v:-•:�.vv:w::::::.v:::::{:{{::i:?4}ri^}:S•JS•}::::::rv:::w::.:�: :::.:::.v::r.•::ni:!!ii::{4.r:::.Fnv:•:::.:;.:_ ::::. ...:::::::::.::•...............:,.....�::::w:._::::::::::.:........... .,...x:�. .:v.•.•rnw•......?..;;`p:r..n.::v.v:v:v:n:............ ..:. ...... :..n..., .: .....x:::::.....• v.;:x::::.:•}'vww.v:'.;...-:::•....:'w::.}}iS•}:G:i.:?•.v:i.{l•:::::;nw:::.w:.:.:.,:.:.:.. ................ :..... ....... .. ::�i;}}�:'S:•}::.'}{:!X?:ji:::�?::}is:i:"�:i'�:�ir:4iiji:i�i}}:?:}::�ii:}�i?'�i vS`:�i:��i .'.'::�i:%�i>::<�:.. ..... .....::.•::...v.:r: ::-::::::.................:v.�•:....,;{:•:• .................................................................................................................... ?$:L�:%+::•:::i:::Jii:iii:S:ii}�:{{iti'::�ijii:•ii'riiii:i{r'y'i i:i�i'i:?r:}irry ii :C�iii:<?>:ii:vyj;•`:i`yS;:j}liii:ti4 i}ii$:iii%�i:'{�?:i:G:i:+'?':!:.- .::::. :•::::::::>•?i}T•iiii:r.v:.�:::::::•v:••v:: :..:v:v:::-. :.;..:•:?•}:•:.v:::•: n..,r.}•.....:............. .. ..................:::x:�:::v}:•}::::;}}:::}}:vv:•n::v:G::::}}:ivvi:•.•{•Y::•}Yr..S}?•:y,:{{::::n... vw:x:.w:.v::nw:::::.v:::::::mow::::.}}:•}nv:.v.:?.::•.v::w{nw:::::w:::.v...:.q:... ..... ..... ........ ............ .:.......... ........:... �.n ♦..n.xr w:.v::.Sw:x.v::.v.v:.v.v-v:S:?!•i:vy....... :.:::........ ......:.............:.v.... .r.....n+.:.vn....................................r.::........ .4•...0 J:.... .;.:.::::.::::. w.v:n..,.{..::.v.!S•}}:iw:::::.w.xv::n,:.. ..:...........:..::�::..........:::........P..::.w:::.:.........................{...v:::nv::x .:...{...r�7k? ..,...v;.};•::.w::::::n!:?:::}:•. �!��j v......., ihiurance•co:,.:,.:.;:::.:;?.;:{?.:?;?.}>;;:.:?.,:::.::,:::::.:::.:::.:::,:::.::...:.::....... .. ON namti anv ::::•:::::.::::.:..::::: ::: ;•;:•}:::;:::•}}; ............ ....................... address: ::::::..:::::::: :.:•..:..::....... ;;:.;.>:::_: ............ ................. city: .:..::.............::.::•:::::::.........n:..... Fatbue to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to SI,S00.00 and/or One years,imprisonment as wen as civil penalties in the form of a STOP WORK ORDER and a ene of 5100.00 a day against me. I mnderstand that s copy of this statement may be forwarded to the Office of Investigatiom of the DIA for coverage verification I do hereby certify under the pain and penalties of 'Wry that the information provided above is&W. co ed Date signature �, C �p 3CIP- 7136 Print -------------- omcial use only do not write in this area to be completed by city or town official city or town• pernOUcense# ❑Building Department ULicenzing Board ies is aired OSelectmen,s Office ❑check if immediateponse required ❑Health Department • - ❑!?tier phone#; contact person: —, (tevusa 9/95 PIA) °F THE The Town n of Barnstable • snaxsTABL& 9q, '& �0� Department of Health Safety and Environmental Services Argo ,,tor a Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner 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: �_zc yyak " i� A Estimated Cost Address of Work: 14 41 J2AU A' e l \ Owner's Names„�l-ltQ W t �I f.�'v✓`J Date of Application: I hereby certify 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 owner: /Date Contrac air Registration No. M OR Date Owner's Name g1orms:Affidav ESTIMATED PROJECT COST WORKSHEET Value LIVING SPACE square feet X$55/sq. foot= GARAGE (UNFINISHED) square feet X $25/sq. foot= PORCH �d square feet X $20/sq. foot= DECK _ square feet X$15/sq. foot= OTHER square feet X$??/sq. foot= Total Estimated Project Cost I o990915b �.�, �am�ntauueal!/ a�✓�aaaac/auaelta 2 i BOARD OF BUILDING REGULATIONS I; License: CONSTRUCTION SUPERVISOR Number CS 015777 Expires 03124J2002 Tr.no: 18731 Restricted To,,, 0 LAWRENCE G THIFFAULT. _ 16 FREYDIS DR S DENNIS, MA 02660 Administrator 1 R i EXISTING HOUSE EXISTING HOUSE 1 EXISTING DECK 2X6 RAFTERS 16. O.C. CDX ROOF SHEATH[NG 2 x10 CONTINUOS HEADER MAX. SPAN 9'3' DOUBLED UP EXISTING 2%6 CEILING JOISTS- SPAN IO•MA%.16' HOUSE 2XID CONTINUOS HEADER DOUBLED.MAX SPAN 9'5• 10'0, +- EXISTING DECK SUPPORTED ON S NA UBES 17 I I EXISTING DECK ON SONATUBES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - EXISTING H❑USE 1 ll EXISTING DECK EXISTING HOUSE . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . , . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . '.'. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . , . . . . . . . . . . . . . . . . . . 1T0 2 x10 C❑NTINU❑S HEADER MAX, SPAN 9'5" BEUBLED UP EXISTING H❑USE EXISTING DECK SUPP❑RTED ❑N S NA UBES 2X6 RAFTERS 16" ❑.0 CDX R❑❑F SHEATHING 2X6 CEILING J❑ISTS- SPAN 10' MAX.16"❑ 2XI0 C❑NTINU❑S HEADER DOUBLED, MAX SPAN 9'5" EXISTING DECK ❑N S❑NATUBES STANDARD LEGEND 't ri ,'' NOTE:not all symbols will appear on a map MAP 308 � GOLF COURSE FAIRWAY II (— r..' EDGE OF DECIDUOUS TREES EDGE OF BRUSH # nA P 0 Q ORCHARD OR NURSERY MAP O V 1 Y Ui V y—p—v--v EDGE OF CONIFEROUS TREES t 2 2 2 MARSH AREA {{ 18 - 1 # 1 6 EDGE OF WATER :MAP — DIRT ROAD It DRIVEWAY PARKING LAD PAVED ROAD 70 - ------- DRAINAGE DITCH ! �' ----- PATH/TRAIL E; MAP �. � PARCEL LINE* MA 08 ��-���� AP110�--MAP# 18 tO 21-<--PARCEL NUMBER - —HOUSE HOUSE NUMBER # 6 7 ' 2 2 --- 2 FOOT CONTOUR LINE - # —ffi-- 10 FOOT CONTOUR LINE ` ElevoWn based on NGVD29 +� ;•�4.9 SPOT ELEVATION STONE WAIL ilk ...-t.... 1 MAP -X.----X— FENCE RETAINING WALL 13AP 307 � - RAIL ROAD TRACK >i # �__=_� STONE JETTY r , MAP 307 f SWIMMING POOL ,•� _ C2 137 �;� PORCH/DECK # 0 BUILDING/STRUCTURE rTL__�$ r U DOCK/PIER HYDRANT 307 a VALVE O MANHoLE 2 g I o POST 0" FLAG POLE is T O W N O F R A R N S T A B L E 0 E 0 0 R A P N I C I N F O R M A T I O N T E M S U N I T SIGN , m STORM DRAIN 11 I' N PRINTED M-IN FfEI *NOTE:The map Is an enlargement of a **NOTE The parcel Ones are only gmphk represent ' DATA SOURCES:Planlmehia(manmade fearoms)were Interpreted fmm I"S aerial pharopmphs by The lames " ''�' 1°=100 sale mo and NOT meet of 0 UTILITY POLE � TOWER l; ;.w e D maY prapenty boundaries,AW are rwt free location,and W.Sewall Campatry.Topogrepby and vegetation were lnterprerodfrom 1"I aerial photagmphs by GEOD Z ii 1� 0 ZO 40 National klapp Auerary Sandards at this do not represent actual relationships to physfal odds Corpaatton.PIaNr riq to plry,ark vegehtbn wee mapped ro meet Nat. Map!0 q Standards 110-40 FEET* enlarged smle on the of o smk d 1'=100.Part Tres were di ntized from 20001orwn of BamstoNe Acsessofs tmr ma O LIGHT POLE o EIfCfRK BOX r� �P• A D� �F,t :..\sitemaps\Public\m208p232.dgn Mar.27,2000 08:54:24 -7/ ' JO 2-3 SHED REGISTRATION 1�4 location of shed(address) kzjtLu a—, - prop! owner's name size of shed %sign re date r Old King's Highway Historic District Commission jurisdiction? THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN shed � �. ♦ ,� � Ili . awvpjl w" wodIN �O� �. 1 w 1 � �� �► � � ��' �,,` it ` I r PLOT PLAN FOR LOT N Indicate location of garage or accessory building Additions with dashed lines --------------- Sewerage disposal (cesspool) well K .� (Lot....................ft. rear) -- _ buttor's Abuttals Name ` tN Lot� / Rear Yard ...ft. ;1 ............... a if this is u If this is a v corner lot, CCC•ner lot, .a MTiiC in V w*te in _ — 4 name of name of": _ __ ocher streitt. other street. `HOUSE _ � .- Sideyirrd— - Sideyard ft. ft. J I � Set Back 1 . (Lot ...................ft. frontage) ------------------------- --- street)- -------------------------- (Name of / \ Wor nation — \ Supplied by Mark North Point y,