Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0045 DAISY HILL ROAD
DPA\5� LL Pb Feb 06 2020 04.06PM Tupper Construction Co, 5087785010 page 1 • fw SJ• TUPPER CONSTRUCTION CO-PLC 546A Higgins Crowell Rd,WEST YARMOUTH,MA 02673 PHONE: 508-778-0111 FAX: 508-778-5010 EMAIL:admin@lupperco.com Date: 2 Town of Barnstable BV�LD1NG DEp i T Building Inspector F . 200 Main Street FEB o 16 2020 Hyannis, MA 02601 To W/V OF BgRN (508) 790-6230 fax STgBCE Re: Insulation Permit at p�� Permit # Issued On I I b y 1 C� This affidavit is to certify that all work completed for the above permit application has been inspected by a certified Building Performance Institute (BPI) inspector. All work performed meets or exceeds Federal and State requirements. Sincerely, Richard Tupper License # CS-69058 ar ,> C o�qr Fee ��- mber.... ....................................... BUILDING DEPT. � ..................... YARNSTABLE °MASSi�34 �0 C 19 ors Initials...�� DE 2019 ..3�.. v."�d..�. ..................... TOWN OF BA ........................ RNSTABLE TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/W NDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: yS Z�,'sy lw,-,f' P-0 NUMBER STREET VILLAGE Owner's Name:fir,G ��� S Phone Number Email Address: Cell Phone Number Project costs , �t 9 8 — Check one Residential Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to matte application for a building permit in accordance with 780 CMR Owner Signature: S e-e A-f(Q cLa C� -Fc�-�- Date: TYPE OF WORK Siding =Windows (no header change)#__❑ Insulation/Weatherization Doors (no header change) # Commercial Doors require an inspector's review Roof(not applying more than 1 layer of shingles) / Construction Debris will be going to W d S46—IP?G4a.I e,r/P� CONTRACTOR'S INFORMATION Contractor's name '�t�an `74 sow - �„(-fie�� Afe,J Fr,' �rv4 Home Improvement Contractors Registration(if applicable)# 17 3 LK.5 (attach copy) Construction Supervisor's License # yg S`7 O' (attach copy) Email of Contractor CrS ee- 9 q56 Phone number �(o/- 2 Z R - 9 Ra) ALL PROPERTIES THAT NAVE STRUCTURES VER 75 YEARS OLD OR/F THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION NUMBER ............................................................ *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 marled) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached.Provide a site plan with the location(s) of each tent If food is being served at your event please obtain a health Department approval between the hours of 8:00am-9:30 am or 3:30 pm-4:30p#L Commercial events may require Fire Department rapprovaL *WO®ID/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: 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 PLICANT9S SIGNATURE Signature Date All permit applications are subject to a building official's approval prior to issuance. Renewal Agreement Document and Payment Terms bYA.111�ndelsen. dba:Renewal B Andersen of Southern New England Y gl Maria Finglas W Legal Name:Southern New England Windows,LLC 45 Daisy Hill Rd ���i RI #36079,MA#173245.CT#0634555, Lead Firm#1237 Hyannis,MA 02601 WINDOW RE LACEYERT 10 Reservoir Rd I Smithfield,RI 02917 H:(310)795-9554 Phone:401-349-1384 1 Fax:401-633-6602 1 sales@renewalsne.com Buyer(s)Name: Maria Finglas Contract Date: 12/04/19 i Buyer(s)Street Address: 45 Daisy Hill Rd, Hyannis, MA 02601 Primary Telephone Number: (310)795-9554 Secondary Telephone Number: Primary Email: calialilly0mac.com Secondary Email: Buyer(s)hereby jointly and severally agrees to purchase the products and/or services of Southern New England Windows,LLC d/b/a Renewal By Andersen of Southern New England("Contractor"),in accordance with the terms and conditions described in this Agreement Document and Payment Terms,any documents listed in the Table of Contents,and any other document attached to this Agreement Document,the terms of which are all agreed to by the parties and incorporated herein by reference(collectively,this"Agreement"). Buyer(s)hereby agrees to sign a completion certificate after Contractor has completed all work under this Agreement. Total Job Amount: $9,998 By signing this Agreement,you acknowledge that the Balance Due,and the Amount Financed must be made by personal check,bank check,credit card,or cash. Deposit Received: $4,999 Balance Due: $4,999 Estimated Start: Estimated Completion: Amount Financed: $9,998 7-9 weeks 7-9 weeks Method of Payment: Financing We schedule installations based on the date of the signed contract and secondarily on the date in which we complete the technical measurements.The installation date that we are providing at this time is only an estimate.We will communicate an official date and time at a later date. Rain and extreme weather are the most common causes for delay. Notes: 50% deposit by bank balance on completion by bank Buyer(s)agrees and understands that this Agreement constitutes the entire understandings between the parties and that there are no verbal understandings changing or modifying any of the terms of this Agreement.No alterations to or deviations from this Agreement will be valid without the signed,written consent of both the Buyer(s)and Contractor.Buyer(s)hereby acknowledges that Buyer(s) 1)has read this Agreement,understands the terms of this Agreement,and has received a completed,signed,and dated copy of this Agreement,including the two attached Notices of Cancellation,on the date first written above and 2)was orally informed of Buyer's right to cancel this Agreement. NOTICE TO BUYER Do not sign this contract if blank You are entitled to a copy of the contract at the time you sign. YOU,THE BUYER,MAY CANCEL THIS TRANSACTION AT ANY TIME NOT LATER THAN MIDNIGHT OF 12/07/2019 OR THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION, WHICHEVER DATE IS LATER SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. Legal Name:Southern New England Windows,LLC dba:Rene�dofern New England Boyer(s) Signature of Sales Person Signature Signature Paul Sandrey Maria Finglas Print Name of Sales Person Print Name Print Name UPDATED: 12/04/19 Page 2 / 11 Office of Consumer ;affairs and Business Regulation 1000 Washington Street-Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Supplement Card SOUTHERN NEW ENGLAND WINDOWS LLC- = Registration: 173245 10 RESERVOIR ROAD Expiration: 09/18/2020 - SMITHFIELD, RI 02917 scA i :, zoroi•osin Update Address and Return Card. Office of Consumer Affairs if Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Supplement Card before the expiration date. If found return to: Reoistiatiiin Expiration Office of Consumer Affairs and Business Regulation 09/18/2020 1000 Washington Street-Suite 710 SOUTHERN NEW ENGLAND WINDOWS,LLC Boston,MA 0211 BRIAN DENNISON 10 RESERVOIR ROAD u SMITHFIELD,RI 02917 Undersecretary tiv' Without signature Commonwealth nwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Constrq:—:06 Supervisor C5-09 70 Epp i res: 09/08/2020 BRIAN D DENNISON CHARLTON MA 415®7 Commissioner f The Corntt mweeide of Massadiusetts Departtatent ol'1n&s&ia1Accidenzs 1 Congress Stree4 Suite 100 Boston,MA 02114 2011 _ www.mms g aa ov1& N orkers' Compensation Insurance Affidavit:l3udders/Coatractors/EiectriciansMambers. TO BE FILED WITH THE.PEI-$MTL•�1G AUTHORrrY. Aaolieant Information Please Print Leiribiv Name(Business/Organization/Individual):---S OL'f'het'p, Aje u) Address: /(} � n—;ev VD1 r CiWState1zip:-SM t-t e-14t R1 Ogg 17 Phone#: ,qol—ZZ r— ? got _ Are you an employer?Check the appropriate box: Tyke of project(required): t. 1 am a employer with �- mployees(full and/or part-time).' . 7. ❑New construction am a sale proprietor or panttersWp and have no employees working far me in S: Remodeling any capacity.(No workers'comp.iruuctnce required.] ❑ 3.0 1 am a homeowner doing all work myself[No workers'comp.insurance required.]* 9. ❑Demolition ' CC]1 am a homeowner and will be hiring contactors to conduct all work-on my property. 1 will 10❑Building addition, ensure that all contractors either have workers'compensation insurance or are sole 1 1.❑Electrical repairs or additions proprietors with no employees. S.®L am a genera!contractor and[have hired the sub-contractors listed an the attached sheet 12.n Plumbing,repairs or additions 'these sub-contractors have employers and have workers'comp.insurance.t 13.Q Roof repairs <3 We arc a corporation and its officers have e.Yercised their right of axemption per MGL c. 14.06ther k/ n 152,§1(4),and we have no employees.[No workers'comp.insurance required.] r-61117 re, *Any applicant that checks box#1 mast also fill out the section below showing their workers'compensation policy infartoatioa t Mmeawnem who submit this affidavit indicating they are doing all work and then hire outside contactors must submit a new affidavit indicating such. t 0atracbm that check this box must attached an addidom it sheet showing rite came of the sub-contractors and state whether or not those entities have employees. Mile sub-contractors have employees,they must provide their workers'camp.policy number. I am an employer that 1s proWdina workers'compensation insurance for my employees Below is the policy and Job,cite information � /� ,,r/� Insurance Company Name: `i"t r ap— lip - p� W f•[.. Policy#or Self-ins.Lic.9: WCA01,573 7, � 11✓ Expiration Date: Job Site Address: S y '' l l 2� City/State/Zip: Va44 •S - p )'t ate Attach a copy of the workers'compensation policy declaration page(showing the policy aamb r and expiration date). Failure to secure coverage as required under MGL c. 1 S2,§25A is a criminal violation,punishable by a fine up to$1,500.00 and/or one-yew 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.A copy of this statement may be forwarded to the Office of Investigations of the D1A for insurance coverage verification. t do hereby ce under the p ' L6d penalties of perjury that the information provided above is tale and correct i ture: Date: /Z P__hone#: 4n1 ? 9 ) O�cW use only. Do not write in dris area,to be completed by city or town 0004L City or Town: Permit/License [sluing Authority(circle one): 1.Board of Health 2.Building(Department 3.Cityltown Cleric 4. Electrical Inspector 5.Plumbing Inspector' ' 6.Other Contact Person: Phone#: OATE(MM!DOIYYYY) CERTIFICATE OFLIABIL171Y INSURANCE . r (2/28/2018 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 O A CoBiz Insurance, Inc.-CO NAME' 1401 Lawrence St., Ste. 1200 PHCN o E 303-988-0446 a/c No:303-988-0804 IL Denver CO 80202 ADDRESS: COMail@cobizinsurance.com INSURERS AFFORDING COVERAGE I NAIC N INSURER A:Acadia Insurance Company 31325 INSURED ESLERCO-01 INSURERS:Firemens Insurance Company of WA,D.C. 21784 Southem New England Windows, LLC, dba Renewal by Andersen of Southern New England INSURER c:Homeland Insurance Company of New York 34452 10 Reservior Rd INSURER 0: Smithfield RI 02917 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER:787175890 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 ADDL SUER . POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WV0 POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CPA3158778 1/1/2019 1/112020 EACH OCCURRENCE 51,000,000 CLAIMS-MADE a OCCUR DAMAGE PREMISES Ea occurrence $300.000 MED EXP(Any one person) $10.000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE UMIT APPLIES PER GENERAL AGGREGATE $2.000,000 X POLICY JECT 7 LOC PRODUCTS-COMPIOP AGG $2,OOQ000 OTHER: $ A AUTOMOBILE LIABILITY CPA3158728 1/1/2019 1/1/2020 COMBINED SINGLE LIMIT $ a accident) 1.(100,00D X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS Per accident $ A X UMBRELLA LIAS X OCCUR CPA3158728 1/l/2019 1/112020 EACH OCCURRENCE S 15,000,000 EXCESS LIAR CLAIMS-MADE AGGREGATE $15,000,ODO DED X RETENTION$n $ B WORKERS COMPENSATION WCA315972924 = 1/1/2019 1/1/2020 X STA UTE ER AND EMPLOYERS'LIABILITY Y!N ANY PROPRIETOR/PARTNERIEXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N❑ N f A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1.000.000 It yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE.POLICY LIMIT 51.0M.000 C Pollution Liability 793W73340000. 1/1/2019 1/1/2020 Each Occurrence $2,000,000 Gaims-Mada Policy Aggregate $2,000.000 Retroactive Date O6@0/2013 Deductihle $25.000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) 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. FOR INFORMATIONAL PURPOSES'ONLY' AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Town of Barnstable Building �, ; :, ., n'o ni!',this Car Must'be Kept, Post Thas Card So,That�t is U�sible From the Street-Approved•Plans Must beRetamed o Jb§a enn. Posted&llntilFinalHlns ection HasBeen Made _ k ,s Permit �y.��: Where a Certificate of Occu an:c „s:Re wired,such Bulldmgshall Notbe Occupied-until-a�F.nal Inspection;has been�made„� �-� . Permit No. B-19-3749 Applicant Name: Richard Tupper Approvals Date Issued: . 11/06/2019 Current Use: Structure Permit Type: Building-Insulation-Residential Expiration Date: 05/06/2020 Foundation: Location: 45 DAISY HILL ROAD,HYANNIS Map/Lot: 326-093 Zoning District: RB Sheathing: Owner on Record: FINGLAS,MARIA T Contractor Name-_,Richard S Tupper Framing: 1 Address: 45 DAISY HILL ROAD Contractor,Llcense CS`-069058 2 HYANNIS, MA 02601 Est,�Profect Cost: $4,664.00 Chimney: Description: Air seal home to restrict air leakage,weatherstrip doors,install 2" ` Permit Fee: $85.00 i' .' Insulation: R-10 rigid board to kneewall and crawlspace walls Install R-37 Fee Paid $85.00 - cellulose to-kneewall floor. Install R-40 cellulose to oppen attic ; space, Install ventilation chutes and R-19 alo g basement sills Date 11/6/2019 Final: Project Review Req: Final inspection required to close permit Lot ��rv� Plumbing/Gas a Rough Plumbing: Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. All work authorized by this permit shall conform to the approved application and'�thelapproved construction documents for which.this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zorimg%by laws'and codes. f; Final Gas: This permit shall be displayed in a location clearly visible from access street ors road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the uilduig and Fire Off clals�are providedntMs-permit. Minimum of Five Call Inspections Required for All Construction Work-, ��� Service: i 1.Foundation or Footing 4 ..° Rough 2.Sheathing Inspection „� . 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Building plans are to be available on site 'Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: ,. Town of Barnstable Buildin g ° Pot,rT•.d Us n.C,.til darhi BAxMMAu F'seto t�fictae o f Occu anc �s Re u red such Bu ldm shall Not.be Occu red until a Final nlns"ectron has.bee made H . 1e1mitWPheeaC Permit NO. B-18-2156 Applicant Name: Francis Sheehan Approvals Date Issued: 08/01/2018 Current Use: Structure Permit Type: Building-Insulation-Residential Expiration Date: 02/01/2019 Foundation: Location: 40 DAISY HILL ROAD,HYANNIS Map/Lot: 326-137 Zoning District: RB Sheathing: Owner on Record: LECKO,JANUSZ Contractor dame FRANCIS S SHEEHAN Framing: 1 Address: 28 BROUILLARD DRIVE Contractor License GSSL-105941 2 .. �`•. CHICOPEE, MA 01013Protect Cost: $3,800.00 Chimney: Description: 528 Sq Ft R-49 Cellulose to attic,288 Sq Ft 211 rigid to craw space, Fee: $85.00 Insulation: Airsealing k' r;Fe�e Pall ' $85.00 Project Review Req: Date 8/1/2018 Final: * � - Plumbing/Gas 4� Rough Plumbing: a .&,s' ,Building Official Final Plumbing: a� Rough Gas: This permit shall be deemed abandoned and invalid unless the work authoraed by this permit is commenced within six months after issuance. All work authorized by this permit shall conform to the approved application Snd the approved construction documents�for whic1.h this permit has been granted. Final Gas: All construction,alterations and changes of use of any building and structures;shafte in compliance with the local zonmg"by laws and codes. This permit shall be displayed in a location clearly visible from access streef�ot road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. =f Electrical � � ,•r Service: , The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided"on this permit. Minimum of Five Call Inspections Required for All Construction Work Rough: 1.Foundation or Footing 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) 6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Final: Work shall not proceed until the Inspector has approved the various stages of construction. "Persons coWaRctring with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department c� Final: -p Building plans are to be available on site All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT ��J TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 3o� Parcel plication # Health Division Date Issued Z-2:�-—i✓�' /� Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address 41.5 J ,5 cA Village , i/O� -nj Owner /I QL r/a. Fi a lGu s Address ys r^zt Telephone ato) "/9rs s 9, 016) � 9.S"- Y6 5y Permit Request G A/1Z LPY 1 .rr 0,eMffZ2aZL �(;l�y� �' IL A Square feet: 1 st floor: existing proposed 2nd floor: existing proposed lu � Total new Zoning District Flood Plain Groundwater Overlay Project Valuation'�r/©,Dr,O Construction Type o?Xq , Tecc.( Lot Size v 7 62 A Q . Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family WL Two Family ❑ Multi-Family (# units) Age of Existing Structure 9<57 Historic House: ❑Yes S No On Old King's Highway: ❑Yes ❑ No Basement Type: X Full ❑ Crawl ❑ Walkout ❑ Other Basement Finished Area (sq.ft.) ® Basement Unfinished Area (sq.ft) Number of Baths: Full: existing_ new © Half: existing Number of Bedrooms: 13 existing d new Total Room Count (not including bat77 hs): existing �0 new _First Floor Room Count 0.p 4 Heat Type and Fuel: -Gas ❑ Oil ❑ Electric ❑ Other cD1. t � Central Air: ❑Yes iNO Fireplaces: Existing New _� Existing wob'g/' oal stove: ❑=Y�s No Detached garage: ❑ existing '❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ xisting neinj� size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: 03 Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes Z-No If yes,site//plan review # Current Use AiAgle Proposed Use -- c-5&" - APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name /-/Q r0 Ct F A) h s Telephone Number Zd/�1� 79 tj— 9' s I Address q,5 Ate ;lie License # lum kj%-la 0ni;sT/"j Q1 : l�v2/1 6 Home Improvement Contractor# Amm Email_�1/0 NIV� COM Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATU DATE FOR OFFICIAL USE ONLY 'k APPLICATION# DATE ISSUED Y r MAP/PARCEL NO. ADDRESS VILLAGE ; OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL 1 GAS: ROUGH FINAL F FINAL BUILDING DATE CLOSED OUT i f ASSOCIATION PLAN NO. _ 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 Legibly' frram�� esso;o niiafioaanaividuall: l Addre - �CtyLSfate/Zip... w �' Y 4` Phone Are you an employer? Check the appropriate box: Type of project(required): 1.El am a employer with C4. I am a general contractor and I employees(full and/or part-time). * Y have hired the sob-contractors 6• ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet 7. Remodeling ship and have no employees These sub-contractors have 8. []Demolition - working for me in any capacity. employees and have workers' 9. ElBuilding addition [No workers'com incT p. rrance m t comp. �,Tance. A 3� rquired-] 5. We are a corporation and its 10.0 Electrical repairs or additions I am a homeowner do' all work officers have exercised their 11. umb right of exemption per MGL 0 Pl �repairs or additions myself [No workers'comp. 12.0 Roof repairs insurance reguired.I t c. 152, §1(4),and we have no employees. [No workers' 13.0 Oilier 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 employers,they must provide their workers'comp,policy nmnber. Iam an employer that is providing workers'compensation insurancefor my employees. Below is the policy andjob site information. Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: City/State/Zip. 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 fne up to$1,500.00 and/or one-year imprisonment;as well as civil penalties in the fomt of a STOP WORK ORDER and a tine 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 ira can w coverage verification. I do hereby certify der Penalties ofperjury that the information provided above is 1true and CCoo7* Si attire y .-Date_,•.=°',�_(� b / U t Phone`#='��l✓J '✓(J . Official use only. Do not write in this area to be completed by city or town qlftciaL City or Town: Permit)License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#- e- 9 -Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. pursuantto 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 of other legal entity,employing employees. However the owner of a dwelling house having not more bran 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 Iocal 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 ofpublic 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-contractor(s)name(s), address(es)and phone number(s) along with their certificate(s)of inc,n mce. 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 instance. 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 lime. 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. In addition,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 shol—i'd 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 bun 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 Commmwealth of Massachusetts Department of lradustdal Accidents Office of Westigat ions oo wauagton St=t Bastcn,MA 02111 ` d.#617-727-49GO cn t 406 or 1-977 MASSAFE Fax#617-727-7749 Revised 4-24-07 www.mass_gov/dia • -. storf,.. �T� . WTI- 40k w�c�ar�c.gr �a • r l rs���mp�saf Izzs Affidxvit RmIdersf cfirs :R�,t4lFF�iels Ply Frig Addle ;�- (�13 Q I am a emploj r via d_ ❑I a=a Dw=9 ccnfcac(_rs_r=dL 6 0 ItTe� . . earplayees��� -���* ha�Irir�$e sub-Corns ®.I mn a sale proper orparb Iisfed as the aacfied shad 7- [� ship znd hz m nQ employees Zhusub-aozm�r nr1 Rave g ❑T�rrrrnSrfin emglayees and haven morier�' �,,;�,.�,.,T Ong 1FlAm agy , �- ❑'-'UM 8dd�an [Nc wvmmmS =mp-rF,�n mce sncnr�,sr 5_ ❑ We are a caPGraiicaaad iig 10.0$Iezhical repair c r add ians I ain a- DMVveXMr doing aII WDfL affi=hnm mmr red fheir I f.O.Pi=3bia.g.repairs cc adrFiticpmyself.[No wadmte mmp- s rigl of e °aFec�fQ- . I F is2,�I(�adw5he� �afrepaffi . m4hTem-ING• °. I30 Amer . COMP_jlyrrtranrt*mpirecq . ��PgP���che�sbarrlamstslsaffio�ti�sedinaheia�shnvaa5ffieirwo�esrmum�oupeTaj- • #F�ame�wn�sah��ba��s�d.Y:. �y a�dung:lI,�,.�-=r t�� cv��samstsn�Iaa3rrmd•-ciY n+"�sarh_ Zrx lffLdeherltbssbdcmnst—rhedsa•611iff 119Ts1rlshac�gt}�n afB� 3�dstst�uise ocnntfrmse 5,� _IftbemT2- a�Ixmmm-T ffit7 pmvide8Eir �s'cn�F•P�S'� I uru�a�lOP�r i�tittisprfrt�g ft�nrkefs'r_arapgxsx�u tzzsrtr-rrrtcff far tsg r-t�myg�r. Below zs��epa8cp m:d job� - • c .. �Ol].G�.#�pL '�f�I.EG� ' �•EsoQ1?ate. Job SIB.Addm=- CrfgfS elTp: litiaf 2Eeapg af&-,2-ems`c'DmcLP nsatimpcHrf dec rsiiaalxage(s fh�1}O 3'a> ers�tdr JII-a�ioa s G}: Fail mm to sac..mm cav-ecage as under SecfmrnSA oEMM c-152 cm lead to the imposifirm nfrrimi"l perms of a fine ug'to�I�OQ Ili anBlor aa�gear���+*T+�f as�1 as ciz*rI gesalfia m me fry of a SIP,�-Dl�ORD�and a fines - of Bg.fu�' 0_t74 a dap agamsk fhe•viaL�L �e atfvismd�a cagp t�ffii€s n:tagbe f�-arded to�e Q�e of • . Irire gffkm irrne of mo DIA Ex in,sm-m=cavm age iDn- I&hsreT7y c art&under ffiaptgas aad psamlffes of cry fhatthe-iq pnr�cdJkn prazhf, a is�us emd cirFract Qfyk&L asa rxaE�. Dr jwt If,-phria ffds arar4 fix ba c ampldid by cii�ar bva of cinL cay or TO-KM Pg Frrittf Tcease f ¢rl mEharitp(Cb**Y- . L BD2ra YfHc;,I&3.Bm Ih t t t fFa aQ rk 4-$Iecb:icalhaspEckar .P hzgxcfor -Cl.cKher can±XCtl3viva= = f Town of Barnstable Regulatory Services r° y Richard V.ScaIi,Director Building Division MASS. ` Tom Perry,Building Commissioner �o59. �.�� 200 Main Street, Hyannis,MA 02601 www.town_barnstable.ma.us Office: 50 8-862-403 8 Fax: 508-790-623 0 HOMEOWNER LICENSE EXEMPTION Please Print DATE:_� `�� `�� JOB LOCATICK_ numb / / street viIl c "HOMIEOVdN : Uv ICJ name home phone# work phone# _ CURRENTA2AII_INGADDRFSS_ city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner'shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit (Section 109.1.1) - The undersigned`.`homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,riles and regulations. _ The undersigned"homeowner''certifies that he/she understands the Town ofBarnstable Building Department minimum inspection procedures andT. is and that he/she will comply with said procedures and requirements. V Signawr fHo r • Approval of Building Official "Y Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control HOMEOWNER'S EXEMPTION The Code states that:: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a persou(s)for hire to do such work,that such Homeowner shall act as superviior." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules &Regulations for Licensing Construction Supervisors;Section 2.15) This lack of awareness often results in serious problems, particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a Iicensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fuIIy aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form certification for use in your community. QAWPFILBS\FORMS\building permit fonns\HXFRESS•doc Rey ised 061313 Town of Barnstable TkiE Tp� , Regulatory Services Richard V.Scali,Director Building Division _-___ -----------_. .. --- ._-------- _. _..___Tom Perry;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 If Using A Builder, I, na o a '� , as OXofeect property hereby authorize ( e " ct on my behalf, in all matters relative to work au razed by this boil permit application for. -2�of (Ad ss f Job) J "Pool fences and alarms the res nsibility of the applicant. Pools are not to be filled or d before ence is installed and all final bons e perf ed and accepte . Sig e:of er ture plicant P t Name Print Name D to Q:FORMS:OP7NERPERMISSIOI\TPOOLS 4 4+ rG I I .Q cn N Q co e-n � o • r � r _ F .l It ti s f i � R I S P4 4: roorr 5 i ,ek C r i, f A roo 00 c\ lo-5Iv �^r K I 1 fis q Q a E4rr • y f �y� � +.s..�` 1 � .s. ..- _ � �j' ++ ' i'z._, t �. - ,�f t� I 1 f ' jj1! 4 ! � �;�� , A ! � `� r � i I + �. ; � ,L,,,,�,;� ..,r..4. j., ' -�, f' 1 ,TM� _ � n,. Mj � 1...4.. i ., _ `� r , .L / i � ` 1�. 1 t F� 1s f a r � t � , l R — � n c� r , _ - � � r 1 i � t. W,F r. .M Assessor's offioe (1st floor): Assessor's map and lot number ...... .a(�.-. .9. �OFTME TOE♦ h (3rd floor): �_�� " r d Sewage Permit number '� 'r•M,,, ...ldo�,.. �i��� ' """" ' Z BAS35T/1DLE, i Engineering Department (3rd floor): �o %AS& House number .......... .?C9 �— ° i63q'e�® ................ . . ....... ... '�a OR APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00 ,2:00 P.M. only TOWN OF BARNSTABLE BUILDING INSPECTOR +... 2�{ ... D.1.d.i.0m.....T'r..... 9. r APPLICATION FOR PERMIT TO ... ��Y� `... ,,,,,,, TYPE OF CONSTRUCTION .....l.�J . . >�xa-a�.......................... ..p. ...... .... .......:...................................... . ........�.b..............19 TO THE ,INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ......... - ........ -. `? ....... .L....,........ .:.. ......... .A.2. .1.. .................................................. i / Proposed Use ....... ,.......➢g-;5.1X>9.Y10 1 A9.J ....... .4.................................................................. 4 ZoningDistrict ..................t.. . . .............................................Fire District ........... . .. . .p.S.......................................... Name of Owner .�n 9�.N... o(.,!.► dl�� �'�Address .. '�...� � TI.I .... .,..[I.��A�A�.I,� ..... Nameof Builder ........... ...�i.L_:r........................................Address .................................................................................... Name of Architect ...... -i" ...........................Address Number of Rooms ..........:2..................................................Foundation .Pb.1A9,j►1>.... FR.-J---ME................. Ex1e for ..lA/.1-1.I7.71 ....4. .Z:.E� ,.... 171.N .E, ..Roofing ..... Ze.:d....... Lww�............... Floors ......�--'.l�ti.ice ®b..7-D...-`......DA I... ...........Interior ... — Heating .. .r. ................Plumbing ....... . 014.16.......................................................... Al. / ..........LX �X�L A roximate Cost � ,.As- Fireplace D� ° . ........................................................... pp ... / ....,1.- .. ..........� . Definitive Plan Approved by Planning.Board ________________________________19________ . Area .... ..... . ..- Diagram of Lot and Building with Dimensions Fee ........... �.®.....--- .............. SUBJECT TO APPROVAL OF BOARD OF HEALTH I A47jg Wei ,, 5<:QLE AVD/77 - !fix Z° �j1, w� - -� I I :six 144 JL A_-q) «.E- �. 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 v...... y ,..s�-a... 6eQ.................... Construction Supervisor's License .................................... Finglas, John C. & Mary AJ 4, No ,3,1 2*33.. Permit for .......acid to...single " ;familv dwelling................... .................................... ................ Location .........45..A4isv!..Hil.l...R�ad................ ... ...... . ........ .. .......................Hyannis........................................ Owner ..........John C. &.. Ty.A. .a.Ma s .................... .... ..... Type of. Construction .........frame...................... ........... ..................................................................... Plot ...... .............. Lot ................................ P'ermi! Granted .......S.e-.p.t e mb.e.r..2.8.......]9 87 Date of Inspection .....z............... ............i Date,'Cbmpleted .......................................19 71 Iv, Assessor's office (Ist•floor): / ' Assessor's map and lot number ..3.a.�.. ...Q.9.3 ,/V...... P110FfHETo`f Board of Health (3rd floor): J 1 Sewage Permit. number .......:. .®o ....Zl..�.. c� Engineering Department (3rd floor): r +oo r a . . .. �House number ............................ ..... . ......... ,a�'b3.4 0 ypY Definitive Plan Approved%by Planning Board ________________________________19________ APPLICATIONS PROCESSED!8:30'-9:30 A.M.Viand 1:00-2:00 P.M. only _ TOWN OF BARNS�TABLE k BUILDINGS INSPECTOR APPLICATION;FOR PERMIT TO .....B N.1.4-ice. 1.. �. / 110 ^ ,�}• . '�' o1.a�,...... ....... ......?"l...rYi. .......... TYPE OF CONSTRUCTION ...............I/L) a7i7.. 1 r i.??').��,..:...................................... .....................:......... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following,, information: Location ......... .......... ...... ........ 1�1 .. .117.?`-�1 .. ..t Proposed Use ...........:A-D. :,..±.e .. .........T.ta.......1 ?-a-,V...... rant. ".................................................... Zoning District ........................�... ' .....:.........................:......Fire Distri t Name of Owner .QCIR,I... .l..n91- 'laRy.... ...................Address ........ ' .....'�1. i�..�yL.....1.1�:?--.'I�.... i�.....:.......... .Name of,Builder .......... .�.l.;,t'..........................................Address .......... ......... ........................................:....................... Name of Architect ......... all- :..............`..........................Address ....`....................... . Number of Rooms ........... ...........................:...................:Foundation �.......L.,.o��C �3 .......... Exterior .... ....................Roofing ......... 1140.1,,.)':........ Floors :.!..!.W.I.,—, ......wj. d......��.�.7r....: ........Interior :ei .....,. �? ,{,................... Heating C*e ......................Plumbing Fireplace .............l.Y..4. ............:.............................................Approximate Cost ..:�. ....I. ..:... .:. PQ P J_7,� Area ..... .oj --T. Diagram of .Lot and Building with Dimensions � 20 • `Fee :� -fie-- --- - ---� .. ........ _—.4_ P Mt; T .)out 4 PRDP 2�)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. r - -� - Name .. . . . ..... ..,....�. ................. Construction Supervisor's License .................................... FINGLAS, JOHN C. & MARY A. ' No : ..32.Q.7.:7 Permit for ....ADDITION r ................ ....: ...D.wel.Ung...... ' L cation -I.4.5-Dalay. ... iLI.....Riaad............ . :............. iy; nni s............................ ......... ' Owner ....,Toh .:.� .. &...Kary...A_...F.ing.las Type of Construction .........F.r.ame.................... ;;.. V,................................... .:... ............ i f t. Plot' ......... -Lot ........ ............ .. Permit Granted ...... . ......1.9 88 r-; rt Date of inspection .. .............. . ....19 Date Completed ................. w `` �.c19 ✓•`C t + •1 ' Al •l � f � . .•�'�` wS. tia r �,5. -Y.t'x .wJ;: �.i�-C � y ,� p •z�...`",'Za �z;' .,-r�rk' x"�_t... .,r-•[.:`:�`= "�.,'..,..�p9+yr :..1:> ^F. Assessor's office and floor): Ooa .. �Q�oFTNETo`o Assessor's ma and lot number ,!. �'..• Board of Health (3rd floor): Sewage Permit number ........... .................. /..z�1... .... >; BaaaSTGDtE, S ' Engineering Department (3rd floor): NAM House number +6}0• ♦� Definitive Plan Approved by Planning Board --------------------------------19-------- . APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only TOWN OF BARNSTABLE BUILDING INSPECTOR J� APPLICATION FOR PERMIT TO .... kE.d. �r...7L6>:... ra to.......��,?.........pt!E aI........... •. TYPE OF CONSTRUCTION ............... ga.�w........ .:��1.':?').?�......................................................................... ..............19.Sk TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the followinng`information: Location .........L ...... .�. ........!..1�. -.......... j. ......l"1., A..�'t�.I1?. ....Yy . .... Proposed Use ........... na........'Tta.......1' .................................................... < 11 . ZoningDistrict ........................l...::.,�.......................................Fire District ........... ...................................... y• Y. Name of Owner ... ./..n'lF1R ... ...................Address ...... .....,!ImAl.>y......Fl?.W......06..a.............. Nameof Builder .......... .-.L—F.........................................Address .................................................................................... -75 Name of Architect ........ .3':,l t=.........................................Address .............................. .................................... Number of Rooms ...........j...................................................Foundation Q.L .P.f 3 ....... a. C..P_ 76 ........... � 1_x Exlerior G—...� Jfq.t7...... .1-?h�.+—le.�r-�....................Roofing '......... ��, �. ;.......��4�.21�?a.Z Floors T).W.l.'`�. .....I��! I�.,,..... '.1 �'?�� ........Interior ....`��.1+>RPT....... �a r �. . .................. .I. ............. Heating !a! s ax" .....'.v? g.�-Seer+?.�.;�:.�......................Plumbin .................................................................................. Fireplace ..............Approximate Cost ........ ..... Pr2r� E,l,tz3 Area j.4?. .���. Diagram of Lot and Building with Dimensions Fee �I I r - � 1 ?P-1W N z,Joe P 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 ,���. ..f ..,... �`� ................. ' O , Construction Supervisor's License .................................... FINGLAS, JOHN C. & MARY A. A=326-093 3 2��� G .3 No ...3.2077 Permit for ...ADDITION............ ......Single, ,Fami1v...dwell ng......... Location .....4.5...D. .sy,.,H,i1,iRoad............ i .................... ......................................... ' Owner ....John... .,.... „Mary,...A.....Finglas Type of Construction ....F.rJAMe......................... ............................................................................... Plot ............................ Lot ............................... Permit Granted ......July 15, 19 88 Date of Inspection ....................................19 Date Completed ......................................19 Ile- -_J C Assessor's otfiop (1st floor): D � FT NET AsseassPor,s�ma and lot number ...... ......... .. ��1� W •Beards-of—Heaft (3rd floor): �� Sewage Permit .number ...,....................... f.... ....... ... ....... t SAIUSTAMLE. S Engineering Department (3rd floor): n �po,,�063Y-a House number ........................................... . c�Cy ` YP APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only i TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO U!+f l.+S. 4T...... .....my.... TYPE OF CONSTRUCTION ......6).® ....... A7.:2'?.11 ............................................................................... � .. ..............19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby `�apppplliies for a permit according to�to;��t,,he following information: � Location ....... ....... J Z.� ....... .1 .. ......^�•, .r.` ..... ..4 .7�?..1..,,��a..................................... :... Proposed Use ........ a.91 PMAP.4..... �.��J'!L?"�1�..��.,....... .cr.................................................................. �t , Zoning District ................. ..........................................!Fire District ..........T? Q .�.cJ.......................................... yy, / ,,Name of Owner .` o ./'+... !? ..!.�pi �... �..... Add ..'''. ... !.�A'7► ... Illy.... .). l9.,04a��� x.. - _ Name of Builder ....................................................................Address .................................................................................... Name of Architect . ....Address Number of Rooms ...... .,...'c...2....................................................Foundation �>tk. F..•�......� F'-.Tt�................. Exterior �.. . .... C._..............��.�........•,?+t1.1.1��.•�.Roofing ..... . . !fib l�!.A: ..........Interior .. +�. �DCt�Floors ....�. ................ ....... . ......... ....................................... Heating. ...T..e..i�, .e... !.��.I ��. .U?�.t ................Plumbing ....... ........................................................... ;. Fireplace Approximate.Cost ✓5" - 6b N .I[rl.�= ............................ .--��.�..../.�.~e........ .... Definitive Plan Approved by Planning 'Board ----------------- 9 Area ...-cz �•.,s.,.,- Diagram of Lot and Building with Dimensions V — Fee ............................ ................ SUBJECT TO APPROVAL OF BOARD OF HEALTH «- /Y&rs : Nis; I $1X N � . OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to_oll the Rules and Regulations of the Town of Barnstable regarding the above construction. .` Name v.... ..,<a,.. .........`,.. Construction Supervisor's License .................................... Finglas, John C. & Mary A. A=326-09 No 31233 permit for ......add to••single•• famil dwellin ........................... g................................. Location ..........45 DaisY. Hill Road 5 - ................ ..................................... i ........................HXannis........................................ t . ' John C. & Mar AlFin las " Owner ......................................Y..Al.......n& . s.. - Type of. Construction .............frame.................. t ............................................................................... - -- I - Plot ............................ Lot ................................ P I Permit Granted .... 28{...... 19 87 -� Date of Inspection ._..................................19 Date Completed .................................... c: 19 pJ- 010 r i i b � t r*l E£• 1 yi� I Town of Barnstable "Permit# Regulatory Services Expires 6monthsfrom is-sue date > siiesLe, ' Thomas F.Geiler,Director Fee Building Division ���RES Tom Perry,CBO, Building Commissioner 7�-- SEP ® 2009 200 Main Street,Hyannis,MA 02601 www.town.bamstable.rha.us To\NN OF 13 Kke. ',&1 6?-4038 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY' 508-790-6230 Not Valid without Red X-Press Imprint Map/parcel Number �?. 93 Property Address• �'� ` 1 Residential Value of Work Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address ol. ma 'in 13 t 4 ) h _ Contractor's Name — ` ` Telephone Number�� ����•q Home Improvement Contractor License#(if applicable)_ 'Ca R- 2*orkman's Compensation Insurance It V �4 0 Check one: ❑ I am a sole proprietor ❑ I am the Homeowner -❑ 1 have Worker's'Compensation Insurance - Insurance Company Name l si`1 11 t nr+Fy.+1r°� Workrnari's Comp.Policy# �����_T Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) LJ Re-roof(stripping old shingles) All construction debris will betaken to ❑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.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy 7ZIlope Improvement Contractors License is required. SIGNATURE: J Q:Forms:buildingpermits/express Revised 12310.7 S P � • I t Page 7 of 7 CAPIZZI HOME IMPROVEMENT INC. SPECIFICATIONS AND ESTIMATES STATE OF MASSACHUSETTS i LETTER OF AUTHORIZATION70 APPLY FOR A BUILDING PERMIT OWN THE PROPERTY LOCATED ATl C —_ - IN ( YR11b7 ,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: C l • ��ee Taom��ahw�ea�lfi o�✓vGaaac�uaeC1G Board of Building Regulations and Standards License or registration valid for individ.ul use only HOME IMPROVEMENT CONTRACTOR before the expiration (late. If found return to: Board of Building Regulations and Standards RegistrAti9a0{ 100740 One Ashburton Place Rm 1301 pltra !7 (23/2010 Boston,Ma.02108 lement Card CAPIZZI HOME �:t .. ►�111�� tARY GUSTAFSOty,- 1645 Newton Rd. Cotuit, MA 02635 Administrator o vali itho.t" `' nature €lq),11•01s ilt 4A€ub'lic S111'0% -- — — fi(t:Irtl ai€"€3uildin. Ro-ulatimls stud Strrtodttr€s Constructions Supervisor License License: CS 74640 Reatrsctedao: qg Ps y GARY GUSTAFSON 8 SHORT.WAY r . SANDWICH'MA 02563 ;: rii Exhiratir,r>: 1 1/291201 0 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' a 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeLyibly Name(Business/Organization/Individual): . �L��j Address: City/State/Zip: Phone.#: re ou an employer? Check the ap r priate box: Type of project(required):_ 1.A in employer with 4• ❑ I am a general contractor and I employees(full and/or p rt-time). * have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling shipand have no employees `These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' 8. Demoaddition [No workers' comp.insurance comp. insurance.t.' ❑Building 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 11. Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 1 Roof repairs insurance required.] t c. 152, §1(4),and we have no _ employees. [No workers' 13.❑ Other comp.insurance required.] *Any applicant that checks box#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. lContractors 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. I Insurance Company Name:_ Policy#or Self-ins. Lic.#: G 6 9 G Expiration Date: Job Site Address: J City/State/Zip: D v� 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'eivil 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 maybe forwarded to the Office of Investigations of the DIA for ins ance coverage verification. I-do-hereby-e--er-tify . der..-th ins and- enalties-o-f-parjury-that-the-information-pravide.d-abave-is-true-and-correct. Si afore: Date: Phone#: — Official use only. Do not write in this area,tb.he completed by city or town official City or Town: IPermit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: r Client#:47298 CAPIHOM .A. CORD, CERTIFICATE OF LIABILITY INSURANCE 05/07/09 DATE(MWDDNYYY) PRODUCER THIS-CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Rogers&Gray Ins.-So. Dennis ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 434 Route 134 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTENb OR P.O.Box 1601 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. South Dennis,MA 02660-1601 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA: National Grange Mutual Insurance Co. CapiZzi Home Improvement, Inc. INSURER B: NATIONAL UNION FIRE INS. Capiai Enterprises,Inc. 1645 Newtown Road INSURER"C: INSURER D: Cotuit, MA 02635 INSURER E: 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. TffSR AfiMDLPOLICY EFFECTIVE POLICY EXPIRATION LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MM/DD DATE(MMIDDIYYI LIMITS A GENERAL LIABILITY MPB1 O75H 06/08/09 06/08/10 EACH OCCURRENCE $1 OOO OOO X COMMERCIAL GENERAL LIABILITY DAMAGE TO c ce $5OO OOO CLAIMS MADE 51 OCCUR MED EXP(Any one person) $10 000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2 000 000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2 OOO 000 POLICY 7X PECOT LOC A AUTOMOBILE LIABILITY BPOI0786 06/08/09 06/08/10 COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $500,000 ALL OWNED AUTOS BODILY INJURY $ X SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY X NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ A EXCESSIUMBRELLA LIABILITY CUB1076H 06108/09 ' 06/08/10 EACH OCCURRENCE $5 000 000 X1 OCCUR CLAIMS MADE AGGREGATE s5,000,000 $ DEDUCTIBLE X RETENTION $10000 $ B WORKERS COMPENSATION AND WC006957000 12/25/08 12/25/09 X WC STATU- OTH- EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICERIMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEEI$1,000,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Carpentry 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 HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Hyannis,MA 02601 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE r ACORD 25(2001/08)1 of 2 #S43470/M43449 KW 0 ACORD CORPORATION 1988 Y `E Town of BarnstablePermt Regulatory Servicese�6mon sjromi�rsue BA Fe KASSBr E, ' Thomas F.Geiler,Director � lF Building Division (�-- Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 Office: 508-862-4038 www.town.barnstabl e.ma.us Fax ESS PERMIT APPLICATION - RESIDENTIAL ENTL ONLY ' S08-790-6230 XPRE Not Valid without Red X-Press Imprint �j 77Map/parcel Number l Property Address Residential Value of Work Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address c IS Contractor's Name Telephone NumbeZ -4d- � Home Improvement Contractor License#(if applicable) Q��•U�O ❑Workman's Compensation Insurance PERMIT Check one: W PRESS❑ I am a sole proprietor❑ I am the Homeowner MAY 2009 I have Worker's Compensation Insurance TOWN OF BARNSfABLE Insurance Company Name Worknian's Comp.Policy Copy of Insurance Compliance Certificate must be on file. Permit 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/doors/sliders.0-Value- (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License is required. SIGNATURE: Q:Forms:buildingpermits/express Revised 123107 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations a 600 Washington Street . Boston, MA 02111 wM ,° www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name(Business/Organization/Individual). - Address:� � City/State/Zip0 p L-\ %q Q2�b2,5 Phone.<3a- 1z q 5 Are you an employer?Check the appropriate box: Type of project(required):. 1 Lam a employer with_ 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7 remodeling ship and have no employees These sub-contractors have $, ❑Demolition workingfor me in an capacity. employees and have workers' y p �'• 9. ❑Building addition [No workers' comp.insurance comp.insurance.$ 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. 11.❑Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.❑ Roof repairs insurance required.]t c. 152, §1(4),and we have no 13. Other 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. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employee§: If the sub-coritractors fiave 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: , e Policy#or Self-ins. Lic.#:����CZ`C -1�Q�� Expiration Date: Job Site Address: - \�\ �.e+ . City/State/Zip: w I Attach a copy of the workers' compensation policy declaration page(showing the policy num er and expiration date). Failure.to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal.penalties of a. fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for' urance coverage verification. I-do hereby eerti der-thy i -and penalties opsrjuay that-the infor-matior-prouided-abouis tr-ue and cor-reef Si ature: Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: e b � 71. COom�rraonwea/�c o�./�aaacae�weeda Board of Building Regulations and Standards . License or registration valid for individul use only ''HOME-IMPROVEMENT CONTRACTOR before the expiration date. If found return to: 'f'� Board of Building Regulations and Standards Registrtj:gp.; 100740 One Ashburton Place Rrn 1301 pMMT2n`tZ 23/2010 �_x_ti• —!—Q� Boston,Ma. 02108 _—? ` `plement Card CAPIZZI HOME tARY GUSTAFS~D 1645 Newton Rd. zy Cotuit, MA 02635 7ova 4Ch, _Administrator Ni nature >I:F...,:tci.la}.sett.,- 1)iitaefr�tttti o Board ol,Buiidino dui"ttlMimis :111t1 ti atidmA, Construction Supervisor License License: CS 74640 Restricted.to: 00 GARY GUSTAFSON 8 SHORT WAY " SANDWICH`MA 02563 7N( X 11/29/2010 7755 Client#:47298 CAPIHOM ACORID,� CERTIFICATE OF LIABILITY INSURANCE °ATE(MM,°°^YYY) 1 PRODUCER 12/30/08 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Rogers&Gray Insurance Agency 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 BY THE POLICIES BELOW. South Dennis, MA 02660-1601 INSURERS AFFORDING COVERAGE INSURED NAIC# Capizzi Home Improvement,Inc. INSURER A: NGM Insurance Company Capizzi Enterprises,Inc. INSURER B: American Home Assurance 1645 Newtown Road INSURER C: Cotuit,MA 02635 INSURER D: INSURER E: 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. SR D LTR NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION DATE MM/DD DATE MM/DD LIMITS A GENERAL LIABILITY MPB1075H 06/08/08 06/08/09 EACH OCCURRENCE $1 OOO 000 X COMMERCIAL GENERAL LIABILITY DAEAGESO aENC1o'uED nce $5O OOO CLAIMS MADE OCCUR MED EXP(Any one person) $5 000 PERSONAL&ADV INJURY $1 000 000 GENERAL AGGREGATE $2 000 00O GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PECOT LOC PRODUCTS-COMP/OP AGG $Z 000 000 A AUTOMOBILE LIABILITY M1 M28044 06/08/08 06/08/09 ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $500,000- ALL OWNED AUTOS BODILY INJURY' ` :.• X SCHEDULEDAUTOS (Per person) $ _ X HIRED AUTOS X NON-OWNED AUTOS BODILY INJURY $ (Per accident) - X Drive Other Car PROPERTY DAMAGE ,$- (Per accident) GARAGE LIABILITY ANY AUTO AUTO ONLY-EA ACCIDENT $ OTHER_.::. ..: AUTO ONLY: ACC .... AGG $. A EXCESS/UMBRELLALIABILITY CUB1076H 06/08/08 06/08/09 EACH OCCURRENCE $5 000 000 X OCCUR CLAIMS MADE AGGREGATE $5 OOO OOO DEDUCTIBLE - $ X RETENTION $10000 $ +BWORKERS COMPENSATION AND WC6957000 $PLOYERS'LIABILITY12/25/0812/25/09 X WC STATU- OTH-PROPRIETOR/PARTNER/EXECUTIVE. E.L.EACH ACCIDENT $SOO,000 FICER/MEMBER EXCLUDED? If yes,describe under E.L.DISEASE-EA EMPLOYEE $500,000 SPECIAL PROVISIONS below OTHER E.L.DISEASE-POLICY LIMIT 1$500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Carpentry CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Barnstable 200 DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL In DAYS WRITTEN ZOO Main Street NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Hyannis, MA 02601 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001/08)1 of 2 #S40650/M40647 KW 0 ACORD CORPORATION 1988 Page 7 of 7 CAPIZZI HOME IMPROVEMENT INC. SPECIFICATIONS AND ESTIMATES STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT I, OWN THE PROPERTY LOCATED AT 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:.