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HomeMy WebLinkAbout0027 FOLSOM AVENUE � � ��� _� _._ a i f �{ ,; f Assessors office(1 st Floor): Assessor's map and lot number c� `t ' I f(' 0 F Q� 'r"Eto eePQituor): .Board of nm ♦o �� — 9 AUS)T CONNECT TO TOWN SEINER Engineering Department(3rd floor): t DAHd94 1 ruIL a House number i639• 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 APPLICATION FOR PERMIT TO PResavT,ft,TaNc--H 0sg I�"uA4-'j*R0MeZ-1E20s:)4ovsCr' �/144,&= v e.,,s 7,9,e4 !.r/ TYPE OF CONSTRUCTION 0 U D J y TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location 2-7 T L 12 c)h, (a U E ��y.91✓ 1_S- Proposed Use - e �o i� try Zoning District � L< i ENe;A-_7 L_ Fire District Name of Owner'45wmejo J .°1 P07-11e/A �&address 2;2? -f-d 4SoAn AU9- 41-7mm Name of Builder Address Name of Architect Address Number of Rooms EVFN Foundation �L- 4,C wT— o e,!& Exterior ^ BOO - S'�/`✓6lc�S�@l,�w kgax120S Roofing S'f/Pf/10a i`_S1111Aq/.Lr_ Floors 0 b Interior 1 �9S�E1Z' V J 04J7 Heating Plumbing Fireplace Approximate Cost O a D Area J�✓v Diagram of Lot and Building with Dimensions Fee 90K i6 w -7 3 T Q ° V1 Q � V z 0 -4 s , 66 A0 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 Construction Supervisor's License T HUGHES, EDPeARD V. & PATRICIA H. Y No 34131 Permit For Convert Gaaae to - Kitchen/ relocate same. 27. Folsom Avenue i :Location- `Hyannis - Owner'` Edward V. &. Patricia H` Hughes y ' '= Type of-Construction Frame ' Plot ` Lot Permit Granted' January 7 , 19 9-1 a , Date of Inspection •19 Date Completed 19 12 or s �. ' TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please print. DATE %- 9 JOB 'LOCATION — /l �.`7aZca Avg Number Street . address Section of. town "HOMEOWNER"_ 77/ Name Home, phone Work phone PRESENT MAILING ADDRESS T—d4S City/-IY/own � State Zip code The current exemption for "homeowners" was extended to include owner-occupied dwellings . of six units or less and to allow. such homeowners to engage an in- . dividual for hire who does not possess a license, provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER: Persons) who owns a parcel of land on which he/she resides or intends to re- - side, on which there is, or is intended to be, a one to six 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 ermit. (Section 109. 1. 1) The undersigned "homeowner" assumes responsibility for compliance with the Stat Building Code and other applicable codes, by-laws, rules and regulations. 4 w. The undersigned "homeowner" certifies that he/she understands the- Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL Note: Three family dwellings 35, 000 cubic feet, or o larger,comply with State Building Code Section 127. 0, ConstuctionlControlqu� red HOME OWNER'S EXEMPTION The code state that: "Any Home Owner 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 Home Owner engages a person (s) ''for hire to do such work, that such' Home Ownex shall act as supervisor. " Many Home Owners who use this exemption are unaware that they are assuming the responsibilities. of a supervisor (see Appendix •Q, Rules and Regulations for licensing 'Coristruction Supervisors, Section 2. 15) . This lack of awarenes often results in serious problems, particularly when the Home Owner hires unlicensed persons. In this case our Board cannot proceed against the inlicensed person as it -would with licensed Supervisor. ` The Home Owner actin as supervisor is ultimately responsible. To ensure that the Home Owner is fully aware of his/her responsibilities, .man communities require, as part of the permit application, that ,the Home Owner 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 to amend and adopt such a form/certification for use in your community. t I I - Town of Barnstable F VE r . O o Regulatory ServicesABLI } �xxsr�gtE Thomas; . Geiler,Direct or C to ' z ass g Building Division -4 pig 3: � �rFo � Tom Perry,Building Commissioner. 200 Main Street, Hyannis, MA 02601 V1WW,town.barnstable.ma.us . Office: 508-862-4038 Fax: 50.8-7,90-623(. PERMIT#. FEE: $ Ut SHED REGISTRATION 120 square feet or less. Location of shed(address) Village Property owner's name Telephone number G.11 Size of Shed Map/Parcel # . Signature Date Hyannis Main Street' aterfronf Historic District? Old Icing's Highway Historic District Commission jurisdiction? : Conservation,Corninissi6n.(si5Aure is required) Sig�o.urs f r Codseryatio 8 3r:00-9:30 & :30-0� PLEASE NOTE: IF YOU ARE WTTfIEN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND "PLICATION FEE. :PLEASE SEE THE APPROPRIATE.COMMISSION FOR,DETAILS. • 'M ♦. w- x*Y tar k THIS� '®RNY�MUSVBE� CCOMPAIVFE-10 B„Y,A WPLOT PLAN-7",' Q-forms-shcdrog . REV:042506 ` OFtHET°wti Town of Barnstable " Department of Health,Safety,and Environmental Services &UWSTAMASS. Conservation Division a 200 Main Street,Hyannis MA 02601 Office: 508-862-4093 Robert W.Gatewood FAX: 508-778-2412 Conservation Administrator MINOR ACTIVITY REGISTRATION 7`7/ /i�/� Property Owner Telephone number , Mailing address Project location Map/Parcel# Project description The following minor activities will be reviewed,under Art.27,by Conservation staff instead of the Conservation Commission,as long as they are constructed at least 60' from a wetland resource area or top of a coastal bank. * Pathways 4' in width * Fencing that does not create a barrier to wildlife movement,6"above grade * Conversion of lawns to decks,sheds,or patios that are accessory to single family homes,as long as: -house existed prior to August 7,1996 -alteration within the buffer zone is less then 250 sq.feet. -sedimentation and erosion controls are used during construction * Stonewalls(this does not include stonewalls for retaining wall purposes,grading and/or fill) 4e� Signature Date C Reviewed Date _GIS Plan Attached(fee charged for plan) t Q/WPFi les/Form/MinorAct �. 324079 #28 i X 1192 � -4 324060 #9 k 01 J J rVrarg �� r s r32g4059 W "' MOREW ` �r '21' Ail �A F /9 u" ,)ter, 1 Zf c ire- s� f } n �T' M 4 z '� �` ,",,,,.• _._ -h"`"".... s°� a+ �.�Y�t ',�z'&' '., ?�.',. v �kl �' it i � - :', &ti '# ,s `°" s,.�:,- -:.���,;,m � �� �.' n-,,. � �F.:' f�" ��k S' `a `�a � �'s T,. n s I s >` ?' .t:%;1`�°. ,•�. f ,f�. '�.'s'^'.::�.l'.�z. �...r r, .t�?,.aR,„,P. ,.. z ^�. � �IiVIATED �IETLANDS � s k y Y xr f 324058 w. - ^: ge aI.�' -n NOTE:PARCEL LINES MAY NOT BE ACCURATE. The DISCLAIMER:This map is for planning purposes only. It ,T , u ;, '.,a ;^ parcel lines on this map are only graphic representations of may not be adequate for legal boundary delerminabori or S ry - Assessors tax parcels. They are not true property regulatory interpretation..T his map does not represent an �- - E 0 5 10 20 Feel 'c boundaries and do not represent accurate relationships to z on-the-gmuntl survey. 5 - - -" physical objects on the map such as building locationsi' � ti� mCf1 equals 26 feet ,. ..n...,,..r.,.r')._,k' :5..,.,.w.,,.r.,.._�w: . ...;..��vi:.,... .,,,,.ytry��.tr'krjti�`�. '-�i' -irr./`:._fa..•.i. r^-M'.r��rn.....ir,�l,.1�'t+r•.......e i..,.,.ty s .`"'. _: d""! 1- .a �'�`""•.'Ttre' LR��'..-LH�.....�,r7i'1`yr,''. Assessor's office(1st Floor): `q Assessor's map and lot number 3 Q J4 " 6`� I Board ofPHealth(3rd'floor). Sewage Permit number = i Engineering Department(3rd floor): DAS39TAXErua House number .:. °o t639. 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 APPLICATION FOR PERMIT TO 1 O!✓UEorz-X/.ti,1�11. Arwc� Igp G-4,r4 AzzaavT tttnZ ,sue a�igcK RJ�Nc�.•>E2�,��.+ovs �cc�tAe[osET�lrrc:q TYPE OF CONSTRUCTION TO THE INSPECTOR OF BUILDINGS: 's The undersigned hereby applies for a permit according to the following information: Location Q -1-o L S o U E / 11,91✓1✓/S Proposed Use E C ►d�W e� y Zoning District � ��in ��✓�%��-- Fire District �1A.ti.4�15 Name of Owner G,I4ic✓1 J .°f &,,'elelAA. t1UG//�Spddress 'f'OL-soA?, RUB Name of Builder Address Name of Architect Address Number of Rooms Foundation C'C jo C v e. Exterior -.0111AI6/ES4 0141'19646WS Roofing 415'11P<i 04 T—S'yl//&/A Floors N 0 U Interior Heating A 0 �//Z- Plumbing (� 5'" �- A6'A97 �4 Fireplace /✓ Approximate Cost Area Z66 6?1�1 a Diagram of Lot angI 13 uil ing wit In Dimensions Fee J<©. Ell rr ycK S ri Q \ o dSr, x t ! J t i + / OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and„Regulations of the Town of Barnstable regarding the above construction. Name Construction Supervisor's License' /� HUGHES, EDWARD V. & PATRICIA H. A=324-059 No 34131 Permit For Convert Garage to Kitchen/ relocate same Location 27 Folsom Avenue Hyannis Owner Edward V. & Patricia H. Hughes Type of Construction Frame Plot Lot Permit Granted January 7, 19 91 ' r Date of Inspection 19 p Date Completed 19 PERMIT COMPLETED Page 324 Lot 59 b�Qy�FTNET��yn TOWN OF BARNSTABLE S ► i BAHBSTADLL i "6 9 NP BUILDING INSPECTOR Y�" APPLICATION FOR PERMIT TO ..Add to dwelling, 4x18 '�2 Sc�, Ft ..... ........ ...... o TYPE OF CONSTRUCTION ...W.....od....................Frame......................................................................................................... exbox...2.2...............19...7.2 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ...HYannis�...MA...�2601................................................................................................ Proposed Use ...D.............inin �5.......................................................................................................................................................... Zoning District ......�A..1........................................................Fire District ...HYaririiB........................................................ Miss Dorothy Willsl Name of Owner .K' SS..g!ertrude Peirce Address 27 Folsom Av„e. Hyannis, MA 02601 ............................. ...... ............................ Name of Builder Rogers & Max'ne , Inc......._....Address .Pt...�.t...BOx 310 Osterville , MA 02655 ....... ................................................................ Name of Architect None .Address Number of Rooms ...........One................................................Foundation .C21Crete Blocks ................................................................ Exterior W• C. Shingles Asphalt............................................................... .................. ........................................ ...................... Woed-Linoleum Paneling. Floors .....................;..............................................................Interior ............................ ....................................................... Heating Hot Air-Oil..............................................Plumbing None ................... .................................................................................. Fireplace fbne .........................Approximate Cost #6 9 000. 00 p ................................... ........................................................ Difinitive Plan Approved by Planning Board ---------------_---------------19________. % S. Diagram of Lot and Building with Dimensions / E leLd LOU / (� J < _ � t \ ' off Q ` (D 0 Im a 4. - < '-Lot Q Z p cn I SXIy yl pa' D: = W , Jm� � Qy� +- ee p a W • 00 >� cn1: a- r ,n _W z z ¢� A I hereby agree to conform to all the Rules and Regulations of the Town or ble re rding he above construction. Name . ............................... - Wills, Miss uorotJzy /& �ioo Gertrude Byiroo - ' No -..1�56».. Permit forto siumIe� :��. —.--.--.'��.. family di-�Te .—.—.~.--.--.--.....—.-----~..---' . . ' 27 �nIax�z i LocoHon —.—_-..--_--__���.�����_____ ........—.—.,.o .�nni.�.---.-.-----.-- Owner ..2�sny. ..��II�_'�..Mi��___ Peirce , .. ..... Type of Construction —..—.f r.a.me-------. ^ --.--..~—.—...—.—.—.,,..~-----.~—.—. / ` . Plot ............................ Lot ................................ ' ' October 3 72 Permit Granted ............................ ..........lg - � Date of Inspection 19 < � Date Completed ~�. \ � - � < ' ^ | . . PERMIT REFUSEDi. � ^ ' - ,—.-.--.-.-----.--.------- 19 ..,.--~..----.--~.—.------------ . _.---.......-_.—..---~.—...,--.--.—.~' - ''—`—'—'--''--^~^—^^^~—~'—'r--'~---_'' ' --.—.—.—.--.—.--..—.~..--.—~—....`...' - F ' Approved \ ^ . ~ .............................................. lg ' -------------~--~'^`^'-'--'---- ` -------'---..--.----.—.-.--.,...— , | ^ . _ `� * 6; �t� Town of Barnstable Permit# ! Regulatory Services 'Fel 6m°11 n issuer/nle (: HARNM Thomas F.Geiler, Director _ AraS. Building Division f2 )10� /�j Tom Perry,CBO, Building Commissioner OP 008 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-40�B` Fax: 508-790-6230 EXPRSS PERMIT APPLICATION - RESIDENTIAL ONLY •--�� Not Valid without Red,V-Press Imprint Map/parcel Number2 PT Property Address � ��� Residential Value of Work �Q _ Minimum fee of$25.00 for work under$6000.00, Owner's Name&Address Contractor's Name Telephone Numberd�� ' Home Improvement Contractor License#(if applicable) XWorkman's Compensation Insurance Check one:' ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name Q(2) _ Workman's Comp. Policy �3, C(—1 20 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: U-Value _(maximum .44) `Where required: ISSU mce of this-permit does not exempt compliance with other town department regulations,i.e.,]listonc,Conservation,ctc.' ***Vote: Property Owner must sign Property Owner Letter of-Permission. 4 - A copy-of the Home Improvement Contractors License is required. I SIGNATURE:' Q:I-'orms:buildingpenriits/express Revised 123107 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: The Commonwealth of Massachusetts Department of Industrial Accidents 4 Office of Investigations a 600 Washington Street �V Boston, MA 02111. 5� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information .Gapizgi H9me ImormipmPnt Inc Please Print Legibly Name(Business/Organization/Individual)1645 Newtown Road Cetuit, MA uz.635 Address: Tel. 428.9518 1 1-800-262-5060 City/State/Zip: Phone.#: Are you an employer? Check the appropriate box: Type of project(required): 1n I am a employer with 4. ❑ I am a general contractor and I _ 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7.�Remodeling ship and have no employees These sub-contractors have 8. ❑!Demolition working for me in any capacity. employees and have workers' 9 ❑ Building addition [No workers' comp. insurance comp. insurance.t 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 employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#I 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 employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:-DG M — Policy#or Self-ins. Lic. #: C( —) Expiration Date: Job Site Address6n City/State/Zip: 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 14A for insurance co/erage verification. - Ido-hereby-c-er--tify- der--thepains-an e a ies-of-perjury--that-the-infor-mation-pr-ovi1ded-above-is-true-and correct.------------- Signature: Date: 11 E�g Phone# Official use only. Do not write in this area,46 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#: Client#: 47298 CAPIHOM _ ACORDI. CERTIFICATE OF LIABILITY INSURANCE osi12i2ooaYYY, PRooucea THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Rogers&Gray Ins. -So. Dennis { ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE i HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 434 Route 134 _ ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. i P. O. Box 1601 --- South Dennis, MA 02660.1601 _— — _ INSURERS AFFORDING COVERAGE NAIC# INSURED j�NsuRE,A. NGM Insurance Company Capizzi Home Improvement, Inc. NSuRER a. American-Home Assurance _ J Capizzi Enterprises, Inc. !INSURER C. 1645 Newtown Road j INsuRER D. --- -------- -- ---__ Cotuit, MA 02635 -"— ---- -------- _ tNSURER° --------------- -'-- -- 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 TC'\NhJCH THIS CER-NFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO A.LI_THE TERNAS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY EFFECTIVE POLICY EXPIRATION --- — LTR NSR TYPE OF INSURANCE i POLICY NUMBER I DATE(MMIDD/YYI DATE(MMIDDfYYI I LIMITS A i GENERAL LIABILITY ;MPB1075H 06/08/08 106/08/09 j eiA(,rl OCCUnRE.NCE 1$1,000,000 X COMMERCIAL GENERAL L IA.BOL _ DAMAGE TO RENTED i PREMISES Ea occurren S500,000 i CLAIMS MAOF. X OCi;UR ' OF FXP•/ny o,^.e person) $1 Q QQQ _ uERSONAL&ADV INJURY $1 OOO OOO GENERAL.AGGREGATE s2,000,000 �GE�N'L AGGREGATE LIMIT APPLIES PER r'F' DUCTS PRO- :COMP/OP AGG $2 OOO OOO r -- l I POLICY I I JECT ! j'_::G -----'—= .. --- 1 � AUTOMOBILE LIABILITY ------- --------- �._.....-'----------------� r—� - COMBINED SINGLE LIMIT S I ANY AUTO i i lce aradent) i I I i ALL.OWNED AUTOS BOD;,.1 N_URY -IT —+---'— i I 11 SCHEDULED AUTOS (Per DersOn) i—I HIRED AUTOS —� I BCI! ci:VJURI CJ --- S I NON-OWNED AUTOS ��Pe.r ac iuin) F'RGrER?Y DAMAGE �$ GARAGE LIABILITY -----_�----"----_�-- i AUTO ONLY-EA ACCIDENT $ ANY AUTO ' 10;'NER 4NAN EA ACC $ ���� Ai;T O ONLY AGG $ A EXCESSIUMBRELLA LIABILITY ICU81076Hi- ;06/08/08 06/08109 ^EACH OCCURRENCE $5 OOO O00 X occuR CLAIMS MADE AGGREGATE _ $5 000 000 I $ i DEDUCTIBLE - — —"_---- --- X RETENTION $10000 j B WORKERS COMPENSATION AND IWC6716562 i 12/25/O7 12/25/O8 ')(','dCSfAiU- IOTH- RRY ITS EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNERIEXECU'I IVE - -_-_EACH ACCIDENT s500,000 OFFICER/MEMBER EXCLUDED? 1~ DiS"CASE- A EMPO LYEE $5OO OOO If yes,describe under I- �_ E I SPECIAL PROVISIONS below E DISEASE-POLICY LIMIT s500,000 OTHER _ --"--- L. i • 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 TOWn•Of Barnstable DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL I n DAYS WRITTEN 200 Main Street NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Hyannis, MA 02601 I IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001/08)1 of 2 #S36540/M36539 KW © ACORD CORPORATION 1988 Board of Building Regulations and Standards License or registration valid for individul use only lugHOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: :f Board of Building Regulations and Standards Registr:44 p,N, 100740 One Ashburton Place Rm 1301 p7ra iQn '23/2010 t l Boston,Ma.02108 y! T ' APlement Card i CAPIZZI HOME to RY GUSTAFS'ON 1645 Newton Rd. Cotuit,MA 02635 Administrator No vali itho,t nature Board of Building Regulations and Sta`hdards Construction Supervisor License License: CS 74640 B i rthdate: 11/29/1975 Expiration: 11/29/2008 Tr# 6430 Restriction: 00 GARY GUSTAFSON yet 8 SHORT WAYT— SANDWICH, MA 02563 Commissioner R' a TOWN OF BARNSTABLE BUILDING,PERMIT APPLICATION r f Map Parcel Permit# " Health Division Date Issue Conservation Division Feed r Tax Collector Treasurer Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH • 'Preservation/Hyannis Project Street Address �'Se►'h f`5o at Village n i S' ' Owner I06aQ_ Z hey Address �7 ` 0ILPM AVe. /l1Chi S Telephone 19 f— Permit Request tiGi Slf • t • 1 Square feet: 1st floor:existing proposed • 2nd floor: existing proposed Total new Estimated Project Cost A 1, 46iffo Zoning District Flood Plain —Q Groundwater Overlay �P Construction Type t� - Lot Size` Grandfathered: El Yes �f yes,attach supporting documentation. Dwelling Type: Single Family ® Two Family 0 Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes O't 6� On Old King's Highway: ❑Yes l�' Basement Type: ❑Full ❑Crawl O 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 t✓entral Air: ❑Yes Z) No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool:0 existing ❑new "size Barn:❑existing,0 new size Attached garage:❑existing 0 new size Shed:❑existing O new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes to If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION NameOL'i;.1 Telephone Number (5-6�) Address ,1 -515' Aked7V id At. License'# 72tz Z, Home Improvement Contractor# 1 ee 7 f(e ti Worker's Compensation# 4C -6k.2 66Y1 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO SIGNATUREJr DATE 3 ; FOR,OFFICIALUSE ONLY ` s _ t 27 PERMIT-NO. ` DATE ISSUED �;, 4 MAP/PARCEL NO. �5 ADDRESS �. VILLAGE t OWNER DATE OF INSPECTI 02�. : FOUNDATION ¢ ,. FRAME INSULATION FIREPLACE r. # ELECTRICAL: ROUGH -'FINAL p} PLUMBING: ROUGH FINAL GAS: ROUGH FINAL '< FINAL BUILDING - DATE CLOSED OUT ASSOCIATION PLAN NO. 3 s ' The Town of Barnstable • 9�A Department of Health Safety and Environmental Services. lEn59�° Building Division 367 Main Street,Hyannis MA 02601 f. r 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: d?e o I�V 19504�Estimated Cost 7 Address of Work: ,2:7 —15�0 J` Owner's Name: ` Date of Application: 57 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: s— &ed, Date Contractor Name *g_ Gri?Piz2i.lkMC,4giegistration No. OR Date Owner's Name q:fomis:Affidav � 2 + i gfl A T IMRV} M5 ENT R CNTRAC „� �fze �poa nz�uSY nuB,eUaI LDING'FR'E GULguTcaOeNlta S9istratr DOF R YPe PR PERVISOR License CONST SU Ex IVATE;.CORPORATO 057032.O umbr . O6/2V00 C . (p, Birthdate 09/26/40 l'; CAPIIZI HOME`:. PRO Sri � �, MPROVE "" t r Tr..M 5742: MENT, INC CaPlzil, r ;�9/26/2401 MINISTRATOR i b 45 Ng = r , i' '' Rpsrlyte 1To,:00 i- wton;:Rd �° Cotu1t MA O2b35 _ THOMAS X.CAP..1U JR t �. 280 PERCIVAL DR , . W BARNSTABLE, MA 0266.8 Administrator ��; p ccctucaeCGi' f _ ENT OF'PUBLIC sett` DEPART �t . Tie �omv�na�uuecci o•_✓� aQac�rweCli a 1 N AFETY - .!. r DEPARTMENT OF PUBLIC;:SAFETY` I `y;� s SUPERVISOR:LICENSE; o E f ytr�.: CONSTRUC.TION SUPERVISOR LICENrSE i Ex fires Bir. Nu 'thdate ber , P Sys P i ; CS 9fl145h 0212412000 @2�24/1944 ,. Number Expires': i' r CS 012749' 02/04/2002_02104J1 .,956 C ° k t &te Toa 0@ r � I' Re�trtct'ed FREOERZTi:},,V RASCN.IIi 'f }'gip 0 ►��°� fiIiONA L�YiR�t�I� i. � I � 6 '•.BO. RNE:'RD 1@ 0 U A 02635 COTUIT,; PLYMOUTH, NA .02368 ! ... ...:.... ...... .. :. ..:..: ....:..�..-� �..,:.:�: .......:� ., - .u.fa.�tm�s-r,...... ..,u.N• �wnv+wanT^^"'wad � r --- - The Commonwealth of Massachusetts ^� =` �� -= Department of Industrial Accidents T' ..... Office aflo1vesagatians -_ t_:. 600 Washington Street .. 1 :;/ Boston,Mass. 02111 Workers' Comyensation Insurance AfTidavit mom name: location: ��tOQ city e ❑ I am a ho owner performing all work myself. ❑ I am a sole proprietor and have no one working in any capacity (rI am an employer providing workers' compensation for my employees working on this job. compnnv name: (?APitU rl we r lu#44 y4s IUAw address: /lLC/L��/�lAl i r city: `n 0 n(l r bd,G 3S phone#. insurance cn. I746 Ab&nFoOnolicv# GJC I a-&(0 8/ J ......' Cl I am a sole proprietor, general contractor, or homeowner(circle one) and have hired the contractors listed below who have the follo«ing workers' compensation polices: company name- address- city: phone#: insarnnce co. ohcv comnanv.name: address: citN- phone insurance co. olicv# pis% // G/// /O%% /// / / Fallure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a tine up to S1,500.00 and/or one year'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a tine of 3100.00 a day against me. I understand that a copy of this statement may be forwarded to the OMce of Investigations of the DIA for coverage verification. I do hereby certify under the pains anddppfennalties perjury that the information provided above is trap and correct Signsture{r� __ !/' Date Q Print name rR Et)EIUGL V. Q A S C H Phone# rcontactperson: se only do not write in this area to be completed by city or town otliciaiown: permit/license 0 ❑Building Department❑Licensing Boardk if immediate response is required ❑Selectmen's Office❑Health Department phone#; ❑Other (mvea gigs PJA)