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0007 FOSTER ROAD
7771 Town of Barnstable Buildin t Post This Card So That it is Visible From'the`Street-Approved Plans Must be;-Retained on Job and this Card Must be Kept Posted Until Final Inspection Has Been Made163 Where.a Certificateof Occu anc is Requjced,such:Building shall'Not be Occupied until a Final Inspection has¥been made Permit Permit No. B-20-267 Applicant Name: Robert Rostocka Approvals Date Issued: 01/30/2020 Current Use: - Structure Permit Type: Building- Insulation-Residential Expiration Date: 07/30/2020 Foundation: Location: 7 FOSTER ROAD, HYANNIS Map/Lot:, 307-178 Zoning District: RB Sheathing: Owner on Record: AINSWORTH,CURT R&JOANNE Contractor.Name:`w,,4ROBERT A ROSTOCKA Framing: 1 Address: 7 FOSTER ROAD _ Contract&License: 11'3252 2 HYANNIS, MA 02601 Est Project Cost: $5,983.00 Chimney: Description: Insulation &Air Sealing 3: Permrt Fee: $85.00 ` Insulation: Fee Paid:l $85.00 Project Review Req: Final: i Date. 1/30/2020 Plumbing/Gas s } Rough Plumbing: 44 .Building Official Final Plumbing: .This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months afier issuance. All work authorized by this permit shall conform to the approved application and the approved construction documents for whichAhis permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structuresshall be in compliance with the local zoning by laws-and codes. � 1 , Final Gas: This permit shall be displayed in a location clearly visible from access street or 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 Building and'Fire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work: a Service: 1.Foundation or Footing = � 2.Sheathing Inspection Rough: 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).. Fire Department Building plans are to be available on site P_ All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT 0 Final: S L-SA YbbA- 0,M(61 +k _Aft -a� on air. w • s - • i Application numb C.�.n Fee 4x ..`, i � � ' _ Building Inspectors Initials.... D........e.. .... 1 Date issued.:.. ..L.k.... ..................................... I 62 Map/Parcel b.2p.. ...................... TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES%WEATHERiZATION • PROPERTY/INFORMATION " Address of Project: FA NUMPER STREET VILLAGE � T Owner's Name: (w it- 4 0-s wo� Lt Phone Number -.v Email Address: Cell Phone Number Project cost$ 1`, Check one esiden 'al� Commercial o OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR . Owner.Signature: Date: TYPE OF WORK ❑ Siding ❑ Windows (no header change)# , ❑ Insulation/Weatherization ❑ ,Doors(no header change)# Co mmercial Doors require an inspector's review . lU Roof(not applying more than 1 layer of hingles) Construction Debris will be going to. ; ` , IPZ-r 01--- L�r CONTRACTOR'S INFORMATION Contractor's name Y C r Home Improvement Contractors Registration.(if applicable) (attach copy) Construction Supervisor's License# CS—�!! D (attach"copy) Email of ContractorYA r k tWOU Phone number ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTYES/N d wcrfmr nicr►irr vni i AAi icr nard►M MiCrnR►r APORnWAI RFVnJ?F d DFRM►T rAm Rr►ccl►rn 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 marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Purpose of Event ' 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 Fuel source being-used LP tank 20 lbs. or>Yes No ,if yes, a gas permit is required. Natural Gas Yes No ,if yes,a gas permit.is required. , 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-4:30pm. Commercial events may require Fire Department approval, *WOOD/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 p cedures,specific inspections and documentation required by 780 CMR and the rf Ba table. Signature Date &2- 2 °Z,0 Y A APPLI ANT'S SIGNATURE Signature Date All permit appl' ' ns are s g o ial's approval prior to issuance. IL The Commonwealth of Massachusetts Department of IndustrialAccidents SO Office of Investigations , 600 Washitngton Street Boston,A L4 02111 www.mass.gov/dia Workers' Compensatio A n'Insurance ffidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please-Prii Legibly Name(Business/Organization/Individual): A1V6 1! E?/l Address: City/State/Zip: H 1� ky Phone 7-2 �� J Are yo n employer?Check the appropriate box: Type of project(required):.. 1. am 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 g, ❑Demolition workingfor me mi an..capacity. employees and have workers' Y P h'• t , 9. ❑Building addition [No workers'comp.insurance 'comp. insurance., required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ 1 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#t must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. =Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. am an employer that is providing workers',compensation insurance for my employees. Below is the policy andjob site information. " Insurance Company Name: -O 0&� i CAL Policy#or Self-ins.Lic.#: A- �5� �S31�'-F- O1J Expiration Date: Job Site Address: Fos J _ City/State/Zip: �� / S' !' Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine 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 maybe forwarded to the Office of Investigations of the DIA for ins coverage verification. I do hereby certify un the pai and penalties of perjury that the information provided above is true and correct Signature: Date: o 2— Phone#: �=2 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#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as ...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do,maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such,employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificates)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom li 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 should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn 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: 4 The Commonwealth of Massachusetts Department of Industrial Accidents Qffti ce of IDvestigatiaDs 600 Washington.Street Boston,MA 02111' ; Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 4-24-07 www.mass.gnv/dia �.r Estimate BELISLANDS ��Da#eEsfimate# Home- improvement 9/3/2019 1044 Bel Islands Home Improvement 204 Cinderella Terraceme Marston Mills, Ma,02648 Curt Ainsworth 7 Foster road, Belislandsroofingandsiding.com Hyannis,Ma 508-280-1794 508-364-6909 Terms Project irX C;;v' `+ -3':. » %.,r � ` x s, �� r . mm '' 5, W'.�r,� Extra charge to upgrade shingles to Landmark Pro is$850 POSSIBLE EXTRA: Any rotted plywood,trim boards,lead flashing or other carpentry needing replacement will be done and charged for as an extra at rate of$60.00 per hour,plus 15%mark up materials Bel ISlands Home Improvement Guarantees the labor for Lifetime of roof and against Blow-offs for 15 Years. Bel Islands Home Improvement:Carries Worksman's Compensation and Public Liability Insurance on the above work, certificate available upon request permit 250.00 250.00 Dumpster 650.00 650.00 Extra work: Replace all rotted roof line trim with Azek( 910 8.00 7,280.00 Labor/materials) 1.Strip all rotted gutters around the house 2.Strip old rotted trim(rakeboards,fascia,soffit) 3.Supply and install Azek trim Total $17,380.00 Page 2 AC40RH CERTIFICATE OF LIABILITY INSURANCE taTf ltai gh€YiY9 THIS CERT3HOVE IS:ISSUE ISSUEO AS A MATTER Of INFORMATION ONLY ANO FERS NO RIGHTS:UPON THE CERTIFICATE HOLDER-THIS CERTIFICATE DOES.NOT AFFIRMATIVELY GFU NEGATIVELY AmEr4O>ExTum'OR ALTER THE COVERAGE.,AFFOR€6EG BY THE POLtCiEs. HELOWY THIS CERTIFICATE.OE INSTFRA`NDE DOES NOT COIS11TT:TTE A. CONTRACT.BETWEEN THE ISSUINu INSURt-Ri,SV, AUTHORIZED, REPRESENTATIVE ORPRDDUCE&AND THE CERTIFICATE HOLDER. IMPORTANT Ir$P a cet'titicEle tiotler is ut ADDITIONAL INSURED,the Palley(W$)ff t4t t¢gVe ADDITIONAL 1 SIDREID pfovi5 wi or It SURROSATION IS IVAIVEDa svbOtt to the teiffly and c„fafliii*rts at Joe poticT,.6ertgiti p6litlei,may fegtise A slafen em all this eeftElitaBe dugs Oat eont,r fl his to tht.cectMute hg&dsf to Ileu gtsftiah eadbrawaam st. Pft Cftit-- BRYDEN 8 SULLIVAN INS. 68 FALMOUTH R P:n�IiE d� HYANNIS,MA 026DI . ,� _, f °47N!°P�;S•�,,,§ s.iP,§7EiFC f~ Vl; k44 - FJaiIA'-,w'fY BEL 1SLANDS t3Cld1E IMPROVEMENT LLBI�ufl rT e 204 CINDERELLA'TERRACE Mf1RSTONS MILLS MA 02648 t f !(ki4 E C 1 VERAG151 C£R11EFUA'1`E PiftNt<t:4 PE1'I53f3PI NUMBER: T+€I k5 Trfi s:£ar T-W THAT TIR RI€S Of diS Pour E LIVED RELOW HAVE SEEtt IlStr€R 10 THE 5i5.OPE.D NA1.40 kgalE fOR 1149 "LIEY P€R¢&V. 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This cadilicata cancels and ss crs o�c ail prey rusty rs feccC s rTiw is only a *.hay rclo z.to warkem "ensaftrrsaaaverade: CEATIRCATt OLOER €aA 1 LLfa ll3 BAONUV ENTERPRISES : SKOULG ANY tl�i4f,ALAO'WE OkStft¢ella Pbticli<5 d �:A*c',I.i.€a kirlia t1iE EftlAYISI Gate P�AscH6dF, €tticL alEtvE� u xk ?2 ANCI&II LANE nI?LxracE rllrl iwl P LI °r t a u ra Cd}TUIT 02635 . -- AuIad61¢E,'ufi3FHgE,EhTaPv:. „� - _ a Jan, I98 2L15I CIkt?C LUR. tiltet t33 All 64Pitsfesefred ACORO 15 42�T16043) The AORO(tame afrd lager art aggls{erad marks of ACUAD ..ul3,52,z 4 4rlw z to"D i^ x ao iT�52_°r t $,.'S h'YS:Q 1:43:Gg AN flal t Parr 1 �f'i 9 'STHW SNOISFJVIN Construction Supervisor j Vi I N10 40Z Unrestricted-Buildings of any use group which contain. lb'�Il:lb'h 11aNV ess than 35,000 cubic feet(991 cubic meters)of enclosed r space. 1N3W3AO t SI IN V/49/(3 i I I IN Failure to possess a current edition of the Massachusetts State Building Code is cause 9 for,cevocation of this . .. - license. — — --— — _. ----- =:-• -��: For information about'-this license ' .Call 617 ( )727-3200 or visit wWw.mass.gov/dpl Jauoissiwwo3 ,V"S71 W SNOJ S21VW f _ i O HWINIO 7rOZ R,. istretlon.vajl d for Indlvldual use:only ' OIMHVA MiGNd j t otath,�e* li;>aftlon dpEe ound return Ro ul A r t Business R09;_ ( ppt9t0�154 n ite 710 r a00a'W 1►ingto $tc .. L 4no/90 :sail 1 b �- 9M L L-SO Boston,MA 02110 JOSIAJ 1"MftISU0:) .�... spiepuets pue suolfeln6aa 6ulpling to Oeo.B ainsua'oij feuelssatoJd{o uaslw,p fit, O,W Si Ul'@ sllasn4oesseA io 4tleaMuouxuo3 NA �'• h ; i i . D �FTHE r Town of Barnstable S�FS 1 P 1' ' )Expires L m.ontlis from issue date BARNGrADLB, Regulatory Services Pee s QU y MAs6. M - iEr-,Director -•�- ----- — �FD A'S pRES S r1ding Division 0 C j 16 20m Periry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Offfice: .508-862•-4ffigWN OF BARNSTABL9 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid WWYout Red X-Press Tinprini 4ap/parcel Number, toperty Address ]Residential Value of Work I t 2 r l inimum fee of$25.00 for work under$6000.00 ►wner's Name&Address IC) (�7 �3 CAW C� <;�Ut l 1 bntraetor's Name --. ome Improvement Contractor License#(if applicable)_ onstruction Supervisor's License#(if applicable) � �( lWorkman's Compensation insurance Check one: Q I am a sole proprietor I am the homeowner I have Worker's Compensation Insurance surance Company Name orkinan's Comp.Policy# C, AN V � S) ? )py of Insurance Compliance Certificate must be on we. TM zmit Request(check box) Re-roof(stripping old shingles) All construction debris.will be taken to � I �]Re-roof(not stripping. Going over existing layers ofroof) Re-side I n Replacement Windows. U-Value (maximum A4) - *Wbere required: issuance of this permifdoes not compliance wide other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. Rome Improvement Contractors Li erase is required. ;nature { orms:expmtrg iseo63004 t i Home Improvement Inc. I, Thomas Capizzi Jr., owner of Capizzi Home Improvement, hereby authorize Lisa Haworth, to sign on my behalf for permit applications filed through the town. Signed: Thomas apizzi, r. Date: Ulhaworth Date: 1645 Newtown Road Cotuit, MA 02635 (508) 428-9518 (800) 262-5060 FAX (508) 428-1547 Page 7 of 7 < CAPIZZI HOME IMPROVEMENT INC. SPECIFICATIONS AND ESTIMATES ESTATE OF MASSACHUSETTS, "w LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT ' ' Y OWN THE PROPERTY LOCATED AT«. Q& IN ntl 1VIASSACHUSETTS. - ti + - ,,., . . I HAVE AUTHORIZED -CAPI:ZZI 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 1 `L LESSEE TOAPPLY FORA BUILDING PERMIT IN ACCORDANCE WITH.780 CMR, THE MASSACHUSETTS" ¢' -R CODE STATE BUILDING SIGNATURE OF OWNERS) '' OWNER'S 1� ADDRESS: b OWNER'S TELEPHONE. t LESSEE'S SIGNATURE - LESSEE'SADDRESS: r y ' k six ♦ s ' 7 a � - LESSEE'STELEPHONE rAPLLICANT'SSIGNATURE ;. �AA ' A ham: APPLI - C ANT,S'ADD�RESS. _ - 164. 5 ewtown Rd ,�Cotuit,MAY 0263 5 w APPLICANT'S TELEPHONE 508-428 9518 r Zt RESPONSIBLE OFFICER , _ a - ._.,,"-.�.RESPONSIBLE_:O.FEICER_ADDRESS.�r:-,�._....�..:__....�..r.....:..,,_... ,...�.......�.._�u.,_.._�_.._..�._�___ e...._.. ..�.�....._... ..•e_..�.�_..�.:._ _._.._ RESPONSIBL&OFFICER—TELEP-ICON—E.- m........_... ,. --__..-.....� _� Date. 6/13/2006 -Tilbe: 8.40 AM To: @' 9,1,5084281547, R&G Ins. Agcy. Paqe: 035 DA //�� Client#:47298 CAPIHOM 4 ACORD,. CERTIFICATE OF LIABILITY INSURANCE 061113�s°' `' PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Rogers 8r Gray Ins.Agency,Inc . ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 434 Route 134 AL TER THECOVERAG EAFFORDED BYTHE POLICIES BELOW. P.0.Box 1601 South Dennis, MA 02660-1601 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA: National Grange Mutual Ins.Co. " Capizzi Home Improvement,Inc. INSURER E: GUARD Insurance Group Capizzi Enterprises,Inc. INSURERC: 1645 Newtown Road 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. I. POLICY EFFECTIVE POLICY EXPIRATION LIMITS " I LTR NS TYPE OF INSURANCE POLICY NUMBER DATE MMIDD DATE MMIDD A GENERAL LIABILITY MP010707 06/08/06 WOW EACH OCCURRENCE $1 00O 000 I I ( X COMMERCIAL GENERAL LIABILITY _ - DAMAGE TO RENTED a $500 000 & CLAIMS MADE a OCCUR MED EXP(Any one person) $1 O 00O fi PERSONAL&ADV INJURY $1 00O 000 GENERAL AGGREGATE $2 000 000 GEN'LAGGREGATELIMITAPPLIESPER: PRODUCTS-COMP/OPAGG $2000000 POLICY PER LOC AUTOMOBILE LIABILITY M1010707 06/08/06 06/08/07 COMBINED SINGLE LIMIT $500,000 E (Ea accident) ANY AUTO I ALL OWNED AUTOS- BODILY INJURY (Per person) $ X SCHEDULED AUTOS X HIRED AUTOS BODILY INJURY $ . X NON-OWNED AUTOS (Per accident) X Drive Other Car PROPERTYDAMAGE $ (Per accident) GARAGE LIABILITY - AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ - A EXCESSIUMBRELLALIABILITY CU010707 06/08/06 06/08107; EACH OCCURRENCE $5 OOO 000 X OCCUR CLAIMS MADE } AGGREGATE $.5 000 000 $ DEDUCTIBLE $ X RETENTION $10000 $ ¢ B WORKERS COMPENSATION AND CAW C702365 12/25/05 12/25/06 x WC STATU- OFR TH- t EMPLOYERS'LIABILITY " E.L.EACH ACCIDENT $500,000 t .. j ANY PROPRIETORIPARTNERIEXECUnVE - ` - OFFICER/MEMBER EXCLUDED? - E.L.DISEASE-EA EMPLOYEE $500,000 if yes,desaibeunder t SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS C j u�. CERTIFICATE HOLDER CANCELLATION - SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAL ln DAYS WRrrMN NOTICE TOTHE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE' MEE O ACORD CORPORATION 1988 ACORD 25(2001108)1 of 2 #M22681 .^ I UJIVI, .�► C)�f1r r x,j �1;i'r�T1�i1i1r1J),ti' /0 8 M C:oz��7�t:33sa�,ic3r3I SDYr; 3ac:eAffidnvil: 3�iilt3c.r�IC�Y��a- c ��7sli;�c>c.�.x-ici�x�s/ ' ��z'1:►c:z;� 1norz3air�x'� >lcase. 'yinI l�t� zl► �, 1J37t; <]:'Snsi��css�U� ar,3xati.t>1,�73divSdua)): Capizzi Home lmprov.e.ment 19m idn-ss_ Cofult, MA 02535 --------------- Tel 4289518 1800 262 506Q oxz --w employer?+C icc the appropriate i3o Type of project()required)-. T am a emyloyer wilb 4. o I am a general co�ti~aciaraxxd S. er �loyees a dJorpa�i- e).�' have l iri--d be sub-contractors 6.' E]N� v ronstctioai T am'2 solcpiop eiorcz ari�er- lisiecT o t ie atfacbed s�eet 7- E Remoacung ship'ane3 h_ veaxo'employ'e js "lhdsesnb-contractorsl).at>e. 8. DemDli ion. ry'erkg zo3 me azly capacity. 7orlfers' coxp.inszai�ce. [No �ozkGs=co ip_inr,,ra�, �_ 9. D 13�.1:diug nddidox3' . El �e az-e a corporation aad it xequire�] ©flicers have exercised heirfl Dlecirical repairs or addiiis��3s I a bomeo er doiAg all oy xi bi of exemption Pei MGL rapairs ox addifions xnyseLr No vor exs' sx�x�xequar � ;c.o. 3_ repai. 52,§ ( ), n w 0 Roofzs e to Tees_ ro111eas' coMp_inslsxn ce rexre�J Mixer tit=cam:Y3121cIeclsboa .1 must also iBI 0:atZesectionbeloy,'sbozvim Yt eir x%,�o&ers' axi or sac µs Cabo i1 Y$is fads t*�!iriclis tang L ie*arc doing nli a�oz�;sncl-EUC i e orjsdc O rs r i rcl su nnaL a uer+ d--;it�di6afixtg sneer eiomsY�hec7 fibs uox»,,,�f at+ clieci r�add�iona7 s7u eisl�or angen�ne od Sze sub toai�aciors�d Y)ie �owes'com_ olacy morneiion. ' . 'rz�rrr��oy,?r-f1za�zs,�7rd7�ZdiJz�'�-i�olkers'ca3r�pcxzs�z`ioxx irzsxctzrxzcs,�,oa-inp c�•pl���.�cs- $e�nn��s t�ie�v�zc����v�i szf� . . z.�rzaTi ace G nm or Sees.T ic. _ CAW -7 0,a31,5/ Expimtian Daie: !c Z, �P j. a copy i the orli exs'x o exissaf oxx poXig deda ailo..page 0le policy nzxMbf.-r a-ad o)a date)- ;#o seize co�rera�e as reclniz d x der Se )3i 25A i3fIAGL e_ 352 canleadiD e osiiiQix oar �,aZ penalises of a •�o 2 0- 00_ audloz flee-yew�pz�soizmencdcl,as%A oU as oil T,e ties%u ii�e o of a S'l-OP TVORK.ORDER.zad a Eme o $2�t3_t}p a d day agaiz)si the Violaioz. Gc advised ib2t a copy of ibis sbt(,.M tnany 13e ox d to die Office o =aiions oflze DLL.for j-us"Muce cot7Cra-,c Vetiffieation_ x 3' ijud age kfaz lz 6an -Ovwzd abiow is lc?e wz�con z Irt: ZFI czrrX 436 0XII11 DO nisi`Isar ire in this area,to ' l ch) 01.town i9ffI-cLaL vx s)ag AaMoxkt., Qaxd of 3(eat# i 2 Ytiltlin�g37�epax#nae�ai 3_PtYrro*A Peak 4.Ilectrical b3spector 5_kkx mbingLispector s _ Board of Building Regulations. and Standards One Ashburton Place - Room 1301 Boston, Massachusetts 02108 Home Improvement Contractor Registration Registration: 100740 Type: Private Corporation Expiration: 6/23/2008 CAPIZZI HOME IMPROVEMENT,,INC !,. . Thomas Capizzi, jr. 1645 Newton Rd. -Cotuit,,MA 02635 Update Address and return card.Mark reason for change. oPS-CA1 Co5OM-o4io5-PC66sa [j Address Renewal 0 Employment Lost Card �f,�\ ✓�ze -Varrr��w�uuec�l�o�,��rxaoacfivael�a .. • Board of Building Regulations and Standards 'License or registration valid, or indiVidul use only i HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: I i Registration: 100740 . Board of Building Regulations and Standards Expiration:'6/23/200g One Ashburton Place Rm 1301 Type:'Private Corporation Boston,Ma.02108 CAPIZZI HOME IMPROVEMENT,INC. Thomas Capizzi jr,.. . 1645 Newton Rd. HQ Cotuit, MA 02635 Deputy Administrator Not valid without.signature v = BOARD OF- BUILDING RE_GULi4T70NS _ License. CONSTRUCTION S ;' i ;•Number;;CS, 057D32 =` .> Birii�i�ate,33_9%2 �-1'63 ' tFx D7 + ! I2eSir6jzec7�pa--� ;,! T-_i �� a1 THOMAS X 1645 NEWto COTIJIT, MA 02635 :-:=:;' Comrn+ssr tier 3 ypFTHET��♦ TOWN OF BARNSTABLE • EAUST"LE, i 1639. am a' BUILDING INSPECTOR 4 &;za APPLICATION FOR PERMIT TO . ... . .. ..... ............... *z 'l-.. ..................... !'' ........................... �'' TYPE OF CONSTRUCTION .........'S... G�................................................................................................................. ®... ... , —.......19...70 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ....... .. ®.. . 4�........... \...e.xl........... 15........................................................................ ProposedUse ...................................................................................................................................................I.......................... ZoningDistrict ........................................................................Fire District .............................................................................. -- Name of Owner .1�2,4,4......,1 lc �.�(. ..6-!%.......Address 7 /'°'GSP f....... Name of Builder ...... :.........Address .............'..........................................., ...�....�!�.6�,l+�,S.01�.�.�.�: .......................... Nameof Architect. ..................................................................Address .................................................................................... Number of Rooms ..................................................................Foundation ....C. ?%)2 .q/ ..../' , mot`........... Exierior ...... Roofing s ........ ........................... .................................................................................... Floors ......................................................................................Interior .................................................................................... Heating ®,�........ �� � ..............................................Plumbing ...... !�4/:�......................................................... F -trFireplace " :...............................................................Approximate Cost Difinitive Plan Approved by Planning Board ________________________________19________. Diagram of.,Lot and Building with Dimensions t Di rk I hereby agree o!form to all the Rules and Regulations of the Town of Barnstable regarding the above construction. 7. Marshall, Frank > �' /Vo C'04 'f-' 13548 replace picture widow ` No ................. Permit for .................................... .....with bay ................................. ......... . .. .... . ..... 7 Foster Road o Location ........... ............................................ i Hyannis } ............................................................................... Frank Marshall Owner .................................................................. i I Type of Construction ..........................frame................ ................................................................................ Plot ............................ Lot ................................ Permit Granted ......December 11.......... 70 ..... "NO 5T 42 To 1 Date of Inspection ! .......19 li _ y � Date Corn Meted ......... ..,. : .. PERMIT REFUSED ` ................................................................ 19 ............................................................................... .............................. ........................ ............................................................................... Approved ....................................... 19 } ................................................................ . ........... 1 .. ...........................................