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HomeMy WebLinkAbout0044 PASTURE LANE �� 14± gar • Town of Barnstable *PermL031 q5� 0 t i es 6 months from issue dwe Regulatory Services Expires T"$ ` Thomas.F.Geiler,Director Fee Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.towr.barnstab le.ma.us Office: 508-862-4038 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Fax' 508-790-6230 Not Valid without Red X-Press Imprint Map/parcel Numbe> � (�y Property Address ^ Residential Value of Work' CYS Minimum fee of$25.00 for.work under$6000:00 Owner's Name&Address .4w\_q Contractor's Nam elephone Numbe ��j Home Improvement Contractor License#(if applicable) 1 QC�VAv Workman's Compensation Insurance,541 Check one: . X-PRESS PERMIT" ❑ I am a sole proprietor ❑ I am the Homeowner JUL 1. 0 I have Worker's Compensation Insurance ZOO S Insurance Company Name���:��X\ �� 1� � TOWN OF BARNSTAB E Workman's Comp.Policy#U1,�� 6 ' 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 XReplacement 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 of the Home Improvement Contractors License is required. SIGNATURE; _d7a%'; Q:Forms:bui Idingpermits/express Revised 123107 CC! / � Pagel of 2 � .' G �j PROPOSAL ( l Date: FID#80-0014011 " ' ' ' I Home Improvement CSL#: 7454 1645 Newtown Road Registration#: 100740 Cotuit, Massachusetts 02635 508-428-9518 800-262-5060 F. 508-428-1547 Established 1976. Serving the Cape for Over 30 Years Name: 1`' (2 04-LA, Job Address: Address: ,p j� City/Town: � City/Town: �sw)V-` �"\', ,Job Phone: State: Other Phone: ZIP: tOt,C E-Mail: Estimator: Job Number: 3 Q We hereby submit specifications and estimates to furnish and install anew door system as follows: ■ Remove exterior and interior casings. ■ Remove existing door slab, doorjamb and threshold. ■ Remove storm door system if applicable. ■ Dispose of all debris, including disposal fees. ■. Install new pan flashing. - - - ■ ' Install new door system. ■ Install new exterior and interior casings. ■ Permit included. Operation Diagram r elip, In Style of Door: _1 Size: A Interior Trim Style- L't 1 � Size: �1& Exterior Trim Style: 14— Size: Out Wall Thickness(Check One): 2" x 4" ❑ or 2"x 6" . Lab_o_r_&Mater_ials: $� NOTE: If rot is found in door area additional costs will be incurred. -77 e Location of Door(s): OPTION. Pa e and exterior and interior casings to complete installation,two [2] coats,one [1] color. Labor&Materials: $ NOTE: If units being worked on have alarms, customer is to contact Alarm Company and be , billed direct for any associated alarm expenses. Accepted By: Date: '� � ~� THIS PAGE IS PART OF AND IN CONFORMANCE WITH PROPOSAL Client#:47298 CAPIHOM .ACORD- CERTIFICATE OF. LIABILITY INSURANCE 0DATE 5/07/09Dmrn `T 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,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O.Box 1601 South Dennis,MA 02660-1601 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: National Grange Mutual Insurance CO. Capizzi Home Improvement,Inc. INSURERB: NATIONAL UNION FIRE INS. Capizzi Enterprises,Inc. INSURER C: 1645 Newtown Road INSURER D: Cotuit,MA 02635 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEOTO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OWOTHER 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. S - POLICY EFFECTIVE POLICY EXPIRATION LTR NSR TYPE OF INSURANCE POLICY NUMBER: DATE MM/DD DATE MM/DD LIMBS A GENERAL LIABILITY MPB1075H 06/08/09• 06/08/1 O EACH OCCURRENCE $1 000 000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTEDPREMISES fEa occurrence) $500 OOO CLAIMS MADE �OCCUR - - MED EXP(Any one person) $1 O 000 • ' - PERSONAL&ADV INJURY $1 000 000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: - - - - PRODUCTS-COMP/OP AGG s2,000,000 RO- POLICY FX1 JE LOC + A AUTOMOBILE LIABILITY BPO10786 00/08/09 06/08/10 COMBINED SINGLE LIMIT ANYAUTO (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) - l t • PROPERTYDAMAGE $ (Per accident), GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO ` - EA ACC $ ' OTHER THAN _ AUTO ONLY: AGG $ A EXCESSIUMBRELLA LIABILITY CUB1076H 06/08/09 06/08/10. EACH OCCURRENCE $5 000 000 X OCCUR CLAIMS MADE AGGREGATE s5,000,000, DEDUCTIBLE $ X RETENTION $10000 $ B WORKERS COMPENSATION AND - WC006957000 12/25/O6 12/25/09 X T RY ER LI WC SLIMIT OTH- EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE - E. EACH ACCIDENT $1 000 000 OFFICER/MEMBER EXCLUDED? - E.L.;DISEASE-EAEMPLOYEE $1 000,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $1,000000 OTHER g. 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 1 n DAYS WRITTEN 200 Main Street E 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 #S43470/M43449 KW 0 ACORD CORPORATION 1988 t _ ` �J' Qp ii�V?<IGiC4�%CIZll6EU6 :J�t¢ 'tOC na.v2Cyruueal.�x L\ 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: Board of Building Regulations and Standards ReglstrA.tlo(;; 100740 One Ashburton Place Rm 1301 .a.. 23/2010_ 7 Boston,Ma.02108 =�7CPplement Card L=�r CAPIZZI HOME�,� Fi? Mll�� t RY GUSTAFS©I 1645 Newton Rd. `�%`• •'`"4 � ' Cotuit, MA 02635 Administrator No vali ttho.Y ` nature \Is•s:aiia�as et t - 13epm,tolcot of Public s:a(•etN -- — VBoard of Buildiol,'Res-I.li.atioaas -1 Id St°rtntl:trtIs v Construction Supervisor License License: CS 74640 Restricted to: 00 k O GARY GUSTAFS N wtit� 8 SHORT WAYS SANDWICH; MA 02563 expiratiow 11/29/2010 rr1: 7755 The Commonwealth of Massachusetts Department of Industrial Accidents W Office of Investigations ' d 600 Washington Street Boston,AMA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address:\\k& 0� � C\ City/State/Zip � Phone.#: C Are you an employer?Check the appropriate box: Type of project(required):. 1�K I am a employer with&J 4. 0 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.)K]Remodeling ship and have no employees These sub_contractors have $• ❑Demolition working for me in any capacity. `employees,and have workers' 9. Building addition comp. insuiance.t ❑ [No workers comp.insurance required.] 5.❑'We are a c,orporation and its' 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 1 LE]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 employees,:[No workers' 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. xContractors 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: �`�1('�t,L_ Policy#or Self ins. Lic.#: 0, 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 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insuranc covera a verification. I-do-hereby-semi der-th in and-penalties-dfperjury-that-the-information-provide bove-is-true-and-correct Si ature: Date: ns�� Phone#: Official use only. Do not write in this area,to be completed_by city or town official City or Town:. Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3 City/Towri;Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: I"Er �� _ : Town of Barnstable * Building Department - 200 Main Street BARNSTABLE, * Hyannis, MA 02601 9� 1639. �' (508) 862-4038 ArFO MA't A Certificate of Occupancy Application Number: 200705435 = CO Number: 20080384 Parcel ID: 273204 CO Issue Date: 07/13/09 ' Location: 5 SCHOONER LANE Zoning Classification: RESIDENCE C-1 DISTRICT Proposed Use: ACCESSORY LAND WIIMPROVEMNTS Village: HYANNIS ,, Gen Contractor: MORIN, JACQUES N. Permit Type: RC00 CERTIFICATE OF OCCUPANCY.RES Comments: Building Department Signature Date Signed z s y TOWN OF'BARNSTABLE, __Building Application Ref: 200705435 rr • * sARIvsTASLE, *` Issue Date: 09/24/07 Per lt y MASS ; . a� Applicant: MORIN,JACQUES N. Permit Number: B 20072315 Proposed Use: DEVELOPABLE LAND Expiration Date: 03/23/08, Location 5 SCHOONER LANE Zoning District •RC-1 Permit Type: NEW SINGLE FAMILY HOME Map Parcel 273204 Permit Fee$ 696.93 Contractor MORIN,JACQUES N. Village HYANNIS App Fee$ 100,00 License Num 057770 Est Construction Cost$ 169,984 Remarks ' APPROVED PLANS MUST BE RETAINED ON JOB AND SCHOONER VILLAGE SINGLE FAMILY DWELLING AFFORDABLE THIS CARD MUST BE KEPT POS—TTD UNTIL FINAL 2 STORY 3)3EDROOM NANTUCKET - — INSPECTION HAS BEE9MADE1 WHERE A, CERTIFICATE OF OCCUPANCY IS1'&66 fiD,SUCH Owner on Record: NELSON;KATHLEEN A BUILDING SHALL NOT BE OCCUPII ' A . AL Y� , Addtp,9s: 12 Svc PHe INSPECTION HAS BEEN MADE. DOUij1 S,YIA 01516 k",Application Entered by F Building Permit Issued By: �-" THIS PERMIT CONVEYS`NO RIGHT.TO OCCUPY ANY STREET,ALLY OR SIDEWALK OR ANY PART THEREOF;EITHER TEMPORARILY OR PERMAt EWrLY. ENCROACHEMENTS ON PUBLIC PROPERTY;NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE;MUST'BE APPROVED.BY THE JURISDICTION'STREET,OR ALLY GRADES'AS WELL AS DEPTH AND LOCATION OF_PUB41C:SEWERS MAY BE'OBTAINED FRO1 1 THE.DEPARTMENT OF.TUBLIC WORKS:, THE iSSUANI E OF THIS PERMIT`DOES NOT-RELEASE THE APPLICANT FROM THE.CONDITIONS OF ANY APPLICABLE SUBDIVISION RLSTRICTIONS MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONTSTRUCTION WORK: 1.FOUNDATION OR.FOOTINGS. 2.ALL FIREPLACES.MUST'BE INSPECTED AT THE THROAT LEVEL BEFORE FIRST FLUE LINING IS INSTALLED. 3;WIRING&PLUMBING INSPECTIONS TO BE COIV1 L' ED PRIOR TO FRAME INSPECTION. 4.PRIOR TO COVERING STRUCTURAL MEMBERS tOADYt TO LATH). 5.INSULATION. 0..FINAL INSPECTION BEFORE OCCUPANCY. .++� WHERE APPLICABLE,SEPARATE PERMITS ARFtEQUIRED FOR ELECTRICAL,PLUMBING AND MECiE'�AI'tr1A�C INSTALLATIONS. WORK SHALL NOT PROCEED UNTIL THE INSPECTOR HAS APPROVED THE VARIOUS.S TAMES OEbON$ CIE:CION. � PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION WORK IS NOT ST j 'gHIN SIX MONTHS:OF DATE THE PERMIT IS ISSUED AS NOTED ABOVE. PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO GUARANTY FUND(as set forth in MGL c.142A). V��v BUILDING INSPECTION APPROVALS - PLUMBING INSPECTION APPROVALS Lik,f4�[ CAL INSPECTION APPROVALS 3 1�(, 1 Heating Inspection Approvals Engineering Dept. } Fire Dept vp 2' A®, �� Bo o lth r `7 R � oFZHEroi, Town of Barnstable *Permittt 1,op ti�P� ti� Expires 6 mot'11 from i s e rl Regulatory Services Fee V tip BARNSTABLE, Thomas F. Geiler, Director AIfD MA'S A Building Division Tom Perry,CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address 1_ _ VA 6 Residential Value of Work,, Minimum fee of$25.00 for work under$6000.00 Owner's Name& Address�N(lky o , Contractor's Name\ �Z'Z, Telephone Number j l�-�5'� I Ionic Improvement Contractor License#(if applicable) 0 Construction Supervisor's License # (if applicable) � ��� �&Workman's Compensation Insurance pP E S PERMIT Check one: ❑ I am a sole proprietor �l)N 2��9 ❑ I am the Homeowner I have Worker's Compensation Insurance T.OWN OF BARNSTABLE Insurance Company Name �\_ j1Y1_ _ Workman's Comp. Policy # Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side XReplacement Windows/doors/sliders. U-Value (maximum .44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. *"Note: Proper Owner must sign Property Owner Letter of Permission. A co; y of the H me Improvement Contractors License is required. SIGNATURE: 'J Pl 11.LS\I:()RMS\building permit forms\EXPRESS.doc Revised 100608 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations- 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Led Name(Business/Organization/Individual): Z Address City/State/Zip: . ( oAk —,%Q Phone.#_ ,C� •q �� Are you an employer?Check the appropriate box: Type of project(required): 1141 am a employer with _ 4. ❑ I am a general contractor and 1 6 ❑New construction employees(full and part-time).* have hired the sub-contractors 2:❑ I am a sole proprietor or partner-' listed on the attached sheet 7. . emodeling ship and have no employees These sub-contractors have g• Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'.-comp.-insurance comp.insurance$ 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 I I.❑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 1311 Other employees.[No workers' comp.insurance required] "Any applicant flrat 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 ttontractors 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 havo employees,they must provide their workers'comp.policy number. lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name. C Policy#or Self-ins.Lic.#A_oQ OQ m Expiration Date: �C1 Job Site Address: �"t `L 1— City/State/Zip. Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure io secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a finq tip 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 insurance coverage verification. I do hereby certify u er the a•n -and penalties ofperjury that the information provided above is true and correct Si Pure: Date: O _ 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#: Information and In tructions 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 7. of the foregoing engag m a Jom enterprise;and inclu3�n`g filie legal-represen�ativ�Zf- dec�aseditmpioyer,-vr-thM7-_-- - - 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-contiactor(s)name(s),address(es)and.phone number(s)along with their certificate(s)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 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 permitthcense 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 of permit to bairn 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 Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 TO. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 11-22-06 www.mass_govldia i ••. �T1. •U10�71/17LdI2LlJECIGciL 6�✓YI./.w[2C/LCLd - _ - Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration(late. If found return to: � Board of Building Regulations and Standards ReglstrAU.0?;, 100740 One Ashburton Place Rm 1301 "c .117n=�23/2010 Boston,Ma. 02108 plemeht Card CAPIZZI HOMEi( RV MFN-, tARY GUSTAFS©!4-T {,._a;� 1645 Newton Rd Cottiit, MA 02635 Administrator. - - -- No vali itho.t nature 1)iitarti)riiii ')f Public Safety - Board of E3uddiri IZc.��t�latit�r-t �►ratl �t=xtt�t��u'tts � Construction Supervisor License y License: CS 74640 Re tricted-#o: 00 r J GARY GUSTAFSON #r. 1 i 8 SHORT WAY u ';v. '. SANDWICH, MA 02563 ;FceK a ;:mot ' : Expiratir)r,,: 11/29/2010 - F (.:tf itritl.til+tiil'r' Fra: 7755 - Client#:47298 CAPIHOM ACCORD- CERTIFICATE OF LIABILITY INSURANCE DATE(9D""'") 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,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O.Box 1601 South Dennis,MA 02660-1601 INSURERS AFFORDING COVERAGE NAIC# INSURED - INSURER A: National Grange Mutual Insurance Co. Capizzi Home Improvement,Inc. INSURER B: NATIONAL UNION FIRE INS. Capizzi Enterprises,Inc. INSURER C: 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. INSR A.DD1 POLICY EFFECTIVE POLICY EXPIRATION LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MM/DD DATE EXPIR LIMBS A GENERAL LIABILITY MPB1075H 06/08/09 06/08/10 EACH OCCURRENCE $1 000 000 X COMMERCIAL GENERAL LIABILITY DDAAMAGETOEREN D n $5OO OOO CLAIMS MADE a OCCUR PREMISES 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-COMPIOP AGG s2,000,060 POLICY a PRO- JECT LOC A AUTOMOBILE LIABILITY BPO10786 06/08/09 06/08/10 COMBINED SINGLE LIMIT $SOO,000 ANY AUTO - (Ea accident) . t - ALL OWNED AUTOS BODILY INJURY X SCHEDULED AUTOS - - (Per person) $ X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS a (Per accident) PROPERTY DAMAGE (Per accident)- GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANYAUTO 5 - - • OTHER THAN EA ACC $ AUTO ONLY: AGG $ A EXCESSIUMBRELLA LIABILITY CUB1076H 06/08/09 06/08/10 EACH OCCURRENCE $5 000 000 X OCCUR CLAIMS MADE j, , - AGGREGATE $5 000 000 RDEDUCTIBLE " $ X RETENTION $1000'0 $ B WORKERS COMPENSATION AND WC006957000 12/25/08 12/25/09 X WC STA IT 0FR e T RY LIMIT - EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $1 ANY PROPRIETOR/PARTNER/EXECUTIVE .: - ,OOO,O OO OFFICER/MEMBEREXCLUDEDT _ E.L.DISEASE-EAEMPLOVEE $1 OOO,OOO If yes,describe under - - - - -SPECIAL PROVISIONS below . .- E:L.DISEASE g POLICY LIMIT $1,000000 . 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 1 n 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 ACORD 25(2001108)1 of 2 #S43470/M43449 KW 0 ACORD CORPORATION 1988 f f Page 7 of 7 CAPIZZI HOME HVIPROVEMENT INC. SPECIFICATIONS AND ESTIMATES STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT I,MARY CURRAN, OWN THE-PROPERTY LOCATED AT 44 PASTURE LANE IN HYANNIS, 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: AI OWNER'S ADDRESS: 44 PASTURE LANE,,HYANNIS,MA 02601 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: i T 'i ,• TOWN OF BARNSTABLE 26754 •- - Permit No. Buil&ng Inspector s+ur&AIM Cash XAS �O Via�" OCCUPANCY PERMIT « Bond __----------- Issued to Ba—s j de D-Uld ng Co. Address 16, 44 Pasture Lane,1�st Hv -d-part Wiring Inspector �� Rom/ Inspection date! Plumbing Inspector j, J .�� Inspection date , Gas Inspector C , � r � � Inspection date y.Engineering Department � �h�~ , Inspection date Board of Healthy �tL`� .c-� Inspection date THIS PERMIT WILL'NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILC/D�INNG} CODE. • . Building Inspector i FROM TOWN OF BARNSTABLE BUILDING DEPARTMENT W. Francis Lah .-d� Ra�87 MAIN STREET HYANNIS, AAA 02601 Town Clerk Phone: 775-1120 SUBJECT: FOLDHERE DATE ww. • Octc er 1, 1984 MESSAGE a Work has 26754 R e � a (B XIs% Building ao) �....... . . � •s..-yea.> r,.•-.o�. ��q ®�i1 w• w+r wtr M Please reFdase•Boyd. -y_. .. _ ` w wAY:9lw•s»4h•fV•" +lN f1'1•'.r �F SIGNED DATE REPLY SIGNED NST•RMI RECIPIENT: RETAIN WHITE COPY,RETURN PINK COPY PRINTED IN U.S.A. SENDER: SNAP OUT YELLOW COPY ONLY.SEND WHITE AND PINK COPIES WITH CARBON INTACT. n . 41 THE Assessors map acid lot number ... s� c� �^�--., Sewage Permit number ......!.......... .............. .v "...r::,�..+'o d Z BARNSTABLE i House number ........................y�1 ! ... ............................: ' rasa °p t639- 'OlfO MAY a. CV TOWN OF BARNSTABLE BUILDING INSPECTOR ra APPLICATION FOR PERMIT TO .........71 ........ ... . t,(........ � �f........../... TYPE OF CONSTRUCTION ........ .. . J. ......... . ............................19.,.. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby,applies fo)?, a permit according to the following information: Location ........... n . ....... V.....1}.. �+�! �. �►��.:...... .l: ..Rst�� }..)l�►,} . ................. ................................... ProposedUse ....... A.WK,.!�h..... r am......... ..... . ....................................................................... ZoningDistrict .... ..::... s ..... . .........••-.,>...�..j..........................Fire District ....... ......... ..,� ...:�"s.c.........�a................................. Name of Owner f '/ / � Gl!1 ! .Address .. I %� i ... f Name of Builder. ..................... ...............................Address .....................✓.. .J✓ �-� ................................. Name of Architect ,. ..'>...j;!.:'.C�<r .......................Address .......! Y ..k f;/!`;:.L............. .,f 7? ................... Numberof Rooms ......................y :.......................................Foundation ........ .; ✓•••..................................... Exterior .... �. /.�rl.....! :..G�Yz......<.:.?. �>._ ...........Roofing ................. ............................. Floors �i�...::..1 �. .�9.� ....: � .�. .( .:..Interior .... /!7 ':? .... �� t' 'J ....... Heating .........,` :.s .......... .. ,-! ...........................Plumbing .........y...'�4.. f +?//4 ........ Fireplace .............................t.. 0..........................................Approximate Cost .`�:..�.1eq)................................. Definitive Plan Approved by Planning Board ________� F' _ 19__ Area Diagram of Lot and Building with Dimensions Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH Fill I J :c 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 _ { !;�:` :;... .. .. -,` ..................... BAYSIDE BUILDING CO. A=248-264 No ...... Permit for ...One„St(RKY............. Sin le Famil Dwelhn ........................ Location 161.....44...Past.ure..L.ane........... .. ........ ...... .. ...... West Hvannisport ............................................................................. Owner ....B4Y4de..Buildina-.CO.................... Type of Construction ............................... ............................................................................... Plot ............................ Lot ................................ Permit Granted ...July 30, ...............19 84 ...................... Date of Inspection ....................................19 Date Completed ......................................19 07 � aye' o•-1� SAG- l/� /d� ' Assessor's map and lot number ........................... ��7 r t, '. ........... . ESEPTIC SYSTEM MUST BE �QyofTNEro�o Sewage Permit number ......: .!?2vS::�......V..s?"../...1.0 INSTALLI± 1 CC�I+ PLIANCI: House number ........................ 'fx�....f .:............., �t'l/ITH TITLE 0 asas s H TAHL *AS& 039. •,t Lys CODE AN TOWN ; OF RARNSY LE`: . BUILDING INSPECTOR 11J Q _J LLi 1-u APPLICATION FOR PERMIT TO ......... TYPE OF CONSTRUCTION ...:......... .......:............................................................... . .. .................. TO THE INSPECTOR OF BUILDINGS: .The undersigne�hhtereb ap I'es f a ermit acc rding to the foll wing informati n:" . >' Location .......... ......... ..,..... /. '..:...'. ....?... .. .�S11�1,�pf. : ................ ................................... ProposedUse .... ....... . .. . .....,/.��—�� !' .. .....................................................I......................... ZoningDistrict .... ...... ....... .A...- .. ................................Fire District ........... ....... . ............................... n Name of Owner •... . . . .C.Address ....... . —.. .. ................. ...... Nameof Builder ...... -...... .........................Address ...................:......��2 ................................. Name of Architect :.. . . ............................. . ..� �..L�..........:.............Address ....... ...,,..... ...... ................:...y�i� Number of Rooms ....Foundation' ........ Exterior ...... /� .....!.`L...C��.... ..............Roofing .................4�& ................................ Floors .........��� % ...... ..Interior ...... / � Heating ...... .........................Plumbing ......... -... .. ...`�� »:- ...... .................. Fireplace ........................ /..�f� ........................................Approximate Cost�. F. ..�1..G 4 .: .................................. Definitive Plan Approved by Planning Board ______ ______ _19 Area ...... ............... Diagram of Lot and Building -with Dimensions Fee I....... ..........D......... SUBJECT TO APPROVAL OF BOARD OF HEALTH 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. � �" Ro/��%`C rs(.�-z 1C 4 `-ef t Name .. ...x^. ;�- ! .............:....... i BAYSIDE BUILDING CO. 26754 011` tory s�" :' ,No ................. Permit for .................................... Single Family,jaweljirjgt 4-i? ............................................................................... Lot 16, 44 Pasture Lane Location ................................................................ West Hyannisport Owner .....Bay.s.ide...Building-Co. ..... ............. ...... . ...... ................. ...... Frame Type of Construction ................................ ............ ................................................................................ Plot .......... ............... Lot ... ............................. ,P'rmit,branted ...................19 84 I 'Ile Date'6f Inspection .... ....... ................19 -.f.Date Co m pleted ...: n. .......19 LIP ZONE IZB /o,000 SF boo ' wDTH • . . N _ Zo�,o�,o a� N � • ul C N 1 AT,oN C. FOUND 9 43 rbx M y CERTIFIED PLOT PLAN t0 F R4 N I- o 7-. /6 f1 S 7-u9,,C /-A MIS ROBERT �, �. PO,r'T BRUCE o ELDRE IN No SDK'%' 8CALEs ,/'f� a' DATE l �7 By ' E E-N VINEE IVe ou I CERTIFY THAT THE FouNb� r1a�ll CLI M4 Q� SHOWN ON THIS PLAN IS LOCATED 901 TER EO REGISTERED 83062 ' CIVIL LAND Jail No. ---- ON THE GROUND A9 INDICATED AN.D, CONFORMS TO THE ZONING LAMS ENGINEER SURVEYOR OR.SY� E �_ OF ®ARNSTAS E , M 'a f 7 l 2 M A I N S T R E.E.T C�1.DY� .,,_..==�=— Zi 7 � H YA N R I S, MASS. $MEET I OF DATE REG. LAND SURVEYOR