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HomeMy WebLinkAbout0270 PITCHER'S WAY vi �4 �J i'f'c-ti ors GC/r¢ �; ���� ;, o ` TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 2-5 d Parcel OZ (i Application 4d Health Division Date Issued —17=15 Conservation Division Q ;Application F Planning Dept. Permit Fee qC 7 Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/Hyannis Project Street Address 276 ?� '-S Wad Village 4u A.V1dk Owner �2r IM�Z L D Address Val�►ll! 5.1—� Telephone 7} aM DZ Permit Request e-,Y .f&m S"ME t2n0 AA_ avyo G Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation coo Construction Type Lot Size SA Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes g No On Old King's Highway: ❑Yes C kNVo Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Q7.. Total Room Count (not including baths): existing new First Floor Roo Count YV Heat Type and Fuel: 4kGas ❑Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/c al stove: ❑Y ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ e isting OTewize_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: , Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial Yes ❑ No If yes, site plan review# Current Use DHrl Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) ~ Name 4j%ft1 o S Telephone Number qW,Yff7• Address L LtiJ. License # C5 - S3 covt-1-t y%414 Home Improvement Contractor# /Dq baq Worker's Compensation # g to 'b'GU BOG-01-0 Z ALL CONSTRUCTION DEBRIS RE ULTING FROM THIS PROJECT WILL BE TAKEN TO W 01— SIGNATUR DATE it i FOR OFFICIAL USE ONLY «APPLICATION# w IC ATE,ISSUED .;u; fl � l MAP/PARCEL NO., ADDRESS7.:� VILLAGE OWNER - r DATE OF INSPECTION: ti , l t FRAME _LINSULATIONS v: FIREPLACE ` ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL i �H GAS:1H g ROUGH . -< ;. FINAL l Y .. �.=DATE,CLOSED.:OUT• _ t ASSOCIATION PLAN NO. S 1 s t Town of Barnstable Regulatory Services • snatvsDOIX • 9e Mass. $, Thomas F.Geller,Director 16.19. o►AY Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder . as Owner of the ero subject l P p rtY hereby authorize_ lu P,IL ( rA-r,�}y I yl 0, to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) 3q � Signature of Owner Date 12191�1�L V I bLLQ Print Name Q:FORMS:OWNERPERMISSION f 1 , massactiusetts - apartment of Public Safety Board of Building Regulations and Standards Cons,ruction suivri 1g111- r 1_icense: 2 ��?i,��xos� `w���T�� ��•, ('UC HOLAS A illy?\C3AJ3,+P!O `� - '.1 •'� Expiration Cr�1 ,;sssional 07/16/2015 Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 104804 Type: Private Corporation Expiration: 7/15/2016 Tr# 255509 LAGADINOS BUILDING & DESIGN, INC: Nicholas Lagadinos 13 Thankful Lane Cotuit, MA 02635 Update Address and return card.Mark reason for change. Address Renewal Employment Lost Card SCA 1 0 20M-05/11 (921 Woar.11.1.4,/z. License or registration valid for individul use only Office of Consumer Affairs&Business Regulation g y OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: gistration: 104804 Type: Office of Consumer Affairs and Business Regulation UW""xe piration: 7/15/2016- Private Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 LAGADINOS BUILDING::&DESIGN;INC Nicholas Lagadinos 13 Thankful Lane Cotuit, MA 02635 Undersecretary Not vali wi o t ignature The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations " 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): w 1 Vl 0 s 'R U I LUt KG d �f S��(/� :RNC. Address: City/State/Zip: Phone#: M f q'Z°v ' Q Are you an employer?Check the appropriate box: I am a general contractor and I Type of project(required): 4. 1.a am a employer with /(� ❑ g 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. W Remodeling ship and have no employees These sub-contractors have g• ❑ Demolition working for me in an aci employees and have workers' g y capacity. 9. ❑Building addition [No workers' comp:insurance comp. insurance.: required.] 5. ❑ We are a corporation and its .10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 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. $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. I am an employer that is providing workers'compensation insurance for my employees. Below is thepolicy and job site information.Insurance Company Name: I"1 b e1 V(Sk— SO rU a q1, seja t 1,,e( l Policy#or Self-ins.Lic.#: U —®8 Q y OG - 01 d Z Expiration Date: t z p Job Site Address: 770 hl+G r 'S WV q City/State/Zip: t 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 . Investig3tk n of the DIA for insurance coverage verification. I do tereb ce ti under pai d penalties perjury that the information provided above is true.and correct. Si natur Date: J 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#: DATE(MWDD/YVYY) ACORN CERTIFICATE OF LIABILITY INSURANCE 16. �. 01/09/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAM Applied Risk Insurance Services, Inc. PHONE (877)234-4420 FA X 10825 Old Mill Rd (A/C,No,Ext): (A/C,No): (877)234-4421 Omaha, NE 68154 E-MAIL ADDRESS: PRODUCER (877)234-4420 CUSTOMERID# INSURER(S)AFFORDING COVERAGE NAIC N INSURED INSURER A: Continental Indemnity Co. 28258 INSURER B: Lagadinos Building & Design, Inc. 13 Thankful Ln INSURER c: Cotuit, MA 02635-2616 INSURER D: CTL 1273 970254 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD SUB POLICY EFF POLICYEXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MM/DD/YYVV MM/DDNYYY LIMIT GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY ❑❑ DAMAGE TO RENTED $ CLAIMS MADE OCCUR irrance) MED EXP(any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PROQU PRO- T - MP P $ POLICY JECT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO ❑❑ Ea acddent $ ALLOWNEDAUTOS BODILYINJURY Per so ern $ SCHEDULEDAUTOS $ HIRED AUTOS PROPERTY DAMAGE Per accident $ NON-OWNED AUTOS $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS MADE ❑ AGGREGATE $ DEDUCTIBLE RETENTION $ $ WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS'LIABILITY "MIT Y ANY PROPRIETOR/PARTNER/EXECUTIVE N NIA --] 4 6-8 8 0 9 0 6-0 1-0 2 01/02/2015 01/02/2016 E.L.EACH ACCIDENT $ 500,000 A OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 5 0 0,0 0 0 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 PF-1 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach Acord 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION Town of Barnstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 200 Main St. BEFORETHE EXPIRATION DATE THEREOF,NOTICE WILLBE DELIVERED Hyannis, NA, 02601 IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 1783118 ACORD 25 (2009109) ©1988-2009 A ORD CORPORATION. All rights reserved DUICaU UL VV aaLU F1UVG11L1U11 t-Ul YUa11Ly - 100216322 hiLw.J BWP AQ 06 Notification Prior to Construction or Demolition Asbestos Project Number# A. Applicability A Construction or Demolition operation of an industrial, commercial, or institutional building, or residential building with 20 or more units is regulated by the Department of Environmental Protection (MassDEP), Bureau of Waste Prevention, Air Quality Division, under Regulations 310 CMR 7.09. Notification of Construction or Demolition operations is required under 310 CMR 7.09 (2)ten(10)working days prior to any work being performed. The following information is required pursuant to 310 CMR 7.09. Is this a fee exempt notification(city, town, district, municipal housing authority, state facility, owneroccupied residential property of four units or less)? Is this a fee exempt notification(city,town,district,municipal housing authority,state facility,owner-occupied residential property of four units or less)? D Yes P-1 No Type of Notification: Revision of an Existing Form. rj Cancellation of Project Instructions: 1.Blanket Permit Project Approval,if applicable: Approval ID# 1.All sections of this 2.Non-Traditional Asbestos Abatement Work Practice Approval,if applicable: form must be completed in order to Approval ID# comply with the Department of B. General Project Description Environmental 1.Facility Information: Protection notification DEPAOLA,BEGG AND ASSOCIATES 270 PITCHER'S WAY requirements of 310 CMR 7.09.. Name of facility Street Address HYANNIS MA 026010000 5087757819 2.Submit Original City/Town State Zip Code Telephone Form To: Commonwealth of NICK LAGADINOS CONTRACTOR Massachusetts Facility Contact Person Contact Person Title Asbestos Program 5087370362 LAGCON@CAPECOD.NET P.O.Box 120087 Boston, MA Facility Contact Person Telephone Facility Contact Person Email 02112-0087 Facility Size: 3600 2 Square Feet Number of Floors Was the facility built prior to 1980? F Yes r No Describe the current or prior use of the facility: OFFICE BUILDING Is the facility a residential facility? r Yes FJNo If yes,how many units? 2.Facility Owner: FRANK MELLO 220 WEST MAIN Facility Owner Name Address HYANNIS MA 026010000 5087757819 CityfTown State Zip Code Telephone NICK LAGADINOS 13 THANKFUL LANE On-Site Manager/Owner Representative Address Cotuit MA 02635 5084284097 Cityfrown State Zip Code Telephone Revised:03/17/2014 Page I of 3 - iviassacrnuseu5 iiepanment Gi rnvirunmemai'rrutectwn -� Bureau of Waste Prevention• Air Quality BWP AQ 06 100216322 Notification Prior to Construction or Demolition Asbestos Project Number# B.General Project Description(continued) 3:General Contractor: LAGADINOS BUILDING&DESIGN INC. 13 THANKFUL LANE Name Address COTUIT MA 026350000 5084284097 City/Town State Zip Code Telephone NICK LAGADINSO 5087370362 General Contractor's On-site Manager/Foreman Telephone C. General Construction or Demolition Description General 1. Construction or demolition contractor: Statement:If asbestos is found LAGADINOS BUILDING&DESIGN INC.. 13 THANKFUL LANE during a Construction Contractor Name Address or Demolition operation,all COTUIT MA 026350000 5084.284097 responsible parties City/Town . State Zip Code Telephone must comply with 310 NICK LAGADINOS 5084284097 . CMR 7.00,7.09,7.15, and Chapter 21 E of Construction and Demolition On-site Manager Telephone the General Laws of the Commonwealth. 2.Licensed Contractor Supervisor: This would include, but would not bw NICK LAGADINOS CS-012653 limited to,filing an asbestos removal Supervisor Name License Number notification with the Department and/or a 3.Is the entire facility to be demolished? rJ Yes R No notice of release/threat of 4.Describe the area(s)to be demolished: release of a hazardous BASEMENT BATHROOM AND BREAKROOM substance to the !� Department,if applicable. 5.If this a construction project,describe the building(s)or addition(s)to be constructed: MassDEP Use Only RENOVATE BATHROOM AND BREAKROOM ' Date Received 6.If this is a demolition.or renovation project,were the structure(s)surveyed for the presence of Asbestos-Containing Material(ACM)? Yes No 7. Was asbestos containingmaterial ACM found? yes No (ACM) I If a survey was conducted,who conducted the survey? Name Department of Labor Standards Certification Number Revised:03/17/2014 Page 2 of 3 I 1VIUSSUCnUseLLS liepartmeni ut rmvirunmemat rrutecuon -R Bureau of Waste Prevention•Air Quality �, .'�+ 100216322 i a BWP AQ 06 ' Notification Prior to Construction or Demolition Asbestos Project Number# C.General Construction or Demolition Description(continued) The Asbestos Abatement Notification Number for this address is: This project r Construction ❑ Demolition is: 4/18/2015 6/18/2015 Project Start.Date(MM/DD/YYYY) Project End Date(MM/DDNYYY) 8. For demolition and construction projects,indicate dust suppression techniques to be used Seeding f—i Wetting F, Covering Paving Jyj Shrouding r Other-Specify: 9.For Emergency Demolition Operations,who is the MassDEP official who evaluated the emergency? Name of MassDEP Official Title Date of Authorization(MM/DD/YYYY) MassDEP Waiver Number D. Certification "I certify that I have personally NICK LAGADINOS examined the foregoing and am Print Name familiar with the information contained in this document and Authorized Signature all attachments and that, based PRESIDENT on my inquiry of those individuals immediately Position/Title responsible for obtaining the LAGADINOS BUILDING&DESIGN INC. information, I believe that the Representing information is true,accurate, and complete. I am aware that there Date(MM/DD/YYYY) are significant penalties for submitting false information, including possible fines and P.E.# imprisonment. The undersigned hereby states, under the penalties of perjury,that I am aware that this permit application or notification shall not be deemed valid unless payment of the applicable fee is made." Revised:03/17/2014 Page 3 of 3 Massachusetts Department of Environmental Protection f eDEP Transaction Copy Here is the file you requested for your records: To retain a copy of this file you must save and/or print. Username: LAGCON Transaction ID: 726527 Document: AQ 06 -Construction/Demolition Notification Size of File: 218.92K Status of Transaction: In Process Date and Time Created: 3/10/2015:9:53:10 AM Note: This file only includes forms that were part of your transaction as of the date and time indicated above. If you need a more current copy of your transaction, return to eDEP and select to "Download a Copy" from the Current Submittals page. t3uicau ui VVMoLU ricvciiuvii- nu yuauny r= BWP AQ 06 Notification Prior to Construction or Demolition r This is a revision to an existing form. Project ID for existing form to be revised: EJ This job is being conducted under a Blanket Permit MassDEP assigned Blanket Authorization ID: r This job is being conducted under a Non Traditional Abatement Work.Practice Permit. MassDEP assigned Non Traditional Work Practice Authorization ID: r None of the above conditions apply,generate a new form. Revised: 11/13/2013 Page 1. of 1 - 'EM5a Town of Barnstable *Permit# Won& laq Expires 6 mo the from issue date kk t. + ZJ1RN8rABLE. Regulatory Services Fee3�0. 9a MAS& Thomas F.Geiler,Director ►+9' Building Division ©� Tom Perry,CBO, Building Co sPio ESS IT ��- 200 Main Street,Hyannis,MA 02601 NOV 15 2006 www.town.bamstable.ma us aa��pp �/ Office: 508-862-4038 TOWN OF BAK HtsL_t30 . EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address 7� T / TC> S �>¢�/ l7 /flN�!/ �" 02601 ❑Residential Value of Work ' % &4$6 . Minimum fee of$25.00 for work under$6000.00 /DOd Owner's Name&Address 11e, AJ r- A/L-z LO o?�D A).' 1V,4 i Aj X T yffN/V/x %1/1.4 Contractor's Name JD f l V j fJ L/1 C.G% Telephone Number 50,?- 7 7 s- Home Improvement Contractor License#(if applicable) /A 7'70 Construction Supervisor'.s License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner 9I have Worker's Compensation Insurance Insurance Company Name /itJ. ,SLR 1AX6 c",je of Gf (f 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 Replacement Windows. U-Value ,3`L (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. Im vem Contractors License is required. Ze . SIGNATURE: l ,QForms:expmtrg 71405 r cu NOV-14-2006 TUE 01:59 PM Depaola, Begg & Associat FAX NO. 508 771 6637 P. 01/01 Town of Barnstable i�gnl>�ttory Services MOo Geller,Director Building Division rwq,C90 Hsi 6%Commbsioner 200 Main 6ut, Hy mis,MA M60 3 ww Pty�,parsahbk�a.Ya Fax: 508-790.6230 office: 509462-4038 — - - Pro Must Complete�,and Sign This Section If losing A Builder as Owner of d=subject property hereby au*Mize .E i rho✓elNE7v;" ojO C- to act oa my behA in aU matters ret'+tive to work aLlo�ed by dais bw7ding pit application for: i 7ztrcx S JA API d Of job) Dace Si a of Owner Ptmt Name Q,fams:oapmaC Hev6e071405 dSz t io so bT noN The Commonwealth of Massachusetts In Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly. Name(Business/Organization/Individual): )4/1/IC Address: � — 1 Yq-7v o a 6 F1 S 6ou� 28 City/State/Zip: /�y'lL,/u/s al Phone#: 6 M 7 7 S—28 Are you an employer?Check the appropriate bog: Type of project(required): 1. / 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. $ Q Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp.insurance. 9. ❑Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its officers have exercised their 10.❑Electrical repairs or additions required.] 3.❑ I am a homeowner doing all work right of exemption per MGL I LEJ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑Roof repairs insurance required.]t employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. +Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. /J Insurance Company Name: /l1/0�Gc f�rV L� 1 e, �/ D Policy#or Self-ins.Lic. CF �G�� /� Expiration Date: Job Site Address: �%o City/State/Zip: di Gi! 0i'I 14 1,4A Z lv0 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 insurance coverage verification. I do hereby fy under taandpenaldes of perjury that the information provided above is true and correctS1 afore: �sl/� Phone#: ,�O0n 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#: i JBOARD OF BUILDING REGULATIONS _ License: CONSTRUCTION SUPERVISOR Number. CS 069152 ' Birthdate: 1 2/1 111 962 Expires: 12/11/2006 Tr. no: 6328.0 Restricted: 00 JOHN M FALACCI PO BOX 1224/1441 RT 132 HYANNIS, MA 02601 Commissioner ,�, ../IfP. �/`0911 JNG17fI.'ofLl�iA C�1(?JAII'f%!flJ2�S Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR - dt-..- Registratio --- - - �� `'--- gyration: 10/25/2�00-- - Type: Private Corporation HOME IMPROV ENT SPECIALIST OF CA D JOHN FALACCI 25 IYANNOUGH RD HYANNIS,MA 02601 Administrator ACORa._ CERTIFICATE OF LIABILITY INSURANCE CSR CT „"."_"......, HOMEI-1 08/30 06 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION The Insurance'Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE of Cape Cod, Inc. HOLDER THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 480 Route 6A, P O Box 960 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. East Sandwich MA 02537 Phone: 508-888-2766 INSURERS AFFORDING COVERAGE -i NAIC S INSUREDJVSUReRA: Safety Insurance Company 1 33618_ INSURER It AIG American International o Home Improvement Specialists 1NsuaFa c Harl of Cape Cod Inc. �_ .. eysville Worcester Ins o P 0 Box 1224 INSURER D: Hyannis MA 02601 - — �INsuaeR e i COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD NOICATEO.NOTWITHSTANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WIT14 RESPECT TO WIIICM THIS CERTIFICATE MAY Be ISSUED OR MAY PERTAIN.THE INSURANCE ACFORDEO BY THE POLICIES OESCRIBEO HEREIN IS SUBJECT TO ALL THE TERM&CXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE IWEN REDUCED OY PAID CLAIMS. INSIR R TYPBQFINSURANCE ._� .• POUCYNUMBER DA�IVE DATE ML�4F TA711!_ LIMITS GOMRAL LIABILITY - .CACHOCCURRENCE $1000000 C I COMMERCIAL%KMAL LIABILITY CBSJ4134 j F�tEMIs' E E w) _ 14 1000 o CLAMS MADE ,OCCUR MED CXP(AnY ono pmon) S SOOO �. .j X Business Owners 09/02/06 09/02/07 PERSONAL sAov1NJIJaY �-:--- -GENERAL-AGGREG'ATEE is 2000000 GEN'L AGGREGATE LIMIT APPLIES PER: - - --- PRODUCTS-COMPIOP AGG't-- --- —- POLICY �� LOC AUTOMOBILE LIABRdTY COMBINED SINGL.Ct LIMIT A ANY AUTO 3953673 09/16/06 09/16/07 (E9xd0entI s 1000000 ALL OWNED AUTOS I BODILY INJURY _ X SCHEDULED AUTOS HIRED AUTOS I BODILY INJURY NON-OWNED AUTOS I I I (Pa xoilsAt PROPGRTY DAMAGE 'S (P9r atCJcicnl) I LGARAGH LIABILITY 1 AUTO ONLY•EA ACCIDENT i ANY AUTO OTHER THAN EA ACC S AUTO ONLY: --AGGI S EXCESS UMBRELLA LIABILITY I I I EACH OCCURRENCE S ` OCCUR �CLMAISMADE i ( AGGREGATE I DecuCTtBLE i _L' _ RETENTION S I S fWORKERS COMPeNSATIOk AND IT IMITS _ I•ER B I E"P ' TM WC8964613 I 09/15/ 09/15/07 E.L. ACCIDENT i s 100000 ANY PROMETORMARTNERM)MCUTNE i IOFFICERIMEMBEREXCLUDE07 a ISeASE-EA EMPLOYEE R1000O0 ryyees�aKw�s Nflaer 1 L.DISEASE•PouCY Lima t 500000 9PECUL PRO%SgN b oNa. iOTHER I l Lr MRTY 95000 I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUMM ADDED BY ENOORSEN601 SPECIAL PROVISIONS 1995 Chevy 010 VAN IGCDG1524SF222051 1986 Chevy Flat DUMP TRVCx IGUC34MOGS199051 Home improvement and remodeling CERTIFICATE HOLDER CANCELLATION WOODpia SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EYPIRATICI DATE THEREOF,THE ISSUING 94UMP WILL ENDEAVOR TO MAR. 30 DAYS WRITTEN NOTICE TO THE 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 EThe7jn!afura!n7cen�ncy ACORD 25(2001/08) ®ACORD CORPORATION 1988 -�3 . Town of Barnstable *Permit# ? �l Expires 6 months from iss date ,ARMAD : Regulatory Services Fee NAM ,0� Thomas F.Geiler,Director Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 X-PRESS PERMIT Office: 508-862-4038 Fax: 508-790-6230 AUG 2 5 Z003 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint TOWN OF BARNSTABLE Map/parcel Number Property Address Cann ®Residential Value of Work V000 Owner's Name&Address t ` Contractor's Name_ C�Q gx.✓i Telephone Number g 9Q_ Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) rye. Q]Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner ❑9 I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Permit Request(check box) 00'Re-roof(stripping old shingles) All construction debris will be taken to V6t/1 ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows. 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: o erty Owner must sign Property Owner Letter of Permission. Hom Im pt Con icense is required. Signature Q:Forms:expmtrg Revise053003 J Fraser Construction 1% Roofing 8v Siding Specialists li l i %Y FRASER CONSTRUCTION Warranties the shingles and labor for 10 years. FRASER CONSTRUCTION Warranties the shingles against Blow-Offs for 10 years. CERTAINTEED Warranties th ingles and labor 100% for the first 5 years, and then on a pro rated basis for 30 0 50 ears total if the shingles become defective. CERTAINTEED Warranties the shingles to be ALGAE Resistant for a full 10 years. Any deviation or alteration from above specification will be executed upon written orders and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays are beyond our,control. Owner should carry fire, tornado and other necessary insurance upon the above work. We, if not accepted within thirty days may withdraw this proposal. FRASER CONSTRUCTION Carries Workman's Compensation and Public Liability Insurance on the above work.. DATE OF ACCEPTANCE: SUBMITTED BY: meowner Fraser Construction 4 z • � � ;/fee�ammwnuiea,/� o�/�oac�ivaelta Licew. Board of Building Regulations and Standards beforE HOME IMPROVEMENT CONTRACTOR Board RegisthA%—n;__112536 One A. iraUon 32:12005 Boston �Typ� 'Daq ix 11 c 4 9 ERASER CONSTI k0cmbk.co, DEAN FRASER 71 TARRAGON CIR COTUIT,MA 02635 Administrator 801Z0 s143sn4:i 10£i uzoo-�j - 33e, spzepums Put suot C J { J. -1 T . t,." -.._,f F�, -v«2, oa �� I 1 µ• � � I( — LiT S i- c c'�Ids�'� s I• . r i T g1 ! F ` . w ` MAI .y a P. - 1 �i � 1 44� ier'g, r D cu N. 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Y 'w+•�,•a`?.++! �+'+he a+,"•^ �, rkl�� 4 x"adl { j� `2` v , v q ' . r �t °i�; r ;�^ "" � � - � its �+i. .� ;F •-�: - k { A i iz'•ad` .3-i � � R S' .,� - � .'k � ,F, V IN i r n . a 6 . �1 zs 4, a s. y� 9 YrF tip a �, �� "'t'`t* `y •..,� r ...�;�F `� � r -tee i� � - "�#-�: t ^{�.. .� 4`. �`��' =ice � "t r �• �"� ��' i�d 3 � r .a' ., Wyk e *v P wv- Vtl dizd %,nr. qzV�: °ep fir_ - s air pp (y t • 4 .*_..&".».•z:..:`,�s�.w—�'.w..-'w�4'�.i>-� �"R � ,L. � I' '�(('.rE E^ s,d '" � ,t..; �C FdJ �' r'" "% , ^e rat r�r .�'i� .nf..w..w, 'r4T•�: ,{�; j�- � S , IpF9 s•t a : �'i w DESIGN BY: NAL Lagadinos Building and Design Inc. 13 Thankful Lane September i9,2014 DePaola Begg Office cotuit MA 02635 '- - � �� •, ' 220 West Main St. - tel 508-428-4097 fax 508-428-7709 Hyannis MA 02601 email lagcon@capecod.net _ www.LagadinosBuilding.com - ' _ .,✓ •;, .. !' ��� yr. t d.t�.-- M. �, .« -