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Home My WebLink About0326 PITCHER'S WAY �� • 0 i Cape Save Inc. TOWN 01� FAWTA L 7-D Huntington Avenue South Yarmouth, MA 0AW4 16 - AM Irk C13 Tel: 508-398-0398 Fax: 508-398-0399 of 06/12/12 Town of Barnstable Thomas Perry CBO Building Commissioner 200 Main St. Hyannis,MA 02601 RE: Building Permits Dear Mr. Perry, This affidavit is to certify that all work completed for 326 Pitchers Wav,Hyannis has been inspected by a certified Building Performance Institute(BPI)Inspector. Ceiling: R-30 cellulose Basement: R-7.2 (1")Thermax on foundation walls & R-19 in fiberglass in box sill area Floor: R-30 cellulose in front over hang All work performed meets or exceeds Federal and State Requirements. Sincerely, William McCluskey TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map h Parcel Application # a 7 J d3 Health Division Date Issued 7" Y Conservation Division Application Fee J Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH . Preservation/ Hyannis Project Street.Address 3 Village Ant Owner Address a,fh(° Telephone Permit Request 1 rd R� 1 cuJ R -30 Ad r, Tamilr S h exprudilqi Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑ Walkout ❑ OtherME c� N o Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.fP- Number of Baths: Full: existing new Half: existing never -n Number of Bedrooms: existing _new Cn Total Room Count (not including baths): existing new First Floor Roo Count -C''+ Heat Type and Fuel: ❑ Gas. ❑ Oil ❑ Electric ❑Other a rn Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing. ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes gNo If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION I I II (BUILDER OR HOMEOWNER) Name �owInclTelephone Number �0$ 39 E 031 Y Address '�� fl n��irVa License# 1C l Oot�1 D Jo4 "144, m ft o a 6 6 w Home Improvement Contractor# a( 3 (D Email Worker's Compensation # Wwr_ 3 96,31 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO SIGNATURE DATE /110 Aq k• FOR OFFICIAL USE ONLY APPLICATION# { DATE ISSUED, I MAP/PARCEL NO.. qr _ ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION t FRAME INSULATION kf FIREPLACE i4 i s ELECTRICAL: ROUGH FINAL f� PLUMBING: ROUGH FINAL GAS: ROUGH FINAL kt FINAL BUILDING DATE"CLOSED OUT AS600 -ION.PLAN NO. c Housing ' �® Assistance Corporation cape CM HOME OWNER WEATHERIZATION WORK PERMIT&FUEL RELEASE: PLEASE FILL OUT AND SIGHT THIS FORM IF YOU ARE f� THE APPLICANT HOME OWNER. IrlFti% hereby consent to and agree that weatherization work may be done by the Weatherization Program of Housing Assistance Corporation ( herein after referred as "Agency" ) on 'the property located at: The weatherization work done will be based on programmatic priorities and availability of funding and it may include all or' some of the following measures: Weather-stripping & caulking of windows and doors, insulation of attics, sidewalls & basements, attic and other ventilation measures and possibly replacement of badly deteriorated windows. in consideration of the weatherization work to be done at my home I agree to the following: 1. I give permission to the uAgency" its agents and employees to travel onto or across said property with such equipment and materials as may be necessary to perform weatherization work on said property. 2. The Housing Assistance Corporation reserves the right to inspect the fuel or utility bill for the weatherized unit on an ongoing basis for no more than five (5) years after the weatherization work is completed. I have read the provisions of this agreement as listed and freely give MY consent. � .. Home Owner: (Signature) -Date: Agent: (signature) '' Date: u__ - j' r I The Commonwealth ofMamaehusetts Department of Industrial Accidents ' Office of Investigations I Congress Street,.Suite 100 7 s Boston,MA 01114-201`7 www.mass govldia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electri.cians/Plumbers Applicant Information Please Print Legibly Name(Business/organization/[ndividual), Cape Save Inc. Address: 7D Huntinotori Ave City/State/Zip: South Yarmouth,lVlA 02664 Phone'#: 508-398-0398 Are you an employer?Check thk appropriate box: Type of project(required)- I.0 I.ant-a employer with 4. 0 I am a general contractor and I 6. New construction employees(full and/or part-time):* have hired the sub-contractors 2.❑ Lam a sole..prnprietor or partner- listed on the attached sheet. 7. n.Remodeling ship and have no employees These sub-contractors have g_ E]Demolition workingfor in an capacity. employees and have workers' ty• 9. [] Building addition [No workers'comp.insurance. com11 p.insurance.* Y p 5. We are a.corporation and its I O.[� Electrical repairs or additions required.] officers have exercised thei r 11. Plumbing 3.� I am.a homeowner doing all.work.. ❑ g repairs,pairs or additions myself.[No workers' comp., right of exemption per MCL 12.0 Roof.repairs insurance required.]t c. 152, §1(4),.and we have no employees. [No workers' 13• .Other lnsulafion comp.insurance required] *Any applicant that checks box#I must also fill out:the section below showing their workers'comp-tion policy information. t Homeowners who submit this arlidavit 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.-addition-al shM showing the name or the sub-contractors and state wheiher or not those'entities 6 employees. if the sub-cons acto s have employees,they must provide Their workers'comp.policy number. I an:an,employer that is providing workers'compensation insurance for my employees. Below is the policy andjob site information, Insurance Company Name: Wesco Insurance Company Po( cy#or Self-'ins.Lic.# WWC3085633 . . Expiration'Date: 04/09/2015 Job Site Address: .f2 City/State/Zip; ftf11J Attach a copy of the workers'compensation policy declara ion page(showing the policy number nd expiration date)., Failureto secure:-coverage as.required under Section 25A of MGL c. 152 can lead to the imposition of criminal'penalties of A fine up to S 1,500.00 and/or one-year impri sonment,as well as civil penalties in the form of a STOP WORK ORDER and a f ne of up to$2.50.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the D1A for insurance coverage veriftcation.. 1 do hereby certi under the a ns and e-nalties of er` that the in orrnation provided above is true and'correct. Simiature:' _ Date . Phone#: 50$-39$-b39$ Official use only. Do:not write in this'area;to he.coinoleted.by city or town official, City or Towne Permit/Llicense# .issuing Authority(circle one): I.Board of Health 2..Building Department 3.City/Town Clerk 4.Electrical inspector 5.Plumbing Inspector. 4.Other _ - . Contact Person: Phone#:_. ,4co CERTIFICATE OF LIABILITY INSURANCE /14/ 014 `../ 4/I4 j2 014 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 1 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 inJleu of such endorsement s). PRODUCER -NAME:CONTACT C011 n Crowley Risk Strategies COUP-Iny PHONE (781)986-4400 FAIL No:(Te1)963-4420 019-1410 15 Patella Park Drive h-MAIL Appgess.ccrowley@risk-stratega.es..com :Suite 240 iNSURER(S AFFORDING COVERAGE .. .:NAIC* . :Randolph MA 02368 INSURERA:Selective Ins.., oP' America INSURED iNsuRERB!Safety Insurance Ccuipany 33611EI . Cape Save, Inc INsuRERc Weseo Insurance Company, _ . 7 D Huntington Ave INSURERD: INSURER E South. Yarmouth. IaL 02664 INSURERF: :AVERAGES CERTIFICATE NUMBER CL1441475243 REVISION NUMBER: THIS IS TO CERTIFY'THAT THE:POLICIES OF INSURANCEi 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 SUCKPOLICIES.LIMITS.SHOWN'MAY HAVE.BEEN REDUCED BY PAID CLAIMS.. INSR. ._.... _ POLICYEFF- POLICY EXP - - L7R TYPE OF INSURANCEIMM WVD POLICY NUMBER MMIDDPrrrn (MMIDD1YYYYI LIMITS GENERAL.LIABILITY.. - - EACH OCCURRENCE $ 1,000,000 X COMMERCIAL A CLAIMS-MADE GENERAL LILIABILITYPREMISES a occurrence) $ 160,000 M1AADE Q OCCUR I99448 O/16/20130/16/2014 0 MED EXP(Any one person) $ 10,000 PERSONAL 8 ADV INJURY $ 1,000,000 r,ENERAL AGGREGATE $ 2,000,000 GENL AGGREGATE LIMIT APPLIES;PER;' PRODUCTS-COMPIOP AGG '$ 2,000,000 POLICY X. T PRO- X .LOC $ AUTOMOBILE LIABILITY Co E accidenf L L I 1,000,000 —� BIx ANY.AUTO BODILY MJURY(Per person) $ ALLOVYNED- SCHEDULED 208200 1J6J20Y3 1/6./2014 - AUTOS X AUTOS _ -BODILY INJURY(Per axident) $ NON-ONMED PROPERTY DAMAGE HIRED AUTOS X AUTOS Perecddent X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000 DEC) I 1ALTENTION Nit S1994480 . :0/16/2613 0/16/2014, C, WORKERS COMPENSATION ' Officers: Included For X VvCSTATU- OTH- AND EMPLOYERS'LIABILITY YIN - T RY MI R ANY PROPRIETORIPARTf4ERIEXECUTIVE overage OFFICERIMEMSEREXCLL$SELY! NIA E.L. ACH ACCIDENT $ 500 000 (Mandatory in NH). 3085633 /9/2014 /9/2015 It yes,describe under E:L.DISEASE-:EA EMPLOYE E $ 500,600 - -- DESCRIPTION OF OPERATIONS b-dow E.L,DISEASE-POLICY LIMIT 'S 500,000 DESCRIPTION OF.OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD:101,Additional Remarks'Schedule,If more space is required) Issued as evidence ,of insurance. Issued as evidence of insurance. Thielsch Engineering, Inc, is listed as additional insured as respects General Liability as required by written contract:.. - - . 4 , t CERTIFICATE HOLDER CANCELLATION msong@capelightcomact.;Org SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Cape Light Compact Attn: Mrgaret Song PO BOX 427/SCH AUTHORIZED REPRESE4ATIVE 3195 Main Street Barnstable, MA.. 02630 chael ChristianjCl;C. < AGORD 25(2010105)': O 1888-2010 ACORQ CORPORATION. All rights reserved. INS025(201005).0l The ACORD.name and logo are registered marks of ACORD e C ✓'a ac i Office of Consumer Affairs.,and Business.Regulation 10 Park Plaza :Suite 5170 Boston; Massachusetts 02116 —Home Improvement Contractor Registration Registration: 171380 TYPe: Corporation Expiration:.;3/14/2016 Tr# 249649 CAPE SAVE INC: ,. WILLIAM MCCLUSKEY 7-D HUNTINGTON AVENUE:�..; " SOUTH YARMOUTH, MA 02664 J, 4 v ry Update Address and return card.Mark reason for change: ' Address Q Renewal Q Employment Lost Card SCA 1 d f 2OM-05/1 T _^T Vfte�pdnv�yaO�ii[Ve[r�Me,aC-1/ 90c7sestllle - Office of Consumer Affairs&Business Regula6u License or registration,valid-for individul,use only. OME IMP.ROVEMENT.CONTRACTOR _ before`the expiration date. If found return to: eg'istration: j71380`- Type: Office of Consumer Affairs and Business Regulation Expiration 3/-14/2016` Corporation 10 Park Plaza-Suite 5170 l� Boston,MA 02116 CAPE SAVE INC..-,. yf f � ` t WILLIAM McCLUSKEY a 7 7-D HUNTINGTON AVENUE � _— SOUTH YARMOUTH;MA 02664 Undersecretary Not vali ithout signature fit Massachusetts.:-Department of Public Safety. Board of Building Regulatior►s and Standards Construction Supert'isor Specialty License: CSSL-102776 WILLIAM J MC SUS r V 37 NAUSET,ROAU West Yarmouth 1V3A.02 Expiration Commissioner 06/28/29015 I v r� Town of Barnstable *Permit# �; c Regulatory Services Fee ! I�� t Expires 6 months from issue date a Thomas F.Geiler,Director �� i63q 0 TO s. 2008 BuildingDivision a gRIV Tom Perry,CBO, Building Commissioner ST,g13LE 200 Main Street, Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY X 508-790-6230 Not valid without Red X-Press Imprint Map/parcel Number��{ `1 Property Address ('0 4a an esidential Value of Work7l L�,�.J _1 Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address Qh_f�,)\1 Contractor's Name Aii Telephone Number �j Home Improvement Contractor License#(if applicable) , `4 0 ❑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# , i Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) XRe-roof(stripping old shingles) All construction debris will be taken to Q ` ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders. U-Value (maximum .44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License is required. SIGNATURE: Q:Forms:buildingpermits/expFess Revised 123107 a Page 7 of 7 CAPIZZI HOME IMPROVEMENT INC. SPECIFICATIONS AND ESTIMATES STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT OWN THE PROPERTY LOCATED AT IN (A Li('l �� , MASSACHUSETTS. I HAVE AUTHORIZED CAPIZZI HOME IMPROVEMENT TO ACT AS MY AGENT TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. I GIVE MY PERMISSION TO LESSEE TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. SIGNATURE OF OWNER: OWNER'S ADDRESS: OWNER'S TELEPHONE: LESSEE'S SIGNATURE: LESSEE'S ADDRESS: LESSEE'S TELEPHONE: APLLICANT'S SIGNATURE: APPLICANT'S ADDRESS: 1645 Newtown Rd., Cotuit, MA 02635 APPLICANT'S TELEPHONE: 508-428-9518 RESPONSIBLE OFFICER: RESPONSIBLE OFFICER ADDRESS: RESPONSIBLE OFFICER TELEPHONE: Client#:47298 CAPIHOM DATE ACORDTM CERTIFICATE OF LIABILITY INSURANCE 06/12/2008 ' PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Rogers&Gray Ins.-So. Dennis ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 434 Route 134 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.0.Box 1601 South Dennis,MA 02660-1601 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA: NGM Insurance Company Capizzi Home Improvement,Inc. INSURER e: American Home Assurance 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. INSRDDTYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLI EXION LIMITS LTR NSR DATE MM/DD/YY DATECY PIRATMM/DDIYY A GENERAL LIABILITY MPB1075H 06/08/08 06/08/09 EACH OCCURRENCE $1 000 000 X COMMERCIAL GENERAL LIABILITY DAMAGEES(Ea occurrence)RENTED $500 OOO CLAIMS MADE 7 OCCUR MED EXP(Any one person) $10 000 PERSONAL&ADV INJURY $1 OOO 000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG s2,000,000 POLICY PRO LOC JECT 17 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY _ AUTO ONLY.EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ A EXCESS/UMBRELLA LIABILITY CUB1076H 06/08/08 06/08/09 EACH OCCURRENCE s5,000,000 X OCCUR CLAIMS MADE AGGREGATE s5,000,000 RDEDUCTIBLE $ X RETENTION $10000 $ B WORKERS COMPENSATION AND WC6716562 12/25/07 12/25/08 X WOY ER C STATU• OTH- EMPLOYERS'LIABILITY E.L.EACH ACCIDENT s500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE s500,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $500,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES I 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 In 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(2001/08)1 of 2 #S36540/M36539 KW 0 ACORD CORPORATION 1988 —, The Commonwealth of Massachusetts Department of Industrial Accidents x W Office of Investigations 1 600 Washington Street �< Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Cozitractors/Electricians/Plumbers A licant Information .Please Print Legibly Name (Business/Organizationflnditiidual): , Address: ca lzzl Home ^` 16 a City/State/Zip: cotuit, io} e.#:: Are,you an employer? Check the appropriate bogs .Type of project(required):. 1, I am a employer wit `h 4• ❑ 1 am a general contractor and I * have hired the sub-contractors 6, ❑New construction . employees(full and/or part-time). �, Remodelin 2.❑ I am a'sole proprietor or partner- listed on the attached sheet. ❑ g ship and have no employees These sub-contractors have g, []Demolition employees and have workers' working for me in any capacity. 9, [�Building addition o workers' com insurance comp, insurance.t [N p. 10. Electrical repairs or additions required.] 5. [] We are a corporation and its officers have exercised their 11. Plumbing repairs or additions ' 3.❑ I am a homeowner doing all work . p myself.[No workers'comp. right of exemption per MGL 12,aRoof 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 o.ut 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 anew affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether ornot 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: Q ro 0) Policy#or Self-ins.Lic.it: Expiration Date: Job Site AdIares81 City/State/Zip: :l7rl 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 statemexit maybe forwarded to the Office of Investi ations of the DIA for insurance covera e verification. I'do hereby certify under the pains and penahie t the information provided above is true and correct. t Si Mature: Date: 1 Phone#: - Official use only. Do not write in this area, tb be completed by.city or town off cial, City or Town, PermitrLicense# 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 : M] 91te Board o u A in e uIaa�n�an tan ar g gds One Ashburton Place - Room 1301 Boston, Mas achusetts 02108 Construction ` upervisor License License CS: 57032 Restriction: 00 ix " i ltf? Birthdate: 9/26/1963 Expiration: 9/26/2009 Tr# 3801 THOMAS X CAPIZZI JR r ----- 1645 NEWTOWN RD = fa 9 ,: jj COTUIT, MA 02635 y � -" � tiNS Update Address and return card.Mark reason for change ❑ Address Renewal Lost Card DPS-CA1 Co 5OM-05/06-PC8490 a ✓fie via»vnu»uuea� n��,tradarizuae(,�6 , 4 Board'.of Building.KR gulatiofis and Standards Construction Supervisor License c -Licon e: CS 57032 j At rs Birthdate: 9 i _ /26/1.963i pit xE 'ice a n 9/ 6/2009 Tr# 3801 ` 1 t j r. fio a, _ i THOMAS X4CAPI ( a 1645 NEWT N R� COTUIT,MA 02635 Commissioner CIN /ze Go�n�rnooz.uea/� o�,/l/�aaauc��u�r/la 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: - Registration 100740 Board of Building Regulations and Standards Ex iration One Ashburton Place Rm 1301 ` P ,6/23/2010 Tr# 267955 Boston,Ma.02108 cType Private Corporation CAPIZZI HOME IMPROVEMENT INC. Thomas Capizzi,Jr.", _ 1645 Newton Rd. ' ''•`V , ,` Cotuit, MA 02635 Ad,1,inistrator Not valid without signatu e y�FTHET TOWN OF BARNSTABLE BASHSTAIMM ' i6aM a' BUILDING INSPECTOR 90p 39. \e� E YPY APPLICATION FOR PERMIT TO ..................... .. .. ..... ....................................... ........................... TYPE OF CONSTRUCTION ........................................................................................... ................................/.. ./ 19.: TO THE INSPECTOR OF BUILDINGS: / 771f The undersigned hereby applies for a permit according to the following information: Location .............................. .. ......s? �? �... .... ..�1. 0 f '�- .. ..... .../ n9 .�N..S� Proposed Use ... 1..qq.!. ... . .`.!. ........� .:.....�11,�'�'.�-.�..�. q. ................................................................... ZoningDistrict ........................................................................Fire District .......•....................................................................... Name of Owner �..Q..... ...!.:J..tiv� ...........Address Y .... 1... .."Y.`?.�.`!..... !.. C//�(. Name of Builder ...............Address .......................................................... Nameof Architect ......... .......................................................Address ............/............................................/j.......................... 'Number of Rooms .........q. /....................................................Foundation �./...�.....�!l.v A..'e �.f.......... .... ............... ... .... Exterior ...//Y.:. + :. i ....... ......................Roofing ...li.� s l,................................................................ Floors 4f .Interior 6. . / ,.................................................. Heating :../.. ...r..... .p2....!e:/4r'.�..4.........Plumbing ...CO..?��........�./.�,.�............................. Fireplace .......t;;:2..- ....................................... . .....................Approximate Cost .. ....o°.. ................................. Definitive Plan Approved by Planning Board ----------------_______________19 Diagram of Lot and Building with Dimensions SUBJECT TO APPROVAL OF BOARD OF HE T THE PROPOSED METHOD OF PROVI6Q FOR SANITARY WATER SUPPLY, SEWAGE DISPOSAL `7AND _ '00 0 /4 — ,;;71" , /� TOWN OF BARN TABLE. BOARD OF HEALTH A LICENSET INSTALLER -MUST OBTAIN SEWAGE PERMIT. AND INSTALL StSTEM. F O RA d Plell tv I hereby agree to conform to all the Rules bnd Regulations Pownnstable regarding the aboveconstruction. 4' Nam ........ ........ .............................. .`" R ^ � Jackson, Lee - - �~ one -story .~" —��!��'' Permit for .................................... �--..��c��..��..�^�^��_____._... ^ Location -- .}�n'-------.---. �- - —'--'----��@��.--.--.___---_._ . ' Owner —' Lee | , _ _ _ -----.��:.�r�.,—..--.—.---' . c� Type of Construction ---..��-----'— ----^-^--'~^^---'—...---- ..~—.—. . —. Plot �� n� ' . ^'--------'' ----,�" —^--' ' �� r, ' `" May g 73 ' | �� Permit Granted -° lA ` / -- �� -- '' Date of Inspection ~ 9Date ` Completed i \ ` , PERMIT REFUSED fy ----''--------.--------- 19 ] — r � � . --'--'-----'—'------------'—'-- & � __--------.---------'--------.. | , � --------.--.--_-_.---..----.-.... —.—.----.---.----_--...----_--'- Approved ................................................ 19 � ------------.----..,---.---.— � , ----^-------'—''^----'~'`--^'^'~^^ \ � ��