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HomeMy WebLinkAbout0028 QUISSET ROAD � ��..�-. i �. L . I\ �\ i -- P12 �TKErpf, Town. of Barnstable *Permit � Expires 6 m hs,f e e Regulatory Services Fee saxxszast E. v tKass R' $ Thomas F.Geiler,Director i639. prEG MAC� Building Division Tom Perry,CBO, Building Commissioner 200 Main StreA,Hyauhis,MA 02601 www.town.bamstable.ma.us Office: 508-8624038 Fax: 508-790-6230 EXPRESS PERNHT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number `j0 //;Ll J 1400 Property Address. Q o is S r: 'R o a a ` e. / [Residential Value of Work �l °w Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address TRWi n G •I-a 16'e kwCt!y JA/7/ Sftllvy ll*4 dlo• Contractor's Name -106/ T WVUM I1ko ,4p i 22 i Jj eive T/Yl "Od"Telephone Number Home Improvement Contractor License#(if applicable) 106-7 V Construction Supervisor's License#(if applicable) C 5 6 b 1/, VWorkman's Compensation Insurance Check one: ❑ I am a sole proprietorAIN I am the Homeowner i` I have Worker's Compensation Insurance Ain b,kile zrivt r Mqy� Insurance Company Name OIA J Workman's Comp.Policy# °�' lU U 70® V, ®F�. p ®J f Copy of Insurance Compliance Certificate must accompany'each permit. S� Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing-layers of roof) Re-side LY-r r'-r Fo[/ A'f'1e kjq l//l'l1,0 etr#i/ el pt e f e j- Jc✓ep,0 goo rr. i. #of doors ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows �. *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&Construction.Supervisors License is required. SIGNATURE: C:\Users\decolli1AAppD \Local\Microsoft\WindowiCTemporary Internet Files\Content.Outlook\DDV87AAZ\EXPRESS.doc Revised 072,110 j The Commonwealth of Massachusetts `! Department of IndustrialAccidents Office of Investigations 1 Congress Street,Suite 100 Boston,MA 02114-2017 °,^ ��•�•� www massgov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual) CAP I ZZ I HOME IMPROVEMENT,INC. Address:1645 NEWTOWN ROAD City/State/Zip:;COTUIT, MA Phone#:508-428-9518 Are you an employer?Check the appropriate box: Type of project(required): 1.0 I am a employer with 40+ 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New.construction _r listed on the attached sheet. 7. ❑Remodeling 2.❑ I am a sole proprietor or partner- 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 1 LF]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.VOther�� 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 the policy and job site information. Insurance Company Name:AmGuard Insurance Company Policy#or Self-ins.Lic.#:R2WC527200 Expiration Date:12/30/2015 r' C�Ji Slef� �o Job Site Address: �d' City/State/Zip: Cent-cdatfle/MA 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 t 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 certi under the pains and penalties of perjury that the information provided above is true and correct. Si ature: Date: �'� Phone#: 50 -428-951 Official use only. Do not write in this area,to be completed by city or town official. J 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#: Page 7 of 7 Capizzi Home Improvement Inc. Specifications and Estimates STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLE'FOR A BUILDING PERMIT s ,� .tf s D AT & ��� /�'e- � �,� OWN THE PROPERTY LOCATE �— IN C, ,. Wl ll` ,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: r t V/re�ianrne4ncaerrl�o���tctsrcr�cite� . ffice of Consumer Affairs&Business Regulation License or registration valid for individu1 use only 9ME IMPROVENIEN T CONTRACTOR before the expiration elate. 11 found return to:' Offnce of Consumer Affairs and Business Regulation egistration: 100740 Type: flb Park Plaza-Suite 5196 Expiration: 6/23/2016 Supplement Card toston,MA 02116 CAPIZZI HOME IMPROVEMENT,INC. c JOHN STRUMSKI ���• 1645 Newton Rd. Vo _ Cotuit, MA 02635 Undersecretary Not valid without signature 0 ' , Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Super;•isor, d License: CS 064817 ' . IS AILDEN AVE lBmards Bay MR 02532 r Expiration Commissioner 06MG12096 :lI.IZ Z0i4 lb:40:10U Guard Insurance Guard Insurance Group 1/1 T . k.. a® CERTIFICATE OF LIABILITY INSURANCE 12 30 DAT / 0DDmrY) 20f4 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 DR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the palicy(les)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 endorsements). PRODUCER CONTACT NAME: ROGERS&GRAY INSURANCE AGENCY,INC. PHONE Fax AIC : AIC No Ex No: 434 Route 134 E-MAIL ADDRESS: INSURER(Sl AFFORDING COVERAGE NAIL q South Dennis MA 026b0 INSURER A: AmGUARD Insurance Company INSURED INSURER B CAPIZZI HOME IMPROVEMENT INC INSURER C: 1645 NEWTOWN ROAD INSURERD: INSURER E: COTUIT MA 02635 INSURER F: _ W COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS 1S TO CERTFFY 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 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE LS POLICY EFF POLICY EXP INSR WVD POLICY NUMBER MMIDDlYYYY MMIDU LIMITS GENERAL LJABILrrY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea mcurra%a $ CLAIMS-MADE OCCUR MED EXP(Any one persw) $ PERSONAL&ADVLVJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-CON00P AGO $ POLICY j,C7 M LOC $ AUTOMOBILE LIABILITY - CO BIN U SI GLL LIb I a acrident $ ANY AUTO SCOILY INJURY(Per Person) $ ALL O'NNED SCHEDULED AUTOS .AUTOS BODILY INJURY(Per acc,dentl�$ , HIRED AUTOS NON-OWNED AUTOS PROPERTYDAMAGE AUTOS Pr accidcntl $ UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIARI ICLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- A AND EMPI.OYERS'LIABILITY YIN R2N10527200 12/25/2014 12/25/2315 x. T RYLMT ER ANY PROPRIETOR/PARTNERiFXECUTIVE E.L EACH OCCIDENT S 1,000,000 OFFICEPiNIENBER EXCLUDED? N I A (Mandatory in NH) E,C-DISEASE•EA EMPLOYE 5 1,DDD,DDD If yes,describe under DESCRIP7ION OF OPERATIONS hei.. - E.L.DISEASE-POLICY LIMIT S 1,D00,ODD DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES(Attach ACORD IV,Additional Remarks Schedule.if more space is required) Thomas Capizzi)r is covered by the Workers compensation policy„ CERTIFICATE HOLDER CANCELLATION Town Of Barnstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 200 Main Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Hyannis,MA 02601 ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION„ All rights reserved, ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD TOWN OF BARNSTABLE.BUILDING PERMIT APPLICATION 70.O Map Q.5 V Parcel "� � Application # Health Division Date Issued Conservation Division Application Fee 66 Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board (o�Z��o Historic - OKH _ Preservation / Hyannis Project Street Ad r ss U/SS 0-c/ Village I M 1+ Owner �1 f IM Q Address �l?� SFri!15�11 e',c i /Q Telephone � �7 0 Permit Request re —Q n cc Squareet:st floor: existing proposed 2nd floor: existing—proposed.- i Total new? Zoning District i Flood Plain Groundwater Overlay �, ca Project��Valuz t nn �d Construction Type-71 w o. r Lot Sipe. y -71 Grandfathered: ❑Yes ❑ No If yes, attach supporting d'ocumEntation. Dwelli6-gType:- Single Family Two Family ❑ Multi-Family(# units) C3 Age of Existing Structure �' Historic House: ❑Yes 1,06o On Old King's Highway: a Yes to 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 Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: 0 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 Ao If yes, site plan review# Current Use _re- i-,--h C 2 Proposed Use ►r�S d APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name S4--Ct-TS t) Y\ Telephone Number 5V 03� ILIle1 ® Address D' � i License # i A I/ 6'1 d f � �'t Home Improvement Contractor# l 1 `L Ce-Worker's Compensation # � C 7� 4/3-To ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 1 SIGNATURE DATE � � O FOR OFFICIAL USE ONLY APPLICATION# 5 DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: , FOUNDATION FRAME ` INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING _ s DATE CLOSED OUT ASSOCIATION PLAN NO. R Client#:47298 CAPIHOM ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MM,DDNYYY) 01/05/10 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 P.O.Box 1601 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. South Dennis, MA 02660-1601 INSURERS AFFORDING COVERAGE NAIL# INSURED INSURERA: Nat'l Grange Mutual Insurance Co. Capizzi Home Improvement,Inc, INSURER B: ACE Property&Casualty Ins.Co. Capizzi Enterprises,Inc. INSURER C: 1645 Newtown Road INSURER D: Cotuit,MA 02635 INSURER 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. S TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LTR NSR DATE MM/DD DATE MMIDD LIMITS A GENERAL LIABILITY MPB1075H 06/08/09 06/08/10 EACH OCCURRENCE $1 000 000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED -PREMISES Me occurrence) $500 000 CLAIMS MADE FXI OCCUR MED.EXP(Any one person) $10 000 PERSONAL&ADV INJURY $1 000 000 GENERAL AGGREGATE s2,000,000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG s2.000.000 POLICY r JEC PRO- LOC A AUTOMOBILE LIABILITY M1 M28044 06/08/09 06/08/1 O COMBINED SINGLE LIMIT ANY $5O0 AUTO (Ea accident) ,000 ALL OWNED AUTOS BODILY INJURY $ X SCHEDULED AUTOS (Per parson) X HIRED AUTOS BODILY INJURY X NON-OWNED AUTOS (Per accident) $ X Drive Other Car PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO EA ACC $ • OTHER THAN AUTO ONLY: AGG $ A EXCESSIUMBRELLA LIABILITY CUB1076H 06/08/09 06108/10 EACH OCCURRENCE $5000000 TOCCUR CLAIMS MADE AGGREGATE s5.000.000 $ HDEDUCTIBLE $ X RETENTION $10,000 $ B" woRKERs coMPENsATION AND NWCC45843208 12/25i09 12/25/10 X TWO C STATU- OH- EMPLOYERS'LIABILITY Y LIMITS E ANY PROPRIETOR/PARTNER/EXECUTNE E.L.EACH ACCIDENT $1 000 000 OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $1 000 000 If yes,describe under SPECAL PROVISIONS below - E.L.DISEASE-POLICY LIMIT $1 000,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Carpentry CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION ,Town of Brewster DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10_ DAYS WRITTEN 2198 Main St NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Brewster,MA 02631 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE l ACORD 25(2001108)1 of 2 #S48110/M48107 KW 0 ACORD CORPORATION 1988 at -7 '. . Board of Bmlding Regulations and Standards License or registration valid.for individul.use only HOME IMPROVE_MENT CONTRACTOR before the expiration date If found return.to: x Board of.Bull ding Regg a.hons and Standards Reglsfr c 100740. O.ne Ashburton Place Rm i301 " �pl 123l201 p f-t ) Boston,`Ma 0�10$ � APCement Canis:, CAPIZZi HOMET1 bARY GOSTAFS'© � 72 r� 1645'Newton.Rd � F Cotut MA 02635 Administrator No vali ttho,t nature b.dseIi' L ar rtYial Of P64-1ic S.tf.ot Bn�ri!of trtltlistt 2t�ut�reIMI.. in9;St�ttdarcls f ons#rut#sort 5u��r�tsor 1_tse L�cei�s cS 74640 " q: - Restricted a' 00 GARY GUSTAFSON 8 SHORT WAY .3r SANDWICH MA 02563 rL. rxq i a��cr:•'l1(2912010 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations d 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name(Business/Organization/Individual): . 0r 2 2 ► -P /llVp pit Address:/ �/ �1� !. 7-b u q_ /l d Gt City/State/Zip:( Phone.#: S-7) G�'_ Are you an employer? Check the appropriate box: Type of project(required) 1., I am a employer with C4/6 1 4. ❑ I am a general contractor and I 6 ❑New construction employees(full and/or part-time).* have hired;the sub-contractors 2.❑ I am a sole proprietor or partner listed on the attached sheet. 7. 0 Remodeling ship and have no employees :. 'These sub-contractors have 8. ❑Demolition working for me in any capacity. employees`and have workers' [No workers' comp.insurance ' comp.insurance. t 9. ❑Building addition required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.[_1 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. tContracton 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: A 61 /f e/ /U DC. ra I�C T— p Policy#or Self-ins. Lic.#:_�W�— L�J �3 o Expiration Date:. Job Site Address: S �fJO S.S�e"� g D o & City/State/Zip '/ fev v; 6k 2-�3 a-- 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. Tdo-hereby-eer-tify and - e-pains-and-penalties-d�perjur-y-that-the-information-pravided-abave-i true-and-correct. .Signature: Date: O Phone#: Official.use only. Do not write in this area,to be completed.by city or town officiat 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#: Page 7 of 7 CAPIZZI HOME IMPROVEMENT INC, t SPECIFICATIONS AND ESTIMATES STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT WE,IRWIN&ESTELLE FEIGELMAN, OWN'THE PROPERTY LOCATED AT 28 QUISSET ROAD IN CENTERVILLE,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: a OWNER'S ADDRESS: 8171 SPRINGLAKE DRIVE,BOCA RATON,FL 33496 OWNER'S TELEPHONE: 561-487-8859 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: TOWN OF BARNSTABLE MBUILDING PERMIT APPLICATION Map d-�SD Parcel 1,R 710 Permit# _ 7 &W Health Division �� � '` Date Issued Conservation Division (I N/ Fee c .0o Tax Collector � SEPT10 SYSTE F '- Treasurer ''' INSTALL'ED'Its PLI BE Planning Dept. , . ����� �[ b�E�Y64 0, Date Definitive Plan"Ap"proved by Planning Board Historic-OKH Preservation/Hyannis - Project Street Address 77-X� Villageper- _ Owner M;f Z�iw/i✓ �=e�Gj�P/yi•9.y u. Address Telephone687 Permit Request ✓'� ��<-l!� �9 /��l'>G� Sin �'���+ ��T� . 1,,v Square feet: 1st floor:existing 95 proposed 5-6 2nd floor: existing 5-Y 0 proposed' Total new Estimated Project Cost -2D, c1510 Zoning District. Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: 0 Yes ❑No If yes, attach'supporting documentation. Dwelling Type: Single Family ® 'Two Family ❑ Multi-Family(#units) E Age of Existing Structure Historic House: ❑Yes ❑o On Old King's Highway: ❑Yes U-No Basement Type: O-F u Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing dZ new Half: existing. new - Number of Bedrooms: existing new. : Total Room Count(not including baths):existing ` new / First Floor Room Count Heat Type and Fuel: Gas ❑Oil ❑Electric ❑Other Central Air: ❑Yes U-N`6­' Fireplaces: Existing• New Existing wood/coal stove: ❑Yes ❑No r Detached'garage:❑existing• ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:l�xisting ❑new,. size 'Shed:❑existing ❑new size Other: : Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes U-110 If yes, site plan review# Current Use Proposed Use • BUILDER INFORMATION Name s.J .J P_S Telephone Number �94 -5857 Address / .rvnK / License# -7 i Home Improvement Contractor# ,Za .540 9 _Worker's Compensation# ,Vli9 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Vl9i'J_7,1"'TA SIGNATURE DATE lP -- FOR OFFICIAL USE ONLY •- • f PERMIT NO. DATE ISSUED _ •; '` MAP/PARCEL!N0. �� s t - ` - r ,. � -, � _. • -i " lipiel , , • - ADDRESS ' VILLAGE • - - OWNER DATE OF INSPECTION: FOUNDATION FRAME - �I`t / ' INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL' GAS: ROUGH FINAL' F FINAL BUILDING DATE CLOSED,OUT ASSOCIATION PLAN NO. ; ` The Town of Barnstable • a�axer�. 9 �m� Department of Health Safety and Environmental Services . Fo►�a't' Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crosten Fax: 508-790-6230 Building'Commissioner Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. ; Type of Work: ,SVO Q�/'� �`_� S�cTo yi � Estimated Costv?�i�'a Address of Work: Owner's Name: Date of Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job Under S1,000 Building not owner-occupied [30wner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner. Cr S D ILO S C 1-5— i ate Contra or Name Registration No. OR Date Owner's Name q:forms:Affidav -= - The Commonwealth of Massachusetts Department of Industrial Accidents T , -- OffiCr of/1IYOM9.1U0/IS ., 600 Washington Street Ugti �'. Boston,Mass. 02111 Workers' Compensation Insurance Affidavit tt�icsn arnratlfftrz%//////%%�//,%%/ name: vy1.25 1 location: city Cf V phone# ❑ I am a homeowner performing all work myself. a sole proprietor and have no one workin in any capacity FVZF- ❑ I am an employer providing workers' compensation for my employees working on this job. comnnnv name: address: city phone#: insurance ca. ValicV# r.... =proprictor, �� asogeneral contractor, or homeowner(circle one)and have hired the contractors listed below who have the folloning workers' compensation polices: com any name: :::.:.,:::•;::......... address: city: JQ � n2T / ice �� �! phone#: insurnnce co. /'V �9 1 I I l `f d� �1C l.; ) .: oiicv#.. P 3- comnanv name: r: :....,. :.,...,...•... ... .... �... ... address: city- phone#' ......:... insurance co. Rolf # Eliid %%%�%///�%��//%%%%%%% /a Failure to secure coverage as required under Section ZSA of MGL 152 can lead to the imposition of criminal penalties of a fine up to S1300.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fitte of Sloo.00 a day against me. I understand that a copy of this statement may be forwarded to the Otlice of Investigations of the DIA for coverage verification. I da hereby cerri4J under the pains and pen es of perjury that the in provided above is truce and coned Signature Date 1 z _ Print �— Phone# 79D -SASS 7 official use only do not write in this area to be comple�edby city or town olnciai city or town: permit/license# ❑Building Department ❑Licensing Board ❑checkif immediate response is required ❑Selectmen's Office ❑Health Department contact person: phone#; ❑Other (revues 9i95 PW Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", an employee is defined as every person in the service of another under any cc=-w-; 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 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 section 25 also states that every state or local licensing agency shall withhold the issuance or renews: 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,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 in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insumnce as all affidavits 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. City or Towns 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. The affidavits may be rcitrri ed io the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you 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 Invesugadons. _ 600 Washington Street Boston'Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 4 - - - -✓die t�om�mza+zurea��c o���a4aac�uiaelCa f D,ERARTRIT Of POLIC SUITY COESTRBC4IOE SBPERVISOR LICEESE Emberc _ .., Expires: ; Reaticted So 4. 3i1lIES P DOOLBY L�.�.,.,►x(�'i /' :199 SEBEEEE! RD CUTRUM, BA 02632 License or registration valid for individual use only before expiration date. If found i return to: One Ashburton Place Rm 1301 Boston Ma.02108 F I A a Restricted !o, gg lone IA - Masonry only P 16 - 1 & failure to rawly B°aea I KessacAusette Possess a current edition of the I is cause for state Building Code ' revocation of . this lice t nse. ► Registration 12500099� t TYPe - INDIVIDUAL ' Expiration 09/25/99 James P. Dooley 199 Skunknet Rd � � Centerville MA 02632 '1DMWIS ;fad TRnTOR j I i . 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F fi V, i eJ ; S- � fiu kw` i kr4 J F Up 54, i CA ED IE I �� ��;fir•rF r I ' i ':�..,�. n � b � R _ 8 - 11 - WIN .++]ep P g e6Yt•a�d t,#��' a } s.L '�r '�Y3G' $ �a .J"�r ��� s r..�Je• k`a-� r kY>w^� v �,xx': y ,y-,t r' s+ �°�'�'.. �r 1; 'j,� '. .. �y,�W�� r;J -J� `„� ' f_ ¢ r'.. � ^c �c•*�r .R. p -.. �3s �u ,t If it 18 0• SM;v{,o'6lti�s,,F�y 7V "Ot o ups i p� fRlo CY, 2>9V44 O47YS it log+. � ., vwD•a � � - i C`7 3 (� J n i x IL�o G.a � 660 +a ILr�oL, 1 � , y � O , Ifl� 4+.(�elo,a Cs�nae S�oT�ge r i • ` . TOWN OF BARNSTABLE 25418 o° Permit No. --------- ----------------- F ;` Building Inspector DAUSTA , Cash ------------------- — tlYL g ,6y0. C v�O �� � OCCUPANCY PERMIT Bond -------------- t---�--�- �'� Issued to S L S Trast Address Wiring Inspector �r � J ,.Z-s Inspection date Plumbing Inspector �{` Inspection date v f Gas Inspector Inspection date Ins Engineering De artment .��-1 '^ ,�` Inspection date.,` " / g p p � �`��,•''� Board of Health r. �f Inspection date THIS PERMIT WILL tNOT 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 BUILDING CODE. 1/71 ....../...... -. 19 *�=� �'...�'i�.., ';•...1,/ ..• Buildin<• Inspector �A essor s map and lot number �....... ���/. ..,:..:...: � , IC SYST 1=? j°'�♦ F E Sewage Permit number —STALLED IN 5 K"WITH r 1 HA"STADLE, • House number ...............�!... ...(0 4�' P�.e,Mb 6 0 `d��a�$C)€�MENTAL C 1owaY a e� TOWN ®F � I � S,�TAIJE BUILDING ASPECTOR _ APPLICATION FOR PERMIT TO 4 ...(2 .................. ...✓....11/!. .......... ...�"' � .................. t� TYPE OF CONSTRUCTION ..... . ..........V " . ........ ...15............................19.. TO THE INSPECTOR OF BUILDINGS: The undersigfne,,....`1.. d hereby applies for a permit according io -eafoll^wing information: Location ....Z4/ ...... .�Z.�....4�V.�..�.�T�1 . �1�!��� �/ .. .. .............. Proposed Use .6.�4 ... �'�/1...... ................................................. ......................................................... Zoning District ...... .....................,..,..................Fire District ....... ....C./................................. s Name of Owner .. .. .... .....�.......... ..... Address .. �. ... ,� �... ........./ �?!�Y/ ��A".4.......... Name of Builder ........Address Name of Architect/PPj, �. .............Address��.�CS.. . ....��..��.���(( /........ .. Number of Rooms ..............Foundation .... . KC:/ Exierior .. ..............................................Roofing ...................................................... Floors .... � / .:.............................................Interior .... ,.�i�A:- /.o�r`.. .................................. Heating ........'E-1�... ...........Plumbing ...., �........... a Fireplace ...... .. �— .............I..........................I....................Approximate Cost ........,.. to.......................`...... Definitive Plan Approved by Planning Board -------------------------------19------- • Area ......`.. ......... ...... �y Diagram of Lot and Building with Dimensions Fee `.` . ......... a.... G SUBJECT TO APPROVAL OF BOARD OF HEALTH u I hereby agree to conform to all the Rules and Regulations of the Town of Barnst le regarding the above construction. Name ... .........., ,..................... PLS TRUST per mit rmit for ... S tort',,,,,,,,,,,,, Singj,q�jjgjgily Dwelli c ................ ..........................n.[............... Location ....L9:t...H. a .................Q.e.n.teXV.i.1 lie.................................. Owner ....SLS Z-Kuq:t........................................ Type.of Construction Fr.dMe............................ .............................................................................. • Plot ..�, .... .................... Lot ................................ A Permit-Granted .........August...1.1............19 83 Datj'.'6f Inspection ........ ........ ....... Date Completed ........e_.<11....... 19 PERMIT REFUSED ......................................... ..............t 19 ............................................................................... ............................................................................... ............................................................ ................. ............................................................................... Approved ................................................ 19 ............................................................................... ............................................................................... Assessor's map;and lot number �,5� r/.,. (1./............ r ! F THE t Sewage Permit number BAREST1IDLE, i House number ' �......r................................:...... .................... 1639. \e� �. TOWN OF BARNSTABLE ;- BUILDING INSPECTOR , f .........tz..............:.. ...................................APPLICATION FOR PERMIT TO �..�...... --� !?�� � � ' TYPE OF CONSTRUCTION ...... � ..�....... i .. ......................................................... y.. r _ - f ......... /. ............................19..x. }� r� TO THE INSPECTOV OF BUILDINGS: The undersig/necr hereby applies for a permit according to e following information: Location ...../,,� � .. ?. ..... �.. ..`�P 1.. . ............. ;PIE�c/ . !..:.................. Proposed Use .... iI r/—*-/ !. £� ....... ..... Zoning District ........................................................................Fire District Name of Owner ../"�z--f�...../............�. '... ........./..... .........Address Name of Builder `. .� "..6 ......... . ,! �.......L .......Address ........... r. ...............�........../` Name of Architect s./..Y: . /. .d ����� .............Address�2-/... T.!.. .,�, � � /... ��,.� 1..... `e.'.?`:fi.. Number of Rooms .........�.....................Foundation ..... ...... . '_.......:. ........................ Exterior ..��� 1; ��E� Roofing ... � .7?`X ................................................,..... .,. f. ..-.. .............. , Floors ....� , ../..0 ......................Interior .....` .... 7.. �( �h r Heating ........ :E. ..........................................Plumbing ...... Fireplace ...... ...........................................................•.Approximate Cost ...........G ��. .............................. Definitive Plan Approved by Planning Board ________________________________19________. Area � .?. ' �, ............. .. Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH y ✓ J A� oh I hereby agree to conform-to all the Rules and Regulations of the Town of Barnstable regarding the above construction. ' Name . ...................... � -_- -_--- A 2- 0-47 254I8 � ^ l� Story No ---��-.. PJnoit for ------------ � � .............. ' Location —..]�At...�}�........2.$....Dni.s.Sqt..JlDad ' ^�- ..................... Owner ........$14.9...TW.U.5.t.................................. Typo of Construction ..Frame........................... _____,______.__________.____ < Plot ............................ Lot .' r--------- . � Permit Granted ....?�z�9.us.t—Ilr ___lg 83 � . � Date of Inspection .................................... ' � - -� Dote Completed ------------.]q . � . ` . . � PERMIT REFUSED ----.----...---- .->�»—,.. 19 ' ~ �� --------------.�—..�—.��..`«----- ' ' ............. ..................................... . . ' ` ^ --------'-------.--..—.—..--.— � ' ...'.......................',...,,'......''...........................',''' ` - ' Approved ................................................ lV ' ------------~^—^----------- � ---------------------.---.—. , � r - lu r _ N L O z2, a 5 7 gF 34•0 � 45•0 o ExrST• h 2I,o I D o ` � S N to Q � N N NOulLJ 17AT jo" Ct�gT l!': I e_AT l O1U 6` 0 LOT T 120A 1.> c ENT I=r-VIU.e, OAlzU5,TAaLlcIMA• N. viN1. M-wArZw►LK A"04. 1Q4. ► Y_ 501 U0,FALtl%ouTa , MA. N Z 48't�"\! _ Iq mt J3C� „ r zo 4 On the basis of my knowledge,. informatio�iQ road belief, I certify to 7ydc ZTZ _ that as a result of a survey made on the ground � ttt Of 4f4. Ori �o , I find that: �o`' WIUTAM The structure(s) are located on the site as M. c WARWICK - shown C~,alla4eecd,-�l� 1he7-,Pwn za•71i)7 Ay-L s No. 19771 H The title- lines and lines of occupation of the 9 GIST 41 04� site are as shown hereon. The site is situated 'in Flood Zone, A?Offa c Sva`t Community Panel No.Z ovo Date: Gl/-Gltl�l/l QJLi�� William I4;. Wax�wio .1