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HomeMy WebLinkAbout0103 SAINT CATHERINE AVE v3 sr. C�r�.�� �✓. \ � ",1 i � ' r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel - APP lication # Health Division l�. Date Issued --Application Fee Conservation Division V - Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board {" _ Historic - OKH _ Preservation ! Hyannis Project St r et Address tb3 5 ?' (q r ►v P S Village Owner yet ,, Address Telephone Permit Request Lmou-e JVlace foo �,Py-400 C P 'ra��q�(S r�rry � l r�wi New 6u tiv<s {o e w N oQs,_IMF Jrz1P t7sLY/S toA1 n6/, a P P?fl)ef irk Itt" QP rozl nJ��IJ elc,&K)6t tN �cl��gR�IRC p y�S, �rtiet$ _ Square feet: 1 st floor: existing I 050proposed ---- 2nd floor: existing --� proposed �� Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type ►-rol la CD Lot Size _ Grandfathered: ❑Yes ❑ No if yes, attach supporting documentation. =, Dwelling Type: Single Family Two Family ❑ Multi-Family(# units) Age of Existing Structure �Q — Historic House: ❑Yes ❑ No On Old King's Highways Yes; ❑ No Basement Type: Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.-ft.) _ Basement Unfinished Area (sq.ft) 9�© Number of Baths: Full: existing_ new Half: existing new Number of Bedrooms: 01 _ existing mew Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: VGas ❑ Oil ❑ Electric ❑ Other_ Central Air: ❑Yes No Fireplaces: Existing New Existing wood/coal stove: ❑Yes/IfN o 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 No If yes,'site plan review # _ A Current Use 1�fj,-W—p -=- . :_ _ __Proposed-Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) NameY�Aftler Jd 1U 1 v C ° Telephone Number 6 Address L rV _ License #_ _Ha rs ION� .i �s Home Improvement Contractor# _ Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO' O( 9 SIGNATURE - DATE i FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO.; , r' ADDRESS VILLAGE et OWNER DATE OF INSPECTION: ` 111 ,FOUNDATION - FRAME INSULATION_ 4 FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL c GAS: .. '` ROUGH _ < FINAL FINAL BUILDING - b` DATE,CLOSED OUT' ASSOCIATION PLAN NO. . nemmanwea.�tFi of Ma,�achrr�e�ts • Deparbnw affied=hjdAccdder& D$"ice ofrtigatians "• 600Ajuhington Street B&SWfl MW QZIII Workers' Compensation Www max&9vyl�a P fas>lu'$uce sPitc Builders/ContractDrrAMectridam/Plambers , A fic$at information Please Prort LeIV 2�Famt; (Bvtdnrss/Organizaiiondndi��; �'k' t . Address: tarty/State%Za:P� �l G:S' B "e /� ..Phone#• 5�5�'�` ����U��d`'Vreou an employer?Check the appropriate boot1.`P atn a employer with 4. [�I Mn a general eonhactor �Pevf project(regnir Md.I - e�• employees (M and/or part-f m .* hive.hxed the subcontract= 6•� []New carman 2• 1 S��ProPIIe��partner- listed'on Em attached sheet �. ship no emp yees These suh-c 7. erode' �sc:firs have g D working ffir me-in any capacity, as Pby=and have workers' cmo [No workers'corms,iasRn�ce camp,msaz�ce,# 9• [] nldmg addition re lUiMd] 5•'0 we ere's cOlpo�on and its. 10. 3•]'I am a homeowner doing all work officers have ❑Electrical repass or additions exercised`they I I.❑Pam'myself [No workers' comp. flat of exemption per McL �repaus or additions iasu mme Mqi�Di]t c. 152, §1(4), and we have no 12•[]Roof repay ' employees.:INC)workers' 13.[]Ofer camp.ias�e requited] Any appbmat that cherl;s bns 91—rat RIM fm out the section b t R—=nM¢s who Mhn it this eidavit ia�they are doing a,w flies eompeasation policy iII{o m that cheer this box mast ay.c =eddifivrra]sheet showing the fo ob_ ft ractaa =Mt yvbmit a new afn ng=J, employees. Tf the sob-oonftaetnn bane MI s end davit cnt oY they�srp¢tspido their ,comp•Polz s whether or sot those entities hope I Q?ls Q?i c3;nnm�¢. emF�J'�that isproYig markers'caaFpensava insurance for nxp 1 02 ,E ,,pp P vyem Below is the pa&cy¢ram job site Insurance Company Name:" C=, Poficy#or Self ins.Lin.# VE rnon I?ate: fill,0.9 . Job Site Address: Co3T �`/S �4►v rvrs �60� Atfach a copy of the Workers' cou�perzsation n ' ' taIDMP FMIUM to secure coo as re p climuon page(shopring ire poii n �'RP' quimd under§Dct m 25A afJf c. 152 can lead to the rrmtber and espn-afion dste)• fine up to$ 500.00.and/or one-year impri ommet¢,as well as civil �oS of dal Penalties of a Of up to$250.OD a daY rt t12e violator. Be P=ahies-in fhe form of a STOP WORT{ORDER and a fine lavestigatims of the DIA for iastn�ce t;oyeiagE eti that e copy of�iis =Y be forwarded to the Office of caficm..` r do her e,by arrdar p andpersalties GfPmjwymat the informadon r �i�atme: �r aba' is true and correct I?ata: d Off. hone�: �'� Yak:o y�� � • agiQal use only. Do not Wrae in this are; to be Cangileted by city or t°anm affici4 City or Toper: PermitlLicettse# /:string Authority(circle one): L Board of Health 2.Building Department 3, IS. Other chty/TuTM Clerk 4.Electrical Faspector 5.Plumbing FaspectDt Contact Petaaa: Phone#: a iFrt:m•Fr!cs Rarr_1t FA:++17^t"1]E CAPE CO--INSI:RP,.. Fa<-3.:s; rte 2.f.8:56 AM Page:2 of 3 i, 7 AM FACE 2/002 Fax' segve Ac; 1R CERTIFICATE OF LIABILITY INBURAN-CF, THi^a CER M. GATE'.£"VED AR t.MATTER OF INFORMATIM ONLY AND C.ONFERSNO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CtRTlrii:A7e WES til.T AFT-'"ATIVELV OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE Af:rOF C F3 Ft?t F P6,110ES C-ELOW, T"9 CFP.T.9^.ATE OF INSURANCE DOES NOTCONSTITIR£A CONTRACT SM%(EENTHE ISSUING WURSNS+ AU74!1P!7£0 RFDRFSENTA?tVE OR PRODUCER,AND THE CERTIFICATE FOLDER, „ IMPORTANT:H the eestificeft holder is A+ADDITIONAL INSURED,the poGog¢est must 6e emftrs d.It SUBROGATION IS WAIVED,suMod to the iwrte mG s tt�Yiwx DI liea ra cr eatt n polfe ea ram!Tat r4 wed eeedarsemeld.A statement on Rds cwtiRade does not OSnfer rights to the rmr4!toV?s lu:d!r u I%v.••oI such erdoesww*s} CONTACT NAME: PHONE FAX OLDE CAPE -`INS AGCS (A C,No,EA): FAX (M NO): i`a'c V:`!.Y'i47i;3TRMI r_.,69AiL ADDRESS: PRODUCER ' P.`sf"FJ-IS.MA tJ2,`.0I CUSTOMER ID it 236RC IMURER(St AFFORDING COVERAGE i NAIC0 INSURED t INSURER A: TRAVELERS I[NDEI1RM COMPANY INSURER B.- NWAGHER,HCHAEi DBA)vlF•AGIERC:MS7 LXT!ON, INSURER C: INSURER D: z 47 ENT A.LA STREET INSURERS: COVERAGES CERTIFICATE TitlMER: ':E7190N HUMBER: 'r,'•-N tST'C GE"PYTHAT TttE POLICIES OFIffiURANCE 14TED BILOW HAVE BEEN iSSURDTOTHEtPFURSO NAMED ABOVE FORTHE POLICY PER IODMOICATEO. NOTRTrWiF-o%INO Amy RECL7REMENT.rEt1MORCOHOTTIONOF ANY CCN'RACTOROTHIROOCUMWW*Jt!V'!'t:Ptk":"T04F3:'HTm4sCOTTIRRCATE WAY BF"SSUED . OR MA'f PERTAIN.THE INSURANCE AFFORDED V,THE POLICIES DESCRDSW HEREIN N SUBJECT TO ALLTHETERMS,EXCLUStOW AND CONDMON90POLCH POLICIE6 - LIMITSSWOWN MAY HAVE SEEN REDUCED BY PAID CLAiPA9_ t _ • - r _ ' LNSR ADL'LSUSR POLICY EST DATE POLICY EAP-DATF - TYPE OFASLRANCE'. -POl(CTNUMB.''R (MM1omff N t(MLMOSNy",. _ -UFATS a 'N°R WVC. 'GENERALitABILfIY EACH OCCURRENCE :-kvT:rT:1ZCiAlOD rti l.',�tiaELRY ° •r ti - - OHMAGE TO RENTER .$ CL/ &WDE Ck-Gtti;. PREMISES(Ea xeuTrancel ` Attu to Fmv one pwxn) 3 PERSONAL&&AOV INN UP,Y S ++. Cs$r •;"CL:1et..: P R`. ' GENERALAOGREOATE 8 FOLr:Y FRu ECl' IeTC PRODUCTS-COMPVP AC`a AUTOUMLE LIABILITY COM614ED SMLE 4 AW AUTO LIMIT(Ea etddoNj ALLOWNEDAI)TOS HOOILYIMURY S SCHEDULE AUTOS 4'er tin) HIRED AUTOS BODILY INJURY. $ (Pe=accident) NON-MNED AU70; PROPERTY DRA4AGE $ t ' . IPer 2cd9el:ct - . WMAELLA LIAR OCCJR' EACH OCCURRENCE`,'. S EXCESS UAB CLAIMS AMADE AGGREGATE S DEDUCTIBLE ' S' RETENTION 3 ,',. S . - F WC STATUTORY LMITS . OTHER. - WORUERIS COWENSAMON AND :. EMPLOYER'S LIABILITY YIN. US-IlMP04A-11 1*41,2011 1.1092012 S.L EACH ACCIDEN' S fO:.OQ ' ANY FRCFERITORiPARTHERSNECOnVE-• N - - E.L.DiSEP.SE £A EUPLOYEE" tMsnrksorAtnNtfl E.L.DISEASE•POLICY UAMT $; SQQADQ r.}•ss,aesaza uiaer . DES"NPTICHOFOPERKT104S 1)9;3CRIPTOTdC=FOPERATIONSILOCAT!Or'roNr—HICLio:RE(',TE:C-tONSISKCIALITEMS ' TTGS R3nACES ANF FBIOR CLR:MCATE1MTED T+ TIM CFFM11CATE IROL)M AFTE-040 WORT03FS CAW COVERAGE- V—PAGEER NECIRAM S COVEM BY THEWORKFDS'SM1FEDK�TMTJ Oil V :u:�C:.Ti HOLISETt' + CANCELLATION, 10 WN OF BAWSTABIE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED " PEFOP,ETHE EXPIRATM RATE THEREOF,NOTICE WILL BE*FIT CRED W 4130 SOlcH STYE;. C.CCORDANCE WTii rKE POLICY rR VISIONS. AUTHORIZED REPRESENTATIVE NYA HIS,MIA 02601 Charles 1 Clark r ACORD 23(20D9/001, 19OW2DD9 ACORD COF.'PONATTON. Ail Ogitfs reswod. k a K t t , 617 lion Cossamer -aits& HOME MpROVEMEW CoKMCTOR Type. Registration:„=1UM Expiration: 4�27=13 DBA M HER BROTt1 S ONS tJGTION MICHAEL MEA61EiJR_" ,= 97 EMERALD L N MARSTONSMI MA 0264 UadersemtBrY LitOnse or r on VAid ft in&vidd use 9 before the ex#hsdon date: If found rdAro tv-. Office of Consomer Affairs and Bay won_ 10 park Ph=-S • 70 '- Boston,MA 021I , N otv d , llassachusetts- Department of Public Safer" Board of Buiidin�g Regulations and Stan(Iard. Construction Supervisor License License: CS 102260 Restricted to: 00 = MICHAEL MEAGHER JR 97 EMERALD LANE MARSTONS MILLS,MA 02648 _ o— �" Expiration: 11)5rM2 - (",.nuai..i,aicr Tr, 102260 • ti e a Town of Barnstable t Regulitory-Services SS �$ Thomas F.Ceder,Director BIIIIdin DivisioII r Y Tom Perry,Building Commissioner t° k 200 Mam Street Aymais,MA 02601 www.Eatvn.barastahle.ma.us A Off_tce: 508 862038, ". 508 790-6230 Property.Owner Must,'-: 4 . Complete and Sign `Plus Section1 t If Using A Build err as Owner of t}ie subject property hereby authorize 11-�e L r '�C �6 to act on mYb If. . . in aR matters re tive to work authorized b �th�s Lbu duig permit appncatwn for � �aN_>uts Address of Job). - -ate PH=Na= R s If Pro Y .e -Owner * ' a I? rtY pplyuig for permit please complete;the Homeowners. License Exemption Form on';the reverse side. FO 0-Q: RMS: QiRdE'RPERMISSION = Town of Barnstable Regulatory Services F « vim « Thomas F.Geller,Director MASS Building Division „ Tom Perry,Building Commissioner .200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862. 4038 Fax: 508-790-6230 HOMEOWNER LICENSE EX 6E enON Please Print DATE: JOB IIJCATION- number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. } DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is, or is intended to be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period sha11 not be considered a homeowner. Such "homeowner"shall submit to the Budding Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1-1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements, t„ ra Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. , HOMEOWNER'S ExEMPTION The Code states that "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if.the homeowner engages a,person(s)for hire to do such ' work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction gu g Supervisors,Section 2.1�) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms.homeexempt a 1 - - - - -- - 1 _- - - -- - - - -- " - I k e y •. ' OF THE r Town of Barnstable Permit • BARNSTABLE, Expires 6 months from issue date MASS. Regulatory Services vr-� iOtFo ;�6, Thomas F.Geiler,Director Fee Building Division Tom Perry, Building Commissioner X. IT 200 Main Street, Hyannis, PRESS Office: 508-862-4038 H y �MA 02601 Fax: 508-790-6230 J U L 5 _ 2005 EXPRESS PERMIT APPLICATION R T OF BARNSTABLE Not Valid without Red X-Press I ,,i,,t V TIAL Map/parcel Number a I 0(yQ-7 Property Address -AAak,ga/Residen'tial Value of Work Minimum fee of$25.00 for worts under$6000.00 Owner's Name&Address �� Mid contractor's Name eft S , �. /• do come Imp Telephone Number U D r= Improvement Contractor License#(if applicable) ;.00nnstruction Supervisor's License#(if applicable) D rjj� /J Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance ;urance Company Name )rkman's Comp.Policy# t , py of Insurance Compliance Certificate m ` 2, r-- ust be on file. < ' ., mit Request(check box) C C� ❑ Re-roof(stripping old shingles) All construction debris wi v� -Dj ... Re-roof(not stripping. Going over ex isting layers of roof) ❑ Re-side Replacement Windows. U-Val ue (maxunum.44) / (1) r.? "Where required: Issuance of this permit does not exempt1( I t compliance with other town dep artment regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign gn Property Owner Letter of Permission. Improvement Contractors License is req�ed .. tore is:expmtrg 1630o4 .� 1 r1c t-ommonweacrn uJ lvluysucn"ac«a z; Department of Industrial Accidents Office of Investigations d 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Cont Aractors/Electricians licant Information /Plumbers Please Print Le 'bl Name (Business/organization/Individual): Address: IWO � City/State/Zip: V* O a Phone#: tre You an employer?Check the-appropriate box: • I am a employer with 4. Type of project(required): ❑ I am a general contractor and I ( q d�' ❑ employees(full and/or part-tune).* have hired the sub-contractors 6. ❑ New construction I am a sole proprietor or partner- listed on the attached sheet. t ❑ Remodeling ship and have no employees These sub-contractors have working forme in any capacity, workers com . ' 8• E] Demolition p insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its 9' ❑ Building addition required.] officers have exercised their 10•❑ Electrical repairs or additions ❑ 1 am a homeowner doing all work right of exemption per MGL 11.0_plumbing r airs or additions myself.[No workers' comp C. 152, §1(4),and we have no­ Insurance . insurance required.] #'`" a to ees.- 12:❑ Roof repairs r employees. [No workers comp. insurance required.] 13•[�Other :y applicant that checks box#1 must also fill out the section below showing their workers' )meowners who submit this affidavit indicating they are doing all'work and then hire outside contractors must submit compensation policy infomiation.' ,. ttractors that check this box must attached an additional sheet showing the name of the sub contractors and their workers' omit a new afdavit indicating such n an employer that is providing workers'compensation insurance for my employees Below is thcomp. a o�lioy inforrraron. ormation, p icy and job site 1 09 trance Company Name: I All cy#or Self-ins.Lic. #: Expiration Date: O Site Address: tch a copy of the workers' compensation Policydeclaration City/State/Zip: aration page(showing the policy number and expirat not date). ire to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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 to$250.00 a day against the violator. Be advised that a copy of this statement maybe forward a fine stigations of the DIA for insurance coverage verification. forwarded to the Office of hereby certify under the pains and penalties oti ��_ fP that the information provided above ' true and correct. � V Date: Q ricial use only. Do not write in this area,to be completed by city or town official. E ty or Town• ' suing Authority(circle one): .. '. Permit/License# Board'of H ealtli 2:Building Department 3.City/To Dther g wn Clerk 4.Electrical Inspector 5.Plumbing In Spector ntact Person: . Phone#• Jan-05-05 03:54m Prom-AIG 478^818-6903 T-724 P,UUZ/UUZ h-lLY R . '' Y' •'�Iit.��pj %irV�,: G R`T[F` C.�AT -t ` '' NS1► F !►1� r. ` s• ;� �; ' ., 'a�. . I:✓ ; ;u� r01 '.11. ;l• ,. - .�.T "!):I :•^1p�••• 1t I •F,'?h yi _ ' PRODUCED THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY ANO CONFERS.NO RIGHTS UPON THE CERTIFICATE Employers Ins Group Inc HOLDER THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 281 Main 6"Gt,Suite#1 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW Fitchburg, MA 01420 COMPANIES AFFORDING INSURANCI` COMPANY A GRANITE STATE INSURANCE COMPANY INSURED Resource Managements Inc 281 Main Street,Suite 46 Ffthburg,MA 01420 I THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE USTED BELOW HAVE VF.FN ISSUE TO THE INSURED NAM>Ap ABOVE FOR THE POLICY PERIOD INDICATED,NOT WITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER. DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY HE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED THE POLICIES DESCRIBED HEREIN IS SUOJECT TO ALL THE TERMS,EXCLUSIONS AND CON01710NS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED 9Y)SAID CLAIMS.• co OF INSURANCE POLICY NUMBER POLICY 9FFCTIM6 DATI1 POLICY MWIRAIUM DATE A COMPENSATION o GMPLOYMV UABtLITY LIMITS OFI`Fllr,�AM IN"o 6XCL t0 C Grow 121L62004 1 Z Fi.;,} ya►'<,�;':;�..+ •� `'•'- P 2! 5/ZU05 A"ruroRr uMrra •I ,�;G.;,�,���, . 0477192 ?�•,I:rli, Be AppAn to MA Opcatons OrdY. CH Ar-=Eff 5 100,CDC 192,I^POLICY LIMIT S 500,0DO $ 10010013 E ON OF OPERATK)P1W{/ KIGLRBISPEGIAL ITEO RE:COVERS THE EMPLOYM OF THE NAMED INSURED LEASED TO:CAPIM HOME IMPROVEMENTS INC,1645 NEWTON ROAD. OTUIT MA UZU5. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF TI@ ABOVE OEBCRIERO POLICIES K CANOGURO MORE'"T CAPITZI HOME IMPROVEMENTS INC MIRA71ON DATE TTtEREDJHEMWMGCOMPANYViLLENDSWORTOMA 22 1645 NEWTON ROAD DAYS WRrrTEN NOnCE TO THE CSTrFICATE HOLDER NAM®TO THE LEFT,BUT COTU IT,MA 02636 FAILURS TO MAIL SUCH NOTICE SHALL IMrOSE NO OMMTION OR L"IM OF ANY KIND UPON TH6 COMPANY"ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ' j godwov uil ing Regula ons and Standards One Ashburton Place - Room 1301 Boston. MasWhusetts 02108 Home Improvement;.V' tractor Registration Registration: 100740 Type: Private Corporation {` Expiration: 6/23/2006 CAPI=I HOME IMPROVEMENT, INC. :` `.. ; Thomas Capi=i, jr. 1645 Newton Rd. Cotuit, MA 02635 Update Address and return card.Mark reason for change. Address Renewal Employment Lost Card ✓ram � � Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Board,of Building Regulations and Standards Registration:_ 100740 One Ashburton Place Rm 1301 Expiration: 6/23/2006 Boston,Ma.02108 Type: Private Corporation CAPIZZI HOME IMPROVEMENT,I %omas Capizzi,jr. 1645 Newton Rd. mil. Cotuit,MA 02635 Administrator - Not valid without _rr _ ✓2. BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS. 057032 Birthdate 09%26/1963 x Expires 09/26/2005 Tr.no: 7171.0 Restricted: .00'_F., THOMAS X CAPIZZI JR 1645 NEWTOWN RD., J COTUIT, MA 02635 " Administrator TOLEy CAPIZZI HOME IMPROVEMENT INC . #AP C�a7/S/ SPECIFICATIONS AND ESTIMATES PAGE 6 OF 6 4/zi/f STATE OF 14ASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT I, sh OWN THE PROPERTY LOCATED AT J�• opm(v Y1fy ` IN VIA I 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: i OWNER'S ADDRESS: OWNER'S TELEPHONE: LESSEE'S SIGNATURE: LESSEE'S ADDRESS: LESSEE'S TELEPHONE: APLLICANT'S SIGNATURE: 1 1 1 OcS �A L 1 I l/ I . APPLICANT'S ADDRESS: 1645 NEWTOWN RD— COTUIT, MA 02635 APPLICANT'S TELEPHONE: 508/428-9518 RESPONSIBLE OFFICER: RESPONSIBLE OFFICER ADDRESS: RESPONSIBLE OFFICER TELEPHONE: ACCEPTED BY DATE THIS PAGE IS PART OF AND IN CONFORMANCE WITH PROPOSAL #