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Home My WebLink About0066 STERLING ROAD lQ / ��• � Town of Barnstable *Permit# O� Expires 6 months from issue date Regulatory Services Fee I/ • BAMSTABr e, 9 , : �� Thomas F.Geiler,Director 4i'°rfo Mai" Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number ?� Property Address 64/ ji/ele `X / /� /�y19/�ile'S / A.4 41201 [gResidential Value of Work ��/Of�O ° �'�' Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address ll9Zesl G,yO Ilelel, r✓i f�P✓L r y f�yGr�i�� /l9ry p z dell Contractor's Name C�'� zzi //If; .e G M v��IJP InPoi t Telephone Number ' "x2 i il Home Improvement Contractor License#(if applicable) I U o 7 y 6 it Construction Supervisor's License#(if applicable) LPET Workman's Compensation Insurance Check one: MARJ � �'..i)'11 [II am a sole proprietor Y❑ I am the Homeowner TOWN OF BARNS ABLEE I have Worker's Compensation Insurance Insurance Company Name C Py6Z-Pt 7, a 4jt) C4,1 i/ /V s re Workman's Comp.Policy# CC `�' 3 �' Copy of Insurance Compliance Certificate must accompany each permit. Permit R (check box) equ 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 #of doors ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows *Where required: Issuance oft his 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\decollik\AppData\Loca]Microsoft\Windows\Temporary Internet Files\C6ntent.Outlook\DDV87AAZ\EXPRESS.doc Revised 072110 I Page 7 of 7 C� CAPIZZI HOME IWROVEMENT INC. SPECIFICATIONS AND ESTIMATES STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT ftF-Al 4,19JAAD OWN THE PROPERTY LOCATED AT �XLiA/6- k() INyA�NAII�. , MASSACHUSETTS. I HAVE AUTHORIZED CAPIZZI.HOME IMPROVEMENT. TO ACT AS MY AGENT TO APPLY FOR A BUII DING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. I GIVE.MY PERMISSION TO LESSEE TO APPLY FOR ABUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. . � x:IrAryr;x:.;:rr::yx+:iiNekiYii�!I,IkJ,r.—..;iu::y,�rrrr:k^!Y4kr•..k�.... .::.ykr .:.r nik��rr�ryux�k, SIGNATURE OF OWNER: ' OWNER'S'ADDRESS: S (ttZL.bV6- RO , �ILIAAt 3 M4, OWNER'S TELEPHONE: 7- 56 f I 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: lov RESPONSIBLE OFFICER ADDRESS: G �S� Ne aj�uLill RI) ru m4 t RESPONSIBLE OFFICER TELEPHONE: s'U Office of Consumer Affairs&B siness Regulation License or registration valid for individul use only —_ ---•�: HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: SAYRegistration:. r, 9 100740 Type: Office of Consumer'Affairs and Business Regulation --=q! Expiration: 6123/2012 Private Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 CAPIZ71 HOME INIPROVEME-NTC. == ' Thomas Capizzi,Jr. _ '- 1645 Newton Rd. =' .. g-- — Cotuit, MA 02635 Undersecretary Not valid ou signat re Massachusetts- Department of Public Safety FWW Board of Buildi iv, Re'guiations and Standards Construction Supervisor License License: CS 57032 Restricted.2o: 0.0 THOMAS.X.CAPIZZI.JR 1645 NEWTOWN RD COTU IT, MA.02635 Expiration: 9/26/2011 Cuuw,issiuncr Tr#: 4113 The Commonwealth of Massachusetts Department of-fndustrialAccidents Office of Investigations - ' 600 TWashir gton Street w , Boston, AM 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/PIumbers A Iicant.Information Please Print Le gib Name (Business/Organization/Individual): . Address: City/State/Zip: 7t7/i f/ D glv 3 5- Phone.#,f: 5D �',70' Are you an employer?.Check the appropriate box: o f P J ect ro' wired I am a employer er with � 4• � I am a general contractor and I Type (required):. ) employees (full and/or part-time).* have hired the sub-contractors 6. ❑New construction ?.[] I am a.'sole proprietor or partner listed on the'attached sheet.' 7. Remodeling ship and have no employees These sub contractors have S. E]Demolition working for me m any capacity, employees and have workers' [No workers' comp.insurance comp. insurance:$' 9• ❑Building addition . required.] 5. We are a corporation and its' 10.❑Electrical repairs or additions . 3.0 I am a homeowner doing all work officers have exercised their g 11.❑Plumbing repairs or additions . myself [No workers'comp. right of exemption per MGL insurance required.]t c: 152, §1(4),and we have no 12•u Roof repairs I I 5 l� employees. [No workers' 13.E Other comp.insurance required:] *Any applicant that checks box 4..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 submifa 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. lam an employer that is providing workers'compensation_insurance for my employees. Below is the policy and job site information yy Insurance Company Name Ace-e- / ✓�y�'��. CAJ-P4 L� y N�j Policy#or Self-ins. Lic.#: ` WeC t / 0 1 �/ Z 3� Expiration Date:— c Job Site Address:. ' &Ip tAr f oo-v City/State/Zip: N ®i� /t7�� zW/ Attach a copy of the workers':corimpensation 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 maybe forwarded to the Office of ' Investigations of the DIA for insurance coverage verification —I-do-hereby c-erfcf3�under-the-pucrr andpanaltie-&of-p.e-r-jur),that-the-infor-motion-pr-guided-above-is-true-andcor-r-ect. Signature:' - 0 -3 C,m 6 2, Date. Phone#: 5-V�' Z 6S — l� , 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.EIectrical Inspector 6. Other 5.Plumbing Inspector Contact Person: Phone#: L Client#:47298 CAPIHOM ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE(m mNY )2011 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 .Karen Walther NAME: Rogers&Gray Ins.-So.Dennis PHONE 508 398-7980 FAX 434 Route 134 (A i° Ext): A/C,No): ADDRESS: waltherka@rogersgray.com P.0. Box 1601 PR UCE - South Dennis CUSTOMER ID#:, MA 02660-1601 INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURERA;National Grange 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 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 CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 - DDL UBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE NSR D. POLICY NUMBER MM/DD MM/DD/YYYY - LIMITS A GENERAL LIABILITY MPB1075H 06/08/2010 06/08/2011 EACH OCCURRENCE $1 000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RE TED PREMISES Ea occurrence $500,000. CLAIMS-MADE E OCCUR MED EXP(Any one person)' $10,060 -PERSONAL BADVINJURY. $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO $2,000,000 POLICY PRO-JECT LOC $ A AUTOMOBILE LIABILITY BPO10786 06/08/2010 06/08/2011 COMBINED SINGLE LIMIT A ANY AUTO M1M28044 06/08/2010 06/08/2011 (Ea accident) $500 000 BODILY INJURY(Per person) $ ALL OWNED AUTOS X SCHEDULED AUTOS BODILY INJURY(Per accident) $ _. PROPERTY DAMAGE $ X HIRED AUTOS (Per accident) X NON-OWNED AUTOS U1 $250/500,000 X Drive Other Car U2 $250/500,000 A UMBRELLALIAB X occuR .CUB1076H 06/08/2010 06/08/2011 EACH OCCURRENCE $5000,000. EXCESS LIAB CLAIMS-MADE . . AGGREGATE $5 0001000 DEDUCTIBLE $ X RETENTION $ 10000 - $ B WORKERS COMPENSATION NWCC45843208 12/25/2010 12/25/2011 X W IMIS AND EMPLOYERS'LIABILITY CRY srATu- orH- ER ANY PROPRIETOR/PARTNER/EXECUTIVE N E.L.EACH ACCIDENT $1,000,000 OFFICERIMEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,0.00,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101;Additional Remarks Schedule,If more space Is required) Workers Comp Information Included Officers or Proprietors CERTIFICATE HOLDER. CANCELLATION 10 Days for Non-Payment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Town of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE ®198 •2009 ACORD CORPORATION.All rights reserved. ACORD 25(2009/09) 1 of 1 The ACORD name and logo are registered marks of ACORD #S61971/M61970 MEE ej , YOF T�,ti Town of Barnstable *Permit# Expires 6 months from Issue date i BAMsTAP Regulatory Services Fee �d2.�, o 0 HAM s6396 �`0� Thomas F.Geiler,Director Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 ��ESS �� Office: 508-8.62-4038 OCT d - Fax: 508-790-6230 2004 EXPRESS PERMIT APPLICATION - RESIDENTQM ]jARN TABLE Not Valid without Red X Press Imprint :,aplpazcel NumberC� ! —W�/ .operty Address 66 JIG - I i n gd 14(h V1 N i 5 (Residential Value of Work OD Minimum fee of$25.00 for work under$6000.00 wner's Name&Address A L E 1J ET-2 S T E 41 ontractor's Name A `- 1A PP" L i�l.)� Telephone Number ,� "' 2 G1 _ t :ome Improvement Contractor License#(if applicable) 'onstruction Supervisor's License#(if applicable) Workman's Compensation Insurance Check one: ❑ I am a sole.proprietor '�Iam the Homeowner I have Worker's Compensation Insurance' ance Company Name lJ r4 Its Inc.,nc.,Z9 r A✓t C e orkman's Comp.Policy#_ �1 L\,J (, o-]6(4 opy of Insurance Compliance Certificate must be on file. ermit Retluest(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!3 (maximum.44) •Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation;etc. *** e: Property Owner ign Property Owner Letter of Permission. Home ment ontractors License is required, gnature Fnrn.e•�vnrntry • s Town of B ai rnstable , :' vpf�HE T �oT Aeg-datorY S enices ' i F ,8 f 'F Thomas =Geller,Director p j,' ISIOI1 id1dfng Con mx ssloner " Tom�'erry, 200 lv t street, gyannis,MA 02601 -- ,n�ysj,toiym,barnstable•ma=us -. ? Fax: 508-79Q-6230 ;. office: $08:862035 ; 4 _. 'p:c0perty Owaer•Must - This Sectiol ---• • .�. . . : -:_- : • - C,o�xl.�lete and . ._.. ,. if using .A_�Builae , 4 h + • Owner of the subject property KcvE�� (W OATN.�� to act on my�iehalf; _ hereby authorize in matters matters relative to work our}-011Ma bythis budding perrrut application for, . � �dG�i�S5 ofsob) li)/0 Y 16 ' Date. . , Stgnatur of Qwner . Print N2 ne F Board of Building Regul tions and Standards One Ashburton.Place - Room 1301 Boston. Massachusetts 02108 Home Improvement tractor Registration -.l Reqistration: 135174 . C t Y { Type: DBA - �� Expiration: 3/11!2006 ALL CAPE ALUMINUM SCOTT PRESTON -- 192 IYANOUGH RD. HYANNIS, MA 02601 Update Address and return card:Nlark reason for chant .( Address Renewal Employment host Card -- ------------ �/ Q /f/ ----- - ze ZJ/097L1)Cp?LlUP,CLGCiL a��/�ac�zuaelta - -- -- lugBoard 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: 135174 Board of Building Regulations and Standards Expiration:",3/11/2006 One Ashburton Place Rm 1301 ,Type:: DBA , . Boston,Ma.02108 ALL CAPE ALUMINUM SCOTT PRESTON 192 IYANOUGH RD.: HYANNIS,MA 02601 Administrator Not valid without signature ; // , •. 1 1 i gJlgNel'ABLS, _ Department of Health Safety and Environmental Services �7d Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner SHED REGISTRATION �P/ Location of shed(address) YillageJ Prope wner's name ' Telephone number Size of Shed Map/Parcel# Date Hyannis Main Street Waterfront Historic District? Old King's Highway Historic District Commission jurisdiction? Conservation Commission(signature required) THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN ♦ Q-fomu-shedreg i �.�Y64 2 i J# � � � ffi}. �:{ ;• �_ .titer. .• •,0% flb 40 • so ••••� IL .. . .. • .....