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HomeMy WebLinkAbout0106 STETSON STREET �'�� �i�s�� � �� i i �� CAPE COS INSULATION ,`SIyl,. 3ii . IIY{N JIJSS S(Aml{SS SPPT fCM fYSP{NDSD ' - • YARf JURf Yf INfuWS10H CHtINOf _ . y ' 1-800-696-6611 DIVISION "['own ofBaunst:able Regulatory Services Building Division 200 Main St l-lyarini.s, Nf,A 0260.1 Date: 0 • Dear Building Inspector Please accept this Affidavit as documentation that Capp Cod In ' lation, Inca performed & completed the insulation and weatherication work at the property listed below. Cape Cod " t lnsulatioii did this in accordance to the specifications listed on the building permit application:All work has been inspected by a certified Building Performance Institute (BP 1) inspector. All work preformed meets or exceeds Federal & State Requirements. ,Property Ownez. � Property Address V11laJ'e /o S S 7` y iS Insulation Installed: Fiberglass Cellulose R-Value Restricted Uiuestric:ted ' C'eilings• Slopes Floors' W,cllls B/altM„E Sih/S He ry 1: Cas. y Jr, President (' e Cod 1 ulation; Inc, r - f c. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map.: Parcel Application # 1 ®q Q-7 Health Division Date Issued 12 /`t Conservation Division Application Fe Planning Dept. Permit FW_ _ Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address IAO Village Owner , ?*,�,�,% �Uie��i�L/ Address �J�VAts4!f-, Telephone cS7� Permit Request �/Z`' � L/6ri Gf ✓`' / X IA. lop � 4 � OF Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new ;Zoning District Flood Plain Groundwater Overlay Project Valuation r Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attac pporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) o «"`'+' Age of Existing Structure Historic House: ❑Yes No On Old King Highway': ❑ s , No Basement Type: ❑ Full 0 Crawl ❑Walkout ❑ Other _' 4 Basement Finished Area (sq.ft.) Basement Unfinished Area ( ft) `P Ca Number of Baths: Full: existing new Half: existing `--never 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: ❑ 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# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) . Name �' � �� J�/��I�� i� Telephone Number , S 7;7 --- Address ,� �,�/Ti�d 4 �/.� License # /oo, /--I Home Improvement Contractor# Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION# t DATE.ISSUED MAR/PARCEL NO. r r i k ADDRESS VILLAGE i OWNER y r DATE OF INSPECTION: FOUNDATION f FRAME 4 INSULATION RREPLACE F ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL l GAS: ROUGH FINAL FINAL BUILDING D'�TE3CLOSED OUT A3S t_�� ION PLAN NO. r 4 f , w - t ' $� Massachusetts - Department of Public Safety '#..:Board of Buildiri g Regulations and Standards t Construction Superl iscir License: CS-100988., HENRY E CASSID-1 8 SHED ROW k WE ST ST YARMOUTH B " "1 Expiration Commissioner 11/11/2015 x Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 153567 Type: Private Corporation Expiration: .12/15/2016 Tr# 259188 CAPE COD INSULATION, INC HENRY CASSIDY 18 REARDON CIRCLE SO, YARMOUTH, MA 02664 Update Address and return card.Mark reason for change: sCA1 0 20M•05111 Address Renewal Employment 0 Lost Card p� ----- - ... ._ . . de �pa/zr�r�zaruuea�t/a�C�/T/Z��ut;rac//aJeCtS, �\ Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: '153567 'Type: Office of Consumer Affairs and.Business Regulation xpi ratio n::::::12/1;5/20:16 Private Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 CAPE COD INSULATI:bN',iNC` HENRY CASSIDY 18 REARDON CIRCLE g , yp� ry SO:YARMOUTH, MA 02664 Undersecretary IN valid wi ut sign e 4 t The Commonwealth of Massachusetts `r Department of IndustrialAccidents N W Office of Investigations W . d 1 Congress Street, Suite 100 oW Boston,MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name (Business/Or zationil dividual): Address: �V City/State/Zip: Phone #; Are you an employer? Check the appropriate box: Type of project(required): 1,$Z I am a employer with 'Z 4, ❑ I am a general contractor and I { employees (full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ' 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 10.0 Electrical repairs or additions 3,❑ I am a homeowner doing all work officers have exercised,their 11.❑ Plumbing repairs or additions myself. [No workers'- comp. , right of exemption per MGL- 12.0 Roof repairs insurance required.] t C. 152, and have no employeees.es. [[No-w workers" 13. Other I. tA 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%f7idavit 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 In formation. + Insurance Company Name: Policy#or Self,-ins, Lic. #: �;J Z 0 I Expiration Date: Job Site Address: /la L � ��✓ b�� / f�/� City/State/Zip: p Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c, 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine ' of up to$250.00 a day against the violator. Be advised that,a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify n r pains a Sind penalties of perjury that the information provided above is true and correct. nature: Date: 1 ` . Phone Official use only. Do not write in this area, to be completed by city or town official, - City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: i CAPECOD-27 KLIGETT CERTIFICATE OF LIABILITY INSURANCE ,s DATE(MM/DD/YYYY) 6113/2014 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). RODUCER CONTACT ogers&Gray Insurance Agency,Inc. PHONE Barbara.DeLawrence 14 Rte 134 A Ne (877)816-2156 Duth Dennis, MA 02660 EMAIL E ADDRESS: bdelawrence@rogersgray.com INSURERS AFFORDING COVERAGE NAIC# INSURER A:Peerless Insurance Company suRED INSURERB:COMMERCE INSURANCE COMPANY Cape Cod Insulation Inc INSURER C:Evanston Insurance Company 18 Reardon Circle South Yarmouth,MA 02664 INSURERD:ATLANTIC CHARTER INSURANCE GROUP - INSURER E: INSURER F t O11ERAGES CERTIFICATE NUMBER: REVISION NUMBER: T IS IS TO CERTIFY.THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD IN ICATED. 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, R TYPE OF INSURANCE A POLICY NUMBER MM/DD�F Y MM/DAY E YY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $_ 1,000,000 CLAIMS-MADE OCCUR CBP8263063 64/01/2014 04/01/2015 DAMAGPREMISES Ea occurrence $ 100,000 ' MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 X POLICY F,PRO- JECT LOC S PRODUCTS-COMP/OP AGG $ 2,000,000 .TM OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 0 accident $ 1',000,000 ANY AUTO 14MMBCKVMK 04101/2014 04/01/2015 BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ x HIRED AUTOS NOWOWNED X AUTOS PROPERTY DAMAGE " Per accident $ X LA X OCCUR EXCESS LIAB EACH OCCURRENCE $ 1,000,000 EXCESS CLAIMS•MADE XONJ453614 04/01/2014 04/01/2015 AGGREGATE $ '~ DED I X I RETENT-16N$ 10,000 Aggregate $ 1,000,000 ORKERS COMPENSATION PER OTH- ND EMPLOYERS'LIABILITY STATUTE ER NY PROPRIETOR/PARTNER/EXECUTIVE YIN WCA00525904 06/30/2014 06/30/2015 E.L.EACH ACCIDENT $ 1,000,000 FFICER/MEMBER EXCLUDED? N I A Mandatory In AE.L.DISEASE_EA EMPLOYEE $ 1,000,000 - 's,describe under ander OF OPERATIONS below E.L.DISEASE_POLICY LIMIT $ 1,000,000 a SCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached II more space Is rectutred) rkers Compensation Includes Officers or Proprietors. iitional Insured status Is provided under the General.Liability and Auto Liability when required by written contract or agreement with the Certificate Holder. .R IFICATE HOLDER CANCELLATION OWNER AUTHORIZATION FORM (Owner's Name) owner of the property located at (Property Address) (Property Address) hereby authorize (Sub ontractor) an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my property. Owner's gnature 1Jl � la-oJy Date e+,. --• ,.. -x'�-. arm a ..i:- 'p . 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'mess `b 1659• ��� 200:Main Street Hyannis,MA 02601.: _Office:..508-862-403 8 Fax 5 08-790-623 0 Notice-®fZonine Ordinahees Violation(s) end Order to `ease, Desist'and .bate: Kenneth P Margo Quinlan Ti­ . and all persons having notice of this order. As owner/occupant of the premises/structure located at 106 Stetson S$ Hyannis -JE 7►a�..�^�r �#� t -�,r � r, x xP ,' aA� (C iotified that you are in violation of the Town of Barnst p° � 1 ` � �' ) � I April l 2014 4 r ' .. �`��j L-SF ��d'�yy��i j����, ,�* �9 p�fr�i''rt'�'•"sjw.�'+�.b '�k�3R"R,��� � 1. CEASE AND.DESIST IMMEDIATELY, °ssf `v a above mentioned remises � lg �ds ;` �� `d�a a�, nrg� �� �uTsa� -SUMMARY OF VIOLATION: A t Violation of Town of Barnstable Zonin Ordi. i " Chapter:240.Sechon:11 A(1) r aky fit ax.'dX� x;� w�£ '1 ' RB single Family Residential Zone ' a - mm � � i�� 2 COMMENCE'iediately, action to abate thk SUMMARY`OF ACCION.TO ABATE`_ if -_4 Collecting,storage,sorting,recycling and distribution of metal,metal items,parts and other miscellaneous junk and/or any and all material or debris of any kind involved.in the process of - recycling,scrapping,and,junk collecting requiring outdoor storage of material and equipment.: And,if aggrieved by this notice and order,to show cause as to why you:'should not be required.to do so,by ;filing an appeal with the Town Clerk of Barnstable, a Notice of Appeal(specifying the ground thereof) within thirty(30)days of the receipt of this order.(in accordance with Chapter 4.0A Section 15 of the Massachusetts General Laws) r j If;.at the expiration of the time allowed,action to abate this violation has not commenced,further action as Y the law.,requires.will be taken. rder, Robin C.Anderson Zoning Enforcement Officer 508-862-4027 Q . . _ .. ._ .. 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For valuables,please consider Insured or Registered Mail. o For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPSe postmark on your Certified Mail receipt is required. o For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". o If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 • • e e e e ® Complete items 1,2,and 3.Also complete A. sign ture item 4 if Restricted Delivery is desired. ❑Agent e .Print your name and address on the reverse X� ❑Addressee I so that we can return the card to,you. B. Received by.(Printed Name) C. Dat- of Delivery ■ Attach this card to the back.of the mailpiece, or on the front if space permits.D� L D. Is delivery address different from item V e 1, Article Addressed to: If YES,enter delivery address below: ' 6 3. Service Type 2 S� JRZetified Mail ❑Express Mail 0 Registered .49�8jurn Receipt for Merchandise ❑Insured Mail ❑C.O.D. I 4. Restricted Delivery?(Extra Fee) ❑.Yes 2. Article Number I 7 012 1010 0 000 15 9 (transfer from service label) PS Form 3811 'Februar)i200d Domestic Return Receipt 102595-02-Mxl54b i UNITED STATEM�. At RVICE _ First-Class Mail `t$• t.ox...._� ,�' Postage&Fees Paid .,.a USPS I ;s;u 1 &A' ':1" Permit No.G-10 I • Sender: Please print your name, address, and ZIP+4 in this box • TOWN OF BARNSTABL1E B�JI200 ING MAIN ST DIVISION i 2 i HYANNIS,MA 02601 i i I 'fill 1111iid"iiii .I'H.�'ii '' J Town of Barnstable K Regulatory Services drIHE tqy� Richard V.Scali,Director Building Division * sAxivsrAsi a Tom Perry,Building Commissioner MAss. 9qj i639. ,0� 200 Main Street, Hyannis,MA 02601 iOfE�MA'S A Office: 508-862-403 8 Fax: 508-790-6230 Notice of Zoning Ordinances Violation(s) and Order to Cease, Desist and Abate: Kenneth P & Margo Quinlan, Tr and all persons having notice of this order. As owner/occupant of the premises/structure located at 106 Stetson St, Hyannis Map 306 Parcel 071,you are hereby notified that you are in violation of the Town of Barnstable Zoning Ordinances and are ORDERED this date, April 29,2014 to: 1. CEASE AND DESIST IMMEDIATELY,all functions connected with this violation on or at the above ,mentioned premises. SUMMARY OF VIOLATION: Violation of Town of Barnstable Zoning Ordinances: Chapter 240 Section 11 A (1) RB single Family Residential Zone 2. COMMENCE immediately,action to abate this violation. SUMMARY OF ACTION TO ABATE: Collecting,storage,sorting,recycling and distribution of metal,metal items,parts and other miscellaneous junk and/or any and all material or debris of any kind involved in the process of recycling,scrapping,and junk collecting requiring outdoor storage of material and equipment. And,if aggrieved by this notice and order,to show cause as to why you should not be required to do so,by t filing an appeal with the Town Clerk of Barnstable, a Notice of Appeal(specifying the ground thereof) within thirty(30)days of the receipt of this order(in accordance with Chapter 40A Section 15 of the Massachusetts General Laws). If,at the expiration of the time allowed,action to abate this violation has not commenced,further action as the law requires will be taken. rder, x Robin C.Anderson Zoning Enforcement Officer 508-862-4027 Q/FORMS/viozonel r "IFS' xt�.ep' q t r li E rt / i' e� '+, `�.. � ? r• }",®/ ��J�� t~ ���� � .�s�lY'�`. ..� �,rf� 1 f`jg.���,�, �y�„+ i ✓ •'"r�/� a i 4.�+ q�yE¢n d 4ti7:, ti i� tt� r �y�+� 'rt1• ' t. �%±�` :` x +Y`yt r" t � y E ..rffi ,er�V .�, a .�. �-�t...�.. 'k. Y.If t•_„ ,, 3�:,�,'��1 *aR`.. - 7°••. III, �r.��4 (gc�eee __¢? i �•. ,y ' n ! '� _!Ik"'rp.! pr^ •. S ..! •'} �3'7J" t�A a. .tl +-S'iA'Y- ♦ -.•�� •r i.y,.' ice^ *.� t},'.« � . . 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"C'"«��{Ji � 'rs,s� »P�" t.� r(' r.. y,�t t.� .+� • 2ff)iq AP'R 29 tM 9' 35 4 Official Website of The Town of Barnstable - Property Lookup Page 1 of 5 Assessing Division Property Lookup Results - 2014 367 Main Street,Hyannis,MA.02601<<BACK TO SEARCH<< IPrint Frie Owner Information - Map/Block/Lot: 306 / 071/- Use Code: 1010 Owner Owner Name as of 1/1/13 QUINLAN,KENNETH P&MARGO TR Map/Block/Lot G/S MAPS 70 GRASMERE ST 306/071/ NEWTON, MA.02158 Co-Owner Name BOSSIDY REALTY TRUST Property Address 106 STETSON STREET Village: Hyannis Town Sewer At Address:Yes GIS Zoning Value: RB Assessed Values 2014 - Map/Block/Lot: 306/071/- Use Code: 1010 2014 Appraised Value 2014 Assessed Value Past Comparisons Building $84,000 $84,000 Year Total Assessed Value Value: Extra $27,200 $27,200 2013-$280,600 Features: 2012-$271,500 Outbuildings: $2,400 $2,400 2011 -$271,900 Land Value: _ $158,800 $158,800 2010-$266,600 2009-$278,400 2008-$311,700 2014 Totals $272,400 $272,400 2007-$311,000 Tax Information 2014 - Map/Block/Lot: 306/ 071/- Use Code: 1010 Taxes Hyannis FD Tax(Residential) $607.45 Community Preservation Act Tax $74.53 Fiscal Year 2014 TAX RATES HERE Town Tax(Residential) $2,484.29 $3,166.27 Sales History - Map/Block/Lot: 306/ 071/- Use Code: 1010 History: Owner: Sale Date Book/Page: Sale Price: QUINLAN, KENNETH P&MARGO TR8/27/1996 10361/195 $1.. QUINLAN, KENNETH P&MARGO 4/25/1969 1434/753 $0 Photos 306 /071/ - Use Code: 1010 I; http://www.townofbamstable.us/Assessing/propertydisplayscreen l 4.asp?ap=0&searchparc... 4/28/2014 re � Inspection Report— Building Department Date - — � �� Address D Referred B �' Purpose of CaMnspectionlLo Reported to Site with Observations & Notes yew L2 ll�—bdLf,/i L. 6 d ( / ��.... ✓ Y t W .v 6 aLt 60 �- w .S i Official Website of The Town of Barnstable - Property Lookup Page 1 of 5 Assessing Division Property Lookup Results - 2013 367 Main Street,Hyannis,MA.02601 «BACK TO SEARCH<< °Print Frie Owner Information -Map/Block/Lot: 306 /071/- Use Code: 1010 Owner Owner Name as of 1/1/12 QUINLAN,KENNETH P&MARGO TR Map/Block/Lot G/S MAPS 70 GRASMERE ST 306/071/ NEWTON,MA.02158 Property Address Co-Owner Name BOSSIDY REALTY TRUST 106 STETSON STREET .Village: Hyannis Town Sewer At Address: No GIS Zoning Value: RB Assessed Values 2013 - Map/Block/Lot: 306/071/- Use Code: 1010 2013 Appraised Value 2013 Assessed Value Past Comparisons Building $84,000 $84,000 Year Total Assessed Value Value: Extra $27,200 $27,200 2012-$271,500 Features: 2011 -$271,900 Outbuildings: $2,400 $2,400 2010-$266,600 Land Value: . $167,000 $167,000 2009-$278,400 2008-$311,700 2013 Totals $280,600 $280,600 2007-$311,000 Tax Information 2013 - Map/Block/Lot: 306 /071/ -Use Code: 1010 Taxes Hyannis FD Tax(Residential) $561.20 Community Preservation Act Tax $73.74 Fiscal Year 2013 TAX RATES HERE Town Tax(Residential) $2,458.06 $3,093 Sales History - Map/Block/Lot: 306 /071/-Use Code: 1010 History: Owner: Sale Date Book/Page: Sale Price: QUINLAN, KENNETH P&MARGO TR8/27/1996 10361/195 $1 QUINLAN, KENNETH P&MARGO 4/25/1969 1434/753 $0 Photos 306/ 071/- Use Code: 1010 i http://www.town.bamstable.ma.us/Assessing/propertydisplayscreenl 3.asp?ap=0&searchpa... 10/2/2013 6 PERMIT PAYMENT RECEIPT 'TOWN OF-BARNSTABLE BUILDING DEPARTMENT 200 MAIN STREET HYANNIS, MA 02601 _~DATE: 10/18/06 TIME: 13:05 -----------------�TOTALS $ PAID 40.99 AMT TENDERED: 40.99 AMT APPLIED: 40.99 CHANGE: .00 APPLICATION NUMBER: 20063941 PAYMENT METH: CHECK PAYMENT REF: 15519 sir Town of Barnstable , *Permit#Q60la 391 Expires 6 months from issue date Regulatory Services Fee Mass. Thomas F.Geiler,Director foruI` Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 %.PROSSPERMIT EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY OCT 1 $ 2006 Not Valid without Red X-Press Imprint Map/parcel Number 36(0 TOWN OF BARNSTAELE Property Address 10C0 Residential Value of Work I-)-1 Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address Cont,^actor's Name ' '� , ) Telephone Number �— Home Improvement Contractor License#(if applicable) 175 (. Construction Supervisor's License#(if applicable) E?W,prkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name t ife i7 Workman's Comp.Policy# b(eii 109 7 Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-r (not stripping, Going over existing layers of roof) Re-side ❑ Replacement Windows. U-Value (maximum .44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: PmDerty OwnAr must sign Property Owner Letter of Permission. o pr m t Contractors License is required. SIGNATURE: Q:Forms:expmtrg Revise071405 - iae 1 � '3r ®r' �'2:.a'� ��„"'�.at��:��•'..ls3p„'I' u1� ;,�,•9 ' p,,:-r,� l .9gc dd 1 er?Check thrappropridebw, Type afprojec#(reg�• : xelogin off oy 4. ❑Y am aScna .=trgtorand1 6. []Few eo ftcd= [�I s>ma a ea�loyes;with --a ]�ave:hired the act . . ' IOYGO�miarput tmae). BsGed on tits attached glad# 7, D R�deft. ® I amt s solo propaetor orpzt=- These smb-ecatractrs have • So ®Dcmaldon and bave so caployaes , worker`camp.�aserauee. g. ❑ ft ad�thn woddag Armin a�ayCqu:�y can d� Pia workas0 Gcmp• C° 5. D w acq .}�aveava eaaas' al r 10.0 xe*kg tepah®r additions • �Q ,p 11.DPb�aobmgrqa s D X aVim'doips A we* e. 132,'11(4),andwehaveno 110 Roof repairs . a:Ysel£(Na ►orkere 00 =;&Yees•vga Vodoara' . 33.D Ot3ur ' dAei ocbbox#1 mvzt 40 b putts o span Way Aawtet�a vwrlcea'�P° p°�� °�'• " is � ��dsvit 3e�cel:n��Y�°�i a4�vae'k endffiealdae a►>�aida eadrsaDa�ua~st uubad�ewer s�v�m�feetYa�each, ehealc�►bmt °a as asftd"Aawfttbe mm ate end�nr woiZsar�evm�r.Potuu•7 • . am 1 er�tcai'S pravtdtng warkera'catnpensadax ttrWOnCe er wy amp Y �.Itefaw!s tke�dligi and,�ob efts. am sat F a7 'f co CompanyNeane: :;�• ;, :h�f#•ot��•LAC'�—.'- ---r—r-'- • VN n A 6DI �itsABdres�8' V1, a sshowW,the poUcy number and expiration lots). &tech R Cap ofthe workers compens�tlon pagr dedaraffon peg { Sectn»t?SA of 1ViGL c.132 ui i k d to 8*e impesWca of crnamatp=dt'aS of a emx' to 10 c+ot►arag:+ °d ym=4 asweltas,ai Im 0aisUf=oh STOP WamMDMER asad a fine o cup to i1AMPO Savor ono-ycat i 3e be fmw ded to the Office of fop EZStl.tltl a�'I$dwt*e*btct, Be"ed that a copy of tLis 9tatesamtmay wiftt m oftsVA for ia=aa COYM8avffMcgd ' do hereby are r p panals�t of psr,f ury that tho�nformar�on provtrled above��r and earree� ; Dote. e#: ' c{a► . no gal *c 0 to is MOW by Cti�rorTown; pe�ttLicense# . ' A (drele one)I edar 5.Plumbia Ins• ertor 1.Beard of Reolth 2.BWNUS Department 3.Cky/Toym Clerk. 4.Electrical ImV $ P. 6.Qthe' phone#: r �TMe 1p�� Town of Barnstable M ASS: Regulatory Services �E°gip Thomas F.Geiler,Director 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 . Property Owner Must Complete and Sign This Section If Using A Builder I , as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signature of Owner Date f Print Name Q:Forms:expmtrg Revise071405 Oct 15 06 03:22p Dana Family 7814559116 p.6 t HOME IMPROVEMENT CONTRACT a � Sold,Furnished and Installed by: Branch Name: A"n Date: THD At-Home Services,Inc. A� � 1b� d/re The Home Depot Home Services J 345A Greenwood Street,Worcester,MA 01607 Branch Number: �� Job#: Toll Free(800)657-5182; Fax:508-756-2859 Federal ID#75-2698460 ME Lie N C 02439 Rf Cont.Lies 16427 CT Lic#..565522; MA Home Improvement Contractor Reg.9126893 Installation Address: , I E f;10/J 37 f AA/1/1rJ Old 426 O► — Yyo6 City State Zip Purchase s: Last 4 Di 'ts of Driver's Lic.4&Ex .Ato/Yr: Work Phone: Home Phone: A MILT tJ 4 I A I ( ) Home Address: 7 D G�1 Al r y— Zi 2Q t=(07V A YYI✓� (? 'i� (If different from Installation Address) City State Zip E-mail Address(to receive updates and promotions from The Home Depot): Project Information: I/We,`You("Purchaser"),the owners of the property located at the above installation address,offer to contract with Home Depot U.S.A.,Inc.("Home Depot")to furnish,deliver and arrange for the installation of all materials as described on the attached Spec Sheet 4: ,incorporated herein by reference and made a part hereof. Home Depot reserves the right to cancel this contract if,upon re-inspection of the job,Home Depot determines that it cannot perform its obligations doe to a structural problem with the home,pricing errors or because work required to complete thejob was not included in the Spec Sheet or Contract. DEPOSIT PAYMENT OPTIONS (Subject to Bard verification and/ur ereLt approval.) l it lif`9 L Cheek,Cashium Check or US Postal Senice Money Order CONTRACT AMOUNT (Made payable to The Horne Depor). *LESS DEPOSIT 2. Credit Card*and%or uthcr paynxmt options-Circle One Below Visa MasterCard Discover American Express BALANCE DUE L f The}tome hnprove=ntLoa" The Home Depot Credit Cunt 7 ON COMPLETION $ I _ - Vew Account )4xistiag Account (HII.&SD('C ONLY) "Minimum 25%of Contract Amount due upon execution Available Credit:S (HIL&IIDCC ONLY) f this contract. 11__ Acct#:�o>_a -��01 1 Indicate Payment Method For *lame as it appears on card:�if.5;a,_, L) (0", � BALANCE DUE ON COMPLETION: *By my/our signature below,[/We agree to allow}tome Depot to charge the above referenced credit card for the deposit indicated. Cardholder's Signature Date • HIL or HDCC Authorization Codes Deposit Final Payment # r €# Purchaser agrees that,immediately upon satisfactory completion of the work,Purchaser will execute a Completion Certificate and pay any balance due. Purchaser also agrees to be jointly and severally obligated and liable hereunder. Entire A eement: This agreement and its attachments, including any fnancing agreement,contain the complete agreement etween t e parties and can not be amended or modified unless in writing in a separate agreement signed by both parties. NOTICE TO PURCHASER Do not sign this contract before you read it You are entitled to a completely filled-in copy of the contract at the time you sign. Keep t it to protect your rights. Do not sign a Completion Certificate before this project is complete. Law prohibits home repair contractors from requesting or accepting a Completion Certificate signed by the owner prior to the actual completion of the work to be performed under the contract. You map cancel this trunsuction at any time prior to midnight of the third business day after the date of this contract See Notice of Cancellation for an explanation or tfiis right. There will be a service charge equal to 25%of the contract arriuunt if the job is cancelled by Purchaser AFTER the third business day. BY MY.'OUR SIGNATURE BELOW,LAVE AGREE TO BE BOUND BY THE TERMS OF THIS CONTRACT. LIYVE ACKNOWLEDGE 'RECEIPT OF A COPY OF T HIS CONTRACT AND TWO COMPLETED COPIES OF THE NOTICE OF CANCELLATION. BY MY%OUR SIGNATURE BELOW, 1/WE UNDERSTAND THAT THE AGREEMENT IS SUBJECT TO REVIEW OF MY/OUR CREDrl' HISTORY AND I:'WE AUl71OR1LE HOME DEPOT TO VERIFY AND REV[EW MYiOUR CRFDff RECORD WITH AN INDEPENDENT CREDIT REPORTING AGENCY AND RELG•NSE TH&O FROM ALI, LIABILTI•Y INCURRED FROM INADVERTENT OMISS) O RRO S. DO NOT SIGN THIS CONTRACT'I"THERE ARE ANY BLANK SPACL5.. SUBMITTED BY:.A`t ` Date:— ! r 0,6 y� es Cons nt ACCEPTED BY: f�156 Date: Hornawner Date: Homeowner NDTFrFa '.DDITIONAt.TF.HMS.CONDITIONSANi I WA RIZANTIRSARF.STATRD ON'TIFI h:REVRRSKNIDEANV)A It KPAR'r OFTI If NCONT W"ICT - N'hi:e-Bench?ire Yel:ow-Cuslomr Pin'.•:-Sala Coesultaul 52-5-05 C-SC _ Board of Building Regina ions and Standards One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Nome Improvement:Contractor Registration Registration: 126893 Type: Supplement Card Expiration: 8/3/2008 THE Home Depot At-Home Services: j -------- -- -- RICHARD FALLONE — 3200 COBB GALLERIA PKWY #200 AtIANTA, GA 30339 Update Address and return card.Mark reason for change. Address R Renewal. E] Employment Lost Card DPS-CA1 Cv, 5OM-05/06-PC8490 ✓32C 't/)pryI7�I➢7,6'I7i/.!Ir.U.WJU O�✓[2Ct'4�Cd�LCQ��l6 Board of Building Regulations and Standards License or registration valid for individuyl use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Board of Building Regulations and Standards, Registration 126893 One Ashburton Place Rm 1301 Expiration g/3/2008 Boston,Ma.02108 Supplement Card THE Home Depot At Home Seniic �+ MCHARD FALLONE , t 3200 COBB GALLERIA PK #20 AtIANTA,GA 30339 Administrator Not vali without signature o MAR � , �~ +� � �CERTiFIG!4TE OF iN$U�ANGE CERTIFICATE NUMBER � .� .° ATL-000915907-11 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS MARSH USA,INC. = NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN THE ATTN:BRENDA BOOKER (404)995-2594 , POLICY.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE MAYA MCCLURE(404)995-3206 OR -AFFORDED BY THE POLICIES DESCRIBED HEREIN. TAMI ROUSE(404)995-3430 FAX(404)760-5663 COMPANIES AFFORDING COVERAGE 3475 PIEDMONT ROAD,SUITE 1200 ATLANTA,GA 30305 COMPANY 100492-IPUSA-GWA-03/04 A STEADFAST INSURANCE COMPANY INSURED COMPANY THD AT-HOME SERVICES INC. B ZURICH AMERICAN INSURANCE COMPANY DBA THE HOME DEPOT AT-HOME SERVICES,INC. HOME DEPOT USA,INC. COMPANY 2455 PACES FERRY ROAD NW C NEW HAMPSHIRE INS COMPANY BUILDING C-8 ATLANTA,GA 30339 COMPANY D AMERICAN HOME ASSURANCE COMPANY, 77 COVERAGES "This Certificate supersedes and replaces any,p�evlGusly issued cert(fcate for the polcy,penod noted below 3 , THIS IS TO CERTIFY THAT POLICIES OF INSURANCE DESCRIBED HEREIN HAVE BEEN ISSUED TO THE INSURED NAMED HEREIN FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THE CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,CONDITIONS AND EXCLUSIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Co TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION - LIMITS' " LTR DATE(MMIDDIYY) DATE(MMIDDIYY) A GENERAL LIABILITY IPR 3757 608-01 03/01/06 03/01/07 GENERAL AGGREGATE $ 4,000,000 X COMMERCIAL GENERAL LIABILITY 'LIMITS OF POLICY ARE EXCESS' PRODUCTS-COMP/OP AGG $ 4,000,000 CLAIMS MADE a OCCUR 'OF SIR:$1,000,000 PER OCC' _ _ PERSONAL&AOV INJURY - - $ 4,000,000 OWNER'S&CONTRACTOR'S PROT EACH OCCURRENCE $ k" 4,000,000 FIRE DAMAGE(Any one fire) $ 1,000,000 MED EXP(Any one person) $ EXCLUDED B AUTOMOBILE LIABILITY BAP 2938863-03 AOS� 03/01/06 03/01/07 E> COMBINED SINGLE LIMIT $ 1,000,000 X ANY AUTO ALL OWNED AUTOS BODILY INJURY $ (Per person) . SCHEDULEDAUTOS HIRED AUTOS BODILY INJURY !- (Per accident) $ NON-OWNED AUTOS X ELF-INSURED AUTO PROPERTY DAMAGE $ PHYSICAL DAMAGE GARAGE,LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ • ' UMBRELLA FORM 3 AGGREGATE $ OTHER THAN UMBRELLA FORM $ WORKERS COMPENSATION AND WC STATU- OTH-'. G 6610§98(AZ,ID,MD,VA) 03/01/06 03/01/07 X TORY LIMITS ER EMPLOYERS'LIABILITY C 6610995(AOS) - 03/01/06 03/01/07 J EL'EACH-ACCIDENT $ 1,000,000 G THE PROPRIETOR/ X INCL 6611326(OR) 03/01/06 03/01/07 EL DISEASE-POLICY LIMIT $ 1,000,000 P ERS/EXECUTNE 6610999 NY,WI 03/01/06 03/01/07 E OFFICERS ARE: EXCL ( ) EL DISEASE-EACH EMPLOYEE $ 1,000,000 OTHER WORKERS E COMPENSATION CONTINUED 6610997(FL) 03/01/06 03/01/07 D 16610996(CA) 03/01/06 03/01/07 1 } DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLESISPECIAL ITEMS CERTIFICgTE HOLDER q 0 �`� ""z� CANCELLATION � � SHOULD ANY OF THE POLICIES.DESCRIBED HEREIN BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE INSURER AFFORDING COVERAGE WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN:NOTICE TO THE FOR INSURANCE PURPOSES ONLY CERTIFICATE HOLDER NAMED HEREIN,BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER AFFORDING COVERAGE,ITS AGENTS OR REPRESENTATIVES,OR THE , ISSUER OF THIS CERTIFICATE. MARSH USA INC. ay: Walter Gilstrap ' . VALID A/0 ALI S OF 02/27/O6 ..v „ ter. • •�-,,.;ba. >..�,��. ... u, mow, �.:... TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION ':Map Parcel U Permit# 'Health Division 1 u 3 .S Date Issued Conservation Division s. ® Na �`ST Ut< Fee $3o Tax Collector (4)efZIND * Application Fee Treasurer Planning Dept. R Checked in By EX�I7 G SEPTIC SYSTEM Date Definitive Plan Approved by Planning Board LA y Historic-OKH Preservation/Hyannis im Project Street Address Village Z, , Owner Lk f (Address Z) 011A)�M Telephone. 14 1 j15 f9 Permit ReqUst a myt_ � 1'^ffi 1)( 7 , 1 (I Ini 0Z W��' Square feet: l st f�lojor: existing proposed 2nd floor: existing proposed fit' �I tal new Valuation o q 0�� Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size l Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family U/ Two Family ❑ Multi-Family(#units) C Age of Existing Structure Historic House: ❑Yes ®'No On Old King's Highway: ❑Yes V<0 C�1 Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) oNumber of Baths: Full: existing Half: existing new Number of Bedrooms: existing ne jTotal 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:LJ 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# Current Use Proposed Use BUILDER INFORMATION 4 Name /V Wt I , V. Telephone Number /L�b rA R"J 'b Address fy License# CSCLAA (1� ffp( V 9kHome Improvement Contractor# Worker's Compensation# A L CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE KEN TO 141"WIA NGODYA1 SIGNATURE IIt DATE << FOR OFFICIAL USE ONLY. F PERMIT NO. DATE ISSUED MAP/PARCEL NO. i ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION 17-o FRAME i INSULATION FIREPLACE - ELECTRICAL: ROUGH FINAL 13 PLUMBING: ROUGH r' FINAL GAS: ROUGH FINAL FINAL BUILDING t DATE•CLOSED OUT ASSOCIATION PLAN NO. 7 - a �.i.(•[1ust'-'t.ts (U J'101TJC JI))PTUVC:JDC'-I)t .o311mcloT 11 ;!,:1!; T-a1joj-j Rcalislralion: 1 D07-4D l ype: l:,rivale Corporation E rpiralion: 612312DDO CAPIZZI HOME IMPROVEMENT, INC. ` Thomas Capizzi, jr. ---- -- - 1645 Newton Rd. Coluit, MA 02635 131A.Me Address:and return card. A'lark reason for cbarnge. 0 A.ddress ❑ Renewal Employmcni. Lost.Ca ✓�ic 7fi�ronmarinur TT✓/ c�.(f� t Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before theeapiraiion date. If found return to: r Registration: 1OD74D Board of$uilding Regulations and Standards Expiration: 6123/20D6 One AsMurton PlaceRm 1301 Type: Private Corporation Boston,Ma.02305 CAPIZZI HOME 110PROVEMENT,I 1110ma5 Capi?s.i,jr. 1645 Nevdon Rd. Cotuil,101A D2635 ' Administrator �Nol-v2ljd without b Sato"r /ae. om —I ���i' isceeClQ. — — BOARD OF BUILDING REGULATIONS License:`'CONSTRUCTIONS i; Number CS 057032 t . P Birthdate A9/26/1963 Expires 0 .126I2D07 ( Restricfed THOMAS X CAPI, ZI1R 1645 NEWTOWN COTUIT, `MA.02635*�71G" ` Commissioner 82.50' c0 N (O LF o PROPOSED 8 x14- BH TANK ° ADDITION �j 25.78' lo LD ELLING10 CH MAP 306, PARCEL 71 #106 STETSON ST. HYANNIS, MA 82.50' STETSON ST. SEPTIC SYSTEM SHOWN LOT AREA 11,211 SF IS DRAWN FROM AS—BUILT EX. DWELLING AREA-1134 SF ON FILE AT THE TOWN EX. LOT COVERAGE= 10% HEALTH DEPARTMENT PROP. LOT COVERAGE= 11.IX CERTIFIED PL 0 T PLAN QUINLAN RESIDENCE I CERTIFY THAT THE IMPROVEMENTS SHOWN P�a OF yqs' #106 STETSON ST. HAVE BEEN LOCATED WITH AN INSTRUMENT ��,`' sc HYANNIS, MA y° DATE: NOV. 8, 2005 DRAWN: RBS SURVEY. ROBE s c SYKES �' SCALE:1"=30, J08 #: E00661 - G CPP No. 35418 EASTBOUND LAND SURVEYING, INC. P.O. BOX 442 ROBB SWES, PA. DATE FORESTDALE, MA 02644 508-477-4511 i k - f + Ij I � �I` f f t I I I J- _i : E 17- ZX �ja�srs �X(oesrs cc) .srm ?Sd- 1 : SST ,c3�s5 : 6T6: G.: ? Sly FGj1 i,o 6 , S7-/' / .1 f I 1 F } i to T. 1-/7j 6E - _ � _ _ _ r. •- - -_ --_ - --- - - -- -• -- - -- _ _.- _=.ate Z- Z - -77 S - /O��ScNoFu3F ea T��J�s � �'br L�lv G,� - --•� = - : - -- —Siiyl ,��aV �dsi ��?�ES _ �.� �/RT h��vv�ERS ��'y�� ---. -- - -- -- - • -�>- _ rD /-Si� 71 __ --1 - --- - - - �- - - ---- - ----- — -- - - f 1NE.1 Town of Barnstable 'L°� Regulatory Services Thomas F.Geiler,Director 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 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: V` Estimated Cost T _ jn Address of Work: Owner's Name: 1' `Rt+VV DW? AIM Date of Application: I hereby certify that: Registration is not required for the following reaso ❑Work excluded by1 ❑Job Under$1, . OBuilding owner-occupied ❑Own pulling own permit Notice is hereby given t OWNERS PULL1150THEIR OWN PERMIT OR DEALING WITH.UNREGISTERED CONTRACT FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS 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: -Nom. J DDT i Date, Contractor Nante Registration No. OR Date Owner's Name Q:forms1omeaffidav uiw tog"o CAPIZZI . HOME IMPROVEMENT INC . SPECIFICATIONS AND' ESTIMATES PAGE 6 OF 6 STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT I, IQ /1IC� ✓1 OWN THE PROPERTY,LOCATED AT IN vY 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: 5081428-9518 RESPONSIBLE OFFICER: RESPONSIBLE OFFICER ADDRESS: RESPONSIBLE OFFICER TELEPHONE: ACCEPTED BY DATE s THIS PAGE IS .PART OF AND IN CONFORMANCE WITH PROPOSAL # I