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0385 STRAIGHTWAY
�s � `'`.��' � --- ��. __ , r '` � "`�:. r i I I II'� " . Q DIME Town of Barnstable rPermrt • ,y 1•p .6 aJ Expires moissu Regulatory Services Fee N ` BARNSTABLE, *_ .. .. - .. .. .. .. .. MAM' $ Thomas F..Geiler,Director 1639. ♦� QED MA'S s wilding Divisian, 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 = RESEDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number fo l a 2 y :Property Address [Residential Value of Work e7 f (1 fJd Minimum fee of$35.00 for work under$6000.00 Owner's Name:&Address : 1 7 D4A1 e_.: : (®m gle.j ll Contractor's Name `� 2�. �f(16'11�. mplaae i1lg/V,' Telephone Number ® yR J. JS 14r, . Home Improvement�ontractor License#.(n applicable) G �d 9j Construction Supervisor's License#(if applicable) [�Zworkman's Compensation Insurance Check one: Ir I am a sole proprietor am the Homeowner . � EP 16 20 S L>d l have Worker's Compensation Insurance 14 vI y Insurance Company Name 'If klra lB �y6 J lVdillY401e PWN OFBARNSTABLE Workman's Comp.Policy:# UD 'd U,�f 7�Z4/ it :. Copy of Insurance:Compliance Certificate must accompany each.permit. Permit Request(check box). ❑ ke-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to El Re-roof(hurricane nailed)(not stripping .Going over:; :. existing layers of roof) I ❑ Re-side C #of doors p 3_r, ( ).[�Re lacement Windows/doors/sliders.U-Value maximum.35 #of window er Vo ... -t'r ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&:Are Permits required; *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 Ho provement Contractors License& or tract on Supervisors License is SIGNATURE: C:\Users\decoilik\ArpData\L6caKMicrosoft\Windows\Temporarytmeme�rass\C0ntent.0ut1ook\QRE6ZUB t'it! Revised 053012 I ` e%e�pd3l29LLR01CLCCLII/cf'C/�`rcJarcc/c%re ffice of Consumer Affairs&Business Regulation License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation egistration: 100740 Type: 10 Park Plaza-Suite 5170 Expiration: 6/23/2016 Supplement(:and Boston,li1A 02116 CAPIZZI HOME IMPROVEMENT, INC. JOHN STRUMSKI 1645 Newton Rd. g - — Cotuit, MA 02635 Undersecretary Not valid without signature kip Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Super isor License: CS-064817 .. JOIiN T STItUli1ISIa 'r r 18 AL DEN AVE r Buzzards Bay MR.025�32� / °:.•�..a ,rtt� Expiration Commissioner 06/18/2016 i The Commonwealth of Massachusetts Department of Industrial Accidents: W Office of Investigations ' I Congress Street;Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Capizzi Home Improvement'Inc Address: 1645 Newtown Road Cotuit, MA 02635 508-428-9518 -City/State/Zip:. Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1. 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 2.❑ I am a sole proprietor or partner- listed on the attached sheet.:: 7: ❑Remodeling ship and have no employees 8. ❑Demolition These sub-contractors have employees and have workers' working for me in any capacity. � 9. ❑Building addition o workers com insurance comp..insurance. p 5. We are a corporation and its 10:❑Electrical repairs or additions. required.] - ❑ �.. . . -3 ❑Tam-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 §. O, • c. 152. 1 4 and we have no: ' employees. [No:workers' 13..EVtherd /dyGl® 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. Associated Em to ers Insurance Co: Insurance Company Name: P Y_. . WCC50050105472013A 12-25-2014 Policy#or Self-ins. Lic..#: Expiration Date: ff Job Site Address: op City/State/Zip:. �l�j/�/ 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 certi and r th pa ns.a d penalties of perjury that the information provided.above is true and correct. Si attire: Date: Athe Phone#: 508-428-951 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): L Board of Health 2.Building Department :3.City/Town Clerk 4.:Electrical Inspector: 5.Plumbing Inspector-: 6.Other . Contact Person Phone#c i I p CAPIHOM-01 APELL A,C DATE(MM/DD/YYYY) �`7� 011�.�� , CERTIFICATE OF LIABILITY INSURANCE 61412014 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 NAME Rogers&Gray Insurance Agency,Inc. PHONE FAX 434 Rte 134 arc No Ert: Arc No):(877)816-2156 AfL South Dennis,MA 02660 ED ADDDRR ESS: INSURER(S)AFFORDING COVERAGE NAIC A INSURER A.Main Street America Assurance Co. INSURED INSURER B:Associated Employers Insurance Co. 11104 Capiai Home Improvement,Inc. INSURER c: Capri Enterprises,Inc. 1645 Newtown Road PISURER 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 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. WSR TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP LTR POLICY NUMBER M LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS-MADE N OCCUR MPB1075H 06/0812014 OW0812015 REMIDAMASES E S( D PREMISES a ocwrrence) $ 500,00 MED EXP(Any one person) $ 10,00 PERSONAL&ADV INJURY $ 1,000,00 nGEN GENERAL AGGREGATE $ 2,000,00POLICY aJECTT FX LOC PRODUCTS-COMP/OPAGG $ 2,000,00 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ a accident A ANY AUTO MI M280" 06/08/2014 06/08/2015 BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BODILY INJURY(Per accident) $ 500,000 AUTOS AUTOS X X NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident 8 X UMBRELLA LIAB N OCCUR EACH OCCURRENCE _ $ 5,000,00 A EXCESS IJAB CLAIMS-MADE CUB1076H OW08/2014 06/08/2015 AGGREGATE $ DED I X I RETENTION$ 10,000 Pers&Adv Inj $ 5,000,00 WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER B ANY PROPRIETOR/PARTNER/EXECUTIVE YIN CCSOOSO1 0 647 201 3A 12/25/2013 12/25/2014 E.L EACH ACCIDENT $ 1,000,00 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L DISEASE-EA EMPLOYEE $ 1,000,00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Barnstable THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis,MA 02601-0000 AUTHORIZED REPRESENTATIVE .. ♦ IdrGT+GtB� . ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD pag e7of7 Capizzi Home Improvement Inc: k Specifications and Estimates STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT I, AN /qyN� GNN C�y , OWN THE PROPERTY LOCATED AT 3157 s7'ocW6,)'7Wf'9 IN I'l lANN if, ,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 P RMI ACCORDANCE WITH 780.CMR, THE MASSACHUSETTS STATE BUILDING D 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: TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel a Application # C 0 � Health Division I Date Issued '? Conservation Division �`� Application Fee Planning Dept. Permit Fee C� Date Definitive Plan Approved by Planning Board Historic - OKH ' Preservation/ Hyannis Project Street Address d;�1/.41'jlkW4V D Village Owner P 1=A/VNe M , - 7)'4Ne Co#h Address I'P M i C he Il£ TEA lit46 APY 1k,4 Telephone 5,04P Permit Request Ale u/ Reck e 4 17E44 oe" AOwJe (411, 6 X /1.P//a le x !z ',�����x/ Al edv 14,aeiC��% f re0,4 g S loft c,(,e'e r lope. Square feet: 1 st floor: existing /s00 proposed 0 2nd floor: existing d proposed Total new a Zoning District ? Flood Plain Ale Groundwater Overlay Project Valuation 2®1 0d0 ' Construction Type Woop Ampt,� Lot Size 0131 Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure 9'r 6 Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl LVNalkout ❑Other Basement Finished Area(sq.ft.) � ��lR ' Basement Unfinished Area (sq.ft) Doo V-14 Number of Baths: Full: existing 3 new Half: existing new Number of Bedrooms: 3 existing -�/nefw Total Room Count (not including baths): existing 61 new 0 First Floor Room Count Heat Type and Fuel: W Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes 31�No Fireplaces: Existing / New Existing wood/coal stove: 0 Yes❑ No Detached garage: ❑ existing 0 new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑new (size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: ;m a. ate: Zoning Board of Appeals A horization ❑ Appeal # Recorded ❑ ❑Yes �Nc If es site Ian review# Commercialy p `Current Use '� /y_--_- __ _Proposed Use-_Cf/fl ple - /1QJ/D�tet�g G- PPLICANT INFORMATION e (BUILDER OR HOMEOWNER) A Name h� � Telephone Number Address License # co vt/*! Home Improvement Contractor# I0d� � Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ' \SIGNATURE _ DATE 0 �/�.7, 2�1Z .far, p FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. f � ADDRESS VILLAGE- OWNER F. DATE OF INSPECTION: k FOUNDATION FRAME x: INSULATION FIREPLACE ' ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL' r FINAL BUILDING F ,. DATE CLOSED OUT ASSOCIATION PLAN NO. ` r - , Tire Cortnmatriuezlth gfAfas�,a,,huser rentofr'ffd 5*igI'4CCidents u -0fe o ` rvstcgrfia 660 Washingtgtt Sfreet gcrstwt,MA 02111 w govldla arkerss dam en atioa Iusurauc�Affidavit: Bu derslC�ati e���• / Iec ieiaas/Piumf�er AnpRe2int fnfhrmafivg ' 3n1e(Susivass/Grganization/TadMdua(}: e Address: Ap?uj �; i� IZ �ifjrlSf3fel�ip: .0 0"I"FJi d .I. t ' r e gait an,emplripee, Check the apprbgriate 6or; t.L�Yt sm a emglnyer ivrtEi .'f 0 'r 4: [J I ain a getferal contractor and I Type�f project(required):. employees(full Aiworpait time). have hired the soh contractors d Q Ne nsEructiori. 2.Q r am a sole proprietor 6rpartuer= listed on the attached sheet 7: emodoli�xg. Ship,and have aQ eaiplbyees. These sub actors have $ [ I3eaiQIitioii wor d for,Ze in any capacity: eZpIoyees and have*orkers` jNQ vrrar.ers comp.insuurmce cor ip-iusuraam: 9. Q 13ruT�ling additii ct required. 5. Q tie are a corporation and its io-[J El6ctrical itparzq or additions 3,Q I zmmhoineownerdoimgajjw0& officers have.exercised their Piiimb' a�,repairs or additions myself-�Nb#'orkers'cdrFtg- right of exemption per IviGL 12 Roof insurance required.j# C. 152,¢E{4},and •e have ao Q emp oyees CNo workers' Q tithe[. I comp.'las�cs required b y?DPic?at that cfi ks boxt Host aisa fill out the sw traa Irct�w shoiv�ag t�eiir -rs`caarisahoa paticy nfocmacioak F[omeaivties who subaut this avert iadtcag tfi y are doing atE work and tFi�n Sorg outside contractors mtict submit a u-w atndavit iadica''su h tGontractacsr$at ehxk tbss box must atth�f an adctitiartaf skirt showFng the hate of the sub contia^ s and stafc wfi or tic:tho"se utiti vc: . em�s[oge I€tbc sub ut actin rave employes dipy ai f pray . their wo cis'a aig pQIicy uumbx E¢ttc arc etrtplayer thatrspravrdurg x*arXers'crrnrpertsa n insurance or rn etrc to eea $efaw is thetrofiry atsd jab site irifarrrtaYicrr4 _._.�' _P.._y _ y` Insuraace.Companyllame_ E'otcy#orSelf--ins.Gic.# / C C- '2 Y'Zoo" Tob-site Address. .. city/StatrJzip 1 ��/il�%/ 1 � 4ttacfi a cagy of the wesricers'comgeksatigtt gb€icp�ecCar-atian gage(sTYnt�ittg.tEte poficy'-rtumlrer and ezlriratrQu date):: FatZure to secure coves a as regtured under Secti q 25A of MGL c. 152 can lead to the ungbsition of crinial'penalttes of a Inc up to$1,SOQ QQ audTor aae-year u�zrisonm at;as well civil penalties im the foie"of a STOP WORK.bjZDER aiid a foe of eP to$25�(�(}.a day a��ains:the viaLeor. Be adxis.•d that a copy Qf.this statement may forwarded to the Office df. Investrgatigt:s of the DL €gr msuraace coverage- erificatiorf Inv liez'eby ichder thegauu aisd pehafti fPerJriry t, at the ircformatiori provided abrxve is true air d correct Sranature� _ � ®: Date: .1� O ficr¢I use arsly. Dd writ scare in thrs nice,to be"camp fetid fry city at,awn a :czar: City ar F'a �• P rniittUcense L4saiagAEttharity(circle que)s F $a$rd a€ffealtli Z,BILII lRas g&Rartateat 1.QylTowa CFerk ` .Electrical Fusge far S: 71ambing Lis{sectoc ' 6_atlter. . Caatact Person: ` Plicme 4• - Client#:47298 CAPIHOM ' � - DATE(MM/DD/YYYY) ACORD. CERTIFICATE OF LIABILITY INSURANCE 6/08/2012 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 8r Gray Ins.-So.Dennis PHONE F4C 877-816-2156 A/C No Ext: A/C,No 434 Route 134 E-MAIL .ADDRESS: - South Dennis,MA 02660-1 60 1 INSURER(S)AFFORDING COVERAGE NAIC# 508 398-7980 INSURER A:National Grange'Insurance Co.' ' INSURED INSURER B:Associated Employers Insurance- - Capizzi Home Improvement,Inc.''' INSURER C Capizzi Enterprises,Inca . INSURER.D: , 1645 Newtown Road . INSURER E: LE I - Cotuit,MA 02635 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 CONTRACTOR 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. INSR TYPE OF INSURANCE. ADDL SUBR .. POLICY EFF . POLICY EXP - LIMITS LTR INSR WVD POLICYNUMBER MM/DD/YYYY MMIDD/YYYY A GENERAL LIABILITY MPB1075H 6/08/2012 06/0812013 EACH OCCURRENCE $1 000 000 ' DAMAGETO RENTED X COMMERCIAL GENERAL LIABILITY - '- PREMISES Ea occurrence_ $500 000 CLAIMS-MADE F_XI OCCUR MED EXP(Any one person) $10 000` PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE, r $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: - ' - PRODUCTS-COMP/OP AGG '$2,000,000 ..'POLICY n PRO- .LOC $ JECT AUTOMOBILE LIABILITY M1 M28O44 6/O8I2O12 O6/O8I201 COMBINED SINGLE LIMIT A Ea accident 500,000 ANY AUTO - BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED - BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS. X NON-OWNED,. - PROPERTY DAMAGE $ AUTOS ' - Per accident X Drive Oth Car $ A X UMBRELLA LIAR OCCUR CUB1076H 6/08/2012 06/08/2013 EACH OCCURRENCE s5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE s5,000,060 DED I X RETENTION$10000 - $. B WORKERS COMPENSATION WCC5010547012011 12/25/2011 12/25/201 X We sTATU OTH- IIT ER AND EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $1 00.0 000 OFFICER/MEMBER EXCLUDED?- N N I A (Mandatory in NH) J E.L.DISEASE-EA EMPLOYEE $1 000 000 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 Town Of BarnstableSHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE, ©198 -2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 Of 1 The ACORD name and logo are registered marks of ACORD #S82889/M82857 TLH Page 7 of 7 Capizzi Home Improvement Inc. Specifications and Estimates STATE`OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT I, DIAly4,z 30tjmii%, l , OWN THE PROPERTY LOCATED IN MAAfAf 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 ODE. _ SIGNATURE O.F OWNER: r 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,lVlA 02635 APPLICANT'S TELEPHONE: 508-428-0518 RESPONSIBLE.OFFICER: vLL RESPONSIBLE OFFICER ADDRESS RESPONSIBLE.OFFICER TELEPHONE: :, e'c'l. PROP. o DECK ,fig 28' O EX DECK & 6.5 STAIRS EX O DWELLIN ° TANK o of EX. GARAGE of � d- 80.00' "1pt. MBLU 269-229 385 STRAIGHTWAY o HYANNIS, MA o aoo 00 N 0 ry� SEPTIC FROM ASBUILT ON FILE AT THE 20.00' TOWN HEALTH DEPARTMENT, BUILDER TO STRAIGHTWAY CONFIRM. ®/_" T ID-LAN CONNELLY RESIDENCE„385 STRAIGHTWAY - I CERTIFY THAT THE PROPOSED IMPROVEMENTS P�tN of MAss9 HYANNIS MA HAVE BEEN LOCATED BY AN INSTRUMENT �`� �+ yG -:DRAWN: RBS SURVEY. ROBE s DATE: 6-6-2012 c SCALE:1"=40' JOB #: E00965 SYKES � DWG. CPP No. 35418 EASTBOUND LAND SURVEYING, INC. ROBB SYKES, P.LS. DATE P.0. BOX 442 FORESTDALE, MA 02644 f � Office of Consumer Affairs&Business Regulation License or registration valid for individul use only m� CHOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: ie Office of Consumer Affairs and:Busin.es Regulation gistration': 10074p TYPe' _ e 10 Park Plaza Suit 5170 tx irat_n. 6123/2-012 SuPPlen ent CardBoston MA 021167 =__= M CAPIZZI HOME'IMPROVEMENl;`INC. JACK STRUNSKi.' 1645 Newton Rd. Cotuit, MA 02635 j Undersecretary Not valid without signature_ tMassachusett.s- Department of Public Safety Board of Building Regulations and Standards CartstrvctiOn Supervisor License 1:icense: CS 64817 :aOHN T $TRUMSKt PO BOX sel BUZZARDS BAY.MA 02532 4 Expiration: 6/18/2012 ('on}n�iuiuner� Tr#: 10573 _ . i THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) m A E DATA COMMONWEALTH OF.MASSACHUSETTS w OFFICE OF CONSUMER AFFAIRS AND -.. VJ BUSINESS REGULATION 10 Park Plaza—Suite 5170,Boston MA 02116 ( I (617)973-8700 FAX(617)973-8799 1f Y� www.mass.gov/consumer l DEVAL L.PATRICK GREGORY BIALECKI GOVERNOR SECRETARY OF HOUSING AND ECONOMIC DEVELOPMENT TIM OTHY P.MURRAY LIEUTENANT GOVERNOR BARBARA ANTHONY UNDERSECRETARY Request For Supple mentary'HIC Cards It is recognized that some construction firms may.have a need for additional identification card(s)for officers,partners,or other key employees as means of identification in dealing with building officials,potential customers,and the like. Additional ID cards_wfll.be. issued upon proper completion and submission of this form along with a$10 fee for each additional card requested ..(CERTIFIED CHECK OR MONEY ORDER). The registration number will be the same as the original applicant registration number,and;the ID card will list the name of the applicant'and the name of the mdividual to whom it Is Issued The address of the Individual should be f a= z the address at which the`person is based(i e,a branch office, mam office,or home address) Cards will be;Is`sued only to officers, G partners,or employees ofthe registration: THE REGISTRATION AND THE NAME.OF.THE-RESPONSIBLE<IIVDIVIDUAL WILL .' STILL HAVE THEJOINT AND SEVERAL LIABILITY FOR WORK CONDUCTED AS NOTED INIVIGLiM42A`AND 7_8 R6 AND WILL BE RESPONSIBLE FOR THE WORK OF THE INDIVIDUALS ISSUED A'SUP PLEiyIENTARY'CARD,'°THE' ' HOLDERS OF THE SUPPLEMENTARY CARDS WILL NOT BY REASON OF BEING ISSUED SUCH:A CARD ASSUME SUCH LIABILITY. THESE CARDS ARE ISSUED AS A CONVENIENCE TO THE REGLSTRANT. Additional Home Improvement Contractor identification cards are requested for the follow PLEASE TYPE OR PRINT LEGIBLY NAME TITLE ADDRESS • � . THE COMMONWEALTH OF MASSACHUSETTS Department of Public Safety i One Ashburton Place, Room 1301 Boston,MA 02108-1618 r APPLICATION FOR RENEWAL OF CONSTRUCTION SUPERVISOR LICENSE NAME le �- ADDRESS ` OLD ADDRESS i CITY ci c E-Mail Address I ' Licenses not renewed by the expiration date become void, and shall after a two-year period, be reinstated only by examination of the licensee"(780 CMR,110.R5.2.4). All future renewal notices will be sent by e-mail communication only unless an applicant certifies, under pains and penalties of perjury, that he\she is unable to be notified via electronic e certification . line at the bottom of - this form.) message. (Please refer to th _.., 4 n o AUTHORIZATION FOR RELEASE OF RMV INI=ORMATION: 'i �§ My sigma re. ow,.authorizes the Department of Public Safe to electronically access my t graph,from the Massachusetts istry of Motor Vehicles databases 1 L or /registra N MA photo release signature y is Otherwise please submit a color Passport Photo 2x2 inches in size taken Within the past 6 .months showing current appearance.Tape photo on edges to the box Attach pttoco on the left with clear tape. �� Tupc Photo edges to this bQR. . . - i Please enclose a check or money order made payable to the Commonivealth of Massachusetts for the required renewal I fee of $100.00. DO NOT MAIL CASH. Please include your license number on the front of the check or money order. i Mail the completed renewal form with payment and photograph to: I Department of Public Safety,-`,CSL Renewal P.O.Box 414376-Boston,MA 02241-4376 Also, please refer to the Department of Public Safety website @ www.mass.gov/dps for newly enacted continuing' education requirements for construction supervisor licensees. I hereby under the pains and penalties of perjury that to the best of my knowledge and belief the information . y certify�' above ' orrect and that I have filed all state tax returns and paid all state taxes required by law and complied with all law of mmonwealth relative t the withholding and payment of child support. gn ture of Applic .'t D ate I hereby certify,under the pains and penalties of perjury;that I Signature am unable to access e-mail notifications and therefore request U.S.mail notifications of renewals. Date s:\admin\current forms\bbrs\appl_csl renewal 8 2011.dooc "' � i : , J( I e �v lW✓ '�.�.r' \\\666 N V�` fff i�• � � �i 1 •M` } d� F�46! XD V J 6I �. � ,, � I jo I �11 A 4 I % �I i ii I _ g I, t •' � rµ F i i ��. I .� I. .1 ! ' . { iito z , ,` 1 3� 77777777 r V _ I ,ti i. . \• t i I RAD h L 41 r� _ N, = - { _ - IN IV Pr GAI 6e � j ZR L FT MR, k,�l CA - Y t ii l 1 t ---- ^'-� -'_ '-_ - _ � f r F � � Town of Barnstable *Permit# off' Expires 6 mo r issu ate ,x+ Regulatory Services Fee • Bninvszesi.E MASS. Thomas F.Geiler,Director VZ� 16 �fD MA'1 Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.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 C� Property Address 311.E i� � hl Y �11s�✓B✓ U to E►f [Residential . Value of Work J` t f'd Minimum-fee of$35.00 for work under$6000.00 Owner's Name&Address-t>i A NA ,- AT 6 e wye W LI e izx1r Contractor's Name' ✓oot/ I 6-h1 lk M (4 j1 j >Z 1�tMe T?re&�llone Number Home Improvement Contractor License#(if applicable)' fit;-I y 40 Construction Supervisor's License#(if applicable) -P, Es lei ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor. ❑ I am the Homeowner,: SAWS STABLE I have Worker's Compensation Insurance f (0,,f W1 OF SAW Insurance Company Name ` . - Workman's Comp.Policy# y�� o Copy of Insurance Compliance Certificate must accompany each permit. 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) yl t � y G eu-" �D ❑ Re-sideh�d V. #of doors •/ t°� [Replacement Window door liders.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. copy of the Home In4Provement tractors License&Construction Supervisors License is SIGNATURE: . C:\Users\decollik\Ap ta\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\DDV87AAZ\EXPRESS.doc Revised 072110 r Page 7 of 7 Capizzi Home Improvement Inc. Specifications and Estimates STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT THE PROPERTY LOCATED AT 3P7 J1 IN �.�. , MASSACHUSETTS. I HAVE AUTHORIZED CAPIZZI HOME IMPROVEMENT TO ACT AS MY AGENT TO APPLY FORA 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 BUILD 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:, . 5 � fC7 i l if QV C`c Pt i CONTRACTOR'-' �r - a �azu tta rii tiz as"cite. T fours return to,.,..., � 3stritaoca t0074,O - , a331t#C}CI �c � } R w C $ b _ P e G t TfCI f } 3 CAPIZZI JACK S(4Rg.�'yvy¢Vr 3pS4I K i d43°'5 t5f#iS ".,+zf t-2"4"tt. f P,�E;.i3�, ^Is & t Jtf `.,•i - U-nderietntiry :� at�h tirl t i fa ut• r as t#are = 4. 2' .. a4;�;aaelaatsettr Oeaaaa tttaalt to# *aata4a xtttts t J7�(,f<.7"{l7 fi ems} 5 auilcllra l e lat ons i"Id Stbaratlbtrtl Q y COnstatxLtton Supervr or i l r€ ". : c 0 48i T. :J0HN T.- UM6K! iT po O � l ",ALLt1YL.«7 03 ! <a' " a ,. :- • }. xpfr�t}on. 151MQ T#s'ddr. fO57 - ,. Y 'y r {#" `� a •D - >P .. x - • �� F�"`d y • e � E � " �fa .f.;f S` Y � n 4 " -' e • 5 it y i d t` • S F r� r� € . . ay 5 t h* � y •a �x �- - _ _ s R +e�. m"s ; '� s. '. a e¢`. P1 4 ay a Mrs s+� iY'' • � v �, c�e a € .,�h w. n.;� a� 'k ve � ' t. YY :S y .. ~`•k f} t ; F ,.'.3 '1 �r� r^."�. Y z r r Client#:47298 CAPIHOM ACORD. CERTIFICATE OF LIABILITY INSURANCE °6;02,2o„m' 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 INSUR_ER(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 _ Rogers&Gray Ins.So.Dennis PHONE 508-760-4630 F 508-258-2230 434 Route 134 L-MAN� ac,No ADDRESS: waltherka@rogersgray.com P.O.BOX 1601 - PRODUCER CUSTOMER ID#: - South Dennis,MA 02660-1601 INSURER(S)AFFORDING COVERAGE NAIC# INSURED - - - INSURER A:National Grange Insurance Co. - Capizzi Home Improvement,Inc. INSURER e:ACE Property&Casualty Ins:Co Capizzi Enterprises,Inc. INsuRERc: 1645 Newtown Road COtult,MA 02635 INSURERD: . 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 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. INSR DL UBR POLICY EFF POLICY'EXP L TYPE OF INSURANCE NS POLICY NUMBER MMIDD MMIDD LIMITS p GENERAL LIABILITY MPB1075H 06/08/2011 06/08/2012 EACH OCCURRENCE A 000 000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence - $500 000 - CLAIMS-MADE a OCCUR MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000000 GENERALAGGREGATE $2,000,000 GEN1 AGGREGATE LIMIT APPLIES PER:. PRODUCTS-COMP/OP AGG $2,000,060 POLICY PRO-JFCTLOC $ A AUTOMOBILE LIABILITY �• M1 M28044 6/08/2011 06/08120U COMBINED SINGLE LIMIT $ ANY AUTO �' (Ea accident) 500.000 ALL OWNED AUTOS - - - _ - BODILY INJURY(Per person) $ X SCHEDULED AUTOS - - - - - + - - BODILY INJURY(Per accident) $ PROPERTYDAMAGE- $ X HIRED AUTOS (Per accident) X NON-OWNED ALTOS X Drive Other Car A uMBRELLAUAB TV IOCCUR CUB1076H' 6/08/2011 06/0812612 EACH OCCURRENCE, $5 000 000 ` EXCESS LIAR CLAIMS-MADE AGGREGATE' $5 00O 000 DEDUCTIBLE k` $ X RETENTION 10000 B WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN NWCC45843208 12/25/2010 12/25/2011 X we srATu- OTH _ . ANY PROPRIETOR/PARTNER/EXECUTI E.L.EACH ACCIDENT $1,000 OOO OFFICER/MEMBEREXCLUDED? ' N ,NIA - ' (Mandatory In NH) - -If yes,*describe under E.L.DISEASE-EA EMPLOYEE $1,000,000 - - - - - " - DESCRIPTION OF OPERATIONS below. - E.L.DISEASE-.POLICY LIMIT $1,000 O00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) - - -- - Additional insured status is provided under the general liability when required by a written contract with the certificate holder CERTIFICATE HOLDER' CANCELLATION 10 Da Vs for Non-Payment i 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 C rights reserved., 0198 -2009 ACORD ORPORATION`All `ACORD.25(2009/09) 1 of 1 The ACORD name and logo are registered marks of ACORD r #S67537/M67480 MEE ' The t~a£rrrrtattweam ofmassaehusetts. Department oflnrfustriad,ccidents - ` (?ice of Invesdgations 600 Washington Street - Sastan,MA 02111 ' w.ttzass_gav/rficr ' Workers' Compensation Insurance Affidavit: Builders/Coati-actvrstElecfricians/Plumbers Applicant Information ' Please Print Ee2ibl�r -NffiTie(Business/Organization/ladividual): ZZl 1/0,n7e— .�Yr P 41c ut'wexj' Address: iU e tilj w lZ f City/state/Zip: C ('t"vi+! M4 624� S' Phone qS,i Are you an employer?Check the appropriate Tsar: Type of project(required): 1 E am a employer with .4t? 4— 4. 0 I am a general contractor and employees(full andlorpart-tine). ` have hired the sub-contractors 6. New'construction, 2.[� T oar a sole proprietor orparttrert listed on the attached sheet. 7. []Itemodelig ship,and Stave tip employees" These sub-contractors have $: [�.Demolitioq working for me n any capacity. employees and have workers' il4Io workers'comp.fi ilt3mce comp.in'smance.: 9. Q Building addition required.] 5. E] Vide are a corporation and its 10.0 Electrical repair or additions 3, I aim a homeowderdo' all work officers have exercised their 11. Pliimb'tng repairs or additions' myself w(j workers'comp. right Of exemption per MGL 12. R incur q repaired.]t c. 152,§E(4),and we,have uo 0 ." employees-NO workers' b. thet _ co _. map.insurance required.] ti Airy ap¢-cant that checks box#1 mvsft,ais6 fdi out d+c sxkon Maw shoiu�ng their x c l cis'comp eeusahon paHcy iafoiYaationt Homeowncts wlra submit this affida4 it indicatitrg dficy are doing all work and then trite outside coafiaclois must submit a new davit indicating such�CoiihaaEarsthet cluck this 6os.must atta,;hed an additional shext showing the Dante of the sub-cazyt and�wheifier or:oot Erin"se entities hawc:etrtp[ayec . IEtfie sub conCzactors havca emPieYees.they iayst pcovide..their woes'camp,policy uumtiec I' an eatpla}+er that isprovrdug workers'coricpertsah'vit insurance for r:ry erccplayees Below fs tliepaficy axd job site rxjgrneaturn r� Insurance.Company Name: PVC C .,e P—Sri"y 61 D 1 S 4 L-f Policy#.or Self ins.Lit.# !tt AlC C. 4 5 8 Zi 3.Z�� i ,2 .. . . Expiration Date 1:c4 �(��1 IA.8rte Address:_ O.S �� f� ��6 City/State(zip �i /* Attach a;copy of the workers'compensation p0cy declaration gage(showing.the poitcy number stall ezgrratit?n date): Failure to secure coverage as requr ell Wade£Sectic}a 25A of MGL c. 152 cart lead to the imposition oecrittriiial penalties of a foie up to$1,500.0()and/or one-year imprisonment;as well as civil penalties in the t`oim of a STOP WORK ORDER and a fine of'trp to$250.t}0 a day a�rainsf the viofatpr: $e advised"that a copy Q€this statement uray be forwarded.to @ie Qffce of Fnvesttgatiaas of the'DIA for insurance coverage"verification I do Hereby under thepairu aKd perialh f perjury that the information provided above is true aitd correct SiQuatirre Date �• 13J 2,61! 9 . Off icial icse.only. Do hv1 write in this area,to be campre£ed by city ar t9rw�r o ciaL' City or Town: Permit/License# Eln�ct IssuiagAathority(circle Qae): I.Baatd o€HeaBuilding Deparfinent 3.C4/Towii Clerk 4.Electrical,faspectorT 6.father. Contact Person: Plroue • t UV i u � - o e -ROPERTV ADDRESS I I ZONING I DISTRICT CODE SP-DISTS.I DATE PRINTED I CSTATE LASS PCS I NBHD KEY NO 0385 STRAIGHTWAY 07 R8 400 07HY 07/09/95 1011 00 556C R2o9 229. 176142 LAND/OTHER FEATURES DESCRIPTION ADJUSTMENT FACTORS ITY UNIT ADJ•D.UNIT J O H N W ffi J A N E MAP- Lana By/Date Sae D--swn LOC./YR.SPEC.CLASS ADJ. COND. P PRICE PRICE ACRES/UNITS VALUE D.scription R OD R I GU E S i / CD. FF-De to/Ages E #LAND 1 24.P200 CARDS IN ACCOUNT - L 10 18LDG.S IT. 1 X .3a =10C 182 34999.99 63699.99 .38 24200 #8LDG(S)-CARD-1 1 113.500 01 OF 01 A #OTHER FEATURE 1 11,100 LOST 1488UU ' N BATHS 2.1 U 1 x C= 100 9500.00 9500.00 1.00 9500 3 #DL LOT 23 4ARKET 53600 D FIREPLACE U X C= 100 3100.00 3100.00 1.00 3100 8 #PL 385 STRAIGHTWAY HY INCOME RG3 GAR/LOF S 24 X 26 1986 C= 93 19-2 17.85 624 11100 F ;ERR 1543 0020 SE ABLA BSMT RM S X C= 100 45.10 45.10 600 27100 d PPRAISED VALUE D J 148P800 A U ARCEL SUMMARY T S AND 24200 A T LDGS 113500 -IMPS 11100 M TOTAL 148800 F E i 4 C S E N DEED REFERENCE Type DATE R,� R I O R T YEAR VALUE A T Bopk Paga Inst. MO.... Vr..D S.1-Pri- AND 24200 T S 9013/15/ EI. 1/94 A 100 3LDG.S 124600 U 73501141: V'J1/92 F 100 TOTAL 14880C ,3 7350/141: V01/92 F 37000 t BUILDING PERMIT F O U N D ONLY 1/8 7 1 Q�� 1/$�...... Date Amount . LAND LAND-ADJ INCOME SE SP-BLDS FEATURES BLD-AUJS UNITS Number 24200 11100 39700 30263 12/86 Type ND 75000 Class Consl. Totat Base R.I. Adj.Rate B It Age Np . ODsv. CND. Lac %R.G Re I Cost New Atl Re I Value Stories Hei M Rooms Rms S.M. I Fi. P Vnits Unils A 1r Depr.rm Contl. P I P 9 .rlyw.0 f.C. 01C 000 105 105 59.65 61.58 86 88 6 95 100 95 119432 113500 1.4 6 3 2.1 9.0 Description Rate Square Feet Repl.Cost MKT.INDEX: 1 0© IMP.BY/DATE: ME 9/91 SCALE: 1/00.75 ELEMENTS CODE CONSTRUCTION DETAIL SAS 100 61.5$ 1152 70940 s v _ UU UFO 60 36.95 32 1182 *__ � N 10--* STYLE 01 ALSED RANCH 5.0 UFO 60 36.95 52 1921 6 FWD b -ESTvN-AbdMT- LT -------------- UFO 60 6.95 96 3547 *--------------- 4$------_--*--10--* r J - RTF4:dA11S__ _T4 I ERT:--S76IN1-----_U.-t7 FWD 85 8.50 60 510 *------------- UFO--------------_-*-__12---* EATfAC-TYPE J7 Ab=ROT-WATFW---U:O FWD . 85 8.50 192 1632 ! ' �• J FWD NTF!T:FI7tfI5H_ _J4 RY4TALL------`----U=Q " •:: r ! ! ! NT IT.LrAYIJUT- TZ VYR:7NVIR'M AL_----U:O - J ! 16 16 NTE-R.-QUA-LTY- -C L7 AWE-AS--EXTFW.- ff- 3 ! ! ! t O J-K-S TR UC T- l72 24 BASE 24 ! E L00-fT-COVER-- -JY A-"ET------------- x E Total Areas Au._ 252 as'.- 1152 ! ! ! Of7F--TYr��----- -TT A-Er E=A-S-P`H-SW---D:-0 BUILDING DIMENSIONS ! '*---1 2---* L EC-rR I C-A-1: - YTT V r=RA GE T B S 6 FO S E N a t •• -OtJalDAT1:0-ht__- -Tt WIZED--C-ONC-----99:-7 A BAS W32 UFO SOZ E26 NO2 W26 --------------- --- I BAS N24. UFO E48 NO2 FWD N06 W10 ! i L S06 E10 UFO W48 S02 .. HAS *--------- ----�1EITiFii30RH D 3SBC'NYAwNTTOTAL -- -:32------*---*-----16----X LAND TOTAL MARKET E48 FWD E12 S16 W12 N16 .. BAS *-------UFO--------* *---- UFO----* PARCEL 24200 148$00 .: S24. .. AREA I 1 :1106 VARIANCE +0 +13349 STANDARD l assessor's offioe (1st floor): " t,vG(NtER MUST SUr'�r` As;eSsor's`'i-lap and lot number ......:�6 `..' .Q a••9 STALLATION AND CERTIFY IN Board of Health (3rd floor): (2 +Ll (�SD THE SYSTEM WAS INSTALLED I Sewage Permit number ............... ................................. Z BABd9fABLE, S Engineering Department (3rd floor): ACCORDANCE TO PLAN- rasa House number ..:.............................. ....... 5..................... t "� 3 spa Usk! 6�0 a �e SEPTIC SYSTEM MUST B APPLICATIONS PROCESSED 8:30:9:30 A.M. and f00-2:00 P.M., only INSTALLED IN CC L.IANCE TOWN, OF BARN Tj CODE ARID BUILDING I,N S P E C T REGULATIONS ••�� v " �� APPLICATION 'FOR' PERMIT TO .... ....... .... �YL..L.?f..../- w�C ......................................... TYPE OF CONSTRUCTION ........ �-- . l oZ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: . ...Location ........L 07 . .........S. _ I6 '7�77 �. /.......... ......................... ...............................f Proposed Use v/JC1�� L r- /L k'C / L_�r C ..................................................... ............................ .................. ... .................................... ........................... Zoning District ................!.�...!�.............................................Fire District .........................................:.................................... Name of Owner .JD GV ....PQ M*&ddress .... c�.. ............................... �?�.. s�ljt/1 S Name of Builder .............:.... ................................................Address ...........�9 ...L'.................................................... Name of Architect ...............:.. ...` ........................Address ......:... 1F �... .................................:............................... Number of Rooms ................... 4... ........eoAj L ..........................................:.................... ........1.(.�(� ...�..........J�I G;LE=.................Roofing ..,:....d �. .L. .....5> /,iN�=L�S Exterior :..... y Floors ......... .L. t ©� �.......: .Interior f - rleotTngD7...C .% T.. ! a .rZ- .l]:�':.r.. l!T -.Plumbing ...---- ...-................:.......:...`........................ Fireplace ....! ,Approximate Cost ....... .5 00 0 ...... �. .......................... ..... ... ........(" ... .. Definitive Plan Approved by Planning Board _________________'______-_______19________ . Area /... . . .. v.•...•.... ........ ... Dito d agram of Lot and Building with Dimensions Fee 7� L— SUBJECT TO APPROVAL OF BOARD OF HEALTH /V 11"T A C D 5 1 1� 4bf 6n ell OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name �.... �... . .............. Construction Supervisor's License .............. .. 0DRIGUES , JOHN W. -1- 30.363. Permit for ............ & Garag.e�.... ...Fam- ' v D w e 3-1 i ng Location 385 Straiq.�tway ................................ ...... ........... H................I.y an.ri i.s................................... john W. Rodriques Owner .......:...............................n................ Type of Construction .... ..............F r ame- ....................... ............ ............ ....................... ....... Plot ... ............. ............. Lot ......................... Permit Gromted ..... D - .e.q..emb.e.r...9.,... 19 8 6 .. .. . ....... .. .. 1)*ate of Inspection .............G/............... 4,7 Date Co mpleted ..... 9' ' M 0 tv Cr tiQ tv M 0 p M 1 - -- _ , 49 o� \oath 1 �: t726Q1201 .tone ; i �a-te .l0=27-8;6; { 27 d. _:: P .L f o , r 1 , • .Co.t 20 19Ou'l'd �24 : __.... __. . ._._....._..270 __... _ T i7 1500 ' 7r- � I i Sound. L6.. - 6 t _._ .. .00p -- — i 16 x^ - I _ i T Sketch p L O� .L�iYG� dA;/dl'Q410G1/J� AiCa !3" tot,-2 aa.; iJwwk on a p P.cwi tecotdd 2 book 331 per' SB.. ei)d r om. ah nown ace ort a c untied p ' I ! �)aeevLt: a�cri-.s<ta�Ze Joao jJ�eb; Ti--•.. �- _* , Beat Pit #P-62 3 3 � j . Wate& e�mouxtetG .('e 4 than 2 nun p e2 - ,� P.2 tray 1 a4S •l zS. µO 1 wide : pupil r cl ` .top -top Jhe oui�tla t t orvl ahwrun on th rZ ptdii ctie .f oc,ilUd • 23.0 2G.4� -. oilu►2r1 as 4{1Own heAeoK, 7KePit fhiej 4P.t f._ back 2egai tenaen& 'of-the gown of 13a&n!z,tabted 3k& : 124 s6 dand 4fcYl� r I DF,q� �Al boneq boneqr c5 No.32490, a !� vt a I d j .. 1 TOWN OF BARNSTABLE, MASSACHUSETTS BUILDIN A=2b9-229 DATE DfF r+>Tnhwr- 19 Sih PERMIT " X3 APPLICANTr ADDRESS aw:71e'r _ IN0.) (STREET) _ (CONTR'S LICENSE) NUMBER ,OF - PERMIT TO �1-" �-)�STORY S, .R. {� 'k 7,r �f.•�sl —DWELLING UNITS } P 0 I P OVEM T) 'N O.. PR OS SE) - ZONING AT (LOCATION) lor 423 - _ DISTRICT— RBB �T (NO.)' (STR ) { - BETWEEN AND (CROSS STREET) (CROSS STREET) LOT SUBDIVISION LOT BLOCK SIZE BUILDING IS TO BE FT. WIDE BY. FT, LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION Jt (TYPE) REMARKS: Sewage #86-121G (owner) 80.00. AREA OR PER VOLUME 1776 sq ft. ESTIMATED COST $ 75,000 FEE MIT 189.00 (CUBIC/SOUARE FEET) OWNER Tnhn W '�odtigllp4 _ �� . BUILDING DEPT. � ADDRESS, 99 D1k771 PTT TPTrn P. fly inn i C. ly,A 02601 BY �� n; 44 UUtb NOT RELEASE THE APPLICANT THE CONDITIONS - ---=--.�-..-------9^'v�c—�wovlv�DTO7v-R"EST�ICTIONS. —��•�-�-T, -- - MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE _ INSPECTIONS REQUIRED FOR _ ALL CONSTRUCTION WORK: CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR 1. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANIELECTRICAL CAL INSTALLATIONS.PLUMBING IO 2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL MEMBERS(READY TO LATH). 3. FINAL INSPECTION BEFORE FINAL INSPECTION HAS BEEN MADE. OCCUPANCY. POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS i 1 2 (� 2 — Q6��C 3 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT i OTHE p BOARD OF HEALTH �w y / f G WORK SHALL N07 PROCEED UNTIL THE INSPEC- PERMIT 'V!LL BECOME NULL AND VOID IF CONSTRUCTION 70R HAS APPROVED THE VARIODUS STAGES OF WORK IS NOT STARTED WIT !7- - INSPECTIONS INDICATED ON THIS CARD CAN BE CONSTRUCTIOV. SI;, MONTHS OF DATE THE ARRANGED FOR BY TELEPHONE OR WRITTEN PERMIT IS ISSUED AS NOTED ABOVE. I" i. NOTIFICATION. 'I, :+. ... , !. •-f �'+.. „ .. ... � ..�+: + .'!..*:�,-:.wf. •"ar,� .,.. .wr.-. s�...,,..vy,.t:l.--.;is.,y...:v'^:.�.y.,,,^..'r+a^+';✓"xi'+.�-.�.'r".-.r�<<,".:w.•-�-....a.-y 'A, L+�,:,, - 5 oiTHE ro• TOWN OF BARNSTABLE Permit No. . 026.3...... BUILDING DEPARTMENT Cash ($80. .00) .rllSl&l ;a TOWN OFFICE BUILDING . . ......... HYANNIS,MASS.02601 Bond CERTIFICATE OF USE AND OCCUPANCY Issued to John W. Rodriques Address Lot #23, 385 Straightway Hyannis, Iiassachusetts USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT 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. June 15 87 /'/ r. ....., 19................. .............. /��� Building Inspetor �'f Assessor's o�ffioe (1st floor): � p �'(, rT- *THE Assessor's map and I0\1 number .......... . 1 °� ° o � a a � ....................... ...... ... Board of Health (3rd floor)':. Q d Sewage Permit number ` . ........................... ...................... i BARNSTADLE. S Engineering Department (3rd floor): �o rasa House number O .6}q• APPLICATIONS PROCESSED 8:30-9:30 A.M, and 1:00-2:00 P.M. only TOWN. OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ....... U�1� A SlJ�ICr —E .PW." L Y /`VuSC _ .............................................. TYPE OF CONSTRUCTION ....... .......� �V�`177ON/i L ........................................................................................................ �O V l a..........19.. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .................................. ........ 1JJt/l. ...y....IV�/'..... Proposed Use `s�IU�rL !�f L L' Zoning District ................� ...... .............................................Fire District .............................................................................. Name of Owner ..JON)'�....W......R.Q...DIZ*G.0 Address ...�1.�7..0449 VA cv /V SJ Alivl S Imo, ......................�................................ -/ �� r Name of Builder S ........Address L" Name of Architect ...................:.�f ....- .....................Address s Number of Rooms ................... .............................................Foundation ........C0� � Sf I 1L ..Exterior ..............w ... .........: .... - . ............Roofing ........14.5.�J/ l L. .....>S>../,C>GLES....... Floors n ..teJOd ....... ". Y.............................. ..U.. ...................Interior ..........!1. 1 I1 t (' C)T Heating .... ..�.............� �.... �.y Q�.S....Plumbing 7 Fireplace ..........Approximate Cost 7J 00 CO P................................................... Definitive Plan Approved by Planning Board ____________________________19-------- . Area .......................................... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH l r " t . 1 OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name Construction Supervisor's License .G. ....5.. .z.�i.. R,OrDRIGUES, JOHN W. A=269-229 No^:q�9.26.3.. Permit for .,1...5tory............... & Garage/Single Family Dwelling ......................................................................... Location .Lot #,23.........3.85. ....Straightway... . .. .. . ...........................Hyannis.................................. Owner John W. Rodrigues Type of Construction Frame ........................................................................... Plot ............................ Lot ................................ r - Permit Granted .,. December 9 , 19 86 ........................... Date of Inspection ....................................19 Date Completed 19 o*IHE Town of Barnstable *Permit# ? 3� Expires 6 months ro�u i.ssue date • Regulatory Services Fee aAMSTABM v� MASS. Thomas F.Geiler,Director 139. �0 A'FD�AO'`°i Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 - E E ''"IT Office: 508-862-4038 APR % 7 2004 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint I UVV F BARNSTA"OLE Map/parcel Number 1;Z G a Property Address Residential Value of Work Owner's Name&Address o,%_, A�W %Q1 W 1� VA LS Contractor's Name T JL0 \. Telephone Number I Home Improvement Contractor License#(if applicable) as Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: 2kI am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) �e-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 (maximum 44); fie eo?rvnw ...M a�,/�aaaacfu�aelta. c *Where required: Issuance of this permit does not exempt compliance with other told $olaa d-of Budding Regulationsnd Standards HOME IMpflOVEMENT CONTRACTOR ***Note: Property Owner must sign Property Owner Letter; Home Improvement Contractors License is require' Registtt fi 133580 matt5 2005 Signatures MICHAEL S.TUCA�Ej� Q:Forms:expmtrg MICHAEL � s Revise053003 19 CAPTAINS HARWI'CH,MA 02645 Adndnistrator cFTME,a�sti Town of Barnstable Regulatory Services a�xxs�►s . ' Thomas F.Geller,Director auss. 4'Pre16 o 9. Building Division _ Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 office: 508-8624038 Fax: 508 790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I �1CUnn e 0 nn 2L hereby authorize rn R e�. U Q .to.act on my.behalf,. in all Mattets relative to work authoiizetl•by this building-petmit.application fot: �� nn rS ddtess otjob S• a er Date Yln eA Print Name