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0090 CAP'N LIJAH'S ROAD
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Post This.Card So,`That�t is.V�s�ble Frorn the Street Approved'Plans Mt be Retained on lob and' his Car d Must be t Kept MAPosted Unt!,Fin' Inspection Has Been Made = = 16 ` VUh� re a Certificate of Occu pa `'s Re u�red such Bu ldin shall Not�be Oecu ied�until a Final,lnspectroo`has been rna,`tle� _ '" Permit e P Y� q� _. ! _; g zp_ .. „ . m_.� a _... Permit NO. B-19-2160 Applicant Name: Robert Rostocka Approvals Date Issued: 07/03/2019. Current Use: Structure Permit Type: Building- Insulation- Residential Expiration Date. 01/03/2020 foundation: Location: 90 CAP'N LIJAH'S ROAD,CENTERVILLE Map/Lot: 192-179 Zoning District: RC Sheathing: Owner on Record: WEINER,JANE R -Contractor"Name:'.° .ROBERT A ROSTOCKA Framing: 1 Address: 90 CAP:'N CIJAH'S RD - ti ' °Contractor License 113252 2 CENTSRVILLE„MA 02632 i Est Protect Cost`. $3,417.00 Chimney: Description: Insulation &Air Sealing. Permit Fee: $85.00. Insulation: Fee Paid-`,Project $85.00 Project Review Req: Date 7/3/2019 Final: Plumbing/Gas Rough Plumbing: k Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months d er'issuance. Rough Gas: All work authorized by this permit shall conform to the approved application,and the approved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and structure§'shall be in compliance with the local zoning by laws and codes. Final Gas: This'permit shall be displayed in a location clearly visible from access street orroad and shall be maintained open for.public inspection for the entire duration of the work until the completion of the same. ` Electrical The Certificate of Occupancy will not be issued until all applicable signatures-�by the Building and Fire Officials are provided on this permit. Service: Minimum of Five Call Inspections Required for All Construction Work: 1.Foundation or Footing Rough: 2.Sheathing Inspection U 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection, ' 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site t' Final: All Permit Cards are the property of the APPLICANT- ISSUED RECIPIENT S� ® i 4(o53 3 IKKE Town of Barnstable *Permit# P' Expires 6 months _-!issue date y ®� Regulatory Services Fee snxtvsTnsLE, . Thomas F.Geiler,Director �fD MA'S{► _ ..�1511 U�O� Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannisj MA 02601 14 www.town.barnstable.ma.us Office: 508-862-4038 ��� DLE EXPRESS PERMIT APPLICATION. -: RESIDENT . . , . Not Valid without Red X-Press InWrinf Map/parcel Number j j Pro e Address L P 1 CAD D Q S Residential Value of Work Minimum fee of$35.00 for work under$6000.00 _ . Owner's Name:&Address . J A/:Q !•l): 70 Contractor's Name J �U4i . . . Telephone Number Home Improvement Contractor License#(if applicable) 7 Construction if'Su ervisors License# a licable r r P C PP e0) �f�� �dl./y �orman's Compensation Insurance Check one: I am a sole proprietor ❑ VarntheHorneowner have Worker's Compensation Insurance Insurance Company Name J© cetL 'i�i: /© �� �w�: 'v . .AUG 14 2014 Workman's Comp.Policy#.. 0e 5r610sd .20131r OFBARi ABLE: 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) R a�e-side ,6r U 1G' ��VV.: . #of doors ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows ❑ Smoke/Carbon Monoxide detectors 4 door plans marked with red S and inspections required: _. Separate Electrical&Fire Permits required, *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic;Conservation,eta **.*Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvftmwt Contractors License& onrtr+rct on Supervisors License is re SIGNATURE: C:\Users\decollik\AppData ocat(Microsoft\Windows\Temporary Internet Fi1es\Content.0ut1ook\QRE6ZUB Revised 053012 Page 7 of 7 Capizzi Home Improvement Inc. Specifications and Estimates STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT ® K civil V I, �a e e , OWN THE PROPERTY LOCATED AT IN MASSACHUSETTS. 7 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: 1110—' �i9 7-Te 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: The Commonwealth of Massachusetts Department of Industrial Accidents s Office of Investigations 1 Congress Street, Suite.100 e� Boston,MA 02114-2017 �� 5.•�� www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Capizzi Home Improvement1n:c Address: 1645 Newtown Road - City/State/Zip:Cotuit, MA 02635 Phone#:508-428-9518 Are you an employer? Check the appropriate box: Type of project(required): ❑ I am a 4.+ general contractor and I 1.❑■:I am a employer with 40 g 6. ❑New construction employees (full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g• ❑Demolition working for mein any capacity. employees and have workers' 9. Building addition comp. insur 1 ❑ g [No workers comp. insurance p ance.. required.] 5. ❑ We are a corporation and its 10;❑ Electrical repairs or additions :.,.,.officers have,exercised,their... .:. . -3:-❑-I am-a homeowner-doing all-work.-.. . . . 4 T:❑_Plumbing,repairs•or-additions-- I m self o workers' comp. right of exemption per MGL Y P 12.0 Roof repairs insurance required.] t c. 152,'§1(4),and we have no employees. [No workers' : 13:E�Ather comp. insurance required.] ` on R/ *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. �'e. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. TContractors 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. ers Insurance Co: Associated Employers Insurance Company Name: P Y 12-25-2014 Policy#or Self-ins.Lic. WCC50050105472013A#: Expiration Date: � Job Site Address: Ty C A P 'Al �_ i `?,[ 14 City/State/Zip: 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, e t un r t/i pains and penalties of perjury that the information.provided above is true and correct. Si nature: Date::. e z 0/ Phone#: 08-428-951 _ 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): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector: 5.Plumbing Inspector 6.Other Contact Person: Phone#: V�u�04Y1//%2092c/1eCCL�{G Q��i(�GCLJJCcclZccre�. .. - . o�ffice of Consumer Affairs&Business Regulation License or registration valid for individul use only 'OME 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: -6/23i2016 Supplement Gard Boston,MA 02116 CAPIZZI HOME IMPROVEMENT;INC. JOHN STRUMSKI 1645 Newton Rd. Cotuit, MA 02635 Undersecretary Not valid without signature Massachusetts -Department of Public Safety Sward of Building regulations and Standards Construction Supervisor License: CS-064817 -�- JOHN T STRUMSII 18 ALDEN AVE a r Buzzards Bay MAY 025332€ till oJ- — Expiration Commissioner 06/18/2016 r� CAPIHOM-01 APELL E(NMIDDNYYY) A R � CERTIFICATE OF LIABILITY INSURANCE DATE(MMM 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 N Ext: Arc No):(877)816-2156 South Dennis,MA 02660 E-MAIL ADOREss: INSURER(S)AFFORDING COVERAGE NAIC S INSURER A:Main Street America Assurance Co. INSURED wsuRERe:Associated Employers Insurance Co. 11104 Capiai Home Improvement,Inc. INSURER C: Capiai Enterprises,Inc. 1645 Newtown Road INSURER D Cotuit,MA 02635 INSURE 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. LOTR TYPE OF INSURANCE ADDL SU POLICY NUMBER POLICY EFF POLICY EXP UNITS A X COMMERCIAL GENERAL LUIINUTY EACH OCCURRENCE $ 1,000,00 CLAIMS-MADE OCCUR MPB1076H 0610&2014 06/08/2015 D PREAMAG TORE E 500 OO MISES a occurrence $ MED EXP(Any one person) $ 10,00 PERSONAL&ADV INJURY $ 1,000,0 GENT AGGREGATE LIMIT.APPLIES PER: GENERAL AGGREGATE $ 2,000,00 POLICY N JEo- a LOC PRODUCTS-COMP/OP AGG $ 2,000,00 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ L a acdderd� A ANY AUTO M1 M28044 06/08/2014 06/08/2015 BODILY INJURY(Per person) $ ALL OWNED �( SCHEDULED BODILY INJURY(Per accident) $ 500000 AUTOS AUTOS r NON-OWNED PROPERTY DAMAGE $ X HIREDAUTOS X AUTOS eracdden[ X UMBRELLA UAB X OCCUR EACH OCCURRENCE $ 5,000,00 A EXCESS CLAIMS-MADE CUB1076H 06/08/2014 06/08/2015 AGGREGATE $ DED I X I RETENTION$ 10,000 Pers&Adv Inj $ 5,000,00 WORIU=RS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY LITE ER B ANY PROPRIETOR/PARTNER/EXECUTIVE YIN H CC60060106472013A 12/25/2013 12/25/2014 E.L.EACH ACCIDENT $ 1,000,00 OFFICERIMEMBER EXCLUDED? N❑N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEd$ 1,000,00 If yes,descnbe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I$ 1,000,00 DESCRIPTION OF OPERATIONS I 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 AUTHORED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD ?1l11i? Q C � > Town of Barnstable *Permit# Fxpires 6 monthsfrom Issue date Regulatory Services Fee . anntvszaste, % . v Thomas F.Geiler,Director Building Division X.,,PRESS pEI�i�iilT Tom Perry,CBO, Building Commiser 200 Main Street,Hyannis,MA 02601 JUL 11 2013 www.town.bamstable.ma us Office: 508-862-4038 Fax:508-790-6230 EXPRESS PERMT APPLICATION RESIDENT NSTABLE Not Valid without Red X-Press Imprint TQ Map/parcel Number ® �" i Property Address �n�� P�+�. % .�'4�� %?e, 51 Residential . Value of Work ©t7r ®d _ Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address JAAItr W elhev 16 C401 UX4HIi R® (ewellw/!e-, O26 3� laid NrJ4✓vpz l"i �'B Contractor's Name �/J�0114 P&EAT �G Telephone Number � Home Improvement Contractor License#(if applicable) JBd 7Y$4 Construction Supervisor's License#(if applicable) S d 0 11 [?Workman's Compensation Insurance • Check one: ❑ I am a sole proprietor ❑ I am the Homeowner [ I have Worker's Compensation Insurance Insurance Company Name �Sf 0�l C �10 y f/✓ N✓IJ AI�e. 4011e / Workman's Comp.Policy# W C G,'0/0 �y74 26/y 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) 51/Re-side 8011ZQ d4c �fd #o doors ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows 'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ' ***Note: Property Owner must sign Property Owner Letter of Permission. copy of the Home provement tractors License&Construction Supervisors License is SIGNATURE: CXsers\deco1lik1A to\Local\Microsoft\Windowffemporary"met Files\ContentOutlook\DDV87AAZTMRESS.doc - Revised 072110 - C4 Page 7 of 7;. Capizzi Home Improvement_Inc; Specifications.and Estimates STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLE'FOR A BUILDING PERMIT I, Jet pic ����{��;�' , OWN THE PROPERTY LOCATED AT. r IN �� ��r r �C' , 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: iw LESSEE'S ADDRESS: LESSEE'S TELEPHONE: APLLICANT'S SIGNATURE: APPLICANT'S ADDRESS: 1645 Newtown Rd., Cotuit,MA.0263.5 APPLICANT'S TELEPHONE: 508-428-9518 _ u: RESPONSIBLE OFFICER:: RESPONSIBLE OFFICER ADDRESS: ` RESPONSIBLE OFFICER TELEPHONE: , Wasachss�gs -Depart"meta£of Pubk:sa Board of BuOddi ,g Reg. Wazttons anct Standards. LMrFsra CS416M7 TMP Bards RV MX11 Co*sR.t�sss��� w t1t1 �t{ ; V2IICE of trpacxtrl.�AIMII'S 4%:3fi6SLS= ttPutsun . �$ L[CCUYts t)l.rC t�ft.[9tttOlt YPttq!itJt ttriunu ut uAw t jul OME IMPtVYEIf►EW—CAN'1'RACTOP, before i is expiration daft. If found refurn.tof ns€eraer 9 ffas an�i RegistratYdar; c' D Office,of Business latio E�T1 1aParkfti*-Sim5170.' Suppterr�eM Card Boston,MA 02116 P. 4P=HOMES JO.�HN���S,TjRUMSK CQEi%MA 02$35 ;'ti �3 a•t y:, G���.. ` _ Ulndersecrttsry Not v oat sire CAPIHOM-01 CBENISCH A�ORO' F�A TE(MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE6/12/2013 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. r 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 CONNAME CT Chris Benisch " Rogers&Gray Ins.-Dennis Branch PHONE . FAX 434 Rte 134 A/c No Ext:(508)398-7980 A/c No):(877)816-2156 South Dennis,MA 02660 AD RESS:cbenisch@rogersgray.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Main Street America Assurance Co. INSURED _ - INSURERB:Associated Employers Insurance Co. Capizzi Home Improvement,Inc. INSURERC: Capizzi Enterprises,Inc. 1645 Newtown Road INS uRER D Cotuit,MA 02635 INSURER E: INSURERF: .. 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. ILT R - TYPE OF INSURANCE A B POLICY EFF POLICY EXP - - - -LTR - INS D - POLICYNUMBER MMIDD/YYYY MM/DD/YYWI I LIMITS GENERAL LIABILITY - - EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY MPB1075H 6/8/2013 6/8/2014 PREMISES Ea occurrence $ 500,000 CLAIMS-MADE a OCCUR MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ . 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY PRO- ECT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ A ANY AUTO MIM28044 - 6/8/2013 6/8/2014 BODILY INJURY(Per person) $ AALL UTOS OWNED X SCHEDULED AUTOS BODILY.INJURY(Per accident) $ 500,000 X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS PER ACCIDENT $ X UMBRELLA LUAB OCCUR EACH OCCURRENCE $ 6,000,000 A EXCESS LIAB HCLAIMS-MADE CUB1076H 6/8/2013 6/8/2014. AGGREGATE $ DIED I X I RETENLION$ 10,000 $° 5,000,000 WORKERS COMPENSATION WC STATU- OH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS X ER B 'ANY PROPRIETOR/PARTNER/EXECUTIVE WCC50.10547012012 12/25/2012 12I25/2013 OFFICER/MEMBER EXCLUDED? a N/A E.L.EACH ACCIDENT $ 1,000,000 (Mandatory in NH) _N/A E.L.DISEASE-EA EMPLOYE $ 1,000,000 If as,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) " 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 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts l h_ Department of.Industrial Accidents Office of Investigations 1 Congress Street,Suite 100 Boston,AM 02114-2017 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Auplicant Information Please Print Legibly Name(Business/Organization/Individual): Capizzi Home Improvement Address:1645 Newtown Road City/State/Zip:Cotuit, MA 02648 Phone#:50.8-428-9518 . 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 2.0 I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ' These sub-contractors have 'ship and have no employees 8. F-I Demolition working for me'many capacity.. employees and have workers' coin insurance. 9. Building addition [No workers' comp.insurance P required.] 5..❑ We are a'corporation and its 10.0 Electrical repairs or additions ' 3. officers have exercised their.I am a homeowner doing all work 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c..152, §1(4), and we have no em to ees. o worker' 13. ther s P. Y _ [N comp.insurance required.] *Any applicant that cheats box'#1 must also fill ou+fthe section below showing their workers'compensation policy information..,': ' f 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 a6fitional sheet showing the name of the sub-contractors:and state whether or riot those entities have- ° employees. If the sub-eontractors have employees,they must provide their:workers'comp,policy number. 1.4 am an employer,that is providing workers'compensation insurance for my employees Below'is thepolicy and job site information. Insurance Company Name:Associated Employers.Insurance Company WCC5010.547012011 Xp 12/25/2013 Policy#or Self-ins.Lc.#: Expiration Date: v Job Site Address: G Cq rip B City/State/Zi : fi 1'Q. .V 11114 . 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 cer if u he.Rains and penalties of erjury that the information provided above is true and correct Si ature: Date: Phone#. 508-428-95 Official use only. Do not write in this area,to be completed by city or town official City or Permit/License`# Issuing Authority:_(circle one):, I:Board of Health 2..Building Department 3.City/Town.Clerk 4.Elecfrical Inspector S.Plumbing Inspector 6. Other Contact Person:' Phone#: }} 6 Town of Barnstable *Permit e 7 � F_vnires h months fr n iss nt Regulatory Services , Fee RMARN BLE, : Thomas F.Geiler, Director - �°renMD,t••e Building Division r- tb4lb�J)�- Tom Perry,CBO, Building Commissioner `. ..�� 200 Main Street. Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Validwithout Red 1-Press Imprint Map/parcel Number Property Address_ �\ (\�_5_ �+ zt\ Residential Value of Wo> �` Minimum fee of$25,00 for work under$6000.00 Owner's Name&Address Contractor's Nam T. Telephone Number �b' 1� S Home Improvement Contractor License#(if applicable)_ ❑Workinan's Compensation Insurance Check one: ❑ 1 am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance ® ES PERMIT . Insurance Company Name Workman Comp. Policy#_l p�(�. _ r 5 2008 Copy of Insurance Compliance Certificate must be on ile. TOWN OF BARNSTABL.E Permit Request(check box) y ❑ Re-roof(stripping old shingles) All construction debris'will be taken to'. ❑ Re-roof(not stripping. Going over:__-_existing layers of roof) ❑ Re-side �•, Replacement Windows/doors/sliders. U-Value (ma imum .44). CD J a r *Where required: Issuance of this permit does not exempt compliance with other town department regulations.i.e.Historic..z:,6nservation etc. "- ***Note: Property Owner must sign Property Owner Letter of Permission. Q A copy of the Home Improvement Contractors License is required. ' SIGNATURE: O:[-ornns:build ingperm its/express Revised 123107 s. 9 . uY J Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration elate. If found return to: Registrdtlg�0; 100740 Board of Building Regulations and Standards plr� Q23/2010 One Ashburton Place Itm 1301 SON Iry dement Card Boston,Ma.02108 — CAPIZZI HOME f 'I CHARY GUSTAFS�m �=i�-=af_ 1645 Newton Rd. .. __...._. _. _._ _.. .___ ._........._...._...__._:_....__. Cotuit,MA 02635 Administrator No vali itho .t'' nature Board of Building Regulations and Standards Construction Supervisor License License: CS 74640 Expiration: 11/29/2008 Tr# 6430 Restriction: 00 GARY GUSTAFSON 8 SHORT WAY SANDWICH,MA 02563 Commissioner I Page 7 of 7 CAPIZZI HOME IMPROVEMENT INC. SPECIFICATIONS AND ESTIMATES STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT I, OWN THE PROPERTY LOCATED AT IN , MASSACHUSETTS. I HAVE AUTHORIZED CAPIZZI HOME IMPROVEMENT TO ACT AS MY AGENT TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. I GIVE MY PERMISSION TO LESSEE TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. SIGNATURE OF OWNER: OWNER'S ADDRESS: OWNER'S TELEPHONE: LESSEE'S SIGNATURE: LESSEE'S ADDRESS: LESSEE'S TELEPHONE: APLLICANT'S SIGNATURE: APPLICANT'S ADDRESS: 1645 Newtown Rd., Cotuit, MA 02635 APPLICANT'S TELEPHONE: 508-428-9518 RESPONSIBLE OFFICER: RESPONSIBLE OFFICER ADDRESS: RESPONSIBLE OFFICER TELEPHONE: Client#: 47298 CAPIHOM ATE ACORD,. CERTIFICATE OF LIABILITY INSURANCE 06/1212008vvv) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Rogers&Gray Ins. -So. Dennis ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 434 Route 134 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P. O. Box 1601 South Dennis, MA 02660-1601 INSURERS AFFORDING COVERAGE i NAIC# INSURED i NSuRERA NGM Insurance Company -~— Capizzi Home Improvement, Inc. NsuRER e. American Home Assurance Capizzi Enterprises, Inc INSURER- 1645 Newtown Road NSURER:; ~I Cotuit, MA 02635INSURER E -- --_ COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHS rANDING 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 EX;'t.USIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUZED BY PAID CLAIMS. —T'-- POLICY EFFECTIVE _'POLICY EXPIRATION - - LTR NSR TYPE OF INSURANCE POLICY NUMBER --' DATE(MMIDOIYY) r DATE iMM/D DNYI_ ._- LIMITS _— t A i GENERAL LIABILITY —PMPB1075H 06108/08 06/08/09 A(,'H Oct.•1NRENCE $1 000 000 _ I X rMAGTO 14 EONrcT�ErDre ncel $SOOOOORMCOMMERGIALGENERA. .AB� SES;Ee —_ CLAIMS MADE 7 OCi V E..,-)W(Anv une person) $1 O 000 —_-- P_RSI WAL 6 ADS INJURY $1 OOO 000 iENEHAt_AGGREGATE I$2 O-OO,_000 GENT.AGGREGATE LIMIT APPLIES PER NRC D IC TS_COMP/OP AGO $2 000 OOO_ _ - I� _..... POLICY PRO JEC• �� T I AUTOMOBILE LIABILITY COMBINED SN131 F LIM j ANY AUTO tEnarclAenlf $ F— A,, OWNEU AUTOS Buis_% 'N WAY SCHEDULED AUTOS Pel l,rrsn_i $ --- - I HIRED ArJTOS FIC.0 ,:'4.JkY NON-OWNEL)AUTOS P,:•;,:^,uvnl--. 4 PROPERTY DAMAGE I S ncr,Iaem; RAGE LIABILITY OM Y-cA ACCIDENT $ ANY ALI r0 BIER T HAN EA ACC $ !._..._ A;,Tn OW Y -- i A EXCESS/UMBRELLA LIABILITY CUB1076H '06l08108 06108/09 �AC;H I:GcuRRENGE $5 000,000 XOCCUR CLAIMS MADE AGGREGATE $5,000,00C �.. Is — DEDUCTIBLE _V--.—.-- $ -------_----. XI RETENTION $10000 ~_ H. $ B WORKERS COMPENSATION AND WC6716562 I', 12/25107 12/25/08 tXT OR I IMITATU OTR EMPLOYERS'LIABILITY ANY PROPRIE'fOR/PARTNERIFXECU I`I r_ACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED _oISEASE-EA EMPLOYEE $500,000 — I1 yes,aescr10e under SPECIAL PROVISIONS Oelow - DISEASE-POLICY LIMIT $SOO,000 ----t-- ---- ---r-- ----- --'-- --- OTHER DES CRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Carpentry CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Town of Barnstable !DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL In DAYS WRITTEN 200 Main Street !NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO 00 SO SHALL Hyannis, MA 02601 !IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR j REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001108)1 of 2 #S36540/M36539 KW © ACORD CORPORATION 1988 i The Commonwealth ofllMassachusetts Department of Industrial Accidents e W Office of Investigations j 600 Washington Street ! W` Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name (Business/Organization/Individual): BpIZZI Ome mprovemenInc.- Address: Cotuit, MA 02635 City/State/Zip: Phone.#: Are you an employer? Check the appropriate box: Type of project(required):. 1� I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6 ❑ New construction 2.10 I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling 1 ship and have no employees These sub-contractors have g. ❑ Demolition working for me in any capacity. employees and have workers' j [No workers' comp.insurance comp, insurance.# 9• ❑ Building addition j required.] 5. ❑ We are a corporation and its' 10.❑ Electrical repairs or additions 3.i1l I am a homeowner doingall work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL insurance required.] t c. 152, §1(4), and we have no 12.❑ Roof repairs employees. [No workers' 13.0 Other comp. insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tcontractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: `t)CQ(`(\ Policy#or Self-ins. Lic. #: W C-Qo I(@5�Q Expiration Date: di Job Site AddressQ 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 finel,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 again the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DI fl insurance covera e verification. -- —I do l hereby-c-er-tify-und -r e-pains-and p alti -of erjury-that-the-infor-motion p.r-owided-abo-ve-is-true-and-cor-r-ect.._--- Si nature: -- j Date: Phone#: - (4aS Official use only. Do not write in this area, to be completed by city or town official. if City or Town: Permit/License# Issuing Authority(circle one): 1.!Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.PlumbinglI'n:spe:ctor 6.iOther Contact Person: Phone#: t 't. • TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION " / - Z i t Map Parcel ?S - Permit# - b n Date Issued '- 1 �^ 9 ConsaaawftaiwGion Fee ' DO Tax C011ecbr. - Treasur - r��-s Date Definitive Plan Approved by Planning Board A Histofi+ Project Street Address A 0 _ C A"Ill 1-414 Ws` Rb Village oal 71�, VI L� _ ,.Owner A-��, LO EOkUL. `Address 41 b IQ Telephone `� ( = ( i' 3 3 \ Permit Request _ S r D►2 S�(S;M . �S i SJZ�T r� Square feet: 1 st floor: existing proposed 2nd floor:existing proposed Total new Estimated Project Cost Zoning District 'Flood Plain F Groundwater Overlay Construction Type lb D f�Z_ Lot Size Grandfathered: ❑Yes k(No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes No On Old King's Highway: ❑Yes Flo Basement Type: ❑Full ❑Crawl ❑Walkout Cl Other Basement Finished Area(sq.ft.) f Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths):existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil O Electric ❑Other Central Air: .❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: 0 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 AINo If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name 'Telephone Numbers Address ?(sSQ( License'# �S Home Improvement Contractor# 100 7O Worker's Compensation# 1 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO r SIGNATURE e y DATE /� FOR OFFICIAL USE'ONLY PERMIT NR. DATE ISS( ED MAP/PARCEL_NO. .� ✓�^ t _4, �' -lam _ 14 ADDRESS �'Z 1�, "'-'VILLAGE OWNER DATE OF INSPECTION FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH { FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. ' r f The Commonwealth of Massachusetts Department of Industrial Accidents Office 0llclrest/AsUdos .600 Washington Street Boston,Mass. 02111 Workers' Comiensation Insurance Affidavit can : ocvrlfznrc name: .a location: n city one# // 0 J 33 ❑ I am a homeoti performing all work myself. ❑ I am a sole proprietor and have no one workin in amp rd acity VM,I am an emplgver providing workers compensation for my employees working on this job. . comaanv name• Nviizi ./ /� address: ���� AteuJ'yaAl ': city: Co Tic I r Daf,SS phone#: insurance co. W olicv# //////(Ia. o.laar////!O//`/�/.6/!/!!C(l(//lllGi(/Li/Gl�'!//%/iv�l�/////////////�//////' ❑ I am a sole proprietor, general contractor, or homeowner(circle one)and have hired the contractors listed below who have the folloi%ing workers' compensation polices: � company name: n address: c1ty phone#• insurance co. rolicV :,. ... eomnany name: .:;...;:... address: city: ... phone#: ::..:...::,.::. ...::.. 7- : nsnrance co. :-•: ollcv# .: : iY# ss %%Gi%lG0% /%/%/ / FaIIure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a 6ne up to SUS00.00 and/or one yean'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a One of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the OMce of Investigations of the DIA for coverage verincatlotL 1 do hereby terrify under the pains anddppennalties perjury that the infor►nation protided above is tru: correcit Sigaattur[ - Date z � G Print name �/e Ed E�ieK �. Q A S C N_IIr Phone/ o fficialusely do not write m this am to be completed by city or town otflcial perndtMcense 0 ❑Building Department ---- OHealth phone N; QOther Department (nmaee 9 95 P1A) i The Town of Barnstable � ea VATRAATO i 9 Department of Health Safety and Environmental Services Building Division �rangy' 367 Main Street,Hyannis MA 02601 Ralph Crossen Office: 508-790-6227 Building Commissiore- Fax: 508-790-6230 For office use only 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. � � Est. Cost C m Type of Work: . Address of Work: Owner's Name I Date of Permit Application: ` �� I hereby certify that: i t Registration is not required for the following reason(s): t Work excluded by law 7A _Job under$1,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEE OWN HOME PERMIT UNREGISTERED OR DEALING WITH IMPROVEMENT WO DO NOT HAVE CONTRACTORS FOR APPLI OR GUARANTY FUND UNDER MGL c. 142A ACCESS TO THE ARBITRATION PROGRAM SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: - 9 7 Contractor Name Registration No. Date - OR nwner's Name f �� ✓/ze V�arrLnzaruue o` -f/lauac/zuoeli OEPAR IMF NT PUG:I_ '.4 TY CONSTRUiTTON SUPFFIV,Slup ..?FNSF Number: _s;,_• .. ,:;. <L Restricted TO: �3" HOME IMPROVEMENT CONTRACTOR x /TH0MAS- CAPI_Zi Registration 100740 1645 NEWTOWN RO Type - PRIVATE CORPORATION Expiration 06/23/00 CAPIZZI HOME IMPROVEMENT, INC as Capizzi, Sr. �ri 45 Newton Rd. ADMINISTRATOR Cotuit MA 02635 _..__._._—,----- ✓!ie TDarnarzarzurer�� o/�(/�,rr;:JacRrcJe�il - DEPARTMENT Of PUBLIC SAFETY CONSTRUCT-ION SUPERVISOR LICENSE Number:, Expires: RestrictedTo 00 THOMAS X` -GAPIZZI JR • 280 PERCIVAL OR W BARNSTABLE, NA 02668 i ✓1ze oorz•-mo-uaeaIll, o/.Awjaclujef DEPARTMENT Of PUBLIC SAFETY 'ONSTRUCTION SUPERVISOR LICENSE =f Number: Expires: Restricted To: 00 _ FREDERICK V RASCH !Ii fPrui--'1060 BOURNE RD PLYMOUTH, MA 0?360 / s ss 'A ap and loti nurn SEPTIC SYSTEM UST BE . ��— INSTALLED IN COMPLIANCE ' ,!S6wagd Permit number ..................,............. ........�::..,..,.. WITH ARTICLE II STATE �" SANITARY CO AND TOWN F Hof THE ro�� TOWN OF 'BARNS :fig �': Z. B9B.B$TOIILE, i Ll "6 �•�� ; BUILDING* INSPECTOR ` y" 'APPLICATION FOR'PERMIT TO 0 5 Pic ' TYPE OF CONSTRUCTION t ...t,P '... .., .... ' ........................ • ...... ............../...............19. (�.. TO THE INSPECTOR OF BUILDINGS: < The undersigned hereby applies for a permit according to the following information: Location .............. v.f.................................. /(...............r/" .. .:..... ....���. i/Ivy! ...................................... • ProposedUse ......... �/r".G .....:...................................................................................... ......................................... ZoningDistrict .............. .... ......................................Fire District ........... ................................................................ Nameof Owner .... ...'..!.....'`........1....... ........Address ............................... ........................ Name of Builder Address .. < S ...........: �..41r............................. �?. ... . ...................... Name of Architect `/- .`'� .........Address "����c ..... �............................. �. .. ............,..........................� Number of Rooms ............... .........................................Foundation ...................................... ...........,. ��7i.�.�.......Roofing ............:`�.�1.%./ .... Exterior .... `d.....(�.........(.� .....................�`- / ...J.. Floors ..... Z/�X. •.... j... ........`...... .f.!t'! ...............Interior ............. S........................................................ Heating ... .......................OAA...........................Plumbing ...C�J�f............ ....&.6 .....:.......................... Fireplace .........U.ltZ�( .... ' 5��?d1./.............................Approximate Cost ...... 6 .�?.��.;. .. . Definitive Plan Approved by Planning Board ________________________________f9--------. Area .......(,1..� ..... ' ...�...:. Diagram of Lot and Building with Dimensions Fee �...... SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ...D9v.��(... ft ..... ./ .............. .. ` 7alle�an~Fmrrmne ' \ ^^ | 18873 ' ' I 1/2- otmry . - ' single� ^a~^ - ' - ' r Rm4id ' , Location --.. ---------.. � Centerville ` a__�_..'�___.. ' Tell � C�wmer -----.-_ _..�____ ` - �� ��������- ^ Tvpe�of Construction --.��raome'...------` ` . . . ^ -----.--...--,---.-.---------' ' Plot -.. ..................... Loi --..�31-----.. � . 6obmr 13 76 Permit Granted .......................................' .lV ./ l�°�-�/ ' oo�e o*l p�c�on - !..�..�-.]9 _ ............... ' Dote Completed .' ............... . . . . ' PERMIT REFUSED ''n........................................... - lV ' --..�--.. ~ - . ' ^'�--^^---r .~^-----^----'----^' . . . .~�...--,.-..---....--.-..--...-.-.. '/ .. . . ` . . . � ��'���,,����,,��'��,�,,',�'���'�` � —^--'-^--'�; ~^--^—^--^�--^^^^^~'''' ` ---'�-----------. l9 � . . ^ . . . -r----'''------^-^^^--`-------� , -------`------------..~-~-.. . . . ' . . . - . . . Assessor map and lot.: number ] 1 '4_ Sewage Permit number .......................................................... ,r ., THE'Tp�yw TOWN OF fBARNSTABLE Z BAHHSTADLE, i r "6 q BUILDING , INSPECTOR C APPLICATION FOR PERMIT TO f ✓ . c TYPEOF CONSTRUCTION ..........�................................... ....................................................................................... i �'........ ...............19. ,.: TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ..............f' .?. ... .. .........Cf?� /,......?''. !S' .............( .... ............. ... Proposed Use ............................ . .......................... .. ................... ......... ............................................................ � ZoningDistrict .................6�.................................Fire District ............ ?..� ^............................................................ Name of Owner /rx"� c r.,� I,- �iiiloo ,:.........Address .................... �J 4��. ............................................ ................ ` .> Name of Builder ............:! ............................Address ....................... .............................. Name of Architect l/ti `''J Address ��r yt�'c ...................... '.................................... .................................................................................... /CD Number of Rooms ................--?..............................................Foundation .. 7- ....................................................::.:...................... Exterior /..... �� 'q��� �- h �.,.�.......Roofing .. ./ ....... .... �.................................. Floors .........:..l ..... �X.✓.:.... j/..:.. .....�.�...:/?^.. ......:........Interior ............�Z. ......�...:�:f yr. c.. .......................... ... Heating ( `...........................Plumbing ('o�fv3 � ......r............;. ....... ................................:..:.................................... ��- 6 O Fireplace ( � r�� /i�I,a a��. Approximate Cost .......,.....................................................:..'.... ...............::.............,...................... .. . Definitive Plan Approved by Planning Board ________________________________19________ . Area ....... ............................... Diagram of Lot and Building with Dimensions Fee ......... `:.'.......................... SUBJECT TO APPROVAL OF BOARD OF HEALTH hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Tellegen-Ferrone A=191-179 N„ 18873 Permit for .....1 1/2 story; ' ng�le familX dwelling Location w,qf! Li ah Road ••......... ........................ Centerville ............................................................................... Owner Tellegen......Ferrone ' Type of Construction .........frame #31 Plot ............................ Lot ......................... .... Permit Granted December 13 19 76 Date of Inspection ....................................19 Date Completed ......................................19 PERMIT REFUSED .......................... .................................. 19 �........� .,�.............. .................... . .................................. . ................ p•^ ..................................... .................................. .. �. ............... 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