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"f : �l. , `� , ,� - � , I-l" �i� ', r, I.::.", ,�" -01, 1XV: - , 0­1 - � I ,% ;­': ., , � �1 , ',�­ ­­ ­.1"t ,­� ,i,,,:,�i4�4",�,'q ", - c I?— � ; S' ;`_�T - - , it 11 IV Li�;"�,-�'�-.if,iLi�:"",��i'� 0'-7,1, ),,,­?1',1�.Ixj*­o , , � 14 I ,� 'L . . , i� , ,.,� .�� :,� , � �:. � ,,, ,��, , , ;1­ �i ;j , , � -_L,�,,�,%Ti'X,�­,,�-���',`!',"",t,.;T't_rc ,�t" . ;�!�,,,": ,. . , , (1��1,%',"_,:L l�.,�lz,�,iw� li,421'1­,x �,� :­`! �,"�� - Asior's office(1st Floor):WO1 2 Z ., /'0 2 Assessor's ma and lot number < J P iTMET Co ervation 4th Floor): Board of Health(3rd floor): - - Sewage Permit number $" �.�� t srAnta G' p�ij eT��- 'oo ego. ,d° Engineering Department(3rd floor): �GC;�/ .,9AM R House number OMPLI � Definitive Plan Approved by Planning Board WITH MILE 6 y APPLICATIONS PROCESSED 8:30-9:3Q A.M.and 1:00-2:00 P.M. TOWN OF -BARNS"-TABLE' BUILDING ,,,fI.NSPECTOR APPLICATIOWFOR PERMIT TO TYPE OF.CONSTRUCTION 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a_ f 1p_ermit according to the following information: Location ES`2 e�7 I/O / t 41 Proposed Use s5l s/ Zoning District Fire District Name of Owner4� ,&4bi! 4/2" Address. 177 �APG,,-ter✓J ll Name of Builder `?� ,o �w/ems Address Name of Architect !`0ec" JJ�y�Jrr� Address //!r yl�i64;r Number of Rooms Foundation Cc, /IV Exterior 01,40-b .-1) Roofing Floors �� Interior Heating Plumbing Fireplace Approximate Cost �d ce) Area Diagram of Lot and Building with Dimensions Fee J �� v� OCCUPANCY PERM, S REQUIRED FOR NEW DWELLINGS I hereby agree to conOrm to all the Rules and Regulations of the Town of Barnstable regarding the above construction. y s % � Name Construction Si ipervisor's License ���/OJ�3 j, CREELMAN, WILLIAM & JEAN t -,�;ZZ/10_3 ` 4o i% Permit For REPAIR ,. FIRE DAMAGE Location- 377 Elliott Rd, Centerville -1 F � l 'r• �.{ f ,. n�` ' • +...�i^.-/..:may, '7 it Owner William & Jean Creelman + Type•of C6nstruction Plot '�� - Lot Permit Granted , July 26 , 19 94 Date of Inspection: Frame 19 ' ' Insulation /�3c>) gY 19 - ,Fireplace 19 Date Completed i, ) 19 • _ _ t` ? �- - 3 . y Y - + 7 J A A ;t Yx ,4 ... - 1 11 71 FOXY tAO"u, III � �•� ��'.�%,•^�� i I r -Lt:5411�5.:. ... ,�`stC�414�y JA.,.µrSLk1:.Ek1.57?7dCq... . a k; rar Ttv Ku31i2C7�Ji3 .M, qi tf�*YPI,d.SarG.?17 • ra^1! INA- _$30:T��PESt`VEIaT`D� � wo k3 JDIiT Copyrl9ht_Qf494 "; I - Ata ,RigAcs ReservevA f � ! xii.P V. L�Yl4EhY£�4:.. .i t, i 4 fP1 fit BUiU - GAR"CCr€kflf=Tleti4. T?FAil�e4 : -11sN. ' �� q8�� � 2�s'tf.•. I �--�'C[rt.�1VS'..t:'$V��_1YX�lSffiR) 1 T 'K uco � 1 I 2'CS i I ( P y to tc o f ......qq .,�� _.—_-�•. ..�__.-.._ .. ,«.+� +eM, n..'m ,y.w..�s Y'>+ni »:u�-ms.'1.�. �.n� e I 8 .. tl• — _ R I r ' N ' fps E:... 1 �••'� �n'IY+yaz'artiaa4K+4, wsv$$ro.ttaEt.,,.. rw { . W "$4 r � , e's rir . ` t'opyrig:ht Q 9994 a; %%ll Rights eteivedt I + I I i I h Y J ' at i a '>r zd7JJ Eg''1'Sy�7.l $, (]J/ pfr'�C3k lrE!'f`Ur+E EJ EIYS$ (}'P:.CMetr Cll'$'EOrh�:'T.r 4't'Jl�.,r/{. 4 y�„+l1rS...,xi.',.tSE P�J•i-Elyv t�?V'Y3h� 1N '� ` `,. s `F I Av .uNYI:S�u15u'b v.lv,W`i �4 : v 1Nw, ...-W :' SA`M 4��l L �1} .�! { u� r -ryyKC Y2 1 �f Not"1 au i '. w tt x c d VF . c g -':2'a" - .. .. J .e, Af airy. Klt76t;C32f"C`kit ! .. .. .. ,' ,, '. 9°xZ�Q��I.•n01'�IG ''.. J"X'T°'Q1�}.1'10raF I TOWN OF _RNSTABLE BUILDING:ERM T •' COONPOVEALTH OF �ACHUST� 3= DL1'1SIZ ?� . i OF;?�DUSTT�ACCIDENTS 600 WASHINGTON STREET ,James-' Canocec BOSTON, M SSACHUSETIS 02111 Coa:rJ-ssone: WORKERS T '.COMPIISATION Il�ISURN = VI � t 4a 1. 4 - . with s principal pla(x of bus m i::arM' dcnoc _ __,R dounder the pcmie=Qfpcqury :�-- herrbyonufy pat:uand i'7 I un zn employs providing the followingworkcre compcsu�rion oo form eta i job. vcrzgc y P°�'wo $on this Insu=cc Company Policy Number () lam a sole propricror and have no one working for me () l am a Solc praprictor,gcntxal eonrnaor or homeowner(circle one)and havc hired the contractors listed below Who have the following work='compensation insurance polices: Name of Conuaaor Insurance CompanylPoliey Numbs Mmc of Contraor Insurance Company[Policy Numbcr Name of Contraaor Insurance Com anv/Poli Number P cY 0 1 :r.J a homeowner performing:Jl the work:myself. NOTE'-Pl.c be aware t at w+i C bosacowacr%woo ctaalov Qcmcs to 20 caiatcoaaoc.consttuctioa or tcp1;rwoc1 oa 1M-cliinc of not wort toaa L—rcc emits is wa;L tic bor_cowacr asso restccs or on L`c Frouacs appurtcaamt 6cecto arc cot rcacr:U%' eons�eerc('to be crvlo%,crr L ccr Lc Corl crs•Cor ac satioa Ae.(G'—C 152.scc-10)),application by a boraeowoer(Of,Jicet:sc or permit nav cvicczcc tic ICE st.r.:s of an c raploytr uadcr 6c C-orlcrs'Cor_pccrauoa Act. 1 -cc-:��c:�:::C:.•c:t cn: %-;L'be io ••:-ccc to&,- -c.t c:::c;J::::'Accdcnt:'O rrcc of Insura-^c for coVC:!-,c c ,_—sc rccC::<_t rcc: CCn:i:CnC C �cc:c n=c=.'C.::C_!c:C-.icsc to t:`.; i-:po:ition Crc :-:i_1:l pc " !: O: cZ ro CL<VC:.:Z'.0 C�- �✓O L: LC JOt7:]07r L�IOp tK OtC :i.cC`; fine of S 100.00:cay a:im:Jac. Sicncc m s aks�_ J d;y of 19 t- I r � Application number:... QQ .� 36 ��s .. ' Date Issued......... ! Building Inspectors Initials...... . iMap/parcel.........�z,......1 °........... .......... .... TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION ..Address of Project: 311 -E1 l i o T 't�v . C e ni're✓ NUMBER STREET VILLAGE Owner's Name: S u d 4 AJ CA r✓ Phone Number 1�0 k -1 R o - z. t fY 'kI id�i/�`( C Free 1.^{arJ TNUsf Email Address: C a,.✓` Mac. o m. Cell Phone Number N 14 Project cost $ y 0,ov Check one Residential Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize (1 R izzi I�or�� 2M P✓oyeK �-t ✓� to make application for a building permit in accordance with 780 CMR Owner Signature: S� Al &141C4 41/77'-01/i�T�u�/Date: TYPE OF WORK ❑ ding ❑ Windows (no header change)# ❑ Insulation/Weatherization � Doors (no header change)# Commercial Doors require an inspector's review ❑ Roof(not applying more than 1 layer of shingles) �Lo Construction Debris will be going to -I--ow A 0¢ tom, ARN J;r4610- t/q Nl, Fi 1 /Ka-rJTAIL/./ a CONTRACTOR'S INFORMATION r Contractor's name 1 ohAj T, styVn J 141 G A f►22 i 14 o ti-e Z ✓e Je t�bf' N �� � t o0'1�0 Home Improvement Contrac ors Registration(if applicable)# (attach copy) Construction Supervisor's License# (J �o B� (attach copy) Email of Contractor -C g M 1 f e 64 Zt 4 o ti? r1 Phone number SQL' ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION NUMBER *For Tents Only* ' Date Tent(s)will be erected Removed on number of tents total Does the tent have sides? Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Check one this event is : ,or profit non-profit event Check one: Food se ed Yes No Flame Spread S et of each tent must be attached. Provide a site plan with the location(s) of each tent If food ' eing served at your event please obtain a Health Department approval between the hours . of 8: am-9.30 am or 3:30 pm-4:30pm. Commercial ev is may require Fire Department approval, *WOOD/COAL/P ET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab' Offsets from combXlb ' - nt back left side right side HOMEO 'S LICENSE EXEMPTION Homeowner's Name: Telephone Numb Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLICANT'S SIGNATURE Signature Date 0 All perm' applications are subject to a building official's approval prior to issuance. s DocuSign Envelope ID:BFEB13D9-D192-455C-95F0-10AB39080DEF Page 6 of 6 Capizzi Home Improvement Inc. Specifications and Estimates STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT I, WILLIAM CREELMAN C/O MY DAUGHTER SUSAN CARR , OWN THE PROPERTY LOCATED AT 377 ELLIOT ROAD IN CENTERVILLE,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 Cg-gnedby: SIGNATURE OF OWNER: E(I-soROC.998'06851 OWNER'S ADDRESS: 377 Elliot Road, Centerville MA 02632 OWNER'S TELEPHONE: (508) 790-2158 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: • ' - • n . C —� �i't--� rev,'! � . SCA 1 d9 r ,,t y� ,.e�kniaaxt�"iitetlon' Registration Wid for individual use ONy Office o�consumer before the expi HOME IMPROVEMENT CONTRACTOR ration date- ti found return to: anon , TYPE:Suoft Card Office of Consumer'Afros Business Regal o bu rion Pia .guile 1301 R 100740 Ore A 021� 6 CAPIZZI HOME IMPROVEMENT INC. JACK STRUNSKI Not V� WMIOU 8lgr abure } 1645 NEWTON RD. Underf3ecretasY . COTUIT,MA 02WS ' Construction Supervisor Commonwealth of Massachusetts ' - `Unrestricted-Buildings of any use group which contain $� Division of Professional Licensure less than 38,000 cubic feet(991 cubic meters)of enclosed Board of Building Regulations and Standards 1space- �sratr3i f €irvisor • CS464817 , Expires:0611812021 JOHN T STRUMSKI 18 ALDEN AVE c BUZZARDS BWYMA'OY832 Failure to possess a current edition oftite Massachusetts °'�`�IS .T,4����5 State Building Code is cause for revocation of this license. For information about Otis license , �.:� •,� �/ .— The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations 600 Washington Street Boston,MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/organization/lndividuat): CAPIZZI HOME IMPROVEMENT Address: 1645 NEWCOWN ROAD City/State/Zip: COTUIT MA 02635 Phone#: 508-428-9518 Are you an employer?Check the appropriate box: Type of project(required): 1. ./ I am a employer with 40+ 4. 1 am a general contractor and I 6. New construction employees(full and/or part-time).* have hired the sub-contractors 2. 1 am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have 8. Demolition working for me in any capacity. employees and have workers' 9 Building addition [No workers'comp.insurance comp.insurance.: required.] 5. We are a corporation and its 10. Electrical repairs or additions 3. 1 am a homeowner doing all work 'k officers have exercised their 11. Plumbing repairs or additions myself.[No workers'comp. right of exemption per MGL 12. Roof repairs 4E,/1N-11-1 insurance required.]t c. 152,§1(4),and we have no I 0 0)✓ employees.[No workers' 13. Other comp.insurance required.] T *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-cofactors 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: AMGUARD INSURANCE COMPANY Policy#or Self-ins.Lic.#:112wc863728 Expiration Date:a 12/25/2018 Job Site Address: 31Z I` °t r City/State/Zip. C-L ��✓I/� Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine, of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify u er a pains andpenalties of perjury that the information provided above is true and correct Signature: Date: 0T/06/2018 Phone#: 508 -0269 Official use only. Do not write in this area,to be completed by city or town q ffkial b City or Town: PermitlLicense# 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#: �Aco O® CERTIFICATE OF LIABILITY INSURANCE F °ATE(MM,°°"r"' `.� 12/27/2017 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 and Gray Processing ROGERS & GRAY INSURANCE AGENCY INC AONE No Ext (508)398-7980 Fa,c No: E-MAIL mail@rogersgray.com @ ogersgray.com 434 ROUTE 134 INSURERS AFFORDING COVERAGE NAIC# SOUTH DENNIS MA 02660 INSURERA: AMGUARD INSURANCE CO 42390 INSURED INSURER B: CAPIZZI HOME IMPROVEMENT INC INSURER C: INSURER D: 1645 NEWTOWN ROAD INSURERE: COTUIT MA 02635 INSURER F: COVERAGES CERTIFICATE NUMBER: 225491 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. ILTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDDPOLICY/YYYY MMIDDIYYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PRO- POLICY JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED N/A BODILY INJURY(Per accident AUTOS AUTOS ) $ HIREDAUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE N/A AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION X1 SPER TATUTE EORH AND EMPLOYERS'LIABILITY YIN ANYPROPRIEfOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBEREXCLUDED? NIA NIA N/A R2WC863728 12/25/2017 12/25/2018 (Mandatory in NH) - E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.govllwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE MA 02645 0000 Daniel Cr ey,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD Town of Barnstable t Pe Regulatory Services Egpereesfimortutnvmissuedate + BARNSTABIX • KASS. Richard V.Scali,Director 059. � DN Building Division Paul Roma,Building Commissioner 200 Main Street,Hyannis, MA.02601 ww-w.town.ba rn stab 1 c.ma.us Office: 508-862-4038 Fax:508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Map/parcel Number 211110112 Not Valid without Red X-Press Imprint Property Address -- 3_17—���r"`� � _�A_ _ C. 2a1Ar-e AVy l -P, __.------- Residential Value of Work$ j j1 y vv,o, Minimum fee of$35.00 for work under$6000.00 y Owner's Name&Address tt j J(iA§4 C r'tB jMA,0 1 ;:rddAA) C.4V fUk Contractor's Namely G Ud���� Telephone Number �� y 9 YZ Home Improvement Contractor License#(if applicable)_ 0 Email: &'44,/g ld Cd 91'Zt;tic7�, to Con traction Supervis is License#(if applicable) orkman's Compensation Insurance w Check one: ❑ I am a sole proprietor ® [y I am the Homeowner T Sep I have Worker's Compensation Insurance `�1 Insurance Company Name,H Workman's Comp.Policy#_____ '?tJ G -7� S 3 2.6 Copy of Insurance Compliance Certificate,must accompany each permit. Permit Req st(check box) • L J F 11A✓e. 4e4Y- 4 P PZ' r 1)0' [7 Re-roof(hurricane nailed)(stripping old shingles) All construction.debris will be taken to /V•,eu) s-e&?r�'vPQ ❑Re-roof(hurricane nailed)(not stripping. Going over_ existing layers of roof) ❑ Re-side [ Replacement Windows/doors/sliders.U-Value �' ° (maximum .32)#of windows #of doors: *Where required: Issuance of this permit does not exempt compliance with other town department reguiatiom.i.e.Historic.Coiuervation,etc. ***vote: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is requir d. SIGNATURE: C:1Users,decollik',AppData'.Local;Microsoft,Windo%s4lNetCache`tContent.OutlooktL7U69LF2iEXPRESS(2).doc 01/25/17 r Page 6 of 6 Capizzi Home Improvement Inc. Specifications and Estimates STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT I, WILLIAM CREELMAN, OWN THE PROPERTY LOCATED AT 337 ELLIOT ROAD IN CENTERVILLE, 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 C SIGNATURE OF OWNER: � 'li� OWNER'S ADDRESS: 337 ELLIOT ROAD, CENTERVILLE MA 02632 OWNER'S TELEPHONE: 508-790-2158 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: Construction Supervisor Restricted to: 'Massachusetts Department of Public Safety Unrestricted-Buildings of any use group which contain Board of Building Regulations and Standards less than 35,000 Cubic feet(991 cubic meters)of 9 enclosed space. License: CS-074640 .. Construction Supervisor GARY GUSTAFSON 8 SHORT WAY ; SANDWICH MA 02563 Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. DPS Licensing information Visit: WWW.MASS.GOV/DPS �iu�— Expiration: 111-ommissio he 11/29/2018 " .!/ii- a•r:u.ii�rlii•rv�%//i r ..//[iiJn�/�ai�/!J r ,a4_gffice of Commer Affairs&Business'1Regalattoo d ;1 {t,;x OME IMPROVEMENT COPITRACTOR , I r�Registration: 100740 TYPE -,, XAceuse oe aegistivUen valid for indivitdul use only Expiration: 6/2812018 Supplement Card before the expirabiOn dabs. If found return b0: CAPIZZI HOME IMPROVEMENT,INC. Office of cCousamr Affairs and B®sieiess RegWation: r 10 Park iaiaaz-Suite 5170 GARY GUSTAFSON iBosWn,MA d116 1645 Newton Rd. � Cot uft,MA 02635 Underseeretary _ t out signature --- f r l ® DATE(MM/DD/YYYY) ACORO CERTIFICATE OF LIABILITY INSURANCEF�� 12/30/2016 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(les) 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 and Gray Processing ROGERS & GRAY INSURANCE AGENCY INC FA PHON o Ext: (508)398-7980 AIc No: E-MAIL ADDRESS: mail@rogersgray.com 434 ROUTE 134 INSURERS AFFORDING COVERAGE NAIC# SOUTH DENNIS MA 02660 INSURERA: AMGUARD INSURANCE CO 42390 INSURED INSURER B: CAPIZZI HOME IMPROVEMENT INC INSURERC: INSURER D: 1645 NEWT'OWN ROAD INSURERE: COTUIT MA 02635 1 INSURER F: COVERAGES CERTIFICATE NUMBER: 114654 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 ADDLSUBRI TYPE OF INSURANCE INSD WVD POLICYNUMBER MM/DDY L /YYYY MMIDDIYYYY LIMITS TR COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES Ea occurrence $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY❑PRO LOC PRODUCTS-COMP/OPAGG $ JECT OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS N/A BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ HIREDAUTOS AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE N/A AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION X1 SPER TATUTE OERH AND EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBEREXCLUDED? WA NIA N/A R2WC775326 12/25/2016 12/25/2017 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If as,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ 1,000,000 N/A DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is.required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given-to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/lwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION 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 AUTHORIZED REPRESENTATIVE Hyannis MA 02601 Daniel Cr ey,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD ' The Commonwealth of Massachusetts = Department of Industrial Accidents I Congress Street,Suite 100 Boston,MA 02114-2017 www.mass gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Leeibly Nari18(Business/Organizatiott/Individual): �� 1 Z21 D►°� 7r ID l3 g I,t C. Address: , � /1119ai b ujil R 1, City/State/Zip: L 4"09 f j 11-4 0'26 3 r Phone#: Are you an employer?Check the appropriate box: ' Type'of project(required): L yI am a employer with 1 employees(full and/or part time).! 7, ❑New construction 2, 1 am a sole proprietor or partnership and have no employees working for me in a any capacity.[No workers'comp.insurance required.] 8• Remodeling 3.01 am a homeowner doing all work myself.[No workers'comp.insurance required.)t 9. Demolition 0 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will � ensure that all contractors e 10 Building addition either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. oOf repairs These sub-contractors have employees and have workers'comp.insurance) p 6.M We an:a corporation and its officers have exercised their right of exemption per MGL c. 14.[tither s �V I p o to 152,§1(4),and we have no employees.[No workers'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 affidavitindicating they are doing all-work and then-hire outside contractors must submita'new-affidavitindicating 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: 6UARG Policy#or Self-ins.Lic.#: ;' W c ir 9 Expiration Date: - 311 ��� / �u City/State/Zip: C tit.r e,,udl,P Job Site Address: �o• Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 112,§25A is a criminal violation punishable by 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$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance 4 coverage verification. I do hereby certify�ndr 'pains and penalties of perjury that the information provided above is true and correct. Signature: Date: 0 Phone#: J-6 t -2 f 4 or Official use only. Do not write in this area,to be completed by city or town official a, City or Town- Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.EIectrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: WE Town of Barnstable *Permit# Expires 6 moat/is from issue date Regulatory Servi ,._ Fee * swatvsrnet e � m •/'� 1 ,� Richard V.Scali,Director �' V Building Divisi� t R 82016 Tom Perry,CBO,:Building CoMdfl� 200 Main Street,Hyannis,MA 02601 � °TA Nt www.town.barnstable.ma.us ti Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY y o 3 Not Valid without Red X-Press Imprint Map/parcel Number pr� Property Address .3 rldl ELLS 0% I-RV C eAI AexvdJe [residential Value of Work$ -2 5"0 0, end Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address �EE IJ M 4,n p 7-4h ll j/t rn C-r ---e,, rn 4 Al 3111 A:F ) 1;64— RP its+ 0 2-(o 37-- Contractor's Name�rAHZ S ile- ee RVAA C,7;. Telephone Number �b a q.R k p Home Improvement Contractor License#(if applicable) f?d7�}0 Email: � i s n e C,4 Q�'Z2 i 1-)o to a 1d a I,,. a c'r?„ Construction Supervisor's License#(if applicable) J 0 -7 4Workman's Compensation Insurance Check one: ❑ I am a sole proprietor Mam the Homeowner have Worker's Compensation Insurance Insurance Company Name A el 6)q fz 0 :rNi ugn N t Q A G&AM y Workman's Comp.Policy# R--L W(,6 Serra 1—,() 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) [❑ e-side Replacement Windows/doors/sliders.U-Value 'Z (maximum.32)#of windows '3 00b 1,P— PA a &ej (,Ve f eltl V i A) P rz/t. S #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor 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,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: C:\Users\Decolli pDataV ocal\Microsoft\Windows\Temporary Intemet Files\Content.Outlook\2PIOIDHR\EXPRESS.doc Revised 04021 Page 7 of 7. Capizzi Home Improvement Inc. Specifications and Estimates STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT , OWN THE PROPERTY LOCATED AT3?, �'�l/�(li � IN MASSACHUSETTS. I HAVE AUTHORIZED CAPIZZI HOME IMPROVEMENT JO 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: i_ � Massachusetts Department of Public Safety i Board of Building Regulations and Standards License: CS-076261 Construction Supervisor JAMES MCCORMACK 73 FEARING HILL ROAD WEST WAREHAM MA 02676 Expiration: Commissioner 11/13/2017 %�n r�riirrniiruc�r�l�r rl rt.t�cr.�u.1r./(, License or registration valid for individual use only before the expiration date. If found return to = ffice of Consumer Affairs&Business Regulation R T g Office of Consumer Affairs and Business Regulation �� ` '��OME IMPROVEMENT CONTRACTOR 10 Park Plaza-Suite 5170 Registration:„ Boston,MA 02116 � � .Expiration 00740, Type: 6/23/2018 Supplement Card CAPIZZI HOME IMPROVEMENT, INC. i.. f JAMES MCCORMACK 1645 Newton Rd. al,_•_.z__� No valid without signature Cotuit,MA 02635 Undersecretary ,�coR CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYI) 12 29 2015 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 endorsements). PRODUCER CONTACT NAME: ROGERS&GRAY INSURANCE AGENCY,INC. PHONE Fax A/C o Ext: A/C No): 434 Route 134 E-MAIL ADDRESS: INSURERS)AFFORDING COVERAGE NAIC II South Dennis MA 02660 INSURERA: AmGUARD Insurance Company 2390 INSURED INSURER B CAPIZZI HOME IMPROVEMENT INC INSURER C: 1645 NEWTOWN ROAD INSURERD: INSURER E: 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 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR POLICYNUMBER MMIDD MM/DD GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE T RENTED PREMISES Ea occurrence) $ CLAIMS-MADE 1-1 OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PRO- LOC $ AUTOMOBILE LIABILITY CO BINED SINGLE L MIT Ea aaident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $HIRED AUTOS AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION X; WC STATU- OTH- A ANDEMPLOYERS'LIABILITY YIN R2WC655250 12/25/2015 12/25/2016 Y I I - 1 ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? F N/A (Mandatory In NH) 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) CERTIFICATE HOLDER CANCELLATION Town Of Barnstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 200 Main Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Hyannis, MA 02601 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED* ©1988-2010 ACORD CORPORATION. All rightereserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD • • .,� The Commonwealth of Massachusetts Department of IndustrialAccidents 1 Congress Street,Suite 100 Boston;MA 02114-2017 www mass gov/dia 11'orkers'Compensation Insurance Affidavit:Btiilders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY Applicant Information Please Print LesibI� Name(Business/orgauization/Individuai):CAPIZZI HOME IMPROVEMENT INC 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): 1. d0 I am a employer with 40 employees(full and/or part-time).* 7. El New construction 2.❑I am.a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required] 9. ❑Demolition 3_❑I am a homeowner doing all work myself.[No workers'comp.insurance required]t 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10[]Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.Q Electrical repairs or additions proprietors with no employees. 12.Q Plumbing repairs or additions 5. I am a general contractor and I have hired the sub-contractors listed on the attached sheet ❑13. Roofre airs These sub-contractors have employees and have wodcers'comp.insurance.= p•� ��/ 6.a we are a corporation and its officers have exercised their right of exemption per MOL c. 14.[ her J �p f (J 152,§1(4),and we have no employees.[No workers'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 em io er that isprovidingworkers'conWensadon inurancefor mJ employees. Below is the policy andJo. b site : information. Insurance Company Name:AmGUARD INSURANCE COMPANY. Policy#or Self-ins.Lic.#:R2WC527200 Expiration Date:12/25/2016 Job Site Address: 71 El I t p-� �p 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 MGL c.152,§25A is a criminal violation punishable by.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..A co y of t ' statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify der a pai and penalties of perjury that the information provided above is true and correct Sim ature: Date: v- G 0� Z 6 Phone#:508-428-95 8 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 &Other Contact Person: Phone#: Town of Barnstable ,. E.t�tet 6 monthx r Regulatory Services. Fee KASS Thomas F Geiler,Director Building Division Torn Perry,CW, Building Commissioner. 200 Main Sit,Hyannis,MA 02601 www.town-barttstable.na.us Office; 509-852-4038 Fax:508-790-6230 . EXPRESS.l'ERM APPLICATION - ' RE,SIDENTIAL ONLY Not VaUd wrthhnut;Red X-Pras1nFrhu Mapipamel Number a.1-1 /l e Property Address 3 1 l l/OTT 0 C c h'�crV i/fie'. &(Residentiat Value of work L/000 Minitnam fee of$3 oO for work under'$S6000.00 Owner's Name&Address ,rEAu Al- . .CY-CC L /N4N 371 C-Uio Cem-rerdillee AfA Contractor's Name 44 Xy U s-0,4 410 M Telephone Number 5W f10?00 9s�i Home Improvement Contractor License#(if applicable) J 44 y0 "} . C s NIP Yvrkz j Construction.Supervisor's License#(ifalrplicable) - gUG WWorkman's Compensation Ins mee. pecIama proprietor sole TQUUN CIF BARNSTA.S,LE t am:the Hcmteowner. Yl have,Worker's Compensation insurance Insurance Compwy Name_. ACE P✓o�e��fl a� �.�✓tl��7. �/V f. Cor,! ,q�/ Workman's Comp:Paticy# Copy orbsurance Compliance Certificate most accompany each permit. Permit Request(check bok) r Re-roof(hurricane nailed)(stripping old shingles) All constr ction-debris will be taken to Re-roof(hurricane nafled)(riot stripping. Going over ecis Dyers of roof) El e-side of doors Replacement trndows/doorslsltders U-Vaitie {maxtrritim.35) tifwinrlows M%crc.require& Tssttancc of this pet"does not exempt comptiartce with other tows dot.regulatiotts Le.HIS cons ati4 etc. Property:._ r must st Pro a Qvn er L#ter of Perrrussroti.; gn' p rty A opy o it oime npcovement.out actors-Lfceme&Gtrnsirucfisro Super isrirs T tense is C 1t7sersldecctllr iApp intemet FilcsIContent.C?tri9oolcl DV87AA;7.1 'PIt.F, Zoe, Revised 0721.I0, The Commonwealth ofMassachusetts Department of Industrial Accidents Office of Investigations 600 Wash ngton'Street Boston,MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): C 1'2 ! ��d 1�'l _J-r JYOLJe ryl /G Address: G 4T IV-ew i OLLM y City/State/Zip: (6-a MA Ugh 93-1 Phone#: . Are you an employer?Check the appropriate box: Type of project(required): 1.[!4am a employer with y0 t 4: I am a general contractor and I 6. New construction (full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.. `7. 0 Remodeling ship and have no employees These sub-contractors have g, `❑Demolition`. working for me in any capacity. employees and have workers' [No workers'comp.insurance comp.insurance.# 9. ❑Building addition required.] 5. E] We are a corporation and its 10.0 Electrical repairs or additions 3.[] I am a homeowner doing all work officers have exercised their I I ZI 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 employees. [No workers' 11[vother comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeownem who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ;Contractors°;hat check this box must attached'an additional sheet showing the name of the sob-contractors and state whethdi 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 isproviding workers'compensation insurance for my employees Below is thepolicy andjob site information. Insurance Company Name: C E P tro f-eg T (4 J 1/4 L/. ,Z—W IIIM N!-R- Policy#or Self-ins.Lic.#: N G G S� 32 Gd, Expiration Date: 712.1,;- 3 ?? F hll.0 f' xd (' { Job Site Address: KT'!✓. ' City/State/Zip: V/Yle 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 verage verification. I do hereby certify un the i and penalties of perjury that the information provided above is true and correct Signature: Date' a �l Z 4 Y/ Phone#: kUf '�VR Official use only. Do not write in this area,to be completed by city or town ociaL City or Town: PermittLicense# Issuing Authority(circle one): i.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person; Phone#• Client#:47298 CAPIHOM A ORDTM CERTIFICATE OF LIABILITY INSURANCE °6102120�;"") 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 endomement(s). PRODUCER CONTACT Karen Walther NAME: Rogers&Gray Ins.-So.Dennis PHONE F ac No Ext:508-760-4630 A/c,Ne: 508-258-2230 434 Route 134 E-MAIL waltherka ro ers ra com ADDRESS: 9 9 y P.O.BOX 1601 PRODUCER CUSTOMER ID#: South Dennis,MA 02660-1601 INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A:National Grange Insurance Co. Capiai Home Improvement,Inc. INSURER B:ACE Property&Casualty Ins.Co Capiai Enterprises,Inc. 1645 Newtown Road INSURER C: Cotuit,MA 02635 INSURER D: 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 POLICY NUMBER MMIDDIYYYY) (MMIDDNYM LIMITS - A GENERAL LIABILITY MPB1075H 06/08/2011 06/08/2012 EACH OCCURRENCE $1,000,000 X MERCIAL GENERAL LIABILITY DAMAGE PREMISES TO Ea omu RENTED . s500,000 CLAIMS MADE OCCUR MED EXP(Any one person) $10,000 70M PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: - t=UCTS-COMP/OPAGG $2,000,000 POLICYFI PRO- LOC $ A AUTOMOBILE LIABILITY M1 M28044 06/08/2011 06/08/2012 COMBINED SINGLE LIMIT " $ ANY AUTO (Ea accident) 500,000 BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ X SCHEDULED AUTOS - PROPERTY DAMAGE - X HIRED AUTOS f (Per accident) $ X NON-OWNED AUTOS - $ X Drive Other Car $ A UMBRELLA LIAB X OCCUR CUB1076H 06/08/2011 06/08/2012 EACH OCCURRENCE s5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE s5,000,000 DEDUCTIBLE - - $ X RETENTION 10000 - - - $ - - B WORKERS COMPENSATION NWCC45843208 12/25/2010 12/25/2011 X WC STATU- OTH- AND EMPLOYERS'LIABILITY Y ANY PROPRIETOR/PARTNER/EXECUTIVE NIA E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,()00 If yes,describe under DESCRIPTION OF OPERATIONS below - E.L.DISEASE-POLICY LIMIT $1,000 000 DESCRIPTION OF OPERATIONS/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 Days for Non-Payment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Town of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE' 1 ©198 -2009 ACORD CORPORATION.All rights reserved. ACORD 25(2009/09) 1 of 1 The ACORD name and logo are registered marks of ACORD #S67537/M67480 MEE ,� /fi8 Lt�rvnx: zer3erxlCfiqrJLZtsv6eafarcCeLz \ Office of Consumer A.flairs&Business Regulation License 6r registration valid for indMdul use only :y OME IMPROVEMENT CONTRACTOR before the.exjiration.date. If found return to: r. bffiee of Consumer Affairs and-BasineSt Re ulation Registration:- Type. 10kark.Plaza-suite"51a70 ExpCAPIZZI ��� �. Supplement Card. Boston,MA•021`16 s at.�5 s GARY GU5TAr ''1 1645 Ne eton Rd. � �l&n� � Crsluit MA 0265 . I nd€rseerefary *Noidsignature ax. 11.t•scac ltu�ctt�- D It trtn trt(if.Public.sak- ti 3<t,tt 1. t# B sildita�o RcaulatiOnS .ttt4 5t.trttlytrtls Canitr' ion Supervisor License License: CS 1464C3 " w CARP GUSTAFSON kORT WAY SANDWICH; MA . �63 Expiration. 41f23B2t712 Try: 7058' 3'? +llaf/P . r Page 7 of 7 . CAPIZZI HOME IMPROVEMENT INC. SPECIFICATIONS AND ESTIMATES STATE OF MASSACHUSETTS • s, LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT LA4 l li G I, OWN THE PROPERTY LOCATED AT. 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. p I GIVE MY PERMISSION TO LESSEE TO APPLY FOR A BUILDING PERMIT IN A CORDANCE WITH 780 CMR,THE MASSACHUSETTS STATE BUILDING CODE. SIGNATURE OF OWNER: OWNER'S ADDRESS: OWNER'S TELEPHONE: - - LESSEE'S SIGNATURE: A LESSEE'S ADDRESS: LESSEE'S TELEPHONE: APLLICANT'S SIGNATURE: APPLICANT'S ADDRESS:. '`1645 Newtown Rd., Cotuit,MA 02635 ' ' APPLICANT'S TELEPHONE: 508-428-9518 y RESPONSIBLE OFFICER., i RESPONSIBLE OFFICER ADDRESS: RESPONSIBLE OFFICER TELEPHONE: r e Town of Barnstable.: *Permit Regulatory Services Expires 6monlh roe ssyellate Fee J sAart ®, ESS ftas F.Geiler,Director �OrtbMe�a Building Division �o%� JUN m 2 2008Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 TOWN OF BARNSTABLL'ww•town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel•Number � 7�/D Property Address Residential Value of Work tf� , c�za Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address Contractor's Name_ q l�T.4,otf Telephone Number Home Improvement Contractor License#(if applicable) XWorkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ 1 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) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of rood s ❑ Re-side Fv-1 Replacement Windows/doors/sliders.U-Value' I (maximum.44) *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 Home Improvement Contractors License_is required: SIGNATURE: �Y Q:Forms:bu ildingperm its/express Revised 123107 Page 7 of 7 CAPIZZI HOME IMPROVEMENT INC. SPECIFICATIONS AND ESTIMATES STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT I, C,a-P—e OWN THE PROPERTY LOCATED AT 3 7 L� /-�o • IN C v t l l ,MASSACHUSETTS.. I HAVE AUTHORIZED CAPIZZI HOME IMPROVEMENT TO ACT AS ' IY 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 P1 .ERMIT IN ACCORDANCE WITH 780 C MR, THE MASSACHUSETTS STATE BUILDING CODE.. SIGNATURE OF'OWNER, OWNER'S ADDRESS ! I , ,] OWNER'S TELEPHONE: LESSEE'S SIGNATURE` LESSEE'S ADDRESS ' LESSEE'S TELEPHONE; APLLICANT'_S SIGNATURE. APPLICANT'S ADDRESS 1645 Newtown Rd, Cotuit,I 02635 APPLICANT'S TELEPHONE 508 42&9518. RESPONSIBLE OFFICER; RESPONSIBLE OFFICERADDRESS:, RESPONSIBLE OFFICER TELEPHONE: f ' Client#:47298 CAPIHOM rf DTM CERTIFICATE OF LIABILITY INSURANCET—DATE / s/oi°"r"' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION y Ins.-So.Dennis ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 4 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 1s,MA 02660-1601 INSURERS AFFORDING COVERAGE NAIC# ED INSURER A: NGM Insurance Company Capizzi Home Improvement,Inc. INSURER B: American Home Assurance Capizzi Enterprises,Inc. INSURER C: 1645 Newtown Road INSURER D: Cotuit,MA 02635 INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY EFFECTIVE POLICY/Y EXPIRATION LIMITS LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MMIDDY DATE MMIDDIYY A GENERAL LIABILITY MP010707 06/08/07 06/08/08 EACH OCCURRENCE $1 000 000 DAMAGE TO RENTED $50O OOO X COMMERCIAL GENERAL LIABILITY M CLAIMS MADE 51 OCCUR MED EXP Anyone person) $1 O 000 PERSONAL&ADV INJURY $1 OOO OOO GENERAL AGGREGATE s2.000.000 GEN'L AGGREGATE LIMIT APPLIES PER: - - PRODUCTS-COMP/OP AGG s2,000,000 PRO- LOC POLICY JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO ALL OWNED AUTOS BODILY INJURY $ (Per person) SCHEDULED AUTOS HIRED AUTOS BODILY INJURY $ (Per accident) NON-OWNED AUTOS - PROPERTY DAMAGE $ (Per accident) AUTO ONLY-EA ACCIDENT $ GARAGE LIABILITY - ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG 1$ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE Is OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE RETENTION $ $ WC STATU- OTH- B WORKERS COMPENSATION AND WC1764953 12/25/07 12/25/08 T I ITI ER EMPLOYERS'LIABILITY E.L.EACH ACCIDENT s500,000 ANY PROPRIETORIPARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $500,000 If yes,describe under E.L.DISEASE-POLICY LIMIT $500,000 SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Corporate officers are included in Workers Compensation coverage. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL l n DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001/08)1 of 2 #S33209/M33205 KW 0 ACORD CORPORATION 1988 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street UTBoston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affi" !>ii$A!14ep1l)cmty �IgEs/Electricians/Plumbers Applicant Information Read Please Print Leeibly Name(Business/Organization/Individual): Cohilt, MA 02635 Tel. 2 1.8 1 1.800-262-5060 Address: City/State/Zip: Phone#: _ Are you an employer?Check the appropriate box: ` .,? Type of project(required): LIN I am a e to er with � 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. Z. ❑ Remodeling ship and have no employees These sub-contractors have g. Demolition working for me in any capacity. employees and have workers' co insurance.t 9• ❑ Building addition [No workers'comp.insurance �• required.] 5. [] We are a corporation and its 10.0 Electrical repairs or additions 3.[3 officers have exercised their I am a homeowner doing all work 11.❑Plumbing repairs or additions myself. o workers' co right of exemption.per MGL Y � �• 12.0 Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. (No workers' 13.[3 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 subcontractors 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 an information. Insurance Company Name: � ��-'• Policy#or Self-ins. Lic.#: / / �%7 r.._� _ Expiration Date: Job Site Address: 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 S 1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains an i ry that the information provided above is true and correct Signatu e: Date: Phone#: Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# . Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: II i - Board of Building Regulations and Standards �r License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: / Registration: 100740 Board of Building Regulations and Standards Expiration: One Ashburton Place Rm 1.301, p� 6/23/2008 Boston,Ma.02108 Type: Supplement Card CAPIZZI HOME IMPROVEMENT. I / NARY GUSTAFSON 1645 Newton Rd. Cotuit, MA 02635 Administrator N6t valid with t sig ture R / . -ea/ =` Vl/Board of Building Regula ions and Standards One Ashburton Place - Room 1)01 Boston. Massachusetts 02108 Home Improvement Contractor Registration. Registration: 100740 Type: Supplement Card Expiration: 6/23/2008 CAPIZZI HOME IMPROVEMENT, INC. GARY GUSTAFSON 1645 Newton Rd. ' Cotuit, MA 02635 ---J-- --- Update Address and return card.Mark reason for change. L] Address F] Renewal F� Employment ❑ Lost Card .1//2G �/(YiYUIi'KIILCIM.I,L/1J7. O�J�.'(�ALJJILI,YLLf4P.�d - ::,. : Board of Building Regulations and Standards " Construction Supervisor License License: CS 74640 Expiration: 11/2k008 Tr# 6430 Restriction: 00 GARY GUSTAFSON 8 SHORT WAY SANDWICH,MA 02563 Commissioner Assessor's office-(1st Floor): �fd P APPROVE Assessor's map and lot number_ yoi YN t to` Board of Health(3rd floor): f C�`S^IN EY`STE -ese Conservat :s,t ^i L b w Sewage Permit number INSTALLED er Engineering Department(3rd floor): 0 WfffFM 71 _ House number ENVIRONMENTAL CODE 11'I8d Y�Y b Definitive Plan Approved by Planning Board WN . ULATIONS APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only i TOWN OF BARNSTABLE BUILDING I SPECTOR �ff.11�� 1 M) t s APPLICATION FOR PERMIT TO nu LIV144 TYPE OF CONSTRUCTION I,✓0 "1 ✓ 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for aPJermit�/according to the following information: Location 6}® U �� Vi fV Z�K Proposed Use Zoning District I 1 r ' i Fire District Name of Owner l Q 0 0 U/•R` 4} Address �7 17 /�Q "� C fit WWII D Name of Builder V d � Address Name of Architect Address 2 1A✓I0` 61410 �t V` Oc-, �f j Number of Rooms Foundation Exterior C Q L Roofing AIL.IAi I��L 45 Floors f<L Interior `��(� , Heating p[[ �o S-p bo Q o d Plumbing 'V` Fireplace Approximate Cost s � on Area Diagram of Lot and Building with Dimensions Fee i 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 E7u� V. sf CREELMAN, WILLIAM & JEAN No 34516 -Permit For. Build Addition t Single Family dwelling Location 377 Elliott Road 3 Centerville - OwneF William & Jean. Creelman Type ofyConstruction Frame Plot - Lot PermiWranted Anrn,,t 19 91 Ca Dansp motion' 19 Da® =Nd`­ 19 12 I Ti �. tip- � • 4 f I, 3a+Ce� t A Wtolou; COPov aaer cty h9Ht f,4 Lallb✓ j itN��w ALL - sri - ------------ EX/51iNh Q1006 LtaJ will LP Gir►o1 wtlli fill . top 5 ctl Fl&4 Pl fl LdtMlhufl.1 fa 2 Zx 10' uoN �t✓�ct�ual uoll�y OPPv1....FnLfJ foAP�✓ Vcr(�{. i jh I II ! e i I I I I i 1 /r Nail �12uC1uJu� Jull�y anew �uc.�eJ cop�or �� Ile� j` y A tnotly (2-IJ c4iv Ce,Iivn - %- 5I4� .LDx 2ooF ��rart�,h9 Art Livt v)p}oit, 30 z vi c-t- IU T F N b P-r p t✓oiS� P- ' Soff'I will tmd ttL -exfc hlny h0IAf sou%e/h 7kllow Poe vntllid cerljncg ilel L�1uo CfuP6bGv� �Sia�hs �`` fa w.tot4��tr Alt" C tix �;,,ull c,GtG Won IZ--11 2(A)L�UFIb� -Lr%LI wfill IOIACfvvtfIO h U?� ioo/ i3oon @✓� Q,'r L)JK 1✓lood StitafihA I Zxto" jot(.(; 3 L•oh,�na�F2J 11� 11-" K� �� FltrF g" foL4Cd LpuII 3 o�v t b A,x x 2.Y r.n f ng ji cr Lally Colt,dpn 1r1'' t@%AC,0Wf. PQati u" fflviCi4 fl f l�a✓ COMMONWEALTH I OF DEPARTMENT OF PUBLIC SAFETY MASSACHUSETT$ II COMMONWEALTH AVE, F+I/nrsfopo+••+stltr►tsst BOSTON,MA 0221B M++sesha& ftst�INfdiso LICENSE C°�N°a'n�to�twroo�tan EXPIRATION DATE i C O N S T R. SUPERVISOR sI UN/ M. 05/31/1995 CAUTION RESJWCTIONS EFFECTIVE DATE LIC-NO. FOR PROTECTION AGAINST 1 2 FAMILY HOME 05/31/1993 047933 THEFT, PUT RIGHT THUMB PRINT IN APPROPRIATE JAM .S F C RO WL E Y BOX ON LICENSE. WIND SONG OR SO PLYIMOUTH MA 02360 L:11N PERAT iS (}f v " patuys' .'tNL» FS�! DE PH p, NOT VALID UNTIL SIGNED BY LICENSEE .. `s •. !. ENSEE AND OFFICIALLY HEIGHT: STAMPED.OR (�.SIGNATURE DF 711E COMMIS,gIONER ' b 1y93 .i•_:,tr._ :�,• THIS DOCUMENT MUST BE -:,;r:.,.,-.,5-...%:�• CARRIEDON THE PERSON OF S •p. i THE HOLDER WHEN EN. SIGNATURE CENSEE •) OTHERS'RIGHT THUMB PRINT GAGEDIN THISOCCUPATION.- SIDINER _ J i �T I ✓/ee�ommoouoealde ../uaaaar,�ivaa,Cla E HOME IMPROVEMENT'CONTRACTOR Registration 115103 Type - DBA EXpiration 12/09/95 KEVIN SHUTKUFSKI. KEVIN M. SHUTUFSKI P 0 BOX 563 - 23 DOUGLAS AVE j ADMINISTRATOR MONUMENT BEACH MA 02553 • i. tl / .fir:'**:litfi w�"?F7+��'4'ayt�-4XK" Yx.;�� �"�:t'.F.'fr'.�r t.��r£�}:��^1�+$'dw-.'*` .. y,pM1.• .+-rn r�.�..�,'a,� w�..e...�„��.�'r'*r s•+'^�..v+.. � .. rP r 4 p't Assessor 's office. 1st Floor): As'sessor's map and lot number Board of Health(3rd floor): ` Sewage Permit number . 2 '1X A Engineering Department(3rd floor): 9 ,nL �o •ius o number House 7 Definitive Plan Approved by Planning Board 19 APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only asp' TOWN OF BARNSTABLF -- - BUILDING INSPECTOF. R r a APPLICATION FOR PERMIT To l U CjV 4 �0U4I TYPE OF CONSTRUCTION I1/0 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a([10# rmitaccording,to the following information: l,�,� r /j Location el' 1 l t N o U r 0.Z U J 2 U� II (Looms 13 / u��Ct��- Uoo � Proposed Use � Zoning District Fire District ;} Nene of Owner t l � 0 U/ fifth Address �7 � Ill4 trl 9-1 (f I(/IIt C Name of Builder �^t' Vy Address Name of A.rchitect Address �� WI 0`"WO (I V, OC7`e 441�I Number of. Foundation Pot,��� �'�PW 61 r� s �lC Exterior Roofing Floors �C `� ^.Interior Lt/U ff Heating td r Plumbing jV fi I ,r Fireplace All Approximate Cost �7r Area 7 Diagram of Lot and Building with Dimensions Fee C�y 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. ` 1 Name Construction Supervisor's License CREELMAN, WILLIAM & JEAN A=227-103 .d._ .r No 34516 Permit For Build Addition Single Family Dwelling Location 377 Elliott Road Centerville Owner William & Jean Creelman Type of Construction Frame Plot Lot Permit Granted 19 Date of Inspection August 12 , 19 91 Date Completed 19 -r • J i PERM COMPLETED / 7�) r E 6 Assessor's office(1st Floor): /�-Z fo QyoFTNf�To`` Assessor's map and lot.number i, , Board of Health(3rd floor): Sewage Permit number ! + r Z 33MUS AXE i Engineering Department(3rd floor): rnss House number '�� Definitive Plan Approved by Planning Board 19 �p rar a• 1<? APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN OF BARNSTABL•E BUILDING INSPECTOR J +r APPLICATION FOR PERMIT TO (&E1 I/VC woo`' ��� TYPE OF CONSTRUCTION woo� �y U tm 19 TO THE INSPECTOR OF BUILDINGS: + The undersigned hereby applies for a permit according to the following information: Location "?��-7 -e/V c��`r', 04 u ' Proposed Use �F< Zoning District �`�Si� cA`rf u I Fire District t Name of Owner t(�I�� .00� kIGGJ (ItilVAq h Address Ofd( 40kU ✓cl.(-o Name of Builder 0f( 41 (70 AL4 Address 7r� �f�1 ����i✓��� �� ✓• ������/11�� �� - Name of Architect �^ Address Number of Rooms Foundation Exterior / Roofing �l Floors f7�� t r Interior Heating /t✓ Plumbing / Fireplace A[ Approximate Cost Area Diagram.of Lot and Building with Dimensions Fee J9 - . p 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. Namet - ` Construction Supervisor's License o r Z t CREELMAN, WILLIAM & JEAN 7 Io3 A=227-103 No 33935 Permit For Build Deck Single Family Dwelling Location 377 Elliott Road Centerville Owner William & Jean Creelman Type of Construction Frame Plot Lot Permit Granted August 27 , 19 90 Date of Inspection 19 ' Date Completed 19 PERMIT COMPLETED � f G -7 TOWN OF BARNSTABLE 20132 `�.l •�w Permit No. ------------------------ -- I r�n.r� Building,Inspector $632,00 11 Cash` ----------------------1 �o r►r�• t OCCUPANCY PERMIT Bond "No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to Daniel C. Hostetter Address Osterville lot #1 377 Elliott Road, Centerville; Wiring Inspector -10e .} Inspection date Plumbing Inspe t4---' i $ Inspection date Gas Inspector D Inspection date /Engineering Department,-.— � ���� Inspection date/Q"Z-5 - 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. 19................ Y.A" - ..................._., ....._... ........................Building..Inspector.........................._.. z- 7,(- —s Assessors map and lot .number f ` �a. SEPTIC 'SYSTEM MUST BE T INSTALLED `IN COMPLIANCE number ....................Sewa a .2-57........................... WITH ARTICLE II STATE TOWN OF - +-BARN 00 ° ,oWN ,rc "AG` , BUILDING^ -IINSPECTOR� --i 900,e�a639• 9� j " c APPLICATION~FOR�PERMIT TO .�.�QIUsJ�T`T�.012z ........... ;• k?�v�/ G. TYPE OF CONSTRUCTION ........ G7 ?52.... ............................................................. 'TO THE INSPECTOR OF BUILDINGS:, The undersigned hereby applies for a permit according to the following information: Location ..slued. ....z........ .. Gra.�P.... !2..........��.....,r 1.4l . 6t .....:............................................. ProposedUse ... ........................................................................... . kZoning District ..... ..................................................Fire District ... ...................................... Name of Owner .. nh ....,,i.. IJ6�ldl . � ......Address ..................................................................................... rr .... Nameof Builder .........\\. .M.-e<:................. .......................Address ......:.............:............................................................... Name of Architect v� .:...................Address ....................................................................,............... l,�...... eoNumber of Rooms .........................Foundation `a.LC/d/r� G~ Exterior ................. . .�k�'++!�....................,..........................Roofing ..... ..5elf.. ......................................................... Floors .....� .Interior '14`7'Q0 c* Heating ...............................................................Plumbing ..........:......... ............................................................. Fireplace ...... . /..........................................................Approximate Cost ........•/••;.. 0................................. B ..DefinitivePlan Approved by Planning Board _______________________________19________. Area ................. .®�................. Diagram of Lot and Building- with Dimensions Fee do SUBJECT TO APPROVAL OF BOARD OF HEALTH S 3 or,* � �© ) 1°` Cf I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ........... Hostetter, Daniel C. 4 *, 2Q132 1 1/2 story No ............... Permit for .................................... f amily,�dq.e'�ling sitiglel .............................................Elliott `Road ............................................ Centi . ille . ................................T7........................................... Owner ..........Daniel C. Hostetter ........................................................ Type of Construction ......frame...................... ........... ............................................................................... # Plot ........... ................. Lot .......1 ......................... Permit Granted ....... ..............1978 Date of Inspection ....................................19 Date, Completed ... . -19 . .. ..... ... 'PERMIT REFUSED ................................... 19 .......................................................... ............................................................................... ................................................................................ Approved ................................................ 19 .............................................................................. ............................................................................... Assessor's map and lot number f 1 P i 4'rl Sewage Permit number ...........................-2..q.............................. ,r y�FTHET��y TOWN OF BARNSTABLE Q Z BASH9TODLE, i "b 9 BUILDING INSPECTOR a OR APPLICATION FOR PERMIT TO .>.'`-�.Tl�'� ....,,i�� .....,f'/J j'S/f............X� TYPE OF CONSTRUCTION .......L°l C�i...... ............................................................ TO THE INSPECTOR OF.BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ....... .r / .� ...L.//">.T"T ....... ...........-..../J/ /.•...."" .................................................. Proposed Use .. ;!!.��.:�:.� .!`................... Zoning District ..... �...�-'..................................................Fire District .r'..,> !...G. ...rC-�...........(1�7"i..:.... .......� Name of Owner ...... ....;i,. :........:........Address .................................................................................... Nameof Builder 1 i` ..�..............................................Address................... .. ...................................................... Name of Architect .............................................................' Address � Numberof Rooms ..................................................................Foundation .............................................................................. Exterior .....................:............................................................Roofing .....'....`f. ...... .......................................................... Floors .Interior .�' �.. ` ..................................................................................... .....:..............................:............................................... Heating ..................................................................................Plumbing i 44 e '"Fireplace .......................................... 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 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. 41, Name .......��. ...!{.... .(.f,1' ...1'.................................... . � Bmatottez* Daniel C. A=227~103 ° ' ^ 5-1 � 2CKl32''= 1 1/2 story No ................. Permit for .................................... ��m�1 l � � �� ���'-6� ---�z�—..��.x.�..,�`..�.,���`—/—�--.��--. 377 Elliott Road Location --.--.--.',.-.—.-..^—~.-----. Centerville ^-------'—'------'---~-------' ' Daniel C. Hostetter Owner ---'------^----------^—' frame Type of Construction .......................................... #1 . Plot ............................ Lot .--------,— / � � } il 24 78 ( Pannii Granted —..���� ------.—]A - Dote of |pspection ..................................... ' � Dote -Cqp�o| � ---.-----.—.--.]Q � � Completed ' ` / � � PERMIT REFUSED . � ^ � l�—_---.,.---.--..—..----....- > _,___ _ ......................... � < _..--..,---.�.---.----,... .......................... ~ ' / ----' !> ` ' ----'' , ' Ap ............................................. 19 ` ) -------------'--~-----^----- � � ------------'—'------^^—'--^'— � |/ v tir ' ,'r �, �� � J � 1. (' •k•?A'.� )1 ♦ �^.i�'�^i .I�n�� tir 'r� Y if q,t { } }t'} rc :f I '�,r ri(i t �4?♦4Ff''I,i�Je�Hr•r 4 r�ti' , �JUN ` r `J ' � a,�htti''°•rV�;rt�t�.t'�f��'!u` r(dn�1 rr,r. ? 1 t� 5 ii+Kjyr.ttr'la( '.NIk-1' t�,.i'h.. .' 1 \••\� cif rk�'�. � r1` � �v.L •.�. .r t '• jI� • � l� r n T,1.9. ti t• J 1 •�+ i r (t ,Y t � � t •t � RL%other Ani " i�, c� O Q <3 �t U A ,2F / �02 � />l�S• iY/�f2E O c. �y/�/C.�S CERTIFIED PLOT PLAN L 0 C A T I O N'. 5--'4-�TEfe I//G 4 '0% . S C A L E: / - 5/O D A T E R E F E R E N C E : ,6A-=/A/G Z­--::)T ,ni0 6,E �� D A T E �s'l 1 HEREBY CERTIFY rHAT THE B UIL DING REG. LAN 0 SURVEYOR SHOWN ON THIS PLAN 15 LOCATED ON THE GROUND AS SHOWN HEREON AND ' THAT IT CONFORM TO THE ZONING SETBACK EQUIREMENTS OF T H E TO W N O F - —q Az-am WHEN CONSTRUCTE D . C M S ASSOCIATES , INC . 6 R E G I S T E-RED ENGINEERS d LAND S U R V E Y O R S `°.h ;,.• ^� # MID - CAPE OFFICE BUILDING - 1 2 6 5 ROUT E 28 SOUTH YARMO UTH, MASS. 02664 I rERVIL AIVCR �E NOTES: SEE PLAN BOOK 305 PAGE 43. SEE DEED BOOK 2693 PAGES 225 6 226. B.M. P.K. NAIL IN Pro YEMENT REV! - 17.57 (NGYD) X2.4=EX/Sr ELF / PAUL ✓> m A��Q R. 1 ap� a°Fc�srce�S�Q��� " EXISTING CONDITIONS SITE PLAN LOT 1, ELLIOT ROAD b. ROGER PAUL MMERYILLEI BARNSTABLE, MA. o MfNo 30 20 Z CIVIL SCALE 1' - 40' OCTOBE9 30, 1989 0 0 HA EAGLE SURYEYIN6 6e/ - u•�•e9 ENGINEERING, INC. 2.0 441 ROUTE 130 Fo�� o MARSH SANDWICH, MA. 02563 DGE OF 2.-5 L, EAH�G PROJECT NUMBER 89-094 8.3 6• .5 41 ±' 1 a� 6 \ N EXISTING SEPTIC SYSTEM 9•r�!F � r t oe. r 4.2 3.8 �- CRANBERR BOG 0 00 Sri Lop o �o. Q4� toOVr O-` - VV `� i INCH - 40 FEET 40 0 40 BO 120 D of ok IN �. Assessor's office(1st Floor): Assessor's map and lot number ?iZ 7 SEPTIC SYSTEM ANUS TWE j0 Board of Health(3rd floor): o INSTALLEDINCor4o Sewage Permit number ® s i BABlSTABLL Engineering Department(3rd floor: EIMRON WAL s `House number 7 TOWN REGULATIO WY.y,eO' Definitive Plan Approved by Planning Board 19 APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN OF i BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO `(�ACl 1 ,C (//190 TYPE OF CONSTRUCTION W/00 d �rct(q I ZZ 19 TO TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a()ermit/according to the following,information: Location 7� �110 t7 2� - ��Qy! �-��/r✓�(`( IMG Proposed Use 'Dec(C Zoning District C' 1 Q-QSfN Feu ( Fire Districts Name of Owner U/((1104 O(A 'l eQfn (,ttt I IMu h Address t6 9 ��. Ceu kQ✓t/c((r m q i Name of Builder GAL IC4Qf J (At 11 Address 31 w(ci T-w-k Q(I c , 04er+/ llf k(,a Name of Architect Address Number of Rooms % Foundation (' C U Exterior / Roofing / Floors j7(U Interior Heating Plumbing Fireplace Approximate Cost Area Diagram of Lot and Building with Dimensions Fee C c � Fuca �(dU 5 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 ©"L 174 1 CREELMAN, WILLIAM & JEAN r 33935 Build Deck No Permit For _ Single family Dwelling I Location 377 Elliott Road Centerville Owner William & Jean Creelman _ f Type of'Construction Frame Y Plot Lot Permit-Granted August. 27, 1 g 90 Date of Inspection 19 Date Completed �6�� ! r 19 M n e I .y y K /V + �n '. k ,g,N .•5 '' / r • .. . } fr'•, ' • , ' . • .. • . . t F� N ' / a� .�,'"` ,iA ' r • • ! - 4: '3 ,.'Y.' <� ( '�:_. 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