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HomeMy WebLinkAbout0121 LONGFELLOW DRIVE ..4, 4,0k. l } y ,I1r i1� of t'r. '3 yA f'*/J ��Oq�TYs ,s .����J JZ. k,t.[h !f ",�iI�IT� ` ''r., / ! * 1 41 `J I f ," t, i p t g r ! , 4. j u 1kf 'z }. f e P f ,f t ra r, .fit "` r >y�Trrr{'.'73' �iru ="elf,.t, 'o:r°r' _n d{ ''d rv<.r 6aa7,« '�fZg;:. r' 4. 6 ir:.- 4, "1. `!i?tv 'ai'.- F ±�M-pe.. rri S�.t ' ('a d s ► riit `E ,.�, >,1 n'J.a. « �, c 7 n.. �� n t. •�t r. '' ,�� ��� v. ., ml ,, t k., yr"?" ^.,: 9 J y + rat., i t ti t tx ,f x ,' .N. a 1< • ,r1 ,' a .,rr ,.:c 4 jtW ; a ; , ,: t� } r i aJ ; &� '} n pp• s •; .'I - ,4 :M .. t - ,t . :, ' r �`s` Y .: , v c ;' �II ZT «1 j. E, : _ I':; R — I{ /, x .. r: t. S .,;7'. , " tj3"['91 i II :, c '{' '`,f: e ., ....: .., : _ . . < x 6 I x -a . .. r . n h , r a; e ;.�. tr s . ' Town of Barnstable Building Post.This GardSo That,it-isVis�bleFrom the Street Ap ,roved,Plans Nlust;be Retained on Joband#his Card Must,be Kept . ° .'nti lF i MAW pal.lns :; ' PW{ e 29 � ` Posted�lJ ,:,... ,= pect,on Has rBeen ade .' £t a a Certificateof Occa i .Re aired rsuch Bwldin shall'Nobe Occu ied until a Final Ins 'ectron.has fieen made er mt Where w pancy s g p p Permit No. B-19-2926 Applicant Name: CAPIZZI HOME IMPROVEMENT INC. Approvals Date Issued: 09/09/2019 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 03/09/2020 Foundation: Location: 121 LONGFELLOW DRIVE,CENTERVILLE Map/Lot 189-111 Zoning District: RD-1 Sheathing: Owner on Record: SYRJALA, FREDERIC J& MARY ELLEN w Contractor Name CAPIZZI HOME IMPROVEMENT Framing: 1. Address: 121 LONGFELLOW DR - § r INC. 2 - .-Contract&License 100740 CENTERVILLE,MA 02632 - �z g Chimney: A st Project Cost: $3,500.00 Description: door Insulation: PermitFee: 35.00 Project Review Req: ZZ Fee Paid: M $35.00 Final: Date 9/9/2019 Plumbing/Gas Ji • � � ��_ � Rough Plumbing: p, uilding Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authonzedj-by this permit is commenced within ssz months after issuance. Rough Gas: All work authorized by this permit shall conform to the approved applicat nand the approved construction documents fog which this permit has been granted. �a s Final Gas: All construction,alterations and changes of use of any building and stucturesshall be in compliance with the local zornng by laws and codes. This permit shall be displayed in a location clearly visible from access street or roadand shall be maintained open forp blic mspection for the entire duration of the work until the completion of the same. ;t Electrical y. Service: The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work: Rough: 1.Foundation or Footing L _<_ _..-� -• "` 2.Sheathing Inspection Final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final: ' .7.Final Inspection before Occupancy Health • Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. 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 Final• All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Application number Fee .............................................................................. SAMSTASM X(kt Lek— Building Inspectors Initials.......A.............................. Date Issued................. ..................... 0 9 Map/Parcel...... .. . ...... ...IJ................................... TOWN OF STABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: L 0 96'F e I 0u) �T�V E; C v; NUMBER STREET VILLAGE Owner's Name: VYC4,trtie. 5711K,IA (A Phone Number r0i Email Address: 141e5,g1*5 c vexi-ioti-IftrCell Phone Number � Project cost$ 3 00. 0,0 Check one Residential Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize See.4TJ'4ctteOL-40714 Ma;7.,+,riotI to make application for a building permit in accordance with 780 CMR Owner Signature: Date: TYPE OF WORK Siding 0 Windows (no headq change)# F1 Insulation/Weatherization Doors(no header change) (I � N oo Commercial Doors require an inspector's review ,4/ EDRoof(not applying more than I layer of shingles) Construction Debris will be going to & eui 13ecro;10 RJ40,r-e 5"4oK/1�dJ,#*cA CONTRACTOR'S INFORMATION Contractor's name To k su -—t 54 V L)fl S Icti C ,a ; ?-'2 k, Po ft-t Home Improvement Contractors Registration(if applicable)# (attach copy) Construction Supervisor's License# 6 5 06YJ-1-) (attach copy) �-eVmf*¢ e c,4piz2iko;4.e- (,-ep.1 Email of Contractor JAC e f— (4 p t'T7 i A OW - I i* Phone number ALL PROPERTIES THAT HAVE STRUCTUkES 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. S. a 8 SCA 1 d5 20f"5117 0916onsumer 41.1�Bus Hess BQU aeon Registration valid for Individual use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: TYPE:Supplement Card Office of Consumer Affairs and Business Regulation RealstretloA A o one burton Place-suite 1301 06f2? 100740 NIA 02108 CAPIZZ.I HOME IMPROVEMENT,INC. JACK STRUNSKI Not Val without signature 1845 NEWTON RD. COTUIT,MA 02635 Undersecretary .... .. . ....o.•.Lv....gr .^F,.IMYv N''. r r .Y. .n..::2ry .. --•wv,.....q Construction Supervisor = Commonwealth of Massachusetts Unrestricted-Buildings of any use group which contain Division of Professional Licensure less than 35,000 cubic feet(991 cubic meters)of enclosed Board of Building Regulations and Standards space- Constr ibrlUogrvlsor CS-064817 E Ores:06/18/20 JOHN T STRUkiSKI 18 ALDEN AVfE BUZZARDS 13RY',IA 02532 Failure to possess a current edition of the Massachusetts Qk State Building Code is cause for revocation of this license. For information about this license .� Page 7 of 7 Capizzi Home Improvement Inc. Specifications and Estimates STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT UWE r�C Sr' , 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 AC ANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING SIGNATURE OF OWNER: �. OWNER'S ADDRESS: OWNER'S TELEPHONE: i LESSEE'S SIGNATURE: LESSEE'S ADDRESS: LESSEE'S TELEPHONE: APLLICANT'S SIGNATURE: APPLICANT'S ADDRESS: 1645 Newtown Rd., Cotuit, MA 02635 APPLICANT'S TELEPHONE: 508-428-9518 RESPONSIBLE OFFICER: RESPONSIBLE OFFICER ADDRESS: RESPONSIBLE OFFICER TELEPHONE: 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 attached on a separate piece of paper. Purpose of Event Ch/Fod event i : for profit non-profit event Ch se ed Yes No Flaet of each tent must be attached.Pr vide a site plan with the location (s) of each tent If ferved at your event please obt n a Health Department approval between the hours of am or 3:30 pm-4:30pnL C mercial events may require Fire Department approval, 77 *WOOD/ OAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from co ustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Z/ Telephone Number XX Cell or Work number I understand my responsibiliti under the rules and regulations for Licensed Construction Supervisor in accordance w' 780 CMR the Massachusetts State Building Code. I understand the construction inspect" procedures,specific inspections and documentation required by 780 CMR and the Town arnstable. Signature Date APPLICANT'S SIGNATURE Signatulitapp��Iications Date 61 All per are subject to a building official's approval prior to issuance. ® DATE(MMIDDIYYYY) A�?D CERTIFICATE OF LIABILITY INSURANCE 12/14/2018 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 PHCONE,N Ext), (508)398-7980 FAX No: E-MAIL mail ro ers ra c ADDRESS: Gc� 9 9 y om 434 ROUTE 134 INSURE S AFFORDING COVERAGE NAIC# SOUTH DENNIS MA 02660 INSURERA: AMGUARD INSURANCE CO 42390 INSURED INSURER B: CAPIZZI HOME IMPROVEMENT INC INSURERC: INSURER D: 1645 NEWTOWN ROAD wsURERE: COTUIT MA 02635 INSURERF: COVERAGES CERTIFICATE NUMBER: 348068 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 IYPEOFINSURANCE ADDLSUB POLICYNUMBER MM/DDPOLICYIYY`Y MM/DD/YYYY LIMITS LTR COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMA CLAIMS-MADE OCCUR PREMISES Ea occurrence $ MED EXP(Any one person) $ N/A PERSONAL BADV INJURY $ POTHER: L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $POLICY PE� LOC PRODUCTS-COMP/OPAGG $ AUTOMOBILE LIABILITY (Ea tleDSINGLELIMIT $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED N/A BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS AUTOS PROPERTY DAMAGE $ Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X TAME ORH AND EMPLOYERS'LIABILITY YIN $ 1,000,000E /EXCUTVE E.L.EACHACC ENTANYPROPRIETOR/PARTN A OFFICERlMEMBERDCCLUDED? NIA WA NIA R2WC921272 12/25/2018 12/25/2019 (Mandatory in NH) E. EMPLOYEE $ 1,000,000 If yes,describe under E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS below N/A DESCRIPTION OF OPERATIONS I LOCATIONS I 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-compensationTiinvestigations/. 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 _ '3wp CP Daniel M.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 1- CAPIHOM-01 DEATON AcoRo� CERTIFICATE OF LIABILITY INSURANCE D 1 211 712 0 1 YY) 12/17/2018 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 have ADDITIONAL INSURED provisions or 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 (A/C,No,Exq):(800)553-1801 (A/C,No):(877)816-2156 South Dennis,MA 02660 aI DRIEss:mail@rogersgray.com INSURERS AFFORDING COVERAGE NAIC# INSURER A:Arbella Protection Insurance Company,Inc. 41360 INSURED INSURER B: Capizzi Home Improvement,Inc. INSURER C Capizzi Enterprises,Inc. 1645 Newtown Road INSURER D: Cotult,MA 02635 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS L IN SD WVD /DD (MM/DDTYYYYl A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 ❑X OCCUR 8500067380 06/08/2018 06/08/2019 DAMAGES(RENTED 500,000 CLAIMS-MADE PRE ES Ea occurrence) $ MED EXP(Any oneperson) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENE RALAGGREGATE $ 2,000,000 POLICY❑X PRa ❑X LOC PRODUCTS-COMP/OPAGG $ 1,000,000 OTHER: $ A AUTOMOBILE LIABILITY CO accliden SINGLE LIMIT $ 1,000,000 (EaANY AUTO 1020064960 02 06/08/2018 06/08/2019 BODILY INJURY Perperson) $ OWNED SCHEDULED AUTOS ONLY Ix AUTOS BODILY INJURY Peracadent $ X AUTOSONLY AUTO-0S ONLY PPeOr acc�dent AMAGE $ Fe $ A X UMBRELLA LIAB X OCCUR - EACH OCCURRENCE $ 21000,000 EXCESS LIAB CLAIMS-MADE 4600067381 06/08/2018 06/08/2019 AGGREGATE $ 2,000,000 DED I X I RETENTION$ 10,000 $ WORKERS COMPENSATION STA PER OTH- AND EMPLOYERS'LIABILITY _ YIN T TE E ANY PROPRIETOR/PARTNER/IXECUTIVE ❑ NIA E.L.EACH ACCIDENT $ FFICE.UMEMBER IXCLUDED7 Mandatory m NH) E.L.DISEASE-EA EMPLOYE If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Additional insured as respects general liability provided when required by written contract. WORK COMP CERTIFICATE TO BE ISSUED DIRECTLY BY THE CARRIER 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 ACORD 25(2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Department of Industrial Accidents Office of Invesdgations 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/In( vidual): 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 bog: Type of project(required): 1. I am a employer with 40 4. 1 am.a general contractor and 1 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 g. Demolition working for me in any capacity. employees and have workers' [No workers'comp.insurance comp.insurance.: 9. Building addition required.] 5. We are a corporation and its 10. Electrical repairs or additions 3. 1 am a homeowner doing all work officers have exercised their 11. Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12 Roof repairs insurance required:]t c. 152, §1(4),and we have no employees.`[No workers' 13: Other�O o�/ 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 hue outside contractors must submit a new affidavit indicating such. (Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and Job site information. Insurance Company Name: AMGUARD INSURANCE COMPANY Polio #or Self-ins. Lic.#:R2WC921272 12/25/2019 Y Expiration Date: Job Site Address /2 / L m,tl A r,e I el City/State/Zip: C e 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 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the 1DIA for insurance coverage verification. I do hereby certify ix the airs and penalties of perjury that the information provided above is true and correct. Signature: Date: G 9 / og Phone#: 508-428-9518 Official use only. Do not write in this area,to be completed by city or town o_,/j`iciai City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.EIectrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#• Engineering-Dept.(3rd floor) Map j Parcel Permit# House# ]Z I Date Issued Beard of Health(3rd floor)`(8:15 -9:30/1:00-4:30) `W$ Lf 7 X* Fee Conservation Office.(4th floor)(8:30- 9:30/1:00-2:00) 4TIS`I'AlsL ® IN ®MPLIA Planning Dept.(1st floor/School Admin. Bldg.) WITH TIT "� E Definitive Plan Approved by Planning Board 19 ENVIRONMENTOWN REG °T TOWN OF BARNSTABLE Building Permit Application Project Street Address_ Village LeA2G�ll Owner �/�("�-� _ Address S Telephone Permit Requester �Q�(,L� � ,�,y rt i ��� r Qom , �Q First Floor square feet Second Floor square feet Construction Type 00&b r q_t__ Estimated Project Cost $ Zoning;District Flood Plain Water Protection Lot Size ,. Grandfathered ❑Yes ❑No Dwelling Type: Single Family ►l Two Family ❑ Multi-Family(#units) Age of Existing Structure �- Historic House ❑Yes ❑No On Old King's Highway ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half: Existing New No. of Bedrooms: Existing New Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No - G4rage: ❑Detached(size) Other Detached Structures: ❑Pool(size) IUAttached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# - Current Use / r Proposed Use W(ND-ow W c"Cre, Builder Information Name.4 �2 - Telephone Number `T 72 s Z 2(9 Address &A-.(,J 57 License# ® 6-7f- MJB Home Improvement Contractor# Worker's Compensation# �¢ �,t.t , 1617 -0-0 --O fl] S�j NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO mika6- 5_ sa�� 1 — - SIGNATURE DATE ` h 7 j 7 BUILDING P MIT NIED FOR THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED , MAP/PARCEL NO. ? f , ADDRESS VILLAGE OWNER f DATE OF INSPECTION: FOUNDATION FRAME INSULATION Y FIREPLACE a. ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL : GAS: 'ROUGH FINAL FINAUBUILDING .DATE CLOSED OUT ASSOCIATION PLAN NO. �TME�n . � The Town of Barnstable • 9aRxsrnEM 9e� " ,0�' Department of Health Safety and Environmental Services '°TEn 59. Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner 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. 4. -3- / Type of Work: ' �� U o-rj , o Est.Cost �� Address of Work: ry La4a� f1_ g� lc-- God A.,�c Owner's Name 4&A i--m-- Date of Permit Application: c� I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under$1,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a per as the agent of the ow r: j 1477 1g bait Contracto Name Registration No. OR Date Owner's Name r Tic• Commonwealth of:1lassac•husetty Department of Industrial Accidents oficeo//nves#9121/ons \_, ':" r 600 11'a.0inrtttn Street Boston. A1uv:v. 02111 Workers' Compensation Insurance Affidavit �1l�nlic•tnt intorntation• _ _ Please PRINT c� G: . - —_ name• �L�2�'�y � -Qit-•Q+n�t Inc•ttion•❑ 1 am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity Yram an entpiover providing workers' compensation for my employees working on this job. couinanv name: LjtNp(Iw address- W1/*_ 7J situ ilVltr�i Rhone#: —/��� 2—T&_�7 insurance co. f lieu# S Cj I am a sole proprietor, general contractor, or homeowner(circle one) and have hired the contractors listed below who have the followin_ workers' compensation polices: comn•tm• nime• atitiress• sin•• Phone#: incur-incr ro nnliev# •i.-' - Yam._- � -Z•::Y'^ i - —� �T^^^c�::��'l4 iT"l�.w�y,'�r �T�..._. ___ •f•ti.-_...i...-._... . �_..__._.... .._ -_.�--....._. _�_L_-•r J�,_�__u,.rw._.rYr:�w!.r.-.J�. __-- all• - - _.�L'.j��Y•-- .Y--_.� comnanv nuns•address: sin•• Phonc#- incur-ince co Polio # .Attach additional sheet if ncccs sat V_ :'._':`"_*_ _ ":_,l. 'CifiiL•���=- ''•-- --s-�=s=__..: �=—_---_.., vaut'•�-�»r:.iw:���:rx: Failure to secure covera>_;c:is required under Section 25A of AIGL 152 can lead to the imposition of criminal penalties ol'a line up to SIS00.00 andiur one years* imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. 1 understand that n cop} of this statement ma% be forwarded to the omcc of investigations of the DIA for coverage verification. 1 do herehv certifi-under the pains an enalties of perjure•that the information provided above is true and correct. Si_naturc '" Date r L2 Print nam s Phone# 2'f/6_,� official use unh• do not write in this area to be completed by city or town oRcial V *'tll N. Jr city or town: permit/license# ruilding Department E C3Liccnsing Huard t 0 check if immediate response is required Selectmen's Office : [311calth Department contact person: phone#: rjOUtcr Ifh IS[il J.O NA) information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law". an e»tpl( ree is defined as every person in the service of another under any contract of hire, express or implied. oral or written. An entpl( rer is defined as an individual, partnership, association, corporation or other legal entity. or ally two or more the foregoing enI- in a joint enterprise, and including the le-al representatives of a deceased employer, or the receiver or trustee of an individual , partnership. association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein. or the occupant of the dwellings house of another who employs persons to do maintenance , construction or repair work on such dwelling, hous or on the '-rounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. VIGIL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant ,who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally, neither the commonwealth nor am of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter ha been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names. address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested. not the Department of Industrial Accidents. Should you have any questions regarding the "law" or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. City or Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Pleas be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. Tile Office of Investigations would like to thank you in advance for;rou cooperation and should you have any questions. please do not hesitate to give us a call. . Tile Department's address. telephone and fax number: The Commonwealth Of Massachusetts r Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,Ma. 02111 fax #: (617) 727-7749 phone #: (617) 7274900 ext. 406, 409 or 375 Assessqk%,map"ancl lot number. .... ........ SEPTIC SYSTEM MUST 8E MISTALLED IN COMPL Toy WITH TITLE 5 Sewage Permit number .......... ........ E5 1 -4 ENTAL C SAW LB Maea LE, Houee number ............... ............................................. V ;P 6 40, 39- TOWN OF BARNSTABLE BUILDING INSPECTOR C-0, 4- LIA APPLICATION FOR PERMIT TO .... ...........Y(,...)c...t.?.........bo.r.......................................................................... .TYPE OF CONSTRUCTION ...........k/c-)0 A................. ...................................................................................... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ............ .......... . A6....0u/............................ ......... ........................................................................ ProposedUse ...........6.,4Jx.0 ...... .......................................................................................... ...................... Zoning District ........................................................................Fire District .N............C.A . ........................................ Name of Owner ....l.a... . AddressU 4 vf ......... Name of Builder 6.aam�..?...... Nameof Architect ................... ..............................................Address ................................................. .................................. Number of Rooms ..........Q�... 104r-I d" ti .... ....................................64T .. ounclation .... ........6.................................................. Exterior .........N.��........... ......................Roofing ....... ........... .. ...... ................................. Floors ........ ........... Interior ..........b . of je,, .. ...... . . ............ ............ 14 Heating ..........Aaf ..:................Plumbing ....... ley.. ........ o Fireplace ........... ...................................................................Approximate. Cost ......... ........................ . ..... Definitive Plan, Approved by Planning Board -----------—--—---------------19--------- Area ....4_.4rf.... ...... ...... Diagram of Lot and Building with Dimensions Fee ..............j ..................... SUBJECT TO APPROVAL OF BOARD OF HEALTH 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 .......... .......................... ....................I............. Construction Supervisor's License ..5p-3 7C)o....................... .......... L Syrjala, Frederic to N9' ... permit for ...... ....................... -A single...family dwelling ........................................... ..... ..... Location ............. ......... . .. ...... -44 . ....... Centerville ................................................................. Owner Frederic.. ....... ............................. ........... Type of Construction .............frame................... ............................................................................... Plot ............................ Lot ............................... -Decmeber 1 86 Permit Granted .......... ........19 Date of Inspection .............. ......19 Date Completed ......................................19 tu 1,Z 4 Assessor's ma and lot number map,and ............... �QF THE Sewage Permit number ................... 1 ................. d +� ( f Z HAUSS ,i TABLE Houi6 number ...............�. .�.........:........'.."' ........3..`'�.......... � f p1 � M xy �-- ro e a � r TOWN OF BARNSTABLE . BUILDING INSPECTOR K 1 a�r1-o,'. .I- ID, APPLICATION FOR PERMIT TO ..........................b................................................................................. 1 TYPE OF CONSTRUCTION .. ..:1:�.a:- TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: �� Q�l�, .......Q , ce.n l z:� I )" k Location ... . .......... ...................:................................. ProposedUse ........... .c?„fix as? ........ :........................................... ............................. ....................... ........ . Zoning District .....Fire District Name of Owner . .!"..........................r�:. ✓Y j oC /c.............................Address ...� .! L n� �(4u/.. :....� .4 n. ✓ lli............ . Name of Builder ?vA �r,�n ?r�Je Jett �j <,0 cl�5gddress ... -.� �.:c wi ly. ............... �?�Z�?C4;s1t.�.. . . .... J Nameof Architect .... %f .....`............................................Address .................................................................................... 1 . :. .... �r.:.......... ,Number of Rooms ...........�:... ......�............ ...r�"`�. oundation .... .) . . ( f Exterior ........kt/�t.'.12 .....��9..�................... Roofing � G�.�i�f �t Floors ;t ......�... ............�'!.tea.......b)lJee-f�yt.a�r......Interior ..........���e.. Od. ........ .......................... Heating ...V1,4r....... S.t?..c c).,tz� ...............Plumbing ........�. f .��.!.a ........ Fireplace ....... ..................................................................Approximate. Cost .........1............. ..............f............ • Definitive Plan Approved by Planning Board -----------_----------------___19--------. Area ... �..` ............ ,+.... ........ Diagram of Lot and Building with Dimensions '_ Fee .............................................. tA SUBJECT TO APPROVAL OF BOARD OF HEALTH ( f 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 . ................................... e 70� Construction Supervisor's License .................................... Y 7 Syrjala, Frederic A=189-111 30234 >•. i add /s* �gleNo .............�... Permit for ............... family dwelling Location 121 Lon gfel VW Drive Centerville ............................................................................... Owner Frederic Syrjala .................................................................. frame Type of Construction .......................................... ................................................................................ Plot ............................ Lot ................................ Permit Granted ....December 1 19 86 PeS.e.mb.e.r... Date of Inspection ....................................19 Date Completed ......................................19 4 V ti P l.a'T: FOR Lo'r 1 '1 Indies,te.)xstibs� o�',=a �ig,c or aeccssory building iiddldons with,daa?ied'.l�aes:---------- -- Sewerage disros#1 (Ces{pool)'® wcU R71° re it) . ......•�..�. :.:�L., l+uttarst - i Al+utlor't Fame lams vi F jtrat�a��:, .:. n. papal U this Is a • " Co.. hTitt ir, othcrr rct. SSdeyard I�pA• HOUSE .. Sidcy.ard "'other r� • a4 . fL .... 3 rL •(hat....: {u s�t2rt) hovsF n, L o fellow �Cl pRopos Auc'itroa am � � �nlOrr»atrbo�' 11 C Mari Nortlo.Point