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Home My WebLink About0116 NOTTINGHAM DRIVE � Z to of z; a fib+. •.s-a; f�Fs ua;�� ,�ara,fir` #x� fit..-� *t s�',.r/ F�,. --— �. .,..1 Yy� . • .,i. t� n� A �:.., -;.x. ,� ��r a�. 4'x6�G S;t* �� nr � },�`i..�t �tk� S t ? 5 TM, of M2 K ' • r i r r,: W.. � v9 x � ?'i, 5 y .x� ! 1 �... '`':s S 1 ' S �' , r r e ,� aws. ' 'k 7 U3. � .,. � er F J1� `a '4 :' j,i �Yt';le 7 a. .. x 'la?�. �,"3 I r �'t er }'3:. a e..x t, s �,�� e 6.t:�.�k '+r •.�•,;, ,;•,;'�: ,,�. A �� a': .1.,j' a r x �i,cst„ 4x ' x� x l +�t lry�C `�� sx � R j, .ry y ��9 _rSt-� 1 ''� ..�7 a 4" x,3 r s ., -. <. � s F;; .'4 `"�6ik,�, �' s n<',�Ax �* _, x rf .:�� r r�'r � r�1'�t:�r .. .t �k r, .r� j ¢Ei '� ,, it �;, r ..°�, 1,=+;� �,�;a5 �' . , �., f �r>ti,< ., �..,, �. o,e t �. cr a' ., " .; •. �. . .. � , .. a - - '� V � .. � _ .. ._ .. y ., � u - .. - - a rt � .. .. ,o - .. z - „ � c ' - .. A F :,- 8 E r a I a � � !. 1 [ C r a. � t _ ,, ;: -y � +t 6 m�... y v .. .> �. .4 m. ,� A a �— � � _ �.; � -- .., ... rn -.r a- �, r" , p V L � r t. �+ a �. u ., �. � .. � , t] . ' . c 9 0 y -`� � ., ' .a' � � -' n e � :.. �' a .,. �� ... . f :.,,. 4 • x s - . = .. .. . �; ..' , �; n ,: - ., .. .. _ � .� _ , .. �. u .. .. .. .. � � , �. � o - ' .c r n,. ., Town of Barnstable . M � .... �. ad _ Building tvsn Post This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept MA Poste&LIntil Final Inspection Has Been Made. p 1 O�i i Where a Certificate`of Occupancy'is Required,such Building shall Not be Occupied until a Final Inspection'has been made. Permit NO. B-19-2307 Applicant Name: JOHN T STRUMSKI Approvals Date Issued: 07/18/2019 Current Use: Structure Permit Type: Building-Alteration INTERIOR Work Only- Expiration Date: 01/18/2020 Foundation: Residential Ma Lot: 172-018 Zoning District: RC Sheathing: Location: .116 NOTTINGHAM DRIVE,CENTERVILLE ^� Contractor Name:�,,.CAPIZZI HOME IMPROVEMENT Framing: 1 Owner on Record: VIOLA,VICTOR J SR,JEAN M&COCCORO, INC. 2 Address: 158 MEADOW LANE _,.Contractor License 100740 Chimney: WEST BARNSTABLE, MA 02668 y Est. Project Cost: $ 16,600.00 � )Description: Legalize The Bedroom that is in the garage. ) 4 Permit Fee: $ 134.66 Insulation: Remove 1 Bedroom in the house by creating a 5ft. cased opening to Fee Paid $ 134.66 Final: 6K- FS�� )q create a study in middle room: ` Upgrade Smoke Detectors. . Date;., 7/18/2019 _ p Plumbing/Gas Project Review Req: Rough Plumbing: i Final Plumbing: Building Official This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. Rough Gas: All work authorized by this permit shall conform to the approved application and the'approved construction documents for which this permit has been granted. i _ Final Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Service: Minimum of Five Call Inspections Required for All Construction Work: N Rough: 1.Foundation or Footing , 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 tsorrower: jean uuuai Property Address:116 Nottingham Drive Case No.: Ci Centerville State: MA Zip: 02632 Lender:Cape Cod Co-Operative Bank ' 7ou� five/east 17P1/i�/ i� tJ jo Co /pf-, re .: 16' ;, G4/A �ei,us ude� A 1JCH cI le. � a UJ.-� A 136MOclAf 12': woodDedc : 12' . (A) bVavglZt- G A 1/A ! e ) Hall I •X 2 e C .3� f� / fa.i2A F Batt Be om Bedroom Batt Ox Bedroom ,43 t �/ y D-h-bg Lining Room a �1pP14'� Kithen 6 oa f i ------- 16' 42' FborPhn N OM Staff t F y SMOKE DETECTORS REVIEWED d . JST E ILDINGDEPT. DATE Approved by: _ � ✓ter oy eg Permit#s_ __ 7236 7 FORE OERARTMENT DATE t 96M WAAMPES ARE REQUIRED FOR PERuirTING ��QR1 �a.bLG''J„C^4'� � • !/ I I� �'ifi� � i i , ,,.,' w = * ; � + V 4 ' ' ' `� �, 1 } .� T � ems' � ' 1 , j. � � s a t �•.� 1 \ 1 . '�� tea. as .. - � �. ..�.� r -.ram_ s , 4 ; � � _- — . - - _ '_ � 1 �_ r y ,, �-^Y `' i • � r � 1�� i �_ '` .1t�='.► �:;�r;T',. .� i �L :.....:. is r � � �E e _ � ',� , .' .. ? � { 's . i p� Application Number.. !.. .J.. ®... ............... 9 KAee. g Permit Fee............................ .....Other Fee: ..................... 1639. ♦0 Total Fee Paid...................: .13: ... .............. ...... TOWN OF.BARNS_A-BLE Permit Approval by..... ;. on...7 �(9....... f3lttjt;, i ' BUILDING PERMIT ) o i l Map........................................Parcel............................................. APPLICATION ` s -I— Section 1 — Owner's Information andTroject Location Project Address_ N o 4 IX kAO-t. y Village C efi+e va/ 1 l e, Owners Name -J lJ i o"l,AN Owners Legal Address City Ld e S-r 13 41z a J TA h i e. State . HA Zip O 2l0 Owners Cell# , 0" 3 q— 3 y '7 E-mail A)1� Section 2 —Use of Structure Use Group ' A ❑ Commercial Structure over 35,000 cubic feet El r Commercial Structure under 35,000 cubic feet Single/Two Family Dwelling Section 3 —Type of Permit ❑ New Construction ,� ❑ Move/Relocate ❑ Accessory Structure ❑ Change of use ❑ Demo/(entire structure) ❑ Finish Basement ❑ Family/Amnesty ❑ Fire Alarm Rebuild ❑ Deck Apartment ❑ Sprinkler System ❑ dition ❑ Retaining wall ❑ Solar Renovation ❑ Pool ❑ Insulation Other—Specify Section 4 - Work Description -el-Cv v,e- oud� C��a�-rN .4 Last undated: 11/15/201 S Application Number.................................................... Section 5—Detail Cost of Proposed Construction 14 1 6 D v ' Square Footage of Project Age of Structure 2 Dig Safe Number # Of Bedrooms Existing ''% Total#Of Bedrooms (proposed) 3 110 MPH Wind Zone Compliance Method ❑ MA Checklist ❑ WFCM Checklist ❑ Design Section 6—Project Specifics Wiring ❑ . Oil Tank Storage Smoke Detectors ❑ Plumbing ❑ Gas ❑ Fire Suppression ❑ Heating System ❑ Masonry Chimney ❑ Add/relocate bedroom Water Supply Public ❑ Private Sewage Disposal ❑ Municipal &On Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: N-eui, a-e p re-lb ?alp I re., I am using a crane ❑ Yes ❑ No �j Section 7—Flood Zone Flood Zone Designation X Within or adjacent to a wetland, coastal bank? Yes ❑ No V Section 8—Zoning Information Zoning District Proposed Use 5"' /J FAx i/y Lot Area Sq. Ft. Total Frontage Percentage of Lot Coverage # of Dwelling Units(on site) Setbacks Front Yard Required Proposed VIA ` Rear Yard" Required Proposed' Side Yard Required Proposed Has this property had relief from the Zoning Board in the past? ❑ Yes l No I Last updated: 11/15/2018 Page 7 of 7 Capizzi Home Improvement Inc. Specifications and Estimates STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT V 1�TO,4 R/L I/WE, V i oL.A FR1n11 7Xt6 OWN THE PROPERTY LOCATED AT /40 l)O-eir]7 44,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. P ` GIVE MY PERMISSION TO a eve s J I GI �s�' o� .Ham LESSEE TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. SIGNATURE OF OWNER: TA A,,,, OWNER'S ADDRESS: 023 !�'ei�'�i Vqt� p�./ W BI /V 5 C P ��°b OWNER'S TELEPHONE: g 3 y -3 V-7 w 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: SCA 1 db 20N1-05117 r�tp tittitt-itu�a��(��'[lfxiJttt� aiijition��onsumer Afla�rs Bus Hess ee Registration valid for individual use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:TYPE:Supplement Card Office of Consumer Affalrs and Business Regulation RegiSAR4011 ®E�020 Ona Burton Plate-Suite 1301 100740 MA 02108 CAPIZZI HOME IMPROVEMENT,INC. JACK STRUNSKI ` 1645 NEWTON RD. Mot val Without Signature COTUIT,MA 026M Undersecretary Construction Supervisor - Commonwealth of Massachusetts Unrestricted-Buildings of any use group which contain OF Division of Professional Licensure less than 35,000 cubic feet(991 cubic meters)of enclosed Board of Building Regulations and Standards space. ConstrAjs*6A 009rvisor CS-064817 , r E�Aires:06/18/20 JOHN T STRUMSKI t 18 ALDEN AVE a _ BUZZARDS BAYaMA 02532 ` Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For information about this license r►.� , Ak The Commonwealth of Massachusetts Department of fndustri"al Accidents fi `'- Office Of'Invesfigadons 600 Washington Street s Al Boston,MA 02111 - www.mas&.govAfla Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le¢ibly Name(Business/Organization/lndividuai): CAPIZZI HOME IMPROVEMENT Address: 1645 NEWTOINN'ROAD - City/State/Zip: COTUIT MA02635 Phone#: 508-428-9518 Are you an employer?Check the appropriate box: Type of project(required): 1. ✓ I am a employer with 40+ 4. I am a general contractor and I 6. traction employees(full and/or part-time).* have hired the sub-contractors 2. I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have g. Demolition working for me in any capacity. employees and have workers' 9. Building addition [No workers'comp.insurance comp '��' required.] 5. We are a corporation and its 10. Electrical repairs or additions 3. I am a homeowner doing all work officers have exercised their 11. Plumbing repairs or.additions myself.[No workers'comp. right of exemption per MGL 12. Roof repairs insurance require( ]-t s c. 152,§1(4),and we have no employees.[No workers' 13.✓ Other_- a__ Te coup.insurance required.] — *Any applicam that cheer box#]must also frill out the section below showing their worlters'coa4xnsation policy.information- t Homeowners who submit this affidavit indicating they are doing all wok and then hire outside contractors must submit a new affidavit indicating such. :Contractor that check this box must attached an additional shed showing the name of the sub contractors and state whether or not those entities have employees-if the sub-contractors have employees,they mast piuvide their wakens'conip.polity number.. I con an employer that is providing workers'compensat ion insurance for my employees. Below is the poftcy and job site information. Insurance Company Name: AMGUARD INSURANCE COMPANY Policy#or Self-ins.Lic.# R2 `l �"' Expiration Date: 12/25/2019 Job Site Address: 11 (0 N 0 44 i M6 VAN City/State/Zip: �.PjU-!p✓✓�/l.6 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requited under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 aid/or one-year imprisonment,as well as civil penalties in the form of a STOP STORK ORDER and a fine of up to S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the f9r insurance coverage verification. I do hereby the Pains andPenaLdes ofperjwy dw the mformadon provided above a vue and correct; S Date_ G 7 �P Phone#: 50&64"2 Official use only. Do not write in this area,to be completed by city or town ojficiaL City or Town: Permit/License# Issuing Authority(cirrcle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other , Contact Person: Phone#: �-1 CAPIHOM-01 DEATON ACOROA CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 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 CONTA A E:CT Rogers&Gray Insurance Agency,Inc. PHONE,Ext):(800)553-1801 a/c 434 Rte 134 ,No):(877)816-2156 -EM South Dennis,MA 02660 ADORAILEss:mail@rogersgray.com INSURERS AFFORDING COVERAGE NAIC# INSURER A:Arbella Protection Insurance Company,Inc. 41360 INSURED INSURER B: Capizzi Home Improvement,Inc. INSURERC: Capizzi Enterprises,Inc. 1645 Newtown Road INSURER D: Cotuit,MA 02635 INSURERE: 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE IN SD WVD POLICY NUMBER /DD/YYYY)- fMM/DDfYYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE �X OCCUR 8500067380 06/08/2018 06/08/2019 DAMAGE TO RENTED 500,000 PR MIS Ea occurrence) $ MED EXP(Any oneperson) $ 5,000 PERSONALBADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: ' GENERAL AGGREGATE $ 2,000,000 POUCY❑X YEa ❑X LOC PRODUCTS-COMP/OP AGG $ 1,000,000 OTHER: $ A AUTOMOBILE LIABILITY COMBI aEeD SINGLE LIMIT $ 1,000,000 (Ea accANY AUTO 1020064960 02 06/08/2018 06/08/2019 BODILY INJURY Perperson) $ OWNED SCHEDULED AUTOS ONLY Ix AUfOSS . BOODILY INJURY Peracddent $ X AIURTOS ONLY AlO1TNOS ONLY PerOacEcid AMAGE $ A X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 2,000,000 EXCESS LIAB CLAIMS-MADE 4600067381 06/08/2018 06/08/2019 AGGREGATE $ 2,000,000 DED I X I RETENTION$ 10,000 $ WORKERS COMPENSATION PTR OTH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIEfOR/PARTNER/EXECUTIVE ❑ NIA A an d ato in NH E.L.EACH ACCIDENT $ OFFICERlMEMBE�EXCLUDED? E.L.DISEASE-EA EMPLOYE $ 1IMM If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/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 Stratford Pools Condominium THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. American Properties Team 500 West Cummings Park Suite6050 AUTHORIZED"'./REPRESENTATIVE Woburn,MA 01801 ACORD 25(2016/03) @ 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACORO® DATE(MM/DDIYYYY) 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 PHO No . (508 398-7980 A/C 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 NEWTOWN ROAD INSURERE: COTUIT MA 02635 INSURER F: 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 ADDLSUBR POLICY EFF POLICY EXP LIMITS LTR TYPEOFINSURANCE' POLICY NUMBER MMIDDIYYYY MMIDD/YYYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE To CLAIMS-MADE DOCCUR PREMISES ETED a occurrence) $ MED EXP(Any oneperson) $ N/A PERSONAL&ADV INJURY $ GEN'LAGGREGATELIMITAPPLIESPER: GENERALAGGREGATE $ POLICY❑PRO ❑LOC PRODUCTS-COMP/OP AGG $ JECT 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 NON-OWNED PROPERTY OPERTY DAMAGE $ HIREDAUTOS AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE N/A AGGREGATE $ DED I I RETENTION$ PER $ WORKERS COMPENSATION X STATUTE OERH AND EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBEREXCLUDED? NIA WA NIA R2WC921272 12/25/2018 12/25/2019 (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 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.govllwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION II 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 02601-0000 Daniel M.C;oey,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 Application Number........................................... Section 9- Construction Supervisor o � �� 0:2 Name -5'o 6i T• Telephone Number 5W 6 '1? c%9 Y 9 Address i G 'l'r N-Ru14owu 'Ru City Cr-tu►'r State M A Zip 0 2-4 3" License Number ' 64`L�'1 License Type U Expiration Date 640 116 /7" a Contractors Email-e r M i4 e CA q, Zz.a h owe. . <or-1 Cell.# 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 requir d by 780 CMR and the Toyvn of Barnstable.Attach a copy of your license. Signature Date 0 -7 Na 12o/q Section 10—Home Improvement Contractor —je I( Name_ C R Pt 22a 14 o i-t t TH?veve M tWr, Telephone Number 5 4 6.26 S Address 1 0eUA,ow,, J$ City ca-1 use f State /�-4 Zip 024 5r Registration Number i 0 0 7."t u Expiration Date 61 t l 2 I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 CMR the Mass husetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation e�' ed J�0 CMR and the Town of Barnstable.Attach a copy of your H.I.C... Si Date e tor ( / ® (a lid 1 c gna Section 11 —Home Owners License Exemption . Home Owners Name: Telephone Number Cell or Work Number I understand my responsibilities un r the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State B ding Code. I understand the construction inspection procedures,specific inspections and documentation required by 7 CMR and the Town of Barnstable. ` Signature Date APPLICANT SIGNATURE Signature Date �� l� / 1% C' a Z2' u o M-e— Z roc p vo✓e W-vA)�'-ry Print Name 140J _T M J Telephone Number E-mail permit to: T 'e 'm14 C CAT; Z2' Ame. �oim Last updated: 11/15/2018 Section 12 —Department Sign-Offs Health Department ❑ Zoning Board(if required) ❑ Historic District ❑ Site Plan Review(if required) ❑ Fire Department ❑ Conservation ❑ For commercial work,please take your plans directly to the fire department for approval Section.13— Owner's Authorization I � I, S 2 Z A AAC-6d, , as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of job) Signature of Owner _ date Print Name �f 1 f r" + 1 1 Last updated: 11/15/2018 Town of Barnstable %Permit# °�Y�Teti Lcph es 6 rig fr m issu to Regulatory Services Fee O • _ t - - 1ARNSTaBLE, ' y arnss. Thomas F. Geiler,Director C5 417/�� [ s639. �e J ATED►.1P"1� Building Division Tom Perry, CBO,'Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us. Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY ]Vot valid without Red X-Press lmprinl Map/parcel Number 2 �( Property Address 1p � Tn` L -7 f �� lYlinimum fee of$25.00 for work under$6000.00 residential Value of Work r Owner's Name&Address1 L � �(�/ umber 76 F C 1L Contractor's Name etr (j/U � � W Telephone N �� Home Improvement Contractor License# (if applicable) rp ' Construction Supervisor's License# (if applicable) / l d orkman's Compensation Insurance �� PERMIT. ❑W ensation Ins P Check one: JUN 0 .7 2-010 ❑ I am a sole proprietor ❑ I am the Homeowner g 'OWN OF BARNSTABLE r!have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance'Certificate must accompany each permit. Permit Request(check box) n [/Re-roof(stripping old shingles) All'construction debris will be taken to_/3&4L ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side Y # of doors. maximum .44 # of windows Replacement Windows/doors/sliders.U-Value. ( ) _ t *Where required: Issuance ofthis permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. *-""Note: Property Oviner must sign Property Owner Letter of Permission. A copy'ofthe Home Improvement.Contractors'License &'Constr`uction Supervisors License is req SIGNATURE: �elL The Cotntnonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ,! . 600 YYashington Street Boston, MA 02111 Mvw.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name (Business/Organi-zation/Individual): Address: �G/lam �l2cQ City/State/Zip: Aea1A_,e Phone#: b 7Z(z, Are you.an employer? Check the appropriate box:. Type of project(required). 1.RjX am a employer with 4•:❑ 1 am a general contractor and 1 6 ❑New construction employees (full and/or part-time).* Y have hired the sub-contractors 7. ❑Remodeling 2.❑ I am a sole proprietor or partner- listed on the attached sheet. . ship and have no employees These sub-contractors have g• ❑ Demolition working for me in any capacity. employees and have workers' 9 El Building;addition [No workers' comp. insurance. comp. insurance.$ at required.] 5: ❑ We are a corporion and its 10.0 Electrical repairs or.additions- .- 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions right of exemption per MGL 12. .__Roof.repairs '... . . ...-.-._.myself,..[No workets°.Gowpa. -' ❑ aired. t C. 152, §1(4),and we have no insurance required.]] employees. [No workers' 13.❑ 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. $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. h am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: �Y t Policy#or Self-ins. Lic.#: Expiration Date: / Job Site Address: dU 4,4t �. City/State/Lip: 16e r�— 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. 1'do hereby certi it r the p ;;am enalties ofperjury that the information provided above is true and correct. aGfiZ( c�` Date: f l7 Signature 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.ElectricaLTnspector 5. Plumbing Inspector information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for.their employees. Pursuant to this statute,an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise,and including the,legal 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 dwelling house of another who employs persons to do maintenance, construction or repair.work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to bean employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renetival 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,NIGL chapter 152, §25C(7)states "Neither the commonwealth nor any 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 have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s)name(s), address(es)and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP)with no employees other than the members or partners,are not required to carry workers compensation insurance.' If an L]JC or LIP does have employees, a policy is required. Be advised that this affidavit 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. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials 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. Please be sure to fill in the permitllicens.e number which will be used as a reference nuunber. In addition, an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and tinder"Job Site Address"the applicant should write "all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may'be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number; The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax 4 617-727-77.49 Revised 4-24-07 ,;,,,,,,,Mace arnr/rlia '22/2010 09: 05 5084204474 PALUMBO INS COTUIT PAGE 01 � Rr' CERTIFICATE OF LIABILITY INSURANCE 4/21/2 0Y' PRODUCER (506)428-1943 FAX: (508)420-4474 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION William Palumbo Insurance Agency, Inc... ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS.CERTIFICATE DOES NOT AMEND, EXTEND OR 4527 Falmouth Road ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Cotuit MA 02635 I INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER AI Travelera 39357 RLT CONSTRUCTION INC, INSURERS:Guard Insurance Co 31 MANNI CIRCLE .._.... _. _....-------_..___.___._._........... ._..---•--•--... . . . .._ INSURER C: INSURER D; CENTERVILLE MA 02632 INSURERE: 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 OFSUCH POLICIES,AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR ADD T POLICY EFFECTIVE POLICY EXPIRATION GF INSUJ�ANCE I POLICY NUMBER DAT5 WMIDDIYYYYt I OATE.IMM/DD/YYYY1 LIMITS OENERALUABILITY EACH OCCURRENCE S 1,0 , -15AMAGE TO RENTED...----------._—_..._.._._00 000 X1COMMERCIAL GENERAL LIABILITY PREMISES(Eeo�currence)_ S —_—,,300,000 —i— -- A l .—,CLAIMSMADE LXI OCCUR'680847GN705 ' 6/1/2009 8/1/2010 MEDEXP(Anyoneperson); -,•� 5,000 — --- ---- -- --- -_I __----------- -- PERSONAL&ADV INJURY S. _ _------ -- _ 7 1 GENERAL AGGREGATE S. ,_ 2�000,000 GEN'LAGGREGATELIMffAPPLIESPER 'PRODUCTS-COMP/OP AGO $ 2.,..000,000 X POLICY PRO- LOC F ----— — JrCI AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ,a ANY AUTO (Ea eccldenq _ -- ALL OWNED AUTOS BODILY INJURY S . SCHEDULED AUTOS (Par parson) I --------------------..... . .--- -_HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Par accldanl) $ i ---- ---- I PROPERTY DAMAGE (Per $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT —SS , ANY AUTO OTHER THAN EA ACC $•,-,_.— -- AUTO ONLY: AGO S hEXCESS I UMBRELLA LIABILITY - EACH OCCURRENCE S OCCUR I CLAIMS MADE AGGREGATE S — DEDUCTIBLE 3 RETENTION 3 S B WORKERS COMPENSATION WC STATU- IOTH- AND EMPLOYERS'LIABILITY TORY LIMITS . ..J—EFL ANY PROPRIETORlPARTNERIEXECUTIVE YIN E.L.EACHACCIDENT 500,000 OFFICERIMEMBER EXCLUDED? '"— (MandawrylnNH) RLWC019737,, 12/24/2009 12/24/2010 P,L.DISEASE=EA EMPLOYEE $ Boo,000. Il'yea,descrbe under SPECIAL PROVISIONS Deldw E.L.DISEASE=POLICY LIMIT S 500,000 OTHER - _ j DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENt I SPECIAL PROVISIONS Job: 100 Eatery Avenue, Hya=i.s NA 02601 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Town of Barnstable k. DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 1 O DAYS WRITTEN 367 Main Street' Hyannis, MA 02260]. NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL ' IMPOSE NO 06LIGAMON OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR ' REPRESENTATIVES. _ AUTHORIZED REPRESENTATIVE j.LaRocca, 8r/SROCER ACORD 25(2009I01) Cd 1988-2009 ACORD CORPORATION. All rights reserved. INS025(zaceoi) The ACORD name and logo are registered marks of ACORD _ r Island Sidirr� and Wpof ng a division of RLT Construction, Inc. 3196nni Circfe Centerville, W.A 02632 Vic Viola May 5, 2010 116 Nottingham Dr. Centerville, Ma. We are pleased to submit the following specifications and estimates for reroofing. Remove existing 2 layers.of asphalt shingles. Install aluminum drip edge and.pipe flashings. Install 3ft. ice shield to eaves and interwoven with step flashings. Install 151b. paper to remaining roof. Install 30yr. Certainteed Landmark Woodscape architectural grade shingles. S 44e- A-P Install ridge vent to all ridges. Clean up and haul away all debris to landfill. We hereby propose to furnish material and labor- complete in accordance with the above specification, for the sum of: $7,900.00 " Reside over existing T-1-11 with Grade A R&RPre-stained white cedar.$6,500.00 Bleaching oil treated Grade A R&R white cedar or Vinyl siding $5,000.00. Time and materials for carpentry regarding rot repair and trim work @$40.00 per hr. Terms: No deposit required. Payment in full is due upon completion. All material is guaranteed to be as specified.'All work to be completed in a.workmanlike manner according to standard practices. Any alterations or deviations from the above specifications involving extra costs will be executed only upon written orders,and will become an extra charge over and above the estimate. All agreements contingent upon strikes,accidents;or delays beyond our control. Owners to carry fire,wind damage and other necessary Wsurance..RLT Construction, Inc.carries General Liability and Workman's Compensation Insurance. Certificates 60h' surance provided upon request. ACCEPTANCE Of PROPOSAL: The above prices, specifications and conditions are satisfactory and hereby accepted. You are authorized to do the k as specified. Payment will be made as outlined above. Date of Acceptance: _ " i Signature Starf Date: Signature Telephone 508.420.5243 and,508.776.8914 (Facsimile 508.420.1776 i t • �. �- Vl tssu�hu �ttti-'�3�'partnjcnt of Puiilic.Sactj Board:of Buildin- Re-ulations and St:ind;ai•tli Construction Supervisor Specialty License License: CS SL 99910 - Restricted to: RF,WS ,t R-ONNIE TAYLOR 31 MANNI CIRCLE UNTERVILLE, MA 02632 Exp ation: 10/26/2011 C"onnni si ri��r Tr#: 99940 . Z/I09IzwtoI7towza g1,-,4K2d6QC1wieZ t41, Office of Consumer Affairs&Business Regulation I HOME IMPROVEMENT CONTRACTOR Registration I 134286 { Expiration 10/22/201I Tr# 293257 # Types; Individual , ;'; i �RLT CONST.INC DBA s-"ISID SIDING&ROOFIN *s' RONNIE TAYLOR ` _-" 31 MANNI CIRCLE ' CENTERVILLE, MA02362 Undersecretary 4 _ } 1►d ford►v►dul use only w isfration 1{{qund return to ,,' or reg date. ulat►on I,►cense_ ex iratton. Business R g e before'. timer A{{air and m g »; '.� Office of-cons Suite 5170, laza 10yirk? . $ E+ N1 6 1 021 >: $o&torsi n 'g I + A9 n t a l „ ture itl► na l►d�; Notv out t +