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0119 TERN LANE
, • � 3 e� , e .. r a r ° a e � R ° e . Town of Barnstable BuRdin �nros-ran .� Post'TFiis Card So, al.it is Visible From the$treef-Approved Plans,Must be Retained ori,Job and this,Card Must be Kept- a-_ &r Posted Until Final Inspection Has Been Made.39. V ° Where a Certifi cate of O ccupancy is Required,such Building§hall Not be Occupied until a Final Inspection has been made,, Permit Permit No. B-20-1749 Applicant Name: William Callahan Approvals Date Issued: 07/16/2020 Current Use: Structure Permit Type: Building-Insulation-Residential Expiration Date: 01/16/2021 Foundation: Location: 119 TERN LANE,CENTERVILLE Map/Lot: 212-020 Zoning District: RD-1 Sheathing: Owner on Record: WILLIAMS,MATTHEW LEE& DANIELLE Contractor Nam Framing: 1 Contractor License: , Address: 19 ASSABET HILL CIRCLE 2 NORTHBOROUGH, MA 01532 'Est. Project Cost: $9,300.00 Chimney: Description: attic insulation Permit Fee: $97.43 Insulation: Fee Paid: $97.43 Project Review Req: - Date: 7/16/2020 Final: Plumbing/Gas Rough Plumbing: i Building Official - -- Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six:months afteekiissuance. A.All work authorized by this permit shall conform to the approved applicacttion.and the approved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and st Iuuresshall be in compliance with the local zo;ing by-laws a`nd codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspectiorj for the entire duration of the Final Gas: . work until the completion of the same. The Certificate of Occupancy will not be issued until all applicable si natures b the Building and Fire Officials are rovided on this Electrical P Y PP g Y g P permit. Minimum of Five Call Inspections Required for All Construction Work: Service: 1.Foundation or Footing 2.Sheathing Inspection "' x Rough: 3.All Fireplaces must be inspected at the throat level before fir est flue lining is installed""_ 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Final: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Rough: 7.Final Inspection before Occupancy Low Voltage Final: 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. Health "Persons•contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: � >• Town of Barnstable *Permit# s ° Expires 6 months fr issue date Regulatory Services Feet. wtvs�rAetE ®� �0�' Thomas F.Geiler,Director s UAA'I A Building Division fSS PERP41T APB 0 9.1�15 Tom Perry,CBO, Building Commissiono WN er T 200 Main Street,Hyannis,MA 02601 OF gq R n' TAB www.town.barnstable.ma us NSTABLE Office: 508-862-4038 Fax:508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY 1 Not Valid without Red X-Press Imprint Map/parcel Number Property Address �- �� � ��(l� V. Fv Ilse 4f d� 6 p [Residential . Value of Work® ^-� Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address _j ©u A_.- AIVAJ Atj L {'11 rf Contractor's Name Jtlhxj' f jj LM s Telephone Number Home Improvement Contractor License#(if applicable) / Construction Supervisor's License#(if applicable) e S o 4 e-%f ❑Workman's Compensation Insurance • Check one: ❑ I am a sole proprietor' " h am the Homeowner 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) ❑ 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 roofl ❑ Re-side vi-1 ' #of doors Replacement Windows/doors/sliders.U-Value o .3 a (maximum'.35)#of windows . *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. copy of the Home provement tractors License&Construction Supervisors License is equ' SIGNATURE: C:\Users\decollik A ocaMcrosoftWindowsUemporary Internet Fies\ContentOutlook\DDV87AAZ\ENPRESS.doc eised 072110 - Page 7 of 7 Capizzi Home Improvement Inc. Specifications and Estimates STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT I,Jo 14tv 4 U✓ , OWN THE PROPERTY LOCATED AT IN L` ,MASSACHUSETTS. I HAVE AUTHORIZED CAPIZZI HOME IMPROVEMENT TO ACT AS MY AGENT TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR,THE MASSACHUSETTS STATE BUILDING CODE. I GIVE MY PERMISSION TO LESSEE TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. SIGNATURE OF OWNER: OWNER'S ADDRESS: OWNER'S TELEPHONE: LESSEE'S SIGNATURE: LESSEE'S ADDRESS: LESSEE'S TELEPHONE: APLLICANT'S SIGNATURE: APPLICANT'S ADDRESS: 1645 Newtown Rd.,Cotuit,MA 02635 APPLICANT'S TELEPHONE: 508-428-9518 RESPONSIBLE OFFICER: RESPONSIBLE OFFICER ADDRESS: RESPONSIBLE OFFICER TELEPHONE: The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations I Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): CAPIZZI HOME IMPROVEMENT,INC. Address:1645 NEWTOWN ROAD City/State/Zip:{COTUIT, MA 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 employees full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner= 6. ❑New.construction ( ) 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.insurance. required.] 5. ❑ We are a corporation and its ME]Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I LEJ 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.[90ther comp.insurance required.] 0 so *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. (Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:AmGuard Insurance.Company Policy#or Self-ins.Lie.#:R2WC527200 Expiration Date:12/30/2015 Job Site Address: 1 g ���4 L N city/State/Zip: to—e K f 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 penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cer ' under the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: Phone#: 50 -428-951 Official use only. Do not write in this area,to be completed by city or town official. J City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: , V/re�(inrrarrea�rruerclf�a�VGZcrJJccelcUe - --- -ffice of Consumer tAffairs i Business Regulation License or registration valid for individu.I use oiily ME IMPROVEMENT CONTRACTOR before the.expiration date. If found return-to:' Office of Consumer Affairs and Business Regulation egistration: 1.00740 Type: 10 Park Plaza-Suite 5170 _. xp 'ME !ration: 6/23/2016 -Supplement Card Boston,MA 02ii6 CAPIZZI HOME IMPROVEMENT,INC. �� • JOHN STRUMSKI .� 1645 Newton Rd. Cotuit, MA 02635 Undersecretary. .:.1?1ot valid without signature e II ; I , i ° sassacfiusetts -Department of Public Safety Board of Building Regulations and Standards Construc tion Supervisol- _. _ License: C"64817 " J01W T. } r tYJ - IS AMEN ACC Buzzards Bay.R99 02 32� p ✓.�>�J Ex iration. . Commissioner : 0611812016 I .. i • 311.12.2014 16:49:00 Guard Insurance Guard insurance Group 1/1 ACORL7® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDOlYYYY) 12 30 2014 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 WANED,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 CONTACI NAME: ROGERS&GRAY INSURANCE AGENCY,INC. PHONE FAX AIC No Ext: AIC No): 1 434 Route 134 E-MAIL ADDRESS: INSURER S)AFFORDING COVERAGE NAIL N South Dennis MA 02660 INSURER A: AmGUARD Insurance Company INSURED INSURER B: CAPIZZI HOME IMPROVEMENT INC INSURER C: 1645 NEWTOWN ROAD INSURERD: INSURER E: COTUIT MA 02635 1 INSURERF: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ADDINTR TYPE OF INSURANCE L SURR POLICY EFF POLICY EXP INSR WVD POLICY NUMBER MMIDDlYYYY MMIOD LIMBS GENERAL LIABILITY - EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE O REN ED PREMISES Ea occurrence -$ CLAIMS-MADE F—IOCCUR HIED EXP(Airy one person) $ PERSONAL B.ADV INJURY $ GENERAL AGGREGATE $ GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PECTRO- LOC $ J AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY(Per person) $ ALL O'•NNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS .AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ .AUTOS Per ecddentl UMBRELLALIA11 HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPNSATION A AND MPLO ERSELIABILITY YIN R2WC527200 - 12/25/2014 12/25/2015 X, TNRV L M T ...i DTH- ER ANY PROPRIETORlPARTNERIEXECUTIVE E.L.EACH.ACCIDENT S 1,000,000 OFFICERIMEMBER EXCLUDED? FN� NIA - (MandatoryinNH) E,L.DISEASE-EA EMPLOYEE S 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS bel-, E.L.DISEASE-POLICY LIMIT S 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Thomas Capizzi Ir is covered by the workers'compensation policy. 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. AUTHOR12ED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD I . zh7hi - Town of Barnstable *Permit# 1 Expires 6 months from issue date y7 Regulatory Services Fee �5 * snxtasenat.E, » 9 , ,� Richard V.Scali,Director ��fD MAC a Building Division Pt Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 F�t� ��16 www.town.barnstable.ma.us Office: 508-862-4038 'r®w1v Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIA � S Not Valid without Red X-Press Imprint �� Map/parcel Number �l�' G'�-� Prop Address Residential Value of Work$ '1L d ' Minimum fee of$35.00 for work under$6000.00 Owners Name&Address li 012 L C�,e.a 4-P v v/`11-d 0 Z &3 z_-.� Contractor's Name J o ho S+Y'U M S Ki Telephone Number 5d 01-' 6 � 15 V Home Improvement Contractor License#(if applicable) Email: 'e CL ln, 4- CA y J 2.21 h eyn,-, c+a� 7Workman's ction Supervisor's License#(if applicable) C 5 0 . Y�1f Compensation Insurance Check one: ❑ I am a sole proprietor ❑ m the Homeowner EVI have Worker's Compensation Insurance Insurance Company Name 6 L)A R v '::�L NJ U i(A N t Co Workman's Comp.Policy# ;j Lo G 51 a 7 Z 00 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 cd-t�� �/126t1Ct1'�N C szc�tQ�rJ J a J?0,4ee 40 z- //Z d gi.%nvA t 0 it PA ❑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: ❑ 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. o License&Construction Supervisors License is r uir SIGNATURE: - C:\Users\Decollik\A Da ocal\Microso8\Windows\Temporary Internet Files\Content.Outlook\2PIOlDHR\EXPRESS.doc Revised 040215 -J Page 7 of 7 Capizzi Home Improvement Inc. Specifications and Estimates STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FORA BUILDING PERMIT . I/WE, s its ANN AYI-M.q , OWN THE PROPERTY LOCATED AT 4vv IN MASSACHUSETTS. I HAVE AUTHORIZED CAPIZZI HOME IMPROVEMENT TO ACT AS MY AGENT TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. I GIVE MY PERMISSION TO LESSEE TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. SIGNATURE OF OWNER: OWNER'S ADDRESS: OWNER'S TELEPHONE: LESSEE'S SIGNATURE: LESSEE'S ADDRESS: LESSEE'S TELEPHONE: APLLICANT'S SIGNATURE: V APPLICANT'S ADDRESS: 1645 Newtown Rd., Cotuit, MA 02635 APPLICANT'S TELEPHONE: 508-428-9518 RESPONSIBLE OFFICER: RESPONSIBLE OFFICER ADDRESS: RESPONSIBLE OFFICER TELEPHONE: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www massgov/dia ANorkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERNHTTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/organization/Individual)-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 boa: Type of project(required): 1.0 I am a employer with 4 o employees(full and/or part-time).* 7. ❑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.] IM I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. El Demolition 10❑Building addition 4_❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole I L❑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.F!3�00f repairs. These sub-contractors have employees and have workers'comp.insurance.: 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.[:1 Other 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. $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 isprovidingworkers'compensation insurance for my employees. Below is thepolicy andjob site information. Insurance Company Name:AmGUARD INSURANCE COMPANY Policy#or Self-ins.Lic.#:R2WC527200 Expiration Date:12/25/2016 Job Site Address: i fie. �1 C Irev City/State/Zip: yl"r'e✓O`112 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 copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verifi 'on. I do hereby c fy under the d penalties of perjury that the information provided abov is true and correct. oy�r/r� Si tore: Date: Phone#:5087428-9518 Of vial 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#: Aco CERTIFICATE OF LIABILITY INSURANCE DATE(MM,DD"YYY) 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 endorsement(s). PRODUCER CONTACT - NAME: ROGERS&GRAY INSURANCE AGENCY, INC. PHONE FAX C o AIC No): 434 Route 134 E-MAIL _. _. .. ADDRESS: INSURERS AFFORDING COVERAGE NAIC# South Dennis MA 02660 INSURERA: AmGUARD Insurance Company 2390 INSURED INSURER B CAPIZZI HOME IMPROVEMENT INC,: wsuRERc: 1645 NEWTOWN ROAD INSURERD: INSURER E: - COTUIT MA 02635 INSURERF: COVERAGES CERTIFICATE"NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED:NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED_ HEREIN IS SUBJECT TO.ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR: POLICY EFF POLICY'EXP - LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER - MM/DD/YYYY MM/DDIYYYY - LIMITS GENERAL LIABILITY - - - EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY -" - - -" ... ... .: .DAMAGE TO RENTED _ - PREMISES(Ea occurrence $ CLAIMS-MADE OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ .. PRO- .. .. POLICY T LOC $ AUTOMOBILE LIABILITY - "" ... ... COMBINED SINGLE LIMIT. .. Ea accident ANY AUTO" BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS " BODILY INJURY(Per accident) $ '. .. NON-OWNED . ." PROPERTY DAMAGE $ HIRED AUTOS AUTOS .. Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB: .. HCLAIMS-MADE ." - .. AGGREGATE. .$. ..- DED. RETENTION$ - $ WORKERS:COMPENSATION - - - """ ": WCSTATU- OTH- A AND.EMPLOYERS'uABILITYY:/.N R2WC655250 :: ._ 12/25/2015 12j25%2016 XIQE ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N/A - - " (Mandatory in NH) E.L.DISEASE-EA EMPLOYE '$ 1,000,000 If yes,describe under - - - - - DESCRIPTION OF OPERATIONS below I I - 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 rights reserved. ACORD 25 2010/05( ). . The ACORD name and logo are registered"marks of ACORD ��e T(inr«rrrasrruerrl��n���urrco�are� ffice of Consumer Affairs Lc Business Regulation License or registr ation val3d for individsl use osjly . ME IMPROVEMENT CONTRACTOR before the expiration date. 1a found returl,to:' Office of Con.su,rer Affairs and Bvs3ness Regulation TExpiration: egistration: 100740 type Ilp ParePlaaa-Barite 3�Il90 6/23/2016 Supplement Card Boston,MA 02116 CAPIZZI HOME IMPROVEMENT,INC. JOHN STRUMSKI \ �. 1645 Newton Rd. Cotuit,MA 02635 Undersecretary Not vatt•d without signature f "/f,. Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Siipen-isor , License: CS-9648jy �. 18 AI<DFN AWE 7: gizzards Bay A19 0253i' ✓ y�i ' Expiration '12016 Commissioner i Town of Barnstable Permit# Expires 6 months jro issue date Regulatory Services Fee BABNs?ABLE � "'"0 .9 Thomas F.Geiler,Director ; �� plfG Mp'I s Building Division v� q/ d Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax:508-790-6230 EXPRESS PERNIIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X Press Imprint Map/parcel Number ���✓ O� Properly Address /a El i esidential . Value of Work �4 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address 1/y �renA/ �X/ C ee-1eerr11l&1 6n Contractor's Name <I 7G� �IC/ Telephone Number Soy ��9 51�. Home Improvement Contractor License#(if applicable) /00 7 V 0 Construction Supervisor's License#(if applicable). Ql ' 0 Y,1'/7 XPRESS PER 9�orkman's Compensation Insurance •Check one: SEP 19 2012 ❑ I am a sole proprietor ❑ I am the Homeowner [v71 have Worker's Compensation Insurance TOWN OF BARNSTABLE Insurance Company Name �J✓G CI.9/P d, EG?t�'1U��v/ Nd L OLWZ,4N j/ Workman's.Comp.Policy# V`� G C �Jl e 5�7 0�d l/ E_IC Copy of Insurance Compliance Certificate must accompany each permit. . Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles),.All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of root) ❑ Re-side p e,�rl t'G2t P/1/� (F /7C cat'<t #of doors [(Replacement Windows/doors/sliders.U-Value /a ro (maximum.35)#of windows *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. t_. ***Note: Property Owner must sign Property Owner Letter of Permission, copy of the Home provementjMtractors License&Construction Supervisors License is equ, SIGNATURE: CAUsers\decollik\A ta\Local\MicrosoMWindows\Temporary Internet Files\Content.Outlook\DDV87AAZ\E3CPRESS.doc Revised 072110 k Dapla eltt0flifdir Ceddents Office qfhT_-s6gadajFrs 690 W&RIf9faft Street ffa&ortf MA 0211.E arkerssQmeatiaiF Imsurallee Afddzvit:Bud deraf acf�rFtecrieiauI �ser APplicdiat FifarIuidoi ` I �3e�t`fflt�e41 ale(StisinessfQr izatiatz/individual)- �� F7 t - 4-c u-emeAj4 7,e,I C Ad ass: ify/ tate�Zip: o' i 1 4: 624, isv? Are ynEl Inlesuplafyer?Check tie g gr gri$fe tin s I'yge�f project(requLred): I. srzi a eriiglnyer urith - f Q ' 4s []I axrt general contractor and I' e gIoyees(filff a uil dk have Ak-ad the sub-mntractdrs �: Neer ccinstructia�. dart ❑ aizt a sale groprietar arparttrer� listed ed the attaehed sheet. 7. [�Iein4ch*Iirfg shig'anci Stave uQ employees. These stih-coactars have : [�Dei�iofitioit W�ddao for Mc in any capacity.., employees and have workers' jNa waiiceis`comfs,insurance cotng ,nc�M=e,t 4, Btcldiug•addid6n - repaired 5. � We are a coLporaticia and its 10[ Electrical rep fm or additions .Q Taia a hoMeocnerdaiag aj wane ofncers Kaye exercised their I I_•. PIiLm6' a �ii or additions myself�a ivarFcers'c°mP, rt�f of exemption per MGL, iustiraace seguired j e. and iFehave aci 12.[ It ,frepairs • - - - �Iayees.[No w.orTcers' I�-��� w� : : . comp.insuraizce regfired� *.#ay aop cat that cfi=ks box f Must 46-s!(oc�E Ykd s_ ko¢betaur shoiviag their err s`co�i deusahod policy nfo5inatxou` t Ffotneoienct vt sv&iiiiC off v$indi _ tg tii p arc dQ ag aII work and tl=lure outside coattacfors deist submita a^ i xrn�t a0icatiag such ' �. �ntraoEacs'tffat ahec�t[si�bay{nest�,��an'additiottat shot s}�gsrrriig t� oPYhc sub-coo •• .�p(oyc� TftficsuEs-cQn€zacfossFakdedip(oyes theyiuvstpcuvid::.tficir waikcs anQ'statcwhet5crar:notffigsmcatiti��ava: _ F am arc earplayer titrr is protKdzrL¢x=txrlers'corixpertsaitrt rnsuraaceat ray errcpPayees $elaxi is the pafuy¢rid�cyb site ttt at7rtafrat4 _ Fasvrariae:Ca s©C ' 5 //�.�t'lJ . �ds7�������•.%�✓ f�/lij�+',,�/a,+�� _ . Palicy,# or e1 ins rad _ d 5 _ 6 '�j. C fr aII Hate , ®E C�41C,�L�^ t Ctty/Sta (Zip 4ttach a cagy of a arai`icers'campegsatiote go€icy a cclara gn Ixage(slracviug the pa►dcy r rc feet-and i u atiart date:FarInre.tasectzre crzvera�e as rcgvited uudeF Secttau 25A of Mdt-r t 52 Can Iead tei the imgasitioiL of czi al:pe j#ies of a' due ng tQ 5I,5(3U OQ au or one year mrpriidamziit as vreu ag civil penalties`vi tl a farm of a T P (3RF .ORf' ' "and a fee of irg tca:SZSQ. t}a day a��ainsf'tevialatar- Be.adxis.'^d'that a copy a .this stat^meIIt ttry be foi warded the{3fce of Invest�o Cioiis P f the DIA€ge it c coverage eFificati g` ' riliereby tcrtiier fhepains ttrrd�erraf (perjury that the irtformat�ottlrrevzdedabave is(rue itRdcairret€ (� cral riseorilp. Flo tart wrrte iri firs area to be Cam lefe fiy c�i r a�Ewa a vial: CLly ar T6T _:. . Perri!UUcease smagAraftoity(Ckcle 6ue)s t l ir$rd ct€$eal€� �, fu Dep en f A:CRY/Town clerk c Eleetrzcal�gectar 3_PInFnFirsg Tt�s�ectar 64.Eldiir.. . Caatact Persaa: Client#:47298 CAPIHOM ACORD. CERTIFICATE OF, LIABILITY INSURANCE DATE(MM/DD/YYYY) 6/08/2012 ;HIS 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 COVERAGEAFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A.CONTRACT,BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED;the policy(ies)must be'endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to.the certificate holder in lieu of such endorsement(s). ~ PRODUCER - - - CONTACT. Karen. - - - NAME: , - . Rogers&Gray Ins.-So.Dennis PHONE,Ea: a No): 877-8.16-2156 434 Route 134 E-MAIL ADDRESS: South Dennis, MA 02660-1601 :�' INSURER(S)AFFORDING COVERAGE NAIC# 508 398-7980 INsuRERA:National Grange Insurance Co. INSURED INSURER B:Associated Employers Insurance Capizzi Home Improvement,Inc: Capizii Enterprises,Inca INSURERCi INSURER.D 1645 Newtown Road 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. INS TYPE OF INSURANCE ADDL SUB POLICY EFF POLICY EXP LTR INSR WVD POLICY NUMBER MM/DD MM/DD LIMITS A GENERAL LIABILITY • _ M1PB1075H 6/08/2012"06/08/201 EACH'OCCURRENCE $1,000,000. X COMMERCIAL GENERAL LIABILITY - - - PREMISESE.occurrence)- $500,000- CLAIMS-MADE 5 OCCUR MED EXP(Any one person) $10,000 • PERSONAL&ADV INJURY $1.,000,000 - y GENERALAGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: - - PRODUCTS-COMP/OPAGG $2,000,000' - POLICY PRO- LOC $ JECT A' AUTOMOBILE LIABILITY M1 M28044 6/08/2012 06/08/201 COMBINED SINGLE LIMIT Ea accident 500,000 ANYAUTO - - BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED AUTOS_ AUTOS ( )BODILY INJURY Per accident $ - `NON-OWNED - PROPERTY DAMAGE X HIRED AUTOS X AUTOS - Per accident $ X Drive Oth Car $ A X UMBRELLA LIAB OCCUR CUB1076H - . 0 6/08/2012 06/08/2013 EACH OCCURRENCE $5000 000 EXCESS LIAB HCLAIMS-MADE - AGGREGATE $5 000 j000 DED I X RETENTION$10000 $' . B WORKERS COMPENSATION _ WCC501054701.2011' -1.2/25/2011 1..2/25/201 X,.WC STATU= OTH. AND EMPLOYERS'LIABILITY- Y/N' - _ S R ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH`ACCIDENT $1 OOO OOO OFFICERIMEMBER EXCLUDED? �. NIA - - (Mandatory in NH) - ." E.L.DISEASE-EA EMPLOYEE-$1,000,000 yes,d scribe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT- $1,000000 DESCRIPTION OF OPERATIONS/LOCATIONS1VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required).--. - - Workers Comp Information included Officers or Proprietors CERTIFICATE HOLDER CANCELLATION. Town of Barnstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE` EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200 Main Street ACCORDANCE'WITH`THE POLICY PROVISIONS. Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE ©198 -2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S82889/M82857 TLH k1a nuWtts .Departmeol of Pubfic Salety a0ard of awldmg Regutations and Standards U C15-064817 IS ALDEN AV"1 Dmards 84 NtXtip , 06/1812044, ' aOOfr� LJIIIiCB 8I L:AAStttti8r1 II�:tk'3 cY#LSifiP.3S ne wuuu� LECeFtJe Ui iC+L•cl.t'dt3U.l1 YHJLIU Jul ADUAVIUU,aac uuty OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business,Regulation RegistraUon:. T6GV40 ~", TYPO: 10 Park Pima-'Suite 5170 1�>, Supplement Card ]Boston,MA 02116 CAPIZZ!}TOME P ERIC. !z `., JOHN STRUMS • -:-` 1646 Newton Rd. "� _ Cotuit,MA 02635 Uadersecreta ' Nat v id wr out s re j � � �v f y t j Page 7 of 7 Capizzi Home Improvement Inc. Specifications and Estimates STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT WE, JOHN &ANN AYLMER, OWN THE PROPERTY LOCATED AT 119 TERN LANE 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 CODE. SIGNATURE OF OWNER: OWNER'S ADDRESS: 119 TERN LANE,CE ERVILLE,MA 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: �OFtHE rqr� Town of Barnstable tabl,e *Permit# b 1`t,5 Expires 6 mouths jran issue dale • Regulatory Services Fee BAItN&TAELE, • � �(o• `� v� t6 SS. ,0Z Thomas F.Geiler,Director Building Division Tom Perry, Building Comulissionet' 200 Maui Street, Hyannis,MA 02601X-PRESS & Office: 508-862-4038 Fax: 508-790-6230 OCT 1 8 2004 EXPRESS PERMIT APPLICATION - IU SIDL'NTIAL ONLY 22 y� Not Valid►vithout Red X-Press Imprint TOWN OF BARNSTABLE 01 Map/parcel Number 1 / Property Address Residential Value of Work Owner's Name&Address o h YA A41 ryy cia qjM_V_/t V1 021A)_ Tele hone Ntunber `� �� 9��� •+�`'� Contractor's Name �l�Q S I Z�1 p Home Improvement Contractor License#(if applicable) /OD-7 CID Construction Supervisor's License#(if applicable) CsD S-7032 ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner lave Worker's Compensation Insurance t S Vr" Insurance Company Name / Workman's Comp.Policy Pernut Request(check box) WRe-roof(stripping old shingles) G�P ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows. U-Value (maximum.44) Other(specify) 9 I! l�V e �2N *Where required: Issuance or this permit dots not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. R Signature Q:Forms:expmtrg Revised 121901 s aoaTaT l]ci�l OnS 2D D JISIl dS VW` One Ashburton Place-Room 13 01 Boston.Mass4hiisetts 02208 . - Home I=ovemen a t`actor e; ation _ Repistration: 1 D074D P Type: Private Corporation _ l iration: 512=006 CAPIZZI HOlAE IMPROVEI�f� 7, INC. . Thomas Capizzi,jr. 1645 Newton Rd. Cotuft, MA 02£35 } - 'Update Address and return card.Marl:reason for change " ^ Address —, Renewal Employment —; Los.Card - �>�'i//D7I+i7siOo7lliE� 6.�✓I/LQdOdC� Snare o.'Builfli F. ulatio'ns and STanaarns License or registration valid for individu)use olih° g HC)M=_IN?RDv=—m=,i�0A,'"�2i AL',DR before the expiration date. If found return To: ; Board of Building Regulations and Standards _. sy r'ceaisz-anon 1 i4D One Ashburton Place Rim 1301 ` imtion: h = fi_3,_DD° Boston.Ma.0.108 ;ype: Private Co pombor, , A.Jr' 1$45 Newton Rt. � � ,,,✓ Cmiui,ML.C2£35 Not valid without signature j hdminisr.aror � - , i VA CAPIZZI HOME IMPROVEMENT INC . Z9Yr-Z SPECIFICATIONS AND ESTIMATES PAGE 6 OF 6 STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FOR BUILDING PERMIT' OWN THE PROPERTY LOCATED AT ��'I �9 �I ' Lhfit, IN Ufl yi V1 MASSACHUSETTS. I HAVE AUTHORIZED CAPIZZI HOME IMPROVEMENT INC. TO ACT AS MY AGENT TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. I GIVE MY PERMISSION TO LESSEE TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. G% j' SIGNATURE OF OWNER: i 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: 508.1428-9518 RESPONSIBLE OFFICER: RESPONSIBLE OFFICER ADDRESS: RESPONSIBLE OFFICER TELEPHONE: ACCEPTED BY DATE 01 0 THIS PAGE IS PART OF AND IN CONFORMANCE WITH PROPOSAL # �IKE Town of Barnstable r�V_emit# L- 7 Expires 6 months from issue date Regulatory Services Fee a►xrtsrna[s, MASS16 Thomas F.Geller,Director Q� 9�ptfDMA'tp,�� ���IJI �/'_ 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 PERNIIT APPLICATION -. RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number I D� Property Address A .110 Csidential Value of World t J,�,,L�.p O , 4)(p Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address �(f Contractor's Name n D t22 ( l �/I/ltt. L1 of` Telephone Number SO Home Improvement Contractor License#(if applicable) l Construction Supervisor's License#(if applicable) 4. ❑Workman's Compensation Insurance Check one: }i.1, .' ''t -' ❑ I am a sole proprietor ❑ I am the Homeowner V 1 j ARINS A LE gave Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# A)(,t)('C 7) 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) ❑ Re-side #of doors 0 g/ placement Windows 500—D, liders.;U-Value (maximum.35)#of window *Where required: Issuance ofthis 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 �requ'ted , SIGNATU C:\Users\decollik\AppData\ cal icrosoft\Windows\Temporary Internet Files\Content.Outlook\DDV87AAZ\EXPRESS.doc Revised 072110 The Commonwealth afMassachusetts Department oflndustrialAccidents Office oflr vestigations ' 600 Washington Street Boston,MA 02111 www.rriass.gov/dia _ Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information f 'y Please Print Le 'bl Name(Business/Organization/Individual): .. Y-a V-f__1'k t I— Address: City/State/Zip: 6 1}'�l¢ . d 3�� Phone.#: Are you an employer? Check the appropriate box: Type of project(required):. 1. . m a employer with �' 4. ❑ I am a general contractor and I employees(fall and/or art-time).* have hired the sab-contractors 6. ❑New construction ❑ I am a-sole proprietor or partner- listed on the-attached sheet 7. ❑Remodeling ship and have no em Io ees These sub-contractors have p P y 8. ❑Demolition: working for me in any capacity: employees,and have work'01 o workers' co com msurance.t 9• ❑Building addition [N trip.insurance p• . 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.❑Plumb ing 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.®-�ther /(,Qt j doo✓— comp,insurance required.] *Any applicant that checks box#1 must also fill out the section below showing-their workers'compensation policy information.. Homeowners who submit this affidavit indicating.they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I iim an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. 1 Insurance Company Name: �� ��1� ,►'` V .� I Policy#or Self-ins.Lic.#:- N Ws� 3 Expiration Date: v f Job Site Address: City/State/Zip: � �/ll ►'(�f 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 MOL 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' , urance covera e verification. ado herBby eer-tifi;Lu r aix� am penalties paxjur-y-that-the-iifo-zrzcation prvuide above i true-and-carxect Si afore: Date: /d' Phone#: 7' �- 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): I..Board of Health 2.Building Department 1 City/Town CIerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone# Client#:47298 CAPIHOM ACORDrM CERTIFICATE OF LIABILITY INSURANCE DATE 06/04/2010/04/2010 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 CO c Karen A Walther CISR - - NAME Rogers 8r Gray Ins.So.Dennis PHONE 508-760-4630 508-258-2230 434 Route 134 f Cl No Ext: (A/C,No); ADDREss: waltherka@rogersgray.com P.O.Box 1601 VKUUUVLK CUSTOMER ID#: South Dennis,MA 02660-1601 INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURERA:National Grange Insurance Co. Capizzi Home Improvement,Inc. INSURERB:ACE Property&Casualty Ins.Co Capizzi Enterprises,Inc. INSURER c 1645 Newtown Road 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,TILE 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= - POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR POLICY NUMBER MMIDDIYYYY) (MMIDDIYYM LIMITS _ A GENERAL LIABILITY. MPB1075H 06/08/2010 06/08/2011 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $500,000 CLAIMS-MADE r_X1 OCCUR MED EXP(Any one person) $10,000. PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY FE 4 LOC $ A AUTOMOBILE LIABILITY M1 M28044 06/08/2010 06/08/2011 COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $50O 000 BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ X SCHEDULED AUTOS PROPERTY DAMAGE X HIRED AUTOS (Per accident) $ X NON-OWNED AUTOS Uninsured $250000/500000 Underinsured $250000/500000 A X UMBRELLA LIAB X OCCUR CUB1076H 06/08/2010 06/08/2011 EACH OCCURRENCE $5,000 000 EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 DEDUCTIBLE $ X RErENTION $ 10000 $ B WORKERS COMPENSATION NWCC45843208 12/25/2009 12/25/201 X WC STATU- OTH- AND EMPLOYERS'LIABILITY RY LI IT `. E YIN ANY PROPRIETORIPARTNERIEXECUTIVE[ N WA E.L.EACH ACCIDENT 1 $1,000,000 OFFICERIMEMBER EXCLUDED? � (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTIONOF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS f VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) - _- Carpentry 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 ©198 -2009 ACORD CORPORATION.All rights reserved. ACORD 25(2009109) 1 of 1 The ACORD name and logo are registered marks of ACORD #S52549/M52541 KW Page 7 of 7 CAPIZZI HOME RVIPROVEMENT INC. SPECIFICATIONS AND ESTIMATES STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT I, of OWN THE PROPERTY LOCATED AT IN ,MASSACHUSETTS. I HAVE AUTHORIZED CAPIZZI HOME IMPROVEMENT TO ACT AS MY AGENT TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. I GIVE MY PERMISSION TO LESSEE TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSAC1 USETTS STATE BUILDING CODE. SIGNATURE OF OWNER: E 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: Page 6 of 7 CAPIZZI HOME IMPROVEMENT INC. SPECIFICATIONS AND ESTIMATES Pre-Installation Checklist(prior to scheduling any project) 1. Was a copy of the sales agreement and all information about the product and project received? N/A YES NO 2. Were the extra charges explained for special protection of shrubbery, landscape,professional cleaning or relocation of any personal items or furniture? N/A YES NO 3. Was the possible need to touch up trims,rake boards, gutters, etc., if no painting is included? N/A YES NO 4. Was the need explained for full access to exterior/interior of the building (key, etc.)during entire job without delay? N/A YES NO 5. Was the noise&dirt explained? (Dirt will fall inside your building.) ,N/A YES NO 6. Were the problems associated with antennas, satellite dishes,HVAC units and cables explained?And if needed,who will remove? N/A YES NO 7. Will there be adequate electric service available for power tools, etc.? (20 amps required for commercial work) Note: Increase in all your utilities to be expected. N/A �NO 8. If yes,where? 4 J ,rr& 9. Will bathroom facilities be available for the crew? N/A YES NO 10. Is there outside access to water? N/A YES. NO 11. Was the commitment explained for your timely progress and final payments to be given to our project manager? N/A YES. NO 12. Was it explained that every change to original scope of work would add additional time to project. N/A NO 13. Did you read our New Arrival brochure? N/A YES NO 14. Was it explained to you not to hire directly any employee or subcontractor of Capizzi Home Improvement or make any payments in any name other than Capizzi Home Improvement unless prior authorization is given by CHI representative? N/A YES NO 15. What e the most important things to you on this job to assure a raving fan? 111 1P� The items listed abov have been explained to me and I am satisfied that there is a mutual understanding of what is being provided. I have read&understand the New Arrival brochure. ust er Signature: Customer Signature: g - g Date: I Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation Registration:-400740 Type: 10 Park Plaza-Suite 5170 Expirafmn 6T23 Y1,2. Supplement Card Boston MA 02116 CAPIZZI HOME'IMRROVEVIENT,4NC. _ i'A 'iv p-_-- GARY GUSTAFSOffi--f=-'F!-g~<`? 1645 Newton Rd. Cotuit,MA 02635 `�'`C:��"�" Undersecretary No id without signature '= Massachusetts- Department of Puhlic SafctN MWBoard of Building Regulations and Standards Construction Supervisor License License: CS 74640 GARY GUSTAFSON. f jr` ' 8 SHORT WAY SANDWICH;`MA 02563 . Expiration: 11/29/2012 {'onunissioner Tr#: 7058 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map _r Parcel •� - - Permit# 11; Health Division ���� /�j ' Date Issued 1 -30 --C Z Conservation Division C O l p 2 Fee Tax Collector ' OD 4 30�0 0� SEPTIC SYSTEM MUSS'BE Treasurer D IBC L — 1D�a o2 INSTALLED IN COMPLIANCE Planning Dept: 0M TITLE Sr` ENVIRONMENTAL CODE AND Date Definitive Plan Approved by Planning Board •TOWN REGULATIONS Historic-OKH Preservation/Hyannis' Project Street Address, 9, // q / E �ti L.9ti E i Village C EN TC2 �//L G E Owner 'ye iyN F Iq YL I-P2 E2 Address //I Ti52"t/:•`G�9tiE�CE•vT. SDI'- 77S - �3 Z 3� Telephone Permit Request CD�/�S'i•�2-: . O F %O O L S' Yip P4.4 eEQ l�/PoN EX/ST-/NG Pay2C� ('DAJC2ETC �04/N/6,'14T/D�V (2� eITACH67-> F-lep/1j Ibtd67L6oN6 Square feet: 1st floor:existing proposed. 306 42nd floor:existing' proposed Total new Estimated Project Cost 13. 100 Zoning District r� �+— Flood Plain Groundwater Overlay Construction Type DOA2f1�/E Lot Size -Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure YER P-5 Historic House: .O Yes No On Old King's Highway: ❑Yes No Basement Type: g Full (Crawl ❑Walkout ❑Other a . Basement Finished Area(sq.ft.) 7 3 Basement Unfinished Area(sq.ft) ` Number of Baths: Full: existing 1 new Half:existing I new - Number of Bedrooms: existing 3• new1L Total Room Count(not including baths): existing q new First Floor Room Count Heat Type and Fuel: ❑Gas AOil ❑Electric ❑Other Central Air: ❑Yes XNo fireplaces: Existing New Existing wood/coal stove: ❑Yes XNo Detached garage:0 existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:O existing ❑new size Other: Zoning Board of Appeals Authorization ❑' Appeal# Recorded❑ Commercial ❑Yes ANo If yes,site plan review# Current Use 9ES/bEw0"/,4L Proposed Use BUILDER INFORMATION v Name L/Off/ �5r� �l�� Telephone Number S�- 77 S= 3 2,3 go Address- /1 T�••� Zy� License# Home Improvement Contractor# OZw3 Z Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ` SIGNATURE - DATE _ ��� -- 40v&± 2DV 2 ' c - FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED r I MAP/PARCEL NO. O R 6. ADDRESS VILLAGE s ti OWNER r. DATE OF INSPECTION: FOUNDATION FRAME ' INSULATION FIREPLACE 29 US ELECTRICAL: ROU FINAL : If PLUMBING: ROUO'ka FINAL + GAS: ROU6�H� FINAL mC7 FINAL BUILDING +n I * I CIO l s r• DATE CLOSED OUT �. ASSOCIATION PLAN NO. ' ; i RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings,Additions $50.00 ` Alterations/Renovations $25.00 Building Permit Amendment $25.00 . FEE VALUE WORKSHEET NEW LIVING SPACE square feet x$96/sq.foot= x.0031= plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet x$64/sq.foot= x.0031= plus from below(if applicable) ACCESSORY STRUCTURE>120 sq.ft.i Qo ' >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building permit square feet x$96/sq.foot= x.0031= STAND ALONE.PERMITS Open Porch x$30.00 (number) Deck x$30.00= (number) Fireplace/Chimney x$25.00= i (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 . Relocation/Moving $150.00 (plus above if applicable) Permit Fee projcost 11 , � .• �(�\�� 7ZANJAG -- V W2—Llu(=, tZ r N � i OF i c< W ILLIAM �� J c. �• cEeT►FIEL7 p►-b-r MY .- i 14334 L o cAT 1 o'" �'' •Suo�u�! PLA<`1 R�Fcc�E�IGE LSRT1F�( T14AT' T1->.� elWE ��1 JQV- t-�ESZ _o64 fO.AAPL YG W ITN Tt-lE 51L�E.L.t►-1t= �CJ�"� 3 a � c�� Q1.1D SETB�CIC 1'E4UtcLEN�.,�►-tTS mil= TNT ' 'jovvU: OF ?LA/ J LvG AT'=Z> \.V I T�-1 l 1�1 FL CD t a,4XTC4Z uYE tuG_ / _ V c`(o _ ►► ,, \\ - �D l�<Jo Sue i .. • > l�-� Rc G 4 S t� � - T N l5 P L.A N I S �-1 oT BAS E� •A�J 11,1 y'r-Q U AA F- 1 T SU Q\I c`( j T:4 f= o t=t=S ITS 614 tj t ::> Ap P I I t�iGT 6G uSC:o To DeercZMINC Lor t✓I�a�S ---.... 19AJ &1,rr/AvG rocfNA,►T/OtJ OF ,ko'E g zoo 1,9V� t11wrAr0 E" 19 Po.erio•v wN, �• a �No- w Lo - `�- 6, z •.J ss;;;;s ;;; Lot Part of °`',�' 16•a 6.55'S ' Northerly P 6 69 w Lot Reserved for \ N N 162' � o Drainage on original � po z record plan. / \ Lot ` 35 / '►� W� 109.10' � N86 40'03"E o Southerly Part of j Lot Reserved__for Drainage on original record plan. RES. ZONE- "RD-1" This MORTGAGE INSPECTION Plan is For FLOOD ZONE.- "C" Bank Use Only TOWN: _C�'IYT BYlI.I — — _ — — _ REGISTRY OWNER: 101H1Y_E AL gyL4ffR_DEED REF: _ 9j /-fZ2- - - - - -BUYER- _FEF7NAN� - - - - - - - - - - - _ DATE: �I,L1,�9 - - - - - - - _ PLAN REF: 8V13 - - - - - _ _SCALE:1"= 40'__FT. I HEREBY CERTIFY TO �'�PE_G BANKTB�1�T EQ_& First American_Titl_e_ n_s. 3. THAT THE BUILDING Eq��N OF YANKEE SURVEY SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS �y CONSULTANTS SHOWN AND THAT ITS POSITION DOES _ _ CONFORM g° PAUL �, A. TO THE ZONING LAW SETBACK REQUIREMENTS OF THE MER THEW y 143 ROUTE 149 TOWN OF &A8 NffA&Z_____________AND THAT 9 No. 320M a MARSTONS —5553 MILLS MA. 02646 IT DOES_ NOT_ LIE WITHIN THE SPECIAL FLOOD HAZARD ° 9 0 ' AREA AS SHOWN ON THE H.U.D. MAP DATED_8f�/.�1_ �`�sioyqIsiAba s� FAX428 —0055 Community—Panel # 250001 0015 C t _____ THIS PLAN NOT MADE FROM AN I TR ENT PAUL A mERIT BLS SURVEY NOT TO BE USED FOR FENCES ETC. 13080 KJH l CF THE Tpy,_ • . �tnrsrnatc. - The Town of Barnstable 9� , `m� Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner 9 Permit no. r Date (,-3 y�a2- 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. Type of Work: CONSTR• O 10 F TOO L Si`fED EX/S i.FOMMi -Estimated Cost �'i 0 L YP Address of Work: ���t TEk^l Gi9NE CFN7 f y/LLE4 ' OZ(a Z Owner's Name: �-/O!`f/✓ Jr-T /q YL k" Date of Application: I hereby certify that: Registration is not required for the following reason(s): []Work excluded by ❑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 permit as the agent of the owner. Date Contractor Name Registration No. OR G�3 0 �,9iv�ri9 2 y 200 Z Date Owner's Name q:fonns:Affidav "Z"Nl The Commonwealth of Massachusetts r:- a =- =•.x Department of Industrial Accidents Office 0llayest 90tivos 600 Washington Street --- ` Boston,Mass. 02111 Workers' Com ensation Insurance Affidavit „ 01149�ME name: 19 Y L/n�' location: l �2 ti city ��9 2N,S/�'l9&C phone#Jr0�= 77S' I am a homeowner performing all work myself I am a sole i3raprietor and have no one working in any capacity workers, compensation for my employees working on this job. : <.;:.;»::<:»>.::::>:<:: <::::<:>«,:;:::;;:,; :»>::;:::...:.. $tldre ................ ,.::;::.;;:•::�;::::;:...:;::: ;::.::<:;;:... hon .: :. J istrranct ca:: ❑ I am a sole proprietor,general contractor, or homeowner(circle one)and have hired the contractors listed below who have Iices: workers compensationp the following .............. ....:...:.::::::::::::::.;:.::.:::.:::::.�::..�.:;:.::::::::::.:.;:.,,.:::::::::::.;::.::::::.:;<;;.,:,::::::::.�:::.::..;;;.:.;:.:;:;::.::::,::::.::::.::.::.;;:.:::::::::::::::::::;<.:;:.:,:::::::::::.;: com anvname.. ..:...;:::::.:;:;.::.:.,;;;. :......:.:................ a .........:........ ........................... ..-...... ............................ hon ............... .................................. ...... ci .:'.::::�ii:iy:'.:.:.:.:�:.::.::::::i;.i:•i:?vi:�:?-:-0:?i.'ii•::•i"iii::iii}::^}:i�i:'vi::iY;�iiii:; �ii::is":::::C:�::•::••:::::.::::............... Dii anv ::•::.:....:...::;:..: .::::.:...:........... ... atidres . .....................:...:::::.:.::::::::.::.:..:::...�.;�.;:... s:Cv li 0 i asnrance / Faflare to sectuz coverage ss:equlred order Section 25A o[MGI.152 can Lead to the imposittoa of criminal penallies of a Sae ap to 51,500.00 and/or one ears �priioranmt as well as civfi peniltin in the form of a STOP WORK ORDER and a Sae o[5100.00 a day agslnst tne. I understand t a y � be forwarded to the Once of Iavestl;rrtions of the DIA for covers;e veriScation. copy of this statement may I do hereby certify ttrtder the pauv and penalties ofP�J�l'that the information provided above is trt�and correct ' Signature G� - Date Print name Phone# official use only do not write in this area to be completed by city or town official perrnitNcaae# ❑Building Department city5 or town' ❑Llcensurg Boo-d ❑Selectmen's Oince ❑check if immediate response h required ❑Health Department contact person: phone#; ❑Other (mnwd 9/95 PIA) �F KE MSZAB The Town of Barnstable 9�A i69: per Regulatory Services Thomas F. Geiler, Director Building Division Peter F. DiMatteo, Building Commissioner 200 Main-Street,Hyannis MA 02601 . .ce: 508-S62-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: �Q lT/¢{��C/9•Ei y e<l/�/Z JOB LOCATION:_ E— number street village �C Gf "HOMEOWNER": il ,j �J — 7 r— 3 Z 3 name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage Ian.individual for hire who does not possess a license,provided that, the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and require ents. Sigaature/Hom2#G= Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State'Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 105.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as partt of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:FORMS:EXEMT`TN ' 1 A >136 %v Assessor's map and lot number ' .......... .....:.. ..X: /` THE f % To Sewage Permit number! : .. w``Q� �y0 House number I . .....i T@�% �YSTEA/i:f�t.d Z BAWSTAILE, ....�.�. ...........f .. '�.. �T MA39 119STALLED IN �0 ®lV1�Lls4� pypYd• 0 I Eb TOWN O A R l &T CODE AND .. TOWN REGULATIONS BUILDING INSPECTOR APPLICATION FOR PERMIT TO .... ........ .... ......� ..............L � TYPE OF CONSTRUCTION .....�). (.. .". .............:..........:............................................ ...... ....19........ TO THE INSPECTOR OF BUILDINGS: The undersigned h^e-r-er-b-y�applies /for a permit according rtio the following information: Location . .1..1...... ........... ........................................................ .................. ............. Proposed Use ... .('j t ............................................... ZoningDistrict ...11. .E1....................................................Fire District .. ............................................................ Name of Owner ' ... ...(:7^ .1. !1.Etr........................Address`J.l.....Vei-h...... ......... 2fn. .:........................ I Name of Builder . ... -.1 ,Q,w.. ��t+. .....Address ...... . .. Nameof Architect ..................................................................Address ..................................................................................... Numberof Rooms 2...........................................................Foundation .......................................................... Exterior ..� .................................................................Roofing ..IQSUP —31-k ............................................................ Floors .. ..............................Interior ..�Nt7�, .......................:................................ (..._....;.... L� ' lieatrng .f'�: '1'�h. .......:......................:.:..-............... :Pfumb'in� ....... ..:...:.. ....:...:..::::.:`.:..:::....... ,.. a Fireplace I\JG3...................I................................................Approximate Cost .. d C�? m......,...................................... �• Definitive Plan Approved by Planning Board -------------------_-----------19________. Area ........... Diagram of Lot and Building with Dimensions Feel....-r........... SUBJECT TO APPROVAL OF BOARD OF HEALTH 7� Q p5 Z0 41 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Na m \5 ��� �� �--►�.................. I AYLMER, JOHN F. 24256 ADDITION No ................. Permit for .................................... t. . .........Single...Fanij-1-y...Dwal-li-ng............ Location ............................ -Centerville ............................................................................... John F. Aylmer Owner ................................................................. Type of Construction ......F.ra.m.e......................... .... .. .. ............................................ ................................ 'Plot ............................ Lot ................................. July 30 8 2? Permit Granted ..........................:7�........19 Date 6f Inspection ...................................19 aa Date Completed ........n`-1 9 PERMIT REFUSED .....................1.. 19.................................. .. ................................................................................ ............................. ................ ................... .......................... ............................................... ................... .:%........................................................ Approved ..... I.............................. 19 ............................................................................... ............................................................................... Assessor's map and lot number }--z........`....-!..........:....... f y THE 0 0 Sewage Permit number J Z MAHHSTADLE, i 119 / House number ......:...........................................�...............`..... 9�G M6 9 �Fo MP`(a' TOWN OF BARNSTABLE . BUILDING INSPECTOR APPLICATION FOR PERMIT TO ... !;�?............�.......:..;�cell�...�: :+ ........................................................... - - TYPE OF CONSTRUCTION °'�,. i -.. r.t =- .. � ........ _ ................................................7. ........ .�....................... ......................��.. .,l' t_ ..............19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ...��..�...... .::: �...... .:^............:.....�.�,v..',:tt....`...................�.-.�......................:........:.....:.................................... Proposed Use 1,—t t c..,.�r.. 1 '� �� �1c ��.... ?:.. .................................. y ..................................................... .i. ............................................ Zoning District A� ................................................Fire District L— is.) Name of Owner ...:�p :.^..... ...............+ �. :............... Address ............................:* ..........Cr^:"�:�........................... .... ti Name of Builder «e - .C..=} .Mrt".v, ,,;.!......tu:.``L-......Address :........................... ... J,.... ... ...... Nameof Architect ..................................................................Address .................................................................................... —r ,,—, Numberof Rooms Foundation .... .:.................................................................. ................................................................... Exterior .. a ?r,« ..................................................................Roofing ......Cry :. Floors .. { r.= ....i.......:..................................`� .Interior ....:.:.:..:.a':!:?. :;........................................................ ....... _ .... Heating ........................... ......................................................... ..,, Plumbing Fireplace .....�Y ..............Approximate Cost ?.Cg C,I.`.3 Definitive Plan Approved by Planning Board ________________________________19________. Area .. .! Diagram of Lot and Building with Dimensions Fee a SUBJECT TO APPROVAL OF BOARD OF HEALTH f` `. t.� ✓ r D I I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name . :An * .�...::r'�:"s............................ AYLMER, JOHN F. A=212-20 No ... permit for ...ADDITION .............. Single Family Dwelling . ............................................................ Location ...119...Tern....Lane. ..... .... .. ............................. Centerville ............................................................................... Owner John F. Aylmer .................................................................. Type of Construction .....Frame ..................................... ................................................................................ Plot ............................ Lot ................................ July 30, 82 Permit Granted ........................................19 Date of Inspection 19 t Date Completed ......................................19 PERMIT REFUSED ...................1. 01W............................ 19 .................................... .�.�.: . . ................. ............................................................................... .................... ............................................ ............................................................................... Approved ................................................ 19 ............................................................................... Assessor's office(1st Floor): �. tH `TITLE 5 Dot - ENV1R0NW,ENTr� Assessor's map and lot number � Conservation ?— Board of Health(3rd floor): 18arhatab1�A j' A U a�sr�ytt Sewage Permit number V Engineering Department(3rd floor): // onservatjoc C ��o 39���� House number 6 �� � .S� cmwissto Definitive Plan Approved by Planning Board 19 ect n APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1,00-2:00 P.M.only ate TOWN . OF BARNSTABLE� "10 BUILDING INSPECTOR �N D �ctlM3�� , APPLICATION FOR PERMIT TO 00V C�-05-L` &- CJJ T//l/& LD�� T dC' TYPE OF CONSTRUCTION 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: �-- Location !j Proposed Use 'es/25 / stir/ Zoning District 40 / Fire District S 7- ZA,yij, Name of Owner Off �L E2 Address Name of Builder Address .S Name of Architect ��� Address . Number of Rooms Foundation ewl"8. /�l/�ll�l��S�iC�/J�/'�6 IC A2�,j313�/2 f20C Exterior - Roofing Floors pz-y"d y Interior Heating Plumbing /y61A1G Fireplace Approximate Cost OGU Area d4 M C�. Diagram of Lot and Building with Dimensions Fee —�-- 00 � 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 . AYLMER, JOHN No' 34668 Permit For Enclose Deck Single Family Dwelling Location 119 Tern Lane Centerville -. Owner r John 'F. Aylmer* Type of Construction Frame CC ev t Plot -Lot - k Permit Granted i October � 30 ,s� • a � r r f Date of Inspection Date Completed 19) CC' j ',g, _• i/ ` I 1 r JAI ' I` �' ' a J r 1 1 f L, r ' . i Assessor's office(1st Floor): / 1; � Cr Assessor's map and lot number / �" ` `off THE>o Conservation �-'<G Board of Health(3rd floor): Sewage Permit number s�sran Engineering Department(3rd floor): o630. .� House number ) Rio asr Definitive Plan Approved by Planning Board 19 APPLICATIONS PROCESSED 8:30-9.30 A.M.and 1*00-2-00 P.M.only ell t` 3 -e,E&a,m-s TOWN OF BARNSTABLE t'y' ' cA BUILDING_ INSPECTOR 'mil APPLICATION FOR PERMIT TO eW CC.O,S C f-kI J 7-/AJ& D E C' 2��N / j l7EG k, TYPE OF CONSTRUCTION 19 ' / TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for Ta�permit according to the following information: Location dd �E/� /(/ Proposed Use Zoning District ►`-� Fire District C�N j�0 S 7— Name of Owner l�0 /q Yt- A" !F Address ����/� Name of Builder _ l Address S Name of Architect Address A,/• ,', Number of Rooms T Foundation earn. �v�,vda�rl/s�2 .y/J'*// 4 rL ���3t3 � /2o`�C /�oo�=i Exterior Roofing Floors pL Interior Heating Plumbing tieA1G Fireplace tiD�C Approximate Cost U00 Area G. mo Diagram of Lot and Building with Dimensions Fee r ' 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 210114A ' AYLMER, JOHN L. hg A=212-020 No 34668 Permit For Enclose Deck Single Family Dwelling Location 119 Tern Lane c Centerville - Owner John L. Aylmer ' • i Type of Construction Frame Plot Lot + Permit Granted October 30, 19 91 Date of Inspection ' 19 Date Completed 19 . F PERMIT COMPLETED 1/1/ f TOWN OF BARNSTABLE BUILDING DEPARTMENT Y HOMEOWNER LICENSE EXEMPTION Please print. DATE . .2, � JOB LOCATION /f Number Street address ..,.:.., -�— Section 'of town . "HOMEOWNER" ' Name Home. .phone PRESENT MAILING ADDRESS // Work Phone �/T'�i2 t/lL CE itY town State The current exemption for "homeowners" zi. code dwellings of six units or less and to was extended to include ow dlvidual for hire who does not ner-occupied allow such homeowner acts as su Possess s supervisor. P sess a license to engage an in- DEFINITION OF HOMEOWNER: Provided that the owner Person(s) who owns a side, on which there Ps, or of land on which he/she attached or detached °Y is intended resides or intends to re- side,person who structures accessory o a one to six family considered constructs more Y to such use and/or dwelling, a homeowner, than one home in a farm structures. on s form ac Such homeowner two-year t period shall not be for all suchcworkble to the Building officia111 submit erformed that he/shetO the Building Official The undersigned �� under the buildin ermit. (Section 109r1s1°nsible Building Code and Other assumes responsibilit � other applicable codes, Y for compliance with the Stat Barnstable geed homeowner" regulations. Building Department that he/she and that he/she will com minimum ins understands PlY with pection the--Town eof m HOMEOWN � said rocedures an requirements. and re ER S SIGNATURE �D requirements. quirements t APPROVAL OF BUILDING OFFICIAL Noe: Th t ree famil to comply with Y dwellings 35 , 000 c State Buildin cubic feet,g Code Section 127. 0, or Construction Will be required trol. HOME OWNER'S EXEMPTION The code state that: "Any Home owner.Permit is required shall be exempt frometherming work for which a. building (Section 109. 1 . 1 - Licensin :provisions of this section Home Owner engages a person(s) ffornhirectoodoSsuchvworks that , such Home shall act as supervisor: " ) : Provided omethat ,if , e Owne: Many Home Owners who use this exemption are unaware that the are a the responsibilities of a supervisor (see A Y ssuming for licensing Construction Supervisors , Sectiond2X15) . This Lack often results in serious 'prSupobler 5) Rules and Regulations unlicensed , ersons�. . of awarene: p In this case�ourrBtoardacannoteproceed�against' hires : irilicensed person as it would with licensed Zupervisor. ,: ThegH against' the ,,. as supervisor is ultimately responsible. } ome',Owner actir To ensure that the Home Owner is fully v communities require, as part of the prmitrapplicatione of r that�thebHoirieies, mar.., certify that he/she understands the responsibilities of a �su er Owner last page of this issue is a form currentlyused b P visor. On the care to amend and adopt such a for.•m/cc`rtifcation for use 'in our co' y, several towns. . You may • Y community. FRO� N, T TOOL SHED ELEVAT I ON s 119 , TER LANE CEN7ERV 11 LE woo FRAME - CONSTRUCTION 7 S GAS I.,E : I " s ,I , FOOD. I �,T'0H N F. AYL ME fo Ps, � I4- w i I i j _ 4 E - -- - --- - ---- - - --- --- - - --- OOL SHEP , #III CE N TE RVILL f " ► 1 �l(L.I' , 1 f I s !�C REAR E LE ' ......... A►LE 1 i ► ► f 5 r . i 7 1 j-mot Tom" � VAT: N a I � 1 r 1 - 1 17 3 ► I 1 S , 1 1 f l { 4-- exisriNG C0N C. REre FOUNDArio N • 1 I , - 1 SPH A l- r RooFIN & —� i 1 I i 13' iTT ii - � �-- W141Tc ce-mR SNl�t16l..0 SJD/fit i � TX L 5HEP - 5OUTH ELEVATIO�t SCALE 3/4 F - E--- A S R H A L7- c o fwr 6 .—i I s t i -- .r-- E-- WHIT-6 R H/N 1 ts,9„ TOOL. SHED --- NORTH ELEVATION SCALE 3/4" = � '. 20 .�� �. �.� —.i.. �« ��. wwnlw �� .�� ,� .� �+ter w�� �� •wn :s w.� +i ..��. .� +.�� .�.� �.. ��r.� �� �� .�. � .�. �� a I y ..r .�� �.. ��• ..... .ram. ,r... r.. w.�.l. lrww, ,+�..• 'w...• +� 1ww. �� r.. �.. ..... . ....4.. .... �� .: f v ! { x a ' ' �� _ �- � �� �� �• �� III/�l �II�� �� i. +.�� }IPU �� Illr! A� �� �/• i .. !., ,j •- �r �• ��� �A� �� ��� �� QI�4 f�� # �� � 11� �� �w �IIIl�� 1111� �• �� -� �� ��� a� �.. ` w 2 00" RAFTERS AND TRUSS "I(oll ON CENTER ; s -� �� �I�r �� � IPlwlr T�' /UO ��• �• •� �� lI4411� ,��� �A� �r 1 S. x } i 1 2 AFTERN.� I USA I Ilk a� CENTER' 0 R ! . . . _ oR / H a �- SOUTH Y A t . y a. r R t ti i r 77 HE D 9TERNTOoL. AT I LANE: CENTERVILLE' MA5S. FLOO R : 'PL jl� N RAFrCK AND FRAMING SCHEFDto.LE SCALE 3A " = 1 FOOT 'TOOL. SHED II TERN LANDON PLAN F,O, UNDAT I ' z 9 f 3 I MOT SCALE E , N tl N F V A f • � � j K-722 r , Qu V • EARTH ' 3 � F � 4 v 1 L L + G� lflo p J 0 Q a JOHN F AYLMEK . r 119 TERN LANE •} , CENTERVILLE MA. • • �. P 71 di 0 r G