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HomeMy WebLinkAbout0088 HIGH STREET �� �h s�. -- �IMME Town of Barnstable Permit# p Expires 6 months from issue 11 e ~' Regulatory,Services Fee aaxtvsrna= MASS9 , Thomas F.Geiler,Director o teA'1°i t; 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 doy 11 Pr ope Address y V 9 ��G l� J"f'�/ZEp�" C ®7 l/l esidentia] . Value of Work 3.0 o Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address j p./ G 141� A-4&AiCA Jr— t LI B opt J7 f ✓��r C o�i�� . Contractor's Name�4 I'l Yl� f (�' f l Telephone Number me Improvemen ontractor Lic nse#(if applicable) �_ �, Cons 'on Supervisor's License#(if applicable). ���� y��� �.� - ® Il. orkntan's Compensation Insurance; q Check on OCT 31 201 I a sole proprietor TOWN nn'' pp- Dp pp�cc❑ am the Homeowner T®VUIU ®F l7Afl1U�7TA�� I have Worker's Compensation_Insurance Insurance Company Name. f O t /"'�}-T e CL.. Workman's Comp.Policy# g11 C-(, rPO T 0 j �' T. I l 3:r1- Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) 7 ❑ 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-" - r_ - - �."`——#of doors - Replacement Windows/doors/sliders.U-Value G s.2 (maximum.35)#of windows. �_ *Where required: Issuance of this permit does not exempt compliance with other town department regulations,Le.Historic,Conservation;etc. ***Note Property Owner must sign Property Owner Letter of Permission. copy of the Home L provement tractors License&Construction Supervisors License is equ' SIGNATURE: C:\Users\decollik\A ta\Local\Micrbsoft\Windows\Temporary Internet Files\Content.Oudook\DDV87AAZTMRESS.doc Revised 072110 The Commonwealth of Massac h usetts Department of IndustrialAccidents Office of Investigations ' a I Congress Street,Suite 100 e` Boston,MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/OrganizationAndividual): Capizzi Home Improvement Inc . Address: 1645 Newtown Road City/State/Zip:Cotuit, MA 02635 Phone#:508-428-9518 Are you an employer? Check the appropriate box: Type of project(required): 1.❑E I am a employer with 40+ 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the.sub-contractors 6. ❑New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8, ❑ Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance. # 9. ❑ Building addition 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. ' right of exemption MGL Y �o workers comp. per 12.❑0.Roof repairs insurance required.] t c. 152, §1(4),and we have no 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. XContractors 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:Associated Employers Insurance Co. Policy#or Self-ins.-Lic. #:WCC50050105472013A Expiration Date: 12-25-2014. ' Job Site Address: f�`ryl f� City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify (14 der the a''s and penalties ofperjury that the information provided above is true and correct Signature: l Date: j 613 /L7 Phone#: 508-428-951 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: ,t Page 7 of 7 Capizzi Home Improvement Inc. Specifications and Estimates STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLE'IF OR A BUILDING PERMIT LeG/a- A, OWN THE PROPERTY LOCATED AT IN , MASSACHUSETTS. I HAVE AUTHORIZED CAPIZZI HOME IMPROVEMENT TO ACT AS MY AGENT TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR,THE MASSACHUSETTS STATE BUILDING CODE. - I GIVE MY PERMISSION TO LESSEE TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE: SIGNATURE OF OWNER: ���1(.!C,� �-06 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: (;VZe rp11.-)aanm1erclf11 n�C�/�laJtac�ccfe : ffice of Consumer Affairs&Business Regulation ]License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation Registration: 100740 T Ype. Park 10 l[Dr9c Plaza-Suite 5170 Expiration: 6/23/2016 Supplement Card ' Boston,MA 02116 CAPIZZI HOME IMPROVEMENT,INC. JOHN S'TRUMSKI 1645 Newton Rd. ga � _. Cotuit, MA 02635 Undersecretary Not valid without signature o D Massachusetts -Department of Public Safety Board of Building Regulations and Standards i Construction Supers isoj' License: " C 64817 I >t®]EIN T STRUM« I IS AIC.g➢)N A`l T r ;Z if mairds Bay MIA OAh t . Expiration I - Commissioner 06/96/2096 I CAPIHOM-01 APELL ACORO� DATE(MMIODIYYYY) k*�-- CERTIFICATE OF LIABILITY INSURANCE F6/4/2014 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 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 8:Gray Insurance Agency,Inc. PHONE FAX 434 Rte 134 fAIC,N Fi : (A/C.No):(877)816-2156 South Dennis,MA 02660 E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIL i INSURER A:Main Street America Assurance Co. INSURED INSURER e:Associated Employers Insurance Co. 11104 Capri Home Improvement,Inc. INSURER c: Capri Enterprises,Inc. 1645 Newtown Road INSURER°' Cotuit,MA 02635 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDLSUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER (MMIDDrifym IMMIDDryYyy) LIMITS A X COMMERCIAL GENERALLIABILr1Y EACH OCCURRENCE $ 1,000,00 CLAIMS-MADE FXI OCCUR MPBII 75H 06108=14 061111M15 PREMI GE O RE ED 500,004 'ES a occurrence $ , MED EXP(Any one person) $ 10,0 PERSONAL&ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,004 POLICY �d � Fk]LOC PRODUCTS-COMPIOPAGG $ 2,000,0 OTHER: $ AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT $ a acciderd A ANY AUTO Mi M28044 06/08/2014 06/08/2015 BODILY INJURY(Per person) $ ALL OWNED rx SCHEDULED - BODILY INJURY(Per accident) $ 500 0AUTOS AUTOS X NON-0NMED PROPERTY DAMAGE $ HIREDAUTOSAUTOS (Per accident) X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,00 A EXCESS LIAB CLAIMS-MADE CUB1076H 06/011/2014 06/0=015 AGGREGATE $ DED I X I RETENTION$ '10,000 Pers 8r Adv Inj $ 5,000,00 WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILTrY STATUTE ER YIN B ANY PROPRIETORIPARTNERIEXECUTIVE CC50050106472013A 12/26/2013 1=5/2014 E.L EACH ACCIDENT $ 1,000,00 OFFICERIMEMBER EXCLUDED? N❑N I A (Mandatary in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Scbedude,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Barnstable THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis,MA 02601-0000 AUTHORED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD I i� Town of Barnstable *Permit# W1 O T® ZOGB Expires 6 months from issue date Regulatory Services Fee [iA MASS' Srq�L , .Thomas F.Geiler,Director 7 MASS. Building Division 6-7 FD MAC Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not!Valid without Red X-Press Imprint Map/parcel Number c)3(� 0"l� Property Address � � Lr ��{J Lfl. 'Residential Value of Work A®Q, Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address (Y� Contractor's Name_ (�'a� y7_, NUM (Y�,i� \ t��t Telephone Number-1 Home Improvement Contractor License#(if applicable) � ��� 'QWorkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name (1(1'm Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. 4• Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side Replacement Windows/doors/sliders. U-Value (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License is required. SIGNATURE: Q:Forms:buildingpennits/express Revised 123107 The Commonwealth of Massachusetts Department of Industrial Accidents x W Office of Investigations a' 600 Washington,Street �< Boston,MA 02111 wN ,.�'y www,mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers AAplicantInformation Please Print Legibl.Y Name(Business/Organization/Individual): c2piZZl Address: 1645 Newtown Road Cotut , MA 026 City/State/Zip: rel. 428-95181 p#Rg6 ,5060 Are you an employer? Check the appropriate box: :Ty7R-Rernodeling f project(required):. I am a employer with( 4. I am a general contractor and I New constructionemployees(full and/or part-time).* have hired the sub-contractors listed on the'attached sheet. 2.(7 I am a'sole proprietor or partner- These sub-contractors have ship and have no employees 8. ❑Demolition employees and have workers' working for me in any capacity. 9. ❑Building addition comp, insurance.$ [No workers comp,insurance 10. Blectcical repairs or additions required.] 5. ❑ We are a corporation and its ainsurance. ❑ I am a homeowner doing ell workofficers have exercised their 11.❑Plumbing repairs or additions[No workers' comp. right of exemption per MOL 12,0 Roof repairs required.]t c. 152, §1(4), and we have no 13.❑ Other 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 anew 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. Iam an employer that is providing workers'compensation insurance for my employees. Below is.thepolicy and job site information. Insurance Company Name: — Policy#or Self-ins.Lic,#: �JC li>�l -�D��� Expiration Date' lob Site Address: SS1 City/State/Zip Attach a copy of the workers' compensation policy declaration page'(showing the policy number and expiration date). Failure.to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK,ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investi ations of the DIA for insurance coverage verification. I-do hereby certify under the pains.and penalties o information provided above is true and correct. Si afore: Date: — Phone#: Official use only. Do not wriMns 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#: g1W Board o ui in e ulaQns Fan�t g grds One Ashburton Place - Room 1301 Boston, Mass-a,�chusetts 02108 Construction 'Supervisor License ,a2k -r License CS: 57032 _v...... Restriction: 00 wr k Birthdate: 9/26/1963 M * t _ i Expiration: 9/26/2009 Tr# 3801 a� THOMAS X CAPIZZI JR I --- 1645 NEWTOWN RD COTU IT, MA 02635 Update Address and return card.Mark reason for change Address 0 Renewal [� Lost Card DPS-CAI Co 50M-05/06-PC8490 k ✓ --- . anzmooua n .��r ./ivae/�6 a Board of Buddin} Reguiatfo c and Standards a Construction.Supervisor License Lic n CS 57032 mix F �as Birthdate 9/26/1.963 i'Mr 1 i y Fri itd0n `9/2�12009 Tr/f 3801ul f ` i fT THOMAS X CAPIf i. i 1645 NEWTOWN R•r,,, - COTUIT,MA 02635 Commissioner: � ✓/� Gom�ir.om,�.uea�! o�✓l2aaaacluaeCla Board of Building Regulations and Standards License or registration valid for individul use only - HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registrtioris 100740 Board of Building Regulations and Standards Ex iration One Ashburton Place Rm 1301 P 6%23/2010 Tr# 267955 tTyg6. Private Corporation Boston,Ma.02108 CAPIZZI HOME IMPROVEMENT;INC. Thomas Capizzi it 1645 Newton Rd ,Cotuit,MA 02635 Administrator Not valid without signatu e Page 7 of 7 CAPIZZI HOME IMPROVEMENT INC. SPECIFICATIONS AND ESTIMATES STATE OF MASSACHUSETTS _ LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT vhec OWN THE PROPERTY LOCATED AT 577 IN L y/ cz/ 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 PETACCO ANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. SIGNATURE OF OWNER: , OWNER'S ADDRESS: OWNER'S TELEPHONE: Z—6', ��S LESSEE'S SIGNATURE: LESSEE'S ADDRESS: LESSEE'S TELEPHONE: APLLICANT'S SIGNATURE: APPLICANT'S ADDRESS: 1645 Newtown Rd., Cotuit, MA 02635 APPLICANT'S TELEPHONE: 508-428-9518 RESPONSIBLE OFFICER: RESPONSIBLE OFFICER ADDRESS: RESPONSIBLE OFFICER TELEPHONE: Client#: 47298 CAPIHOM ACORD,. CERTIFICATE OF LIABILITY INSURANCE osi12/2008 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Rogers&Gray Ins. -So. Dennis ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 434 Route 134 I HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O.Box 1601 South Dennis,MA 02660-1601 INSURERS AFFORDING COVERAGE NAIC# INSURED NsuRER A: NGM Insurance Company Capizzi Home Improvement, Inc. INSURER s. American Home Assurance Capizzi Enterprises, Inc. - INSURER C: 1645 Newtown Road INSURER G: COtuit,MA 02635 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. P EFFECTIVE POLICY EXPIRATION LTR NSR OLICY TYPE OF INSURANCE POLICY NUMBER DATE MMIDD/YY DATE(MMIDD/YY LIMITS A GENERAL LIABILITY MPB1075H 06/08/08 06/08/09 EACH OCCURRENCE $1 000 000 DAA X COMMERCIAL GENERAL LIABILITY I P FMMGISE S �cTO RENTED r S500 000 CLAIMS MADE D OCCUR I I I MED EXP(Any one person) $1 O 000 PERSONAL&ADV INJURY $1 000 000 GENERAL.AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER'. i PRODUCTS-COMP/OPAGG $2 000 000 POLICY PE LCC - AUTOMOBILE LIABILITY I COMBINED SINGLE LIMIT' ANY AUTO .(Ea accident) I$ ALL OWNED AUTOS I I - I BODILY iNJURY $ SCHEDULED AUTOS I i I(Per person) - HIRED AUTOS P.CUIl.YINJURY f I maenl) $a Per NON-OWNED AUTOS ( I I I . --i - PROPERTY DAMAGE - $ . (Per acodenl) GARAGE LIABILITY I- - - - ! i AUTO ONLY-EA ACCIDENT $ ANY AUTO I I OTHER EA ACC $ THAN AUTO ONLY AGG $ A EXCESS/UMBRELLA LIABILITY ICUB1076H .06/08/08 06/08/09 EACH OCCURRENCE $5 000 000 j X OCCUR CLAIMS MADE IGGREGATE $5 000 000 I $ DEDUCTIBLE X RETENTION $10000 i I -- B WORKERS COMPENSATION AND I WC671 6562 1.12/25/07 12/25/08 _X TWC STATU- I ER OTH- EMPLOYERS'LIABILITY , IT ANY PROPRIETOR/PARTNER/EXECUTIVE E.L..EACH ACCIDENT s500,000 OFFICER/MEMBER EXCLUDED? I E.L DISEASE-EA EMPLOYEE $500,000 If yes,describe under SPECIAL PROVISIONS below i - ,E.L.DISEASE-POLICY LIMIT $500,000 OTHER I `1 DESCRIPTION OF OPERATIONS I:LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Carpentry 1 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Town of Barnstable DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL ) DAYS WRITTEN 200 Main Street NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Hyannis, MA 02601 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES, AUTHORIZED REPRESENTATIVE ACORD 25(2001/08)1 of 2 #S36540/M36539 KW © ACORD CORPORATION 1988 I �TMETpy Town of Barnstable U P� *Permit# �S,��{. 1 LVIres 6 months from Issue date BMWStABM i Regulatory Services 9 Fee 1 `0�' Thomas F.Geiler,Director plf0 MA'S� Building Division Tom Perry, Building Commissioner ►ffice.: 508-862-4038 1200 Main Street Hyannis,MA 02601 aSC .b ax! 508-790-6230 JUL EXPRESS PERMIT APPLICATION RESIDENTI AL Not Valid without Red X-Press Imprint ,ONLY Not parcel Number 013 orty Address s {— .esidential Value of Work Minimum fee of-$25.00 for work under$6000.00 er's Name&Address MA aaco 3.5 ractor.'s Name. . Telephone Number D ��" �►� Le Improvement Contractor License#(if applicable)_ w3-7 L� of ftruction Supervisor's License#(if applicable) 02(p3 aS torkman's Compensation Insurance Check one:' ❑ I am asole proprietor I am the Homeowner -I have Worker's Compensation Insurance rance Company Name ;ktnan's Comp.Policy#_ Q�C� `) (3-('l� n ry of Insurance Compliance Certificate must be on file. nit Request(check box) r ,&Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing.layers of roof) ❑ Re-side ❑ Replacement Windows. U-Value (maximum.44) 'Where required: Issuance of this permit does not exempt compliance with other.town department regulations.i.e.Historic.Conservation.etc. ***Note: Property Owner must sign P.roperty'Owner Letter of Permission. Home Improvem t Contractors License is required nature )rMs:Wrntrg ise063004 The Commonwealth of Massachusetts Department of Industrial Accidents ;4 '-`' Office ofinresUffatinas . = t i500 Washington Street Boston,Mass. 02111 Workers' Com ensation Insurance Affidavit name Le r location: OF- Mh S city % phone# ❑ I am a homeowner performing all work myself. ❑ I am a sole propr'etor and have no one workin in any capacity V/////%%%%%%%/%/%% :com :::::>iii!:`v:vi±ii:•i:iirii:•::•i.i::>��iii :•::.•::is iY•::':li::..Y.:::v;:•:::... .:::. ::4::{:,{:. j{ F `�dris a p ynsurance'co.':..:•::;:::.. ..::..:<�;:;>.>.::>::::>>:r:::;:;ss:::::��:;>:<::� oltcv#•:".:/ 0111111111 011 01111 / ❑ I am a sole proprietor, general contractor, or homeowner(circle one) and have hired the contractors listed below who have the following workers' compensation polices: '`nine com v p .......................................,..........::.:::::::.:::::.:::.::... airy" r ........... .......................................... .:..::::..:...................:•::.�:...:...............,........................ .....a.... ................ ................................................................. . . ...........................................................................:..::::::•::::..•::•.: ..............,•::r:•:;::::•:•;;•:.:..;:.• :^>.v..r:' :::�' ............. ...... .. ::::::::::::::.::::.::..::::::::::::::::::.::::.:.:.:::::;;;.;:.:::<.;,:.:.;:.;;':..;•.;':/�,�l//%/%%lam/ c an ;ram address ::;:::•.::.:::::. 'tiEiAn ?:J:v:•::.�::::::::::::::•::::.�:.�}:ii^:^i:•:i::•iii:•±:ii•'r:iti•is•Y+F•ii>i?i}::i:>:::':ii.`i;iif•::•iii{1.:;:$::::i:�<•'.SS�:i;:i}Y.•i:ii:i':}?iii::}ii:: artsn.rance.co.:. :....... ,:. ,. ,._ ,...:..............................: ....... . i .:: Failure to secure coverage as required smder'Section 25A of MGL 1S2 can lead to the tmposittoa of aiminal penalties ota tine up to 51,500.00 and/or one years'imprisonment as well as dsfl penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification I do hereby certify under the pains and penalties of perjury that the information provided above is tau.-and correct Signature Date £� Print name Phone oMCW use only do not write in this area to be completed by city or town ofncisd city or town: permit/license# - ❑Building Department ❑Licensing Board ❑checkif immediate response is required ❑Selectmen's Office OHealth Department contact person: phone#; ❑Other 0cmed 9195 P]!a �oY 1E Town of Barnstable y Regulatory Services snaHMBLE,XAM _ Thomas F.Geiler,Director 10 6:19. a Building Division Tom Perry, Building Commissioner 200 Main Street, 7:iyannis,MA 02601 www.town.barnstable;maxs Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Comple e and Sign This Section If Using ABuilder / as Owner of the subject e I, `�o�w� e S �CL a i r lect property � P P riY hereby authorize. Pam 1 [�G7 ec4 k,-J+ .�0-r, S to act on mybehalf, in all matters relative to work authorized by this building permit application for, (Addr6ss of Job) )Znat=ure of Owner \ amp �-CIn; r Print Name O:FORM&OWNERPEPIMSION Y fie Board of Building g Re ulatfons an tan ar s One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvement i.Contractor Registration Registration: 103714 Type: Private Corporation I Expiration: 7/9/2006 PAUL J. CAZEAULT & SONS, INC ; Paul Cazeault ' 1031 MAIN ST ` OSTERVILLE, MA 02658 Update Address and return card.Mark reason for chang DP8-CAI 0 50M•04/04•G1012/6 Address Renewal Employment Lost Card �ItC �001fn)LOJL(lICCLGUL 0�✓[�LQCdCLGKIGPu4 .+a Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR License or registration valid for individill use an IN Rogistratlom. 103714 before the expiration dale. If found rclurn to: Expiration::7192006 BmIrd of Building Regulaliuus and St-andards Uuc Ashburton Place Rin 1301 Jype ` Private Corporation liu,lou, NIa.i12108 PAUL J.CAZEAULT;B,.SONS,.INC'. Paul Cazeault 1031 MAIN ST OSTERVILLE,MA 02658 ""/ ✓�i. o�iireo>c,ue� 1. /�, 'uJlu���tJe�d Administrator t`'lit BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 026325 Birthdate: 10/20/1959 Expires: 10/20/2005 Tr,no: 8603.0 Restricted: 00 PAUL J CAZEAULT _ 1031 MAIN ST OSTERVILLE, MA 02655 � Administrator 07-1 A& Board of Building eqqulation- One Ashburton Place, Ism 1301 Boston, Ma 02108-1618 License: CONSTRUCTION SUPERVISOR LICENSE Birthdate: 10/20/1959 Number: CS 026325 Expires: 10/20/2005 Restricted To: 00 PAULJ CAZEAULT 1031 MAIN ST OSTERVILLE, MA 02655 " ------------- Tr.no: 8603.0 ' Keep top for receipt and channp nf neie4,— r� ACOR CERTIFICATE OF LIABILITY INSURANCE DATE(MM,°Dm, .[rx 9004 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION McShea Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE- CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 749 Main Street, Suite#H ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Osterville, Ma. 02655 508-420-9011 INSURERS AFFORDING COVERAGE INSURED Paul J CaZeault & Sons INSURER A: r s of London Roofing Inc. INSURER B: Traveler's 1031 Main Street INSURERC: Osterville, Ma 02655 INSURERD: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE POLICY NUMBER DA MMFDDC/YY TE E PDATE YMMPDD/YYI LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000 ,000 x. COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Any one fire) $ CLAIMS MADE OCCUR MED EXP(Any one person) $ LGL0.34776 04/30/04 04/30/05 PERSONAL&ADV INJURY $ GENERAL AGGREGATE $2,000 ,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000 ,000 POLICY 7 PRO- JECT LOC AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ - (Ea accident) ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY $ (Per person) HIRED AUTOS NON-OWNED AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ LEDEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND f� W AT - TH- EMPLOYERS'LIABILITY fJ TORY LIMITS ER 7PJUB-0095664A04 08/13/04 08/10/05 E.L.EACH ACCIDENT B $ IE.L.DISEASE-EA EMPLOYEE $i OTHER. E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER ADDITIONAL INSURED;INSURER LETTER: CANCELLATION , SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 1Q— DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. _ AUTHORI7RE"41'-,N4'AT11'17�'ACORD 25-S(7/97) 0 ACORD CORPORATION 1988 Glientl;: 1 JJ69 ZGAZEAULI NA ACORD. CERTIFICATE OF LIABILITY INSURANCE 05/DAT09/05Dmm c ODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION owling & O' Neil Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE gency HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 22 West Main St. PO Box 1990 ALTER THE COVERAGE AFFORDED BY THE POLICIES-BELOW.. yannis, MA 02601 INSURERS AFFORDING COVERAGE NAIC# SURED INSURERA: Western World Paul J. Cazeault&Sons Roofing, Inc. 1031 Main Street INSURER B: INSURER C: Osterville, MA 02655 INSURER D: INSURER E: OVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. R NSR TYPE OF INSURANCE POLICY NUMBER. POLICY EFFECTIVE POLICY EXPIRATION DATE MM/DD/YY DATE MM DD LIMITS GENERAL LIABILITY NPP925580 04/30/05 04/30/06 EACH OCCURRENCE $1 000 000 X COMMERCIAL GENERAL LIABILITY DAMAREMGE TO RENTED $50 000 ccurrancel CLAIMS MADE F_X1 OCCUR MED EXP(Any one person) $2 500 X BI/PD Ded:1,000 PERSONAL&ADV INJURY $1 000 000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $1 OOO OOO POLICY PRO- JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS $. SCHEDULED AUTOS BODILY INJURY(Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND I TWO STATU- OTH. EMPLOYERS'LIABILITYI. ANY PROPRIETOR/PARTNEWEXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? It yes,describe under E.L.DISEASE-EA EMPLOYEE $ SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $. OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Operations performed by the named insured subject to policy conditions and exclusions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Paul J.Cazeault&Sons DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL I Q DAYS WRITTEN Roofing,lnc. NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL 1031 Main Street IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Osterville, MA 02655 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE -07 C_ ACORD 25(2001/08)1 of 2 #M38166 LS1 © ACORD CORPORATION 1988 • 7' tM" Y TOWN OF BARNSTABLE BUILDING DEPARTMENT . a HOMEOWNER LICENSE E$EMPZ'ION =h' Please print- DATE JOB LOCATION All" C4 Number reet Address Section Of Town "HOMEOWNER" Name Home Phone Work Phone PRESENT MAILING. ADDRESS. P0. Q dh;' City/Town State -_ Zip Code The current exemption for "homeowners" was extended to include owner- occupied dwellincs of six units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided the owner' acts as supervisor. that DEF IN ZT ' ION OF HOME0Emp Person(a J ha oc:-ns a,parcel: of land on 'which he/she `resides or intends to reside•; on"which there is, or is intended to be, a one to six 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 *+erfo-mpd uncle-- the buiidinc pernit. (Section 109.1.1) The undersicned "horeo:.-ner" assumes .responsibility for compliance with the State Buildinc Code and other applicable codes, regulations. . by-laws, rules and They' un`dersicned{:;"hopeowne. ;�- ' '••- :, To j'�, ertifies that he/she understands `the �.-n of arnstable Eu lGing,.Depzrt t m B ninimum inspection req"uirements P Procedures and HOi�.EOF�'FtER' G'; TUFE : APPROVFj 'OF EUILDI2.G _F I7-.L Note: Three family dwellings _ . 35,000 cubic feet recu or larger, - will bepyWt State Building Code Section 127.0, Constructicn ,. HOME O?,TNEF,S EXEMPON The code states that: 'Any Home Owner performing work permit is required shall be exempt from the for which a btx:i;lci3ng (Section. 109.1.1 - Licensing Of ConstructionpSuvisions of this secti®ni ; ' Home Owner engages a person(sJ for hue to do such wo�ks)' provided that if' Owner shall act as supervisor.•': • . that such Rome . ;:Many Home'•Owners who use this exemption the responsibilities of a supervrsee Appendix unaware that they are umiiag for Licensing Construction Supervisors, Section Z,1Of Rules and Re awareness often. results in Sup rus Regulations problems J ' T s lack .o� Owner hires unlicensed • part. when the H®ffie persons. In this case our against the unlicensed person as it would with lic Bo ensed cannot an of proceed Rome Owner acting as supervisor is ultimately responsed supervisor. . The e. To' ensure that the Home Owner is fully aware of his/her res many communities require, as ponsibilities, Owner certify that he/she understands the responsibilities of he permit application, that the Home On the last page of this issue is a form currently used b a supervisor. You may care to amend and adopt such a form/certification for use ial towns community. n your i THE LOFT POST & BEAM GARDEN SHED EVE AND CONSTRUCTION Iyanough :Road " Hyann i s, `MA 02501 ti FRAME - ALL LUMBER TO BE FULL DIMENSIONAL PINE 2 X 6 FLOOR JOISTS, RAFTERS, COLLAR TIES @ 24" O.C. 4 X 4 CORN ER POSTS 2 X 4 STUDS AND PURLINS 1X VARIOUS WIDTH DECK, ROOF BOARDS & SIDING ALL VERTICAL SIDING TO HAVE 112" X 2" BATTONS @ SEAMS OTHER SPECS ' '`' •• ' SOLID CONCRETE BLOCK FOOTINGS (POURED WHERE REQUIRED) ALUMINUM GABLE •VENTS ALUMINUM PLINTH POST FEET i ASPHALT ROOF SHINGLES., UNLESS OTHERWISE SPECIFIED 1 X 8 RAKE BOARDS; 1 X 6 FACIA; 6" TEE HINGES; LOCKING HASP • ALL HEIGHT DIMENSIONS APPROXIMATE ZZ v• a 7T 4,4 • �} �f tit .. {n Assessor's office(1st Floor): Asses'sor's map and lot numb t 'O.3 _�� Poi TMc iro`` Conservation(4th Floor): �����LL�i� MUST BE do Board of Health(3rd floo N COMPLIA t sea»rant,t Sewage Permit number f WITIj TITLE NCErb 9- Engineering Department(3rd floor). ENVIRONMENTAL ����� na��� ,t0 Yet`. House number Definitive Plan Approved by Planning Board 19 �i APPLICATIONS PROCESSE 8:30-9:30 AM an 1:00-2:00 .M.only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO Ck f s� TYPE OF CONSTRUCTION Apr,.)r,.) 19� TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for ar permit according to the following information: / Location �T iCh /11/ Proposed Use STo ra Zoning District Fire District C—G 716 Name of OwnerV Avg 1 °s r�a� ���c�i r Address U Name of Builder PLa `Stv',A r }r" Address 020 Name of Architect Address Number of Rooms Foundation 'orC..kC Exterior Roofing Floors Interior Heating Plumbing Fireplace Approximate Cost G� Area Diagram of Lot and Building with Dimensions Fee ��� l� i gv-P r r)ore OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnst regarding the above construction. Name C ruction Si ipervisor's License _ l LeCLAIR; JAMES & BARBARA .,. , f No 136629 permit For BUILD SHED ; Accessory to Dwelling Location 88 High Street ' . i 9 COtliit Owner] James & .Barbara LeClair ; Type of Construction Frame Plot Lot Permit Granted April 19 , 19; 94 Date of Inspection: , ` - Frame 19 ' Insulation 19 4 t T j Fireplace 19 Date- ompleted" - 19 Tt • 1 ! t _ - t