Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0651 MAIN STREET (COTUIT)
1 I, l I, _ 91 i 4'i L Edo 11- 30-17, a lid Town of BarnstIse le Permit j� F tres S months from fssue dale 01, Regulatory Servi • Fee KAM a Richard V.Scan,Director zes�. NOV�/3 Bu lding DivislIRL4 .� Z®1j Paul Roma,Building Commissioder Ok 200 Main Street,Hyannis,MA 02601 � /� ' ww°w.towm.barnstable.ma.us Office: 508-862-4038 Fax:508-790-6230 EXPRESS PERMIT APPLICATION -, RESIDENTIAL ONLY ®/9 Not Valld without Red X-Proms hapint Map/pa rcei Ntunber Property Address d Residential Value of Work$ Minimum fee of$35.00 for work under$6000.00 Owmer's Name&Address AFHd y 7ACXJ aM G 67 /YAAV J f' e'v raAj, "A O Contractor's Name C a/'%Ut #044. rMyg#t MIV •CAI'- Telephone Number Home Improvement Contractor License#(if applicable) Email: CxH,V- °. Construction Supervisor's License#(if applicable) Wworkman's Compensation insurance Check one: ❑ I am a sole proprietor . ❑ I am the Homeowner FYI have Worker's Compensation Insurance Insurance Company Name �' �UAd p ZNJ• `/Krq ttI y Workman's Comp.Policy _ .w G 7� M___�__._.._.__.....: --- _----____-. Copy of Insurance Compliance Certificate must accompany each permit. Permit Rcgi/st(check box) [�r'Re-roof(hurricane nailed)(stri tng old shingles) All construction debris will be taken to �� /d�d✓� '. CGs�,�1'Nlt�cl E.AAjtoMa✓K �' Aemovoan ❑Re-roof(hurricane nailed)(not stripping. Going over __ existing layers of root ❑ Re-side [Replacement Windows/doors/sliders.U-Value "�6 (maximum.32)#of windows � ���vx #of doors: *Altere required: Issuance of this perniit does not exempt compliance with other toy+n department regulations.i.e.Historic.Conservation etc. ***vote:.. Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is >. requi ed. SIGNATURE: C:!Users�decuilik'Appllata;Local%Microsoft;WindoivskiNetCache%Content.OutlooktL7U69LF2'tEXPRESS(2).doc 01 r_5/17 .t Page 7 of 7 Capizzi Home Improvement Inc. Specifications and Estimates STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT I/WE, "U Sctq , OWN THE PROPERTY LOCATED AT IN MASSACHUSETTS. 7—`7 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 ACC RDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING COD . SIGNATURE OF OWNER: `-- � ll 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: ne com wxwed*©filonch as DepartmentOfhmu Act ons r _ BOstOu, :VIA 8Z111 www. on Rork rs'Campensatlon Insurance A vft:Bafiders(C n CAPIZZI HOME IMPROVEMEN C INC 1 N€WTOWN ROAD phone#: g.42B.9548 �• % . COTU of t� Are�roa� Cbecktba aPlAwrim b N . 4. I am ageaera3 rasdl & New ism a amp `with , bked the 7. Remodefg 6.cmurqyees�8�llmultor a�• an tw armed shot. WM 2. I sm a.solepzd O'er Them stib-oomracnors bave g. Dema spd3 �+ P � mployeas and have worms 9. gaftwm 1©. g��irs or a wo a� g, We are a Owpcsudon and fS I boo�� M S or additiams 3. ismaha�w� gallwork 0f onparM(1L 12.v✓ Eoofraplils jNo wader WMP• a.152,1l(4),and we have no 13.✓Other bomme mvih&l �,:[N0 wart ms d !AM. 8 belawsh °LOW Y�; gg�ilvaadth�tcu�fde � thossehave 1 ana �0�agtiie �r�evvhatbe�' �aploy+ees,lftba ' °Ba�C wot oo p.1� ' ; jo b oft Name: AMOUARD INSURANCE COMPANY R2WCT758 ��. l2jM2D17 Job SitsAd / �'� + � pona� ( g�poiicy nnm�r� - s:'Cq B Ww 25AafMGL o.152 cm lead �� p�i�"ofa Pam + ed-wderent,as well as civil peciaMa inihe fmm of a STOP WORK ORDF��a Sne .� a fltu�upt� ,�D OQa�one�yt�r.� be��y�►�te 0tiice afvp b6 S2g aj Y tlna vines Be adv� a 'oftlds sta�am�ntmal+ �rtb� p a l r l 517 r 7 h .. .. .... 0r W m 177777777, 'pare � t1Vl�ia� i"�►lfrca►I�P�ted bj'+�y' permit(Lieense C ar °` 3,f tylTowa CM* 4.UghftI ftPww p bsp"*r b:otbr T%one� �,tactpet+eau: a , ® DATE(MMIDDiYYYY) A��v CERTIFICATE OF LIABILITY INSURANCE 12/30/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THiS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the poticy(les)must be endorsed. if SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements). " PRODUCER CONTACT Rogers and GrayProcessin ROGERS&GRAY INSURANCE AGENCY INC PHONE 508 398-7980 Farc Ne: E-MAIE ; mail@mgersgray.com 434 ROUTE 134 INSu 3 AFFORDING COVERAGE NAIL# SOUTH DENNIS MA 02660 INSURER A. AMOUARD INSURANCE CO 42390 INSURED INSURERS: CAPIZZI HOME IMPROVEMENT INC INSURER C: INSURER D: 1645 NEWTOWN ROAD INSURERE: COTUIT MA 02635 INSURERF: COVERAGES CERTIFICATE NUMBER: 114654 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE I LSUBR: POLICYNUMBER PO1DDNYV POMroO EXP LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCEDAMAGE TO RENTED $ CLAIMS-MADE 7 OCCUR PREMISES aoccu ce1 $ MED EXP(Any one persm) $ NIA PERSONAL&ADV INJURY $ GEML AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY JET ❑LOC PRODUCTS-COMP/OP AGG $ $ OTHER: TOMOBILELIABILITY COMBINEDrill LE MIT $ AU as enter, ANY AUTO BODILY INJURY(Per person) $ ALL LLOS 1ED ACHODSULED wA BODILY INJURY(Peracddent) $ NON-OWNED PROPERTY DAMAGE $ HIREDAUTOS AUTOS a acdd t I I $ UMBREIJJL LIAB OCCUR EACH OCCURRENCE $ EXCESS IJAB CLAIMS-MADE NIA AGGREGATE $ DED ETENT 0 $ WORKERSCOMPENSATiON X PERM ER AND EMPLOYERS'LIABILITY ANYPROPRIETORIPARTNERIEXECUTIVE YIN E.L.EACH ACCIDENT $ 1,000,000 A OFFICERtmEMBEREXCLUDED7 NIA NIA NIA R2WC775326 12i2612016 12/25/2017(Mandatory in NH) EL.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,dasaibeunder DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 N/A DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the Issue date of this certificate of Insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/lwd/workers-compensatfonfinvestgations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN TOWII Of BamStable ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street AUTHORIZED REPRESENTATIVE c Hyannis MA 02601 Daniel M.Crcyey,CPCU,Vice President—Residual Market—WCRIBMA ®1988-2014 ACORD CORPORATION. All rights reserved. ACORD 26(2014101) The ACORD name and logo are registered marks of ACORD , 4 ors �>J/rr. Y:c,�xr�rn.rruc�rll%r f n(lrr.;.rnrr i; Massachusetts Department of Public Safety ~ —' ficeofConsuatpr�ffnirs!!:$resflasessltegalaEioi Board-of Building Regulations and Standardsjg OME FNiPROVEMENYCONTi2ACTOR License: CS-064817 •' �Re Registration:Construction Supervisor ~' �; �?. 9 lion: 100740 TO Expiration: men JOHN T STRUMSKI i,i' CAPIZZI HOME IMPROVEMENT,INC. Suppleen ' 18 ALDEN AVE i BUZZARDS BAY MA 026321 . JOHN STRUMSKI j 1645 Newton Rd. Cotuit,MA 02635 • Undersecretary (�,,,vK �r Expiration: �. � - Commissioner 06/.18/2018: -•.L-. _ :es9-lkfl(%ap of aW use group which as 4M 35,000 Cubic a ('99Irans) assess a currerreedilion of the liliassachusetts 9 We 14 cwse for ra voraion of this license, ing info,oration visii:: WWW.Masssoviop5 License or registration valid for individual use only before the expiration slate. If found retina to, Office of consumer Aftairs and Business Regulation 10 Park Plaza-Suite 5170 Boston,MA 02116 " Not valid without signature � � � 1311w Town of Barnstable 'Permit#30 / ckiVcS 'b Expires 6 mouths from issue date y ®� Regulatory Services Fee a RAxxsTABLE. * . MASS' m� Thomas F.Geiler,Director a63q• �� �gD N1p'l� Building Division Tom Perry,CBO, Building Commissioner A-PRESS PERMIT 200 Main Street,Hyannis,MA 02601 OCT 2 2 2014 www.town.bamstable.ma.us Office: 508-862-4038 � �LE EXPRESS PERMIT APPI,ICATI®I� e RESIDE1T � Not Valid without Red%Press Imprint Map/parcel Number 0 a y Property Address Residential Value of Work .� - Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address 14 z gr5 e n - BA9,64n4 IA' Crf 014 PO 60�' Y'Ol Co va , Nq 612 63 ✓ut�1 N� (J U c Telephone Contractor's Name hone Number p Home Improvement Contractor License#(if applicable)____' G y0 Construction Supervisor's License#(if applicable) NCrkman's Compensation Insurance Check one: ❑ I am a sole proprietor I am the Homeowner I have Worker's Compensation Insurance r i-� —� Insurance Company Name A f J OL(A to d- �Vn l®yo�� • (®/t'I P4AjY Workman's Comp.Policy# W Cc �®t)f o I U 1 / rt' Copy of Insurance Compliance Certificate must accompany each permit. Permit Req st(check box) ��/ �� �� L. �v�jif [VRe-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 ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows ❑ 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. ***Mote: Property Owner must sign Property Owner Letter of Permission. A copy o the Home Improvement Contractors License&`t' ftor=trtfon Supervisors License is SIGNATURE: C:\Users\decollik\Ar \IocaKMicroso indows\ emporaryimeincL,,.es\Content.Outlook\QRE6ZUBN\I' PHI`0 W1 Revised 053012 (A _ Page 7 of 7, Capizzi Home Improvement Inc. Specifications and Estimates /G .d0, iK STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT ge 6 5/ 01a OWN THE PROPERTY LOCATED AT IN MASSACHUSETTS. I HAVE AUTHORIZED CAPIZZI HOME IMPROVEMENT TO ACT AS MY AGENT TO APPLY FORA 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 PqCORDANCEWITH 780 CMR, THE MASSACHUSETTS STATE BUILDING COD SIGNATURE OF OWNER: M 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 a APPLICANT'S TELEPHONE: 508-428-9518 RESPONSIBLE OFFICER:- RESPONSIBLE . OFFICER ADDRESS: RESPONSIBLE OFFICER TELEPHONE: it ' ��e�(iarra7czo�uuecclf�a��a;taacicree�. 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 7 egistration: 100740 Type: 10 Park Plaza-Suite 5170 Expiration: 6/23/2016 Supplement Card Boston,MA 02116 CAPIZZI HOME IMPROVEMENT,INC. j JOHN STRUMSKI - 1645 Newton Rd. 7� — Cotuit, MA 02635 Undersecretary Not valid without signature - Massachusetts -Department of Public Safety Board of Building Regulations and Standards i Construction Supervisor ..License: CS-064817 ; J®ter T S�>M�� r 18 ALDEN AVE 1PUY Buzzard$Bay l*025 Expiration - Commissioner 06/18/2016 i r CAPIHOM-01 APELL ACOR 7' DATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 6/4/2014 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&Gray Insurance Agency,Inc. PHONE FAX 434 Rte 134 A/C No Ext: A/C No):(877)816-2166 South Dennis,MA 02660 EDD ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC 11 INSURER A:Main Street America Assurance Co. INSURED INSURER B:Associated Employers Insurance Co. 11104 Capini Home Improvement,Inc. INSURER C: Capiai Enterprises,Inc. INSURER D: 1645 Newtown Road 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 ADDL SUBR POLICY EFF POLJCY EXP LTR TYPE OF INSURANCE INSO WVD POUCYNUMBER MMfi)DNYYY) (MMIDDNYYYl UNITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS-MADE N OCCUR MPB1075H 06/08/2014 06/08/2015 DAMAG TO RENTED PREMISES a occurrence $ 500,00 MED EXP(Any one person) $, 10,00 >�r PERSONAL&ADV INJURY $ 1,000,00 GEN'L AGGREGATE UMITAPPLIES PER: GENERAL AGGREGATE $ 2,000;00 POLICY JET ®LOC PRODUCTS-COMP/OPAGG $ 2,000,00 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ a accident A ANY AUTO MIM28044 06/08/2014 06/08/2015 BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BODILY INJURY(Per accident) $ 500,00 AUTOS AUTOS �( X NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS e�acaderrt X UMBRELLA LAB X OCCUR EACH OCCURRENCE $ 5,000,00 A EXCESS LIAB CLAIMS-MADE CUB1076H 06/08/2014 06/08/2015 AGGREGATE $ 1 O,000 Pe &Adv Inj 5,000,00DED X WORKERS COMPENSATION X I PER OTH- AND EMPLOYERS'LABILITY STATUTE ER B ANY PROPRIETORIPARTNERIEXECUTIVE Y/N CC50050105472013A - 12/25/2013 12/25/2014 E.L.EACH ACCIDENT $ 1,000,00 OfFICERIMEMBER EXCLUDED? ®NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEd$ 1,000,00 If yes,DESCRIPTION underibe ON OF OPERATIONS below I I E.L.DISEASE-POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) CERTIFICATE HOLDER CANCELLATION r SHOULD ANY OF THE ABOVE DESCRIBED POLICIES-BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED,JN Town of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS. ' 200 Main Street Hyannis,MA02601-0000 <'{ AUTHORED REPRESENTATIVE ' :; '` ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD M The Commonwealth of Massachusetts Department of Industrial Accidents w Office of Investigations 1 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/OrganizatiorAndividual): Capizzi Home Improvement Inc Address: 1645 Newtown Road City/State/Zip:Cotuit, MA 02635 Phone #:508-428-9518 7— Are you an employer. Check the appropriate box. Type of project(required): 40+ 4. I am a general contractor and I 1.Al I am a employer,with � g 6. New construction + . have hired the sub-contractors- ❑ employees(full and/or part-time). b contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling- ship and have no employees These sub-contractors have 8: ❑ Demolition working for me in any capacity. employees and have workers' ❑comp. 9. Buildin addition g [No workers' comp. insurance P• insurance.: required.] 5. ❑ We are a corporation and its . 10.❑ Electrical repairs or additions -_ 3•:❑ I-am-a-homeowner-doing-al-1-•wor'k- - -••ofcers.haye.,exercised_iheir_.,-- self. comp. 11:❑:.P ' bing;repairs•ar-additions m o work ' right of exemption MGL Y � workers' com p. xe on per 12. Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 1.3.❑ Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. TContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the 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: 112-25-2014 Job Site Address: ' '�( City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER.and a.fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify u de t e s a d pe alI of perjury that lite information provided above is true a d correct Signature: Date: ' ?jY Phone#: 508- 28-951 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#: Town of Barnstable *Permit#o Expires 6 months from issue date Regulatory Services Fee Thomas F.Geiler,Director . Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 n, www.town.barnstable.ma.us pV� Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number (�; �o l� / Property Address Residential Value of Work I OOD Minimum fee of$25.00 for work under$6000.00 Address // 2� t /t T f �/�R `'}2�f �i4 C/<f � Owner's Name&Ad BLS " `t o Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance "PSS PERMIT Check one: ❑ I am a sole proprietor JU N 18 2�Q7 I am the Homeowner ❑ I have Worker's Compensation Insurance TOWN OF BARNSTABLE Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit R9quest(check box) Re-roof(stripping old shingles) All construction debris will be taken to /„� a h CN / n'//-or i6 ❑ IV 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 vnth other toy—m-dep.'�ar�t7 tyregulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A op of the Home Improvement Contr 4oi'@ jqnsVoquired. U6 SIGNATURE: GIG o ,4'm Q:Forms:expmtrg Revise061306 P �. The Commonwealth of Massachusetts Department of Industrial Accidents " Office of Investigations _ d 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance.Affidavit: Builders/Contractors/Electricians/Plumbers Apmlicant Information Please Print Legibly NaIIle(Business/Orgaaization/Individual): . Address/ it)(/State/Zip:Z p: Co ry iT h, 026&F Phone.#: Are you an employer? Check the appropriate box: Type of project(required):. 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction . . employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the*attached sheet.b 7. ❑Remodeling These su -contract ha ve ave ship and have no employees 8• ❑Demolition workingfor me in an capacity. employees and have workers' Y P tY• $. 9. ❑Building addition comp.insurance. [No workers' comp.insurance required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions (:3 I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance 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. (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: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure.to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$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 a er the pains and p alties of perjury that the information provided ab -o -ve is true and correct Signature:— , �i Date: v v.v —�) Phone#: Official use only. Do not write in this area,to be completed by city or town ofjicial City or Town: Permit/License# Issuing Authority(circle one): 1.Board of 1Tealth 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees.` Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two.or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an-individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." IvIGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to'operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for.the performance of public work until acceptable evidence of compliance with the inscurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s), address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. 'The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete'and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure.to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary) and under"Job Site Address"the applicant should write"alllocations in (city'or town)."A copy of the affidavit that has been officially stamped or marked by the city or town maybe provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves-etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone-and fax number:. the Commonwealth of Massachusetts Deparb.ent of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. #617-727-4900 ext 406 or 1-877-IAASSAFE Revised 11-22-06 Fax# 617-727-7749 wvvw.mass.gov/dia I oFIKE, Town of Barnstable Regulatory Services BARNSTABLE, : Thomas F.Geiler,Director 94, b9. p Building Division ArFO�� Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print - U/Y P _ ^ _ 'JOB.LOCATION: :"-J / !"//l�l ✓ ��e � � �/� `r number street L_r [village "HOMEOWNER":` /4E2 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 an 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 requiremy _ /// , CSign4_ 4 atiire of_Homeowner 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 109,1.1-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 part 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:homeexempt Assessor's Office(1st floor) Map t a310 Parcel ermit#- / 6 7 1 lz� / . Conservation Office(4th floor)(8:'30-9:30/1:00-2:00) Date Issued Board of Health(3rd floor)(8:15 -9:30/1:00-4:45) Fee: , 0 Engineering'Dept:(3rd floor) House# Planning Dept. (1st or/School Admin.!Bldg.) e: ` '• RNSTAOLE. ` Definitive A pro d by Planning Board 19 e �� TOWN OF BARNSTABLE Building Permit Application Project St ess ���, i✓ �i; Village ;.OwnerA L� :V��G,�Sda�/ ; Address 6 /�/�i,✓c5 ' /✓l-Telephone � S .O� • , �- �.. // Permit Request 08i �rlL/5ff-�'i767?9dr/�' �+=-i�'Ple' G�iS�/.ol NUJ y . First Floor �Sy,�dd�eJe square feet Second Floor square feet c� Estimated Project Cost $ Zoning District Flood Plain Water Protection Lot Size Grandfathered ? Zoning Board of Appeals Authorization Recorded Current Use Proposed Use Construction Type Commercial Residential Dwelling Type: Single Family Two Family Multi-Family Age of Existing Structure Basement Type: Finished Historic House A/p Unfinished Old King's Highway /t/y Number of Baths No.of Bedrooms Total Room Count(not including baths) First Floor Heat Type and Fuel Central Air Fireplaces Garage: Detached Other Detached Structures: Pool Attached Barn None Sheds Other _ Builder Information Name w A�al2l V//L- Telephone Number fJ Address //� r/s W6W7r/WW, FQ ��� /,1 License# Home Improvement Contractor# /0.0 2 4.o T / Worker's Compensation# 0,9-lw, NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. .-- ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY _ PERMIT NO. 1 DATE,ISSUED MAP/PARCEL NO. _ A ADDRESS VILLAGE OWNER 1 t j 11 i DATE OF INSPECTION: 1 i i F FOUNDATION ai FRAME' — — INSULATION n FIREPLACE ELECTRICAL: ROUGH 3 s .—FINAL PLUMBING: ROUGH i FINAL GAS: ROUGH $ FINAL FINAL BUILDING o ' 2.4 +l 9 DATE CLOSED OUT ASSOCIATION PLAN NO. ti t ' ` ; HOME IMPROVEMENT CONTRACTORS REGISTRATION I oard of Building Regulations and Standards I -One Ashburton Place Room .1301 Boston, Massachusetts :021.043 r HOME IMPROVEMENT CONTRACTOR 1 ___ _ ____ -------•------------ -Registration 100740 Expiration 06/23/96 r Type — PRIVATE CORPORATION j' --7k 91.,1atns HONE IN.WVEJDT CONTRACTOR..., �: k"Lstratioo 100740 • •Capizzi Home 'Improvement , Inca i TYPO -'..PRIVATE CORPORATION— Thomas Capizzi , Sr . 'ENpirltion • •-06/23/96 1645 Newton Rd. Cotuit MA 02635. i Cepiui Hone LnproveRent, Inc I Thous Cspizti, Sr. -W ig dr 15 Newton-Rd. I ADFA1N TRA" •Cotuit NA 02635 + - Restricted to: 10 DEPARThIENT OEPARTNENT IF IUILIC SAfE11 ONE ASHUUR CONSTRUCTION SUPERVISOR LICENSE ) 10 - Roee DOSTON, tuber: . Expires: 16 - 1 8 1 Tilily Roles CONS rRUCTION SUPERVISOR LICENSE Restricted To: 10 Number - Expi'r'es: �+--�� OAVII N 1[II Restricted l ii: UU C010AWK x 110 PLUN N011OY RD 1 I fILNOUIR, NA 12SH , r, TH011AS,'X CAPIZZI JR 280 PERCIVAL DR ,.:.,. ' " W BARN.STABLE, MA 0266E3 F , ' � 1 The Town of Barnstable S Department of Health Safety and Environmental Services M . Building Division 367 Main Street.Hyamtis MA 0201 Office: 508-790-6227 Ralph Crossca Fax 508=775.33" . , ,� t, Building Commnssione: For office use only Permit no. . Date ' AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICAITON MGL c I42A requires that the"rec0ns=ctr0n,altelatlons,renovation,repair,moderai=don,Conversion, ed a improvement-removal, demolition, or con uction of an addition to any pre- owner adjacent building containing at least one but not more than four dwelling units or to structures to such residence or building be done by registered contractors,with certain exceptions,along with other t requirements- Type of Work: .2-Bfl Est Cost //� Address of Work:/0,!/ //%'i9�i►7 7�/% Owner.Name: //� Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work ccdudcd by law _ob under S1,000 y, _Building not owner-occupied Owner pulling awn pcimt Notice is hereby given that; OWNERS PULLING THEIR OWN PERMIT OR DEALING WILINREGIS'fERF�CONTRACTORS TH 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 hcrcby apply for a permit as the agent of the owner. Date on r ranee Registration No. n, P Owner's name The Commonwealth ofMassaeh usetts f :+,�� �` �► -_ Department of Industrial Accidents -ivo/flef 011" sdlstliss - 600 Washington Street �`�<<.;'� Boston, Mass. 02111 - Workers' Compensation Insurance Affidavit Applicant informa6on: name: I ocati m cit\ /% /![ : 6 3-; phone# 4/?—P-3-$' ❑ I am a homeowner performing all work myself. 1 am a sole proprietor and have no Qne ssorking in an, capacity 2 ' am an employer pros iding workets' compensation for my employees working on this job. _ company name: address: i phone#• insurance co. policy# 8 3 1 am a sole proprietor. general contractor,or homeowner(circle one) and have hired the contractors listed below w ho have the following workers* compensation polices: company name: address- cn• phone#: insurance co policy# company name: address: city: phone#• insurance rn policy# Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine ap to SI,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a tine of SI00.00 a day against me. 1 maderstaad that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. 1 do hereby cerdify ua de pains a d enalties ojperjury that the information provided above is true and coned Signature o/`:�-�. Date �i�i1'—.9-.< _ Print name �� �f0/� Phone 0 ZY Ccheck ly do not write in this area to be completed by city or town official - _ __ permit/license tf flBuilding Department pLicensing Board mediate response is required ❑Selectmen's Office OHealth Department n: phone q;_ _— 00ther t«csea gyros PtAt Assessor's map and lot number . ...b.. �..........b......... of THE H rot . Sewage Permit number ` 33A"STODLE, i House number ...................... ........ ...... j..:................... *oo RF Mb 9 �0 D OR TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO App!:51- ...1.o iq.......... TYPE OF CONSTRUCTION ...... ........(" ................................................................... ........... .r N........�, a..............19.2.6 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location 6 ' .a—v i 7— al ...-...:............................................................................. ............... ProposedUse ....R��! ..... C .:..'....................................................... ................................. ........................... .. Zoning District ••• r.................................................Fire District ........r�Tl /... ...... ....,R:..................... Name of Owner .......:....Address .... .51....IV III! .... .i...:..4 a:�..v.L! .o BuildrName � Z.;....�.....G.1.rV...�....... i.............Address f.i.b .... lGl. �... .3. /....�T .� Y`. :... ✓ Nameof Architect ..................................................................Address ...............:...................................................... Number of Rooms .......... ...6.......................................::....Foundation ..... ........ �if/eN( ..Roofin ...�7`SP!`l.:t.`t '..._•. Exterior ...Y.`�-:��.�J......c.................4.L.....:............................... g * ` /...........:........................,................ /, , ..Interior ..... L <%GtI LG ......... Floors ....!!.��..�..:............................................................ ..,................. ........ `�'� ,fir Heating �.. S Plumbin C c—ai _ 7' g ..................... g .... ...... .......... , �.........., Fireplace X 5 ..............................Approximate Cost ......:G...lS . Definitive Plan Approved by Planning Board ________________________________19________ Area c,,?. .... .. . Diagram of Lot and Building with Dimensions Fe .. , SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the TQ.wprof Barnstable regarding the above construction. Name rl!. / ............... s�J Construction Supervisor's License ..� JACKSON, HERBERT A=036-017 4 No 33468... permit for ...Build„Addition Single ly...awelling.............. Location ..651 Main .Street, Cotuit Owner ....Herbert Jackson...................... ................ Type of Construction ..FX.4XGQ........................... 4 ................................................................................ Plot ............................ Lot ................................ Permit Granted .........................Januar.'......18..�..19 90 Date of Inspection ................................... 19 Date Completed ......................................19 PERMIT COMPLETED 1/1/.QL �r Assessor's map'and 'lot number .R...6..3( .......... ..�. CF THE TO SYMM "o Sewage Permit number f.. Tqfr� Eb` JALLED IN C J House number ......................... .. .......�..'�..:............ EVIa WITHww ' T TOWN OFF BARNSTA� ° BUILDING INSPECTOR APPLICATION FOR PERMIT TO ...... ..... i'%?l.. Ld ..................................................................................... TYPE OF CONSTRUCTION ............ t ........ .............................................................. W. ........� .............19..a..0 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ....6...6``....... ....3't....... i,(1 ,.T......Mou5...-................................................................................. ProposedUse .... ,tl ?t,'J h..................................:....................................... .................................................. .... Zoning District ......... ......................................:. Fire District...... ........ , ................. Name of Owner ............Address ...� .�. v. !- ...... ,...... Name of Builder . ....................... j ..AddressJ, uf .°,...:'. lT..: Nameof Architect ...................Address ............................................................................. Numberof Rooms ............... .............................................Foundation ..... ................................... Exterior ... � ....I.................................Roofng ....96. "— .......................................:...... ..............Interior Floors : — HeatingJ/�Sr....................................................................Plumbing ... � ........... .�...r........... Fireplace ..... ............................................Appr oximate Cost .........L... �..O d�...................................�— Definitive Plan Approved by Planning Board _________ ____________________19________. Area,, . .... .. .". Diagram of Lot and Building with Dimensions Fe �' SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the . arnstable regarding the above construction. C6....................... Name .................... ....... Construction Supervisor's License 63 d 4 / JACKSON, HERBERT No ..3.3.4.6.8 . Permit for ...Ad.djtjc)n Single Family... g............... . .........................:.......... Location .....6.5.1....Main...S.t r.e.e t.' .. .... .. .... . ......................cot.U.i.t.......................................... Owner ......Herbert Jackson ............................................................ Type of Construction ........Frame .................................. ................................................................................ Plot ............................ Lot ................................. Permit Granted ........ 19 90 Date of Inspection .....................................-19 Date Completed ........ ...............19 r1i 0 vi r40 i OD Iz 5.3 WD TR/cam S Sty k6 ,, SET GoTU i�, Cam. JURY 1 , 1988 • r k p �E PY ,. REVISED CODE ----EXAMPLE 1 . H OU SE. - H FATED � B Y OIL - GAS OR HEAT PUMP .=3 PROPOSED HOUSE HEAT LOSS ' i• - f � 02 TRANSMISSION COMPONENT U-VALUE AREA "UA" NET WALL Ll 1 , WINDOWS ID 5 ROOF 033- sea ► 1 to DOORS 9 2 d � FLOOR. --d----- — ---- c( y + �s ED * BETTER .THAN CODE :REQUIREMENT . ** DOES NOT IVrET •CODE REQUIREMENT EX. 1 "CODE HOUSE HEAT LOSS TRANSMISSION COMPONENT U —VALUE AREA "UAdon NET WALL . 08 WINDOWS 65 ROOF 0033 No, DOORS .14 3 = LOOR .05 52o Z� e SINCE CODE 'UA' IS GREATER, PROPOSED HOUSE PASSES 2.36, G Y DATE CAPIZZI HOME IMPROVEMENT RC IM NEWMWN ROAD ell GALE: COTUIT,MA D2635, ' - TEL.428-9518/1-BW282-M SDP= i .llnii DATE:Zi s' E SMCET CAPIZZI HOME IMPROVEMENT K C ONEMA WN R &c TEL.428•9518/1-8n262.506Q °`— P P!T ELEVATION �T ..... e — I i "=1•-O" q 12.15.84 SAG KS:J ti, 1\ES\DCti CE I . . 1_J CnoTVIT� /�/y, �GCc�F ------------ i 7777777 7-51 ikj 1 JII- - T- IT ?-CSaJ �tS�OC�/CE- __.�I J ; � ... i.`-7, `r_ 1__ . �% /�li�/!✓ 1.3.E L;f �JA`s a sor's,office(1st Floor): �°6� Assessor's map and lot number �`' C�' \ 1`�1-3�� �w1` °���t��' -W ?o Conservation '"'� (6 a3 zvl� �W'� e� Board of Health(3rd floor): O � ®� ��'•�y�. Sewage Permit number V �?2 �r�nt Engineering Department(3rd floor): /�( � � � ; House number' Definitive Plan Approved by Planning Board 19 APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2-,W P.M.only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO C / LSLf TYPE OF CONSTRUCTION _ t/lf e/;/ ��j'aj�flwB -�-� 0 19 �� y TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location e�41'7 /-/i W S7'R4,-er 007V! 7- Proposed Use �R Zoning District ~ Fire District CC 7-V Name of Owner /�E/t�$tr2T �• �f1,Q c4�i2�9 `r�`/el/lAddress �"�� �✓��i✓ U T Name of Builder �/t L�� Address Name of Architect Address n Number of Rooms Foundation (_0 C t2 zv-."2r f 2,4 00 Exterior Roofing Floors Interior r Heating ,d Plumbing Ado N �L Fireplace ,0 Ale- Approximate Cost A0 DD U Area Diagram of Lot and Building with Dimensions Fee a �-o 7 ` I 209 tilAi�! CZ OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS Si Ae Lieve I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regard7p the above constru o .` . Name Construction Supervisor's Lice § ��� JACKSON, HERBERT & BARBARA , 36090 � No Permit For BUILD (2) CAR GARAGE -Accessory to Dwel/ling `. { 1 Loca'i6n 651 Main reet COtult, Owner Herbert & Barbara Jackson - '` �' ka 4 Type of Construction Frame Plot ° s Lot Permit Granted Augu s't 11 , ' 19 93 I Date of Inspection 19,• , Date Completed S ell cif ti. _ _. .,.V.Ei�I.'C\� ���' 6 8 i � - Q � �E,f�lE,l�� l� I� GTE£J i N.�'�,..�• �., ._ • .' �� .. __ ro. � © ' G'Gw11i IC ��. �c�r 1�1 L.���T 1C,�1\L.. � /a �S- :ti k 62- wI T-1 cLNT-' >T✓c'�r_o� c��f i. 'sv .Z N' 2 wOoO. c�..�llrlC�G.S, Ttt 1 X P r� - n� 1 r G 1=r <��how a a�E cccrl —. r L 3 S6�'t L�I-� -Il Iri,v r i�C��rzU 1 ti 8 �� D�i�I� A r�•' `rt }� Q2Sr _ OET I L ��� T�c._G�=fl.� crTLIE( f-> 5 5E florI DE T4,(L 4N r_c pRAw1 L r rr ta' 11/L I7E1-. Pj� 40 �o-tapir +. Ir1.I CC MGYJSITOrI �{IrI C�LES 1��6 5 �x7 o2 SIDS Et 1 i ip ou.TSiDE 57Al2 wA-r -13E t ..` _. _pti11-2G_.OF..P2ES5.U��L.T.ti�..E��.I Cp S� ol F 3 A kk� ® ts ''. CD a: i ---- - + J � y f e .. I - f ,.rrrnrtmrrrrrtrnm,-rnm-.gip _ 4 1Y e� - 4P I JOt a6 71 lu LIEC�� G e r-- ----- - J 1 FF LILL IL. 1 F LU -1 FLI _. _ a : 'r�TT�imTRiTmri^i r1rr.,t7 4� i ug ik ' a i \ I - �[Erl.•ca�L of �17. >'�a..��rl Mt C A 1.'14 .� 1_I T E P I X E Ca Ol CII 1 I_ � r , TOWN OF BARN4TABLE BUILDING DEPT. 651 Main Street D ,SEP 2 0 '19931 Cotuit E C E September 20 , 1993 Town of Barnstable Building inspector re: Permit No . 36090 Herbert & Barbara Jackson 651 (Wain Street , Cotuit Dear Sir ; I filed an application for a two car detached garage at the above address . Permit 36090 was issued . Subsequently , I requested an amendment to the plan to include a dormer on the back side of the garage . This request is still under consideration . I hope that it will be approved and can understand your concern . I would like to present some additional information which may help allay any concerns . 1 . The lot is quite narrow which , because of the septic system , required that the garage be placed far from the house . The house has a normal set-back , but we had to place the garage approximately 220 feet from the street . With this large set.-back , Plus the septic system between the house and the garage , domestic water will not be feasable nor will any plumbing . 2 . The house is an 1860 Greek--revival . With this in mind , we purchased plans for a garage which we felt kept in charactor with the house . A cape salt box with an outside stair case . 3 . The garage is for two bays , one of which will be for my day sailer . An interior staircase would limit the ability to store my boat , 4 . I intended to store the mast along the rear wall of the garage . This would be impossible with an interior staircase . If I have to store the mast along the side , I would not be able to use the side near the house as there are windows and a door . I could use the other side , even though there are windows and I had intended to use this area for a bench on which to work on the boats wood work . 5 ; We have a lot of furniture as we purchased the house from my wifes mother . She left her furniture , we had own , and we are storing the furniture of my daughter until they can buy another house . This will not be in the near future . 6 . The house itself does not have an attic , so our storage space is at a premium . l r This all brought us to the realization , that it would be best is we could be permitted to add a dormer to the garage in order to store the extra . we ask for your consideration , for this request for an amendment to the permit to include a dormer on the garage . Very truly , Herbert B . ks n • TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please print.DATE/ . . `O JOB LOCATION Number Street address Section of,_town HOMEOWNER" ' 0� �/� /9�i� f1 c. ;v�� rd-d © Name Home phone Work phone PRESENT-MAILING ADDRESS ' C, vi', /vI ✓J 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 such homeowners to engage an in - dividual for hire .who does not possess a license, provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER: Persons) who owns a parcel of land on which he/she resides or intends to re- side, 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 performed under the bui I lding permit. (Section 109.1. 1) The undersigned '!homeowner" assumes .responsibility for compliance with the Stat � Building Code -and other applicable codes, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands the Town of Barnstable Building Deparr.tment minimi4m inspection proceVuir res and requirements and that he/she will comply with d ro edures and r ents. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL Note: Three family dwellings 35,000 cubic fee or larger, will be required to comply with State Building Code Section 127.0, Construction Control. HOME OWNER'S EXEMPTION The code state that: "Any Home Owner performing work for which Permit is required shall be exempt from the a building (Section 109. 1. 1 - Licensing of Construction of this section Home Owner e u er`vis engages e .�P ors ,• g g s a person(s) for hire to do such work,,,that�sahauthatlf shall act as for �wne� Many Home Owners who` use this exemption' are. unaware that, t the responsibilities of a supervisor (see A s a are assuming for . licensing Construction Supervisors Sectiond2. 15 4, Rules and Regulations often results in serious problems, particularly when the his .ome Owner hire ) . This .lack of awarenes unlicensed, persons. � In this.- case.'our7Board cannot proceed against the s inlicensed person as it wouid' with licensed_ Supervisor. T as supervisor is ultimatelyhe Ho responsible. me Owner �a p nsible. ctin To ensure that the Home Owner 'is' fully aware of his/her communities require, as part of the permit application, that the Home -Own / responsibilities,.. man certify that he/she understands.-the responsibilities of a supervisor. last q er pa a of this issue is a form currentlyOn the care to amend and adopt such a form/certificationbforeuseaint our You may Your community. , . t 1. �, . , ) , . .- .,� I. . . � . i'' ...r a ' j "1 1. IN r;'r -• , -1 I p ' a ' l , . f t .. { ,1 i I , ..� y'' ,-�11 '' .. , t ''' r n i +... `yt rJ _tt& r~� .1,. �%' I .ry I + t t a .r I " ,f ' rtx>..r t ,d �x ,r,�y t } z, I t , 1.�, ,.i I , f i { t •„ y, 4 a 1 ; J, 1 r S.. t -.. r 4' sr i• , �, 3 FAt.N t .A a •11 F- } 4; 4 I I ,t - , : ° l I t a k r !. 1 J r, . I x"t II J f t i 1 +> 'a f h:i: .I ' a _ �t" n, i ' d t J "f rst St ,, /� . \ , . I `` f `' F 7 fir, 4 x .rO.1. i s ®, �C��r�►► 7 (I- 1 �Or t�/E.f�t T Ie�t'I e�L,4 �C�J 'x' r dJ ~ri ar I C - x i l�o rx C !� I ram\5-1 F-O' .W ITI-t �s'(�ItJ , 1 s, w , 3 t. �T - P 3aErt T E GHQ tT e�J�\e, r i 1. G I r-I I`J N GO W 1-R'-4 C L A�?.L' c. c_ t' ' ' ,r Y' + 1 O �/�/I�I�w.�-mow, `{.-\G711 '� ,1.� ' f 1�"�\ I Dr6�-a V.i.{rl I �^ + FI .. F .iY; 17C�OtL fC21'"� CG ''C`1� C- tZ�' t tl �' , L Zr r�lC>r-,) \L 1 '" 4I. �A �. 4 l y fit` p�- ' � D: :T'�OL��D.� •� , tll 7'r,e� CO_�T .'I L 5 ry 'r i �', k ,} 7" a A _ ti .1 a} d. M r _L3�..aC6 i t F..' t r 'Tlc rIt DET�11_� -,L -: t� a���� . ., ,,/I, y I �I-_I,.k(2,l I�L " `;`'4—�T , - 1(, , _ 1 „ ` 'd_. +,r,�.,! ,p 4 .t; a. +, a T _ a ) /,, w '' .�>,IH f Cd�tit c s l-rlC,t-I :,..1"q L.CS AI t t+, :, . , Girl t/L,Ir i7�-r ,r. ., 'a } i . � v x , R '. r �. /v��r�/. C;��(���{r►,�a'E® °F.� �.�i e--11�Ic 1 #I 4 t + e , `F! '��I 1 i•- IL.� l•�..X: 1 �'�1�'y w�,.�Y'c..N;,` 11 YI 'f'• a.11, t .l� ' y 6' J 'a` - - ` { .I VI _ 'I +tit t z `SILLS Ct`+ �:12E,:''Gu i SIDE STA12 rt r ; t A .. - ]S t+ t . 1 tZL r .,, } c� - s�v o ' :� r k t y 1. r. a ,s I ' t '•' R t s: t _ T y 7k } r,, + ° i,r ' 01: ` or t. + 4r. 1. >,, t t r t , 'fir r ,'t j . 1, raj a. a r.: .. x y FI k rta ,� '1 p Y'i. � yr 1-^" A I C F I Y 1. 1 M x�i r , -F I r' t .r ; d T e t en k s t� rt, r 'e, .�',i' i Y r.,, ., i r t .� r P j t Y,^ I Ay 1 ^,> r o a J v r' T ! �', f' _ } M1tt A .,b 'r 1 _ t`jt a _ , ' x ,f: y t r, 'd` l F yt t�1. �I g.I k va �y + ;"'�,i T t J. I'll.y Jl a { „t.• i r ,t tZ. t., 11 tt„ I t i raY Yt � + r �, rs ,'y ''.I , .F (,• x 'tt •.r,r , I'r I t t 'z { A�1 s, 1 , v i r i - } '' d :k' M1 3 t � t a. i *� . 4 ,-,'yd x 7 1 r v i .j, t t� l a X yo'1: �' x. 1 s r, r 1. J 1.L t � t � � t� 1 1 .k : d s�w:,.a I'' 1. i y, ,f�} y I .� t '� ty � r 'tE I 1 c'+'� ? {t ,t' �'r� tt I 1. i fy., d �' ` , h + F ; 11` r t t i I �'�, 'j, x 41 I'lF t J / �>* ` t' t 1 ; t- L . I I t o i ,d•. , f .b 1•. 1 r ,} ryV, r .. I ix, a: a4 �.. t R! '_y {��. t a -''l. t v..,f fl, i�>a t/-)t } tll` I x Yf d r I 1 r:'t 1, a f P x - I t I.+ ' w �, r a,. rya . r !1 :I M',. lx 1. —, s r i`r. •F' } f {xt "4 g$t'✓y,i r,¢ t� � a to s r .TY,•, .mi ., I l - ( a i r ,n' 11, { k x j x. rr ,," „ r '.t J,t ' i k ,t J r ,y a/k 2r ., r,q_ �, ''fry ® 1. I 4 �w , i I .r 1:- n, � J; tt w_" f r t ., . t -'Yr C+I 7y�. 4: t t E z t';.i :.i I .r r ) . ,y.11 f . nJ rr:l ts`{, rr.w,. '..f t , t F t ' r n• _ ry l ,1.' ,:I Ir 4 a I 1 i, d .1 r I b�� t 's ` t w7++., d z i "i t t,)I ro sr"�j 9t gtt�9r :+�+r i,,r ( I t I �, h' i' 1i'�t� v t ,'t 4.t P I I I "opt k t , ., i� Y fy1 I.,tW - 6v, : y r _,' a I� c l J I a t t r '� _: t .. -�, � 1. I 1 Via, 4 ,'.,q . mo t '_Ire r� �,r 5 , ,a f }ay. A % gt3 ��' I t1t 1, art i t 't s 7 L r rY I k+" �� a+ +I. '' { .4 \ - L I `..1• I t T ,ILA dr-"fin � ., r -,, t�. I 't dt e .: �;:;--;I'k5+,....o �. Y'! '' d' d J . - t e .:J x, r, r j .5 ?y� t 1 rl { a 1' , x x t2; ,r �, .r i r 7 f i. Y is f a -� i. FA t t S' J R r r i 3 i `:J t }r,'. y r ::w.t a i.�� +t �' s.Pr^ ,y�£ t 1, - 4- t t. N, .r< .�1W a./• �w C.�. `� t C r < "' itY f�+t.r r f q e t t I k! [[ d '"I* I t.*r,�fl,...a—nlr /\/'� r " x , �•rt c »l +�.f,�R• t* , '>.�I ix 11, !.1 t q y1 I 1 .,7,.?.r' " I ..� �..l,d��1 : ° !�/�• ',AF' y 6—f' f F' :) -J + J _ t Itj + r u 1 .kiliJ"1 ,•.k rl, 7�rw`nI"11 ' t a•,. I �ttwl` ryw l.�,�w�� .3.w } .i` 1Y tf .%,-4 r' 'it {C'c"i n x kl�xc ,', r',`�1.'Yy w' ,.. ii3 1,''t*: l fa. tl x .I 77, /� I ' . + K� ,� s ;( l,:th I C .114 +A t � $5•v 'f9 '! A / \ \1 ^ +P"a,�, '.. '!�,a� rr i M k Y r e•'' -.. '"Ri t,'�s t'c."��kat 1'`I4C ty.^�{j p`,�" n y N' } I r'�'� rvl �' e..qi 1�x 1CFSi .Y dtr+� y .'a!' 7 r✓ ar;,.0 - �,>II yl lef.� IIill'S Sra -tea t .:r ,tp; P rV ! , 111•�, wt l A� 4t 1 .A..... I a;•J+"4,s`1 r.rk v - v "qcF , » w >r.. r t� �:.r I tr M t Yl.-; 1i 1 (� �, ,}• n,}.. ..r r I '`, I I ( AA /'� r' ,Sy',,�p^i°•C� e 5 t�,.►,7J� h a s -trio r l . r'i 1 f ,1 ,, It..�1 1:F" 2 Al;s, �L'r 1 �YN 1/p"6 .4'.t. G 4-+ �i Aia Ld• tN " t ,fi �, f ✓r p !' ' v t i F 1J r 1' ¢I '{ i AI* ° I I�d jy v r ,,I.i �•iz 7 a. � t x 6,,,..+kt !v ry 4 3 r!h �r '+ ' A ,.d•` ,., .(,� w.ad J r.—.+...::;.'�411 md•,���t 14. .'Yt tw, 3e,.wr 1a�I tm a,<s..j 1. I ,r€.�, 1 q FRIEDLINE&CARTER ADJUSTMENT, INC. 436 Main Street,.P. O. Box 338 Hyannis, Massachusetts 02601' Tel. (508) 771-3232 FAX (508) 790-2344 TO: { Building Commissioner or Inspector of Buildings ( ) Board of Health or Board of Selectmen ( ) Fire Department - TOWN OF BARNSTABLE TOWN HALL : Al' HYANNIS; MA 3= RE: Insured: THE HERBERT B. JACKSON REV TRU Property Address: 651 Main St. �s Co'tuit, MA 02635 Policy Number: HM00322595 Type of Loss: Water ` Date of Loss: 10/16/2017 File_#: 127697 Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or cause Mass. General Laws, Chapter 143; Section 6 to be applicable. If any notice under MGL, Ch. 139, Sec. 3B is appropriate, please direct it to the attention of this writer and include a reference,to the captioned insured, location,policy number, date of loss and file number. On this date, I caused copies of this notice.to be sent to the persons named above at-the addresses indicated above by First Class Mail. B. OSTIGUY Adjuster c 10/17/2017