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1169 MAIN STREET (COTUIT)
tic 3 moat -PRE °Z 7U 2 �° FtHE r 9 Town of Barnstable *Permit# 172012 Expir n ue date ' Regulatory Services Fee. - 4 BARNSTABi.E Thomas F. Geiler,Director i. TEfl MA't Building Division Tom-Perry, CBO, Building Commissioner 200 Main Street,'Hyannis,MA 0260.1 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 0/9 [ 3d Vt9/ Property Addresslh �h�i/V S� C67�k%r ` esidential •Value of Work 3 �J Minimum fee of SH.00 for work under$6000.00 µ Owner's-Name&Address Contractor's Name � r Telephone Number—Ayf- Some Improvement Contractor License#(if applicable)/,5 2/72 ") :onstruction Supervisor's License#(if applicable) 10, f 2�f ]Workman's Compensation Insurance Che ne: YI am a sole proprietor ❑ I am the Homeowner ❑.I have Worker's Compensation Insurance : isurance Company.Name 'orkman's Comp. Policy# opy of Insurance Compliance Certificate must accompany each permit. rmit Request(check box) e-roof(strippingold shingles) All construction debris will be to ` r Re-roof(not stripping. Going-over existing layers of roof) ❑ Re-side #,of doors . ❑ Replacement Windows/doors/sliders. U-Value (maximum,44)#of windows - `.*where required: Issuance of this permit does not exempt compliance with other town deparunent regulations,i.c.Histpric,Conservation,etc. ***Note:R - Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License& Construction Supervisors License is equ NATURE: The Commonwealth of Massachusetts bepartm'ent 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 Applicant Information y� Please Print Legibly Name.(Business/Organization/Individual): . /'! Address:fd X A 2 City/State/Zip: G4144f /V,V 0i.�� Phone.#: AiPi�r^ Are you an employer? Check the appropriate box: Type of project(required):: 1.❑ I am a employer with 4..0 I am a general contractor and I . em oyees(full and/or part=time).* have hired the sub-contractors. 6. New construction . 2. am a'sole proprietor or partner listed on the-attached sheet. 7.:❑Remodeling ship and have no:employees These sub-contractors have g• ❑Demolition ' ..., . workingfor me in an capacity. employees and have workers' . y p t3' 9. ❑Building addition [No workers'comp.insurance comp.insurance. required.] 5. ❑ We area corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work': officers have exercised their 11.❑Pliiinbing repairs or additions myself. [No workers'.comp. right,of exemption per MGL 12:; Roof repairs . c insurance required.]t c.°152, §I(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 Lie.#: Expiration Dater lob 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 WORKARDER and a fine .r of up to$250.00 a day againsfthe 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 certi`fyder the pain iid enalti rjuryf that the information provided above is true.and correct. signaiure: Da Phone#: Official use only. yDo 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 Heilth 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,'•pa tdershipi association of other-legal entity,employing employees. However the owner of a dwelling house having not more than three apartments'andwho 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 employer." MGL chapter 152, §25C(6)also states that"every'state or local licensing ageney 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 insurance requirements of this chapter have been presented'to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contiactor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an 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"all-locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or.citizen is obtaining a license or permit not related fo any business or commercial venture (i.e. a dog license or permit to burn 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'faknumben. The Commonwealth of Mmsachusats Dqp'artm.ent of lndusWal A.ecidonts Office of Investigations 600 Washington Suet Boston,MA 42111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Revised 11-22-06 Fax#617-727-7749 ` www.mass..gov/dia rr oFt�Era,, Town of Barnstable ti Regulatory Services 9aaxivesi.E$ Thomas F.Geiler,Director �p i639• Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.b arnstable.maxs Office: 508-862-4038 Fax: 508-790-6230 "Property Owner Must Complete and Sign This Section If_UsinL� ABuilder I, A A hJ IN ft I LA-as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for. (Addr6s of Job) , � S' of Owner Date Print Name If Property Owner is applying-for permit please complete the a Homeowners License Exemption Form on the reverse side. QTORMS:OWNERPERMISSION , Town of Barnstable Regulatory Services BMWST" E, ; Thomas F.Geiler,Director 9 Mass �Ar 1639• A,� Building Division FD MA't Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": 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 OFHOMEQWNER 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 Buildmg`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 requirements, Signature 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 Nlassachusctts-Dcpai-tinent Of Public S ifctc Board df uifdin Rchulations and St; ndards -{COyuction Supervisor License Licensv' 103429 1 Restricted to FJd' PAUL ROMA`+ r P.O. BOX 142 COTUIT,.MA b2635 Yew. Expiration:.9/30/2013 r— 'Tr#, 103429 `-,___-__.__:�_� ✓fie.�anznzo�zcaeczltlo...�aaaccr�tiaelta `�.. _- _� �_. _ — , � - 'Office of Consumer Affairs&Business Regulation License or'registration valid for individul'"use only HOME IMPROVEMENT CONTRACTOR -• before the expiration date. If found return to: Registration: 4 1.47262 Type. Office of Consumer Affairs and Business Regulation Expiration: �ik312013 Individual` ' 10 Park Plaza-Suite 5170 F 1 = ? Boston,MA 02116 P. CHARY ROMA` 4 it e PAUL ROMA 29 BAY BERRY COTUIT, MA 02635 > a_r l '.Undersecretary11ot v without signature TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Q Parcel 1`3 O c�C! I Application #r2 o/ 00 Y71 Health Division Date Issued Z 1 � Conservation Division - Application Fee S cI Planning Dept. Permit Fee (o Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address It &9 +M AI N S 1- Village Owner !R ` Arl T. �JI NV111-L Address I�( N o��M QVS s i A�Xht'fbtIII 11 Telephone �� 5 L K 3 q VA 14 Permit Request f-)o-f'Tlwt_- pe)kc14 AE7C/< - 4-1/e_c/4-1 l— &CP44<--� i,J I 0 bo(.J S 44 K CF c u N ZT" B Co�&v-o ,y .7e A-r1Y FavTM(/Y7— Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new a Zoning District Flood Plain Groundwater Overlay Project Valuation c� Construction Type 3 Lot Size Grandfathered: ❑ Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) c� Age of Existing Structure Historic House: ❑ Yes >'No On Old King's Highway: ❑ems No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑ Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑ Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑ Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number` "�3 e3 Address 41 N COL-0 9",9 OS S'i License # L J-�-x 41YbR-14 , VA a �t Home Improvement Contract Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO &Ala N S%u[6 LA N lt)r`I I S�f-eF S'i74T16 ry SIGNATURE DATE - j FOR OFFICIAL USE ONLY tl "APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL ' PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING Q DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of Massachusetts Department of Industrial Accidents l ' Office of Investigations 600 Washington Street i F Boston, MA 02111 1y www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): P_�,4m)• "►—, /N H i L_L Address: I I R IMB�i hl ST City/State/Zip: C®TV ►"� Uti� � `3 ' 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.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ;�Remodeling ship and have no employees These sub-contractors have g. Demolition working for me in any capacity. employees and have workers' 9 Building addition workers' comp. insurance comp. insurance.$ uired.] 5. [� We are a corporation and its 10.❑ Electrical repairs or addition A/�eaqm a homeowner doing all work. officers have exercised their 11.❑ Plumbing repairs or-addition myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 1.52, §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. 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. lam an employer that is providing workers'compensation insurance for my employees. Below is the policy andjob site information Insurance Company Name: Policy#or Self-ins.Lie.#: 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 fit of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby certi der the airs n penalties of perjury that the information provided above is true and correct. C 4 Si nature: Date: —� Phone# Official ics.e only. Do not write in this area, to be completed by city or town official City or Town: Permit/License # Issuing Authority(circle one): P 1. Board of Health 2. BuildingDepartment 3. City/Town Clerk 4. Electrical Inspector S. 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." MGL 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 insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s)name(s), address(es) and phone number(s) along with their certificates)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 confumation 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"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit, The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax # 617-727-7749 www.mass.gov/dia 4 Town of Barnstable Regulatory Services Thomas F. Geiler,Director 16yQ�. . ,� Building Division PrEDy Tom Perry,Building Commissioner 200 Maiu.Slreet, Hyannis,MA 026.01 wmy.town.b2rnstable.ma.us Office: 508-962-4038 Fax: 509-790-6230 HO'KEOWNER LICF-NSE EXEMPTION Please Print DATE: JOB LOCATION: t q t ST Co'N T h r pnumber strcct • village tr HOMEOWNER": tF— 7 A a) T� u��� H I name home phone# worl_pbone# CURRENT MAILING ADDRESS: r� c GO L U V`1 Ig US S LE x b/L I e4 l4 14 city/town state zip code The current exemption for"homeowners" was extended to include owner-occupied dwellinzs 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. DEFINTITON OF HOA EO' XF_R 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 Biulding Official on a form acceptable to the Building Official, that he/shc shall be responsible for all such work perforated Linder 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. edsbc understands the Town of Barnstable Building Dcparttnent minimum inspection procedures and requirements and that he./shc will comply with said procedLrres and re cments. rgn 'rc 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. HOMEDVrWER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building perrrrit is required shall be exempt from the provisions , of this section.(Scetion 109.1.1 -Licensing of construction Supervisors);provided that if the homeown'cr cngages a prson(s)for hire to do such wort, that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responnbilities of a supervisor(sec Appendix Q, Rulcs&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awan.ncss bftrn results in serious problems,particularly when the homeowner hires unlicensed persons. In this east,our Board canno(procccd against the unlicensed person as it would with a licensed Supuvisor. The home0"Wner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/hp-resp nnbilitics,many communitics require,as part of thc po-mit application, that the homeowner certify that hdshe understands the responsrbilitics 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 forrr)ccrtification for use in your community. Q:rorms:homccxcmpt i � r Town of B ariastahle Regulatory Services Thomas F_ Geiler, r�a9. , Director 6: P Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 )vww.town_barnstable.ma.us Office: 508-862-4038 Fax: 508-790-E e Owner Must - Property Complete and Sign This Section If Using ABuilder as Owner of the subtect.pmperty hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of job) Signature of Owner Date Print Name If Property Owner is,applying for permit please complete the Homeowners License Exemption Form on the reverse side. 614 O C: L / t_ I Jo \ I �® P--G cA PC, > 19 ik4 O-►of S c_6 7o l 7— . K* L IK L ' a' s . c kl' � w � � r Ld`N 1 7- G � 5C 5 C_ e P�04 8Z SOfNC, a-X T f g," A R T74 rr C i6 � srwt fls�e�t SST `] o C M,4X H t,)o u 6 c,E `� P� '�►w�C-- 'Tc—2S � C/� =r � i. Town of Barnstable Geographic Information System September 14, 2007 W 034007 034008 G; Zr 019148 019091 �-...,o,...,,#24034054 22 #26 #1119 #72 J s, - r,,,7 - , 019146 - 034053001� .. #108 J 019149 ( #80 D #10 019088 OQ �019092 Q 034005 034045001 #120 d L_!66 034006 #1131 #69 t#50 t 034003 SHELL LANE '#33 # 4111 � 00334052 #92 019099 098311 #93 '' 034051 #107 019096#75 034002 � #1148 ---�� #115� 019095 �v` 019094 #65 #55 019093 019127 034050 #45 #41 #110 034045 #71 _ 034001- 019101002 #1159 034058 #119 019130002 #1160 #1179 wp #03404 019130001 d #1169 019159 034047 # 0 0 #121 #134 C#,131 Lib 019164 f' f7 ems" #20 tt! r 019162 033033 #35 t+ #1180, �l 033014 W #20033028 033015 01911 �' 019165-3 #142 Z #149 1812� #25 #1199 033034; ED #946 1194° a 0 0180641- +� 1L CROSS S � T'REE7 018057 018066 C 'u #28 #24 , #1207 033012 0330D1 : p }#1208 O #164 W 033 * 02G - #165 ' r r 018063 #31r7L e: '- All 033013 033010 018062 `' #17211 ��pp pp 018061 'y_ #1220 033016 1�104 018903t 018, 9 � 018060 #17 #1221�� fir. #185 3� #25 #30_—�_�.#1233 Q a>3 DISCLAIMERS:This map is for planning purposes only. It is not adequate for legal Map:019 Parcel:130001 boundary determination or regulatory interpretation. Enlargements beyond a scale of Selected Parcel EJ 1"=100'may not meet established map accuracy standards. The parcel lines on this map Owner:SOUZA,JAMES P TR Total Assessed Value:$1140900 are only graphic representations of Assessor's tax parcels. They are not true property Co-Owner:THE 1169 MAIN ST REALTY Acreage:1.00 acres Abutters boundaries and do not represent accurate relationships to physical features on the map Location:1169 MAIN STREET(COTUIT) such as building locations. Buffer 'Parcel Detail Page 1 of 3 Y y e f �V _ ti4 hSb r 5 Logged in As: Parcel Detail Friday, Septemb Parcel Lookup Parcellnfo Parcel ID019-130-001 l Developer LOT 1_ __ Lot E Location 1169 MAIN STREET (COTUIT) I Pri Frontage Sec Sec Road= I Frontage Village'COTUIT � I Fire District,COTUIT Sewer Acct, Road Index 0951 Interactive \s., Map Owner Info Owner!SOUZA, JAMES P TR I Co-owner THE 1169 MAIN ST REALTY TRUST .. -----___._._ Streetl !1169 MAIN ST I Street2 City jCOTUIT � I State!MA Zip�2635 Country!,— Land Info Acres 1.00 Use Multi Hses MDL-01 I Zoning 1RF Nghbd i0116 Topography `;Level I Road I,PBved Utilities=Public Water,Gas,Septic Location ,Rear Location Construction Info Building 1 ®f 3 Year .. ....__. ___..� ___m... Roof _ __._...._.,._ _ ,__ Ext�.. Built `1856 I struct iGable/Hip l wall IWood Shingle I Effect 1735 � � Roof#Asp h/F GIs/Cm I AC`None -- Area 1 I Cover+ p p Type I Bed Style Colonial I Wall[Drywall _I Rooms 4 Bedrooms I ntial l Int 1Car�-- Bath j2 Full Model Reside �I Floor Rooms i Grade` Heat Total Average Plus _ ;Hot WaterL�j E Rooms Type Rooms iI http://Issgl/intranet/propdata/ParcelDetail.aspx?ID=774 9/14/2007 Marcel Detail Page 2 of 3 stories 31 1/2 Stories Heat IGas � I Found- Typical Fuel} ation "� `Fiis rat' I � �� . � _7 tP� , 1 Building 2 of 3 Year i - Roof Ext lMT[50 j Built 11920 `I Struct,able/Hip I Wan .Wood Shingle Effect of Ro _.. Area 1 1435 I Cover;Asph/F GIs/Cm. . p I Type None Int i_ __ _ ___ _ Bed I Style;Cottage I wall 1Drywall I Rooms 14 Bedrooms I � _....._.__..._.__ .___ Int Bath Floor Y .. Model 1 Residential I I I Rooms i12 Full I As i s� Grade!Average Minus I Heat F or Furnace I Total 16 Rooms o1 ' - Type Rooms 1 � Heat S Found- Stories;1 Story J Fuel !Gas I ation Typical I Building 3 of 3 Year�1940 �_ _ Roof Gable/Hip Ext Wood Shingle Built 1 Struct Wall ___ _ Effect,_-_..._.._ �._".�_.______ Roof AC E— ____._ _...-.... 1570 I Asph/F GIs/Cmp I iNone Area Cover Type- Int ID____ Bed Style Cottage I Drywall 1 Bedroom Rooms� � Wall Int Bath 1 ModelResidential __ I Floor _ I Rooms 1 Full UP Grade Below Average I Typeeat Floor Furnace Rooms 1' Rooms I Heat Found- I Stories 1-Story I GasTyplcal Fuel -_.----.-.- ation Permit History Issue Date Purpose Permit# Amount Insp Date CommE 5/26/2005 New Windows 83912 $2,079 9/1/2005 12:00:00 AM 9/28/2004 New Windows 79592 $1,517 9/1/2005 12:00:00 AM 4/19/2001 Roofing 52837 $4,500 10/15/2001 12:00:00 AM 15/1/1993 B35857 $9,000 1/15/1994 12:00:00 AM CO REP http://issql/intranet/propdata/ParcelDetail.aspx?ID=774 9/14/2007 Parcel Detail Page 3 of 3 n Visit History Date Who Purpose 9/1/2005 12:00:00 AM Martin Flynn Drive by inspection only 3/16/2005 12:00:00 AM Paul Talbot Meas/Est 3/16/2005 12:00:00 AM Paul Talbot Meas/Est 10/21/2003 12:00:00 AM Paul Talbot Meas/Est 6/23/1999 12:00:00 AM Frederick Stepanis Meas/Listed Sales History _ Line Sale Date Owner Book/Page Sale P 1 8/24/2000 SOUZA, JAMES P TR C158789 2 7/21/1999 SOUZA, JAMES P C154075 3 5/15/1986 SOUZA, JAMES G & ELIZABETH M C106236 Assessment History Save# Year Building Value XF Value OB Value Land Value Total Parc( 1 2007 $329,200 $2,600 $700 $808,400 $1 2 2006 $281,700 $2,600 $800 $799,000 $1 3 2005 $251,300 $2,400 $800 $680,000 ; 4 2004 $201,700 $2,400 $800 $552,500 ; 5 2003 $163,900 $2,400 $800 $250,000 6 2002 $163,900 $2,400 $800 $250,000 7 2001 $163,900 $2,400 $800 $250,000 8 2000 $144,800 $2,300 $400 $60,000 9 1999 $147,300 $5,800 $800 $60,200 ; 10 1998 $147,300 $5,800 $800 $60,200 11 1997 $118,200 $0 $0 $60,000 12 1996 $118,200 $0 $0 $60,000 13 1995 $118,200 $0 $0 $60,000 14 1994 $124,000 $0 $0 $67,500 15 1993 $124,000 $0 $0 $67,500 16 1992 $141,500 $0 $0 $75,000 ; 17 1991 $171,700 $0. $0 $80,000 18 1990 $171,700 $0 $0 $80,000 Photos http://issql/intranet/propdata/ParcelDetail.aspx?ID=774 9/14/2007 c c f G LOT a� Assessor's office(1st Floor): P �� Assessor's map and lot number. QJ a �O �. ��� , ,Z E `TME t :� �o o� Conservation ' LED IN COMPLIANCE Board of Health(34floor): WITH TITLE 5 • Sewage Permit number - t 11MU3TULC J EM-NVIROMMENTAL CODE AND � r•.a Engineering Department(3rd floor): TOWN REGULATIONS 0� YE1639. House number 117� Definitive Plan Approved by Planning Board 19 APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO TYPE OF CONSTRUCTION _ to 6-0 "f L.: b' /' 19 9 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location 11 77 m 14/ty - ! C o 7'v IT PM<9 Proposed Use Zoning District F Fire District C-0 � Name of Owner �T-!A-y`( C—S a Address I(C, 1 fl S7' co Z i r Name of Builder 1' A-0 6k Address g d C Ae ifr /A Y 7ZIfziff 4-6, _ CO7'u/T Name of Architect Address Number of Rooms f Foundation Exterior .S H 1 Roofing Floors �lrn �_7— Interior Heating Plumbing Fireplace Approximate Cost Area S 1=T Diagram of Lot and Building with Dimensions Fee �—(91 7 ,6 00 OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name V i �"C� R-7*� Construction Supervisor's License SOU'ZA, JAMES i No 35857 permit For REMODEL Sin le Family Dwelling F. 1 (Q ry Location' Main Street 4 ,_ C o to i t lT 1 _Owner James Souza IT Type of Construction Frame - Plot, Lot ^_ ,p Permit Granted May 10 , 19- 93 17' EE-_� „ 1 Date-oflnspection 19, Date Complet'ed.,a " . /Ki YY !I <I �r A ............. ----------- o scol - - ;N b-L ✓ C i r i 1 ------------------- -.---- i s T-o 4 ' 1 1 TAMCS -t- E0Z#7Re" SOU ZA P 04 12 o Po s� ►Z 4 2-6ee -\ 5 P�+ ! I s P�f�c 7 — ? �X1S7-7N6_ -- �0t? r9 � 1 � i q ,; - , �� ;. .. a •`-.�. .. ,-� :.. .e'.,^.1y.�"'�" .+., y+''">< r N �� isr?�.�s a'� e �`�'-+,s^e���; .^y' .E'.. 73 ...a .s f-.._.. _. :.. +_ :.,,. � .:. .: ..,,. :�,.:.1 .,'c§r : 1��:rY•�. ., :..6 �,.._ ,.,.;_.,. . ��.. -»--<. `="�_ _� � �����.G,x}., ��,..L� }Y�, y 5 :-.�r , x:.,� a;'&` 'T. �' �"N�' a4 _� ',, a• .�d.`.,�§�... � r.. ,...�.,1 ...�.Wit. ,t .. vl , .-. r � �'Ka•,�- .tt ,t- - .._. :.. - .- �.� F w�•r: A - - �. ..L �-s+. r*,,,,v NWEAL �Y ,,�• :, �_.-. �; •.: � y,. �..,,.�s:�=� ,xy OF OF PUBLI - Mp 1010 COMM . fiv SSACHUSETT ?` ONWEgLTF1 A1/E - x OST B ,- ON, 0 MA - 2215 D(PIRA`IION DATE L I C Eli1 S E > x z CON S:TR. .SUPER - 7�/37r�994'_ RESTRICTIONS.. .. -.:. EFFECTIVE DATE UIS.OR ; CAUTION NOpE IC-NO FOR PROTECTION AGAINST.: {' 3 10/3 PEFT, PUT 1/7 992 _ 052325 RIGHT TH.uMB P A IN gPRVT 77 E - - ro UL K BONA: ; '. �_ °, :: XOISS 027-3d-'f723 �e0x 6.53 90 (cHERBY C ROTUX MA 02 rr TREE R BLASTING OPERATORS - - - m 63J... - ..PHOTO(BLASTING OPR ONLY). - - - IOVIS 14CM PHOTO. -r - "- - O HEIGHT NOT VALID UNTIL SIGNED BY LICENSEE AND OFFlCLCLLY - - ' :. - - STAMPED-OR-SIGNATURE OF THE COMMISSIONER �. n 6/05/1`94T 1 �� � r THIS DOCUMENT MUST BE CARRIEDON THE PERSON OF, .(.� GAE HOLDER WHEN EN=, URE LINE SIGNATURE OF LICENSEE « SIGN NAME IN FULL ABOVE SIGNATURE -GEDINTHIS OCCUPATION. OTHERS-RIGHT THUMB PRINT COMMISSIONER ,.:.>g....v..,, a.,. -� .�_. � _ >,. _..: r* __.�....a->. -. _. s.__ � � _a- ::: �. -_ •.'- ties: -': .:.a3�."�'.�� - - xa .r»_ F{-.�^- :y.,s,_c...-,=` ri.r� ,.:�..t._�-....c... ._': -.w..-axe�--, as ......A� �?..,_ac".a,r ...�a.�.:,.:•n r- ��'� _-.- .-.:.. :. _ "' a .w" -,=� �z �_.. ..'w-r „.-.,.--. ._- _.� =c'�',x-z'�,st=:-'� __....�rs,.:r;..'w •�-�=;�. s -p=4 - �s- _ - = -�.:n �-, .3.'..�a, r _a _._ �. . ;..-� .. <.g_ .�eY=•�-�5.�:.3. _..; .-`r?-.�.r. -t.._�. '8>�- :--- -� - - .,~. �3 ���s`^;;�e��.. ��`4''�•srC`0'a�--� - '�.� � - ?' �+.' - .v-A=.:. ...fz.>. .,a.,,.. ar-w.s,.. .'�,-,..<y_ 6, •- r,.. -� ., ,.. -: - ._ _-.... - _ �-�-'a,��. "�_� t-� -��� �ac`v�¢xs�-Ssy'>:T, -.•-L a-�_ '_� rin r�',�aa�4wwaxa-�.i'¢•� ,.:��..�..:_.uM�. �EySis`a 'S�T.�t3bintrb%��s�% : ' l�s.�x'cE'RC',x���n;Ei,d:�aica.r..�.l!�k._�s � -r.._.,__..,- ,.. v 51NId 8-�- SHE Town of Barnstable *permit# Z— �, ,O Expires 6 months from issue date • or�tegulat . Serviees e snnNs°r� .�. :. - - Fee 9� 1atass ,m�' :;�._ __.Thomas:F.Geiler,Director .. 'ti'�.�►,''° ..... _ .. .' Building'Division' - . "Tom Perry, Building Commissioner : 200 Main-Street,. Hyannis,MA 02601 ® Office: 508-862-4038 AF.tR._ Fax:'508-790-6230 :::,....;.:.•::•.:...:_:._..: _.... S:S: ER1VlT'T ATPLIC•ATWN - RESIDENTIAL n ;—.. ,OF BFti�;�S iA�� . n Not Valid without Red X-Press Imprint lap/parcel Number toperty Address Residential Value of Work W/ Minimum fee of$25.00 for work under$6000.00 Jwner's Name&Address W`r i SDU w� Shb'd f J� Telephone Number Contractor's Name- Home Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) Ps &Workman's Compensation Insurance Check one ❑ I am a.sole proprietor ❑ I amthe Homeowner [v�I have Worker's Compensation-Insurance Insurance Company Name 11 I S- IL Workmen's Comp.Policy# C" Copy of Insurance Compliance Certificate'must be on file. 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) a ❑ Re-side yReplicementWindows- U-Value il (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. Home Improvement Contractors License is required. Signature /y V ► �f 11 .�i ( J Q:Forms:expmtrg Revise063004 I Town of Barnstable Regulatory Services i Thomas F.Ceiler,Director 9q, ��•� Building Division �'fD MPi TomYerry, Building Commissioner 200 Main Street, $yaunis,MA 02601 www.iown.barustable;ma.u$ Fax: 508 790-6230 Office: 508-862-4038 Property Owner Must Complete and Sign This Section If Using ABuader as Qwner of the subject property 'hereby authorize:' V .to act on nvbehalf; in all matters relative to work authorized bythi building permit applica ; tion for (Address of job) Date Signature of Owner Print I*tame The Commonwealth of Massachusetts �_l_ - Department of Industrial Accidents Office ellnvestigadens 600 Washington Street, 7"Floor Boston,Mass. 02111 Workers'Compensation Insurance Affidavit: Building/Plumbing/Electrical Contractors name: L r address: city state: zi hone# U work site location MR address): ❑ I am a homeowner performing all work myself. Project Type: ❑New Construction modeh❑ I am a sole pro netor and have no one workm@r in an capacity. uildin Addition I am an emloyerro -di worke�rs'Kcompensation for my employees working on this job. a. .w:.' ,?:l h ; ltS Iv'1'il'(' 4,`8.. r• .1 GS ❑ 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 �.. w c � �^�^Y.r.�. �;Yd R�,s•4'�� •�"�"'�'4 z`. .���•s s ^x w� � .�3. ,� <w: 'S l t j d/1Slpfea7lPe:'.�.0.. tbYnban na�th t , , Y : :J ian+ r � .cltf 1 r -4 Y .z. YllOne.TF Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil 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 penal'es of perjury that the information provided above is true aff come Signature l Date NKPrint name � L `�1 Phone# ' official use only do not write in this area to be completed by city or town official city or town: permit/license# ❑Building Department' []Licensing Board ❑check if immediate response is required ❑Selectmen's Office ❑Health Department contact person: phone#; ❑Other {revised Sept.2003) - O Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law",an 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. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings"in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation. Please supply company name,address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. City or Towns 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. The affidavits may be returned to the Department by mail'or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street,7`h Floor Boston,Ma. 02111 fax#: (617)727-7749 phone#: (617)727-4900 ext. 406 Sou Zf} �3038/ CAPIZZI HOME IMPROVEMENT INC . SPECIFICATIONS AND ESTIMATES PAGE 6 OF 6 STATE OF 1ASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT I, aw- lla- OWN THE PROPERTY LOCATED AT I� IN �U ( I MASSACHUSETTS. I HAVE AUTHORIZED CAPIZZI HOME IMPROVEMENT TO ACT AS MY AGENT TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. I GIVE MY PERMISSION TO LESSEE TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. SIGNATURE OF OWNER: OWNER'S ADDRESS: OWNER'S TELEPHONE: LESSEE'S SIGNATURE: LESSEE'S ADDRESS: LESSEE'S TELEPHONE: APLLICANT'S SIGNATURE: Mao APPLICANT'S ADDRESS: 1645 NEWTOWN RD. , COTUIT, MA 02635 APPLICANT'S TELEPHONE: 508/428-9518 RESPONSIBLE OFFICER: RESPONSIBLE OFFICER ADDRESS: RESPONSIBLE OFFICER TELEPHONE: ACCEPTED BY DATE G/ THIS PAGE IS P R OF AND IN 0 FO CE WITH PROPOSAL # ✓546 03:5TPm Frum-AIG 9j8 310-G9U3 i-7Zh P.UUUUUL t^IlC .�i• �• ;•'�Ij;'. ` {{ •i.[�' i •` .. .Y�,• :.)L••r -iJi:'';r,..'• y,iF�i' ;' , r•'.,i.''�-�r:�'�IJ S.y�•-3 , J•?'"it �. I..'�•l'1„ I�hIS11R�4�+C�>. : PRODUCER —_ LEA. r �'•; L R� �,,{ ;' 1 HIS CF_RTIFICAI"E IS ISSUED AS A MATTER OF IN(=O1WATION itt Main Stir ONLY ANO CONFERS NO RIGHTS UPON THE CERTIFICATE Employe Ins Glquit inc HOLDER:THIS CL.RI-IFICATE DOES NOTAMENI-), EXTEND OR FlcclTbur�, MA 012p,120 �11 ALTIER.THI�COVERAGE AFFORDED 13Y-1 HE POLICIES BELOW COMPANIES AFFORDING INSUR.ANCF COMPANY A GRANITE STATE INSURANCE COMPANY - If�15UR1=D Resource Nlanagementc Inc , 281 Main Street,SLIte#5 I'Achburg, NA 01 q20 ` • ?... ,:�.• :-.�'. .•-:"; ',��?'r..' '.' ,_:,a., . :"' ^n '•rig... ..+,- _. ... .•ri' ••.0 C•:, THIS 1©TO CERTIFY THAT 4 HF=POLICIES OF INSURANCE LISTED BELOW HAVE Bl=[N)SSUEI�TO THE INSURED NAtgED ABOVE FOR THai E POLICY PERIOD INDICATED,NOT W MSTANDING ANY REQUIRF-MENT.TERM OR CONDITION 0`ANY CONTRACT OR OTHER DOCUMENT W(71 I RESPEGT7�p WHICH THIS CE-RTIF)CATE MAY BE ISSU,ED OR MAY PERTAIN,THE INSURANCE AFFORDED THE POLICIES DESCRIBED HEREIN IS S1JaJECT TO ALL'n-IE TERMS,I=XGLUSIONa AND CONDITIONS OF SUCK POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CIAJMS.,' IN3l1RANCL' C POL NUMBER POLICY EPrFt,'Tt116 DATR� tDLJCY mCPfRATION DATEi A OMPFN871T?ON XY Cr I4D P,Mq-C7YWVr LIAMUTY N[PROpf2lEfaR! - - LIMITS. Trr INLL Q FxCL 0 C Group 12)252004 12/25/2005 STATurotTruMrrr .�''•} ''•ya 1'`'',';• '�.'1 If 047?192 IS' �illpl .'. �•IE3i ?r'ICY)i• � 8�Appn-t0 MA OPcappm Ody, _ '•I'i• 'tri I ACHnCIDENf S 100,0 .. , rA9S POLICY LIMIT S 5D0,17 E OR p-nQN OF OPERA-nc)N R/1 tilCLR9/RP>rCIAL iTEMg LQYJM S 100.0 RE:COVERS THE EMPLOYEES OF TtiE NAMED INSURED LIED Tea:CAPIM* HOME iMPFtOVEME1JfS INC,1645 NEVI'TON ROAp, ` OTVIT MA 02535. CERTIF'1CATE 1401.,DFR ANCEt_LATIaN • CAPIZZI HOME IMPROVEMENTS INC txDArcYOI rrreAeoVE�enCRIAQDPOLiC1�SR><cgNcbL>SDB6POR�me 1645 NEWTON ROAD EXPUtATION DATE T?iEREOF,THE tS3U1NG COMPANYWA-L END5AVOR TO Ml r&3p COTU IT, MA 0263B DAYS WRITTEN NOTICE TO T"F CeZTTICATE-HULDM NAM®TO THE LEFT.BUT FAILURE TO MAIL SUCH NOTICE SHALL IhlrOac ND ON-MTION ORLKBILITY OF ANY KIND UPON TK-COMPANY,ITS AGrNTS OR RHPMWTATWES• AUTHORIZED REPRGSENFATIVE _rofx,��1C� }3o��Td oJ_3u�Jan r }�c �u.la g loJis aj)d Si-d1iC w-ds Onc A.shbu -t«n Place - Ro cn- ) } 30l Vt 130sion_ 1\�I.a.sacJ�usei:i.s 021 08 }3 cm�e }_711pr0vcm ent, �'c_��i�r-a.ci.or }Z.e�;i sirai.i on Repisiration: 100740 type: Private Corporation Expiration: 6/23/2OD6 CAPIZZI HOME IMPROVEMENT, INC. Thomas Capizzi, jr. 1645 NeMon Rd. - Cotuit, MA 02635 Update.Address and return card.Mark reason for clianre Address Renewal Emp)oyment ❑ Lost Ca Jlrl: Lno77o77•o�ilueol�. o�✓/!(.QdOQ•�/7.ud(.114 - - Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR License, the expiration date. If found return to: •�_:. : Registration: 100740 Board of Building Regulations and Standards >' Expiration: 15/23/2006 One Asbburton Place Rm 3301 Type: Private Corporation Boston,Ma.02108 CAPIZZI HOME IMPROVEMENT,I Y1 'DMas Capizzi,jr. 1645 Nevlon Rd. ` Cotuit, MA 02635 .Administrator : Not vali�withoui tnrc ny.(. BOARD OF BUILDING REGULATIONS , ,u License: CONSTRUCTION SUPERVISOR r Number: CS 057032 B irthdate: 09/26/1963 Expires: 09/26/2005 Tr. no: 7171.0 Restricted: 00 ` THOMAS X CAPIZZI JR _ w 1 1645 NEWTOWN RD COTUIT, MA 02635 Administrator ` I A 27 Harvey Industries A Proud ENERGY STAR Partner I I:ll'\'c \ \'111\1 mlldm\s Im. I•;NI"R(;l' STAR (lu;llili(•(I dllt l"ll(ml fln• I . . \\ill) IZIII . I;NF,R(;Y STAR (lu;llili( (I \\110(t\\s ;n(� "I0 Itlurc• rllicirul dmil (I1;11 ulc•c•I lllOS( IlMimwl Inlil(IiI1ti ( (,(I('.s. II ;111 1)r(xluc I'' III (11( l L�. \\'( r( " I;N,I';R(;l' STAR (Ill;llilic•(I, \C(•(I S;I\'( l(I(I I)illi(,I1 ill (•II(TON, ( usfs O\'c•l, (Ile• ll(•\f I') \c•;ws. FNI';RM' \\'iiidm\s' I'c MY)d 161 I11c, 'I1�'ir(,lilli( III, t1si1l lilt k \cl)jc 11 (';los(' MY 1)(dIMIM), .SlIM0, 1,11)(I dOh;Il \\;Irltlill . sntO'cc': U.,ti. DcA17-17noll n) ,Mum u.ec 1�mt�-I/A)•�un toaehievc U and. K Values U-Value :\ nu":nurr ell Ix",II Ir:nl�n)i„i(�n. R-Value: :\ nu a,nrr of a ( incl0\r>rr,i,l,uur lu 1w;I( ("un(1(Irliun. I'llc hi"hrr dw R-\';Ihu. Ill( 1wilci rI eciuclm\ I�;11)1( In iIUIILur. a d,\I R(: lul -dm. •.Clear L,tiulalin!" - Lo\\"-h: 1 1.ow+-1;/Aron An- Inlillralion VINYL\\?INDOWS LI-Value R-Value\ lI-\'aloe R-Value lI-\+aloe R-Vslue (:LI\sic Illuu1)1( Iiull"(J\I(rltnni(al) 11.')I) •?.1)O O.ii i(I 1�i1 11 (I:r Chs�lc Omlblc I-Illn.g(\\('I(I('d S:Isl, \ FI;III ) O.N 2.01 _'.li:), (L:i l 2.91 I(1 (Elsie A(i)wilicalI)Oul)I( I-lmwS,1,(;1{I (L:ia 3.03 R2') I.(1(1 O.'?I 1.17 (I),. sl",mi urc 1)(mbic Ilun!"(:\l(ch,uli(;II! ll.:,O 2.00 (Lai 2.70 (L:il 2.91 OI' Slin)linc• Ucnll)I(• 111111 (\\i Icl((I ti;Isll c\ I'i;urn l 0.50 2.00 O.:i% :?.iO O.:i;i :i.O:) W) Slir,tlin(-sin."lc Hum,(\\c ldrd S:I.sh Fl;I111c) (L')11 2.00 0.:i7 ?.i(I (L:i:) a.O:i M C;I"c IIlc•nl/A\cnim{ 0.17 2.I:i 0.36 2.78, 0':)3 .10'1 .OI \'in\'I(:au'nu'nl/A\\uitl!{ ` I Itrl'ncll I'nnrl, (1.32 i.13 0.26 i.11') 0.25 I.O(I- .01 Vin\Il)c'si n<'r,511a1u, OA 2.0-1 0..,i1 2,91 0.30 :1.33 --- \'in\i Hn1)1wr 0.47 2.1:1 0.35 2.86 0.32 3.13 llti VIM IPi(tun•\\inc1O\\' (L"1{i 2.1% O.:i1 ;.2:i O.'28) :;.:)i .01 VIII\I ROII(-r-2 I,i(('c\ 'i bile' O.5 2.00 0.:i8 2.6.') 0.3,5 2.8,6. .(H 12-lio i VINYL NEW-CONSTRUCTION WINDOWS Vimii 1)Ouhlc Hone(\VcIdc'<I ti;ish c` I rams) O..")(I 2.00 O.'i% '?.70 (L:ia i.(l:i I(I VW(m)Sin lr I1nn (\\(Icic c1�il.til,c\ I•imlic•) O.')(I 2.00 0.37, 2.70 I).:i; a.O:i I0 \'ic On CI,Is';R I)(nll)Ic I lush(\ Is11<\ 1'i'.I11lc) O."il.l '?.(bl U.:il ?.%,{ RI i \'i(On(:asc u•nt/Awl]In'(' 0.17 2.13 O.:)l 2.O I 0.:;1 ?:; .01 ;. 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I,o\\'-H;/Ar+- I,o -I?/Ark cI'm/Il' PATIO DOOR 1-Valtic 'I!-\>:auc II-Vallle R-\•aloe (1-Value 12-Value II-Value R-Value I Ell- c•\"S(lid\7i11\1 P;Ilic) ])()()I R 1!) 2.01 0.10 2.')() R'i7 2.711 O.'i`") 2.8)li (If) "All vinyl uindO\vs With Lc)\A"E/Arlon qualify for the 1':NI;RG\' STAR lug run tlnou}houl the U.S. I"hr m (A I(IIII)rrr(1 I e,t I: I,I e ncl\ rlli rl :Nl,;k(;Y ST\R cIII:Jiliraliun in Vmll rrpiuu. t ;ulcl R-\'.Ilur,rur auhjrrl Iu rh,nl cillnnu nnli(c P�pFTHETo�ti Town of Barnstable *Permit# Expires 6 months-from issue date y Regulatory Services X-PRESSFRERMIT v MAN. $' Thomas F. Geiler,Director NOV 2�02 r En Mai Building Division a Tom Perry, Building Commissioner .TOWN OF BARNSTABLE 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERNIIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number l� yJ 0 y Q Property Address C O TU 17,�� 6 (, Ste. [Residential Value of Work Owner's Name&Address TA-U4 C—S S 0 v Z Contractor's Name f� (�l''164 Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) 6 ❑Workman's Compensation Insurance Check one: ff-I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# CD = `LL` Permit Request(check box) ?j t�-Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) r� � ❑ Re-side - r ❑ Replacement Windows. U-Value (maximum.44) ❑ Other(specify) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. Signature Q:Forms:expmtrg Revised121901 � Expires 6 pronrhs from iuYr c ,�.A.� ' Regulatory Services FeeBARD ,eg Thomas F.Geiler,Director V�ertnn I 5 a 8�3 7 Building Division Elbert C Ulshoeffer,Jr. Building Commissioner 367 Main Street, Hyannis,MA.02601w _ ,,, Office: 508-862-4038 X-PRESS PER 11 Fax: 508-790-6230 APR 1 3 20041 EXPRESS PERAUT APPLICATION Not Valid without Red X•Press Imprint TOWN OF BARNS iA B L Mapiparcel Number O to O U Property Address� Ixf14/ m ST, � C OTv / 7 Ire ( Residential OR F1 Commercial Value of Work 4�_it Owner's Name&Address T/9 V1 L S Sou 5A 11 69 p4f4, N 57_ C07-ul7— W14 a36 � S_ Contractor's Name 14 tl L R O KM- Telephone Number SZ Home Improvement Contractor License#(if applicable) 1 I S 1 Construction Supervisor's License#(if applicable) C. f7Workman's Compensation Insurance Check one: (� I am a sole proprietor �] I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Permit Request(check box) (� Re-roof(stripping old shingles) Re-roof(not stripping. Going over existing layers of roof) ® Re-side ® Replacement Windows. U-Value `4 (mum-4 ) Other(specify) *Where required: Issuance of this permit does not exempt compliance with other town department regulations.i.e.Historic.Conservation.etc. Signature expmtrg of Town of Barnstable *Permit# Expires 6 months from issuedwe SARKMaM Regulatory Services Fee MAM *m$ Thomas F.Geiler,Director � Building Division Tom Perry, Building Commissioner r 200 Main Street, Hyannis,MA 02601 )ffice: 508-862-4038 SEp 9. 8 2004- 'ax: 508-790-6230 EXPRESS PERNIIT APPLICATION - RESIDENTIALTI§M OF BARNS_.' -- Not Valid without Red) Press Imprint /parcel Number 0 I I ' 13 C) - o O f ierty Address 1 p ftiA G 1 Ylr e 60 tesidential Value of Work �°' � Minimum fee of-$25.00 for work under$6000.00 ter's Name&Address VSatw nmlo, - -G . 1 b tractor's Name 010 3�( 1 Telephone Number ae Improvement Contractor License#(if applicable) struction Supervisor's License#(if applicable)_ Vorkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance rance Company Name I D lanan's Comp.Policy# ,y of Insurance Compliance Certificate must be on file. nit 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- de �' n o� 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. 1 ***Note: Property Owner must sign Property Owner Letter of Permission. Home Improvement Contractors License is required. t. nature , rms:wcpmtrg 463004 Boa: oz T. � : n�_ � ans and �r�aards d' One Ashburton Place- o om 13 01 3 02108 dome"1m rovemennt _a_n `actor e store j: Repist bcm 100740 -rype: r rivate r-o pDration : B=iratbn: 5,21=05 r i - - A �� i= N _T INC. .: I�f IIJ. ,.0 —.. •r.i a ,L. 1 11EThomas C a Fr; J r�4' N..e veto n i Lipdate Address and renter. card.Mark re2son for change. T Addressem 'm lnvmea: "os.Card ✓nc vam'.,ogw.ea�lii cf✓�ic�odtiuneta '" ° Boars o.Building Rc.-uiatio'rs anc 5:ancard_s License or regis--atior.valid for indiVidul.Use oril�° 7�N_!N,?R1VEIJi_K7 ;�K—IRA DR before the expiraiior dz-m- If found ren:rn zc: Board of Building Regulations and Standards c 7' Ke^is.�fioi ID�i4C - One Ashbu.ton?'.ace Rm 1303 Bostor:,KL. C_i08 154t:Newton RZ. Cotu ,iJi �2�35 sdministraror Not valid wiinou-,signature i : 1 I - trf i L S'ouzc ��L �a 930 y J . CAPIZZI HOME IMPROVEMENT INC . 7/ SPECIFICATIONS AND ESTIMATES PAGE 6 OF 6 STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT 3LMI(� tt w OWN THE PROPERTY -LOCATED AT IN ' m MASSACHUSETTS. I HAVE AUTHORIZED CAPIZZI HOME IMPROVEMENT TO ACT AS MY AGENT TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. I GIVE MY PERMISSION TO LESSEE TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. SIGNATURE OF OWNER: OWNER'S ADDRESS: OWNER'S TELEPHONE: I LESSEE'S SIGNATURE: LESSEE'S ADDRESS: LESSEE'S TELEPHONE: APLLICANT'S SIGNATURE: APPLICANT'S ADDRESS: 1645 NEWTOWN RD. , COTUIT. MA 02635 APPLICANT'S TELEPHONE: 508/428-9518 RESPONSIBLE OFFICER: RESPONSIBLE OFFICER ADDRESS: RESPONSIBLE OFFICER TELEPHONE: ACCEPTED BY DATE THIS PAGE IS rR OF AND IN CONFO CE WITH PROPOSAL #