Loading...
HomeMy WebLinkAbout0073 MOORING DRIVE r /to/,J_ J Town of Barnstable *Permit# Z0I505�OGf Expires 6 mo hs rom Issue d� Regulatory Services Fee _ anxxsznsis 1639. `�$ Richard V.Scali,Director Building Division PERAII Tom Perry,CBO,Building Commissioner S►r 200 Main Street,Hyannis,MA 026(�I®`�' II 03 2015 www.town.bamstable.ma.us V V I OF Office: 508-862-4038 ' Rl�Filt�;iS8 790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY D I L�t Valid without Red X-Press Imprint Map/parcel Number Properly Address 2 R sidential Value of Work$ �.��00, 00 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address C"IelazG - (5o / L GG 9Y c4e5ln4,1 c/11'C �O ,Cj�'�wso�' 1,ne, . 0?63/ Contractor's Name 0a n ar I an S Telephone Number �7 y- 271—U 92-/ Home Improvement Contractor License#(if applicable) /� �,�9 7 Email. Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Che one: IaI am a sole proprietor ❑ lam the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) A11 construction debris will be taken to ❑ roof(hurricane nailed)(not stripping. Going over existing layers of roof) Fee-side Replacement Windows/doors/sliders.U-Value ,30 (maximum.32)#of windows / 2_ #of doors: 2 ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. 'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: Q:\WPFILES\FORMS\buildin ermit forms\EXPRESS.doc Revised 040215 t J Ile CoMy olivveah4i of_Vassacltusetfs Departrrretzt oflindus ial Acciderds - of re ofInvesfigadens 600 Washington Street ti Boston,M4 02I11 k►•�rvx�.ntas�guv/din ,. : '. '"Tnrkers' Compensation Insurance Affidavit:Builders/ContradGrs)EIedrkianslPlu nbers Applicant Information: Please•Print blv Name3usssganvatiaadiaiGLrG, l• Address: City/State( :�aa&,_ Wq. 0 2-(o V 2, Plraa'e- Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with. 1 1 4. ❑I am a general contractor and I 6. ❑New construction �Ployees(full andl`or part-time}* have hired.the sub-contractors 2.L�'I am a sole etm or partner- wed on the attached sheet �= ❑�odeliug pzopn ship and have no employees. These sub-contractors have g. 0 Demolition worling far me ita any capacity. - employees aadhave workers' [No w orkers,comp.insurance comp-insurance.# 9. ❑Building addition required.] 5. ❑ We are a corporation and its 10❑Electrical repairs or additions 3.❑ 1 am.a homeommer doing all urork officers have exercised their ' L El Plumbing repairs or'additions mysseZ�o y"�or� -• right of exemption per MGL 17.❑Roof repairs insurance require&]F c.152, §1(4) and we have no A employees-[No workers' 13_❑Other.S! r 0!n comp-insurance required.] (,}�- 'Aayapplicza 1hat checks box 01 also fff cut the section below showingth&workeW compensatienpaIicyinfurnmdon. 1 Hom—hers who submit fins affidavit in icating tbzy are doing all wont anti then hire outside contractors amct submit a new affidavit indicating such. fCantractors that checY this boa must attached an additiond sheet showing the name of the sub-caa¢rictogm and state whether or not those entities have employees.Ifthesub-contmctoeshave etnplofees,theymnutpm ide their workers'comp.policy number. lam an eiiiplopr tilat isprmzding ivtarkers'congwisatiart itmirarxce far my enrploj ees Below is the poNcy lmd job site i►forrnadon. Insurance Company Nance: Policy or Self-iris.Lis_4. MxpirationDate: ,t Job Site Address- CitylState/Zip: Attach a copy of the workers'compensationpolicy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A.o€MGL c. 152 can lead to the imposition of crimisaai penalties of a fine up to$1,500 OG andt'or one-year imprisonments as well as civil peualties.in the form of a STUP WORK ORDER and a fine of up to$250-00 a day against the-violator. Be adtdsed that a copy oft his statement may be ceded to the Office of Investigations ofthe DIA for insurance coverage tiwfflcaticn_ _ I do hereby cal—, ,under the its andponahfies ofpet;jury that f fir hzfaremfiortprm,4 daboiw is trim and correct ...tore: Date: .1 Phonea�- 22 Z/ Offi al use only.-Do not write in this area,to be co'mpieted by city ortown o iciat City or Town: " PertmtUcense# Issuing Authority(circle one): 1.Board of Health 2.Budding Department 3.CitylTown clerk 4:Electrical Insppector S.Plumbing Inspector b.Other Contact Person: Phone#: information and Instructions • , Ma ccar husetfs Ge=al Laws chapter 152 reqm:res all employers in provide workers'compensation for their employees. Pa_suanttn this stye,an.anplvyee is defined as-"_.every person in the service of another Bader any contrast of hie, express or implied,oral or written_" An erppfoym-is defined as"an individual,parfnersbip,association,corporation or other legal entity,or any two or more of the foregoing engaged is a Joint enterprise,and including the legal represenfafives of a deceased employer,or the receiver,or trastee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more do n 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 appurEenanttjiereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local Rcensmg agency shall withhold the issuance or renewal of a license or permit to operate a business or to coiz<strnct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance-coverage regntred_" Additionally,MCrL chapter 152, §25C(7)states"Neither the comm aawealth nor any of its political subdivisions shall enter into any contract for the performance ofpublic work until acceptable eviden_ce of compliance with the fiwmt an ce:- re,na-enients of this chapter have Been presented to the contacting authoi*_" Applicants Please fill out the workers'compensation affidavit completely,by checkiag the boxes that apply to your situation and,if necessary,supply sob-contractor(s)name(s), address(es)and phone number(s) along with their certificates)of incr'rrance. Limited Liability Companies(LLC) or Limited Liability-Partnerships(LLP)v ithno employees other than the members or partners,are not required to taffy worlcers'compensation insurance. If an LLC or LLP does have employees, a policy is regnireci. Be advised that this affrdayh maybe submitted to the Department of Industrial Accidents for conf=aiioa of ffisur-ance coverage. Also be sure to sign and date the affidavit. The affidavit should be retmmed to the city or town that the application for the peunit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are repaired 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 . t Please be sure that the affidavit is complete and pried 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 pemmitllicrose number which wM be used as a reference number. In addition,an applicant that must submit multiple peunitllicans5 applications in any given year,need only submit one affidavit indiraf iag current policy information(rf necessary)and under"Job Site Address"the applicant should write"all locations in (city'or provided to the �° has been officially stamped or marked b the city or tower may be town)-"A co of that ally storm-p Y PY applicant as proof that a valid affidavit is on file for f bme permits or licenses A new affidavit must be filled oat each . year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (Le. a dog license or permit to burn leaves eta.)said person is NOT rimed to complete this affidavit: The Office of Investigations would hke to thankk 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,C-aMM wealth-of Massachmetts ' Depaztmm cif lad izzal Aoai�lent ( �e oftvegtZo 600,VlaffiVGn Sit 13ogtau.,MA GPI I - T�I::#61'-'27-4}GG text 4€lf nr l-a7 =I SAFF Fax 9 617` 27-7749 Revised 424-07 vnvWjmasFLgav1dia r OFF�{y SARMMLE, « ,�� Town of Barnstable �rFD MA't s Regulatory Services, Richard V.Scali,Director Building Division Thomas Petry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 5.08-790-6230 Property Owner Must Complete and Sign This Section , If Using A Builder 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: ' o tA. (Address ob) t . Signature of Owner Date Print Name . r If Property Owner is applying for permit,_please complete the Homeowners License Exemption Form on the reverse side. QAWPHLESTORMS\building permit formsERESS.doc Revised 040215 Town of Barnstable Regulatory Services i of r�ily,� Richard V.Scali,Director Building Division * SARNSTA1314 ` Tom Perry;Building Commissioner MASS. 1639. 16�0 200 Main Street, Hyannis,MA 02601 ArED � www.town.barnstable.ma.us Office: 508-862-4038 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 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 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:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 040215 I Mass.GDV Home State Agencies Search Results • Select the licensee name below for more information. (If your search produced more than one page,you may select page numbers at the bottom of this screen. • Select the Search for a Person or Search for a acility button to perform a new search. • Select the Preview File button to view a sample of the fields included in a file you can download. • Select the Download File button to download a text file of your search results at no charge. • Select Public Information Request Form for a form to order a data file. Name License Number License Type License Statuslistharn ddress AINTA I GARY SLA 00319 onstruction Supervisor S ecWI ctive astham MA 02642 MAINTG SLA 00319 SSL-WS-Windows and Sidin ctive astham MA 02642 ANIS. S G L-100319 SSLSF-Solid Fuel Bumin Device ctive astham MA 02642 S Y SSL-100319 SSL-DM-Demolition ctive stham MA 02642 I T S G L-100319 SSL-RF Roofingdive MA 02642 ©2011 Commonwealth of Massachusetts Site Policies Contact Us Massachusetts Department of Public Safety � Board of Building Regulations and Standards `4 Construction Su en-isor Specialty License: CSSL-100319 GARY K MAINTAAIS 2A OAKWOOD CR G Eastham w6 02A2 tzpitation 0912W20;15 Commissioner r The Official Website of the Office of Consumer Affairs&Business Regulation(OCABR) Consumer Affairs and Business Regulation Home Consumer Rights and Resources Home Improvement Contracting Home Improvement Contractor Registration Lookup To search by registration number, enter the registration number in the textbox below and click the 'Search' button. Search by Registration Number[ y µ Search To search by other fields, enter the search criteria in the fields below and click the 'Search Registrants' button. For the State field, use the two character state abbreviation such as "MA "for Massachusetts and "RI" for Rhode Island. All search fields allow partial text so the search will look for any values that begin with what was entered. For example, if you enter"Fr" in the City/Town field and "MA" in the State field then the search will return records for Framingham, Franklin, and Freetown which all begin with "Fr" and are located in Massachusetts. To return less information enter in more criteria. For instance, entering in a state of"MA" will return a large number of records but entering in a state of"MA" and a city/town of "Medford" will lower the results. Search by Registrant's company's name Search by Registrant's last name is City/Town 'eastham� �_. State F�7 j Zip code :0 642 earch Registrants Click on the registration number to view complaint history. You can also view arbitration and Guaranty Fund history. The list is current as of Tuesday, September 1, 2015. Search Results RESPONSIBLE REGISTRATION EXPIRATION REGISTRANT NAME INDIVIDUAL NUMBER ADDRESS DATE STATUS GARY MAINTANIS 181597 2A OAKWOOD RD 04/13/2017 Current EASTHAM, MA 02642 MAINTANIS CONST. INC. Maintanis, Charles 105261 2 A OAKWOOD 07/16/2006 Expired CROSSING Eastham, MA 02642 ©2012 Commonwealth of Massachusetts. Mass.Gov®is a registered service mark of the Commonwealth of Massachusetts. 1/11 ; x. U aor3 06 a 5�. DIME, . Town of Barnstable *Permit# o� Expires 6 months from issue date �+ Regulatory Services Fee s,.3Ss ztz saxrrsrnatE v� 1639. Thomas F.Geiler,Director X-PRESS PERMIT AtF p�.l p B� �( Building Division Tom Perry,CBO, Building Commissioner JAN O 2013 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 TOWN:Pig- ANSTABLE EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY t, Not Valid without Red X-Press Imprint- Map/parcel Number Property Address 7 3 Al OvAIW G .V/il e. (04t!d-,, IUA "a k 3 s' residential Value of Work �/��a' Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address 14Q,'y E Al .4 C A 04 ni tz� rn ®V4 kuwu? T fz)Yak- Contractor's, ame Telephone Number /C4 itIr )r 0 Wd/P"-l� iG07S/� Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) C.s 0 4 03d" D(Vorkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner []"I have Worker's Compensation Insurance Insurance Company Name �A� Workman's Comp.Policy# /'Y c d/ 0-(Y'70 Z0� Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) D/e-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to 11161d Al'i Ire f4Al0W1,C# jr-4 [7 ❑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 *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outl00k\DDV87AAZ\EXPRESS.doc Revised 072110 � Page 7 0f 7 Capizzi Home Improvement Inc. Specifications and Estimates STATE OF MASSACHUSETTS ?� f LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT I,MARY MACADAM, OWN THE PROPERTY LOCATED AT 73MOORING DRIVE IN COTUIT, MASSACHUSETTS, . I HAVE AUTHORIZED ' CAPIZZI HOME IMPROVEMENT' TO ACT AS MY AGENT TO APPLY FORA BUILDING PERMIT IN ACCORDANCE WITH 7. 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 IA '� C OWNER'S ADDRESS: 73 MOORING DRIVE; COTUIT,MA 02635 .. OWNER'S TELEPHONE: : :. : 508-4287:6603 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: : RESPONSIBLEOFFICER ADDRESS RESPONSIBLE OFFICER TELEPHONE. Client#:47298 CAPIHOM rODryYYY) DATE(MM ACORD., CERTIFICATE OF LIABILITY INSURANCE DATE(MM2012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,.EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(les)must 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). PRoouceR NAME: Karen Walther Rogers&Gray Ins.-So.Dennis PHONE Arc.No.Ext:. Atc No: 8T7-816-2156 434 Route 134 E-MAIL South Dennis,MA 02660-1601 RoDREss: _ INSURER(S)AFFORDING COVERAGE NAIC ti _ 508 398-7980 INSURERA:Main Street America Assurance C INSURED Capizzi Home Improvement,Inc. 1NSURERB:Associated Employers Insurance Caplzz(Enterprises,Inc. IN SURER C: 1645 Newtown Road INSURERD: Ciotuit,MA 02635 - INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES,OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF.ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPEOFINSURANCE ANDSR y yp POLICYNUMBER MWDDYEFF MMfDD/Y LIMITS A GENERAL LIABILITY MPB1075H 6/08/2012 06/0812013 EACH OCCURRENCE $1,000000 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES IF occurrence $500,000 CLAIM84ME I ^r OCCUR MED EXP(Any one Parson) $10,000 - PERSONAL$ADV INJURY $1,000,000 _ - GENERAL AGGREGATE s2,000,000 GENLAGGREGATEM R: PRODUCTS-COMP/OPAGG $2,000,000 PO JEC L .(( T $ A AUTOMOBILELIABIUTY MIM28044 06/08/201 _E ea NGLELIMITa $500,000 ANY AUTO - BODILY INJURY(Per person) $ AIA.OWNED SCHEDULED - BODILY INJURY(Per accident) $ AUTOS X AUTOS j HIRED ATOSNON-OWNED PROPERTY DAMAGEsAUTOS Peraccidentrive Oth Car $ A X UMBRELLA LIAB Or-CUR CUB1076H 0610812012 06/08/2013 EACH OCCURRENCE s5 000 000 EXCESS LIAB HCLAIMS-MADE - AGGREGATE s5 00O OOD DED I X RETENTION$10000 $ B WORKERS COMPENSATION WCC50105547012012 12/25/2012 12/25/201 X WC STA... OTH- AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOPJPARTNERIEXECUTIVE - EL EACH ACCIDENT S11,000,000 OFFICERIMEMBER EXCLUDED? N f A (Mandatory in NH) E.L.DISEAASE-EA EMPLOYEE $1,000,000 It yes,describe under - DESCRIPTION OF OPERATIONS below - _ FL DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS!LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks:Schedule,if more space Is required) **Workers Comp Information** Included Officers or Proprietors CERTIFICATE HOLDER CANCELLATION Town Of Barnstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE 0198 -2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S91859/M91856 TLH The Commonwealth of Massachusetts Department of Industrial Accidents -- Office of Investigations - I Congress Street,Suite 100 - Boston,MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual):Capizzi Home Improvement Address:1645 Newtown Road City/State/Zip:Cotuit, MA 02648 Phone#:508-428-9518 . Are you an employer?Check the appropriate box: Type of project(required): f.2I am a employer with 40+ 4. I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New constriction 2.❑ I am a sole proprietor or partner- ship and have no employees These sub-contractors have. listed on the attached sheet. 7. ❑Remodeling 8. ❑ Demolition working for me in any capacity. employees and have workers' comp.insurance.$ 9. 0 Building addition No workers comp.insurance� p• � required.] 5.. We are a corporation and its 10.❑Electrical repairs or additions 3.ElI am a homeowner doing all Work officers have exercised their. 1 L 0 Pl Bing repairs or additions myself. [No worker s' comp. right of exemption per MGL 12.URoof repairs insurance required.]t c. 152, §1(4), and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that che4s 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 checkbthis box must attached an additional sheet showing the name of the sub-contractors and state whether ob6t 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 and job site information. Insurance Company Name:Associated Employers Insurance Company Policy#or Self-ins.Lic.#:WCC5010 547012011 Expiration.Date: 12/25/2012 Job Site Address: ` q0011114 E e - City/State/Zip: ee t 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 under the pains and enalties of erjury that the information provided above is true an'd correct Si ature: Phone#: 508-428- 518 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#: ,f� �e�pammaizcUea,��z a�G' acfuraet�T - ,.. \ 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: e gistration 10b740 , Office of Consumer Affairs and Business Regulation Typer 10 Park Plaza-Suite 5170 9ExplratJori:',';.6123i20f4 Supplement Card CAPIZZI HOME IMPROVEMENT;INC. Boston,MA 02116 i ROBERT ELLSWORTH::>::::. . 1645 Newton Rd. OL Cotult,MA 02635 ad Undersecretary Not valid without signature ` i -- 1! Massachusetts-Department of Public Safety Board of Building-Regulatibns and Standards Construction Supervisor `License: 6S-061438 . �0 rTS b�A ROBERT T ELORTH ar 69 PALMER.-9,D _ 3 MASHPEE IAA 02 9 7 t9na Commissioner Expiration 10/15/2013 •� I0 f,.,: ,.• F1HE r Town of Barnstable *Permit#C:bV o Expires 6 niol the from issue date Regulatory Services Pee N Thomas F. Geiler,Director 94,A 1639• Building Division Ts� Ata Tom Per CBO, Building Commissioner �- r 0 2008 200 Main Street, Hyannis,MA 02601 ®�� �FBAR� www.town.barnstable.ma.us YYY 0ftice: 508-862-4038 STA13La Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL.ONLY Not Valid withoul Red X-Press Imprint !flap:parcel Number Property Address Zestdential . Value of Work �vV• Minimum fee of$25.00 for work under$6000.00 _� d Owner's Name &Addressl _ Contractor's Name � ( _1�% ��vU ---Y JJ(�{T1,�1� �Nutnber I'lome Improvement Contractor License 8 (if applicable) /_2 q. Construction Supervisor's License t/ (if applicable) Sl_ er rnan's Compensation Insurance Check one: �am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation I/ns�urance Insurance Company Name Workman's Comp. Policy# _ 9y' Copy of Insurance Compliance Certificate must be on tile. Permit Request (check box) / e roof(stripping old shingles) All construction debris will be taken to `ssx L�llc 1 ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Ite-side ❑ Replacement Windows/doors/sliders. U-Value " (maximum .44) _ *Where required: Issuance o,this pennit does not exempt compliance with other town department regulations,i.e. Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Vetter of Permission. A copy of the Home Improvement Contractors License is required. SIGNATI1RE: Q WPFILE'S`J'ORMS\building Pennit fonns\EXPRESS.doc Revised 100608 - F� M E� M id Sawyer Construction Sandwich, MAC 02563 508-539-1992 Town of Barnstable Sally I.give permission to nay wife Donna f Sawyer to nun and/or complete my paperwork for my permits. If you have any questions oar"need anything additional please let me know. Th you id Sawyer ons ction X. tanda�rds Board of Building Regula ons and S one Ashburton Place Zoom 1.301 Boston. Massachusetts 021.08 Home improvement Contractor Registration Regirtratiow. 134313 Type: DBA Expiratiort: .10/24/20 Tr# 259907 DAVID SAWYER CONSTRUCTION DAVID SAWYER _ - --- ,.- 318 MEIGGS BACKUS RD. -.------ SANDWICH, MA 02563 Update Address and return card.Mark reason for change. Address E_l Renewal Employment Lost Card ,5-cA1 b 5oM-05/06-PC8490 u r _ rChu,r;P1��1:CI):u•itr)rrtr l' �'uhlir `�;t11'I:• �� E;n;rr,t nl lvuilrlin� Ett su{;tliun• :r"ul Licerrsrr: CS SI 98859 Resrnrlecl to= RF WS DAVID SAWYER T 318 MEIGGS BACKUS RC O SANDWICH, MA 112563 1/2712011 i r;: 98859 Restricted to: RF,WS IA- Masonry only RF- Roof Covering WS-Windows and Siding SI;!- -Solid Fuel Burning Devices DM-Demolition only Fa�Jmt^���.�.s csr c z,ar,rrvvM,cvAitti�ry.v��1� ' Mvssachusetts State Building Code is r reuse fnr revocation of this license. Refer to: WWW.Marss.Gov/DPS David Sawyer Construction 318 Meiggs Backus Road Sandwich,MA 02563 508-539-1992 Date Proposal Submitted To Work Place STRIP AND REMOVE OLD ROOF SHINGLES. SUPPLY AND INSTALL: COLOR: �b Cal[6-0_Ete�,L G�qc,(/d P/C woud— 14- ckz �z P� CLEAN&REMOVE ALL DEBRIS FROM WORD PLACE AFTER JOB IS COMPLETED. ALL DEBRIS TO LANDFILL. TOTAL INVESTMENT FOR MATERIAL& LABOR:$ (� , 90D , All materials guaranteed to be as specified,and work to be performed in the a cordance with the specifications submitted for the above work and comp l e..in a substantial workmanfi a manner. Payments to be made as follows �-(✓ Any alteration or deviation from tife work specifications involving extra costs 4fll be executed only upon written order,and-will become an extra charge over and above the estimate. All agreements contingent upon strikes,accidents or delays beyond our control.Please remove and/or secure any fragile household items. Not responsible for broken or damage household items. Five-Year LABOR WARRANTY/PLUS MANUFACTURES,SHINGLE WARRANTY. We may with aw his proposal if not accepted within 30 days., Respectfully submitted. ACCEPT OF PROPOSAL The above prices,specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as speciftd. Payments will be made as outlined above. Date g I�d 'Assessor'sS,rnpp and lot number .....r .�j�..'.../. ...... THE F�.. ropy Sewage Permit number(..... .,..................:............... Hpuse number ............ ............................................ W1 1 TITLE 0m� EAIVlR�lr�n,tr A,�n� r• ^' o.Mara. TOWN OF BARNSTABLE '�' BUILDING INSPECTOR APPLICATION FOR PERMIT TO :....................� .�&. ..... .................. .......................... . . ! / .................................... TYPE OF CONSTRUCTION ..........L ..1.. � ..G1� '� .............. ......../ Y' 19........ TO THE INSPECTOR OF BUILDINGS:., r a < The undersigned hereby applies for a permit according to the following information: Location .1.:.�1 ...........,r ....&:�.......... �� ., .. ............... ................................... ProposedUse ..... . ... ..... .. ................................. ............................................ . ....... ......................�, Zoning District ............Y......F.............................................Fire District .......... Name of Owner .7/�"!...0 Yf X:... ..`.............Address ............. r........................................... Nameof Builder ... ...... ......... .:...Address .......................................:............................................ .Name of Architect ..................................................................Address ...........................................................:......................... Numberof Rooms ............... .............................,.......:Foundation ..... ..... .A.......... ............................... Exterior .......... .............................Roofing ......... .. .. ... .................................. ' j Floors .... .......................:.........................Interior .......... ....... ............................................................... Heating ....... `�........ . ....... .........................Plumbing ...............:.... ..............:.......................................... Fireplace ,�fu ......Approximate Cost f Definitive Plan Approved by Planning Board _____ ___________1_J_____19_ Area .......................................... Diagram of Lot and Building with Dimensions Fee BJECT TO APPROVAL OF BOARD OF HEALTH ' 3t / - r a I hereby agree to conform to all the Rules and Regulations of the Town of Barnstab regarding the above construction. Name ..... .... ...... ........................ THEO CONSTRUCTION No ]2194�..... Permit for ..Sjr.jgj;e....afil. ..... .. .D.w l .ng.................................................... t 1Locatio ...............0.8....73. Mooring..Drlvg...... .. � ✓ f �''f/ r t ...............................Cotuit...................................:....... d Owner ... ! r Type'of Construction + ............................................ ................................. Plot ..'............ Lot l .•.r Permit Granted :,,,,,January 23.............19 80 Date of Inspection 19 Date Completed , PERMIT REFUSED 19 1k ....... ............................................................. ........ y:..: ................................................... ......... ." ...................................................... Approv:! :z............................................. 19 .......... .�f�! .......................................................... ...................:........................................................... J Assessor's map and lot number .. ::`.. '.'....... `, THE f rFl� Sewage Permit number ......:y.:............'`............................... Z BAHHSTADLE, i 1 House number ....................... .............................................. 9 Saes ` 4pe�039 9� 'r 'Fp MPY a\ TOWN - OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ...d 'a ......'............. . . .......... ............................................. TYPE OF CONSTRUCTION ......... !' -'"`................f.::-" f'2 ....... f` `. I{ ` ::............ 1 .�%G .............. .�s!, r,. r.......?.............19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .. .1� '� ....fi r'i'�� rrtt' ..... ! >.o. {......� �::.............. Proposed Use ........ ........................ ��............... . ................................................................................................................... ....... . .. . Zoning District " ...........................Fire District Name of Owner .....r'�K....... .......Iil.'t .....� .................Address ............... ...:.:............/................ .._ r........................... of Name of Builder . �::.��.............. ..........'. ' .......:.:!......Address ............... .............................................................. /t Nameof Architect ..................................................................Address .................................................................................... A Number of Rooms .............Foundation � f"�' -................................. ...........................:. ............................... Exierior f r ...Roofng ..... �." � -,yfl,� .. ............... ? ../. Floors............................Interior .............:.....y.r :.::....................................................... ` Heating ...................................... "........' `'..............................Plumbing ..................... ........................................................... Fireplace ................... r: r:. .. .............................................Approximate Cost ........: .......................................................... e Definitive Plan Approved by Planning Board _______u L�,q_j_ ___19__=_5 1. Area 1r f Diagram of Lot and Building with Dimensions Fee. . ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH f f i i J i � 1 ' ' I 9 �\ 1 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. j T Name ! ' ,`, >r,r'r�f.� :'�1 :`d.*..'......................... A-24-12" g� No —21g42 Permit for — . — ° .................................................... Location ...,o-t.-#-1Qa....73-.M0g)?ijag..I � ....................Catui�............................................. . � � Owner "���Theo ����"Const � Type of Construction F � ' . � Plot - � � Permit �ronhad ' � ERMIT REFUSED � ....................... ........................................ lV ................................ --'' ' '----- m � _ .............. ..... ...—./,-y--------.— `� —.----��--...~.--.----.--.----- �� ' ' '---------------~'—'------~~' � Approved ................................................ lQ -----------------^--------'' � - ............-- ............................................................ - - y •_, tea•' 00 `J •t�•• + .* ! 'r `a '9 .A °• .f. t ; A.t tfs. `f Y'` Wo *it �. ! {J 001 o - v 3 _ PLAN . SHOWING a OUNDATfON LOCATION . C 07' t T MAS%of"% E l T Y {a OwNEO'BY 'F4E e� tv.5~r cul�_T'r o rt SCALE . l 4z� GATE: NORMAN GROSSAtAN;—=--—REGISTERED LAND SURVEYOR r I HEREBY GERTIFY.THAT THIS F�6UNDaAT►ON •IS LOCATED OF rs 0'N PHE LOT AS' 'SHOWN AND: CONFORMS .T0 THE TOWN OF OARNSTAOLE, ZONING REGULATIONS`-REFAROINti NORMAN SETBACKS FROM' STREET. LJIVES AND LOT LINES : r,ROsl& : O: NORMAN -GROSSMAN R.L:S. DATE , - a • f °•'"` • TOWN OF BARNSTABLE Permit No. 2i9jF2 l N.Un..� Building Inspector _ Cash 6,0 OCCUPANCY PERMIT Bona "No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to Theo Construction Co. Address South Yarmouth lot #108 73 Moorine Drive. Cotuit / r " Wiring Inspector � ,� � Inspection date °' - Plumbing Easpector Inspection date Gas Inspector' � � f� Inspection date Engineering Department ��1 Inspection date J C) V THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS. Building Inspector,,,,, t