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HomeMy WebLinkAbout0340 OCEAN VIEW AVENUE Assessor';office(1st Floor): - HWSTAL D IN OMPUANCE Assesso s map and lot number `TME r ENVIRONM Board df Health(3rd floor): ,,11t'ewggePermit number TOWN REG ; Z DAHISTULE Engineering Department(3rd floor): rrus h House number OZ/O &a o639. Definitive Plan Approved by Planning Board 19 B� �V t` APR �o NO s� APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only' b1` conSe C V C 'D TOW N O F BARN ry$t�°� BUILDING INSPECTj � a �n APPLICATION FOR PERMIT TO E�St � .� .CQ Aqp TYPE OF CONSTRUCTION WG�s .�/2ky, f ib 19 RI TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location Proposed Use Zoning District / Fire District ent Name of Owner 1 1��5��� Address -Wo o e e2ti V ex j rCs`L, Name of Builder V `Z"`e� Address0�. Name of Architect �( �� Address At q " Q Number of Rooms \ ` Foundation O�Ctr� Exterior �� _ ���� Roofing l Floors Interior A=i hc_J4 Heating - -`�' Plumbing CUBS V I� Fireplace Approximate Cost Area Diagram of Lot and Building with Dimensions Fee Ji ©► OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable r a ing th on rmc'on. Name Construction Supervisor' License AUSTIN, ALy it s" No., 34652 . Permit For BUILD ADDITION ". �- ± Single Family Dwelling u Location 340 Ocean View Road Cotuit Owner - 'Al Austin Type of Construction Frame Plot f.� Lot . t . Permit Granted October 21 , 19 91 Date of Inspection 19 t i. Date Completed 19 �..� � � ,mac; 4•� - ,� � ,p, Y �V F.( 4 1 DEPARTMENT OF PUBLIC SAFETY COMMONWEALTH Vt 1010 COMMONWEALTH AVE. �; ` � OF BOSTON,MASS.02215 t MASSACHUSETTS ENCLOSE CHECK OR MON'E'Y ORDER S CENE EXPIRATION DATE CON$TR�ISUPERVISOR FOR REQUIRED FEE, 06/30/1 993 MADE PAYABLE TO RESTRICTIONS o EFFECTIVE DATE LIC NO. 6 NONE 06/30/1991 014344 o "COMMISSIONEROF PUBLIC SAFE TY" O O GEORGE W BLAKELY (DO NOT SEND CASH). 130 REDWING LN BOX 206 T BARNSTABLE MA 02630 P EASE . NOTE FEE INCREASE i I PHOTO(BUSTING OPR ONLY) FEE: ` .100.00 Ef FECTIVE FEB. • 1 , 1989 NOT VALID U IL GN BY LICENSEE AND OFFICIALLY HEIGHT: 'STAMPED OR St M" TONER NOT DETACH LICENSE STUB THIS DOCUMENT MUST BE SIGN OF ICENSEE SIGN NAME IN FULL-ABOVE SIGNATURE LINE CARRIED ON THE PERSON OF THE HOLDER WHEN ENGAG- TONER OTHERS•RIGHT THUMB PRINT ED IN THIS OCCUPATION. YyOJ�{r fy.-1 r." �•'T . 20OM-2-87.81429 ...... ... - s.:�•x i:t•�i'TI•i;S- .n,K .!..,u.. ';S x.+r �r I.. _ � _fIx ��„� Assessor's office(1st Floor):Assessors map and lot SEPTIC SYSTEM MUS TwE,o`` Conservation �`� ' 9 €NSTALLED IN a Board of Health(3rd flour): D® �i A, Sewage Permit number �• WITH TITLE 5 3TABLE EN�`II3,® Engineering Department(3rd floor): ENVIRONMENTAL COD a -peso. d' ��,,ll TOWN REGULATION �o MAN 6. House number c���lz/ �d/Y!� � � Definitive Plan Approved by'Planning Board 1g APPLICATIONS PROCESSED 6:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN OF BARNSTABLE . BUILDING INSPECTOR APPLICATION FOR PERMIT TO �`► �,$ � c\ �L_„ TYPE OF CONSTRUCTION 19 _ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following info mation- Location ` zL Proposed Use / Zoning District � �` ` Fire District a ,- 1 I I (� Name of Owner M�Lvl , . Address 346 O � V ce� t2e . DMck �Q Name of Builder A Address_ \sC'rAc JCL �xV�5�2� 1 Name of Architect ott Address li Number of Rooms Foundation Pk(' ,-5 ,Le, Exterior � k� �2� Roofing hTD6 Floors Interior �lnuy �C Heating Plumbing l/ Cy P I Fireplace �� Approximate Cost Area Diagram of Lot and Building with Dimensions Fee c 79, ` c Gry (3 excZ(�2- �� V zo � P OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable r a ng t above con ruction. Nam �^l CE S@ t q5 f q Construction Supervisor's License i AUSTIN, ALBERT r. I No 35771 Permit For BUILD DORMER Single' Family Dwelling Location 340 Ocean View Drive - Cotuit 2;lbert• Austin Owner Type of Construction _ r ` U Plot -Lot i - a I ? c Permit Gr�d _y1 Apr i 1 14 191. 9 3 Dat d` ` ' 19 t --- Date Completed /cJ 19 • r r _ ; r q 12 i J ./ 1 r r ;.�- ;� :.3. .-.w.'..., �� ,,� .r•9 ..,..�. ,• k . �.�;. .d. .. v'-..w . a' S'. -:e :. v. �' ;' y�.•t .� Y 'a:, r+3d, a15{�..' t'.1' -W" Gi :a', w...� . k' , a d. � .R �� ,. � ...P..Y�.•iw�K,� ..'1'.�F� .fi�i'a d� 'c� - '1 �TT� � .- .,,_...- kr?[� .- .t -s. ..+ <�..�v,. .-. � :- :� � �''.. .,t,. 4. .,,,... 1 .'S�+"+.:+..., "T': �t .-r.'R'ti.. w..ro 3:' jm� ...r.�. ,.;,,. .�'s �. �.;x,•'��,_,��. ..- w.:..-?.- -'_ �-s<.:..�. t �.,,✓.i.- ,.. • r .�,..,..--. dt�a` :•v. .us. ..�.,'.�.. �. .?"s.'"'S:.,.a�-'. tom.._ .'r. �iFa t-: a .gin �'�: ";�' ;.LG?.'.ate:.. _nt h.� „+;<: ti..:. --+f.. .-� y,,p.. .[: a r...:.5. �. •'�, «ra�z.Su�S'��: :z ` t A-'x""` � r z.x �. _.: .. rn'f*y..: .,r,. ..> Z- .,....-.x� ..��•�"' .„R... :'*r+ . . �. .., �w::.t � •: .' ,-.. ...,, A�'.A a;'G`'k L=• � � �. ���i.?.a.y� ....r. 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SUPERVISOR 1 MADE PAYABLE TO 06/30l1 993 -,1�, Q 4 EFFECTIVE DATE LIC-NO. r RESTRICTIONS ` "COMMISSIONER OF PUBLIC SAFETY" NONE � 06/30/1991 014344 - �� GEORGE W BLAK ELY i (DO NOT SEND CASH). 130 REDWING LN BOX 206 m BARNSTA3LE MA 02630 PLEASE NOTE FLc INCREASE PHOTO(BLASTING OPR ONLY) FEE: 100. 00 r Ef FECTIV(E-JEB. t 989 HEIGHT: NOT.VALID UNTI NED AND OFFICIALLY (� STAMPED- UR THE MMISSIONER , D NOT DETACH LICENSE STUB THIS DOCUMENT Must BE SIGN NAME IN FULL-ABOVE SIGNATURE LINE CARRIED ON THE PERSON OF SIGNATURE OF LICENSEE THE HOLDER WHEN ENGAG OTHERS-RIGHT THUMB PRINT ED IN THIS OCCUPATION �'• t. l{`f COMMISSIONER y i 200M.2-87-81429 a 4 t :� � � ^� ��.t'd -.... { J r y "'w 'r3 �:•. 5 I' f _ - j ,?..�' '� �. t" • in� 4.:-. ,,.?"..S:.C°y^..-x� '.-�'xiDix—r�.c�a. 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S s� .}i'�s-�-�'z' -or3� �,��. � rs ` :�a., ���r..LCL�:•'Y -g2T -. •' - ...-. :.: :s�hJ".z L 1,5 EZ. � t h'•lc•-YJ'...n e'Y X..s ._- '.1 '1 u � .. - t�. :� 4 .._;- ::ic. __- A T _ .. .�-x te`"F -i::.�.�ay. _F•t{ �'1�� - �`.�.., „ -. ._;..,', _ .:.v�,;..:z w, �Y4�v�r1=-.s' S.a..'� '�'era° ;..��.,���^± .....a^� m���d`,�'`5F4as«.;..;" 4�e��__,._�'�i'Aa,s- .v ..< '_.Y.cif...:r�'�a". w�r, 'kr:F.zti�..'�s a'..a�,.3s'r�_r s• - - _ .f:�:.+ 3+.+.,�.�3' x m 4 � y'�,,oF' E T�►!ti Town of Barnstable *Permit# �^ Firpires 6 months from issue date * BAnN Regulatory Services Fee Ord y MASS.ASS. 1639• �0 Thomas F.Geiler,Director %+ij 1? Building Division ass � S�b Tom Per Building 814il ry, g Commissioner ./(f� � 200 Main Street, Hyannis,MA 0260.1 T O w U ?006 Office: 508-862-4038 /V OF e Fax: 508-790-6230 BARNSTq EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY B�F Not Valid without Red X-Press Irnprir:t Map/parcel Number `�3 o a Property Address 4 0 ���-- I V te.�J A �- ❑Residential Value of Work Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address_ M 1�• ,�U C-1 1 V -?-44 o ©e _wu j Ave, . Cg u�t Contractor's Name NA2Z Telephone Numb , Home.Improvement Contractor License#(if applicable) Q 0—+L4 O � Construction Supervisor's License#(if applicable) d ❑Workman's Compensation Insurance Check one: i ❑ I am a sole proprietor ❑ I am the Homeowner I-have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# 2 Copy of Insurance Compliance Certificate must a 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) ❑ Re-side 7L Replacement Windows. U-Value (maximum.44) D pd (7—) "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 Q !:Fomms:expmtrg .evise063004 Page 7 of 7 CAPIZZI HOME IMPROVEMENT INC. SPECIFICATIONS AND ESTIMATES STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT I, ELIZABETH AUSTIN, OWN THE PROPERTY LOCATED AT 340 OCEAN VIEW AVENUE IN COTUIT, 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: 340 Ocean View Avenue, Cotuit, MA 02635 OWNER'S TELEPHONE: 508-428-5312 and 508-642-5629 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: NP IZZ Home 1 Improvement Inc. I, Thomas Capizzi Jr., owner of Capizzi Home Improvement, hereby authorize Lisa Haworth, to sign on my behalf for permit applications filed through the town. Signed: Thomas apizzi, r. Date: r1jahaworth Date: 1645 Newtown Road Cotuit, MA 02635 (508) 428-9518 (800) 262-5060 FAX (508) 428-1547 )ace: b/13/2Uub Time: H:4u AM To: (9 9,1,b0H4181b4'1 R&G 1nS. Agcy. Page: 001 h Client#:47298 CAPIHOM At6RD,M ' CERTIFICATE OF LIABILITY INSURANCE U6;3/0M6�°" ' PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Rogers&Gray Ins.Agency,Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 434 Route 134 HOLDER.THIS CERTIFICATE DOES NOT AMEND;EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.0.Box 1601 South Dennis,MA 02660-1601 INSURERS AFFORDING COVERAGE NAIC# INSURED tNSURERA: National Grange Mutual Ins.Co. Capizzi Home Improvement, Inc. iNsiIRERe: GUARD Insurance Group Capizzi Enterprises,Inc. INSURER C: 1645 Newtown Road Cotult,MA 02635 INSURER D: INSURER E: COVERAGES . THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LTR NS DATE MMIDD DATE MMIDD LIMITS A GENERAL LIABILITY MP010707 06/08/06 06/08/07 EACH OCCURRENCE $j 000000 X COM (Ea orcurrencel MERCIAL GENERAL LIABILITY DAMAGE TO RENTED $500 OOO CLAIMS MADE a OCCUR MED EXP(Any one person) $10 000 PERSONAL&ADV INJURY $j 000 000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG s2,000,000 POLICY JPER� LOC A AUTOMOBILE LIABILITY M1010707 06/08/06 06/08/07 COMBINED SINGLE LIMIT $500 000 ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ X SCHEDULED AUTOS (Per person) X HIREDAUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) X Drive Other Car PROPERTY DAMAGE N $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO EA ACC $ OTHER THAN AUTO ONLY: AGG $ A EXCESSNMBRELLALIABIUTY CU010707 06/08/06 06/08/07 EACH OCCURRENCE $5 000 000 X OCCUR CLAIMS MADE AGGREGATE $5 000,000 $ DEDUCTIBLE $ X RETENTION $10000 $ B WORKERS COMPENSATION AND CAWC702365 12/25/05 12/25/06 xI TWI STATUMrT- FR orH EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $rJOO,000 ANY PROPRIETORIPARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $500,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $500,000 OTHER DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT!SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAL ln DAYS WRITTEN NOTICE TO THE CERTFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001108)1 of 2 #M22681 MEE 0 ACORD CORPORATION 1988 00 11 ash, "fall 0.211) AA)oy-4ers, Cox Capizzi Me Imprmapient 19m Coftilt, MA 026:35 Tel,M951811-800,262,PW IS Astawzip: Ph-D.0 Type of project th 4. E] geDcraj Cont-MC10,and I. famploytes��W andJorpaft-fin3p ia�Te6., El N(-,w CoDstmCLOM an-a'a sold pyoj).Tie toy-otparimey- listed o33 e atLacbe I d sbcpl- 7- El Rt'moaeiimg stern'and hC)employ,, V'170-rlzmg fOT Me ia any capsciLy. [No wolke'?t'C04--- 5- E] w 9. F! Building additio)d P,-we 2 co7poration 2ad it officers have,excx d&� I aDl cal I-q)aiisoj-zdd ilimis I a a homeloTimeT doing all woft- 3i iioexempf ion P CI MGL I LEI Plumbin mqyself fNo wqrL-eim,Co g repa�m m 2ddifions . -13�p- . c.152,§1(4).,and vve hve no E] t [No CD 123at-,dbeo#;s box#I cm,mca-s who hisdi W�dm& Y info -Evo&-sndfb Ca hire*buLia,,,ni,-,,ao,,=Wi Lsub]33it-91MM Sffida;,.�bL j6dj6Saf 43!q ooa.P oficy--b3fb--a5ii0n 7z ace Company,-Name- Ce self-im.Lac. CAW C-7 M3 to S. Addr4s- )L a C-PPY of&C yvoxkexs, Compems2tjola V�Xi�-S dechLmfion page(s�wing.-j4e policy 3ajamb i0 Sere C-DI"erage as MquiTed iivaar Se -,Do au&(),-6ue-year im.PrIso, as Vvell as to $1,500 Ctic)IL25A ofIAGL e- 152 c2alead h3 tae�-bWos -WOP $25 0-GG a day a-,- Ifies ia ihe,fOria of a STOP K ORDER 2oad a fine violatol' ae DIA for mis U'raucf---CON'ezage I-relfficatioli, 7 y Ce7 Q C,27 nat thiS 07re4a,to b_1 CO3rZZ officiaL or T jAg Altai,.brt� card of lawth Z,.)3XdJqiAg QtYITON,A f-lerk 4.Viectaw Imspector S-"Kumbb*Inslie-r-tor' fact Persom P J= = Board of Building Regulations. and Standards -- One Ashburton Place - Room 1301 . Boston, Massachusetts 02108 Home Improvement' Contractor Registration Registration: 100740 Type: Private Corporation Expiration: 6/23/2008 CAPIZZI HOME IMPROVEMENT, INC: Thomas Capizzi, jr. 1645 Newton Rd. Cotuit, MA 02635 Update Address and return card.Marlc reason for change. DPS-CAI Co 50M-04i05-PC8698 � � Address Renewal 0 Employment F-1 Lost Card - _ f�_ ✓12G' "C/J0477/I72097AA/L'CZLLIL O�✓(�GQ.dd(X.GIL000P.�d - . Board of Building Regulations and Standards License or registration valid for individui use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Regis TOp� Board of Building Regulations and Standards xpiration:' 6/23/2008 One Ashburton Place Rm 1301 Type: Private oration Boston,Ma.02108 CAPIZZI HOME IMPROVEMENT,INC. Thomas Capizzi,Jr. 1645 Newton Rd.' � ` Cotuit, MA 02635 — Deputy Administrator �ot valid without signature • . .� ✓�ie�oy�Lnzo�u*�a�o��eczG'zu.G�.a. t . 130AR1)OF BUILDING.R! GWt PANS license. 'CONSTRljCTION 5ti Alumberv,.CS 057032 , ',E>cpi e�'0�/26720D7 :: ,.•' ;�. 41 I THOM Restricted AS X CAP 1646 I` COTUIT, MA 02635�� • ComrnissioriP'r�`�`f - r oFtHE TOw Town of Barnstable *Permit# !aSS 2 ti Expires 6 niontlis from issue date BA NSTABLE, : Regulatory Semites Fee d y MASS. g Gb 039. Thomas F.Geiler,Director Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 X-PRESS PERMIT Fax: 508-790-6230 V 2 2 2002 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY" Not Valid without Red X--Press Imprint ,TOWN OF BARNSTAB(_E Map/parcel Number Property Address .3 YO (D Can V I C jAj— C��. Residential Value of Work T 0 9�7. au Owner's Name&Address Contractor's Name 43 Ale— __�rma�j1,� Telephone Number Home Improvement Contractor License#(if applicable) GCS—7'10 iy Construction Supervisor's License#(if applicable) C5 05 703 A { I fr 210 orkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I a e Homeowner , ave Worker's Compensation Insurance Insurance Company Name z—�r &Lo Workman's Comp.Policy# CADC, ;� ` DQCK, 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 (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 r P�OFVE roy� Town of Barnstable *Permit# (Q 4 Eypires 6 noouths front issue date BARNSTABLE. : Regulatory Services Fee �5�-�J ass' Thomas F.Geiler,Director �p s639. ♦0 rFD"'AAA Building Division Tom Perry, Building Commissioner �^'P�E�S PERT 200 Main Street, Hyarmis,MA 02601 S E P 2 7 2002 Office: 508-862-4038 Fax: 508-790-6230 AJO&Y BARNSTABLE EXPRESS PERMIT APPLICATION - RESIDENTI Not Valid without Red X-Press Imprint Map/parcel Number C)53 Property Address o ouan l, [ esidential Value of Work SLY, o�'Ir Owner's Name&Address 'e5liZ DUST )-ag-a-, Arvt14- AA J 10 c// Contractor's Name�� /Z�1 I�O y�1� ,pn Z�ie e-n� Telephone Number 7 a 0 Home Improvement Contractor License#(if applicable) /CO J 7 0 Construction Supervisor's License#(if applicable) G5 0570o.) EK101rk an's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I the Homeowner have Worker's Compensation Insurance Insurance Company Name /I tl z I c Cam. f-0 Workman's Comp.Policy# C)q c a Oc CC) Permit Request(check box) e-roof(stripping old shingles) ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ 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. i Signature Q:Forms:expmtrg Reviscd 121901 V TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel 690 Application # (!�5 0 Health Division Date Issued Conservation Division !emu Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/Hyannis Project Street Address 3 io d C c 0- I/ C 4J 't-- Village D I v i yyy d a b 3 Owner 25 i Z a 2 7� S i h Address 3L6) a C-e 0,, " eLi Telephone �� Z & 3 S— Per mit Request 0 e-, W\ Y\ ,-M h Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation ` /7 S Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ 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 stover Yes' ❑ No s� Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑rnew `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 ti (BUILDER OR HOMEOWNER) Name r—L4 . Telephone Nu/m�ber Address v� RA �icense # l � 4 7" l 0"I Z� t VrV'- .�N�V M ✓ 4,n� Home Improvement Contractor# �� U U y� C�qL\4 U-�u 0_J Worker's Compensation # j� �-e�s��-3 2- D ALL CONST UCTION DEBRIS RESU FROM THIS PROJECT WILL BE TAKEN TO v 1 r ►1S- r v� SIGNAT RE DATE U } FOR OFFICIAL USE ONLY `APPLICATION# ' DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: ' I4 FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL - PLUMBING: ROUGH FINAL-- GAS: ROUGH FINAL - FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' d 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(susiness/Organization/Individual): . ZL-jn Address: r-,, RD GL D� City/State/Zip: 3� Phone.#: �Z�' 9 S/ Are you an employer? Check the appropriate box: Type of project(required):. 1, m a employer with t 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or art-time).* have hired the sub-contractors ❑ I am a sole proprietor or partner- listed on the attached.sheet. 7. ❑'Remodeling ship and have no employees These sub-contractors have $, ❑Demolition working for me in any capacity. _employeesand have workers' [No workers' comp.insurance comp.insurance.$ 9. ❑Building addition required.] 5. ❑ We are a corporation and its' 10.❑ Electrical repairs.or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13 ther �� Uo` U 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 and job site information. Insurance Company Name: /v (� 54 Policy#or Self-ins. Lic.#: A) �-- / S. 3 Z Expiration Date: Z� D Job Site Address:37 (��.`�Qyl �U�' City/State/Zip: C)a 3 Attach a copy of the workers' compensation policy declaration page(showing the policy number and a piration 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the IA for-idsurance coverage verification. ; I-do-her-eby-eer-t' end = pains-and penaltie�of-perjur-y-that-the--infor-mation-pr-ou' ed-above-is-true-and-correct/.) Sip-nature: Date: V Phone#: —V Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3:City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other _ Contact Person: Phone#: Client#:47298 CAPIHOM ACORD-, CERTIFICATE OF LIABILITY INSURANCE F DATE(MM2010 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Karen A Walther,CISR Rogers&Gray Ins.-So.Dennis PHONE 434 Route 134 A/C,No,Ext:508-760-4630 (FAX No): 508-258-2230 s: waltherka@rogersgray.com P.O.Box 1601 AODREs CUSTOMER ID#: - South Dennis,MA 02 6 6 0-1 601 INSURER(S)AFFORDING COVERAGE NAIL# INSURED INSURERA:National Grange Insurance Co. Capizzi Home Improvement,Inc. INSURERB:ACE Property$Casualty Ins.Co Capizzi Enterprises,Inc. 1645 Newtown Road INSURER c: INSURER D: Cotult, MA 02635 ' INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL,THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL=1 POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR POLICY NUMBER MM/DD1YYYY) (MMIDDNYM LIMITS A GENERAL LIABILITY MPB1075H 06/08/2010 06/08/2011 EACH OCCURRENCE $1,000,000 DAMAGE To RENTED X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence s500,000 CLAIMS-MADE 51 OCCUR MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS COMP/OP AGG $2,000,000 POLICY PROECT LOC I $ A AUTOMOBILE LIABILITY M1 M28044 06/08/2010 06/08/2011 COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) 500,000 BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ X SCHEDULED AUTOS PROPERTY DAMAGE X HIRED AUTOS (Per accident) $ X NON-OWNED AUTOS Uninsured $250000/500000 Underinsured $250000/500000 A X UMBRELLA LIAB X OCCUR CUB1076H 06/08/2010 06/08/2011 EACH OCCURRENCE $5000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 DEDUCTIBLE $ X RETENTION $ 10000 $ B WORKERS COMPENSATION NWCC45843208 12/25/2009 12125/2010 X WC STATU- OTH- AND EMPLOYERS'LIABILITY Y LI T ER ANY PROPRIETOR/PARTNER/EXECUTIVEY/N E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? ❑N N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) - Carpentry CERTIFICATE HOLDER CANCELLATION 10 Days for Non-Payment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Town Of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE ©198 -2009 ACORD CORPORATION.All rights reserved. ACORD 25(2009109) 1 Of 1 The ACORD name and logo are registered marks of ACORD #S52549/M52541 KW -----.._.._ Office of Consumer Affairs&B siness Regulation License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration:-,.,100740 Type: Office of Consumer Affairs and Business Regulation Expiration: -,6l-2372012 Private Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 VCAIZZIHOME I t. 1f7fElijEET;l C. Thomas Capizzi,fir: 1645 Newton Rd. i,? r' »:. y Undersecretar ' y Not valid �65 �sgate Cotuit, MA 02635 " Nlas-sachis set t.s- Dt.,partutirt-t t)f P.1ji.4iic .afet� T2t,.F.;"( F liiialtii !t i t"��iaiti[)tt+ lint, aiandaril.s COr]structiOn Supervisor License License: C5 74640 Restricted to: 00 s �x GAR GUSTAFSONs p•r h !, 8 SHORT WAY SANDWICH, N1A 02563 E"plruflOn: 11/29/2010 "i'r;�; 7755 - �-• Jam• �. �.,..-�'"' �....--^-"'i_ ". � _. •" w�_f{.,,• w, -»� �+-"' y •.--^ ,,.-may ,..*.-.� J ,� .� / lA,,,,�_.+f' ,� anytir. 1� � ��y.,�..-+a��M ..,.+,> �,:... j+ ,.,,,^.-..� .� �,g,.,,,,,w• y:e s a.>�aai'ar "- 4 ',`� a>� �#i'`w ,w_.r•.w.-...erg" �-vw+" ,.wn�, ' ,� - x�r '.,,s.Y^•"��,�� .wc�,,.s-+r•A+ ,�,,+,w.. 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