Loading...
HomeMy WebLinkAbout0252 PINE RIDGE ROAD __... _ .. _ .. .. .. _ _ _ 1 I� i I Z � � � � ��"T i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map ! Parcel !� Application #a ® [6q Health Division Date Issued e> v�Conservation Division ;'..Application Fee Planning Dept. Permit Fee ' Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/ Hyannis Project Street"Address ;2�Z rN e 'Z i U 6,e Rmt, Village co .1 d Owner �j�ii Address T iv% e P ;06e 12p Ca�yirf' Telephone Permit Request h e d�-Q d r z'e o A ;�X i'o i r« X G K Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Sa o Zoning District Flood Plain �14 Groundwater Overlay - 1. ,O l� Project Valuation 'Do o `'f'4M e a 1 Construction Type , A F') o � _ Lot Size 61 4 C✓ Grandfathered: ❑Yes ❑ No If yes, attach su,pportindocurnentation. Dwelling Type: Single Family ;7Two Family ❑ Multi-Family (# units) t Age of Existing St7ctule �r Historic House: ❑Yes ❑40 On Old King'slHighway.,❑Yes ❑ No Basement Type: l ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) A/fA Basement Unfinished Area (sq.ft) Number of Baths: Full: existing I new 6 Half: existing new Number of Bedrooms: I existing 0 new Total Room Count (not including baths): existing new 0 First Floor Room Count y Heat Type and Fuel: LY/Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes W40 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 0 new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use R Z i`p+o�Zii G ��a�j l rMn J ooposed Use ` Red/D t 1dT 1al S e i:s l E -r4►n l y APPLICANT INFORMATION Co'vZi6 l ����lt 1UAj� (BUILDER OR HOMEOWNER) Name 'Toe��1't2 7y Telephone Number S01 � 27Y y Z 3 Address l6 q� A/aV-4 oOn P Y License #S �76 3� CU' dr�" I^ Home Improvement Contractor# OUP 11 D Worker's Compensation # lI U) e C 310 y ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJE�T WILL BE TAKEN TO SIGNATURE DATE Qd'- FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL N0. - ADDRESS ;VILLAGE OWNER DATE OF INSPECTION: FOUNDATION �D�®� ®� ���<l�✓ 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 zJ- Office of Investigations. ' a 600 Washington Street: Boston,AL4 02111 ="'y`� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers APPReaut Information FIease Print Le ibly Name(Business/Organiza ion/IndividuaI): C(d,2.Z t /`�� -� jtt e j4,b �- NC Address: 1 2.u1 Ae v1 y� a0• , ��``� City/State/Zip: (')�7t7/i f �'l D 9v 3 f I Phone.#: J Are you an employer?Check the appropriate box: 4. I am a general contractor and I Type of project(required):. I am a employer with 'D � ❑ employees(full and/or part-time).*,' have hired the svb-contractors 6•. �ejw construction 2.01 am a'sole ro rietor or listed on the,attached sheet. 7: e p p partnex= odeling shipand have no employees These sub-contractors have 8. 0 Demolition,.. working for me in aay capacity. employees and have workers' [No workers'comp:insurance comp.insurance.$ 9• D.Building addition required.] 5. 0 We are a corporation and its' 10.El Electrical repairs or.additions 3.❑ I am a' homeowner doingall work officers have exercised their 11.0 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' 13.0 Other` - comp.insurance required.] *Any applicant that checks box#.1 must also fill out the section below showing their workers'compensation policy information. 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 emgloyees,they must provide their workers'comp.policy number, I am an employer that is providing workers'compensation insurance for my'employees: Below is the"olicy and job site informatio�� Insurance Company Name CCU - � y � y . Policy#or Self ins.Lie. �'13�a Expiration'Date: �'�-' Job Site Address: �°a �!14 21���l a Ru City/State/Zip Ce7'Uf 4 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 rip to $1,500.00 and/or one-year imprisonrnent; 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 hivestieations of the DIA for insurance coverage verification. Ido hereby c-er-tif under-tlie-pain,s-andPgnatties-of-p.e-r-jurilthat-the-i,z-or-matior-pr-0uidec-a-boue-i�tr-ue-and-correct Si ature Date:. vQ l 12,6 Phone#: Offrcial zese only Do not write irz this area,to be completed by city or town offzciaL. City or Town: Permit/License# Issuing Authority(circle one): 1.Baard of Health 2.Building Department 3.,City/Town Clerk 4.EIectrical Inspector 5.PIumbi-ig In .3 6..Other Contact Person: Phone#: Client#:47298 CAPIHOM ACORD. CERTIFICATE OF LIABILITY INSURANCE °6/02/2011 ' 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 CONTACTKaren Walther NAME: Rogers 8r Gray Ins.-So.Dennis PHONE 508-760-4630 F 508-258-2230 434 Route 134 E-MAIL Ext: ac,No P.O.Box 1601 ADDRESSR: waltherka@rogersgray.com USTOMERID#: South Dennis,MA 02660-1601 c INSURER(S)AFFORDING COVERAGE NAIC# INSURED - - - INSURER A:National Grange Insurance Co. - Capizzi Home Improvement,Inc. INSURER B:ACE Property&Casualty Ins.Co Capizzi Enterprises,Inc. ' INSURER C: - 1645 Newtown Road Cotult,MA 02635 INSURER D - INSURER E: - INSURER F: - COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFYTHAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS ' CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. FPC'M DL UBR POLICY EFF POLICY EXP - TYPE OF INSURANCE POLICY NUMBER MM/DD MM/DDIYYYY - LIMITS GENERAL LIABILITY MPB1075H 06/08/2011 06/08/201 EACH OCCURRENCE $1,000,000 MERCIAL GENERAL LIABILITY - DAMAGE TO RENTED PREMISES Ea occunence s500,000 . CLAIMS-MADE FX 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 PRO- LOC $ A AUTOMOBILE LIABILITY M1 M28044 06/08/2011 06/08/2012 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 - - (Peraccident). - $ X NON-OWNED AUTOS - $ X Drive Other Car $ A UMBRELLA LIAB X OCCUR CUB1076H 06/08/2011 06/08/201 EACH OCCURRENCE $5 OOO OOO EXCESS LIAB CLAIMS-MADE AGGREGATE $5 OOO OOO DEDUCTIBLE X RETENTION 10000 $ B WORKERS COMPENSATION NWCC45843208 12/25/2010 12/25/2011 X WC STATU- oTH- AND EMPLOYERS'LIABILITY TORY LIMITS ANY PROPRIETOR/PARTNER/EXECUTIVEY/N OFFICER/MEMBER EXCLUDED? �N NIA E.L.EACH ACCIDENT 1 $1,000,000 _ (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/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) Additional insured status is provided under the general liability when required by a written contract with the certificate holder 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 ILA 0198 -2009 ACORD CORPORATION.All rights reserved.. ACORD 25(2009/09) 1 of 1 The ACORD name and logo are registered marks of ACORD -« #S67537/M67480 MEE STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT L '14 z'h v b it -4 q 'D .. D -e cd e C c, M e it' Ti OWN THE PROPERTY LOCATED AT S'2 N e lZ t D 6e IN , MASSACHUSETTS. — I HAVE AUTHORIZED CAPIZZI HOME IMPROVEMENT TO ACT AS MY AGENT TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. I GIVE MY PERMISSION TO i �m LESSEE TO APPLY FOR A BUILDIN PE IT IN ACCCE ITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. SIGNATURE OF OWNER: "rye f OWNER'S ADDRESS: OWNER'S TELEPHONE: 7. 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: C�V� ' RESPONSIBLE OFFICER ADDRESS: RESPONSIBLE OFFICER TELEPHONE: 71 \' Office of Consumer Affairs&B siness Regulation License or registration valid for individul use only before the expiration' date. If found return to: ( a HOME IMPROVEMENT CONTRACTOR (-! �_; Registration:;;..100740 . Type:' Office of Consumer Affairs and Business Regulation W1W Expiration: :6/23/2012 Private Corporation 10 Park Plaza-Suite 5170 , __ Boston,MA 02116 t✓APIZZI HOME IMPRQVEN[ENT;;INC. Thomas Capizzi,jr. 1645 Newton Rd. Cotuit, MA 02635 Undersecretary Not valid ou signat re Ma53aehuSCttS- Department of Public Safety Board of Building Rc�gyulations and Standards Construction Supervisor License License: CS 57032 Restricted.to 00 THOMAS.X.CAPIZZI.J.R 1645 NEWTOWN RD COTU IT,MA 0263.5 Expiration: 9/26/2011 Co[lull issioner Tr#: 4113 ��. hNe Rio e R� C 0 w�' j M4 i LET yo, \ - f J�r yr tv X. t ` - jo -B p3 �t8 : d. SCHEDULE , q PROPOSED SITE PLAN rION /?• a SEWAGE SYSTEM DESIOIN TANK = ( , IN, TIC .TANK IUTION :BOX =_` ki SCALE 1"= ya- jan. /9, 1978 . RIBI►T'InN Anif 1 - r,:2 C— 640 Assessor's map and lot num er .�. ....... SEPTIC SYSTEM MUST BE o y"+ 71s` �.� INSTALLED IN COMPLIANCE Sewage-;Permit number ..........................�. ,............................... WITH H ARTICLE 11 STATE r .a " ,�• � SANITARY CODE AND TOWN THE T��o �. TOWN OF BARN S�k ` Xff", �E BARASTABLE, y MABt 4. � �...�P" ;. r °0 163q•a�� DU•I1DIAG ! INSPECTOR APPLICATION 'FOR PERMIT TO ......... 1i ...... .................... ................................ "• L�C� ........... TYPE OF CONSTRUCTION ........... ........................................................ .................................... • � M' - / -THE INSPECTOR OF BUILDINGS: u The undersigned hereby applies for 9 permit according to the following informatio ..le2 z z Location ..... d ..s ......... ..... .....:. .....,1!1f��!! e���,•�. ' .....iC.. .yr....Ce.'�l..U� .................:.:....................................... ProposedUse .. ...................................................................................................................................... Zoning District 4.F................................................ .Fire District �� t:.� ................................................ ..... ... . .. Name of Owner Awm_, J,•a. 41_".44_411; .....................Address �.: o���.� ?i!�'�y 1Y .r�?!�>'f/. ✓ Name of Builder ...................... 1�4e�Yl�/.?`�.............. Name of Architect ..v.�/Y/1 ..... ��G''?....................Address ... h. �!YJ ..�?.7,[...... . ............. Number of Rooms .. ..�. ..............Foundation ......AOC, OYII;����...:�.vl� l�9.. ........... . .................................. Exterior / !4�.: /lKr�flf� rr4,.f.... ................................Roofing ........". FloorsIldf ...............................................................Interior .....��i�J!f...,,� ............................................ Heating � �...................................Plumbing .................... . .sliF1J'.:�......................................... v P /u Approximate. O Fireplace ....... . ..�..................................................................A roximate. Cost ........... .....t.. ................................ ........ Definitive Plan Approved.by Planning Board _________ ___________19________. Area ....2� S' Diagram of Lot and Building with Dimensions Fee ......../.X SUBJECT TO APPROVAL OF BOARD OF HEALTH aN av /36 ,t v� _24., � I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ............. DeAccangelis, Michael J. & Henrietta A. 20044 1 1/2 story No ................. Permit for .................................... single family dwelling ............a.................................................................. Location .......2.5.2..P.ineri.d.ge..Road.......;........... . .. .. .......... . .... .. . .... Cotuit ............................................................................... ...........................................................1.1..Owner Michael J. & Henrietta A. DeAccange s frame Type of Construction .......................................... Plot ............................ Lot ........#82 ...................... Permit Granted ......March 24 78 .............. ........... .......19 JJ Date of Inspection .... .....................:.19. . Date Completed ;..........19 PERMIT REFUSED ......................................................... ..... 19 .................................................................. At . ............. LIM" ee ............................................................ ............................................................................... Approved ................................................. 19 ............................................................................... ............................................................................... Assessor's map and lot number .. ...... .............................. ;(7 Sewage'Permit number ............... ................................... THE TOWN OF BARNSTABLE EARISTABLi, 03 VU& 9- BUILDING INSPECTOR PERMIT TO ......... 4rl 41WI-7- APPLICATION FOR .................................................................................................................... TYPE OF CONSTRUCTION ...............//JAW.�........................................................................................................ .......... ... ......I.........................................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Z, Location .....4,./" — ...............................t......................................................................................................... ProposedUse ... ...................................................................................................................I......................... ZoningDistrict .....................................................................Fire District ..................................................... Z5 Name of Owner ,/ "?�,� ..............................Address .........4.. ..................... " 1 Name of Builder ......JI-7/27 -............ ......................Address ..................................... Name of Architect ....................................Address ................................ .. ............................................ -14 Number of Rooms ..................................................................Foundation ....... ...... Exterior ............:l,.U!...... ...............................Roofing ........ .................................................................... Floors ......................................................................................Interior ..... ............................................. Heating .... -z- 2 .......................................................................Plumbing ............................h,- ...................................................... Fireplace ....... )- ..................................................................Approximate Cost ......................................................... ..... Definitive Plan Approved by Planning Board -------- - Area ..................... .................... Diagram of Lot and Building with Dimensions Fee ......... ............................. SUBJECT TO APPROVAL OF BOARD OF HEALTH �O A)40 J7J(t,5- /36 97, 0 o '7 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name,.1. 411 .................... ................ DeAccangelis, Michael J: &t ' Henrietta A. a A=18-124 No 20044 permit for ..,, 1 1/2 story single family dwelling ............................................................................... Location .....252 Pineridge. . ..Road. ....................... . ...... .. ...... Cotuit ............................................................................... Owner Michael J. & Henrietta A. ...................................... . .... DeAccangeffs Type of Construction ...frame rI \ .................................. ................ Plot ............................ L t ..,1 Permit Granted Marc 24 78 ........ ...............19 Date of Inspection .....................................19 Date Completed .. ...................................19 PERMIT RE SED ........................................... ....... 19 .......... ........................ ... ..� ............. ....... .. ...... ............ ............................................................................... ............................................................................... Approved ................................................ 19 ............................................................................... ............................................................................... THE. ` TOWN OF BARNSTABLE 20044 r` •s , Permit No. ---- ------------------------ ( 7�EE7T� : Building Inspector cash i • _ ti. OCCUPANCY PERMIT Bond ---_____ 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-ythe -Building Inspector." Issued Michael J. & Henrietta A,AAkaCenasl,l,s t Address Bqx 521, West Hyannisport, HA lot #82 252 Pineridge Road,.Cotuit Wiring Inspector Inspection date Plumbing Inspe6tor -�-' ' Inspection date Gas Inspector � Inspection date Engineering Department � �� w Inspection date --S/. �. y 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. I.a.1`................... 19...... ................Building...Inspector.......................... ._ t oFt r Town-of Barnstable *Permit#n2 b 0c) P� r s 6 nian a ern-issue date Regulatory.Services * BAMSTABLE, n.; e 6 M-- `m�x a Thomas F.Geiler,Director 39 ' . ..., JT Building Division M { � -, rTom Perry,CBO, Building Commissioner ` `"e 200 Main Street Hyannis,MA 02601 TO AEBLE www.town.barnstable.ma.us Of'ice: 50856A2-40 LAYic Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY ? ; Not Valid without Red X-Press Imprint Map/parcel Number Property Address a—, � {i l• G� r; D.a l�J D l'1 [/ �o.3 S� sidential Value'of Wort{[" J ( D Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address K -�G ✓�� l l` Contractor's Name G ��Ste' d Yl Telephone Number �Y 7.2-,a Home Improvement Contractor License#(if applicable) c (] r. Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner ave 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(stripping Told shingles) All construction debris will be taken to. ❑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 department regulations,i.e.Historic,Conservation,etc. *,**Note:; Pr perty Own must sign Property Owner Letter of Permission. opy of t me Improvement'Contractors License&Construction Supervisors License is ' re uire SIGNATURE: , Q:\WPFILESTORMS\building permi fo \EXPRESS.doc Revised 090809 Page 7 of 7 r CAPIZZI HOME IMPROVEMENT INC. SPECIFICATIONS AND ESTIMATES STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT I, OWN THE PROPERTY LOCATED AT IN ,MASSACHUSETTS. I HAVE AUTHORIZED CAPIZZI HOME IMPROVEMENT TO ACT AS MY AGENT TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. I GIVE MY PERMISSION TO LESSEE TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. SIGNATURE OF OWNER: OWNER'S ADDRESS: r) d) c, D ( Tv i T� �P 3•� OWNER'S TELEPHONE: O� 7 _2 LESSEE'S SIGNATURE: LESSEE'S ADDRESS: LESSEE'S TELEPHONE: APLLICANT'S SIGNATURE: APPLICANT'S ADDRESS: 1645 Newtown Rd., Cotuit, MA 02635 APPLICANT'S TELEPHONE: 508-428-9518 RESPONSIBLE OFFICER: RESPONSIBLE OFFICER ADDRESS: RESPONSIBLE OFFICER TELEPHONE: Client#:47298 CAPIHOM ACORM CERTIFICATE OF LIABILITY INSURANCE 0DATE 1105/10° Y) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Rogers&Gray Ins.-So.Dennis ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 434 Route 134 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O.Box 1601 South Dennis,MA 02660-1601 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Nat'l Grange Mutual Insurance Co. Capizzi Home Improvement,Inc. INSURERB: ACE Property&Casualty Ins.Co. Capizzi Enterprises,Inc. ' INSURER C: 1645 Newtown Road ' INSURER D: Cotuit,MA 02635 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. " S - POLICY EFFECTIVE POLICY EXPIRATION LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MM/DD DATE MM/DD LIMITS A GENERAL LIABILITY MPB1075H 06/08/09 06/08/10 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTEDPREMISES(Fa occurreng $500 OOO CLAIMS MADE a OCCUR MED EXP(Any one person) $1 O 000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $Z 00O 000 POLICY PRO- JECT LOC A AUTOMOBILE LIABILITY M1 M28044 06/08/09 06/08/10 COMBINED SINGLE LIMIT ANYAUTO (Ea accident) $500,000 ALL OWNED AUTOS BODILY INJURY X SCHEDULED AUTOS (Per person) $ X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) X Drive Other Car PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY - AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ A EXCESS/UMBRELLA LIABILITY CUB1076H 06/08/09 06/08/10 EACH OCCURRENCE $5 000 000 X I OCCUR CLAIMS MADE AGGREGATE s5,000,000 RDEDUCTIBLE $ X RETENTION $10 000 $ B WORKERS COMPENSATION AND NWCC45843208 12/25/09 12/25/10 X I TW.RCYSIT ATU- OE H- EMPLOYERS'LIABILRY E.L.EACH ACCIDENT $1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Carpentry CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Town of Brewster DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 1_ DAYS WRITTEN 2198 Main St NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Brewster,MA 02631 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001/08)1 of 2 #S48110/M48107 KW © ACORD CORPORATION 1988 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 Le 'bl Name(Business/Organization/Individual): . p /�� ✓� +P n f 1 Address: City/State/Zip: eJ/VJ ;�10aLfe3J_ Phone.#: 4-12-Y 9 J17 Y Are on an employer?Check the appropriate box: Type of project(required):. am a employer.with dam- 4. ❑ I am a general contractor and I I have hired the sub-contractors 6. ❑New construction employees(full and/or part-time). 2.❑ I 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' [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' 13-9�rOther Jre r tt n comp:insurance required.] J *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. 1 Insurance Company Name: XA Q �� /� (/'Q/( C-f Policy#or Self-ins. Lic. 2-6 k Expiration Date: Z� t Job Site Address: ® 'e. It Wo 0, City/State/Zip: V 243 5— 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-Eer-tify t pains and-penalties-fperjur that-the-infor-matioxapr-avidet-abave-is-tr-ue-and-carr-ect. Si ature: Date: 5 �0 Phone#: 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#c Tk-e� Board of P3 doing Regulations and Standards License or registr.atioq valid for individ.ui,use only HOME IMPROVEMENT CONTRACTOR before the expiration date If found return.to: Board of Budding Regulaaions and Standards RegistiJoL� 100740 Mill, I=@ 23/2010One Ashburton Place Rm 1301 Boston,Ma 0,108 r �pement Cana�. CAPIZZi HOM.E ` -n,x NARY GUSTAFS(DI WE- 1645'Newton.Rd FF Cotuit,MA 02635 Administrator No vall itho,t nature bep'i wit6t of lt=01W S.{!'ct� Btu rtt of i wilding t��Mitt36&,;,' any's darcis r6ns#ruc#ior� S,Vpervisor Licpnse Lycerlse t;5 14640 : Restr►cted o 00 s N 8 SHORT V1fAY SANDWICIf MA 02563 �� En?«atir n -1 1/291201 0 �6Engineering Dept.(3rd floor) Map Parcel ermit# / House# _ Date Issued Board of Health(3rd floor)(8:15 -9:30/1:00-4:30) AA .�, d Conservation Office(4th floor)(8:30-9:30/1:00-2:00) _ 124 Plann' A . n�t �:�.�n�.��;.g.) X'S B_ D Defin' ' n A and 19 SIT ANCE ENViRolymE TOWN OF BARNSTABLETOt'vily E A9® Building Permit Application Project Street Address ,�7Jo2 ��f=,e�1jC� o oil Village Nt' - Owne r£ Address t i• Telephone Permit Request �di min Qp s m vS First Floor square feet Second Floor square feet Construction Type Estimated Project Cost $ 6.0 C) Zoning District Flood Plain Water Protection Lot Size DO y 7 Grandfathered ❑Yes ❑No Dwelling Type: Single Family p-' Two Family ❑ Multi-Family(#units) Age of Existing Structure I& Y,eS. Historic House ❑Yes ©-Ko On Old King's Highway ❑Yes pN6 Basement Type: 2-full ❑Crawl [�alkout ❑Other Basement Finished Area(sq.ft.) P1 Basement Unfinished Area(sq.ft) e2 Number of Baths: Full: Existing / New U Half: Existing 0 New � No. of Bedrooms: Existing New (] Total Room Count(not including baths): Existing New % First Floor Room Count Heat Type and Fuel: a Gas ❑Oil 2-101ectric ❑Other Central Air ❑Yes 21* o Fireplaces:Existing _0 New 6 Existing wood/coal stove ❑Yes l�o Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) lone ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes <o ,If yes, site plan review# Current UseS� �-i�-ice Z. Proposed Use Builder Information Name Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT) SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATUR DATE BUILDING PERMIT DENIED OR THE FOLLOWING REASON(S) j(10 RZ p 1 v J . i `OFTHE TO,,� The Town of Barnstable O� 9 BARNSTABLE.D` Department of Health Safety and Environmental Services MASS. 0 i63q' �0 prFo � Building Division 367 Main Street, Hyannis,MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner Inspection Correction Notice Type of Inspection P (� n Location 2 �tli-�� lci�l3 IC.,10 6i �Permit Number 60 Owner Builder One notice to remain on jobsite, one notice on file in Building Department. The following items need correcting: Ka P,eiiD I'k.�c- z� ��n �lu tiJ c • v Please call: 508-790-6227 fPor� reeinspection. Inspected by 9- Date 915 3'2 2X4 P-T. 3�14' 3910' CD m 2 X 4 K D. 3t(�14' 31 @ 1'0! N-1 2X4 KD 87 _ o �" mto 10 1314 C-L-;"X 3 SHEETS E Fi !X12 Pil-) U LAR 2@16 '30X68 UAN IDOOR PREJ :U N-l'-�,- 1 2 Z':X 6 8, L U A N DOOR PREHUNG 2 40X68 zLOUVER BIFOID T INSULATION 2X4 160'C' 500SQFT —UP- 2X1 0 160C 300SQFT < DROP CEILING 300 SOFT --------- ............. n 0 V) ROOM SIZE 14'X22' i-a 1'. y cr- W < L z ::k u DRYVJALL 20@8' F— :D 4 PAILS JOINTCOMPOlk-)ND 3 ROLLS JOINT TAPE Y Lo 0 TRIM C'01-- BASE 70' CN COL CASEING 111 Or STOOL CAP 12' ANDERSON 14' HANDRAIL & 3 BRACKETS i q PAINT 1 @ 5GAL WALL PRIMER 2 @ 1 GAL CEMENT SEALER 1 ROLL POLY CLEAR 12'9 LIVING AREA 13'9 X z 305 sq ft 0 Z 0 TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please print. DATE eL 0?6-96 JOB. LOCATION -- ' Number Street address Section of town "HOMEOWNER" Name Home phone Work phone-- .. PRESENT MAILING ADDRESS 'I' s City town State Zip code The current exemption for "homeowners" was extended ' to include owner-occupie dwellings of six units or less and to allow such homeowners to engage an in- dividual for hire who does not possess a license, provided that the owner acts as supervisor". DEFINITION OF HOMEOWNER: Person(sj who owns a parcel of land on which he/she resides or intends to re, side, on which there is, or is intended to be, a one to six family dwelling, attached or detached structures accessory to such use and/or farm structures A person who constructs more than one home .in a two-year period shall not be considered a homeowner. Such "homeowner"- shall submit to the Building Offic: on a form acceptable to the Building Official, that he/she shall be responsil for all such work performed under the building permit.. (Section 109.1.1) The undersigned "homeowner" assumes .responsibility for compliance with the St- Building Code -and other applicable codes, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirement: and that he/she will compl with said procedures and requirements. HOMEOWNER'S SIGNATURE Z., V APPROVAL OF BUILDING OFFICIAL ; Note: Three family dwellings 35,000 cubic feet, or larger, will be required to comply with State Building Code Section 127. 01 Construction Control. p HOME OWNER'S EXEMPTION The code state that: "An Home Owne r perfor ming work fo _ ding r which� buii permit is required shall be exempt from the provisions of this section (Section 109. 1. 1 - Licensing of Construction Supervisors) ; provided that. i: Home Owner engages a person (s) for hire to do such work, that such Home Owr shall act as supervisor. " Many Home Owners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,_ Rules and Regulations for .licensing Construction Supervisors, Section 2. 15) . This lack of awarer often results in serious problems, particularly when the Home Owner hires unlicensed persons. In this case our Board cannot proceed against the inlicensed person as it would with licensed Supervisor. The Home"Owner act as supervisor is ultimately responsible. To ensure that the Home Owner is fully aware of his/her responsibilities, m communities require, as part of the permit application, that the Home Owner certify that he/she understands the responsibilities of a supervisor. On t. last page of this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community THE : . ,.� The Town of Barnstable • snarrsTnai.E, • Department of Health Safety and Environmental Services ArEDya Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner For office use only Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors, with certain exceptions,along with other requirements. Type of Work: o- add ��I;7 Est.Cost '9600, Address of Work: 1 ^ d� d ru/T Owner's Name > .�" /t ii Date of Permit Application: 616-- � I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under S1,000. Building not owner-occupied lo�Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit.as the agent of the owner: Date Contractor Name Registration No. OR Date ' Owners a IN The Commonwealth of jvassach use&s Department of lndustrialAccidents = - 600 Washington Street Boston,Mass 02111 Workers'Compensation Insurance Affidavit u,1,nt: 1QC81inn• city phnn >'f l am a homeowner performing all work nnyself. ❑ lam-a sole proprietor md have no one working m any capacity ❑ I am an employ providing workers'compensation for,my employees working on this job. an n dslttrex.-'• ... .. .. city: hon •te•. olkc '# :. . . ❑ I am a sole proprietor,general contractor,or homeowner(eim le one)and have hired the contractors listed below who have the following rkers' compensation polices' /`i 0C, 3/3 ' 'rani . :. (/�• - ,�., .. . ;..: . .. • spin fan City- 4!! 6'ailure to secure coverage tls required 1111dtr Section 25A of MGI.152 cap lead to the impo9itioa of criminal pentllticq or a fine up to St,.500.00 aad(or nac years'imprigattment tls wcl!as Clvit prnaiticl itt the form ota STOP WORK ORDER and a tine of�100.00 tl day aaaioat lac. I tltlderstand that a tarry of this statement mby be forwarded to the()ma of Javcstigatinag Of the DlA far eovernge verification. I do Herr M ' raider r Pains f per' that file information provided above is true and correct. Signature atc !'rintnumc %C hcnci,--��=x�� nfricial use only do not write lit this urea to be completed by city or town 91mci4i city or town; periniNicewc N Building Department Q check if immediate response i9 requiredQ1 Kensiog Board) QSdecruitn's Office QHcaith neparlmcnt coatset pEgon: phone*; Other J (MV149d i/9f PIM T. I3r�LV aT �M __r T U& TOP + MR0 ,� T—H �I APt U_ 10 - f s� - IL-Kit � i s — 1 -�: _It "lam 11- ►�� ,. +ter.WWI LAH M r _ 5 - 45 ��U�l/►VAnx�JK b.✓�/ r�. 1r .Va�wiA/c rux „'v' mA /00• Z PEASTONE L•..LOAM d FILL IE°MAX. b S Te� 99'Z • ' s d- • s pe0 �el uDI Sy. � . , L � O BOX ��� • e o Pn � 97_7 2�'MIN. io'4111:Lva 11500 IOOU— GAL. ( AL. , e• PRECAST OR ° °I l SEPTIC 6'1• e� BLOCK e0 0 Low TANK �'. ° . SEEPAGE PIT D •• o Sol. n 'I J + 0 Q 20, MINIMUM. •..°, -.Tq�a��= ,s" �h' o °� FOUNDATION I i' +�-WASHED 'STONE w. Ir_ ►0, - . i. FROG. RATE ELEVATION SK<ET'CM SCALE: I°A4' L $�� f'EBICUI/G' '~Zfl�SF� i �ar �^ ]ViRt",1 TE S T BY ' c A rya 7/-lets •+� c' I . TOWN INSPECTOR teach Ama prpvlca-- P6751' BACKHOE OPERATOR J^z' ►'` �-'�� TEST MADE ON : --� �^� ice' ;/276 a Q � �'� S`I'9• �1 1 q °1 ea / tA. z. • "age; S '?�' � vy 777 i , 05ti' A \ 1 9 s�. R va A oq dp do _ s - ,moo, t, - ;...._.. -.,.s., .; �,_..,_._.._�• eM c s ,,.....�../ r f;r CK 1 i -ter- 9 " - ;...P,o �I p�No 716ri4 v — —►y p Vo ELEVATION, SCHEDULE PROPOSED SITE PLAN 91 I. INV. AT FOUNDATION - 4. SEWAGE SYSTEM DESIGN 2. INV. INTO SEPTIC TANK _ IN 'T 3. INV. OUT OF SEPTIC TANK - / �� ! 4. IINV. INTO DISTRIBUTION :BOX + SCALE: I°= ja q /9.) 1978 • 640 4 5. :f NV. OUT OF DISTRLBUTIOIV BOX I C_ za CAPE COD SURVEY CONSULTANTS `'.. 6. :INV INTO SEEPAGE PIT. - +b� ROUTE 132 T, s OT:TOM OF PIT- 9D�.0(Q HYANNIS,.MASS. A otVIS10N BO/TON SURVEY' C'ONSULYANTS', 1"e. 8. O•fTOM OF STONE LAYER. = 4;: , w F h qr {. * a ** s ♦ICY f l M►4�ae�x 1A�e�rrfi�.3.�ylyy�i i wtA�G/vx Z. 2 P+EASTONE _� •LOAM A FILL- 12°MAX. 6+.�0 h' , 1 7. 0. s I DIS 1 I,°° ° o.• G D0 t✓ /�.' 4etS►,T. BOX °"°° 0 . , pkme— ol 2."..N. MIN. 11500 I D°.�e' 1000-- GAL. D c� GAL... _ - . `, e.e PRECAST OR' t _ SEPTIC , 6� o° °. BLOCK. TAB4K �;',�° °' SEEPAGE PIT o° o° I Gota let 6,F I°° ` IQt• a .It �"{3 ': 0 0 D ,< 20 MINIMUM ;a°°. °o — — — — ° FOUNDATION , I 8LP• Z 1#/V,LWA$HED''STONE ELEVATION SKETCH ' l©' 'tllA. RATE & ewes. z�r�% {,�A� TEST BY: C.=a..:.rt��•i�.'f�./ �tfiEqu�! SCALE 1° 4� �G'!1a. tJl & �it '11` IPtl�t` "',fir �OW"N� I;NSPECTOR:�'•�G rjsu.G+llr'.4� " .4'IG><T� o�prAt � 7sfi: BACKHOE OPERATOR': `'. TEST MADE ON cp .��►-,���.�.�.�.�' �r•,/a�.�. rf.����s LCST , t fr� OF J, JAME a= � _x all Ai «a144 ` aea 7ae► . �� .tea ti - ' CHAi*IArI h g6 xi8"e 6 4 Fla,Zl&54 O ELEVATION. SCHEDULE, PROPOSED SITE PLAN I.' INV. AT FOUNDATION �. SEWAGE SYSTEM DESIGN 2.' INV. INTO SEPTIC TANK IN /'� '7" I � 1✓ ! F k n. 3.t INV. OUT OF SEPTIC TANK = 9(o.(�D ' �/ � } 4. (NV. INTO DISTRIBUTION BOX =` ' SCALE: I" S/p ' Jarj, /9j 197a t t, , .5. JNV. OUT OF DISTRIBUTION BOX C- 640 CAPE COD SURVEY CONSULTANTS ' 6. INV INTO SEEPAGE PIT _al ROUTE 132 T. OTTOM OF PIT" 90102 '� FIYANNIS,MASS. f A DIVISION BOSTON SURVEY CONSULTANTS, INC, a 8 ElTTIOM OF STONE LAYER , s _ ° t` I d I i 4 .erg G✓�e,��� ��a s: �� �--