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HomeMy WebLinkAbout0085 PRUDENCE LANE ZZ7i l { was 4 SNE Town of Barnstable *Permit# Expires 6 months i issue,date Regulatory Services Fee = BARN ABLE. Thomas F.Geiler, Director MASS. t639. Building Division C Tom Perry,CBO, Building Commissionernn.II 200 Main Street, Hyannis,MA 02601 M1 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X.Press Imprint Map/parcel Number� � Property Address `[Residential Value of WorlC po. , Minimum fee of$25.00 for work under$6000.00 n Owner's Name&Address `� Contractor's Nam L Telephone Number A4% Home Improvement Contractor License#(if applicable) \RWorkman's Compensation Insurance - 'S PERMIT Check one: ❑ I am a sole proprietor OCT oo$ ❑ I am the Homeowner f 1 have Worker's Compensation Insurance �C3(� TOWN OF BARNSTABL Insurance Company Name Workman's Comp.Policy Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side Replacement Windows/doors/sliders.U=Value (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement.Contractors License is required. SIGNATURE: Q:Forms:buildingpennits/express Revised 123107 I n °T �.. Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: 4f,\ Board of Building Regulations and Standards Registrdtl.Qp; 100740 A�' flan= 23/2010 One Ashburton Place Rm 1301 ms -? Boston,Ma.02108 ptement Card CAPIZZI HOME ` 'Fti-R.�- /. h�1,il bARY GUSTAFSO _ '--' I• 1645 Newton Rd. .. Cotwt,MA 02635 ' Administrator No valiA itho i7t nature J�te 'IOOmvrnp-iuueaG[Ie oj��!/ �zc a[ulel�b ' Board of Building Regulations and Stftdards Construction Supervisor License License: CS 74640 ei rthdate: 11/29/1975 Expiration: 11/29/2008 Tr# 6430 Restrictlon: 00 GARY GUSTAFSON 8 SHORT WAY SANDWICH,MA 02563 Commissioner I 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 (Business/Organization/Individual): Address: Capizzi Home lmprov:m.ellt 'rig ,645 PlewtewR d Cotuit, M 025 City/State/Zip: :3 nGio [ 59''6 Are you an employer? Check the appropriate box: Type of project(required):. LM I am a employer with _ 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' [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.❑ Other comp. insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the subcontractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: i1 fy) Policy#or Self-ins. Lic.#: 0 a ExpirationDate: Job Site Address: D AZNCR \jy City/State/Zip t M z ( L(� 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 coveram v9fification. I-do-hereby-cer--tify-under, a pains-and-pe It o er-jur-y-that-the-inf-ar-mation-pr-o-vide.d above-is-tt r-ue-and-corr-ect. Signature: Date: b Phone#: L�-"1o1�s,q�l 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#: 7 Client#: 47298 CAPIHOM DATE ACORDT CERTIFICATE OF LIABILITY INSURANCE 06/12/2008YYY) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Rogers&Gray Ins. -So. Dennis f ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 434 Route 134 L ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 1601 South Dennis, MA 02660-1601 j INSURERS AFFORDING COVERAGE NAIC# INSURED _ INSURER A. NGM Insurance Company j Capiui Home Improvement, Inc. I INSURER B: American Home Assurance Capiui Enterprises, Inc. ;INSURER, 1645 Newtown Road INSURER D I Cotuit� MA 02635 L ------------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]'HIS CERTIFICAI-E MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO A LI.THE TERM; EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, iNSR POLICY EFFECTIVE rPOLICY EXPIRATION! — - — --T'------. —'--- LTR NSR TYPE OF INSURANCE POLICY NUMBER_ DATE MM/DD/YYh 1 DATE iMM/DDIYYI_ —_ LIMITS A GENERAL LIABILITY MPB1075H — 06108/08 106I08/09 T C I R NCR 1,000,OpO — I X COMMERCIAL GENERAL LIAb L Y I ,OAt��CE TO i�c.NT("f) -- R M 5F51_r orc rrencel ($500,000 CLAIMS MADE f)Cl Ui? f ! f'�Ar mr.parson} T$1 O 000 _ —�� rIERSUNAL n r )\j INJURY $1,000,000 -'NERAL,AGGkEGATF1 s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER, j 'RODUCTS. COMP 0� !OP AGG s2 000 00 - �. _- POLICY I 1_'_ - I POY 117, 'EC' I L' i .___......._.__._ T._.____._._—..�i —._.—__ AUTOMOBILE LIABILITY I;OMrJ NFp SIN,L.E..;.1111`! ANY AUTO (Ea incident •�' .Ai i OWNED AUTOS — --_---------- i ` - I I SCHEDULED AUTOS i '.I asrm $ . !HIRED AiJT09 —I-------_._._.—.— NOWOWNEO AUTOS OPFR7Y - . GARAGE LIABILITY AU 1-?CHV;__Y_A ACCIDENT' —------_.— ANY AUTO ;;:T HER THAN - 4C^0 ONLY AGU i --------- I ___ __ _ ....-7----------------------._._.._t._._-__...-------------- S A EXCESS/UMBRELLA LIABILITY �CU81076H 1 06/08/08 06108/09 ; '.A%II )Gcur.RENGE $5 000,000 OCCUR n CLAIMS MAE)E. i iu3uliEGAT^ —,—�$ 00,000 —_ X RETENTION $10000 • - _,_�.—._. —_— _ —I-----t .�—WC ST.41U- OTH. B WORKERS COMPENSATION AND ,WC6716562 12/25/07 112/25/08 ;X EMPLOYERS'LIABILITY ! --�_'OR I WITS R �.. ANY PROPRIETOR/PARTNER/EXE'GUTIV'E F__L EACH ACCIDENT $SOO,000 — OFFICER/MEMBER EXCLUDED? E.!-.DISEASE-EA EMPLOYEE $500,000 If yes,describe under SPECIAL PROVISIONS below _ �.y� -— E DISEASE-POLICY LIMIT $SOO,000 OTHER — I. —'---------- ---�-----� ---' ---(----._._-- i DESCRIPTION OF OPERATIONS LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Carpentry CERTIFICATE HOLDER CANCELLATION '. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Town of Barnstable DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL In DAYS WRITTEN 200 Main Street NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Hyannis, MA 02601 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE — ACORD 25(2001108)1 of 2 #S36540IM36539 KW © ACORD CORPORATION 1988 Page 7 of 7 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 MASSAC1 USETTS STATE BUILDING CODE. SIGNATURE OF OWNER. f OWNER'S ADDRESS: OWNER'S TELEPHONE: LESSEE'S SIGNATURE: LESSEE'S ADDRESS: LESSEE'S TELEPHONE: APLLICANT'S SIGNATURE: APPLICANT'S ADDRESS: 1645 Newtown Rd., Cotuit, MA 02635 APPLICANT'S TELEPHONE: 508-428-9518 RESPONSIBLE OFFICER: . RESPONSIBLE OFFICER ADDRESS: RESPONSIBLE OFFICER TELEPHONE: f oF'fHerO� Town of Barnstable *Permit 0 7 S� F-Virca b months from issue date r Regulator Services 3F'ee �- Y 'S e39• �0 Q Thomas F.Geiler,Director 2 ArFp MAC A N 1 O ZOO 1-� BA���TABLE�coz� Building B�i a�Di�visio�a TOWIN OF y, . g commissioner 200 Main street, Ilyannis,MA 0201 Office: 508-862-4038 - Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - :RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Viap/parcel Number 'roperty Address �—� Residential Value of Work Q C � A inimum fee of$25.00 for work under$6000.00 )wner's Name&Address C6-+ bntractor's Name Telephone Number S tome Improvement Contractor License#(if applicabble)_ ©o onstruction SuperUisor's License#(if applicable) d ]Workman's Compensation Insurance Check one: ❑ I am a.sole proprietor I am the Homeowner I have Worker's Compensation Insurance tsurance Company Name 7orkman's Comp.Policy it P4 q �� opy of Insurance Compliance Certificate must be on file. -emit Request(check box) Re-roof(stripping old shingles) All construction debris will be taken to �]Re-roof(not stripping. Coung over existing layers ofr000 Re-side. eplacenient Windows. U-Value ' 2) um.44) *Where required: Issuance of this permit does not exempt compliance wifli other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner muss sign Property Owner Letter of Permission. Home Improvement Contractors License is required. gnature Forms:expmtrg vise063004 G NP I 21 Home 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: aworth Date: 1645 Newtown Road Cotuit, MA 02635 (508) 428-9518 (800) 262-5060 FAX (508) 428-1547 Page 7 of 7 -- CAPIZZI HOME IMPROVEMENT INC. SPECIFICATIONS AND ESTIMATES STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT I, c'o OWN THE PROPERTY LOCATED AT 1N�O�LI (,� MASSACHUSETTS. I HAVE AUTHORIZED CAPIZZI HOME IMPROVEMENT TO ACT AS MY AGENT TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. I GIVE MY PERMISSION TO LESSEE TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. SIGNATURE OF OWNER: OWNER'S ADDRESS: OWNER'S TELEPHONE: LESSEE'S SIGNATURE: LESSEE'S ADDRESS: LESSEE'S TELEPHONE: APLLICANT'S SIGNATURE: APPLICANT'S ADDRESS: 1645 ewtown Rd., Cotuit, MA 02635 APPLICANT'S TELEPHONE: 508-428-9518 RESPONSIBLE OFFICER: RESPONSIBLE OFFICER ADDRESS: RESPONSIBLE OFFICER TELEPHONE: R Client#:47298 CAPIHOM ACQR& CERTIFICATE OF LIABILITY INSURANCE DATE(A9NJODIYYYY) o 10sJro7 PRODUCRogerER THIS CERTIFICATE 1S ISSUED AS A(NATTER OF INFORMATION Rogers 8 Gray Ins.Agency,inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 434 Route 134 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR P.O.Box 1601 ALTER THE COVERAGE AFFORDED SYTHE POLICIES BELOW. South Dennis,MA 02680-1$01 INSURERS AFFORDING COVERAGE. NAIC* INSURED INSURER A. National Grange Mutual Ins.Co. Capizzi Home Improvement,Inc.Capizzl Enterprises,Inc. INSURER$;American international Gr 164S Newtown Road INSURER Cotult,MA 02635 ` -,:.ci COVERAGES INSURER D. _ .....^-� _ INSURERS . - . 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 DOCUNENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSJED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 1S SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID.CLAIMS. , LTR RN TYPE OF INSURANCE POLICY NUMBER POLICY .EFFECTIVE POLICY EXPIRATION - 'LIMITS A Gt1INIA TY MP010707 -... - W08/06 06/08/01 EACH OCCURRENCE' $1 00O 000 GENERAL LIABILITY - PAMAGETORENTED $500 000AAOE OCCURMED EXF(Any one person)PERSONAL&ADV INJURY '$1ODO 000 GENERALAGGREGATE . 's2OOQOpp E UMITAPPLIES PER:. PRODUCTS'•COMP/OP AGG :$2,000 000PRO- 1ECT LOC AUTOMOBILE LIABILITY - - - - 7COMBINEOSINGLE LIMIT _ 4NY AUTO IEz.ecciden ALL ONTED ALTOS SCHEDULED AUTOS BODILY INJURY. - . - f,Perperson) _ HIRED AUTOS NON-OWNED AUTOS BODILY INJURY g'.. '.(Per acc d=) PROPERTY DAMAGE (Perawde6d) $ • - GARAGE.LIABILITY _ AUTO OPLY•'EA ACCIDENT ,III, ANY AUTO - - EA ACC' $. OTTER THAN" - _ AUTO ONLY: AGG. $ _ I i EXCESSAJMBRELLA LIABILITY EACH oCCURRENCE $" OCCUR -.a.CLAlNISMADE - AGGREGATE. �_> ». '�-.,$... •...... ..„ DEDUCTIBLE RETENTION B WORKERS COMPENSATION AND 1764953 1212510E 12125/O7 `1VC STATU•EMPLOYERS'LIABILITYER .MY PROPRIETORIPARTNERIEXECUTIVE ....- -. -- - .. -". - .. - _ .. .. E.L.EACH ACCIDENT _"',� 400000 GFFICETscrbe under ER EXCLUDED? If yea,dasv tm u E.L.DISEASE•EA EMPLOYEE�$5O0 000 _ � � - SPECIAL to cw 07HER E.L DISEASE-POLICY'Udm .$500 000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS J VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT J SPECIAL PROVISI DNS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED,SEFORE THE EXPRtATION-. DATE THEREOF,:THE ISSUING INSURERVALL ENDEAVOR TO.MALL. in .DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.BUT FAILURE TO DO SO$HALL - _ IMPOSE NO OBLIGATION OR LIABILITY OF ANY.KIND UPON THE INSURER;ITS AGENTS OR REPRESENTATIVES. ----^'--•AUTHORIZED REPRESENTATIVE ""'"`""" -- - _ --°•--�-_,T.__�._ ACORD 26(2007/08)1 of DMyy....._._O.ACORD CORPORATION 1988-- - 1-ne uommonweam o etts . massaenus I Depai*r ent of Andiisiridl Accidents • 'Office of hnvestzgations 600 Washington Sheet .. t� Apston,llfA �12111 -W w"-Ma''ss. oVFAU Workers',Coinipensation Insurance Affidavit UiiiMits/Contractors/Electricianis/Plunabers Appcaotuformation L Please Print eibly _{ i Name(Busmessl0rganization/Inctivdual): �- ; A 3 1b45 tyeHitown Road Uty/State/ ip Tel 4?8 9518 0�e# e ou.an employer.?Cbreck t7le.appropriaie box.. 4 e of rig ect uai`,ed): .��I h P l Crl I am a employer wr�h 4 �} S am a genes contractor anal 6 �Newconstsact�on le Im -es(, . and/or wart tunej.* have hued the snb-contracto r 2. I am asole panpnetor orpartaieT- listed on the attached sheet 4 [� Remodelmg ship aaad Dave iao employees Theseslab-eontfaMrs a ve $ Demoi�twn vpo kmg forme in any capacity. vorkeis'pomp aaisivance 9 Building additaon �. H . [No workers'con v atis Trance 5 we are-a coaporation and its J.r oared. Of lcerS.haVe exe IL3he � r�` rased ar � iectci � flr additions 3_Q I am a homeowner doing all vvcirk right of exemptxan pea MGLPlumbing repairs of additions hr self[No workers' co aap:' c. 152,§1(4},and urehaue iio 12 0 Roofrepaars msiirance regaaared.j�" � employy+ees �No workers' 13[� 01het. j _ cd�.:rnsurance rscluued-] *�3'apphc�rit that checks box#i must also fill out�e secUlon below showing their worlcers'cot{on pDhcy mfoxinehon t Homeowneis who submit this adavat mciic�tuig they aze doing sIl work and#hennrc outside contractors must submit a new affidavit mdt such. tConhactors that deck thrs bog must attached en: site addrhonai sheet shownig�e name of&e sub trontracfors aIId# ear woken'comp Policymfoririafon I am an employer thatslnrovrding workers'comperrsatronstsurmsce for my employees $elow is t3ie o mid o t=�anyName^ � V LL B► p_ Policy#or~Seif ans i rc.# �j - Date: tJ Job SrteAddress:::__ _ CitylStAe/Zip Attach a copy of the workers'compensataon polacyRdeclarataon page(showang 1ffie poLcy flnimber and exp date). Fa fire do secure coverage as regiaared under Section 25A of ViGL c. i$2 can lead.,to the maposation of cnmiiaal penalties of:a fine'up to$1,500 tiU and/or one-year airipnsonnent,as well as civil penalties m the form of a STOP CORK ORDER and amine w w w of-iap�$25(100 aacllay agaiast-t�e vaolaior :�dvis�d`8aat a co - _ ln.. tions ofthe DiA for�� �ra� _. _ pyoftlias sta maybe foru�arded�to tie Office of Yestiga. ce coverag-e verifc�hon: . Cement t do`hereby ce unde tine pains and penirlttes o.f �' ;thrit�Jie anforinatu»i.provided above rs true aril correci� - Date: 'use only. Dowot write in this area,to be completed by.city:or town officiut — Permit/License# Is"sniiig KliL r ty(circle one): _____ ___ µ .Ar 1.Board of Health Z.Building Department 3.City/Town Clerk 4.Electrical inspector 5.Plumbing Inspector 6.Other on _ on " -6,09w Board of Building'Re Iations�• and Standards n One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvement Contractor Registration Registration: 100740 TYPO: Private Corporation CAPIZZI ,HOME IMPROVEMENT, -INC. Expiration: 8I23/2008 Thomas Capizzi,Jr. - 'I645 Newton Rd. . Cotuit, MA 02635 Update Address and return eard.Mark reason for change. DPS Cq I is soM o uos pcesee Address 0 RenewalEl employment 0 Lost Card - � ''✓1t6 T004fLJ1l04tt11/acLGG/L O�i///GCtdd�tttdEG� - f I bard of Bull '1119 Rogutatlons and Standards ' F10M8 1MPROVEM License or registration valid forindividuI use only EiNT CONTF24CTOa before the expiration date. lffound return to.' Registratfoft: 100740 Board of Building Regulations and Standards'' Expiratioh:' 6/2gj2008 OneAShburtbn PIaceRm 13ol 7yP6: Private Corporation Boston,Na.0210E CAPIZZI HOME:IMPROVEMENT,INC. _Thomas Capizzi,Jr. 1645 Newton Rd. � Cotult, MA 02635 Deputy Adminfstrator Not valid without signature 130ARDPtr BUILDING Via, 1:i1:erse. •'�bNsrRue�oN s" ;� i � S Nurnbeti� 5 0$7032 ate ew THOMAS I 165NW7'OU1i� C071JI7" 9A 02G *�,. i f ioh-JbI e `-'�oFrw r ti Town of Barnstable *Permit# 813 7 S 1 P Expires 6 monlhsJroin issue date BAR 'STABLE, : Regulatory Services Fee y MASS. qj 1639. Thomas F.Geiler,Director m Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 jh � Office: 508-862-4038 Fax: 508-790-6230 OCT17 2-005 _EXPRESS PERMIT APPLICATION - RESIDENTIF BARN��,gBL� Not Valid without Red X-.Press bnprint Map/parcel Number n Pro erty Address Residential Value of Work4 CP"/� Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address C01A -29 C11AMV, VA-rV- (M),I1 02AIF Contractor's Name vL Telephone Number �JUD o'b ` qgg Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable)_ Idworkinan's Compensation Insurance Check one: ❑ I am a sole proprietor VIam the Homeowner have Worker's Compensation Insurance Insurance Company Name � I l� � '�j f4s Workman's Comp.Policy#_ P Copy of Insurance Compliance Certificate must be on file. Permit Reque t(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 ❑ Replacement Windows. U-Value (maximum.44) "Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. Home Improvement Contractors License is required. Signatureq W L 1645 S Capizzi Home Improvement 1nt ewtown Road Q:Ponns:expmtrg Cotuit, MA 02635 Revise063004 te1. 428.9518(1-800.262.5060 *,- CAPIZZI HOME IMPROVEMENT INC. SPECIFICATIONS AND ESTIMATES PAGE 6 OF 6 . J� l� 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: OWNER'S TELEPHONE: LESSEE'S SIGNATURE: LESSEE'S ADDRESS: LESSEE'S TELEPHONE: APLLICANT'S SIGNATURE: APPLICANT'S ADDRESS: 1645 NEWTOWN RD. , COTUIT, ILA 02635 APPLICANT'S TELEPHONE: 508/428-9518 RESPONSIBLE OFFICER: RESPONSIBLE OFFICER ADDRESS: RESPONSIBLE OFFICER TELEPHONE: I ACCEPTED BY DATE THIS PAGE IS PART OF AND IN CONFORMANCE WITH- PROPOSAL # 4 w I 3o. Ion- I 01� Fj oil-I c 1.117pi-ovel'13PI. Res)istmficm: 10D740 I yr)(.": Private Corporation Expiratioi 6123/20DG CAPIZZI HOME IMPROVEMENT,.INC. Thomas CaPj77j, jF. 1645 Newton Rd. CcAult, MA 02635 Update Address qnd return card.AJarj{ reason for change. Ej- Address E) Renewal F-1 Employment F-1 Lost Car 9211, - License or registration valid for individu) use only HOME IIAPROVEMFNT CONTRACTOR before the expiration date. If found return to: Registration: Board of BuildirigRegD12tions and Standards Expiration: 612312OD6 One Ashburton P]2cc Rm 1301 Type: Private Corporation Boston,Ma.02108 CAPIZZI HOME IMPROVEMENT,I %ornas c2pizzi,jr. 1645 f4evAon Rd. Cotuit,MA 02635 �1 3�A Administmior Notv2lid without 00-35.()00 cl enclosed space (M(;[,C (iol) IA M,1SC111, BOARD OF BUILDING REGULATIONS' only 1111 Iliv t lon le's License: CONSIIlU(.-I ION SUPERVISOR I dJJLJtC 1(,possess a CMem e(ilfol of Number: CS 074640M8SSa,hL1SejlS, ury is cause fo,ie ic Cod( OC'Mon()f III,!; irthdate: 11/29/1975 Expires: 11/29/200C, Ti no: 9431 0 Restricted- 00 GAkY G L J S TA F 1)'0 N H SI i0k I WAY ----------------------- DIG SAFE CALL CENI ER: (888) 344-7233 c 0111111issionel 2 - n,•4,,,,y .... ,..s. .`.,y., + Nv}P:%'�4a,.:.r•7u-+.m R��'..«+ .,b�.+u.ft«`.r`-�i*ov`aY���.la• L�te"'"^,-t v_x.... .� .. .. -- Assessor's office(1 st Floor): Assessor's map and lot number Board of Health(3rd floor): a/� / /qo , yy�Sewage Permit number �/ f • Engineering Department(3rd floor): = D►L93TABLE `/Y }r. !� rhea House number � o E'09• Definitive Plan Approved by Planning Board '`' 19 MAII 6• APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only t'l TOWN OF, BAR.NSTABLE . BUILDING INSPECTOR APPLICATION FOR PERMIT TO /41 n / T' S U TYPE OF CONSTRUCTION _ (�6 `-'! 13C4 VV 6 ( O U Ngcri J 0 L � 16 19 9(a TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location C-( ode in C 0 1, Proposed Use 1� ! Zoning District �� �'" Fire DistrictJ 1 I Name of Owner e- /a � Address (13� �� �'�� th C c.. h u Name of Builder 1 J G V I U hO A P, Address 3 tJ Ce ll t? S ' `M Name of Architect D yj Address Number of Rooms V\ C c Foundation C h C Exterior C, d !1 ! h `l Roofing . 3 1� 14c, C Floors j iD Y tx-,O,'7d Interior S 9CC6 © c • t W Heating h V\, - Plumbing b cp 8 �Fireplace t'J In `e - Approximate Cost © �g Area --.~- 4 Diagram of Lot and Building with Dimensions Fee "�V, 9 " '-70, , 14 6' al OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name c>o ��•a � - - • Construction Supervisor's License C7�S �D ' DeCOSTA, LEO A=039-045 y No 33868 Permit For Build Addition Single Family Dwelling Location 85 Prudence Lane Cotuit 3 Owner Leo DeCosta Type of Construction Frame Plot Lot Permit Granted July 17, 19 9t:1 Date of Inspection 19 Date Completed 19 r PERMIT COMPLETED VIAL ��% YI/ Assessor's map and lot number ..: ��..:.' ?�..a��?�:,,�c'........ �o 4 TN E Sewage Permit number �Ca �•3/ ..0��. .,, �b'� w`' � y� Z BARNSTADLE, i House number w 9 MABa i................................. Apo,1639. \00� TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ....... 1, 3..::. ti. ....... 5...... i i n `! ,r'................................................. TYPE OF CONSTRUCTION . . ./:::...� .�• f. ... ............................... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location /p � l r2..... t �i!/ . /U ........................................ Proposed Use .......... . 8.,�_'.. ! ?.:�`rJ......... .. ..Z ... r Zoning District ....... f..!.............................................................Fire District ............. ................................ Name of Owner T7 /}/.. R �. l. !�. %�?../1.�� 1t(A'dd ss ...... !........ . Name of Builder .....,%,.;,1?c ,C_ . . ,.�„r C' ;. ? ......Address .......... .Name of Architect ..............'?:7..,;..:'s?.. .:.............................Address ................................................................................... Number of Rooms .......... 1�....................................................Foundation ......!:. .� !' (Ifi kkf� �.............. ...... . Exierior 1� L:y ,� r ...................Roofin ......................._. ...................................... g .....,:.,...: .................... Floors �rl Fi�i fait t.'n ,r. .�•4.�r� ...Interior : ... ....... ...... mating .... .... .... .�'`!7? :t r.... W .=-I!� g rxn,./'�t �tAm �..... � {iQt$tr��, ............Plumbin ................... ,..,. . t?.. ' r Fireplace ............... l ` 1' ....................................................Approximate Cost ?.... 'J --,v / F✓ Definitive Plan Approved by Planning Board ____ _______________________19--------. Area - ....:_: Diagram of Lot and Building with Dimensions F .,2. . G 9 9 Fee' ......_...:.................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH . fr ! k I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name IM-1-4.�..... on„�?; irn,�fl.�n '..................T � 7 , A�]9-45 TBEOH&8IDIS & BELEN ' ` � ' No _2�I.11... Permit z-4 .Ooe_.Stor��........... � Frame Dwellingr ----------- -------.--. . � Location Lot #62 85 �� Lane ' ----~--,----~.---. ---.. —.--.—.C��g��--.:—.—...-------. \ ^ Bo�� & Helen Tbe�b i io < Owner -- ���]�- --!� �o . . a���� ` ame \ � '' \ . � \ - -E Plot 2 � | ` Permit. Granted. L � � -_- of Inspection` � ` , . � -_- ,_-- � . PERMIT REFUSED / | ' ................ lV ` ` ~ �� " ~ ~ � | ' -----' ^:'—'' '--'f'�'---^-----'' | - V � ' —'-~—^'`'^' '^^'—`—^'—^------'--^--' . ___.0 . � . _ ^ _.____... .--.. ��-'_-----. . .. _.` .. — � � ----^--^-~—'--~~—^'~`^~------~''- 1 ` / / Approved ----------------' lR . . --------'—'--''—'—'--^~—^^'-'~—'-- -----------^—'---'--^~~^^'--^^'- � H MMMEM MMMM i M■��i■ii� MEMO i� i o� mi�iiMEN MEMMEN M OMEN mom M MEN ME WE MEMOMMOMM NNE MEN MEMEMOMENE MEMO ME mommi MMMEM ONSIMMEMMEEM ONOMM OEM MMMNMMMM MEMO 0 ME no NONE MEMEMMME IN SEEM MEMNON MEN mommomm ME EMOMMEM ME No MEN= MEN ON IN MMMIMMMMMM MEMO ME No M ON MEMO 0 ME M no No MEN ME ONE MEN MEN MI MOEN 0 No mom ■ MENNI INN INN MORE mom SOMEONE somom M ME mommoommumm nommosomms MOMEMMOMI mom MEMO ME M manummumommumno ��iH■■■■�! M■■■■EMM■MMM■■i=ME■■rid■ ONSON No Mill 11,11mommillimm son ME ME NONE ON ON so so 0 EMMEM M 0 ME ME ME MEMOMME ME mom M MEMNON ON ON M Emima MEMMINES mom 0 no MOMM No 0 0 ENE ME EMMEM ME so MMEMMEME WE NONE No 0 MEMEMEMSE 0 NONE on 0 00 M 0 0 No M Immums ME 0 m MEMMMEMSM MEN ONO NONE ME M 0 MORON IMMENOMME MMMMMMMMMM 0 MEMION SOMEONE ON No MOM M MEMO M No 0 ON M NONE MEMEMMOM ON MEMEMEM MENOMONEE ME ON mom 11 No MEMO i�iiiii MEMO EMMU� ■iii iomiMEi■ni�iE 0 SOMEONE NONE m NONE EMMOMMEMMOMMOMM E■m■■ NONE Nis E■!!■M W■■N■EM■■■GNU ME MOMON MOMMOMM ME NNE mommom MOME� MOEN ii■iiiieiiiM■Mse���i■�no�in■ii ON �ii �■n��■�i=■iii��■��i��Nii■i�ui�i�iiii� M MMINE, MMMMMMMIIMMMMMMM M MIMMUMMEM mom NNE ME MEMEMIEN IME m mummmom NME m m ME ONE ME so so IME ON IME Moloo ME 0 mom mom EMEMS! MINIM== MEMESIMMENSIMMISM EMEMENNEMMEME MEMME MEMO MEN MOM 0 MOMMISOMMOMMOME MOEN SEINE m 00 SOMME IMINIMME NMMIMMMMMMMMIMM MEN! MEN MEMOMMOMMEM 0 ON ON MEMOM MMM MINIM SOMEONE mom 0 0 0 0 moommoomm 0 MEMNON 0 MNMMMMMmMM___ _MM OMENS MMEMISMEMMEMEN NO MENSIMMESIMMEN MONO MMMMISMMMMMMEI so EN MMmNm EMEMIMMEMMISM mom mom SOMME MMMIMMMMMMMMMMI MEMMOMMOOMEM iiuii�i�MIN� ��� i�■■Mii�i�M■■ M ME ■ EME Ham■■■■iEMMM ME ME MENOMME MIN MERNME■ME NO��� ■ ■ �MEMMUMMEM ��■■■■MEMMEMOSIM No ME MEN �wMis ��■��_�_■■� i��iiiiiii■i=i���■ ■ii��ii■■■ Mi ■ MOONS Assessor's office(1 st Floor): Assessor's map and.lot number (J I K �. . � poi THE job Board of Health(3rd floor): Sewage Permit number Engineering Department(3rd floor): - J /ll OCy b"� 71, to 2 �, �TH e u U LC rasa House number ` '`- +�vt''- '��.� t6}0� Definitive Plan Approved by Planning Board 19 fW RE ` � o. d APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only^ ��������`' TOWN OF BAR.NSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO / / T' l� VL (`� (�� h O e—Q t �' TYPE OF CONSTRUCTION lit✓ Q O P- U V1 CN �D G�yVS j 0 d 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location Prude tic e - cy k C-- 0 U 1% LL Proposed Use 6 X q r Zoning.District ", Fire District Name of Owner �� C �9 Address (J de tx C 4�[ k e Name of Builder L°a Address nRei ae— Name of Architect ` ` l'� h Address Number of Rooms Foundation h Exterior Cc 0/ Roofing As P ``'� 1 t N 11,0� "'e� Floors L[e Interior Heating �(2 Plumbing P �'1 o In 'Q A v © o O Fireplace� Approximate Cost Area Diagram of Lot and Building with Dimensions Fey o. S V2 4100 1 1400 Y OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name Construction Supervisor's License �� DECOSTA, LEO i No 33868 Permit For Build Addition Single Family Dwelling r Location 85 Prudence Lane 4* Cotuit Leo DeCosta Owner -• , •Type of Construction Frame }x } Plot Lot Permit Granted July 17 19 90' t ' '-Date of Inspection ��-�' 19 r , y Date Completed 2 19J-7 i tt ,1 1 t �y p; TOWN OF BARNSPermit.. . Ti�iBLE Permit.No. ` 1 eAMT.oc B � •uilding,,Inspector ; Cash — —-- v.a G-PERMIT, -,_ _._ "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 theiefor first having been obtained from the Building Inspector. No building shall be'occupied,until a certificate of occupancy has been issued by th'e Building.Inspector." Issued to Barry' -heo aridis Address Worcester T.ni- f�F;7 �ti Pv�iiva v�r.t� T,�rem Cc�l-�i•� , f _ _ rFa t •-� a — _ - ape Wiring Inspector � .� � ,- �--e coon dateZ,? Plumbing Ihsp cttoor � J � Inspection date Ins Gas Inspector y� �/Jry� Inspection nil �I 'li , iL/1s73r/ P `f Engineering Department 1 �*%. �.. 3.r !, Inspection date THIS PERMIT WILL NOT BE VALID,:AND THE BUILDING SHALL NOT BE -OCCUPIED UNTIL SIGNED BY THE BUILDING. INSPECTOR UPON SAT_ISFACTORY' COMPLIANCE .WITH TOWN. REQUIREMENTS. 4 141 f. Building.,.Inspector ...... _. . . . LOT kt co ry), Ise I 19 . 2 a : 2 s� A IG'P-5 E R ra.`q DRU v E ELEVATION OF TOP OF FOUNDATION I CERTIFY THAT THE FOUNDATION SHOWN DOES NOT VIOLATE ANY EXISTING ZONING REGULMION Of THE TOWN OF ��C.���� �BG� TC��✓+.IP.S O t ��.�P�'�sT'�.�I_; Q,T 7u 1 0 Fzc as re \ ' S L 4'A e sor's map and lot number .%<.......... _. `'" .. yoF roe ? E Q f Sewage Permit number' SEPTIC SYSTEM MUTT Be i B, sTLE, i a ,� House number ..................... ..... ...� INSTALLED IN WMKIANd MA �i........................ 'oo i639 WITH � 5 �OMPYp,•� TOWN OF B A RI~ AND BUILDING -. IKS'PECTOR APPLICATION FOR PERMIT TO .. ...... .......,lJ:c7:.fil/tlr :................................................. TYPE OF CONSTRUCTION pta-.w....... ...... TO THE INSPECTOR OF BUILDINGS: { The unders' 'ned .hereby applies.fora ermit accordin to the following information: Location �1.... . .. '...... c� .-�....�.�'e.........^. ` ....�... ................................... Proposed Use ........... ...... ........,X ...L� ............ �.......r...... Zoning District ......�� .................... ................... Fire District ............ ... ......... Name of Owner .. .. . .. .. 11 ...�. �XCddress ......f............ ... lylY• . U / Q Name of Builder�Q/l�< ..Sr... .........Address......... ..... ,3W..�.�d Nameof Architect ............: .............................Address .........................................;.......................................... Number of Rooms ..........� ...................................................Foundation .....�C..X1Tl..� Exierior ..... B. Q.O .........................................................Roofing ..... '� .. ,........................................... i Floors ..... . � .. .... .. ...................Interior ......... .2.....Dj-'-w--qji eC.-............................ Heating -::. . .. . .......: . .. :.:?!!�.@L :...........Plumbing ...:.:.:....::/:. ..... 2....✓%:7E'?..:.(.f�GQay Fireplace ................. .:............................................... Cost o�.. Q,..Q. .7. . .Approximate Definitive Plan Approved by Planning Board ---------------_--------------- 19 Area d Diagram of Lot and Building with Dimensions F . Q�Ll .. SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above . construction. v Name .1................... 'i THEOHARIDIS, HARRY & HELEN A ....22.111 permit far One S�ory.... ..... .......................... RY & HELEN S r ...... . .... ....... ..... Frame Dwelling ................................................................... .......... Lot #62 Pr den Location ...................... ........ ....... Cotuit ...................... Harry & Helen Theohari Owner ..............................................................dis Frame Type of Construction .......................................... .................... .......................................................... Z Plot ............................. Lot ................................ Permit Granted ....Apr.11...1.4.,,..,...........19 80 Date of Inspection .............. 19--,?0, , Date -Complete ................... 19 M's rK efRMIT REFUSED tx ........... .. ................................. 19 co ........... .......I..................................I . . . ............ ......................................................... ........... ....................... ................................ C.C. -.1 ............................................................. Approved ................................................ 19 ............................................................................... . ...............................................................................