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Home My WebLink About0019 ROOSEVELT ROAD �, `. 1 l Town of Barnstable Post This Card So=That it is.Uis�ble From the Street Approuetl Plans Must be Retained on Job and this Card`Must be Kept Shed MyiNE3'CABL.�, z `' 1639. Posted UntilF�nal Inspection HasBeen�Made F - � u, ,% �� . .,z ,M 1 _:� _, , Registration 1A/here,a Cert�ficate,ofOccupancy=is Requred,.3swch Buldmgshall Not,be Occupied until a Final Inspect�onhas beenmade e�lstrat ��, ..,.�s Registration Number: B-20-653 Applicant Name: JohrrZompa Approvals Date Issued: 03/03/2020 Current Use: Structure Permit Type: Building-Shed-Residential-.200 sfand under Expiration Date: 09/03/2020 foundations Location: 19 ROOSEVELt ROAD,COTUIT Map/Lot 039 141 Zoning District: RF Sheathing: Owner on Record: ZOMPA,]OHN&DENISE Contractor Name Framing: 1 Address: 19 ROOSEVELT ROAD Contractor:,.LicenseB ": 2 COTUIT, MA 02635 a` Est Protect Cost: $800.00 Chimney: v' Permit Fete: $35.00 Description: build wooden shed approx 8 x 10 ft.foot print Insulation: ,Z Fee Paid $35.00 Project Review ReM .`111�1 7 J q r Date 3/3/2020 Final: �:x N Plumbing/Gas Rough Plumbing: Building.Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. �M �. - All work authorized by this permit shall conform to the approved application and the1approved construction documentstforIwhich this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public k i$ ft on for the entire duration of the Final Gas: work until the completion of the same. Electrical The Certificate of Occupancy will not be issued until all applicable signaturres by the Build ni g and Fire O iff cials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work:, Service: 1.Foundation or Footing 2.Sheathing Inspection yA Rough: x� _Wiz.. 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Final: 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. - Work shall not proceed until the Inspector has approved the various stages of construction. Health "Per ting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: fi Building plans are to be available on site Fire Department � �- All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: f t r Town of Barnstable Per # of � Expires 6 nson r `issue ate' Regulatory Services Fee ,C • RAMSTABIX, , �'39: ,0� Thomas F.Geiler,Director •C Building Division Tom Perry,CBO, Building C6mmissioneiV 200 Main Street,Hyannis,MA 02601 ^ °PRESS PER MI www.town.bamstable.ma.us DEC 1 20 Fax:t5 8�� Office: 508-862-4038 -790-6230 EXPRESS PERMIT APPLICATION - RESIDES I r l to RNSTASLE Not Valid without Red X-Press Imprint . Map/parcel Number Property Address._�, 1" , C)® 1;�_ Z 0 eha a7'0 I $esidential Value'of Work $ ]�6- Aj i OrMinimum fee of$25.00 for work under$6000.00 Owner's Name&Address Contractor's Name (, r _(� t � Telephone Number. -1�,��' — 2 c - Home Improvement Contractor License#(if applicable) J (� Construction Supervisor's License#(if applicable)_ " (� ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor I am the Homeowner 1,1 ave Worker's Compensation Insurance Insurance Company Name n/r� l Al (A— l) j Workman's Comp.Policy# � Copy of Insurance Compliance Certificate must accompany each permit. Pemut 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) p a Re-side #of'doors Replacement Window ors 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 wire SIGNATURE: QAWPFIL8TOPM3 building permi form\EXPPESS.doc Revised 096809 • fie �o� !/z a�./ aaczc�umetla Board of Building Regulations and Standards License or-registration valid for individ.ul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to; a '4* Board of Building Regulations and Standards Registr;i_t1..op.; 100740 One Ashburton Place Rm 1301 plcat#sm 2312010 _ �—_. _ ,-7) Boston,Ma. 02108 '�C: _ zT1'^_�` APlement Card CAPIZZI HOMEyM ;F2st C/.y�* _i�r/Nllp� NARY GUSTAFSOty=,'.al1{i__ 1645 Newton Rd. , Cotuit, MA 02635 Administrator No vali itho•t nature � Set t t#.�- 13�1t<rr'trrri�rtt A Public S:44'01 -- -- — Board asl' Btliltlr,t:.:; Re ulit6on. and St<ttrrl:ar•11`i Construction Supeyviscr License License: CS 74M Restricted to: 00 GARY GUSTAFSON . . 8 SHORT WAY4Y : SANDWICH, MA.02563 1 1 129/201 0 Page 7 of 7 CAPIZZI HOME IMPROVEMENT INC. SPECIFICATIONS AND ESTIMATES _. STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT I, f- OWN THE PROPERTY LOCATED AT rP ) t IN�h )'�,MASSACHUSETTS. /0L 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_.EOR ABUILDING PERMIT-INACCORDANCE WITH 780 CMR;TIC-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,MA 02635 APPLICANT'S TELEPHONE: 508-428-9518 RESPONSIBLE OFFICER: F: RESPONSIBLE OFFICER ADDRESS: RESPONSIBLE OFFICER TELEPHONE: The Commonwealth of Massachusetts Department of Industrial Accidents m 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: — L�t2 City/State/Zip: �- � Phone.#: AKoeu an employer?Check the ap r priate box: Type of project(required):a employer with El4. I am a general contractor and I employees(full and/or p rt-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 p $. ❑Demolition working for me in any capacity. employees and have workers' insurance.#. 9• ❑Building addition comp.[No workers' comp.insurance required.] 5• ❑ We are a corporation and its' 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all 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' IlQtherJ)� comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showingAheir 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: [/ , Policy#or Self-ins.Lic.#:_V4 G CJ (� Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure,to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a ' fine up to$1,500.00 and/or one-year imprisonment.as well as civil penalties in the form of a STOP WORK ORDER and a 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 ins ante coverage verification. ' Tdo-hereby-c-er-tify - -der,-th ins-and- enalties-of-perjury-that-the-infor-mation-provided-abave-is true-and-cor-r-ect. Si ature: Date: Phone#: — S' 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 I City/Town Clerk 4.Electrical Inspector.5.Plumbing Inspector 6.Other Contact Person: Phone#: ACORD. CERTIFICATE OF: LIABILITY INSURANCE 0DATE(MM11 5/07/09DlYYYY) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Rogers 8r dray 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: National Grange Mutual Insurance Co. Capizzi Home Improvement, Inc. INSURER la: NATIONAL UNION FIRE INS. Capizzi Enterprises, Inc. INSURER C: 1645 Newtown Road llvsuRER 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. INS TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LTR NSR 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 SO RENTED PREM occurrence, $500 OOO CLAIMS MADE F x1 OCCUR MED EXP(Any one person) $1 O 000 i PERSONAL&ADV INJURY $1 000 000 GENERAL AGGREGATE $2 000 000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2 OOO OOO POLICY )( PRO- LOC JECT A AUTOMOBILE LIABILITY BPO10786 06/08/09 06/0$H 0. COMBINED SINGLE LIMIT $SOO,000 ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ X SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ A EXCESSIUMBRELLA LIABILITY CUB1076H 06/08/09 06/08/10 EACH OCCURRENCE $5 000 006 X OCCUR CLAIMS MADE AGGREGATE . $5 OOO OOO DEDUCTIBLE X RETENTION $10000 $ B WORKERS COMPENSATION AND WC066957000 12/25/08 12/25/09 X WC STAT,T O R EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT .. $1,000 OOO OFFICER/MEMBEREXCLUDED7 E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $1,000000 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 Barnstable DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL I0_ 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(2001/08)1 of 2 #S43470/M43449 KW 0 ACORD CORPORATION 1988 s . *Perm Town of Barnstable P ti Expires 6 mouths jrori&sut�r ate Regulatory Services Feel_ +' BARNSPABLE, y� MASS' g Thomas F. Geiler, Director AlfD MPr h �( Building Division Tom Perry,CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY 1) Not Valid without Red X-Press Imprint .klap,'parccl Number (ri 1- Ld Property Address Residential Value of Wort. �C�. Minimum fee of$25.00 for work under$6000.00 Owner's Name& AddressC? �� ''��1• \ k Contractor's Name Telephone Number '-7��— � I Ionic Improvement Contractor License#(if applicable). Construction Supervisor's License 4 (if applicable) IWorkman's Compensation Insurance -PESS PERMIT Check one: ❑ I am a sole proprietor MAY Z009 ❑ I am the Homeowner I have Worker's Compensation Insurance TOWN OF BARNSTABLE Insurance Company Name ,!`�,�(�tC' s 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 vw uvN-ILA ❑. Replacement NV4H ers. 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. copy of the Home Improvement Contractors License is required. SIC;NATUI2E: A/V PFII.F.S\Pt)RMS\building permit forms\EXPRESS.doc Re-vised 100608 Client#:47298 CAPIHOM FPRID&E�R - CERTIFICATE OF LIABILITY INSURANCE OATE(MM/°°^,YYY, 12/30/08 Gray Insurance Agency THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 9 Y 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 BY THE POLICIES BELOW. South Dennis, MA 02660-1601 INSURED INSURERS AFFORDING COVERAGE. NAIC# Capizzi Home Improvement, Inc. INSURERA: NGM Insurance Company Capizzi Enterprises, Inc. INSURER B: American Home Assurance 1645 Newtown Road INSURER C: Ciotult,MA 02635 INSURER D: COVERAGES INSURER E: 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. INSR D LTR NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION DATE MM/DD DATE MM/DD LIMITS A GENERAL LIABILITY _DATE 06/08/08 06/08/09 EACH OCCURRENCE $1 000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE S a �TOR $5O OOO CLAIMS MADE OCCUR MED EXP(Any one person) $5 OOO PERSONAL&ADV INJURY $1 OOO OOO GEN'L AGGREGATE LIMB APPLIES PER: GENERAL AGGREGATE $2 OOO O00 POLICY , a LOC PRODUCTS-COMP/OP A $2 000 000 A AUTOMOBILE LIABILITY M1 M28044 06/08/08 06/08/09 ANY AUTO (Ea accident)SINGLE LIMIT $500,000 ALL OWNED AUTOS X SCHEDULED AUTOS BODILY INJURY person) $ X HIRED AUTOS X NON-OWNED AUTOS BODILY INJURY $ (Per accident) X -Drive Other Car PROPERTY DAMAGE- (Per accident) $ GARAGE LIABILITY ANY AUTO AUTO ONLY EA ACCIDENT $ !XN � C $ AC , .. ..EXCESS/UMBRELLA LIABILITY AGG $CUBt076H 06/08/08 06/08/09 CE $5 000+000 X OCCUR CLAIMS MADE $5 000 000DEDUCTIBLE $X RETENTION $10000 $B WORKERS COMPENSATION AND WC6957000 12/25/O8 12/25/09OTH- $EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? E.L.EACH ACCIDENT $SOO,OQO If yes,describe under E.L.DISEASE-EA EMPLOYEE $500,000 SPECIAL PROVISIONS below OTHER E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Carpentry CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 200 Barnstable DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 2OO Main Street _10_ DAYS WRITTEN 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(2001/08)1 of 2 #S40650/M40647 ' KW 0 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 AC CE 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: /Z z' APPLICANT'S ADDRESS: 1645 Newtown Rd., Cotuit, MA 02635 APPLICANT'S TELEPHONE: 508-428-9518 RESPONSIBLE OFFICER: RESPONSIBLE OFFICER ADDRESS: RESPONSIBLE OFFICER TELEPHONE: i • e . , a �� a� —\ Board of Building Regulations and Standards License or registration valid for individul use only HOME`IMPRl7VE-MENT-CON'FRACTOft- -.- before the:expi.r.a.tion date.-:If:fou.nd.return,to;..,-,;, Board of Building Regulations and Standards Registritjo.,0; 100740 One Ashburton Place RM 001 AJ"d1T0 ' 23/2010 Boston;Ma.02108' `element Card; CAPIZZI HOME,. ii�S/, fN' Ill�ti tARY GUSTAFSOty 1645 Newton Rd. k•,. F `;i Cotuit, MA02635 t"_)� Administrator `' ture a `.l �•.+.is t)t).st.it, l)i l)i)F t ivot sI Pub �sti'e N Bo;ird ail Pttilile,) Regulations and Si ticl W&S Cens ructton.Supervisor License 'License: CS 74640 Restricted to: qQ GARY GUSTAFSON 8 SHORT WAY �e SANDWICH, MA 02563 11/29/2010 7755 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' a 600 Washington Street e` Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leizibly Name(Business/Organization/Individual): Address: lW_ f-,_ � City/State/Zip Phone.#: Are you an employer?Check the appropriate box: Type of project(required):. 1 R I am a employer with rn 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. ISIRemodeling ship and have no employees These sub-contractors have g, ❑ Demolition workingfor me in an capacity. employees and have workers' Y P h'• 9. ❑ Building addition [No workers' comp.insurance comp.insurance.$ 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'- ..R. �., 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 einp]oyees: If the sub-contractors have'eiriployees,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: %Nk ICpzzL "C' Policy#or Self-ins. Lic.#:_wa(� cQ_5� Expiration Date: Job Site Address: City/State/Zi 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for i urance covera e verification. I-do-hereby-c-er-tifj�u er-th a' and-penalties-qf-perjur-y-that-the-infor-mation-pr-0uide4-above-is-true-and-cor-rest. Si ature: r/! Date: i. Phone#: Official use only. Do not write in this area,to be completed b city or town official. P Y ty ffcial. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector .6.Other Contact Person: Phone#: �� ;,�.,y.y�,5y,,�j{{; .y-�Sai"• � c - v s � . '{�. rr o �y�. ? .�. �( "�;�,� �� - ,r3"»...� TMv>, TOWN OF BARNSTABLE -. 33714 Permit No.. BUILDING DEPARTMENT TOWN OFFICE BUILDING Cash 7 ML 9 .679• HYANNIS,MASS.02601 Bond CERTIFICATE OF USE AND OCCUPANCY Issued to William Bain - Address Lot 439, 19 Roosevelt. Road Cottuit, Massachusetts USE GROUR'' FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT,.BE VALID, AND THE BUILDING SHALL;'NOT.BE OCCUPIED- UNTIL SIGNED BY THE BUILDING.INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 110.0 OF THE MASSACHUSETTS STATE;' BUILDING CODE. August 2$, 90 Building nspector w+r� n[Jy;WW 1 Y°!i^pi.. . . +ASaTi:1• - .i,... '" A+"F "' ,;,:.:'�Fi '.'..�. ."!sr.::3+'�. .}ix"' ,'. �wy+"bw. .' '�`t'•. '{rat d Yry,#4b%:1,T`^�{;.. °gr�+,-t`.,r.x+:i4., 'f#'�S•� f`�+re..;. w'e§Yi f`^v'f}j Assessor's office(1st Floor): Assessor's map and lot number �� G �. p�THE Tp - - W Board of Hea lth 3rd floor), o Sewage Permit number 5?e5pBLE Ij �� .\ Engineering Department(3rd floor): Z �sassTs 'L q �j�' � rruaI House numbers I Definitive Plan Approved by Planning Board __, , �S l�ir� - 26-19 '990 �otr�r A- c �- APPLICATIONS PROCESSED 8:30-9:30 A.M'and 1,:00-2:00 P.M.only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO t_ L�'7 S4�/G TYPE OF CONSTRUCTION 40 06(Y /-Q 1-74•C e4, x 19 91J TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location G.1 T % 70OS 't/c �(` CU�U• 1, f Proposed Use Zoning District Fire Fire District Name of Owner ��r�" �' r9r`� F Address Name of Builder /'` S�i4s� (^U 5 '' `1 C w Address �� i'/ �" Name of Architect % ' - Address Number of Rooms Foundation �©UnC Exterior y`� re .tit /��v��f �� i`�/Roofings �•,�t j' ��! S Floors � Interior �nrc 0 10,541C r �"' Heating /f^ ' �>' .��'r Plumbing Fireplace Approximate Cost /�a 5 d U Area Diagram of Lot and Building with Dimensions Fee r• 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 BAIN, WILLIAM A=039-141 » No 3 3 714 Permit For One Story Single Family Dwelling Location Lot #39 , 19 Roosevelt Road Cotuit Owner William Bain Type of Construction F r_ame Plot Lot Permit Granted May 2 , 19 9 Q Date of Inspection 19 Date Completed 19 Fa PERMIT COMPLETED 1/1/ qL Assessor's office(1st Floor): SEPTIC SYSTEM MI1ST®E Assessor's map and lot number `1 of TNf to Board of Health(3rd floor): $ INSTALLED IN COMPLIANCE Sewage Permit number WITH TITLE 5 Engineering Department(3rd floor): vet i r AJ ENVIRONMENTAL CODE AND 7 D"RI9;s LL . House number �` TO� t _ � �5 �c„�16yo6��' Definitive Plan Approved by,Planning Board t9 _� APPLICATIONS PROCESSED 8:30-9:30 A. nd 00-2:00 P.M.only ` TOWN OF BAANSTABLE BUILDING - INSPECTOR APPLICATION FOR PERMIT TO TYPE OF CONSTRUCTION 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location L D Proposed Use TCS `cle.1Ce Zoning District Fire District Name of Owner 60,1� .� �� Address/r !/ �� Name of Builder ^6" co"5 '` C Address /y6� � Name of Architect Address Number of Rooms Foundation �D u2c CD�c�c Exterior C -1� C`� !)� dJ,cec1.,< f5- /Roofing ��`jr�/� S .'�•�.4 f Floors �"� ®�/� Interior b/u3 (J.f�L� Heating 6T^�° � �r ( Plumbing ' Fireplace b�t.'`G/C Approximate Cost / ° �� Area Diagram of Lot and Building with Dimensions Fee 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. , �✓ NameLL4 Construction Supervisor's License � �� BAIN, WILLIAM e' No 33714 Permit For One iStor;y Single. F Location Lot #391, ;r1-'9,—RooseveL.t'"1oad ��- Cotuit Owner William Bain Type of Construction Frame f Plot Lot Permit Granted May 2, 19 90 Date of Inspection 19 D C d' 19 �s - N ..e — , Of M ..•I r O Y THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I M ^�C(, I DATA 'TOWN OF BARNSTABLE, MASSACHUSETTS BUILUING A=039-141 DATE 19 90 }PERMIT NO. 33714 APPLICANT MCS11alIC' COI'Str ADDRESS !-'cl.Intouth Road, Cotuit - .#0460x' (NO.) (STREET) (CONTR'S LICENSE) PERMIT TO Build Dwollincl (_-1) STORY OF NUMBER tjDWELA ING UNITS (TYPE OF IMPROVEMENT) NO. USE) tttrt O ) - ---AT.(LOCATION) Lot #39 , 19 ZONING DISTRICT. . (STREET) BETWEEN' (CI?OSs STnI:I`T_)___- AND (CR05.5 5;Rj:li I) SUBDIVISION LOT I Z E BUILDING IS TO BE FT, WIDE BY FT'. 1 ntj(G IiY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTIOT1 TO TYPE USE GROUP BASEMENT WAL LS OR FOUNDATION (TYPE) REMARKS: SC:wage #90-139 Bond AREA OR VOLUME 2684 sq. i'L. PERMIT. :EE 13 4 i I M A I I I Ct):..I 0 0 0 . 00 (CUBIC/SOUARE FEET) OWNER ADDRESS 1050 N. W. 18 th Avu I ai(_,, I I U I L.D I N G DE PT, BY e: o I.HIS p L M rr L)U t s-N o-.[--R *i O'N' OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF THREE CALL INSPECTIONS REQUIRED FOR APPROVED PLANS MUSI DERETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE;" ALL CONSTRUCTION WORK: CARD KEPT POSTED UNTiL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED RED FOR I. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CER I-IFICATif ELECT AL, PLUMBING AND 2 RC ILLAT IONS.' OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS: PRIOR TO COVERING STRUCTURAL QUIRED.SUCH BUILDING SHALL NOT BE OCCUPIED' UNTIL MEMBERS(READY TO LATH). .3. FINAL INSPECTION BEFORE FINAL INSPECTION HAS BEEN MADE. OCCUPANCY. POST THIS CARD SO 1.T IS VISIBLE FROM STREET . BUILDING INSPECTION APPROVALS Pl-UMIIIN(;IN PI :I ION APPI iOVAI': ELECTRICAL INSPECTION APPROVALS 2 2 III AI IN, If 4.I'I I 111 IN Al'I'l ioVN I N(;INI 1.10W.I.ULPAHIN11,1\11 OH MIAMI 01 111 Al 111 yo WORK SHALL NOT PROCEED UNIII IHI INSPI C FER.IT I'LL 13ECO.1' :J'ULL AND VOID IF CONSTRUCTION TOR HAS APPROVED IFIL VAHIOULP;SIA(;P;01 INSPLCTIONS INDICATED ON THIS CARD CAN k WORK IS NO! STARIFI, WI SIX MON iHS OF DATE THE AIMAN(;I:I) FOR RY TELLPHONE o 'iI :ONSIRUCTION. PERMIT ;S ISSUED AS to! FD AIIOVE. NO 1 FICA I If)N 13 WHII H. E . F: lz j_- S 3�46"E r-A'_P RI rri ie 00 Q pti R 8 J OO � � :4:do 8 �� LOT 39 70, 25, 165 S. F. $ g O 30.E 174.41 iV 90,00 l oo IN PLOT PLAN OF .LAND TO THE BEST OF My . THE L OCA TED IN FOUNDATION _sHOwN ON N s ,aS BA PNS TA BL E - MASS. . IT ACTUALLY EXISTS ( H�A�R o CHARLES PREPARED FOR oa rE•APR.zs s990 sANICKiJ 28085 MCSHANE CONS TRUC TIOl1/ CO. � 9FClST E �� OA TE.•APR.24 1990 SCALE: 1'-40 FT. FLOOD ZONE C (NON-HAZAA CAPE 6 ISLANDS SURVEYING D-38 FALMOUTH MASS. ,a ;S WILLIAM A. PRICE, JR. ATTORNEY AT LAW 4 CENTER PLACE 1550 ROUTE 28 CENTERVILLE,MASSACHUSETTS 02632.1809 s TELEPHONE(508)7904221 TELEFAX(508)7904238 March 9, 1990 ,To: Joseph DaLuz Building Inspector Town of Barnstable Town Offices Hyannis, Ma. 02601 STATEMENT Re: Contiguous ownership of 19 Roosevelt Road, Cotuit, Ma. Shown as Lot 39 in Land Court Plan 36608-C (sheet 3 ) at Barnstable Registry of Deeds and also shown on Assessor ' s Map 39 as Parcel 141 (hereafter "Locus" ) PRESENT OWNERS Louise Bain and William Bain DATE ACQUIRED January 5, 1990 DATE RECORDED January 5, 1990 TITLE REFERENCE Certificate of Title No. 119501 PRIOR OWNER(S) James E. Regan, III Trustee of Whaler Realty Trust DATE ACQUIRED September 30, 1986 DATE RECORDED October 2, 1986 TITLE REFERENCE Certificate of Title No. 108212 PRIOR OWNER(S) George H. Hamilton DATE ACQUIRED August 10, 1977 DATE RECORDED August 10, 1977 TITLE REFERENCE Certificate of Title No. 71464 I, William A. Price, Jr. Esquire hereby certify that the above named present or prior owner( s ) of Locus at no time during their ownership contiguously owned other contiguous parcels 140, 142 or 149 as shown on Assessor ' s Map 39 since August 10, 1977 . z PRIOR OWNER(S) _ Atlantic: .Savings Bank DATE ACQUIRED October 14 1977 DATE RECORDED October 21 ,., 1977 TITLE REFERENCE Certificate of Title No. 72174 Document No. 227370 I, William A. Price, Jr. Esquire hereby certify that the above named prior owner(s) were the last owners to contiguously own Locus with other parcels or lots. Respectfully submitted, William A. Price, Jr. , cc: William and Louise Bain John McShane, McShane Construction 7, t......... IIIfIIIIII 5,W IItIiIItIIIIIII ----------I17 IiIIIIIIz 4,Iif...................... II .. .. ....... 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