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HomeMy WebLinkAbout1000 SANTUIT-NEWTOWN ROAD /600 �a-�Zvi�. - 1�,�1�-o�vez r - . -- - i .. ._ ... �7 ���. _ ,� _ r , L �� III TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 02,7 Parcel 0 5'b Application 0 k a OS 3B� Health Division 91-329 A-t u^ly �17 �c�� Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address 1000 5_1A�11_Nl`r_ AEM tJ F_D curytlf A Village roW14 OF Q'W_IJ 5r0 b�- C01-0 If O" 3, Owner ANW.-, M6"6W Address l q 0/11V porn 1.199" i l be Telephone 5*6 8--7 7 9 '5'q 7S_ 07637, Permit Request FoUh OMP 6G 09- , MoDVLAh 9 U5f /,/A5 rIlYl1.46P Od 13T J�a D Z Y. A 0 0 i 8G) OI&A ' A t4t) /TA1 441-R Or�lc16 AiMyAI 6 i s()4A1_1®A/ 8At# %�1,1661_"t1Z t,�5TCP_ CAk66 1, ©Ufi s Square feet: 1st floor: existing p o�osed a 2nd floor: existing proposed �(� Total newt" Zoning District Flood Plain /10 Groundwater Overlay Project Valuation Construction Type /!' Lot Size Grandfathered: ❑Yes KNo .If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure 11 t O Historic House: ❑Yesx No On Old King's Highway: ❑Yes )(No Basement Type: XFull ❑ Crawl ❑Walkout ❑ Other Basement Unfinished Area Basement Finished Area(sq.ft.) (sq.ft) Number of Baths: Full: existing ' new Half: existing new Number of Bedrooms: 2 existing / new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas AOil ❑ Electric ❑ Other Ci tral Air: ❑Yes No Fireplaces: Existing New 0 Existing wood/coal stove: ❑Yes No Det ed garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ n-e* size_ Att ed garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other '. Zoning Board of Appeals Authorization 0 Appeal # Recorded ❑ :" Commercial ❑Yes No If yes, site plan review# > Current Use Aenv I&A ze, Proposed Use 4�AI;0A� `p C5 APPLICANT INF N __50 —77(b (BUILDER OR OMEOW ) Name A Telephone Number 566 Address 1 l ��� YVS1' License # Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE !o—-2— �f III r r f I FOR OFFICIAL USE ONLY APPLICATION# r IRATE ISSUED R MAP/PARCEL NO. q f ADDRESS VILLAGE OWNER t - DATE OF INSPECTION: F " FOUNDATION FRAME INSULATION AbS otc z/L3��1'��k �'EtiT `b,, -s-P.� FIREPLACE q j ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL ` FINAL BUILDING a I f 1 t r f q 1 DATE CLOSED OUT ASSOCIATION PLAN NO. 1 � r TO WTI. of Barn table ; 'ces �2egulatory 5 ervz T mas P. G �I er e' Director �xxsrA�c�, -• ho , ,r 6ss�h�e8 $uilding Division Thomas Perry, CB 0,Building Corn.nzissioner 200 Main Strcet, Hyannis,MA 02601 �.town.barnstable.rna,us Fax: 508-790-6230 -f Offices 508-862--4038 PLAN REVMW Owner- /�aRES�E1i Map/PMcI I. • /�oO �j'A,�f�ur lV�yj,�.ru�uiIder: s�-�11't E • Project Address Cr The fallowing items were noted-on reviewing: ;lN.3K.L� O�t' Sdtt� / L/ OL�S..NOT /IGCT . •N�i2 G C.�.� � �EQ u/i2 L its-C-�✓tS• N . . _ /Nfalt- A w"14o LNG AmF. ce/, ,=te-A/Irs Reviewed by: Date: The Commonwealth of Massachusetts r Department of Industrial Accidents ' Office,of Investigations 600 Washington Street �Vv . Boston, AM 021II �`14"mass.gov/din Workers' Compensation Insurance Affidav it: . Bu;tlders/Contractors/Electricians/Plumbers APplicant Information Please Print Le 'bl Name (Businneess/Organization/lndividuaI): 1'!'e, 11,111 Address: / �v5(' C a �v,,,�.q A4 62Z �2 City/State/Zip: 644V i) A Phone#: 77 19 Are you an employer? Check the appropriate box: 1.❑ I am a employer with 4. ❑ 1 am a general contractor and I Type of project(required): employees(full and/or part-time).* have hired the sub-contractors 6. New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' [No workers' comp, insurance comp,insurance.$ . - 9. Building addition required.] 5.❑ We area corporation and its 10.❑Electrical repairs or additions 3. I am a homeowner doing all work r officers have exercised their i' 1 I. Plu mbing umb' ❑ � airs or additions s myself: [No workers comp. right of exemption per MGL repairs insurance required.]t c. 152, §1(4),and we have no, 12:0 Roofrepairs employees. [No workers' t13.❑ Other ' comp.insurance required.] *Any applicant that chocks 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. tContracton;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. Bcid job site information elow is the policy a Insurance Company Name: -' Policy#or Self-ins,Lic.#: �f 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 insurance coverage verification I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Si store: Dater Phone#: 7 Official use only. Do not write in this area, to be completed by city or town official City or Town: PermitlLicense# 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#: Town of Barnstable " - ' �+f"� Regulatory Services BABNSrAaLE, Thomas F.Geiler,Director MASS. Building Division rf0 MA'I A Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax:. 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: 1660 �vr�—pl/Qt�Tot��l �� CQ t/t' {v+/y 45� �pJ�7_ number street -7 Q t village �j�� "HOMEOWNER": M n,4?— 1 rld t�J�kDtp� d / 78 name 9 o phon # work phone# CURRENT MAILING ADDRESS: / ph S�I 70V efe N04 oa43 Z_ city/town � state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is,or is intended to be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. N&g..tof Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may caret amend and adopt such a form/certification for use in your community. Q:forms:homeexempt THE Town of Barnstable Regulatory Services BLAUMM MAM Thomas F. Geiler,Director E1619- � Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must .Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit. (Address of job) Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled before fence is installed and pools are not to be utilized until all final inspections are performed and accepted. Signature of Owner Signature of Applicant Print Name Print Name Date Q:FORM&O WNERPERMISSIONPOOLS ry; ' 1 V 29 0. MICHELE CUDILO, P.E. Consulting Structural Engine`er� ; Centerville,Massachusetts 02632-1979•(508)771-7601 •Fax(508)771-7163 mcudilo@comcast.net November 4,2011 AND November 29,2011 Anne Moreshead 99 Old Post Rd. Centerville,MA 02632 RE: STRUCTURAL REPORT 1000 Santuit Newtown Road,Marstons Mills,MA Dear Ms.Moreshead, At your prior request,I met with you at the above captioned residential property on November 1,2011,for the purpose of addressing the structural integrity of the residential structure, in particular as related to existing framing. This Structural Report reviews structural items only,which can be visually observed.Further hidden conditions need to be verified or are the responsibility of the original parties involved. It is understood that the existing one-story building,24'w x 36' long,is a modular home,constructed around 1984. A full set of drawings showing steel beam sizes and framing plans was not available. The following items were concluded: 1. A 2°d story conversion of the attic space to habitable space is structurally feasible given the center carrying beam of 4-2x12 spanning 7' o/c. The kitchen header between living room has a small crack at the corner, however if the bearing wall is removed to the driveway side,the replacement beam would extend to replace this header and frame correctly to posts at each end. 2. The first AND 2ND floor joists 2x10 @ 16"o/c are adequate for the 12' span,for any type of habitable space, i.e.2nd floor BR(live load=30 psf)or loft(live load=40 psf). The above information provides you with the minimum requirements for maintenance of the structural integrity of the above captioned residential structure. Consult with a licensed contractor,such as one you may find in The Blue Book of Building and Construction,is recommended to perform the scope of work to reinforce or add to the timber framing. I trust that the contents of this report meet your needs at this time. Should you have any questions on any,of the above,please do not hesitate to call. Sincerely, Mi lel Cu t/o �tH OF ass' /2011-194 / G�%2v"� �� MICMELE �� cs G O CUDILO m. U No.34774 STRUCTURgL �FGrSmRE� s��AL '� i aLA± I Ok't j F ARN1_,i 'b"' �l}l€ it a MICHELE CUDILO, P.E. Consulting Structural Engtne:er ;' Centerville,Massachusetts 02632-1979•(508)771-7601 •Fax(508)771-7163 mcudilo@comcast.net November 4,2011 Anne Moreshead 99 Old Post Rd. Centerville,MA 02632 RE: STRUCTURAL REPORT 1000 Santuit Newtown Road,Marstons Mills,MA Dear Ms.Moreshead, At your prior request,I met with you at the above captioned residential property on November 1,2011,for the purpose of addressing the structural integrity of the residential structure,in particular as related to existing framing. This Structural Report reviews structural items only,which can be visually observed.Further hidden conditions need to be verified or are the responsibility of the original parties involved. It is understood that the existing one-story building,24'w x 36' long,is a modular home,constructed around 1984. A full set of drawings showing steel beam sizes and framing plans was not available. The following items were concluded: 1. A 2°d story conversion of the attic space to habitable space is structurally feasible given the center carrying beam of 4-2x12 spanning 7' o/c. The kitchen header between living room has a small crack at the corner, however if the bearing wall is removed to the driveway side,the replacement beam would extend to replace this header and frame correctly to posts at each end. 2. The first floor joists 2x10 @ 16"o/c are adequate for the 12' span,for any type of habitable space,i.e.2°a floor BR(live load=30 pso or loft(live load=40 pso. The above information provides you with the minimum requirements for maintenance of the structural integrity of the above captioned residential structure. Consult with a licensed contractor, such as one you may find in The Blue Book of Buildiny,and Construction,is recommended to perform the scope of work to reinforce or add to the timber framing. I trust that the contents of this report meet your needs at this time. Should you have any questions on any of the above,please do not hesitate to call. Sincerely, TH OF Michele Cudi ,P.E. �ys�'� ass /2011-194 MICHELE 9°s 0 CIJOILO m� STRUC4 1J4A L I y 'To rt o -gar' table . Regulatory Services -- nu�xsrA�L� Thomas eiler,Director XA-'M . jy sbfg, h.' 13uEding Division Thomas Perry,_CB O,Building Coinm.issioner 200 Main St-64 Hyannis,MA D260 I ' �W.fown.barns�able.rna_us � . Officct Fax: 508-790-6230- 5D8-852-4038 PLAN 7-0 Owner /btooie�l9E/+-D ' Map/Parcel: Project Address /000 S,oN>.r�r.NE+��o«�a/I cv. Builder- The fallowing ztems were noted.on zevzewzng: Ciy6 t ICI SEGP� UC t,c i2 /!lo ore !t- colt/ �� /i•o FF-s g�N�� ,�Pw,�cov� �� �DOl1'iO��L ��fl 4� _ 2SG. �l / Jam ,✓ .OA) GC lei S.Ra lvcc L 8 G �� CEZG ,iJ 5 i(. � ) 2 N�o k�A-7 vaJ i Reviewed by.-. TOWN OF BARNSTABLE Permit No. 4 »n.X Building Inspector cash ---- ------------ 'gw�e�o OCCUPANCY PERMIT Bond Issued tom+ I11C. Address T.�} 1, "900 Wiring Inspector Inspection date Plumbing Inspector ,i ( ��' / Inspection date Gas Inspector Inspection date Engineering Department Inspection date Board of Health Inspection date 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 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. .......................................... lf)_...._._ ...............................................................................__............................... Building Inspector W u FROM TOWN OF BARNSTABLE _ BUILDING DEPARTMENT W. ftancis iahteim367 MAIN STREET HYA dg MA, 02WI Town.Clerk .� s• �+k s asx,�ca� ' Phone: 7 &1120 SUBJECT: -FOLD HERE - .. DATE -- MESSAGE _ - • � , . >�k have •C1+ad > Ft3tabs '26481 26482`{T , Tnc F 3axrt'x Yt.. ss Ars'.t •d+@tcw-5s ik d't'g'a'r3.3'ffis:N:..q .tnh?'s�[-.z• 2�Ai=�'= ',., ;A.S't,+. -ir w+ay.. PZeaserelease Bcnds. IGNED fDATE k REPLY SIGNED Ne7-Rml - - - - - RECIPIENT: RETAIN WHITE COPY,RETORN PINK COPY •, - .PRINTED IN U.S.A. SENDER: SNAP OUT YELLOW COPY ONLY.SEND WHITE AND PINK COPIES WITH CARBON INTACT.' y � � •�< fly), >•,� • l i . i ft�r,'•��. _ - � .�'9 ' � �J` +'.�`o J Sri �` .f� � �f{ �rl�._ 1 1p MF I. �•. �„ c k �„�♦r <.,`. a i � 3, ft. — r 1 •IT J J , Wf V ; , x M , • S p - SKI STiN C� - 1 5 1 1�'�' � S CERTIFY THAT THE FOUNDATION v SHOWN DOES DOSS NOT VIOLATE ANY K � EXISTING:ZQNIA{G RECLDL4T10I+�` _ �� r r r , _ t' THEAIA TOWN'd ' $ R1�'.STA�L€ Uhl UAT l 01E < of _ - •i �, f ���r•� r ALTERY P. v OLDHAM ,A No. 23207.0 NAAl �N SUR��yo 4��.+ �pc w 1 ✓7' �ti!t�t'"yc jf �'' :1�? 5° 'I _.. -' .. - �`• _ ..r i. .. N� ���i- j` � .. -}Y., - .- .. _- � -- _ _ems. r "'hL Assessors map and:lot number ... - I cs THEPT SYSTERA MUST GE ro Sewage Permit number .......... A.....�r .� ................... - ". �.. � J .1 m �� r �+y!�yq ���g r E - i . • .. e 9 n'E ;� BAHB9TAD B i r House number .....?....... ,lG. ::��. ..: ......:;. VIPONIVI :sa.S�t`A; �` �,, m roo MAG L� am : . 1639. TOWN- OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO. ...',... ... ......��:......... .. .` `. �/`�- cc TYPE OF CONSTRUCTION .......4��..... � ..: 11..� .... `� .... ....... ......... .... ... ..: �► ................. •.. ..................19..g TO THE,INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: ►� Location ......... n. •.......... 1�..........Vz",�............................................................. .. .. .. ................. ProposedUse ...%�.f1 ,.Q.r.... `!`�` ............................................................................................................ Zoning District ...�, ............................................ ... .Fire District ............ te..\...............................:................... Name of Owner .. ..wc, t....................:......Address ....�1.h44?!�1. Name of Builder ........��. ..�........................................Address ...................... .....................`.... -Name of Architect .... .. .t.....Address 'Y�1�..•.\.1 �. �a -� t / Number of Rooms ..........4....................................................Foundation ........:�....... �� .. 77 Exterior ...... �C. 411a ��5........................:.............Roofing ....... ......................................... Floors .....V �..................................................Interior ......SJY ............................................. Heating r.� .�W.r......... ....................................Plumbing .........o '�:........V• - '.. - ... 00 .Approximate Cost ......... ...... �.Fireplace .......�!Gy�Q{!1r�'�r.............................................. pp �...... �..................... . ........... Definitive Plan Approved by Planning Board ------------------------------19--------. Area ......./•u•t�....:` .......... pP Y Diagram of Lot and Building with. Dimensions Fee _2-- ter ...... SUBJECT TO APPROVAL.OF BOARD OF HEALTH O�� r OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable reggWing the above construction. . me ...... y ................ ....... ........ Construction Supervisor's License ..d��.. ? ..�........... s a, INC. y -�o Permit for .. q.. tQ ?............... .. ` { SiAd1e„Fam Y...I ej7.jzLLj t Location .Pt..1.......�0M.Ahwtown-Road..... � .........................- .......... .{4' (1- "� r•� '�,"` e^ Owner .. Karaco....IG:...... {= tTYPe of Construction on kxae......... . LA Plot Lot ........... .......... LA "Permit Granted' 23 ,, T9 84 � t I ... .. ... y .. .. Date of Inspection ........... .! .19 Date Completed ? ........................, ..1,9- A Qr x i TOWN OF BARNSTABLE BUILDING INSPECTOR TYPE OF CONSTRUCTION ..... Co TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information. Zoning District .... SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS ` ` | hereby agree to conform to all the Rubs and Regulations of the Town ofBarnstable regarding the above construction. - ` ._~._ .......~........ —......~.~�. .................................. -^` �(�^ Construction Supervisor's License --..�����.i1—_—. | ' � � ' KARACO. INC. ^^=~' 5° , No 26481.... Permit for —PN.. ---- --'�a�,�'.F.a.PoJy. ----. --~---' - Location ...... ' -----����g��-----.----'------.. ' ^ Owner —Inc........................................ ' Type of Construction —.J��am.......................... - _-------------------------. . ^ . ` Plot ............................ Lot ................................. ' ' Permit Granted —.....May...23r.—'----lq 84 Doia of Inspection ------------lg . Dote Completed ............................ ` �~ / ' ` ` . ^ Town of Barnstable *Permit# V� ` Regulatory Services �ees6months ro, issu late rt tarresr 8, ' Thomas F.Geiler,Director xM 9. ` '�fa,,u,�►._ Building Division ` Tom Perry,CBO, Building Commissioner U 200 Main Street,Hyannis,MA 02601 www.town-bamstable.ma.us Office: 508-862-4038 EXPRESS PERMIT APPLICATION - RESIDENTIAL pl�,y :508-790-6230 Not Valid without Red X-Press Imprint Map/parcel Number Property Address Residential Value of Work �--� Minimum fee of$25.00 for work under$6000.00 Owner's Name&'Address �pQ N z4a�Uo Contractor's Nam n �, ��_� 1� �' Telephone Numbe Home Improvement Contractor License#(if applicable 4lb Workman's Compensation Insurance Check one: ❑ I am proprietor PER iT El am thehe HoHomeowner o - - - I have Worker''s Compensation Insurance Jul- Insurance Company Name �( 1 TeVVN OF BARNSTABLE 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 betaken to Ej 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 Rome Improvement Contractors License is required. O -SIGNATURE: '� Q:Forms:buildingpermits/express Revised 123107 i The Commonwealth of Massachusetts_ Department of Industrial Accidents Office ofTnvestigations 600 Washington Street Boston,AMA 02111 www.mass:gov/dia _ Workers' Compensation Insurance. Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information _• Please Print Le ibl Name (Business/Organization/Individual): . Address:� � 'Z City/State/Zip.QE cQ %G� . �a�9 Phone.C�%- �X-qf-�?� Are you an employer?Check the appropriate;box: Type of project(required):: 1O I am a employer with &?) 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 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.❑ 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 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. Insurance Company Name: C Policy#or Self-ins.'Lic.A�lU Dal mQ cs Expirationl)ate:\��\� Job Site Address: �Q N 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 ffisivance coverage verification. Tdo-her-eby-eerti udder-thy and penalties-o'fperjut-y-thet-the-inf-or-oration-pravided-abaue-is-tr-ue-and-carr-ect. Si ature: Date. Phone Official use only. Do not write in this area,to be complete&by city or town official. . s City or Town: Permit/License# , Issuing Authority(circle one): 1.Board of Health 2.Building Department 3 City/Towii,Clerk 4.Electrical Inspector .5 Plumbing Inspector. 6.Other Contact Person: ` " Phone#: Client#:47298 CAPIHOM ACORD- CERTIFICATE OF LIABILITY INSURANCE 0DATE 5/07/5/071M/DD/YYYIf) 09 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 P.O.Box 1601 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. South Dennis, MA 02660-1601 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: National Grange Mutual Insurance Co. Capizzi Home Improvement,Inc. INSURERB: NATIONAL UNION FIRE INS. Capizzi Enterprises,Inc. INSURER c: 1645 Newtown Road Cotuit,MA 02635 ' INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED'TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR:OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. SR ADD' TYPE OF INSURANCE POLICY NUMBER- POLICY EFFECTIVE POLICY EXPIRATION LTR NSR DATE M/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 TOE RENTED n $500 000 PREISESCLAIMS MADE 51 OCCUR MED EXP(Any one person) $10 000 PERSONAL&ADV INJURY_ $1 000 000 GENERAL AGGREGATE $Z 000 OOO GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG s2,000,000 POLICY f X JPE Q LOC A AUTOMOBILE LIABILITY BPO10786 06/08/09 06/08/1 O COMBINED SINGLE LIMIT ANYAUTO (Ea accident) $500,000 ALL OWNED AUTOS - - _ BODILY INJURY $ X SCHEDULED AUTOS - • (Per person) X HIRED AUTOS 4 - BODILY INJURY - $ X NON-OWNED AUTOS - (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY x .. ..:. . ' AUTO ONLY-EA ACCIDENT $ ANY AUTO - OTHER THAN EA ACC $ .. AUTO ONLY: AGG $ A EXCESS/UMBRELLA LIABILITY CUB1076H O6/OSIO9 06/08/1 O EACH OCCURRENCE $5 000 000 X OCCUR CLAIMS MADE+ AGGREGATE $5 000 000 $ HDEDUCTIBLE i $ X RETENTION $10000 $ WC B WORKERS COMPENSATION AND WC006957000 12/25/08 12/25/09 X ORY MIT I IMIT OTH- EMPLOYERS'LIABILITY _ ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? - E.L.DISEASE-EA EMPLOYEEI$1 OOO,OOO If yes,describe under - SPECIAL PROVISIONS below - E.L.DISEASE-POLICYLIMIT $1,000000 OTHER v 1 DESCRIPTION OF OPERATIONS/LOCATIONS/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 i DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10_ DAYS WRITTEN `..ZOO Main Street _ NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Hyannis,MA OZ6O1 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR - - - REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001108)1 of 2 #S43470/M43449 `, KW © ACORD CORPORATION 1988 i • � III • ✓2. -e,. o�/!!Gaaaczc�urtel7a L. 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: Board of Building Regulations and Standards Registrwj b 100740 One Ashburton Place Rm 1301 p�'r3#117n_�=@ 23/2010 Boston,Ma.02108 _— lernent Card i pis.�,. _ CAPIZZI HOME MRRRX/, Nll�� tARY GUSTAFSO4N. 1645 Newton Rd. Cotuit, MA 02635 Administrator lYo vali itho,t nature ,1a.":tcjtusrtts- Dt-p-trtrtri2tl.t Of Public safely — —' — (3trtrci aii'(iaiWill- Re.4, ,l:rtions anii si.=tt,t#arils . .r moons#ruction Supervisor License. License: CS 74640 Re.stricted.to: 00: H t rt s GARY GtUSTAFSON w�a 8 SHORT WAY r t = SANDWICH; MA02563 cam— —f� Expiration: 11/29/2010 t:i�uai;„f,tiocr; Try; 7755 I L • y Page 7 of 7 CAPIZZI HOME UVIPROVEMENT 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: 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: 35'-5" 1It 20l_511 14 82 . � ,Y s . . I - 3 Insulation Detail: 1 8 . Closet _ - W II 4 as 3� F4-TRo6f & Ceiling SMOKE DETE D DTQRS EVIE_ _ .. 51-211 5 2 5 �� BARNSTABLE BUILDING DEPT. ATE 2 -8 LA DTMENT BOTH SIGNIA7 RESAARE REQUIRED FOR P DATE _ ERMITTlN All R& r a 6,_2„ Heat Heat Office Heat e 14'-3" 8, Master Bedroom F - ill--31-5 16 Bath 141-8-11 2 . � 1 Anne Moreshead � `NEW - Finish ExistingSecond Floor �������°�� - u����� ���uII7�n STATE BUILDING CODE REQUIRES THE UPGRADING OF SMOKE DETECTORS FOR THE ENTIRE DWELLING WHEN 1000 Santuit-Newton Road Add: Master Bedroom, Office & Bath ONE-OR MORE SLEEPING AREAS ARE ADDED ORCREATED, Cotu It, MA 02635 NOTE: A SEPARATE PERMIT IS REQUIRED FOR THE INSTALLATION OF SMOKE DETECTORS-THE ELECTRICAL GREEN - NEW CONSTRUCTION PERMIT DOES NOT SATISFY THIS REQUIREMENT. T CARBON MONOXIDE ALARMS MUST BE INSTALLED PER MASSACHUSETTS BUILDING CODE l Insulation Detail R13 Walls R19 Roof & Ceiling 81-211 17'-311 Anne Moreshead NEW - Finished Second Floor Layout 1000 Santuit-.Newton Road Add . Master Bedroom Office & Bath Cotuit, MA 02635 GREEN NEW CONSTRUCTION 111_10511 { 8 , 17 _1. 1 16 r 1 6_1 12 f - 121_61" Living # 1 RoomCO Y COLJ 26' 12 Deck 15' Kitchen Bath Bedroom # 2 11'-10" r o _ 8' O 36' Anne Moreshead First Floor Layout 1000 Santuit-Newton Road �0 Cotuit, MA 02635 r