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1645 SANTUIT-NEWTOWN ROAD
-- �� i i 1615 4-6 Town of Barnstable Building �# t POst "^ 'x ? "+ r .^ ..«ram + ..,�,- .- ". .Y...�*�:«_ _ _ _ This Card So That it�s`Uis�ble From the Street Approved,Plans Must be=Retained on Job and this Card Must be Kept � A ♦ - / i t : Posted,Unti1 Final Inspection Has Been Made �' g ,bsa . , 4 z c Permit �axt° Where a Certificate of Occupancy is Required,such'Buildmg.shall Not,be Occup�e,d until a Final Inspection has been made Permit No. B-20-478 Applicant Name: Robert Rostocka Approvals Date Issued: 02/19/2020' Current Use: Structure . Permit Type: Building-Insulation-Residential Expiration Date: 08/19/2020 Foundation: Location: 1645 SANTUIT-NEWTOWN ROAD,COTUIT Map/Lot 024-041 003 Zoning District: RF Sheathing:' Owner on.Record: CAPIZZI,THOMAS JR TR � Contractor Name ROBERT A R,OSTOCKA Framing: 1. Address:. 1645SANTUIT-NEWTOWN RD Con�tractorLicen'se 113252 2 COTUIT, MA 02635 i Est Project Cost: $6,539.00 Chimney: Description: Insulation&Air Sealing. Permit F e: $85.00 R Insulation: Project Review Req: Fee Paid $85:00 Date, 2/19/2020 Final: Plumbing/Gas Rough Plumbing: a` 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`Jssuance. All work authorized by this permit shall conform to the approved application and the'approved construction documents for which 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 an,"d Lodes. � Final Gas: This permit shall be displayed in a location clearly visible from access street or road-and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. > Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Offici ls=are provided on this`permit. Minimum of Five Call Inspections Required for All Construction Work: "' Service: 1.Foundation or Footing - Rough: 2.Sheathing Inspection l;__.._ �.. . g 3:All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 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. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT 0��~ Final: ALTERNATIVE WEATHERIZATION Date: / Town of Barnstable 200 Main St 1 Hyannis,MA 02601 , U Re:Permit# '� •Village . The insulation weatl�erizabbn�+vork at ! } W►'�/ �ao� � — a�been completed nccoi-cZance with.7$OC1vIR.' _ = Regards;: .:.. 0 Timothy Cabral, 4 President CSL-105454 N 58 DICKINSON STREET ( FALL RIVER,MA 02721 (508)567-4240 I ALTERNATIVEWEATHERIZATIONQGMAILCOM Application number. . `' ate Issued..............�.. ..�..�.`1.... , ... ........... Building Inspectors Initials............. ......% ..... OCT, 19 2018 Mop ...l�.2 TO1�N OF BARNSTA, TOWN OF BARNSTABLE I D EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY hNNFORNiATION Address of Project: 162 _ �U IIT�n- f �Q•II�7,Gf� NUMBERC� ,'i " STREET VILI AGE Owner's Name: f7 f 22a Phone Number � ' �01 - �j�`�/? Email Address: h i cAacod , net Cell Phone Number Project costs irf Check one Residential Commercial OWNER'S AUTHORIZATION . As owner of the above property I hereby authorize j+,#e;-/-I/`jWe to make application for a building permit in accordance with 780 CMR Owner Signature: Date: TYPE OF WORK ❑ Siding ❑ Windows(no header change).#.• Insulation/Weatherization ❑ Doors (no header change)# Commercial Doors require an inspector's--review ❑ Roof(not applying more than 1 layer of shingles) Construction Debris will be going to CONTRACTOR'S INFORMATION Contractor's name l� FfPI'11G,�'1l/P. G(.'�aher'i ZA �; Cr J a Home Improvement Contractors Registration(if applicable)#fi '7�6 fi attach copy) rY) Construction Supervisor's License# (attach copy) Email of Contractor Phone number 6"-6 1-YdL 4#t0. ALL PROPERTIES THAT HA LYE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN. A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATIONNUMBER ............................................................ *For Tents Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Check one: this event,is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent If food is being served at your event please obtain a Health Department approval between the hours require Fire Department approval, .30 m-4:30 m. Commercial events may q P PP of 8:OOam-9.30 am or 3 p p *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date AP LIC 'S SIGNATURE Signature Date—All -3 All permit applications are subject to a building official's approval prior to issuance. i r i = Town of Barnstable 4-t. i BAR. ST11 AIIEE, e° Bu lding Department Services ices - 16-191 ,MASS. 4 Brian Florence,CBO 63 �A� Tab M 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 1, Thomas Capizzi ,as Owner of the subject property 1 hereby authorize ! �/�/� V2s /20'hN— to act C on. my behalf, in all matters relative to work authorized by this building permit application for: 1645 Newtown Road Santuit (Address of Job) Signature of Owner Signature of Ipplicant Print Name Print Nam Date } The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print LeLribly Name (Business/Organization/Individual): ALTERNATIVE WEATHERIZATION, INC. Address: 2 LARK STREET City/State/Zip: FALL RIVER, MA 02721 Phone#:508-567-4240 Are you an employer?Check the appropriate box: Type of project(required): 1.❑✓ I am a employer with 16 employees(full and/or part-time).* 7. ❑New Construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 3.7 I am a homeowner doing all work myself.[No workers'comp.insurance required.]' 9. ❑Demolition 4.F�I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 Q Building addition ensure that all contractors either have workers'compensation insurance or are sole 1 1.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.' 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.�✓ Other INSULATION 152,§1(4),and we have no employees.[No workers'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: LIBERTY MUTUAL INSURANCE Policy#or Self-ins.Lic.#: XWO(`l9)58867158 Expiration Date:6/8/19 Job Site Address:--Ms 4�e"Lee, �. City/State/Zipt,S,Z &I Attach a copy of the workers' i compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by 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 S250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify u d pain a p lti s f perjury that the information provided above is true and correct. Si nature: Date: Phone#:508-567-4240 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#: AC�® DATE(MMIDDIYYYY) �� CERTIFICATE OF LIABILITY INSURANCE oMM/DDs THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CURTM NAME: Anthony F.Cordeiro Insurance Agency A/C,N.Ext: 508-677-0407 FAA/C,No): 508-677-0409 171 Pleasant Street ADDRESS:Fall River,MA 02721 HSouza@Cordeiroinsurance.com Fall INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: Liberty Mutual INSURED INSURER B: Ohio Security Alternative Weatherization INSURERC: Ohio Casualty 2 Lark St - INSURERD: Fall River,MA 02721 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR RIJULSUISKI POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDD/YYYY MM/DDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 CLAIMS-MADE �OCCUR PREMISES Ea occurrence $ 300,000 MED EXP(Any oneperson) S 15,000 A Y Y BKS58867158 06/08/18 06/08/19 PERSONAL&ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER, GENERAL AGGREGATE S 2,000,000 POLICY❑PRO- JECT ❑LOC PRODUCTS-COMP/OPAGG S 2,000,000 OTHER: S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 ANY AUTO BODILY INJURY(Per person) S B OWNED rx SCHEDULE❑ Y BAS58867158 06/08/18 06/08/19 BODILY INJURY(Per accident) S AUTOS ONLY AUTOS X HIRED NON-OWNED PROPERTY DAMAGE S AUTOS ONLY AUTOS ONLY Per accident $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE S 1,000,000 A EXCESS LIAB CLAIMS-MADE Y Y US058867158 06/08/18 06/08/19 AGGREGATE S 1,000,000 DED I I RETENTIONS I I $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT S 500,000 C OFFICER/MEMBER EXCLUDED? NIA XW058867158 06/08/18 06/08/19 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Action Inc and NGRID,USA its direct and indirect parents,subsidiaries and affiliates is added as an Additional Insured for General Liability on a Primary&Noncontributory basis per the terms and conditions of form CG2001 (04113),for Ongoing Operations per the terms and conditions of form CG2010(04/13),for Completed Operations per the terms and conditions of form CG2037(04/13)and Waiver of Subrogation applies per the terms and conditions of form MEGL0241-01 (04-11) Additional Insured for Automobile Liability applies per the terms and conditions of form SCA005(02/16) Excess Liabilitv is a following form. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN NGRID USA - ACCORDANCE WITH THE POLICY PROVISIONS. 40 Sylvan Road Waltham,MA 02451 AUTHORIZED REPRESEN� ©19kp-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD I E 't I Lrl- Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home lmproveme iC htractor Registration Type: Corporation ALTERNATIVE WEATHERIZATION, INC a r Registration: 175E83 2 LARK ST k�""� .. Expiration: 05/28/2019 PALL RIVER,MA 02721SC w Update Address and return card. Mark reason for change, _ . Q..Address...t�i L // //// ... ._. __,.......__................., .._ Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registratlan valid for individual use only � Y. TYPE:CarooraUan before the expiration date. If found return to: A Registration Fzo:iration Office of Consumer Affairs and Business Regulation 175693 05/28/2019 10 Park Plaza-Suite 5170 ALTERNATIVE WEATHERIZATION,1NC. n,MA 02116 TIMOTHY CABRAL 2 LARK ST r " FALL RIVER,MA 02721 Undersecretary Ot V O 3i�ature 'Commonwealth of:Massachusetts..4 W �: Sheet Metal Permit - Map Date: "JUNO 2 Estimated Job Cost:$ ��' Tll f Peit Fee: $ Plans Submitted: YES NO - ' Ied YES NO Business License# 1 Appficant License# Business Informatidn:.. /._ Property Owner/Job,Locatioin.Isfonn lion: Name: lZT `7�Ci A%ti Name: ��•���'2� �I.rh� �,,�1oro � �rq !-- City/Tov1n_ .94 Mr fi A4 Cltyftawa Telephone: J-08-SSG y y l/9 Telephone: y Z g Photo LD.required%Copy of Photo.D. attached: YES ✓ . NO . . S 1 strjcted.license .-2 f•M-2resticted.to dweIngs.3-stories or less acid commercial up-to 10;000 s4 f../2-stories or less ResidentW: 1-2 family Mu*famil7 Condo I Tawnhouses j M.d i Commercial: Of :. Retail Industrial• Edneatianal 1 Fire Dept Approval Instilufional_ Other Square Footage:*under 10,000-sq. f over 10,000�sq.fL Numbei of Stories: Z- / i Sheet metal,�York'to be completed:- New'Wgrk: ✓ Renovation: ' TVA Metal'Watershed Roofing. Kitchen Exhaust,System Metal-'Chimney/Vents .Aii'Balancing • i Provide detailed description of wank to be done: 0, Kew. et,k, "% L yl e w t.c<�U�m� JNSURANCE COVERAGE: 1 have a current rJobiW.Insurance policy or its.eguivaleitwhich meets the requirements of PLG:L.Ch.112 Yes No ❑ 9 you have checked Y-4mAndicate the type-of c6 mr3r,).'.e-by checking the apprppriate box.below: ! A liability. insurance policy Other type of indemnity ❑ Bond ❑ OWNEWS IMSURANC'r=WANEiZ:'!am.aware•that.the licensee cioes.•nof have the insurance coverage required by Chapter 112 of the Massachusetts General laws,and that mysigratture on'this-pennif application: -this requiremerd: Check One Only -Owner ❑ Agent ❑ sgiwlu2 of Owner or Owners Agent ' } By checking tfits.b ,f heratry cerfffy ftsat all of the details and informatEon 1 have submitted(or entered regard�l3 this application an:true.and accurate to the best of.-my knowledge avid that'all sheet iristal work add insialiations.performed undaF the permit issued-forthis..appricatidn will be in compliance with all pertinent provisi'ori'of the Mas:Sachuseds'Ruild]ng Code and Chapter 112 of the'General ' ` riot to insulation iInstallation:YES • y NOS"%"* Dud inspection requBred p Prolrresslmspmgiong I Date Ct=mts RnRl jgEt ectaon . Data Comments . Type cerise: • Master rbe ❑Master-Restricted i 'ltyfrown , ❑Jourheypeisolt' ' 'Signature of Licensee =etmtt# .❑Jourreyperson-Restricted VUcense.N rritw. =ee$ Check-at www_mass.grsvic#al nspector Signature of Permit Approvar d - 60 WmMm�meet ffws too,MA 92 Ix�en�atfma MeasePrkt k -2 Gay/Sta&21 p- �c. '�t mxmo L/�� Are emglo fir?Check t 2p zair btr= Twe of pmiect(regdwec� L Iamae�sloymvia. 4_ ❑1 ama gemenaca taraadf aIoyLes{€af1 have bftvathe�S fi 'O lde If] I am a sole propzietor orpartper listed au the a fled sheet. 7- sh s acid hac�e no cmployees I snh-oontrarfos have S_'Q DemaliEOU. ; waddng frame in any capacsig � andhave vro�is' g Euc g addifiou [No 'C=P-*"seance som}�_su re,T&, 1 S_F-1 We am a c arpotafimandifs If} brill repzi=or addi±iaas 3_❑ I am a home aw=doing all vD& ours have cm sed Emir 1 I�FkMg3ing=Pal=Or WidifiMSI. f[No WDd3!IZ'=- rigaOfeM=P5.oaper7y m I�Q$nafrepaiM x esegniserLli C_IP,§1(4} aml we b.m w tl�tlrrr -ks=anm rmpkmLl tudA -k thisbcx iattilrh;4ata flidm9TAeetshMdngrhe aMe =3sWEzchEthwW=$aammdsmSxm if the mplayees ffik-Y=mjt rj6e*dr F p ammbes lam arE gaap�p�s thatisprrs� tvrrriers'cazupsrrsaiiart irr4�r �'ar ra}<e�rrg�,p Be�air is f3ie ga�tc}*and Fob szla viz,fnrn�atia� Into$� 3dfess yr .34n�"''e : et",106V Bch a copy Gf the ceorkers'coxnpeasati=paNC-awl==tioa page(4wweag ffie':polkT 1€mo¢7=Zma loon ffithe " Failure to-sm=-,--cav=ge as repined m dcr SecEi=25A of 'MM c. M cau lead to.the impassti-ofctimaiai Pmz2i=of a f=up tc�$L500-OD arWar one-yearim m f e fon of s STOP WGRK ORDER—and a fine ofup to$250-00 a day agate fhe;violater- Be advised fma a copy of this stamen maybe 5=wa rdod to the.Offim of IsnrcwE afions cf thy DIA for i=m=M mverW v=E5=d=- IF da hereby aertFfy paints"dpmaMcr afpediay fattthe infomudian pra v Mad aahave is b%a and curmct E},f&ia£us$=r,}. Lta mat tvri&in 69s ar-ca,to bit cauzpfetad by city ar to=v�'�iaL City or Tower: iffL*euse B=dng Authority{drds oncjac L 3==d of Healtli 2.Bidmg I3T-xI taent I Cuter(2crk 4.EI=ft=ai Inspxtcr :.Yb=h erg} tur ConfactFerree- Phi : Information and Idstructions r Musach:nsetis General Laws chapter 152 mquirms all employers to provide workers'compensation for their employees. Pursuantto this she, an employee is defined as"every person in,the service of another under any contract ofhire, express or mhplied, oral or written!' An mipL7yer is defined as`pan individaal,paitamship,association,corporation or other legal entity,or any two or more of tie foregoing engaged in a joint emerprise,and mclndingthe Iegil rCplesentafives of a deceased emplaycr;or the receiver or trustee of an individual,parti3m-h association or other legal entity,employing employees. However the owner of a dwelling house having not more than three aparhneois and who resides therein,or the occupant of the . dwelling house of anofizet who employs persons to do mice,construction or impair work on such dwelling house or on the grounds or building appmtmuaut thereto shall not because of such employment be deemed to bean employer." MGL chapter 152, §25C(6)also states that'every state or Iocal licensing agency shall withhold the issuance or renewal of a license or permitt D operate a business or to constructbutadiizgs in the commonwealth for any applicant who has not produced acceptable evidence of corapliance with the ffisuxanceL coverage required Additionally,MGL chapter 152, §25C(7)states`Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance ofpublic work uatil acc ptable evidence of compliapce with the insinaTce requirements of this chapteshave,been presented to the contracting authority.- App&cants Please fill out the workers'compensation affidavit comcpletely,by checking the boxes that apply to your situation and,if - necessary,supply sub-contractor(s)name(s),addresses)andpbrme ntanber(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships 9J2)withno employees other than the members or partners,are notrega red.to cazry workers' compensation insuiance. If an LLC or LLP does have employees, a policy i requa-ecL Be advised that this affidavit may be submitted to,the Department of Industrial Accidents for conf ation of insurance Coverage. Also be sure to sign and date the affidavit_ The affidavit should be returned to the city or town that the application forthe peUnit or license is being mqu sted,aot the Department of industrial Accidents_ Should you have any questions regarding f e law or if you are required to obtain a workers' compensation policy,please call the Department at the maaber listed below. Self insured companies should enter their self-insurance license number on the,appropriate line. City or Town Officials Please be sure that the;affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regar-ding the applicant Please be sure to fill in.the penmitdicense number which will be used as a reference number. In addition,an applicant that must submit multiple penniyiicense applibations in any given year,need only submit one affidavit indicating current policy Information(ifnecessary)and under"Job Site Address- the applicant should writm"all locations in (city or town)."A copy of the affidavit thathas been officially stamped or marked by the city or town maybe provided to the applicant as proof that.a valid affidavit is on file for fitruepennits or licenses. A new affidavit must be flied out each year_Where,a home owner or amen is obtaining a licrase or permit not related to any business or commercial venture (Lm a dog license or permit tq bum leaves etc.)said person is NOT required to complein this affidavit The Office.of Investigations would like to thank you in advance far your cooperation and should you have any •questions, please do not hmi ate to give-as a call., The Department's address,telephone and faxmmnber: • 'Elie�o��It�x of I�assach : Degaztme�nf of raj AQ0id its Wce af1MvMigatin,!i GM waakabn Sires $awn,MA G2I I I D,-L 4 617 727-4 cxt 4-06 of I- IZavised 4-24-07 Fax#6I7-727-774-q w-mmgovIdia DIME Town of Barnstable Regulatory.Services r t Musa Richard V.Scali,Director Mu s639. 1e� . . Building Division, Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601, www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 4 ' Property Owner Must 1 Complete and Sign This Section If Usin-a A Builder ' I , as Owner of the subject property hereby authorize to act on�� "�'��'�` ;'' my behalf, in all matters relative to work authorized by this building permit application for. (Address of Job) 5 u .**Pool fences and alarms are the,responsibility of the applicant:Pools, are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signs. e of Owner SikatuiZof Applicant 2--L �dyt P j (J I e e Print Name Print Name 77, Date Q:FORMS:OWNERPERMISSIONPOOLS MM MWEALTH i F MASSAOH SETT. SHEET METAL WORF4ERS ISSUES THE FOLLOWIN �CNS�, UNRESTRICTED �+•r,� ^��` �% . DAMES M DIED �f , pI :3OX 666 , .- pI2T R EA.al+lU,&°A/c 44 _ BUZZARDS BAY, I � .. k 0412812019 259060 + 101 ,aco CERTIFICATE OF LIABILITY INSURANCE F °A TE 9/7/°°'2016 9/7/ THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the pollcy(les) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Cheryl hollis C.L. HOLLIS INSURANCE ,air m.PHONE (508)295-9500 FAX (508)295-9898 140 Marion Rd MAIL c No: ADDRESS:cherylleeC�insurehollis.com INSURERS AFFORDING COVERAGE NAIC# Wareham MA 02571 INSURERA:Safet Indemnit INSURED INSURERB:Safety Indemnity JAMES DIEDE DRT HEATING & AIR CONDITIONING DBA INSURERC:Twin City Fire in Co PO BOX 666 INSURERD: INSURER E BUZZARDS BAY MA 02532 INSURERF: COVERAGES CERTIFICATE NUMBER:CL156202364 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUER LTR TYPE OF INSURANCE POLICY NUMBER MMIDDnEFF M0�1 pY EXP LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 11000,000 A CLAIMS-MADE Fx�OCCUR DAMAGE TO RENTED 300,000 PREMISES Ea occurrence) $ BMA0024109 9/12/2016 9/12/2017 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO- ❑LOC JECT PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: EPLI $ 10,000 AUTOMOBILE LIABILITY COMBINE (Ea accid INGLE LIMIT $ 1,000,000 B X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS X AUTOS 6233263 5/4/2016 5/4/2017 BODILY INJURY(Per accident) $ X HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N X STATUTE ER _ ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? yy N/A C (Mandatory In NH) OBWECTK6573 9/13/2016 9/13/2017 E.L.DISEASE-EA EMPLOYEE $ 500,000 If es describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town Of Barnstable THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200 Main St:. ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis, MA 02601 AUTHORIZED REPRESENTATIVE Cheryl Hollis/CHERYL ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025/�otaml Town of Barnstable BUlld111 9 e Post"fhrs�Card �hat°rt"�s�Uis�ble�Frorn;the Str.._eet�A rovetl�>�ians Must beketainerJ ortob and't}��s:Cartl€Mu be Ke't � �; *'A'l'Si''tB78. � ' " � £ .� y,,. �' p x "f: � s, t 3 - p a -• - -- Posted U tiI Finat i,s coon as�Been Made , �� � �. �,,. Permit .. � ;hei�e,a.Cer#ificate of,.Occu an .;ts,R wired �suc .Buflcl,m ,shali�Nox be c";cu r. :rrt�l a;Fnal�ns ect�on as,beenmatle. "�:s'' ... .uKe.o: �.a.:�• p �,�;t �zf. ..�..�.. +':�;�iu�,g;�,.�-:zL'"� . � ,�. w�����u .%�r:�:�tpwa`3 �.,�. .� "os' �;a�sv,-.%rdbb"." _ Permit No. B-17-620 Applicant Name: CAPIZZI HOME IMPROVEMENT,INC. Approvals Date Issued: 03/17/2017 Current Use: Structure Permit Type: ,Building-Alteration INTERIOR Work Only- Expiration Date: 09/17/2017 Foundation: Commercial Map Lot 024041 003 Zoning District: RF Sheathing: Location: 1645 SANTUIT-NEWTOWN ROAD,COTUITFk Cont actor Name: CAPIZZI HOME Framing: 1 "Mu . Owner on Record: CAPIZZi,THOMAS JR'TR 5" IMPROVEMENT;INC. Address:. 1645 SANTUIT-NEWTOWN RD Y ." _f 6 .._ �oriactorLcer se 100740 Chimney: COTUIT,MA 02635 Est Rrofect Cost: $10,000.00 y y Description: REMODEL EXISTING:COMMMON AREA REMODELING OF ICE SPACE �Perrt ee: $191:00 Insulation: MOVE THE KITCHENETTE TO.LEFT SIDE,CREA E LARGE0000NFERENCE Final: AREA FOR BUILDERS REMOVE CLOSETS AT REAR TO A1.L®W FOR Fee Paid: S 191.00 WINDOW TUBE REPLACE NEW SHEETROCKEDWA Cf1LING RE A RA Drate� 3/17/2017 _ r >Plumbing/Gas Project Review Req: REMODEL EXISTING COMMMON AREA REMO LING,Q CE _ Rou h Plumbing: SPACE MOVE THE KITCHENETTE TO LEFT SI®�E fRE 1EILA GER g CONFERENCE AREA FOR BUILDERS REIVIUVV CL©SETS AT REAR "" Final Plumbing: Building Official TO ALLOW FOR WINDOW TUBE REPLACElNEW SHEETROCKED Rough Gas: WALLS CEILING REPAIR ,. Final Gas: This permit shall be deemed abandoned and invalid unless the work a Ahonzedby this permit is commenced within suc mon suance. All work authorized by this permit shall conform to the approved application and the approved construction documents torwhich this permit has bee approved All construction,alterations and changes of use of any building and str' ctu es shall be in,icompliance with the loca vinir by I wS a`nd codes. Electrical This,permit shall be displayed in a location clearly visible from access street or road ands=shall�mamtaine I upenfor public inspection for the entire duration of the work until the completion of the same. Y Services , The Certificate of Occupancy will not be issued until all applicable signatures by the Bui d ngand f ire„Officials are pn" ed on this permit Rough: Minimum of Five Call Inspections Required for All Construction Work: Final: 1.Foundation or Footing 2.Sheathing Inspection Low Voltage Rough: J 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 Low Voltage Final: 5.Priorto Covering Structural Members(Frame Inspection) _ 6.Insulation Health ' 7.Final Inspection before Occupancy Final: i Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shallnot proceed until the Inspector has approved the various stages of construction. Fire Department "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: ' r Ada - �?- 17 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION i Map 02 y Parcel (J 003 Application # B Health Division Date Issued Conservation Division Application F' ob Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address 1 W 31 5,4 -At aitdula� < ���� d Ut l�� 1 11.4vel��v/� Village Owner © � ��� Z Zi �y Address Telephone0J 77 H - Permit Request Ioea✓ gut /A� Ho`UM rN,5 gi�cheNe,1& Te !-fit s I.A ` e req.fe 16,4eye.- cwlmemee_ ,4/t� fay duo11erS AJ-f a) J teeYW 61r f'e d-- �? 'a ye- c/o✓.e r✓ AT re 4'9 �=e � ; Gov ues�toae�.e rv,94 n,eP/a -c-Pe, 0 AIli �- - y Square feet: 1 st floor: existing proposed U 2nd floor: existing proposed Total new a Zoning District Flood Plain A/d Groundwater Overlay d0o,od aUouo�/ZAn�Project Valuation / Construction Type Lot Size. °2- ' !9e Grandfathered: ❑Yes ❑ No If yes, attach se porting documentation. 4 a o�6rl r rr✓y y�E 'To/IAyE' Dwelling Type: Single amily Two Family ❑ Multi-Family(# units) - Age of Existing Structure /9�� Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full Crawl ❑Walkout GdOther 3 Basement Finished Area(sq.ft.) AJd 41'Z Basement Unfinished Area (sq.ft) Number of Baths: Full: existing / new d Half: existing new Number of Bedrooms: © existing d new Total Room Count (not including baths): existing .3 new d First Floor Room Count 3 Heat Type and Fuel: O'Gas ❑ Oil ❑ Electric ❑ Other Central Air: Yes ❑ No Fireplaces: Existing ® Newt' Existing wood/coal stove: ❑Yes 0/No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: RUIL DsN G DEpT Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ MAR 17 2017 Commercial UYes ❑ No If yes, site plan review# TOWN OF BAP C 0LFr8vI/,L1WJ a , NSTA�3�� Current Use sT SAS"� Proposed Use ©/- te. r1e APPLICANT INFORMATION 011 y b,/1w Job (BUILDER OR HOMEOWNER) �0 L�� y y yz K419 Name C 4lr 22r #eqe, l twl �Ode y6,1_ Telephone Number Address 16 Y!� XJ?40-1-oa/G/ Re License# C .S o7 /4 Y 0 l o`f0/�, tlA VZ45S, Home Improvement Contractor# / 0®?�0 Email 6A R I e- CA f/ Uzi aM e. ('p 1, Worker's Compensation # 0- 4 IVA ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 0u/N 01- 13/4AAd1t-X d& 14Npl)�/ SIGNATURE DATE 03107111 FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION - r FRAME INSULATION FIREPLACE F ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING + I i DATE CLOSED OUT ASSOCIATION PLAN NO. ' BUILDER TO CONFIRM ALL CONDITIONS c AND DIMEN51ON5 ON 517E E10 p N v N 3 Note:These plans are for the sole purpose and o I� y' use of Capizzi Home Improvement and are not a a E I be distributed or used for constru�tio other t than by Capizzi Home Improvement. N 1 i N o o EX ry t V 13'-61/4" I STAIR V 3'-4" 1 C 7 EXISTING Q r BATH � PEDESTAL LU SINK' tU PROPOSED ----------- V OFFICE ( EXI5TIN !{Ij EXISTING CLOSETTO BE REMOVED I U) UTILITM s` n RELOCATE DOOR in — 4 in E ` v XISTING E E Z V Z OFFICE � - Ln i I w in ,_n a — ;r u� r T-5 1/2" — — Date: 10-18-16 Revisions: 10-31-16 11-1-16 EXISTING 12-1-16 STORAGE 1-18-11 EXISTING 1-19-1 l 14'-1' OFFICE 2-14-11 1 Final: FIRST FLOOR PLAN scale: 114=1-0 1 I BUILDER TO CONFIRM ALL CONDITION5 c AND DIMEN51ONS ON 51TE s Note:These plans are for the sole purpose and o w' :R of use of Gapizzi Home Improvement and are not a m E n to be distributed or used for construction other £ L r 1 than by Gapizzi Home Improvement.17 &n 1 _ Q. 33 N Y F. 7 EX151-61/4" STAIR o J } EXISTING p li BATH LU PEDESTAL SINK LU LU {j PROPOSED ----------- ' t lL } 1 OFFICE 1 O i CD ry EXISTING CLOSET TO ;;EX15TIN BE REMOVED - N n r 1—---T J 4._y„ UTILITY s` M RELOCATE DOOR in i in ! ._. O 2'.2" ut �i F 7 s EXI5TING W - g Z OFFICE 7� Ln ZX in N r ul it 9'-5 112" V ------------- - - - Date: 10-18-16 Revisions: 10-31-16 11-1-16 EXISTING 12-1-16 STORAGE 1-18-11 EXISTING 1-11-11 14'-1" OFFICE 2-14-11 Final: Final: FIRST FLOOR PLAN scale: 1/4=1-0 m � ., ` i 1 - rt . .............................. �P�� g 6 r � r 1 . The Commonwealth of Massachusetts Department of Industrial Accidents - w Office of Investigations 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): CAPIZZI.HOME IMPROVEMENT INC Address: 1645 NEWTOWN ROAD City/State/Zip: COTUIT , MA 02635, Phone #: 508-428-9518 Are you an employer? Check the appropriate box: Type of project(required): 1. ✓ I am a employer with 40+ 4. 1 am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. /ew construction 2. I am a sole ro rietor or artner- listed on the attachedsheet. 7., emodeling ' proprietor p 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. 1 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, §l(4);and we have no employees. [No workers' 13. Other comp. insurance required.], *Any applicant that checks box 41 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: AMGUARD INSURANCE COMPANY Policy#or Self-ins. Lic.#: R2WC527200 Expiration Date: 12/25/2017 Job Site Address: 16 Y-r ldtW�_auwft Al` 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. Signature: /' Date. S J0/2 60 Phone#: 508-428-9518 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#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership,association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on'such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for theperformance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and,if necessary, supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies (LLC)or Limited Liability Partnerships (LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or.permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax# 617-727-7749 www.mass.gov/dia l ® DATE(MM/DD/YYYY) A�o CERTIFICATE OF LIABILITY INSURANCE 12/30/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsemen s. PRODUCER NAME: T Rogers and Gray Processing ROGERS&GRAY INSURANCE AGENCY INC PHONE . (508)398-7980 A/C No: E-MAIL mail roe ra ADDRESS: 9 rsg yCOm 434 ROUTE 134 INSURERS AFFORDING COVERAGE NAIC d SOUTH DENNIS MA 02660 INSURERA: AMGUARD INSURANCE CO 42390 INSURED INSURERS: CAPIZZI HOME IMPROVEMENT INC INSURERC: INSURER D: 1645 NEWTOWN ROAD INSURER E: COTUIT MA 02635 INSURER F: COVERAGES CERTIFICATE NUMBER: 114654 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR 4TYPEOFINSURANCE ADDLSUBR POLICY NUMBER POLICY EFF Ll MM/DDIYWY LIMITS LTR COMMERCIAL GENERALLIABIL(TY EACH OCCURRENCE $ DAMAGETORENTED CLAIMS-MADE F—IOCCUR PREMISES Ea occurrence $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY❑JEa LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO B ODILY INJURY(Per person) $ ALL OWNED SCHEDULED N/A BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident UMBRELLA LIAR HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X I STATUTE ERH AND EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $ 1,000,000 A OFFICERIMEMBEREXCLUDED? WA NIA MIA R2WC775326 12/25/2016 12/25/2017 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under - DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ 1,000,000 N/A DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached it more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this Certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/Iwd/workers-wmpensabon/iinvestigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town Of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street AUTHORIZED REPRESENTATIVE 1 p Hyannis MA 02601 Daniel M.Cr y,CPCU,vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD Construction Supervisor Restricted to: Massachusetts Department of Public Safety Unrestricted-Buildings of any use group which contain ® Board of Building Regulations and Standards less than 35,000 cubic feet(991 cubic meters)of enclosed space. License: CS-074640 c Construction Supervisor r.. GARY GUSTAFSON 8 SHORT WAY SANDWICH MA 02563 ,-*i R Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. �q ; DPS Licensing information visit:WWW.MASS.GOV/DPS Expiration: � _ _------- - -- ,Commissio er 11/29/201E 11 - i `.!pr• 1 riivar•trrrrrt///r r�C'`lltiiJnr/rtisr'/lJ r ,f -' ffice of Consumer Affairs &Business Regalatiou a .� t' =� OAIIE IMPROVEMENT CONTRACTOR j 1 Registration: 100740 Type: Lcense oe regi9tra8ion valid for individul use only Expiration: 612312018 Supplement Card Before the eupiradon date. If found return to: office of Consumer emirs and Busigem Regulation: HOME IMPROVEMENT,INC. s 10 IDgrk j%=-Svelte 5170 Boston,MA OhI6 GARY GUSTAFSON r 1645 Newton Rd. Cotuft,MA 02635 Undersecretary _ x X'�� IleProt v ZY 'tllGot Signature `+ i STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION FOR A BUILDING PERMIT f I I, Thomas Capizzi Jr,Santuit Realty Trust own the property at 1645 Newtown Road in Cotuit, MASSACHUSETTS I have authorized Capizzi Home Improvement inc and Gary Gustafson act as my agent to apply and obtain a building permit in accordance with 780 CMR the Massachusetts State Building Code. SIGNATURE OF OWNER OWNER'S ADDRESS 1645 Newtown Road, Cotuit, MA OWNER'S TELEPHONE 508-428-4613 APPLICANT'S ADDRESS 242 MEADOW STREET, CARVER, MA 02330 APPLICANT'S PHONE: 774-454-6278 Cotup:t Iias;e/Resctic Department 4` FIRE DEPARTMENTS OF THE TOWN.OF BARNSTABLE Fire Prevention Office --'Hinckley Building 200 Main Street, Hyannis, MA 02601 " (508) 862-4097 BUILDING CODE�COMPLIANCE FORM ` Plans dated 17 for the property locatedat c` ��i��1 ave been reviewed'bye, n also known as C +-i `� - , ' of the ❑. Barnstable ❑ COMM Cotuit ❑ Hyannis ❑ West Barnstable. Fire Department. THE CHART.BELOW INDICATES THE STATUS OF THE REVIEW: ` TYPE OF CONSTRUCTION,DOCUM ENT N/A RECEIVED= REVIEWED COMPLIES 1. Narrative Report 2. Firefighting & Rescue Access 3. Hydrant Location &Water Supply 4. Sprinkler Systems - 5. Sprinkler Control Equipment ` 6. Standpipe Systems ` �p 7. Standpipe Valve Locations - 8. Fire Department Connection S0 9. Fire Protective Signaling System 10. F.P.S.S. & Annunciator Location ` 11. Smoke Control/Exhaust _ �p 12. Smoke Control Equipment Location 13. Life Safety System Features . 14. Fire Extinguishing SystemS° o/ 15, F.E.S. Control Equipment'L::ocation 16. Fire Protection Rooms ° 17. Fire Protection Equipment Signage r 18. Alarm Transmission Method j 19. Sequence of Operation Report 20. Acceptance Testing Criteria We believe this documerit to be complete and compliant for the issuance,of a building permit. We have completed the acceptance testing for the occu i ncy permit and believe that within.the scope ` of the building permit, the above issues ar in c mplian e. I ILIE Massachusetts Department of Environmental Protection eDEP Transaction Copy Here is the file you requested for your records. To retain a copy of this file you must save and/or print. Username: CAP1645 Transaction ID: 909234 Document: A4 06-Construction/Demolition Notification Size of File: 227.42K Status of Transaction: In Process Date and Time Created: 3/8/2017:7:50:50 PM Note: This file only includes forms that were part of your transaction as of the date and time indicated above. If you need a more current copy of your transaction, return to eDEP and select to "Download a Copy" from the Current Submittals page. -ROM:Cotuk Fire Dept T0:15087906230 03/13/2017 09:50:01 #002 P.001/001 6 (3G Cotuit Fh-e/Rescue Department FIRE DEPARTMENTS OF THE TOWN OF BARNSTABLE Fire Prevention Office - Hinckley Building 200 Main Street, Hyannis, MA 02601 (509) 862-4097 BUILDING CODE COMPLIANCE FORM f J Plans dated S'O? ' t7 for the property located at _ also known as C- '"'`� ave been reviewed by 3 - 1 td of the L7 Barnstable ❑ COMM Cotuit 0 Hyannis ❑ West Barnstable Fire Deparent. Un THE CHART BELOW INDICATES THE STATUS OF THE REVIEW: } �-- TYPE OF CONSTRUCTION DOCUMENT N/A RECEIVED REVIEWED _ COMPLIES 1. Narrative Report 2. Firefighting & Rescue Access 3. Hydrant Location &Water Supply 4. Sprinkler Systems 5. Sprinkler Control Equipment ---� 6. Standpipe Systems -- 7. Standpipe Valve Locations -- I 8. Fire Department Connection i 9. Fire Protective Signaling System --- 10. F.P.S.S. &Annunciator Location F11. Smoke ControllExhaust `P - 12. Smoke Control Equipment Location 13. Life Safety System Features J 14. Fire Extinguishing Systems ✓ --__ 15. F.E.S. Control Equipment Location - - 16. Fire Protection Rooms 17. Fire Protection Equipment Signage - 18. Alarm Transmission Method -- 19. Sequence of Operation Report -- 20. Acceptance Testing Criteria We believe this document to be complete and compliant for the issuance of a building permit. We have completed the acceptance testing for the occu pricy permit and,believe that within the scope of the building permit, the above issues ar in c mplian e. r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map_ -- Parcel �� �� // Permit# Health Division aCOO —1 ) e Date Issued rsV Conservation Division 1.J --Z� B Application FeeV •0 Tax Collector Permit FeeS0•o0 Treasurer ISEPTIC SYSTEM MUSS'BE Planning Dept. *4ST LUD IN COMPUANCE Date Definitive Plan Approved by Planning Board `'111 .E 5 cNS11R O%mN1E14TAL CODE AND Historic-OKH Preservation/Hyannis 101.FM REGULIArTION3 Project Street Address �TJ [.ctJT2)(�tJ�7 Village 6 a Owner 6X14 0 � t 2-24 Address z Telephone _a r. Permit Request z v Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Job 1J Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool: ❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ , Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name 0Telephone Number lla Address L.N �_ License# 06 os70 3a CO"fLU rYl } Home Improvement Contractor# __ w07 yv Worker's Compensation# ('# )�. Y&d 9(.,3 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE;• DATE L 1.,/USG FOR OFFICIAL USE ONLY j PERMIT NO. r' DATE ISSUED R MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION:. FOUNDATION t FRAME INSULATION , FIREPLACE r ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH, ZJ >_ FINAL , < FINAL BUILDING DATE.CLOSED OUT ASSOCIATION PLAN NO. ' f 03i19/U:1 VVk:1) uy: ly FAX 6036279559 RARVEY INUUS'TRIES 11YA.NNIS W14SE 11vUU1 mom ✓-�'`-00�.� HAI�l//�"Y lNC3�.1►.�7'"1�/E� -�., ENEnciy S IAR r+AgTN�:FtI � AV, IG09DOt� _ � 1 TEST RESULTS Harvey Manufactured Windows and-Doors U-Values in acr:c)rdahc:e with NFRC-1 t)0 • Fl 3ed on residential sizes • U- and R-Values are subject to change without notice •Whole windom, values • Air infiltration results are subject to change without notice All vinyl windows with Low-ElAryr ll qualify far the FNFnOY STAR"program throughout the U.S.- Rvdeed 01/03 Clear Insulated Low-+. ' Lvw-F./A.rgvn* ,Ilr U-VAhte !t-VAph U-V�Ine )R-Value t)-ve,4m It-Y�Ino f Mill lal;fill Y1111!I.�OL!MUQ}6L� rCndlt: Classio Double Flung (Mechanical) 0.50 2.00 0.37 2.70 0.34 2.94 0r Classic Double Hung (Welded Sash) O.GU 2.r)O 0-30 2.7A 0.3a 3.03 .04 Classic Double Hung(Welded Sash & rame) 0.49 2-04 0.36 2.78 0.33 3.03 .10 Classic Acoustical Double Hung STC40 0.:23 4.:;5 o.18 s.56 u.17 5.8A .09 Signature Double Hung (Mechanical) 0.50 2__0l0 0.37 2.70 0-34. . 2.94 U4' r ignature 1]ouble Flung (vVelded ,�'aash)f 0.50 2.00 0.37-2.70 o-,f• 2.94 .11-" )Slimline Ouuble Hung (Welded Sash) 0.5-1 1,96 0.36 2.63 0.34 2.94 .08 Slimline Double Hung(Welded Gast! R rame) O_5U 2-00 0.38 2.63 0.35 2.86 '09 Slimline Single !-lung (Welded Sash & rame) 0.50 2.00 0.38 2.63 0.35 2.86 .08 Vinyl CaseTrenl/Awning 0_17 2.13 0-34 2.94 0.31 3.2.3 .01 Vinyl Casement/Awning and TherrTmi Panel 0.31 3.23 0.25 4.00 0.24 4,17 .01 Vinyl Desiriner Shapes 0.49 2.01 0.34 2.94 0.30 3.33 - Vinylllopper U-4-1 2-13 0.35 2.86 0.32 3.13 .08 Vinyl Picture Window 0.46 2.17 0.31 3.23 0.28 ., 3.57 .01 Vinyl Welded Dendlile 0.50 2.00 0.34 2.94 0.31 3.23 -- Vinyl Roller- 2 Lite and 3 Lite 0.50 Z.00 0.36 2-78 0.33 3.03 U9 (2-tile) p'lesl resullc,are bamdo on cummmmial sums Temp.Clefrr 'Hemp Low-Cr Temp.Argon :fir U.VM141n R-'value U.VAIue R-VON'! U-Value R-VAIu! Irlliltraliv:l rfnt/Ct= e►��o�u�l3 I Harvey Solid Vinyl Patio Door 0.49 2.04 0.40 2.50 0.37 2.70 U9 Air inflitratlun is in accrtidarice with ASTM E283(u)25 mph. "I he use of lerrlpered Low-E ginss may effect ENr-Rcr S►rdk*quallflcatiun in your region. U- and R-Valuea are subject to change witltuut 11rh . The Common wealth of Massachusetts _ 6 Department of Industrial Accidents office o//nrestlgal/oos 600 Washington Street Boston, Mass. 02111 Workers' Compensation Insurance Affidavit a tlame Ilea IV1ca,�3 CG�J� Z�� �.J (� location city phone# _ ❑ I am a homeowner performing all work myself. ❑ I am a sole proprietor and have no one working in any capacity ❑ I am an employer providing workers' compensation for my employees working on this job. Z A 44 4- � � ��►► phone insurance co ��'~/� 1��.Sit.l tfi(t/�CO� Z "/'ot at policy# .. IY61 0 Y�2 ❑ I am a sole proprietor,general contractor, or homeowner(circle one) and have hired the contractors listed below who ha.: the following workers'compensation polices: company name* address•. city:: phone il• insur tuctco policy#. company.name: city: phone#• irtsarantx co: policy# So Failure to secure coverage as required under Section 25A of IIIGL 152 can lead to the imposition of criminal penalties of a fine up to S1.500.00 and/o, one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. 1 understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature Date Print name :,t t Phone# T official use only do not write in this area to be completed by city or town official city or town: permit/license N flBuilding Department. h. OLiccnsing Board �check if immediate response is required C]Sdectmen's Office pHealth Department contact person: phone N; C101her � Z (rc isM 1195 P1A) - r �L\ ✓�o '�o�nartosr�ue�U o�./f?'.aaanc�eueelta. hoard of IluHJing Ilegulatlons and Standards I; HOME IMPROVEMENT CONTRACTOR Registration: 100740 Expiration: 6/23/2004 Type: Private Corporation CAPIZZI HOME IMPROVEMENT, 916'omas Capizzi,jr. 1645 Newton Rd. �� -4-'Sfr� Coluil,14A102635 Administrator ✓lab 6IlYI7l09t1!/P.QI[iL BOARD OF BUILDING REGULATIONS License: CIDNSTRUCTION SUPERVISOR Number.Ct 057032 Explres.09126M05 Tr.no: 7471.0 r Restrict0di 00 THOMAS X CAPIZZI JR i 1645 NEWTOWN RD. 1 I COTUIT, MA 02635 Administrator y k 20239 Pg 326 #62747 BLDG 1 28 �qE DRt�WpY BLDG 2 Q 0 0 Ld ASSESSORS MAP 24, ASSESSORS MAP Z4, Z PARCEL 41-2 Q PARCEL 41-3 BARN EXHIBIT SHOWING DRIVEWAY � tw LOCATION FOR EASEMENT R0 1ROMBARNSTABLE, MA. SYKES PREPARED FOR MIS THOMAS CAPIZZI R, EASTBOUND LAND SURVEYING, INC. P.O. BOX 442, FORESTDALE, MA 7EL. : 508 477-4511 PROJECT E00403 DWG: MASTER.DWG BARNSTABLE REGISTRY OF DEEDS TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map �Parcel ®L � 7 ' 093 � Permit# Health'�Division =i`I / 3�Zrr�-c? Date Issued /a `� Conservation Division Fee Tax Collector ��J�- C l��l ZDI� PTIC SYSTEM 6�U 'T'� Treasurer �,�-c.ec�' I Planning Dept. INSTALLED IN COMPLIANCE WITH TITLE 5 Date Definitive Plan Approved by Planning Board ENVIRONMENTAL CODE AND TOWN REGULATIONS Historic-OKH Preservation/Hyannis ° Project Street Address 110 45 0T-b[�111 YZh Village Owner lMil` C--6,Z-2I , I2. Address qo 143!!fT_a of 7 i0end M iM Telephoned Permit Request I Ni Jr 4f,i( t l y e m y roar eg=t�) r Ct�6-9. Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Valuation Zoning District Flood Plain Groundwater Overlay Construction Type JA @ fif=.. l6 0� all� Lot Size Grandfathered: D Yes �o If y , a ac suppor ing ocumentation. Dwelling Type:, Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes Q<oo On Old King's Highway: ❑Yes U Pdt Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other /lam Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage:❑existing ❑new size Pool: ❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial O'Yes ❑ No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name I Z _ l "25 Telephone Number Address .164s License# CS Q'7�--7 AA A.. 3S Home Improvement Contractor# Worker's Compensation# {� qw is- ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO a iZ SIGNATURE .f Atd,44 /T DATE 16 FOR OFFICIAL USE ONLY MIT NO. DATE ISSUED MAP/PARCEL NO. �gg ADDRESS VILLAGE. OWNER i DATE OF INSPECTION ••- W FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH s FINAL 7 + FINAL BUILDINGin s• has ¢ r 'I .. - DATE CLOSED OUT }lL��= j ASSOCIATION PLAN NO.' — ZI j f LAW OFFICES OF JOHN R. ALGER, PGW� [)" lIALE ATTORNEY AT LAW S PARKER ROAD P. O. BOX 449 2305 DEC 28 AM 1 E. 58 OSTERVILLE, MA 02655-044S TELEPHONE(SO8)428-85S-4 t"flilpe�. - (SOS)420-3162 December 27, 2005 Mr. Thomas Perry Building Commissioner Town of Barnstable Building Division 200 Main Street Hyannis, MA 02601 Dear Mr. Perry: I am appealing to the Board of Appeals in an attempt to get permission to build a residence (log cabin) on the land of Thomas Capizzi shown as Lot 1 and Parcel A on his plan and as Parcel 041-001 on Assessors Map 24. I have filed in three parts; first, to overrule your ruling; second, for a special permit; and third, for a variance. I find that on November 101h you wrote me and pointed out my error as to the definition of the original business district, but never stated in a letter that I can find that you would not issue a permit because it was part of the business lot at the corner of Santuit Road. Would you please issue such a letter so that I may qualify before the Board of Appeals. V ry tru y yours, i JRA/gek DC2 The Town of Barnstable /� Permit#05 714 Massachusetts ,niuverAat� ; Date �e 9: SOLID FUEL STOVE PERMIT Fee This constitutes an official stove permit after inspection and approval by the building inspector. Owner Tel7 ephone . ,Address of Property ,/G�/—S— y✓ Village ocation and Stove.Type /J ;F:7 o- 7-- .13",4j d� Date: 11—/4-1_97 Building Inspector The solid fuel burning stove at the above location passed: failed: inspection. po,2q- ogl .z)vi 43 #44me 95 ON RM `, MMIR,,MM n rw -s�+�. PP #4527 _ ��✓ � 24035 ;e.w ,, `:; .... ��02'40Y41'003 �".. i �'+-n 0240$lF - p E�r 024036Mftpk � � l `Nqpm L 024082 i a� v W 0#4D37 �1 024047x002 62 �� vi v 2 506i 02404�1001� � r 024083 !PIP Q t 4591"n"` `�� F� LU "PiO ml 4,1'S7 r I— i x� x r 024400, Assessor's offioe (1st floor):- ` - _ - /� �. •�/�I C�TH E t0 iAssessor's 'map"and lot number: ..... ..... ....... ..:............. Q� �♦ • , Board of Health `(3rd floor): Sewage Permit. number ......'............. ... ° . E easa9Tsncs, S Engineering:Department (3rd floor)': ;` Mb3o , House number ........:.................. ... by ale O YP APPLICATIONS PROCESSEDf;8:30-9:30 :A.M."and' 1:00-2:00-' P.M. only , TOWN OF '" B�ARNSTABLE ' BUILDING INSPECTOR APPLICATION FOR PERMIT TO ..:.............. .. ....,..1.".: .:........��.. ..... . ................... r� C�U.0 TYPE OFF CONSTRUCTION .:...•,....,.................:......,. ..............................:........................... .................................:.. ' 1 rj tir r - rS7` ............:19......._ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a. permit410.......................CU............rding to the following information:• 4 Y. ..4W.. .. . `M ...../. ..t....41. ..: . ........:......................... Location .....�.4�4..... . Proposed Use Zoning District ...:... ' •:�..................................................Fire Distract rr Name of Owner . .....o...: �S .:.1. Zh...`�.�f.:.Address ..... a Cam............................. Name of Builder ............... G„bh-�...................:............Address ......v.. .................N ...... X4_ Name of Architect . ............Address ...../....��.r. ..................... ................ ........ ... ...................... Number of ,Rooms ..................................................................Foundation ... .......CClY�a; 2 Exterior ...... `U....................r....Roofing ('v� :.........................•... ..... .... :!- + � e.f Floors` ................k..!'..................................................................Interior Heating ...:... - •................Plumbing ........ ......................................................... Fireplace ..............:.Approximate`Cost ....Zo ..........._......... .. ------ ---------19-------". Area �— Definitive Plan Approved`by Planning Board _______________ ��..- ..............-..•....••. Diagram of Lot and Building. With Dimensions Fee ��:...... +..... ......... ............... SUBJECT TO APPROVALI.OF BOARD OF HEALTH s • I ,,` w OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to; conform to oll.the Rules and Regulations of the Town of Barnsta e r rding he above construction. Name ............. • Construction Supervisor's License . 6 6{� CAPIZZI, THOMAS SR. No 30456. ,Per'mit for ..••INSTALL NEW ROOF, ,On Barn............................................. Location ., 16.45 Newtown Road f� r Cotuit �. ..........' ..... ................................... ............. r , _w`Y {` .• t 1 •, ; / • • ry • " «. Owner Thomas Capizzi Sr. ......................... e ." Type of Construction , ...Frame:...... ......... K Plot"..............3.......... + Lot ................:.......... Yf.. , . ., • :` , _ '� s t......February 25 ;7'Permit Granted �. Date of Inspection" .....................................}q �y w Date Completed ,,7......... 19�.... t S/-Vky6 r Assessor's map and lot number,.. . .. ...�1':. .... GS c Ole - 7 A ' Z/- 7 F — �5 "sr� �c-ems Sewage Permit number ..................................:....................... y�F7NETp�y TOWN OF BARNSTABLE i r i EARNSTABLE, i "6 BUILDING IN;SP�ECTOR YpY Q a APPLICATION FOR PERMIT TO ............. .................................... . M�. .......................................................................................................................:.. TYPE OF'CONSTRUCTION ........... ................................................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .��.5/....J.l.!° t?!�?h.... c......... ��s- � .�. ............................................................. ProposedUse ..... !. .I; ................................................................................................................................................ Zoning District ........l ..lA,.. -............................................Fire District .... ..C?.f u..Ll............................................... Name of Owner .. .i7.!'?f t1,k..5�...... ..li.10.1.z Z.. ..........Address �.��:�.....1.Y.t°.�Qr°.�..`�.�........C '..�s.c.►. . ......... Nameof Builder ....................................................................Address .................................................................................... Nameof Architect ......../..........................................................Address .............................................: ...................................... Number of Rooms .. ....1.........................................................Foundation Q AOV5 ............................................................ Exterior .054.1......................................................................Roofing .................................................................................... Floors ......................................................................................Interior .........�........................................................................... Heating ..4o.qt.......................................................:..........Plumbing ....P.R� .............................................................. Fireplace ..!...'. ?................................. .....Approximate Cost .2.Sd c,.>..ev Definitive Plan Approved by Planning Board -----------_-------------------19_______. Area 4................ Diagram of Lot and Building with Dimensions Fee T.!....�". ................... SUBJECT TO APPROVAL OF BOARD OF HEALTH 70 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. C Name ................. I" 7 ' Capimzi,' IhOnzas . . ' No��l-§_-. Penn� for building ��� - -.---. ' � . . . .....................�-_'--'�~------.-'---, ' ~ ~ Location --..I�45.. -I���d---.. - � -'_---� _-.- . -.------ �-----------.. . . . C�o� ^ ' ' Owner ---.-����!��-�=�.=����---_-' ' � Type of Construction ----.1���Pl�.----- ^ . - _~-.-.~--....-----.----------... _ . Plot ............................ Lot .......................... ^ . . ' - . Permit Granted ----JL�x�i][''�2]L--l9 78 - ' . . � -Date of Inspection ------------lg 'Date Completed ---.---.. - ' - PERMIT ROUSED ..--.-_-.--...........-.-..... lV . ' ~-'-----,~------^--^-^^'----'- -.~~......,^...,........--.---.---..- ` ^~^--'-^''-~-'_--''--^--^'^^^^^'`^'--' ----^---^-^-^^`~-^^^-^^.-.^'---^, � ~ �r~`^~ ----------'--'''r-' lA . ' -------'-^--^------^-^^'-----' , . | . '----------^-------~'.'-'^^'-~'- ' > . . � , Assessor's offioe (1st floor): T E Assessor's map and lot number to 0 Board o'f Health (3rd floor): 0,2-3- 1 Sewage Permit .number .......... �.,D.............. 333A�RNSTL"B Z. Engineering Department (3rd floor): MA Ii d 1639- Houser,number ..............................1r..zr-...................9.. APPLICATIONS PROCESSED 8:30-9:30 A.R.-and 1:00-2:00 P,M. only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO .............................................................................................. TYPE OF CONSTRUCTION ... ....................................... ............................. .......................................... ....... .................19. TO THE INSPECTOR OF BUILDINGS' —r-®rrr r-0- C�, Maccordin(� The undersigned hereby applies fo, p rrr g g to the following information: Location .....................................................I..................... .. ......................................................................... Proposed Use ........ \r-S Q- a,C?N ....... .......... 4 ............ ...................... ........................................ tLx�-� ZoningDistrict .......RE......................................................Fire District ..........0......O.............................................................. Name of Owner ..............Address ,9(j..!l!.!4p:T .TkA?744... ak!l N./ Name of Builder ...T.O.�........capj' ...........Address .................................................................................... Ai Nameof Architect .............. .....................................Address .................................................................................... Number of Rooms .......................................... .......................Foundation .......... ........................................ P Exlerior ji�o.. .. ........ 15-w ^ ............................................. ..............................................:.............Roofing ............ .... ... .......... .. ..........Floor .... . ..... C. .................................I ..................................... .............±(A-y 4 s .. nterior ......... Heating ............... ...................... Plumbing ... ........ j ........................ .................I....... %r Fireplace .............. ....................!.......................Approximate Cost ................ (i o0o• ............................ Definitive Plan Approved by Planning Board --------------------------------19-------- - Area ......... Diagram of Lot and Building with Dimensions Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED�.FOR NEW DWELLINGS I hereby agree to conform-to, dll t*'Rules and Regulations of the Town of Barnstable rega-rding th)e above construction. Name ....... ................ ......�...T& ...C 7 24 0,)V�s�"*Construction Supervisor's License ...... CAPIZZI, TOM, A=024-041-002 32295 p ....Build Horse Barn ...t No ................. Permit for .... ........ ............... Accessory to Dwelling ........................................... ........... 7' Location ...,41-,-7-5--F-a-lmo-u-t-h-R-oa-d z......... ....................................... cotuit ........................................................................ Owner ..... q.aRiz.z.i................................. Type of Construction ..Frame............................. .. ... .. ............................................................................... Plot ............................ Lot ................................ Permit Granted ....S.e.pt.emb.e.r...23,..lg 88 .. .. .... ....... .. .. ....... Date of Inspection ....................................19 Date Completed ......................................19 ' 4 'PERMIT COMPLETED VIAL L Assessor's offioe Ust floor): 2 , /� D L// oSTHETO Assessor's map and lot number ..............`.f... ................... /' Board of Health (3rd floor): Sewage Permit number ............................ AGIL i BAHdsTSDLE, S Engineering Department (3rd floor): '°o Mb 9• \e� Housenumber ........................................................................ �Fo war ,. 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 C . ...... ... .... .... TYPE OF CONSTRUCTION oa j.......... 19 O0 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location / �`� /V W 0W-K �U��lt 1' i/' `� , o.�:v..`?.` .................................. ... .........................e.................................................. ............. .I..................... ProposedUse ............................................. ............................................................................................................................... Zoning District ........ . . .....f ......................Fire District .................................. . . . r e Name of Owner .........fir..�:5.........� 1. Z1.... r�...Address .................................................................................... Name of Builder (.................................................Address r J G''aa� e ...... ,2............................................................ Name of Architect �r.............................Address ..... `V/ ........... .. . . ................................................ � d14 Number of Rooms ........................�...................................Foundation .... .......��:`.'..........!:...........�............................... I CXX 4 jj k-/7L Exterior ..... U.9. ................. ..... .. ............................Roofing .............. �. Floors /- ...Ae Interior ..... �.. i, f Heating I' ... ... ........................................Plumbing .............�ll r .....1 ,,............................................................ Fireplace ..................................................................................Approximate Cost ............ ..............:.......................... Definitive Plan Approved by Planning Board ________________________________19-------- . Area �—.. ....................... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH ju� e W t OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regordin the above construction. Name ...... �::i.................................................................. Cja a 7G/ �S Construction Supervisor's License .................................... CAPIZZI, THOMAS SR. A=024-041 { L/ ✓ -` - qi No 30456 Permit for ....INSTALL NEW ROOF .....IN.STARL... On Barn ................ . `. ............................. Location ....IA4.5..Newtown Road ................................................ Cotuit ............................................................................... Owner ....... homas...Capiz z i, Sr............. Type of Construction .....Frame........................ ............................................................................... Plot ............................ Lot ................................ Permit Granted February 25 , 87 .......................................19 Date of Inspection ....................................19 Date Completed ......................................19 ,,s The Town of Barnstable 9 A& �'� Department of Health Safety and Environmental Services .ta 9 � P; Building Division 367 Main Street,Hyannis MA 02601 ' ` • v Office: 508-862-403 8 Ralph Crossen Fax: 508-790-6230 Building Commissioner Permit no. DateV AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,:demolition,or construction of'an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work:ge,1,0c�:k")a_o I,I)a I J5 4-MO L))b(4 &jJ Estimated Cost Address of Work: q 5� /V r? 1 U USM J CC 1kt T Owner's Name: —1^'`MCt-S C its j ZZ�� S� - Date of Application: I hereby certify that: Registration is not required for the following reason(s): . Work excluded by law Job Under S1,000 Building not owner-occupied, Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner. 0 a- hoo 7 Date Clodtractor Name Registration No. CAP 1 u� o rri l; S,MfjtpVF,MEuT . OR Date Owner's Name q:forms:Affidav _- --.---, The Commonwealth - ealth of Massachusetts _ Department of Industrial Accidents -_ -- Office 0118yesUgaUoas - 600 Washington Street f Boston, Mass. ,02111 Workers' Compensation Insurance Affidavit name- I)YY)a—A l"Qi/J?z 2 1 - — Co I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. company name: (2,q P 3-n7 11E/m,11-Al address- city: C 6%Gt.l T 6,:21 phone insurance:co: '6 66 T 64CI MAJ CATS (�� policy# LIC P 95� I Q►6 I am a sole proprietor,general contractor, or homeowner(circle one) and have hired the contractors listed below who h-.,:: the following workers'compensation polices: company name: address:. city: .::... phone#• insarance'co polio# company name Witt: situ, phone# insuranceco. policy# Failure to secure coverage as required under Section 25A of NIGL 152 can lead to the imposition of criminal penalties of a fine up to S1,500.00 andmr one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct SignatureA�i.[e.e�i_J �1!Lo-Qi l Date Print name f'/CFa)elUL H,% ®f-- 0-.Y,Z- Phone# �.�dJ Cche-ck ly do not write in this area to be completed by city or town official permidlicense# rlBuilding Department Licensing Board mediate response is requiredoSelectmen's OfficeoHealth Department: phone#; 00ther (revised 3195 PIA) 1 h; I BOARD OF BUILDINGfREGULATIONS iLlcOnse CONSTRUCTION SUPERVISOR (`q\ r'!ie�om�non«eal!/o�%�aarac/u�elGs i Number GS 0,57032- } HONE IMPROVEMENT CONTRACTOR e 31 A` I Reetrlcte To 00 no: I':5742 Explrgs 9/26/�-Pl T Reglstratlon 100740 , { a , , C`Expiration: 6/23/02 Fx r j Type: Private Corporatio THOMAS X.CAPIZZI JR',•° } f _ ,_ 28,0`PERCIVAL DR: 4 APIZZI HOME IMPROVEMENT,. W BARNSTABLE MA 02668 Administrator: Thous Capizzi, Sr. 1645 Newton Rd. .. f ADMINISTRATOR t Cotuit MA 02635 ✓�t6 L/dI7YI72G i� a�✓/�CQ.Od2C�7.UG pp ;. BOARD OF BUILDING REGULATIONS " .:�ie (oomvn�mwiea .o�vcutdac/zur i License: CONSTRUCTION SUPERVISOR OEPARTMENT OF PUBLIC SAFETY e Number: GS 007454 i .` CONSTRUCTION SUPERVISOR LICENSE Number r> Expires: i ftetrlC�eT0 00~ Restricted To: 00 THOMAS CAPIZZI !� i FNEOERIi V_RASCH III 1645 NEWTOWN RD y4 Il""ll 06 AT—S CIL F11 COTUIT, MA 02635 Administrator 1: l r. i I �j , Dr--F-►cz " - „ 1 .. 4 I - -- -- ► Z-6 5, + /U IK�c ox w ``6 o. "I - 1 L45, � ' + - r I,t Bk 20239 Ps324 IL62?47 09-05-2005 a 11213ca. GRANT OR EASEMENT Thomas Capizzi, Jr., Trustee of Santuit Realty Trust u/d/t dated 26,2Das- , of 1645 Santuit-Newtown Road, Cotuit, Massachusetts 02635 i in c nsideration of ONE($1.00)DOLLAR paid Grant to Thomas Capizzi and Jeanne Capizzi, Trustees of The Thomas Capizzi Revocable Trust Agreement u/d/t dated October 24, 1994 recorded in Barnstable County Registry of Deeds in Book qT l S Page G of 90 Head of the Pond Circle, Marstons Mills, MA 02648 and its successors, agents and/or assigns, as appurtenant to the land and the building thereon shown as Lots 1 and 2 on a plan entitled "Plan of Land Lots 1,2 & 3 State Highway-Route 28, Barnstable, MA" Arrow Engineering; Inc., 10 Cape Drive, Suite B Mashpee, MA 02649, Scale 1" = 30', Date: May 12, 1987 and recorded with the Barnstable Registry of Deeds in Plan Book 434, Page 13 the perpetual right and easement in common with the Grantor herein to use an existing 15-foot wide driveway over Lot 3 on the aforementioned plan to pass and repass and provide access to and from said Lots 1 and 2 and Newtown Road. The existing driveway is shown on the sketch plan attached hereto as Exhibit A and incorporated by reference and may be used for all purposes for which a driveway is used, no parking of vehicles or personal property in the said driveway by Grantee. No utilities will be constructed in or above the said driveway by Grantee. The Grantor hereby agrees to be solely responsible for the maintenance of said driveway located on Lot 3 as shown on the Plan referenced above, provided, nevertheless, the Grantee shall have the right to improve the same as needed to comply with the requirements of the Cotuit Fire Department and the Engineering Department, Building Department and other departments of the Town of Barnstable for adequate driveway access to Lots i and 2 at Grantees expense. The Grantor reserves for itself the right to relocate the existing driveway to another portion of Grantor's property as long as it provides Grantees' with adequate access to Lots 1 and 2. Any newly relocated driveway shall be off Newtown Road only and similar in design, grade, topography, material and appearance to the currently existing driveway. For Grantor's title reference, see Deed recorded with the Barnstable County Registry of Deeds in Book 90,139 Page 315 GRANTOR'S PROPERTY ADDRESS: Lot 3, 1645 Santuit-Newtown Road, Cotuit, MA 02635. GRANTEE'S PROPERTY ADDRESS: Lot 1 and 2, 1645 Santuit-Newtown Road, Cotuit, MA 02635. w Bk 20239 Pg 325 #62747 SCPTC-hec-A WITNESS our hands and seals this 3 R� day of A-6, f , 2005. Santuit Realty Trust By: Thomas Capizzi,Jr., e STATE OF t- (9SSA ri4vSET7 S COUNTY OF 4�3A R NS-r Fl On this 3 Q� day of S6 Pre/-16 e'R , 2005, before me, the undersigned notary public, personally appeared Thomas Capizzi, Jr., Trustee, proved to me through satisfactory evidence of identification, which was -JR ivE+2'S L-ig:.>SE, to be the person whose name is signed on the preceding or attached document, and acknowledged to me that he signed it voluntarily for its stated purpose. NOTARY PUBLIC y7 All My Commission Expires: ��� S� � a::. eY R _""Ui1:�1AfA.ddic1.1.6k. " Barnstable Assessing Search Results Page 1 of 2 PIK- 3 x.r1....... Home: Departments:Assessors Division: Property Assessment Search Results 1645 A lJ E Owner: CAPIZZI,THOMAS TRS& Property Sketch Legend Map/Parcel/Parcel Extension 024 /041/003 Mailing AddressFra CAPIZZI,THOMAS TRS& i CAPIZZI,JEANNE TRS 90 HEAD OF THE POND DRIVE MARSTONS MILLS, MA. 02948 2005 Assessed Values: y'a Appraised Value Assessed Value ' MI.:, __ . .... Building Value: $ 129,100 $ 129,100 Extra Features: $0 $0 Outbuildings: $42,300 $42,300 Land Value: $ 145,200 $ 145,200 Interactive Property Map: ap requires Plug in: Totals:$316,600 $316,600 1 have visited the maps before zGk yr Show Me The Map April 2001 photos available Sales History: Owner: Sale Date Book/Page: Sale Price: CAPIZZI,THOMAS TRS& 6/15/1995 9715/085 $ 1 CAPIZZI,THOMAS&JEANNE 2426/97 $0 2005 REAL ESTATE Tax Information: Tax Rates: (per$1,000 of valuation) Land Bank Tax $57.46 Town Fire District Rates Other l $6.05 Barnstable-Residential $2.12 Land B. Barnstable-Commercial $2.80 Cotuit FD Tax(Residential) $202.62 C.O.M.M.-All Classes $1.01 Cotuit FD Tax(Commercial) $202.62 Cotuit FD-All Classes $1.28 Town Tax(Residential) $957.72 Hyannis-Residential $1.52 Town Tax(Commercial) $957.72 Hyannis-Commercial $2.39 W Barnstable-Residential $1.44 W Barnstable-Commercial $2.10 Total: $2,378.14 Due to rounding differences these values may vary IJ http://www.town.bamstable.ma.us/Assessing/AssessO5/displayparce103.asp?mappar=0240... 1/10/2006 Barnstable Assessing Search Results Page 2 of 2 y- Land and Building Information Land Building Lot Size(Acres) 1.21 Year Built 1890 Appraised Value $ 145,200 Living Area 1680 Assessed Value $ 145,200 Replacement Cost $ 167,660 Depreciation 23 Building Value 129,100 Construction Details Style Office/Apt Interior Floors Pine/Soft Wood Model Commercial Interior Walls Plastered Grade Average Heat Fuel Gas Stories 2 Stories . Heat Type Hot Air Exterior Walls Wood Shingle AC Type None Roof Structure Gable/Hip Bedrooms 2 Bedrooms Roof Cover Asph/F GIs/Cmp Bathrooms 2 Bathrooms Total Rooms 7 Rooms Extra Building Features Code Description Units/SQ ft Appraised Value Assessed Value SHED Shed 288 $2,000 $2,000 SHED Shed 128 $900 $900 SHED Shed 288 $2,000 $2,000 FGR8 Gar w/Lft Exce 1196 $37,400 $37,400 Property Sketch Legend BAS First Floor, Living Area FST Utility Area(Finished Interior) UAT Attic Area(Unfinished) BMT Basement Area(Unfinished) FTS Third Story Living Area (Finished) UHS Half Story(Unfinished) CAN Canopy FUS Second Story Living Area(Finished) UST Utility Area (Unfinished) FAT Attic Area(Finished) GAR Garage UTQ Three Quarters Story(Unfinished) FCP Carport GRN Greenhouse UUA Unfinished Utility Attic FEP Enclosed Porch PTO Patio UUS Full Upper 2nd Story(Unfinished) FHS Half Story(Finished) SFB Semi Finished Living Area WDK Wood Deck FOP Open or Screened in Porch TQS Three Quarters Story(Finished) htt ://www.town.barnstable.ma.us/Assessin /Assess05/dis la arce103.as .ma ar-0240... 1/10/2006 P g p YP p PP pyp•In MYI NwYs'aal.,',wv rlu auN LOCUS W9 aREIAIdD af�[ORO�NI�Z�wM .:� .....ryri: uw�iseaa6Ens AE A�0`OYIDs s). _ . LOT I 9rP m w.93.i:c�il.em J'S% _ OL 1 wa \ \ LOT 2 M TAEL[PtANOF 9WIID F.R/MTWY \ a290k SF IMx r.cm.W' PlaCE15 A a 9 ME Nor a wiw IRIS. \ Oo ream A a ro eE Nsmm ro ANN cONaOED - LOT 3 mr i.rnla:n a 19 ro SE az>;om ro azseas u uo cmenrm wlrx I4r z. \ .. . PARCEL A \ p h �PARCEL B - PARCEL SF a9969...NAP.........Y. PLAN OF LAND a E LOTS.1,2 8;3 OWNER/APPLICANT 'O STATE HIGHWAY—ROUTE 28 e o . a aEAn.cAvrrn IE a 9ANTUIT•NEWa GOAD BARNSTABLE, AAA . canYr,NA ozsaa .. ARROW EWNEERING INC... 1016ASHf AACA A 0264SU4TE9 9 auN NN k 23238 Ps 5 0 10-28-2008 a 02 0 15p ASSIGNMENT OF MORTGAGE For and in consideration of One ($1.00) Dollar, the receipt of which is hereby acknowledged, THOMAS CAPIZZI, of Marstons Mills and JEANNE CAPIZZI, of Melbourne Beach, Florida, as CO-TRUSTEES of the THOMAS CAPIZZI REVOCABLE TRUST AGREEMENT under Trust Agreement dated October 24,. 1994, recorded with the Barnstable County Registry of Deeds in Book 9715,Page 67 as amended by a First Amendment to the Thomas Capizzi 'Revocable Trust Agreement, dated November 17, 2005, recorded in Book 20947, Page 259, of Marstons Mills, Massachusetts, hereby grants, assigns and transfers to THOMAS CAPIZZI, SR. of Marstons Mills, Massachusetts and JEANNE CAPIZZI, of Melbourne Beach, Florida, as tenants in common, that certain mortgage executed by THOMAS CAPIZZI, JR., TRUSTEE of the SANTUIT REALTY TRUST under declaration of trust dated August 26, 2005 and recorded in Book 20239, Page 314, dated September 3, 2005, and recorded with the Barnstable County Registry of Deeds in Book 20239,Page 321,together with the note described therein. 4 IN WITNESS WHEREOF, THOMAS CAPIZZI and JEANNE CAAPIZZI, •l- TRUSTEES of the THOMAS CAPIZZI REVOCABLE TRUST AGREEMENT, the undersigned, has executed this assignment - on this day of ()CCOthQZ ,2008. Thomas Capizzi,Trustee of the me Capizzi, ste the Thomas Capizzi Revocable Trust Thomas Capizzi Revocable Trust Agreement Agreement Q ° COMMONWEALTH OF MASSACHUSETTS COUNTY OF BARNSTABLE On this Yrt day of cat. , 2008, before me, the undersigned notary public, personally appeared THOMAS CAPIZZI, Trustee aforesaid, proved to me through satisfactory evidence of identification, which was , to be the person whose name is signed on the preceding or attache ocument, and acknowledged to me that he signed it voluntarily f ..its stated • 1•I p111W1111pI it �^ purpose. . ���GEC� •�,� ,i•�, SARAH F.A GER,P.C. "OTARYIC :` J M~ ATTORNEYS AT LAW My Commission Expires ¢ FM PMXER Roro•Posr Oma Box 449 Q• ,.t_d,,lg '.7t�U _ . Osrue,Mnssacevs�•02655 - S V. Tw_pwr4E 508428-8594 rnammm 50&420-3162 Bk 23238 Pg 51 #55541 STATE OF FLORMA COUNTY OF 4%Q1(;V AR,a On this _QgTN day of DCTdbW , 2008, before me, the undersigned notary public, personally appeared JEANNE CAPIZZI, Trustee aforesaid, proved to Zthrough satisfactory. evidence of identification, which was through L%WA E, to be the person whose name is signed on the preceding or attached document, and acknowledged to me Aat she signed it voluntarily for its stated purpose. HATA3MAY0UN%CAMP8ELL NOTARY PUBLIC p Notary Public,State of Fbdda Commissiort#DD744133 My Commission Expires. �C^ expires Dec.25,2011 . ....�. ......,.._ .:•max:,. ,.. BARNSTABLE REGISTRY OF DEEDS TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map o2 Parcel �7� (� o3 Application # �b Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee 00 Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis d/ Q Project Street Address �S 4n to i t AJ f-J u)►i ` o, Village II a i Owner n :Z4 j-/Q, y Addres l � ��� �� h�L) A)e u�fzJ n a.J Telephone a �U i f' 2G� ry S Permit Request 3 Al U 11 f U) O el 51- s Square feet: 1 st floor: existing roposecl V 2nd floor: existing proposed Total newN Zoning District Flood Plain d Groqndwater Overlay Project Valuation Construction Type_C � Lot Size / • �- CLUC-S Grandfathered:/ Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure lie fo Historic House: ❑Yes/�I o On Old King's Highway: ❑Yes '100 Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: -Tik�-Ias ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes Fireplaces: Existing&New Existing wood/coal stove: ❑Yes o Detached garage: ❑existing ❑ new size—Pool: ❑ existing ❑ new size _ Barriw0 existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Others k_J ^:3 Cr Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial Yes ❑ No If yes, site plan review# 3 Current Use fy\\ f_ r C Q-- -Proposed Use C'b YY\ 0, APPLICANT INFORMATION (BUILDER OR HOMEOWNER) (, Name Telephone Number Address ���� �!���j/�y/f��r.�/7`�G�� License 0",_20 . lV7Aye I-«yr.DJena,,en't Home Improvement Contractor# 0 (D 7't fZn ei v Worker's Compensation # W C��J� 3 20 8 ALL CONSTRUCTION DEBRIS RESULTING FRr1M THIS PROJECT WILL BE TAKEN TO r o d tti /Yk�f-�er SIGNATURE DATE x FOR OFFICIAL USE ONLY r - x APPLICATION# DATE ISSUED MAP/PARCELNO. ADDRESS VILLAGE OWNER - DATE OF INSPECTION: - FOUNDATION FRAME J INSULATION FIREPLACE " ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING w DATE CLOSED OUT ASSOCIATION PLAN NO. - r ti The Com monwealth of Massachusetts Department of Industrial Accidents u w Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeLYMY Name(Business/Organization/Individual): . ry f'e.wt t h fi Address: r�, )2D CL .k City/State/Zip: 0 MA . Phone.#: JV ,:�r Are you an employer?Check the appropriate box: Type of project(required):. 1. m a employer with t 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or art-time).* have hired the sub-contractors ❑ I n a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have $, ❑Demolition working for me in any capacity. :employees:and have workers' [No workers' comp,insurance comp. insurance.$ 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. o workers comp. right of exemption per MGL y ' p 12\ .00f repairs 3 00,S 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 anew 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: Policy#or Self ins. Lie. #: IN W (� �S 3 x Expiration Date: ?ter Job Site Address: h it,I —�eUjf'DO)r\ '20( City/State/Zip: (7 i J, b2-63 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 tip 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 Tdo-hereby eer-ti&, dew pains-a-nd-penalties-afperjuKy-that-the-infar-oration-pr-av' d-aboue-is-true-'a�nd-co.rr-ect. Sip,nature: - Date: !� Phone#: %. '4 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3 City/Town Clerk 4.Electrical Inspector 5.'Plumbing Inspector 6.Other Contact Person: Phone#: Client#:47298 CAPIHOM ACORM CERTIFICATE OF LIABILITY INSURANCE roE(MMIDolo THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES '6EL10W.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Karen A Walther CISR NAME: Rogers&Gray Ins.So.Dennis PHONE 508-760-4630 508-258-2230 434 Route 134 A/C,No,Ext: (A/C,No): ADDRESS: waltherka@rogersgray.com P.O.Box 1601 CUSTOMER ID#: South Dennis,MA 02 6 6 0-1 6 01 INSURER(S)AFFORDING COVERAGE NAIC# INSURED., .INSURER A:National Grange Insurance Co. Capizzi Home Improvement,Inc. INSURERB:ACE Property&Casualty Ins.Co Capizzi Enterprises,Inc. 1645 Newtown Road INSURER C: Cotult,MA 02635 INSURER D INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH'POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DL UBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE NSR WVD POLICY NUMBER MM/DD MM/DD - LIMITS A GENERAL LIABILITY MPB1075H 06/08/2010 06/08/2011 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $500,000 CLAIMS-MADE �OCCUR MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY JEC PROT LOC $ A AUTOMOBILE LIABILITY M1 M28044 06/08/2010 06/08/2011 COMBINED accident)SINGLE LIMIT $500 OOO ANY AUTO (EaBODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ X SCHEDULED AUTOS PROPERTY DAMAGE $ X HIRED AUTOS (Per accident) X NON-OWNED AUTOS Uninsured $250000/500000 Underinsured $250000/500000 A X UMBRELLA LIAB X OCCUR CUB1076H 06/08/2010 06/08/2011 EACH OCCURRENCE $5,000 000 EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 DEDUCTIBLE $ X RETENTION $ 10000 $ B WORKERS COMPENSATION NWCC45843208 12/25/2009 12/ 2O1 X WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN TQRY LIMITS IER /E ANY PROPRIETOR/PARTNERXECUTIVE E.L.EACH ACCIDENT $1,000,000 /M OFFICEREMBER EXCLUDED? �N NIA - (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under - DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) ' Carpentry CERTIFICATE HOLDER CANCELLATION 10 Days for Non-Payment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Town of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS. .200 Main Street Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE ©198 -2009 ACORD CORPORATION.All rights reserved. ACORD 25(2009/09) 1 of 1 The ACORD name and logo are registered marks of ACORD #S52549/M52541 KW I Office of Consumer Affairs&B siness Regulation License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration:., 100740 Type: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 G23 Expiration: 67-2012 Private Corporation Boston,MA 02116 CA IZZI HOME I,`, ROUEIf?fEI51T1 C. 2-= _:; Thomas Capizzi,'r, J '= 1645 Newton Rd. __`_- Cotuit, MA 02635 ;,by " Undersecretary Not valid o�signat�re �� >3.a s,atlata.'e.tty- Dcp aroilural of Public s.feo ' Bo -d 4d Bidlilar,, `xIe-ldaii ons and stand aril's i.l;s MW Construction SUperVisor t_iCense License: C 5 7�640 v/ .. Restricted to. 00 GARY GUSTAFSON 8 SHORT WAY }" 1 SANDWICH, MA 02563 E.; iraflo,: 11/29/2010 / LITTLE R E tP0`ND R F qq � 1 JONES ROAD 2 JASPER ROAD 2 ROAD 7i'v 3 BLACKTHORN 1 I 4 PEBBLE PATH 8 6 1 / ` - 5 EMERALD LANE 3 `d 6 TURTLEBACK ROAD g 6 7 ARBOR PATH \ D O - V 1 1 Y /`f H 3 !! g BLUE RIDGE AD RAMBLE PATH T J ``: J,. Q g B 1 q n i' d ti s 4. MSTIG` c°Oe .". 5 LAKE \ S T. scN //�� - MEWS RD. - MpNSF1E. 5P ac HHpYW YS � ��J,/ RF A rdK�b Wgg MIDDLE. .q � POND Q _ �SNO�F DRIVE \\ a o"W� R �` HAMBLIN = 1 > :o FLUME AVE. ' POND, m L - Q \LONG' 11 MIDbLE' D POND PATH/ MUDDY�1 a R D POND E RD 2 l 7T t -_ K r ...� � \ PO HAMBLIN p i 90 � rABL WPOND 6F T`r'aE'OY�L o > .. V,'. ^ , Cy/p'O/,yOSTO �PO• � / NF R D ,p _N 500 d' O?O ANE r7 WAY 90 = AT I p 5• �4� ti CAM 3pU0 ILLS 0 p O°ar 300 UB CHAt i �E \ D r S & D i LOVELLS o i•� N °POND Zap 4 • , ` � �cF '0 BW �'V,.; SMOKE 3 W0p0 pO i. VIP � ti Q / G ¢� ao Q GURU PJ D J n o _ , o N (/l T hV I 1 i0 110 NORTH ' _� ttil moo RECINC1 ` \ BAY . , /` R j Q +' w ,Y 7 _ h r - - r d ;�.'7" w � RBRC- I .. _ g 000 RD J R F \ d t RD-I 20000 12S MARSH ^ :t.., RD-2 , .O_3 �000 125 POND I - R D-3 a FOOD 160 '3 , 50 RE-I F 43A60'RE _ RF RF-I F-I 43,560 RuSiNESS - ;us s /I < V_ u MAMBLIN 'm F ME AVE. 1 Q LONG !('� POND, ��L . MIDDLE PONDS ■ 1 F POND MU '; DDY�' PATH r f PDNor = 1 9 A .- �\ .✓ - HAMBLIN POND �i ,B '� Mr WAY 6F T„•: pY�l ?PCA I Er0 _�NE K. SPUR `iTr1-4 WII 8 •W � `/ Rm �� Jpa tweI r CHA o 1 LOVEL-S o J & D j •�. D POND a' ` 4. —1 as NB'A 1 Iz�. I R 1 R � �'� � �?•?a C9 ao R �W `r JR�w �a _• � � � c wH\ZE o• PO• I., 2 %P0 i A c . C qo Q N U/T Q x'a aO• I 1 D 1_. O• '03 NORTH �a REC I INC RF Ll ( BAY 7. �r AQ,D L li W �d r� o _ r< i / i It • ��� 4 ra O - ay G �00PE R S F COTUIT WES 771 T � ' i • BlyCESARAH I =.•+ '�, DODGE t DR \\l` "-; CHEDN / pIMOUI9 SETT RD A. RR MAPLE ST. 1-KEEI�G� s .+ i Ova - 3t:AhllT Pw s - d 5 R MAR / f RI RI ;3 •, i I RI RI ♦ RI t t POPONESSET �p l prl W PI ' > FLAY 6\ / i kr r f One hundred (100) feet along Routes 28 and 132 .t a I U flfty:l581 feet roan abating a residentially area 9 •X, Ir r no - (2) The ilnlaus total side yard setback-shaII be thirty 1101 feet, provided that no A location of such total a results In a setback of less than ten(101 feet, except abutting a residential district, where a mintwn N r, Of trgntyd201 feat is teQllrtd. t3)The alnlaua total side yard setback shall Lt thirty 1301 feet, provided that no allocation of such tetat k results In a setback of less than twenty (0)flat,evcrft abutting a residentlal district, where a S A $ [coleus of twenty 1I feet is' ur ea 'ted. (a)Mo sore than thitty-threw perceat t33t1 of the total upland area of any lot shall be adde Ispervious by. the Installation of.01141I structures and pared surfaces;hell 190-60 approved 4/4I1901, a I ;E- n A� � r N I ZONING MAP ..N y� c OF ai BARNSTABLE •1 MA.SSA.CHUSETTS ^9. FEBRUARY 3, 1969 REVISED MARCH.. 3, 1970 REVISED MARCH 27,1971 , REVISED ,AUGUST 31, 1971 RLVISED MARCH 25,1972 hE V.I',Lr--*D MARCH L4, 1973 REVISED t`AARCH ? ?, 1974' REVISED JULY 3C:, 1974 1w FEET 1 REVISED NOV 4.1976 \ REVISED. 'MA'( 5�1979 RED°ICED N c v , 19 ?3 REVISED JAN.23,1985 RE N RF LITTLE RF.I JONES ROAD .. .. .,: . _ 2 JASPER ROAD ..... ....._. �. - .. _ M" + .3 BLACKT`HO,p N:,ROAD 2 • -..rq":.:. PEBBLE-e PATH .. ''�„ •I w J �\"`7 z S 'ENE RALD LANE ,•.•.. n8' G '•I .`,W `� 6 TURTLEBACK ROAD 7 ARBOR PATH B a ~ B BLUE R ///��� IDGE ROAD 9 BRAMBLE PATH RFC r ••�3 T .f'2 �\ / v ,t, eae j NFL V � I y y.. M STIC � e h - �3 y 0 LAKE S T. Sc C • _ �,. • s r MEI W.J RD. HH BWPS \ �/If sP � 1 pp �. � RF PANS MIDDLE I POND DRIVERF O OW S>V HAMBLIN ' ' LONG � P ME AVE. POND; \gyp J POND POND / ' i..,MUDDY�. PATH �I �•r� _� R F ; POND r s .� 09 R F zo HAM 3LIN MY - ipp/"CST :. °"fR F ray Q m IL q Z T 1 SODA' OeV y t�-SPUR lq �� CA v ww lLLS V B .. p •,4 a 5 `�� Q �mm E. \ CHAN -� & ' LOVELLS S Do 0_ POND 6 /�✓�