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0046 FARM HILL ROAD
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J ' In r , ,t t� „ Town of Barnstable Building Post This Card So That it is Visible From the Street=Approved-Plans Must be Retained on Job and this Card Must be Kept M"m ¢ Posted Until Final Inspection Has Been Made. 1639, `$ . ,.• o-. - 'Where a Certificate of Occupancy is Required,such Building shall Notbe Occupied.until a Final Inspection has been made x',= Permit Permit No. B-20-1988 Applicant Name: Thomas Mackey Approvals Date Issued: 08/13/2020 Current Use: Structure Permit Type: Building-Addition/Alteration-Residential Expiration Date: 02/13/2021 Foundation: Location: 46 FARM HILL ROAD,CENTERVILLE Map/Lot 247-079 Zoning District: RB Sheathing:' Owner on Record: BUXTON, MARILYN P& PHILBRICK, FRANK H Contractor Name: THOMAS MACKEY TOM MACKEY Framing: 1 FRAMING &REMODELING Address: 41 JOYCE ANNE RD 2 CENTERVILLE, MA 02632 - Contractor License: 157765 Chimney: Description: Remove and replace asphalt roof shingles. Repair any rotten trim. Est. Project Cost: $ 12,000.00 Permit Fee: $ 111.20 Insulation: Project Review Req: } Fee Paid: $ 111.20 Final: Dater 8/13/2020 Plumbing/Gas. Rough Plumbing: 5 Final Plumbing: Building Official This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months'after issuance. Rough Gas: All work authorized by this permit shall conform to the approved application and the'approved construction documents for which this permit has been granted. Final Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. Electrical Service: The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work: Rough: 1.Foundation or Footing 2.Sheathing Inspection Final: 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 Rough: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. 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 Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT S • TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application # l I w01 Health Division Date Issued L Conservation Division _ �� .Application Fee Planning Depf. "'Permit Fee Date Definitive Plan Approved by Planning Board �i''2�r1 o Historic - OKH Preservation / Hyannis Project Street Address LIG �c,r m HI Village Cen-l��v j Owner . f t-G,,(b (d. -Ply 1 AddressGVYI� Telephone Permit Request �f rn t As6U X-3 I and t c� � ��(1•� QV 6-fbl-Le K��"S- . Y�� C CA JCn�rXO Square feet: 1st_floo. --e i tines proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation ,e1 Construction Type 26' Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family" ia/ Two Family ❑ Multi-Family (# units) Age of Existing Structure S o Historic House: ❑Yes do On Old King's Highway: ❑Yes a-Ko- Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area(sq.ft) //Number of Baths: Full: existin N ew . Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric Other " 'F `"� r T-, C; Central Air: ❑Yes ❑ No Fireplaces: fisting New Existing wood/coal stove-'=❑Ye ❑ No .D;, Detached garage: ❑existing ❑ ne size Pool: ❑existing ❑ new size _ Barn: ❑'existing ❑chew sze_ Attached garage: ❑ existing new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ rn Commercial ❑Yes U1go If yes, site plan review# Current Use Proposed Use , APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name r [6-VU_Y-AATelephone Numberg Address '1(0 ',S' �f y(1 License # R OoZ Home Improvement Contractor# l QU Worker's Compensation # AX-0CCIS- Sc(3�0 FS- ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO V& CM I(�i✓�� 17TSIGNATURE DATE l� Tl FOR OFFICIAL USE ONLY 'APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION CD FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL y PLUMBING: ROUGH FINAL r GAS: ROUGH - , FINAL ` FINAL BUILDING ' � d DATE CLOSED OUT ASSOCIATION PLAN NO. A k ',i Map Page 1 of I Town of Barnstable Geographic Information System Parcel Viewer Custom Map Abutters Map Size Zoom Out In C y he K;' f ® JPG Map: 247 Parce 247091 -N 58 Location: 46 FARM HILL R, 247092 060 247093 Owner: PHILBRICK, HAP N 88 �tp {Lt`: Location Information tt Map &Parcel 247079 Location 46 FAU Acreage 0.20 aci 247067 N 47 Current Owner Mailing Address PHILBRI BOX 13. 247019 W HYAN q'46 Appraised Value (FY 201( 247o7s Extra Features $3,100 #77 Out Buildings $1,800 Land $125,8C 247066 Buildings $121,2C 4A . Total Appraised $251,9C 247080- Assessed Value (FY 2010 u36 Extra Features $3,100 247077 .__. 45 Fe f a85 out Buildings $1,800 Land $125,8C :> Buildings $121,2C - -- Total Assessed $251,9C Set Scale i1" 45 I Aerial Photos I MAP DISCLAIMER Copyright 2005-2010 Town of Barnstable,MA All rights reserved.Send questions or comments to GIS BarnstableMA v1.2.3867[Production] http://66.203.95.236/arcims/appgeoapp/map.aspx?propertyID=247079&mapparback 11/10/2010 i a 1 i Page 7 of 7 CAPIZZI HOME IMPROVEMENT INC. SPECIFICATIONS AND ESTIMATES STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FOR A.BUILDING PERMIT a Iry , ) OWN THE PROPERTY LOCATED AT ✓'"� �`� IN Cy-�L- Wle ,MASSACHUSETTS. I HAVE AUTHORIZED CAPIZZI HOME IMPROVEMENT TO ACT AS MY.AGENT TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR,THE MASSACHUSETTS STATE BUILDING CODE. I GIVE MY PERMISSION TO LESSEE TO APPLY FOR A BUILDING PERMIT IN AC ORDANCE WITH 780 CMR;THE MASSACHUSETTS STATE BUILDING CODE. SIGNATURE OF OWNER: d OWNER'S ADDRESS: OWNER'S TELEPHONE: %�- g' j LESSEE'S SIGNATURE: LESSEE'S ADDRESS: LESSEE'S TELEPHONE: APLLICANT'S SIGNATURE: APPLICANT'S ADDRESS: 1645 Newtown Rd.,Cotuit,MA 02635 APPLICANT'S TELEPHONE: 508-428-9518 RESPONSIBLE OFFICER: RESPONSIBLE OFFICER ADDRESS: RESPONSIBLE OFFICER TELEPHONE: The Commonwealth of Massachusetts Department oflndustrialAccidents Office of Investigations _ ' a 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeLyibly Name(Business/OrganizationdI dividual): . d.r ZL•i P?Y-D V'f—/K t I fi - Address: ,r''j N-�W n 0:C(__ City/State/Zip: 6 414 . j — Phone.#: Are you an employer? Check the appropriate box: Type of project(required):. l. . a employer with t 4. d I am a general contractor and I employees(full and/or art-time). have hired the sub-contractors 6. ❑New construction ❑ I am a sole proprietor or partner- listed on the-attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. =employees,and have workers' o workers' co comp. insurance. $ 9. 0 Building addition [N comp.insurance P• required.] 5. We area corporation and its- 10.❑-Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 412.❑Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13. ther lrQ 1 ,� 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 she0t 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:_ /v G� l�4�X` -e- U k, t L.CJ Policy#or Self-ins:Lic.#: N 1� �� �5 5 q-3 Z Expiration Date: Job Site Address: r(� (� t r 4 City/State/Zip: t?�A'k 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$250.00 a day against the violator. Be advised that a copy-of this statement may be forwarded to the Office of Investigations of the DIA for ' urance coverage verification. ado hereby Eer-tif u ai &-a sd panaltie-s f-psxjury that-the infor-mation-p-r-ouideci-above-iis-tr-ue-and-correct Signature: Date:• Phone#: Official use only. Do not write in this area,-to be completed by city or town official City or Town: : Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 1 City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector .6.Other Contact Person: Phone#: Client#:47298 CAPIHOM A CORD, CERTIFICATE OF LIABILITY INSURANCE D 6/4/2DNY 010 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER - NAME:CONTACT Karen A Walther,CISR Rogers$Gray Ins.So.Dennis PHONE 508-760-4630 508-258-2230 434 Route 134 -M No,E:d: (A/c,No): AIL ADDRESS: waltherka@rogersgray.com P.O.Box 1601 CUSTOMER ID#: South Dennis,MA 02660-1601 INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURERA:National Grange Insurance Co. - Capizzi Home Improvement,Inc. ACE Property&Casualty Ins.Co INSURER B: p � C - Capizzi Enterprises,Inc. 1645 Newtown Road INsuRER c Cotuit,MA 02635 INSURERD: 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,TIDE 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 I ADDLSUBR1 POLICY EFF POLICY EXP - LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MM/DD MM/DD LIMITS A GENERAL LIABILITY MPB1075H 06/08/201 O 06/08/2011 EACH OCCURRENCE $1,000,000 X MMERCIAL GENERAL LIABILITY G O PREMISES Ea occurrence $500,000 CLAIMS-MADE �OCCUR MED EXP(Any one person) $10,000 CO 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 PRQ LOC $' A AUTOMOBILE LIABILITY M1 M28044. 06/08/201 O 06/08/2011 CO aid Mj SINGLE LIMIT $500 000 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-OWNEDAUTOS Uninsured $250000/500000 Underinsured $2500001500000 A X UMBRELLA LIAB X OCCUR CUB1076H 06/08/2010 06/08/2011 EACH OCCURRENCE $5 000,000 EXCESS LIAR CLAIMS-MADE AGGREGATE $5,000,000 DEDUCTIBLE $ X RETENTION $ 10000 $ . B WORKERS COMPENSATION NWCC45843208 12/25/2009 12/25/201 X TQ OTH- AND EMPLOYERS'LIABILITY RY LIMITS IMIT E Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? �N N/A - - (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 I LOCATIONS/VEHICLES(Attach ACORD 10%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 Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation Registration,---,-4'00740 Type: 10 Park Plaza-Suite 5170 a'Se Expiralror�i:~_p�3k1,2 Supplement Card Boston,MA 02116 CAPI=l HOME'11V1 0lEIVIENA INC. GARY GUSTAFSa1V yr - 1645 Newton Rd. Cotuit, MA 02635 Undersecretary No id without signature Dt-p<artnitnt of Public S:tl'etl Board of Builtlim', tit td aiivn.,,and S attcl:arcl, -- Construction Supervisor License License: CS 74640 Res, tYi:cted to 00 y z, GARY' G.USTAFSON: $ 8 SHORT WAY ' SANDWICH, MA 02563 Ea?i,ama: 11/29/2010 Trtl: 7755 P p 1 a i i i i Cl _ OF Fffr, ,1 R 7 211 i 3 JVO I oOAX r j L N F T c� ? - — - P C e P J u 13 Gd.1 v 8 � , i > F j s. M_ f t. K 7 x a `s...S. 3: ` '� t ���` k et', tom•#A T� .. � `p' �6�1� •+r�¢:{{ f;a'!#i' `�, I!' ram, '���,� �•� � �� - ,� '�+'S '4 T its x�! `� � � s w Ll IS k ad. gyp±. _ �'.•. � �f� � ]'gh�a���,., i¢ - Town of Barnstable *Permit# t6a�a� Expires 6 months from issue date Regulatory Services Fee Thomas F.Geiler,Director C3ARN&TABt�. � , MASS. 1639. Building Division Tom Perry;CBO, Building Commissioner (( 200,Main Street,Hyannis,MA 02601 _ U www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number.-,? Property Address P ®Residential Value of Work ' Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address 9�AI -1441.Gt_� k Contractor's Name. GLS U/�O1Z2/ Telephone Number Home Improvement Contractor License#(if applicable) et s � '�1t��1#� ® S �`ERINNii � -nWorkman's Compensation Insurance Check one: APR 3 ® 2008 ❑ I am a sole proprietor I am the Homeowner TOWN OF BARNSTABLE I have Worker's Compensation Insurance. / Insurance Company Name �d�'edes <5�U7' Workman's Comp.Policy#` Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side Replacement Windows/doors/sliders.U-Value .. (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License is required. SIGNATURE: '{ r Q:Forms:bu ildingpermits/expre Revised 123107 I The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations V 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affi".Ti�i1$�ilo.ef���ov �tiEs/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/individual): Cofuit, MA 02635 let. 428-9518 1 1 800.262-5060, Address: City/State/Zip: Phone-#: ' Are you an employer?Check the appropriate box: Type of project(required): 1. I am a employer with � 4. ❑ I am a general contractor.and I 6. New construction employees(full and/or part-time).* have hired the sub-contractors 2.[1 I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. []Demolition workingfor me in an capacity. employees and have workers' . Y P tY• 9. []Building addition [No workers'comp.insurance comp.insutrance.t required.] S. [] We are a corporation and its 10.❑Electrical repairs or additions 3.❑ q officers have exercised their 11. Plumbing repairs or additions I am a homeowner doing all work ❑ g eP myself.[No workers'_comp. right of exemption.per MGL 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no employees.(No workers' 13.❑ Other comp.insurance required.] Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors 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- information. Insurance Company Name: P�o Policy#or Self-ins.Lic.#: / 7'`! Expiration Date: IX Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and.expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine. of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do he��,fy under the pains anry that the information provided above is true}and correct. Si atu Date: v Phone#: -Official use only. Do not write in.this area,to be completed by city or town officiaL City-or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health I Building Department 3.City/Town Clerk 4.Electrical Inspector- 5.Plumbing Inspector 6.Other Contact Person: Phone#: - Client#:47298 CAPIHOM ACOR& CERTIFICATE OF LIABILITY INSURANCE DATE(MWDD/YYYY) 12/26/2007 PRooucea THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Rogers&Gray Ins.-So. Dennis ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 434 Route 134 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR P.0. Box 1601 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. South Dennis;MA 02660-1601 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: NGM Insurance Company Capizzi Home Improvement, Inc. INSURER B: American Home Assurance Capizzi Enterprises, Inc. 1645 Newtown Road INSURER C: Cotuit,MA 02635 INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REOUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, LTR INSRE TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION DATE MM/DD/YY DATE(MM/DQ1YYj LIMITS A GENERAL LIABILITY - MP010707 06/08/07 06/08/08 _ EACH OCCURRENCE $ 1 000 000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $5OO OOO CLAIMS MADE a OCCUR Is MED,EXP(Any one person) $1 Q 000 PERSONAL&ADV INJURY $1 000 000 GENERAL AGGREGATE s22000,000 GEN'L AGGREGATE LIMIT APPLIES PER: - - PRODUCTS•COMP/OP AGG $2 OOO OOO POLICY PRO- JECT LOC AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ (Ea accident)ALL OWNED.AUTOS _ BODILY.INJURY $ SCHEDULED AUTOS .,(Par'persori) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS _ _ (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY :.. - AUTfTHAN EA ACCIDENT $ ANY AUTO - OTHEA ACC $ AUT - AGG $ EXCESS/UMBRELLA LIABILITY _ EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE DEDUCTIBLE $ RETENTION $ $ B WORKERS COMPENSATION AND WC1764953 12/25/07 12/25/08 WCY TIATU• CIETH- R EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED?If yes,describe under E. DISEASE•EA EMPLOYEE $500,000 SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $500,000 - OTHER DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Corporate officers are included in Workers Compensation coverage. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Town of Barnstable DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 1 n " DAYS WRITTEN 200 Main Street- NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Hyannis,MA 02601 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR + REPRESENTATIVES. . AUTHORIZED REPRESENTATIVE ACORD 25(2001/08) 1 of 2 #S33206/M33205 KW 9ACORD CORPORATION 1988 �p� JlGG TDdI77g7ZCJ J2C11�..lLGLfL GL✓I�GCLJ�d2lC6G�co - tt�~ Board of Building Regulations and Standards License or registration valid for individul use on V� HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 100740• Board of Building Regulations and Standards •Ezpiratfoni. 6/23/2008 One Ashburton Place Rm 1301 Boston,Ma.02108 Type:.:Supplement Card , CAPI=I HOME IMPR-OVEMEf4T, I dARY GUSTAFSON 1645 Newton Rd. ` Cotuit, MA 02635 Administrator t valid with t sign tore Board,of Building Regula ions and Standards One Ashburton Place - Room •1301 ._.... Boston lVlassachusetts 021 U8 Home Zmp ovement Contractor Reglstrat.' . „:Re:isfration.,�• 100740 :, .;> .,,. ' Expiration: 6/23/2008 IMPR-ONIEMENT, INQ, GARY G USTAFSON 164,5 Newton Rd. = COtU MA 02635 Update Address and return card.Mark reason for chance. _.. Address Ej Renewal Employment 0 Lost Card - NORM,, Board of.B�uilding Re lahons nd Sta rds - UCtlOrlS '2 1 (''L.IC e,1,.�'.i."V.,TMy_G::� w:. ,trs r• rrty� c i i v t -, + "�,r � Rbl 1 License CS''.f, Q' _--:r. f`�;a5`+ 77'--e i 3: „i c X1 ntr.+ '•�.s... r 'v.,l Z 7 t 2 'tom�t A t �u 6: rlt�}u� ><...1 ec't t- ' � it. s '�w �('"'?.ktw �,t.r^€' , S�. m EXpifatlo 1�/29/2008 a T a s t 4 t a a: •4'i 'r. �-a Kam rYi rr'.sue Res tfa r y 7 rt.' �P h ! ZS'f' Y+'` aT!,—•ir.r^Y' +LRf W y '' d ,t•,cu" -e°i" kF'ktNi .t(Y'-Lx, 3��r0 ct -,t OR o..'^r x. A.bx�t1t • :^�" t�.�'.,.� �' ,r T. f � '_.: # t ""uc1vt`v2 .y ,f'1R.'�, F ,4� 'x � .J���'�>•'�r � -,<-�i� t\ '�t c� � 5�,.u'le•�-if C S7':r v' F'-�t.�•Tti s�� XC ^r i �4' t 'fir'• GARY GUST ..SQN ::. 8 SHORT AY ! SAND . C MA 02563 Commissioner. I f z , -4 1 Page 7 of 7 CAPIZZI HOME IMPROVEMENT INC. SPECIFICATIONS AND ESTIMATES. z. STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT f a� d® i OWN THE PROPERTY LOCATED AT6 IN �:2 I� L�� ' ; MASSACHUSETTS I HAVE AUTHORIZED - CAPIZZI HOME IMPROVEMENT` TO.ACT AS MY AGENT TO APPLY FOR:. A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR HE MASSACHUSETTS STATE BUILDING CODE. I GIVE MY PERMISSION TO LESSEE TO APPLY FOR,A BUILDING PERMIT IN CORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. SIGNATURE OF OWNER: OWNER'S ADDRESS: � ^^Q OWNER'S TELEPHONE: ] LESSEE'S SIGNATURE:' ; LESSEE'S ADDRESS. LESSEE'S TELEPHONE APLLICANT'S SIGNATURE: APPLICANT'S ADDRESS: 1645 Newt6lAM Rd , Cot t' MA 02635 'APPLICANT'S'TELEPHONE 508-428-9518 RESPONSIBLE OFFICER: RESPONSIBLE OFFICER ADDRESS.` RESPONSIBLE OFFICER TELEPHONE S - i a TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 67Y Parcel jQ 'Application# o?0 7(� e0077 Health Division Conservation Division - �1. )� Permit# f Tax Collector Date Issued 6 Treasurer Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address Village Oj2A:A--ej2 MU Owner h I �r Address�� ��J �� W Telephone -I � P)q 1 —I Permit Request --V7 - c_n 1 S t4 n -CW,C,1L W 1 --fi- )J o -� Pie c,c 10 C)Lo- br t dc, v Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation '�O 0 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 A No On Old King's Highway: ❑Yes '1� 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 0 Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal st ve: ❑Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑neWR 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 UseFri , BUILDER INFORMATION Name0g2PI Telephone Number Address i u qS ne_,oy oujn License# C6__� V��o Home Improvement Contractor# �o o Worker's Compensation ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO 60 SIGNATURE vl CAt DATE i FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED i MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING rO2 61 DATE CLOSED OUT ASSOCIATION PLAN NO. _ f _62 - : Board of Building Regulations and Standards -- a a One Ashburton Place - Room 1301 Boston, Massachusetts 02108 Home Improvement Contractor Registration Registration: 100740 Type: Private Corporation Expiration: 6/23/2008 CAPIZZI HOME IMPROVEMENT, INC. Thomas Capizzi,jr. 1645 Newton Rd. Cotuit, MA 02635 Update Address and return card.Mark reason for change. oas-cni SOM-04105-PC8698 Ej Address Renewal Q Employment Lost Card ✓&, tooa���zo�acue 0 _4K eaczc/WdeCld Board of Building Regulations and Standards License or registration valid for indh iduI use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 100740 Board of Building Regulations and Standards Expiration:' 6 123/2008 One As hburton n Place Rm I3 01 Type: Private Corporation Boston,Ma. 02108 CAPIZZI HOME IMPROVEMENT, INC. Thomas Capizzi,Jr. 1645 Newton Rd. �,� Cotuit, MA 02635 Deputy Administrator Not valid without signature BOARD OF SUILDING RAG J 5cense: :CONSTRUCTION S '-I �ONS i -+4T k Numb6i�_6q 057o32 `• t �� t•' f • tarn I ..a Ij 1645 . .:. NEWToWN Rl Vy -� i COTUIT, MA 02635�Tf_l ' 0 { Binder,for Workers' Compensation and Employers Liability Insurance e-Commerce Specialty Workers' Compensation Member of American International Group, Inc. - December 22, 2006 To the Employer Through the Producer Capizzi Home Improvement, Inc TPA INSURANCE AGENCY, INC. 1645 Newtown Road t 10 NEW ENGLAND BUS CTR DR Cotuit, MA 02635 ANDOVER, MA 018101096 FEI N: 800014011 Phn: 978-691-2470 Reference Number: 1651-19DEC06 Fax: 978-691-2477 A Workers Compensation policy for your insured has been bound with policy number 1764953 and based on the quote issued with above Fein, for the 12/25/2006 to 12/25/2007 policy period . Please reference this policy number on all future correspondence, Binding is subject to the following: • Any changes in rates and/or experience modifications by any entity having jurisdiction over this policy. • Final premium will be determined at the end of the policy period after payrolls have been audited and applicable rates and experience modification have been applied. • Receipt of a completed signed Acord Application and experience modification worksheet within 48 hours. PLEASE BE ADVISED, this binder has been prepared based on the information provided by you and your insurance representative(s) in your application. If any of the information provided in the application is incorrect, outdated or otherwise should be changed, please provide the updated information to us. This offer of insurance may be rescinded or revised because of changes in (1)the information from the application, (2)applicable rates, (3)-the experience modificationfactor-or(4)other-reasons,The changesmay be reflected in a revised.proposal or when we issue your policy. The final premium will be determined after policy expiration and completion of a payroll verification audit in accordance with the terms and conditions of the policy. Notice about the Office of Foreign Assets Control (OFAC) This proposal or resulting binder, the continuation of any bound insurance, and payments to you, to a claimant or to another third party,,may be.affected�by.the.administration and enforcement of U.S. economic embargoes and trade sanctions by the Office of Foreign Assets Control (OFAC), if we determine that any such party is on the "Specially Designated Nationals or Blocked Persons" list maintained by OFAC. Member Companies of American International Group Inc. American Home Assurance,Inc.,AIU Insurance Company, Granite State Insurance Company,Illinois National Insurance Co., New Hampshire Insurance Company,National Union Fire Insurance Company,Insurance Company of the State of Pa Services As an AIG Specialty Workers'Compensation policyholder you now have access to the Partners in Productivity® website, www.aigswc.com, at no additional charge. This site will provide links to the following policyholder services: • First Notice of Loss, this online claim reporting system allows you to report claims via the internet—reducing processing time for individual claims and engaging claims management capabilities on a more timely basis. Claims services are delivered by the AIG Companies'Primary Claims unit. • AIG RiskTool System®, our online loss.prevention and risk management tool, can assist you in,managing the risks your company and employees face every day. Use the tool to build loss prevention programs tailored to your needs. • Request and receive loss runs electronically. • Locate medical service providers. • Submit voluntary payroll reports. • Research general information on Workers' Compensation insurance. These valuable services are only available to current inforce policyholders and their brokers. First time users of the website will need to have the following information, which can be found in your workers' compensation policy, on hand for the online registration process. • Policy Number • Agent or Broker Number • Issuing Company The Employer is urged to refer to the policy(ies) immediately upon their delivery for a complete description of the scope and limitations of coverage and other details including premium determination and payment plans. You may also report claims by calling our toll free claim reporting line at(888)-393-6828. 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I—— !I , I 1, 11. 1; ,, .��._--i—:1,__ - , ..'�%i,_ .., ". , :" ...� ,i;177 il__I 1,i— . . 7. ., - :, 1, . � I ..,_;'_�,4, , �;, !: I1� i .�i - _� , I I p rx, . i I � �. . . I t I , - ;l 1 n A t:�_. 1'- .,i ' dF ?r :a. 1. 9 r c i{ aFy 4r - _� — _ t I,� r 1 Al,?,.i', a .� '£ S s _o....w., l . ..: ._ �.- i._.. �.�. ,- I. ._.. . .r,r ter. , r I. .; -ice_ I: _ �- tet 1/9/2007 Tirael 10:19 AM To: TOAm of Barnstable ® 9,1,5087906230 R&C Ins. Agcy. Paget Do'- Client#:47298 CAPIHOM ACORD. CERTIFICATE OF LIABILITY INSURANCE 01109//07DTYYYY, PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Rogers$Gray Ins.Agency,lnc. ONLY AND CONFERS NO RIGHTS UPON`rHE CERTIFICATE 434 Route 134 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES IRELOW. P.0.Box 1601 South Dennis,MA 02660-1601 INSURERS AFFORDING COVERAGE NAIL 0 INSURED INSURER.A: National Grange Mutual Ins.Co. Capizzi Home Improvement,Inc. INSURER B: American International Gr Capizzi Enterprises,Inc. INSURER 0: 1645 Newtown Road INSURER D: CotUlt MA 02635 INSURER E: COVERAGES THE POLICIES OF!NSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABG,/E FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT;TERRA OR CONDITION OF ANY CONTRACT OR OTHER DOCUNENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE!SSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMBS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, LTft 114SR T POLICY EFFECTIVE POLICYYPE OF INSURANCE POLICY NUMBER iM I mm DATE IEXPIRATION MMIDD;YYI LIMITS A GENERAL LIABILITY MP010707 06/08/06 06/08/07 EACH OCCURRENCE $1 000,000 X I COMMERCIAL GENERAL LIABILITY DANAGETORENTED PREMISES a currence $500,000 CLAIMS MADE l X J OCCUR VED EXF(Any cne person] $10 000 PERSONAL 8 ADV INJURY $1,000 000 GENERAL AGGREGATE $2 0QQ,0QQ GENT.AGGREGATE IJPAI I APPLIES PER: PRODUCTS-COIVP/OP AGG $2,000,000 +�PC•LiCf PRO. I AUTOMOBILE LIABILITY •^CMBINED SINGLE LIMIT ANY AUTO :Ea accident) $ .ALL OWNED.ALTOS BODILY INJURY ! SCHEDULED AUTOS (Per person) $ HIRED AUTOS ,I•--ti I BODILY INJURY NON OWNED AUTOS leer am dart) $ ri I PROPERTY DAMA.AGE $ .Per acc dent} ! GARAGE LIABILITY AUTO ONLY•EA ACCIDENT $ .ANY ALTO EA ACC $ OTHER THAN AUTO ONLY: AG $ - J EXCESSiUMBRELL.A LIABILITY EACH OCCURRENCE $ OCCUR ❑CLANS MADE - AGGREGATE9 $ �_ OFDUC1ISLE $ I j RETENTION_ $ $ B I WORKERS COMPENSATION AND 1764953 12125/06 12125/07 � =sTATIA 6 1 IIT51 ER EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $500,000 ANY PRCPRIFTCR+PARTNERIEXFCUTTVE CFFICER/MENIBER EXCLUDED'i E.L.DISEASE•EA EMPLOYEE $500,000 'If yes,deers he ender SPECIAL PROVISIONS Le cw E.L.DISEASE-POLICY LIMIT $500,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS!VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEIAENT 1 SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLEDBEFORE THE EXPiRA. 1014 Town of Barnstable DATE THEREOF,THE ISSUING INSURER WILL ENDEAVORTO MAIL In DAYS WRITTEN 200 Main Street NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Hyannis,MA 02601 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENT S OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001/08)1 of 2 Q6435 DMW 0 ACORD CORPORATION 1988 3' p� P Z 'z f Home Improvement Inc. I, Thomas Capizzi Jr., owner of Capizzi Home Improvement, hereby authorize Lisa Haworth,to sign on my behalf for permit applications filed through the town. Signed: Thomas apizzi, r. Date: vLa Haworth Date:. 1645 Newtown Road Cotuit, MA 02635 (508) 428-9518 (800) 262-5060 FAX (508) 428-1547 The Commonwealth of Massachusetts Department of Industrial Accidents dffice of Investigations ' 600 Washington Street r Boston,MA. 02111' •�'� vlVOw.mass.gov/dia ' Workers'Compensation Insurance davit: Builders/Contractors/Electricians/Plumbers Applicant Information .Please Print Legibly Name(Business/Orgamzation/Individual): s21 . •Address: (y ruto-�o wrl 1 D cbiu�A mr� City/State/Zip: Phone.#: Are ou an employer? Check the appropriate bog: .Type of project(required):, 1„ I am a employer with 4. ❑ I am a general contractor and I employees{full and/or part-time).* . have hired the sub-contractors . 6. ❑New construction . 2.❑ I am a''sole.proprietor or partner- listed on the'attached sheet. 7. ❑Remodeling ship.and have no employees These sub-contractors have. g, ❑Demolition working for me in any capacity. employees and have workers' g ❑Building addition [No workers' comp,insurance comp;insurance.$' l required.] 5. ❑ We are a corporation and its 10.0 1Electrical repairs or additions officers have exercised their 3.❑ I am a homeowner doing all work . 11.❑Plumbing repairs or additions ' myself.[No workers'comp, right of exemption per MGL 12.7 Roof repairs . insurance.required.]t c. 152, §1(4),and we have no employees. [No workers' l Other A� 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 ornot those entities have employees. if the sub-contractors have employees,they must provide their workers'comp.pofidy 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 f \ Cj(J ()CA 1 y Policy#or Self-ins.Lic,#:- 1.� �� �J Expiration Date: lob Site Address City/State/Zip: Attach a copy of the workers' compensation policy declaration page'(showing the policy number and expiration date). Failure,to secure coverage as.required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK.ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the-Office of Investigations of the WA for insurance coverage verification. I do hereby ify undf r the pains•and penalties o perjury that the information provided above is true and correct. ,JA(� �.^ Sim, '-"'�,� 1.1 Dater Phone#: Official use only. Do not write in this area,to be completed by,city or town official City or Town: ' Fermit(License# Issuing Authority(circle one): .-I.Board of Health 2,Building Department 3,City/Town Clerk 4;Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: 1 .1U�'IIlA.�,1lJi1 A.lA�.l lll�t,l ���.it➢1».� • 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 bite, 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.the performance of public•.work until acceptable evidenee-of,compl%ar?ce vyith:tlie 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-conf actors)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 maybe 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 c f 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 (Le. 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 Depazhment's address,telephone-and fax number:: The Co' monwedth of Mmac =tts Btpartm mt of ladustd4 Aceze eats ' Off!"of Imvesdgations 600 wawnattori Street B-6ston,M4 02111 • . TO #617-727-400 ei t 406 or 1- '7-MASSAFE Fax#617-727-7749 Revised I1-22-06 WWW.Mam8ov/did 1 V T I u V a J./641 ii1.7 L,W& W Regulatory Services [, UWS asLE. - Thomas F.Geller,Director s6g9 ?0� Building Division sec a+� • Tom.Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 ww mtown.b arnstabl e.ma.us Tice: 508-862-4038 Fax: 508-790-6230 Permit no. Date, w 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: Estimated Cost Address of Work:. � Q1u'1'� Owner's Name: 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: pyyNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE' ACCESS TO THE ARBITRATION PROGRAM OR GUARANTYFUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: L40 Date Contractor Signature RegistrationNo. OR Date Owner's Signature Q..wpMes.for=;homeaffi day Rev: 060606 r R.of � � � A ! will �20 NIB y. , B� x�awQ> TAW- s pry w a a } am � . not a adi, w az r B Y" s . now ¢ . 5r MAC I r pq Jv rill c r s Nov d r 9 a✓i i xx�VERB Page 7 of 7 CAPIZZI HOME IMPROVEMENT INC. SPECIFICATIONS AND ESTIMATES STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT OWN THE PROPERTY LOCATED AT6 IN C,e� "v;��° MASSACHUSETTS. I HAVE AUTHORIZED CAPIZZI HOME IMPROVEMENT TO ACT AS MY AGENT TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. I GIVE MY PERMISSION TO LESSEE TO APPLY FOR A BUILDING PERMIT IN A CORD CE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. ♦ SIGNATURE OF OWNER(S): OWNER'S ADDRESS: 6 OWNER'S TELEPHONE: S� 77 S 7 LESSEE'S SIGNATURE: LESSEE'S ADDRESS: LESSEE'S TELEPHONE: y r)� APLLICANT'S SIGNATURE: APPLICANT'S ADDRESS: 16 Newtown Rd. Cotuit MA 02635, APPLICANT'S TELEPHONE: 508-428-9518 RESPONSIBLE OFFICER: RESPONSIBLE OFFICER ADDRESS: RESPONSIBLE OFFICER TELEPHONE: TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION T Map rt Parcel 4-A _ Permit# 39./0- T bea+tb-Bivis►ar� - � Date Issu d n T Fee Tax Collect r= SKI�A v C1/gk Treasurer -1 0- -W�-0ept• Date Definitive Plan Approved by Planning Board F -- EH PfesewatneiVlml j F Project Street Address q(P- kd . t t,-I Village cl�� v� � " -� • << ' " Owner ffiM61`(� �}><1"Ll3YLf � Address U,13 d )('l3 7 ahtils aq Telephone 'Permit Request S l ►/�P� �e�D� i r► 5a WZ A-A e&ae_h PO),"a,54i,--Icl(544g, Square feet: 1st floor:existing proposed 2nd floor: existing proposed Total new Estimated Project Cost Zoning District Flood Plain Groundwater Overlay Construction Type (��1J - Lot Size Grandfathered: ❑Yes .If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Q Age of Existing Structure Historic House: ❑Yes kNo On Old King's Highway: ❑Yes 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 - -AO Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing. -New Existing wood/coal stove: ❑Yes, ❑No .Q Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size XIC Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization 0 Appeal# Recorded❑ Commercial ❑Yes XNo If yes,site plan review# Current Use Proposed Use " BUILDER INFORMATION Name_ Owl ZZi. HDTe j �Pe& Telephone Number oZ 9 Address License# C6 auo/ /I /���� �� Home Improvement Contractor# U ?qP Worker's Compensation# w C 5'9a 97 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS.PROJECT WILL BE TAKEN TO SIGNATURE �— -DATE._ r FOR OFFICIAL USE ONLY `k PERMIT NO �. r DATE ISSUED p _. _ i � _ vF _. -� - �' �_ • '._ � MAP/PARCEL NO. ADDRESS s{ VILLAGE OWNER - DATE OF INSPECTIO$tw FOUNDATION a . FRAME INSULATION FIREPLACE '" •" i f, _' ELECTRICAL: ROUGH FINAL - PLUMBING: ROUGH FINAL GAS: ROUGH FINAL ' FINAL BUILDING DATE CLOSED OUT f 4 ASSOCIATION PLAN NO. Barnstable arns : . _ The Town of B . Mg Department of Health Safety and Environmental Services 0196 Building Division Ec LA 367 Main Street, Hyannis MA 02601 Ralph Crossen Office: 508-790-622.7 Building Commissioner Fax: 508-790-6730 For office use only Permit no. , Date AFFIDAVIT HOME 1MPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization, r construction of an addition to any pre-existing conversion, improvement, removal, demolition, o 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: 5 r��u � G' Est.Cost ± �_Aa Address of Work: � w Owner's Name a Date of Permit 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 APPLIRATION PROGRAM OR GUARANTY FUND UNDER MGL HOME IMPROVEMENT WORK DO O 142A� ACCESS TO THE ARBITRATI SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: o ` Contractor Name Registration No. Date - OR Ya �7e Lazu�rzanu�etz`C� a/ lhr�rc�u�eCC� �y.. NENT ;---. S ? acCr:::2d To .3 �\ ✓�t¢�aomrnox�uea�i o�./uaaaac%r��e!!a HOME IMPROVEMENT CONTRACTOR xdTHOMA-3 CAP':_ii Registration 100740 6 NEf;TOIJN Rr Type - PRIVATE CORPORATION Expiration 06/23/00 —- CAPIZZI HOME IMPROVEMENT, INC as Capizzi, Sr. ADMINISTRATOR 1 45 Newton Rd. Cotuit MA 02635 - — `- ��ze Vaax.�rrtizuuea�� of-lra::jack jee7<; DEPARTNENT OF PUBLIC SAFETY CONSTRUCTION SUPERVISOR LICENSE Number: Expires: t Restri .ted ?01 PP THOMAS X. tAPIZ'ZI JR - -u 280 PERCIVAL OR W BARNSTABLE, MA 62668 1. ..�i' ✓1e �anr»ranu�ealr~�. o/�-l�dn�u�e%Y' DEPART.►.ENT OF PUBLIC SAFET" s iONSTRUCT:ON SUPERi,rM LICENSE 10 Number: :x0ires: Restrict:d To: d8 J FREOERICX V RASCti 11i 06a BOURNE RO PLYMOUTH, MA 8236P „r r -.= The Commonwealth of Massachusetts Department of Industrial Accidents OlJlce oll"s918980S .600 Washington Street Boston,Mass 01111 Workers' Compensation Insurance davit ' ,M... % name: s f/ Qd location: �t �Q/1/!Yl f/ city phone p �7S 1s 7 ❑ I am a liomeowria performing all work myself. ❑ 1 am a sole provnetor and have no one workiniin any capacity ----------------- I am an employer providing workers'compensation for my employees working on this job. eomponv name: Ny/�,/ /�SmE =Iw*AQV0s Nf"1" address: /t(Cte17Z3/11A/ i . city: eO ZU l l- . phone Insurance co. oiiCV# 4V SJU(04211 ❑ I am a sole proprietor,general contractor, or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: company name. address. dtv: phone#. ;:... insurance co. .. • /i/.�2:Y/////////!////0.6Ga/i///,G%G%//,/,u✓.11�u«i�ir//,lGi%///////%///////i///////////.(/�/////!/,%////////!////////// ///,�/ '%/; company name: address" nserance co. :::.::::»:•.> «.::.. .. :.olicy ....... s�1 !� AYiB%/ %//%/�%//� /%// / Failure to secure coverage as required under Section 25A of MGL 152 an lead to the imposition of criminal penalties of a fine up to SI300.00 sndfor one years'Imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a tine of 3100.00 a day atainst me. I understand that s copy of this statement may be forwarded to the Office of Investigations of the DU for coverage vedIIeation. I do hereby terrify undo the pains anddppenak*es perjury that the information provided above it tru:and eorred Signature/—�--g _ !/' _ Date Print name rR Ed Fluty- V. Rti S C HJ�l Phone f 1 g- Cortluo-n- y do not writs in this area to be completed by city or town of>lcial pertndt/nceme 0 ❑Building Department __-- _.__ ❑Ilcestsia=Board ediate rn b used -.- —_- ---_.- -- -- ---- - - -------Poore req ❑Sdeconen s OtfiuOHealth Department • phone ft; OOther (Rvuea 9,95 PIA) AsWssor's office (1st floor):-' 1 • As map and lot number 14 J`• Se `aSYSIM B , rd of Health (3rd floor)* ft�Tk..b Se age Permit number. A Engineering Department (3rd floor) 7r o r63 House number '.... . :.l��P. . x,, y a Definitive Plan App�roved'by Planning Bo W t _____ __________ _ ___19 �� �ir� e x �� gyp, ----- • .ULATi()iqS 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 1 T�i/(T�/l� i TYPE OF CONSTRUCTION Lr/1J6D. ................ ......................................................... . 19 ._ TO THE INSPECTOR OF. BUILDINGS: I The undersigned �yhereby applies for a.]�permit according..tto'.the following information,: , Location .. ........FA-aW...f..1.444. ?. ....:ul/ `�.�....f,h �tr{+f/-�. a �........ .. ........ Proposed Use ................ta....!.D.... � ... ......:...................:;...... Zoning• District ! ...Fire District ....... .................... 'Name of Owner �1(,l MTh lL�. 4n �:�?iGl ..�..... lt:.......:.. Address .: ..... ......f1...........................�.... Name of Builder . .........Address . ..... .t.�?/: . . .:. �. .. , Nameof Architect. .................. Address ...:.............;....................................... . .................,................................................. A r�i5..:......!.T.! f1.g.E t�.`r.. Number`of. Rooms .......Dot.. .P............. .............Foundation ............. Exlei for .......S.�u r t-t�L S....... .................'Roofing (a}1.i..-?..1' ?a. '.. 1�/r�-1G....e� Floors . ........ .:............... ........Interior ?.I........i...?.�.i..0..`...c.s....,............._................................ Heating ..................Plumbing .......... �k1S l ........ .... Fireplace ..... .......... :..... Approximate Cost ..• -7Z Area. .............................. Diagram of Lot and Building. with Dimensions Fee .. .... .. ....... • lip J 1C `rY J ,o Lor. OCCUPANCY PERMITS' REQUIRED FOR NEW DWELLINGS CL I hereby agree=to conform to 'all the Rules and Regulations of the Town of Barnstable regardi g the above construction. Name .... .. . Construction Supervisor's License � PHILBRICK, HAROLD No 32353 Permit for .,Build Addition ' Sinc[le.•family Dwelling Location -4.6 Farm Hill Road ..p..(�.j p `Y ................: r.....J........ ....... ............... r • ~ +Cw.s J ., - _ y ' Owner :.,Harold Philbrick .' .. . ............................ ........ ' Frame Type of Construction - , ......................... .......... ........................... ....... Plot .................. ...... tot `w-T _ . .October 14� Permit Gr_anted ........................................19 Date of Inspection .......... .......19 •-, xDate Completed ............................ .19 � t 4 - - - ': -...�. .. • ..da_J`r—�;;:d.-.:�.. .•.•.}..r'2�-T"f._..�+,ft t.....��.+': x�.tt#w..::&, •,r»;riiw.' ^fJ.7+......t.a:.Tar.4�•: . Hs-, t.� „ ._ ^+i Assessor's office (1st floor): : _ t Assessor's map and lot number Q ` ^134rd of Health (3rd floor): Sewage Permit number ................ ........ ...,..... ...................... i BAHd9TGDLE, Engineering Department (3rd floor): rasa if r! O 1639• �0 House number ......... ... .�....................... '°� n• 0 ypY Definitive Plan Approved by Planning Board ________________________________19________ - APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00'-2:00 P.M. only TOWN OF BARNS:TABLE y.. BUILDING INSPECTOR APPLICATION FOR PERMIT TO ��57 Tl,uc i mp t '`�t< ( b !r•5 t P E tc c r 1...........'........ ......... ............................................................. TYPE OF CONSTRUCTION "CR, �, 7;mr'-/ f........... ................................................................................................ .....'... ............19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location e' Fi4�txl Pi Lc V. P$1' t�i�r r<•.' .............................................. ........................................................./.................................. >rslt� Frt�cE ProposedUse ............................................................................................................................................................................. ZoningDistrict ........ .:......................................................Fire District .............................................................................. Name of Owner .........A. i•ol.. ...1 ............Address Lo <( ►r-r �1 i�c �s�• t `r�(4�r,r�}�^:. . ................................................................................. ... Name of Builder ...�.� .. l�. r!i?•..l. stld�a t(...............Address .. "g'. ... =a1'.:./�S (� .:.,,.... .c�!7 Ezi�VP[t ice....... Nameof Architect ......'......................................�......................Address .................................................................................... Number of Rooms f`��� �- ?` 5 T-i , �................................................Foundation ................. ............................................................. Exterior ....... tl rtlGL:83...................................................Roofing ....'As I Pf�. f`� ! P �!-J /A e r- ................ ......................................................... Floors ��� � ............I...............................:.................Interior .......... ......................................................................... Heating ............ y ......................................................Plumbing Fireplace .....Approximate Cost ) >I � z. i � Area ..r:...... ............................... f Diagram of Lot and Building with Dimensions Fee .................................. .tq � 44 N t J. C. T. OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS -C /(i5�•i I�I�L t�1 J_ I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable_regarding the above construction. �lcr�, / < Name r f' .. Construction Supervisor's License ....d ... $ )� ........................ PHILBRT,CK, HAROLD A=247-079 ...413.5 3. Permit for ...B.vild..Ac ' tj.Qn No ....... ..... ........ ......Sin le...F.dMily-Dwellix1g. ......... Location ..4.6...F.arxo..Hill....Ro.ad Ce h 4er-,j i tl ....................vqohl!5!�� .. ...... ..................... ........ Owner ....Harold Philbrick .............................................................. Type of Construction TKATe............................. ............................................................................... Plot ............................ Lot ................................ Permit Granted ...October....1.4.f........19 88 Date of Inspection ....................................19 Date Completed ......................................19 L.� ` Assessor's map and lot number ....�'j`..<.:.`! ! , - faC�'d�j " / � l t rA Sewage Permit number" HETD�y TOWN OF BARNSTABLE S • i 'BAWSTULE. i "6 9. BUILDING INSPECTOR n M a APPLICATION FOR PERMIT TO .... t t j. r?l TYPE OF CONSTRUCTION ......... ........... n€ tnry............................................................... nTrc+mhnr TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ........ r?....'s 5.2I1Yt :�.....:On-A......`36.t Tf,7;.'T1i1.1;R.nort.................................................................................. Proposed Use .......D'r i.r.-, n,,vv.' .................................................................... ........................ Zoning District .......... �T•...........................................................Fire District ......:........ Name of Owner 'LTO�C�I r' . �,' [_. ?Z'? �.................Address ..�� ... n.p.orn ill Road., ad.,...................................... ` St�l`Tj: Name of Builder C r]-....T riP_n 01onfl�?�'....................Address ..f^.-.r's...ji-ate"r "t. I..Y�rs�� ........ Name of Architect ...f ...I....................................................Address ...............................�- ..... Number of Rooms ... ??' Foundation C Y2r P era r 'J.... ' t?:� T.LF* ...................... ....:..:................ .......................... Exierior .. :lncei3_n.xla ...Roofing Floors yi -nI Interior �� 'r!:f:" : '�` ................................................................................ .................................................................. Heating . s�.� i'� ^�'tri hnt: r�n ...........................Plumbing .............rinsTn.......................................................... ........................................................ nono 5,t 67.04 Fireplace ..................................................................................Approximate. Cost .................................................................... Definitive Plan Approved by Planning Board ________________________________19________. Area ...'. � ..:`? '... ................... UO Diagram of Lot and Building with Dimensions Fee r.................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH / L GO rA am H,% ez A i`► I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ...................... _.:: . . ................................ Philbrick, Harold F. Now 1 4�4 permit for .,, add to single .................. family dwelling .................''.(...'........................................................... `�tY4T Farm Hill Road Location ............��... ..........,...l C>................... 1 t Owner Harold F. Philbrick .................................................................. Type of Construction frame .......................................... ................................................................................ Plot ............................ Lot ................................ Permit Granted ....... November .. 74 Date of Inspection ....................................19 Date Completed ......................................19 .• PERMIT REFUSED ............................................................. 19 ............................................................................... ............................................................................... ............................................................................... ............................................................................... Approved ................................................ 19 f ............................................................................... ...............I............................................................. Assessor's map and lot number ....2.47-.7.9.....:................: e J 14, STALLED IN C014R Sewage Permit number �...GC ,R �» ,. _ ,T � 00 a . y�F THE TO�y TOWN OF . BAR LE B9SHgTdDLE, i " 9 •�� DUI-LDING INSPECTOR _. O�G MPY Ar• APPLICATION FOR PERMIT TO .....Col`is:GY'uat....one...a.daition...t0...QAi.,q:t-1X1 ;... W!P11iAg..... ' TYPE OF CONSTRUCTION ........ ...........OOd fYa121@ Q=...at.RX7............................................................... ..... ... .......7..1gQ.v mb.(P.:..............19..7.4 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ........z3... '' ??. ...R4ad•.,... Est,.Byannisport..................................................................................... ProposedUse .....iT1iAg..a;reA..................................................................�....`................:.................................................. Zoning District FM............................................................Fire District ... -.. 11�kAA.... 4.Z.... Name of Owner . 'old„F, Ph....................................k Address .. .'>.. .fir?hill„Rogd,,�, .��,-I,yaYu�is oY't Name of Builder Carl.„Bran..0ndx....................Address .2.5.8.. tr, St, Iyanns, .Tass. Name of Architect ...P�'` I ....................................................Address ..........................S Tt? ................................................ ....................Foundation Coac.. .... 4,... rs...and„footing.)..... Number of Rooms ...0�?:�.................................. ...X �.. Exierior .................................................Roofing .AQj). aj.t:..Aher?g. ........................................... Floors 11P.1,�:tll...:.......... .....I,..........1= ..............................................Interior dryWalle.a............................................................ Heating gas..fo.xce.d....hot...air.................................Plumbing .............l: 0XM.......................................................... Fireplace none .........................................Approximate Cost ....&�`C� Definitive Plan Approved by Planning Board ________________________________19________. Area ....1.32...a.q..ft............... C3 d I Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH ' . Ny%._... 00 izA I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .... .:.b!`1►rs.r.. ............................... Philbrick, Harold 'F 1747r3 add to single No ................. Permit for .................................... family dwe 1 1 ing ............. ..................................................... Location q t2-3-Farm Hill Road ...... Cet"t...... ............................................... Owner. Harold F. Philbrick .................................................................. Type of Construction ...........frame.................... ........... . ................................................................................ Plot ............................ Lot ................................ Permit Granted .....November...a............19 74 Date of Inspection ..... .........19 /*Date Completed PERMIT REFUSED ........................................................ ........ 19 4 J ............................................................................... ................................................................................ ........................................................i...................... . ................................................................................ Approved 19 top ........................................................ ......................