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Town of Barnstable
n a
A Post This Card So That it is Visible From the Street Approved`glans Must beRetamed,onlob and this Ca'rtl Must"'be Kept hed
�+ Posted Until°°Final Inspection Has Been Made. � � � F � s� •
s61q
Where;a Certificate of Occupancy is Required�suchsBuildmg sliall'Not be Occupied:until aFinal Inspection has been made
Reg istrRt ion
Registration Number: B-20-244 Applicant Name: CAIN, PETER G N Approvals.
Date issued: 02/10/2020 Current Use: Structure
Permit Type: Building-Shed-Residential-200 sf and under Expiration Date: 08/10/2020 Foundation:
Location: 530 OLD CRAIGVILLE ROAD,CENTERVILLE Map/Lot: 226-107 Zoning District: RB Sheathing:
Owner on Record: CAIN, PETER G Contractor NameHOMEOWNER IS APPLICANT Framing: 1
Address: - 50 SHERRICK AVENUE `Contracto`r License: EXEMPT 2
HOLBROOK, MA 02343 ry Est Project Cost: $0.00 Chimney:
Description: 8X14SHED _ Permit Fee: $35.00
Insulation:
Fee Paid:. $35.00
Project Review Req: SHED TO COMPLY WITH SETBACK REQUIREMENTS. 4 s Final:.
Date. 2/10/2020
d¢r Plumbing/Gas
Rough Plumbing:
` Building Official Final Plumbing:
This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance.
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 and codes.
a 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 Officials are provided on this permit.
Minimum of Five Call Inspections Required for All Construction Work: . Service;
1.Foundation or Footing
Rough:
2.Sheathing inspection
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 Final:
G�
Town of Barnstable
�r►�z� s�T
°FINE ram, Building Department Services
s "
°s Brian Florence,CBO
BARNSTAaLE. » Building Commissioner
v MASS.
039. �a+� 200 Main Street, Hyannis,MA 02601
:www,;town.barnstable.ma.us
t
Office: 508-862-4038 Fax: 508-790-6230
PERMIT# YV FEE: $35.00
SCANNED
SHED REGISTRATION
RESIDENTIAL ONLY FEB 10 2020
200 square feet or less
s �
a c C
Location of shed(address) Village
6,� -4
roperty owner's name Telephone number
a
Size of Shed Map/Parcel#
E-Mail 62yg C,,'57 ®6L O/(�6rz,7
Signature Date
Hyannis Main Street Waterfront Historic District? NO
Old King's Highway Historic District Commission jurisdiction? (�
You must file with Old King's Highway 1
Conservation Commission(signature is requi _
Sign off hours for Conservation 8:00-9:30 �.iO-4.30
PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE
ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION
FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS.
THIS FORM MUST BE ACCOMPANIED BY A
PLOT PLAN
Q-forms-shedreg
REV:08/6/17
n Lege d
Parcels
' Town Boundary
� �,� ��� " Railroad Tracks
e 1 Buildings
Approx.Building
2261€2001 �aIM Buildings
t s1
y •.` - 226156 Painted Lines
Parking Lots
1 Paved
Unpaved
J2 6t?1 ~� ~ � '� '� Driveways
w
Paved. I
� V
Unpaved
Roads
r ... , rf �. 0 Paved Road
EI Unpaved Road
" Bridge ,
Paved Median _
i 01� Streams
Marsh
2261114 c XZ2 ,� Water Bodies
545 yam``
¢. SCANNED
G
2260 s � f f FEB 10 2020
657 J 22.6106
�i ,. 1'7'
226108
#544 x
41
.246022
Map printed on: 1/17/2020 This map is for illustration purposes only.It is not Parcel lines shown on this map are only graphic Town of Barnstable GIS Unit
adequate for legal boundary determination or representations of Assessor's tax parcels.They are
Feet regulatory interpretation.This map does not represent not true property boundaries and do not represent 367 Main Street,Hyannis,MA 026oi
O 42 83 an on-the-ground survey.It may be generalized,may not accurate relationships to physical objects on the map 508-862-4624
reflect current conditions,and may contain such as building locations.
Approx.Scale: 1 inch= 42 feet cartographic errors or omissions. gis@town.barmtable.ma.us
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map 10® Application
Health Division Date Issued
Conservation Division Application Fepv
Planning Dept. Permit Fees
E Date Definitive Plan Approved by Planning Board
Historic - OKH _ Preservation / Hyannis
Project Street Address 0 OUD r _-E
Village
Owner Address ���a OLD it �
Telephone 30 --
.Permit Request Of4
Z x
C)
Square feet: 1 st floor: existing proposed3 2nd floor: existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuation (t Construction Typed e>
Lot Size l DO x 1 00 Grandfathered: 2(Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family 20" Two Family ❑ Multi-Family (# units)
Age of Existing Structure '1" Historic House: ❑Yes Cho On Old King's Highway: ❑Yes ❑ No
Basement Type: Full ❑ Crawl ❑Walkout ❑ Other (off HT' _=
o
Basement Finished Area(sq.ft.) Basement Unfinished Area (s+ 'A)
Number of Baths: Full: existing_ new Half: existing
Number of Bedrooms: 2- existing onew
Total Room Count (not including baths): existing 14 new 'E�l First Floor Room Count
Heat Type and Fuel: Cf GaS ❑Oil ❑ Electric ❑ Other co
Central Air: ❑Yes 20�o Fireplaces: Existing ✓ New r"' 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
APPLICANT INFORMATION
(BUILDER OR HOMEOWNER)
Name �o�``y'!'"� Telephone Number bD 7 4C
Address i AM LEY License #
Mh" 0245Z- Home Improvement Contractor# (71 7020
Email, Worker's Compensation # '
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE `�v\ �l/`' DATE
I'
FOR OFFICIAL USE ONLY
APPLICATION#
k
DfTE ISSUED
`t MAP/PARCEL NO.
jz '
ADDRESS VILLAGE, i Y
p -
OWNER
' DATE OF INSPECTION:
.. :Li_FOUNDATION 27l
FRAME
INSULATIOND!
FIREPLACE
ELECTRICAL: ROUGH :t FINAL
s PLUMBING: ROUGH FINAL _
GAS: ROUGH FINAL'
FINAL BUILDIN 11 C ZJ
DATE CLOSED OUT ;
:i ASSOCIATION PLAN NO.
The Commonwealth of Massachusetts
Department of Industrial Accidents �---�--- -
a '• . .
, Office of Investigations '
600 Washington Street
Boston,MA 02111
www.m_ass,eov/dia. .,
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information (( Please Print Legibly
Name(Business/Organization/Individual):
Address: 45 'fit ooj)tz /=
City/State/Zip: Phone
i
Are you an employer?Check the appropriate box: Type of project(required):
1.�am a employer with (� 4.y I am a general contractor and 1
employees(full and/or part-time).* `�t have hired the sub-contractors 6. ❑New construction l
2.❑ I am a sole proprietor or partner , listed on the attached sheet. 7. 0 Remodeling
ship and have no employees These sub-contractors have g. Demolition
working for me in any capacity. ' employees and have workers 9. uildin addition
[No workers' comp. insurance. comp.insurance.1 g
required.] 5, We are a corporation and its y , 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their l LE] Plumbing repairs or additions r
myself. [No workers' comp. right of exemption per MGL 121-1 Roof repairs
insurance required.] t c. 152,§1(4),and we have no
employees. workers' l;f Other
ees. o '
. . P Y � E w:
comp:insurance required.]
*Any applicant that checks box#1 must also till 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,
1 am an employer that is providing workers'coinpeniation insurance for my employee& Below is the policy and job site
information. ^
i
Insurance Company Name: J� WW C-1a;0
Policy#or Self:ins.Lic.#: ��� 0 40/o(n t Z�1l Expiration Date:
Job Site Address: .G �� � � City/State/Zip:ell6k1�1(LLJeF77
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 certi under the pains andpenalties ofper'ury that the information provided above is true and correct
4. �J
Signature: Av + Date: 3 '� 3
Phone (e l
Official use only. -Do not write in this area,to be completed by city or town ofciaL
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 co ora•ion or other le al end --
y ,p p, rp g ty, or any two or more
of the foregoing engaged\m a joint enterprise,and including the legal repres ntatives of a deceased employer,or the
i receiver or trustee of an individual;partnership,association or other legal en'•ty,employing employees. However the
owner of a dwelling house having not more than three apartments and`who r 'ides therein,or the occupant of the
dwelling house of another who e\mploys persons to do maintenance,construc `on or repair work on such dwelling house
or on the grounds or building appau•tenant thereto shall not because'of such a 'ployment be deemed to bean employer."
MGL chapter 152, §25C(6)also states�t at every state or local licensing a ;ency shall withholdthe issuance or
renewal of a license or permit t e p o operate a business or to construct boil ergs inthe commonwealth for any
applicant who has not produced acceptable evidence of compliance wit the insurance coverage required"
Additionally,MGL chapter 152,§25C(7)states"Neither the commonweal nor any of its political subdivisions shall "
enter into any contract for the performance o ublic work until acceptabl evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting auth
Applicants \
Please fill out the workers' compensation affidavit co letely,by c cking the boxes that apply to your situation and, if
necessary,supply sub-contractors)name(s),addresses) rid phone umber(s)along with their certificate(s)of
insurance. Limited Liability Companies(LLC)or Limite iabili Partnerships(LLP)with no employees other than the
members or partners,are not required to carry workers' coin ensa ion insurance: If an LLC or LLP does have
employees,a policy is required'. Be advised that this affidavit be submitted.to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be.Sur to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permi or\license is being requested,not the Department of
Industrial Accidents. Should you have any-.questions regarding e�w 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 a ro riate line.
City or Town Officials
Please be sure that the affidavit is complete-and pr'mi ted legi y. The Departm tit has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of vestigations has t contact you regarding the applicant.
Please be sure to fill in the permit/license number which wi be used as a refer e ce number.'In addition,an applicant
that must submit multiple,permit/license applications in an given year,need only ubmit one affidavit indicating current
policy information`(if necessary)and under"Job Site Add' ss"the applicant sloul write"all locations in` (city or
town)."A copy of the affidavit that has been officially sta ped or marked by the ci or town may be provided to the
applicant as proof that a valid affidavit is on file for f itur permits or licenses. A ne affidavit must be filled out each
year. Where a home owner or citizen is obtaining a licens or permit not related to an business or commercial venture
(i.e. a dog license or permit to burn leaves etc.)said pers is NOT required to complet this affidavit.
The Office of Investigations would like to thank you in a vance for your cooperation an should you have any questions,
please do not hesitate to give us a call. - x
The'Department's address;telephone and fax number:
The Commonw lth of Massachuse -
- Department of dustrial ents
Office of I ves ations
600 Washington Street
Boston,MA 02111
Tel. #617-727-4900 ext 406 or 1-877-MASSAFE
Fax#617-727-7749
Revised 4-24-07 -
www.mass.gov/,dia .
-
I
.w
TOWN Or- BARNSTA.BLE
CERTIFICATE
^p /►bra �/! �E(� p�► /'►CUNIOCON•01 KESTANO
A�R®� CERTIFICATE t�.i F -11ABIL11TI 11 �IVY7UfC/ NCE DA76IM.UDDff"
7/8/2013
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLYAND 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(he certificate holder Is an ADDITiONAL�NgVRED, he;policy(les)must be endorsed. if SUBROGATION IS WAIVED,subject to
Ilia, terms and conditions of the policy,certain poilcios tttayr CIAI =aneiMorsoment. A statement on this certificate does not confer rights to the
cortlffcate holder In Ilou of such o_ndorselhent s. 7p
PRODUCER C E• 7
3 R ors&Gray Insurance Agency,Inc, OIL.
No:�
434 Rte 134
South Demnls,MA 02600 b�Ea
111SURERS AFFORDINOCOVERACE LAIC®
INSURERA:AsSOClated Employers Insurance CO.
INSURED r INSURERS:
Union COnSlructlen Inc INSURER C:
C/O CA$ - INSURER:
50 Tonner St
Lowell,MA 01852 INSURER R
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TOTHE INSURED NAMED ABOVE FOR THE POLICY PERIOD i
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 TOALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.L[EdITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 1
LTR TYPEOFIIISURAI(CE _,-,.,..•)USE LI YNUMBER 1. D POLICYVFF 0. P LI1dRS - 1
OERERALLIABILITY EACH OCCURRENCE $
COMN.ERCIALGEh'ERAI.LUIalLTIY PREMISESrim o rt� S
CIAIMS•VIADE D OCCUR Lie 0EXP(AAy wePerson) s _
PERSOHAL6ADVINIURY 3
_• GENEJiAI.AGGREWE $
GEHLAGGREGATEUI.Ur APPLIES PIER; PRODUCTS•COURIOPAGO 3
POLICY 0 LOC 3
I AUTOMOBILELU1etLTTY Eaa S
ANYAUTO EO � BODILYLWURY(Pe(person) $
AUTOSm AFJTOS O 8OOILYI4IURY(PetWddenl) 5
HIREDAUTOS AU(SYTEO 0 D E $
S
UMORELLALIAB OCCI . - EACHOCCUIUtEr:CE $
EXCESSLU1a CLAIMS-MADE AGGREGATE S
Di I I RETE)nii S
WORKERSCOMPEtISATION - X V AT
AND EMPLOYERS'UABILITY Y1H �R- w
A ANY PROPRIETOWPARTNERIMCUTiVE 005004061012012 710/2013 71612014 E.L.EACHACCICENT $ 600,00
(M n0IRWE11NH)EXCLUDED? FN NIA
Nyyes desutbound� E.LDISE -EAUTLOYE 0
S 600,0 1
DES�rtlPTIONOFOPERATIONStgJ m E.L.DISEASE•POUCYUI.IIr S 600100
DESCRIPTIOHOFOPERATIOHS/LOCAIKINS/VEHICLES(AltachACORDtei,AddiUonetRomrks$ch4dute.Ilmofospacoisroqulredl -
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CA14CELLED BEFORE
Evidence of insurance THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ?�
ACCORDANCE WITH THE POLICY PROVISIONS.
-. - AUTHORIZED REPRESERTATIVE - -
01088.2010 ACORD CORPORATION. All rights reserved.
ACORD 26(2010105) Tito ACORD name and logo are registered Enarks of ACORD
Town of Barnstable
Regulatory Services
Thomas F.Geiler,Director
Nua Building Division
Tom Perry,Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 j Fax: 508-790-6230
' f
Property Owner Must
Complete and Sign This Section
If Using A Builder
J r
I, CAI tit , as Owner of the subject property
hereby authorize C-O fASAiJJU to act on my behalf,
in all matters relative to work authorized-by this building permit
53o DD �G-�I Wtt
(Address of Job)
**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.
-6, "L.
ignature of Owner S' tore of Applicant
1 •
Print Name Print Name
Date
QTORM&OVA RPERMESTONPooLS 6/20n
Town of Barnstable
Regulatory Services
' KAM ' Thomas F.Geller,Director
y6.1 Building Division
Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.ns
Office: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EKE ON
Please Print
DATE:
JOB LOCATION: \
number sheet village
! /"IOMEOWNER": i
name home phone# work phone#
CURRENT MAILING ADDRESS: !'
city/town state zip code
The current exemption for"homeowners"was ded to include o4ner-occupied dwellings of six units or less and to allow
homeowners to engage an individual for hire wh does not possess a license,provided that the owner acts as supervisor.
DEFINMON 4 HOMEOWNER
Person(s)who owns a parcel of land on which he/s a resides or' tends to reside,on which there is,or is intended to be, a one or two-
f nnily dwelling,attached or detached structures ace ssory to suc use and/or farm structures. A person who constructs more than one
home in a two=year period shall not be considered a meowner Such"homeowner"shall submit to the Building Official on a form
acceptable to the Building Official,that he/she shall b res onS' le for all such work Rerformed under the building permit. (Section
109.1.1)
The undersigned"homeowner"assumes responsibility f ' co pliance with the State Building Code and other applicable codes,
bylaws,rules and regulations.
The undersigned"homeowner"certifies that he/she unde ds the Town of Barnstable Building Department minimum inspection
procedures and requirements and that he/she will comply said procedures and requirements.
Signature of Homeowner .
Approval of Building Official
Note: Three-family dwellings containing 35, 00 cubic feet o arger will be required to comply with the State 13uiilding.Code
Section 127.0 Construction Control.
OMEOWNER'S EXE ON
The Code states that: "Any homeowners rforming work for hich a building permit is required shall be exempt
from the provisions of this section(Section 109.1.1-Licensing of constru lion Supervisors);provided that if the homeowner
engages a person(s)for hire to do such work,that uch Homeowner shall t as supervisor."
L
Many homeowners who use this exempti are unaware that they a assuming the responsibilities of a supervisor
(see Appendix Q,Rules&Regulations forLicens' g Construction Superviso Section 2.15) This-lack of awareness often
results in serious problems,particularly when the omeowner hires unlicense ersons. In this case,our Board cannot
proceed against the unlicensed person as it would 'th a licensed Supervisor. a homeowner acting as Supervisor is r
ultimately responsible.
To ensure that the homeowner is fully aw a of his/her responsibilities, any communities require,as part of the
permit application,that the homeowner certify that she understands the respo sibilities of a Supervisor. On the last page
of this issue is a form currently used by several towns. You may care t amend an adopt such a form/certification for use in
your community.
C:\Users\decoU&\AppData\Local\M=soft\Wmdows\Temponuy Intemet Fi1es\Content0utlook\Q N1FJtTRFSS.doe
Revised 053012
`1
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., Office oCCousumcr Affairs&Busikcss Hcguia.tiun
p� _ ME IMPROVEM ENT CONTRACTOR
istration: 177M Type:
�piration:.;,.Tf.'14120.9.6. Carporafion
UNION CONSTRUCTION;
_ C7.
JOSEPH CONSALVQ;
45 WOODLEY AVE.
WESTROXBURY,MA 02932 L]udersecre�ry
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Massachusetts -Department of Public Safety
Board of Building Regulations and Standards
Construction Supervisor
License: CS-027012
JOSEPH M CONSkLVO
45 WOODLEY AVE
W ROXBURY MA 02132
P1 Expiration
Commissioner 10/19/2015
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ci rj GRAIGV11-L ' POAD
- - IEGL JR. A REGISTERED LAND SURVEYOR, DO HEREBY CERTIFY TilAl THE ABOVE MORTGAGE INSPECTION
IVSTEF'Hl;N J • S 1N CONNECTION WI Tit A NEW MORTGAGE AND IS NOT INTENDED
ING
P101 PLAN WAS .l'R.EPAAED FOR COIhMONFrEALTI� 0 CBE USED
0 REPRESENTED TO BE A LAND OR PROPERTY LiNC ..SURVEY, NO CORNERS W[AE SEi,HE LAHO DW[A OR OCCUPANT.
ES1[1OL11SHN01
R ,n e , , y
FCHCE,. N.EDGE OR BUhLDINb.``C'iJttS. NO R:CrO.a�,D1, 11, I� :CX.ENbE,n HEREIN 10
INTENDED TO BE RECORDED.
i
p� STEPHEN 1 ��.
SIEOL, IR• i LEGAL OCSCRJI'iION;�RECQ�AE TN
Alert I CAN 9t pvEY I t, c DNPAW 10365 Q LLB�--=�--
of Boston, Inc. -
7ar� 2 -Lp-
1J5 Beaver Str cet �4 SUR���IQ3 ADDRESS:
Waltham, KA 02154 PURCIIASER:
(617) 899-0477
SUBJECT PROPLRIY 15
DATE `1- �= 9 — IIIE LOCATION OF flit DWELLING AS LOCAIED IN A FEOERAL INSURANCE
11TLE CO, SHOWN HEREON IS IN COMPLIANCE WITH ADMINISTRATION DESIGNATED
THE LOCAL APPLICAULE ZONING BY- FLOOD HAZARD AREA.
a IN EFFECT WHEN CONSTRUCT(D,
J.O.k (nQD�3 P1�1 - LAWS AS PER MAP .__go Q)g)�
�
WI]if_RESPECT 10 'IIOR1108IAL DIMENSIONAL PANEL' _Q-Q.90i __'DATE i9�&5
5
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OLD C RA I G
V I L L.E R D CENTERVI LLE, MA
N FA #1324
--� Architect .
-. - - Neshamkin French Architects, Inc.
S.Monument Square
Charlestown,MA 02129
-� - -
.�,-;� T* 617-242-7422
SMOKE DETECTORS REVIEWED.
LIU
T _E4;61�1DING DEFT. GATE
FIRE GEPAP.TMENT - DATE
BOTH SIGNATURES ARE REQUIRED FOR PE.RMO T!NG
- 530 OLD CRAIGVILLE RD - -
Drawing list -"
. � ,.,,, O �...e..�.�. ^^'"^•"°":' CS.1 COVER SHEET "o-�°'•." .
ARCHITECTURAL
EX-101 FLOOR PLANS _ f -
EX-400 ELEVATIONS ,, -
I� �..,�,�a..n �•�°� EX-300 SECTIONS
A-101 FLOOR PLANS a'
A-401 ELEVATIONS
A-DOOR AND WINDOW SHEDULE
M IMCTU MATEFIALS S-5-E ATE -
CS.1
FEBRUARY 19,2014
530
OLD CRAIGVILLE
RD
CENTERVILLE,MA
S
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xeame
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EXI5TING ROOF FLOOR PLAN I EXISTING FLOOR PLAN
FIRST AND ROOF
FLOOR PLAN
EXISTING SITUATION
' PERMIT SET
Ex-ioo
Sale t/ye c 1'-0„
530 .
OLD CRAIGVILLE
RD
CENTERVILLE,MA
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. .• PERMR SE7
LONGITUDINAL SECTION EX-3O'I
Sale: 1/4"=1W
530
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CENTERVILLE,MA
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1/4" I'-D' Sale: 1/4"_1•-0"
530
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530
r OLD CRAIGVILLE
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CENTERVILLE,MA
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Company Name Cape Cod Insulation Phone Number 508-775-1214
Applicator Name
Installation Date 8-6-14.
���, ��; �,�� •
lobsite Address 530 Old.Craigville Rd. Centerville Ma. A-Side Lot #'S
Permit Number B-Side Lot #'s \, A4��:
Walls 3„ 21 560
Atd c
t
t -
817-640-4900 • Info@Demilec.com • www.DemilecUSA.com
c8DEMILEC
E Town of Barnstable *Permit# '
Expires 6 montl s�om issue date
•U�_egulatOrySem. .ce3 .... Fee
snx
Tliomas:F.Geiler Director
_--• ... . _.._ . ......_: Building Division
Perry, Building Commissioner MAC
•200 Main-Street,. Hyannis,MA 02601•-
Office: 508-862-4038 TOWN OF BARNSTABi_
Fax: 508-790-6230
EXP iESS:PER1CnY'T I'I�LICA'Y'�ON =•-RESMENTIAL ONLY.
Not Valid without Red X-Press Imprint
,lap/parcel Number `o
:rd'rAess � 1OU1C� .. 6" ll U
Residential Value of Work_�JI • Minimum fee of$25.00 for work under$6000.00
owner's Name&Address 1 A,W emu,
Contractor's Name 1 �' Telephone Number
Home Improvement Contractor License#(if applicable) 4010
7Wtronacti Supervisor's License#(if applicable)orkman's Compensation Insurance
Check one:
❑ I am a sole proprietor
I am the Homeowner
I have Worker's Compensation-k=ance
Insurance Company Name �ly't !V U 1 UI 1 •
Workman's Comp.Policy#
Copy of Insurance Compliance Certificate'must be on file.
PermitReque (checkbox)
Re-roof(stripping old shingles) All construction debris will be taken to f , C
❑Re-roof(not sAking lj over existing layers of roof)
❑ Re-side
❑.Replacement Windows. U-Value (maximum.44) -
*Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
***Note: Property Owner must sign Property Owner Letter of Permission,
Home Improvement Contractors License is required. -
Signature Tnna
Q:Forrns:expmtrg
Revise063004
4
The Commonwealth of Massachusetts
=y
Department of Industrial Accidents
-- Office oflnvestigat/ons
- 600 Washington Street, e Floor
Boston,Mass. 02111
Workers'Compensation Insurance Affidavit: Building/Plumbing/Electrical Contractors
u. aiAn : lIe �;' le b'k hca o tin: s
name: ��dls Ga) oil"[ I
Ctza4address:
fV
city ct 1 ` y V' I state: zip: phone#
work site location(full address):
❑ I am a homeowner performing all work myself. Project Type: ❑New Construction❑Remodel
❑ am a sole ro rietor and have no one working in an ca acity. ❑Building Addition
I am an employer ovtdtng workers' compensation for my employees worktng on this lob _
r �n
� - v,.f � � �r�, r,<x •�mt'ke*�;.,caMa,�.�.H.- '§ �y.� ..� �' a � �'
nx k.. h,� :• .,h� yv'N4�'q. .J. t�t j' S ds; � v}' �i 3
tnsiirahceico: ., �, s, � a.<. a�. ,:�s,,,, .: o�l►c. ;#... 4
❑ 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
iiih
. n
coti9panv name. . `'
h
uisuranee.co. .... ,. .. ..... ..
co nyanv.naine.
a'ddcess..
c�tv nFione#..
insurance eo.. ri6c. .# .
tsar dd' alp e e.
Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or
one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a
copy of this statement maybe forwarded to the Office of Investigations of the DIA for coverage verification.
I do hereby certify under thepains and pens ties ofperjury that the information provided above is true and correct
I In
Signature UAo, Y f Date
Print name tGA Phone# '
official use only 'do not write in this area to be completed by city or town official
city or town: permit/license# []Building Department
❑Licensing Board
❑check if immediate response is required ❑Selectmen's Office
❑Health Department
contact person: phone#; ❑Other
(revised Sept.2003) -
Information and Instructions
Massachusetts Genera aws chapter 152 section 25 requires all e loyers to provide workers' compensation for their
employees. As quoted fro the"law", an employee is defined as e ery person in the service of another under any
contract of hire,express or im lied, oral or written.
An employer is defined as an indi 'dual,partnership,association,c orporation or other legal entity,or any two or more of
the foregoing engaged in a joint ent rise,and including the legal epresentatives of a deceased employer,or the receiver
or trustee of an individual,partnershi association or other legal ei tity,'employing employees. However the owner of a .
dwelling house having not more than t ee apartments and who res des therein,or the occupant of the dwelling house of
another who employs persons to do main enance,construction or r pair work on such dwelling house or on the grounds
or building appurtenant thereto shall not b ause of such employm nt be deemed to be an employer.
MGL chapter 152 section 25 also states that a ery state or local I censing agency shall withhold the issuance or
renewal of a license or permit to operate a b iness or to cons ruct buildings in the commonwealth for any
applicant who has not produced acceptable evi ence of comp ance with the insurance coverage required.
Additionally,neither the commonwealth nor any o 'ts political s bdivisions shall enter into any contract for the
performance of public work until acceptable evidence f compli ce with the insurance requirements of this chapter have
been presented to the contracting authority.
Applicants
Please fill in the workers' compensation affidavit completely,by ch king the box that applies to your situation. Please
supply company name, address and phone numbers along wit a certif to of insurance as all affidavits may be
submitted to the Department of Industrial Accidents for con ation of i urance coverage. Also be sure to sign and
date the affidavit. The affidavit should be returned to the c or town that e application for the permit or license is
being requested, not the Department of Industrial Accidents. Should you have y questions regarding the"law"or if
you are required to obtain a workers' compensation policy,p ease call the Dep nt at the number listed below.
to
0111
City or Towns
Please be sure that the affidavit is complete and printed legib y. The Department has provided space at the bottom of
the affidavit for you to fill out in the event the Office of Inve tigations has to contact you regardi the applicant. Please
be sure to fill in the permit/license number which will be use as a reference number. The affidavi may be returned to
ail or FAX unless other arrangements the Department by m h e been made.
The Office of Investigations would like to thank you in adva e for you cooperation and should you ha any questions,
please do not hesitate to give us a call.
IS
gir
The Department's address,telephone and fax number:
The Commonwealth f Massachusetts
Department of Indu rial Accidents
Office of Invest! ations
600 Washington Stre t,7`. Floor
Boston,Ma. 02
fax#: (617)727-7749
phone#: (617) 727-4900 ext. 406
CAPIZZI HOME IMPROVEMENT INC . �Aiti
SPECIFICATIONS AND ESTIMATES PAGE 6 OF 6 3�z�
STATE OF 14ASSACHUSETTS
LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT
I,
OWNTHE PROPERTY LOCATED AT
IN MASSACHUSETTS.
I HAVE AUTHORIZED CAPIZZI HOME IMPROVEMENT
TO ACT AS MY AGENT TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR,
THE MASSACHUSETTS STATE BUILDING CODE.
I GIVE MY PERMISSION TO
LESSEE TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE
MASSACHUSETTS STATE BUILDING CODE.
/y 1
SIGNATURE OF OWNER:
v-
OWNER'S ADDRESS:
OWNER'S TELEPHONE:
LESSEE'S SIGNATURE:
LESSEE'S ADDRESS:
LESSEE'S TELEPHONE:
APLLICANT'S SIGNATURE-
APPLICANT'S ADDRESS: 1645 NEWTOWN RD. , COTUIT, MA 02635
APPLICANT'S TELEPHONE: 5081428-9518
RESPONSIBLE OFFICER:
RESPONSIBLE OFFICER ADDRESS:
RESPONSIBLE OFFICER TELEPHONE:
ACCEPTED BY DATE
THIS PAGE IS PART OF AND IN CONFORMANCE WITH PROPOSAL #
�6-06 03:57vm From-AIG 978-316-69113 T-?Z4 P.UuzlUul t-I[t
w
lNI~ :.� ,r..h� r• ,(,' `� :'
AT��' t^''�'�J�� 1� �7. p� a ut:—o,,I<. 010 0
t�
'.;. ,`.%' �•7�. ,.• .J •"71 l'"lp;�' �',a i, ,: 4., "'i.r• 'i;�?.� :�,M p�f':•� .�,:•� . , ,•,l, �(til'�.� •-�-f ..1 .:'.,
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
281 Main
Ins Group Inc HOLDER THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
FitMain Stle 0 420Suit #1 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW
Fitchburg, MA 01420
COMPANIES AFFORDING INSURANCE
COMPANY A GRANITE STATE INSURANCE COMPANY
INSURED
Rewurce Managements Inc
281 Main Street,Suite#6
Fitchburg,MA 01420
THIS IS TO CERTIFY THAT THE:POLICIES OF INSURANCE LISTED®FLOW HAVE 61=EN ISSUED TO THE INSURED NAMEp ABOVE FOR
THE POLICY PERIOD INDICATED,NOT WITHSTANDING ANY REQUIREMENT.TERM OR CONDITION OR ANY CONTRACT OR OTHER
DOCUMENT WrM RESPECTTO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE iN3URANCE AFFORDED THE
POLICIES DESCRIBED HEREIN IS SUOJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN _
MAY HAVE BEEN REDUCED BY PAID CLAIMS.•
POLXYNOMBER POLICY 9TFt, M DATO POLICY mCYIRATION DATE
A COMPENSATION
D SMPLOYMIT LIABILITY
tip vRopRrErow LIMITS
F'F1GeTtSAG:t lR�.�lT1vE {':.• :•.:. .:.I�µ..'i� K'�a�.
NCI.o GML Q C Group 12/262004 12/25/2005 STATWORYLIMrMB }ftv
0477192
le
DTHER
APpAn ro MA Opcmy um OrAy,
Cn ACCIDENT' S 100,0
I9CAM POLICY Lw S 500,0
E C "QN OF 0PERAT9)NSIVkHI(N-RgjgPjtGIAL 11RFA0 $ too,0
RE:COVERS THE EMPLOYEES OF THE NAMED INSURED LEASED TO:CAPIM HOME IMPROVEMENTS INC,1645 NEWTON ROAD,
OTUIT MA 921535.
CERTIFICATE HOLDER ANCELLATION
SHOULD ANY OF THEABOVE DESCRIBED POLICIES rite CANC1 LUSD 96pORQ*M0
CAPIZZI HOME IMPROVEMENTS INC DTIRATIONDAYETmEREOP•THE ISSUING COWAWWFLLROSAVORTQM#A a
1645 NEWTON ROAD DAYS wPATEN NOTICE TO THE CERTwicATE HOLDT R NAM®TO THE LEFT.BUT
COTUIT, MA 02636 FAILURE T'O MAIL SUCH NOTICB SMALL IMrem NO oBUO MM OR LMel=OF
ANY KIND UPON THt CO6IPANY,ITS AGERM OR REPPMENTATwn.
AUTHORIZED REPRESENTATIVE
cam ----
2��Q o
Board o uil p Regula >ons and Standards
One Ashbulton Place- Room 1301
Boston_ Massachusetts 02108
Home Improvement,1(;-�.ogtractor Registration
- Registration: 100740
Type: Private Corporation
Expiration: 6/23/2006
CAPIZZI HOME IMPROVEMENT, INC.
Thomas Capizzi, jr.
1645 Newton Rd.
Cotuit, MA 02635
Update Address and return card.Mark reason for change.
Address Renewal n Employment Ej Lost Card
Board of Building Regulations and Standards License or registration valid for individul use only
_ HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Board of Building Regulations and Standards
Registration: 100740 One Ashburton Place Rm 1301
Expiration: 6123/2006 Boston,Ala.02108
Type: Private Corporation
CAPIZZI HOME IMPROVEMENT,I ,
T omas Capizzi,jr.
1645 Newton Rd.
Cotuit,MA 02635 Administrator �Ntvlid�withu�t
"r
,„'i: ,. � ✓>ie {oo�xmw�uueall� o�✓��,aaa�zrcvelld
r BOARD OF BUILDING REGULATIONS
' License: CONSTRUCTION SUPERVISOR
u =
Number: CS 057032
B i rthdate: 09/26/1963
Expires: 09/26/2005 Tr.no: 7171.0
Restricted: 00
THOMAS X CAPIZZI JR
1645 NEWTOWN RDA
COTUIT, MA 02635 Administrator
i
—_—� The Colnntoti wealth of Mas'sachuseffs
— 6 Deparintetti oJLldustrial Acciderity
'  fltACe o//IlresUgaUoas
_ z 600 Washington Street
isJ Boston, Mass. 02111
Workers' Compensation Insurance Affidavit
,
location: _
situ —
❑ 1 am a homeowner performing all work myself nhon u
❑ l,am a sole proprietor and have no one working in any capacity
I am an employer providing workers' com ensation for my employees working on this job.
::... . .....
address: ly'.� � � �L �I -�iL�Y•.t
REMMEMMU
❑ 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 namp.
addccss-
4.
nhorie>y
,.:
.city;
1Lh4nc b
in9arencc'�o .
Failure to secure coverage as required under Section 25A of 1%IGL 152 can lead to the imposition of criminal penalties of a fine up to Si.500.00 andn
m.
one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of SI00.00 a day against me. I understand that a
COPY of this statement may be forwarded to the 0.MCC of Investigations of the VIA for coverage verification.
I do heri b},cerrify under the pains and penalties of perjury ghat the information provided above is true and correct
.. i
Signature �
A Date / IIIJJJ""��J
Print nrunt
,
(hone ty� AN
Official use only do not write in this area to be completed by city or town official
city or town: permit/license N I
nBuilding Department +,
[]Licensing Board
Q check if immediate response is required
QSclectmcn's Office i.
contact person: []Health Department .
phone N; Other
Vr isad 3/95 PJA)