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Home My WebLink About0070 OXNER ROAD a m .. f ,. a Town of Barnstable *Permit it Expires 6 months from issue date Regulatory Services Fee wwsreals, � Richard V.Scali,Direct 039. ek 13 .0 Building Division ; Tom Perry,CBO,Building Commissioner1 RN a 200 Main Street,Hyannis,MA 026. 0 www.town.barnstab�.r °��gIV �-y ��,� Office: 508-862-4038 `\" OF8p Fax: 508-790-6230 EXPRESS PERMT APPLICATION - RESIDENT �� Y 113 f Ili r Not Valid without Red X-Press Imprint Map/parcel Number ✓( Property Address t o O X N5IZ 13 o C e&reily Ile: Residential Value of Work$ `�/ �� Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address G e o ff eeq i, q up_r -- Contractor's Name �rAmzS MG&X m4 e�L Telephone Number i elf 917PYYV Home Improvement Contractor License#(if applicable) C 01 Y0 Email: It M P, C4f iZZ e- . Cons ction Supervisor's License#(if applicable) 6S U 7 26/ orkman's Compensation Insurance Check one: V❑ am a sole proprietor am the Homeowner I have Worker's Compensation Insurance Insurance Company Name Am 6U4p'o o j ag4oCe �d Workman's Comp.Policy# T a— W (" r),z dad Copy of Insurance Compliance Certificate must accompany each permit. Permit RVRte-roof (check box) !1- 2tl e ze G�/l�[� I'��1�i�0�t'a��'Td lw,4Tn!�/ hoij r (hurricane nailed)(stripping old shingles) All construction debris will be taken to l°W&I ej' 1340 w�419 P- ��.R D rt 11 -roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *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&Construction Supervisors License-is required. SIGNATURE: C:\Users\Decol pppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\2PIOlDHR\EXPRESS.doe Revised 040215 Page 7 of 7 Capizzi Home Improvement Inc. Specifications and Estimates STATE OF MASSACHUSETTS LETTER OF.AUTHORIZATION TO.APPLY FOR A BUILD ING PERMIT WE, GEOFFREY&JENNIFER PORT, OWN THE'PROPERTY LOCATED AT 70 OWNER ROAD IN CENTERVILLE.,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 COD SIGNATURE OF OWNER. OWNER'S ADDRESS: 70 OXNER ROAD, CENTERVILL MA 02632 OWNER'S TELEPHONE. (508)428-3375 LESSEE'S SIGNATURE;. LESSEE'S ADDRESS: LESSEE'S TELEPHONE: APLLICANT'S SIGNATURE: APPLICANT'S ADDRESS: 1645 Newtown Rd.,Cotuit, MA 02635 APPLICANT'S 508-428-9518TELEPHONE: - RESPONSIBLE OFFICER: RESPONSIBLE OFFICER ADDRESS: RESPONSIBLE OFFICER TELEPHONE: = Massachusetts Department of Public Safety IVj Board of Building Regulations and Standards License: CS-076261 Construction Supervisor -, JAMES MCCORMACKrt> 73 FEARING HILL ROAD ..9, WEST WAREHAM MA'02576 r,.,-'jZCK l_— Expiration: Commissioner 11/13/2017 r• QTXe. n�ua�enrrrverr(�/r n�O!�l�auac%uJetfi ice of Consumer Affairs&]Business Regulation IL,ice nse or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs.and Business Regnlation eg1stratlom 100740 Type; 20 Park Plaza-Suite5170 Expiration: 6/23/2016 Supplement Card Boston,MA 02116 CAP1771 HOME IMPROVEMENT,'INC. JAMES MCCORMACK'. 1645 Newton Rd. Cotuit,MA 02635 Not va id without signature Undersecretary L r ... ... ... ... The Commonwealth of Massachusetts z Department of Ind.ustrialAccidents 1 Congress Street,Suite 100 0 Boston,MA 02114-2017 www mass gov/dia 11'orkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Lesi61� Name(Business/Organization/Individual):CAPIZZI HOME IMPROVEMENT INC Address:1645 NEWTOWN ROAD City/State/Zip:COTUIT,MA 02635 Phone#:508428-9518 Are you an employer?Check the appropriate boa: Type of project(required): 1.0 I am a employer with 40 employees(full and/or part-time).* 7. New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required] IM I am a homeowner doing all work myself.[No workers'comp.insurance required]t 9. El Demolition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10[]Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5. I am a general contractor and I have hired the sub-contractors listed on the attached sheet ❑ 13.❑Roof repairs These sub-contractors have employees and have workers'comp.inaursmce.t 6.❑we are a corporation and its officers have exercised their right of exemption per MGL c. 14.[:]Other 152,§1(4),and we have no employees.[No workers'comp.insurance required] *Any applicant that checks box 9 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 isproviding workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name:AmGUARD INSURANCE COMPANY Policy#or Self-ins.Lic.#:R2WC527200 Expiration Date:12/2512016 Job Site Address: -7 D JL 1/l '/Z p City/State/Zip: 0,ttkit v/de Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby c fy under the pains and penalties of perjury that the information provided above is true and correct. Si afore Date: o 61616 G Phone#:508 -9518 a Official use only. Do not write in this area,to be completed by city or town official icial 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#: `E r VE Town of Barnstable *Permit Expires .monthom issue date Regulatory Services Fee 9snxxnst.E,� Thomas F.Geiler,Director Oj9/o i639. Building.Division [ rFD MA't A . SS PER I om Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 FEB ® 8 2008 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 TOWN OF BANSNPIkkMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint 2 9 r Map/parcel Number Property Address (Residential Value of Work 0-djQ Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address k- Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) 1 ('/ orkman's Compensation Insurance Check one: , -I am a sole proprietor I am the Homeowner --I have Worker's Compensation Insurance Insurance Company Name 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 6o 6!M ��5�,�- ❑\\Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.35) *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. s SIGNATURE: QAWPFILESlF4� uilding permit forms\EXPRESS.doc Revise020108 , s . The Commonwealth.of Massachusetts Department of Industrial Accidents Office of Investigations 1 ` 600 Washington Street Boston, MA 02111 _ www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: City/State/Zip: c Phone.#: Are you an employer? Check he appropriate box: `Type of project(required): 1--RI am a employer with 4. ❑ I am a general contractor and I . employees(full and/or pa 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 workingfor me in an capacity. employees and have workers' Y P ty• �� 9. ❑ Building addition [No workers'-comp.insurance , comp.insurance. 10. Electrical repairs or additions required.] 5.❑ We are a corporation and its ❑ P 3.❑ I am a homeowner doing all work officers have exercised their I L E]Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.] t. c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp.insurance required:] , *Any applicant.that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ' 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 job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: �� /� City/State/Zip: Z� j/V( 1 ' Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under..Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,'as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signafore: 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 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 emplyer 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 represe tatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal a 'ty,employing employees. However the owner of a dwell' g house having not more than three apartments and who esides therein,or the occupant of the dwelling house of a6ther who employs persons to do maintenance,cons ction or repair work on such dwelling house or on the grounds orb%dingappurtenant thereto shall not because of su employment be deemed to be an employer." MGL chapter 152, §2so states that"every state or local licen ng agency shall withhold the issuance or renewal of a license oit to operate a business or to constru buildings in the commonwealth for any applicant who has not produd acceptable evidence of complia a with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states`Neither the co nwealth nor any of its political subdivisions shall enter into any contract for.the pen of public work until ac eptable evidence of compliance with the insurance requirements of this chapter have be presented to the contrac ' authority." Applicants Please fill out the workers' compensation a fidavit completel ,by checking the boxes that apply to your situation and, if necessary,supply sub-contractors)name(s),\&ddress(es)and hone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)\or Limited ability Partnerships(LLP)with no employees other than the members or partners,are not required to carry wo�r ers'co pensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that thi affi ding may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. so a sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions r the law or if you are required to obtain a workers' compensation policy,please call the Department at th n er 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 compl/nd p ted legibly. a Department has provided a space at the bottom of the affidavit for you to fill out in the ee ffice of Investiga 'ons has to contact you regarding the applicant. Please be sure to fill in the permit(licens r which will be used s a reference number. In addition,an applicant that must submit multiple permit(licenselions in any given year, eed only submit one affidavit indicating current policy information(if necessary)and under" b Site Address"fhe appli t should write"all locations in ._(city or town)."A copy of the affidavit that has ficially stamped or marked y the city or town may be provided to the applicant as proof that a valid affidavit is for future permits or licens A new affidavit must be filled out each year.Where a home owner or citizen is g a license or permit not relat to any business or commercial venture (i.e.a dog license or permit to bum leavesaid person,is NOT required to mplete this affidavit. The Office of Investigations would like t you in advance for your coop and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone ale,partmentof fax number: e Commonwealth of Massachusetts Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 11-22-06 www.mass.gov/dia Town of Barnstable Regulatory Services KAS& Thomas F.Geller,Director. �b 39. Building Division Tom Perry,Building Commissioner 200 Main Street,.Hyannis,MA 02601 www.town.barustable.ma.us Office: 508-8624038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using.A Builder I, ( 0)(� Y110 11+ ,as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for. (Ad(Ires s of Job) Signs f r Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the. reverse side. Q:FORMS:OWNERPERMISSION' _ a '}+�• tom} • t W' t f v t_ .. •' t .� f l NOTICE u W NO A;\ TO W 9 a EMPLOYEES EMPLOYEE, OEM Svc The Commonwealth. of Massachusetts DEPARTMENT OF INDUSTRIAL ACCIDENTS 600 Washington Street, Boston, Massachusetts 02111 617-727-4900 http://www.mass.gov/dia As required by Massachusetts General Law, Chapter 152, Sections 21,22&30, this will give you notice that I (we) have provided for payment to our injured employees under the above mentioned chapter by insuring with: ZURICH—AMERICAN INSURANCE GROUP NAME OF INSURANCE COMPANY ONE TOWER SQUARE HARTFORD, CT 06183 ADDRESS OF INSURANCE COMPANY { (6ZZUB-7982B18-1 -07) 06-28-07 TO 06-28-08 ,f POLICY NUMBER EFFECTIVE DATES SCHLEGEL & SCHLEGEL INS 34 MAIN ST RTE 28 — c� , WEST YARMOUTH MA 02.673 NAME OF INSURANCE AGENT ADDRESS PHONE# �— MCMORROW, JAMES DBA 53 LEWIS RD JFM PAINTING _ WEST YARMOUTH s MA 02673 EMPLOYER ADDRESS i EMPLOYER'S WORKERS COMPENSATION OFFICER (IF ANY) DATE MEDICAL TREATMENT The above named insurer is required in cases of personal injuries arising out of and in the course of '= employment to furnish adequate and reasonable hospital and medical services in accordance with the Provisions of the Workers' Compensation Act. A copy of the First Report of Injury must be given to the injured employee. The employee may select his or her own physician. The reasonable cost of the services j ' provided by the treating physician will be paid by the insurer, if the-treatment is necessary and reasonably i. connected to the work related injury. In cases requiring hospital attention, employees are hereby notified i that the insurer has arranged for such attention at the I - i -NAME OF HOSPITAL ADDRESS 007125 W20P1G02 TO BE POSTED BY EMPLOYER Board of Building Regula Ions and Standards One Ashburton Place - Room 130.1 Boston, Massachusetts 02108 - Home Improvement Contractor Registration s Registration: 133704 Type: DBA Expiration: 7/31/2009 Tr# 130177 JFM CONSTRUCTION ,' JAMES MCMORROW 17 CIRCLE DR. HYANNISPORT, MA 02601 Update Address and return card.Mark reason for change. - DPS-CA1 0 50M-05/06-PC8490 _ Address Renewal Employment Lost Card 7p1 °Q' �« t IZfl <t ' f - .'® Assessor's map and lots nu er Or `A / ate° A°G x 2 3 i SEPTICSYSTEMMUST gE , Sewage$Permit number :...................�.�.�...........•.......,.,;'.............j.' STALLED IIV IN COMPLIANCE .WITH ARTICLE II STATE PvFTHET� r : 1 ® N' ® 'LA1l 1ffAk', ivEAND ;TOW1` 339HBSTADLE' .i639BUILDING ` INSPECTOR �1 p w to i • ..... R ...........APPLICATION. FOR PERMIT ,,;,-TO .:..........:.. TYPE OF CONSTRUCTION ......................: ..........................................:.. �c ... ................. .. ..........190 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a `permit according to the following information: .................. .... ...1... .`................................. Location ....................4:0............... . .........:........................ ProposedUse .......................�.. ................................................................................................,......................... - Zoning 'District ................................ .......................................Fire District .................................... ........................ C �. ......................Address ......................:'....y/ Name of Owner ... .... ...... ..................... Name of Builder �� ...Address ............................................................... . Name o So%f Architect .....................Address /D , Numberof Rooms ....... .......................................................Foundation ............(/............................................................ Exie'ior ................................. .!..............................................Roofing ...............I...... ....°".................:.:................................... Floors �°�f ....Interior ��G .. / Heating .. . ..,.. . ...�......... bmg ............. ....... ........................... .......:...... - -- - - .Plum Fireplace .........................................................:..................Approximate Cost ............... .....® d O .. . Definitive Plan Approved by Planning Board ---------------------_----------19________. Area .... +. 1.... ......... 4 d Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH _e c I hereby agree to conform to all the Rules'arid Regulatrons of the Town of Barnstable regardin the above construction. or Nam . ....... StauleyqC. F. Permit 1�r ......1 1/2 story NOTP!�?§.... Per ..................... ........................ Location .......Oner.load................. ...... .. ...... ...... ..............I...............Centerville........................... Owner .............C. F...Stan4y ........... ........... ........................ Type of Construction .......CKAMA........................ ............................................................................... Plot ......► I...................... Lot ........ 29.................. Permit Granted ...... June 30 ...........19 76 Date of Inspection ..7. 19 Date Completed .......................................19 PERMIT REFUSED ................................................................ 19 ......................................... ..................................... ................................................................. ............................................................................... ........................ ...................................................... Approved ................................................ 19 ............................................................................... ............................................................................... • o LOT 28 0 1 PROOOSEO i i. ---�-iao v i jQ I FouuJA'fiow o Altz co �N. a _WLY a 40,o �4 4 t � .; LOT' 4711 32.a¢ 4� R c .Ey � OXW ER - .J.. ,�cl,..i r.. .is .i.• F' ) a:. < ', .<:, 1. .f `;f1 .(, r i C T' — as b.2 l f r' r 'T s _ f _ i Scale 401 - Q P CERTIFIED PLOT, LAN. , j Being lot 29 as shown on a:: subdivision plan entitled rr r I, hereby certify that Crosby Hill East in Center- the existing foundation ! ville, by Charled N. Savery __�, --- location is correct as l Ind. , Hyannis, Mass. , dated I shown and does c(bnform Aug. 21, 1973 and recorded �_ with the building setback' Barnstable Registry of deeds` �gH of reouirements of the Town ' in book 27T page 98. of Barnstable. o Thomas A. R, r d April 27, 1976 E JACKSON -- , „�" - Bun ear': a ,.Tharles F. `StAnlipY S'inPd -e.C;ente.rville Mass. _... en ~M