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Home My WebLink About0017 LOUISBURG SQUARE S'v u�-�- a, �+ �� TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION bo � 10,4f DI(b� ` ' O Map P rceIApp Health Division Date Issued �A �_o Conservation Division Application F It 40 Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address o �` b�d S 6 e✓� ��V�dIC Village y atilarJ Owner 14,4 e,letr n• Ali c 4 0 4, Address �� f �� Iziw/J &Z 60/ Telephone Permit Request �L2� 14« Y poop- W1-7'!fi ez,4C_t flat 4!P1,0 '11,1V G(_.i-,y ,1/ ujl W o w ix To /MK/j'e,e lx l,Vrin 1 ` IV O C l-1171y f S_ j / Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District 8 Flood Plain Groundwater Overlay Project Valuation 2/1 aU Construction Type Lot Size �`/I C a��6 Grandfathered: ❑Yes ❑ No If yes, attach s&porting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure / `1 19 0 Historic House: ❑Yes ❑ No On Old KingM )l�ighway:�Yet ❑ No Basement Type: Full ❑ Crawl ❑Walkout ❑ Other a/4 k Basement Finished Area (sq.ft.) Basement Unfinished Area (sq. / Q / q9 Number of Baths: Full: existingnew Half: existing n eaau 9 Number of Bedrooms: a existing®new Total Room Count (not including baths): existing new ° First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil Electric ❑ Other Central Air: 2/Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes 2�4o If yes, site plan review# Current Use JProposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Nameldhil l Jfim�k1 Telephone Number ,i' M me ��'tR�f�d(/2�A�7e a't:NG Address / i f A1,e&1�`P'& �D License# S �f7 T C Al �a6�� Home Improvement Contractor# /007�d �'� Worker's Compensation # Nw CC Y32 i ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 1. FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED _ MAP/PARCEL NO. i ADDRESS VILLAGE" OWNER DATE OF INSPECTION: FOUNDATION ! FRAME INSULATION z FIREPLACE ELECTRICAL: ROUGH FINAL- PLUMBING: ROUGH FINAL " GAS: ROUGH FINAL FINAL BUILDING t DATE'CLOSED.OUT ASSOCIATION 'PLAN NO. The Commonwealth of Massachusetts Department of Industrial Accidents UIP Office of Investigations 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Binders/Contractors/Electricians/Plumbers Ai3plicant information Please Print LePiblY Name(Business/Oiganiza6on/In4ividual): �nr Z! ��i'YTt' 1-�1�Yc7l.��dnt'�✓� �C Address: S' ii fj4-,tt u 0 121v . City/State/Zip: C 0+U s f:t MA U.'Lly 3 r Phone#: 56,f.V-2,k-' t Y i�1 Are you an employer?Check the appropriate box. Type of project(required): 1.EL am a employer with 40 '1` 4. ❑ 1 am a general contractor and I employees(full and/or part-time). have hired the sub-contractors 6. ❑New construction 2.0 I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have to employees These sub-contractors have g. [)Demolition working for the in any capacity. employees and have workers' 4. Building addition [No workers'comp,insurance comp.insurance.t ❑ g required.] 5. Q We are a corporation and its 10.0 Electrical repairs or additions 3.0 I am a homeowner doingall work officers have exercised their 11. Plumbin r'❑ g pairs or additions myself. [No workers'comp. right of exemption per MGL 12.E]Roof repairs insurance required.)t c. 152,§1(4),and we have no employees.[No workers' 13.VOther P 0$11,4- comp.insurance required.j o n a all wo tw *Any applicant that checks box#1 must also fit[out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing ail 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 naive 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. [am an employer that is providing workers'coiitpensation insurance for my employees Below is the policyand job site infonnaden, Insurance Company Name: 'V P P y 'N v C A S uA L4y . CG 5� �1 32.0 Policy#or Self-ins.Lic.#; A/ �/ Expiration Date: i -2 .2. , :Z oil Job Site Address: .� �.o Uu J e✓j oi->'-e City/State/Zip: �y 4ydl%J &,'- Attach a copy of the workers'compensation policy declaration page(showing the policy ttumber.md 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 S 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 under the pains and penalft f perjury that the information provided above is true and correct Signature: Date: Phone# OJJ'rcial use only. Do not write in this area,to be completed by city or town o,#77ciai City or Town: Permit/License# issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Client#:47298 CAPIHOM ACORU, CERTIFICATE OF LIABILITY INSURANCE DATE 01/04/2011m 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 N2MEAt: Karen Walther Rogers&Gray Ins.-So.Dennis PHONE F Ac No Ext:508 398-7980 AI 1,No 434 Route 134 E-MAIL ADDRESS: waltherka@rogersgray.com P.O.BOX 1601 PRODUCER South Dennis,MA 02660-1601 CUSTOMER ID M INSURER(S)AFFORDING COVERAGE NAC# INSURED Capizzi Home Improvement- ,Inc.- INSURER A:National Grange Insurance Co. INSURER a:ACE Property&Casualty Ins.Co Capizzi Enterprises,Inc. INSURERC: 1645 Newtown Road Cotult,MA 02635 INSURER D: rINSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDLSUBR1 - POLICY EFF POLICY EXP LIMBS L - TYPE OF INSURANCE NS POLICY NUMBER - MM/DD MMIDD A GENERAL LIABILITY MPB1075H 06/08/2010 06/08/2011 EACH OCCURRENCE $1000000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED .PREMISES Ea occurrence $500,000 - CLAIMS-MADE IF7VA1 OCCUR MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY L1 PRO-in LOC $ A AUTOMOBILE LIABILITY ` BPO10786 06/08/2010 06/08/2011 COMBINED SINGLE LIMIT ;i ? A MY AUTO M1M28044 06/08/2010 06/08/2011 (Ea accident) $500000BODILY,INJURY(Perperson) $, ALL OWNED AUTOS BODILY INJURY(Per accident) $ X SCHEDULED AUTOS PROPERTY DAMAGE - X HIRED AUTOS (Per accident) $ X NON-OWNED AUTOS U1 $250/500,000 X Drive Other Car U2 $250/500,000 A UMBRELLA LIAB X OCCUR CUB1076H 06/08/2010 06/08/2011 EACH OCCURRENCE s5,000,000 EXCESS LIAB .CLAIMS-MADE - AGGREGATE $5 OOO O00 DEDUCTIBLE $ X RETENTION 10000 $ B WORKERS COMPENSATION NWCC45843208 12/25/2010 12/25/2011 X WC STATU- OTH- AND EMPLOYERS'LIABILITYFIR ANY PROPRIETOR/PARTNER/EXECUTIVEY/N E.L.EACH ACCIDENT $1,000,000 OFFICERIMEMBER EXCLUDED? �N NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Workers Comp Information Included Officers or Proprietors CERTIFICATE HOLDER CANCELLATION 10 Days for Non-Pa ment 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 i 0 198 -2009 ACORD CORPORATION.All rights reserved. ACORD 25(2009/09) 1 of 1 The ACORD name and logo are registered marks of ACORD #S61971/M61970 MEE 1 Center Village Condominium Trust Robert Dalton President 73 Captain Cook Lane Centerville MA 02632 Date: June 1,2011 To Whom It May Concern, I have been made aware of and approve the alterations to be made to the unit listed below in the Center Village complex: Owner: Margaret Nichol Address: 17 Louisbur Square Centerville, MA 02632 Alteration(s) 1 front door 1 octagon window I have found these changes to be in keeping with our prescribed format. Date: Robert Dalton, President Center Village Condominiums ------------ Page 7 of 7 CAPIZZI HOME IMPROVEMENT INC. SPECIFICATIONS AND ESTIMATES STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT I, Al a fir-l- A) tehin OWN THE PROPERTY LOCATED AT y,Pt r- IN C&1*pry t �� ,MASSACHUSETTS. I HAVE AUTHORIZED CAPIZZI HOME IMPROVEMENT TO ACT AS MY AGENT TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. I GIVE MY PERMISSION TO LESSEE TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR,THE MASSACHUSETTS STATE BUILDING CODE. SIGNATURE OF OWNER: OWNER'S ADDRESS: OWNER'S TELEPHONE: LESSEE'S SIGNATURE: T.FSRRR'4 AT)T)R -S LESSEE'S TELEPHONE: APLLICANT'S SIGNATURE: APPLICANT'S ADDRESS: 1645 Newtown Rd., Cotuit,MA 02635 APPLICANT'S TELEPHONE: 508-428-9518 RESPONSIBLE OFFICER: 4--e c lc RESPONSIBLE OFFICER ADDRESS: RESPONSIBLE OFFICER TELEPHONE: vii,cC U1 t-unsumerAnairs&ssusmess xeguianon, License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: =100740 T e: Office of Consumer Affairs and:Besinsss Regulation 3— YP 10 Park Plaza-Suite 5170 Expiration: 6/23/2012 Su lenient Card PP Boston 1VIA 02116 CAP1771 HOME IMPROVEMENT,-INC. r JACK STRUNSKI 1645 Newton Rd. g� — Cotuif, MA 02635 Undersecretary Not valid without signature ' YNlassachusetts- Department of Public Safety Board of Building ReLrlutions and Standards Construction Supervisor License 'License: Cs 64817 0.r JOHN T STRUMSKI .:,PO BOX 861ti BUZZARDS BAY, MA 02532 Expiration: 6/18/2012 Conlrniwtiiunei' Tr#: 10573 i i