HomeMy WebLinkAbout0209 MEGAN ROAD
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Cape Save Inc. J�X
7-D Huntington Avenue
South Yarmouth, MA 02664
Tel: 508-398-0398 Fax: 508-398-0399
11/18/19
En
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Brian Florence CBO s"
,sue
Town of Barnstable
Building Division `
200 Main St. v� y
Hyannis,MA 02601 v
RE: Insulation Permit 19-2707
Dear Mr. Florence:
This affidavit is to certify that all work completed for 209 Megan Road,Hyannis has been
inspected by a third party Certified Building Performance Institute (BPI)Inspector.
All work performed meets or exceeds Federal and State Requirements.
Sincerely,
William McCluskey
Town of BarnstableBuilding
.+. :.«-..+w-..0 R�' rar---w�- e•ro+um •......v--r --.rr+-x--Iaa..w.rr-...+w+-.-n.:w- . r....-r�..wwww..-. .._•u -wwn...; _ .. .r..taa.� y*w+y -
8nnxnsraeM 1. IPost This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept
:Posted Until Final Inspection Has;Been Made-
di
se39 jai A
Fa►, ° >Where a Certificate of Occupancy is Required,such Building shall Not-be Occupied until a Final Inspection.has been made 1
P y, 4
Permit NO. B-19-2707 Applicant Name: William McCluskey Approvals
Date Issued: 10/24/2019 Current Use: Structure
Permit Type: Building-Insulation-Residential Expiration Date: 04/24/2020 foundation:
Location: 209 MEGAN ROAD, HYANNIS Map/Lot: 291-241 Zoning District: RB Sheathing:
Owner on Record: GARRETT, KELLY A&JOHN M Contractor Name: William J McCluskley Framing: 1
Address: 209 MEGAN ROAD Contractor License: 102776 2
HYANNIS, MA 02601 Est. Project Cost: $3,900.00 Chimney:
Description: Add R-38 fiberglass,and R-22 cellulose to the attic.Add R-19 Permit Fee: $85.00
fiberglass to the basement.Air seal the attic plane and basement Insulation:
Fee Paid $85.00
with expanding foam.General weatherization.
Date: 10/24/2019 Final:
Project Review Req:
Plumbing/Gas
Rough Plumbing:
k _ „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.
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 Final Gas:
work until the completion of the same.
r1 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 k�. x'
2.Sheathing Inspection _ T _ A k_ -" ° Rough:
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
i Work shall not proceed until the Inspector has approved the various stages of construction.
Final:
"Perso acting 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:
{
WWI
Application number.... ......... ........................
/
Fee ......�....�.............................. .... ........
Building Inspectors Initials....
•asp �. t'CT 1. , 2 i3
Date Issued.:.....
Map/Parcel.............:...............
TOWN OF BARNSTABLE
EXPEDITED PERMIT APPLICATION:
ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION
PROPERTY INFORMATION
Address of Project:
t R tTREET VILLAGE
Owner's Name: tv /�-/� 7�" Phone Number
Email Address:�A �.����i�caPl Cell Phone Number
Project cost$ �— Check one Residential Commercial
OWNER'S AUTHORIZATION
As owner of the above property I hereby authorize
to make application for a building permit in accordance with 780 CMR
Owner Signature: Date:
TYPE OF WORK
❑ Siding Windows(no header change)# ❑ Insulation/Weatherization
❑ Doors(no header change)# Commercial Doors require an inspector's review
Roof(not applying more than 1 layer of shingles)
Construction Debris will be going to
CONTRACTOR'S INFORMATION
o
Contractor's name Jf/4-tom
Home Improvement Contractors Registration(if applicable)# ® (attach copy)-
Construction Supervisor's License#. CS Ft) ,IP6 2l (attach copy)
Email of Contractor f y S/L 04 T Al CO'Ihone number !�70 Y e2
ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN
APPLICATION NUMBER
*For Tents Only*
Date Tent(s)will be erected Removed on number of tents total
f
Does the tent have sides?Yes No ' (If yes please attach floor plan with exits marked)
Dimensions of each Tent X X X
Additional tent dimensions can be attached on a separate piece of paper.
Purpose of Event
Check one:this event is a: for profit non-profit event
Check one: Food served Yes No
Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s)of each tent
Fuel source being used LP tank 20 lbs. or> Yes No , if yes,'a gas permit is required.
Natural Gas Yes No ,if yes,a gas permit is required.
If food is being served at your event please obtain a Health Department approval between the hours
of 8:00am-9.30-am or 3:30 pm-4.30pm. Commercial events may require Fire Department approval,
*WOOD/COAL/PELLET STOVES
Manufacturer# Model/I.D.
Fuel Type Testing Lab
Offsets from combustibles: front back left side right side
HOMEOWNER'S LICENSE EXEMPTION
Homeowner's Name:
Telephone Number Cell or Work number
I understand my responsibilities under the rules a regulations for Licensed Construction
h 780 CMR the ach
Supervisor in accordance w' usetts State Building Code. I understand
the construction ins ures,sp c inspections and documentation required by 780
CMR and the n tabl .
Signature Date L z
PLIC 'S SJ649TURE
Signature /// Date
All permit applic ti ns are subject76a building official's approval prior to issuance.
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information I Please Print Legibly
Name (Business/Organization/Individual): AE11,0Zti
Address:
City/State/Zip: f Phone#: ® 6 2
Are you an employer?Check the appropriate box: Type of project(required):
1.❑ I am employer with 4. ❑ 1 am a general contractor and I 6. ❑New construction
e loyees(full and/or part-time).* have hired the sub-contractors
2. 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.
required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions
3.❑ I am a homeowner doing all-work officers have exercised their 11.❑Plumbing rep airs 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.
$Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lic.#: Expiration Date:
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 hereby certify u e ins and a h s o erjury that the information provided above is true and correct.
Si ature: -- Date:
Phone#: 15W 2 v
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#:
a�
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire,
express or implied,oral or written."
An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to bean 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 evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permittlicense number which will be used as a reference number. In addition,an applicant
that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or
town)"A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address,telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
Tel.#617-727-4900 ext 406 or 1-877-MASSAFE
Revised 4-24-07 Fax#617-727-7749
- www.mass.gov/dia
Michael Silva
8t WALTON AV.
HYANNIS MA. Ot601 _
508 245 2906
CS 106219
H.I.C. 17570
John Garrett
209 Megan Rd.
Hyannis Mass 02601
Description On front house Right side remove one mull double hung window and then replace
with Harvey double hung new trim outside and inside. New white cedar shingles on front little
gable wall.On right side of house remove 4 double hung windows and then replace with new
Harvey double windows with trim on outside and inside.Rear of house remove one double and
replace with one new Harvey double hung with new trim outside and in. All windows will have
grills in Glass.6 over 6.All trim outside will be P.V.0 Trim outside and wood trim on inside.
Remove all rubbish and clean grounds.
Total cost Labor and Material$6,100.00
Start 1/3 when window on job 1/3 Rest when done
Mi ilva John Garrett
Town of Barnstable *Permit, L7,,
4
Regulatory Services Expires 6 monthsfrom issue date
Fee
~P '; ThMITomas F.Geiler,Director
zbq.
lE �,,,, Building Division
MAY .
�9 Tom Perry,CBO, Building Commissioner
200 Main Street,Hyannis,MA 02601
TOWN OF BARNSTABLE . 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 CD9 @ 4`
Property Address&NQ
Residential Value of Worlc"__ � Minimum fee of$25.00 for work under$6000.00
Owner's Name&Address ��_
Contractor's Name Telephone Numbe7,5L� a
Home Improvement Contractor License#(if applicable)
�RWorkman's Compensation Insurance
Check one:
❑ I am a sole proprietor
❑ lam the Homeowner
I have Worker's Compensation Insurance — -
Insurance Company Name�M�,(�\
Workman's Comp.Policy
Copy of Insurance Compliance Certificate must be on file.
Permit Request(check box)
❑ Re-roof(stripping old shingles) All construction debris will be taken to
❑Re-roof(not stripping. Going over existing layers of roof)
Re-side
❑ Replacement Windows/doors/sliders.U-Value (maximum.44)
*Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
***Note: Property Owner must sign Property Owner Letter of Permission.
A copy of the Home Improvement Contractors License is required.
SIGNATURE:
Q:Forms:buildingpermits/express
Revised 123107
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Le 'bl
Name(Business/Organization/Individual):
Address:,UB
City/State/Zip. Phone.#: 0
Are you an employer?Check the appropriate box: Type of project(required):
1 I am a employer with' 4. ❑ I am a general contractor and I
employees(full and/or part-time).
* have hired the stab-contractors 6. ❑New construction
..2:El am a sole proprietor or partner-' listed on the attached sheet 7R modeling
ship and have no employees These sub-contractors have g, '❑Demolition
working for me in any capacity. employees and have workers' 9. ❑Building addition
[No workers'-comp.-insurance comp. insurance.$
required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions
myself.[No workers' comp. right of exemption per MGL 12.❑Roof repairs
insurance required.] t c. 152, §1(4),and we have no 13.0 Other
employees.[No workers'
comp.insurance required.]
"Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this a$davit 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 subcontractors and state whether or not those entities have
employees. If the subcontractors 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: �C —
Policy#or Self-ins.Lic.#:� �5 �c�Q��7 c� C7 Expiration Date:,
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
fim 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 IA for insurance coverage verification.
I do hereby certi nder ains andpenalties of perjury that the information provided above is true and correct
Si fuse: Date: _
l
Phone#
Official use only. Do not write in this area,to be completed by city or town of xiaL
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health *2.Building Department 3.City/Town CIerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire,
express or implied, oral or written."
An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more
- of the fpregoing-engaged in a join -Fn_Eipnse;i-nd incl5d.ng th&leg-a-represeiiutive-�c5fY&mased empluym,=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( )states"Neither the commonwealth nor any of its political subdivisions shall .
enter into any contract for.the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and, if
necessary,supply sub-conti-actor(s)name(s),addresses)andphone number(s)along with their certificate(s)of
insurance. Limited Liability Companies*(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete'and printed legibly..The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant
Please be sure to fill in the permit/license number which will be'used as a reference number. In addition,an applicant
that must submit multiple permittlicense applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address" the applicant should write"all-locations in , (city or
town).".A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that'a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit
The Office of Investigations would like to-thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call
The Department's address, telephone-and fax number:
The Commonwealth of Ma sachusetts
}department of Industrial Accidents
Mee of Iave stigatlons
600 Washington Street
Boston,MA 02111
Tel. # 617-727-4900 ext 406 or 1-877-MAS.SAFB
Fax#617-727-7749
Revised 1 i-22-06
www.mass.gov/dia
r Client#:41298 CAPIHOM
FRogers
D_ CERTIFICATE OF LIABILITY INSURANCE [7DATE(MM/DDNYM 8
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
y Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
434 Route 134 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
P.O.Box 1601 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
South Dennis, MA 02660-1601 INSURERS AFFORDING COVERAGE
INSURED NAIL#
Capizzi Home Improvement, Inc. INSURER A: NGM Insurance Company
Capiai Enterprises, Inc. INsuRER B. American Home Assurance
1645 Newtown Road INSURER C:
Cotult,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 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION
DATE MMIDD DATE MM/DD LIMITS
A GENERAL LIABILITY MPB1075H 06/08/08 06/08/09 EACH OCCURRENCE $7 000 000.
X COMMERCIAL GENERAL LIABILITY DAMAG DAMAGE RENTED occurrence) $50 000
CLAIMS MADE OCCUR _PREMMED EXP(Any one person) $5 000
PERSONAL&ADV INJURY $1 000 000
GENERAL AGGREGATE $2 000 000
GEN'L AGGREGATE LIMB APPLIES PER:
POLICY PRO-- LOC PRODUCTS-COMP/OP AGG $2 00O 000
JECT
A AUTOMOBILE LIABILITY M1 M28044 06/08/08 06/08/09
ANY AUTO COMBINED SINGLE LIMIT
(Ea accident) $500,000
ALL OWNED AUTOS
X SCHEDULED AUTOS BODILY INJURY $
X HIRED AUTOS (Per person) i
X NON-OWNED AUTOS BODILY INJURY $
(Per accident)
X -Drive Other Car
- PROPERTY DAMAGE
(Per accident) $
GARAGE LIABILITY
AUTO ONLY-EA ACCIDENT $
FCEBRELL
OTHER THAN EA ACC $
AUTO ONLY-A A LIABILITY AGG $
CUB1076H 06/08/08 06/08/09 EACH OCCURRENCE $5 000 000
CLAIMS MADE AGGREGATE $5 OOO OOO
DEDUCTIBLE $
X RETENTION $10000 $
B WORKERS COMPENSATION AND WC6957000 WC STATU- OTH- $
EMPLOYERS'LIABILITY 12/25/08 12/25/09 X
ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L.EACH ACCIDENT $500,000
If yes,describe under E.L.DISEASE-EA EMPLOYEE $500,000
SPECIAL PROVISIONS below
OTHER E.L.DISEASE-POLICY LIMIT $500,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Carpentry
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
200 Mai Barnstable DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 1n DAYS WRITTEN
00 n 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 #S40650/M40647 KW ACORD CORPORATION 1988
r
e
r
a
rP� �le -too•.»r�no7:iuea��i a�,/�aauzc/Zuselta
�-\ Board of Building Regulations and Standards License or registration valid for individul use only
``HO`M'E`IMFR`OVEME-?,M-ONTRACTO#i =•--,- before-the:ex:p.ir.,ition:da.te.:.If_fo,und rctu.r�to- =_„ :,
Registry fp{ 10o7ao Board of Building Regulations and Standards
- One Ashburton Place Itm 1301
p4rat19-7n:-Q 2 312 010
77) Boston,Ma.02108
2 7y K`: pplement Card
CAPIZZI HOME _( V. Nl` Nll�ti
bARY GUSTAFSOtM.-
.1645 Newton Rd.
Cotuit, MA 02635 Administrator �0411
i itho t nature
`.- • .., �f:! i.�' t�- ll�� >iirtiits:rtl J:;I I'til�iti' �,afct� - --- —.
I.i .ic t ct. l
3
Board O'Buiiilin�g R i-ulatiolls and 'S.at.➢[l1111,
Construction Supervisor License
Licsnse: CS 74640
Re.stYicted to: 00
GARY GUSTAFSON �
8 SHORT WAY a ;'
SANDWICH, MA 02563 x
G%--�- �5'� C i 4l i• n: 1 1/291201 0
i :fJitdJt�ei+ei;ri- ?t. 7755
Page 7 of 7
CAPIZZI HOME IMPROVEMENT INC.
SPECIFICATIONS AND ESTIMATES
STATE OF MASSACHUSETTS
LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT
I,
OWN THE 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 n LESSEE
TO APPLY FOR A BUILDING PERMIT IN ACCORD CE WITH 780 CMR, THE;LSSACHUSETTS
STATE BUILDING CODE. i
SIGNATURE OF OWNER:
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: 508-428-9518
RESPONSIBLE OFFICER:
RESPONSIBLE OFFICER ADDRESS:
RESPONSIBLE OFFICER TELEPHONE:
o � ��0-10 OF 4f
Assessor's map and lot number ......................... ...... ......
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Sewage Permit number ... 5".i5... .��................................. c�i K.EIIY
40.613 C �'
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BABB4TSIILE, i '�.a.�.,. �•��' •{
NAM Cb UING INSPECT'OhR
2639'
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(��/ ............. ........................... ......................................
APPLICATION FOR PERMIT TO ....`'�'��.. .. .. ...... ....
TYPE OF CONSTRUCTION ...... .... ..............................................................
.4�r// ....
.` .E.. ..............19. ./..
TO THE INSPECTOR OF BUILDINGS: , s
The undersigned hereby applies for a permit
according to the following information: a
Location ....... .. ......... . .. .......... ..... ... ........................ ....................:........................
... ... ................................:...............
Proposed Use . .! ....
Zoning District ...Ae.—r.........................................Fire District .....(./. ...... .....................
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Name of OwnerG ,* .i... !� .. / ............Address ............................................ ........... "' ��'.!-/
Nameof Builder ..1I.......r !�...............P...................................Address ....................................................................................
�................. o ........��
Name of Architect .�:......P.................. .................Address .......�.`.............:. ..........................,
Number of Rooms ...e�!��.............................................Foundation ..,/� ...�..... � .
Exterior ....... ..... ... .................................Roofing ...... .. ... .. ,. .........................................................
F/
Floorsl '. - ........................................Interior ...... ..............................................................
Heating ......................Plumbing ....�-.....................................................................
9 r,�-w......../W.-AUA .
Fireplace Approximate Cost .........v`4�a.... ................ .......
f L�
Definitive Plan Approved by Planning Boar ____ _____19� —r Area
Diagram of Lot and Building with Dimensions Feej
SUBJECT TO APPROVAL OF BOARD OF HEALTH
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I hereby agree to conform to all the Rules and Regulations of the Tow4i of rnstable regarding the above
construction.
Name ........................ . ........ .............................
i
Dacey, William E. .Jr.
l�
!i7089 one St
y,
No ......... Permit for ....................................
sir*igle family dwelling
,L .....................q.......................................................... �
Location® 1.......................................................ega11 Road
Hyannis
William E. Dacey, Jr.
Owner .................................... ,
............................ LIP
..
Type of Construction frame4
...................................................... ......I..............
23
Fiat .....:...................... Lot ...........':;..................
Permit Granted.....4 9 74
Date of Ins
Date'Completed .�.� � / �
PERMIT REFUSED
........ ' .�' ............................. 19 , /.R 1 j
..............r:... ........................................................
.......... .. ..........................! .............. Ar
.................................................... .1....................
Approved
)(A 19
............................................................................... ,•
y___ .................... ....................................................�. - J
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` I F1E ® PLOT PLAN :
L"O CAT 10 h/ NIS
SCALS 342 DATE
sr
RE F E R EN C E Bi�-/N C, L.07— 2. 3 /I S -r//,0 wN
off`".L..�:f'� •a z o' D 99,
D A �T.. E ;
9 'HEREBY C E R T I "F Y T H A T T H"E. .8• U•I-"L D I NnG R E G. L A N D S URVEY R
SHOWN ON THIS PLA,.N :: I.S. LOC `A,TED ON ,
TH:E GROUND.—A'S SHOWN HEREON AND
T H'.A T 1 r o CONFORM T 0.' ,T H E tN OF
ZONING BY - LAWS OF THE TOWN ., OF
BAR�MSTABLE' W H E N CONSTRUCTED 1787
A R N 5 T.A B L E S U. R V E a Y..,�_C.0-N S U L T f�: N T S, 1 N C
' WE S T Y A R M 0 U.T H, M 'A S S, Sure
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