The URL can be used to link to this page

Home My WebLink About0205 SEAPUIT ROAD n2o�,d i t ._ _ - = .. . _:. ,. .�.+, I t 1 2-c S vL� � � ►ems � ,��n�� { i s y � 1 C ASEK. �M.ANN Advisory Service tonprofzt, -Organizations n E PLANNING FUNDRAISING INSTITUTIONAL DEVELOPMENT Box 361, Osterville, MA 02655 5'08:540.8169 - Fax: 508:540.81.95 ., CaseandMann@aol.com i WHAT PEOPLE SAY ABOUT CASE & MANN "David Case's extensive consultancy with us involved several creative and successful fundraising initiatives. His valuable role in coordinating and facilitating our strategic planning process resulted in an important management plan, which we are now implementing. As Board President, I believe his consultancy was a sound investment in our future." Joyce Braude,President, Barnstable Land Trust. "The team of David Case&Sarah Mann developed a business plan study which is invaluable for our organization. Their timely, thorough and professional approach, reinforced by extensive professional experience,was just what we needed. I endorse them strongly." Rick Keller, Executive Director, Mount Washington Observatory. "Sarah Graham Mann was of immeasurable assistance to our international marketing committee...without her insight and skills, we would not have the success we do today in our international outreach. The process she put into place is running as smoothly as silk." Wendy Northcross, Executive Director, Cape Cod Chamber of Commerce. "The English-Speaking Union extends its grateful thanks to management consultant David Case who conducted an in-depth study of our current organization and management.David's enthusiastic participation inspired us all on the national staff with a renewed sense of dedication, pride and purpose." David Olyphant, Executive Director, The English-Speaking Union of the U.S. THE FIRM: EXPERIENCE COUNTS Why consider a consultant? Simple. All nonprofit organizations today are facing enormous challenges in planning for future growth. For example,earned income is more important than ever in the overall revenue mix; fundraising campaigns are more competitive and professional than ever; staff and board members all need clear,concise practical plans to which they can refer for guidance and action. Where does a nonprofit go for straightforward'advice in facing these challenges? What consulting firm offers over 50 years of top-level leadership experience, with demonstrated problem-solving results? Case &Mann bring their unique backgrounds in --"nonprofitmanagement,government,grantwnting, fundraising and strategic planning to bear on their clients' needs. No two clients are. alike; each assignment addresses specific challenges and creates opportunities for growth. ELL-7LL L - CAS �MANN Advisory Service to onprofit Organizations sw�a.. � THE TEAM David K. Case David Case is an acknowledged leader in the nonprofit world. As the President & CEO of Plimoth Plantation for nearly 20 years, he achieved record-breaking results in fundraising and earned income objectives. A member of numerous nonprofit boards and committees,his consultancy has brought outstanding results to nonprofit clients throughout the U.S. Prior to joining the Plantation, David was an advisor to Boston- based cultural organizations. Earlier cor- porate management experience included marketing, communications and public relations. He has received top national awards for non-profit leadership. Sarah Graham Mann Sarah is the former Director of Tourism for the Commonwealth of Massachusetts and then founded and ran the six-state nonprofit agency for tourism promotion & develop- ment,DISCOVER NEW ENGLAND.She has over 20 years of highly successful marketing and management experience with nonprofits in both the public and private sectors. Ms. Mann speaks frequently at conferences throughout the U.S.and teaches at NYUs Center for Hospitality,Travel and Tourism Management at both the graduate and undergraduate levels. She was also a Presidential Appointee to the White House Conference on Tourism. I SERVICES OFFERED Planning • Long-range planning • Strategic plans for marketing, fundraising and organizational growth • Business plans • Market assessment/Earned-income program design and evaluation • Facilitation of planning meetings i Fundraising • Fundraising`.`Case for Support"statements . • Feasibility studies • Donor research and identification . • Annual Fund counsel (all aspects) —•-Capital.Campaign_preparation.&direction—I • Major individual, corporate &foundation I solicitation strategies and proposals • Grant writing • Stewardship and patron programs • Staff and Board training in fundraising techniques and programs • Volunteer training • Membership enhancement programs Institutional Development • Institutional assessments • Staff and Board professional development j • Board recruitment,orientation, motivation, evaluation,retention • Organizational chart and job descriptions • Community relations and cooperative program development and assessment • Marketing audits and assessments WHY RETAIN CASE & MANN? • Services, are based on.a;proven track record of outstanding-results. Case WMann bring sound, : professional, ."hands-on" experience, providing ` objective and extensive comparative analysis: Highly personalized services are geared directly to the specific needs of each client. Clients interface directly with Case&Mann,not subcontractors or junior associates. Services are cost-effective. g "The tearn'ofCase�& 1Vlarn offers �` time-tested exp�eriencea'nd expertise in the fields of non-profit rnanagement, fundraising=and; r � arlcetng. I have had the pleasuFre of. ` .knowing both priricpals fo many `. years and I salute their iew iionpron consultancy which offers clients an ttnpressiye array 1i f creative J eas=and praeticalsolutionsfor todaysr , M y`;opportunities aii�d challenges " � k CrawfordLincolnRetired president, µ "Ol`dSturwn tiridgevillage' rd CASE MANN' Advisory Services,to n Organizations w� BSI l>N DATA i _ —�_------- - r C,10&,E FAMILY 4 zEDebOW S4e I or- W%T* (,Ae3A6,E 61ZIWPeV- DA i L-q FLov), 4 x►Io 4 r-DVv-6&D 6?a . SEE PLAID orb F3a X 14 Et.coF SEpT1 c, -F rJIL=-M 2ao%=b8o 6Po LOT t 48 �Pv IT ?oa� u6c- Isoo 6ac. , L EA�ct-I I�1 G S`(sT>�n- .�2'x.�s.t i�u-Zo-3 x�'['.1dA►v►'B�zS osT�2.v� APpWaTi oO AOeA REQul y _ - 6&D 0 7�CALhF/awY NSF, APPLICA1100 AQEA bESI�N --- --___ wa �"� -- "� s ^CIZ'+1')&V+I' ) = 69-1 SF LU i� i PRtO k 12 l;m 47PvG I14F1LTMA-M2 .0 OF 1,A of 'NAIL of D15P054L P—JE J.> QX>IAF a� A. a PETER Wren " SLItl I'lr��i}1 IVY.c3,;. ! �i3'Pe►sratE IGacQ�, `Toc1E -vy 'PF .. �'✓'s•'� ova �``� v��-,;� �fd -�-- T• _�otl T>�eaU c�I P , ._�CST' 91 ti5 qPUAIUYLd w r �.:: u. $ ~�'`"`y ►� bo 4 p�G INS• sa►�a I7SUa NJ ° 13•� C, m eDLEAN rI eta w� icy i 13 &AL F Ioz �" �"sta1lr:°gases � raNV- C Mda a: iJo Seems ! MdP qS PCL I3 6PAeT� C�e'nFl�b PLOT PQl- LO ATI oN 03rEq-\nLjc- IJo WATM- - RzopoS�D PLAN V-EFEP-E W-C- 1 GeP-Ti VY TH AT. TuE 't>WEu.I N i. L.or I� NFEEON 604 /S W'rrg THE SIDELIIJE 5ETB L r2wuteemw% of THE TW4 oFFAU45TABLc- Sc1ar>.. ur- L,c- -LS --z& - Alb I) Ndr'LocATeD wlrN iw 'A Rood *U9D 7o 4E, P"10" G SATE. 1 C� " 5,1995PRo>:eS�tOrJAL. LAIJ� <_�ev�y:x4t P20 "Io A%- L D SVpvE or 77IIS PLAI-! IS WT BASED 0►J Ail 1�15Tl2uMEW-r 5ueVE`� 0STE L �iJ�ilJtCiAA %`ZVI L1-t� � MAS1, Auo 'rilF- or-PSETS SNOIXt) Nor SG u5Ep Tv IrS-w�u e,N Peope eTy U►J E5. APRU CA !-r - -pA v l "s C- -Do,vr*) CASE- ��acz l 5o Lcr. �,tq9< 1 �\ � `n 5'ruJE Town 7.o4je 2F-I 3o/,s�r, `�, Fc- f5,20 �7:t \,op i 20 •� N 83.E i i rvrvee E, vi / c4 WE- a-- FurulZE %R opmem �h z• V.BvxTru I I r TEIJ Nl i A l Vp WET A O /,V -110 �r►ofA��N � c SAXTEA C.7 . ..,�.3 y I qq -7�' Oq`- o t 3 No_15 �3fL— THE COMMONWEALTH OF MASSACHUSETTS P 5^ 3 BOARD OARD OF i1HrE�A�L�TSH 1.✓.W.Lv..........OF.......�.A'.!^I.`.I...t'�r'.vG.._...................... �>pfllirtxtion for Disposal Mar�lt�(�nn�trurtinn hermit Application is hereby made for a Permit to Construct (") or Repair ( ) an Individual Sewage Disposal System at: 146 t oa-Addre /Z�Q»� ........ 0— Addteu ....._...—.._..—__......__.._....»......_._........._....._. _.. a ._.........__.._...._........—..._...Instiller..._.._..._.._............._.._ Addreu. ,,{{gg Type of Building Size Lot_ 't`'tom - �_Sq. feet Type Dwelling—No. of Bedrooms............4....-•-......••••••••••Expansion Attic ( ) Garbage Grinder ( ✓)/ "3 Other—Type of Building ............. .........T ... No. of persons...._......_._......_... Showers ( ) —Cafeteria w ( ) A. Other fiat% ......................................................_............_....._......_..............._.._....... ..._ .._..._..—.._._ a gallons per person per day. Total daily flow..........__.__._.�P�d_:.gallons. WW Design Flow...................i. WSeptic Tank—Liquid capacityI�.gallons Length................Width..............Diameter................Depth_........._... x Disposal Trench—No.....�...__..»..Width... t� .......Total Length._.. -...Total leaching arm..:. °.`J7 3 Seepage Pit No................. D' eter.................... Depth below inlet--.----Total leaching area.--....».. .sq.ft. z Other Distribution box ( D k ) QQ Percolation Test Results Performed'by... 41 � --�_..._. Date.. _�.'»�..:_l.�........ t l minutes per inch Depth of Test Pit.......IQ ._Depth to ground water..." Test Pit No. 1.....2 � ti. Test Pit No. 2._............minutes per inch -Depth of Test Pit......... Depth to ground water....................... 7_ y' �. f�. ----- Description of Soil...._...�y.iV i...4--- •�-_- („Q.._.._ r ........................ x U Nature of Repairs or Alterations—Answer when applicable......._...................._..._......_._..._.......................... _-_•-•-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed.............................._........................................................_........_..._... __............. .................. Application Approved By ............ .. ......-..+'-.�. . ... .._.........................-...._.. Application Disapproved for the/ollowirtg reatont: ........................._..__......................................................._........_...................._........ ..... ...................................................................._............................_..._................................__........................ ................p.........._........ Permit No. 9167..7: ............... Issued Co j................ THE COMMONWEALTH OF MASSACHUSETTS -r-- �......BOF TD. HEALTH ................................. fQerfiftrutg Of f1IOntplizIncP THIS IS TO CERTIFY,That the Individual Sewage Disposal System constructed( )or r Repaired( ) by.................................................................................................... .. t�n.ik. ........................................................................................... at .........:......... Ili._....KA1..............................................................._..........._............._......................._._........ has been installed in accordance with the provisions of TITLE 5Rf The State Environmental Code as described in the application for Disposal Works Construction Permit No. .....7..5......:....J...7. �.. dated ...f0...-.G..-..g'••5 -••• THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.........................................................................._....----................. Inspector.................._............................................................._ THE COMMONWEALTH OF MASSACHUSETTS -I BOARD OF HEALTH CqyyTw..IY OF.. .......................................... No...l, -(.[._�3 Ftta... Fisposal Marks f�onstrurtion Permit Permission is reby granted....................................__................_........._..._._............................................... -_----- to Construct (� or R r ( I-an Sc ge Disposal System atNo............�oi.._._.1 ._.... f1Ti�....... ......................._...................._.................................__ __.. t' --_ St-4 as shown on the application for Disposal Works Construction Permit No.&./1_5 Dated................................. _ _.... ...__..._•...................-._... ............_..-..._....._.........___.., su..e HCilIA DATE................................................................................ 'n -Sze, .s 74, `�7.rov d Nyv� 1 /Vr �a�s �ir�dda'� e nS o� . IIL"3-iAoa o ON 1O7 .d. y Hor Jo H �:7729d1-57VYW -.-AO /YIVOZ �fr! YO ryy7.c,Q' 91v/NOZ 0-Z Sd✓�P�NP� gA/ 'oN 10 7 ,ems O [\ IN ° O R,0-1 'O,l/107 �00 8/=� QV 000 —coo -- 0 35- 7 Assessor's Office(1st floor) Map 61 Parcel 6- Permit# Conservation Office(4th floor)(8:30- 9:30/1:00- 2:00) & Date Issued 960 Board of Health(3rd floor)(8:15 -9:30/ 1.:00-4:45)9, '/7s7,:� e,00;Kee 4�-o ce Engineering Dept. (3rd floor) House# 0 5" 17J S 101 Planning Dept. (1st floor/School Admin. Bldg.) EEP'TIC S ST BE IN3.STAL.LE SCE Definitive Plan A nning Board �p y0 t �' 19 o v .L w , - 2 P ODE AND TOWN !OF BARNSTABEE" "� LAT9�c'"?S Building Permit Application Project Street A dress Village 05 tVf—o,1�� Owner ' -DaU i J- e c s e Address 3 7 S '?_i V e.(L S+ 0-6-ru-h ILA-6— Telephone _ { -7 ___gZ 6 50-7 1 Permit Request 0 -6 A)e.w WOO,) �r � 5,,► le �A0 First Floor square feet Second Floor square feet Estimated Project Cost $ 4 Z ip .0(30 �4 S Zoning District Flood Plain Water Protection �U O Lot Size 1, 51 &crc S Grandfathered ? J.lp Zoning Board of Appeals Authorization Recorded Current Use Proposed Use Construction Type w dt,A ,^1e_ Commercial Residential i Dwelling Type: Single Family L/11� Two Family Multi-Family 'Age of Existing Structure New Basement Type: Finished Historic House Unfinished t✓ • Old King's Highway Number of Baths 3 V2 No. of Bedrooms Total Room Count(not including baths) First Floor y Heat Type.and Fuel / 6e) (j, , Central Air Fireplaces Z rAD,50 f Garage: Detached Other Detached Structures: Pool Attached Barn o None Sheds Other Builder Information Name �f_VL-.. U ln,i S ii AA Telephone Number Y72 —- -7 1 Address CL%ec ci y License# Qq 7 A t_'5 Home Improvement Contractor# Worker's Compensation# 6 kf®U'6 2 3VIC /R3`f s NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE BUILDING PERMI DENIED FOR THE FOLLOWING REASON(S) 0 FOR OFFICIAL USE ONLY 4 , .PERMIT NO. 0 DATE ISSUED MAP/PARCEL NO. - ADDRESS VILLAGE OWNER , DATE OF INSPECTION: FOUNDATION FRAME , 1 INSULATION FIREPLACE, � ��9 oa/la '9�o ELECTRICAL: ROUGH FINAL ; PLUMBING-' ROUGH FINAL GAS: I,ROUGH' FINAL ,- U1 4 11 FINAL BUILDING �.♦, ' to ban '.. ,� � tea: i ♦ - ' 1 DATE CLOSED OYc -_; t ASSOCIATION PL°A 0i,0 : + e, , The Coinmon►vedlth of Afassachusctts Department oJludusrrial Accidents . oxceof/nvesaffaUons -600 11'asltitiltun Street 4y\:�.-•;°' Bnsfon,Muss. 0 111 Workers' Compensation Insurance Affidavit Annhcant information• - Please PRiIYT'lebtblv_„ • ,r � • name: location: ci , I phone it I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity �.....�..a..,.. .•�„a—svr_-.r.�:��:..iy.��.�C.7�!'�'�m ..�r rr;.�...q,e-�•t+�1 am an employer providing workers' compensation four my employees working on this job. omPan_}•name' .I 1 P xy%-6 ( rj (— 1�c9r,M:5 �- Fs fuel AJ a( dress: )6 y 1 cite De NN 1-3, N-41 phone#• insur•nce co. zws C d nolicy# 6 9 i Dus •73qJC /elq.3n7$ . ,... .. _. . - ... ._.,w:. ..:...- "•�- - -•°$_ •__ - ,..:. :�•,ram,., 1 am a sole proprietor, general contractor, or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: I company name: address: city: phone#• insurance co. 1 R.I•_} # LEI. �� +rnc:rr..�..:.•:n-os - �uewrTes�'av�. -- oc_mlians name: _ address: cit-• ! Phone#• insurance co. 1 policy# .Attach additional•sheetiftiecessa n Wnt"A?f`�1 �' ape y:- :.riyd., • ��:��.•ri 7,_ _>>' 'r'.�{�^� �►+'•._ Failure to secure coverage as required under Section 25A of AIGL 152 can lead to the imposition of criminal penalties of a fine up to S1.500.00 a one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do ltereht'CCltifI-under thypains and penalties ojperjuq•dial lire information provided above is true and correct. � I j Si_nature Date �zl�s�ss Print name /V�L PiC lJv�`3 i Phone# 4177 "771 j official use only do not write in this area to be completed by city or town official city or town: permit/license# niiuilding Department Licensing Board Q check if immediate response is required { 0Seleetmen°s Office C311callh Department �s contact person: phone#; ! nUthcr =t. (rr,5ed;;9s PJA) Information and Instructions e Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their enployees:. As quoted from the "law", an emplt tvee is defined as every person in the :service of another under any contract dhire, express or implied, oral or written. An emplt�v r is defined as an individual, partnership, association, corporation or other .cgal 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 tlae 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 1'52 section 25 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 -n-ho has not produced acceptable evidence of compliance with the insurance coverage required. Additionally. 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. ,. .:-.. .:;.:t...+. ...>•rq:}::• 77. :;y:: i�;,U.�Jt{i,iaC�`,y2w:...'•:':5r4 �..�JS'.�.�,.�.,. .. a •- Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names. address and phone numbers as all affidavits may be submitted to tlae 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. �.,w s.....r+ewsKwr.�a�R-• • 707 :,.-..,�,•-.a,r-�.-'cam'---�+ae . F.r,;`.t j{&s.'Y:e Y�1`; -."6- t ':.e:�d'� ,-s .. •s... �_T ,. a r' :. ......,yam;: ... .. .':.'. ' - .'.;hp:" _ y.• aM,t., v i Cite or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at tlae 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. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office.of Investigations would like to thank you in advance for you cooperation and should you have any questions, piease do not hesitate to give us a call. r ►�1�f [�.Mr...p»T•.�� ,.?.tt"..a.'!�A,91••f`A.VYRI .ji•e..'..� ..Y:•✓. _ - Flt'••1I+►f+ 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 fax #: (617) 727-7749 phone #: (617) 7274900 ext. 406, 409 or 375 ............................ ........ ............ .............................. . ...... ................. TE . .......... ISSUE DA (MM/DDNY) .................. .......... .. .. ..... 1-IINSU. ....... . . .....1 11 ....... . ....IF �ix....... ..... 12/29/95 X ....... ....... .—......... ..xi' ....... ..... . Xx ....... ....... . ..... ....... ....... .... ....... ........ ...... ....... ........................................... . .......... . ............ ....... . ....... ................................................ PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS MO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE ROGERS & GRAY INS. AGENCY, INC POLICIES BELOW. 434 ROUTE 134 ........................................................................................................................................................................ P. 0. Box 1601 I COMPANIES AFFORDING COVERAGE SOUTH DENNIS MA 02660-1601 ....................................................................................................................................................................... COMPANY LETTER Reliance ins Co/WC POOL ............................................................................................................................................ COMPANY ...................................................................................................................................: 6 INSURED LETTER ...................................................................................................................................................................... Unis Realty Trust COM PANY C LETTER ICheckerberry Lane ....................................................................................................................................................................... COMPANY I Forestdale MA 02644 LETTER D ............................................................................................................................. ..................... ........ COMPANY LETTER E . ................. .................... .... ... ....... ..... :xx .. ........ ..... ......... ....... . .............. ................. P- Ov. I • THIS IS TO CERTIFY THAT THE POLI•CIES 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. ........................................................................................................................................................... ........:........................................................................................................................... co POLICY EFFECTIVE ::POLICY EXPIRATION LTR: TYPE OF INSURANCE POLICY NUMBER...................................................... UMBER LIMITS DATE�(MMIIDDNY) DATE(MM/DDfM .............................................................................................................................................................................................................................................................. ...... .. GENERAL LIABILITY GENERAL AGGREGATE :$ ... . ................................... ................................................. COMMERCIAL GENERAL LIABILITY PRODUCTS AGG.-COMPIOP :$ ................................ ........................................................ CLAIMS MADE OCCUR. :$ PERSONAL&ADV.INJURY ..................... ........... ........................................................................................ OWNERS&CONTRACTOR'S PROT. EACH OCCURRENCE :$ ........................................................................................ FIRE DAMAGE(Any one fire) :$ ......... ....................................................... ................................................:........................................ MED.EXPENSE(Any one person)::$ ............ ............................................................................................................................................................................................................................ ........................................... AUTOMOBILE LIABILITY COMBINED SINGLE................. : ANY AUTO LIMIT $ ........... ...................................................................................... ALL OWNED AUTOS BODILY INJURY .......... :$ SCHEDULED AUTOS (Per person) HIREDAUTOS ....................................................................................... BODILY INJURY :$ (Per accident) NON-OWNED AUTOS GARAGELIABILITY ...................................................................................... PROPERTY DAMAGE :$ .......... ................................................................................................................................................................: ........................................................................................................................... EXCESS LIABILITY : ::EACH OCCURRENCE $ ................................................ ................................. UMBRELLA FORM AGGREGATE .. ........... ................... .......... ........... ..........OTHER THAN UMBRELLA FORM .............................................................................:....................................................................................................................................................................................... -:,", .....*..... ..................................................... ... WORKER'S COMPENSATION STATUTORY LIMITS ...................................... ................................ AND ................. H ACCIDENT : A 6RIOUB7349194395 03/14/95 03/14/96 EAC $ 100000 ............ .................... ....................................... EMPLOYERS LIABILITY DISEASE-POLICY LIMIT :$ 500000 ............ ............................................. DISEASE-EACH EMPLOYEE :$ '100000 OTHER ................................................................................................................................................................................................................................................. .................................................................. .......... .......... ........ ................ ......................................................................................................................................... DESCRIPTION OF OPERATIONSILOCATK)NS/VEHICLES/SPECIAL ITEMS USUAL TO OCCUPATION ISSUED FOR INFORMATIONAL PURPOSES ONLY ........................ . ......... ........ ........ ............ : ........... ................ . ..... ............ ......... ....... ........... ....... ......... ........... ...... ....... ..... ... ..... ...... ................ ............... ............... .. .......... ........... .... ............... .. ............... .................... ............... ......... ..... ................C . ............... . ........ ................ ...... ..... ............... ............... SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO TOWN OF BARNSTABLE 10 MAIL-DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE BUILDING INSPECTOR LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. BARNSTABLE MA 02061 ^'n A'V T'kTC-'TT1M A Nlrn10 Ar_-VNT(-V INTO. AUTHORRED REPR 19 By: . ............. ......... .......... .............. ...... . .............. ............... I. 023 '. . ,l I o ,a ,�•N .0..' � -T 'Y ' •�.�'��_a:..�i.'� t./.+ 4.4,, -�a/'�c-.u'vG�ai�•r_X•`rw/��i�t <' . . .v«+..Wr._...a�.tne.�..i++�•-•.'.•I--,� �o ✓.I':'� _ f`' f�- ' t t��ti�: COMMONWEALTH "':�. `:'3 DEPARTMENT OF PUBLIC SAFETY =' rolttC�f/ 1auaQAsiBltiditNQld OF J : ONE ASHBORTON PLACE TH +{lode/iCa1fNI�tIA MASSACHUSE 9' BoSTOW,'MA 02108 ;q. '•L ;=:ciu:_: CAUTION EXPIRATION DATE i;`j 1/ a`. -' `� I_i ilt"=_;T�e '_ �I;V?'=_a iF: i ;T -•. :`' FOR PROTECTION AGAINST :. e EFFECTIVE DATE LIC-NO. THEFT, PUT RIGHT THUMB ` RESTRICTIONS ? PRINT IN APPROPRIATE ` BOX ON LICENSE. t ^T M1i ! !T ; " BLASTING OPERATORS c�:=.:=—`_;4•—:: %`:S J. ti,:!. = a::c=f�F i==F'Y L(v . MUST INCLUDE PHOTO. e-.: PHOTO(BLASTING OPR ONLY) FEE: - i.T U C_)0 NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY 4 HEIGHT: c STAMPED-OR-SIGNATURE OF THE COMMISSIONER -2 r i DOB: 1_ •, F::IMIZA I/ 1 _ THIS DOCUMENT MUST BE: - SIGN NAME IN FUIrL ABOVE SIGNATURE LINE . C EE ' - CARRIEDON THE PERSON OF- GAGED INTHISO - THE HOLDER WHEN EN- Y ♦ _ CCUPATION.' MMI CIONER OTHERS-RIGHT THUMB PRINT � d- �.l•+'. -i �c-ti.�>r;�atc,.'.vAr _._ -:.►_'Tsaect^:•M+i.[ r��. i>S:- i i . -ram • " j? vnx !t-_� ^." I I r I _ If..�l---I-�• y.' I�� I I- - it i • 4!>,Gi�'r I.__c.:ll�i wq � -'4 �1... ._.. _�i,. .,..-� '] t• I I I- 1I . . it -. ("Tiff 1j. Li i, ilil�ll-I %� rl1�� , .. ii. i,:':'.4�-�' =�'=----- ' ;i�:7.aI• (f) I. I I._.( _�'r�lf!p .�! ? j •i' -w- i�l Ili'. -'I 0 ��.' illli I !/;% I I ! ....�:�V m '\ '. iZ it ESL—`z)i�•, jl i '' II f i !•��+;_=_-=�'� � .. � � � E: • .. $ s is d I j yii -. •_^ I..," � 2 a 3�=Eg2§kH ;°Ha6 �{.{ao;BG'�Pg a ! � � iy'•t�:......_.. �� ' � a � :y1 0 98 d 0 .P:d:6'.: G I . u_��I'..:('• I �d� � - �• 2� .g H"-.':d.. d fit{ .aH2 a ! . _�_' -......—--.1�'�' :I ! �"� � � ¢ �y� 6 ® �4G6� � ��9d�"6Gy�QP .•8 I I f' ��'-. .. a• P d . g � � r d . .-�� s�• .9adaa g I ii i:- sTaj. . �� cs d d �H 5 a$ d =r; 8$.e a�g°a•Q'aHaa ! ! L! d d 4Q v �' co°' � •°a�g� G� i �f.98r Fi. •.�;;:Fi I it �— o � --- --- � 0i --- ----- rF RFraFp °ElFrea•te:e Jc:: RxR' -c. l 1 (QsFP^iFPP4- ! �I' i I E�y9�y"xyEy:J9€9}Geri@rE` •A f�JgS cE 6' A a '�` :.E_ss FFFy�i�.P� •sc'y{{J a iF'EFE�r ^� t4i r. �$ m a �pl F�FF •y"tE_ 5`yiygtJFrloy� &�i.n.Pjl�''c g _._. 'i �� m o o' i �r�� FF�,PiEti.-cys.FFciE�••x:�:'R;FI�PE-;fj d � ,� I I• aQ a �,. i aa� Ey .� P P. .rRs7iF�E{ #�-rc'?:F"FF i o i q Rr g: 1111i•g E i Ee_ Rac ^! �• it; VI "i c:i 14, 1:cad. 1 r • , 1.. It _ 1 11 I ! ::iicr I #. r=— ' f ! a _. •i ; '.:\ � aj is•':..I _.1 \. ____ _• I •Y•� y\ 1 �.5:• _:' :: _ f; FiM — — �I:.`•— ---=— it !T .� :1 III 1, •,•• � 'r -I a t 11 i ❑ I i• � L :I •-fP if ail- '✓ .'� ! ' C `_ II'''' c�tJ i}l r.' Ire •_:t�, sir '! ' =xl u. 4.`..:i..._Iiil s;! / uj ' 'I -.c_—=I,, i' t7�!•�'' I� qi- !'. � \ li!!i �! Ijlil,;�` iil' ii.l1 ��'! .li_ r i I I M S N G Ah I �R � � tg � pRg RA °��`°.` S.<• gEaRCgS 4� � � I Gg"g •®e f ao 0 0 " OVA 4 In p Q G '` � .. 9Qoi x O m _ r s .-- J: �ro iz, — I —jN ij� � ) .. A a•o � I i I i 1 j � i �•I(''1 'ID a I iI 1 , I _ I iI Et ,h-J" jL p f A by e . "• I 2�oi co C�J1 V II. � vn ov�iro.at' ✓.- I , . a � _ I 11 a °y� �0� �� •I�a6€ Q a� a. �^ ,�a � a B a8 i a i. s '-ii i° $ as a 1 aa •E�• yp�° tp {p a:@ 3:le C °A9 a ape "a" a a�•` i y ® '\^ e�' :�i•' �@ :1 Boe 6°�� Y. i �� I�i 31 d" c� �£ r � s �� E3 la �1.0�I. �� .�� I� .�:S� •� �. � : - �° �; @ro�� €e �a� ��1�� p� �� . � � i,4iy 3; g e a y c S Fi i i a! ::......yINA ° O `r ._?r r a 1 . .� '� 5 F S e. a� .�� pp ',w 109ZO q=QMM'SIUUE(H •r�•wtA•rtalml'aM+si Yfo�w � e:,_,,I�6r7alr�a rOd � /'YN7d a(q�Zd.O/Y07�S . mrwtsw rr.wycaram inn NM30 DH38V3S"I'U w®uipedea 411e8H ---- ---- - --- --'-- - -_ _ 1r MN•IIM- 41r.IG 'OM 9Cr' :- •�.�__-�i-: � ((� � •' .� ��. -- --- yoor!�s.t I J �.r• _i..- - i Y:ia� /" is� ,J FI ,�.• i Y �........ �a=..s•r+✓(war)m�u�'+YY tl '� �. 1- I "`an+• :s �,YOJ7VP i�-.��_'j- e..+..:..r:.e.:.: em.• 1+.¢.�'F+�.�,TM�•'z_., �'0 ,-��_` 3JiO�' .4 �,,s L. .Y VU ••• m" ocorR�s o>.gs c 1-' �p. NG0.,a7.v ,p .em�'."..�mom: :.�;: - -_ .. � •.. v"�°' �T'T .� .� t �naYv+a t� � �� 77aQ'Cb0l1i'i1LQ1P0 5F. - e � (ir�aflFJ.f�-'�� _�. ,,,<..� � - .ors."Sy 9'Z✓Jl .�. � o.�Jfrr�—' � �� (C�PY1aN>C!/01J •.,�• J. -sn i..r _aam or•wu : ��_._._ nil J �..__' �fy4'-05 .. .may. �1Red MW✓��fN __-_ � Yi3 Ks 59'/�fx/.. 2�] � (�a(/r✓A�y � .. �.>a'nm..•�� (olafles.c :'.r�•`'J c-/ .ao 1�S, . " .. � � ....../ rvov dvneJsr °�'-..' tw✓a>s�+®_r—. 4 *' v, la:c�os T _,- 41('�I T�J7 4V/�\/ fit; t•3 r tr.' ' � Tom: V • I 1 , : i i :;I; ka � 3 I •pro .� i Ul � � ib �_f•�1' � } 4 - r � -�4..• _T}- I h .. , ' �A� -'1} \� i.LItF�� J Cb I ; y• .If,� j..i,. • of A�. , �.. � f- ^�. 'j ��. 2�•U .i- '. '^�, _-tIla�• .. .. , i L _ IILL I � OFF I I j o f-7 1 p i Ir An I '^ 4 ' n� -e^prcicF°ExS°F{�ce�F:FEES{egqc•agisjjgga.g rIF 3jyy itF{e{r3 iya .�: a"•{�E�gLF�{f${jc{f !�y'. � � N€ �° {"i eei i:( E,fSi.ac !tl{"d FE9cde• ° L"C{ � [FA 15 �!{•r� E{:�F+=xEFi �'" � / - ,� O :� to 4,p� �€��cF;i�l c�{Flt�(t5sc Fie{j r.{E�cc1�•�(:SE�Fjt"'s � ct tyy f _,{ {fe (�ac6yisr^i:c• ac�r •sE+ {e' � Y t��aF3 r a{c { i tp a 0 tc i(F{:t.��A +�021etts. {�r' r i � c r s�i��il {tlf� I+we� i! r � Z EISAE,r•;� "s rg: a•[Ei� t ,t6�e�.�FFs� �'i�rA{{cit.[_: I�. 777 ka5�c."'- { � 1 " ! E3 r Ft S' rlc 3•i .-. ' y i R cs Ac e5c•c E ttg J.t;p t e'cl�[ !c ?• e 1�'1 E'E e{ C a•�,� t.:EAf IE! s b F' +i'� i y g t c { gg t rr 1 � {�� ^{-•, tll Lr�a a F�Fi I I� i� y t{E{ F +cfEI CD �.�....gg a G L e�AF£� ES�i � ��EgTt 9 � �� 1° F�Far` $$ e. ac 4e rc�• [ ,1 t:�[a F• tf�' Iaf aF"M�Fp� ir f_a +� :1 l iGa ' F �_ a F�EF A t „ q�El { 1'{e � �� ;, t �a i lgtij,{ 9° r. {. e . g •r; CME HOUSE I , OBlerville, Ma. } CCCry o i . ,:I I � ?, ..:` `r � i f:ipKJ�.�r.,r•,., � " it � , j"' I` '�1' .. .. _,._ � J—.,,�...._ i,� � I lk Tr- - �o , 11 o-S �:•I,.'. i t ?- ��pp our. .i /m"'l '*?ill" �� ! �� <�w+cvvr4-rz<•r�i :`n= 'ri�� I r' , `�-' 'I. t � = `3_ a<.rx s.•rx_' T' -� —' - aor ro. owwr-e.-I E.,:... I :... �`.-".i'•`.,..:vvt.) ,r��es/ocC i/._l...fA. e` - _—__..—�444 :YeT':F.- O77 FYA/ei/Xa .� Jr - '"` .ro R.L.SEABERG DESIGN . , s r—.__.... .. j � � uvc000rroswr,r• n,m•aw, � fj __- -..._.... __. _ ,_,..,.i ....._.._._ °wereuw.naac• .man•,w _ sz iia•+s :rn:f r'-,'p' Ixvdrwa � R w: 3 Qgt,eiviI16, Ma., MY .. ��f SS ____�r`/'7a?R --Dflr �'/ 'E _ �* y �• .�'�� z� •tip � ' • �I /. I ;Y.`�� /<s +T f Y/zrfLb IV �,Lr�.�. 11 —_ « "+e-+ :.- ..__.__Y ___ __. _ 6TtubG I :za •z>.:„ 1— tys�l fyp`/+tag I�/ yG-�' I• -i.. - y, I I \ -_— _.... , f ' i 77 ' �y70�0yy t f udi7 ; Y L ILL ' I D Ilapyl�PU � ♦ c R ' i j II �_ � 1•e../bCLtr DOJ�eh �. � I`—_taifp•i o• �� _ !�'•r�.-cN R/IMLI) .,:,' - , .++n•c 7,...L .mac r/s R.L SEABERG DESIGN ; . ECO/JO F.:OOK rX/'/4UJ� PLAN O uaa aoo�eos*a��+ �++maae t- �sr.`cF �/�•^r..,• `;-.'u �. s,oee e�uo,aolw.non-fw �63:. s frs•e . .H'Z.�p.'M1r,'xq. F,+y(�-,», �kr14�,w � S^ Z7i � ci i �7✓ r, C�ti k g - G 1.. i ~ f � r .._ -_ 1 I hs ♦ b � ix �1 , T�°xIR :.1 iT.Y'd••`.�'� s. °�>'Yi`f`' S _ LIE I I II — j o" Idi iM I�. � II e-i 9-- - . A--,s� I -�i�aF� � �•F I •I '' i III+ /-'(� sly .fib• �( - IR l k S w S q � � �� E��,etEr��LPEE (dJEiyPE�•)P{irl!ii��l�� 1�7EE�1 EIP! E�E ( J • O s P F ! c 9 < ,��t��,$F 11 [F p r' � T f.e tpr.riE ii�_'i 1 ` F atP{�i E�tEEP !L��Err��:..•.,.. '.�:� a�:;': . I � 7m0 � F � �)1r Fi i� r•r � t� tl �� -�� P,f �y+�„'; ... i Pi ee i)r�{ i = m p� The Town of Barnstable Department of Health, Safety and'Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph M.Crossen Fax: 508-790-6230. Building Commissioner Home Occupation Registration Date: 6�L� oo Name: Casa_ Phone#: 6O8 q-zo -2.3/L Address: e aS' Village: 65k Name of Business: CRs e Maw.v Type of Business: (�WS uL4-r,4 : 14e) mo y- Map/Ut: 4 SAS— 01,3 - ,-t. INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home. occupation within single family dwellings, subject to the provisions of Section 4-1.4 of the Zoning ordinance, provided that the activity,shall not be discernible from outside the dwelling: there shall be no increase in noise or odor; no visual alteration to the premises which would suggest anything other than a residential use; no increase in traffic above normal residential volumes; and no increase in air or groundwater pollution. After registration with the Building Inspector, a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit;located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings, and there is no outside evidence of such use. ' • No traffic will be generated in excess of normal residential volumes. - • The use does not involve the production of offensive noise, vibration, smoke, dust or other particular matter, odors, electrical disturbance, heat, glare, humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials, or flammable or explosive materials, in .excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation, and not within the required front yard. • There is no exterior storage or display of materials or equipment. •_ There is no commercial vehicles related to the Customary Home.Occupation, other than one van or one pick-up truck not to exceed one ton capacity, and one trailer not to exceed 20 feet in length and not to exceed 4 tires, parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business, the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. 1, the undersigned, CChave read and agree with the above restrictions for my home occupation I am registering. Applicant:, rJa J«_ K. Ca U, Date:. C a& Z 00 Homeoc.doc TO ALL NEW BUSINESS OWNERS Fill in please: YOUR NAME: 1&V;d APPLICANT'S YOUR HOME ADDRESS: f ' BUSINESS a a n ,�;`P,�✓c 11 Telephone Number.(Home) S'O.k �1-O TELEPHONE I TYPE OF BUSINESS C�Nsul �1vrs NAME OF NEW BUSINESS IS THIS A HOME OCCUPATION? ADDRESS OF BUSINESS 3 MAPIPARCEL NUMBER I own When starting a new business there ar e several things you must do in order to be in compliance with the rules and regulations helateo u red tsignatures or Barnstable. This form is intended to assist you in obtaining the in listed office (Ist floormation you may or Town Hall).. Once you have obtained listed below, you may apply for a business certificate at the Tow -1. GO TO BUILDING.INSPECTOR'S OFFICE (4TH FLOOR TOWN HALL) This individual ha b en ' formed of any permit requirements that pertain to this type of business. Authorized S' natur COMMENTS: 2. GO TO BOARD OF HEALTH (3RD FLOOR TOWN HALL) This individua4Au een jnfor ed of the permit requirements that pertain to this type of business. 9 thorized Signature COMMENTS: 3. GO TO CONSUMER AFF AIRS LICENSING AUTHORITY) - (3RD FLOOR SCHOOL ADMINISTRATION BUILDING) This individual has be h,ipformed of t,e I' nsi g requirements that pertain to this type of business. Authorized Signature COMMENTS: - our business e required signatures you must return to the Town Clerk's Office to obtoai must do by M.G.L. fit doesficate not ost $20.00 After obtaining the give you for 4 years). A business certificate ONLYhEouS h completion ofERS YOUR nthe'pr processes fromcthe various departments involved. permission to operate -you must get thatg R G 12, /A �,KME r Town of Barnstable *Permit# - I oS H y�' 0 Expires 6 months from issue date ' b �l latory Services Fee + L1RNSfA13" �0$ Richard V.Scali,Director iOrED�.ta JUND 6 2016 Building Division TOXIN OF BARD;TA IBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXI?"SS PERMIT APPLICATION RESIDENTIAL ONLY 7 O'�l Not Valid without Red X-Press Imprint Map/parcel Number Property Address 5 'S eG jOLiAA7 Q +(Ul J vak- Residential Value of Work$_LG I MI. Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address 'D Cwt a � ,Q� Cu.u*K_,t—R, Contractor's Name ( 9 eo(CA 4 i&in Telephone Number 502- ,-57LZ- Q Home Improvement Contractor License#(if applicable) z�� Email: .� � Cons ction Supervisor's License#(if applicable) orkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ am the Homeowner have Worker's Compensation Insurance Insurance Company Name -Ty^c ovc r-e 4_7Zs S,a 'R tA-f(LA . a Workman's Comp.Policy# � ! P L/ l(�Q2. 9,5 1 S Copy of Insurance Compliance Certificate must accompany each permit. Permit Reque check box) Ve-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to � ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows t #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,ctc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is req . ed. SIGNATURE: C:\Users\Decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\2PIOI DHR\EXPPESS.doc Revised 040215 r tinxtvsTnet.e. b 9 Town of Barnstable CEO MA'1 A Regulatory Services Richard V.Scali,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder cKKk�� , 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: . (Address of Jo ) . Signature of Owner Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Users\Decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\2PIOlDHR\EXPRESS.doc Revised 040215 t% a S i cam` 77te Commornr•ealth of Massachusetts Aeparnisent o,f hidirstrial Accident's z Office of Investigations 600 W shingtou'Street % Boston,M4 02111 - Tx. wn..,sr.niass.gmldia Workers' Compensation Insurance. tda«t:BuiIders/Conti-actors,Electricians/Plumbe.rs applicant Information Please Print Lei bl-N- Natne t usinesr4r anizationPlndrv;anal}: , Lk Ada ess: � PT V, CitylstatdZip: Z bone 4: — —. ❑ am a vamgna employer withemployer"Check t appropriate box: Type of project(required): I 4. €eneral contractor and I emplo)ees(full and/or part time):" have,hired the sub-contractors 6- ❑New construction 2.0 T:ant a sole prtipn.ctor or pxrrrren°. listed on the attached.sheet. 7. ❑Mriodeling .slip arm have no enap)oYecs TUese sub-coxttractors.have g ❑Demolition norking fox me in anv capacity. "loy�=d have workers' [No ;Porkers'comp.insurancecomp.insurance.* wilding addition re(luire>] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I ama homeowner doing all work officers have exercised their 1.1.❑Plumbing,repairs:or additions self o workers' right,of exemption per MGL. ffi3 (N �- 12:[DRoof repairs insurance required.]{ c. 152,;,C 1(4).and we:have no employees,[No workers' 13.❑Other comp.msuiauce required.] •Acy appkcact that cb eckc hox a l musr Ow Wow ate eecdon belaw curdu io;tbeit wot ketr.'coo)pwu;ion policy Wdrt atioo. 4 Homim aen who submit tbtis:affidtr:•ii nsdtcsting they are doing,all+work ind @en hire outside couT actors mast subnal a uen'a idav t:iodicatin;s+ech Goner :cars that check this box trust uuchtd in addiiionat sheet show us°•the.acme of the sub-contractors and state vrhedtrr or not those earities blare empkyees. If the subcontractors hire emplo,ee%they must pmride**.r warkers'comp.policy number. I am run eniptayer that is prosidijtg xork4ers'cottrperrsatiori iristtrance for try etttplvjtees. Below is the police eutd job site information. Insurance Company Name:__Tr(AJV l/ �� J a.✓�� T Policy or 5el£ii►s.Lc.«; _] ] txtf n Date: t Job Site Address_ Awd ` CityiState#Zip. LO�Q "A Attach a copy of the corkers'caropensa on pohcy declaration Pise(showing the policy number and expiration date). Failure to secure coverage.as required tinder Section 25A of MGL c..152 can lead to the imposition of criminal penalties of a fine up to,S1,500.0D andror one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a day against the:xiolator. Be advised that a copy of this statement:may be:fin-warded to the Office of Investigations of the,DIA for insumqLcoverage.verification. Ido hereby rert(ft U der tire paints r jet 'sr4 that the irrforruntion pro+ ded above{; cirri rtrrd t orreer: Si tune, / Date. z__0 _Z4 Phone 4_ G —. (I,Oieialrue onit. Do not strife itr:this erica,to be completed b3 cii.1,or totcjt o;OSc al Cite:or Ton-n: Permit/License# ISSI tig Authority(ri>cle one), l..... and ofHealth 2.Building Depatrtmetrt 3.Ciq/TowuClot 4.Electrical Impcctor• S.Plurtihutg Irrspcctor 6.Other Contact Person: Phone#: N Office of Consumer Affairs and Business Regulation -10 Park Plaza - Suite 170 Boston, Massachusetts 02 116 Home Improvement Contractor Registration Registration: 173263 Type: Private corporation Expiration: 9/20/2016 Tr# 259342 RYAN HOLMES CONTRACTING INC. GEORGE RYAN 180 NINIGRET AVE. MASHPEE, MA 02649 Update Address and return card. Mark reason for change. el sc- 1. 20M.-n; Address — Renewal Employment Lost Card Office of Consumer Affairs Business Regulation License or registration valid for inclividul use only IR.OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: WIMM GIN Registration: 173263 Type: Office of Consumer Affairs and Business Regulation W 4 - xpiration: 9/20/2016 Private Corporatic;i 10 Park Plaza -Suite-i 170 RYAN-HOLMES CONTRACTING INC. Boston. MA 02 116 GEORGE RYAN 180 NINIGRET AVE. MASHPEE. MA 02649 1'ndersec.retary Not valid without signature 81,0zi0ZA0 6*9Z0 VW 33dHSVVY —.0 '3AV.1.3210ININ 081• NVA8 H 306030 ZZ9600-SZ) §0jeoueicz oue suoi,.eIn6GZi 6w.pj)nE to ojeoS At ,o :u@u-:ijed@C, siasnuDeSSLV-' I /06/2016/MON 16: 03 PaulPetersAgency FAX No, 15084776498 P, 001/001 DATE(MM/DDJYYYY) Ac Ro o® CERTIFICATE OF LIABILITY INSURANCE %.. � r 06/0612016 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 i9 an ADDITIONAL INSURED,the pollcy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER NAME: John Lynch IV PAUL PETERS AGENCY INC. PMONE 508 477-0021 IFAX AIC ,: ACOORES& jay(Mpaulpetersagency.com 680 FALMOUTH RD. INSUREP491 AFFORDING COVERAGE NAIC9 MASHPEE MA 02649 INSUPERA: TRAVELERS PROPERTY CAS CO OF AM 25674 INSURED INSURER B: RYAN HOLMES CONTRACTING INC INSURERC: INSURER D: 180 NINIGRET AVENUE INSURERE: MASHPEE MA 02649 (NSUPMF: COVERAGES CERTIFICATE NUMBER: 58825 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. LI ADDLINU YYYI I�TR TYPE OF INSURANCE VAM POLICY NUMBER POM//001 EFF M�<E/LIO�/EXP LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE bCLAIMS-MADECLAIMSADE OCCUR PREMISES b MED EXP we on $ N/A PERSONAL&ADV INJURY b GEN'L AGGREGATE UMIT APPLIES PER: GENERAL AGGREGATE S POLICY❑JECT LOC PRODUCTS-COMPIOPAGG 5 OTHER S AUTOMOBILELIABILITY COMBINED SIN LIMIT 5 Ea aeodenl ANY AUTO BODILY INJURY(Per person) 5 ALL CWNED SCHEDULED N/A BODILY INJURY(Per acddern) S AUTOS NONZWNED PROPERTY DAMAGE b HIRED AUTOS AUTO$ fp S UMI3RE-LA LIAB OAR EACH OCCURRENCE S EXCESS UAB CLAIMS-MADE NIA AGGREGATE $ DED I I RETENTION S $ wORKER9 COMPENSATION X NY AND EMPLOYERS'LIABILITY APROPRIETORfPARTNEWEXECUTIVE Y/N E.L.EACH ACCIDENT b 1.000,000 A OFRCER/MEMBEREXCLUDED? wA WA NIA 7PJU89F41829515 12/21/2015 12/21/2016 (Mandearyin NH) E.L.DISEASE,EA EMPLOYE $ 1,000,000 If yes.desutbe Linder DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 N/A DESCRIPTION OF OPERATIONS I LOCATIONS I VDBCLES(ACORD 101,Addl0onal Rerrlarfts Schedule,may be attwhed N more space Is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B.no authorization is given to pay claims for benefits to employees in states other than Massachusetts If the Insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy In force on the date that this certificate was issued(unless the expiration data on the above policy precedes the issue date of this certificate of Insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.govAwd/workers-compensetionrinvesogatlons/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Barnstable Attn Building Dept ACCORDANCE WITH THE POLICY PROVISIONS. 357 Main St AUT14ORMREPRESENTATIVE H MA 02601 Hyannis Daniel M.Cr y,CPCU,Vice President—Residual Market—WCRIBMA ®198&2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD TOWN" 0 BARNSTABLE CERTIFICATE OF OCCUPANCY ?ARCEL.. ID 000 000 035 GEOBASE ID 4466 IDDRESS 205 BBAPUIT ROAD PHONE i Osterville ZIP '- '• 67 BLOCK LOT SIZE )BA DRVELOPMENT DISTRICT CO ! ?ERMIT 23936 DESCRIPTION SINGLE FAMILY DWELLING ((P rAt12557) ?ERMIT TYPE BCOO TITLE CERTIFICATE OF OCCUPANCY ifet ;ONTRACTORS: Department of Health, Safety I kkCHITECTS:. and Environmental Services ices DOTAL FEES: 3OND $.00 , ;ONSTRUCTION COSTS $.00 756 —' CERTIFICATE OF OCCUPANCY ; BAItNB,i,ABLE. : ; )WNER CASE, DAV I D. 6 'ADDRESS 205 SEAPUIT ROAD OSTERVILLE MA BUILD O BY DATE ISSUED 06/24/1997 EXPIRATION DATE THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET.ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY.EN- CROACHMENTS ON PUSUC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROMTHE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OFTHIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF FOUR CALL INSPECTIONS REQUIRED APPROVED PLANS MUST BE RETAINEC ON JOB AND FOR ALL CONSTRUCTION WORK: THIS CARD KEPT POSTED UNTIL FINAL INSPECTION WHERE APPLICABLE, SEPARATE t.FOUNDATIONS OR FOOTINGS HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU- PERMITS ARE REQUIRED FOR 2.PRIOR TO COVERING STRUCTURAL MEMBERS pA S B E REQUIRED,SUCH BUILDING SHALL NOT U- ELECTRICAL,PLUMBING AND MECH- (READY TO LATH). OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. ANICAL INSTALLATIONS. 3.INSULATION. 4.FINAL INSPECTION BEFORE OCCUPANCY. IWI• 4 BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS q 1 1 . 2 2 os'' 1 00 5 �C' 3 1 H G I PF ENGINE ING DEP TMENT 2 OF HEA SITE PLAN REVIEW APPROVAL EHER1 X � NDICATED ON WORK SHALL NOT PROCEEDO=STRUCTION WORKL P M WILL O S NOT THIS ME STARTED WITHIN S X CARD CAN BE AND VOID IF CON- INSPECTIONS (ARRANGED OR BYTHE INSPECTOR HASNTHS OF DATE THE PERMIT IS ISSUED AS TEOPHONE OR WRITTEN NOTIFICA- VARIOUS STAGES OF CONED ABOVE. TION. �, i R TO G� BAR NSTABLE-r CERTIFICATE OF� OCCUPANCY PARCEL ID 000' 000 035 GEOBASE ID , 4466 ADDRESS -• 205 SEAPtJIT ROAD ^ y PHONE Oster4ille ZIP I • I - LOT 67 BLOCK LOT SIZE DBA X. DEVELOPMENT DISTRICT CO iPERMIT 23936 DESCRIPTION SINGLE FAMILY DWELLING (PMT_#12557) PERMIT TYPE BCOO TITLE CERTIFICATE OF OCCUPANCY CONTRACTORS: ! Department of Health, Safety ARCHITECTS:. and Environmental Services TOTAL FEES`- ttlE j BOND i CONSTRUCTION COSTS $.00 i 756 --- CERTIFICATE OF OCCUPANCY + BARNST'ABLF, + MA83. OWNER CASE, DAVID. � t. ADDRESS 205 SEAPUIT ROADAr OSTERV I LLE MA BUILDI ,G D� LION/ BY DATE ISSUED 06/24/1997 EXPIRATION DATE r TOWN OF BARNSTABLE BUILDING PERMIT PARCEL ID 000 000 035 GEOBASE ID 4466 ADDRESS 205 SEAPUIT ROAD PHONE Osterville ZIP - LOT 67 BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT CO. PERMIT TYPE BUILD DESCRIPTION SINGLE REESIDENT AL DWELL PMTW PMT 095-1753 CONTRACTORS: UN I S, WALTER Department of Health, Safet; ARCHITECTS: and Environmental.Services TOTAL FEES: $208.00 BOND $.00 CONSTRUCTION COSTS $210,000-00 101 SINGLE FAM HOME DETACHED 1 PRIVATE P MA88. - OWNER CASE, DAV I D ><b3 U� ADDRESS 205 SEAPUIT ROAD O OSTERVILLE MA BUIL IVIS B DATE ISSUED 01/02/1996 EXPIRATION DATE THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY.EN- CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF FOUR CALL INSPECTIONS REQUIRED APPROVED PLANS MUST BE RETAINEC ON JOB AND FOR ALL CONSTRUCTION WORK: WHERE APPLICABLE, SEPARATE 1.FOUNDATIONS OR FOOTINGS THIS CARD KEPT POSTED UNTIL FINAL INSPECTION PERMITS ARE REQUIRED FOR 2. PRIOR TO COVERING STRUCTURAL MEMBERS HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU- ELECTRICAL,PLUMBING AND MECH- (READY TO LATH). PANCY IS REQUIRED,SUCH BUILDING SHALL NOT BE ANICAL INSTALLATIONS. 3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. 4.FINAL INSPECTION BEFORE OCCUPANCY. . ® Lin I• BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS Jule-� 2 ,h q �Pl�- 2 O-r G'Gr ft pt� -a9-C'Fl 14-'do 00 3 12r H �AZftG i ECTy, P /ENGINE ING DEP �TM7ET �� _ 0 c ; v_ F7 2 OF HEA�HH OTHER: SITE PLAN REVIEW APPROVAL 0't s tqt d WORK SHALL NOT PROCEED UNTIL P MIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON THIS THE INSPECTOR HAS APPROVED THE STRUCTION WORK IS NOT STARTED WITHIN SIX CARD CAN BE ARRANGED FOR BY. VARIOUS STAGES OF CO pMI�TED ABOVE. ATE THE PERMIT IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICA- TION. _ a3�� -