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0024 YORK TERRACE
�i ,� v P 7' I 1� IIII X JI r I 1� ii� )' A Z 9 k u 1 it J a C Y R Si a s TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map lV Parcel �61 t Application Health Division Date Issued Conservation Division_ Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation / Hyannis Project Street Address z5,q, 17( ,X7 f �,,C e . OU ctllllP 02 0. 5 Village� Owner' /�Fr r��r'/'d�� _Address a Telephone Permit Request G a. '612 0 /IrT a-r) a �r /G Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new . Zoning District P&I Flood Plain Groundwater Overlay Project Valuation �I�Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes L: .<o On Old King's Highway: ❑Yes to Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas . ❑ Oil ❑ Electric ❑ Other ',Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing woo coal stove: ❑_Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: 0;existing c] new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other:- ' r Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ . cz� Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number(_j �` Address �� ��•�n, o�% License # Z,��,• .� rr ,�i�c OPSa Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE A2, a, 1I FOR OFFICIAL USE ONLY -APPLICATION# 5 ' DATE ISSUED f MAP/PARCEL NO. a ADDRESS VILLAGE t OWNER DATE OF INSPECTION: q , 'FOUNDATION ' FRAME YINSULATION! FIREPLACE C, ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL r :GAS: ROUGH FINAL FINAL BUILDING 't ® �• DATE.CLOSED OUT ASSOCIATfON PLAN NO. Tlie Commonwealth of Massachusetts =� Department of Industrial Accidents U. t l Office of Investigations 600 )Washington Street \%/ Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information- Please D-'—Legiblv Name(Business/Organization/Individual): 7 �' l�/7� /�`rl'Qf/L aisI� Address: City/State/Zip: /� 02S'lihone #: Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I a employer with 4. ❑ I am a general contractor and I ------------ ployees(full and/or part-time).* have hired the sub-contractors 6. ❑ v'construction 2. I am a sole proprietor or partner- listed on the attached sheet t 7• Remodeling ship and have no employees These sub-contractors have B. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance S. ❑ We are a corporation and its required.] officers have exercised their 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 1 ],❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §](4),and we have no 12.❑ Roof repairs insurance required.] t. employees. [No workers' comp. insurance required.] 13.0 Other *Any applicant that checks box#I 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 their workers'comp.policy information, lam an employer that isproviding 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. f do hereby certi under the pains an en es of ury that the information provided above is tr71; correct Si afore: Date: 2 Phone#: so 3 tf [Bo e only, Do not write in this area, to be completed by city or town official wn: Permit/License# hority(circle one): Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5• Plumbing Inspector son: Phone#: i 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 ofthis 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-contractor(s)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 D.eparlment 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 permittlicease applications in any given year, need only submit one affidavit indicating currept I 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 bum 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 De-partmient of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. # 617-727-4900 ext 406 or 1-977,MASSAFE Revised 5-26-05 Fax # 617-727-7749 www.m,ass..gov/dia aoF > ti Town of Barnstable. Regulatory Services Thomas R.Geller,Director Building]Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.b arnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign. This Section If Using A Builder as Owner of the subject property authorize '��� hereb y -,4//"b'4_r0 d� ��<Y�U r1/ on my behalf, in all matters relative to work authorized bythis biulding permit application for , (Address of Job) Signature of Owner Date ��1�E►� �f122.v c..C_ . Print Name ' f QFORMS:OWNEMERMISS ION i :�9assachusetts- Department of Public S:afet\ Board of Building Re-ulations and Standards Construction Supervisor License License: CS 17232 LAWRENCE A PERRAULT 10 DEACON PATH SANDWICH, MA 02563 Expiration: 9/3/2013 <'unnnisi net Tr#: 883 CIS = Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 137897 Type:- Individual Expiration: 1/23/2013`. Tr# 207601 LAWRENCE A. PERRAULT LAWRENCE PERRAULT 10 DEACONS PATH SANDWICH, MA 02563 Update Address and return card. Mark reason for change. Address - Renewal Employment Lost Card DPS-CA1 as 50M-04/04-GG�1012166p ✓1. L�O%7Yp20Itfl�CCLLUL O�✓��ECIQC� �--\ Office of Consumer Affairs R Business Regulation License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: _ Registration: )37897 Type: Office of Consumer Affairs and Business Regulation Expiration: 1/23/2013 Individual 10 Park Plaza-Suite 5170 Boston,MA 02116 LAWRENCE A.PERRAULT LAWRENCE PERRAULT°' 10 DEACONS PATH:, SANDWICH, MA 02563 - Undersecretary i t itho t signature _ 6g ov 17 tmi"MAW. rroult Cat5bVdla? & des/gn Servlces A l ilders IOMCON6PMN•-9AVnlW,,MA 02563 "r'" 24 Ya�E &r", 05tavllle, AM 02655 �• 91 111 Plan.•(546e)M"04 `ior 15A9�833 6/B5 qq S c3aC• o/n�/�/ A _ / r/,®o k �CAyO(J`I o�n c� I A'� ,, f�lYCf Af CAw L ff V AW rault Ccnstiuct/cn 9 des/qh Services A� 10MAC06PAIN,�a MVYW0-00,0'' 24 Ya4 rfrr", O54ffAle MA 02655 /Jr,-LitbRilders �ak�n C5Gi9�B33 d/B9 fac C5Q9>e331��e5 ae+ r a /op f' A�t✓7" f 2G� CD CD A-m-PLov kkv/7l'dwim ne51-ow A7 ar/ayre�led nGsae ardrawh desdepp-Hgof GavrareA r'esra/tcd�!'endkR�/d�s adaerotl�f�used m re&07 u�le re-r�ed,reptdridvr�Li�d,h w4deahp3t wlr/rut deerp-ess ,�»��,of�r,�A•f Cohs�ruc�ioh drawihc� CMf[fi1lM4�len6i&q GXA{MVBY G.Aoaak FFb.FM GRAWLIL�i R7H(ders lult Ch5bvchm & Peslgh Services A1 10MKON5PAtH 5AA//� OI hM 02563 Zg YcnF retrace, Ostervl//e, Mil 02655 wwwP&raA*Aiaaam �(509)M.341,B9 fw(509)M"14B5 !� oA� ro/i3/ir l3at,�iram ClarGlan �first Clcrr" J/ I I CD aday rdawdnmolb ae,adrawhdrfdepvg?*o£ 6aKrareA,Farah AaParaJ Mdm-s, adore wl iw&-sed ro re✓/5lw dwe reused,rq�xlredcrpeE�IsJ,ed,h wldea-hp�t,w/Nut tleerp-ess pff mhs�mv oftmrare A FarakCons�ruc�lon l�rawln� CVFIZAl44f..•Cg d* GA'AMPY-C.A Pa'ak I F�2EC� MW W AUW..• rrault CM5�1W&O'I & design Sevlces 1N�CA�('000 5/d�iVC� A 1 ilders 1OPeACOrV5,-A#15AVMQV,MA 02563 '�"'�" 24 York terrace, Ostervllle, Mfl �,p���•� �•(5C�9I B33 G/B4 Par•(5C�3>B33 6/B5 �Wyw,�,. OAS• /0/l3/ll 5ecand flOan A3athram Clar flan , ,t 201:06 a oFtt , Town of Barnstable *Perrnit# P� Expires 6 month ron. issue date Regulatory Services Fee _ O anarisTes>.s, 'K"�ASS. ��' Thomas F. Geiler,Director I171 to �TFD MA't Building Division Tom Perry,CBO, Building Commissioner l 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-8624038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number ( J ' zdressAd !� cS ,n , U ential Value of Work V S 3 Mini mu fee of$25.00 for work under$6000.00 Owner's Name&Address P Cgryd /h Contractor's Name j /lm e-S AocA Telephone Number Z101--C 21::C— �Q Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) orkman's Compensation Insurance .-PRESS PERMIT Check one: ❑ I am a sole proprietor J U N 1- 6 2010 ❑ IXthe Homeowner ❑X have Worker's Compensation Insurance TOWN OF BARNSTABLE Insurance Company Name �, U Workman's Comp.Policy#__ S Copy of Insurance Compliance Certificate must accompany each permit. 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) 7Replacement ide #of doors in ow doors/sliders.U-Value (maximum .44)#of window *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction.Supervisors License is required. SIGNATURE: Q:\WPHLES\PORMS\building permit formS\EXPRESS.doc Revised 090809 r The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 '�.k ,�•` www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name(Business/Organization/Individual): AloO vc &k Address: _ n City/State/Zip:W (% /Phone#: AVam an employer?Chec ty appropriate box: Type of project(required): 1. a employer with 4. ❑ I am a general contractor and I ❑ e c * have hired the sub-contractors 6. Nonstruction employees(full and/or part-time). 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. emodeling These sub-contractors have ship and have no employees 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 I LE]Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.❑ Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insur nce for y employees. Below is the policy and job site information. Insurance Company Name: V J eo C /y ' V Policy#or Self-ins.Lic.#: Expiration Date:--- � Job Site Address: City/State/Zip: 1 , U Attach a copy of the workers' mpensation 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains•and penalties of perjury that the information provided above is true and correct. Signature: ` d�--�-- Date: "& _ Phone#: rV 7/— WO 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#: w■�■ • ■• ■wi a ■ r w• ■psi ar■■�■ ■ • ••sw.r. a► u�v� MOONA-1 05/07/10 PRODUCER t, THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Hunter Insurance, Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 389 Old River Road, P.O. Box 1 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Manville RI 02838-0001 Phone: 401-769-9500 Fax:401-769-9502 INSURERS AFFORDING COVERAGE NAIC INSURED Moon Associates Inc. 1NSU±PERA: National Grange Insusance Co 14788 DBA Gutter Helmet DBA Renewal by Andersen Of RI INSURER6: beacon Hutual Insurance Co. DBA Gutter Helmet Roofing DBA Moon Works IN �ER c: 1137 Park East Drive ItSURER0: Woonsocket RI 02895 INSLIRER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REGUIREMENT,TERM OR COPJDITION OF ANY CONTRACT OR OTHER,DOCUMENT WITH RESPECT TO`A'HICH THIS CERTIFICATE PAY BE ISSUED OR FAY PERTAIN,THE INSUP.MJCE AFFORDED BY THE POLICIES DESCRIBED HEREIr4 IS SUBJECT TO ALL THE TERMS,EY.CLUSIOPJS MJD COta011'IONS OF SUCH POLICIES AGGREGATE LIMITS SHOWN PAY HAVE BEEN REDUCED BY PAID CLAfMa. LTR NSRd T1PE OF INSURANCE POLICY NUMBER DATE(POLI-MMIDD.41'YYy DATE(MM/DDfA'%-0 LIMBS GENERAL LIABILITY EACH OCCURRENCE $ 1000000 A 'X COYMERCIAL GENERAL LIABILITY MPS26619 09/16/09 09/16/10 PP.EMISES(Ea xcurencs) $500000 CLAIMS MADE Fx�OCCUR MED F P(°n'r one Peon) $10000 PERSONAL a ADV INJURY $ 1000000 1 GENERAL AGGREGATE $2000000 I GE AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPjOP AGG $20 00000 POLICY PR LOC AUiOMOBILELIABILITY COMBINED SINGLE LIMIT $ 1000000 A 1 X ANYAUTO B1S26619 09/16/09 09/16/10 (Ea accident) j ALL OWNED AUTOS BODILY INJURY (Per person) $ I SCHEDULEDrUTOS HIRED AUTOS BODILY INJURY $ { N (Per accident) ON-OWNED AUTOS PROPERTY DAM0.GE 4 (Per accident) GARAGE LIABILITY AUTO ONLY-EAACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS J UMBRELLA uABILrY EACH OCCURRENCE $1000000 A �OCCUR F1 CIAMSMADE CUS26619 09/16/09 09/16/10 AGGREGATE $ $ j DEDUCTIBLE $ X RETENTION $10000 $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY X TORY IIMiTS i ER YIN B AtjYEP� EiE�IVE a 28586 10/01/09 10/01/10 E.L.EACH ACCIDENT $500000 CJMEM6EEujEp (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $500000 It yes,describe under SPECIAL PROVISIONS below E L.DISEASE-POLICY LIMIT $500000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION RENEWAL DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Renewal By Anderson REPRESENTATIVES. 1137 Park East Drive AUTHORI DREPRESENTATIVE Woonsocket RI 02895 I ACORD 25(2009/01) O 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD . i 1 .: :v, � � �. t. to-v 1 `` r "' .28Wph 3 �•. �:...,�.....� rY_ �F Ste. ?�._� •f+ ' ,:: VWOONOPOKE ', e`j Lott ei-secr #airy .. j .Sfqf�-Il of and 4-�Wtwfgrd� Ir 1 L 4 SP r: Sand Fud .ftrW ,i 8 MOON MOD a a CustornerName: P2 Ar ( ¢ELLIiq erg/?r?J4ZyearBuilr. J / 71 Renewal r' Address: '%61 ep n t< 7o? Customer If)#: Cape al by Andersen of Rhode Island& Sales Agreement cape c:od //''' City,State,Zip: 'QhS;n n tir ki. 6 ,HQ n�!Pt-Order Number: 1137 Park Ease Drive WINDOW NOLACiMtNT anAndwmComps" <.G Phone-Home: _ Woonsocket,Rl 02895 Phone Work: Page:, _of J Darr. licence#RI-30839 Rl-12259 MA- Emalk l U't Q f 119535 CT-562725 UNITS T' l GRILUS 7961 r" : 9• °°scriRo txn # �• = ix ap ; F a i b` e � le `� iI t 0 pt on # S e f pRtCE f i > ~ ,7r a a r Ir a 0 v,ail IL30, R-) ! 11.E s .) 1 >- o n tl COL lit -! Coy. 3 7 Z 3 e 8 > > I I t t t ti 4 z- 44 Yk S 6 - ) y Y y z- 4 y Jr- wu µ 10 - Co141w 7.0 3 1- �• �z tacep to dire, r Etc ruses Sub Total ta»n P[oposal:Ail of the tbnvc vlrnkrva era)ati.a,,n be pnw6lnl rm the nail armwn wtcd in du•gtnemrnl.The � (�} rye� A D ✓ ��Mt Method P^'P.r�niR rtmain r+dhl l,r JI) a anJ in wbj u�.eecptmta by Wnh l:uxnmcrarwl RcneWil hp AnJrnan Hawker a. ( !sing,.w.onp,Rot ir,PmnbAon,sae) Imrrnkd bekrm• Sub Total pest.hem Dacrlption/Notct ` /� � l j price s Mw by A xn 5a4w Rry,n9mnlMNe Synwturc S/ Q�L L 1� l..s l U V�f Z/ /�['A-1„-) J INS Stab TOW"ftwo L �t 7���1 � Cuatataer Acy e:}'nY OfC IMt�'tY[IMMt>nl n1 rUmbh d Whit-]MI,�MIK lttlVlrlll rn tlutgtkre thb t#AZ r O FlI � . w/�ile, 13 M6L Cre�tf Or Enpenm Q p j �tt�t� ypccrnent C,r,. 't nd.•roigneil aXrm m pap tk avnnap tetra•)In this taprenwm argil om,Ni,gt w the tams hcretd. See Reverse Side foe Terms and Condit(ioae of Sale.You,the buyett may cancel L oSpY O fh 1-OA A4Y r✓�tJ 1tRwdng Chia transaction at any drne ppo�or to tTtldnl�t of the third business day after - -r Tam 3 the date of this transacdon.P1em see artSche4 notice Of ancellation for an ,FJ $ates Tax on"dow� v'a t;i explanation of this right. -•--}� ,I Total Mitodluteore GtAin se P0m n st i.� i / M6[bW Odw imn sAtudtM Accrptcd s���L-Y10 d�F#1 (aap ova[wil ro mla.rndlr f expense column n right) Work Penult Cott ),Jp( Wwsw chda all Ow�1 Dur f.usnmKr Appa val gnattur t � MMyrpiralq ruAWnopa•d lh++euv l t'r Andanra Mtnyacr Slgwttuc SpecialOrder Notes Total Ammt of AgreanNnt I .Oo DOW Shret D ow ��ed ; C RarwaltgAdwaet Rtealoa ttesORttlon MwemshMwW 11,93 OrifIj C /9 n. � DIpONRequired 2177 SpedsftvftWm wlbtpeM1p wtuOt.q doe mt yOwq"wtM dWesavm�t w ar tea."p�Roseaea aey ueteett4rtae C O 1 Balance DW On[oanpietion s 6e etWrdb am tadedd ddnlpGW- tdda per�ptr00a . kAfmwred Aatnp MatYlatlaIMMSA oytplM nW_t p Wes toa+rktotdarncwruan theouaeertku +°lenrgt7wV1 Epp Prkelucl,uicslahor,nwterixlt,ituulktion, >y.maac ynotd tdon. are rudwtl. ekrwhanaea awtad of tea�E.I to.ta dteA{rw� O / S Ceno�e Castarr Gametes. j�,��/ emw�td awe we,MrtyownewwWowsato White-ReewallyAnOnsm YdWw-Irstdatim Pink-Hareorwbr remowl.anddlspuulofpruduct.reylaced. (ff1�� ��,��' tr�1VA" . ,Noah: �ty1 Initleb: RJ)R7 w"als: TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map ' P/b Parcel 2 Permit# r Health Division A.,_#(,1J1*7V2V WDate Issued Conservation Division Q Application Fee �Q ' p© Tax Collector I Permit Fee ,_?d a Treasurer ®�- SMC rfr=MUST BF- Planning Dept. INSTALLED IN COMPLIANCE WITH TITLE 5 Date Definitive Plan Approved by Planning Board ENVIRONMENTAL CODE AND .u: TOWN REGULATIONS Historic-OKH Preservation/Hyannis Project Street Address Z V Y o r k Te►ter a Ge Village 0 S -der-V) Ile Owner Eller Caro Address Telephone ;O 0• 420• 0 6 41 Permit Request Ta ,d /"eplaie exisilmI ale e,,L ir> baek o Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 59/ 00f Construction Type Lot Size Grandfathered: ❑Yes Q No If yes,attach supporting documentation. Dwelling Type: Single Family Cd Two Family Q Multi-Family(#units) Age of Existing Structure �s�S Historic House: O Yes CVNo On Old King's Highway: ❑Yes ► O No Basement Type: O Full O Crawl O Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing f new Number of Bedrooms: existing Lk new Total Room Count(not including baths): existing O new First Floor Room Count 1 Heat Type and Fuel: Gas ❑Oil O Electric O Other Central Air: C)dYes O No Fireplaces: Existing i/ New Existing wood/coal stove: ❑Yes ( iMo Detached garage:❑existing ❑new size Pool: O existing ❑new size Barn:O existing ❑new size Attached garage:O existing O new size Shed:O existing ❑new size Other: J Zoning Board of Appeals Authorization O Appeal# Recorded❑ 111 �o 0 — Commercial ❑Yes Flo _ If yes,site plan review# Current Use 5W6LE nStkl i &P6 Proposed Use Co7 t v; BUILDER INFORMATION cfn P / r Name Ln�a Coh S�ru�Tiwr A e . Telephone Number 50 8 38 S Address �P o /3ox 1737 License# C 7 C/ /yl14 Home Improvement Contractor# (a'viol Worker's Compensation# 1/ LJG Dp ZZXVkZ DOS ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO G✓r kG� SIGNATURE DATE FOR OFFICIAL USE ONLY 9 E PERMIT NO. DATE ISSUED r MAP/PARCEL NO. .- ADDRESS VILLAGE OWNER a� .•? DATE OF_INSPECTION: _ FOUNDATION 5 "/ 7- 0-s- 1 - FRAME i - r INSULATION ` `t FIREPLACE ELECTRICAL: ROU FINAL PLUMBING: ROU O FINAL GAS: ROU — a m m FINALca f %� FINAL BUILDING sh K /2-2 Z-p co DATE CLOSED OUT Rt --- ASSOCIATION PLAN NO. �Iv T � � �,/�Craaacluaetla B'.OARD•OF B10ILDANG RE-00607TIONS License: ONSTRUCTLON SUPERVISOR N u m 087579 I007 Tr.no: 87579 BEN-JAM iN G LA; :j P&BOX 1737 t qq 7 �-� � S..� a v '_w+ �'-flu•, I BREI�USTER, MA 026 AeUre`9:C' mf"oner j QX Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registr tto 146367 14/2007 ate Corporation LINEAL CONSTiJ fa BENJAMIN LAM j 7 MEADOW LANE roK4 j HARWICH,MA 02631 Administrator 1 � _ The Commonwealth of Massachusetts �. = ..- _ _i Department of Industrial Accidents - , Office of Investigations 600 Washington Street, ;'"Floor �f Boston,Mass. 02111 Workers'Compensation Insurance Affidavit:Buildin lumbin lectrical Contractors name YV� ��R A addres_s�pn 12* city�jQiriW N/P6 state: MIN zip: 6I&Y phone# work site location(full address): ❑ I am a homeowner performing all work myself. Project Type: ❑New Construction gRemodel ❑ �. Addition working in an capacity. Building A I am a sole ro netor and have no one o ty g g Y•„yP .a9,�._.�'�AP�...���.'Y'�..�"..i�;'.lFb-...Ir: 7,�8�ti� ,'+'•'i'3+'3u'rw;:.'Jt�'e' q1J� ..�,�:�r...r..f ,i:'...i?"i.3.',' •_e:',::7+1A'�r.y;a!'c.�,-.w:a.�,`�: ��<'•' ?`�i�::s•.:.:.:...`. ..i.:: I am an employer providing workers' compensation for my employees working on this job. companv name: L-,1 t ` 1t gf m t9N w t address: 71 �:C.� . ._......._.-NV�.._... ............................_............. uhone# 05 city 1 insurance co. 12011c,# WL d l loan ❑ I am a sole proprietor,general contractor,or homeowner(circle one) and have hired the contractors listed below who have the following workers' compensation polices: company name: address: city: phone M insurance co. nolig# company name: address: city: phone M insurance co. olia# Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to S1,500.00 and/oru one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of SI00.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature GG /► Date Print name �yN (,/lrti7Q� Phone# �7 ✓��� [co cial use only do not write in this area to be completed by city or town official or town: permittlicense# ❑Building Department ❑Licensing Board check if immediate response is required ❑Selectmen's Office ❑Health Department tact person: phone#; ❑Other sed Sept 2003) 5 Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law",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;of any two-of more' of the foregoing eng�ged in a ©intsnterprise,and ino)uding the legal representatives of a deceased, mp ,�gr,the rec eloyerelver, or trustee of an individual,partnership,association o other legal entity,employing employees.'However`'the owner'U4,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 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 buildingsJu l be coiiiriionwealth:Lri laay applicant who has not produced acceptable evidence of compliance with the insurance coverage required.r Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any coritract fdr'the performance of public work tiiTitil%iicc t#le' iOence of compliance with the insurance regttirements of this.chapter have rE been presented to the contracting aptllorjtZ, t NAM Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation. Please supply company name, address and phone numbers along with a certificate of insurance as all affidavits 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. Rom- City or Towns 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. 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, please do not hesitate to give us a call. The Department's address,tel'IihorW`arid fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street,7'h Floor Boston,Ma. 02111 fax#: (617)727-7749 phone#: (617) 727-4900 ext. 406 LO OT N O F STANDARD LEGEND. NOTE:not all symbols will appear on a map GOLF COURSE FAIRWAY • / � ,,•y�Vr•• EDGE Of DECIDUOUS TREES 36 " / EDGE OF BRUSH ORCHARD OR NURSERY EDGE OF CONIFEROUS TREES MARSH AREA EDGE OF WATER ——— DIRT ROAD `9 ---_ r^ DRIVEWAY PARKING LOT r PAVED ROAD rAN at — — DRAINAGE DITCH ————— PATH/TRAIL PARCEL LINE** AP I 0 . .� MAP Sze - MAP# 1 ti 021 PARCEL NUMBER #367 E HOUSE NUMBER 2,FOOT CONTOUR LINE —L� 10 FOOT CONTOUR LINE to r // Elevation based on NGVD29 2 4.9 SPOT ELEVATION STONE WALL X....-_-X-- FENCE RETAINING WALL ;.__.__;......;_..\ RAIL ROAD TRACK STONE JETTY SWIMMING POOL PORCH/DECK 0 BUILDING/STRUCTURE "- DOCK/PIER 'Re_ (C' � � HYDRANT P 14 u 3 I e VALVE a0 MANHOLE �., o POST 0" FLAG POLE T O W N O F B A R N S T A B L E G E O G R A P H 1 C I N F O R M A T I O N S Y S T E M S U N I T o SIGN ® STORM DRAIN N PRINTED SCALE:IN FEET *NOTE:This ma is an enlargement of a **NOTE:The onel lines are on graphic representations DATA SOURCES: Planimetria(man-made features)were Interpreted from 1995 aerial hoto ra hs 6 The James o TOWER R p ro p n D p p o D P Y 0 UTILITY POLE � .,. "•,_...,._,_,._ .. 1°=100'scale mop and may NOT meet of property boundaries.They ore not true locations,and W.Sewall Company.Topography and vegetation were interpreted from 1989 aerial photographs by GEOD w,`, ` National Ma Accuracy Standards at this do not represent actual relationships to vegetation were mopped ro meet Notional Ma Altura Stondards �rr�r 0 �. 15 ~30 P ryps physical objects Corporation. Pianimetria,topography,and ve p w •C LIGHT POLE o ELECTRIC BOX i 1 INCH=30 FEET* enlarged sco e. on the map. ate scale of 1"=TOO'. Parcel lines were digitized from FY2004 Town of Barnstable Assessors tax maps. Torn:of..Barnstable Gp�E l�ti ' Regulatory Services ' t. s�xrtsres Thomas F:GeRer,Director: 9� Dun =Building Division TomPdth Building Comidssioner 200 Main Street,'Tjyannis,MA 02601 Wrf.yy,.townb arnstable.ma.us Fax: 508-790-6230 office: 508-862-403 8 Property Owner Must Complete and Sign This Section If Using ABuilder as Owner of the subject property hereby authorize to act on mybehalf, in all rriatters relative to work authorized bythis bunding permit application for: Z Y O r 'C- �L'r✓ 0.�e (Address of Job) lV��Signature of Owner Date Print Name • �TMel Town of Barnstable y Regulatory Services Thomas F.Geiler,Director Fa�9.y p Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Fax: 508-790-6230 Office: 508-862-4038 peffiitno. Date k P.1L 2- 1'W AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction It of an n addition to any prair,Mting o�wne�occupied conversion, improvement,removal,demolition,or construction than four dwelling units or to structures which ale adj acent to building containing at least one but not more such residence or building be done by registered contractors,with certain exceptions,along with other requirements- 3�, Coo Estimated Cost Type of Work: QflkOw► Address of Work; ' &ner's Name: Date of Application: - I hereby certify that: Registration is not required for the following reason(s): Work excluded by law ❑Job Under$1,000 []Building not owner-occupied []Owner pulling own permit Notice is hereby given that: tNRE GISTERED OWNERS•PUtLING THEIR OWN PERMITS E0 ]PROvEEMEING�NT wORKDO NOT HAVE CONTRACTORS FOR APPLICABLE ACCESS TO THE ARBITRATION.PROGRAM OR GUARANTY FUND UNDERMGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I he eby apply for a permit as the agent of the owner: J.Vb_w Contractor.Name Registration o. Date OR Date Owner's Name Q:form -.homeaffidav 2 4 y�, �. 1� �� �- � � , . S ©�, � �3 �3 � ;� �( � _ � , �`� ,c F; �: � . �,_ r . � t , � � • i �-Engineering Dept. (3r000r) Map - O Parcel PeFrnit# _ House# d Date Issued 19 9 -9:30/1:00-4:30) Fee As—, Con..,. w' (4th 2QQr4&-M- 9:30/1:00-2:06) P Bldg.) 1 �. oard 19 BARNIMBLE. _ MSS. p - - f639.p�•S' . - TOWN OF BARNSTABLE v Building Permit Application 3 Project Street Address a? / ©A c Village d:) S c C Owner a Address Telephone < ,,Permit Request f2 t First Floor square feet Second Floor square feet Construction Type Estimated Project Cost $ 6 D Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes ❑No On Old King's Highway ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half: Existing New No.of Bedrooms: Existing New' Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove .❑Yes ❑No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use Builder Information �1 Name �S� CA Z rz-A u IT Telephone Number S6 o yo2 cg al�o Address C`� i`,jC 7 S oZ License# 4> 3 4 7 l3' Home Improvement Contractor# ./off Worker's Compensation# 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 _Pc C_ B IL�PER?AKNIED FOR THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY PERMIT NO. -DATE ISSOED 3 r MAP/PARCEL NO. +Yt ADDRESS •r VILLAGE ( OWNER - DATE OF INSPECTION: ' FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL • F- y FINAL BUILDING DATE CLOSED OUT. ASSOCIATION PLAN NO. �i •4 The Town of Barnstable Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crosses Fax: 508-790-6230 Building Commissic: For officetuse only Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units or to structures which are;adjacent to such residence or building be done by registered contractors, with certain exceptions,along with other requirements. o � Type of Work: 2 �� Est.Cost_ Address of Work: Owner's Name C 'e- Date of Permit Application: 'Q C 12. I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under SI,000. _Building not owner-occupied Owner puffing own permit Notice is hereby given that: OWNERS PULLING THEM OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR TJrc• CflnrrrrUnll'ealth elf.1lussuchrasctts - it: • r� . ;-:_:%�_ Dcpart»rctrt of ludirrtrial.4cciflcrrts officceflnyestfgalfons •:\.�i i="""{{ _ _+ 600 11'asltintirun Street �.� ''f Bustun.A1usr• 03111 Workers' Compensation Insurance Affidavit ,�lpplic�int inftirniatititi• —• Plcnse 1'R11VT'les��^!�'—M ���—V _�-- �- name• , M i s / l �-7 ,A+�; fnc�tinn 1 am a homeowner performing all work myself. Ufa sole proprietor and have no one working= in any capacity [s I am an employer providing workers• compensation for m% employees working on this job. entnn•rnv n•tmr- •ttlrlrecc• city nhnnc k• incnr-mce rn nniicv 0 I am a sole proprietor. general contractor. or homeowner(circle one) and have hired the contractors listed below who ha%: the following workers' compensation polices: cmmminn n•ttnc• •ttlrlrrcc• City. nhnnc 0* incur-nrr ro toiler 0 .T_ _�__ �..t._.. _- '-ram--yr--��:r••r•+.w�..• � —�+.:._- �� �......s.-.�..._. cmmnanv nnmr• addrecc- rit nhnnc 1�• incur•tnce rn teller --_ Attich additio'n21 sheet if necessary• '— .;._.., _-+:..:.'�.•'.-.. —w:"+�.�+.• +::+..-_: -..a.. F:uiurc to secure coverage as required under section 25A of AIGL 153 can lead to the imposition of enminal penalties of a line up to SI.500.UU andiur une%cars' imprisonment a. well:ts civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. I understand that n Copy of this statcotcot ma% be forwarded to the office of Investir2tions of the DIA for coverage verification. !do herchr cerriA-un • the parrs and Matti e of perjun•than the information prorided above is true and correct. Signature Oatc —2c c /2 /S g7 Print name ��/"t t s C,4 Z rz�k Phone>* w official Ilse univ do not write in this area to be completed by tiny or town 0[]1621 city or town: permit/license d r•ttluilding Department ❑Liccnsin;!!loud L l- tt ❑ check if immediate response is required ❑J•elcetmen's Office l'. ❑Health Department phone ft• —0ther. k contact person: �'. t Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensatio1 for ;: etnplovees. As quoted from the "1a++". an enrpturec is defined as every person in the service of :mt)thcr under am contract of hire. express or implied. oral or written. An entplorer is dcf incd as an individual. partnership. association. corporation or other legal entity. or an}, t++•o or m: the foregoing cngagcd in a joint enterprise. and including tic legal representatives of a deceased employer. or the receiver or trustee of an individual . partnership. association'or other legal entity. employing employees. Hove%-cr owner ofa dwelling house Navin- not more than three apartments and who resides therein. or the occupant of the cl% cllin`_ house of another wlin employs persons to do maintenance ;construction or repair work on such dwc1lin;; or out the `_rounds or building appurtenant thereto shall not because of such employment be deemed to be an ernpicv: MGL chapter 152 section :5 also states that ever- state or local licensing agency shall withhold the issuance or �r++al of a license or permit to operate a business or to construct buildings in the contmonivealtli for any icant wlto lies not produced acceptable evidence of compliance with the insurance coverage required. AdL;::ionall+-. neither the commonwealth nor any of its political subdivisions shall enter into any contract for the pci-fonnznce of public work until acceptable evidence of compliance with the insurance requirements of this chapter been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit compictely, by checking the box that applies to your situation and Supplying company names. address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The '_.iavit should be returned to the city or town that the application for the permit or license is being requested. rn ,he Department of Industrial Accidents. Should you have any questions regarding the "taw" or if you are reeuire. :o obtain a \\'orkers' Cotnpetlsation policy. please call the Department at the number listed below. City 1)r Towns Please be sure that the affidavit is counplete and printed legibly. The Department has provided a space at the bottom tite a!"davit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Ple be _. : to fill in tite permit/license number which will be used as a reference number. The affidavits may be returnee- 'le 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 questie: please do not hesitate togive us a =11. The Departtnent*s address. telephone and fax number. TIte Commonwealth Of Massachusetts Department of Industrial Accidents "` --• Office of Investigations _ 600 Washington Street Boston,Ma. 02111 fax R: (617) 727-7749 nhune =. (6I7) 727-4900 exr. 406. 409 or 5 �a � �'C`\.+'� ,✓i�.Tao�no�uoeallJ�o���aaaaal�i •: • K� oi�i.a` -Tl HOME IMPROVEMENT CONTRACTOR '•=' - Registration. 120689. Type - Di .. r = ` Expiration 02/21/98 CAZEAULT-CO ,,i ES L. CAZEAULT �`D7r"O �° 7031'MAIN ST ADMINISTRATOR `OSTERVILLE MA :02655 - v %'.• DEPARTMENT OF PUBLIC SAFE]05/20/ 4 CONSTRUCTION SUPERVISOR LICENS z.-. Rudd- '_ -z Expires: ,CS ;0367@1 8511011998 Restricted Toe= :00 `_JAMES L CASEAULT' CLAMSMBLL'COVE K COTUIT, XA•.82635 j Book 858 Page 22 Doc. No. 384,652 Ctf. No. 105O22 TRANSFER CERTIFICATE OF TITLE From Transfer Certificate No. 64694 Originally Registered June 13, 1975, in Registration Book 521 Page 94 for the Registry District of Barnstable County. THIS IS TO CERTIFY that Paul J. Sullivan and F. Daniel Meehan, Trustees of the Tamarack Trust under a Declaration of Trust, dated January 14, 1986 being Document No. 384,629, of 129'Airport Road, Barnstable (Hyannis), Barnstable County, Massachu- setts 02601, are the owner(s) in fee simple C`ELLL�L of that land situated in Barnstable in the County of Barnstable and Commonwealth of Massachusetts, bounded and described as follows: BEING LOT 3 as shown on subdivision plan 15870-B dated February 15, 1969, drawn by Nelson Bearse - Richard Law, Surveyors, and filed in the Land Registration Office at Boston, a copy of which is filed in Barnstable County Regis- try of Deeds in Land Registration Book 294 Page 75 with Certificate of Title No. 37425. Said land is subject to the rights granted in an easement given to the New Bedford Gas & Edison Light Company et al dated August 30, 1972 being Document No. 165,932. And it is further certified that said land is under the operation and provi- sions of Chapter 185 of the General Laws, and that the title of said Paul J. Sullivan and F. Daniel Meehan, Trustees as aforesaid to said land is registered under said Chapter, subject, however, to any of the encum- brances mentioned in Section forty-six of said Chapter,.which may be subsisting. WITNESS, MARILYN M. SULLIVAN, Esquire, Judge of the Land Court, at Barnstable, in said County of Barnstable, the seventeenth day of January in the year nineteen hundred andreighty-six,, at 12 o'clock and 53 minutes. Attest, with the Seal of said Court, STEPHEN WEEKES, Assistant Recorder. Land Court Case No. 15870 • I MEMORANDA OF ENCUMBRANCES ON THE LAND DESCRIBED IN THIS CERTIFICATE 105022 DATE OF INSTRUMENT NUMBER DOCUMENT KIND RUNNING IN FAVOR OF TERMS SIGNATURE OF 1, DISCHARGE DATE AND TIME ASSISTANT RECORDER OF REGISTRATION 154,585 State. of Town of Barnstable Re: Lot 3, etc., P1. 15870-B. 12/16/71 8:45a.m. Cond. 307,152 Easement David T. Gregory et al Trs. Rts. over York Terrace, Pl. 2/11/83 15870-B appt. Lots 15 & 16, 3/9/83 12:53p.m. P1. 15967-E. 307,772 Mtge. Berkshire County Savings Bank Lot 3, $t20,000. 3/16/83 01SCHAR6ED LPL Sj 1 9 P ev Dpr„NO. =N A 1 1 3/22/83 10:24a.m. 47EST: asp .-cos_•==' 384,655 Mtge. Sentry Federal Savings Bank Lot 3 & other Reg. Ld., 1/15/86 $900,000. 1/17/86 1:07p.m. }tsu 384,656 Mtge. Sentry Federal Savings Bank Lot 3 & other Reg. Ld., 1/15/86 $200,000. 1/17/86 1:22p.m. LOT: -PLAN: SEE CTF.VO. /09.h0$ I d11"iNuT�•c: s - EGIST' TRUE V4:1,•F��y KI 4'.� �• I So = -t969 � _ w s RIC<r IST Gwaet au H. Anglin ,2 �-l 3 -7Y 1?c Ird 1 to -5- 43 k ot rs -Zz--`7cGq -IW �Z kh— _`I New England Jewelry Exchange Michel Mangalo 349 Main Street (508)771-6161 Hyannis,Ma.02601 i SUBDIVISION PLAN OF LAND IN BARNSTABLE �Nelsori�'Bearse, 87® Richard Lax Surveyors •February 15,, 1969 ROAD 40•0o W11 0" �e• Y - � a b •s6 � s47 io Qo e s v 12737 a r ,. 2I2. fig" 4. � � � S 1h9•ryM1� o i 01.72 i , %j v , ° H 42°21 o p. W . a 3 O p l4�S4 j pV 42•,o2, 20#W i �► O � h : CIO A `j L.Cp, Sa$�S13— LO/�y6 L64Iff w w/ANNp (60, oo N9y• j7 3p"��� J w/DE� h AMENUE Subdivision of Land Shown on Plan 15870A Filed with Cert, of Title No. 4015 Registry District of Barnstable County ;sr Separate certificatte of tide may be issued for land .I shown herem os_144 _l.hr� -----�--------------- Copy ofpa�ofp/an _,., By the Coart: LAND R£GISTRATIOV OFFICE » 107 _ 50le a this p✓an 80 feet to ea inch 1 DEC. 14 197/ - "" -----o� _ -- 2 L W%Adl,...... Fnnin"r 6ir rV11# _J `BARNSTABLE LAND COURT REGISTRY DISTRICT JOHN F. MEADE, REGISTER SY425RP: COPY REQUEST * HANDLED BY SYSTEM DATED: 04-29-1997 08 :28: 17 REQ BY: DEB STN: LCVIEW01A LOCAL ------------------------- ----------------------------------------------------- DOCUMENT # 604,279 PAGES: 5 PAGES REQUESTED: ALL FEE: 3 .75 ------------------------------------------------------------------------------ CUSTOMER WILL PICK UP ----------------------------------------------------------------------------- O JvH?1 F. 13 lU 21 P11 'J�I o � z HUTCHINS,WHEELER&DMUM A PPAXESSIONAL OORPORATION 101 FEDERAL.STREET BOSTON, MA 02110 HUTCHINS, A PROFESSION 101 FEDERk. BOSTON, Mf- DEED 1 , Grace S. Adair, Trustee of 24 York Terrace Nominee Trust under Declaration of Trust dated October 29, 1991, filed with the Barnstable Registry District of the Land Court as Document No. 537655, for consideration of One Dollar the receipt of which is hereby acknowledged, grant with quitclaim covenants to Grace S. Adair, Trustee of the Grace Shumway Adair Residential GRIT under Grantor Retained Income Trust Agreement of Grace Shumway Adair t �Kdated January _ 1994, to be filed herewith, the land in Barnstable, Barnstable County, Massachusetts, with the buildings and improvements thereon shown as Lot 3 on a c� Subdivision Plan 15870-B dated February 15, 1969, drawn by N Nelson Bearse-Richard Law Surveyors, and filed in the Land NA o Registration Office at Boston, a copy of which is filed in y Barnstable County Registry District of the Land Court in Land cv o Registration Book 294, page 75 with Certificate of Title No. N y 37425. Said premises are conveyed subject to and with the k " b benefit of the easements, restrictions, agreements and d encumbrances set forth or referred to in Certificate of Title N No. 124739 and the Memorandum of Encumbrances annexed thereto. 0 Meaning and intending to convey and hereby-conveying the same premises described in said Certificate of Title 124739, Book 1022, Page 59 . Executed as an instrument under seal this �_ day of January, 1994. Gr ce S. Adair, Tr stee as aforesaid COMMONWEALTH OF MASSACHUSETTS Norfolk, ss. January $, 1994 Then personally appeared the above-named Grace S. Adair and acknowledged the foregoing instrument to be her free act and deed as Trustee, before me. j 'Ile otary Public My commission expi j 5365T � • �` 2 .. TRUSTEE'S CERTIFICATE 24 YORK TERRACE NOMINEE TRUST The undersigned, being the sole Trustee of 24 York Terrace Nominee Trust under Declaration of Trust dated October 29, 1991 failed as Document No. 537655 with the Barnstable Registry District of the Land Court, hereby certifies that the VI undersigned has been authorized and directed by all of the o-� beneficiarie eof said Trust to execute and deliver, for nominal consideration, a deed of the property described in Certificate of Title No. 124739 to Grace Shumway Adair, Trustee of the Grace Shumway Adair Residential GRIT under Grantor Retained Income Trust Agreement of Grace Shumway Adair dated January !W, i+/"0C 1994 , and further certify the said 24 York Terrace Nominee Trust is in full force and effect as of the date hereof and has not been amended or rescinded. � h Executed as an instrument under seal this �day of January, 1994 . Gra a S. Adair, Trustee of 24 Yor Terrace Nominee Trust i .I • M ti COMMONWEALTH OF MASSACHUSETTS Norfolk, ss. January $, 1994 j Then personally appeared the above-named Grace S. Adair, Trustee ss aforesaid and ooknawledged the foregoing instrument to be her free act and deed as Trustee, before me. Notary Public My commission expirpf,;- 536ST ,►S�. , •Q_ , - 2 - BARNSTABLE REGISTRY Of DEEDS ,4 o a c . o 0 Book 1022 Page 59 Doc. No. 537,654 Ctf. No. 124739 TRANSFER CERTIFICATE OF TITLE From Transfer Certificate No. 109508 Originally Registered January 17, 1986, in Registration Book 895 Page 68 for the Registry District of Barnstable County. THIS IS TO CERTIFY that Grace S. Adair, Trustee of 24 York Terrace Nominee Trust, under a Declaration of Trust, dated October 29, 1991 being Document No. 537,655, of 24 York Terrace, Osterville, Massachusetts 02655, is the owner(s) in fee simple of that land situated in Barnstable ,fv; in the County of Barnstable and Commonwealth of Massachusetts, bounded and described as follows: BEING LOT 3 shown on subdivision plan 15870-B dated February 15, 1969, drawn by Nelson Bearse - Richard Law, Surveyors, and filed in the Land Regis- tration Office at Boston, a copy of which is filed in Barnstable County Registry of Deeds in Land Registration Book 294 Page 75 with Certificate of Title No. 37425. Said land is subject to ,the rights granted in an easement given to the New Bedford Gas & Edison Light Company et al, dated August 30, 1972 being Document No. 165,932. And it is further certified that said land is under the operation and provi- sions of Chapter 185 of the General Laws, and that the title of said Grace S. Adair, Trustee as aforesaid to said land is registered under said Chapter, subject, however, to any of the encum- brances mentioned in Section forty-six of said Chapter, which may be subsisting. WITNESS, JOHN E. FENTON, JR., Chief Justice of the Land Court, at,Barnstable, in said County of Barnstable, ' the thirty-first day of October in the year nineteen hundred and ninety-one, at 10 o'clock and 32 minutes. Attest, with the Seal of said Court, VIVO,. ' i JOHN F. MEADE, Assistant Recorder. Land Court Case No. 15870 MEMORANDA OF ENCUMBRANCES ON THE LAND DESCRIBED IN THIS CERTIFICATE 124739 J-j" DATE OF INSTRUMENT SIGNATURE OF DISCHARGE NUMBER DOCUMENT KIND RUNNING IN FAVOR OF TERMS DATE AND TIME ASSISTANT RECORDER • OF REGISTRATTON 154,585 State. of Town of Barnstable Re: Lot 3, etc., P1. 15870-B. 12/16/71 8:45a.m. Cond. 307,152 Ease. David T. Gregory et al, Trs. Rts. over York Terrace, P1. 2/11/83 15870-B appt. Lots 15 & 16, 3/9/83 12:53p.m. P1. 15967-E. 384,655 Mtge. Sentry Federal Savings Bank Lot 3 & other Reg. Ld., 1/15/86 $900,000. 1/17/86 1:07p.m. .T•t Sv'.FE 0ORrER [FS`:C7 JA 384,656 Mtge. Sentry Federal Savings Bank Lot 3 & other Reg. Ld., 1/15/86 �7�SC ir: =..�..!�=`�- f/ $200,000. 1/17/86 1:22p.m. AT'EST: /am'J fiECOROEF - `.� t '�"• ._.arm-...�+. 537,655 Decl. of 24 York Terrace Nominee See Doc. 10/29/91 Trust Trust 10/31/91 10:32a.m. LOT: � Puw: �1L SEE CTr.NO: 13 I9 IA- , �'�ti.—.�1� A TRDS UE COP,gfEST t L HN F. — a. i I �� ��� ��I Book 895 Page 68 Doc. No. 416,176 Ctf. No. 109508 TRANSFER CERTIFICATE OF TITLE From Transfer Certificate No. 105022 Originally Registered January 17, 1986, in Registration Book 858 Page 22 for the Registry District of Barnstable County. THIS IS TO CERTIFY that 'Jane D. Powers, of. 133 Starboard Lane, Osterville, Massachu- setts 02655, is the owner(s) in fee simple n of that land situated in Barnstable in the County of Barnstable and Commonwealth of Massachusetts, bounded and described as follows: BEING LOT 3 as shown on subdivision plan 15870-B dated February 15, 1969, drawn by Nelson Bearse - Richard Law, Surveyors, and filed in the Land Registration Office at Boston, a copy of which is filed in Barnstable County Regis- try of Deeds in Land Registration Book 294 Page 75 with Certificate of Title No. 37425. Said land is subject to the rights granted in an easement given to the New Bedford Gas & Edison Light Company et al dated August 30, 1972 being Document No. 165,932. i And it is further certified that said land is under the operation and provi- sions of Chapter 185 of the General Laws, and that the title of said Jane D. Powers to said land is registered under said Chapter, subject, however, to any of the encum- brances mentioned in Section forty-six of said Chapter, which may be subsisting. WITNESS, MARILYN M. SULLIVAN, Esquire, Judge of the Land Court, at Barnstable, in said County of Barnstable, the thirtieth day of December in the year nineteen hundred and eighty-six, at 9 o'clock and 13 minutes. Attest, with the Seal of said Court, STEPHEN WEE FS; AAssistant Recorder Land Court Case No. 15870 MEMORANDA OF ENCUMBRANCES ON THE LAND DESCRIBED IN THIS CERTIFICATE 109508 -- DATE OF INSTRUMENT DOCUMENT, SIGNATURE OF DISCHARGE NUMBER KIND RUNNING IN FAVOR OF TERMS DATE AND TIME ASSISTANT RECORDER i OF REGISTRATION 154,585 State. of Torn of Barnstable Re: Lot 3, etc., Pl. 15870-B. 12/16/71 8:45a.m. Cond. 307,152 Easement David T. Gregory et al Trs. Rts. over York Terrace, Pl. 2/11/83 15870-B appt. Lots 15• & 16, 3/9/83 12:53p.m. P1. 15967-E. 384,655 Mtge. Sentry Federal Savings Bank Lot 3 & other Reg. Ld., 1/15/86 $900,000. 1/17/86 1:07p.m. 384,656 Mtge. Sentry Federal Savings Bank Lot 3 & other Reg. Ld., 1/15/86 $200,000. 1/17/86 1:22p.m. /o - 10:3 LOT: 3 PLAN:L 5 8 7G-6 16 — �✓/ —9/ /� SEE CTc.N1. /d Y 7 % �.�✓�. /G- 3/537 lo$ � c`,c. . BAHRSTABLE COU"N REGISTRY OF DEWS A TRUE COP i .\� . ^i {� „- -- - -- ", � . ��j •�,. -__-�.,�;•- _.�.,.._..��.._ .. .. _... Rook 521 Faec 94 , FORM E-3 fo. 196,945Doc. N r rr � Certificate of Title. Ctf. No. 64694 "{ From Transfer Certificate No. 37425 Originally Registered Aprl1 15, 1966 in . fir.-t 'i 294 Pa 75 for the Registry District of Barnstable County. Registration Book Page g ' io to eertifp j-.,•._? that Francis A. Ricci and Marjorie Ricci , husband and wife, of 3-York Terrace Osterville, Barnstable County, Massachusetts 02655, are ,y the owner( sl in fee simple. {' as tenants by the entirety f of that cer�ain parcel of land situate in Barnstable (0 s t e r v i l l e) ,�•"=y in the County of Barnstable and said Commonwealth.of Massachusetts. bounded and described as follows:' i I • •, Northwesterly and Northerly by York Terrace, one hundred fifty-three and ;t1 56/100 (153.56) feet; i Northeasterly by Lot 4, one hundred fifteen and 94/100 (115.94) feet; ' Southeasterly by a portion of land now or formerly of Charles H. Brown, one hundred and 45/100 (100.45) feet; and Southwesterly by Lot 2, one hundred forty-one arid 25/100 (141 .25) feet. All of said boundaries are determined by .the Court to be i,. located as shown on subdivision plan 15870-B dated February 15, 1969, ' drawn ;''Y• by Nelson Bearse - Richard Law, Surveyors, and filed in the Land Registra tion Office at Boston, a copy of which is filed i.n Barnstable County Regis i try of Deeds in Land Registration Book 294 Page 75 with Certificate of Title ; ; No. 37425 and said land is shown thereon as LOT 3• Said land is subject to the rights granted in an easement. i - given to the.New Bedford Gas E Edison Light Company et al dated August 30, 1972 being Document No. 165,932• And it is further certified that said land is under the operation and provisions of Chapter 185 of the General Laws, and that the title of said Francis A. Ricci and Marjorie Ricci to said land is registered under said Chapter, subject, however, to any of the encumbrances mentioned in Section forty-six of said Chapter, which may be subsisting WITNESS,WILLIAM I. RANDALL,Esquire,Judge of the Land Court,at Barnstable,in said County of Barnstable; the t h i r t e e n•t h day of June in the year nineteen hundred and seventy-five at 2 o'clock and 26 minutes. Is Attest, with the Seal of said Court, Land Court Case No. 15870 STEPHEN WEEKES, Assistan., Recorder. MEMORANDA OF ENCUMBRANCES ON THE LAND DESCRIBED IN THIS CERTIFICATE 64694 DATE OF INSTRUMENT DOCUMENT SIGNATURE OF NUMBER KIND RUNNING IN FAVOR OF TERMS DATE AND TIME ASSISTANT RECORDER DISCHARGE OF REGISTRATION Condition c� 154,585 State. of Town of Barnstable Re: Lot 3, etc. , P1. 15870-B• 12/16/71 8:45a.m. �r ItiJ ry / G •Mflo '7 '7 ... of Cape Cod 7/14/72 162,326 Mtge. 1st Fed. Say. .E Loan Assn Lot 3, $29,000. 7/14/72 3:07p.m. �T PIS-OVE2 YODICTE122ReF,PL I5-87O-G Z- II-83 S :GEE (TY L OTS IS*16 S 67-t' 3- -83 8U6oeo"% MUeD1Np>1N6 MT-6E• DOG IG2,3a6 2.23-83 307, 153 AGeE To FRSEM BUI 00C. 387, 15-1 3- -83 ),2'536m LOT NO. DISCHARGED. — 7—9"// ' • BY DOC.NO. 3 tf 4t 6 S ATTEST: ASST.RECORDER �-C S- O b 1""""• 614 Got SEE CM Na /D -4R a 3FI ,(osa au2 ae l-17-BG �a;53 ksai. k� BARNSTABLE COP Ty REGISTRY OF DEE S A TRUE COPY,ATTEST ;n1N F.N"EADE,REGISTER 4 :mac. •.�� 1, ,.�. ), I.t •., ,: $7• REVISIONS �Y Y'T T 1 _ L , vi i Lo a { r -Co MA-r cN x k5"T{ I � 7� v\• ! §K It p F fi'. ' { OWN i .--^-.�.___•.�-�!' - � _ ., Y :�, �T _p,� �RY''.,fhF hl 11 r I f ; • t! r ki i fr 4 F A',M P so 14 I: N Gj: a � 4 -:- Z : � ..-.,.......,.—.......•.--�............w«:-.,�.W.....�.e.�..�.�....„w..r,.-.....'..�. ,;n._...�s.:n-,,,..,:...:-•-_-......v,_r.,,.,....,.:. � :�t..: `- r ., ) ,, .' - - :. :•.. aS "rti ��. .�.%naa ).,��; _ ., . lz o DATALE m a SCE. • DRAWN 1 ' a q JOB i 0 U SWEET r 4 a , .. OF SHEETS . xx�^n^z e.r�:ms ¢eca vsaosan re, _ �S70CIiORAFTING FORM NO.101�SD - - •. ..' - ..- _ __,. _ _. _ _ _ .......... 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