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1170 MAIN ST./RTE 6A(W.BARN.)
e e JF�QECYC[f0-o2 UPC 12543 NO PoSI-CON`V _.y-ti.Y,"E'^r^�.•.. :G,7J4:rrR: - -,-., ��.....: ..,,n.. - - ._ - M N..� ,.. ...,�e.-•--,-e„-,«. _ MASt,LN.G.S.. PER MTT'�PAYMENT RECEIPT'4 TOW OF' BARNSTABLE BUILDING DEPARTMENT 200 MAIN STREET HYANNIS, MA 02601 DATE: 07/16/15p� TIME: 14:50 • f -------------------TOTALS-------:=--------- PERMIT $PAID 75100 AMT TENDERED: 75.00 AMT CHANGE PLIED: 75.00 APPLICATION'NUMBER: PAYMENT METH: CHECK PAYMENT REF: 1220 ' a Sign TOWN OF BARNSTABLE ' Permit * BARNSTABLE, MASS. i6 A� Permit Number. Application Ref: 201504452 20071126 Issue Date: 07/16/15 Applicant: Proposed Use: SINGLE FAMILY HOME Permit Type: SIGN PERMIT Pe $ 75.00 Location 1190 SSTJRTE 6A(W.BARN.) ` �(� 179 Map Parcel 178015001 Town WEST BARNSTABLE Zoning District SPLT Contractor PROPERTY OWNER Remarks REPLACE EXISTING FREESTND SIGN 32 SQ BRIDGE CREEK PROFESSIONAL BUILDING 1170 I Owner: DREW, ERIC W I Address: 163 ELLIOTT ROAD CENTERVILLE, MA 02632 Issued By: p ^� 1 :.....:::::::: :....:::. :.. . ::>::>:>:::<. M.THE. . :BEET >: ::><:.::;::.. ::>::>:: <:.::::,:::>::: ::;: THAT..I VI IBLE.. T.TII ARD;: S S FRO..... POS S C SO Town of Barnstable Regulatory Services / �� Mg Richard V. Scali,Director v jDrEDrAA'�� Building Division `� Tom Perry, Building Commissioner O t� 200 Main Street, Hyannis,MA 02601 a www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Permit# Building Official approving ` ` /► r Application for Sign Permit Applicant !4 (Ne/( Assessors No. O "6 S— Doing Business Ash/V4y(//-PBJe�a 4,ej �1JAIr Telephone No-.-AY ba 3 U 3 Sign Location Street/Road: & /j 1)2,j/1t1 S% W-6 VT�> Zoning District Old Kings Highway? Yes o Hyannis Historic District? Yes/No Property Owner Name: N11_saf/ HONE/ -/V//4SP/1 Telephone: iG� 33�3 Address: 11 Z AIAJ Village: UIGST !)I//A574 410 Sign Contractor c Name: T/V Telephone: U Mailing Address:X k0ios STET S+/A&—&4,,V A /1 X Od M I/ Description Please follow the cover directions.You must have an accurate rendition of sign with dimensions and location. Is the sign to be electrified? Yes/No (Note.Ifyes, a wuing permit isrequired) Width of building face AL, S� ft x 10 Q ,UD S x.10— U, .S, t. Check one Reface existing s or New Total S Ft of ro osed s' (s) .�a��Z)-5 C, q• P P �. /— Ifyou have additional signs please attach a sheet listing each one with dimensions If refacing an existing sign please provide a picture of the existing sign with dimensions. I hereby certify that I am the owner or that I have the authority of the owner to make this application, that the information is correct and that the use and construction shall conform to the provisions of §240-59 through§240-89 of the Town of Barns ble Zonin rdin ce. Signature of Owner/Authorized Agent Date — SIGNS/SIGNREQU revisedl 10413 r • t FTHE T Town of Barnstable Regulatory Services • RMtNSTAaLE• MAS& Richard V. Scali,Director i639• �� "lE1639. A Building Division Thomas Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us I Office: 508-862-4038 Fax: 508-790-6230 I I SIGN PERMIT REQUIREMENTS 1. A photograph showing the existing facade, on which has been indicated the proposed sign location. The photograph is to include a portion of adjoining stores or building. For a proposed building or new facade, an architect's elevation may be submitted in lieu of a photograph. 2. A scale drawing of the proposed sign. A scale drawing indicating: 1) The type of proposed sign(wall, hanging, free standing) 2) Dimensions of the proposed sign and any designs, logos, or lettering 3) A cross-section with dimensions showing edge detail. Minimum scale 1"= 1 . Minimum sheet size, 8.5 x 11". 3. A scale drawing of the bracket. A colored scale graphic indicating dimensions, showing colors, materials and method of affixing it to the sign and to the building. Minimum scale 1"= 1'. Minimum sheet size, 8.5 x 11". < 4. A completed Town of Barnstable Sign Application, including scaled diagram showing location of sign on building or location of free-standing sign. Show dimensions. 5. The width of the building face or the leased area. a NOTE: the map/parcel number is required on the application. SIGNS/SIGNREQU revised110413 RECEIVED JUN 0 3 2015 GROWTH IUTANAGEMENT ,! 3 }r T \, yYA ` a 'I __`_ �_ _ _ � _r/• •�.I c ` ' �, .N NEWCOLONYOIL EMMA M. RIiL , Northwestern Mutual �- - JUDiTH POWER, — Clinical P:ychnlu Iq WEST B. LE BUILDERS - Deakm H AT/POST A BEAM —t 'r J I 'Media Technology, Inc. AMG REALTY .� �UMMI:ItCln 1, li✓.A�. 1.1Tnf/. 1 - � 1 �~ � - _:w Timoth>M,Chrk ACSIVLICSW t i ' I�,urnorilepnrt r 10 s; -.. --��-- ..�. :1L }.f .�.. ;�- ��. . , + .. . !� ��rrrr����ac�c� G��z,.� �'��� 6/2/2015 1170 9:06:28 AM •� ii l` CREEK ' 0` 9R • • z VERSION: 1 2 3 4 5 NO PROOF E-Mailed Called REQUIRED o W o CUSTOMER • W z I COMPANY: CONTACT PERSON: STREET: �► CITY: STATE: C ZIP: PHONE: FAX: EMAIL: DESCRIPTION PVC Post&Panel Sign 8 in L ®30.In®� 641n File Name:Bridge_Creek_dWctory_elgn.fa Folder Name:MBacku&7LEXI_FILEMB%Brldge Creek ©COPYRIGHT 2014,SIGN-A+RAMA,Inc. THIS RENDERING IS INTENDED AS A SAMPLE ONLY.COLOR,TEXTURE,MEASUREMENTS,AND ACTUAL APPEARANCE MAY VARY SLIGHTLY FROM COMPLETED WORK AND IS CONSIDERED NORMAL B USUAL. Please check layout(artwork spelling,dimensions)end fax back With signature,Production I HAVE REVIEWED THE ABOVE SPECIFICATIONS&HEREBY FULLY UNDERSTAND THE cannot begin until written approval to resolved.Additional charges will be applied for any changes Sic 1 Inarama CONTENT OF WORK TO BE PERFORMED that are needed after approval to reoehred.810N•A'RAMA Is not responsible for any arrore in AND APPROVE THIS PROJECT TO BEGIN sponing,layout,or dimensions that haw been approved by the custonrort This proof Is for Ib"d CUSTOMER APPROVAL SIGNED BY: items only,Any changes or deletions by the customer not shown or charged heroin will be billed (:j]MEffwll: e a,Bouth Yarmouth,MA 02ae4 separately,S0%DEPOSIT DUE AT TIME OF ORDER INN amount If under$100b balance due �er�l;�n01PRINT: DATE: upon time of Insto:lation,I HAVE READ AND AGREE TO ALL TERMS. INITIAL ame-ayermouth,com —0j —01 THIS ORIGINAL DESIGN AND ALL INFORMATION CONTAINED THEREIN IS THE PROPERTY OF SIGN'A`RAMA AND ITS USE IN ANYWAY OTHER THAN AS AUTHORIZED IS EXPRESSLY FORBIDDEN.THIS PROPERTY MAY NOT BE REPRODUCED OR DUPLICATED WITHOUT WRITTEN PERMISSION OF SIGN'A RAMA OR THROUGH PURCHASE c i � :� , OT.THE o� Barnstable Old Kings Highway Historic District Committee „AMM,BL ; 200 Main Street, Hyannis,MA 02601, TEL: 508-862-4787 Fax 508-862-4784 APPLICATION, CERTIFICATE OF APPROPRIATENESS Application is hereby made,with five(5)complete sets,for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470,Acts and Resolves of Massachusetts, 1973,for proposed work as described below and on plans,drawings,or photographs accompanying this application for: Check all categories that apply; 1. Building construction: ❑ New ❑ Addition El Alteration 2. Type of Building: ❑ House ❑ Garagelbarn ❑ Shed ❑ Commercial ❑ Other 3. Exterior Paintiniz, roof ❑ new roof ❑ color/material change, of trim, siding,window, door 4. Ste: �� New Sign ❑ Existing Sign ❑ Repainting Existing Sign 5. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Retaining wall ❑ Tennis court ❑ Other 6. Pool ❑ Swimming ❑ Other man-made pool ❑ Solar panels ❑ Other Type or Print Legibly: Date 6 3A5 f NOTE AM applications must be signed by the current owner Owner(print): &6M A 6141anzifM t— Telephone#: SOB—316a 33 613 Address of Proposed Work: //7Q AX 7.—;Me 64 Village IJ09 90ANS740f Map Lot# 7�"fit Mailing Address(if different) Owner's Signature Description of Proposed Work: Give particulars of work to be done: kedkr e ��lS//nay �llfy Gv`fZ�., Agent or Contractor(print): SIC iy R R A rA►Rl Telephone#: Address: I.9 tv n j l Q S Contractor/Agent' signature: For committee use only. This Certificate is hereby APPROVED ENIED RECEVED Date 2 �� Members s' natures- 14611 r 01s, GROWTH IVMANAOEME APPROVE® *mac �o J U N 2 4 2015 Town of barnstautu, Old King's Highway Committee 1 Q:Woards and Commissions101d Kings Highwayl0KF1 Applicationsl0KH 2O11 Cert Appropriateness.doc 1 CERTIFICATE OF APPROPRIATENESS SPEC SHEET Please submit 5 Copies Foundation Type: (Max. 12"exposed)(material-brick/cement,other) i Siding Type: Clapboard_ shingle_ other Material: 'red cedar white cedar other Color: Chimney Material: Color: Roof Material: (make&style) Color: Roof Pitch(s): (7/12 minimum) (speck on plans for new buildings, major additions) Window and door trim material: wood other material,specify Size of cornerboards size of casings(1 X 4 min.) color R,E+ CENED Rakes Ist member 2nd member Depth of overhang JUN 0 31015 Window: (make/model) material color C,-ROWTH MANAGEMENT (Provide window schedule on plan for new buildings, major additions) Window grills (please check all that apply true divided lights_ exterior glued grills_ grills between glass_removable interior None Door style and make: material Color: Garage Door,Style Size of opening Material Color Shutter Type/Style/Material: Color: Gutter Type/Material: Color: Deck material: wood other material, specify Color: Skylight,type/make/model/: material Color: Size: Sign size: �Y T e/Materials: �'udm laWl'su�iN�C�� � yp Q U C. �)uSTt��14-�.t 2�S Color: Z►dens � �. Fence Type(max 6') Style -APMOVE13-Color: Retaining wall: Material: JUN 2 4 2015 Lighting, freestanding on building illuminating sign Town of Barnstable OTHER INFORMATION• Old Com Highway Committee THE ATTACHED CHECK LIST MUST BE COMPLETED AND SUBMITTED Please provide samples of paint colors,manufacturers brochure of windows,doors,garage door,fences,lamp posts etc Signed: (plan preparer) Print Name 2 Q:IBoards and Commissions101d Kings HighwaylOKHApplicationslOKH 2O11 Cert Appropriateness.doc Town of Barnstable Geographic Information System June 3,2015 178024 178009001 , 01026 #1064T 178010 �— d L#1074 1 178011 178012001 # 089 89 #1084 #1090 1780' 178013002 #1049 #1106 ♦ 1780112 01094 • 178004002 178026 i 178029 #1160 #1085 I 178014 178013 001 #2 6 � i 178006 #0 #1140 178017 #1071 #0 1 78004 00 3 #1096 178003 • Ah#1121 •'::•:�ill:::�•••'�:::;•::.•:::;;':i:'.:�::•`::�::••: 17 8028178 044 :'•`:'178015002CND 178004 #116 5 178016 01194 <r� 178018 R` #1220 1177001 178018001 #0 #0 I 0 97 Feet 178021 178001 #1247 #0 DISCLAIMERS:This map is for planning purposes only. It is not adequate for legal Map:178 Parcel:01502A Historic Preservation boundary determination or regulatory interpretation. Enlargements beyond a scale of Selected Parcel W+ 1"=100'may not meet established map accuracy standards. The parcel lines on this map Abutter List Type-Direct abutters—all parcels that touch subject property. are only graphic representations of Assessor's tax parcels. They are not true property including those across the street or way that would touch but for the road. Abutters boundaries and do not represent accurate relationships to physical features on the map such as building locations. Buffer RECEIVED JqN q 3 2015 - _�—'r'.-- - ----- GROWTH-MANAGEMENT - 4 r NBW COLONYOIL EMMA M. - pnrciurrnERers Northwestern Mutual IUDITH POWER, PSYD Clinical p;V0010111111 I WFS :1 BG�FBI iIDER,' I Gila H/�rTAT POST{BEAM ,�i 11 edia echnolo �, r` AMG REALTY* .0 i'r MI:Nc'.Inr,nrin r. f.�Pn�-C. i -Timolh)K lor ACSN LICSW' a P!<1 IRMIIERAI'Y I r S ,. -.............. 8:59:19 AM PROOF "' " E E CA G ` K PR"OFFSSIONAL BUILDING VERSION: 1 2 3 4 5 E-1 E-Mailed Called RE PROOF REQUIRED � � W CUSTOMER ' CY1 z COMPANY: V O CONTACT PERSON: 7 STREET: CITY: STATE: C ZIP: PHONE: FAX: EMAIL: D _Oo a� C DESCRIPTION in�7 Z � o PVC Post&Panel Sign �`� 'Co. �' ?� `'. ��v C �- —30 in (D M 64 in 0 File Name:Bridge_creek—direewry_elgn,fe Folder Name:11BeokupNoWLEXI FILES%SWdge Creek ©COPYRIGHT 2014,SIGN*A•RAMA,Inc. THIS RENDERING IS INTENDED AS A SAMPLE ONLY,COLOR,TEXTURE,MEASUREMENTS,AND ACTUAL APPEARANCE MAY VARY SLIGHTLY FROM COMPLETED WORK AND IS CONSIDERED NORMAL&USUAL. Please ohook layout(artwork opolling,dimensions)and fox back with signature.Production I HAVE REVIEWED THE ABOVE SPECIFICATIONS&HEREBY FULLY UNDERSTAND THE cannot bsgin until written approval Is received,Additional charges will be applied for my changes A • CONTENT OF WORK TO BE PERFORMED that are needed after approval to received,SIGN"A'RAMA Is net responsible for any orrors In AND APPROVE THIS PROJECT TO BEGIN spoting,layout,or dimensions that have been approved by the customer,This proof Is for listed CUSTOMER APPROVAL SIGNED BY: Items only.Airy changes or deletion by the customer not shown or charged haroln will be billed 12 VyhMWWw.SIgNnma-Sy8jMOUth,ODM 6,Soath Vermouth,MA 02664 separately,50%DEPOSrr DUE AT TIME OF ORDER(full amount If under$10%balance due Phone: .0100 Fox:508-398.1760 Upon time of Installation,I HAVE READ AND AGREE TO ALL TERMS. INMAL osen8verizon,nat j , - PRINT: DATE: THIS ORIGINAL DESIGN AND ALL INFORMATION CONTAINED THEREIN 13 THE PROPERTY OF SIGN-A-RAMA AND ITS USE IN ANY WAY OTHER THAN AS AUTHORIZED IS EXPRESSLY FORBIDDEN.THIS PROPERTY MAY NOT BE REPRODUCED OR DUPLICATED WITHOUT WRITTEN PERMISSION OF SIGN'AWRAMA OR THROUGH PURCHASE. Town of Barnstable Building s ��� ? Post This Card So That it is Visible From the Street-Approved Plans Must be Retained.on Job and this Card Must be Kept BARNM' Where a Posted Until Final Inspection Has Been Made.' .h, 163P C Permit ertificate of Occupancy is,Required,such Building shall Not be until a.Final Inspection has beenmade. Permit No. B-17-3874 Applicant Name: Charles E Filling Approvals Date issued: 11/27/2017 Current Use: Structure Permit Type: Building-Sheet Metal-Commercial Expiration Date: 05/27/2018 Foundation: Location: 1170 UNIT 4 MAIN ST./RTE 6A(W.BARN.),WEST Map/Lot: 178-015-02D Zoning District: SPLIT Sheathing: Owner on Record: MALONEY,ALISON A TR Contractor Name: Charles E Filling Framing: 1 Address: 1170 MAIN ST/RT 6A,#5 Contractor License: 1539 2 WEST BARNSTABLE, MA 02668 - Est. Project Cost: $ 1,500.00 Chimney: Description: return ductwork system Permit Fee: $ 160.00 Insulation: Project Review Req: Fee Paid: $ 160.00 Date: 11/27/2017 Final: wt Plumbing/Gas Rough Plumbing: ._--.._�__._.____� Building Official • Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. Rough Gas: All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-.laws and codes. Final Gas: This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. --- ------ Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Service: Minimum of Five Call Inspections Required for All Construction Work: Rough: 1.Foundation or Footing 2.Sheathing Inspection Final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Final: j "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department I Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT . .� Town of Barnstable _ _ Building 1. Post This Card So.That it is Visible From the Street-Approved Plans Must be Retained'on Job and this Card Must be Kept 6'& �$ Posted Until Final Inspection Has Been Made. Permit tWhere a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made. Permit No. B-17-3874 Applicant Name: Charles E Filling Approvals Date Issued: 11/27/2017 Current Use: Structure Permit Type: Building-Sheet Metal-Commercial Expiration Date: 05/27/2018 Foundation: Location: 1170 UNIT 4 MAIN ST./RTE 6A(W.BARN.),WEST Map/Lot: 178-015-02D Zoning District: SPLIT Sheathing: Owner on Record: MALONEY,ALISON A TR Contractor Name: Charles E Filling Framing: 1 Address: 1170 MAIN ST/RT 6A,#5 Contractor License: 1539 2 WEST BARNSTABLE, MA 02668 Est. Project Cost: $1,500.00 Chimney: Description: return ductwork system Permit Fee: $160.00 i Insulation: Project Review Req: Fee Paid $160.00 Date: 11/27/2017 Final: Plumbing/Gas Rough Plumbing: 9 ` Building Official Final Plumbing: 1 This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. Rough Gas: All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. Final Gas: This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. ? y z Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Service: Minimum of Five Call Inspections Required for All Construction Work: Rough: 1.Foundation or Footing 2.Sheathing Inspection _ Final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT JAG Commonwealth of Massachusetts _ Sheet.Metal Permit Map Parcel Date: Permit# /�' ���O 7 (/ Estimated Job Cost:$ Permit.Fee: Plans Submitted: YES NO Plans Reviewed: YES NO Business License# ! Applicant License# Business sIInformation: jj,�(j//q�j Property Owner C//jJob Location Information: l.,/v v� t �/' 'vvl f r W vV� . A.I[�V ♦ "we-1 j V • Name: �j Name: Street: LL Street: 0 �M h 7 City/Town: City/Town:u V 6J ifs iN ocl �.kL Telephone: -Z 7 Telephone: 11 7+/1 b - Photo I.D.required/Copy of Photo I.D. attached: YES ✓ NO / Staff Initial J-1/M-1-unrestricted license J-2 I IY);'-2-restricted to dwellings 3-stories or less and commercial up to 10,000 sq. ft./2-stories or less Residential: 1-2 family Multi-family Condo!Townhouses Other Commercial: Office Retail Industrial Educational Fire Dept. Approval Institutional_ Other Square.Footage: under 1 0,000 sq..ft.4/_ over 10,000 sq. ft. Number of Stories: Sheet metal work to be completed: New Work: Renovation: HVAC Metal Watershed Roofing Kitchen Exhaust System Metal Chimney/Vents Air Balancing Provide detailed description of work to be done: U L L ........_.___.........-_. A i INSURANCE COVERAGE: I have a current liability insurance policy or its equivalent which meets the requirements of M.C.L Ch.112 Yes[ +lo El If you have checked YM indicate the type of coverage by checking the appropriate box below: A('lability insurance policy Other type of indemnity ❑ Bond ❑ I OWNER'S INSURANCE WAIVER:i am aware that the licensee does not have the insuranc overage required by Chapter 112 of the Massachusetts General Laws,and that my signature on this permit applicatio this requirement Check One Only own ❑ Agent ❑ Signature of Owner er's Agent s By checking this boxO,I hereby certify that all of the details and information i have submitted(or entered)regarding this application are true and accurate to the best of:my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 19 2 of the General Laws. i Duct inspection required prior to insulation installation:YES NO ]Proflra-ess Izispections Date Comments i Final Inspection Date Comments Type of License: 3 3y "Master i Fitie. ❑Master-Restricted .ityfTov'n ❑Journeyperson Signature of Licensee 'emit# Gy ❑Joumeyperson Restricted License Number. S� 3 =ee$ Check at www.mass.aovldlal nspector Signature of Permit Approval BORQHEA-01 TVANRYSWO0D '4��� CERTIFICATE OF LIABILITY INSURANCE °1010 ATE A/2017Y' 10/0212017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WANED, 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 _VIMIACT Rogers&Gray Insurance Agency,Inc. PHONE FAX 434 Rte 134 I=,Na.Exq: (A/C,No):(877)816-2156 South Dennis,MA 02660 EA I6s:maii@rogersgray.com INSURERS)AFFORDING COVERAGE NAIC$ INSURERA:Arbella Protection Insurance COMMny,Inc. 41360 INSURED INSURERB:Arbella Indemnity Insurance Company,Inc. 10017 Bourque Heating&Cooling,Inc.&B&L Equipment,LLC INSURER c: PO Box 770 INSURER D: MarstorLs Mills,MA 02W INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUB POLICY EFF POLICY EXP L TYPE OF INSURANCE POLICY NUMBER M orfym LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 CLAIMS-MADE FX]OCCUR 8500066405 10/01/2017 10101/2018 DAMAGE TO RENTED ce 600,000 MED EXP(Any oneperson) S 6,000 PERSONAL&ADV INJURY S 1,000,000 GENL AGGREGATE LIMIT APPLES PER � GATE 2000,000 POLICY LOC PRODUCTS-COMPIOP AGG S 2,000,000 OTHER EBL AGGREGATE S 2,000,000 B AUTOMOBILEUIABILITY COMBINEDSINGLEUMIT 1,000,000 ANY AUTO 1020058494 10/01/2017 10/01/2018 BODILY INJURY Per rson s OWNED X SCHEDULED BORDILY INJURY Per accident s AUTOS ONLY AUTOS X ALTOS ONLY X AUrO NEY (F eO t AMAGE s A X UMBRELLA LJAB X OCCUR EACH OCCURRENCE S 3,000,U00 EXCESSLIAB CLAIMS-MADE 460006SU6 1010112017 10/01/2018 AGGREGATE 3,000,000 DED I X I RETENTIONS 10,000 WORKERS COMPENSATION PER OTH- AND EMPLOYERS-LIABILITY YIN TTUT ANY PROPRIIMETBORIPARTNERIEXECLMVE ❑ EL EACH ACCIDENT OFFI ry In NR EXCLUDED? N 1 A EL DIE -EA EMPLOYE tf yes,describe udder DESCRIPTION OF OPERATIONS below EL.DISEASE-POLICY LIMIT s DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,AddlUonal Remarks Schedule,may be attached If more space is required) HVAC Contractor General Liability Coverage includes: Per Project Aggregate Limit Blanket Additional Insured endorsement as Required by Written Contract Additional Insured-Contractors-Completed Operations as Required by Written Contract Primary&Non-Contributory as Required by Written Contract Transfer of Rights of Recovery as Required by Written Contract SEE ATTACHED ACORD 101 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town Of Barnstable THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Main Office 367 Main Street Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE ACORD 25(2016103) ©1988.2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 0-4 5/22/2017 7:48:58 AM PAGE 2/002 Fax Server CERTIFICATE OF LIABILITY INSURANCE DATE 50nU IYYYY) "t IFICATE 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 BELON(. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE IMPORTANT:If the certificate holder In an ADDITIONAL INSURED,the poGc�r(ies)must be endorsed. It SUBROGATION IS WAIVED,subject to he terms and conditions of the policy,certain policies may require and endorsement. A statement on this certificate does not confer rights to certificate holder In IEeu of ouch endwseme s. PRODUCBi CONTACT NAIVE RO(3ERS&GRAY INS AGCY PHOME FAz 434 ROUTE 134 Imo+No,Oct): (AtC,Nog E-ML SOUTH DENNIS,MA D2660 ADDRESS: 72 WFB INSURISMS)AFFORDMO COVERAGE NAIC d INSURED INSURER A: CONnNENTAL CASUALTY CAMPANY BOURQUE HEATING&COOLING CO INC INSURER B: INSURER C: I PO BOX 770 NSURER D: tN$VREIi E: MARSTONS MH LS,MA 02648 INSURER F: COVERAGES CERT14CATE NUMBER: REVISION NUMBER: TMIS M TO CERTIFY TNIIT THE roLICEe6 or wwRAnce LISTED M*WHAVE Beim OWED To T"C 01SNRRD VARIED ABOVEFOR TnE POLICYPERIGO INDICATED.NOTVfflMTAND= ANY REQYIR®IFM,Tom OR COROrnon Or ANY CONTRACTOR OTM ER DOCIRSENT WRM RESPECT TO WIMN THIS CERTIFICATE MAY REISSUED OR MAY PHRAOL TIIH rNSUgANOE AFFORDED BY THE POWME9 DEa'aI^HEREIN 6 SUBJECT TO ALL THE TERYb,EXCLUSIONS AND CONDITtOMOF SUCH POLICES$.UN"SHOWN My HAVE BEEN RWLCW BY PAW CLARM ADD SM POLICY EFF DATE POLICY EXP DATE LTR TYPE OF RISURANICE L R POLICY NUMBER INURDDIYYYY) ImmaD1YYIrY) VE LIMITS OENIMLLIABILITY URRENCE $ CCnrMERCIAL GENERAL UABILrTY O RENTED S CLAIMS MADE a OCCUR. (Esaacunence) ny o-perco $ ADV INJURY $ GEN'L AGGREGATE LIMB APPLIES PER: GGREGATE $ POLICY OPROJECT OLOC -COMPAOF AGG S AUTOMIOBIIE LIABILITY SINGLEANY AUTO eitler¢) ALL OWNED AUTOS DLY INJURY $ SCHEDULE AUTOS fFr pan) HIRED AUTOS DILY INJURY $ NON-OWNED AUTOS racclftM OPERTY DAMAGE S r acpCent) UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LOB CLAIMS-MADE AGGREGATE g .El DEDUCTIBLE $ RETENTION S $ A � 710PAND x � ATuroRY OTHER �ELOYEWOLItMYIN US93953DA-17 05n720I7 051172018 ANY PROPERrrORIPARTNER/6XECVTIYE Q 0MCERI9EMMR GXCUJV5D? WA E.L EACH ACCIDENT $ 1,000,000 IMMda1wy to NH) E_L DISEASE-EA EMPLOYEE $ 1,000,000 TES IPTIO a uriOP er O EA-DISEASE-POLICY LIMN S DESCRIPTION�OPERATIONe DI?IIIa 1,000000 DESCRIPTION OF OPERATION&ROCATKXa/VEMCLESM OTPJCTt"SispEaAL ITEMS TITLS REPL.ACBS Aare PRIOR CHRrnRCAT6 WUI1D TO 77M CERTIRCA7b AOIDER AFFECI4NG WORKERS COMP COVERAGR CERTIFICATE HOLDER CANCELLATION TOWN OF BARNSTABLE SHOULD ANY OF 11-EABOVEDGMMIRE OPOLICIESBE CANCELL® BEFORE TH TION DATE TH6tECF,.NOTwE WILL DELNIMED 367 MAIN ST rN ACCORD E WITH THE POLICY PRO s AVTHO ENTATIV6 HYANNIS,MA 02601 ACORD 25(201OMq The ACORD name and logo are registered marls of ACORD 19IIEL.2010 ACORD CORPORATION. AN ri tesernred. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): 6o t* Crf Address: (Ef�l l o City/State/Zip: himlisi AM Q44 Phone #: 66 D " 190 'CM 8 Are you an employer?Check the appropriate box: Type of project(required): 1. ✓ l am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time). have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑.Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp.insurance comp.insurance.t required.] 5. ❑ We are a corporation and its 10.El Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no 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. XContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that isproviding workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: �uv t �/ OAS VQ, Policy#or Self-ins.Lic.#: U p -5-8 �ISWA "17 Expiration Date: 5 ? d 8 Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby ce u �rt4heins and penalties of perjury that the information provided above is true and correct. Si ature: �'` Date: 1 '` 0o1 Phone#: 5.6A •r 1[Q -cMp S I Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/Liceuse# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: • • 508-790-2887 (TEL) 508-771-9696 (FAX) 10/26/2017 To Whom It May Concern: I hereby authorize Master Sheet Metal License# , to pull shed metal permits for Bourque Heating & Cooling Co. HVAC projects. Robert Bourque Date President Offices: Mailing: 1199 Pitchers Way PO Box 770 Hyannis, MA 02601 Marstons Mills, MA 02648 r _ COMMONWEALTH OF.MASSACHISETTS . NO Mola • BGARU'Cf SHEET ME7`AL WORKERS-,W" ' x 4' TISSUES TW FOLLOWING LICENSE AS A MASTER-UNRESTRIGTE s c. aCHARLES E FILLING"I cl 4<1 FRESH PQND J2D : EAST FALiVIOl3TH,M 025363425�"h A 1539 :�� .Y�; osrzsr2als � _ -ZtsaS /s "To; Town�ofBarn4staplea 20Q Man?Stieetl _ H"yanrns��MA,QZ601, �F�om Birid'ge C�eel�Professional Center Condomr'nruvm'Trust:� :.. �1170,Main�Sr�;et:#5 , West_Barnstabte,�MA�026i,8; hNoiember 2,;2.U17� TfeBndge+Greek Professional Center Condominium Trust fieebyauthorRes Bourque Heatrn4g and^ Coolrng o,Eomaplete woFk?to`t#e heatng�arid�'coolrng"umfs;foF"Units 4andv5 at`the�Bridge�Creek< R61W Tonal 0ff Mlocatetltat;117,0"Nlarn Streetx�n West.Ba i�stat le Work sha11 include but may�nof be; I m ted t0,'"a'ce and.upkgrade two heat pump�systems,$detivery and>�nstallafron,of outdoor condenseP �u_rnts,�matchingairhandler�unitsscrawlspa-ce ductwork�wrth.,insulatedsheet mefalXmain�trunks ari'i' in§ulated flex_du'et run�outs?; �Sigmetl; e Y ..dater � .c � Matt ewmm"(1Uitrneye.c 4Trustee;lBridge�Creek4"Profess l 1 Center:Candom h'ium Trust r: N Commonwealth of Massachusetts r SheetMetal Permit Map ..7 Parcel�,,���E Date:' Permit# 7 _ 73 Estimated Job Cost: $ SO O Permit.Fee: $ % in Plans Submitted: YES NO Plans Reviewed: YES NO Business License## [ Applicant License Business Information: Property Owner/Job Location Information: //�� I Name: EGG r Name: / o 94Lz l� Sheet: Street: Z I Z[�z ,4 / f'J' V.✓ /S City/Town: City/Town: Telephone: — Telephone: ? 0 Photo I.D.required/Copy of Photo I.D. attached: YES NO_ Staff laitial J-1/M-1-unrestricted license J-2/M-2-restricted to dwellings 3-stories or less and commercial up to 10',000 sq. ft./2-stories or less Residential: 1-2 family Multi-family Condo/Townhouses Other Commercial: Office v�l Retail Industrial Educational Fire Dept. Approval l s5 Institutional_ Other „f 1 all Square.Footage: under 10,000 sq.-ft. ✓ over 10,000 sq. ft. Number of Stories: Sheet metal work to be completed: New Work: Renovation: HVAC '� Metal Watershed Roofing Kitchen Exhaust System Metal Chimney/Vents Air Balancing Provide detailed description of work to be done: .. ...._...__..__ ... p� i INSURANCE COVERAGE: I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L Ch.112 Yes g<0❑ If you have checked Y,indicate the type of coverage by checking the appropriate box below: A liability insurance policy Other type of indemnity ❑ Bond ❑ I OWNER'S.INSURANCE WAIVER:I am aware that the licensee toes not have the insuranc overage required by Chapter 112 of the Massachusetts General Laws,and that my signature on this permit applicatio ii this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner er's Agent By checking this boxO,I hereby certify that all of the details and information 1 have submitted(or entered)regarding this application are true and accurate to the best of.my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. i Duct inspection required prior to insulation installation:YES NO i Zo ess Usneetions Date Comments i i i I i Final Inspection Date Comments i Type of License: 3y (aster i i Fite. ❑Master-Restricted :ity/Town Joumeyperson ❑ Signature of Licensee 'emit#f ! 2 9 ❑Joumeyperson-Restricted License Number. :ee S Check at www.mass.aovldtial i nspector Signature of Permit Approval I r COMMONWEALTH OF MASSIItISE7TS� BflAi01 � ff - s _ _ "SHEET"MALWORKERS t r �.�SSUES FOLLOWING LICETIE AS A ., ' t MAS, UNREST CTE S 4'O'.sr� s RL'ES E FILLINGS EAST=F THEMWo65 t539 �t�3r2i/618.ism F '2f64J � t 1. f - • BORQHEA-01 TVANRYSWOOD CERTIFICATE OF LIABILITY INSURANCE DATE 1010212 Y017 10/02127 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or 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 Ileu of such endorsement(s). PRODUCER CRMIACT Mers&Gray Insurance Agency,Inc. PHONE FAX �134 (ANC,No,Ert►: (AIC,No:(877)816-2156 South Dennis,MA 02660 EDNa IL .mail@roger5gray.com INSURER S AFFORDING COVERAGE NAIC 0 INSURERA:Arbella Protection Insurance Company,Inc. 41360 INSURED INSURERB:Arbella Indemnity Insurance Company,Inc. 10017 Bourque Heating&Cooling,Inc.&B&L Equipment,LLC INSURERC: PO Box 770 INSURER D: Marston Mills,MA 02648 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDLITYPEOFINSURANCE INS)) B POLICYNUMBER POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE Fx—]OCCUR 8500066405 10/01/2017 10101/2018 DAMAGE TO RENTED $ 500,000 MED EXP(Any one on $ 6,000 PERSONAL&ADV INJURY $ 1,000,000 GENL AGGREGATE LIMIT APPLIES PER 2,000,000 POLICY❑X Pea LOC PRODUCTS-GREGATE 2,000,000 J PRODUCTS-COMP/OPAGG $ OTHER: EBL AGGREGATE $ 2,000,000 B AUTOMOBILELIABIUTY COMSINFASINGLELIMIT 11000,000 IxANY AUTO 1020058494 10/01/2017 10/01/2018 BODILY INJURY Per s OWNED X AUTOS SCHEDULED AUTOS ONLY BODILYINJURY Peracddent s HIRED X NON-0WNE� PROPER�Y AMAGE AUTOS ONLY AUTOS ONL Pere ent $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 3,000,000 EXCESS LLAS CWMS40D 00066406 10/01/2017 10/01/2018 AGGREGATE 3,000,000 DED I X I RETENTION$ 10,00E WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y I N ANT PROPRIMETgOtVVARTNER/EXECUTIVE EE.L.EACH ACCIDENT b (rolanda0ory Ein NFU EXCLUDED? N I A desWbe under EL DISEASE-EAEMPLOYE If yes, OF OPERATIONS below EL.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES(ACORD 101,Additlorral Remarks Schedule,may be attached Ir more space Is required) HVAC Contractor General Liability Coverage Includes: Per Project Aggregate Limit Blanket Additional Insured endorsement as Required by Written Contract Additional Insured-Contractors-Completed Operations as Required by Written Contract Primary&Non-Contributory as Required by Written Contract Transfer of Rights of Recovery as Required by Written Contract SEE ATTACHED ACORD 101 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Barnstable THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Main Office 367 Main Street Hyannis,MA 02601 AUTHOR®REPRESENTATIVE ACORD 25(2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 0-4 5/22/2017 7:48:58 AM PAGE 2/002 Fax Server CERTIFICATE OF LIABILITY INSURANCE DATE(MEEIIIDDIYYYY► FIGATE 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 RODUCER,AND THE CERTIFICATE HOLDER- IMPORTANT:Ifthe certificate holder in an ADDITIONAL INSURED,the po"ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require and endorsement. A statement on this certificate does not confer rights to the certificate holder In IEcu of such andorseln®n s. PRODUCER CONTACT NAME: ROGERS&GRAY INS AGCY PHDHE FAX 434 ROUTE 134 LAIC.Na,iiXQ: WC,No): E-ML SOUTH DENNIS,MA 02660 ADDREaW. 72WFE INBL REms)AFFORONG Commas NAIc A INSURED INSURER A: CON71NENTAL CASUALTYCO?OANY BOURQUE HEATING&COOLING CO INC INSURER B: INSURER C: Po sox na INS'RER D: INeWWR E: MARSTONS MILLS,MA 02648 INSURER F: COVERAGES CERT*WATE NUINBER: REVISION NUMBER: TIM 13 TO CW TIM MAT THE POLICES OP IRSYRANCE LISTED MOW HAVE OCEN ISSUED TO TIM 1113URED NAMED ABOVE FOR THE rMCT 1`0I00 DIDCATCO."OTVYrr115TAMI IG ANY RFSg09tmimr,Tom OR CoKorno 1 OP ANT CONTRACT OR OTM Mt DOGMENT sVnH RESPECT TO WHCI1 THIS CERTIFICATE MAY REISSUED OR MAY PERTAIII,TM UISURARCE AFFORDED BY THE POLICIES DESCRIBED"EREN IS SUBJECT TO ALL THE THIM9.EXCLUSIONS AM COMUTIOM OF SUCK POLICIES.LOUTS SHOlDI1 MAY HAVE SEEM REDUCED BY PAD CLAMi MISR ADD WIS POLICY EFT DATE POLICY E7XP DATE LTR TYPE OF MSURAMCE L R POLICY►IUAISIM IhMM%YYYV) lbURODWYYY) LaIna GENERAL LIABILITY OCCURRENCE 3 COMMERCIAL GENERAL UABILrTY AMPGE TO RENTED $ CLAIMS MADE OCCUR. MISES(Ea accurreme) D EXP(A one porso Y F BADVINJURY $ GEM AGGREGATE LIMIT APPLIES PER GGREGATE $ POLICY aPROJECTO LOC -COMPIOP AGG $ A11T0{MOBILEUABRJTV OMBINEO S(NGLE S ANY AUTO EMIT(Ea accitler¢) ALL OWNED AUTOS DLY INJURY S SCI EDULEAUTOS Perperson) ERRED AUTOS DILY INJURY $ NON-OWNED AUTOS (Pet acclderlt) FROPERTY DAMAGE S Per acciaerd) UMBRELLA LIAR []OCCUR EACH OCCURRENCE S EXCESSLIAB CLAIMS-MADE AGGREGATE g DEDUCTIBLE S • RErENTICNV$ S A WORKEYB COMPENSATION Alm SrAnNORY OTHER EMPLOYEIrS LIABILITY TIN UEl5EI39530A-17 OSM72017 0511712M UNITS ANY PROPERITOPJPARTI E�TIVE OFFICERNEMBER S XCUJDF.D? ® NIA E.L EACH ACCIDENT $ 1,000,000 Imsomoryln NH) EL DISEASE-EA EMPLOYEE $ 1,000,00U 6 yes,oescrioe UROer DESCRIPTION OF OPERATIOPM WOW E.L DISEASE-POLICY LIMIT $ 1,000.000 DESCRIPTION of OPE RAT1ONWLOCATIONSAFE-30CLE3/RE$TRICTIONSISPSCAL ITEM TIM RBPL.AMS AID'MOR CHR77FICATE ISSUIiD TO TM CERTYIRCATE AoiDbR AFFECrM wORKM COMP CDVHRAGR CERTIFICATE HOLDER CANCELLATION TOWN OF BARNSTABLE SWULD ANY OF THEAOOVEDGMMIRE DPOLIaGs BE CANCELLED ED 367 MAIN ST BEFORE TION DATE THEREOF..NOTICE WILL OFDISUVC-RED rN ACCOEjD E WITH THE POLICY PROM .; AUTOO 94TATIVE HYANNIS,MA 02601 ACORD 2S(201OMS) The ACORD name and logo are registered marks of ACORD IBM-2010 ACORD CORPORATION. AM ri i reserved. The Commonwealth of Massachusetts Department of Industrial Accidents -- Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information _ Please Print Legibly Name (Business/Organization/Individual): V� Heat, Address: I t Ci q A fa C ts A City/State/Zip: ilvkA 6 s 0 I Phone #: 60 9 " I Q O 'aa 8 Are you an employer?Check the appropriate box: Type of project(required): 1.❑✓/I am a employer with 10 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' [No workers' comp.insurance comp.insurance. # 9. ❑ Building addition required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no 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 hue outside contractors must submit a new affidavit indicating such. =Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp,policy number. I am an employer that isproviding workers'compensation insurance for my employees. Below is the policy and job site information. ekval�y Insurance Company Name: eoewei/1/ , Policy#or Self-ins. Lic.#: U p "59 M WA "17 Expiration Date: 5 1? d 8 Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby ce u r the ins and penalties of perjury that the information provided above is true and correct. Si ature: �'` Date: Phone#: 1 1 Q •JU S I 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#: DocuSign Envelope ID:3CCEB2B2-5E62-47F3-96D0-AD2298D6047C T Town of Barnstable r Regulatory Services Thomas F.Geiler,Director Building Division Tom terry,Building Commissioner 200 Main Street,Hyannis;MA 62601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign 'Phis. Section If Usi=A Builder Alison A.: Maloney as Owner of the subject property hereby.authorize Bourque Heating and Cooling to act on may behalf, in all matters relative:to work authorized by this building permit. 1170 Main St. , units 4 & 5, west Barnstable (Address of Job) **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled before fence.is installed and pools are"not to be utihzed.until all-final inspections are Performed and accepted. DocuSigned by: Q�1sew Q..&JJhy�t,y, OI ar QM.G Iec,a y, UL ig'si°a°tiire`ooFbwner Signature of Applicant Alison A. Maloney Paint Name Print Name 10/26/2017 Date Q:F0RMS:0WNERPER?&SST0NF00IS a • • 508-790-2887 (TEL) 508-771-9696 (FAX) 10/26/2017 To Whom It May Concern: I hereby authorize 061 Lem' hJ( ( ),/' Master Sh eet Metal License# ! � , to pull shee metal permits for Bourque Heating & Cooling Co. HVAC projects. Robert Bourque Date President Offices: Mailing: i 1199 Pitchers Way PO Box 770 Hyannis, MA 02601 Marstons Mills, MA 02648 To Town;=ofarnsl`afe 00 Nl-AFU reet� Hyanns;MA;.�Q260.1 Frgm Bridge�reel�Rcofessional�Center Condominium Trust: , `1170;Ma_ t;Stre'et;#5' 1Alast;:Barnstabl.e�11AA:Q266$ :Novente 'Z,2017 j 'The.B�ielge Creek_Professional Center Condominwm Trust hefeby,author�zes Bourque Heating and,' Co'olrng to;complete w.ork,to tli'e hea 000fi unTtsfor Unit 4;Wn at the Brrdge.Creek,. Pr ooafiOffice?s located,at`1`1Z, NON Str6 in West.Barnrstable Worfi -S;Wl include But may:not B;e: liridiited.tg;,repl4c and upgra.003W heat pump systems,delivery'and insta'I[atton,ofnutdoor 4orjdenser units,matching air handler�r�its,crawaspace ductwork wrth,;insulated sheet metaiL;ma�n ttu�ks;and 'ns°elated fle =dutvtwout`s: ,Signed; Matt ew1N rQuitmeyer; .r 'Trustee;Brf c eek Profess onal itenier`Condornihiurn Trust Town of Barnstable Building . �g,� . PostThisCard So That it;is Visible from;the Street-Approved Plans IVlust be Retained on;Job�and:thisCardgMust be Kept rase Posted Until it Final,Inspection Ha' eMade. Permit 1 erm ` arc_.. Where.a�Certificate of Occupancy is�Required such Building shall Not be Occupied until a Firial Inspeetion�hasYbeen made. Permit No. B-17-2261 Applicant Name: JAMES PCURLEY Approvals Date Issued: 01/2S/2017 Current Use:. Structure Permit Type: Building-Sid ing/Windows/Roof/Doors Expiration Date: 01/25/2018 Foundation:. Location: 1170 CONDOWORK MAIN ST./RTE 6A(BARN:),WEST Map/Lot 178-015 001 "Zoning District: Sheathing: Owner on Record: DREW,ERIC W a d ,Contractor€Name: JAMES P4CURLEY. Framing: 1 Address: 163 ELLIOTT ROAD ¢, � � � Contractor License CSSL-099138 .2 �ENTERVIL'LE,MA 02632Est, ProJectCost: $:7,000:00 Chimney: Description: STRIP APPROXIMATELY 10 SQ:`Of.CEDAR.CLAPB`OAR-SIDING AND . � mitfee: $160.00 s � Insulation: "REPLACE WITH LIKE FOR LIKE GEDAR CLAPBOARD SHINGLES l lation: Fe&Paid 5:160.00 Project Review Req: STRIP APPROXIMATELY 10 S,C1..OFCEDAR�CLAPBOARD SIDING ����� g�� Final: g � �Date.` 7/25/2017 AND REPLACE WITH LIKE fOR LIKE GE CLAPBOARD �n a� }� � ��, SHINGLES- Plumbing/Gas k � � � `A .....kf/K� p ` Rough Plumbi • ��� �3 £ g rig max , � Buifding Official Final.Plumbing: This.permit shall be deemed abandoned and invalid unless the work authorized W4this permit is commenced within six months aft&1issuance. 8 Rough Gas: All work authorized by this permit shall conform to the approved application and the approved construction documents,for whKh tF is permft has beerrgranted. All construction,alterations and changes of use of any,building and struct.uresshall be in compliance with the local zoning by laws and codes. 'Final Gas: '" � �3'YLN."�k �',`"� e�.°Q��This permit shall be displayed in a location clearly visible from access street or road end shall be maintained open for public inspection for the entire duration of the work until the completion of the same. : ` > " ¢ Electrical The Certificate of•Occupancy will not be issued until all applicable signatures.by,the Budding and FZre"Officials ar�e,pro ded onithis permit. Service: Minimum of Five Call inspections Required.for All Construction Work: r �� s �win I.-Foundation or Footing. P ` Mg r ' Rough: 2.Sheathing Inspection N .• ,.=- g 3.All Fireplaces must be inspected atthe throat level.before.firest flue lining is installed -Final: ' 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection .5.Prior to Covering Structural'Members(Frame'lnspection) Low Voltage"Rough: 6.Insulation 7.Final Inspection before Occupancy low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various:stages of construction. Final: "Persons contracting With unregistered contractors do not have access to the guaranty fund"(as set forth in MGL c.142A). Fire Department Building-plans are to be available on site final: All Permit Cards are the'property of the APPLICANT-:ISSUED.RECIPIENT , ` TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application #6V 1 -7 Health Division Date Issued 71.1 S- ! �X Conservation Division Application Fee Planning Dept. Permit Fee /6 1 Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis — Project Street Address 0 ,` ,cqo 711 Village Owner �1)�� �,� ddress Q ,r I�In Telephone Permit Request Square feet: 1 st floor: existing osed 2nd floor: existing proposed 50talcnew C Zoning District Flood Plain Groundwater Overlay l �- �a Project Valuation 1.M••nonstruction Type 33 z Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporti9q documentation. CU -t Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) m 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 hew 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 wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use — APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name V "V e Telephone Number Oka - �0 Address 1 - 0 • License# 1� h �7, 0Au 0 1 Home Improvement Contractor# Az 0 Email e w�.� l orker's Compensation # 1't ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO rl � SIGNATURE DATE I� r 2 3 i' y FOR OFFICIAL USE ONLY 11 ' APPLICATION# DATE ISSUED. r; MAP 7 PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: � FOUNDATION FRAME I'' > INSULATION Et; . FIREPLACE ELECTRICAL: ROUGH - FINAL ,. PLUMBING: ROUGH FINAL-- GAS: ROUGH FINAL I / FINAL BUILDING DATE CLOSED OUT -;§OCIATION.PLAN NO. r Depwtzramt qfIndrrstrialAcddadst - Office of-&meinka ots 600 Waslurigtort Srfreet _ Boston,M4 02111 1sir'wi nza_w.gvvldia Winners' CumpensafimTnsarmce AfRd vit B.ugderslCantr-acfarslEIec€ririan&Tbiimbers AppVcm#Infmanat nn Please Prof Leer ily N` aS1C57iP_RaD�dt1(tlJl111L1k\i1L111d1 Address Are yroou an employer? the appropriate bos; Type of project r . I am a+ eaeial casdraclar and I YP F 1 ( e���'= L❑ I am a employer with ❑ g 6- ❑New constuc€ioa Iayees(falland[nr liavelniredthe sub-coakmctom I atn a sale or ar er- PisFEd onth-e attached sheet. 7- El Remodeling 2, F� These sob-cofl4ractam have sliip and tea no employees. , 8. ❑I7emalitiotx worldng,far 7tta inaup capacity. employees and,have workers' 9. ❑Building additioa 194 tvoeoftm,camp.Lisa=a comp-inmrance—I regivred j I ❑ We are a corporation and ifs 10.❑Elecfdcal repairs or ad�iaus 3-[] I alma homeovmer Doing all work officers leave emarcised their 1L❑Flumbsngmpaim or auditions MyselE END wolkere gyp- right of exemption per MGL 127_❑Roafrepairs fe nce resluiied j Y c.152,§1(4k andwe have no employees.[No waders' 13.0Other cam-in an-re requ red-I �f e 5-16 tcheCIMIMXr'�I ma_;i HISQ ffiGt]Etfie secfEanbeIaarshauiag it�e�zaod'cFss''c�PeP58t)aIIpotlLy 1IIfLGIDY6L� �r�„mF�va�svrha submit dris dBdaeB i�cztmg dreg zte fain;g] Wok and 61M]�a�da Cru�C�nmd snbmit a new� rda8t indicsdiag rnrTt an±n'3T5•ffi%tcher7c b=" zttacbLd=2ddidm shed showing the ann.•eofthesub-cautudaa.snds avrha*erarnot•rhasaematinhma EMpIIayem I€thesuh-contactnshzse MaRICTzes,9fie3'=Lst'PM%d&th-9t wadie&gyp.Polky a es lain im en; Ta}srflsrrtispratzditzgmarkers'cortrirPrtrafiartiitrrtratzcafor y enrplv}�ees $elatvisfhapofic�attd1obsits frc,forffuLdb . Insurance CompatiyhaniT 'Poliicy 4 or Selfas_lle_:g: ExpirationDate: Job Sife Address CitylStafelZp: Adach a copy ofthewarkers'compensationpolic r declaration page(shawhig the poTiry,number and expiration date). Fairs=to secure cavenge as requiredunder Section 2.5A of MCI c�15 can lead to the iamposilioa of criminal penalties of a fine up to$L5.00,OD endear one-year impui oumeut,as W@1 as civil peaalfies.ia$ie farm of a STOP WORK(MER..and a fine of up to$250_00 a day against the violator. Se adidsed that a copy oft its statement maybe fx varded to the office of InwesEgatians o€Ihe DIA far insu=ce-coverage yeri fimation Zdo hear,6 _ a�,11� artrF ufgerJtEtlr that f7ae irafarirte�ioriprotir �s i��b{ar acid rest Si sre: Date. Phasic ir t3,ft*d zoo arty,. D47)10,1 ot-rita in fW3.area,err be wigpieted by cdg artow-n of yciaL City or Town: PerwiVLicense:g Issuing Amffior*y(code one): L Board-of$ealth 3.Ruffdiug Department I Cay!£irsm Clerk 4.Electrical I•uspector S.PPbmmibing Inspector 6.Other Contact Person: Phone#: laformation and Tas a Moyers`fn gavide worker'��on for their e�IoY�- M�cca r-I,,,�r�-fs Ge:�eaal Laws �� ll egsonm$�.e sexPice of another render any a5nirart ofhae, Pmsuani-to this sty,an M-PrOyee is defined as'�e=YP . or implin4 6ral or orat[on or othe2legal e�rty,or uY tw or more Atl�&Y�is defined as"an in�vidnal,paxinnship, Aing sm peon,cozP Cr or the ofib_e foregoing m aJomt e�rgrzse,andinclnd�the Iegal Fe�res�dives ofa deceased enrpIoY . receiver or trastes of an individual,Pam,association or of3ier Iegal emtdp,e�ploYing emp�Y - However the house having not more than tlr=apartments and who resides theacin,or the octet of$e- owner of a dwelling conshuc ion or re air work on such dwcIlmg h E: dweIIing Tmnse of anodiei who�oYs P��t o do mai�an , P or on the grounds or buildmg appm-t�therefo shallnotbmanse of such mploymentbe dwmedtn be an employes." MGL chapter 152,§25C(6)also sh&s that"every stafn or local licenzMg agency shall wiffihold ffie issuance or renewal of a ticrose or pe�ittn operate a bm-mess or to construct begs �e co�aonw eater for t RP Wlio has notprodnced acceptable evidence of crim.PIi=m wit i the IDs�'ance rnY�rage regnsed Adffiionally.MGZ chapter 152,§.2SC(7)stains�Teathcr the�`rwealtb.nor any ofiis political subdivisions shall enter into any con-tad for the p ct"0f2nblic woI'&_Mtl acceptable evidence of campliancevviflitlieinsure•_ r e s of this chapter have been pres=±rd to ihe cunft mg aufllozity." APpIzcaafs • Please ffiI o� $ze wormers'compensation affidavit completely,by chm"E g i-he boxes apply i o 9oT� 0n 'if necessary,SUPPIY�-co s)n�gs)' address(es)MIAPhonemm�ber(s) alongwi$Lthcit ceriifr (s)of Wince. LIm=Eed Liability ContpanieS(LLG�or I Liability Part' YPS l)��n.o employees A=than'ho members or paitneas,are not requited to cagy wo��'�P ensation ` If an LLC'or LLP does have To ees a olic is Be advisedfbatthis a$da:Vtmaybe sobm&d to the Depac-finent of Indusfdal C=P- Y , P y - 9dso b e sure iD and date he affidavit Tfie affidavit should Accideis for conffimation offiISCtance coverage nottheD�parenl'of be ref=ed to-Ee cify or flown that the aPplicat'ion for the permit or license is being arequest � . in l AST rL� M012JAYou 7�e any g=duns rega�g llie law or ifyon rued to obtain a�so�ers' rAn�ensation poficy,Please call the Dep arime�at the n=bez 1is�d below. Self--insol ed c�anies rl ovld ear their self-;,,manceIiceme fiber on the applupEidc line. City or Tower o ffi a Te _ Ietc end rim d lgAly- The Deparimenthas provided a space at tlic bow Pleasebe sore$rat the a$davitis comp P has to co]¢a tyouregurdingthe applicant_ of the:affida�t fur Yontn fM onf in the event the Office ofInves igoIIs Pleas e b e sure in fillip the pe��fic®se mnnbes which will be used as na er. In addr�n,as aFP�t chat rarest sabnirt niuliiple permtllicense appIitstians is=Y&=Yin one affidavit and�dei`lob s`b_-b_d.�iress"the applicant sh orld "aII Iocatiz ns in (city or p olicy incbr�tioa Cif necesary) the or r-'allto W y be provided to the " inwn)»A copy of the-aff davit that has been official LY moped or maimed by �Y applicant as proof t that a valid affidavit is on file fur fame pcuni�s or licenses Anew affidavitmvst be famed out ear�i year.There a home ownea.or cfti2=is obbir g 2L arose or p�tnot=afed to any bu=css or commercial v� (ie_a dog license or permit to btu leaves etc.)said person is NOT required to coMPIe#e this affidavit, The:Officeaflnvestiga wovldliketnthankyDLinadv'mm for yourcoope-ion and shouldyouhaveanygaesfi� . please do not hcsifafm to give us a call. The1}epartment'smess,telephone and fare=Mnbca: ' 'fie art of l�as�'aah _ - Deparbn mt cflBftzIdaA nts f tc �f LL tiw;s 6R4-W T(1L 4 61.1-'t -45kW Q)t 4-16 or 1477 MAMS Rzvisea4-24-07 gAIiR_ °4THE Town of Barnstable Regulatory Services • sexxac��.p . WLAM Richard V.Scali,Director 1 6596 `fig rE g Building Division. Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder ' � as�Owhsubject Property hereby authorize to act on my behalf in all matters relative to work authorized by building permit application for. (Address of Job) **Pool fences and alarms are the responsibility of the applicant Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. S' ture of Owner e of Applicant Print Name Print Name Date QYORMS:0 VNERPERMISSIONPOOLS Massachusetts Department of Public Safety �! Board of Building Regulations and Standards License: CSSL-099138 Construction Supervisor Specialty JAMES P CURLEY 287 FULLER ROAD ` CENTERVILLE MA 02632 (�-�� lJL_ Expiration: Commissioner 01/28/2018 Office of Consumer Affairs&Business Regulation _ HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Individual before the expiration date. If found return to: ,Registration Exoiration Office of Consumer Affairs and Business Regulation "" 124310 05/31/2019 10 Park Plaza-Suite 5170 JAMES CURLEY;=?' Boston,MA 02116 JAMES P.CURLEY'_' ';'` _" 287 FULLER RD. CENTERVILLE,MA 02632J Undersecretary Not valid without Si a re YOU WISH TO OPEN A BUSINESS? For Your Information: Business Certificates cost $30.00 for 4 years. A Business Certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L. - it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, 1" FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) and 200 Main Street Offices at the Licensing counter. ` DATE: / 2 — Zef 7 x rP, Fill in please: t" APPLICANT'S YOUR NAME: /BSc �• �YJ�t lo//e BUSINESS YOUR HOME ADDRESS: /y Le�/4 ,E'er e Lam. G�'1k1sfa->7,S d7l �Ls TELEPHONE # Home Telephone Number: '7?y-8,3 6 3 �4 NAME OF NEW BUSINESS Arne 4e_4 li' , L L C TYPE OF BUSINESS IS THIS A HOME OCCUPATION? YES NOS Have you been given approval from the building division? YES NO ADDRESS OF BUSINESS 1174 /�'I�t�� S�,R�-�A,N�LiI-�Pri'�ss(e�#S ) MAP/PARCEL NUMBER �71F D/S�O�C When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. — (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COM TONER'S OFFI This individ al a een-ifl ed y permit requirements that pertain to this type of business. u ho iz d S' re* COMMENTS: 2. BOARD OF HEALTH This individu I ha i ormed of the permit requirements that pertain to this type of business. Aut orize Signature** COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual Nt=tiL ed oft ce ing r uirements that pertain to this type of business. Authorized Signature** COMMENTS: BAx�vsTAs LE, . TOWN OF BARNSTABLE :rlzr , ��: 7eiASS 9 i6 m s.3' It 2 w �ArED .1 A� y BUILDING-DIV. l Application Ref: 200801322 p�Fti�q'NoroPvrP�y�Q Issue Date: 03/12/08 °F REGUl.PtO Applicant: MALONEY, ALISON A TR Proposed Use: Permit Type: SIGN PERMIT Permit Fee $ 25.00 Location 1170 MAIN ST./RTE 6A(W:BARN.) Map Parcel 17801502E Town WEST BARNSTABLE Zoning District SPLT Contractor PROPERTY OWNER Remarks AMG REALTY COMM REAL EST - 1 WALL 1 - LADDER 17" x 4" WALL & 8.5" X 4'.SNIPE ON LADDER SIGN Owner: MALONEY, ALISON A TR Address: 1330 PHINNEYS LN HYANNIS, MA 02601 Issued By: .. I . ARff, SO.... .�IAT rS.:VT.TBLE::FR. . YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$4r 0 0_0-for 4 ears). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) Yo must first obtain the necessary signatures'on this form at 200 Main St., Hyannis. I., 367 Main St., Hyannis, MA 02601. (Town Hall) and getthe Business Certificate that is Take the completed form to the Town Clerk's Office, 1st F . required by law. DATE: a `7 Fill in please: ;�s rL: :`i}=•'.nl 'nr�fit. s., :y'" :I — e yY APPLICANT'S YOUR NAME/S: i'.r1%;sF'• h,,��y. 4' �;�y: BUSINESS YOUR HOME ADDRESS: XLA LAil < �te'; lY pia S b do-�( .-4- U fit; Lrt' ,:s,wk, �i TELEPHONE # Home Telephone Number, —1� �-f �l R ( I eallr�yi�J6f �� E-MAIL: NAME OF CORPORATION: `n NAME OF-NEW BUSINESS TYPE OF BUSfNESS GCS IS THIS A.HOME OCCUPATION? . YES NO ADDRESS OF BUSINESS 1-1-70 YriGUY1 5 LUI,S� 16a-`'nS4�bye MAP/PARCEL NUMBER-. J (Assessing) When starting a new business there are.several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST. GO T QO Main S . (corner of Yarmouth ' Rd. & Main Street)•to make sure'you have the appropriate permits and licenses required to legally operate your usiness in this town. 1 BUILDING COM IS ION R'S OFFIC This individu I he n nfo • e f y pe �Iies pertain to this type of business. 2AU ). , h rized_5ignat e COMMENTS 1 V 2. BOARD OF HEALTH This individual has been informed of the permit requirements that pertain to this type of business. ; Authorized Signature** COMMENTS: 3.' CONSUMER AFFAIRS.[LICENSING AUTHORITY] This individual has been informed of the licensing requirements that pertain to this type of business. •Authorized Signature** COMMENTS: • Sign TOWN OF BARNSTABLE Permit * BARNSTABLE, MASS. z6 39..�A Permit Number: Application Ref: 200801322 20070147 Issue Date: 03/12/08 Applicant: MALONEY, ALISON A TR Proposed Use: Permit Type: SIGN PERMIT Permit Fee $ 25.00 Location 1170 MAIN ST./RTE 6A(W.BARN.) Map Parcel 17801502 E Town WEST BARNSTABLE Zoning District SPLT Contractor PROPERTY OWNER Remarks AMG REALTY COMM REAL EST - 1 WALL 1 - LADDER 17" x 4" WALL & 8.5" X 4' SNIPE ON LADDER SIGN Owner: MALONEY, ALISON A TR Address: 1330 PHINNEYS LN HYANNIS, MA 02601 Issued By: C f) ktlpl-yl 411 0'5� M.THE STREET.. ....:> :':.. : POST THIS.:.CARD..SO:.;TI3AT.IS:.VTS 1".—u : 'RO .. r Town of Barnstable Regulatory Services Thomas F.Geiler,Director '" MASS.'�� Building Division i639. '°�i�Mectp Thomas Perry,CBO Building Commissioner �O 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Permit# Application for Sign Permit Applicant: /'/1�s� QL / Map&Parcel# Doing Business As: XE�417y, Telephone No. J`b Sign Location Street/Road: //fib /3?s�in rff /Pf—�o � Ot/r�fgi��iz.�faC� � /vr ff Zoning District: Old Kings Highway? &No Hyannis Historic District? Yes/No Property Owner Name: /72--- 7k-"/-Zcl' 71-2�sAeIephone: Address: Village: Sign Contractor Name: '-7 J:p—'F -xA-y''114 Telephone: 51)S 3 7t— <7 U o Mailing Address: Description Please draw a diagram of lot showing location of buildings and existing signs with dimensions,location and size of the new sign. This should be drawn on the reverse side of this application. Is the sign to be electrified? Yes/No (Note:If yes,a wiring permit is required) -16 %2 II Width of building face yo ft.x 10= /4 x.10= y Sq.Ft.of proposed sign g��r�- y X 7 10, I hereby certify that I am the owner or that I have the authority of the owner to make this application,that the information is correct and that the use and construction shall conform to the provisions of§240-59 through§240-89 of the Town of Barnstable Zoning Ordinance. � D Signature of Owner/Authorized Agent: �!' Date: � Permit Fee: Sign Permit was approved: Disapproved: Signature of Building Official: Date: i In order to process application without delays all sections must be completed. Rev. 9/12/06 COUNSELING FOR WOMEN ' 62-6227 362-90 30 � F ' , 7� i c ' WEST BARNSTABLE BUILDERS1 Dealer: HABITAT/POST & BEAM 1 {•J ! iM.edia Technology, Inc. AMG REALTY t� COMMEKGIAL REAL ESTAI Timothy "M. Clark ACSW LICSW IIISYCliOTHERAPY . 4 i 17-in s _ COMMERCIAL REAL ESTATE i I' � 1� . T T f V c, dy F Y?— X 4 It v a i F �� i r I , l 1 ' THET°``y Barnstable Old Kings Highway Historic District Committee BARNS.AeLF- ? 200 Main Street, Hyannis, MA 02601, TEL: 508-862-4787 Fax 508-862-4784 y 7639. m "'A� APPLICATION, CERTIFICATE OF APPROPRIATENESS Application is hereby made, with four(4) complete sets, for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470,Acts and Resolves of Massachusetts, 1973, for proposed work as described below and on plans, drawings, or photographs accompanying this application for: Check all categories that apply; 1. Building construction: ❑ New ❑ Addition ❑ Alteration 0 2. Type of Building: ❑ House ❑ Garage/barn ❑ Shed 0 Commercial ❑ Otgeer =+03 CO D a 3. Exterior Painting, roof ❑ new roof Elcolor/material change, of trim, siding, window, dock 71 4. Si n : New Sign ❑ Existing Sign ❑ Repainting Existing Sign ul `7 y 5. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Retaining wall ❑ tennis court (5 Othe-ram' �rn 6. Pool ❑ swimming ❑ Other man-made pool Type or Print Legibly::: Date: Address of proposed work: House# /l'70 Street: �IwIrA S iel m Village A��f���ih►S��Assessors Map Lot# o Description of Proposed Work: Give particulars of work to be done:_C oUiF2 CX r'l r S re:f 0-17 rr,Li.fie 5 2 e ell Agent or Contractor(print): 10114-G�ev Telephone#: Address: 11A �� "�f(11 Contractor/Agent'signature: NOTE All applications must be signed by the current owner Owner(print): '3lfk. , o l Telephone#: Owners mailing address: ��jy✓! �}t .�-�U t/� Owner's signature: For committee use only. This Certificate is hereby APPROVED/DENIE12�7 Date 1/1> /6 Members si tures ECl Y E � JAN 14 2008 . t Any co ditto f appr TOWN OF S�0NSTA6 E i . 1 Q:1 CMD-OroupsiOld Kings Highw6ylOKH New AppIOKH Cert Appropriateness 07.doc Town of Barnstable Old King's Highway Regional Historic District Committee CERTIFICATE OF APPROPRIATENESS SPEC SHEET Please submit 4 copies Foundation Type: (Max. 18" exposed) (material -brick/cement, other) Siding Type material: Color: Chimney Material: Color: Roof Material: (make & style) Color: Trim material Color: Roof Pitch: (7/12 minimum) Window: (make/model) material color Size(s): Door style and-make: material Color: _ Garage Door, Style Size MaterialW `� v Shutter Type/Material: Color: EJ:AN .� 4 2008Gutter Type/Material: Color: F BARNSTABLE bEHVN Decks: material Size Color: Skylight, type/make/model/: material Color: Size: XY Sign size: -7 Type/Materials: kt1Y-7—, ' Color: 4 . Fence Type(max 6' ) Style material: Color: Retaining wall: Material: Lighting, freestanding on building illuminating sign Please provide samples of paint colors and manufacturers brochure of style,of windows, doors, garage door, r fences, lampposts etc ADDITIONAL INFORMATION: j Signed: (plan preparer) c� print name /� ,wL tel. no. Location pplication: • Street no. Street Village 2 Q:IGMD-GroupsiOld Kings HighwnyIOKH New AppIOKH Cert Appropriateness 07.doe 1 ' 4. SIGNS Diagram of sign, showing graphics, size, design and height of post, color and materials. Spec sheet. Site Plan on a GIS map or mortgage survey, OR photographs OR to-scale sketch of building elevation showing location of proposed sign; and any tree to be removed near a freestanding sign. Fee according to schedule. 5. FOR LIST OF ABUTTERS: PLEASE SEE OKH STAFF SIGNED (plan preparer) Print Date: � �`2j ��� Tel. Phone no's: NOTE ALL applications MUST BE ACCOMPANIED by the CERTIFICATE OF UNDERSTANDING The Old Kings Highway Historic District Committee MA Y DENY INCOMPLETE APPLICATIONS ATTENDANCE AT MEETINGS.• If the applicant or his/her representative is not present during the hearing is scheduled, the application may be either CONTINUED OR DENIED APPEAL PERIOD APPROVED PLANS PLAN PICK UP There is a fourteen(14) day appeal period for approved plans. This is necessary for each Certificate of Appropriateness and/or Certificate for Demolition issued by the Old King's Highway Committee. Plans approved by the Old King's Highway Regional Historic District Committee may be picked up at Growth Management,Regulatory Division, 200 Main Street,Hyannis, after expiration of the 14 day appeal period. If the 14"'day falls on a Saturday, your plans will be available the afternoon of the following business day. DENIALS Applications that are denied may be appealed to the Old Kings Highway Regional Historic District Commission within 10 days of the filing of the decision with the Town Clerk. For more information, see the Bulletin of the Old Kings Highway District Commission. BUILDING PERMITS, OTHER AGENCY CONTACTS •`: , dW, In most instances, before commencing work, a Building Permit is required. The Building Division will require a certified plot plan for new construction and/or demolition. Commercial work may require Site PAP approval. Demolitions: the applicant should check with the Building Division as to conformance with Zoning requirements. Other Regulatory Agencies at 200 Main St, Hyannis MA 02601: Building Division 508-.862-4038 Conservation Division 508-862-4093 Health Division 508-862-4644 g QUESTIONS ABOUT YOUR APPLICATION? 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G i'" ✓ i^ ,i q• q K. � ' 'e t�? - 0 y i°jri 4rA: �tf4?� -� c y�"' � �t F Je Aw.+t,� .� _ {,r[ • n..r - p ° ,G, .. �I .. -- r w�9'!Lt )!a[ - # �1} r wir�`i+. � -, a.n =� �•,.w 'c �° k.. 3 •� ,'v. * b. R �•t��.'.�iK gli`'?'r� FY�i ��j'4 �' '_ t f��.�� � • �.: �,��-v � t _ r � ,ts ,ji W.a• r a^":,•+c�i"�f�'�!}���� a. �1 f��� �r.' � �,? ••ja 4 .`�'� s �,� , 1 41 s '° n ? t t �: ,r � fia�r{ ` `� r e'.��r !d ' }_ R - at• 't. .r, .�3� 7- ,1r. .{t., ,= h c J � h... �tf'_ �� ' � "'J :a }t � t , t p' '64 FMk rt �h �W .t ii Y fa �v J f j l F1� Lt v y � �i� _AU. i�M�+Y++r,.!'� *'ti .,.! i ha�*$�iD tx "�,,� "'fifr{��.t!7'�ut �"1•r�.����a �� i d r:7 r yr t+� >A� 1 .�'�'. [(� jam.".S'M'i�• i YOU WISH TO OPEN A BUSINESS? For Your Information: Business Certificates cost $30.00 for 4 years. A Business Certificate ONLY REGISTERS YOUR NAME in town (which You must do by M.G.L. - it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, 1" FL.;367 Main Street, Hyannis, MA 02601 (Town Hall) and 200 Main Street Offices at the Licensing counter. DATE: / — -6 7 37 �.A_-4 '6-A Fill in please: �R ;� , APPLICANT'S YOUR NAME: A/'S�n ode BUSINESS YOUR HOME ADDRESS: ly TELEPHONE # Home Telephone Number: 7?y—Y36 3 NAME OF NEW BUSINESS A41 G 4eg /f% , LLe TYPE OF BUSINESS Camnr2r��'�( sPe�� 7�� IS THIS A HOME OCCUPATION? YES NOS Have you been given approval from the building division? YES NO .X ADDRESS OF BUSINESS 1170 S,-,/Kf- ) MAP/PARCEL NUMBER When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is _intended to assist you in obtaining the information you may need. . You MUST GO TO .200 Main St. — (corner of- Yarmouth'Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COqala IONER'S OFF' j This individ eeft42 ed y permit requirements that pertain to this type of business. utho iz d Si re* COMMENTS:. 2. BOARD OF HEALTH This individu I ha i ormed of the permit requirements that pertain to this type of business. Aut orize Signature** COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual een inf rmed of cet�n�g.ruirements that pertain to this type of business. Authorized Signature** COMMENTS: J �..� °•o TOWN OF BARNSTABLE BUILDING DEPARTMENT t INsaaar = TOWN OFFICE BUILDING o r�r I, �� HYANNIS, MASS. 02601 y MEMO TO: Town Clerk FROM: Building Department • ji DATE: //A �S An Occupancy Permit' has been issued for the building authorized by BuildingPermit $k.........»..�r-�. » .............................................. .........._...................... issued to � �9oK. ?, ,,—./ .._....... ..?���� � � .... � »�. � _ .»>.... fir. Please release the performance bond. �sessor's map and lot number ....... . /...��.. . . : a . ... SUBJECT TO APPri?3309.'11. DF' o*THE T Sewage Permit."number ......�-� ..�.�.CQ BARNSTABLEn'CINSEnVA ...... ........... �i�%�... F Z B>HB9TADLE, i House number �.. r.70 �� ............................ '0 "63 IL :.... O 9• - YPy a` A P P R 0-V "W N ' OF -B A R N S T T YSTEM MUST BE D IN COMPLIANCE i : � WITH TITLE 5r„ I H G I H P E C T ObVIRONMENTAL CODE AND Signed Da a �s M OWN REPUL.ATIONS 'APPLICATION FOR PERMIT TO .Ti4 A.....&I.�.....l...... RQST.% .....Co.. ............................... TYPE OF CONSTRUCTION ......W ......Flpum. .......................................... .................................. ......NZI...1.►. .......................19.. 's TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location �T a,. ... ? ... �...... k ��. a3c _. n.t �.S.,. ............................................................. ' ProposedUse .... .z?N.`�. 4Q1-� 1.(. ..� .l. 1. ,.,............................................................................................ Zoning District ....1► -. 5.�-.. .....................................Fire District ....... .,.! �4�15........................................ Name of Owner � QS.&.1.0... kq Address ZDY..ai.7.S... Name of Builder DAP% LADE l`�.......�t.DRQS:. C.p...Address cass-.. i.................. Name of Architect ..................................Address ... E �'�e...l 1M.k\.I .Z................. Number of Rooms ..................................................................Foundation ...riot 3..........=-.:�... QPr-........ Fl g .< L............................................... Exterior .. .... ................................Roofin ... ....`3pt� Floors (,l` Ca l��•L•�1 .1 ...Interior ........ ....F1.../ }L!................................................... Heating ... .�.......�V.!I`n. Plumbing ............ .. .........c6T .................... ...... Fireplace ..... ..1. .................................................... ®. Approximate. Cost �..... ..................... `� •zs' _ Definitive Plan Approved by Planning Board ___ __________________19 55. Area .........-...... Diagram of Lot and Building with Dimensions Fee .: SUBJECT TO APPROVAL OF BOARD OF HEALTH /0g'0 OCCUPANCY, PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all�the Rules and Regulations of the Town of Barnstable regarding the above construction. " coo,,— �- 'Name . ..... ........)se .. .. ...................... Construction Supervisor's Lice d32.1. ,........ ,-AYLOR, A'�110, I✓lAC 28885 " Permit for IWA...Stcm COI.....................................ER :.............. .......................... IEA ;3 Location .....1170 Rte. 6A,::.:.:..... .... V ..........West$arnsta �.�........................ Owner Tia ................... Type Hof Construction ....FKA ej............... a ...........................................A ............................ Plot° ............................ Lot J ......................... Permit Granted January„27...........19 86 Date of Inspection�'��-?� ....19 ,gyp Date Completed 71:1 f L i a I - - - - ,r J . l 7-20993 PCB of Cass iL at+�+�°` . DEPARTMENT OF PUBLIC WORKS pBRRRTT BARNSTABLE Subject to all of the terms, conditions and restrictions printed or written below, and on the reverse aide hereof, permission is hereby granted to ALLAN C.. TAYLOR AND WILLIAM D. MULLIN, JR. , Box 205, West Barnstable, MA 02668 , to enter upon State highway in the Town of Barnstable locally known as King's Highway, Route 6A for the purpose of constructing a drive to their property be- tween Stations 116+72 and 117+02 at the Westerly line of the State highway loca- tion, flaring to Stations 116+47 and 117+27 at the edge of the hardened surface, as shown on the attached sketch. Light grading may be done between Stations.- 116+47 and 117+27. .-Within State highway layout, the drive must have a six inch foundation of ' com- pacted gravel and be paved with. three. inches of bituminous concrete mix, 12 inches binder and 12 inches top to be laid in two courses. It must butt into and not overlap the edge of the highway surface. The Grantees must not apply the bituminous concrete mix to the proposed drive before the gravel base is inspected by the. Section Foreman. The Grantees must call Mr. Candido Pinto at 775-1015 to arrange for this inspection. All disturbed areas within the State highway layout must be loamed and seeded. 'The 'drive must be graded in -such a mariner 1that no p6nding of water occurs within this highway layout. If such ponding results, the Grantees shall be responsible for its correction. All present and future structures located on the property of the Grantees shall be at least twelve feet from the Westerly line of the State highway. That part of the drive located within the. State highway location shall be main- tained by the Grantees at their expense to the satisfaction of the Engineer. The drive must be constructed on a minus grade from the edge of the hardened surface of the State highway. The Grantees are responsible for the disposal of all--surface water- to enter the State highway layout. If the Grantees should paint any curbing or curb returns within the State highway layout, the paint must be white and must be applied at the time the drive is installed. The- Grantees shall •indemirify 'and save harmless the Commonwealth and its Department of Public Works against all suits, claims or liability of every name and nature arising at the time out of or in consequence of the acts of the Grantees in 'the performance of the work covered by this permit and/or failure to comply with the terms and conditions of this permit whether by themselves or their employees or subcontractors. (Continued) HMD-603 - 1 No. 7-20993 ALLAN C. TAYLOR AND WILLIAM D. MULLIN, JR. -2- BARNSTABLE Please contact George Michael, Maintenance Foreman at 775-1015 when the work required under this permit has been comVleted in order that an inspection may be made. A copy of this permit must be on the job site at all times for inspection. Failure to have this permit available at such site will result in suspension of the rights granted by the permit. All required signs and traffic warning devices shall be furbished by the appli- cant. All -signs and devices shall be in accordance with the Massachusetts Man - ual .on-Uniform Traffic Control Devices. The number and location of all signs and devices shall be as deemed necessary by the Engineer for. the safe and effi- cient performance of the work and the safety of the travelling public. II All warning devices shall be subject to removal, replacement and/or reposition- ing by the applicant -'as often- as deemed necessary by the Engineer. Cones or non-reflectorized warning devices shall not be left in operating posi- tion on the highway when the daytime. operations have ceased. If it becomes necessary for the department to remove any construction warning.devices or their appurtenances from the project due to negligence by the applicant, all costs for ttiiss =work will be charged to the applicant.. All vehicles, excepting passengers cars, -which are assigned to the permitted ! project and which operating on the site at -speeds of 25 MPH or less, shall have € -an official SLOW MOVING VEHICLE emblem displayed. -All pets'6niiel who are 'workEiig' oh the ttavelled way or breakdown .lanes .and who ' are not protected by traffic cones or similar protective devices shall .wear safety vests. (SEE OTHER SIDE FOR ADDITIONAL CONDITIONS) No work shall be done under this permit until the Grantee shall have commuri cated with and received-instructions from. the District Highway Engineer of the Depart. ment of Public Works, at Taunton, MA 02780 824-6633 This permit shall be void unless the work herein - contemplated 'shall have been completed before November 30, 1986 Dated at Taunton this 15th day of November 1985 RLG:rmj Department of Public Works - cc: J. McCarthy By �• R. A. Smith, P.E. HMD-604 District highway Engineer 7- .0 O . COMMONWEALTH OF MASSACHUSETTS DEPARTMENT OF PUBLIC WORKS TRAFFIC DIVISION PLAN COVERING PERMIT REQUESTED BY ALLAN C. TAYLOR/WILLTAM D. MULLIN, JR. FOR DRIVEWAY APPROACH IN BARNS TAB L E DATE I I I I 2rt�- `-' SCALE I� = 40� I I 0 -. i I �_' 17 072 ;02 S WA LY D'^t:`_ct - TRAFFIC ENGINEER t , r 91, \ t y r..»x.. tcY t !Ar•' R ., t'�'•� �i" }`9 't. c� ,T��. t.a PINK DtPT FILE COPY/,WHITE FIELO COPY/YELLOW .rAPPLIGANT f�OPY' BUILDING; Q a` is ` / [� VA, LID ATION.;. .. BARNSTABLE':MASS ACHUSETTS PERMIT TOWN.. A=17a=015 - . S• , PERMIT NO,. mr D'ATE ...,• ADDRESS lcoNTR s LICENSE) APPLICANT NUMBER OF ( ! ' DWELL ING UNITS STOR,X •. .p p SEd`USE) PERMIT TO;' NO • ZONING. ' Cd1T,) DISTRICT AT (LOCAT.IONI STREET NO ) AND 1CR055' STREET) 7 BETWEEN ICROss 'STREET)•.: I OT > ' BLOCKSIZE LOT ; SUBDIVISION I FT IN HEdGHT AND SHALL'CONFORM:.IN CONSTRUCTION ,.. •.FT- LONG BY •r FT W IOE BY�— BUILDING IS TO BE=___ . •BASEMENT WALLS OR FOUNDATION' _ --)TYPE) ' USE GROUP TO TYPE' REMARKS Sewa `e8511168 Bond 3. PERMIT `436.00 ESTINIAT.ED COST• 280 ��� 00 1 �t AREA OR 3/{rj6 S ! " VOLUME ' (CUBIC/SOUAREiFEET) _ i BUILDING DEPT OWNER c s � - BY ADDRESS, rWl'(C WORKS. THE ISSUANCE OFTHIS PERMIT DOES NOT RELEASETHE•APPLICANT FROM THE CONDITIONS RATE OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. PEHERE RMITS ARE REQUIRED FOR MINIMUM OF THREE CALL CARDAPPROVED PLANS MUST POSTED UNTIIL FIINAL INSPEBE RETAINED OCT ON HAS N JOB OBEEIN ELECTRICAL,C PLUMBIING ABLE A AND INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: a MADE. WHERE A CERTIFICATE OF.00CUPANCY IS RE- MECHANICAL INSTALLATIONS. 1. FOUNDATIONS OR FOOTINGS- 2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTI MEMBERS(READY TO LICTH.).. FINAL INSPECTION HAS BEEN MADE. �'REET 3. FINAL INSPECTION BEFORE OCCUPANCY. T u c ��,R� SO IT IS �VISIBLE FROM S . T• ■1� ELECTRICAL INSPECTION APPROVALS' — PLUMBING INSPECTION'APPROVALS B UILDING'INSPECTION APPROVALS 2 2 1 2 ♦ _ ♦ Iv �� ALS _o (' APPROVALS RE I I HEAT•NG ENS. ECTIN.i 3 1 �• IL�--- - Kc 2 '2 i. O'H E R —{ T — I Njcv ON L' NC INSPECTIONS INDICATED ON THIS CAN BE ARRANGED FOR BY T`L•` W i,RK crA �' '.00cED .UN?�L THE PERMIT WILL BECOME NULL AND VOID IF CONSTRUCT) NSPEc- ' !As rR'4 ti"-�' vE 'JAR CUS WORK 15 NOT STARTED WITH) DR WRITTEN NOTIFICATION. X MONTHS OF DATE THE a TRUC?��N• PERMIT IS ISSUED AS NOTED'ABOVE.. o txs�• TOWN OF BARNSTABLE Permit Nlo. ......?8885... BUILDING DEPARTMENT I TOWN OFFICE BUILDING Cash :......... �to'riv HYANNIS,MASS.02601 Bond ................ CERTIFICATE OF USE AND OCCUPANCY Issued to Taylor, Mullin, McElhiney Address Unit #1 1170 Route 6A, West Barnstable USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL 't SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. November 10 86 ,/��� Building Inspector ;S> -f. -.+-.. ,- -�-� %v.. . ,.-nN. �•.✓.,T. .' - .an, • ,F.i'++ _.a,.: .-» - A:r- 11.E':ta.�'�Tti.-� 4t. `Ki` .. ' 1 ..'7• •. :r,. .. ,-.,,w-, 4 1 TOWN OF BARNSTABLE 28885 Permit No. ................ m BUILDING DEPARTMENT W } TOWN OFFICE BUILDING Cash HYANNIS,MASS.02601 Bond CERTIFICATE OF USE AND OCCUPANCY Issued to Taylor, Mullin, McElhiney Address Unit #2 1170 Route 6A, West Barnstable USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. ' November 10 `86 , 19................. ....... ............ .................. Building Inspector t • � V r TOWN OF BARNSTABLE 88 Permit No. ....2. .85..... BUILDING DEPARTMENT D°H;a 1 TOWN OFFICE BUILDING Cash HYANNIS,MASS.02601 Bond CERTIFICATE OF USE AND OCCUPANCY Issued to Taylor, Mullin, McElhiney Address Unit #3 1170 Route 6A, West Barnstable USE GROUP FIRE GRADING OCCUPANCY LOAD 40 THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. November 10 86 .......................... 1 9................. ...... ....... Building Inspector f �• oa•Nr�` TOWN OF BARNSTABLE Permit No. .....RAK5.... BUILDING DEPARTMENT D°81� I TOWN OFFICE BUILDING Cash HYANNIS,MASS.02601 Bond CERTIFICATE OF USE AND OCCUPANCY . Issued to Taylor, Mullin, McElhiney Address Unit #4 1170 Route 6A, West Barnstable USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. November 10. 86 ........... ............. ............................ 19...... ...:........ Buildi g p ctor - n�Ins e , I +++•..-5., •`Y-.;-cn, r�-'- .'1' ^.. ,._ .-.. - �,,, ,z; � ,a.�, �Ah:c:r'v1�.�..n..�.; ,... �. - a .. •- =-7`..,..«- ,.a:..y: �s�_ ,r.t,.,.a. .-N!' �..i•. ."-.1"-.:, .5.. y -:ter �..1,; .`�... o`txe�♦ TOWN OF BARNSTABLE Permit No. .....28885.... BUILDING DEPARTMENT . TOWN OFFICE BUILDING Cash °dour HYANNIS,MASS.02601 Bond ................ CERTIFICATE OF USE AND OCCUPANCY Issued to Taylor, Mullin, McElhiney Address Unit #5 1170 Route 6A, West Barnstable USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL'NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE: November 10 86 .a.... 19................. ................... .................. Building Inspector ux b oaTME TOWN OF BARNSTABLE Permit No. ....`. 8-35..... BUILDING DEPARTMENT TOWN OFFICE BUILDING Cash ' nuv HYANNIS,MASS.02601 Bond CERTIFICATE OF USE AND OCCUPANCY Issued to Taylor, Mullin, McElhiney Address Unit #6 1170 Route 6A. West Barnstable USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NQT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY'THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. November 10 19 86 ' � .......................... :.. ......... ...... BuildingyInspector --........�:-. ,, .++yl,. ,...�y,x...�_ � .� �.,, .,�.-.ry wr.�r:..•.c.-..a*^t,}i.+;{1r,'",r' -�; ..:..n r: trrn.:r. „rf t.t', .. '] "y'.V. .. ,,. '"'• + ..}�..� ...� -...iv. Y...wf 44 " TMErO TOWN OF BARNSTABLE Permit No. .....28855.. . s BUILDING DEPARTMENT � TOWN OFFICE BUILDING Cash HYANNIS,MASS.02601 Bond CERTIFICATE OF USE AND OCCUPANCY Issued to Taylor, Mullin, McElhiney Address Unit 7/7A 1170 Route 6A, West Barnstable USE GROUP y FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT-BE VALID,AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY'THE BUILDING.INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. November 10 19 86 Building I Spector o � TOWN OF BARNSTABLE Permit No. .......? .l? .5.. BUILDING DEPARTMENT Cash TOWN OFFICE BUILDING HYANNIS,MASS.02601 Bond i CERTIFICATE OF USE AND OCCUPANCY Issued to Taylor, Mullin, McElhiney Address Unit R/SA 1170 Route 6A WPGt Barnstable ' USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT. BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. Nco / .�"- . ,,� e say a �'" .. - ...... Building Inspector `d'''• 'ti,l• .<_»+.:."G.r:�•;r - ti•n. �.0, TOWN OF BARNTABLE 28885 S o txe ` _ Permit No. ................ BUILDING DEPARTMENT TOWN OFFICE BUILDING Cash ................. HYANNIS,MASS.02601 Bond ................ CERTIFICATE-OF USE AND OCCUPANCY Issued to Taylor, Mullin, McElhiney Address Unit 9/9A 1170' Route 132, West Barnstable USE GROUP } FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY`COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. ; November 10 $6 f 19................. ........;......... Building Inspector . , .. Y�f h ���17� b_�� �`�. —_ �,�.= ,,� �fib• ���,� ��� <`�;�,--� . i Assessor's map and lot number :.� .. .f -j 1 1 ...0. 1i,'"�' *THET . o 0 Sewage Permit number ...... ::.-:.1.(,?A.. 3............. d 'I /�O / B6HOAS& LE, i House number ........................................ . ro rasa � pow 039 90 MPY a, TOWN OF BARNSTABLE tIL ING INSPECTOR vita AIG_ APPLICATION FOR PERMIT TO -T,H K......5 ... ' `�C�). ..... '.r.?..:................................ _TYPE OF-CONSTRUCTION ...... (,X ......�'�R�'11r................................................................................ �..�.... ........... ..19.. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ....I A.J41 ,.i. .............. ..................... Proposed Use .....�k-.or. .. fCJI�-1 f �_ �... �:...� i3t.t ............................................................................................ Zoning District ........... Lisa.--.. .....................................Fire District ....... .!.,Et�.. - ..................................... Name of Owner .... QQA.0...Nn.A..C.>......Address �d..w ...�� ....1.�.1.s. ,4. ..F............ Name of BuilderTO..:...Ut7. ,`.:. �r....;1_7_5 R _Z:...C.P...Address.,..... uc .. P ,.'o..t" �1.1?.►, -�`�.r. i Name of Architect ...................................Address ... .1:...i .l.�?.. �y....� '�.1�... 5................ ` Number of Rooms ..................................................................Foundation ... :�..........�C� -.�:. ............... ,................................. Exierior .o,! ...... .................................Roofing .. ��` .aQ.l.::1.................................................. Floors LOC.) 010a!.c,7.1..�. A.......4.�.J.1���1] :;.f1�1 �?,..lAw ...Interior .:....VIVAk4....................................._........... Heating ..0 + ..� ��.� .,rJ...............................Plumbing /. ........ r T" �..5'.......................... �.. �� v iFireplace ..... .... .1�................................................... Approximate Cost ..�-.��.... .................t............. Definitive Plan Approved by Planning Board __- ----________---19 Area .............. I Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS ^` I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. � s -.. Cr NameN ............ L Construction Supervisor's License ......... TAYLOR$ MOLLIN, MAC A=178-015 0 nn C,,�C,h 2888 v No ........... .... Permit for ... ............... COMMERCIAL ................................................................. ............. Location .....1.1.7.0.....Rt.e...6.A................................. . West Barnstable ............................................................................... Owner .........Tailor, Mollin, Mac ......................... Type of Construction ....F.r.ame........................... ................................................................................ Plot ............................ Lot ................................ Permit Granted .............................January 27.,...........19 86 Date of Inspection ....................................19 Date Completed .......................................19 TO ALL NEW BUSINESS OWNERS Fill in please: t ,'%_ :s.. { ..._.;,.�' ;{:; S ( ne- le.xo,nde� ..:� �:; <�,`.� ...� YOUR NAME: BUSINESS i' ,.� ' ': YOUR HOME ADD SS:�a7 8 TELEPHONE Tele hone Number (Home_ oB 99 b 9 9 " f NAME OF NEW BUSINESS :Soa'f'hir,a Tug-cL� i'Y��_SS `''yR- 'l i�e�^c�.,�'N TYPE.OF BUSINESS IS THIS'A HOME OCCUPATION?_ ADDRESS OF BUSINESS.-hA--K`"` � �+- �'n _MAP/PARCEL NUMBER �'l� O I S h When starting a new business there are-`several things you must do in order to be in compliance with the rules and regulations of the Town o information you may need. Once you have obtained the required signatures, Barnstable. This form is intended to assist you in obtaining the listed below, you may apply for a business certificate at the Town Clerk's Office (Ist floor- Town Hall). 1. GO TO BUILDING INSPECTOR'S OFFICE (4TH FLOOR TOWN HALL) ' This individu ha een-info d of any permit requirements that pertain to this type of business. uthorized_S gnature COMMENTS: 2. GO TO BOARD OF HEALTH (3RD FLOOR TOW,'I HALL) This individual has n informed of erm� r quirem�nthat pertain to this type of business. /i / uthorized Signature COMMENTS: 3. GO TO CONSUMER AFFAIRS (LICENSING AUTHORITY) - (3RD FLOOR SCHOOL ADMINISTRATION BUILDING) This individual has en i fo ed f the licensing requirements that pertain to this type of business. iol Authori ed ignature COMMENTS: After obtaining the required signatures you n;ust return to the Town Clerk's Office to obtain your business certificate (cost$20.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in the town (which you must do by M.G.L. - it does not give you permission to operate -you must get that through completion of the processes from the various departments involved. a TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel 1 Application Health Division - Date Issued ( F60t, Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address //70 g,41,v i4/gf-r Village G il`e"91'1105 7-4,5,L e- Owner 5n`Zie.erz4 en^do Aso e . Address //7 ✓✓1.�/n ��#$ W. ���'K-�' � Telephone -M. 3G 7-- 3 3z3 Permit Request a�o����rr n/� O�4 X IWe a a 6 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation G"75G• Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ ° Two Family b Multi-Family (# units) Age of Existing Structure / Historic House: ❑Yes ❑ No On Old Kir��'. Highw 2:11.0 No n Basement Type: ❑ Full Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) \< Basement Unfinished Area (sq ) n Number of Baths: Full: existing new Half: existing r JV r _ 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 wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size —Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization, ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) (Name= — =�— l Telephone}Number--•-`—S7(5_-=5 Address--�� �w / i�J� Eicense#"a�' --=-��(`'7l0 Home Irriprovemefft Contractor#~~-i�7d Vfe o � mail'. Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE - ---. - _DATE t. FOR OFFICIAL USE ONLY AP%ICATION# - DATE ISSUED MAP/PARCEL NO. I� P {' ADDRESS VILLAGE OWNER k j DATE OF INSPECTION: z . t)AFOUNDATI.ON!r AT-.xt}.;,pK3; FR'w-NQFHk- FRAME _ i INSULATION;'----', FIREPLACE f E - „ ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL S a GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. i the Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ir 600 Washington Street Boston,MA 02111 wnw.mas&go+1dia Workers' Compensation Insurance Affidavit: Builders/Contractms/Electricians/ umbers Applicant Information Please Print Legibly Name(Baseness/�tionlindiv dual): /ti �2 Address: �S� /7 Awo,1 City/State/Zip: h7 s A Phone# °SZG-GG ja Are as employer?Check the appropriate box: Type of project(regmred). 1.Erl am a employer with 7- 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-conhwtors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sob-contractors have g_ ❑Demolition working for me in any capacity. employees and have wodoers' 9. ❑Building addition [No workers'comp.insurance comp.insuranml require5. ❑ We are a corporation and its 10.❑Electrical repairs or additions d� officers have exercised their I L❑Plumbing 3.❑ I am a homeowner doing all work g repairs or additions myself.[No worlms'camp. right of exemption per MGL 12.❑Roof repairs insurance mod)j c.152, §1(4),and we have no ,�,� employees.[No Workers' 13.1N�Other comp-insurance required-) •Any appbcaa that checks box#1 must"fill out the section below showing their workers'competrsatian policy informatian. Homeowners who submit this affidavit indicating they are doing an moat and then line oatu&contractors mmst submit a new affidavit indicating each. TContmctors that check this boa mast attached an additional sheet showing the name of the sorb-cinstracmrs and state whether or not tbase entities have employees. If the sub-contactors have employees,they¢mist ptavide their workers'comp.policy mmiber. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site informallom c Tncuurance Company Name: -- Policy#or Self-ins.Lic.#: Gr/CC' �GG fed///�r7o2 G/3 Expiration Date: G/3a�iy Job Site Address: /,/7 17 4,7 V JI City/State/Zip: G✓• GZ GGf Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152.can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance a coverage verification. I do hereby certify under the pains an per s ofpedm y that the information provided above is true and correct Si tore: Date: t t t 3 Phone#: �/G —�G G •-GG�G Official ruse only. Do not write in this area,to be completed by city or town officiaL City or Town: PermitUcense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.CitylTown Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone 9: 6 ACORD. CERTIFICATE OF LIABILITY INSURANCE VA It: MMNU YYYY) 11/1512013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND.EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S).AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements). PKOIUCEK CONTACT NAME: Dowling&O'Neil PHONE 508 775-1620 FAX 5087781218 IAJC,No,Exu: WC,NO: Insurance Agency 1:-MAIL ADDRESS: 973 lyannough Rd., PO Box 1990 INSURERS)AFFORDING COVERAGE NAIC 0 Hyannis, MA 02601 INSURER A:Guard Insurance Group INSUKEU INSURERB:Associated Employers Insurance James Healy INSUHEK C 15 Annawon Road Mashpee, MA 02649 INSURER D INSUKEK E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INS" TYPE OF INSURANCE AUU UM POLICY EFF POLICY EXP LIMITS LI K INSK WVD POLICY NUMBER (MM/UU/YYYY) (MMIDDIYYYY) A GENERAL LIAMILI I Y JABP404697 1/24/2013 01/24/201 FAC:H017,17IIKKFNCF $1 000 000 X COMMERCIAL GENERAL LIABILITY PHFMMGE 7 FRErrmnrr. $50 000 CI AIM;;-MAI)F n OCCI IN MFI)FXP(Any mr.nrr:nn) $5,000 PFKSONAI RADVIN.nIKY $1 000000 GENERAL AGGREGATE $2,000,000 (it-M AGGRI-GA I I-I IMI I APPI IF i PFK: PKC)IJIIC:I;i-C:oMPmp A(ili $2,000,000 POLICY PKO LOC $ AU OMOHILE LIAHILIIY COM HINFII SINCil F I IMII (Ea ncudt+nl) $ ANY AUTO BODILY INJURY(r'm ye,wo $ ALL AIII();i AIII(1;i OWNED SCHEDULED HOW]Y IN.111HY(Prrarr.)rlrnl) $ NCJN1)WNFIJ PH(1PFK I Y IIAMA(it- HIRED AUTOS At l l p;; r n,nc�ideul $ $ UMHKELLA LIAR OCCUR EACH CJGC:IIKKFNC:F $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DIED RETENTION $ B AND E RS PLOYLK 'LIAHI II WCC50050111292013A 6/30/2013 06/30/201 X ;i)KY AM I; OH" ANU EMPLOYEKS'LIAtlILI I Y ANY PK()PKIF I(JKMAR INFKIFXF(:11 I IVF Y/N E.L.EACH ACCIDENT $500000 OFFICER/MEMBER EXCLUDED? N I A (Man Calory In NH) -I-.].Ur;FA;iF-FA FMPI OYFF $500 000 If VeS.d=ibt+undo, uFiCKIPI ION OF 11PF K41IC1N;i hnlnw E.L.DISEASE-POLICY LIMIT $50t1,000 UESCKIP I ION OF OPERA I IONS I LOCA I IONS I VEHICLES(Attach ACOKU 101,Additional Kamarks Schadula,If morn spaca Is raqulrad) James Healy is excluded on the workers compensation policy. (n v Z Insurance coverage is limited to the terms, conditions,exclusions,other limitations and endorsements. C) Nothing contained in the certificate of insurance shall be deemed to have altered, waived, or extended tho coverage provided by the policy provisions. Z CERTIFICATE HOLDER CANCELLATION t'- 1.17Its Town of Barnstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis, MA 02601 AU I HOKILEU KEPKESEN I A I IVE @ 1988.2010 ACORD CORPORATION,All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD OS 120833/M 120832 EAM i Massachusetts -Department of Public Safety ' .Board of Building Regulations and Standards Construction Supervisor 1 &2 Family License: CSFA-056765 .: HEALY JAMES P ` ;. AT 15 ANNAW9N RD � MASWEE MA 92649.> ffl" ,rw Expiration commissioner 04/24/2015 �°min'��1�fua�iness' oasamer HOME IMPROVEMENT CONTRACTOR Type :;F3egistration: .1 248. Expiration 7C)J2014 Individual EALY1 '�.. `ems'."ai -JAMES HEALY tti, •�5z.. 15?ANNAWON RD ;_ _ 02649 %� Undersecretary is MASH } 4 y n �: Bridge Creek Professional Center Condominium Trust 1170 Main St. W. Barnstable, MA 02668 November 18, 2013 Thomas Perry, Building Commissioner Town of Barnstable 200 Main St. Hyannis, MA 02601 Re: Bridge Creek Professional Building 1170 Main St. W. Barnstable, MA 02668 Dear Mr. Perry: Please be advised that I am a trustee of the Bridge Creek Professional Center Condominium Trust. James Healy came to your office to apply for a building permit. This letter will allow you to issue a building permit to Mr. Healey for work at the property. If you have any questions,please don't hesitate to contact me. Very truly yours, Gael B. G►il"more Trustee �IKE Town of Barnstable Regulatory Services MABS.IE Thomas F.Geiler,Director 16;A ��� Building Division Tom Perry,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 r as Owner of the subject property C d-0 i rIA hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit 1170 4.. 1V J-i �sT 6AMIJIY4 le (Address of Job) Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signature of Owner Xpat<e of Applicant -A17 C-CaYj-L ��e5 t1-2 ` y Print Name Pi�9 6v�-a-�i�-�/ Print Name Date Q:FORM&OWNERPERMISSIONPOOLS 62012 i Town of Barnstable Regulatory Strv><ces sJAarvsn+I= ' Thomas F.Geiler,Direetor .�� . Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 r' www.town.barnstable.ma.us r� t Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION.'" \ Please Print ✓ DATE: i JOB LOCATION: number street village "HOMEOWNER": name home phone# / work phone# 1 CURRENT MAILING ADDRESS: ' city/town \ state zip code The current exemption for"homeowners"was extended toinclude owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hue who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such,use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a ho�eowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall h responsible for all such work performed under the buildin ermit. (Section 109,1.1) The undersigned"homeowner"assumes responsj/ility for compliance with\the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that,he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and,requirements. a Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Coritrol. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. C:\Users\decollrk\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content0udook\QRE6ZUBN\EXPRESS.doc Revised 053012 TOWN OF BARNSTABLE.BUILDING PERMITAPPLICATION, /75 AT Map Parcel Application Health Division Date Issued oe) Conservation Division Application Fee l� Planning Dept. Permit Fee Date Definitive Plan,Approved by Planning Board ►�/AA' Historic - OKH Preservation/ Hyannis t �Iv Project Street Address -70 k 7 &. U` Village Owner W41K CWd Aea5 Q e,Address l 1 -7 O A- Telephone Permit Request ���L`W / 4 A,07, rJ S I /AD S ffs+ o ILA .7 0 11VA G� L�nJ lvb Square feet: 1st floor: existing proposednd floor: existing proposed�I new Zoning District ' Flood,,Plain Groundwater Overlay Project Valuation Construction Type l� . Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family (�❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure 1 �i Historic House: ❑Yes �#(No On Old King's Highway: 3r<es ❑ No Basement Type: ❑ Full Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft).. 3 d U® + Number of Baths: Full: existing new Half: existing n6\& Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count- N Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑Other a yl Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stoves ❑Y`;es ❑ No w Detached garage: ❑ existing ❑ new size—Pool: ❑existing ❑ new size _ Barn: ❑ ex sting �nevF size _ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Ap s Authorization ❑ Appeal # Recorded ❑ Commercial WYes ❑ No If yes, site plan review# Current Use �-, t- Proposed Use C� APPLICANT INFORMATION A),n A I Cf- ER OR HOMEOWNER) Name /"1i42 j,?, MLLMA Telephone Number Address ,2 bcr�[,�A) he 4") License # ( �AA Home Home Improvement Contracto, # /IAJ- J- ./Al6SV-dnj _ i I'� d 03 y of 6 Workers Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 0 ' C cl-M)Y�M __* 90 �_ SIGNATURE DATE FOR OFFICIAL USE ONLY a` ' PPLICATION# ' DATE ISSUED MAP/PARCEL NO. :ADDRESS VILLAGE }. OWNER i 1 DATE OF INSPECTION: _ FOUNDATION ` FRAME INSULATION - FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL A )[! GAS: ROUGH FINAL - FINAL BUILDING L � DATE CLOSED OUT ASSOCIATION.PLAN NO. r r The Comtllonwearth of Kassachusetts Department of Industrial Accidents " Office of Investigations . r 600 Washington Street Boston, AL4 02.111 www.mass.gov/dia Workers' Compensation Insarance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information 4 Please rint Le ibl Name (Business/Organization/Individual): J Address: Aj ' "\ b City/St e/Zip:LA , Phone � Are y u an employer? Checl the appropriate box: Type of project(required): 1. 1 am a employer with 4. I am a general contractor and I . employees(full and/or part-tim.e,),* have hired the sub-contractors 6. ❑New.construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet 7. ❑ Remodeling ship and have no employees I These sub-contractors have g. Demolition working :For me in any capacity. employees and have workers' 9 E] Building addition [No workers' comp.-insurance comp. insurance.$ required.] 5. We are a corporation and its 10.❑Electrical repairs or additions 3.0 I am a homeowner doing all work officers have exercised their I hEl 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.❑ OtherWmyl comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing thcii workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. rContractors that check this box must attached an additional sheet showing the name of the sub-contractors and staid whether or not those entities have employees. if the sub-contractors have employees,they must providt their workers'cornp.policy number. I am an employer that is providing workers' cornpensatiort.insurance for my employees. Below is the policy and job site information. n j / � �/� 1 ,�/ n nn Insurance Company Name: i� CC i fA �(' W A yUY *vim' LZ'"'' 4w 1� Policy it or Self:ins. Lic. #: LNG � l © I (�3L/ U Expiration Date: ( ( Job Site Address: g_f . State/Zip: w.4,L�'�'V Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date)VI+ Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine tip to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Jnvestigations of the DIA for insurance coverage yerifacation. I do hereby certify und the-nALtis,andpenalties of perjury that the information provided above is true and correct Si afore: Date: Phone#: — Official use only. Do not write in this area, to be completed by city or town offtciaL City or-Town: PermitfLicense# Issuing Authority (circle.one): 1.Board of Health 2.Building Department 3. City/Towu Clerk 4.Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: information ana inst ucuum Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees: F� , 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, coristruction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the 'insurance coverage required." Additionally,MGL chapter 152, §25C(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 N�dth the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation.and, necessary, supply sub-contractors)name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies'(LLC) or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are.not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required_ Be advised that this affidavit may be.submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to.obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permit/license number,which will be used as a reference number. In addition, an applicant that crust submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessarv) and under`Job Site Address" the applicant should write"all locations in (city or officially stamped or marked by the city or town may be provided to the town)."A copy of the affidavit that has been applicant as proof that a valid affidavit is on file for future perroits 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 vcnture (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 Department of Industrial Accidents Off-i.ce of Investigati.ans 600 Washington Street Boston, MA 02111 Tel. # 617-727-490.0. ext 406 or 1477--MASSAFB Fax# 617-727-7749 evised 11-22-06 www_mass..gov/dia . SHE T� "m Town of Barnstable I HARNSTABU, R '�^� Regulatory Services pTfD �A Thomas F, Geile'r,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 Proper ,, Owner Must Complet6.and Sign This Section If Using .A. Builder 1 I, 1k4WZ---- !� �� ( W" as 0 r of the subject property hereby authorize to act on xny behalf, n all znat-ters relative to work authorized by this building pernut application.,for: (Addt-ess of job) � ;igniature f Date 'nnt Name \WPFILES\FORMS\building permit forms EXPRLSS.doc evise020108 Town of Barnstable oOHE r Regulatory Services 1 Thomas F. Geiler,Director �1 BARNSTABLE, MAS& 9� 1639. Building Division Arab^tA�n Tom Perry,Building.Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 --__-- HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The cuirent exemption for"homeowners"was extended to include owner-occupied dwellings of six twits or less-.and to allow homeowners to engage an individual for hire who does not possess a license,Provided that the ounner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is untended to be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned "homeowner" asstunes responsibility for compliance with the State Building Code and other applicable codes,bylaws, rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department ' minimum inspection procedures and requirements and that he/she will comply with said procedures and. requirements. Signature of Homeowner 1 Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work-for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a persons)for hire to do such work,that such Homeowner shall act as supervisor." naware that they are assuming the responsibilities of asupervisor(see Appendix Q, Many homeowners who use this exemption are u Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification.for use in your community. I I Q:\WPFILES\FORMS\homeexempt.DOC j 7 Client#:12900 +=AQQRDTM C'EiRTI�F'�ICA E O'F ILIA�BIL`I Y 'INS'UR NCE 0 8°"Y"' [PRODUCER THIS CERTIFICATTE IS ISSUED AS A MATTER OF IN FORMATION Dowling 8r'O''!Neil Insurance ONLY ANDCONFERS NO RIGH TS[UPON THECERTIFICA IE Agency IHOLDER.THIS CERTIFICATE[DOES SNOT AMEND,IEX! ND OR �. ALTER THE COVERAGEAFFORDEDIBY THE,POLICIESlBELOW '973 ilyannough!Rd., !PO'Box'1990 Hyannis"MA 0:2601 IINS'URERSAFFOR'DINGCOVERAGE f,NAIC.# IINSURED IINSURERA: !National Grange Mutual!Insurance West;Bamstable[Builders,!Inc. nNSURERIB:-Associated E'mp'loyers Insu.rance'Compa I P:O.Box'516 IINSURER,C: I West Barnstable.,'MA 026684124 1 iINSURERID: iINSURERIE: COVERAGES THE iPOLIUS OF IINSURANCE(LISTED(BELOW(HAVE IBEEN!ISSUED TO THE(INSURED IMAM ED ABOVE FOR THE IPOL'ICY IPERIOD IINDICASED.!NOTWITHSTANDING ANYIREQUIREMENT,TERM'OR(CONDITION,OFANY�CONTRACTOROTHERiDOCUMENTWITH!RESPECT TOWHICHTHIS,CERTiIF.ICATEiMAY,BElISSUEDOR i M'AY:PERif,A'IN,THE IINSURANCEA'FFORDEDIBY THE IPOLICIES!DESCRIBED IHEREEIN II&SUBJECT TO:ALLTHE TERMS,IEXCLUSIONSAND CONDITIONSOF•SUCH POLICIES.AGGREGATEiLIMITS'SHOWN!MAYIHAVEIBEENIREDUCEDIBYlPAID(CLAIMS. INSR' 'DD+. ! ! :POLICY EFFECTIVE TPOL'ICY'EXPIRATION LTR INSRE TYP.E,OFIINSURANCE IPOL'ICY NUMBER (DATE MMIDD I .DATE.MM/DD..: ]LIMITS A GENERALILUiBILITY M.SO43965 01124108 101124109 IEACKOCCURRENCE :$�,�000'0OO .X I'COMMERCIALIGENERALILUYBILI77 IDAMAGE T' :RENTED { P.REMISEI ,occurrence I�$5O'000 ! 1 CLAIMSIMADE E Xll'OCCUR ! IMEDiEXP{(Any:one;person) '$5'000 X !BUIRD IDed:500 (PERSONAL:&ADV!INJURY 'M000000 I GENERAL.AGGREGATE ;S2'000.'000 ! GEN'LAGGREGAT!EILIMIT,A'PPLIES!P.ER:� IPRODUCTS-1COMP./OPAGG j's2000A00 j [POLICY 'JE QIF I;LOC j I j:AUTOMOBILEILIABILITY COMBINED'SINGLEILIMIT 'I.$ ANY AUTO t(Ealaccident) li I,ALLOWNEDAUTOS I I ! I , BODILYIINJURY $ I :SCHEDULEDAUTOS ! ' 1 ;(P.erlperson) HIRED.AUTOS ,BODILYIINJURY c Peraccident I [NON-OWNED.AUTOS i ( ) [ I IPROP.ERTY(DAMAGE j ((Per:accident) '$ GARAGE[LIABILITY � I,AUTO,ONCY-!EA,ACCIDENT �:$ .ANYAUTO IEA.ACC 'I �OTHER THAN I ,AUTOiONLY: :AGG f,$ I IEXCESSIUMBREL'LAILIABILITY t IEACH,OCCURRENGE '$ (OCCUR i CL'AIMS!MADE ;AGGREGATE '$ j I(DEDUCTIBLE $ I I � I [RETENTION '$ I $ IB `WORKERS�COMP.ENSATION AND WCC5002701012008 06111'108 �'06111�109 �( .'WC,STATrum U I OTH-I !EMPLOYERS'[LIABILITY ! ANY:P.ROP.RIEI'OR/PARTNER/EXECUTIVE iE L'EACH ACCIDENT S�OQ;000 n 'OFFICE R/MEMBERIEXCLUDED? IE:L.IDISEASE EAIEMPLOYEE:A00,000 ! ffyes,,describewnder �SPECIAL IP,ROVISIONSibelow ! E IE1L.:DISEASE !POLICY[L'IMIT I'$500,'000 OTHER l I i I I I !DESCRIPTIOMOFOP.ERATIONS PLOCATION&I VEHICLES4 EXCLUSIONS ADDED BY ENDORSEMENT4 SPECIAL!PROVISIONS j Insurance,coverage'is Ilimited ito the terms,conditions,exclusions,Other limitations-and endorsements. [Nothing contained'in the certificate Of insurance shall ibe deemed,to'have altereld,waived,or-extended.the coverage provided!by tie policy',provisions. � i(See.Attached'Descriptions) CERTIFICATE!HOLDER CANCELLATION SHOULD:ANY�OF THE.ABOVE IDESCRIBED IPOL'ICIES:BE CANCEI 11 ED!BEFORE THE IEXPIRATION 'B.nd a C'reek'CondoTrust '.DATETHEREOF,THEIISSUINGIINSURER'WILLIENDEAVOR'TOIMA'IL . 9 . In ',DAYS'WRRTEN I t IPOBOX516 NOTICE TO THE CERTIFICATE'HOLDERiNA'MEDTO THE ILEFT,;BUTIFAIGURETO Do'SO'SHA'LL I [ 'West Barnstable,IMA 102668 I�IMPOSEINO�OBLIGATION,ORiLIABILITY�OF:ANYXIND;UPONTHEiINSURER,IITSAGENTS,OR j � I REPRESENTATIVES. I AUTHORIZED;R EP.RESENTATNE ACORD.25(2001108)1 Of 3 #54216 JV 0 ACORD CORPORATION 1988 eJ)EP: Print Receipt Page 1 of 1 a , t Submittal Summary & Receipt Your submission is complete. Thank you for using DEP's online reporting system. You can select"My Homepage"to review your status. 'a DEP Transaction ID: 212321 Date and'Time+Submitted: 11/10/2008 1:51:40 PM User Email : wesibarnstablebuilders@verizon.net Other Email : Form Name: BWP-Demolition Form for AQ-06 Payment Information DEP code: 34992 Date: 11/10/2008 1:50:50 PM Amount($): 85 Payment Detail: Ann.Marie Kingston —Card—5784 Contractor Contractor Number Name Address, , Supervisor Project Monitor Lab https://edep.dep.mass.gov/Restricted/webpages/printreceipt.aspx 11/10/2008 r LlMassachusetts iDepartment Hof,Environmental Protection Bureau(of UVaste Prevention :Air Ouality 11,00081,062 IB i` � iP Q 101� Decal INum.'ber Notification Pfiar to Construction er ID:em,o'Jiti:on Important w,?�r�l;gout A. Applicability forms(on.the computer„fuse ,onlythetab!key A Construction or Demolition operation of an industrial, commercial, or institutional building, or ~ toimove you,r residential building with 20 or more units is regulated by the Department of Environmental Protection (cursor-ado mot wse the[return (DEP), Bureau of Waste Prevention -Air Quality Control Regulations 310 CMR 7.09. Notification of [key. Construction or Demolition operations is required under 310 CMR 7.09 (2)ten (10)days prior to any Vwork being performed. The following information is required pursuant to 310 CMR 7.09. �UPI B. General Project Description it. a.Its ithisfacility fee(exem;pt-(city;,town,,(district,[municipal Ihousin.g,authority,Towner-:occgpied Instructions [residence fof four iun'its(or Mess?❑'Yes COM 1../Allsections,of b. Provide blanket decal number if applicable: Blariket[DecaliNumber this[form[must Ibe Completed in Corder tocom,ply*ithithe 2. [Facility[Information: DePartment,of Bridge creek!Professional center [Environmental Protection a.IName notification 11, 70 Route 6A requirements(of lb./Address :31(0CMR TM 'West(Barnstable iMA ,02668 ic.O TFown (d.,State (e..Zi p Code f.Tele hone Number area code:and extension q.E-mail.Address i d tional 7,200 2 Ih.;Size(of[Facility, iin,Square FeO R.(Number cof(Floors j. Was the facility built prior to 1980? ❑ Yes ❑✓ No k. Describe the current or prior use of the facility: office condos I. Is the facility a residential facility? ❑ Yes ✓ No _o m. If yes, how many units? NumberofiUnits :3.. (Facility(Owner: a Bridge Creek Condo Trust �o ,a.iName �0 1170lRoute!6A,IRO I1BOX516 b..Address =T West IBarnstabie MA 02668 (c.(Ci. Rowe (d ,State (e.:Zi Code ;moo i(.'S08)362-7647 gle hone Number area code,and extensiori: .,E-mail,Address o tional O e'Kin.gston Q Ih,.(Onsite [Manager[Name ag06.doc•10/02 IMP AQ 06—(Page 1,of 3 Massachusetts'Department(of IEnviro.nmenta'I !Protection iBureau,of W aste Prevention Air Quality liwwitO62 B" ,,` P AQ 0 Decal(Number IN.otifcati�on (Prier-to Construction er ID.em:oliti:on General�Statement:llf B. General Project Description cont. asbestos its found (during ca Constructiomtor 4_ (General(Contractor: Demolition West!Barnstab'le!Builders,Ilnc pperation,,,all responsible,parties a.Name must wm.plyWith POIBOX:516 :3TOCMR7l00:, b.,Address ( 9,;,t ,and �Chapter2lE.of the [West IBanstab'le 02668 (General ILaws tof (c.Qt,gown (d.'State te.:Zip Code the Commonwealth. ((508)362-7647 westbarnstablebuilders@verizon.net butwo ld !include;, f +ele 'hone!Number((area(code and textension: mail Address(o tional !butwould.notlbe E_ Ilirnited ito;,filing an [Maek)(ingston asbestos removal ih.On-site Manager:Name !notification with the (Department andZer a!notice(of release/threat of release of.a C. General Construction or Demolition Description . hazardous :substance(to the 1. Construction or demolition contractor: !Department,fd applicable. West Barnstable!Builders, Inc. a.Name PO BOX 516 Ib./Address (west IBarnsta'b'Je IMA 102668 ,c.,Citvrrown d.State e.Zi Code (508)362-7647 westbarnstable'builders@verizon:net if.7e'le0home(Number((.area code and(extension)) g IIE-:mail/Address(gptiona'h) (Mark(Kingston In.Un=site!Manager iName 2. On-Site Supervisor: .Mark'Kingston (0m;Site.Su,penvisor I N a m e 3. Is the entire facility to be demolished? ❑l Yes [ill No _0 4. Describe the area(s)to be demolished: f9aDc-&('0T4q - 0'Ulrf' o gable,end!basement: water damageq:sill -etc. S'A e d. '`(y ��- jM d_t-erl dT N t✓1� Tr I'�vl U 1 ' �p 5. If this is a construction project, describe the building(s)or addition(s)to be constructed: �(D �o �a �Q I� ag06.doc•10/02 IBINP/AQ(06 IPage:2(of:3�� iMassaclhusetts'D,epartme,nt,of!Env ronmental '!Protection ;M IB.ureau of Waste Prevention.•Air Quality 11,00081062 (Decal!Number BWVP .AIQ 06 INotification Prior to(Co,nstruction(or Demolition C. General Construction or Demolition Description (cont.) 6. a. If this is a demolition project, were the structure(s)surveyed for the presence of asbestos containing material (ACM)? ❑ Yes ❑ No Ilf yes,,�who(co:md.ucted the!survey? lb.'Survevor!Name cc.(Division cof(Occupational;Safety(Cedification(Number 7. Construction or Demolition: 11/;,-Kf2008 12/31/2008 ,a.'Start(Date(mm/dd/yyyy) !b.End.Date(mm7dd/yyyy;) 8. a. For demolition and construction projects, indicate dust suppression techniques to be used: ❑ seeding ❑ paving b. If other, please specify: ❑ wetting ❑ shrouding ❑ covering ❑✓ other ,not applicable 9. For Emergency Demolition Operations, who is the DEP official who evaluated the emergency? .a.(Name(of!DEP Official lb.Title cc.IDate((mm1dd/,,,,')of/Authonzation id.IDEP 1Waiver!Number D. Certification aue ca Fed t Mare IKin.gstonII cettif that II Ih -o ,above,and that ito the(best,of,my ;a.lPnnt!Name o knowledge iJt is true;and corm,p'lete. The:signature!below subjects the Ib.,Authorized signature N signer to.the.genera'(statutes office manager =o �re,gardin,g.a�fa'Ise;amd imis'leadim.g cc. ,osi ion; to =o statemenY(s)).• West IBarnstabte Builders.,Jnc. d.Representing ce.(Date((mmlddlyyyy�) �d agWdoc•10/02 IBWP.AQi06•'Pa.ge.3,of3 11111 i i FIRE DEPARTMENTS OF THE TOWN OF BARNSTABLE Fire Prevention Office - Hinckley Building 200 Main Street, Hyannis, MA 02601 (508) 862-4097 BUILDING CODE COMPLIANCE FORM Plans dated Al '^'O4N for the property located at .�1 7o also known as 2Rju 2zak have been reviewed byA94,/,�,,.,�� of the ❑ Barnstable ❑ COMM ❑ Cotuit ❑ Hyannis AWest Barnstable Fire Department. THE CHART BELOW INDICATES THE STATUS OF THE REVIEW: TYPE OF CONSTRUCTION DOCUMENT N/A RECEIVED REVIEWED COMPLIES 1. Narrative Report 2. Firefighting & Rescue Access / 3. Hydrant Location &Water Supply 4. Sprinkler Systems 5. Sprinkler Control Equipment 6. Standpipe Systems 7. Standpipe Valve Locations 8. Fire Department Connection 9. Fire Protective Signaling System 10. F.P.S.S. &Annunciator Location V^ 11. Smoke Control/Exhaust 12. Smoke Control Equipment Location ✓ 13. Life Safety System Features 14. Fire Extinguishing Systems 15. F.E.S. Control Equipment Location ✓' 16. Fire Protection Rooms 4/ 17. Fire Protection Equipment Signage V, 18. Alarm Transmission Method I/ 19. Sequence of Operation Report 20. Acceptance Testing Criteria We believe this document to be complete and compliant for the issuance of a building permit. We have completed the acceptance testing for the occupancy permit and believe that within the scope of the building permit, the above issues are in compliance. Va r_ Bi8 olw m�iot an tan 's• Consfruction Supervisor License License: CS 22223 a Ex [0 15/2010 Tr*20081 ` f ; ' +� . .X ���Rest#Fct�on._00� l MARK T i<INGSTO - 23 DUBLIN RO.W ROCKLAND,MA 023�' Commissioner "! November 12, 2008 Building Department Town of Barnstable Re: Repairwork @ 1170 Rt. 6A, Bridge Creek Center, West Barnstable, MA To Whom It May Concern: This letter authorizes Mark T. Kingston, construction supervisor for West Barnstable Builders, to apply for a permit to do repairwork in the crawlspace area and right driveway side of the building. He has been hired by the Bridge Creek Condominium Trust to do so. Thank You, I/-/i v Mi I L. Kingston Trustee, Bridge Creek Condominium Trust c' � w CO a r N � TOWN OF BARNSTABLE Permit No. p BUILDING DEPARTMENT { D°81R I Cash TOWN OFFICE BUILDING °'tobui� HYANNIS,MASS.02601 Bond CERTIFICATE OF USE AND OCCUPANCY Issued to Taylor, Mullin, McElhiney Address Unit #5 1170 F�. West Barnstable USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. NOvember 10 86 =/ �"'" �'+—�► 19................. .....4...... .................... Building Inspector o niero• TOWN OF BARNSTABLE Permit No. ....2MM.... BUILDING DEPARTMENT 1 nenn I TOWN OFFICE BUILDING Cash AS � Ewa HYANNIS,MASS.02601 Bond CERTIFICATE OF USE AND OCCUPANCY Issued to Taylor, Mullin, McElhiney ' Address /11 AW Unit #4 1170 West Barnstable USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. November.10 86 L Building Inspector TOWN OF BARNSTABLE 85 � Permit No. ....2.88. ..... BUILDING DEPARTMENT { uua TOWN OFFICE BUILDING Cash HYANNIS,MASS.02601 Bond CERTIFICATE OF USE AND OCCUPANCY Issued to Taylor, Mullin, McElhiney Address Unit #3 1170 1����:�=�, West Barnstable , USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. November 10 86 �--�.� 19................. ...... ........................... Building Inspector r ,f � TOWN OF BARNSTABLE Permit No. ......28885... BUILDING DEPARTMENT '"80 } TOWN OFFICE BUILDING Cash ' ouv HYANNIS,MASS.02601 Bond CERTIFICATE OF USE AND OCCUPANCY Issued to Taylor, Mullin, McElh ney Address Unit #2 1170 R--� �, West Barnstable USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. November 10 19 86 � WL -. ....................... ................. Building Inspector r . TOWN OF BARNSTABLE Permit No. ......28885 .......... BUILDING DEPARTMENT TOWN OFFICE BUILDING Cash � rwa '�nuv HYANNIS,MASS.02601 Bond ................ CERTIFICATE OF USE AND OCCUPANCY Issued to Taylor, Mullin, McElhiney Address Unit #1 1170 P=- ,, West Barnstable USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. November 10 19...86.......... r Building Inspector.. TOWN OF BARNSTABLE Permit No 28885 . ................ BUILDING DEPARTMENT TOWN OFFICE BUILDING Cash ''�rcuV HYANNIS,MASS.02601 Bond CERTIFICATE OF USE AND OCCUPANCY Issued to Taylor, :Iullin, McElhiney Address Unit 7/7A 1170 A.—==—=, West Barnstable USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. November 10 86 , .......................... . 19................. ..................... .................... Building Inspector TOWN OF BARNSTABLE z8885 Permit No. ....... a BUILDING DEPARTMENT TOWN OFFICE BUILDING Cash ................ HYANNIS,MASS.02601 Bond CERTIFICATE OF USE AND OCCUPANCY Issued to Taylor, .Mullin, YlcElhiney F1 Address Unit 8/8A 1170 Went Barnstable USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. November 10 86 f/ f"llwt7l_. Building Inspector i oaTNr�,. TOWN OF BARNSTABLE Permit No 28885 . ................ BUILDING DEPARTMENT TOWN OFFICE BUILDING Cash IF ' �tnuv % HYANNIS,MASS.02601 Bond ................ CERTIFICATE OF USE AND OCCUPANCY Taylor, Mullin, McElhiney Issued to Address Unit 9/9A 1170 Rom, West Barnstable .I r USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. November 10 86 ........... ............... 19................. ....................�....................... Building Inspector o TOWN OF BARNSTABLE Permit No. ....28 5 BUILDING DEPARTMENT TOWN OFFICE BUILDING Cash HYANNIS,MASS.02601 Bond CERTIFICATE OF USE AND OCCUPANCY Issued to Taylor, Hullin, McElhiney �j "' ,� Address Unit #6 1170 West Barnstable USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. November 10 86 19................. Builds g Inspector............. n /� [ ' Joe //,Q A I 6 ,* West Barnstable Builders, Inc. SasEs- 0. rg) � S sr-a &-jE • - CALCULATED BY DATE 1 11 70 RT. 6A • West Barnstable, MA 02668-1124 . 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