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HomeMy WebLinkAbout0065 SHAWS LANE 1 't o 9 UPC 12543 'UPC '�► HASTINGS,UN P ° ''�S Gs �� l.n� �/, � oFVE Town of Barnstable Z ermit# r��l Expires 6 months from issue d Regulatory Services Fee •' BAIWSIASL.F rMASS. Thomas F. Geiler,Director �o i639 lED pAA'�A Building Division g'W Tom Perry, CBO, Building Commissioner lQ�l- 200 Main Street, Hyannis, MA 02601 _ www.town.barnstab 16.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number I / �-O 0:3 Property Address (� �/7'/� LL) ,L /�AU"L_Zk Residential Value of Work D o0 �—Minimum fee of$35.00 for work under S6000.00 Owner's Name &Address 7i3.10 Contractor's Name ;�u�. L U ,� Telephone Number S o Home Improvement Contractor License#(if applicable) 3 `7 oP Construction Supervisor's License#(if applicable) 7 ❑Workman's Compensation Insurance X-PRESS PERMIT Check one: ❑ I am a sole proprietor 10AR 10 2011 I am the Homeowner I have Worker's Compensation Insurance TOWN"OF BARNSTABLE Insurance Company Name Workman's Comp. Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) -c— �. Re-roof(stripping old shingles) All construction debris will be taken to ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side #of doors ❑ Replacement Windows/doors/sliders. U-Value (maximum .44)#of windows 'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Ownei must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License & Construction Supervisors License is requi SIGNATUR Q:\WPFILESTORMS\building permit formAEXPRESS.doc ' Revised 070110 I S4=�ZN W.B i •�,. .r. �� +►� ��. al 3-. .. . ,; :�4 � .. ": �;y` `� .. Y� �• � :'�1 ... .!� 1 ter. _ <` } _ + '��+ l_ v yM�Y+ t�� P.- �,;t �,1t�Ak� A 6 . �'��'��' ��� � f � . �.,, . .,� �• , i ., j^.. � _����. � ;t"�• -- ���'^�„� -. _. ` 4 � - The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ir li 600 Washington Street Boston, AM 02111 c- www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): C�ra V �'�1 y Address: City/State/Zip: 4>,(:;Dl t�, t_-: S Phone #: .-e 7 d y s 1 `t•6 Are you an employer?Check the appropriate box: Type of project(required): 1e?91 am a employer with 4. ❑ I am a general contractor and I 6. ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 2. ❑ 1 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. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself. [No workers' comp. c. 152, §](4), and we have no 12.[J Roof repairs . insurance required.] t employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic.#: ' Expiration Date: Job Site Address: t')Aw ch,�---k City/State/Zip:ec� Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify unde and penalises of perjury that the information provided aho a is tru and correct Si ature: Date: D J Phone b 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#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual, partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to 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 with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is-required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple,permit/license applications in any given year, need only submit one affidavit indicating current policy information(if necessary) and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations' 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax # 617-727-7749 www.mass.gov/dia I � Ro CERTIFICATE OF LIABILITY INSURANCE OP ID Ds DATE(MM/OD/YYYY) DADM-12 06/03/10 /PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Bryden & Sullivan Ins Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE bf Dennis Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 485 Route 134, PO Box 1497 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. So. Dennis MA 02660 Phone: 508-398-6060 Fax:508-394-2267 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Associated Xployers Insurance INSURER B: David Dadmun INSURERC: 43 Pond Street Unit 7 INSURERD: West Dennis MA 02670 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY EFFECTIVE POLICY EXPIRATION LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MM/DD/YYYY DATE MM/DD LIMITS GENERAL LIABILITY EACH OCCURRENCE . $ COMMERCIAL GENERAL LIABILITY PREMISES Fa occurence $ CLAIMS MADE OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PRO- JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO EA ACC $ OTHER THAN AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION WC STATU- _ AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER A ANY PROPRIETOR/PARTNER/EXECUTIVl[—] 110 0 8—119 0 7 0 5/17/10 0 5/17/11 E.L.EACH ACCIDENT $ 10 0 0 0 0 OFFICERIMEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 10 0 0 0 0 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 5 0 0 0 0 0 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION BARNS—1 DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Town Of Barnstable Building Dept. REPRESENTATIVES. 200 Main Street AUTHORIZED REPRESENTATIVE annis MA 02601 Dennis Office ACORD 25(2009/01) ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD �e i�am�rrxaouuea�! r�✓�aaaaclucaelta + . Board of Building Regulatiof(�is and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR i before the expiration date. If found return to: Registration:. 128718 Board of Building Regulations and Standards Ex(&-Otion:j 5_/9/2011 Tr# 283798 One Ashburton Place Rm 1301 3 Type DBA. Boston,Ma.02108 t. D.L. DADMUN CUSTOM BUILDERS F DAVID DADMUN?,,"' P�j 51 POND ST W. DENNIS,.MA 02670'' 11.1­ Administrator 4. Not valid without signature t i i j Massachusetts- Department of Public Safeth Bo;ud of Building Rc(,ulations and Standards I Construction Supervisor License i One-and Two-Family Dwellings License: CS 74205 DAVID L DADMUN 51 POND STREET WEST DENNIS, MA 02670 IL I ' ('unmiissioner Expiration: 12/31/2012 ` T. . n�•.. Town of Barnstable ` Regulatory Services AMiss.BLE$ Thomas F. Geiler,Director o;¢c►�� 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 Owrier Must Complete and Sign This Section If Using A Builder as Owner of the subject.property hereby authorize ,--fV112 0/�121V(/A to act on my behalf, in all matters relative to work authorized by this bw1diag permit application for. (Address of Job) 30 signature er Date Print Name If Property Owner is applying for permit please complete. the Homeowners License Exemption Form on .the reverse side. e , 0 Town of Barnstable ��THE Tpjfy . O Regulatory Services Thomas F. Geiler,Director �P 1619.1 },mob Building Division Tom Perry,Building Commissioner 200.Ma R.S_:reet, Hyannis,MA,02601 www.town_barnAable.ma.us Office: 508-862-403 8 Fax. 508-790-6230 HOMEOWNER LICF-NSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER", name home phone# work phone# CURy-ENT MAILING ADDRESS: eityhown state rip code Tic current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF BOMEOW"NER- a. Person(s)who owns a parcel of land on which he/she resides or intends to.reside,on which.thrre 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 constn}cts 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`horn6ownce'assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowners'ccrtifics that.he/she understands the Town of Barnstable Building Depa-Iment minimum inspection procedures and requirements and that he/she.will comply with said procedures and requirements. Signature of Homeowner Approval of Building.Oficial 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 bomeowncr performing work far which a building permit is required shall be exempt fiorrr the provisions of this section.(Scctian 109.1.1 -Licensing of construction Supervisors);provided that if the homoowncr engages a pmoin(s)for birt to do such work,that s-u`ch Homcawnor shall act as supervisor." Many homeowners wbo use this exarrption are unaware that they art assurrvng the responsibilities of a supervisor(see Appendix Q, Rules&Rzgblations for Licensing Construction Supervisors,Section 2.15) This lack of awumcss born results in serious problems,particularly when the homcownq hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with p licensed Supervisor. The homeowner acting as Supervisor is ultimatcly responsible. To ensure that the bomeowner is fully aware of his/her irsponsrbilitics,many communities require,as part of the permit application, that the homeowner certify that brJshe understands the responsibilities of a Supervisor. On the last page of this issue is a.form eurrcntly used by several towns. You may care t amend and adopt such a formcertification for use in your community. � Ro CERTIFICATE OF LIABILITY INSURANCE OP ID DADMD DATE(MM/DD/YYY`n I2 06/03/10 /PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION B. dem & Sullivan Ins Agency ONLY AND'CONFERS NO RIGHTS UPON THE CERTIFICATE Of Dennis Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 485 Route 134, PO Box 1497 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. So. Dennis MA 02660 Phone: 508-398-6060 Fax:508-394-2267 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Associated ffiaployera Znauraace INSURER B: David Dadmun INSURERC: 43 Pond Street Unit 7 INSURERD: West Dennis MA 02670 INSURER E COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY NUMBER PO C EFFECTIVE PO CY IRATIO LIMITS LTR NSR TYPE OF INSURANCE DATE MM/DD PATE NWD GENERAL UABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY PREMISES Ea occurence $ CLAIMS MADE OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS.-COMP/OP AGG $ POLICY PRO LOC JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ E DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER A ANY PROPRIETOR/PARTNER/EXECUTIVEr—] 110 0 8—119 0 7 0 5/17/10 0 5/17/11 E.L.EACH ACCIDENT $ 10 0 0 0 0 OFFICER/MEMBER EXCLUDED? (Mandatary In NH) E.L.DISEASE-EA EMPLOYE $ 10 0 0 0 0 tI yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 5 0 0 0 0 0 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION BARNS-I DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Town of Barnstable Building Dept. AUTHORIZED 200 Main Street AUTHORIZED REPRESENTATIVE Dennis Office annis MA 02601 ACORD 25(2009/01) ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts William Francis Galvin - Public Browse and Search Page 1 of 2 ,; The Commonwealth of Massachusetts i._ �% William Francis Galvin Secretary of the Commonwealth, Corporations Division x One Ashburton Place, 17th floor Boston, MA 02108-1512 Telephone: (617)727-9640 BARNSTABLE LAND TRUST, INC. Summary Screen U Help with this form Request a Certificate The exact name of the Nonprofit Corporation: BARNSTABLE LAND TRUST, INC. The name was changed from: BARNSTABLE CONSERVATION FOUNDA on 9/30/1992 Entity Type: Nonprofit Corporation Identification Number: 222483963 Old Federal Employer Identification Number(Old FEIN): 000109288 Date of Organization in Massachusetts: 09/08/1983 Current Fiscal Month/Day: / Previous Fiscal Month I Day: 12/31 The location of its principal office in Massachusetts: No. and Street: P. O. BOX 224 COTUIT, MA 02635 407 NORTH ST. City or Town: HYANNIS State: MA Zip: 02601 Country: USA If the business entity is organized wholly to do business outside Massachusetts,the location of that office: No. and Street: City or Town: State: Zip: Country: The name and address of the Resident Agent: Name: ALEX FRAZEE No. and Street: 380 WHEELER RD., MARSTONS City or Town: MILLS State: MA Zip: 02648 Country: USA The officers and all of the directors of the corporation: Title Individual Name Address(no PO Box) Expiration First,Middle,Last,Suffix Address,City or Town,State,Zip Code of Term PRESIDENT TOM MULLEN 38 COACH LANE upon election of BARNSTABLE,MA 02630 US successors TREASURER JOE HAWLEY 16 BEECHWOOD RD. upon election of CENTERVILLE,MA 02632 US successors CLERK KEVIN GALVIN P.O.BOX 700 upon election of MARSTONS MILLS,MA 02648 US successors VICE PRESIDENT ANNE GOULD 150 HUMMOCK LN upon election of COTUIT,MA 02635 USA successors http://corp.sec.state.ma.us/corp/corpsearch/CorpSearchSummary.asp?ReadFromDB=True... 3/30/2011 The Commonwealth of Massachusetts William Francis Galvin - Public Browse and Search Page 2 of 2 DIRECTOR HID WELCH 344 ANNABLE PT.RD upon election of CENTERVILLE,MA 02632 US successors DIRECTOR WILLARD MASON 71 MINTON LN upon election of W.BARNSTABLE,MA 02668 US successors DIRECTOR LYNN RICHARDS 84 MARSTONS LANE upon election of CUMMAOUID,MA 02637 US successors DIRECTOR MARK WIRTANEN 1894 MAIN ST upon election of W.BARNSTABLE,MA 02668 US successors DIRECTOR JIM INGRAM P.O.BOX 177 upon election of OSTERVILLE,MA 02655 US successors DIRECTOR CHRISTOPHER BABCOCK P.O.BOX 312 upon election of HYANNISPORT,MA 02642 US successors DIRECTOR DONNA LAWSON 46 WOODUCK RD upon election of MARSTONS MILLS,MA 02648 US successors DIRECTOR SAM KEAVY 140 PALOMINO DR upon election of BARNSTABLE,MA 02630 US successors Consent _ Manufacturer _ Confidential Data _ Does Not Require Annual Report Partnership _ Resident Agent _ For Profit _ Merger Allowed Select a type of filing from below to view this business entity filings: ALL FILINGS Annual Report Application For Revival Articles of Amendment Articles of Consolidation-Foreign and Domestic View Filings I New Search Comments O 2001-2011 Commonwealth of Massachusetts All Rights Reserved Help http://corp.sec.state.ma.us/corp/corpsearch/CorpSearchSummary.asp?ReadFromDB=True... 3/30/2011 Assessor's map and lot-numb 1 *THE Sewage Permit number ... �.. v Z BJBB9TOBLE, i House number '..................................... ............................ rasa TOWN - OF• .;_BARNSTABLE BUILDING INSPECTOR C0N 3TRt1CT l GARAGi, AARN APPLICATIONFOR PERMIT TO .:..................................................................................:......................................... PIRAME TYPE OF CONSTRUCTION �QaD . ..................................................................................................................................... .......... .......................19. . TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following informations, U13� \ ' Location ............S.h x?!a„' ?�?.;, u1 `: ;xlinta►XP.........QQMn�;r�f?,rd.... 4 ...�..��C1.....1,,.!n :.. 1, ... v�n� ;,. ProposedUse .....R SAXa.�re.............................................. ...................................................................................................... Zoning District .....�. ............................................................Fire District ....t c.at�;,,R,arnaa a la,+'........................................ Name of Owner ....arytt ,r.;,il?��p..t`s ?a*A..............................Address ........ptna..e¢ G�e�R11 -! arma :tab I a C . �. North Point Constr. , Name of Builder. ..... .......................... Address.....tu, r,o.;,, ..?,thlc? Li.c. # 015827 ................. Name of Architect .....r]. ...a'n,:?�r.�s� d..A�,.. �a!+.....................Address .. s 1Rorta...Corms............................................... Number of Rooms ............................Foundation ••.i?ourcd concrete .......................... o ........................ ............... Exterior .....crhite cedar hin(9�f....................................Roofing asphalt shingles ................................. Floors cement unfinished ............................................................................Interior ................!................................................................... T�7T13. None Heating .............................................................:....:......:S.:.Plumbing ..::;:................................................ ........................ Fireplace No*1� .......Approximate Cost S�lb„OOOpO®'...........:..:............................................................ ............... .......................................... Definitive Plan Approved by Planning Board ______3__ n�_2d------------19___ Z. Area ...50d..$q�ft!.................. Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH ' I - r% e q s� Q,,aa OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS , I hereby agree to conform to all the Rules and Regul4o, s of the Town of Barnstable regarding the above, construction: ', Name . ,.. �'............. 0 J `l`' UNGERMANN, WALTER A=176-1-3 No 2 7.2A,,, Permit for ...Garage/ er s ......Acgessory... 4...AW.elliag................. Location ..;7b r�,.S...J.�de...&...Pr1.e...Street w r West Barnstable Owner ....wa It—.Q :...Uxl.CjeTmaX1a................... , Type of Construction Frame.................... Plot ...........:................ Lot ................................ Permit Granted ....,,November 1.8_c...19 83 Date of Inspection ....................................19 Date Completed ...............19 �— . r . Assessor's map and lot num 7 :..... . ... ."....... . j yof THE ro` d' Sewage Permit number .M Basa 39 is House number .............. ....o S. �o S TOWN : OF BARNSTABLE BUILDING . -INSPECTOR t CONSTRUCT A GARAGE/BARN t APPLICATION FOR PERMIT TO TYPE OF CONSTRUCTION WOOD FRAM .... ... .... ..... ..........(U?u:.A.Z......................I U_ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information- U.0 Lz ' ran,S�. .Location ............$?.akl�S...IrcZltt~.�...WAS ..�s�xxl9c�b�......... i!a1�,de... ....'�, ...C�.�1..... ..�................. ................ ProposedUse ....S.tarage......................................................................................................................................................... Zoning District .....ftF......................................:.....................Fire District ....Uest..Barnatable........................................ Name of Owner .....Walter..BngermanTL.............................Address ........Pine..St...Dlest..Barnstable....................... North Point Constr. Name of Builder. .....Charles.. ey..............................Address ....Meadow...Lane.,•.:Test•••Baraztable.................. Lic. # 0 Name of Architect .....Sli.2awnsen,d..&-Son.....................Address .hest ,port, Conn. ............................................... Number of Rooms oe....................................................Foundation oncrete .......................................................... Exterior .....white..cedar shingle....................................Roofing asphalt shingles .................. .................................................................................... Floors cement .Interior .......,unfinished .:..................................................................................... .................................................................. Heating None .'..............................Plumbing None Fireplace ......J199?1%...................................................................Approximate Cost ...... •.000.•00......................... Definitive Plan Approved by Planning Board -----J,&La_2�___-_______19 82. Area 600 sq.ft. _ Q O Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH r f t • . f e` 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. Name . ... ....... . .............. UNGERMANN, WALTER 25790 GARAGE /BARN No ................. Permit for .................................... Accessorto DwellinJ........................................... ................................ Location ................. ...................... Owner WA1.f;QV..UT}.9 ]:J@dilXl.................... Type of Construction .kXAMe............................ Plot ............................ Lot ................................ Permit Granted ...,,November 18, , ,9 83 Date of Inspection ....................................19 Date Completed ................. ............19 I�I �1T n a i � RESIDENTIAL P ERTY MAP N(?. LOT NO. 53 FIRE DISTRICT SUMMARY STREET Parker St. & hurch ',-Test Barnstable � BLDGS. OWNER /e r! zC A � ' `(�'�"�" TOTAL �. 5O • LAND ^� RECORD OF TRANSFER DATE EIK PG I.R.S. REMARKS: 74 BLDGS. 4: Ol •apt 12,-21 -861 458 TOTAL .�� .5-'7 r;!:A!�±T^:+us0.1XAi-"'h•MI,M Ro'^••�:mr,.:•,•,eft... ,- LAND H i-3-1=7 .282-- •210- t ' V BLDGS. o TOTAL efl..­n5, RowenaB. , - LAND 1 )�• BLDGS. :2,, 01 Jenkins Rowena B. 1-6-77 roba a #54 08 (c rr mon, r -r� _ TOTAL ,a r•� 8/ ° 13. ��" i' L�✓...'.r: ,r 1 P,(r J Q o( 7 BLDGS. t7 D o� LAND BLDGS. 1 �) TOTAL JAND BGS. TOTAL LAND INTERIOR INSPECTED: '-'), BLDGS.� > �!y) � /) TOTAL DATE: r! c9 Gt......'_, r s! Y•... ! 7'-r ✓r'. . , LAND , ACREAGE COMPUTATIONS BLDGS. LAND TYPE # OF ACRES PRICE TOTAL DEPR. VALUE TOTAL OUSE LOT . Q_ ZQQ onn - 12 no 0 _ l' ? LAND I,• u L _.! 7`' BLDGS. LEARED FRONT ^ ----- 0) REAR TOTAL GODS&SPROUT FRONT LAND REAR , . ' Q�Qp 0 _ BLDGS. ASTE FRONT - .- TOTAL REAR LAND � BLDGS. TOTAL LAND -- =� 7S BLDGS. LOT COMPUTATIONS LAND FACTORS TOTAL FRONT DEPTH STREET PRICE DEPTH% FRONT FT.PRICE TOTAL DEPR. COR. INF. VALUE HILLY TOWN SEWER LAND V o - l: ROUGH TOWN WATER BLDGS. Ko0 HIGH GRAVEL RD. TOTAL G*p s rJv LOW DIRT RD. LAND SWAMPY NO RD. O BLDGS. FOUNDATION BSMT. & ATTIC PLUMBING PRICING . LAND COST c.Walls Fin. Bsmt.Area Bath Room / L� Base BLDG. COST c. Blk.Walls Bsmt.Rec. Room St. Shower Bath Bsmt. PURCH. DATE 5Walls aF Bsmt.Garage St. Shower Eat. Wells Ottic FI. &Stelrs Toilet Room PORCH. PRICE. Roof RENT Fin.Attic Two Fixt. Bathoors INTERIOR FINISH lavatory Extra f 2 3 Sink rh 'A Plaster Water Clo. Extra / Attie dt7 S.fed OP KTERIOR WALLS Knotty Pine Water Only ile Siding Plywood No Plumbing Bsmt. Fin. ' I� / 3 to Siding Plasterboard Int. Fin. a2/ 'y1 8 Shingles TILING S 7 elk. G F P Beth Fl. Heat J8 Brk.On Int.Layout Bath Fl.&Wains. f. Auto Ht.Unit N Is Veneer Int.Cond. Bath Fl. &Walls Fireplace �� Brk.On HEATING Toilet Rm.Fl. Plumbing O . Cam. Brk. Hot Air Toilet Rm.Fl. &Wains. f s Tiling Steam Toilet Rm.Fl.&Walls ket Ins. Al Hot Water St. Shower 7 Ins. Air Cond. Tub Area Floor Furn. Total a3 IFIX to ROOFING COMPUTATIONS •8 Shingle ✓ Pipeless Furn. —S.F. I Shingle No Heat 5 S.F. 0 O Shingle Oil Burner 11t1l S.F. 2. ' Coal Stoker . ...3.3 S.F. tj Gas S F 7 OUTBUILDINGS ROOF TYPE Electric a Flat S.F. 3 7� 1 2 3 4 5 6 7 8 91101 1 2 3 4 5 617 8 9 10 MEASURED Mansard FIREPLACES S.F. /(y• /o ff Pier Found. Floor brel Fireplace Stack ✓ Well Found. ✓ 0.H.Door LI FLOORS Fireplace Sgle.Sdg. Roll Roofing ^p� LIGHTING Dble.Sdg. Shingle Roof ✓ No Elect. DATE Shingle Walls t/ Plumbing � � �. • wood ROOMS Cement Blk. Electric r .Tile Bsmt. 1st L..1 G TOTAL �3 �Q Brick Int.Finish PRICED le 2ncLS 6 3rd FACTOR c 9 (� REPLACEMENT --`t./,�/�� •� OCCUPANCY CONSTRUCTION SIZE AREA CLASS AGE REMOD. COND. REPL. VAL. Phy.Dep. PHYS. VALUE Funct.Dep• ACTUAL VAL. LG. '.rr�:q/. 9s/C;' �ie S/f• G2 'TT O -Ala • y. - OTAL Property Location: 65 SHAWS LANE W BARN MAP ID: 176/ 001/ 003// Other ID: Bldg#: 1 Card 1 of 1 Print Date:12/18/1998 ,, �. ", },r vac�? y��p< F'.vi o- a a w - �- s ss ����pp�,�dd ar<..r . ,as a�.:,;xxs �axsstilw.'+.ksr+rn< a `2C +ia Description Code Appraised Value Assessed value 1 OLD COUNTRY WAY RESEDNTL 1010 10,30C 10930 801 BARNSTABLE,MA 02668 BARNSTABLE,MA Account# 104238 Plan Ref. Tax Dist. 500 Land Ct# er.Prop. #SR ♦ I S I O N Life Estate ,•. DL I LOT 4 Notes: v DL 2 ota IL,IU , �-a:: ' � - �. <;., _. , "� �.r;s �;d' �9 u�V t l r �. .4 f; " �a,• � m 8 d .aa:'{',F�. .a�y�'° ��, a,� �'v�..�� � ,.. -�.•�. F :a... -.._� :. .. mow' .. -a.��s:-�. �. s r. Gode Assessed Value Yr. Code" Assessed Value Yr. Code Assessed Value GERMANN,WALTER W 3452/20 3/15/82 U I 27,50 . G ota. ota. , ota. , a Data o ector or ssessor Year I)vpODescription Amount Code Descnption Number mount Gomm. nt. • _ _ - - fib"&. ..., r ,� ,X., �.:� Appraised Bldg.Value(Card) 0 Appraised XF(B)Value(Bldg) 0 Appraised OB(L)Value(Bldg) 10,300 ora Appraised a g s " � .. Special Land Value�u p e(Bldg) 61 800 Total Appraised Card Value Total Appraised Parcel,Value 72,100 Valuation Method: . Cost/Market Valuation INCt'I'Otal AppraisedFarce a ue ..._; .r.:.y ,C^ ;j �Y '. �.::< ., �'.=. '...,. <....N„<. 4. .. •.... .., 5-?"5th .x.<. ,:.,�la�,:.rl. �""Fr a.t4�'_:. � .<{ '. .:�•: .:.4�wM<.Yii..�..,xaR,Yx�s`iw°Q`o%::.+, i:'.'YN�t: h.3.-. .YYVa ermit ID Issue Date Jype Description Amount Insp.Date o comp. ate Comp. Commen.ts. Date urpos esu t k. •�7 a, ,� L >a,--• � :-•,>r,..spa. :,.7:.,r ...<:.^• .�.r_, -tr ....w,'., a_ .',.. „ >:.':4n�„a•4= s..aa.,.�..«.. �„rzkma>:Y�.:, --sr mw .e�` ti Use Code Description Zone D Prontage . ept Units nit rice actor otes peciaPricing- I di. unit Price Land Value 1 1010 Ingle Fam 5 -3 3.19 AC 16,500.00 1.00 5 0.7 80AC 0.4514 IACREAGE 5,280.0 16,80 15tal i.ndnit4.0Aq Property Location: 65 SHAWS LANE W BARN ' .MAP ID: 176/ 001/ 003// Other ID: Bldg#: 1 Card 1 of 1 Print Date:12/18/1998 .... .. •.x..Cm ..Y,�� .r..Y ,. ..,w -, ,. ..<. v...,.s '....b .. 6.... . . :+.'4, <c.., ., *r. .?'.. l"" �: -iu ement Cd. Ch. Description Commercial DataElements Style/ ype 94 Uutbuildings Element Ca. escription ode] 00 Vacant Heat rade Frame Type Baths/Plumbing tones _ ccupancy CeilingfWall ooms/Prhis Exterior Wall 1 %Common Wall 2 all Height oof Structure Roof Cover Interior Wall l UFF RIF, 2Element o e Description F actor nterior Floor 1 Complex 2 Floor Adj Unit Location eating Fuel Heating Type Number of Units C Type Number of Levels /o Ownership. . - Bedrooms Bathrooms aV . Total Rooms na j.Base Rate ize Adj:Factor BathKitchen Type Grade(Q)Index dj:,Base Rate tchen StyleBldg.Value New Year Built ff.Year Built rml Physcl Dep uncnl Obslnc con Obslnc ,.< x. e Spec].Cond.Code peel Cond Go de Description Percentage—Mu S Overall%Cond. urge am eprec.Bldg Value Go de Description nits Unit Price Yr. Dp Rt %Cnd Apr. Value arageAvg a h Uff= T a s .....eat-.v.<c.Code Description Living Area Ciross Area Eff.Area Unit Gost Undeprec. Value T Uross Liyli ease Area Bldg Val: I 0000 SHAWS LANE 05 500 05we 07/09/9 QA 7 zR LAND/OTHER FEATURES DESCRIPTION ADJUSTMENT FACTORS TY UNIT ADJ'D. UNIT {- R M A N N. A L T E R Sd MAP — y ACRES/UNITS VALUE Description U N a£Land 8 /Oate Sae Dimension LOC./YR.SPEC.CLASS ADJ. COND. P PRICE PRICE CD. FF-De th/Acres E ' 4 L A ND 1 6 4.8 0 0 CARDS IN ACCOUNT — L 10 18LDG.SIT 1 X 1 =10 100 34999.9 34999. 99 1 .00 350001 40THER FEATURE 1 8.900 01 OF 01 A 14 1ACREAGE 1 X 3.19 =100 a= 70 89 15000.00 9345.00 3.19 21)300i :4PL 55 SHAWS LANE a BARN COST 7370C N ' #0L LOT 4 MARKET 6190C D RG1 DETGAR S 24 X 25 1983 C= 90 16.55 14. 89 600 8900 F #RR 1475 U493 INCOME A JSE PPRAISED VALUE D D i 73.700 A ARCEL SUMMARY T S AND 6480C A T J L►DGS i -`I MPS 8900 M TOTAL 7370C F EN CNST E N DEED REFERENC Type DATE Recorded R I 0 R YEAR VALUE A T t Book Page Inst. MO- Yr.p Sales Price A IN 64 8 0 C. T S I ' 3452/20 I03/32 G 27500 LDGS 890C U I OTAL 7370C R - I I E BUILDING PERMIT S Number Date Type Amount LAND LAND-ADJ INCOME SE SP-BLDS FEATURES OLD-ADJS UNITS 64300 1 8900 Const. Total Year Built Norm. Obsv. Class Units Units Base Rate Adj.Rate Actual Ell. Age Depr. Cond. CND Loc %R G Repl Cost New Adl Repo value Stones Height Rooms Rms Bathe M Fix. Partywall Fac. 0 Description Rate Square Feet Repl.Cost MKT. INDEX: IMP. BY/DATE. LE: ! ELEMENTS CODE CONSTRUCTION DETAIL S T /1 ------------ --- ---------------------- R 116 r - - --- --------- --- ---------------------- A , - - - --- - - ---=--- --- ---------------------- ------ --- ---------------------- TY; - - - - - - - -------- --- ---------------------- GU�o R ----------------- --- ------------------------ A - - ------ --- - L D --------------- --- ------------------------ ETotal Areas Aux Base = ---------------- BUILDING DIMENSIONS A -------------- ----4 EIGyl0R�i L -3ZTAC-W5'9T-8A9N3Tk LE L LAND TOTAL MARKET PARCEL 64300 73700 AREA 16533 V-ARIANCE +0 +0 STANDARD 25 r < > ICU :. .. :.. R. ' r <`} ><:: T TIT DING Ky 3y: ••• : ;?1l'•,:)Y�}''. ? .':`:�,`�.�.}};;? ti:':`%2yjt%"'4` •,`:52?%<i«?'y;:: S:?," `: •,`: ;`: ti; ': •,`: {`ti: # 2 ~: '�:�+�##? :: `��:��"'4 : ... �s NGERM 2 A S LANE 4M14 ... < € ;}4 .... i..•. ,••• '•�•�'.:'.~:: :.: :'��"�'?`..:1,'`.. ;i.f3:..:::,``.;``.' ``` S'.•':.%•}:` M1'`:::?: y`: ``.:::,` i::: .'•:`•: tZ�':. ES S-D NOT GIVE OUT /.� 3 9 7 � y H ED.:; O N PROPERTY RTY BEING USED ED FOR }:i};: SI BUSINESS PURPOSE-THIS IS>� I N RES DE TIAL PRO PERTY.PERTY. ME ..::::........:....:.::: : ....:::::.... ........::... ..... »>� "•'�<�:EMMETT GLYNN CALLED T .:,�: �`:•.:`•,.:.`.:•`�......�'"•�� O ASK RE:HARRY H LLAW O AY O T RIN S G N THIS -IT OLD,LD EQ UIPEMENT O S O E.G. :.THAT T KN TH IDID O OW H.H.-BUT TH IS HI S <~WAS LED A INVOLVED V WI TH ITH A M P C LAINT x...,, O AND W W E LD OU CHECK. C E.G. 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