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0031 ATLANTIC AVENUE
/ �� %r' r �. �. �. `� :, , First-Class Mail UNITED STATES POSTAL SERVICE Postage&Fees Paid USPS Permit No.G-10 • Print your name, address, and ZIP Code in this box• T-OWN OF BAR VSTABLE I BU ILD ING 01 NIS ION 367 MAIN ST HYANNI S Mk,- 0 26 0 1 i I I d SENDER: v •Complete items 1 and/or 2 for additional services. I also wish to receive the rn ■Complete items 3,4a,and 4b. following services(for an 0 ■Print your name and address on the reverse of this form so that we can return this extra fee): card to you. ai j ■Attach this form to the front of the mailpiece,or on the back if space does not 1. ❑ Addressee's Address ° permit. d ■Write'Return Receipt Requested'on the mailpiece below the article number. 2. ❑ Restricted Delivery W .L. ■The Return Receipt will show to whom the article was delivered and the date ,. delivered. Consult postmaster for fee. ° o v 3.Article Addressed to: 4a.Article Number d c QLr✓�S Z Z�j E 4b.Service Type ° �— ❑ Registeredertified W ° aj ❑ Express Mail ❑ Insured c all N c t Wetum Receipt for Merchandise ❑ COD Yat f eiv w 5.Receiv y: (Print Na e) K ��%�� Addressee's Address(Only if requested and fee is paid) t g 6.Sign : ( dressee o ge t) ~9 X 'A PS Form 3811, December 1994 Domestic Return Receipt TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION M Parcel Application d 37, Health Division Date Issued ! P, Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board _ Historic - OKH _Preservation/ Hyannis Project Street Address 3/ Village n x A h n 1i J70 It-/- Owner 3/✓/4-/-44-4m A-e LG-G Address Telephone SO`•77,.�'- 7/77 Permit Re uest TZ7 RPc� y0 X�o �C^Od,7a�y /� rn eves w�fG� ZGL0�e i r RI✓� C P � ��- ec�'u - - � a RUc��es Q P Square feet: 1 st floor: existing proposed 2nd floor: existing - proposed Total new F Zoning District Flood Plain Groundwater Overlay Project ValuationolO, Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family. ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's way: ❑Yes &No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other V n Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) C 1t r ` Number of Baths: Full: existing new Half: existing new :`' Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Cou t 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 Ll Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use?QWc, tPa4+,4 9,t 6-esq gut(G�'1P� APPLICANT INFORMATION (BUILDER OR HOMEOWNER) f KS PLI of C rt 78A 7 - o a 0Name C P UYlQ Telephone Number a9 y Ld pAddress 3 b R ct License# D(2 0 a(g 6uo.bQanl MA G! 9,01 Home Improvement Contractor# Ao99d,;L Worker's Compensation #tA)M?- ff?;D&S 01 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE el�olw 1 FOR OFFICIAL USE ONLY ` APPLICATION# _ r `r DATE ISSUED MAP/PARCEL NO. - - ADDRESS 0 0VILLAGE OWNER f9 , DATE OF INSPECTION: FOUNDATION c _ FRAME INSULATION. FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS:,, ROUGH FINAL x FINAL BUILDING DATE CLOSED,OUT ASSOCIATION'PLAN NO. r The Cmmiiodwee' lilt of JItissuchilsetts R , Depanmet t of Inrlitstrial Accidetzts 1 Office of7nvesti atiotzs 1 600 6Ycishirz-ton Street i Boston, t1j 02111 tv)V)V.tnass.ov/dia NVorkers7 Compensation Insurance`AffidsN'it: Builders/Contractors/Elects iciatis/Pitimbers Applicant Information L Please Priiitleaibly �i1Il1C iBttinast�ranizaUon lltilio'idua{.): @ f e�S (/� .I L�(rL J ��'/� Tf'<�` . i 60- � Citv/slatz%Zip: TZvn 0) Phoiie -7,F 7d9- r IN,-oil an employer? Check the appropriate box: Type of project (required),:.,- , 1. I aril a e1m)IOyer.vith �Gam .-�] I am a nuai.cuntractot aiid•I enlployees(full and/or part-tinse). r have.h.red u1b Je;1C-C-0Iltl"aCt0I5 �' ❑\Icw Coll StructlOil >,r- v 2.[J.Lam a sole proprietor or paruier- I1>ied cl the !tt� h d shut. 7. Remudelm,1 a ! ship and have no employees Th,se sub-co;)Trictors hay e � l l .�. � Demolition �.... workiiti for me in an.'capacity. employee,;and have w(Ae.rs' p coni nuataiico.= c) ❑ Bulldim, idjltiuil [\o\ orker,',cc,mp. lnstn"ance. p. 4y'e arc a :.oi" trun.ali 7 its 10.❑ Electrical rclairs or additions c:juucd ] FJ pt' '1 ant a honte,i1..ilur doin_all work bftic.cr; na:e exercise t tlizir- I I TTPlunib'il_ rei}ai!s ul'additions i rk.,011 o xcillutioh l .`1GL _ Il1'c;eif. [�o\�ttlnCl comp e - - iIL7 Roof l epairs c I 1(1), a td vve have no — upli;`c >. (No .workers• -Coilip. lilsat-aillCr!�cuircd.] 'i - :•)\n'..2,•tvicam tr_t the .. I .; 1 ^:act a'.•IT out -.,_u•c.i workers nr n.„sa i tn policy milormaliun _ - I Iv ac,•, r.r;.I•ho sutmtit cl,;;::filda':•rt indltaiinL the arc u;ti u all wnr;ar innrratt u.t !l':nut a u f ;:,. ',!. _utg>u;l' -CCcn'h,:Rms taut chick!hk boN i-.ust attaclicu all <hcci shoving tirc ll-Jm to t,h uu'naclnn jnJ;tat I fl,,-I:mr c(�l uto' :.i u.;es.hnce _;t'�IoCe It the snh-vi,r:ru`tor>h-axe rtp o;•zz;,;n Il u ?pic,�;dL'the il pnl iv nuittber. I am Ern empit_Ver that is pr ovidill,n'nr;:er e co-npensation rr s r;".lice t of 1711'e rrploPee's. Bclolr is the policy°_r/rid jnb site in fornratio11. _ !Ilsuranee Crnrpanr \anle:�J .. �, /��: ���(��C1✓( �17f 'D --- - -- - -- 'ti — -- /— Pulse\'f u, �tiers'-ins. Lic�r:�j�/7 Z Cr'J &S __r�L txp.i otl D ti.: 3/ ����7 b Si w tc��' ess L City State;'Zip: Att;tch a coPe of the workers' compensation policy decluration p:i-c: (shol�in<,the policy nun er ind aspiration date).- Failure to secure coverage as required under Section 2�.`,cf ti G.L e 1.:_ can lead to the imposition of criminal penalties of a tine ilp to S 1.500.00 and/or one-y ear impn5on llent,as well.as cn it .tties.in the loan of a STUD\PORK ORDER and a I-ins Of up to 5250.00 a day against the violator. Be ad\ e.<{aha ;;i c of,!:is,tatem:nt iii<t\ be foiw<Irded to Eli fiice of fnveslleatlons of the DiA for insurance coverage Seri icutio i:' I dn,l7erel>t'cer tifi'under the pains undpenulties of pe jur I t ai the i;i./ormation provided above is trite and c'oerecti Official rise only. Do not write in this to-ert, to'be completed by cirl'oi-touvv( ic'ial:; . City or TowFnS Pcrnrit/Lieu rsc Y — ---- 'Issuing Authority (circle one) 1. Board of Health 2.'Building Departiiient 3. (:ity'/-[o\\n ( ` 4 Electrical Inspector 5. pit I-i;iu, Inspector . 6. Other Contact Person: — Phone PAGE 3 OF 4 A� C , ERTIFICATE OF LIABILITY INSURAN ' E DATE(14M/DWYYYY) 10/l/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPO THE CERTIFICATE HOLDER CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVER GE AFFORDED BY TH BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE I SUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. E POLICIES IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the polic les the terms and conditions of the policy,certain policies may require an endorsement. A statement on this ce ificate does not confer rights to th Y( )-must be endorsed. If SU ROGATION IS WAIVED, subject toh certificate holder in lieu of such endorsement(s). - PRODUCER - 9 e Bonacorso Insurance Agency, Inc. PHoaeTMichael Bonacorso NAME: " 83 Cambridge Street (781)273-3200 FAX E-MAIL (A/C.Nol- (781)273-0600 P.O Box 1502 ADDREss:mike@bonacorsoins. m Burlington MA 01803 INSURER(S)AFFORDING OVERAGE INSURED INSURERAAcadla Insurance COmpan NAIC 9- Peterson Party Center, Inc. INSURERB:C N A Insurance o, 36 Cabot Road INSURER C AIM Mutual Insur nce Co. INSURER D: - Woburn / MA 01801 INSURER E: COVERAGES/ INSURER F CERTIFICATE NUMBER:2013 Master THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED N MED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY REV ION NUMBER: CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HE EIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN'MAY HAVE BEEN RED OUCEDABY PA DOCILAIMS HEIR DOC MENT WITH RESPECT TO WHICH THIS INSR LTR TYPE OF INSURANCE ADDL SUBR GENERAL LIABILITY INSR WVD I POLICY NUMBER POLICY EFF POLICY EXP (MM/DD/YYYy II-IM/DD/YYYy LIMITS X COMMERCIAL GENERAL LIABILITY " EAC OCCURRENCE A I DAM GE TO RENTED $ 1,000,000 CLAIMS-MADE OxOCCUR. X X PA 5061026 10 0/9/2013 0/9/2014 PRE ISES Ea occurrence S 100,000 MED XP IAny one person) $ 10,000 PEP a ONAL&AD11 V INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GEN RAL AGGREGATE S - 2,OOO,OOO 0 - POLICY I n l PR e LOC PRO UCTS-COMP/OP AGG $ .2,000,000 AUTOMOBILE LIABILITY $ A ANY AUTO COM INED SINGLE LIMIT (Ea a cidenl 1,000,000 ALL OWNED X AUTOS ULED .X X _ BODI Y INJURY(Per person) I$ AUTOS AA 5063173 10 0/9/201 X HIRED AUTOS X AUTOS 3 I10/9/2014 gOD11 Y INJURY(Per accident)(5. I i PROPERTY DAMAGE Per cident) $ X UMBRELLA LIAR }{ I - Unins red motorist 81 sclii limn ' OCCUR X B EXCESS LIAB I EAC; OCCURRENCE CLAIMS-MADE �s 10,OOO,000 DE D I X RETENTIONS 10,00 �0854 96458 AGG EGATE $ 10,000,000 C WORKERS COMPENSATION 10/9/2013 0/9/2014 AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTN= ❑ - X C STATU- OTH- OFFICER1M tASFR DED7 CUTIVE Y/N R IMI R E EXCLUDED? N/A If in and Z8006586 E.L. CH ACCIDENT D S.CRI TIONunder 0/9/2013 0/9/2015 $ 1 000,000 DESCRIPTION OF OPERATIONS below - E.L. SEASE-EA EMPLOYE $ - E.L. ISEASE-POLICY LIMIT $ 1 000,000 000 000 DESCRIPTION OF OPERATIONS(LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) - CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESC IBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREO NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PR VISIONS. AUTHORIZED REPRESENTATIVE Michael J. Bonacorso 4CORD 25(2010/05) NSn25nn,nnslna - © Ttio 1988-2010 CORD CORPORATION. All rights reserved. nrnpn „e r Arnon I ..i,' .1 -I ... a ,. F�,e � ' • - - e ♦. - '' r • .. a J,. . ;. `-' �Oa-d of Su(iolf!O,Raquiaaons ._nd_S cdar.^.a, . _„s... CS-060219' MARK TRAL\A 4 _:.33.1 `FORD.FIl _... _- Stoneham NIA 0313U - 0-4127/20415 t � CV It �F T+'T73C.7%G Cl�.��✓L�CI...G'..J..L�4-- - � ,. _ Ofnca Of Ce_su;er Affairs& t,._ic's Rcgu[atioc =' 'O"tEn,.DROV="'EN. _fir i 5 cis-tr`,ion: c2� j y ps: STQVEH:ANI,MIA 02180 Undersecretary_ Li ense or registration valid for indiyidul use oniv 1 • before the empiration date. If fcerd return to`. Otnce of Cousu ler Affairs aad 5urner ReQutattoa n 10 Park Plaza-Suite 51710, Boston,}L-k 02116 - - .• - of Valid without si gn'atu re .f _ Town of Barnstable Regulatory Services HAP" LE Tlicsmis F.Gcilrr,I3irccior r aq° Building Division Tam Perry,Building Caanmissioner 200 Mein Sv-ect,Hyannis,MA 0260I w�vw,tasvn.burnstobic.ma.us Olfice: 503-Ss2-403.8 Fax: 508-71M6230 Property Owner east Complete and Sign This Section If UsinZ A,Builder as Gwaer of the 3uL'ect copert=- Hereby au€zoGze S ti to act tin :sty ben:alf, is all mn tte:; sciabvr to-w.or;.auwQzizte by this btl2clag pcanit. (Address of]ob) Pool fences and alarrns are the responsibEiry of the applicant. Pools are not to be wed or a hzed before fence is installed and all.final iecpt� ns are Performed and accepted, Si Wtutc:of CMDCr Siguatutc of.Appl cult P of Name Taut IN;U--c t Q:T'01Lpis;0W"1L�iP-r-R M,I K)10 N P 00 1 S(W20i2 e. 4 6, w5 »x , �1,:;�n 13N a d 4NED y i w i a i n tar�E PrJEPGPr PrJEPr�IflJ�r�_FEJ_rQr IMPORTANT Po'LrcrctPl�rJ�JPI�Pr�rJrJ�ucl�crD fa �� ' CON 5Certif ISSUED BY REGISTRATION Date of ShipmentImam 5 5 v '� p 5 NUMBER _IINDUSTRIES INC.`' 5/12/2008 5 5 f � EVANSVILLE INDIANA 47725 Tent Identification ] 5 F140.1 �� �P °� MANUFACTURERS OF THE FINISHED 04618268 Fj TENT PRODUCTS DESCRIBED HEREIN 5 5 This is to certify that the materials described have been flame-retardant treated S 5 (or are inherently noninflammable) and were supplied to: [5' 657150 5 S PETERSON PARTY CENTER INC S 139 SWANTON ST 5 5 WINCHESTER MA 1890 5 5 5 5 5 5 S 5 SCertification is hereby made that: 5 S The articles described on this Certificate have been treated with a flame-retardantc S approved S 5 chemical and that the application of said chemical was done in conformance with California S 5 Fire Marshal Code. All fabric has been tested and passes NFPA 701-99, CPAI 84, ULC 109. S 5 Serial # 5 5 8108985(2) 5 Description of item certified: 5 S5 CENTURY MATT EXPANDABLE END 5 40WX20 SNYDER WHITE VINYI., 5 Flame Gaeta dant Process Used Will Not Be Removed By 5 5 5 Washing And Is Effective For The Life Of The Fabric 5 5 S YDER MPG NEW PI-IILADEL.PI IIA,01-I Signed: Name of Applicator of Flame Resistant Finish ANCHOR INDUSTRIES INC. j �r.Pr_l"r21��1"r�Prl�rJ�rJcl�r�r_fc.Pr�rJ��.f� Cl . L r�r��ePcncJ�r�rJ�r�rPrJ�rJ��l?cJ�r�r1?r�i DOCUMENT Corti.Cortif to e- Fla-IT? S ISSUED BY Date of Shipment 5 5 REGISTRATION �F NOR o9it4ioa INDUSAPPLICATION TRIES INC.. 5 5 NUMBER 5 5 Tent Identification EVANSVILLE, INDIANA 47725 5 C 03938764 [J F1.ao.I MANUFACTURERS OF THE FINISHED li 5 TENT PRODUCTS DESCRIBED HEREIN 5 This is to certify that the materials described have been flame=retardant treated 5 5 (or arm inherently noninflammable) and were supplied. to: 5 5 657150 5 7 -PETERSON•PARTY CENTER INC 5 5 139'SWANTON ST 5 . 5 WINCHESTER MA 01890 ' a'1 5 5 S 5 5 ' 5 5. 5 5 Certification is hereby made that: 5 y 5 The articles described on this Certificate have been treated with,a:flame-retardant approved 5 5 'chemical and that the application of said chemical was done in conformance with California 5 5 Fire Marshal Code. All fabric has been tested and passes INFPA 701799, CPAI 84, ULCI 109. 5 5 Serial # S10897;(2) 5 SDescription of item certified:- 5 5 CENTURY MAT EXPANDABLE MIDDLE 5 S _ ! 40WX20SNYDER WI-ILTL VINYL 5 5 �Iar�� R�t� ��.nr� ��� e� !�(iig NotBe Behoved y 5 5 Washing r�� �.s Effective For The Life Of The Fabric . 5 SNYDER MFG NEW PHILADELPI-IIA,01-1 Signed ______L 5 5 , SPECIAL EVENTS DIVISION ANCHOR INDUSTRIES INC. ;mac t J-'c1�rJ�rlrPeP1P�PnrJ�rlc�J�cT?iT�J�PPPJ?1?I�P�Pr��(?1?�c'1?J�cTc�frJ��PrJ?�iPrJ L � Pr�r�rl�L�c?nr c f .I�r;F1P �l?!r?PrSr�1�� �r� Jr'J�(�r�`1ePcPlc��PfrJ�c- t�7 ---- - C] �rrJ�rJ�cJ�r�ccrap�clr�cJ�rJ��rr�rar�crIMPO "" E^Pc f�r�ui_rrJ�rJ���r�f�c rr?lLf�cl�r ter C�1 5Certificate Of Flarqe 5 REGISTRATION v 1 ��� �Se SUED BY Date of Shipment S NOR 5/12/2008 Ca j NUMBER $� INDUSTRIES INC. , EVANSVILLE, INDIANA 47725 Tent Identification 5. 0-y P140.1 MANUFACTURERS OF THE FINISHED 04618268 5 5 TENT PRODUCTS DESCRIBED HEREIN . 5 5 This is to certify that the materials described have been flame-retardant treated S 5 (or are inherently noninflammable) and were supplied to: S 5 657150PETERS 5 5 1A ST ONTON PARTY CENTER INC 39 S1/V S 5 5 S WINCHESTER MA 1890 S ,5 5 5 S Certification is hereby made that: S 5 The articles described on this Certificate have been treated with.,a flame-retardant approved S 5 chemical and that the application of said chemical was done in conformance with California 5 5 Fire Marshal Code. All fabric has been tested and passes NFPA 701-99, CPAI 8�, tJl"C 1 pJ. c5) 5 Serial # 55 8108985(2) 5 5 SDescription of item certified: CENTURY MATE EXPANDABLE END 5 40WX20 SNYDER WHITE- VINYL. 5 Flame Retardant Process Used Will Not Be Removed By 5 Washing.lend Is Effective For The Life Of The Fabric LS] b YDELZ MFG NEW PI-IILADE'L.P111A,01-I Slued: �) 5 5 5 Name of Applicator of Flame Resistant Finish ANCHOR INDUSTRIES INC. C� (� rJ��PrJ�i teafrPr��rJ�r�r�rlrJ�r�ePr�r�rP�r�i�r_ffcf ar��fc?rrJ�cldlnPe PEPrr_ Pr_PE_ Pd'd`_i-J�dfupePJ3rpr-pc--tic pr-FE2 i�rr��PefpLLpr- pLpL-r..f r�rPi.!`�.l�rJ�rlrJr_(�r�t� C7 Mass. Corporations, external master page Page 1 of 2 �',,: "e ti� � � ��t'k�� � ay7• .tea. m r„ Corporations Division Business Entity Summary . ID Number: 263742245 Requestertificate.I c 3 New search) Summary for: 31 ATLANTIC AVENUE, LLC The exact name of the Foreign Limited Liability Company (LLC): 31 ATLANTIC AVENUE, LLC Entity type: Foreign Limited Liability Company (LLC) Identification Number: 263742245 Date of Registration in Massachusetts: 11-24-2008 Last date certain: Organized under the laws of: State: DE Country: USA on: 11-18-2008 The location of the Principal Office: Address: 330 MADISON AVE. NO. 280 City or town, State, Zip code, NEW YORK, NY 10017 USA Country: The location of the Massachusetts office, if any: Address: 31_ATLANTIC.AVE. City or town, State, Zip code, HYANNIS PORT, MA 02647 USA Country: The name and address of the Resident Agent: Name: CORPORATION SERVICE COMPANY Address: 84 STATE ST City or town, State, Zip code, BOSTON, MA 02109 USA Country: The name,and business address of each Manager: Title ' Individual name; Address MANAGER ROBERT SARGENT 330 MADISON.AVE. NO. 280 NEW YORK, NY SHRIVER III 10017 USA The name and business address of the person(s) authorized to execute, acknowledge, deliver, and record any recordable instrument purporting to affect an interest in real property: Title Individual name Address http://corp.sec.state.ma.us/Corp Web/CorpSearch/CorpSummary.aspx?FEIN=263742245&SEARC... 5/6/2014 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION MapCD Parcel 60 166 I. Application # e;)6 o� d Health'Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/ Hyannis Project St t Address Village Owner —Address 33o�11"S,i,n ..fig "ele r it/ - Telephone S0 9- 77S'7/7//7 Permit Request � �� T cR.- yC> )((Po 2-tn'✓OIzGty �913 P4 f�"qk aa,� Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuatior�doz_-jo Construction'Type Lot Size :Grandfathered: ❑Yes ❑ No If yes, attach sups, rting dotameFation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's ighway:�❑Ybd,_L] No Ile Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other ec Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft � Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑Other Central Air: ❑Yes ❑ No Fireplaces: Existing New _ Existing 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 ��OC TQ/`I�- Telephone Number 7FI VY yO'Dv Address 6 � gd_ License# 06,0�2! � Ing D/ fo( Home Improvement Contractor# /6F9a Worker's Compensation #&W Z,?eV(PSd 6 ALL CONSTRUCTION DEBRIS RESULTI,NrG�FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE_ I /3 FOR OFFICIAL USE ONLY -F k 'APPLICATION# DATE ISSUED 4 I MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: s ' ' I' ,-FOUNDATION FRAME INSULATION 'F FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL 5 -GAS: ROUGH�;=� FINAL 5 y -FINAL BUILDING''. - DATE CLOSED OUT ASSOCIATION PLAN NO. P F - Ir F The Commonwealth of Massachusetts T Department of Industrial Accidents Office of Investigations - 600 Washington Street Boston, MA 02111 _ T www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le6ibly Name (Business/Organizatioivhdividual): �� f f' �Cyl— looez& Address:_3 City/State/Zip:�00� M/q Gt Fol Phone#: 1781 Z?2- �lUc)© Are you an employer? Check the appropriate box: Type of project(required): 1. 4. I am a general contractor and I � I am a employer with d v O ❑ 6: ❑New construction employees (full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling shipand 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.1 I 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' 13.2 Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. *Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. lam an employer tliat isproviding workers'compensation insurance for my employees. Below is the policy and job site' information. Insurance Company Name: Policy#or Self-ins. Lic.#-.(x).M Z FUc�, Expiration Date: /p A /3 Job Site Address: &/ fTT/G?`i fTc �2e City/State/Zip: 141V4,V111 p.a Attach a copy of the workers' compensation policy declaration page (showing the policy num er 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 under the pains andpenalties of perjury that the information provided abov is true and correct. Signature: Date: g //Y Phone#: Z,2 y O 0_0' Official use only. Do no t write in this area to be completed .ff y p by city or town official. r 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 A. Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employee's. 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 Q em to ees.-However the receiver or trustee`o -an`individual.partnership,association or other legal entity,employing p y . 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. licensing,agencyshall withhold the issuance or renewal°of a license or permit to operate a�busi iess or to construct buildings to the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,lVMGL 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 unril acceptable,evidence of compliance with the insurance requirements of this chapter have been presented to the-contracting authority." S N, Applicants Please fill out the workers' compensation affidavit`completely,by checking the boxes that apply to your situation and,if necessary,supply sub contractors)naine(s);addresses)and phone numbers)along with then cerhficate(s)oft insurance: Limited Liabihry Companies(LLC)or'Limited Liability Partnerships (LLP)with no employees er than the oth 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 maybe 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 peiinit or,license,is being requested,not the Department,of „ Industrial Accidents Should you have any questions`regarding the aw or if you are required to obtaui'a workers',: compensati10—n hcy,please call the Department at the number fisted below Self-insured companies should enter their self,uisuraiice.,lcense niimber:;on the;appropnate tine City or'Town'Officials Please be sure that the affidavit is complete and prnited 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'peinut/license nu uber which will be used as a ri f ence number In addition,an applicant that must submit multiple pennit/license.applications in any given year,need only submit one affidavit indicating current policy.information(ifnecessary)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 Anew affidavit must be filled out each year.Where a home owner or citizen is obtaiiung a license"or.permit not related to any biisiness'or commercial venture (i.e. a dog license or permit t *burn leaves etc)said.person is NOT required to complete'this affidavit. 11 The Office of Investigations would Like to thank you.in.advance for your.cooperatiori 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 Invvestigations 600 Washington Street Boston,MA 02111 Tel. # 617-727-4900 ext 406,or 1-877-MASSAFE Fax# 617-727-7749 Revised 1122-06 www.mass.gov/dia , DATE(MNiDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 10/19/2012 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 endorsement(s). RODUCER CONTACT__Michael BOnacorso NA"E: (onacorso Insurance Agency, Inc. PHONE (781)273-3200 FA'X NOJ: nsl)z%3-0500 13 Cambridge Street E-DMDRAIL .mike@bonacorsoins.cora A = .0. BOX 1502 INSURER(S)AFFORDING COVERAGE I NAIC Burlington MA 01803 INSURERA:Acadia Insurance Company JSURED INSURER 8:C N A Insurance Co. leterson Party Center, Inc. INSURER C:AIM Mutual Insurance Co. 1 6 Cabot Road INSURER D _ INSURER E Toburn MA 01801 INSURER F :OVERAGES CERTIFICATE NUMBER:2012 Master 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. NOTIPATHSTANDING ANY REQUIREMENT, TERN 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 TERNIS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOVIN MAY HAVE BEEN REDUCED BY PAID CLAIMS. SR TYPE OF INSURANCE ADDR SUER POLICY EFF POLICY EXP TR! I IAl`;P n I POLICY NUNIBER I LIMITS IMMiDO/'lYYYI rd?AiDDIYYYYI GENERAL.LIASILITY EACH OCCURRENCE I S 11000,000 DAiNIA.GE TD R6NTED X I COP>IMERCIAL GEPJERAL LIA2ILITY PREMISES(Ee cccurrence! 15 100,000 ? ICLAINIS-KADE a OCCUR X _-X CPA 506102E 1G 10/9/2012 10/9/2013 PIED EXP(Any one person; I S 10,000 PERSOil.SL 3 ADV INJURY I S 1,000,000 GENERAL AGGREGATE I s 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: I .I PRODUCTS-CONIFIOP AGG I S 2,000,000 I I POLICY I X l PRO- n LOC ....I_AUTON108ILE.LIAB.ILLTY l - CONIBINED SINGLE LIMIT I I I (ca zmdentl S 1,000,000 � I ANY AUTO I IIII II I iIl BODILY INJURY(Per p' ercn) ALL.01, ED SC=EDULEDx x NS?! 5063173 10 6001LY 1,1JURi(Per acciden tII s AUTOSnX I AUTOS XI XI NON-OVOIJED PROPERTY DAMAGE HIRED AUTOS ' IAUTOS (Per accident) Sa Uninsured motorise Bi sciit limit I = X UMBRELLA LIAR X I OCCUR -I `Y I� i I EACH OCCURRENCE I $ � 10,000,000 EXCESS LIAR CLAIMS-MADE I AGGREGATE S 10,000,000 DED I X I R=TENT ION S 10,00C� 15083496458 I10/9/2012 10/9/2013 S WORKERS COMPENSATION I j I 'I 4VC STATU- I loll AND EMPLOYERS'LIABILITY - Y A! T FR YIN A.NY PRO PPJETOR/FARTNE-/-XECUTI'JE i I E.L.EACH ACCIDENT S 1,000,000 .�"r=ICEF.r�Ac.`Kri EXCUJDED? N N/A Mandator in y wMZ8006586 10/9/2012 10/9/2013 �o ( 1 N ) cL.DISEASE-EA Eul�LOY�c C S 1,000,00() 1`yes,describe under DESCP.IPTION OF OPERATIONS bela:v E.L.DISEASE-POLICY LIMIT S 1,000,000 i IESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (.Attach ACORD 101,Additional Remarks Schedule,if more space is required) ,ERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS: AUTHORIZED REPRESENTATIVE Michael J. Bonacorso 1CORD 25(2010105) ©1988-2010 ACORD,CORPORATION. All rights reserved: NS025(20u0,)01 The ACORD name and logo are registered marks of ACORD 1 16�W Town of Barnstable ; T.rrus>ra�.Cte�er,i.7fi'eclor Building L�i�fs fin. Tuns Fen-y, tnlmfag uuuai;io,cr 200 M S cc; FYeMis;MA b26501 P-Mpe.rty Owaer Must Complete atid.S g"n T11js Sdctien if VSing,A Bu.Ider As 07- l.i('.�p�u��r�yJa`u'�-F� �•i�GII'4! /�=_�J� �. v . ILI 5 i a H2�U 12� I Alf Avg; er UV , -Al lb 0 d r r t � r 4 , .. ..._.. 3 t _r- � ' __..... �" ,.. � � �� � i . ' __ � � , I _ _ ------ a �6_ O :T -:� ------ -----X ��?� t C ------ � _ ------ ------, i��� ------ � � � -z- , , i i � � � .. � i � i r i � � _ � i � � i � ` !, . . - . .. e f ` ��� �� 5 � . �Uu� ,• , 1 Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction Supertiisor ., `License: CS-060219 rY1ARK TRAI iA - 33 HANFORD RID � Stoneham MA 02480 Expiration Commissioner 04/27/2015 & f:iiii,csti ((ern ii,ir❑ HONE Iir1PROVEiNIENT CONTRACTOR Registration: ..169922 1 ype: EaPirai1011: S,?3,20i I idi,ridual L4,2NFO!'ID RID. ST0!,1 H,=.M, t il-A 0 2 1 E 0 t na::,�irctai, I,icinSc in rN istralion tinliil Ivr iu.lipiilul use unl. before the C.xhirution tl:tte. If fuuntl ICturn In: Office of*( f.)ii s u I I I e r Af*hIr5 anti Gusi110S lie_ulati m 111 I'arl; P1:rz:t-Suite .I ill Gaston, MA 02116 i�iul ti'alid �•:ilboul si•�n;ttu rC EMMMErrJMEMr?r��Pr..N I T Epcnd-rJprJ�cPLPLprr PLPL LPLPccnrPupc a 5Certif leate of Flan-?cesi ee 5 5 REGISTRATION ISSUED BY � Date of Shipment 5 5 APPLICATION INDUSTRIE INC. 5/10/2006 . 5 NUMBER s 5 5 P EVANSVILLE, INDIANA 47725 Tent Identification 5 5 F140.1 MANUFACTURERS OF THE FINISHED 04278316 5 5 TENT PRODUCTS DESCRIBED HEREIN 5 This is to certify that the materials described have been flame-retardant treated 5 5 (or are inherently noninflammable) and were supplied to:657150 5 S SPETERSON PARTY CENTER INC S 5 139 SWANTON ST 5 5 WINCHESTER MA 01890 5 5 5 Certification.is hereby made that: 5 The articles described on this Certificate have been treated with a flame-retardant approved S ` 5 5 chemical and that the application of said chemical was done in conformance with California 5 5 Fire Marshal Code. All fabric has been tested.and passes NFPA 701-99, CPAI 84, UL-C 109. 5 5 Serial # S 5 8108985(2) 5 r 5 5 Description of item certified: 5 CENTURY MATE EXPANDABLE END 5 5 40WX20 SNYDER WHITE VINYL Lj 5 Flame Retardant Process Used Will Not Be Removed By 5 5 Washing And Is Effective For The Life Of The Fabric 5 5 5 Si ned: 5 S,,,..nFAR 44FQ Naar 14111 Ap9I 2WI QI4 9 5 5 Name of Applicator of Flame Resistant Finish ANCHOR INDUSTRIES INC. 5 IO �p�PrPr1rJ�r�rPrJ�d�r�r.PrPr.Pr�rPrJ�rPrJ�r�rPr��PrJ�r�r�r�rJ�cPrPr.PrJ�rPrJ�r��P�Pd�d�rPr�r�rPrPr�r.l�cPr_prncpcPrJ��PrPrJ�d�rPrJ�r�rJ�rJ�d�rJ�r�rnr.Pr�r�rnd�rPrJ7d�rP [� t o !IMPORTANT T �Pr�rJ�irJ��.Pr�rJ�rJ�rJ�r�r�r��P�Pr�cJ� Ll s Certificate f e s ISSUED BY Date of Shipment S 5S REGISTRATION APPLICATION 06/08/04 5 NUMBER INDUSTRIE 5 0 k EVANSVILLE, If�9®IAIVA 47725 Tent Identification 5 P140.1 � ®� MANUFACTURERS OF THE FINISHED o3850284 5 5 TENT PRODUCTS DESCRIBED HEREIN 5 5 This is to certify that the materials described have been flame-retardant treated S 5 (or are inherently noninflammable) and were supplied to: S 5 657150 5 5 PETERSON PARTY CENTER INC 5 5 139 SWANSON ST S 5 WINCHESTER MA 01890 5 Certification is hereby made.that: 5 5 The articles described on this Certificate have been treated with a flame-retardant approved 5 c5� chemical and that the application of said chemical was done in conformance with California 5 5 Fire Marshal Code. All fabric has been tested and passes NFPA 701-99, CPAI 84, ULC 109. 5 5 Serial # 8108975(2) 5 r5j Description of item certified: SCENTURY MATE EXPANDABLE MIDDLE 5 40WX20 SNYDER WHITE VINYL 5 Flame Retardant Process Used Will Not Be Removed By 5 5 Washing And Is Effective For The Life Of The Fabric SNYDER MFG NEW PHILADELPHIA,OH Signed: .' ' '��• 5 "SPECIAL EVENTS DIVISION-ANCHOR INDUSTRIES INC. Cj 0 rJ'Mr-rJprJrPLJ-d3-�r3d3-L3 J-r3Fg- ��Pr�r�r��r��PrJ�rJ�rJ��PrlrJ�r�rJ�r�r��PrJ��PrJ�r�rJ�rJ�rPrJ7cP�PrJ�r��PrJ��r�r�c l�rJ�rJ�r�J�r�rJ�r_I�rJ��Pr�GPr�Pr�r�r��P�Pr�r�cJ?rJ��I� 10 t] rJ�c�rJ�r1rlrPrJ�rJ�c!tJ�r�r�rJ��Pr�tPcfI OPL PdL]Pr L3PLPLr PLPL�� LJPL LPrr- � 5 m e e 5 5 � 5 5 REGISTRATION ISSUED By Date of Shipment C5 APPLICATION Q 5/10/2006 5 5 NUMBER7* INDUSTRIE INC. 5 EVANSVILLE, INDIANA 47725 Tent Identification P 5 5 5 F140 t ® MANUFACTURERS OF THE FINISHED 04278316 5 TENT PRODUCTS DESCRIBED HEREIN 5 5 This is to certify that the materials described have been flame-retardant treated 5 5 (or are inherently noninflammable) and were supplied to:, cS S5 657150 5 PETERSON PARTY CENTER INC S 5 139 SWANTON ST S 5 WINCHESTER MA 01890 S 5 5 S 5 5 5 S5 5 Certification is hereby made that: 5 5 The articles described on this Certificate have been treated with a flame-retardant approved 5 5 chemical and that the application of said chemical was done in conformance with California 5 5 Fire Marshal Code. All fabric has been tested and passes NFPA 701-99, CPAI 84, LIL-C 109. S 5 Serial # 5 5 8108985(2) 5 CC 5Description of item certified: 5 CENTURY MATE EXPANDABLE END 5 5 40WX20 SNYDER WHITE VINYL 5 5 Flame Retardant Process Used Will Not Be Removed By 5 5 5 5 Washing And Is Effective F®r The Life Of The Fabric 5 rrvn Signed: c 5 �N1rC AIFW PI-lll h619bP1•-11�"Qw 5 Name of Applicator of Flame Resistant Finish ANCHOR INDUSTRIES INC. a LQJ-Ccl]PRL PcPu��nrPr rP�PrPrJ�r�cP�PrP�r�PrJ�rPcl�cf�rJ�cf�PrP�ncP�PrP�nu��PcPrJ��re�rPcPrPrPrJ��PrPcn�PrP�cfcP�PrPrJ��P�PrP�n�PrPcP�Pr rcJ�rJ�cnr�rPrPr nr� o 05/67/2013 14:39 FAX 781 729 4999 PETERSON PARTY 002/002 own of Barnstable as i Regulatory S��� Thtt.'asF'.t;ciier.Iiindur Building Div&, Tact�'�t•r;';Lt:'sldin��crtFstt�sslc�ser 200 Main Byallpis,�;%u4 0260 i Propertv Complete and. S-Ji ii This "Section co t:b y i Ut12C}-d-yc" r L.nJ U-I ,i4,..:::?:i;�T�,. .��:Y;rr[^,ern ;>y�s„-'r -zy Nl..:�_ `i' } •f ` 5.+ L taCkt .ems ox'1 oob **Poolfences a-ad vdarras Gx� the res-ofa!"'t.sibi z% ,t`.vf tf-le w Ps;E:ran'. pools ;<�ot to be `ice€e 0r utjized bdfb e e'nice �,S z�15t €xc d -andf?U _%:pia.` Z-7 Rg'awma-, Of Own ix lm,- �;c;^it.h� e1V:?,i�TtP >�.h'?F�SiC•?'f°:f.}?.�±i��l2 The Commonwealth of Massachusetts William Francis Galvin- Public Browse and Search Page 1 of 2 The Commonwealth of Massachusetts William Francis Galvin e Secretary of the Commonwealth,Corporations Division One Ashburton Place, 17th floor _ Boston MA 02108-1512 _.y Telephone: (617)727-9640 31 ATLANTIC AVENUE, LLC Summary Screen ID Help with this form Reguesta�aCertificate ' , The exact name of the Foreign Limited Liability Company(LLC): 31 ATLANTIC AVENUE,LLC Entity Type: Foreign Limited Liability Company(LLC) Identification Number: 263742245 Date of Registration in Massachusetts: 11/24/2008 The is organized under the laws of: State: DE Country: USA on: 11/18/2008 The location of its principal office: No.and Street: 330 MADISON AVE.NO. 280 City or Town: NEW YORK State:NY Zip: 10017 Country:USA The location of its Massachusetts office,if any: No.and Street: 31 ATLANTIC AVE. City or Town: HYANNIS PORT State: MA Zip: 02647 Country: USA The name and address of the Resident Agent: Name: CORPORATION SERVICE COMPANY No. and Street: 84 STATE ST City or Town: BOSTON State:MA Zip: 02109 Country:USA The name and business address of each manager: Title Individual Name Address (no PO Box) First,Middle,Last,Suffix Address,City or Town,State,Zip Code MANAGER ROBERT SARGENT SHRIVER III 330 MADISON AVE.NO.280 NEW YORK,NY 10017 USA The name and business address of the person(s)authorized to execute,acknowledge,deliver and record any recordable instrument purporting to affect an interest in real property Title Individual Name Address (no PO Box) First,Middle,Last,Suffix Address,City or Town,State,Zip Code Consent _ Manufacturer _ Confidential Data _ Does Not Require Annual Report Partnership _ Resident Agent _ For Profit _ Merger Allowed http://corp.sec.state.ma.us/corp/corpsearch/CorpSearchSummary.asp?ReadFromDB=True&... 5/7/2013 The Commonwealth of Massachusetts William Francis Galvin-Public Browse and Search Page 2 of 2 Select a type of filing from below to view this business entity filings_ ALL FILINGS Annual Report I... Annual Report-Professional Application For Registration Certificate of Amendment —20 View�Filing5 '' New�Sear'ch „;.' Comments O 2001-2013 Commonwealth of Massachusetts t=d All Rights Reserved Help http://corp.sec.state.ma.us/corp/corpsearch/CorpSearchSummary.asp?ReadFromDB=True&... 5/7/2013 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 One Ashburton Place, 17th floor Boston MA 02108-1512 Telephone:(617)727-9640 31 ATLANTIC AVENUE, LLC Summary Screen I Help with this form °Request.a Certlficae , The exact name of the Foreign Limited Liability Company(LLC): 31 ATLANTIC AVENUE,LLC Entity Type: Foreign Limited Liability Company(LLC) Identification Number: 263742245 Date of Registration in Massachusetts: 11/24/2008 The is organized under the laws of: State:DE Country: USA on: 11/18/2008 The location of its principal office: No.and Street: 330 MADISON AVE.NO.280 City or Town: NEW YORK State:NY Zip: 10017 Country: USA The location of its Massachusetts office,if any: No. and Street: 31 ATLANTIC AVE. City or Town: HYANNIS PORT State:MA Zip: 02647 Country: USA The name and address of the Resident Agent: Name: CORPORATION SERVICE COMPANY No. and Street: 84 STATE ST City or Town: BOSTON State: MA Zip: 02109 Country: USA The name and business address of each manager: Title Individual Name Address (no PO Box) First,Middle,Last,Suffix Address,City or Town,State,Zip Code MANAGER ROBERT SARGENT SHRIVER III 330 MADISON AVE.NO.280 NEW YORK,NY 10017 USA The name and business address of the person(s)authorized to execute,acknowledge,deliver and record any recordable instrument purporting to affect an interest in real property Title Individual Name Address (no Po Box) First,Middle,Last,Suffix Address,City or Town,State,Zip Code Consent _ Manufacturer _ Confidential Data _ Does Not Require Annual Report Partnership _ Resident Agent _ For Profit _ Merger Allowed http://corp.sec.state.ma.us/corp/corpsearch/Corp SearchSummary.asp?ReadFromDB=True&... 5/7/2013 The Commonwealth of Massachusetts William Francis Galvin- Public Browse and Search Page 2 of 2 Select a type of filing from below to view this business entity filings: ALL FILINGS r Annual Report Annual Report-Professional Application For Registration Certificate of Amendment ] Comments O 2001-2013 Commonwealth of Massachusetts 11J All Rights Reserved Helo I http://corp.sec.state.ma.us/corp/corpsearch/CorpSearchSummary.asp?ReadFromDB=True&... 5/7/2013 The Commonwealth of Massachusetts William Francis Galvin-Public Browse and Search Page 1 of 2 The Commonwealth of Massachusetts 5 . William Francis Galvin 1 Secretary of the Commonwealth,Corporations Division One Ashburton Place, 17th floor Boston,MA 02108-1512 �h . w Telephone: (617)727-9640 BEST BUDDIES INTERNATIONAL, INC. Summary Screen ID Help with this form :n,„ �l�equest a�iCerttitcate;;� The exact name of the Foreign Corporation: BEST BUDDIES INTERNATIONAL,INC. Entity Type: Foreign Corporation Identification Number: 521614576 Old Federal Employer Identification Number(Old FEIN): 000000000 Date of Registration in Massachusetts: 09/23/1996 The is organized under the laws of: State:DC Country: USA on: 01/19/1989 Current Fiscal Month/Day: 12/31 Previous Fiscal Month/Day:00/00 The location of its principal office: �I No. and Street: 100 S.E. SECOND ST., STE. 2200 City or Town: MIAMI State:FL Zip: 33131 Country: USA The location of its Massachusetts office, if any: No. and Street: City or Town: State: Zip: Country: Name and address of the Registered Agent: Name: CRAIG WELTON No.and Street: 45 BROMFIELD STREET 7TH FLOOR City or Town: BOSTON State:MA Zip: 02108 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 ANTHONY K.SHRIVER 100 SE 2ND STREET MIAMI,FL 33131 USA TREASURER GERALD KLINGMAN 100 SE 2ND STREET MIAMI,FL 33131 USA SECRETARY ROBERT FRIEDMAN 100 SE 2ND STREET SUITE 2200 MIAMI,FL 33131 USA DIRECTOR RICHARD BOOTH 100 SE 2ND STREET MIAMI,FL 33131 USA http://corp.sec.state.ma.us/corp/corpsearch/CorpSearchSummary.asp?ReadFromDB=True&... 5/8/2013 The Commonwealth of Massachusetts William Francis Galvin- Public Browse and Search Page 2 of 2 business entity stock is publicly traded: The total number of shares and par value,if any,of each class of stock which the business entity is authorized to issue: Par Value Per Share Total Authorized by Articles Total Issued Class of Stock Enter 0 if no Par of Organization or Amendments and Outstanding Num of Shares Total Par Value Num of Shares STK $0.00000 0 1 $0.00 0 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 e_ntity filings: ALL FILINGS Amended Foreign Corporations Certificate Annual Report Annual Report-Professional ; Application for Reinstatement I- ; rViewF,�lings � , uNew Search Comments O 2001-2013 Commonwealth of Massachusetts �I All Rights Reserved Help http://corp.sec.state.ma.us/corp/corpsearch/CorpSearchSummary.asp?ReadFromDB=True&... 5/8/2013 05/07/2013 13:59 FAX 781 729 4999 PETERSON PARTY LM002/003 wa /star r s A, of Barnstable Regulatory Serviccs- 1. '� �snxw 1,� T?i:,;rt2s F. ��iitr,i,'treccur Building Division Torn i'e^3�.B��idsng Laa rnissi�¢;e 1tiS"f'. [ii"_iFa.Lis Wow 5GS4614038 Fax: 5084911201, Complete ?,,-,.d Sign Th-is Section. it USi.i1F B-d,', u: an „x ..a..Ty:i d by As ku',:J ^i' : x a.Col.ol Lei-ices andrii:lrnns, `ct":.e the 4es ons bi jq; of the apYri1.carl" 0 S W one not to KIM or LtilEW f4%:i,aefez"C'-- iS. inst-i#led i1n aI?. i?.T:x<z? C) - 't�••tt e { ^ fin p o ep / � .A'..ir`.iJ4c�i i.:iil.Aw5 iictL jJ'.�-.z w.r..31 LA.�.�� 41 i�f�. f?��i.4.�Jik-d. v-s 7 boo I J ' 1 «► : 16pt 4 r/", Sri t� TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION i j aft r' A li t n Ma P r ly ca ,p acet t♦ pp .,..4je? lY Y Health Division ,�PDatetlss.upd Conservation`Division " Application Fee Planning Dept. � , `;` -Permit Fee Date Definitive Plan Approved by Planning Board Historic- OKH _Preservation/ Hyannis Project Street Address _3- z,411a./tic. �VVc Village ae)n-s 0 oti�, Owner 3/ ,oir�ic ���' _Address 33o 1,1�4Wt.;ao -Ap/ �/, A4' Telephoney3 Permit Request 702-3 ec cz-- rYn X6v a,<C,�� ( e U V P a on 6ol3ZI PZl/ri.yY Pl u ih c 4pc 91 k o r-e l/ Square feet: 1 st floor: existing proposed 2nd floor:.existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuatior&,,?oao Construction Type I Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family-. ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure _ Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑ Walkout ❑Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) y . Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑Oil ❑ Electric ❑ Other Cen"tral 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) IV6?ftk Name llfa"9 �e�e'KsM Telephone Number 771— 7d 9- 5/0 o C1 Address .�� C.Q JO �4r� License# 0&0,;z l (004Uyt h, 0/ FU! Home Improvement Contractor# 1� 9 9aoZ Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN,TO - SIGNATURE DATE // / FOR OFFICIAL USE ONLY APPLICATION# i DATE ISSUED r MAP PARCEL NO. - I I ADDRESS VILLAGE OWNER DATE OF INSPECTION: p } FOUNDATION FRAME INSULATION -{ FIREPLACE 1 . ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: , ROUGH FINAL -FINAL BUILDING--,.- DATE CLOSED OUT ASSOCIATION PLAN NO. 771c Commonwealth ofttilassachusetts (y Departuicnt of Indttstrial Accidents Office of Mvesti,,,,ations I 600 Wcishitwton Stt-cet Boston, MA 02111 11 orhers' Compensation Insurance affidavit: 13tiilders/Contractors/Lleclriciall5/I'lutnbers Applicant Itifortttation y Please Print LeggiblN Nallte (13usincs '7rgani� t k yG I l d hud K Address: 0 . City/State/Zip: tj ( he k-e_S4e_K M/,9 Phone : 7cgl 7a9- /a a c) Are you an employer? Check the appropriate box: Type of project (required; I. I arrempioycr with O O ❑ 1 am a Qeneral contractor and I a 6. ❑ New constructtor, employees (full and/or part-time).' have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. = i. El Remodeling ship and have no employees These sub-contractors have S. ❑ Demolition kvork_in2 for me iri any ca acity. ��orkers' comp. insurance. P 9. 0 Building addition (No workers' comp. insurance 5. ❑ «'e are a corporation and its ❑ Electrical required.] officers have exercised their 10. ,cal repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. t to workers' comp. c.. 152, $1(4),and we have no v � P i_.❑ Roof repairs insurance required.] ` employees. [No workers' 13. Othcr -e �� , cor,p. insurance required.; t —. `An% a piicant teat checks box#I must also till out the secuon below showing their workers'compensation poIic;inromation. t Horr�co.vr.e s who submit this atTdavit in;iicatir,e they at`loin-all work and then hire outside Contractors musi subrrut a new affidavit indicating such. 'Contractors that check this box must attached an additional sht— showing the name of the sub-contractors and their�a'orker'comp.policy information. I am an employer that is providing workers'compensation insurance for nzy employees. Below is the policy and job site information. Insurance Company Name: U b !1 L a h l t ►-� Policy or Self-ins. Lic.. i/!L C Expiration Date: w Job Site Address: � City/State/Zip: �d/I4e S Attach a copy of the workers' compensation policy,declaration page(showing the policy number anti 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 S1,500.00 andor one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DI-A for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Sitrnature: Date: Phone Official use only. Do not write in this area, to be completed by city or town officiaL City or Town: PermiULicense € 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 r: 1 (11l'n( �11 I'ullli� �:11 l;ll:lrcl �ti Id f, («'�tll:l(iMn. :incl . _onstruc(ion SLJP7�r,''Sor Llcensr- t_icensc': CS 60219 ORD FRG S 1 ONEHAN,, MF; 021180 - F Expiration: 4/27/2013 Tr--: 13389 a A CERTIFICATE OF LIABILITY INSURANCE D"TE''•'1 lDOrY1 10/G/2011 THIS.CERTIFICATE IS ISSUED AS A Pr1ATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRw1ATIVELY OR- NEGATIVELY APAEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOV". THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPP.ESEN'TATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IWiPORTANT: If the certificate holder is an ADDITIONAL INSURED, the POlicy(ios) must be endorscd.�If SUBROGATION IS 'Ai.AIV6D, subject to the terms and conditions of the policy, certain policies may require an endorsement. A staternont on this certificate does not col;fer rights t coriificate holder in lieu of such eadorsemont(s). c UIe PRODUCER. ccNTACT , _ r+1cha�i Oa a CQr 50 Bonacorso Insurance A ae, Inc. PHOuE (761)273-32C0 ----- --.Fr,•x -.. t',IC tJjJI. 13811233-_;C, 83 Cambridge Street E-MAIL ADDRESS:mike@bonacorsoins.com P.O. Box 1502 INSUREF,(5)AFFORDYdG COVERAGE cAIC_ Burlington 2f 01803 INSURERARe ublic Franklin Ins . Co. INSURED - INSURER e Travelers Cas & Sur of Illinio Peterson Party Center, Inc. INSURERCUtica National Insurance Co 139 Swanton Street --- --- - - - j IN.SURERD:Travelers Casua-lty and Surety INSURER E: �+ir1c;ester - 24 01890 ----- ------ --- _. INSURER F; COVERAGES CERTIFICATE NUMBER:2011 KL-.ST_R REVISION NUPABER: THIS IS TO CERTIHY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAM D ABOVE FOR THz_ POLIi-- PERICL' INDICATED. N:OTVVITHSTANDINJG Ar;'r.eI=OUIREitriEiJT, TER,y1 Gil CONDITION OF AtJY CONTRACT OR OTHER DOCUN:1EiJT N;ITH RESPECT TO VaiiCri T:-:!S CERTIFICATE MAY BE ISSUED OR F.AY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERiMS, EXCLUSION'S AND CONDITIONS OF SUCH POLICIES.LIMITS SHOViii MAY HAVE BEEN REDUCED BY PAID CLAIFdS. INSR AI I L I I ItPOUCY EFF I EXP II^cR LTR TYPE OF INSURANCE LIMITS GENERAL LIABILITY EACH OCCURRENCE I S 1,000 0001 }: COM:tErtCVL GECJERAL LIABILITY - DANIA E TORE r!TED -- PREMISES Ea occurrence: i S 50,G00� CLAJMS-:LADE a CCCUP, k X CPP4361629 10/9/20f1 10/9/2012 MED EXP(Any one person) S 10,000I I I � PERSONAL L ADV INJURY I S 1,000,000 GENERAL ASGR=_3� GE'• GGR=GATE LIMIT APP_ P;P. - IC r 0 LCC ' AU TOMOBIL-LW9!1_17Y CU!.;BItdEG 11000,Cc J: ANY AUTO ( I i I BODILY INJUR'I tPer S ALLOV,"NED SCHEDULED I X f tBA-9296RS36-11-ST, 10/9/2012 AUTOS AUTOS £ 1 BODILY ItJJLRr(Peracc:duq-I—s - - - HIRED AUTOS X P:ONES;„JED _ PROPERTY DAMAGE S 1Peraccident' I _� X UMBRELLA UAB X X - Uninsured motorise EI sclit lint I S 1 000,o00 OCCUr, EACH OCCURRENCE I S 10,0oo,000 C EXCESSLLIB �CLA!MS-btADE r AGGREGATE IS -10,000,000 . DEO (RETENTIONS •:34361631 0/9/2011 0/9/2012 IS D WORKERS COMPENSATION VV STAT! c U- OEB TH- A ND EMPLOYERS'LIABILITY I - I }- T P Y/N _ . -- ATrf PP,OPP.IETOPJPn.STYE?JEXECUTIVc EL EACH ACCIGetJT I s _ 500,GOO( OFFICEP,I,AEMBER EXCLUDED? N NIA. - (MandatorY!nNH) I �+•C 4361630 10/9/2011 10/9/2012 E.L.DISEASE-EA EMPLOYEE S 500,000� If pes,desc be under Dc SCRIPTION OF OPERATIONS belcw ( - E.L.DISEASE-POLICY LIM:T I S 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,H more space Is required) I • I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCF,!8ED POLICIES EE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, .WDTICE WILL 6E GEL.IVERED. IN .ACCO?i,ANCE VlIT;i T!--"' . _ P:O'•IIS;:, I - AUTHORIZED REPRESENTATIVE I , t-t_chael J. Bonacorso ACORD 25(201905) ©1988-2010 ACORD CORPORATION. All rights reserved.' INsn2s nmr.icin: Tho ernan i lnnn a.o ronicicrnH ,rt r n(,.npn IMPORTANT DOCUMENT 5 s 5 ISSUED BY SREGISTRATION Date of Shipment 5 5 NUMBER $y 5/12/2008 5 5 INDUSTRIES INC. 7 5 J i Id Tent Identification . 5 r = EVANSVILLE, INDIANA 47725 5 5 � - 5 Pt40.t MANUFACTURERS OF THE FINISHED 046►8268 lj TENT PRODUCTS DESCRIBED HEREIN 5 5 This is to certify that the materials described have been flame-retardant treated 5 55 (or are inherently noninflammable) and were supplied to: 5 5 657150 PETERSON PARTY CENTER INC 5 5 139 SWANTON ST 5 5 5 WINCHESTER MA 1890 5 S P T 5 5 5 Certification is hereby made that: 5 The articles described on this Certificate have been treated with a flame-retardant approved 5 5 chemical and that the application of said chemical was done in conformance with California S S Fire Marshal Code. All fabric has been tested and passes NFPA 701-99, CPAI 84, ULC 109. 5 SSerial # 5 5 8108985 Q) 5 5 5 Description of item certified: 5 5 5 CENTURY MATE EXPANDABLE END 5 40WX20 SNYDER WHITE VINYL 5 Flame Retardant Process Used Will Not Be Removed By , 5 Washing And Is Effective For The Life Of The Fabric 5 S YDER MFG NEW PH I LADE LPI-I IA,OH Signed: 'W 5 Name of Applicator of Flame Resistant Finish ANCHOR INDUSTRIES INC. 5 0 rJ�rJ�rPr�r�rJrJ�c�_f"t�cJ�rPGPrPrJ��P�Pr1�cPrlrJ�r��PrJ�r�r�r�r fc_(rJ�rJ�r�r1rJ��PcJr�rP�PrJ�r��cP�PrJ?cfcPrJ��P�P�P�.f�rJ�rJ��PrJ��P�P�PrP�P�PcPr�r��P�r�rJ�cfrPrJ�r�rPrJ� C] ,. ...... _...vim.._ ..._.C. , .....,,... . ._._c._....._l� ._.._.._._.u,..eJ}.r:..:t.:......__� ........>.....v....�v........ s �•C.__.��._ {.f .Y' i4.1. > IMPO RTAN T ®O C U M E N T���������������� .' v5 5 Certificate of- Fla e AResistapee S 5 5 REGISTRATION ,ISSUED BY 4 5 � Date of.Shipment 5 4 5 5 APPLICATION siloi2oos 10, ;�NUMBERRIE INC. 5 Tent Identification 5 5 EVANSVILLE, INDIANA 47725 S k. 5 F140.1 MANUFACTURERS OF THE FINISHED 04278316 5 TENT PRODUCTS DESCRIBED HEREIN 5 This is to certify that the materials described have been flame-retardant treated 5 h S (or are inherently noninflammable) and were supplied to: 5 657150 5 i. 5 P39 SWAONTON STY CENTER INC 5 5 5 5 'WINCHESTER MA 01890 5 � 5 5 5 Certification is hereby made that: 5 5 The articles described on this Certificate have been treated with a flame-retardant approved 5 5 chemical and that the application of said chemical was done in conformance with California S 5 Fire Marshal Code. All fabric has-been tested and passes NFPA 701-99, CPAI 84, ULC 109. S SSerial # 3103975(2) 5 5 5 5 Description of item certified: 5 5 5 CENTURY MATE EXPANDABLE MIDDLE 5 40WX20 SNYDER WHITE VINYL 5 5 Flame Retardant Process Used Will Not Be Removed By 5 5 Washing And Is Effective For The Life Of The Fabric C 5SN YL)P 2 LdEC4 NEW TT AnELPHIA,QW Signed: -�---� � � � 5 Name of Applicator of Flame Resistant Finish ANCHOR INDUSTRIES INC. 5 • � [1�r�[PrJ�[PAP[PcPrJ�r�r��Pr�rJ�r�[Jfl�rJ�rJ�r�rJ�[J�r�[P�Pr�r�cPrJ�r�r�[PrJ�rJ�r�[.rrJ�rJ�rJ�rJ�rJ��Pr.J�rJ�rJ�rJ�rJ�rJ��P[n[PrJ�r.Pr�rJ�rJ�rJ�rJ�[n[P[J�rJ�r�r�[P[l[J�rJ�[PrJ�r.lrJ�r1� 0 o rJ�rJ�rJ�r�rJ�rJ�r�rJ�r�rJ�rJ�r_PrPr f�rJ��Pr JiIMPORTANT i?frPr�r PrJ�r�rJ�rJr�rPr��PrJ�r_frPrJ� O 5 - f S S 5 5 5 ' ISSUED BY Date of Shipment 5 REGISTRATION a S S NUMBER �� 5i12i2oos 5 - INDUSTRIES INC. EVANSVILLE, INDIANA 47725 Tent Identification T F-140.1 MANUFACTURERS OF THE FINISHED 04618268 55 TENT PRODUCTS DESCRIBED HEREIN 5 This is to certify that the materials described have been flame-retardant treated S 5 (or are inherently noninflammable) and were supplied to: 5 657150 5 5 5 PETERSON PARTY CENTER INC S 139 SWANTON ST 5 5 - S WINCHESTER MA 1890 5 5 5 5 S 5 5 5 Certification is hereby made that: 5 S The articles described on this Certificate have been treated with a flame-retardant approved 5 5 chemical and that the application of said chemical was done in conformance with California 5 S Fire,Marshal Code. All fabric has been tested and passes NFPA 701-99, CPAI 84, ULC 109. c5� SSerial # 5 5 8108985 c2, 5 5 Description of item certified: 5 5 5 5 CENTURY MATE EXPANDABLE END 40WX20 SNYDE Z WHITE VINYL 5 Flame Retardant Process Used Will Not Be Removed By 5 5 Washing And Is Effective For The Life Of The Fabric 5 5 S YDER MEG NEW PHILADELPHIA,OH Signed: 5 Name of Applicator of Flame Resistant Finish ANCHOR INDUSTRIES INC. 5 H2rU� �1, ArcAlvr/c AVEr o7 0 �0 ® Y ' o p 0 ®0 o J I.A.4a4MS co--T k'tt S,i p� SCC tiar- �ft;� ABui"akr �,1,..-•-�c 4� e��•_���}�-L,n it��u�fir.���r�f� J Shiiver ...addition. . Continued from page l What made this enforcement.order. .Appeal of the enforcement order can =stand out from the pack.was the.loca ;_.be made in the Barnstable County Su- place 33 feet from the bank tion of the work, and the:fact that rt ,_orior Court,.but:that is not likely to The minimum distance allowed un- _:was issued to the Kennedy clan be- _happen unless the two sidesfait to :.,.:der the rules is 50 feet unless the con= cause the addition was twice as big.in:;',aeach:agreement,on a solution to the servation commission issues a waiver 'reality as it:was on paper: ;conflict.,:. from the rule,which is what happened- Enforcement orders.are issued:on .5,'. he site in question includes"2.59 in this case. average about once a:.week.in_.town, .:acres:of land with two buildings;the. "You have to judge each case on with 60 having been issued'in 1995;":;;land is assessed at$488,300 and'the what is being done in the resource .waivers are also issued fairly.regu buildings are assessed at$520,700 and area,"commission member Jim West larly,West said. $.IO 700,.with an accessory feature ,.:.,.explained. y:.: r, ;, - _ Other issues mentioned by:Munson assessed.at $8,000, for a total of .West and his colleagues are now, :.:in her report.were:the permit awarded,.i$1,119,700 s - awaiting a new plan to be submitted .,for the mork.had expired May-18;And. _,,.And,what:ended.up happening at. for its next-meeting y = :staked haybales were not used to pro Ethel Kennedy's houses t "It's dead in. the water until mct the shoreline during construction. ;;The roofer came.in the next day, (Jaxtimer) is through with conserve. Shriver was given until October 4 to tpok:out a`peimit..and.the work re lion,"Crossen said. submit,new plans �, � �,� snored,.Crossen said. 1. • y.g .. r.11f vJ„� 4�.Y.L"[JSIr :i _•AUt'.1'W7.� �:.L �c l; :it.. " I A-6/CAPE COD TIMES SATURDAY,SEPTEMBER 14,1996 rive ' M -stopped - b w tow.11 I i \ By PAUL GAUVIN STAFF WRITER HYANNISPORT = Construc- tion of an addition has been tem 3 porarily terminated at a property staff Photo by sTEVE HEASUP controlled by Arnold "The Ter- hay-bale dikes.. proval from the conservation minator" Schwarzenegger's The large white house sits atop commission." mother-in-law, Eunice K. a knoll with•panoramic vistas of Munson said yesterday the Shriver, because the town con- Vineyard Sound, Squaw Island, conservation commission had tends it is larger than allowed. extensive marshlands and part of agreed to allow a 10-foot addi- a The Shriver •A source who did not want to. the Hyannisport Golf Club. tion. The one built extends 20 house on be identified said the addition In addition to the conservation feet and,is now 23 feet from the Atlantic Ave.in was to accommodate the grow department's enforcement order edge of a coastal bank where -Hyannisport. ing Shriver family.. Actor issued with the citation,building generally a 50-foot buffer is-re- Officials Schwarzenegger is married to inspector Ralph Crossen has is- quired,Munson said. contend the television reporter Maria Shriver sued a stop-work order. The conservation division's en- addition is. and they occasionally visit the In a letter delivered by.hand to forcemeat order requires the larger than Cape to sail out of Hyannisport builder Ernest J.Jaxtimer yester- contractor to erect the hay-bale initially Yacht Club. day, Crossen said the contractor dike, add clean fill to ground specified,and Barnstable conservation agent . . . exceeded the scope of the eroded in the area,file a new no- exceeds Darcy Munson forwarded a cita- building permit issued on March tice of intent with new engineer- conservation tion with a$100 fine yesterday to 19, 1996, by building a much ing plans and show where the ad- commission Eunice K. Shriver Kennedy En- larger addition than that shown dition exists as built. guidelines. terprises in New York City. on the plans you submitted." The town contends an addition Jaxtimer's office said yester- Barnstable assessor's files list to the Shriver house at 31 Atlan- day he could not be reached. the house under the name Eu- tic Ave. exceeded limits set by To lift the stop-work order,the nice K. Shriver, trustee. The the conservation commission, contractor will be required to house, a short walk from the was built under an expired order: provide an "as-built of the addi- Kennedy Compound,sits on 2.95 of conditions and failed to pro- tion on a site plan; a foundation acres and is assessed at $1.104 tect surrounding pristine envi- plan; a set of plans that match million. It includes an additional ronment by erecting required what was built; and a new ap- •63-acre lot valued at$270,300. i q(GH/WORLD �►5 iA J.S. • D agents �• the first g for s in B sent to in Bosnia. I I vtIons go well, `nost U.S.troops k: , e by Christmas. altl ,x roops since the first eeks of their Security team to f M ' ' resident rie day that is going .,:���" > ,� ' k � �, protect p reak us,"said Har- is stationed at this THE ASSOCIATED PRESS in a former meatar in Bosnian Serb ter- WASHINGTON — U.S. security agents flew on a to soldier in Bosnia re- _��� � ,x g P secret mission use every soldier,in to Haiti yesterday to help protect ¢ z3: President Rene Preval whit h re- one e e e or organizes his personal security one in the NATO n g P Y ` Bosnia with a mili- q force,U.S.officials said. mind. But it is one Members of Preval's civilian U.S.- h trained Presidential Security Unit 's impressive day how v f are suspected of involvement in a pressive show series of politically motivated as- sassinations,said the officials,who lit ultimately may a spoke on condition of anonymity. loyment's future.. u; In the most recent attack, two O preparations for In politicians were is event in Bosnia gunned down on Aug.20. us countrywide re- Preval, who was inaugurated in o civil war,in 1992 February,inherited a palace guard 3 extensive and de- made up of agents loyal to his pre military operation decessor, Jean-Bertrand Aristide. e He has been eager to undertake a r ASSOCIATED PRESS reorganization but has been fear- nth just to educate Liberia relief ful that doing so could jeopardize I could begin ap- g J P soldiers about the ■A Liberian woman carries her daughter along the roadside in Tub- his security, one U.S. government Capt. Greg Ander.- manburg, Liberia,yesterday. U.N.workers resumed aid convoys to source said. s planning officer the area,50 miles north of capital,Monrovia,after factional fighting The U.S. security team is made overn, a U.S. base between rival militias cut off supplies of food,bringing hunger to the up almost entirely of State Depat. tpqted own of population of 35.000.Dozens have starved to death r I ment agents. An official said t 1tF�`nx�' °,' c a'�"' _ �1 '4 s. j �` �.. ?,.�;i� te�+r,, • t .. v .. JnSpector sto s% .nriver c� iioirn ' ti�4i '�::iW7 -By Jeff Blanchard If this ,;'were an Arnold 1 4. - . Schwarzenegger movie, it might be I called"The Cease and Desistor,"and C - e Ralph Crossen would be the one vow- g,"I'll be back:'" .. . - Crossen,the town's building inspec- tor,recently issued a stop-work order on the Shriver family home because_a building addition was twice as exten- sive as the permit allgwed. And how did Crossen come to dis- cover the violation? ..r. .He was around the corner at Ethel . :Kennedy's house, parrof the fabled ....Kennedy Compound,slapping a stop- _ work order on an.unpermitted roof job - there,when"someone tipped him off _ '; to the illegal. construction..at the.. - Shriyers,he told The.Barnsfable.Pa-.*! - - r 'otyesterday. Once he got.to the Shrivers,he iaid ` to'himself,"Wait a rmnute,that's aw w • , - fully tight to the coastal bank;'and so iy, he notified Darcy Munson of the Con- -*rvation and Natural Resources De ; Munson,"the,Barnstable conserva- » . 'ftton eufdreement-officer, issued an"+ t eof o rc e'e o September 13 that m nt rder included a$10O fine and a demand for- new plans on a building project at the , 1,, ' Shriver house on Atlantic Avenue,in - Hyannisport. The house is owned by Eunice Shriver, sister of the late President . John F.Kennedy and mother of Maria . F '" Shriver,wife of Schwarzenegger,the;,.. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map ` Parcef'0 Applicatign # Health Division Date Issued 3 Conservation Division Application Fe Planning Dept. Permit Fee Date Definitive Plan,Approved by Planning Board Historic - OKH Preservation / Hyannis Project Street Address -3/ : ,4-11a t c- Zl_G Village 54 o c Owner_ S rz lyeK", Address Telephone S0 7 7,!- 7/77 Permit Request ?-O Z!�Wlenc . a 5�U x �o d w on &&7 aVelge Square feet: 1'st floor: existing proposed 2nd floor: existing proposed. Total new Zoning District Flood Plain Groundwater Overlay . (lw Project Valuation Construction Type _.. Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. 9 ry Dwelling Type: Single Family. Two Family ❑ Multi-Family(# units) - co Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new 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 T,q ryr►ly Ida nTY APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name ,06 atna a /-KJrn aw/ /%'/9 K (R 7� �'Y Telephone Number 750- Address /--'1 .5&t,44'7 Y4r -S License LOl hc_kP5 A6, !J/ f'?0 Home Improvement Contractor# Worker's Compensation # 1/3G C ALL CONSTRUCTION DEBRIS ESULTING FROM THIS PROJECT WILL BE TAKEN TO / n of / S7 SIGNATURE DATE FOR OFFICIAL USE ONLY . $ APPLICATION# - r S DATE ISSUED I S i rE :MAP l-PARCEL NO. ADDRESS VILLAGE f OWNER - DATE OF INSPECTION: ._:FOUNDATION. f FRAME ' IF r rINSULAnoN, FIREPLACE f ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL ROUGH ' -" -- FINAL .. r 1110FINAL_BUILDING A,,DAT,E CLOSED OUT: t ASSOCIATION PLAN NO. 2\ Tie Comilfoiz;velZ th of Alas,—,chose is par.FrFvrFt Of IFF.dFts.FF(tlfl.cCl!eeF1e.> to!1, l ei 0 211 x z-r it'it%it'.111ais.-01'I is AVorkers' Conipeilsal-on Ir-,mi'a ace Affidavit: Builders/Contractors,/E ice trici."_ns/3'1t.RIlI% ?= A-Ye--A—i 'a t-Informat"io y Name (Busines Organization'Individual): (/ (�7�P>�s L� //6? Address: City/State/Zip: /I PS s� Phone #: 2 Are you an employer?Check the appropriate box: Ty� of project.,(required): 1.® I am a employer Nwitho�OZ 4• ❑ I am a general contractor and I r, - 1\Te��'corsh action ei":ir. ogees dl a;'..`u; pa r „). 1_:;?'• L';i d tilt s t j-C• ;�aCi:Ql'S Z 1." i l '. listed on the attached sheet. 7. ❑ Remodeling 2.❑ I am a sole proprietor or partner- ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' 9. Building addition [I�To workers' comp. insurance comp. insurance.' ❑ required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions Myself ENTo workers' comp. right of exemption per MGL 12 ❑ Roof repairs insurance required.]1 c. 152, §1(4), and we have no employees. r o workers' 13.©,Other comp. insurance required.] I *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. dditional sheet showing the name of the sub-contractors and state whether or not those entities have $Contractors that check this box must attached an a employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. l anz ah eiiiploj'er that is p;•ovi&,'izg workers'coizzpensatioiz izisiirai,ce for my eiizployees. Below is the policy and job site IF formation. Insurance Company Name: �6L) CJ�(� r�C1�7 k'I i� �fLS• (�'� t Policy#or Self-ins.Lic.#:, //UCC_ (��(0 3O Expiration Date: /U / Job Site Address: / &,,YI C. t—e City/State/Ziir r*n kl l S u nl Attach a copy of the workers' compensation policy declaration page(showing the policy mum er 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. .l do hereby certify under the pains and penalties ofpeijuiy that the information provided above is true and Correct Sianature: Date: Z� Phone#: 7 F/— 7a29- YUv-v Official use only. Do not write in this area,to be completed by city or jowl,official. Cif,'o, Town: L°e,rrri!I..,., Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector S.Plumbing li,s"Pector 6.Other r Contact Person. Phone#: 1 0 }= Massachusetts - Depal"talent of Public �a,dc , Bom-d Alt• Buildinu Reuulations and Standard. Construction Supervisor License 1 License: CS 60219 . MARK TRAINA 33 HANFORD RD STONEHAM, MA 02180 Expiration: 4/27/2013 ( nuui..incr Tr#: 13389 r 3 ti' z A��'� CENT , f FICATE OF LIABILITY f NS(. RANtCEI-SH (MM/DIVYYYY) TIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS 5/2010 ATE DOES NOT AFFIRMATIVELY OR NEGATIVELY ANIEND, EXTEND OR ALTER THE COVERAGEHE CERLDER. THIS THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSUTHORIZE(, [:W:: NTATI`✓E OR PRODUCER,AND THE CERTIFICATE HOLDER. AFFORE POLICIESMPORTA : It the certificate holderis an ADDITIO14AL INSURED, the policy(iesj must be endorsed. If SU6ROGATIOhe terms d conditions of the policy,certain policies may require an endorsement,A statement on this cer ificate docrights to L't�certificate holder in lieu of such endorsement(s), IS , subject h'RUCR _CONTACT Michael Bonacorso °Bonacorso Insurance Agency, Inc. NAfnl (781)273-3200 F 83 Catnbridc= Street (�'c,rro,Ext):_ " E-MAIL - (A,'C,Nol:(761) P.O. Box, 1302 DDRFSS:nike@bonacorsoins.c,;;; C�urlin9 ton CUSTOt,iL-R.ID,a�0003879 URED . - MA 01803 INSURERS)AFFORDING COVERAGE INSURER A-Republ lC Franklin Ins, Co, NAIL Peterson Party Center, Inc, NSURERB_Travelers Indemnity ..__ 139 Swanton Street INSURERc$artford Insurance-Co. INSURER 0: _ Winchester MA 0189,J INSURERE: - - _ . COVcRA. - .INSURER F: F ---- E?,TiF!C,; C f:(Jhr cR. N?�r F E TO CERTIFY THAT 7HE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUKLU NAMED ABOVE FOR THE POLICY p ED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMSONS AND CONDITIONS OFSUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAIDCLAIMS. TYPE OF INSURANCE IN R ti^lVDi AL LIABILITY POLICY NUMBER MMIDD/YYYY MtdfDD/YYYY, LIMITS EACH OCCURRENCE — X COMMERCIAL GENERAL LIABILITY -..- S 1,000,000 A DAMAGE TORENTED CLAIMS-MADE X_;OCCUR X X ICPP 4361629 ;10/9/2010 10/9/2U11 PREMISES"(Ea"occurrence) $ - SOO,000 I + MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY S 1,000 000 GEN'L AGGREGATE LIMIT APPLIcS PER GENERAL AGGREGATE [ 2,OOO,COO ...POLICY X P"O- - - PROCUCTS CO°t-?iCP���� $ 2,GOO, i�t 0 E T LOC _ _._ - AUTOMOBILE LIABILITY - _ $ ANY AUTO I COMBINED SINGLE LIMIT �n �(Ea—accident) $ 1,000,000 B ;ALLOVvNEDAUTOS - - - X X �" 9296R836 • L10/9/2010 I10/9/2011 BI ODILYINJURY(Perperson) $ -' X I SCHEDULEDAUTOS -- j BODILY INJURY(Per accident).s - I _..-_....--..__..__ X 'HIRED AUTOS - - PROPERTY DAMAGE - X NON-OWNED AUTOS ; (Per accident) S - Underinsured motonst EI blr, _ 1,000,000 . X I UMBRELLA LIAR OCCUR - - i Uninsured motons:Bi s I •n;t S 000,OOO EXCESSUAB CLAIMS-MADE EACF(OCCURRENCE $ 5,000,0v0 j r__, DEDUCTIBLE -- i-AGGREGATE $ 5,000,000 A . RETENTION $ 'TO4 X X 43616311 r0/9/2010 �10/9/2011 r"----- i$ A VOR �C( r Nc I AND EhYLOYr_E LIASIU Tl' ; 'bC STATU- $.ANY PROPt1E O,PARTNE°.=XECUTivE Y l k ) } TORYUM ._ C N: - •. -OFFICEcJM_MBER EXCLUDED? �� NIA. _. E L EACH ACCICENT (tyes.doryinNH) WC 4.361630 110/9/20i0 I10/9/2011 5 - _ _500,C.GO Byes, IPTIONunder E.L.DISEASE-EA EMPLOYEE$ DESCRIPTION OF OPERATIONS below --------- soo,eoo C Equipment Floater X BE DETERMINED 10/9/2010 130/9/2011 E L.DISEASE-POLICY LIMIT;$ 500 000 Leased and Rented Equip. DESCRIPTICt;Or Or'ERATi0I1S I LOCATIONS/VEHICLES A.•t:ch AC - !$100.000 Urrot ( ORD 101,Add'riunal Remarks Scneduie,A more space is reyu(red) Evidence of Coverage. — CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE A7DESD POLICIES BE CANCELLED BEFORE THE EXPIRATION DATNOTICE WILL BE DELIVERED IN ACCORDANCE.WITH THESIONS. AUTHORIZED REPRESENTATIVE - - - -. Michael J. Bonacorso INS025(2009o9) The ACORD name and logo are registered marks of ACO:�RO CORPORATION. All rights re a. I ".:..;;.:........ .';,., ,.r •r.!' >sh -+,. i:; .1*'".'" :rip '`^e •x +kza. 4 siiZ.,e... siti^.. .i ..._.:�:..._..._..._ .. ,]�".s'L^';..:3d.•�.'•'".,s"_-..�.. :'..�'.u.e���.i '� �..ay...:�.r.''....+._±,...a......._...G�_•,}�.•._F� .,�,' '.,v5j*"'K° !.:t$' 1.;.. DOCUMENT 5 Ccr of icatc of FlalW RcsistaPce 5 : 5 5 REGISTRATION.. ISSUED BY Date of Shipment 5 R 5 5 APPLICATION �F ° tw%NC.® 09/14/04 5 NUMBER s 5 5 ~ EVANSVILLE INDIANA 47725 Tent Identification Lj rlao.l MANUFACTURERS OF THE FINISHED 03938764 5 5 E TENT PRODUCTS DESCRIBED HEREIN . 5 5 This is to certify that the materials described have been flame-retardant treated 5 5 (or are inherently noninflammable) and were supplied to: 5 5 5 657150 5 5 PETERSON PARTY CENTER INC 5 139 SWANTON ST A 5 5 5 WINCHESTER MA 01890 C55� 5 5 5 5 Certification is hereby made that: 5 5 The articles described on this Certificate have been treated with a flame-retardant approved ' 5 Schemical and that the application of said chemical was done in conformance with California 5 5 Fire Marshal Code. All fabric has been tested and passes NFPA 701-99, CPAI 84, ULC 109. 5 5 Serial # 8108985(2) 5 5Description of item certified: (5 CENTURY MATE EXPANDABLE END 5 5 40WX20 SNYDER WHITE VINYL 5 5 Flalne Retardant Process Used Will Not Be'Removed By 5 5 Washing And Is Effective For The Life Of The Fabric 5 5 5 5 SNYDER MFG NEW PHILADELPHIA,OH Signed: 5 Cj SPECIAL EVENTS DIVISION-ANCHOR INDUSTRIES INC. i.`..ti'�y.l „. "•.:' . t X._,.v[:.5�.'...�... ....._f.�:.._._...:.sri.<......1...... _....,./d.?:._.1............._..i_....w._...v... •��`ie.:..,..er..e .c.� - - ,,_ E o ���������������grrJpLprJrPr�rJ�J�J�prjLlpl-j P�-iI M PORT DOCUMENT 5 Certgf leaW of Fla ' Resistapee S S ISSUED BY S 5 REGISTRATION Date of Shipment 5 o � C 5 APPLICATION s Q® �� 5/10/2006 5 + 5 NUMBER rs NDUSTRIE INC 1 5 ~5 Tent Identification Pj a EVANSVILLE, INDIANA 47725 MANUFACTURERS OF THE FINISHED 04278316 S r-140.I 5 5 TENT PRODUCTS DESCRIBED HEREIN 5 5 This is to certify that the materials described have been flame-retardant treated S C5 (or.are inherently noninflammable) and were,supplied to: c5 5 657150 5 5 PETERSON PARTY CENTER INC S 5 139 SWANTON ST S 5 s 5 WINCHESTER MA 01890 5 5 - S 5 5 Certification is hereby made that: 5 5 The articles described on this Certificate have been treated with a flame-retardant approved S 5 chemical and that the application of said chemical was done in conformance with California 5 C5 Fire Marshal.Code. All fabric has been tested and passes NFPA 701-99, CPAI 84, ULC 109. c5 SSerial # 5 C5 8108975(2) Description of item certified: 5 CENTURY MATE EXPANDABLE MIDDLE 5 40WX20 SNYDER WHITE VINYL 5 5 Flame Retardant Process Used Will Not Be Removed By S 5 5 5 Washing And Is Effective For The Life Of The Fabric 5 SA��'n�R�v1L-G�lE1N PHILALIELP1lIA,C1H Signed: 5 5 5 5 Name of Applicator of Flame Resistant Finish ANCHOR INDUSTRIES INC. 5 � rJ�r��PrJ�rJ�r�r�r��PrJ�r�r�rJ�rJ�rJ�r�rlrlcP�PrJ��clrlr..P�PrJ��.JflJ�r�r�r��PrJ�rJ�rJ�r��PrJ�r�rJ��PrPr��cPrJ�rJ�rJ�rJ��PrJ�rJ�rJ�rJ�rJ�rJ�r�rJ�r�rJ�cP�PrJ��PcPr.J�r�rJ��PrJ�rJ�rJ� O .lY.�a.: :::.. :...: ..�...:.r...x.�u'.h.�;�'_���=�f_...L..+. .;........''�'5..'e.....�u. ':�<l..- .lav`..::•.....-....__-�....-........:J.r.':_..t.-w:.:d ''a^:, .i., _ !'.r �° CJ7Ll CJ2�CPLI�LIU L C:3C:3j J J-CJ�LI0e g I 1 ,V, Y ® R TA N DOCUMENT .L�CPC�CJ7C�CPLPC�C PCPLnCPCPC�C�Gn �° F�' 5 Certificate of `lame slstaPee 5 5 REGISTRATION ISSUED BY Date of Shipment 5 5 APPLICATION a _° � ® ositaioa 5 NUMBER 's INDUSTRIE INC. e x 5 Tent Identification EVANSVILLE, INDIANA 47725 5 03938769 5 fi 5 I-IaO.I MANUFACTURERS OF THE FINISHED E v ENT PRODUCTS DESCRIBED HEREIN r ej 5 This is to certify that the materials described have been flame-retardant treated S 5 (or are inherently noninflammable) and were supplied to: 5 5 657150 5 5 PETERSON PARTY CENTER INC : 5 5 139 SWANTON ST 5 WINCHESTER MA 01890. S - 5Eli 5 5 5 SCertification is hereby made that: 5 5 The articles described on this Certificate have been treated with a flame-retardant approved 5 5 chemical and that the application of said chemical was done in conformance with California 5 5 Fire Marshal Code. All fabric has been tested and passes NFPA 701-99, CPAI 84, ULC 109. 5 5 5 -Serial # 8108985(2) S 5 5 _ 5 _ 5 5 Description of item certified: 5 - 5 CENTURY MATE EXPANDABLE END 5 40WX20 SNYDER WHITE VINYL 5 Flame Retardant Process Used Will Not Be Removed By 5 5 Washing And Is Effective For The Life Of The Fabric 5 5 SNYDER MFG NEW PHILADELPHIA,OI I Signed: `a.a • i 5 SPECIAL EVENTS DIVISION ANCHOR INDUSTRIES INC. •J rJ�Lf"�J"LnLf�cJ�J�cn1rJ�,_.nr�c�SJI���n r,-i n���n n n�..JP.1�1J?nlr��u'�r_I�nf,�n�,n nrJ��nrJ��.PL.n�n�n�n�n�n�n�r-�n�n�n�n�n�nn�nrJ?n�n��nl:.Pr.Pc-�P1�rJ��n l7 0)(60 HILL Qr�r 0 0 ** 0 HILL s�6 oo* J� CJO HQUSE GARAGE HOUSE 04/29/2011 14:49 FAX 781 729 4999 PETERSON PARTY CENTER Q 002 yt Tc�wn of Barnstable T Regmj'aton, services 9.n1�Stl.i-, T,Y�OInY�cF`.Gtilis,Ulr�c7 :i $.uif,tib-ig Division. T.uw l'cYr�•, $uL1.cL1.r.:�t•:daa�nl_�:otigt' , . 20GMajnSm&., F7>en,.iSD•ih U2601, ' ShTrYN'X�q'C'L'.U.:I�labZc.gf><.gS GLbce: 509462-401F, Pi-opera OR°7t'erMuS Can"plete a-ad Sign This Sect-ic)n if U-S ng _ lluildex r.�c r^, a;�;Chi� ;. of•lye sasL�rr J :ti �rcv 1acrebp4utb0.Y:17t .1h L hn)_, in-a t iers=6tive w work'autborizrri'b7 ii its Ind',IL f,j�nnir ap)�1i�:atio��.for; QFo�fi'E:vf141jliP�itM6_SrOt; TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map CeParcel Application # Ot6 Health'Division ` Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/ Hyannis Project Street Address —3 Z At at,4tc. Village /7YG?r1h��lJu2.� Owner 14APW /A 0-1,< Address /!lHT�G ClAhc dhy� Telephone Permit Request 7-0 2EK-ec /0 �X(00' OF f' �l'Y7 f1i/�oL 06,01 /rn Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type bLot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) gAge of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new 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.Z existing .C� ne8 size_ Attached garage: ❑ existing ❑ new size _Shed: ❑existing ❑ new size _ Other`zi' o Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ ' Commercial ❑Yes ❑ No If yes, site plan review# 00 5-1 Current Use Proposed Use _102l0a� AlrI7 74;rn APPLICANT INFORMATION 0 a I✓ - - -- - -----(BUILDER OR.HOMEOWNER) Name Telephone Number 21 7e?-9- y07ro Address h .S License # j�n e Los��o z/d D/ F9U , Home Improvement Contractor# Worker's Compensation #66CaZ//a2S9& 120 9 ALL CONSTRUCTION DEBRIS RESULTIN FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE/i0Ct� DATE t E V t FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL N0. f - ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE A ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING I DATE CLOSED.OUT ASSOCIATION PLAN NO. r The Cottutioltwealth of3fassachusetts i, Deparinteltt oflndustrial Accidents Office of In vestigatiolts 600 Washiltgtolt Street Boston, ;1fA 02111 www.ntass.goildia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers ADDliC2nf Information Please Print Le ibl Nanle (Business/organization:'lndividual): Address: City/State/Zip: /U Ij� !j ,� � � mVT Phone #: 7 /- wag- %vim Are you an employer? Check the appropriate box: . I•[H I am a employer with -;?crZ� 4. ❑ 1 am a general contractor and 1 Type of project (required): 2.❑ employees(full and/or pa * have hired the sub-contractors 6 ❑ New construction I am a sole proprietor or partner- listed on the attached sheet. ❑ 7: Remodeling ship and have no employees These sub-contractors have g. ❑ working for me in any capacity, workers' comp. insurance. Demolition [No workers' comp. insurance 5. ❑ We area co 9. ❑ Building addition required.] rporatlon and its officers have exercised their 10•0 Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL I I.❑ Plumbingre myself. [No workers' comp. C. 152, §1(4),and we have no pairs or additions insurance required.] t employees. 12•❑Roof re airs [No workers' �_ comp. insurance required.] 13.aOther_l•Cf�,� /1-n *Any applicant that checks box+Yl must also fill out the section below showing their workers`opmprnsation policy information. t Homeo«neth who submit this affimust vitindicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. *'Contractors that check this box must attached an additional sheet showing the name Of sub contractors and their workers'camp,policy irifonnasuc i am an employer that!s provldltfg workers'compensation lttsurance or m employees. Below is the o! information. j ypolicy and fob site Insurance Company Name: /XPft, . Policy#or Self-ins. Lic. # C Z, !'01 '� / Expiration Date: Job Site Address: Attach a copy of the workers' coinCity/State/Zip: pensation 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 fine up to S 1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine penalties of a of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office a Investigations of the DIA for insurance coverage verification. 1 d >: x «�«r ««��t under the Pains and penalties ojperfun�that the injormatiotr prorided abov is true and correct Si nature: Phone Date: S o2 aU/U #• Official use onlr- Do not write in this area,to be completed by city or town official City or Town: Issuing Authority(circle one): Permit/License# 1. Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing C Other br g Inspector Client#:635556 PETERPAR2 ACOR®,M CERTIFICATE OF- LIABILITY INSURANCE 4DAE(0MM/DD/YYY)l PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION US[ Ins Sery of MA, Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P O Box 920444 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Needham, MA 02492 INSURERS AFFORDING COVERAGE NAIC# INSURED - INSURER A: Hanover Insurance Company 22292 Peterson Party Center Inc 139 Swanton St INSURER B: Liberty Mutual Insurance Company 23043 Winchester, MA 01890 INSURERC: INSURER D: COVERAGES INSURER E: 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. I 01�AL LTR INSR1 TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION DATE MM/DD/YY DATE MM/DD/YY LIMITS A GENERAL LIABILITY ZBN6482025 10/09/09 10/09/10 EACH OCCURRENCE $1 000 000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED P $300 000 CLAIMS MADE 51 OCCUR MED EXP(Any one person) $5 000 PERSONAL&ADV INJURY $1 000 000 GENERAL AGGREGATE $2 000 000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG s21000,000 POLICY X PRO- JECT X LOC A AUTOMOBILE LIABILITY AMN6398554 10/09/09 10/09/10 COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $1,000,000 ALL OWNED AUTOS BODILY INJURY $ III X SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY X NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG E A EXCESS/UMBRELLA LIABILITY UHN6482021 10/09/09 10/09/10 EACH OCCURRENCE $5 000 000 X1 OCCUR CLAIMS MADE AGGREGATE $S 00O 000 - $ DEDUCTIBLE $ RETENTION $None $ B WORKERS COMPENSATION AND WC2Z11259.617029 10/09/09 10/09/10 X we sl IMIT oTH- - EMPLOYERS*UABIUTY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $500 000 OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $SOO OOO Des.describe under SPECIAL PROVISIONS below OTHER E.L.DISEASE-POLICY LIMIT S500 0OO nESCp!pnnN OF OPERATIONS I LOCATIONS I VEHICLES I FYQI USIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL fin_ DAYS WRITTEN I NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHA'L i IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. - AUTHORIZED REPRESENTATIVE - ACORD 25(2001/08)1 of 2 #S4312552/M4063373 BJECG o ACORD CORPORATION 1988 �IaN AmNett:, - Ucllact'fi - i►t PUI)Ill' salCt\ foam! (it' Bitilcling Rc<-uiatic►nx and Standards "' Construction Supervisor License ' License: CS 60219 Restricted to: 00 MARK TRAINA 33 HANFORD RD STONEHAM, MA 02180 Expiration: 4/27/2011 ( immi.simier Tr#: 14425 i . - . �+ms 7►.Catse.��� Bts(j���1�bSi Itto 1ti�, t own"�1'�UiiL Coz1ftte gad Sip This zcc dau if Laing A"r �_.5�-.��yE•f.�`�°'f�l'Z' ,a O.—.�cF tic ctis�;rece�`vp'�,� ' ® r, of Jvprrtf f _ s,k.. .�r 4/f,r. .i>'�t t t T f aft �'d J' sl�k'�.r ',+.�i •,Y. _ _ _ _4". �a^+4..e;a .d. i�;�s J..w,� ..h x , 0 �P�nr P�n�nr�rJ�rJ�rJ��nrJ�rJ�rJ��PrJ�rJ��fi IMPORTANT DOCUMENT�r prr Jr3j: ��nrJrJ��PnrJ�crcPcrr rrJr_ o 5 Ica �f lam 5 �T 5 REGISTRATION ISSUED BY 5 , Date of Shipment0 APPLICATION 5 NUMBER is101o� E3 i� 5/10/20065y 5 EVANSVILLE, INDIANA 47725 Tent Identification ;. 5 MANUFACTURERS OF THE FINISHED 04278316 5 P 140.I 5 TENT PRODUCTS DESCRIBED HEREIN 5 � 5 This is to certify that the materials described have been flame-retardant treated 5 . 5 (or are inherently noninflammable) and were supplied to: 5 5 657150 S 5 PE ER OT PARTY CENTER INC �j ON ST 5 ;r 5 WINCHESTER MA 01890 Pj 5 b- P 5 S � • 5 5 5 Certification is hereby made that: 5 } r, SThe articles described on this Certificate have been treated with a flame-retardant approved 5 chemical and that the application of said chemical was done in conformance with California S 5 Fire Marshal Code. All fabric has been tested and passes NFPA 5 701-99, CPAI 84, ULC 109. 5 C Serial # 5 ; 5 8108985(2) 5 F Description of item certified: 5 S 5 CENTURY MATE EXPANDABLE END t 5 40WX20 SNYDER WHITE VINYL 5 r� 5 Flame Retardant Process Used Will Not Be Removed By 5 , } f• 5 Washing And Is Effective For The Life Of The Fabric 5 5 Q11,,V„ga nQr4�Pltt ,Eut signed: Name of Applicator of Flame Resistant Finish ANCHOR INDUSTRIES INC. 5 i rJ�rJ�rJ�r1rJ�rJ��PrJ�rJ�rJ�rJ�rJ�rJ�rJ�rJ�rlr�rJ��Pr�rJ�rJ��PrJ��PrJ�r.PrJ�rJ�c1�rJ�r_PrJ�rJflJ�r�r�rJ��PrJ��PrPrJ�r�rJ�r.PrJ�rJ�rJ��PrJ�rJ�rJ�rJ�rJ�rJ��PcPrJ�rJ��PrJ�rJ��P�P�.PrJ�rJ�rJ�rJ�r.PrJ��.P O . f r �,-a�: �7.:.�:. �fz �i$"'," - _ - . .•*r v 'z^". •.%r.'. ;t .7bsa.'. f" Eat ;� o ��Pr�r�cfr��rJ��PrJ�rJflJ�rJ�r�rJ�rJ�rJ IMPORTANT DOCUMENT �P�PrP�PrPrJ�rJ�rJ�r�rJ�r PrJ�r�rJr3P .: 4 5 Certificate of Ala esis ee 5 z� 561st ' SREGISTRATION ISSUED BY 5 APPLICATION Q ' Date of Shipment 5 � S �*r 5 NUMBER z INout+°srae 5/10/2006 , 5 " Ide ntification entification 5 r EVANSVILLE, INDIANA 47725 5 MANUFACTURERS OF THE FINISHED o4z78316 5 F140.1 TENT PRODUCTS DESCRIBED HEREIN 5 5 is to certify that the materials described have been flame-retardant treated 5This 5 (or are inherently noninflammable) and were supplied to: 5 � ; 5 657150 . S 1PETERSON PARTY CENTER INC 39 SWANTON ST 5 WINCHESTER MA 01890 5 5 5 5 5 4' 5 a 5 Certification is hereby made that: 5 , 5 The articles described on this Certificate have been treated with a flame-retardant approved 5 5 chemical and that the application of said chemical was done in conformance with California 5 5 Fire Marshal Code. All fabric has been tested and passes NFPA 701-99, CPA[ 84, ULC 109. 5 5 Serial # 5 y 8108985(2) 5 t 5 eS�I 5 Description of item certified: 5 CENTURY MATE EXPANDABLE END 5 5 40WX20 SNYDER WHITE VINYL 5 ` 5 Flame Retardant Process Used Will Not Be Removed By 5 ' ' 5 Washing And Is Effective For The Life Of The Fabric 5 - 5 c 9 _/4 --- r4 5 �rvnB�A4�C NEW 1?1=IIbr1� SIbP�I,t�,9�I ned: Name of Applicator of Flame Resistant Finish � PP ANCHOR INDUSTRIES INC. . � [J�[P[.fry[P[1[P[P[nrJ�[J�r�[.P[�rJ�rJ�i�c.l�[J�[J�rJ�rJ�rJ�[.PrJ�r1r.P[.f[J�[J�[J�rJ�[J�rJ�[J�r�rlr�[PrJ�r.P[J�[J�r�[J�rJ�rJ�[_f'rJ[P�P�PcPrJ�cl[P[J�[Pry[J�[.J�rJ�[.fcPcP[_f[.fC.fCPCJ�rJ�[P[1� � a :, �4 `,t ;... ..1 4.�i« ,.;;.;sr€}*`.j.;ra✓ 9T «`r, ' Q4 '+y; ,.,,r•�zrr;. �". _ ''i� ;�<'� �..l } __j 1, IMPORTANT DOCUMENT���������������� 5 rtifleate of �a esista ee Ce 5 ISSUED BY 5 Date of Shipment 5 REGISTRATION � ® R 5/`12/2008 .y,. NUMBER INDUSTRIES INC. ti tifi t Ide ntification 5 , r EVANSVILLE, INDIANA 47725 t rlao.l MANUFACTURERS OF THE FINISHED 046I8268 ? Oj TENT PRODUCTS DESCRIBED HEREIN 5 1 i 5 This is to certify that the materials described have been flame-retardant treated 5 5 (or are inherently noninflammable) and were supplied to: ftti ,h sr�, 657150 5 PETERSON PARTY CENTER INC 01 5 139 SWANTON ST 5 WINCHESTER MA 1890 S 5 4$- S i 5 Certification is hereby made that: SThe articles described on this Certificate have been treated with a flame-retardant approved 5 5 chemical and that the application of said chemical was done in conformance with California 5 Fire Marshal Code. All fabric has been tested and passes NFPA 701-99, CPAI 84, ULC 109. 5 �, 5 5 Serial # 5 ; s 10s975(2) 5 ` 5 Description of item certified: 5 r 5 CENTURY MATE EXPANDABLE MIDDLE 40WX20 SNYDER WHITE VINYL 5 Flame Retardant Process Used Will Not Be Removed By 5 S Washing And-Is Effective For The Life Of The Fabric 5 SNYDER MFG NEW PHILADELPFIIA,OH Signed: Name of Applicator of Flame Resistant Finish ANCHOR INDUSTRIES INC. 5 O r_!-�PrJ��PrJ�r�rJ�rJ��PrJ�rJ�rJ�rJ�rJ�rJ�rJ�rJ�r�r�r�rJ�r l��r��PcJ�r�rJ�cPrJ�rJ�rJ�rJr�rJ�rJ�r�r�rJ�r�rJ�rJ�rJ�r�rJ��PcPrJ�rJ�rJ��rJ�r Pr��P�P�PrJ�rJ�rJ��PrJ�rJ�rJ�c l�r�rJ�cPrJ��PrJ�J�cP r { _ TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Ma Parcel: 06 _ p Application # ! J Health Division Date Issued Conservation Division Application Fee Planning Dept. _ Permit Fee Date Definitive Plan Approved:by Planning Board Historic OKH Preservation/Hyannis Project Street Address / /47-44 4 4 VJ Village HYr4/1/I�ot.P IUD Owner -WRI415,0Z Address 31 0177,0^Zzr jpy� Telephone_ Ss5-.37y—"33 Permit Request"i4 f M&IMIr 410V AfAwi / fit���✓G y 7Z 31 A7z,4wT7t ,4✓f- Square feet: 1 st floor: existing proposed 2nd floor:existing proposed Total new � Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type ' Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) P Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new 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 NW ��/ (BUILDER OR HOMEOWNER) .14 Name /17720GAKI NIP7Y e54e W— Telephone Number 7y!- 7i9- Address /3f _?,Wdn/721*V jr, License# GS Dbe W,1A140VfJ77- 4 AW p/� Home Improvement Contractor# Worker's Compensation #i*e 7 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 44& SIGNATURE DATE 4 t FOR OFFICIAL USE ONLY APPLICATION# ' DATE ISSUED MAP/PARCEL NO. i . ADDRESS VILLAGE °r OWNER ' DATE OF INSPECTION: FOUNDATION FRAME INSULATION i FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL r GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. r N C z P�4©G3©O© May 12, 2009 Town of Barnstable Building Department 200 Main Street Hyannis, MA 02601 Dear Jen: A we discussed by phone yesterday, the Best Buddies event originally scheduled at 111 Irving Avenue has been moved to 31 Atlantic Avenue. I have attached the documents you requested. Please contact me with any questions. Thank you, Jayne Diamont Customer Service Manager 139 Swanton Street Winchester,MA 01890-1918 Tel:781-729-4000 • Fax:781-729-4999 • Email:sales@ppcinc.com www.ppcinc.com IMPORTANT D O C U M E N T s Certificate of flame 'Rol5ta urr 5 ISSUED BY 5 5 REGISTERED 5 APPLICATION o- NOR® w Date of Manufacture 5 5 NUMBER 10, 15 TTRIES INC. 5 EVANSVILLE, INDIANA 47711 Order Number 5 5 F 121.4 E MANUFACTURERS OF THE FINISHED 5 5 TENT PRODUCTS DESCRIBED HEREIN This is to certify that the materials described have been flame-retardant treated r5� 5 (or are inherently noninflammable) and were supplied to: 5 5 657150 J 5 PETERSON PARTY CENTER INC 5 C� 139 SWANSON ST - 5 5 • WINCHESTER MA 01890 5 5 Certification is hereby made that: 5 5 The articles described on this Certificate have been treated with a :flame-retardant approved 5 5 - chemical and that the application of said chemical was done in conformance with California Fire - 5 Marshal Code, equal to exceeds NFPA 701, CPAI 84, ULC 109. 5 5 The method of the FR chemical application is 5 5 Serial #: 8025000(I) 5 5 5 r Description of item certified: 5 5 5 5 FI EXP TOP 30W X 30 VL W W _ 5 - Flame Retardant Process Used Will Not Be Removed BY S 5 Washing And Is Effective For The Life Of The Fabric 5 5 . 5 5 JOI-IN BOYLE STATESVILLE NC Signed: 5 Name of Applicator of Flame Resistant Finish TENT DEPARTMENT—ANCHOR INDUSTRIES INC. 5 5 5 o PPPPPPPPPPPPPPffff IMPORTANT DOCUMENT pPdL E Lpr L;LPQLJ[3 da o 5 -t�e of F la - ARes is ce 5 5 Certificate me t 5 5 REGISTRATION ISSUED BY 5 Date of Shipment 5 APPLICATION Q �" osiosioa 5 5 NUMBER = INDUSTRIE INC.® 5 r 5�i EVANSVILLE, INDIANA 47725 Tent Identification 5 . 5 M*a 5 p 03850284 F14 .1 'y MANUFACTURERS OF THE FINISHED 5 0 c S TENT PRODUCTS DESCRIBED HEREIN - 5 5This is to certify that the materials described have been flame-retardant-treated 5 (or are inherently noninflammable) and were supplied to: 5 5 657150 PETERSON PARTY CENTER INC 5 5 .139 SWANSON ST 5, 5 5 5 WINCHESTER MA 01890 5 5 5 , 5 5 5 5 5 Certification-is hereby made that: 5 5 The articles described on this Certificate have been treated with a flame-retardant approved 5 5 chemical and that the application of said chemical was done in conformance with California 5 5 Fire Marshal Code. All fabric has been tested and asses NFPA 701-99, CPAI 84, ULC 109. 5 S5 p 5 Serial # 8108975(2) SDescription of item certified: 5 CENTURY MATE EXPANDABLE MIDDLE 40WX20 SNYDER WHITE VINYL S 5 Flame Retardant Process Used Will Not Be Removed By 5 . 5 . Washing And Is Effective For The life Of The Fabric 5 5 SNYDER MFG NEW PHILADELPHIA,OH Signed-- SPECIAL EVENTS DIVISION-ANCHOR INDUSTRIES INC. 5 0jQg�r ,J-[J�cP�l�rJ�[J�[J�cPr�[J�cPr��PrJ�r�cJcPr�r�cPrJ�rJ��Pr��Pr PrJ�cPrJ�rJ�cP�P�l�r PcncP�tcPrJ�tJ�r��P��PrJ�rJ�rJ�rJ�[f[P�frJ�c1��f�rJ�rJ��P�PrJ�c l�rJ�rl�Pr�cP�fr�rJ�r�rJW ED IMPORTANT DOCUMENT i?PrJ�rJ��P�PrJ�rJ�cl�cPrJ�rJ�rJ�oPrJ�rJ�rJ� o 5 Certif lea#k>, of Fla Resi -stance s S REGISTRATION ISSUED BY 5 Date of Shipment 5 APPLICATION S 5 NUMBER NDUSTRIE�ING� 8/28/2006 5 VANSVILLE INDIANA 47725 Tent Identification 5 5 MANUFACTURERS OF THE FINISHED 043J7696 5 5 r 5 5 140.1 TENT PRODUCTS DESCRIBED HEREIN 5 SThis is to certify that the materials described have been flame-retardant treated 5 (or are Inherently noninflammable) and were supplied to: 5 , S 657150 5 5 PETERSON PARTY CENTER INC 5 a 5 139 SWANTON ST 5 4 5 WINCHESTER MA 1890 _ 5 5 5 5 5 5 5 , 5 Certification is hereby made that: 5 55 The articles described on this Certificate have been treated with a flame-retardant approved c5� 5 chemical and that the application of said chemical was done in conformance with California 5 5 Fire Marshal Code. All fabric has been tested and passes NFPA 701-99, CPAI 84, ULC 109. S 5 Serial # S 5 810898;(2) 5 5 Description of item certified: CENTURY MATE EXPANDABLE END 5 40WX20 SNYDER WHITE VINYL 5 Flame Retardant Process Used Will Not Be Removed By 5 SWashing And Is Effective For The Life Of The Fabric 5 Signed: 5 Name of Applicator of Flame Resistant Finish ANCHOR INDUSTRIES INC. 5 n�n���r o x The Conunonwealth 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 Leeibly Name (Business/Organization/[ndividuai): � �y1m) A1G7zl Address: I-q'9__ City/State/Zip:L(/jI&h/gf 0t— 414 Phone#: 7E-/-7�—l6jjr) Are you an employer?Check the appropriate box: Type of project(required): I.VI am a employer with V/y .4. ❑ I am a general contractor and 1 6. ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7• ❑ Remodeling F 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 an1 a ho!ncowner doir:g all wol k rif7ht of exemption-per A;(�I: 1 1.❑ Plumbin repairs o;addiuons myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' comp. insurance required.] 13.210thei/7,0 9A rfA� Mmvhi *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. 'Cor.±11.tors thzt check this box must attached an additional sheet showing the name of tr,e sub-contractors and thei-w }, policy inf3m-nion. / i??iI a`r Pi?i .Yii)'er /far rs f3TUDr�rt£ 'workers'col: ensa(o"insurance or in empl6 ,ces—. I—ei—ot:.is — i—na—b sitethepolicyr fn�fornraiio;r. insurance Company Name: Policy#or Self-ins.Lic. 177,027 Expiration Date: U o d 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 S 1,500.00 and/or one-year unprisonment,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. Y I do hereby c 'y�udgxt::ins and penalties of perjury that the information provided above is true and correct. Si nature: Date: t Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# 1 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# ' t This certificate is executed by Liberty Mutual Insurance Group as respects such insurance as is afforded by those companies. BM0068 Certificate of Insurance This certificate is issued as a matter of information only and confers no rights upon the certificate holder.This certificate is not an insurance policy and does not affirmatively or negatively amend extend or alter the coverage afforded by the policies listed below. Policy limits are no less than those listed,although policies may include additional sublimits not listed below. Policy limits may be reduced by claims or other payments. This is to certify that(Name and address of Insured) Peterson Party Center Inc Li rtjb e 139 Swanton St Winchester,MA 01890-1918 Mlltuilr. is,at the issue date ofthis certificate,insured by the Company under the policy(ics)listed below. The insurance afforded by the listed policy(ies)is subject to all their terns,exclusions and conditions and is not altered by any requirement,term or condition ofany contract or other document with respect to which this certificate may be issued. —Expiration Type Eff./Ex .Date(s) Policy Number(s) Limits of Liability Continuous* 10/09/2008/10/09/2009 WC7-111-259617-028. Coverage afforded under WC law of Employers Liability Extended the following states: Bodily Injury By Accident X Policy Term MA $500,000 Each Accident Bodily Injury By Disease $500,000 Policy Limit Workers Compensation Bodily Injury By Disease $500,000 Each Person 10/03/2008/10/03/2009 TB7-111-259617-038 General Aggregate-Other than Prod/Completed Operations General Liability $2,000,000 Products/Completed Operations Aggregate HClaims Made $2 000 000 x Occurrence I Bodily Injury and Property Damage Liability Per $1,000,000 Occurrence Retro Date Personal and Advertising Injury Per Person/ $1,000000 Organization Other Liability Other Liability 10/03/2008/10/03/2009 AS2-1 1 1-259617-01 8 Each Accident-Single Limit-B.I.and P.D.Combined Automobile Liability $1,000,000 Each Person X Owned X Non-Owned Each Accident or Occurrence X Hired ' Each Accident or Occurrence Excess 10/03/2008/10/03/2009 TH2-61 1-2596 1 7-068 $5,000,000 BI/PD $5,000,000 Products/Complcted Ops $5 000 000 Gcncral Aggregate C O M M E N T S IMPORTANT If the certificate holder is an ADDITIONAL INSURED,the policy(im)must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endotsemenl(s). If SUBROGATION IS WAIVED,subject to the firms 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 ofsuch endorsements. The following applies only with respect to insurance for motor carriers registered in Florida:As provided for in Fla.Stat.§320.02(5)(e),the listed insurance policy may not be cancelled on less than 30 days written notice by the insurer to the Department of Hwy Safely&Motor Vehicles,such 30 days notice to commence from date notice is received by the Department. Notice of cancellation:(not applicable unless a number of days is entered below).Before the stated expiration date the company will not cancel or reduce the insurance afforded under the above policies until at least 30 days notice of such cancellation has been mailed to: Notice of Cancellation does not apply when policy(ies)are canceled due to non-payment of premium. Office: GlastonblayCT Phone: 860-652-0404 1xa1t fo Certificate Holder: AMY SHAW Peterson Party Center Authorized Representative 139 Swanton Street Winchester, MA 01890 Date Issued: ared B P 10 14 2008 re : EH � � P Y . t i f - r. P i fhpic Board of Building Regulations and Standards --- Construction Supervisor License License: ,CS 60219 Restricted to: 00 XXr' MARK TRAINA � 33 HANFORD RD , STONEHAM, MA 02180 ; -00'- �s Expiration: 4/27/2011 ( Pmmi.si one r Tr#: 14425 ' F �pF SHE sARrrsrASLE, TOWN OF BARNSTABLE, * 9 MASS. iOrFn �" Application Ref: 200901741 - 20090615 Issue Date: 04/28/09 Applicant: MARK TRAINA ` Proposed Use: MULTIPLE HOUSES ONE PARCEL Permit Type: COMMERCIAL TENT Permit Fee $ -25.00 Location I III IRVING AVENUE Map Parcel 287065 Town HYANNIS -Zoning District RF-1 r Contractor MARK TRAINA Remarks TENT FOR BEST BUDDIES TO BE REMOVED ON 6/1/09 Owner: FORD, MICHAEL D TR Address: 330 MADISON AVE-SUITE 280 NEW YORK, NY 10017 Issued By: PR 0 ` _. . POST 'THIS CARD SO THAT IS VISIBLE FRO�VI THE STREET TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION. 4 Map Parcel' l/`b' - Application # Health Division o- ® z Date Issued Oft Conservation Division Application F _ Planning Dept. Permit Fee Date Definitive Plan,Approved by Planning Board Historic - OKH Preservation/Hyannis Project Street Address Z& �^K VI&I 14�C. Village a n/3 too It, Owner Address Telephone Permit Request r�TL Fy�e %s f Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuatda?Zcx) Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach su portinr-bocurnentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King"Z'r_�' ighwaf ❑Yes ❑ No CDJ Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing 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 ok � a'i Telephone Number.*.r C . ��� �d•�- yu� /"' Address C1�1 License#� Home Improvement Contractor# Worker's Compensation #41G 7!///- .S7GI7--6629• ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE / DATE a3 0 i FOR OFFICIAL USE ONLY APPLICATION# ! DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER > t t 3 DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL P PLUMBING: ROUGH FINAL ' 4 GAS: ROUGH `FINAL FINAL BUILDING .e DATE CLOSED OUT ASSOCIATION PLAN NO. s E y) C. r The Commonwealth of Afassachiisetts Department of Lldustrial Accidents Office-of Investigations '600 Washington Street Boston, MA 02111 "" www.ntass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Bus iness/Organization/lndividual):���S�IN Address: /3?_S7,( 71+A/ S� City/State/Zip: ! /&6/a?:r_A_�, yf f)-� Phone#: 79-/-7 [ j Are you an employer?Check the appropriate box: Type of project(required): l.L?"I am a employer with 1/-/V 4. ❑' I am a general contractor and I . 6. ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 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. 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,§1(4),and we have no 12.0 Roof repairs insurance required-] t employees. [No workers' comp.insurance required.] 13.Q�Othcr/�191fbr�If,Yf/ ,� *Any applicant that checks box tI must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 'Contractors that check this box must auachai an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I ant an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company TN'ame: /%?L1711,41-- Policy+or Sclf-ins.Lic. Expiration Date: U p /.Of 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 S 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 tq S250.00 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 enalties of perjury that the information provided above s true nd correct. Si nature: Date: 1- /) Phone#: 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): I 1. Board of Iiealdi 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone# - r Town 4f Bar=CBble if RetuUury s"Am iI 7kv T.calk,D�ncmr • . i " �uii�g I}i*�i�na e _ C=Dpkbc mad Sip Thal -<Cc&u If Uj cag A B r t e£chc t k;ecZ vpa ►s-4 Ifni, e e.-.r, 6 � � jupl, r�t N—ca I f m >. ...... .. ..... ,. .. ,...,.._ - --......_..._<:yt`'ys:w��;�,5°�,yUl?;,.Tt. � ,* ,; boa.,* •� +»� r� n� �,�C9' IMPORTANT DOCUMENT 5 5 S5REGISTERED ISSUED BY 5 5 APPLICATION C 5 Date of Manufacture 5 NUMBER y ' INDUSTRIES INC® 9/15/98 F121.4 7,y s� N,��or f EVANSVILLE, INDIANA 47711 Order Number 5 20420 E 8 5 ta MANUFACTURERS OF THE FINISHED c 5 5 TENT PRODUCTS DESCRIBED HEREIN 5 This is to certify that the materials described have been flame-retardant treated 5 S (or are inherently noninflammable) and were supplied to: 5 5 5 PETERSON PARTY CENTER INC. 5 139 SWANSON ST 5 5 5 WINCHESTER MA 01890 rj 5 Certification is hereby made that: 5 The articles described on this ,Certificate have been treated with a flame-retardant approved a 5 chemical and that the application of said chemical was done in conformance with California Fire ` Marshal Code, equal to exceeds NFPA 701-, CPAI 84, ULC 109. 5 5 The method of the FR chemical application is: 5 5 S (0001) , 5 Serial#: 80015 soo 5 S _ 5 . 5 5 Description of item certified: 5 FI TOP 20W X 30 VL W W 5 5 5 5 5 5 Flame Retardant Process Used Will Not Be Removed By 5 5 R(� Washing And Is Effective For The Life Of The Fabric 5 5FSVirTF;N�`` Signed: ✓ S 5 Name of Applicator of Flame Resistant Finish TENT DEPARTMENT—ANCHOR INDUSTRIES'INC. O rJ�r�r�r Pr��PrJ��Pcl�rJ�rJ�rJ�rJ��PrJ�r��PcPrJ�rJ��rJ�rJ�iJ�rJ�rJ��PrJ�rJ�ePrJ�r�r J�cPrJ��PrJ�r�rJ�rJ�cf�PrJ�rJ�r�r PcJ��Pr��r�cJ�rJ��fr�rJ�rJ��PrJ�rJ�rJ�rJ�rJ�rJ�rJ�rJ�r�rJPcPrJ LPd_L]L]Pd_L:3Pdr PL PLPLPLPrPL PL0 - -.... t -.. .. ..__ ... ., ..._.:.... .:. .... .... '.... ... ..'...-. ,.......:._._.,.J_.Z..,.,:f��5aer�Y........ ..0_.._�..,... 's.L ..�h{ fP i'fV�' o rJ�rJ�cPrJcPcPrJ�clrJ�rJ�J��PcPr�rJ�rJ��fi IMPORTANT ® C T�PrJ�r f�P�PrJ�rJ�rJ��PrprprJPdr3PrJ�rP a °' 5 Certificate of a 'ia esista�ee S - 5 ISSUED BY ( S 5 REGISTRATION a ��� Date of Shipment 5 NUMBER ;i "IF TRIES INC. y No It 5/12/2008 5 5 EVANSVILLE INDIANA 47725 5 5 a Tent Identification S 5 F140.1 ' MANUFACTURERS OF THE FINISHED 04618268 5 5 TENT PRODUCTS DESCRIBED HEREIN S 5 This is to certify that the materials described have been flame-retardant treated ji (or are inherently noninflammable) and were supplied to: 657150 5 PETERSON PARTY CENTER INC 5 5, 139 SWANTON ST S 5 5 SWINCHESTER MA 1890 5 5 5 5 5 5 5 5 5 5 Certification is hereby made that: 5 5 The articles described on this Certificate have been treated with a flame-retardant approved S 5 chemical and that the application of said chemical was done in conformance with California 5 S Fire Marshal Code. All fabric has been tested and passes NFPA 701-99, CPAI 84, ULC 109. 5 5 #Serial 5 5 5 5 8108985(2) _ 5�j Description of item certified: 5 CENTURY MATE EXPANDABLE END 5 5 5 40WX20 SNYDER WHITE VINYL 5 Flame Retardant Process Used .Will Not Be Removed By 5 5 Washing And Is Effective For The Life Of The Fabric 5 5 TSNYDER MFG NEW PHILADELPHIA,OH Signed: -�L------- � 5 , 1j Name of Applicator of Flame Resistant Finish ' ANCHOR INDUSTRIES INC. 5 � rJ�r�rJ�r�rJ�cJ�cPrJ��P�P�.PrJ�rJ�rJ�rJ��PrJ�rJ�rJ�rJ��Pr���PrJ�r=P�.PrJflJ�rJ�rJ�rJ�rJcPr�r�r�rJ��r�rJ�r�rJ�r�cPr�r�rJ�rJ��PrJ�rJ�rJ��rJ�rJ�c1�rJ�rJ�tJ�rJ�r�r�rJ��rJ��P�.PrJflJ��Pr�� 0 S S J l � vow M P O R N: T O `I M E N 5Certiflea e of F a 5-3 REGISTRATION ISSUED BY = 5 APPLICATION Q Date of Shipment 5 yti S f �� 5 NUMBER, s NDUSTNIE wc. 5/10/2006 5 a EVANSVILLE, INDIANA 47725 Tent Identification 5 5 F140.1 aP MANUFACTURERS OF THE FINISHED 04278316 5 5 TENT PRODUCTS DESCRIBED.HEREIN 5 This is to certify that the materials described have been flame-retardant treated 5 (or are inherently noninflammable) and were supplied to: S 5 657150 5 139 SWAON PARTY NTON ST CENTER INC S Z_ 5 4.: 5 WINCHESTER MA 01890 5 :. 5 s, 5 Certification is hereby made that: S 5 The articles described on this Certificate have been treated with a flame-retardant approved S Schemical and that the application of said chemical was done. in conformance with California 5 - 5 Fire Marshal Code. All fabric has been tested and passes NFPA 701-99, CPAI 84, ULC 109., S 5 5 Serial # 5 5 5108975(2) 5 5 5 5 Description of item certified: 5 5 CENTURY MATE EXPANDABLE MIDDLE 5 40WX20 SNYDER WHITE VINYL 5 5 Flame Retardant Process Used Will Not Be Removed By 5 5 Washing And Is Effective For The Life Of The a Fabric 5 5 5 cJ.ivnFa N4PC.tIPW nuTT ADELPHI-A-014 Signed: Name of Applicator of Flame Resistant Finish ANCHOR INDUSTRIES INC. ..: ..... _. .. - .. .., __:J..v.:_ ....w..___ .Y:,tZ,a,..:-..' .......:::...__j�•E8':f`.c��'I_.ii}'.�"ti\......f...lrf.I6'RLAI'��� o rJ�r�rJPJr�cPcPr PLPERJ�rEDrJ�r�r�r1J U a[r7 .PcPcPPr PLPLJrJ�rJ�rJ�rJ�rJ��Pr� a r 211 Certificate o ' S IT ISSUED BY 5 5 REGISTRATION ck,, Date of Shipment. 5 5 . a 5 �+ NUMBER �TRIES INC.`y _ 5/12/2008 5 5 r �-C EVANSVILLE, INDIANA 47725 Tent Identification 5 M� T F140.1 * MANUFACTURERS OF THE FINISHED 04618268 Cj 5 TENT PRODUCTS DESCRIBED HEREIN S 5 5 This is to certify that the materials described have been flame-retardant treated S (or are inherently noninflammable) and were supplied to: S 657150 5 5 PETERSON PARTY CENTER INC 5 5 139 SWANTON ST S 5 5 5 WINCHESTER MA 1890 5 5 5 5 S 5 _ 5 Certification is hereby made that: 5 k SThe articles described on this Certificate have been treated with a flame-retardant approved 5 5 chemical and that the application of said chemical was done in conformance with California 5 I Fire Marshal Code. All fabric has been tested and passes RIFPA 701-99, CPAI 84, ULC 109. S ESerial # 5 5 8108985(2) 5 5 5 Description of item certified: S 5 S CENTURY MATE EXPANDA[3LE END 5 40WX20 SNYDER WHITE VINYL 5 Flame Retardant Process Used Will Not Be Removed By 5 6 Washing And Is Effective For The Life f The 5 5 9 e Fabric 5 5 ej SNYDER MFG NEW OH PHILADELPHIA, 5 Wined: 5 Name of Applicator of Flame Resistant Finish ANCHOR INDUSTRIES INC. 5 0 cPrJ�r��Pr��rJ�rJ�rJ��PrJ�c P�PcPrJ�EP�P�PrJ�rJ��PrJ�r�cPrJL PrJ�rJ�r1rJ�rJ�E3 d_L3 LFL3P[r PL.PL PLrQj-r3Pr�r�CPrJ�r�rlrJ�rJ��PrJ�r PrJ�r.PrJ�rJ�r�r�rJ�rJ�rJ��PrJ��PrJfl3FJ�rJ-rJFE.Pr� O Town of Barnstable Geographic Information System April 15,2008 . LS #21 a r 2870k1 t t f i ... #692 k .?. �g�.287070� ff p20 O Pi O i 287062 _ € � � n#697",�� f �'4287006 t Cn x b. W. G vgP1G " _ 1fi , .., NPi xr e • ' ,, . g-' #143 287066131 F 1 rn �" y'r 287065 5 § G #111 4 287068 ��k flt .' s #151 .. :286017� x �.l #8_ 0,7 '' e , 286018286019 286023 rR y t ..a #60 28,60'14 #26 < #732 t� $ �, _ n a �286020 2286022 86021 l #28 286013 266026 "` kY`y .rs € is.£""• g 0 �39' eet 3 #eo #1, ,�.,� k_ r..,..,..�#A.�.ar.� 1�.,�,•r� . •, -� � ' .�vsv� �� s t _.. � ��er '��»'?2� ^mob.,; �. r-DISCLAIMERS This map is for pla nmg purposes only-it is not adequate for legal Ma P:287 Parcel:065 Selected Parcel undary determinatio for regulatory interpretation.,Enlargements beyond a scale of Owner:FORD,MICHAEL D TR Total Assessed Value:$2077600 rLma OOy not meet established'map acc uracy standards. The parcel lines on this map g�aphlq represeMatlons of Assessors tax parcels. They are not true property Co-Owner:C/O PARK AGENCY,INC Acreage:1.39 acres Abutters ON -. and doriot represent accurate relationships to physical features on the map g l0 to`s ,`" Location:111 IRVING AVENUE Buffer .t a z, � ,a .�:.:�€ �t�Lit• - L'c(�.rs'tri;� rii �,"s �31ic �a�i't� t 13,o rra: Rc�-ulatiort:, and Standards �- = Lonstruction Supervisor License License: CS 60219 Restricted to: 00 MARK TRAINA 33 HANFORD RD STONEHAM, MA 02180 Expiration: 4/27/2011 ( nunisigIner Tr#: 14425 y This certificate is executed by Liberty Mutual Insurance Group as res em such insurance as is afforded by those companies. Certificate of Insurance BM0068 This certificate is issued as a maner of information only and confers no rights upon the certificate holder. This certificate is not an insurance policy and does not affirmatively or negatively amend,extend,or alter the coverage afforded by the policies listed below. Policy limits are no less than those listed,although policies may include additional sublimits not listedbelow. Policy limits may be reduced by claims or other payments. This is to certify that(Name and address of Insured) Peterson Party Centcr Inc 139 Swanton St _ Li�ertX Winchester,MA 01890-1918 - M m is,at die issue date of this certificate,insured by the Company under Ne policy(ies)listed below. The insurance afforded by die listed policy{ies)is subject to all their tents,exclu is not altered by any requirement,tent or condition ofany contract or other document with respect to which this certificate may be issued. sions and conditions and Expiration Tv e Ef JEx .Date(s) Policy Number(s) Limits of Liability Continuous" 10/09/2008/10/09/2009 WC7-111-259617-028 Coverage afforded under WC law of Employers Liability Extended the following states: Ix Policy Term MA Bodily Injury By Accident $500,000 Each Accident Bodily Injury By Disease $500,000 Policy Limit Workers Compensation Bodily Injury By Disease $500,000 Each Person 10/03/2008/10/03/2009 TB7-111-259617-038 General Aggregate-Other than Prod/Completed Operations General Liability $2,000,000 Products/Completed Operations Aggregate Claims Made $2 000 000 Hx Occurrence Bodily Injury and Property Damage Liability Per $1,000,000 Occurrence Retro Date Personal and AdvertisingInjury rY Per Person/ $1,000000 Or anization Other Liability Other Liability 10/03/2008/10/03/2009 AS2-111-259617-018 Each Accident-Single Limit-B.I.and P.D.Combined Automobile Liability $1,000,000 Each Person X Owned X Non-Owned Each Accident or Occurrence X Hired Each Accident or Occurrence Excess 10/03/2008/10/03/2009 TH2-01 1-25961 7-068 . $5,000,000 131/PD $5,000,000 Products/Completed Ops C $5 000 000 Gencral Aggregate O M M E N - T S IMPORTANT If the certificate holder is an ADDITIONAL INSURED,the policytM)must be endorsed A statement on is certificate does nor confer rights to the certificate holder in lieu of such endorsentent(s). If SUBROGATION IS WAIVED,subject to the forms and conditions of the policy,certain policies may require an erdorsement.A statement on this certificate does not confer rights to the certi ficale holder in lieu of such ertdorsemems. The following applies only with respect to insurance for motor carriers registered in Florida:As provided for in Fla"Stal.4 320.02(5xe),the listed insurance policy may not be cancelled on less than to the Department of Hwy Safety&Motor Vehicles,such 30 days notice to commence from date notice is received by the Department. 30.days written notice by the insurer Notice ofcancellation:(net applicable unless a number of days is entered below).Before the stated expiration date the company will nor cancel or reduce the insurance afforded under the above policies until at least 3o days notice of such cancellation has been trailed to: Notice ofCancellation does not apply when policy(ies)arc canceled due to non-payment of premium. Office: Glastonbury CT Phone: 860-652-0404 Certificate Holder: AAIY SHAW Peterson Party Center 139 Swanton Street Authorized Representative Winchester, MA 01890 Date Issued- 10/14/2008- Prepared By! EH 310OMR t0.09 Form 5 0904 Pre No. BE 3-2620 :.,. Ito teaWOV414 DEOE► � t,; Commonwealth G41t Tows Hyanniapor,: of Massachusetts. ssrasr.$' Shriver y rwa Aeolcanl Order of Conditions Massachusetis Wetlands Protection Act G.L. cAi 1, r 40. TM OF BARHSTAeF,B O".1WAIlIcze, AATICLS XXVZI From Barnat*ble C r3ix2illitjan commissign _... . _ ._.— Eunice K. Shriver Z'- To Sai rIfOnt & Eunice Shriver „ Kennedy Enterartses (Name of Applicant) (Name of Property Owner) 100 East 42nd Street, Suite 1850 Address—'New York NY 10221 Addrett8..,...._^ map Nlimb4i 265 Parcel Number 9'1 This Order is issued and deliveredas follows. C.} by hatnd deNvery to applicant or•repre3entative on_,-.- (date) a� by.oefidled mail,return recetot requested on "MAY -1993 (date) . Thts project islocets 8t 31 Atkitic AZaii;.,HyaM,iona .* a' rPt' yt�/�-J" The pmperty i8►erc.Jed at toe Ftegic try of.. in aarvatable Book Page y Certlflcate(it ie9iateredl C 376550 „ The Notice of Intent for this project was filed on % March io. t Qg2 (date) The public heerinq wa3s.closea5'on �y l l, 1993 (date) >. �.� Pindln06 — - ........_. The 8arnetabL eenA8LY8S inn rnw+ 1 onj An has reviewed the sbove•relerenced Notice of Intent end plans and has held scuCbc neOng an the aioiect.Based on the inforrnattion available to the Cotnmieaion et this time.file Commibaien - has 0eteMlined lhat . S ± the,Wee'on which the or000sed worKis to 4e done is significant to the following Interests in accordartics wlth . the PresuMotions of Significance set forth in the regulations for each Area Sub)e'of to Protection Under the Act(chuck N appropriate) O Publie.water supply 13' :Flood control � :Ljindfcontaining shellfish - ❑ Prlvalte..wateraupply C$ Storm damage prevention t Fisheries ,. ❑ ;`Ground water•suop►Y. rgr'.Prevent;un of pollution 0---ProleCt{on of wildlife habitat Total ANng'Fee Submltted $386.00 State Share S180.so CltylTown Sh>trs 205.5 _T rf.IeR in excess of S25) 14181 Refund out S Cityfrown Portion s, _ State Portion ,k xMTICL8=Z7 Oatly� (Ih total) (W teal) Pu lie Trust 'Ri Rights- Agriculture (y}' q ❑ q. .. . (�'8rosioa'Control - C] %q uaculture Reaareata ional sistorio Gj-- letat hatia "Effective 11/10/89. V. Therifore, the sarnstable.conservation commission hereby Undo`-that the following conditions ,are necessary, in accordaoce with 'the °performanoe standards set forth in the regulations, to protect these interests shacked above. The commission orders that.all work shall be..perto=od in ,accordance with said: conditions and with the -Notice of intent referenced above. To the extent that the following conditions modify or differ from the plenei spocificeticns or other" proposals submitted with the Notice of .intent, the conditions shall_ control Genus&A aossditions c 1. ,. aailur• to comply with all conditions stated herein.. and with all related statuteo-„and other regulatory measures, shall be deem*4 cause to .revoke or modify this corder. 9. This order does not grant any property right's or any.exalusive privileges] >at does- not autharise'any injury to".private property 4 or invasion 4 arivate right; . 3- This Order "does not relieve rC'io persnittae or, any other person of ` the nsosasity of complying wfah all other appiYioableJfederal# ' state or local atatutepr .ordiriances,trby�laws'or riquI& Qua fir, q 4 The work au horized,'hereunriir s2i`a l be doa�lated"tiithia threw" years frost-the" date of this':Ceder:uf►lrsiher""oithi folloi�i nq a> The v2rk 'ia a Maintenance ar dq nqL proj©ot _as provided for in. .thw Acts or. by ;['hs ° lme f,or completion has been.'extended-to a ape f ,:d r date more".than: three. y.eors,: but _less'.than five *years, from the":date :,of issuence:.and both that dace and` the:'special circumstances warrant iag �the ext4nd4& tim-period-are set forth in this Order. S. This order.may. ba. extendad..by the issuing authority for one"or more periods .off up to-throe ysiars each!'upoti:apylication to :the issuing authority at least 30 days prior t0..the sicpiraCioa:date o! the.Order.:. 6. Any fill used in"" connection with,`this project shall bo clean fill,. containing no .trash, •-refuse, rubbish or debris,. inaludinq but not limited tot°lumber, bricks..;plaotir, wire, fath, pa 'is r,,rcardboa=d, p 1 pipe, tirs�, `aihes, refri9trator , motor vebicloi os yarts`o>: any 's of the foregoing. No work"shall be undertaken until ally administrative appeal ` periods from this Order have flapsed.orr. if such an appeal .has been filed,} until all roc ed. gs ybetore''tlie`.DopartmOn have been completed. 8.. 'No work shale.' be .undertaken•;until. the 'final order has been recorded in the Registry .of Deeds or the Land court for 'the E0 3E)Vd abOd 'S NCSNIiS Z9980Eb$09 85:90 b66T/LZ/L0 Vl y,''ff' i71i . dirCY.ivt, in wh ®h the land in:located, within the chain of. title of the affected Oronerty. in the cast of recorded land, tea aiaal Order shall. slso be noted is the Registzy•r. Grantor indev. eindsr the name of the owner of the'land upon "Loh the proposed' work is to be done. The recording information shall be sutm►itiod to the commission on the form et the end of this. order prior to coNDAncoment.lf the.work. 9. x sign shall ,be '9isplayed at the site not 1es■ 'than two square test or. more'than-thris square feet in si" bearing the words, •Matsach^ueetts Department of Environmental protection# pile NuMir sz natal protsctio.ft Y.■ requested to 1 0 ` Nher• the Department of tnvironmo 'make a determination and to. is■ue a superseding'Ordor, the eonsorvation .Commission shall be & .party to all agency proceedings and hearingsiefore. the Department. !. Upori•rompletion of the work described hereihl the applicant shall fortihwith request in •�rritin ah®t'.a certific��► o! Con+pliance b. x a •�,. � leted. 4tating that the vork_ has b oa:tatirt%atorily comp oriin lane Nand special 11.4 �r Thawork e�iall .aOnfOrati t0 the loll g P ��, , � t ' ��oanditions.•• . W2 MnH.J (1)+na IR WngWT iG T99RQFb8G1q " `89.90 ti6EL%LZ/L0 i AM. Av r�.�'�4�7ixt+•i�gre"M'4` +�, �.±.� ..,t�i a ����`� '�t,#`�" �P £'t✓dl;.a"q 1',';.T "ih � j,'a� _i;y 4S ... - 9. All. �reae disturbed, during .'cofittruction shall be F revegei,aAed'.immediately following dompletion of work At the site.`: No areas >gshall be `left unvegstated or unmulohed for more than days. l0. . Sod shall nQt,. be. used as a landscape feature .of the project: ' All gz*seed. areas rhikIl be seeded and maintained in" fescues. il. This approval`` i ' contingent upon the .approval by the Board of Health of the subsurface sewage disposal l�. Drywells or french drains shall be installed to' accommodate. roof runoff.. aa °r' :,3. Th® es],oared area shall be claimed i denvel y planted " k • in'di�pnbus shrubs ;'an the seaward ens=hal'f., The r Y .Y k 'rya}.{:'N.»� p Kwf 'Y•� Y .. .... _ rematider may be pp2aritsd in feacue '1'ai� F or other `fashon: Planf eh 1 t ing alr„ 'ensue only of ear r.c�oneultation f with .Conservation Department staff s . For F ®ardwalW maint enance: xNo creosote treated.materiale shall be 4 3 15. Deck:plari3�`spay r shall'.Ibis no less!" ' h 'n oast inoh. } e 2 t ,f , it o. . . _ ct' 4,.ya `� $r`t`v7"�ro-,, .,' xf- v oft ,• a: QGl �hH i 1a1f1 "z wngWT I�A I 7.QQRG1PhRAC. QC*QM' M-0, rj b � •`r Y =:t=:a vN uix�'• �s• jb y I� � t• .i r� k�' N � -Q W� •Y c'pa @ .�14• <�1 Q Tgl, '.LQY+ �j'1. . IN x. •t &., <! - t q ut � 4 `{, #'�.ta3 Yat"`+ �� b'1 �' .'+�-. 0.� �~y� T � �.�: . �' a k •z �'' ,q kid"�? 'r�'d�. �.i � � � Y.:.� ,� •�� t X �{1' ' ,,' �, y r i o- ��- �a�x. l�r�t ��€;7 $2 '-� 4 s•a � ;.��3� � }w� c43, � •-+�',' r cy � a4 ,1 aW5 *r x4kv a^ilk. u� c�p! r:`4 ,13 41 • `MHO L-•t'1, E v ,{� b i mAl- � �s����� "�uz`��.�"�f ��`r � �;a .. ' '�� '�'r'• 1 x ,Fw y Px j i i F # u� wi 6 rYrM Wit. �s�'�µ ��"��k - £i• '{ . by . h�4 • ♦ ,c �� �..k_. , r.;,a, aY...,,•, ,r,a�i.1T lc '�aoorSciorar" `or_fora '+;ccT�i�aTra ��d'.,- Y - � F i t. �.� n i 1 S :YY a - - 1 '.'�i• � 8 , w _ Ze SAh,,vs•rA[aLe couNyY FICGISTWOOr•oEr,os MEOPY,ATTEST .doMn,F.Mew AMSTER m•;�.: ' w t,• y3 .. - 'fib,. ! y ^ { • by t5 N iy,'I _ J w,k F S-' . _ f �g f S `'�1,� A e ,a• .. + d -Px *' ,�, ,,.`� ,. C "y a '•'� x,�a1} k�'s p- Iw`�g5'`d g; t`try ��•" _W i M�-fit �*",.e�.� ¢ 80 39Hd QdO� '8 NOSIJc II_, .7ggRGIFtiRGiG W;FT%J 7,/T64;1, , f y t5' :''`.•+fir' 35.". yt ;- a r 1Y .fir'' S. 't `' y 58 .3-2_620 -- ;;:.Shriver Plan of Record: May 11, 1993, Rev. , peter Sullivan, PE special Coaditioms a 1,,' ,_ 1. General- Conditions .1-12 on the preceeding page are binding, and demand both your attention and compliance. 2. Within one month of receipt cif this Order of 'Conditions and - prior a�`o `the commencement 'of any work approv'edl herein, General Condition number 8 (preceding page) shall be .c04,,ALed with. 3. It is the responsibility of the applicant, owner and/or succe �sor(s) to ensure. that all conditiorns' ` of this -Order °are complied with. "4 The pro jecti ` engineer and «i Y aoritraators :are to b� prove de"d� withr ;a .copy, of this ° Order acid referenced currents Kbeforet ttiecommenceaiont of construction. The foregoitgY coidit 'on{ "shall` not be construed rto;., exempt ;': pro ject;�~, fcoritractors .e T f4. rom responsibility Eoz any work per- ormed xq:, ev anon with provisic.ns of:. 'the Order .,oftCondiaions nor with the detail 'o= the .plans of recsa ., 4. The Conservation Commission,* its employees Viand its agents 'shall fiave a right;of #entry to ina�pect for compli.a:i �:e with 'the provis3.ons, of this .Order:"of Condit ims 5. At ,tfle compjeti'on of work; or by°the`expiraty^tt: of the present :permit, applicant shall trequest, inwxiting Certificate: of Compliance; for a ttiewdrk "herein pexntittedr Where a. ,project; has'= been completed in accordance 'with plans stamped . by, a� ;"., regstered profess ona�.= engineer,, architect, :,. larid�Cdpe 7,arGhiteat or : land surveyor, a writteni"`statementby' ,fsuch a profess onik, person . cerLt*.' ngr supretantia � compliance. with ,the plans an _,settings forth; vha`t S,deviaton, if T ti rd 1,eps,a roved¢in titie Order' an , exists with': the yrsao_. P pp; shall ace ally the request E.or a Cartifiaate `'of Compliance. 6. The construction work limitrfor the addition shall. be . 6.' .off `the west and north faaee. ' { 7 Staked. haybales.,shall be set at the work limit prior to the start. of': work and.. maintained throughout 4 � construction.° There ;�ha].l be no diaturbance of the site, . ncludi: .g cutting of vegetation beyond the work limit. 90 3SVd 080_� 'S NOSNIIS Z998060809 89:90 066T/LZ/TO �are: 1 iits M (botmaij oar' '[�}.E.µ�t.T'F.-.?L^U CM WILZ S t.t t"i1y m e-t ��ir. f�l•1��.�/�Z1O�1 ��l�����A� J m IL IL O rmv. � I SS5 1'00'E /244.63' l®m m A-1 D LOMEST FOUNOATON SI:AB �s3' � �'/ CATCH SAsRN / AIL o • co � ! J N� APt'ROVED UN t Ui bb SE3-2620 --� a p uw / a� tb � J �Vn I b 1 a e"A!!P�T1 24Gh _ Ctlt 111fa1! vF2a�-•� \ �G//.yn.. 2y _ �� to X IN OD E 1, - - �rTOAr \ \ \ AtiO t2A2' OF \\ � \ \, LOT 20 AL 1044, \-� `.\\ �2ems, 20\_ -- v � 112.925 S.F. Aye � r,� - 2.59 Ac. 0 ,���.,��►-n Ay kAvAmm sm :Nt. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map ` / Parcel y 6� Application# Health Division Conservation Division Permit# Tax Collector Date Issued Treasurer Application Fee - 60 Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board ` Historic-OKH Preservation/Hyannis Project Street Add re ! ARI Q Yl l C_ i Village lVi9 ff S Owner �S h R I V-.e!2 Address Telephone Permit Request �'d eFeeci4- rA ,�ar�a�y � /y�X-7/ SZ,1/�07 ,, �G��C 2 4512�I 07 Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new Zoning District . Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) i Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full:existing new Half:existing new 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 ?Y >„f 32. BUILDER INFORMATION C Nam a elephone Numbe — T �r Address Egan 57 11'_ License# �f S G4_9 6)/ 2J0 Home Improvement Contractor# Worker's Compensation#W c ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE T, DATE oZ d 7 FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL f; " FINAL BUILDING a i DATE CLOSED OUT ASSOCIATION PLAN NO. ft II`.. �.. �.. .. `.. �0. `" ` Y li Imo. .M.. ^ �� FAO/� O �O` r ",% I� I^ 02 I* Ida I- Imo. : r atc l REGISTERED of �/� G ISSUED BY Date of Manufacture bY\ a0 APPLICATION �� ANCHOR INDUSTRIES INC. 4/08/96 41 »JN EVANSVILLE,INDIANA47711 ►11�� �q NUMBER -• �„ Order Number / 'II,OI J f�F/ M'Qy�P MANUFACTURERS OF THE FINISHED ✓ Fi21.4 �� qE 1 paw TENT PRODUCTS DESCRIBED HEREIN flow y ya > This is to certify that the materials described have been flame-retardant treated ; (or are inherently noninflammable) and were supplied to: PAIN o; M Off "�� mil PETERSON PARTY CENTER INC » 139 SWANSON ST WINCHESTER MA 01890 `o Certification is hereby made that: nJi 1 > The articles described on this Certificate have been treated with a flame-retardant Vo approved chemical and that the application of said chemical was done in conformance ro, isn �o with California Fire Marshall Code, equal to or exceeds NFPA 701, CPAI 84, ULC 109 km The method of the FR chemical application is: iNO � Serial#: o 8040000C (0001) %!AI Description of item certified: ` Xp MI 1 W JoDO N8T 4r r , ULL�FROM WO#118532**** �al ---- pill 'it Flame Retardant Process Used Will Not Be Removed By �• Washing And Is Effective For The Life Of The Fabric "o __JOHN R0=S CO,STATESOILLE—NC %u( —---------- ------------- Signed: "O Name of Applicator of Flame Resistant Finish TENT ARTMENT-ANCHOR INDUSTRIES INC. PO; w ..r .or •.r �r ..r ..r w ar rrm .,r .w ar ..r .. er or <.r e.r .er ..r ..r ..r er ..r ..r ..r .or w. o1 M P O R TA N T D O C U M E N T���'�'�'�'�'r 0 r1-rJ-r1-r�r�r�r�r1-rJ-r r-r.Pr1-rJ�rJ-r�r1-�r 5 5 �l�ica 0f ISSUED BY lane Resi�t�ance 5 S �� 5 5 REGISTRATION Date of Shipment 5 APPLICATION a s VpCE � 5/10/2006 5 5 NUMBER Tent Identification 5 5 � EVANSVILLE, INDIANA 47725 5 MANUFACTURERS OF THE FINISHED 04263446 S 5 F1 40.1 TENT PRODUCTS DESCRIBED HEREIN. 5 This is to certify that the materials described have been flame-retardant treated 5 5 (or are inherently noninflammable) and were supplied to: 5 5 5 6571505 PETETERSON PARTY CENTER INC 5 5 139 SWANTON ST S SWINCHESTER MA 01890 5 5 5 5 5 5 5 5 - S 5Certification is hereby made that: S The articles described on this Certificate have been'treated with aflame-retardant approved 5 5 chemical and that the application of said chemical was done in conformance with California 5 5 Fire Marshal Code. All fabric has been tested and passes NFPA 701-99, CPAI 84, ULC 109. 5 5 Serial # 8040000C(2) 5 5 Description of item certified: 5 FIESTA EXP TOP 14WX14(2PC) SNYD WHT VL#1023970A El Flame Retardant Process Used Will Not Be Removed By 5 5 Washing And Is Effective For The Life Of The.Fabric S 5 Signed ` r 5 Name of Applicator of Flame Resistant'Finish ANCHOR INDUSTRIES INC. 5 o ������n�n�n��������r ��:] n���n�n��n������������nr } F. I f The Commonwealth of-Massachusetts 00. f 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 A licant Information4 Please Print Le ibl Name(Business/Organization/Individual): Address: _ L✓47 �S City/State/Zip: 14),4 4-,ey Arat,. e4 Phone#: 7 kt' -7oR 9- ereUTJZJ Are ou an employer?Check the appropriate box: - Type of project(required): 1. am a employer with 4. ❑ I am a general contractor and I employees(full an or part-time).* have hired the sub-contractors 6. ❑New construction 2.El I.am a sole proprietor.or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These"sub=contractors have g, ❑Demolition workingfor me in an capacity. employees and have workers' Y P h'• 9. ❑Building addition No workers'comp.insurance comp.insurance.: required.] 5. ❑ We are a.corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions thyself. o workers' comp. right of exemption per MGL Y P 12.❑Roof reix$ insurance required.] t c. 152,§1(4),and we have no ---� - - employees. [No workers' 13Qther 4 w comp.insurance required.] Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. - 1 Homeowners who submit this affidavit indicating they are doing all work and then hive outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: /l C'"! 1000, Policy#or Self-ins.Lic.#: Z✓C i!p f Expiration Date: d Job Site Address:_ GY G 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 '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 un r he pains and penalti of perjury that the information provided above ' true and correct. Sign Date: y Phone#: - ... 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#: Board of Building Regulations and Standards ~n Construction Supervisor License License: CS 60219 Expiration:' 4/27/2009 Tr# 11766 Restriction 00 MARK TRAINA 33 HANFORD RD STONEHAM, MA 02180" ,' , Commissioner i • 1 i 3 t f, 4A, / a E artyceter special event equipment and tent rental MARK TRAl !iA DIRECTOR OF TENT OPERATIONS I tel 781-729-4000 - fax 781-729-4999 139 Swanton Street- Winchester MA 01890-1918 http://www.ppcinc.com A I' /UJ/:2U06 15:39 7813584022 PETERSON ACCOUNTING PAGE 02 13Igntfax 10/3/7,006 3:28 PM- PAGE 2/003 Fax--3vrvc;r . en CllanW.40743 PETERPARI . - - ACORD, DATE(MMIDO YYY) , CERTIFICATE OF .LIABILITYa�1SURA,NCB 101`03108 nRODUCER - 7HISCER'IIFlCATE IS ISSUED AS A MATTER OFINFORMATION - U31 In—&Services of MN Inc. ONLY-AND CONFERA NO RIGHTS UPON THE CERTIFICATE .1.2 GII1 Street SUIto 5500 HOLDER..THIS CERTIFICATE DOES NOT AMEND,9XTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIESRIELOW. :PO Box 4043 _._ . Woburn,MA 01888.4043 INSURER 5AFFORDINO COVERAGE NAICO INsuaea INEimrRA., St Paul Fire and Marina Insurance C" 24T07 Pl;teraon Party Canter.Inc. INEURERs! North River Insurance CO. 99999 139 Swanton'Street INELIKERc Commerce&Industry Insurance Compan 19410 Winchester,MA 01890-1918 IN%IRER D: . - - IN9URERE: COVERAGES THE POLIIXrS OF N-R)RANtE LISTED BELOW PIAVE BEEN ISSUED TO THE INSURED NAMED AAOVE FOR niE POLICY PERIOD INDICATPI).NOTMTHSTANOINO ANY REOUIREMENT,TERM OR CONDITION OF MY CONTRACTOR 01IIER DOCUMENT WITH RF_FPFCTTO WHICH 1NtS CERTIFICAm MAY BE ISSUED OR MAY PERTAIN,IH[INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO AI,I.-nit TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES AGGREGATE 00175 MOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR '"RE 01I±CFIN9URANm pa.IDYpuMeEp DA LIN)Ta A atmImALUAs1UTT CK002IT138 10103106 . 10/03107 PA01OCCURRENIE 31000000 X CXW WRrU1t.CCENWAL LYCLITY DOD CLAIMS MA1IE �]X OCCUR. VED EXP Vq one n $5 000, PERWNAL A ACV KWRY 101,000,000 MNERALAGGREGATE $2 000 001) GENL AGGRMATE LIMIT AMFUR PM: PRODUCTS-COMP/oP AGG s2 OOO OOO Popov .1F.CTofm LOC - A AUTaMasrtE uAeluTY MA00200291 1010310E 16103/07 r(wRINFD RINt;ir uam ANYAUTo (ERnenawl $1,000,000 .. ALL DRONED At - - - tIVOILYINX"Y S X SCSIRTJULED AUTOS - ,. FVW PO*M) . X "HIRFO AITQi X NnN_rm F)AU7M (Pri aaf1lNir�i RY Y. S ((Pert r—dW)TY MACE S CWCffUAOILITY" AVTQQKY-"ACCffr=•IT S . `ANYAIrro - OTHIZA TAMFJIACC S . AUTU2INLY: Asa $ B EtCEMMMORELLA LIAML47Y 5530892346 10103106 10/03/07 EACH OCCURRENCE $5 00D 000 X OC Q1R CLAIMS MADE ACiCiZFaA7E 151000,00D — DFDU171131_E $ X r:FTENnON a 1D 000 $ .._.._.----_... .0 . IRORKUtsCOMPrASA11014AND BINDERWC9687269 10109108 10109107 X' YUC ATATU. M N- __.___ EMPLOCERa•LIMILITYFR .. ANY PROPRIETOR/PARTNERIE)0_CUy VE - E.L.EACH AC..=ENT 11600,000 (FFlCERIMEMBER EKQlIDED7 El.DIBEABE-E1 EJdPLO -• *50A DDD oiLIER PRD"19 Anaw E I,asEASE-I'DUCY LDart 3500 000 ":OEA(]7TTON OP OPERATION 4I LCK:A71(H81 VEMCLC%I EXC.LUMONS ADDEO 9Y E HOOP'V MRM TO WFOAL PRUtn sms - RE: Insured'.Oppr9tions renting equipment for business 8,social functions, including erecting tents -CERTIFICATE HOLDER' CANCELLATION - BHOMOANYOFTHEAaaVE DESCRIDEDPOLICIES DECANcFLLADBEFORETNE EXPNUITION POterSan Party Center - DATE THEREOF.THE 0SUINO I NSURER WILL r•XJOEAVOR TO IWI ". DATsvvRm 2N 139 Swanton Street NOTICE TO THE CPRnncATE HOLDER NAMED TO THR LEFT,euT PAILURE TO 00 mO RHALL Winchester,MA 01990 IMPa%F"OOR1,10AnON OR LIAMILTTYCIF ANY KING LW"4'ME INSURER,ITS AGENTS OR " gEPRF-SENTA11VE5. ACORD 25(2001 log)y of 2 #S139494/M138493 AGDCD 9 ACORD CORPORATION 1088 f O5/O7t'00O7 16:01 FAX 781 729 4999 PETERSON PARTY CENTER Ca0O2 ,ry •: u� V��r �, 1J. 41 ,;e53rrl.tiby EXECUTIVE OFFICE PAGE 02 Mai 07 07 1I : 38a P. 2 �� «v� v�:ce 3ao3/71969 E)T-CirEVE OFFVI PAGE 02 Tovm of Bar=tatde XAono: "F1- MLxVw. " _•Siil��d31 Ms_yy A. compictr ✓rrfYF=�SQ 2^' sip rl& secd 11L (AAdft :bed�i�,� v� ���/ C',�ic�t�- �•�.�•�'' tea,�•�a �+a�.n�'c�.�,�j,.t5;,i+o�; � r _ TLm olcojAa ,3wpmow yl IQ 17A , Nit- ✓ � O Jv�r . f - � ilEs►1 'DATA I TIF_._ - 5t.��-+ _. f °► -SEE PLAW �04 Bca Ae2wF 8 e*snij&, ! . Poor' s : . . i �20 A'�-A►�h�G EVE , FP'�'• VAILy FLWWIq -1.,<110= go,Grp Sl Mc, 'T'Rab4 s.'g4o i up lei C98a 6Pn Gib"'toav UO 3- lao� APFa 6ATIoN i- s = APPL1 -- . MvC,. �X. gip, I�IL T1adJCi� Ot L.E" AL "_ AAb : . A 4,2" } y _.. - VA gl*p wv MA oQ I� ROT PLAW 1 i _t:a + r t �►L� `j1-. lj,p MAIZ• iZ,lq% FLAW RISF—MAWM :. LoT 20 l-c• t2a84 su" ' f : : MAP US q ILINOM j7 NyC I NG - �ro a," � �.• ss F���. � - LAbtD StR1/61`!t� •W61�16E� t D _ Savu�t sj us US ' PCL Or 16i .177 41 >lolf " ts 4 1�.'e w� t+ .A�p 41 R• j -r a i IV 3Y S p' 00 i + I �4 4 _ 1 f ti ' L .. , '_. 0 1ZO AD Fa_f�ll� No. THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-TOWN OF BARNSTABLE,MASSACHUSETTS Opp[ication for IDWOOaC *potem conotruction permit Application is hereby made for a Permit to Construct( )or Repair( ✓)an On-site Sewage Disposal System at: Location Address or Lot No. p Owner's Name,Address and Tel.No. SAI SlleltlE+�`�Il EfJ sr►�� T 91 A'rL tatIc. Avs 100 1K f. 4ZivL eo o trs low 0 AaW16PaMT . Installer's Name.Address.and Tel.No. Designer a Name Addnxs and Tel.No. m $Ax Ism i / II'�1.. Psi-A MAW 4r, oer• 4-7-r, j Type of Building: Dwelling No.of Bedrooms Garbage Grinder( ) Other Type of Building No.of persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 56 G•Y I' /b/LY gallons per day. Calculated daily flow �O gallons. Plan Date ��>= l��pQ�+,t tuber°f sheets` 2 �v revision Date Title Description of Soil t ADE Tb TerswJT fins Nature of Repairs or Alterations(Answer when applicable)�x ns —— Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of Health. Date Signed _ Application Approved by 12 Application Disapproved for the lowing reasons Permit No. Date Issued-------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System installed( wl or repaired/replaced( )on by for has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. � dated Use of this system is conditioned on compliance with the provisions set forth below: 4 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS �igpo�aC *potem QCon0ruction permit Permission is hereby granted to to construct(,/Sre air( )an On-site Sewage System located at and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. All construction must be completed within two years of the date below. Date: Approved by :Y Tr � f I • BAX'TER & NYE, INC. Professional Land Surveyors and Civil Engineers 812 Main Street •Osterville, Massachusetts 02655 Tel. (508)428-91 FAX(508) 428-3751 0 WILLIAM C.NYE,P.L.S..-President PETER SULLIVAN,P.E.-Vice President-Engineering RICHARD A.BAXTER, P.L.S.-Vice President March 13, 1996 Mr . Rob Gatewood Town of Barnstable Conservation Commission 367 Main Street Hyannis , Ma . , 02601 Re: Shriver SE3-2620 Daer Rob: Enclosed please find revised copies of the plan showing a' proposed addition to the Shriver residence, Atlantic Ave, Hyannisport . At the request of the Barnstable Board of Health we have upgraded the proposed septic system for the existing dwelling and proposed addition to conform with Title 5 . The septic system for the garage was installed by Arch Construction in March 1994 under Permit No. 92-266. The plan of record in your file. shows both the garage and dwelling connected to one septic system which is no' longer the case. Should you have any questions please call me at the office. Very. truly yours , Baxter & Nye Inc. f za Richard A. Ba ter, P. L.S. Vice President Encl . cc : Michael Ford , Esq. Eunice Shriver MEMBERS OF CAPE COD SOCIETY OF PROFESSIONAL ENGINEERS AND LAND SURVEYORS I AMERICAN CONGRESS ON SURVEYING AND MAPPING MASSACHUSETTS ASSOCIATION OF LAND SURVEYORS AND CIVIL ENGINEERS TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map o?i 5� Parcel l _�Q Permit# a®O 6 6 G 93 Health Division Date Issued Conservation Division Application Fee Tax Collector Permit Fee ��� Treasurer Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis `oZGp� lyD> Project Street Address 47,7,4 ,177 e 411L5_ Village ll.KA ;V F-r`'D_g j Owner Address Telephone 77J r 7/1-177 Permit Request 4577 A6 �� 2=0 " 73-rAIT- 4 AJ S1>7/,06 K 6WV_'--4 L Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half:existing new 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 2�97- W UiJ-0 PZI 96rl, APA zAif&W BUILDER INFORMATION . Name ^ ' Z Telephone Number /-791~ 7w- 41600 Address»V Sum N�-4 A/ sr License# es 4)4621_7 0/�/�A17i� � /�►���L� Home Improvement Contractor# Worker's Compensation# IlVe 3:��71L ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO /V//� SIGNATURE DATE ti FOR OFFICIAL USE ONLY �U PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION r FIREPLACE r a ELECTRICAL: ROUGH FINAL' PLUMBING: ROUGH FINAL .r ' GAS: ROUGH FINAL ` FINAL BUILDING DATE CLOSED OUT ' ASSOCIATION PLAN NO. 3 1 04/27/2006 15:36 FAX 781 729 4999 PETERSON PARTY CENTER Z 003 04/2614006 22:40 3053771969 EXECUTIVE, QFFICE PAGE 62/93 04/75/2806 19:35 385377Z969 um/YD/roue llf:l2 FAA ldl 719 {YdY MCUTIUE OFFICE _ MLI1H YAXI'y I:L�NI'L�lt �UuzG� 02/@4 Town of Barnstable Ropd a ry Services TCM *dWMCGWdWMw 200 MWO but ftmkMAVMI tn�•iow7.Fa�e�eslrb�la�a.m 091m. 581444038 Fa1�: 50®-T9o's�o �A�slid sign TW3 section �7 Oe►narA+iuet if Wag A Sumer �' �G�a�er�f the,na�xcae pnpr�gr i:a �elmiva ro byd&hoft spowl0i for doe- Jury Pam. - -� d9i :?-C 90 G? -+db : S __--3 The Commonwealth of Massachusetts Department of Industrial Accidents -:= office offmtesfigations it :-_ _- 600 Washington Street, Th F/nor Boston, Mass. 02111 Workers' Compensation Insurance Affidavit: Building/Plumbing/I:Iectrical Contractors Applicant information: PlcasePRlNTIc'Pibh n:i111C: addle ti:: woik site location(lull addressj _._.... ....--------. .- _ ❑ I am a homcowiler perfnnnni,,Al \:urk mvu!I: Plojcc1 I ype �_� Ne\\ Collsnuction❑I;emodCi ❑ I am <: solc proprietor and have no(MC Wolkine in any capacity,. ❑ Huilding Addition ❑ I am an emplo.'er piovidinn \\'i)rkcr ' compc:nsatii?i) for my employees\\�iril:in�rltl this joh. comtians'name: >�f / fnSLSN P��T'`1 l£�yT�� Address: Tf �7-A ,_ I :-.:. .. .,��Ie yl;,-,ir,i\i:�:.,cncrai rontrca�.n, s !wnr:o\\net f�.ir�!< unr') am.1 i... 'Lr.�.-i;I:,., , :n;:.I'i+nz fi•;r�:'. . .. pc�!II C7,- address: eit).: phone r: insurance co. policy it company name- address- city: phone#: insurance co. policyk Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to S1,500.00 and/or one years'imprisonment as well as civil penalties In the form of a STOP WORK ORDER and a fine of S100.00 a day against me. I understand that a copy of this statement may be forwarded to the Once of Investigations of the DIA for coverage verification. I do hereby certify under the ppat' sand penalt s of perjury that the information provided above is true and correct. Signature �O�d Date Jr Print name TyvPC i/0+?toa,� Phone# 7F/'Zazl 7ODD official use only do not write in this area to be completed by city or town official city or town: permitflicense k []Building Department ]Licensing Board ❑check if immediate response is required QSelectmen's Office ❑Health Department _ contact person: phone#; QOther (rtv,.d Sept-2003) IMPORTANT" DOCUMENT o 5 LS, S r r S 5 Cerfiftraft of I lame 3a s S ISSUED BY _= REGISTERED Date of Manufacture APPLICATION 4 5/28/99 5 0 NUMBERousTa c;i s i ` 5 5 5 r y Z EVANSVILLE. INDIA.NA 47711 Order Number 5 F121.4 �y M�Pvr I 223672 5 'o a c� MANUFACTURERS O THE FINISHED E 5 TENT PRODUCTS DESCRIBED HEREIN 5 5 This is to certify that the materials described have been flame-retardant treated 5 Li (or are inherently noninflammable) and were supplied to: S PETERSON PARTY CENTER INC 5 5 139 SWANSON ST S S5 5 WINCHESTER MA 01890 5 5 5 5 Certification is hereby made that: 5 5 The articles described on this Certificate have been treated with a flame-retardant approved S 5 chemical and that the application of said chemical was done in conformance with California Fire 5 5 Marshal Code, equal to exceeds NFPA 701, CPAI 84, ULC 109. 5 5 The method of the FIR chemical application is: 5 Serial #: 8020500C (0001) 5 5 Description of item certified: FI TOP IOWX20 1PC VL W W I 5 5 5 Flame Retardant Process Used Will Not Be Removed Rv 5 5 5 Washing And Is Effective For The Life Of The Fabric 5 5 C— Signed_._ 5 Name of Applicator of Flame Resistant Finish TENT DEPARTMENT—ANCHOR INDUSTRIES INC. 5 5 O ePr�rJ�ePrJ�rJ�r.PrJ�r�rJ�rJ�rJ�rJ�rJ��Pr��PrP�PrJ�r��P�PrJflJ�rJ�rJ�r�r�rJ�rJ�r�r�r�ePrJ�rlePr-.f�1�rJ�cPr�CfrJ�r�r�r.PrJ��P�rJ��P�ePr�r�r.Pr�r�r��rJ�rJ��P�PrJ�rJ�IJ�r�r.PrJ�r�IJ�r�r�rJ�r1r_Pr�r�rJ�rJ� � - p�t►+E r Town of Barnstable *Permit# p� Expires 6 months from issue date S.,BM : Regulatory Services Fee '7 I Sd 9e� 1 A 10�' Thomas F.Geiler,Director X-P RL S S PERMIT Building Division Elbert C Ulshoeffer,Jr. Building Commissioner J A N .2 6 2 0 01 367 Main Street, Hyannis,MA 02601w Office: 508-862-4038 TOWN OF BARNSTABLE Fax: 508-790-6230 EXPRESS PERMIT APPLICATION Not Valid without Red X-Press Imprint Map/parcel Number .2 6 S 00g 00 / Property Address 3 0,.�� Residential OR ❑ Commercial Value of Work Owner's Name&Address �c� t.� L c,rm Contractor's Name / ��i�aC/t' ��� �/�'7/O/CJ Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) RWorkman's Compensation Insurance Check one: I am a sole proprietor I am the Homeowner have Worker's Compensation Insurance Insurance Company Name / kg!y_e yiL S V S s. Workman's Comp.Policy# i Permit Request(check box) Re-roof(stripping old shingles) Re-roof(not stripping. Going over existing layers of roof) Re-side Replacement Windows. U-Value (maximum.44) Other(specify) 'Where required: Issuance of thi ermit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. Signature expmtrg +------------------------------ BILL INQUIRY --------------------------------+ -IlAction: Next Prev Scroll Orig-Bill Exit II IlDisplay next installment. II II ALL INSTALLMENTS AS OF O1/29/2001 II I`I Year 2001 Cust # 96016 Bill Name SHRIVER, EUNICE K TR II II Type RE-R Name 1 SHRIVER, EUNICE K TR II II Bill # 24719 Name 2 % JOSEPH P KENNEDY ENTRPRS II II Prop Cd 265009001 II II II II Charge Desc Billed/Adj Unpd Prin Unpd Fee Interest Due Now II Ill HYFDRE 2589. 20 . 00 . 00 . 00 . 00 II 112 LAND BANK 265. 85 . 00 . 00 . 00 . 00 II 113 RE TAX 8861. 44 . 00 . 00 . 00 . 00 II 114 Ii 115 II 116 II 117 II II8 II 119 II 110 II II Totals: 11716. 49 . 00 . 00 . 00 . 00 II ++----------------------------------------------------------------------------++ / S 1 Town of Barnstable *Permit# Expires 6 months from issue date ,, „ AB Regulatory Services Fee 5(77. -V v� NAM.1 Thomas F.Geiler,Director �TED MA'S A� Building Division Elbert C Ulshoeffer,Jr. Building Commissioner 367 Main Street, Hyannis,MA 02601 w X-P RES°S° PERMIT Office: 508-862-4038 Fax: 508-790-6230 JAN 2 6 2001 EXPRESS PERMIT APPLICATION Not Valid without Red X-Press Imprint ,TOWN OF WAS14BLE Map/parcel Number _ 6 S D Property Address A 4 �r v �7�1441-5 ° Residential OR ❑ Commercial Value of Work Cc)v Owner's Name&Address �� ` - S A N , Ve S; Contractor's Name Telephone Numb Home Improvement Co ctor License#(if applicable) / L'i O Construction Supervisor's Lic e#(if applicable) ' �Workman's Compensation Insuran Check one: I am a sole proprietor I am the Homeowner [ .-I have Worker's Compensation Insuran Insurance Company Name—TV, V^ Workman's Comp.Policy# b Permit Request(check box) E Re-roof(stripping old shingles) Re-roof(not stripping. Going over existing layers of roof) Re-side Replacement Windows. U-Value (maximum.44) Other(specify) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. Signature -� expmtrg QUERY.: NEXT PREVIOUS FIRST LAST END DISPLAY NEXT RECORD IN QUERY PENTAMATION----------------------------------------------------------- 01/26/01 CONTRACTOR ID NUMBER 11413 CONTRACTOR NAME HITCHCOCK, THEODORE L. OWNER NAME CONTRACTOR TYPE HOME IMPROVEMENT ADDRESS LINE 1 55 LISA LAND ADDRESS LINE 2 P.O.BOX 211 ADDRESS LINE 3 WEST BARNSTABLE, MA ZIP CODE 02668 PHONE NUMBER (508) 775-7763 BOND EXPIRATION DATE. STATUS A APPROVED LICENSES / CERTIFICATES / REGISTRATIONS NO MORE RECORDS IN THIS DIRECTION �S°� ��� 'r.�-,�+^.�ca>H;r•`.d.-�aK.�,,fw..�s»^q°`�rs...,.F�.;.1u�.. .*��y.^-'-�..�:�.,�.-.,a , Ctev'r' (�'� loo � c t. y+� '4 .1 HOME IMPROVEMENT;CONTRACTOR ' Registration108918 p L u ;�'Ezpiratiohl,,48/27/00VW ?~" ire ...R. .. i.. 2 �> 4 ��THEODORE L t1ITCHCOCK }g PO 13OX 2117 ,55 LISA LN s r adBARNSTABLE MA_02668 x �$r ADMINISTRATOR 3 Results Page 1 of 1 Home Improvement Contractor Look Up Enter Search terms separated by spaces. Search terms can be Town/City,Name, or License number Select Search type: AND a OR Search Results Reg. No. I Applicant Street City State Zip Name Title Expiration BARTINI 290 Bartini 100771 ROOFING PLEASANT Lee MA 01238 Owner 06/23/2002 COMPANY ST Stephen Total of 1 Records 1 e A 4 3 , 0 5 70 matched. Back to Home Page Page 1147 http://www.state.ma.us/cgi-bin/bbrs/hic.cgi 1/26/01 .{ .< .. F - - - +� Hai �Yy 'TM+v- '•� Yr:rr b-� 's 5Y ��`< -^z 7� ,h,.•,.. � � , 3 �--- '"�' �•:v � i:Y•"� #�-,,,:.`'-'' .�+�i�vr �' fi'+3ac � r +• �"f"•➢Rayr,�.�y � C yNSTARLE fz` . 1 -TOWN O Y`DEPARTMENT OF HEALTH SAFETYAND ` , S ERVICES q < $ENVIRUNMENTAL yBU ING DIVISION .+�; rc•y>K 'µ +'4tx'a F ` y'7a 0_ 1 I 54 t ,. -�".�t e. �� ._ ,;i,6ig�:.aSwr,•h,'.•+?'"�,fry y`Z.•� # . -tn rILA[ r �w -� E~'•Y"F�• .r +.haA11 O-P.:*w- � �'4`r`r„.G�.*��" `'"` "s➢ I THIS STRUCTURE AND/OR PREMSES HAS BEEN -f - J r•_> ,5�, brew=;'#Fk � 'act ."'�n""'�:.*4aa�,aY�'.:,a 4 ,� i t. INSPECTED AND THE FOLLOWING VIOLATIONS �� . ,. �.4" s n hs ;OF THE BUILDING CODE AND/OR ZONING � � .d ➢ �. r yr..,,'4 FOUND: , ,{ORDINANCE.HAV EBEENF. ' a s '# �•i'{ t'xd .�F•. q, �. ?. r1.., .r,, ➢v?x ^R,r �s�+• r .ate,�7"���,ry"'K�s."�K'� ''a -. 9. yr MUMM a -mot W "i-� ' r5„•. ,:+. - ,4� ..�ryy.-ram -; to "S. z•*:�: 'f ;. ;.t ..'°'J,,!� `ft V; •,7 ,,l�� "�ai(�f'13"r. v"➢e< T"''��.r'+S' H: �3�''' � "ail°YOU ARE HEREBY NOTIFIED THAT " ,SHALL BE'UNDERTAKEN 3 t NO ADDITIONAL WORK A MIUPON THESE PRESES; OR THE PREMISES ABOVE VIOLATIONS b w OCCUPIED UN'I'ILTHE > f- t CORRECTED. ANY PERSON REMOVING THIS NOTICE WITHOUT Y BE LIABLE PROPER AUTHORIZATION SHALL ' FIFTY, NOR TO A FINE OF NOT LESS THAIvr RED DOLLARS. F 7 ,.�. -MORE THAN ONE HUND k .e. Address q '�`^� f� Date �_._.. Building Commissioner rai-r� t 1 rr , Iv 41 to Ak II N f 3 f NNVC �#3 uJ4 _— W' s' a� i� C�I I C47 Ri t —77 — L -- 1 - - i T FO ND )AT10N o FOUNDATION : FLAN . I AO f°P,, '�p( '� `�. tr 1. r"�►� . (�i`• . /aid DEMOLITIONS NOT@9 .1� ` 1' PIOOFBNCi ND O REMOVE EXIST SAVE`FOR REISE:AS ICATED WQ 0 REMOVE FRWM AND'SLeFLOOA AS REO D TO AGOp+t OQATE NI LIMIT OF DEMOLITION �• �• " 's �• —� 0 FEMOVEDt�OFZHDWRANDTHRESFICLO-RETUM700NVNER. (J �tEMOVE DOOR HOWR AND TH V-qI lD REUSE AS MIQ4TED. ii / �I�" + ` `t, U• REMOVE DOOR'CASMG AND TRIM REUSE AS WDICATED `' 6'. REMOVE STOOP AND STEPS. v U U U at ` REUSE SLATS�S'p' J1TED ID II . 4 II,•'I ;V• q i 'i J REMOVEWMD6W;CA41I ANQTRIM,=REOSEASMDIG►TEUORPA REMOVE MILLWORK CABMET_SAVE CAB64ET DOORS FOR,REUSE J A-6/CAPE COD TIMES SATURDAY,SEPTEMBER 14,1996 Shriver r r rt , -:,A ism ad ition sto ed .r by town By PAUL GAUVIN STAFF WRITER HYANNISPORT — Construc- tion of an addition has been tem- oraril terminated at aproperty Staff Photo by SME HEASUP p y a ., royal from the,conservation controlled by Arnold "The Ter- hay-bale dikes ;< _ "� p minator" Schwarzenegger's The large whit h se sits atop commission." y mother-in-law, Eunice K. a knoll with panor is vistas of Munson:said yesterday.the Shriver, because the town con- Vineyard Sound, S aw_Island, ;conservation commission had tends it is larger than allowed. extensive,marshlan and part of. .:agreed to,allow a IO-foot addi- ■The Shriver A source who did not want to the Hyannisport Go. Club ' tion. The one built extends 20 house on be identified,said the addition In addition to then nsea Qn, feet and is now 23,feet from the Atlantic Ave.in was to.accommodate the grow- department's enfor ment difder, edge of x coastal bank'where. -Hyannisport. ing -Shriver'. family. Actor issued with the cita n,WWI generally d,§O-foot buffer is re- Officials Schwarzenegger is married to inspector Ralph Cr sen area as quired,Munson aid r contend the xeF� `.- n television reporter Maria Shriver sued a stop-work o`,er y � 4,Y The conservation division's en- addition is and they occasionally visit the In a letter delivered by.l'iand�to forcemerit order requires the larger than Cape to sail out of Hyannisport builder Ernest J.Jaxiimeryester-,:: contractor.to,erect the hay-bale initially Yacht Club. day, Crossen said the contractor dike, add clean fill to ground specified,and Barnstable conservation agent exceeded the_scope`of;:the eroded in the area,file a new no_ exceeds Darcy Munson forwarded a cita- building permit issued on March lice of intent with new engineer- conserve" tion with a$100 fine yesterday to 19, 1996, by building a-much ing plans'and show where the ad- commis! Eunice K. Shriver Kennedy En- larger addition than that shown dition exists as built. guidelin terprises in New York City. on the plans you submitted" The town contends an addition ..Jaxtimer's-office'said` yester Barnstable assessor's files list to the Shriver house at 31 Atlan- day he could not be reached. ' " the'house`'under the 'name`Eu- tic Ave.`exceeded limits set by To lift the stop-work order,the nice K. Shriver, trustee. The the conservation commission, contractor will be required:to. house,-AT strort_walk from the Compound,sits on 2:95 was built under an expired order provide an "as-built of the addi- Kennedy of conditions and failed to pro- tion on a site-plan,a foundation acres.'and is assessed at.$1.104 tect surrounding pristine envi- plan; a set of plans that match '-million. It includes an additional cre lot valued at$270,300. ronment by erecting required what was built; and a new ap- " -63-a it �-�� P��.S��` � Lev�J��� '�`P-�`��a � ���� �- - � � � � k V �t !!� '� ,.` �1 i �- - --- }--=- I� - ___ ui ___ _ _ � - _ ._ i'i ii -- - i - _. ri - _ -- ___ _ __ _ - - ui _ _ - - - ----�� iu ii ---_ i, __- ---�� ii _______ TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map s - Parcel t) n q -n0 h•• Permit# 35M Health Division , ` Date Issued ✓a j '9% Conservation Division Fee Tax Collector ILI.1 Yl �/I fP Treasurer ' Planning Dept. Y. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis F Project Street Address• AZq Village. —'C 7 Owner r=l Address -L Telephone Permit Request C.J_ A. Square feet: 1st floor: existing proposed 2nd floor:existing proposed Total new Estimated Project Cost 7000 n Zoning District Flood Plain Groundwater Overlay Construction Type 1 -4-- d` Lot Size Grandfathered: ❑Yes ❑No If yes,attach supporting documentation. Dwelling Type: Single Family J1' Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑No . On Old King's Highway: ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new , Half:existing new 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 ❑mew 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 tt BUILDER INFORMATION Name—T—e- G t I Lk co -Telephone Number Address 0:1 t ( License# ( V aA A '5,-F," 1 ,2 ✓Li A Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO U: -�_ r SIGNATUR -DATE t FOR OFFICIAL USE ONLY ' PERMIT NO. DATE ISSUED MAP/PARCEL NO. + 1� • - Y •i ADDRESS �° VILUAGE _ n y OWNER DATE OF INSPECTI A: FOUNDATION J i FRAME ° i �+ .INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL` - i s f PLUMBING: ROUGH ' FINAL ' GAS: ROUGH FINAL FINAL BUILDING 1 DATE CLOSED OUT ASSOCIATION PLAN NO. S L • �o. The Town of Barnstable 9 M � Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Ralph Croisen Office: 508-862-4038 Building'Commissioner Fax: 508-790-6230 Permit no. , Date �tce AFFIDAVIT ' HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to ' such residence or building be done by registered contractors,with certain exceptions,along with other = requirements. Estimated Cost V cx:x-- Type of Work: "�G Address of Work: "3 / ✓A-�/��+ -�-*�� ' /k/^ -� .�-t r S S r�r e� s t et Owner's Name: Date of Application: �- I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job Under$1,000 Building not owner-occupied C]Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT GUARANTY FUND DER MGL c. 142A. ACCESS TO THE ARBITRATION PROGRAM SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner. Date Contractor Name Registration No. OR Date Owner's Name q:fomu:Affidav - -. The Commonwealth of Massachusetts + == '— '`y=_=: Department of Industrial Accidents Ai : tea ��,.:��� .t- t Office offayesff9atfans l=: LM%- :7 600 Washington Street Boston Mass. 02111 Workers' Com�ensatiGon Insuu�rraannrce davit r / name: „ location: city phone# ❑ I am a homeowner performing all work myself. ❑ I am a sole rot3rietor and have no one working in any ca acity I am an employer providing workers' compensation for my employees working on this job. compnny name: t address: Q'I city: I S 'F'<y L- t-' (RA phone#: insurance co. pniicv# L l " ❑ I am a sole proprietor, general contractor, or homeowner(circle one)and have hired the contractors listed below who have the follo«ing workers' compensation polices: company name: .... .:,...::. ......... address: :.:..: :..:. city phone msarnnce cn. policv# . camnanv name- address: city- Phone#: insurance co. oil&# _ .. Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to S1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of 3100.00 a day against me. I understand that a copy of this statement may be forwarded to the OMce of Investigations of the DIA for coverage verification. 1 do hereby cerrif' nj&r the pains and penalties of perjury that the information provided above is true and co rr ct Signatur _ Date �t g I:;- _ Print name l`( C-1—c li wv�C 1 Phone# otncial use only do not write in this area to be completed by city or town otncial city or town: permit/Ucense# Mudding Department ❑Licensing Board ❑check if immediate response is required ❑Selectmen's OMce ❑Health Department contact person: phone#; ❑Other (m m"9l95 P1A) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their " employee is defined as eve rgi employees. As quoted from the "law", an employ every in the service of another under any co p 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 receive. g 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 or another who employs persons to do maintenance, construction or air work on such dwelling house or on the grounds building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewa: 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,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 in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be rcuriiid io the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions• please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Otilce of Imrestlgadons 600 Washington Street Boston;Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 - ✓!ce (ou�rrt�rrcu�ruueuuio u` ✓`Gc..w.ct.::u,�.��cl � , :'HOME.:IMPROVEME+NTH'-.CONTRACTORS,.RE GI STRAT ION bard of E3uilding Regulations and Standards One Ashburton . Place - Room 1Q301 t_ c 2y s hs�021007 spar e°'Prue 5Y" !y� RA 11 n zlyd :; QM , IMPROVEMENT :CO T q gzstaio108gIE0 / ee}y t om} - ?a �.i' & Li Y, a i� t {� 671 f isewsr rl.»�/J�n��f�aflaer�iu l Fig► 'Y•' -v t i%+i�1 �`6N�..r. 1`Z�� / �' I HONE' IPPROVENENt CONTRACTOR - JI �'a 4 ReDistration 1Ob918 , t' '�^ 7'' �': -'R� `"r a'f w: ►: � � 1 ; 6„� ;' I� i, - Type - INDIVIDUAL THEODORE L :. HITCHCOCid Expiration 08/27/00 wG .PO .BO `211/" .55 E.ISAr;LtY :; , i �: q. j THEODORE L. 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I.Y.tHoHiR Of I A • x t' �'A u$171h{ f n. 110 r°j t r1t r. c� Yn5yCt�t� LkmR �,'�"3yrf. �,, y,.. � t s s, A _A�to s s I} v ,,�}&`�.y "" ��f'p i7•rr#r� �.K`�4'A 4 w.� S;s .p' -J t ' �'Sr1'%��� 4 � 33F d�� '��, 9f",+ •��t� � �r+r��` � c&*,A-�4 arw - t • ,�,� "� 00:#y`'��`a ,• > � a y ��k �.ef 1<x •? z.� e 2�2„-,", »'•h Y. .. y y- a. f1 1 Waop 4H IHb4h'T� f-1�fi,l - '*0 or n 11-114 Hal wn HPIA I' L -- - -- - -- - o0 .10 - = - -- — ---- -- -- - Nam'►�f I I 11NPI77 'r.1Gc�KoU�-1f7 IVNAG�� r — J 77 o , r+ T 1NEST. ;ELEV. e1 ti4 r o pis z MT � s • '- 4-.. a.-Sa ... r I�L�I�h fV��'j�'TA• L-r, � ... - '�.. '' r.. ,. �r far-6-I �vv � •. ' '. �'. , { gy; Ir, ,I 19 r,IN Davao P i lot 01W.. a� N coy � � 0 g F .� r lip 1 , r- Tor f + r tj�aL+ •,t ", i., i.� WN :baa- hc d"�'t"#r `r xA PROJECT NAME:o ADDRESS: C. 7l PERMIT# 3 �P PERMIT DATE: / 940 M/P: LARGE ROLLED PLANS ARE IN: BOA o SLOT - f. Data entered in MAPS program on: BY: � s_w Assessor's Office(1st floor) Map a S� Parcel ��Permit# f 5 6, Conservation Office(4th floor)(8:30-9:30/1:00.-2:00) 3 5 Date Issued Board of Health(3rd floor)(8:15 -9:30/1:00-4:45) Engineering Dept. (3rd floor) House# �� ^ IKE Planning De 1st floor/School Admin. Bldg.) ' ; J R—W LE. - Defimt e P A proved by Planning Board / 19 S �T�C c,4^� � a 07 FINSTALLE o PLIANIC . TOWN OF BARNSTABL � �lr�TITLE� NVIROMMENTAL C®11E AND Building Permit Application TOWN REG jLAT1CAa Pro ct St Address -4,31 Atlantic Avenue C( oZ0 Village Hyannis Port , MA 02647 Owner Sargent & E,.un_ice -Shriver Address 9109 Harrington Dr . Potomac , MD Telephone 301-469-0505 >', r 20854 Permit Request To construct a new bedroom addition First Floor 4 4 0 square feet Second Floor 0 square feet Estimated Project Cost $ $88 ,000 .00 Zoning District R F 1 & AP Flood Plain A-10 Water Protection Lot Size 2 . 59 acres - Grandfathered? Zoning Board of Appeals Authorization Recorded Current Use. Single family Proposed Use Bedroom Construction Type wood frame J Commercial No Residential Y e s Dwelling Type: Single Family Yes Two Family Multi-Family Age of Existing Structure 50 Yrs . old Basement Type: Finished 0 Historic House NA Unfinished X Old King's Highway NA Number of Baths No. of Bedrooms Total Room Count(not including baths) First Floor Heat Type and Fuel Central Air Fireplaces Garage: Detached Other Detached Structures: Pool Attached Barn None Sheds Other. Builder Information Name E -J - J a x t i m e r , Builder - Inc . Telephone Number 7 7 8-4 911 Address 48 Rosary Lane License# 003251 Hyannis , MA 02601 Home Improvement Contractor# 110 6 0 9 Worker's Compensation# 312-2 0 4 2 3 9-0 2 3 NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT) SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Dump SIGNATURE DATE BUILDING PER NIED FOR THE FOLLOWING REASON(S) s FOR OFFICIAL USE ONLY j PERMIT NO. DATE ISSUED - MAP/PARCEL NO. - ADDRESS VILLAGE i :e, OWNER _ DATE OF INSPECTION: FOUNDATION s FRAME INSULATION FIREPLACE .+ ELECTRICAL: ROUGH FINAL PLUMBING: ` ROUGH FINAL _ GAS: ROUGH FINAL f FINAL BUILDING �, DATE CLOSED OUT ASSOCIATION PLAN NO.' i The Town of Barnstable Department of Health Safety and Environmental Services Building Division - 367 Main Street,Hyannis MA 02601 . Office: 508?90227 - - - Ralph Crossen Fax: 508 775 3344 Bm-lding Commissioner For office use only Permi_ro. Date . . . AFFIDAVIT HOME MIPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c- I42A requires that the"reoonstruc ion,alterations,renovation,repair,modernization,conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner-ootupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. V71-1p T of Work: I �� Est.Cost6- o , Dc0 Type ,� I Address of Work: .�n-ra`Ei�„�«" -i`1 7�d7'E A* - �r* C ``W 2 ,� 01 Owner Name: Date of Permit Application: Lp (' I herebv certify that: Registration is not required for the following r+eason(s): Work excluded by law Job under S1,000 Building not owner-ooarpied Owner pulling own permit Nntitx k hrrrhv given that OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: gl (95 J. Ja.ay� /io 4 0 9 Date Contractor name Registration No. Vn Date Owner's name - � 4 .r , � --.ter_ - COMMI us c r D:1'/R—)\ U,'T O T= YND USTRLA-U%A C-CI DDTFS (100 WIASI- P? GTON ST7�`L1 - 50STON, } i1SShCHUSL7IS a2111 .games� Can�aer . vc— ss one ,vORK£RS`COM7 ENShT1ON rNSURANCE AFFID/VIT Q icrnscc/perm i ace) with a principal pl2rx of bust ncss/residcnccac (City/S ra(clZip) do h<rcby ccrzify, undcr the pains and penalties of perjury, char: jql,i am an cmplovcr providing chc followingworkcrs' compcnsarion coverage for mycmployco --ork-ing on ihio }ob- C, - - 2,1)y23� Insurance Com ny Policy Numbcr j ) I am 2 sole proprictor and have no onc working for mc- i j ) 12m 2 sole proprictor,gcnc-r-.J eonmaor or homeowner (Breit onc) sd h2vc hired the eontracrors listed !>Clow i -who h2vc chc following workers'compmsarion insurincc politics: j lamc of Conmaor. Ins-u=cc Compzny/PolicY Number I - I 1 N2mc OfConrraaOr Insu.nncc Company/Policy Numba F-2mc ofConmaor Insur2ncc CornpanyfPolicy Numba 0 12m 2 homcovncr performing all the work mysclL j TOTE: 1'lc=se b<a�-Je that.��<�er<o�<n who employ pereoDs to do taainte.eaDee,eoorttuetion or repair�-orlt on a 2�-cl(ins of trot more tbz-o tLrcc uniu is t,-<bos'co-,ocr:Iro residcz or on 6c Frouncrs appurtcaznt t5<rcto:rr Dot Ecncr--LIlY i <cnz dcr<d to b< employers t:m&r the"�/or:<rs'Gorcp-ni-bon Act(GL C. 152. cccz 1(5)),applicaioc by:bon<owncr for a Ii<cD" cr perr�it r...y clidccc< 6,: IcFJ sin:c!:-:cr-Flo)cr undcr Lac r✓or�crr'Comp<orition/,cL i cnc<rstanc tn_t= copy of tins st_tcrn<r.(.-ic a ic,—a:dcc to Ln< D<ps .cent o�IndurtriJ/,cod<nu'0Ft c<oil sc::ncc (or.<t�cr < -,Xnfication=.nd that f=.Iurc to sccur<coVtrzgc rcSuir<d undcr Sccvon 25A of IAGL 152 can kid to EhC impouuon of-r6minJ pcnJucs consisting of 2 fine of up to S)500.00 z.dcr iapri;onmast of up to onc yea:and 6-,U pcnalrics in dK form of c Srop VorS:Order and a fine of S 100.00 a day against mc- Signcd this -- ---d2yof Liccns C/vCrii, to Licensor/Pcrmir of i 1 .. 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HYANNIS, MA 02601 er- . ,;4Keep top for receipt and change �'�of address notification. f t s e, 1 l `r. Assessor's office(1st Floor): - ���w Qt��> ®! /� Assessor's map and lot number , ���T�� ���TE� TM[ Conservation(4th Floor /—): � ! 3 ���T�L.��® ��CO ., Board Health(3rd floorj: • ssa»r�nt. Sewagea Permit number � WITH T1TL. Engineering Department(3rd floo : ENVIRONMENTAL House number TOWN REGUL.ATIO Definitive Plan Approved by Planning Boar 19 APPLICATIONS PROCESSED 8:30-9:30 A. ,and 1:00-2:00 P.M.only TOWN OF BARNSTABLE ` ,BUILDING INSPECTOR APPLICATION FOR PERMIT TO remodel garage 'and add deck TYPE OF CONSTRUCTION Wo6d/Res ident i'a 1 ! November 4 , 19 93 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location Lot 20, Atlantic Ave. , Hyannisport , MA Proposed Use additional sleeping area for overflow from main house Zoning District RF 1 Fire District Hyannis Name of Owner Mrs . Eunice Kennedy ShriverAddress 9109 Harrington Dr. , Potomac , MD Name of Builder E.J . Jaxtimer Address 48 Rosary Lane , Hyannis , MA Name of Architect E .J . Jaxtimer Address same as above Number of Rooms two Foundation NA Exterior wood shingle Roofing NA carpet Plaster Floors Interior Heating electric Plumbing two full baths None Fireplace Approximate Cost $75 ,000 .00 Area 633 sq. ' Diagram of Lot and Building with Dimensions Fee OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of B�,4=rnstablNam 003251 Construction Si ipervisoes License SHRIVER, EUNICE K.ENNEDY i�� +109 No ' Ziffor REMODEL GARAGE/ADD DECK. 1 Single Family Dwelling- Location Lot - #20 , 31 Atlantic Avenue ►z s Hyannisport Owner Eunice Kennedy Shriver Type of Construction Frame Plot Lot Permit Granted November. 9 , 19 93 Date of Inspection: Frame �� ` �,� 19 r , Insulation 19 Fireplace 19 Date Completed 19 iz „y �-t r flri za- ra t r zae '"i v pa rv` �'rtAS S`W E i �QUERY PERMITS : QUERY END Q QUERY PERMITS PENTAMATION----------------------------------------------------------- 05/14/96 PERMIT NUMBER 13867 PARCEL ID 265 009 001 31 ATLANTIC AVENUE PERMIT TYPE BADDI BUILDING PERMIT ADDITION DESCRIPTION BEDROOM ADDITION CONTRACTOR PERMIT FEE 272 . 80 VARIANCE STATUS A ACTIVE CONSTRUCTION TYPE 434 GROUP TYPE 1 APPLICATION 03/19/1996 EXPIRATION VALUATION 88000 . 00 DATE ISSUED 03/19/1996 COMPLETED DEPARTMENT-----STATUS---DATE-----DEPARTMENT-----STATUS---DATE---- (N) EXT/ (P) REVIOUS/ (C) ONTRACTORS/ PR(0) PERTY/ (I) NSPECTIONS/ (H) ISTORY/ (F) EES/ (A) RCHITECTS/ (V) IOLATION/ (E) XIT L Assessor's Office(1st floor) Map (o S Parcel i Permit Conservation Office(4th floor.)(8:30-9:30/1:00-2:00 810 Date Issued 3 - t —9 Board of Health(3rd floor)(8:15 -9:30/1:00-445) Engineering Dept.(3r4 floor) House# - dt t►u Planning De 1st floor/School Admin. Bldg.) "� 4 n , _ Definit' e P A proved by Planning Board /V ,. r� 19 �= t°C ' E Z INSTALL PLIA6X7 TOWN OF BARNSTABLF;�w;�o�WITH TITLE s :n iVTAL CODE AND Building Permit Application TOWN REGuLATl0,9 j Pro t St Address �31 Atlantic Avenue ll ' Hyannis Port , MA 02647 Village ' Owner Sargent & Eu,nice Shriver Address 91.09 Harrington Dr . Potomac , MD Telephone 301-469=;0505 _ 20859 P Permit Request To construct .a new bedroom addition First Floor 440 square feet Second Floor 0 square feet , Estimated Project Cost $ $88 ,000 .00 Zoning District R F 1 & AP Flood Plain A-10 Water Protection Lot Size 2 - 5 9 acres - Grandfathered ? Zoning Board of Appeals Authorization Recorded Current Use Single f a m= 1 y Proposed Use Bedroom Construction Type wood frame Commercial No Residential Y e s Dwelling Type: Single Family Yes Two Family Multi-Family Age of Existing Structure 50 Y r s - o?d Basement Type: Finished Historic House NA a Unfinished X x' Old King's Highway NA Number of Baths No.of Bedrooms Total Room Count including not ( g baths) First Floor Heat Type and Fuel Central Air Fireplaces j.. Garage: Detached Other Detached Structures: Pool Attached Barn None Sheds Other Builder Information e E J J a x t m e r , Buz ?.der Inc . Nam LTelephone Number_ 7 7 8-.4 9.11 *`f Hyannis Port , , MA 02647 =Vi age Owner Sargent & Eunice Shriver -- 301-4 69=0505 Dry. Telephone. ,W To construct ',a 'new bedroom addition ` Permit Request1 x f' '. "fffg 440 square s feet , First Floor q E i 4::3: • ` Second Floor 0 square feet 1 ' Estimated Project Cost $ $88 ,000 .00 Zoning District R F 1 & AP Flood Plain A-10 Water Protection Lot Size 2 . 59 acres - '' Grandfathered? Zoning Board of Appeals Authorization Recorded Current Use Single f a m-i l y Proposed Use Bedroom Construction Type wood frame Commercial No Residential Yes = - Dwelling Type: Single Family Yes Two Family Multi-Family old Age of Existing Structure 50 Yrs . Basement Type: Finished NA b Historic House Unfinished X Old King's Highway NA Number of Baths No.of Bedrooms Total Room Count(not including baths) First Floor Heat Type and Fuel Central Air Fireplaces Garage: Detached Other Detached Structures: Pool Attached Barn None Sheds ...__...-.._ ._.Other . - ..-- Builder Information Name E J - J a x t-4m e r , Builder . Inc . Telephone Number 7 7 8-4911 Address 48 Rosary Lane License#. 003251 Hyannis , MA 02601 }Home Improvement Contractor# 110609 'Worker's Compensation# '312-2 04 2 3 9-0 2 3 .r NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN AS BUIL SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT ALL CONSTRUCTION DEBRIS RESULTINGFROM THIS PROJECT WILL BETAKEN TO Dump , SIGNATURE DATE BUILDING PERMIT NIED FOR THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY i77 PERMIT NO. _. DATE ISSUED i MAP/PARCEL NO. ADDRESS` { i ( VILLAGE t OWNER DATE OF INSPECTION: , t �• � , , 7 i � i � t i I � i i i FOUNDATION t i i r FRAME INSULATION ! I i FIREPLACE f ti i i i ELECTRICAL: :) ROUGH FINAL t r • ' ��� i ti�-° i i � i i t I PLUMBING: ' ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO: . • `:`. ` ,S`1P-�` '„+mix x -.>sx e4.i`Kr3.�". ATs`'�+. *`r may''-. - •:'a €• . oE� # 244.83' F�GF G4 UQ�`' CATCH BASIN OP O� LAWN Toy•# 1j1 1 /�I o �j �sly* p', \ 33' �p/np (o 2 1 CPCIV t0 TING y V l,p pR. Bq v� � SA � N e pq � 4S ST, � �4C. s T v� s pp �r G Ail. " ' ' �� y�al F- �, r '� �3 -:�K �t+ 4 .&�^ cf'nr-:Cyh.♦y -4 ^,�' x3Ar1APSr� 4 Rg D f h�� d a. 9. n da to c XX N'Vd 0/1 d3S uSp4 1Vp� 0p� 1S/X Xp�ddb `Y O Cb e , r � r \ // "w WWI �10 d� 0Nno852130Nf1 •�' / • rn oo \ rri M.1 3„OO,10.S8S N I a i 40742 a DEPARTMENT O.';., i-'JBLIC SAFETY 40742 ONE ASHBURTON PLACE,. RM 1301 BOSTO&,,��'kA, 02108-1618 CONSTRUCTION SUPERVISOR LICENSE Numbert Expires: _.: Restricted Tot 00 f .. I. ERNEST J JAMMER ;, Hel ach bottom, fold ,+sign on 48 ROSARY .LANE ��: back, and laminate license card. HYANNIS , MA 02601 ff: Keep top for receipt and change f address notification. 1 �Sy,- ._ =P.�''�,Ff °.C�Ir k rKs� � r'.<. <t f�,c...I! ,,+,�•_+j.� x.�, ('i��, .I nC .�,.: I i .. _. I •.S�k n �'3ir�- I �'t.�j�`Y?�~Ai'.��y��� 3�"t p2 a t�F {'P �`��P•-�f.,�{ ° ! ..i' I 1 y Yob < _ ..II I � � �' ` 4�f2e-�Ur d �SV'`� ;`t�11 � ^, i5��h' `��.'iae`a , s. " I�t'��� •�} � , � e --- .Ye Y �/ � ¢��ji�, 1 f � ,��!^�+i '1�•`t f a-4� ;r a��'� K� , .1 ���yy)) r y 1�rr� - � ='}� hk ' `^1Nt�w.•r 4 E1�� ra Hfii�=L7I' , t. I 9p-i' �r ay♦ ��,�j.y; • '� t , ,riiy � �A I l?..�j y. dS.<."' w3�G.�1: �^�vi'.Fj 3,}��M Y�'.yf•` �yl �. i -•-- I2 kl..'IIjM'"1'''11,/'7 � ey{�� .1 � r��/rj'.1 �y�•-r� '"'�'C'',d�� �:}Ey��4}t '\ } k •2� �� \ 'S2\\•\�A\:� 15�7�tr�a�lwYTjTGd7O�/IVI�(acvfV►��%{�C�lIJC, �- "'`• '� �* HoME�IMP(�OVEME TS'CONIRACT�i �`� ,� s -SFr ��gPa�iona11p609 I y}��t '� Pe . . -••ItiATE C�RPORATIO! x^ II,D�R� I K 1 I '� 9 FeiluretoPoisonsacurrent, COMMONWEALTH DEPARTMENT OF PUBLIC SAFETY Alassachusr,;a.c F:1atcBulldJR� �� ONE ASHBORTON PLACE God�lacaaso fvrreroo�tloa . MASSA, .8osr0N;tulA-11rtoa--. of�hfsltcaAso. LICE EXPIRATION DATE 77 CONSTR. E R V I S 0 R CAUTION 01 /1 4/1 996 E DATE LIC-NO. FOR PROTECTION AGAINST .. I RESTRICTIONS THEFT, PUT RIGHT-THUMB '`;':;U .. NONE 6/3 993 003251 PRINT IN APPROPRIATE 5 BOX ON LICENSE. h i F ERNEST J J IMER 48 ROSARY LAN g BLASTING OPERATORS HYANNIS MA . G260 m MUST INCLUDE PHOTO. i `��;• i Plaro MLASTM � h F " 1`~ b 0.00 NOT VALID UNTIL SIGNED BY NSEE AND OFFICIALLY HEIGHT: STAMPED-OR-SIGNATUR THE COMMISSIONER ' THIS DOCUMENT MUST BE 'Iry NAME IN FULLAIIOVE SIGN RE LINE CARRIEDON THE PERSONOF SIGNAW OF LICENSEE µ\; THE HOLDER WHEN E>I- -y-'T, OTHERS-RIGHT THUMB PRINT I GAGED IN THIS CCCUPATION, ' O L CO Mj\f O NWEA-LTH ()I-- M�-�ACHUSE-M 'T0r- V-,DuSTRjjuW-CCIDF11TS ' Goo ?QGTO;� STiZL"T_ Ga n��et 0ST0,N, M/6SACHUSL-TI-S 02A 11 James- .e—r-ss+one wORK£RS'COM7'FNSATION INSURANCE AFFiDIVIT (liccnscdperMitarc) with a principal pl:rc ofbusincss/residcncczc 05 ar-� �-u a_iri n 1 S IM. 4 0 Z G o 1 (Ci ry1S tatc�Lip) do hereby ccrcifj•, under the pains and penalties of perjury; that: ( am an cmplovcr providing&,c following workers' compcnsation coverage for my employees-orking on ihi� job. Z - 20 y 2 3 - I 3 C,2_� ]nsurancc Com ny Policy Numbcr � ) I am 2 sole proprictor and have no one working for rnc- ( ] 1 2m 2 sole proprictor,gcncrJ contraor or homeowner (cirdc onc) and li:vc hard tlk contnabrs.listcd bclot.• who h2vc chc following worker,'compcnsation insurance politics: N-amc of Contractor Insurance Company/Polia.Ntunbcr N-mc of Contractor Ins=ncc Company/policy Number N-zmc of Conmaor Insurance Company/Policy Numbu 0 1 am a homeownu performing 211 the work mysel£ NOTE Plc:sc be aM;:c t5:ti1<)er_<o.+acn wbo employ p<rsoos to�o raaiateasoec,eoortrtsetioa or repair.-vc�c on a d•-,cllins of riot more tb= tbrcc units is N,1-i6 tt<bomco•Mu alco resiLcs or oc cbc r-MuQ6 appunzm=t tbcrctc acc not Fcocrall)' j eenr;Zcred to b<employers u,Lcr the Gor:'<rs'CorepeDs_t;on Act(GL C.152.eeet_ ](5)).appl;atioo by:bamco—ncr for a Ticc" < or porn;(a::y c.-i&ccc tic lc[.-J sun::c!:=cr_,lo;-cr uc8cr 6c Gor1crs•CoMPcosstion/act ;uaccrstz-rtc tn_t a copy of ties sr=tcrncr.+-ic a ic.-•uLcd to ti,c Dcp----cnt of lndustriJ Acad<nts'OFs cc of l ,—ncc for.co-cr:ic <rif,Lcion_rsd th_t f=.;lure to secure corcr�c::tcSuircd undcr Sccvon 25A of MGL 152 c=n k.:8 to the imposition ot-r.6 ink p<nJucs eonsisons o(s fin<o(vp to S]Safl•oa:r•�Jer i�rri:onrsast of vp to one yea:and a•rtl pcnalt;cs in(}se(orrn o(:Seop�1orS:Ordu znd a ` fsnc of S100.00 a dry against nv-- Signcd this _- d2y of _ - _ . 19 1L ccns c/ cr itzcc Licensor/Pcrmittor The Town of Barnstable NAM tee$ Department of Health Safety and Environmental Services c� Building Division 367 Main Street,Hyannis MA 02601 Officcz 508 7 227 - Ralph Crossen Farc 508-775.3344..•::: •- ..; - -. =Building Commissioner . For office use only Fermi?no. Date .. y AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c.142A requires that the"reconstruction,alterations,renovation,repair,rnodexniratioa,conversion, improvement, removal, demolition, or construction tion of an addition to any pre akting owner oocapied building containing at least one but not more than four dwelling units or 'to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: Vd Q6 WA44A4WJ Est.Cost g Address of Work: !St C i vi.a a 1 �ti t ' r* c-'�+ Owner Name: �ar �?�shhV�r Date of Permit Application: �T �1 S ICI L9 I herdm certify that: Registration is not required for the following reason(s): Work excluded by law Job under S 1,0,00 Building not owner-0ocupied Owzrer pulling own permit Nntitx is hereby given than- OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: �IAJt -E, .J lio (,po 9 Date Contractor name Registration No. Vri . Date Owner's namc 14, * ' tvyA 5�th gg �•f s'P�.� t a � t (.I � I * ' f , �s ft" f (0�14.�'�[,(' 1I2f'14. 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"'� :.��^. ? ,Y'.; �+. 1,. .1e4",AF:" a'+w;t' �', 8,1, '�5, _ _ '.. d.+4 '.y Y •.5f :5"'yt4 .?�1w ,v^x -<y{t ,�` 3fi�":.. g. ..s�•:s♦A h-r. nf�'zs+cr+ :•a. -�+�rw.•.- ,YEt *,. ,' • �+ i � ,}'.. •, .ram `1 ;.,, - : 4 .6E `�- : -' , .'-a'. ,-a'�.._ `s".+ �,.....'�. �.� et, ;:.. _ +�^af,c>::,. �. "rl. •�xn, i°«+x;<.� '"��".�'`. ;al� `'A,«tr�xa:a�i~""' "''atsr,'"' .z ... .•n : -;..a. ��ati..e_ .c!:.. ...q. � <,� sr.,......- ;. ,: a;:, .,. f.:,,, .,:.o-_ .♦ +::@R",..es ` `u., .. ,#,w.. ,' .�.:.-.. k :.. :. .:.., ., tr . .,,♦.. s*7ty :S' ..N'•t«..� ;, ;« S ...kr`j„ �sx .,K 7a"'�",�' '4,�y AAS° $y^E, f'n:-S:: :P' �� x ,xs.,xr a„ems'"§'�' 47i;,..r, M �9,✓", rT, � AFFIDAVIT OF SERVICE Under MGL Ch. 131, S. 40 and Article XXVII of the Town of Barnstable Ordinances (to be submitted to the Massachusetts Department of Environmental Protection and the Conservation Commission when filing a Notice of Intent) I, MICHAEL D. FORD hereby (Person making Affidavit) certify under the pains and penalties of perjury that on October 7, 1996 1 gave notification to abutters in (Date) compliance with the second paragraph of Massachusetts General Laws Chapter 131, Section 40, the DEP Guide to Abutter Notification dated April 8, 1994 , and Barnstable Conservation Commission requirements in connection with the following matter: A Notice of Intent filed under the Massachusetts Wetlands Protection Act by Sargent and Eunice Shriver Applicant) with the Barnstable Conservation Commission on October 4111996 �, for property .located at 265 and (Date) (Map) 9-1 , 31 Atlantic Avenue, Hyannisport (Parcel) (Street Address) The form of the notification, and a list of the abutters to whom it was given and their aadresses, are attached to this Affidavit of Service. r. 10-7-96 Name Date Z0 99bd (360—d hN'OstviiO Z9980CV809 9b:ZT 966T/L0/01 f DIRECTIONS TO SHRIVER PROPERTY MAP 363 o PAaRczL 9-1 31 ATLANTIC AvENua3, HYANNISaPORT Leave gown gall and turn West Onto Main Street Follow to Sea Street and take left onto Sea Street Follow Sea Street to the and and take a Right onto Ocean Avenue Follow Ocean Avenue to Hyannis Avenue and turn left onto Hyannis Ave. 70110w Hyannis Avenue to IyAnough Avenue turn left onto IyanoUgh Follow Iyanough to Wachusett Avenue turn aright onto 'Wachusett Fo21ow Nachusett to Scudder turn left onto Scudder Follow Scudder to Irving turn right onto Irving Follow Irving to Hawthorne turn left onto Hawthorne Follow Hawthorne to Atlantic turn right onto Atlantic to Locus 60 ?SGd fnjo-� �R NOSNIis Z9980EV80S 9b:Z1 966L/L0/01 °FTMe The Town of Barnstable * BAMSrnsi,E, • 9eb ' � Department of Health Safety and Environmental Services ArFDDAA'�A Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner September 12, 1996 Ernest J.Jaxtimer 48 Rosary Lane Hyannis,MA 02601 Re: 31 Atlantic Avenue,Hyannisport Dear Mr.Jaxtimer: As you now know,a Stop Work order has been posted at 31 Atlantic Avenue in Hyannisport. This was done on September 12, 1996 at 3:00 p.m. The reason for this work stoppage is that you have exceeded the scope of the building permit issued on March 19, 1996 by building a much larger addition than that shown on the plans you submitted. At this point,we will need the following in order for the Stop Work order to be lifted: 1. an as-built of the addition on a site plan 2. a foundation plan 3. a set of plans that match what was built 4. a new approval from the Conservation Commission. I am sorry that this action had to be taken and,hopefully,it can be straightened out soon. . Sincerely, Ralph M. Crossen Building Commissioner RMC/km DELIVERED IN HAND SEPTEMBER 13, 1996 eceived By. Q960912A P 229 805 287,E US Postal Service Receipt for Certified Mail No Insurance Coverage Provided. Do not use for International Mail See reverse Sent to -T i Street&Number Post office,State,&ZIP Code Postage $ Certified Fee Special Delivery Fee Restricted Delivery Fee N Return Receipt Showing to Whom&Date Delivered Return Rw*Stawag to Whom, Dale,&Addressee's Address CO TOTAL Postage&Fees is V) Postmark or Date 0 rL CO a Stick postage stamps to article to cover First-Class postage,certified mall fee,and ` charges for any selected optional services(See front). 1.If you want this receipt postmarked,stick the gummed stub to the right of the return 6 address leaving the receipt attached, and present the article at a post office service m}}, window or hand it to your rural carrier(no extra charge). In n 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the m return address of the article,date,detach,and retain the receipt,and mail the article. 2 to 3. If you want a return receipt,write the certified mail number and your name and address on a return receipt card,Form 3811,and attach it to the front of the article by means of the gummed ends if space permits. Otherwise,affix to back of article. Endorse front of article RETURN RECEIPT REQUESTED adjacent to the number. 4. If you want delivery restricted to the addressee, or to an authorized agent of the O O addressee,endorse RESTRICTED DELIVERY on the front of the article. 5. Enter fees for the services requested in the appropriate spaces on the front of this receipt. If return receipt is requested,check the applicable blocks in item 1 of Form 3811. li 6. Save this receipt and present it if you make an inquiry. a : . The Town of Barnstable MAM • ssnusTr►au. � 039. Department of Health Safety and Environmental Services Eo +' Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner September 12, 1996 Ernest J.Jaxtimer 48 Rosary Lane Hyannis,MA 02601 Re: 31 Atlantic Avenue,Hyannisport Dear Mr.Jaxtimer: As you now know,a Stop Work order has been posted at 31 Atlantic Avenue in Hyannisport. This was done on September 12, 1996 at 3:00 p.m. The reason for this work stoppage is that you have exceeded the scope of the building permit issued on March 19, 1996 by building a much larger addition than that shown on the plans you submitted. At this point,we will need the following in order for the Stop Work order to be lifted: 1. an as-built of the addition on a site plan 2. a foundation plan 3. a set of plans that match what was built 4. a new approval from the Conservation Commission. I am sorry that this action had to be taken and,hopefully,it can be straightened out soon. Sincerely, Ralph M.Crossen Building Commissioner RMC/km CERTIFIED MAIL P 229 805 287 R.R.R. Q960912A oFTMe . . °: The Town of Barnstable * BAiuvsrAsM • 9� Department of Health Safety and Environmental Services prfDnwe't°i Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner September 12, 1996 Ernest J.Jaxtimer 48 Rosary Lane Hyannis,MA 02601 Re: 31 Atlantic Avenue,Hyannisport Dear Mr.Jaxtimer: As you now know,a Stop Work order has been posted at 31 Atlantic Avenue in Hyannisport. This was done on September 12, 1996 at 3:00 p.m. The reason for this work stoppage is that you have exceeded the scope of the building permit issued on March 19, 1996 by building a much larger addition than that shown on the plans you submitted. At this point,we will need the following in order for the Stop Work order to be lifted: 1. an as-built of the addition on a site plan 2. a foundation plan 3. a set of plans that match what was built 4. a new approval from the Conservation Commission. I am sorry that this action had to be taken and,hopefully, it can be straightened out soon. . Sincerely, ` Ralph M. Crossen Building Commissioner RMC/km DELIVERED IN HAND SEPTEMBER 13, 1996 Received By. Q960912A lot �DEDROOMA ti 2 { r 03�;' #, _ � '.:;j LIMIT. OFCONSTRUCTIOtV .x s _ r i 9T�} S 4 rt�� 3 CLQSE'[` `�. � j s #d x` (UNLESS OTHERWISE'NOTED) JV�3+24 ya3 ,� n 1 d - 3 !o a - ✓ 4 t 0 z -. L - r AU�+t 1 t y O 0 # ; 2 s� r BATHROOM: 11 AThfR00M HALL 108. 4 l6z 054 0 i.. N NURSERY ►I ; ; a�I�N 3 R 105 ' v I CLOSET !06 b 7 4 I 1 '� 515 IA �. 9 �' IA O - -Y, CLOSET ,EXISTING PARTITfiO N 7 r NEW PARTITION A �� Ir lug" I `WALL T. E { l- fHHHIHih.- .EXIST. BASEBOARD RADIATOR BEDROOM b. - i f 4 C " php Trr— HA 1Nlflfi 941 ' ' Ny(IIIG �O i�l �M joy, 4 Zi7w� 3 `feaH+ Z,t'G1� t ` CA - - r a ors+T Assesor'soffice 1 st Floor): Assessor's map and lot number `W —1 �o�TEE To` Board of Health(3rd floor): _9io ✓�����/'� V/ Q m (' Sewage Permit number • Engineering Department(3rd floor): '�" e" ' = DAHJS'r�DtL House numberVAAL LED IN Definitive Plan Approved by Planning Board 19 WOT•f j,rLd , yFq APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only IVV11q01VA1E E 5 TOWN O F B A R N S T A B'�� R�Gru �-o®E,41VO ®�S BUILDING INSPECTOR APPLICATION FOR PERMIT TO ���dya-jtG. I�-I;CVZ.I � t TYPE OF CONSTRUCTION �e.t_ Cfl - 17 19 q2 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location AT L,�1"t 1 C Qy �AIJIJ\S POST �—oT CPO Proposed Use Zoning District Fire District S Name of Owner y iJ�<<C S�►'2 IV�e 12 Address u 44Ok >D02r-� kA Name of Builder �� t �� wC Address Cox 31O C&1 Name of Architect tiL.�aCy1✓ N 1C��dLA (� Address CS1C=QVIL_Lrr K\k Number of Rooms FoundationX—C Exterior S \AWC kh (em(A) Roofing C'F:-X-Z C& ) .,i..... .Floors. Interior �'1�1'� Heating �1— �•- Plumbing 2 1526n Fireplace Approximate Cost `5.oacc Area 594 4r Diagram of Lot and Building with Dimensions r '-TONEXISTING e WAS` LIVING �_ � COUAI2Z rYZS p�rt�vA��b 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 tj "^ Cons ruction Supervisor's License SHRIVER, EUNICE . K. t No 35153 permit For REMODEL INTERIOR i i ff i Single Family Dwelling Location -Lot #20, 31 Atlantic Avenue <t Hyannisport Owner Eunice K. Shriver ' -- -. r Frame Type of Construction Plot Lot ` 4: June 23 '' 92 Permit Granted 19 ' Date of Inspection ` '.19 _ Date Completed 19 �' r In p0ayy { 24 g -,, f o Q s• C. CATCH BASINoA- I '. LAWN 2 \ A, p0.".. W ' Li } • �_ UNDERGROUND .6 A P OIL TA',.+K rx y \ 15 03 o I / o N 1 s Eris / TANG E<< / !y a . 24 ,r \^ O A P q. P 1C ON t coC k e w T �� PTjC LNG A 770 EDGE i , {� a �. ct ;r� •0'_. I,c 7..,., ,• '+ :, a .a-- '.: ... :�. •�,. �a n f ..,t.e ,{{ D Q R �;,y # ,�y °1 V 6,.. r.'; Nt ca -.s,i ' 1 - s yy - p� . 12 •'� , 8 .., ._ ... a. .. ... . �ep.. :.. ,. .... ,'.max. .� �" ,. -�.. .�*;. J,i':c.:�"r• _ F .. „ _ t e , ..r.,. , , w..,,.. rs> ..... s 4x.. . e � � .. ��,.. .,♦ � _'.:,.ty '} -.: v. -. ._ - § n�,. +Tr.,. -."K 4. .r. :L,.w. .�. . -. ,4<' .. ,... 1 i. '' 3.•' XX�LLbb.. t :. tV. r ,7- .. All i ,� .. 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NIZA51411 . �As I OCEAN �m AV of N' a- U Z J f z o I HYANNIS Q� _ LOCUS Ate. HARBOR \R�`�AN 0 v P� \S� RO PO F9��S 0 SQ NANTUCKET \ SOUND LOCUS MAP SCALE 1 : 25,000 ASSESSORS —' MAP 265 PARCEL 9-1 l� f ZONE RF-1 & A.P. FLOOD PLAIN ZONE A-10 E ELEVATION 11.0 N.G.V.D. 37 _ FEMA PANEL 250001-0008D �\ REVISED JULY 2,1995 All -"� ?Z7 �`5 _ . C -- /S85' 1'00"E o LOWEST FOUNDATION SLAB / A ELEVATION = 12.1 N.G.V.D. 244.83' S85'01'00"E 49.37' CATCH BASINAL ILLI Q / LAWN JAL Li 9' 1W00 d 'I o C3 t7 I ` 95p J W o END OF COASTi4 BAN oll FOOTPRINT \ _ v cVoLo B LAW �� APPROVED UNDE N co 18X SE3-2620 wwt II UNDERGROUND OIL TANK to co 5•.6 o N co e�E�sT FCo< #vo S � )O o -_82.p 7 00" 12.42E &0 0`F \\ e % M OF SUE APPR O ST OX. ONF p ( XISr HOC �. j� \ \ \ ` ` q Teo I SEPTIC f -lA AL to LET 20 112,925 SF, FT,y� o�,T , \\ rop J oG Q �\ o2,59 Ac, 6y �` �. �'\�`'\ �,� \ \\`\ �< of Q ALI- `^ MARSH -- — -- _ �'-- — EDGE OF FLAGGED WETLANDto to 0) U) co �t4 to Z I s,, pFK iS4� gpNK f�-��10i0 ,Nc tN- 'I SOW- PLAN SCALE: 1" = 20' 0 20 40�' , i ELEVATIONS ARE BASED ON N.G:V.D. Y 100 YEAR FLOOD ELEVATION = '11' m OF I i I i 1; I• �H of y SULLIVAN NO.29733 REHARr CIVIL A. BAXTER No awe /STE ern pro O SITE PLAN IN f (HYANNISPORT) i BARNSTABLE MASS . FOR ROBERT SARGENT SHRIVER I CERTIFY THAT THE EXISTING ADDITION SHOWN HEREON REVISED: 10-04-96 COMPLYS WITH THE SIDELINE AND SETBACK REQUIREMENTS OF SCALE: AS NOTED DATE: OCT. 1,1996 THE TOWN OF BARNSTABLE, AND IS NOT LOCATED WITHIN THE BAXTER & NYE INC, I REGISTERED LAND SURVEYORS FLOOD PLAIN. CIVIL ENGINEERS -` DATE: / tl�jc R.L.S. �4; ci ;� OSTERVILLE, MASS, y N . 29874 I, OWNER: EUNICE K. SHRIVER C/O KENNEDY ENTERPRISES CTF. 376550