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0065 BARNSTABLE ROAD
6✓� �9,en��38GE �-- ACTIVE i - � - �, 1 0 �1 1 V ^ J �v ,.� (� v` � i � I ,, I I � � . � � 4 i { r s • TOWN OF BARNSTABLE BUILDING PERMIT APPLkCATION Map Parcel V Application Health Division Date Issued 41;r' Conservation Division Ap lication F Planning Dept. 44= Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis ` _ _ 'O Project Street Address SZZ�6le a Village l Owner Li 6,. to 9 PI-W Address Telephone NOD 2 (` Permit Request Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type wo�Z 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 8' o 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 peals Authorization ❑ Appeal # Recorded ❑ Commercial Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name I �v Telephone Number "—Wo 2 Address 2� �� NA License # 1 I060 O Home Improvement Contractor# 16 Email C 02 00 D 10 C C�kdr( L. C->M Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Of 0 tWQ LA,1A4 SIGNATURE DATE C) I-4-I FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING { DATE CLOSED OUT ASSOCIATION PLAN NO. Cu�u�za��a,�'�rFssr�e�trfsr�i`s Dew- OffMa Acc&,vits # ' 690 Way jv&reef - wH.�w Trzass:ga��rr� . 'markers'CompensatmrtInsm-ance-�daeiE:RugdersfCQnfFa:ctnr&(JE!ectric=nMumbers App cantInfe ma6on. Pleas-epErmtL ihT�r Name�ssl �,a ,„7n: C a C.o� �'c�y c�. Y o vcu- - mess- d—Cify�statk--� _==L=�j 0 -� Are Au m employer?Check the•2pggmpriafe ham T of Irrb ecE fir - I I am a emp Ioger witft � 4_ ❑I atu a 1 ctmfmctar aud I Iayes{full a4dlorgatf-Aisne _ 6 N,-w rna r„Octica � have- tie MZ-COUtE&�fof& �'_El am a sore prup64or o'rpartner- Iisfe�on the gtt�Thed sheet I- ❑ ship and have no employees These vib-coahmcfors have g- ❑Dcmolifit�a wadcing forme is my rapadfy emplayees and have wo&-er.' SI_ ❑$nildmg addition., �6T;CQ1'�ErS�COnlp:rst*arnrnrg . COS_+ncnrarrr�, � . re2uired J 5_ '%Te am a carlsaraficmand ifs 1{I��itucal repairs cs adr�ians 3_❑ I am a homernrner doing all wo&' or=,=s have exercised their 1 LO Plumbing.zepai=s ar adc€itiorls f �art cis MGL ' *�tt LI�To ur�arl-�s'sxsnig_ right of p L2�$oaf iMVranceregnirz ri F r-13Z j1(4),andwe(ravenos �� - eT1oyees_Irawod' 13-0 ether comp_t„=znm rmprerl. *Any SMFsCCUTdate-TAP, b-cx-flym AsoftoUrsfie bekws1=Ein;C rap �t off=ecan6sWhOSUBMRihisaf8dzvffinXMstes theyasedffiagrIiti�7csadtheab¢zeo aer�rn.�,,.ramstsaha a €fna r T s Zl.3 C 6< CbYTC t&b-mc MUa sttaCb M aaa]IIIM Sheet ffibKMy tIM nxaIE Of she gab- S]MA5'tEh�LCheffier GE=t tEmsE h--c;? �hry�s Iftbe s�co-atra�sh-cue®gIQ�ES,ch�g�st giaviae ter wa��s'comF P�LE�a•�vaIrer. T nm ara srrtgFr�yet rh ispr+�aa�irrg traders'co uvliott xrrrr�rrrrce$fat-rrz}'ra aye�ar. HeLpf is thepalrcy andjob site Fiz•fvt�tiQfia�tL • Iasm ce CompanyNanae: 1M Lk.GL-A N&Y:ff cc Self-ius Uc-4k, 6 � 22 Lt FS Fxpisatzoanate: OG b 2,1 t 6 � : �'5 ACV k Q"Je. �� c� taws_ . �-c Q 'I IS €ach x ooPy of the worke�'campensaiiun pafrcf derl*rstiaa bags(shag the gn rmr eq3h7_tio-a date). Faalure to secs caveaage rsgeirednuder Sectiora?5-k o€MGL c I52 can Iead to the suxp oa afciinrinal ge�ffi es of a fmupt6$L50D-ODandforonz-yearimpdsa=n=3tatsweaascivApen2Wes is f he form.of a STOP Wt}RIK ORDM and a fine cTup try$ZO-00 a day against the vio}ator_ Be advised fbaf a copy of lffiis statagent maybe fQswuxW to the Office.of , fur,cu Epdc=of fac DIl for insar mc* a cvveMge ve ffic;dim I&hereby ccrlijp under the . ger�u2�'thatthe iqforuttzi5Faa pratddsd ahare fs h7w mid earrm:f- satn 16 lied iWOCLTl use attFy. Da teat Wi&is this areas#a bg caxag£&d by dty ar tOWa a,f �iul C)fy-or T'owa: Peatffacerrsc- Iss¢mg Authority{arde ouey: L Board of Health 2.EwMng D pa tme t S.CftyHawa Qe rk 4.Electrical Inspector- S.Plumbing r .6.Ckdter Comet persnhr:. I'h�o-rre: 6 Town of Barnstable - Regulatory Serviees Richard V.Scab,Director Building Division Thomas Perry,C'BO Building Commissioner .200 Main Street, Hyannis,MA 0260I www.townbarnstable.ma.us- Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must r Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize to,act on my behalf, in all matters relative to work authorized by this building permit application for. . (Address of Job) Signature of Owner Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. 4 • QAWPFII ESTORIAMbuilding permit formslEXPRESUDD Revised 061313 • ff �y I �{ M z e. ? y� F �F� a„r h ' � ds I v e � p ni l R f a'y n y; x sr, s Y. / Y•� -M r^��, ".,su sm , 3 5 J r c, y z a x z ��x'1+s .fib .`• v� ��*t+,� �!' "�' �i .s'� _ ��' �w, .z , xfi '� ��• ,,� .`., {Fro ", j.P�� •- ! • t • • ,. .;. V `t+ • • S a^f �'". ro+ i Sri �t.,..%�+.•�� � `m�, � '�` ""•= `° '''�`' ;,tom �"��" .��; �t��,�,1► � „ t,�`w... .';��t �,' y � z y a�" .••ram, �;} F` '-.�"� k: «'l j 4p�. "r F i r" r , Nq Office of Consumer Affairs and Business Regulation p 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 -,Home Improvement Contractor Registration Registration: 168043 ' + Y r Type: Corporation Expiration: 12/7/2016 Tr# 260419 CAPE COD HOME IMPROVEMENT LLC �,�: x x: ANATOLI SIVITSKI _ ' ,,. _ ,..__�.._.,......_...--..__._.._._�_ .._. .. - 27 MILL POND RD _.__.:.__._____ _.._ ___.. „ T_..:_ h,...._....,._..._ , r WEST YARMOUTH, MA 02673 Update Address and return card.Mark reason for change. scn i a, 2oM-esr i fG Address Renewal Employment _,3 t.ost Card ' ,� _ '%/re Yr�niryici uncx///r �':%l�at•;arl�.rc.r,lLa .� _..,.-.. w ,. __, v ` \ Office or Consumer Allau•s&Business Regulation ° License o registration valid for individul use only el �; OME IMPROVEMENT CONTRACTOR F. before the expiration date, If found return to: (a egistratwn: 1.68043 Type: office of Consumer Affairs and'Business Regulation 10 Park Plaza-Suite8170' �� Explration 12/7/2016 Corporation e t- �'� �: :.. Roston,MA 02146 f CAPE COD HOME IMPROVEMENT;LLC. s`-7 ANATOU SIVITSKI 27 MILL POND RD �w., WEST YARMOUTH,MA 02673 Undersecretary No"alid witlknut signature 1, c x j r 1- :. , . ,M, , ---a, Ssachus.. -ett,,so Public Safely . Board of Build ' Ke9waTions and Standard PCIrAl S01r, speciialty ice,n sle CSSL-106040 ANATOLI SIVIT!�,Kt, 114 TA 4 ,'*D RR '222 BUCK tS"LA-N . - ti 00 aR West Yarmouth MA 02 673 Ae � y c Expiration . commissioner 05/114/2018 , AC R& * , DATE CERTIFICATE OF LIABILITY INSURANCE /29`2015 YYY' 06 2 201 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF.INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements. PRODUCER CONTACT - - NAME: DOWLING&O'NEIL INSURANCE AGENCY PHONE FAX AIC No: 973 Iyannough Road E-MAIL ADDRESS: P.O. BOX 1990 - INSURER(S)AFFORDING COVERAGE NAIC# Hyannis MA 02601 INSURER A: AmGUARD Insurance Company 42390 INSURED INSURER B: CAPE COD HOME IMPROVEMENT INC INSURERC: 27 MILL POND ROAD INSURERD: INSURER E: WEST YARMOUTH MA 02673 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE _ - ADDL SUER POLICY NUMBER POLICY EFF MMIDDY EXP LIMITS GENERAL LIABILITY - - EACH OCCURRENCE $ ENTED COMMERCIAL GENERAL LIABILITY DAMAGETO R PREMISES E 000unenc ' $ CLAIMS-MADE OCCUR _ MED EXP(Any one person $ PERSONAL&ADV INJURY $ • GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PRO-JErT LOC" - _ $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT - - Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED „ - - BODILY INJURY(Per accident) $ AUTOS AUTOS - - HIRED AUTOS NON-OWNED - PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION * $ ' WORKERS COMPENSATION X' WC STATU- OTH- A AND EMPLOYERS'LIABILITY YIN. R2WC642248 6/3/2015 6/3/2016 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ S,000,000 OFFICER/MEMBER EXCLUDED? a N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT _$ 1,000,000 - DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space is required) - a CERTIFICATE HOLDER CANCELLATION Simon Property Group SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cape Cod M611 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 769 Iyannough Rd ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis, MA 02601 AUTHORIZED ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD b RESIDENTIAL PROPERTY MAP NO. LOT NO. FIRE DISTRICT SUMMARY STREET 6 Barnstable Road Hyannis 73 LAND 3 27 18 H al BLDGS. U .7 OWNER TOTAL RECORD OF TRANSFER DATE BK PG I.R.S. REMARKS: 7.3 LAND BLDGS. O Panesis James 3/9/21.. - 379, 33 _,, B TOTAL " 3 ✓u c��s 8/ .33 aC 7 LAND 7.IO 0 -par Rub ^m �0 — �' O i" Z1 2 James . BLDGS. Z D G7 , • e eS a e - TOTAL Q orgce, Helen P. &. Panesis Peter J. 10-10- Prob. 116 Rubi LAND O V BLDGS. TOTAL LAND BLDGS. TOTAL LAND 01 BLDGS. TOTAL LAND m BLDGS. TOTAL LAND 'INTERIOR INSPECTED: / _ H CI wareb BLDGS. y �l�'J � ToraL DATE: `�' 702 !c ,7. ? / / 1 LAND ACREAGE COMPUTATIONS ,,U =D BLDGS. rn LAND TYPE # OF ACRES PRICE TOTALb VALUE TOTAL LOUSE LOT . LAND :LEARED FRONT BLDGS. REAR TOTAL VOODS&SPROUT FRONT L q ! c . LAND REARS BLDGS. rn VASTE FRONT TOTAL REAR LAND BLDGS. TOTAL LAND Q) BLDGS. LOT COMPUTATIONS LAND FACTORS TOTAL FRONT DEPTH STREET PRICE DEPTH% FRONT FT.PRICE TOTAL DEPR. COR. INF. VALUE HILLY TOWN SEWER LAND / ROUGH TOWN WATER BLDGS. HIGH GRAVEL RD. TOTAL LOW DIRT RD. LAND SWAMPY NO RD. rn BLDGS. FOUNDATION BSMT. & ATTIC PLUMBING L G PRICING LAND COST aa&Walls Fin.Bsmt.Area Bath Room Base �0 3 EILDG.COST Cone.elk.Walls I Bsmt.Rae.Room St. Shower Bath Bsmt. — 3� PURCH. DATE — Cone.Slab Bsmt.Garage St. Shower Est. Walls PURCH. PRICE q• = �~ J. Brick Walls Attie FI.&Stairs Toilet Room o n Root RENT. �/1 ti/> ••� Stone Wells Fin.Attie IVV Two Fist. Bath Floors p Q Piers INTERIOR FINISH Lavatory Extra Bsmt. F 1 2 3 Sink / yl ' s/ y= y� Plaster Water Clo.Extra Attic =_ XTERIOR WALLS Knotty Pine Water Only S ��qq 3 Plywood No Plumbing . . t�P /;p —*S)Double lfiding g Bsmt Fin L/N F'/AI' A'rt Single Siding Plasterboard Int.Fin. Shingles y TILING Conc. Blk. G F P Bath FI. Heat 7?() Face Brk.On Int.Layout Bath FI.&Wains. Auto Ht.Unit d' t) Veneer Int.Cond. Bath Fl.&Walls . Fireplace Com.Brk.On HEATING Toilet Rm.FI. 30 Plumbing Solid Com.Brk. Hot Air Toilet Rm.FI.&Wains. -- Tiling Steam Toilet Rm.FI.&Walls Blanket Ins. Hot Water St.Shower y Roof Ins. Air Cond. Tub Area Total Floor Furn. C� O ROOFING E COMPUTATIONS sJP Asph.Shingle Pipeless Furn. S.F. -I A 3 3 6 Wood Shingle No Heat S.F. 00 Asbs.Shingle Oil Burner S.F. 3 /3 CO. Slate Coal Stoker 360 S.F. /7-L p G 3 3(, E' v �/r1 A qw 5 rE Fr " / 5 Tile Gas S 9 L OUTBUILDINGS ROOF TYPE Electric Gable Flat S.F. 8ss" 1 2 3 4 5 6 7 8 9 10 1 2131415 6 7 819110 MEASURE Hip Mansard FIREPLACES S.F. Pier Found. Floor C- _ Gambrel Fireplace Stack Wall Found. 0.H. Door LISTED FLOORS Fireplace Sgie.Sdg. Roll Roofing a Conc. / LIGHTING Dble.Sdg. Shingle Roof — - —Earth No Elect. Pine Shingle Walls Plumbing DATE 1. Cement Rik. �' Electric Hardwood ROOMS a /S PRICED Asph.Tile Bsmt. 1st * TOTAL Brick Int.Finish Single 2nd 3rd FACTOR $'r REPLACEMENT OCCUPANCY CONSTRUCTION SIZE AREA AREA CLASS AGE REMOD. COND. REPL. VAL' Phy.Dep. PHYS. VALUE Funct.Dep. ACTUAL VAL. DWLG. r,4 �' S f SII L G F Is 3 /I b 3 `f / FG 0 0 - 3 4 5 6 7 H 9 10 _ TOTAL _ 3;tL90r7 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map "7 Parcel 0 Permit# Health Division Date Issued Conservation Division Fee Tax Collecto Treasure Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address g 5 JT;q ��r" S Ti f( i /c Village t i N ) S Owner 66Y rib reewl 7viu5f Address jo 1,1>,; 4 % C/A,, l 6 Telephone �� U0 0 o0 ZlArz 110A.,A6 4A)Q ez/_ # ) NyxjNA,► s v 20, Permit Request 0 v 57tc 1/J� 0 f Cj Uz L r�/r,��' /A S Q Vr%Vie` 16 �S�Ato; 0 (Z.A C I!5 �� � � ��� cw��iNiti� s 0 %b �C�cr AL 1 cC tvA)fir`- � %M ;N% ti6 L (3 v co PWj'o,,,otrr- I.pAM Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Valuation 4 3 y©O . Zoning District Flood Plain Groundwater Overlay Construction Type u. Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. f' 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 Cl new size Shed: ❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commerci4/d/Yes ❑No If yes, site plan review# Current Use - Proposed Use= c.� BUILDER INFORMATION Name i��� c�1 /`7 )-°A WAi-I Telephone Number Address A Ke-VI f=ty A,V License# C J 0-7 0 6 3 ►..i t��V l�-( � /� U 1 6 Home Improvement Contractor# Worker's Compensation# u.) C �� 80d- ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO A 6 et-7 e- T SIGNATURE DATE 1l�/u )) i FOR OFFICIAL USE ONLY k� PERMIT NO.' DATE ISSUED • f MAP/PARCEL NO. " ADDRESS VILLAGE OWNER- 'fir r DATE OF INSPECTION: i rl FOUNDATION FRAME f.� INSULATION FIREPLACE j ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL ` J L GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. ' PROPERTY ADDRESS I I ZONING I DISTRICT CODE SP-DISTS.I DATE PRINTED I CSTATE LASS I PCS I NBHD PARCEL IDENTIFICATION NUMBER KEY NO. LAND/OTHER FEATURES DESCRIPTION ADJUSTMENT FACTORS TY UNIT ADJ'D. UNIT Land By/Date FF- p,h,ZIOR ACRES/UNITS VALUE Description GEORGE/ HELEN P MAP— CD. FF-De th/Acres LOC./YR.SPEC.CLASS ADJ. COND. PE PRICE PRICE CARDS IN ACCOUNT - L WAREHOUSE U X C= 100 *108688.00 108688.00 1.00 108700 3 02 OF 02 A COST'214300 N MARKET 204500 D INCOME 177200 A USE D APPRAISED VALUE D J A 214#300 A PARCEL SUMMARY T U LAND 90400 A S T LOGS 123900 M —IMPS TOTAL 214300 F E N CNST E N DEED REFERENCE Tye DATE Recorded PRIOR YEAR VALUE A T Book 1>a9e in MO.MO. Yr.p Sa1es p"m LAND 90400 T O SLOGS ' 123900 U TOTAL 214300 R I 1 E I I BUILDING PERMIT aS - Number Date Type Amount LAND LAND—ADJ INC ME SE SP—BLDS FEATURES BLD—ADJS UNITS 108700 Class Cons,. Total Year Built Norm. Obsv. Units Units Base Rate Adj_Rye A4�I itfh Age Depr. Cond. CND. Loc. %R.G. Repl.Cost New Adj.Repl.Value Stories Height Rooms Rma Baths If{a. Pariywall Fsc: 65C 001 000 001 50 60 34 45 100 45 108700 48900 1 . 1 Description Rate Square Feet Repl.Cost MKT. INDEX: 1.00 IMP.BY/DATE: SCALE: 1/00.37 ELEMENTS CODE CONSTRUCTION DETAIL S SAS 100 .00 5250 GROSS AREA 5250 WAREHOUSE CNST GP:0T T ----------- STYLE 38COMM,. WAREHSE 0.0 R ! ! _ESIGN_ ADJMT 00 __________________ 0.- U ! _XTER.WALLS_' _04CDNCRETE BLOCK-_ 0.0 C ! ! EATlAC TYPE' 00 0.0 T LNTER.FINISH 00 0.0 U _NTER.LAYOUT_ -00 ------------------ 0.0 R - NTER.QUALTY Od 0.0 A F L --OOR �_f, - -00-- -------------------0-.-0- ! ! ' --- ---------------------- L D W 75 BASE 75 E-LOOR_ COVER__ _00 0.0 ------------------ .- E Total Areas Auz = Base = 5250 1 1 OOF TYPE OG 0 BUILDING DIMENSIONS - - —L E C T R I C A L--- OG 0. A SAS W70 . N75 E7D S75 .. ! FOUNDATION OD ---- 0.- �. -------------- --- ---------------------- � --------------;- --- ---------------------- ! ! LAND TOTAL MARKET PARCEL *----------70-----------X - AREA VARIANCE +0 +0 STANDARD PROPERTY ADDRESS ZONING I DISTRICT CODE SP - DISTS.I DATE PRINTED I CSTATE LASS I PCS I NBHD PARCEL IDENTIFICATION NUMBE KEY NO. 1 0065 BARNST 8 ROAD LAND/OTHER FEATURES DESCRIPTION ADJUSTMENT FACTORS T,, UNIT ADJ'D. UNIT Y Land By/Date Size Dimension LOC./YR.SPEC.CLASS ADJ. COND. P PRICE PRICE ACRES/UNITS VALUE Description G FOR G E - H.EL E N P MA P- CD. FF-De th/Acres E #LAND 1 43,800 CARDS IN.ACCOUNT - L 30 3SITE 1 X .3 =10 203 134999.9 274049.9 .17 46600 #LAND 3 46.600 01 of 02 A 10 1BLDG.SIT 1 X .3 =10 203 134999.9 274049.9 .16 43800 #8LOG(S)-CARD-1 1 75,000 COST 21430G N #SLDG(S)-CARD-2 3 48.900 MARKET 204500 p BATHS 101 U X B= 100 7600.0C 7600.00 1 .00 7600 3 #PL 65 BARNSTABLE RD INCOME 177200 A #RR 0076 0074 USE D APPRAISED 214 D .300 ' 'q PARCEL SUMMARY T U LAND 90400 A S T SLOGS 12390C 0-IMPS E ) TOTAL 214300 F N CNST E N DEED REFER ENC Typs DATE Recorded PRIOR YEAR VALUE A T Book Paps Inst. MO. Yr. Ssles Prig S LAND 90400 T 5176/011: I:07186 A 1 SLOGS 123900 U 53116/R0; :10/79 TOTAL 214300 R I 1 S Number D.s ILDING PERIrMIT An+oww LAND ADJUST. F O R USE LAND LAND-ADJ INC ME SE SP-BLDS FEATURE BLD-ADJS1 UNITS 50/50 90400 7600 Const. Total Year Built Norm. Obsv Class Units Units -Base Rate Adj.gate Aquel 11,9 Aga Depc Cond. CND. LOC. %R.O. Reel.Cost New Adl.Reel Vt iw StOrNs Might RoonN NrM l�tM oft. P�t1ywM'�C. 018- 000 100 100 67.95 67.95 40 70 24 74 80 100 59.2 126769 75000 1 .4 7 3 1.1 6.0 Description Rate Square Feet Repl.Cost MKT. INDEX: 1 .00� IMP. BY/DATE: / SCALE: 1/O O.38 ELEMENTS CODE CONSTRUCTION DETAIL S SAS 100 67.95 1251 85005 GROSS AREA 2502 SINGLE FAMILY DWELLING CNST GP:00 T FOP 35 23.78 220 5232 *--19--* TYKE ______ _10OLD STYLE 0. R FOP 35 23.78 108 2568 ! * _E-SIGN ADJI�.T 60--------------------- ______ 6- U FOP 35 23.78 36 856 ! FOP EXTER.WA AT/A _LLS 01 WOOD FRAME 0._ C 814 30 20.39 1951 25508 33 * HEC TYPE OTGAS-HOT----WATER___ 0._ *9_* ------- ------- - - - 040 U 12 12 ! INTE AY R.L0UT _12AVER./NORMAL ____ 0._ R FOP! BASE ! INTER.OUALTY 02SAME AS EXTER.__ 0. A *9-* 54 FLOOR- STRUCT- _02 -D _JOIST/BEAM_- __ 0. _ ------ ------- -- - - -- -- -- L p W ! EF_LOOR_ COVER- _02YID EBOARD---------0._ 364 1251 ROOF TYPE ' 01 GABLE A_S_P__H__S_H_____0._ E Total Areas Aux = Base = 1 1 ---__ - I T BUILDING DIMENSIONS 3 0ELECTRICAL _ 01 A V E RAGE ____ 0.0 A SAS W23 FOP S10 E22 N10 W22 .. FOUNDATION_- 01 POURED -CONC ---- 99._ � SAS W01 N30 FOP N12 E09 S12 W09 814 L .. SAS E09 N33 E19 S09 W04 FOP *---23---X* COMMERCIAL NSHD IN HYANNS HY09 S09 E04 N09 W04 . . SAS S54 _ .. 10 10 LAND TOTAL MARKET 814 N54. E04 N09 W19 S33 W09 S30 . I FOP ! PARCEL 90400 214300 E24 814 .. *---22---* AREA VARIANCE }0 }0 STANDARD 50 I A oFWE Town of Barnstable *Permit# �� oZ 9 �•s Xvpbes 6 mondhs front Issue date • a�vsrw Regulatory Services Fee 1 Thomas F.Geller;Director • Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 ®P F EXPRESS PERMIT APPLICATION - RESIDEN'I'IALO- 1 4 Zut15 Not Valid without Red X Press Imprint ' 4ap/parcel Number • I O/ TOWN OF 13ARNSTACLE 'roperty Address Residential Value of Work Vroo G, 0 0 Minimum fee of•$25.00 for work under$6000.00 )wner's Name&Address //tg t P Mo P PA M A� 7-�"5 T�G contractor's Name I I A P d�j A 6`4A Telephone Number Home Improvement Contractor License#(if applicable) _ 2onstruction Supervisor's License#(if applicable) G 7 C 7 6 3 ]Worlmun's Compensation Insurance Check one: I am a sole proprietor a I am the Homeowner I have Worker's Compensation Insurance insurance Company Name (A L-P 6 V-L l Woritman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All.construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) 9/Re-side VReplatcement Windows. U-Value (maximum.44) 4 DO U a S *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. Home Improvement Contractors License is required. Signature Q:Fo=:expmtrg Revisc063004 The Commonwealth of Massachusetts Department of Industrial Accidents 600 Washington Street Boston,Mass. .02111 Workers' Com ensation.•Insurance Affidavit-General Businesses / .'p��.r,,�,.�<�'�} .''i ���.•ups. .c,.,.�,;5:.,'`bt,,.. ... • ' ,,. _ „,ry.. �. name: 4, address: 1.06 In is F r-V? A l city G'-1�) �)`-�"►s state: I'1 �A. �jL6 ° p �i Goa- ��� phone# S work site location M11 address): ❑ I am.a sole proprietor and have no one Business Type: ❑Retail❑ Restaurant/BaAating Establishment working in any capacity. ❑Office❑ Sales(including Real Estate,Autos etc.) 01 am an em to er with eln to ees full& art time. ❑Other I am an employer providing workers' compensation far my employees working on this job.. comDanVltahie:.. - t V address: 7. !�qq L dI - /% 7_•/ hone. ,' Y] : 4 V � � '. . insurance.ev: : I am a sole proprietor and have hired the independent contractors listed behiw who have the following workers' compensation polices: comAany name: - • _ _:�-• - id essd - dr city.. shone'#.' ,.... _ insurance co. ' co 'i _a, m�A V n.• riiee" 'n address:. . -•.. ',' .'. ... . .. •- cityc insurance co:•. , . :.. •. .. . 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$1,500.00 and/or one years'imprisonment as well as civil penalties in the foim of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under thepains and penalties of perjury that the information provided above isgqtru��e�a/nd correct Signature Date Print name Z, } d �/1 Phone# official use only . do not write in this area to be completed by city or town official city or town: permit/license,# _ Building Department V ❑check if immediate response is required ❑Licensing Board ❑Selectmen's Office []Health Department contact person: _ phone#; (revised Sept 20D3) ❑Other t - Information and Instructions Massachusetts General Laws.chapter 152 section 25.requires all employers.to provide workers'compensation for their.. employees.. As quoted from the"law", an employee is.defined as every person in the service of another under any contract of hire, express or implied; oral or written. An employer is defined as an individual,partnership, association, corporation or other legal entity, or any two or mare of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased,employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the.occupant of the.dwelling house of another who employs persons_to do.maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment.be deemed to be an employer. MGL chapter 152 section 25 also states that every. state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the.commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the coinmonwealth 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.. Please supply company name, address.and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents'. Should you have any questions regardinethe"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 filLin the permit/hoense number.which will be used as a reference number. The.affidavits maybe returned to the Department by mail or FAX.uriless other arrangements have been made. The Office of Investigations would lice 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 ofte of Imsdgamns 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 exL 406 !P'► +b• (: n aT pa 3" y, 01113/2605 ,- t Vim:, . RATE tMMIDWYYvyp +-��>r a aRclRUCkRt _ .. ., 9 � ^ � ' 3 INFQRta1ATIQ i€ fir 3 N ►'EE CERTIFICATE NO, EXIM) OR 41* .AOLICIES BELOV'B .,. +_,y�. r wNA :e.�' +r ;4� s aq+ 1 +} r t'n '4"`' r` + �, �t,y, `�` ,4} '+" 83 ^: 4a F°k°ci`n' ,w.. t a'" •'"'�, d.. .za,•,^ kv ,y'[.,r ✓� ...,.,.' f y . 26018,Li akc '-18929 - n ''E"`0.tiH` w 6 +P" "`^'�3n3A�"�i`� " r.."'—T= ., j - f=� �"°��^1' f`&� �" ��a4.si�+H'..��• � -�R� "+ '.. �x.aYT r � y t u3 .� 6r-4 ^C.� "- •' x .w- �...'�r" -. k -.e,® `r..ar+.�`,•.+:.'a„'++e - '1u�.+/vM< �...r:,+a '•��. r„+.^h-+^ 1° 4• .,rF T�' ps. • ,.t zv Y$ r �lr .: t.1T�3? r'eZtY � kt -t a0 sr ' ,-. t'�Wi"fi•lSTP.NDING - .� .+'3, �'�t ,�+ t �� •�t'a }k��* '�r`� �f � �.z�, C� �' tiY�3E�ISSUE9;Gft r ' =yr {te.4r tr.',CZ a wQ1ts FIB �> A x�w Tx ' " r` d �a " � �. c'; ff')fS`J1V8 OF SUCH rNt"'s v t � q �t .ate y m >, 4 •—--- 4 a�g •,Y_ 'va.,• R�" A •"~` � �#,�" �� a k '� cc) 000' 000 e n'�. �. tt ..s �. •-. h �`' �.., sr +lT'-4fi.� z.�- 'a�,F .� 7' .5 ��X. 5,000 . -00 2.000,000 .. 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'+.�c`�ti }' :*�a�.r ",¢{�,,,c�"`..M.«�i"syi�C,l'v:Ac,5 0 p-5#t'�' �5+ ,rat:. :4s � a.E r*'r y `. #r`r }�t r-.a`.d tr� $. �:�v'�+' `,YA, � a•a,� y 's" `,"hh-' ':m �t ' ,C, ""1 r A�I - ' .i �X40' r,�"gy ®* Ls�'�.:'"'1�.�'�,°'� �`.$? ��" a�?k��,.,g,�5.u�a� E�n.� s,�,f',r� � •'�+ w�" ,�w� + r� ,�� �^��,..T�,"C,rn:w� d �! .5' 'i�3s u '`'✓ `�`L. ,*,ky � "+5a"T ti.. "-LR'}'Am>d"tSlx $ pip ':,�"', r '� b :A' R' ` �stltis�YlNzS z}�` et* � Fw � k r� ytt : n ��° �a`-h�'�'• '"'""3y� #�'�' '��C2" g ``a•Y °' r ' #r,,,•3 .sRd t r., S*,� tk�.Y��s„Ap ��'�a� .. ��.� r'�. � . �%{.x�� �;h. '-s'�aa. �' ai' e � �• °��` �i ~�+G"Ai`7y''', �`�"��;-�a'Y$g�7Y`A13.�.iSd�S WRVTrT rz��. '�t Y RE SO o n v n�s fig} x (Y + )I Y'1 StL$J TQfi4SMALL�N R, AGENTS OR TA X �qw yy - K.R T°3E.I•�T wa�, ACORO 2S(2Q0�l4+Pa) •, . 'r w' ,),ACORD CQr"1PxQRAY,OiV.99&R }. 79 R 0 �P _ r S 'c b i �.. M-0, O-C^ Of It ---- FIT mml OR .Aw wn- MA A -S A gp, v jpvg.5", k' A .'dV R2N AM:, 011;5i MR .......... ............ TI q It b A Jv Town of Barnstable *Permit# . 6702- Expires 6 mo t m' dote r g�E Regulatory Services Fee r �rFD. A` Richard V.Scali,Director - ------- ------ Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number V( f t c /�/�,/� Property Address G 5' &01 r-d1 S4k bl e �CI. fulls ri'1 A C7� (9 O Residential Value of Work$ 20 d/O Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address �raPi/► I'L:d ii.4 6.0.11 Contractor's Name Eri K CTW I: Telephone Number S6q, q 32_s- Home Improvement Contractor License#(if applicable) / b 6 Email: Construction Supervisor's License# if applicable) [ ]Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name ; Lo S + ,-101S. Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany ea&permit. Permit Request(check box) . �] Re-roof(hurricane nailed)(stripping old'shingles) All construction debris will be taken to 1 OLOM VV ❑ Re-roof(hurricane nailed)(not stripping. Going over existing-layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red-Stand inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. ' A copy of the Home Improvement Contractors License&Construction Supervisors License is re uiread. SIGNATURE: Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 040215 F' s 9Z 4'a� mg,, , ,, 4IieaH4.S1a;eSaotl'ani�sao� a3 .6'P 1' stn s:.-se e� ao0 8u16$61,uos;ad, Y' y= �� s IuatadwoO�yHSO ue pataidwm�(ilnlssa�ns seyWmIA 06.5 I1 - yf I' �•'.: f y.-' — �12P�QOiI77/I7249Z1!{2CLLG�O�C-/!/GQ/JO�CJZLUJ�6 : Office of Consumer Affairs&Business Begnlati� ME IMPROVEMENT CONTRACTOR egistration: '166150 T'YPL- t xpiration:F 4/29/2U16= DBA t EMC CONSTRUCTIQ,N ERIK CAT INI " .114 SAVOIE ST. I FALLRIVER,MA 02723 Undersecretary I _.: � . Massachusetts-Department of Public Safety Board.of Building Regulations'and Standards Construction Supervisor I do 2 Family License: CSFA-106116 ERIK CATINI 114 SAVOIE STRiETa - Fall River MA Og123 ',. i Expiration Commissioner 08/05/2017 F 9Ti�Z0�LN 4ao�sB� I � OLTS. S . _glaX? a�Ot BSiisjn�3�.ss3ui�8�'pu6�i�i�`�amns"uo�•;'d'3��� ' • :61 u:in;33 pofi831 a;Vp ii61;ugH'' 5qj igpq E" A66 3sii�npi^ipiii i8 pi�is�Ubi� ;siIa3 3a 3s ra3i� l l-a wr nS'fi� WA j Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor 1 & 2 Family License: CSFA-106116 ' ERIK CATINI 114 SAVOIE STRiETd Fa11 River MA OP23 Expiration Commissioner 08/05/2017 f _ r ?Tie Conintorrivealtli of-4assarJjusetfs Department of r4d'ush ial Accidents t @ice of lm-w igatia is 600 Washington Street 1VFSnk:rl&Mg0V1diri Workers' tlampensateon Insurance Affidavit: BunldersiContractorslEIectdcians/Plvmbers Applicant Inform,a{ an Please Paint Legibly , Nme(Husinewtorgmizatianffu& idnal):i5�1 ` C&\\s ru c- �b y. Address- ed City/State1 :5WAV5rA-,Mfg- O'Zr7Q 7 Ishcne� ' SD? %�2 2t7 Are you an employer?Check the appropriate box: Type of project(required): 1,'�14 I am a employer uith +�- 4. ElI am a general contractor and I 1;— 6. ❑New construction employees(full andfor part=fine * have hired.the sub-contractors ' 2. j I Tilted on the attached sheet. L ❑ odeSinga sole Ietor or a and have no employees R. These sub-contractors have g. ❑Demolition wod-ing forme in any capacity. employees andhamre workers' 9. ❑Building addition [No sv orimm' comp.insurance comp.insurance-1 required-] 5. ❑ We area corporation and its. 10_❑Electrical repairs,or additions 3.❑ I am.a homeouaer doing all work officers have exercised their 11.❑Plumbingrepairs c r•additions nryself[No workers'cep- fight of exemption per MGL 12. Roof repairs insurance required.]l c.152, §1(41 andwre have no employees.[No workers', 13. Other camp.insurance required.] 'nayappHcznr9wtchecks'6os9l most also 5llovtthesectionbelowshnwiugffiekwo&erecompensatianpolicginfor=dc=-' Homeoerners who sabaait inns LMh.ft=&toting thv-y are doing all waal sad dum lase au=&contractors mmst submit anew affidavit in hCXdMg stnciL =Contactors*9 chest ibis boa mist attached an additional sheet showing the name of the sub-contrwAm and state whether at not those entities:have. empluyees.If the sub-coahacrmshave employees,they=stpm%dde their worlrers'comp.policy number. Iain an employer that fspm ddh workers corrperesatzon iusrirauce for my*empkt wes Belate is thepoScy amen'job site infotnnation. a. Insurance Company Name: Policy*,cc Self-ins.Lic.#: EipirationDate: Job Site Address: ' CityfStaW25p: Attach a copy of the workers'compensation policy declaration page(showing the policy number_and expiration date). Failure to secure coverage as required.under Section.25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,50G OD and'or one-year imprisonment,as we11 as civil penalties.in the fora of a STOP WORK ORDER and a fine of up to$250.00 a day against the-,violator. Be ad%ised that a copy of this statement may,be fiarwarded to the Office of ' Investigations.ofthe DIA for insurance coverage ueri Ecatiam I do hemby certri neuter t ie paces and penalties ofper,jury that the informadon primided abate is lairs acid correct Si Date: Phone ik '50 CI V 2'3 Z Official use only. Do not write in this area,to be.camp,Ieted by city or town officiaL City or Town.: PermitUcense 4 Issuing Authority(tdrele one): 1.Board of Health 2.Budding Department 3.Cityl Town Clem d.Electrical Inspector S.Plumbing Inspector b.Dither Contact Person: Phone#: Information and Iastrudions Massachusetts General Laws chapter 152 regoaes all employers to provide warkeas'compensation for rhea employees. pm suautto this sty,an eplo3'ze is defued as."-.every person in the service of another under any contract of brie, express or implied,oral or wriite� An vvPrcy,,x is defined as"an individual,partnership,association,corporation or other Iegal entity,or any two or more of the foregoing engaged is a Joint enterprise,and including lire legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employers. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occapant of the - dweIIing house of another who employs persons to do maintenance,construction or repair worts on such dwelling house or on the grounds or bunking appvcfenaatlhemb shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance ar business or to construct buildings renewal of a license or permit to operate a b in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the hLwran ce.coverage required." Additionally,MGL chapter 152, §2.5C(7)states`Neither the commonwealth nor jay of its political subdivisions shall an contract for the erf=ance of ublic woricumtl acceptable evidence of compliance with the inairance.. enter into . Y P P . reT=emen s of this chapter have been presented to the contracting aruihozity.-" Applicants ` Please fill out tine woulsers'compensation affidavit completely,by checlong the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s), address(es)and phone numbers) along with their certificate(s) of ;n c=ce. Limited Liabflky Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the. members or partners,are not regtmed to carry workers' compensation insmmmce 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 retrmmed to the city or town that the application for the permit or license is being requested,not the Department of IhAnstriai A ccidents. Shouldyou have any questions regarding the law or ifyou are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-i gr ce license number on the appropriate line. City or Town Officials t Please be sere that the affidavit is complete and priuted legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of luvesizgations has to contact you regaining the applicant. , Please be sure tu)fill in the pemlit/licewe number which will be used as a reference number. In addition,an applicant that must submit multiple pemmWhcense applications in any given year,need only submit one affidavit mdirafing cmrent p olicy inl =a-tion t<if necessary)and under"Job Site Address"the applicant should write"all locations II (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 fu>tre pezmiis or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (Le. a dog license or permit to bung leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to titan you in advance for your cooperation and should you have any questions, please do not hesitate to give Us a call The Deparhnenfs address,telephone and fax number. -Thu C�a=jan th-of Massachusztts . IDepaitnent cif Iiidus�tial Agents �it�e r�£�tv�ffrg�tio� 604,washivoon t Boston,YA G21 I I `ff,-L:6617727-4900 Qxt 4-06 or 1-9 MA-S&AFR, Fax 9 617-727 7M Kevised 4-24-07 Mass-gagld oFIME ems• BARNSTABLE MAIM ,�� Town of Barnstable ----------- -- . _.------__ ----- ___.._ ---_-_ ...__Regulates�er_�c�s---- ------------------------------------ Richard V.Scali,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main S&eet, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject pro ertp hereby authorize L` G r V— to act on my behalf in all matters relative to work authorized by this building permit application for: (Address of Job) - w , Signature f caner hate Print Name If Property Owner is applying for.permit,please complete the Homeowners License Exemption Form on the reverse side. r Q:\WPHLESTORMS\building permit forms\E)TRESS.doc Revised 040215 Town of Barnstable Regulatory Services Richard V.Scali,Director Building Division ` saaxs[asrE •' Tom Perry,Building Commissioner Mass 1e59. 200 Main Street, Hyannis,MA 02601 ArED www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# . CURRENT MAILING ADDRESS: �. city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow' homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not,be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building_permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. r The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required.shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules &Regulations for Licensing Construction Supervisors,Section 2.15 This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page, of this issue is a form currently used by several towns. You may caret amend and adopt such a form/certification for use in ;. your community. Q:\WPFILES\FORMS\building permit forms=RESS.doc Revised 040215 TOWN-OF BARNSTABLE BUILDING PERMIT APPLICATION s Map S Parcel yt y Permit# ��J�O Health Division Date Issued r Conservation Division C Fee �� �D Tax Collector ( 7i� ' Treasurer (20 Planning Dept. r Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis , Project Street Address [� S '�(Z Village ��?� N )S r? CO -, 6 .0 ) Owner ✓3 R Yea 5 r D 1, 19 A dress j L Telephone y 7 7 -' 6 9 6 v t ' ne O Permit Request - ' 7,19 1 l 6 A lzA 6 Cr /) o cl (Z S b o v r,s 0 o V S IN%lC Ar � tr(r0r0 , R(YPA)&/ rZc►oCr'cCs ANY 1Z01'1tu U . Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Valuation 0400 Zoning District Flood Plain Groundwater Overlay 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: ❑)V ❑ 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);exjst'ing. new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes ❑No .Fireplaces: Existing New -Exiisting wood/coal stove: 0 Yes ❑ No Detached garage:O existing ❑new size Pool: ❑existigg-0 new size Barn:❑existing 0 new size Attached garage:0 existing 0 new size Shed:-6 existing ❑new size Other: Zoning Board of Appeals Authorization ❑Appeal# Recorded❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name L Iii k7 -t-7 d AI A �Rlq k) Telephone Number Address IOU L-1s5 r l-1 m) u ST CI ti 1 T 9 License# C S 07 0 -7 6 3 S I M k,) S A , O Jt 6 U l Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 7/7/ a } _- -, FOR OFFICIAL-USE ONLY PERyMIT NO. r � - }, '•- L � � - - -- r. � � DATE ISSUED •Nam' .` t- � .. - •�` - �`. .Y_ MAP/PARCEL NO. 1 ADDRESS; ' M VILLAGE - - OWNER ' , DATE OF INSPECTION: FOUNDATION FRAME INSULATION e FIREPLACE t T ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING + - DATE CLOSED OUT. , ASSOCIATION PLAN NO. e =_'__._ The Cofnmonwealth of Massachusetts Department of Industrial Accidents Office offonesmo foes N 600 Washington Street +r Boston,Mass. OZlII Workers Co m ensation Insurance Affidavit name L /oqr7 o� Gels 5 T �"� m N 5�' L IT location 'o p� li A , p �b phone# 7� � - l� ! 6 C- I am a homeowner performing all work mysekf. I am a sole pro rietor and have no one working in nay capacity , I am an employer providing workers' com ensation for my employees working on this job P comonnv name: (s - Ll address C IO: ;/7Il� t1 S!1 ft /f �r y �fi '� city �1J2'2- � nA. .pS shone# oiicv# `fN ❑ I am a sole proprietor, general contractor, or homeowner(circle one)and have hired the contractors listed below who haN-e the follo«zng workers' compensation polices: comonnv name: address: r hone# city: -... 14 .:............. insurance rn: comnnnv name: address: hone cit"7 _a imprance co. //,%:. Failure to secure coverage as required under Section 25A of MGL 152 can 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 5100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the'DIA for coverage vedflcatlon. 1 do hereov certify under the pains and penalties of perjury that the information provided above is truo and correct Date - 'Signature ' ) Print name P, O Ir 1� (�/`l A Phone# 'oiIIci:1 use only do not write in this area to be completed by city or town otncial permit/license# ❑Building Department cite or town ❑Licensing Board ❑Selectmen's Office ¢ 7 check if immediate response is required ❑Health Department phone#; contact person: (]Other 3` ::A v. :;.a Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their oted from the"law";an employee is defined as every person in the service of another under any cone--z employees. As qu of hire, express or implied, oral or written. An employer.is defined as.an individual,partnership, association, corporation or other legal entity, or w the receiver or more ct the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein' or the occupant of the dwelling house of another who employs persons to do maintenance, constriction or repair work on such dwelling house or on the grounds c appurtenant thereto shall not because of such employment be deemed to be an employer. building app . . .. __._ .. _... . . . . MGL chapter 152 section 25 also states that=every=state or local licensing agency shall withhold the issuance or reneN of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who h: not produced acceptable evidence of compliance with the insurance-coverage,-required. Additionally�neitherthe- - shall eater into any contract for the performance of public work until commonwealth nor any of its political subdivisions acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contract authority. Applicants q completely,b + , ► Please fill in the workers' compensation affidavit comp X Y checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance ash affidavits tts In and Accidents for confirmation, - r> submitted to the Department of Industaal. _. . : of insurance coverage date the aff davit. The affidavit sbauld be returned to the city-or town that the applicatio>�for the peimrt �`li CIS_ the"law"or if yc being requested,not the Department of Industrial Accidearts...Shauld you,_have any.qu�ons a slow. are required to obtain a workers' compensation policy,please call the.Departaaeni at the numb EAM City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of t affidavit for you to fill out in the event the Office of hivestigations _ has to contact you regarding the applicant. Please be sure to fill in the pemiit/ e number' which will be used as a reference number. The affidavits may be returaeii 10 the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would Bice to thank you in advairce for you cooperation and should you have any questions. please do not hesitate to give us a call. MEE= The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents DInce of Invesduadons 600 Washington Street Boston;Ma. 02111 fax#: (617) 727-7749 phone#: (617) 7274900 ext. 406, 409 or 375 1 IL cmITIM Au : Willi ok,1 1; y 1 Il cia 10, ITN it N k.'� I'� 1 N,l 1 ��• ,. N@ N yr-,,v. T 1�i i 11 . � „ .. _ F QyovTNETo�y . TOWN OF BARNSTA.BLE Z BA"ST"LE, i "b 9 BUILDING INSPECTOR APPLICATION FOR PERMIT TO �.G/.���!�� �-`" TYPE OF CONSTRUCTION b,,., ..GI.dSj AL ................................../................................. 1 .........tt ...........19-1; TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .... `P. .....a. ..... ... .......:a.CJ.. ...... �`,.. .................................... r Proposed Use ..... ................. ZoningDistrict ........................................................................Fire District .............................................................................. Name of Owner a .............Address / ..tom..... .. ...... ... . .. .... Name of BuilderD C�6ca ..r j..?. . .................Address ...�%...... �L.a.. . ... ..........!w..lh ............ Name of Architect .... Ll--e..L-A.......................................Address ...... ........... ...✓ e Number of Rooms ..................................................................Foundation/. ...L-t)..-/c�Lc ExteriorC.,,.tu...0- ..�.� .............................Roofing .................................................................................... Floors ..................................................Interior .................................................................................... HeatingPlumbing ........................ .................... ................................. Fireplace ..................................................................................Approximate Cost .. •-= .. .. ........../�. ........................ Difinitive Plan Approved by Planning Board _________________________ s� ? Diagram of Lot and Building with Dimensions P� / �p 1 hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name . L % PCs ... `.....::........................ /r� e Atsalis, James No .... Permit for .........PAT49PY............. ................................................................................ Location ..........60 Barnstable...FQld.............. ........................... ...................................... Owner ........James Atsilis .......................................................... Ty.pe,of Construction ............frawe.................. ................................................................................ Plot ............................ Lot ................................ September Permit Granted ...............................5.........19 69 Date of Ins p rtion .......:4.4:2............196 q Date Completed ......................................19 PERMIT REFUSED ................................................................ 19 ............................................................................... re.......................................................... .................... ............................................................................... ............................................................................... Approve'd .................................................. 19 ............................................................................... ...............—............................................................. - - w 17:e Commonwealth of Massachusetts — = Department of Industrial Accidents „� ,� - , '__� 011fcaollalestlOa�O�s 600 Washington Street a . 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Fa�etoseems dt mvise8eellon2SAofMQ.IS2esaleadlstisa�paitlesds aipeaa8ltsdatfasuptosi.M00 NOW" om ss weII as e#rII peaaitles in tba to:m der b1�OP W�ORS OADEBaadafteetnt1M a day apimd ma I m)deltu d oopF of this statmmt ms7 be totwaeded to tba OIDee otIaratiptima oltba DlAtos.taAa's�� l de hereby ems'i► the paw and aial s perjury WM-11—M*n PMti&dabvM is trna mrd earrad ✓ � Date Side olIIdal ma onO do not welts in tlds atsa to ba cmwleted b1&y err taws gin" city or town: P � 0 ma Board 's Otsre ❑cbeckif famsed(ate:QPo+oa is required (]Hnith DeParUneat contact person: FbOde DOther---- f�errw OJ95 PIA) f 40 3-3 Commercial Districts 3-3.1 B, BA and UB Business Districts 1) Principal Permitted Uses: The following uses are permitted in the B, BA and UB Districts: A) Retail and wholesale store/salesroom. B) Retail trade service or shop. C) Office and bank. D) Restaurant and other food establishment. E) Place of business of baker, barber, blacksmith, builder, carpenter, caterer, clothes cleaner or presser, confectioner, contractor, decorator, dressmaker, dyer, electrician, florist, furrier, hairdresser, hand laundry, manicurist, mason, milliner, newsdealer, optician, painter, paper hanger, photographer, plumber, printer, publisher, roofer, shoemaker, shoe repairer, shoe shiner, tailor, tinsmith, telephone exchange, telegraph office, undertaker, , upholsterer, wheelwright. F) Gasoline and oil filling stations and garages. G) Hotel/motel subject to the provisions of Section 3- 3. 1 . (6) herein, except that hotels/motels shall be prohibited in the BA District and prohibited in the Osterville UB District. H) Any other ordinary business use of a similar nature. I) Multi-family dwellings (apartments) subject to the provisions of Section 3-2 . 1 (1) (J) (a) through (h) except that multi-family dwellings shall be prohibited in the BA District. J) Single family rsidential structure (detached) , except that single family residential structures shall not be permitted in the B District. (Added by a 9 Yes 2 No vote of the Barnstable Town Council on Feb. 20, 1997) . 2) Accessory Uses: A) Bed and Breakfast operation within an owner occupied single family residential structure, subject to the provisions of Section 3-1 .1 (3) (F) except sub-paragraphs a) and b) . No more thant six (6) total rooms shall be rented to not more than 12 total guests at any one time, and no Special Permit shall be required. For the 42 purposes of this Section, children under the age of (twelve) 12 years shall not be considered in the total number of guests . Bed and Breakfast operations shall not be permitted in the B District. (Added by a 9 Yes 2 No vote of the Barnstable Town Council on Feb. 20, 1997) . 3) Conditional Uses : The following uses are permitted as conditional uses in the B, BA and UB Districts, provided a Special Permit is first obtained from the Zoning Board of Appeals subject to the provisions of Section 5-3 . 3 herein and the specific standards for such conditional uses as required in this section: A) Storage yards for coal, oil, junk, lumber or any business requiring use of a railroad siding; such uses being provided for in the B District only. B) A building or place for recreation or amusement but not to include a use which is principally the operation of coin-operated amusement devices; such uses being provided for in the B District only. C) Any manufacturing use; such uses being provided for in the B District only. D) Windmills and other devices for the conversion of wind energy to electrical or mechanical energy, but only as an accessory use. E) Public or private regulation golf courses subject to the provisions of Section 3-1. 1. (3) (B) herein. 4) Special Permit Uses : (reserved for future use) 5) Bulk Regulations : ZONE MIN.LOT MIN.LOT MIN.LOT MINIMUM YARD MAX. BLDG. MAX.LOT AREA FRONTAGE WIDTH SETBACKS IN FT. HEIGHT COVERAGE SQ. FT. IN FT. IN FT. --------------- IN FT. AS % OF FRONT SIDE REAR LOT AREA B --- 20 --- 20 * -- -- 30 # -- BA --- 20 --- 20 -- -- 30 # 35 UB --- 20 --- 20** 0** 0** 30 # 35 3* One hundred (100) feet along Routes 28 and 132 ** Fifty (50) feet when abutting a residentially-zoned area . # Or two (2) stories, whichever is lesser. Front Yard Landscaped Setback from the road lot line: 42 6) Special Hotel/motel Provisions: In addition to the provisions of Section 3-3.1 (5) , hotels and motels shall be developed only in conformance with the following: A) The minimum lot area ratio shall be two thousand five hundred (2500) sq. ft. of lot area per each of the first 10 hotel/motel units, and an additional two hundred fifty (250) sq.ft. of lot area per each unit in excess of ten (10) . B) The minimum lot frontage shall be one hundred twenty-five (125) feet. C) The maximum lot coverage for all buildings shall not exceed thirty percent (30%) of the gross land area. D) In addition to the parking requirements of Section 4-2 .7 herein, there shall be two (2) additional off-street parking spaces provided per each ten (10) hotel/motel units or fraction thereof. E) The minimum front yard setback shall be thirty (30) feet. F) The minimum total side yard setback shall be thirty (30) feet, provided, however, that no allocation of such total results in a setback of less than ten (10) feet. G) The minimum rear yard setback shall be twenty (20) feet. H) No other uses shall be permitted within the required yard setbacks, except driveways in a required front yard. All yard areas shall be appropriately landscaped and adequately maintained. I) A site plan for each development or addition shall be submitted to the Building Commissioner along with the request for a building permit. The site plan shall include, but not be limited to, all existing and proposed buildings, structures, parking, driveways, service areas and other open uses, all drainage facilities and all landscape features such as fences, walls, planting areas and walks on the site. 7) Special Screening Standards, UB Districts: In a UB District each lot shall have a green strip ten (10) feet in width along each side abutting an existing roadway, on which grass, bushes, flowers, trees or a combination thereof shall be maintained. 8) Special Screening Standards, B Business Districts: Along Route 28 (Falmouth Road) in Precinct 3 as it existed on June 15, 1973, where the lot abuts a residential zone, the one 44 H) No other uses shall be permitted within the required yard setbacks, except driveways in a required front yard. All yard areas shall be appropriately landscaped and adequately maintained. I) A site plan for each development or addition shall be submitted to the Building Commissioner along with the request for a building permit . The site plan shall include, but not be limited to, all existing and proposed buildings, structures, parking, driveways, service areas and other open uses, all drainage facilities and all landscape features such as fences, walls, planting areas and walks on the site. 7) & 8) Deleted by unanimous roll call vote of the .Town Council on 3111199 in item 99-056 43 _ hundred (100) foot front yard setback shall include a twenty- five (25) foot green belt. e � t H 'L nl Xt rn CERTIFICATE OF INSURANCE ISSUE CATE: 1 /27101 THIS CERTIFICATE IS ISSUE?AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTICATE-. HOLDER. TH''S CERTIFICK E DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BELOWr PRODUCER HART INSURANCE AGENCY INC 1 COMPANIES AFFORDING 'COVERAGE: 240 MAIN ST. PO BOX 700 ; COMPANY A NEW LONDON COUNTY MUTUAL BUZZARDS BAY, MA. 02532 COMPANY s R ARBELLA PROTECTION INSURANCE INSURED: -�--- HYANNIS TRAVEL INN COMPANY 16-18 NORTH STREET C EASTERN CASUALTY INSURANCE ' HYANNIS,MA. 02601 COMPANY D - COVERAGES: THIS IS TO CERTIFY THAT THE POLICIES OF INSUR44NCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOT INITHSTANDING ANY REOUIRENIENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RE:3PECT TO WHICH THIS CERTIFIC7E MAY RE ISSUED OR TRAY PERTAIN,THE ;NSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN!S SUBJECT TO ALL TERMS EXCLUSIONS AND CONDI- TICNS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CL_f.ilJIS _ Cr a�Type of Insurance Policy # Effective Expiration LIMITS A Commercial General 5SWN21 10/25/C1 10/25102 Gen Aggregate $2,000,000 Liability Products/Comp Op $1,000,000 Occurrence X I Personal A Adv Inj $1,000,000 Claims Made I Each Occurrence $1,000,000 \ Fire Damage " $ 50,000 Medical Expense $ 5,000 B Automobile Liability 042 7/15/01 7/15/02 Combined Single $ Any Auto 68400000 Limit All Owned Vehicles Bodily injury $1,000,000 Faired Autos ° (Per Person) Non Owned Autos i I Bodily Injury $ I Garage Liability - (Per A eldent) Property Damage $300,000 I Excess Liability Each Occurrence $ --Umbrella Form _Other Than Aggregate $ Umbrella C Workers Compensation Wo 81J1/01 5/01/02 � Statutory Limits, And 99708024 Each Accident $5001000 Employers Liability ' Policy Limit $500,000 Each Employee $500,000 Property +— DESCRIPTION OF OPERATiONSiLO_CATIONS,'VcHI,DLES/SPECIAL ITEMS: OPERATIONS PERFORMED BY NAM INSURED AS PROVIDED FOR BY THE TERMS A CONDITIONS IN THE POLICY. a - _ CERTTIFICATE HOLDER: CANCELLATION: SHOULD ANY OF T HF ABOVE DESCRIBED POLICIES II�V BE CANCELLED BEFORE THE EXPIRATION LATE THEREOF,THE I TOWN OF BIARNSTABLE i iSSU!iNG COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN Fax 3flf5-790-6230 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO MAIL SUCH NOTICE SHALL ni IPGSE NO OBLIGATION OR LIAEILITY OF ANY KIND UPON THE CQ,'.IPANY, TS AGENTS OR F'EPRESEITATIVES.o ACCORD 258 (7-90) -� { a • ^ 99EL 'S9r BOS 'k3W39IJ 33kiu NnSW T ��H z =0I 10' 8? 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