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0339 BARNSTABLE ROAD
- - - � IX M 1 � 4 i n, utpi � WENJE i I ONLY OUR NAME... N 7 OUR TALENTED PROFESSIONALS! l k ij Aida Tracy � Ted Williams 4 Jim Delise I' Andrea Anderson Samuel Ayer ' Jessica Ryan 'Carmen Silva Dayana'Domigos, RECEPTIONIST M-F 8:20-8•Sat.8-5 I� Walk In Smice eveong Appointments :. AwaVable -° HEAD ' ? .'YOU HEARD HER. 7r6 EVEN AUNMAY ub E I ELVTHINKS ZSO .D SH ESN'HAVE A FULL KNOW YhU' �ZO� TIME.70B. SPIDER MA © Q uR Cn 0 a m y-17 4 by Scott Adams FOR BETTER OR WORSE RBCoGNZE ANY OF THESE YEZ.TH YOU I RAN OUT PH6rcGRRPH8,MH'AM? TnE MP NEED OF MATERIAL. h i ING,ToI A MASK IT WAS A `r T�of TOO. MISTAKE TO MAKE A TIE.- Y is ISM ..V.,NYC•'. P NY iw S � oPP YOU W1SW TO OPEN A BUSINESS? " C For Your Information: Business certificates (cost$40.00 for,4 years].```A.businesscertificate ONLY•REGISTERS YOUR NAME in town (which you must do by.M.G L.- it does not give you permission to operate.] You must-first obtain the necessary signatures on this form at 200_Main St., Hyannis. Take th.e completed form to the Town Clerk's Office, 1st FI., 367 Main St.,`Hyannisy MA 02601. (Town Hall) and getthe Business Certificate that is required by law. . DATE t 1 Fill in please: ti'r..l '•'i +"LI``�;++�,((y�; APPLICANT'S YOUR NAME/S: Ili Z SC G L u•rr�;.eas, ;v3i 1 st� ;:i r, ;:' ME ADDRESS: _ Y.._ 1 '• BUSINESS YOUR Hq '' U-il� TELEPHONE # Home Telephone Number ( ` f`%f 1'ri4�ijS�ilf's��1ir�7rl `}� c 1. .Gv E—MA.IL: $G.o t• NAME OF CORPORATION: �: TYPE OF BUSINESS NAME OF-NEW BUSINESS w� . �, C t✓ lip IS THIS A HOME OCCUPATION,..+. YES NO : ADDRESS OF BUSINESS- T MAP/PARCEL NUMBER f7 .I (A l. .y (Assessing) I3G1 P When starting a new business there are several things you must do in order to be. in compliance with'the rules and regulations of the Town of Barnstable. This for is intended to•assist you in obtaining the-information.you may need. You MUST GO TO 200 Main St. — (corner of Yarmouth Rd:.& Main Street) to make sure you have the appropriate permits and i'censes required to,legally operate your business in his town. . 1. BUILDING COMM R'S OFFICE Thin individual ha b dif, irrFo e1 an p mitre uiremen that,pertain to this type of business. u orize� Sig tur ti COMMENT71 l • 2. BOARD OF HEALTH This individual has been informed of the permit requirements that pertain to this,type of business. Authorized Signature** COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature* ,-COMMENTS: . YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do.by M.G.L.-it does not give you permission to operate.] You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1st FI., 367 Main St., Hyannis, MA'02601 (Town Hall) and get the Business Certificate that is required by Law: DATE: U /� Fill in please: �? APPLICANT'S YOUR NAME/S: =Thh 01.., r %t B SINESS YOUR HOME ADDRESS: �Io ti ts yrl /YI i 11 �. ��S/-�iII�T)k7/( T LEPHONE # Home Telephone Number 40,- /gad 9%97 . NAME OF CORPORATION: NAME OF NEW BUSINESS TYPE OF BUSINESS IS THIS A HOME OCCUPATION? YES NO L� ADDRESS OF BUSINESS ,�C (' MAP/PARCEL NUMBER.— I (Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form.is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd..&Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COM SSION R'S-OFFICE This individu I ha pe infor f d %aner it requirements that pertain to this type of business. uth rized Signa * ��- COMMENTS: 2. BOARD OF HEALTH This individual has been informed of the permit requirements that pertain.to this type of business. Authorized Signature* COMMENTS: 3. CONSUMER AFFAIRS(L ENS G AUTHORITY) This individual has b in f the licensing requirements that pertain to this type of business. M Q Autho�iz Signatur COMMENTS: !l n 1 YOU"WISH TO OPEN A BUSINESS? For Your,Information: Business certificates(cost$40.00 for,4 years). A business.certificate ONLY REGISTERS,.YOUR NAME in town(which you must do by M.G.L.-it does not give you permission,to operate.) You must first obtain the necessary`signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1 st Fi:, 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. ' DATE:, Fill in please: . APPLICANT'S YOUR NAME/S: r� BUSINESS YOUR HOME ADDRESS:_ -e (bVp YAWIe k5tyvsl l l S MCC, TELEPHONE # Home Telephone Number 00� NAME OF CORPORATION: NAME OF.NEW BUSINESS TYPE OF BUSINESS IS THIS A HOME OCCUPATION? YES NO p,� p,�,,�� ADDRESS OF BUSINESS r MAPIPAI�CEL NUMBER (Assessing) When starting a new business there are several things you must do in order to be incompliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. &Main Street) to make sure you have the appropriate.permits and licenses required to legally operate your business in this town. 1. BUILDING COM SS_ IO ER'S-OFF n�an This individu I ha i .or er it requirements that pertain to this type of business: A orized Si COMMENTS: 2. BOARD OF HEALTH This individual has bee for d f the permit requirements that pertain-to this type of business. Authorized Signature* COMMENTS: 3. CONSUMER AFFAIRS[LI NSING AUTHOR1, This individu bee i o e lic ing re me s that pertain to this type of business. Auth ized Signat COMMENTS: YOU WISH T O OPEN A BLDS!(\IESS? For Your Information: " Business.certificates(cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not giveyou permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's'Office, 1 st FL, 367 Main St., Hyanris,'MA 02601 (Town Hall) and get the Business Certificate that is required by law. „ . DATE: YF.) �7i 217� 2 . Fill in please: APPLICANT'S YOUR NAME/S: QQCk Kew1 Lots ` ,a BUS NESS YOUR H �/IE ADORE S: R I Vl b hoP �g� 3 (_ vIII MA TELEPHONE # Home Telephone Number NAME OF CORPORATION: NAME OF NEW BUSINESS (1tiGQ i nS C K TYPE OF BUSINESS_ I V_CLi�'C.S SC1V ` IS THIS A HOME OCCUPATION? `� YES NO ADDRESS OF BUSINESS v'r\S �- fXl nis h K(02601MAP/PARCEL NUMBER 3.SC1. &'A_5� `' V?Rssessing) 3 t o 11_- l When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of : Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. (corner of Yarmouth Rd. & Main Street) to make sure you have.the appropriate permits and licenses required to legally operate your business in this town.. 1. BUILDING CO MISSIO ER'S OFF E This indivi ual h s n i e o an er it requi�reme��nents that pertain to this type of business. Aui<.orized Si na * � ,:, • COMMENTS(( _tA 2. BOARD OF HEALTH This individual ha b n infor a oft a per i requir ents that pertain.to this type of business. Authorized. ' nature* COMMENTS: MUST,,XMPLY WITH.ALL MRDOUS MATERIALS REGU ATI NIS 3. CONSUMER AFFAIRS(LI NSIN AU HORITY) This individual has b 'i infor d t e licensing requirements that pertain to this type of business. Authoriz d Sig ture* COMMENTS: n /� p. YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to opera e.—�Ui must first obtain the necessary signatures on this form at 200 Main St., Hyannis. . Take the completed form to the Town Clerk's Office, 1st FI., 367 Main St., Hyannis,VA 02601 (Town Hall) and get the Business Certificate that is' required by law. _ DATE: Fill in please: ra��a APPLICANT'S YOUR NAME/ `_EF �11 'Iy�1�1�C'_1)\F"C BUSINESS YOUR HOME ADDRESS: \ct9 1tis \x\'XnM k r �^t'\n s 4-V\ fit 1�A C Z 66A TELEPHONE # Home Tblephone Number '-its i• 76-� NAME OF NEW BUSINESS ` " "'TYPE OF BUSINESS Y\G�l��it �5� ° / MBE.R �, w ADDRESS:OF BU$INESSa y MAP.- .PAR CEL NU (AssessiIgill , When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of : Barnstable. This form is intended to assist you in obtaining the information you may need: You MUST GO TO ?OLIO ain St. - (corner of Yarmouth Rd. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. . 1. BUILDING,COMMISSIONER'S OFFIC This individual has been i0forma o ny permit requirements that pertain to this type of business. Authorized Signature* COMMENTS: 2. BOARD OF HEALTH This individual ha$ bee�f��f d of the per mit,requirements that pertain to this type of business. 1..� �V I►'� Authorized Signature* COMMENTS: 3. CONSUMER AFFAIRS [ CE SING AUTHORITY) This individu as n inf rmed of th lice requir ents that pertain to this type of business. Auth6 riz d Sign tur _ COMMENTS: TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application o4?xff Health Division Date Issued Conservation Division y Application Fee 1 Planning Dept. k �P�- fir'�b'C1 = Permit Fee + Date Definitive Plan Approved by Planning Board Historic - OKH 'N Preservation /Hyannis h Project Street Address 3 3 9 � G.a.vwi,E-..G2i Village Owner ` J�tgj Address um Telephone 508-`l74 - 7 yJ1$ Permit Request h W t4 WX,4,�� j,4" ah Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation a, 200 '� 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 0 Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new J 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 1 ca Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wosod/coal stove: ❑;es ❑ No Detached garage: ❑ existing ❑ new size Pool: ❑ existing ❑ new size _ Barn:,', 0 new size_ -rug 'existing, 3 Attached garage: ❑existing ❑ new size _Shed: ❑ existing ❑ new size Other: _ —a Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # `° Current Use Proposed Use - r-- APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number SOP- Address �`� Rdu.� �� License# C5 6660 Home Improvement Contractor# 14�DIS Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TOE„ "A SIGNATURE DATE 11 f 30 Idq FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: f FOUNDATION Y FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL < FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. . _ The Commonwealth e Commonwea o Massachusetts Department oflndustrial Accidents Office of Investigations + 600 Washington Street Boston, MA 02111 s www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): M2AR ',(D5 QUl ljer Address: (09 lA City/State/Zip: VA-iLmo rtk Dnk W 0 Z6 z5" Phone-th S 6 0� Are you an employer? Check the appropriate bog: k Type of proj Oct(required): 1.❑ I am a y emP to er with 4. ❑ I am a general contractor and I - 6. El New construction employees(full and/or part-.time).* have hired the si b-contractors .2. II 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 tY # 9. ❑Building addition [No workers' comp.-insurance comp. insurance. required.] S. ❑ We are a corporation and its '10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 1 L[j 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.�thereipiat�i 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 anew affidavit indicating such. Icontractors 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-contractots 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: Policy#or Self-ins.Lic. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year inaprisonment, as well as civil penalties in the form of a STOP WORK'ORDER and a fine. of up to$250.00 a day against the violator. 'Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties ofperjury that the information provided above is true and correct. Signature: Date: 2 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#: Information and Ins* ttuctions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their_employees. Pursuant to this statute, an employee is defined as"...every person in.the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership,association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall . enter into any contract for,the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-conti actor(s)name(s),address(es)and phone number(s) along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers'compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials .Please be sure that the affidavit is complete*and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under."Job Site Address"' (he.applicant should write"all locations in (city or town).".A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or comurercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: 'The Commonwealth of Massachusetts Depaitment of Industrial Accidents Office of Investigations. 600 Washington Street Boston, NIA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax# 61742777749 Revised 11-22-06 www.mass.gov/dia I IHIE Town of Barnstaple Regulatory Services SBA-RNSTARM Thomas F Geiler,Director 659, Building Division Tom Perry, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: S08-790-6230 Property Owner Must 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. 331 5;-r b (Address of job Signature of er D Print Name . If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. A 0.n\1 rMz:U DCDA A I CCIMIT ' 1 Town of Barnstable o Regulatory Services BARNs-r,BL Thomas F. Geiler,Director Building Division Tom Perry,Building Commissioner 200 Maiti.Street, Hyannis, MA.02601 wvm.town.barnstable.ma.us Office: 508-862--4039 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 huneowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Persons)who owns a parcel of land on which be/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. 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.(Secticn 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 arc assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for.Licensing Construction Supervisors,Section 2.15) This lack of awareness bftcn 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/hQ msponsibilitics,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a,form currently used by several towns. You may care t amend and adopt such a fomr/ccrtification for use in your community. Q:forms:homccxcmpt - N4assadn"e is- Department of Public Safct� !lop Board of Builclinh Re!gulationvand Standards Construction Supervisor License License: CS 66658 Restricted to: 00 'Ti JAMES R MEDEIROS "3 696 RT 6At YARMOUTHPORT, MA 02675 -' Expiration:_4/16/2011 Commissioner Tr#: 5104 . r e �t ram, Sign Permit �STABIZ. TOWN OF BARNSTABLE MASS. 9� 1639. p?fD •�A Permit Number: Application Ref: 200800645 20070132 Issue Date: 02/05/08 Applicant: TRACY, AIDA Proposed Use: MIXED USE RETAIL•&RES Permit Type: SIGN PERMIT Permit Fee $ 25.00 Location 339 BARNSTABLE ROAD Map Parcel 310141 Town HYANNIS Zoning District HG Contractor PROPERTY OWNER Remarks SALON AT 339 REFACE EXISTING FREE STANDING SIGN FORMERLY IDA'S HAIR SALON Owner: TRACY, AIDA Address: 339 BARNSTABLE RD HYANNIS, MA 02601 (f v Issued By: p� POST THIS CARD S.o THAT IS VISIBLE FRAM THE STREET Town of Barnstable �ptHE rO�ti Regulatory Services r VU Thomas F.Geiler,Director Gt II g�� t d� 1 f,c? , BAMSTA13M + 7008 JAN 1 5 i M 1: 48 9 E . g Building Division 1639. ♦0 Atfp ,is Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us e • Office: 508-862-4038 Fax: 508-790-6230 Permit# 1.6 6-6 r�Application for Sign Permit i Applicant: 4i 1 L,Z`.\C LJ-1/1�- _ __ Map &Parcel # 0 1�' Doing Business As: Sclt OrN `� J "0; Telephone Sign Location (, r� Street/Road: :13q la's cd(-N 4,u ar,)A 4,�; Q�I o f Zoning District:Old Kings Highway? Yes/No Hyannis,Historic District? Yes/No Property Owner Name. t""1 ) C�, ca-w Telephone: 11 Address: a�-jo Zj(, Village: Sign Contractor 1 Name: 1 Telephonk S a�) S `� Mailing Address: Description Please draw a diagram of lot showing location of buildings and existing signs with dimensions, location and size of the new sign. This should be drawn on the reverse side of this application. Is the sign to be electrified? Yes o (Note:If yes, a wiring permit is required) Width of building face k ft.x 10= x.10 r Sq,Ft. of proposed.sign4--± X. ✓� j ' I hereby certify that I am the owner or that I have the authority of the owner to make this application,that the information is correct and that the use and construc 'on`shall Sgiiform to the provisions of§240-59 through§240-89 of the Town of Barnstable Zoning Ordinance. �rjfit� Signature of Owner/Authorized Agent: /�/v (� � Date: 1 Z� Permit Fee: Sign Permit was approved: Disapproved: I Signature of Building Official: Date:;o �{ In order to process application without delays all sections must be completed. Q:I WPFILESISIGNSISIGNAPP.DOC Rev.9112106 cAl n, e ��- r jW^,LK•IUS W�LCOM�= .. � "`_ e rib _ '' 2008 1 14 tea+ P� r M A •O `✓� ice' .� �*rP i f t�` f A 7 to t1 r � r M r^ A r�� tv, �.�1 I J� AAA �vs� G(-jl-1 7 if i f am� rr- -- 5X AT 339 ON ------------ 1 i I i i c,+V44 r - i i I t E Rc:,rj- i _ .. I { 1� 4 i I r� ,Q " ' �KE Town of Barnstable Building Department - 200 Main Street MAS& * Hyannis, MA 02601 MASS. 9$A 1639. , (508) 862-4038 Certificate of Occupancy Application Number: 200701527 CO Number: 20070223 Parcel ID: 310141 CO Issue Date: 09/18/07 Location: 339 BARNSTABLE ROAD Zoning Classification: HYANNIS GATEWAY DISTRICT Village: HYANNIS Gen Contractor: ABREU, DAVID A Permit Type: CC00 CERTIFICATE OF OCCUPANCY COMM Comments: SALON 339 � — q -07 Building Department Signature Date Signed BIKE TOWN OF BARNSTABLE BU i .Iding Application Ref: 200701527 • BARNSTASLE, Issue Date: 04/05/07 Permit 9 MASS. �pr16 3319. A Applicant: ABREU,DAVID A Permit Number: B 20070683 Proposed Use: MIXED USE RETAIL&RES Expiration Date: 10/03/07 Location 339 BARNSTABLE ROAD Zoning District HG Permit Type: COMMERCIAL ADDITION ALTERATION Map Parcel 310141 Permit Fee$ 162.00 Contractor ABREU,DAVID A Village HYANNIS App Fee$ 100.00 License Num 049990 Est Construction Cost$ 20,000 i Remarks APPROVED PLANS MUST BE RETAINED ON JOB AND TENANT FIT OUT FOR SALON 339 INTERIOR ONLY THIS CARD MUST BE KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN MADE. WHERE A CERTIFICATE OF OCCUPANCY IS REQUIRED;SUCH Owner on Record: TRACY,AIDA BUILDING SHALL NOT BE OCCUPIED UNTIL A FINAL Address: 339 BARNSTABLE RD INSPECTION HAS BEEN MADE. HYANNIS,MA 02601 Application Entered by: PR Building Permit Issued By: THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY ALLY OR SIDEWALK OR AN Y PART THEREOF,;EITHER TEMPORARILY;OR.PERMANENTLY. ENCROACHEMENTS ON PUBLIC PROPERTY;NOT,SPECIFICALLY PERMITTED;UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION. STREET ORALLY GRADES AS WELL AS DEPTH AND;LOCATION OF PUBLICSEWERS MAY BE.OBTAINED'FROM THE DEPARTMENT OF PUBLIC WORKS THE ISSUANCE OF„THIS.PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION.RESTRICTIONS.' MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONTSTRUCTION WORK: 1.FOUNDATION OR FOOTINGS. 2.ALL FIREPLACES MUST BE INSPECTED AT THE THROAT LEVEL BEFORE FIRST FLUE LINING IS INSTALLED. 3.WIRING&PLUMBING INSPECTIONS TO BE COMPLETED PRIOR TO FRAME INSPECTION. 4.PRIOR TO COVERING STRUCTURAL MEMBERS(READY TO LATH). 5.INSULATION. 6.FINAL INSPECTION BEFORE OCCUPANCY. WHERE APPLICABLE,SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL,PLUMBING AND MECHANICAL INSTALLATIONS. WORK SHALL NOT PROCEED UNTIL THE INSPECTOR HAS APPROVED THE VARIOUS STAGES OF CONSTRUCTION. PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE PERMIT IS ISSUED AS NOTED ABOVE. PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO GUARANTY FUND(as set forth in MGL c.142A). BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTTfRICAL INSPECTION APPROVALS AUr�(�/N� I A/ C CM 2 1'P)-k 0rC— S 4-0_ 2 2 � (tfSu0t�- fo-d 2-ate 3 /. 1 p i e 1 fleadfug Inspecti Approvals Engineering Dept � 2 Board of Health Fire Dept t 4 � The Commonwealth of Massachusetts Division of Professional Licensure 239 Causeway Street, Boston, MA 02114 Board of Cosmetology - www.mass:gov/dpl 617-727-3067 or 617-727-9956 Electrical Inspection Form Date: This is to certify that I made such additions and corrections to the electrical wiring and electrical fixtures used for lights,heat,and power in the premises located at: Street Number Street Name ` 1 Gn n Cityk \ State and occupies v 1 Lb Name of Owner of Shop as were necessary to make the same comply with the Rules&Regulations of the Board of Fire Prevention Regulations of the Department of Public Safety as adapted pursuant to the Provisions of Sections 3L of Chapter 143 of the General Laws(inserted St. 1950,c617) Name of Electrical Contractor Address S��dl W1�4 nlv+ Holder of Master Electrician License#.4 17 9/2 Signatur t / Holder of JoumeymanElectrician License# Si ature Signed:,— 4 2����� + TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION �or � - Map Parcel ( Application# Health Division Conservation Division Permit# Tax Collector Date Issued Treasurer Application Fee Planning Dept. - Permit Fee r Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis t. Project Street Address w Q bL Village r Owner t�0_�4. Address Telephone o� Permit Request ,(e"J,-k Square feet: 1 st floor:existing proposed 2nd floor:existing proposed " f Total new -� Zoning District rr�� Flood Plain Groundwater Overlay { Project ValuatioSO,0 Construction Type CZ) rn 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 BUILDER INFORMATION Name— DAU> O Telephone Number Address H_( C 4 61�k_y 0140S '� �' License# o q q G ql -a U Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 3 fa O? r � FOR OFFICIAL USE ONLY "PERMIT NO. DATE ISSUED MAP/PARCEL NO. T s ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION , FRAME � D 7 INSULATION D FIREPLACE ELECTRICAL: ROUGH FINAL f PLUMBING: ROUGH FINAL GAS: ROUGH 9 �OFINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. s ; s The Commonwealth of Massachusetts Department of Industrial Accidents ; Office of Investigations d 600 Washington Street Boston,MA 02111' wWW.mass.gov/dia ' Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: 7 Ce vLss . City/State/Zip: 21 Oa-k.o Phone.#: -9,9r 9a5`( Are you an employer? Check the appropriate boa: . :Type of project(required):, 1,[-I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part time).* • have hiredthe sub-contractors 6 ❑New construction . 2.❑ I am a'sole.proprietor or partner- listed on the-attached sheet. 7. ❑Remodeling ship.and have no employees These sub-contractors have g• ❑Demolition working for me in any capacity. employee's and have workers' [No workers' comp.insurance comp.insurance•$' 9• ❑Building addition re uued 5: ❑ We are a corporation and its 10.❑Electrical repairs or additions q ] officers have exercised their '3.❑ I am a homeowner doing ill-work . 11.❑Plumbing repairs or additions , myself.[No workers' comp. right of exemption per MGL 12.❑Roof repairs . . insurance.required.]t c, 152, §1(4),and we have no employees, [No workers' 13.❑ Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners.who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether ornot 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 isAe policy and job site'' information. Insurance Company Name: r4arwt,�_ti u (� Policy#or Self-ins.Lic•#: 1 Expiration Date: O7 Job Site Address: 335 Xk City/State/Zip: FAO. AA I3 t Attach a copy of the workers' compensation policy declaration page'(showing the policy number and expiration date).' Failure,to secure coverage asi 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 and penalties of perjury that the information provided above is true and correct. Si ature: �� Date Phone#: Official use only. Do not write in this area,to be completed by city or town of City or Town: ' Permit/License# Issuing Authority(circle one): A,Board of Health 2,Building Department 3, City/Town Clerk 4.Electrical Inspector 5,Plumbing Inspector 6.Other Contact Person: Phone#: Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a-deceased employer, or the receiver or trustee-of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to*operate a business or to construct buildings in the commonwealth for any applicant who has not produced�acceptable evidence of compliance with the insurance coverage required." . Additionally,MGL ehapter..152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for,the performance of public-work until acceptable evidence oi'•complLmice with:lie insurance requirements of this chapter have been presented•to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if it certificate(s)s of umbers along with the and hone n ) necessary,supply sub-contractors)name(s),address(es) p ( ) g � insurance. Limited Liability Companies•(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members'or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit:may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit.or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers,' e listed below. Self-insured companies should enter their . compensation policy,please call the Department at the nurrtb r mp self-insurance license number on the appropriate-line. City or Town Officials Please be sure that the affidavit is complete'and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all-locations in (c4'or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related fo any business or commercial venture (i.e. a dog license or permit to bum leaves-etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have-any questions, please do not hesitate to give us a call. The Deputment's address,telephone-and fax number:. Thy Coz .onwW1h ofMmarhusntts Dqpnimlmt of ladustdsJ A.ccidionts Offt"of In-VeAldigafloas 600 Washington Stet B�ston, 02111 • . TO. #617-727 4900 ext 406 or 1- 7-MASSAFE Faye#617-727- 749 Revised 11-22-06 www.mass.gov/dia Towm'of Barnstable Regulatory Services i 1E, + ThomasF. Geller,DirectorSTAB . E Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,NU 02601 Fax: 509-790-6230 Office: 508-862-403 8 Property Owaer Must Complete and Sign'This Section If.Using .A.Builder d ,as Owner of the subject property hexeby authorize D4 to act on my behalf, in all matters relative to work authorized by this building p ermit application fox: (Address of Job) ate gjgnatuxe of Owner ' print Name Q:FORMS:OWNERPEFjM SIGN 03/16/2007 12:26 5087469330 SCHELLE INSURANCE PAGE 01 ACORD„, CERTIFICATE OF LIABILITY INSURANCE "IMme6el'yYy 3/16/07 PRODUCER THIS CERTI FIC ATE IS ISSUED AS A MATTER OF INFORMATION Schelle Insurance Agency, Inc ONLYAND CONFERS NO RIGHTS UPON T HE CERTIFICAT E 116 Long Pond Rd HOLDER THIS CERTIFICATEDOES NOT AMEND,EXTEND OR P O Box 887 ALTER THE COVERAGE AFFORDF,;DBY THE POLICIES WOW. Plymouth, MA 02362-088 INSURERS AFFORDING COVERAGE ! NAIC# INSURED _.. _ _ . .... .. .. •. f tNSURERA• Essex Insurance Co. David ,Abreu — J INSURER B American Home Assurance Co. 47 Cedar Oaks Dr. I — _ —`--..._. _.__... Plymouth, Ma 02360 INsuRERG: - -- - - INSURER D: 1 tNSURER E COV9RAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTVYITHSTANDINC ANY REQUIREMENT,TERM OR CONDt11ON 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 A_L THE-ER1418, EXCLUSIONS AND CONDITIONS DF SUCH POLICIES.AGGREGATE LIk-TS SHOWN WAY HAVE BEEN REDUCED BY PA;D CLAIMS, J.M S POLICY NUMBER POUC'YEFF nTIVE POLICY EKPIRAT ION LIMITS - -- t i ;GENERAL LIABILITY ! i I I EACH OCCURRENCE 3 l,000 j 0( X I.COMMERCIAL GENERAL_LIABILITY i I I , -'TDB' 50,0C —I CLAMS I I f PRE A MISES 5a cccuercd S i _�.. LAMS MADE , X;OCCUR!3CUB612 { 9/16/06 9/16/07!r�EDFxP(AIr/4,•oCrxen)_ s 1.0c PERSONALSADVINJURY i GENERALAGGREGAT- : 1'00.0,OC i GEN'CAGGREGATEMAPLIES PER: I j FRODLICTS•00PAP/0P AGG a j QOO,0 C I i I POLICY JEC C 7 LOG r _.. .._.. t IAUiOM013tLELIA6ILRY I COMBINED.SINGLEUMrr i i ;AIWAUTO i (EAB[cdar111 _!ALL OMED AUTOS I ( ! BODILY INJURY SCHEDULED AUTOS I I Per peer4k) WIRED AUTOS -- ( BODILY INJURY J NON-OVMEDAUTOS itPErmdawq ; -- ! PROPERTYDAVIAGE 3 1 I i{Par I GARAGELIAetUTY I I -- i. AUTO ONLY-EA ACC 3EtiT. ' Z R^IYAITO I OT'w THAN EAAC, ! rEXCE531UdIBRELCALUIBILITY + j EACH OCCURRENCE i I -.I OCCUR CLAIMS MADE ; I I ACL�EGATE $ DEDUCTIBLE l� i RETENTION i WORK ERSCOMPENSATIONAND c_ EMPLOYERS'LIABILITY --.. TORY LLI RS_I X..; ER ANY PROPR IETORFARTNERIEICECUTNE i i EL EACH A�C IDENT $ 50 0,Q 01 B OFFICER&SNIBEREXCLUDED? iWC $96-23-31 6/1/06 6/1/07'— --- 500,OOi I} tleBCIItYnYeltr I ELL DISEASE-EAEY.?LCYEE 'a SP�I�.i ALPROVI9WSbebw OTHER E.L DISEASE-POUCYLIhAI' I IS500,00( i - - I ' D MCRIPTID N OF OFr;RATIONS I LOCATIONS t VEN ICLES I EXCL LESIONS A130M BY ENDORSEMENT I SPECIAL PROVISIONS i r s CERTIFICATE CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED DEFORE THE E)IRRATIQD DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS W RIT7EN Town Of Ba=Stable NOMETOTHECERnIz TE HHyannis, HOLDER DTOT LEFT.BUT FAILURE TODOSQSHALL ya Main StreetI MPOSENOOBUGATIOit R LIABILITY F KIN PON THE INSURER,ITS AGENTS OP- nnis, MA 0250j E 4ENTAnVES. Fax;SO8-f3$8-ZS6H, I UTH RIZEDRFFRESE ATIVE v v , ACQRD 25(2001l08) G1 ACORD CORPORATION 1918 F - BOARD OF RUILPING REGULATIONS f License: CONSTRUCT60N SUPERVISOR Number 049990 4 _ R)pirk 0 /23�f 008 Tr.no: 19165 i �t Re ` f I DAVID:q ABREU�s ated r,00 r,a� s 47 CEDAIR OAKS'.'(g a3y PLYMOIJTH, MA 0236fl J' ' E Cmissioner - Roma, Paul From: Perry, Tom Sent: Tuesday, March 20, 2007 9:31 AM To: Roma, Paul Subject: FW: 399 Barnstable Rd Fyi;make sure that this is ok before the permit is released.thanks -----Original Message----- From: Lt. Don Chase (mailto:dchase@hyannisfire.org] Sent: Tuesday, March 20, 2007 9:02 AM To: Perry, Tom Subject: 399 Barnstable Rd Hi, Guy came in this AM for ok on renovation permit for a hair salon @ this address. He mentioned that the spiral stairs in the center of the room lead to a 2nd floor apartment. We just want to make sure that there is detection/ notification between the store and the apartment. Also, that the proper devices are in place and there is the proper separation (if needed) between dwelling and business. Thanks Don ps: say hi to Chris from BFD AN YOU WISH TO OPEN A BUSINESS? For Your Information: Business Certificates cost $30.00 for 4 years. A Business Certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L. - it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, I" FL., 367 Main Street, Hyannis, MA 02601 (Town H II) and 200 Main Street Offices at the Licensing counter. DATE: V4,913aME,IA Fill in please: � tom:�,. ; •. APPLICANT'S YOUR NAME: � 7r,. . u : YOUR HOME ADDRESS:BUSINESS TELEPHONE # Home Telephone Number: 7 I-(3ac� NAME OF NEW BUSINESS a n G. 3 TYPE OF BUSINESS IS THIS A HOME OCCUPATION? YES NO ve .iding-d-i-vi-s.ion? YES._.. �_... NO___ 1 ga.r �s W> MAP/PARCEL NUMBER ADDRESS OF BUSINESS � -piA 3 When starting a new business there are several things you must do in order to be in compliance with the•rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 2� 0�",Maig,t. — (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMONER'S OFFICE c This individual b en-infra any permit requirements that pertain to this type of business. ut rize ture** � COMMENTS r ' 2. BOARD OF HEALTH This individual has been informed of the permit requirements that pertain to this type of business. Authorized Signature" COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature*" COMMENTS: TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map ` Parcel ( / Application# Health Division Conservation Division Permit# Tax Collector Date Issued Le Treasurer Application Fe " 1r0° Planning Dept. Permit Fee " Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address Village s t-W• CZ4.6 C Owner Address Telephone Permit Request 1"2 VZ1,d(-�-- r Square feet: 1 st floor:existing proposed 2nd floor:existing proposed -F Total new 4 � _ Zoning District Flood Plain Groundwater Overlay Project Valuation o Construction Type ='t Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentatior 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:0 existing ❑new size Pool:0 existing ❑new size Barn:0 existing ❑new size Attached garage:0 existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial_ If yes,-site-plan review#—. _ .❑Yes.__.O No Current Use Proposed Use BUILDER INFORMATION Name Telephone Number Address Q 6- 66,e l,A h License# 02Aa&_0 Home Improvement Contractor# -• ����� l,(M66 4l� Worker's Compensation# & �3?=SDI �s� ZC ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO :5-Z lI etc a -�M�r v SIGNATURE i`A'i hlw.� DATE FOR OFFICIAL USE ONLY -PERMIT NO. F DATE ISSUED MAP/PARCEL NO. 7 , ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE *" ELECTRICAL: ROUGH FINAL t - PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT J ASSOCIATION PLAN NO. v�.IKE�p� Town of Barnstable ti Regulatory Services 9 AS& `� Thomas F.Geiler,Director e ''�fD►ae.�a, ,, Building Division. Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www-town.b arnstabl e.m a.us Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section. If Using A Builder as.Owner of the subject property hereby authorize - Z4of"�,- eoq to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address of Job) Signature o OwnerA10 a e r Print Name Q TORMS:O WNHRPERMIS SIGN The Commonwealth ofMassachusetts w Department oflndustrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.massgov/dia Workers'-Compensation Insurance Affidavit: Builders/Contractors/Flectricians/Flum hers Applicant Information Please Print Legibly Name(Business/Organization/Individual), z, Address: P - &0 A w ?( City/State/Zip: Phone 3Q, 6rs-4 Are you an employer? Check the•appropriate boa: Type of project-(required): 1,[ I am a employer with V 4. ❑ I am a general contractor and I employees(fall and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or pat-trier- listed on the attached sheet t 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' wmp.insurance• 5. ❑ We are a corporation and its required,] officers have exercised their 10.0 Blectrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11-❑ Plumbing repairs or additions myself.[No workers' comp; c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.] t employees. (No workers' camp,insurance required.] ' 13.❑ Other *Any applicant that checks box#l.rnust also fill out the section below showing their workers'eompensatiom policyinformatioa: t Homeovimers wbo submit this affidavit indicating they are doing all work andthen hire outside contractors must submit a mew affidavit indicating such k7oatract=tbat check tti's boil=ust attacbed an additional sheet showing the name ofthe subcontractors end weir workers'cony.policy info�c n. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job siti information. Insurance Company Name: 91-AIL-v �e J�le Policy#.or Self-ins,Lic.#: /L- 3 ? y Expiration Date: 4ZL47-A 2 Job Site Address:_ 6a1,Vf City/State/Zip': h lrzra o t T 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 e.. 152 can lead to the imposition of criminal penalties of a fine up to$1,500,.00 and/or one-year imprisonmem, as well as civil pena'Ities in the form oi'a STOP WORK ORDER and a fine of up to$250.00 a day kgafi st 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. 1 do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Sidature: Z466— Pate: &�Z%4 Phone#:Sao Official use only. Do not write in this area,io be completed by city or town official City or Town: Permit/License# Issuing Authority (circle one): 1.Board of!"iealth 2.Building Depart ment 3.City/Town, Cleric 4.Electrical inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: .,..�a.�V i iii M ri V ii �f ii Mr .t.�./l7✓ri r>L"ri v ii N n r•." Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.~ Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied,.oral or written." An employer is defined as-"an individual,partnership,association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the . receiver or trustee of an i_odividiial,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartinents and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to constmct buildingsiin the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall eater into any contract for the performance ofpublic work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone numbers)along with their certificates)of insurance. Limited Liabi�zty Companies(LLQ or Limited Liabik Partnerships(LLP)with no employees other than the i 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•affidavitt should be returned to the city or town that the application for the permit or license is being requested;not the•Depar went 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 Deparment at the number listed below. .Solf-insured comp m5es-t hau3d meter their self-insurance license member on the appropriate line. City or Town Officials. Please be sTue that the affidavit is complete and printed legibly. The Department has provided a space at the bottom. of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permit/license number which will be used as a reference number. In addition;an applicant that must submit multiple permitgicens a applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and.under"Job.Site Address"the applicant should write"all locations in__�;__(city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town maybe 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}tome owner or citizen is obtaining a license or permit notrelated to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this of idavit The Office of Investigations would h'ke to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel,.#617-727-4900 ext 406 or 1-877-MASSAFE Fax#' W-727-7749 Revised 5-26-05 vrarw.mass.govldia MAY 24 '06 09:31AM SANDPIPER INS ancy i er Insurance A enc ice` Agent Code: May 24,2006 Town of Barnstable 200 Main Street Hyannis, MA 02601 ATTN: Building Dept. RE: WC 8737554, Bert Mosher To Whom It May Concern: We have requested a Certificate of Insurance for the Town of Barnstable on behalf of B.L. Mosher and will fax it over to you as soon as it is received from his carrier. Than u, orrie Ro. an, CIC 12 Enterprise Road, Hyannis, MA 02601 - 508-790-1919 • Fax 508-790-3560 MAY.24 '06 09:55AM SANDPIPER INS P.1/2 s ° RANiTE STATE INSURANCE COMPANY 78075-0000 WC 873-75-54 3102 ................._.........----------------- 013-66-o 106-0o JillPENNSYLVANIA L ADSHER CONSTRUCTION INC member Companies of GUTTHMDEN I S. AA 02660-0000 01M American International Group EXECUTIVE OFFICES! 70 PINE STREET, NEW YORK, N.Y. 10270 EE NAME AND ADDRESS SCHEDULE - WC990610 D# MA WI#1 SANDPIPER INS AGCY INC WORKIERS COMPENSATION AND EMPLOYERS 12 ENTERPRISE RD LIABILITY POLICY INPOWATION PAGE -HYANNIS, MA 02601-2253 Y URED tS PREVIOUS POLICY NUUIPI O PORATION RENEWAL 00246 )THER WIOWI.ACES NOT SHOWN AWVE.SEE NAME AMU ADDRESS SCHEDULE - WC990610 Ire-MY POLICY PERIOD 1211 A.M.ataMard time al the Insured's - mtdnn9add(ess mom 01/28/06 To 01/28/07 M 3 A. Workers Campensatidn Insutattcw Part One of the policy,applies to the workers Conlloensation Low of the Stites listed hem MA 9. Employers I sMilty Insurance: Part Two of the policy aMnes to tha work In such state listed In item 3.A. The limits of out nablllty Yoder Part Two are. 6061y injury by Accident $ 1 .000.000 each ae:ellisnt Bodily Injury by Disease $ 1 ,000,000 policy Ilmit Bodily Injury by Disease $ 1 ,000.009 each employes C. Other States lmuranca Part Threa of the IboHcy applies to the states, If any, listed here: 'SEE ENDORSEMENT - WC200306A nW A The pretWum for this policy will be dMeMined sty our Manuals Of Ruins, CIesSlfloatlonsr Rates and Rating Plans. All,Information requlred below Is subject to verification and change by audit. E:fimalad 7clal gab Per Eatlmafse Its unaratlan PreMium(( ClffilthatlOn{ Code PlumblN ❑ ❑ mynar}F11An Annual 03 Veer X Annul 3 Yasr SEE EXTENSION OF INFORMATION PAGE - WC7754 TAXES/ASSESSMENTS/SURCHARGES $449 �XPEN9E CONSTANT t17tc�WHERE APPLICABLE BY STATZI $264 f4A aHIMUM PREMIUM S QO MA TOTAL ESTIMATED PREMIUM �10,420 I indicated baleW,Interlm edjUstmants W pramlum shell lea made. 13 baml-Annually 11 awrtedy ® Mentnly DEPOSrrPREMIUM tENDORSEMEMS(FORM KUMa6R) SEE ATTACHED FORM SCHEDULE - ►dC990612 12/24/06 ASSIGNED RISK 66 Issue Date issuing olnce Attlharizad R60rof 01411Ve WC 00 00 01 9®b7 MAY,24 '06 09:55AM SANDPIPER INS P.2/2 04-28-06 02:11'pia Froa-AIG ,6;7, V, 8569 T-646 F-CA0002 F-614 wa: y s `. PRODUC ER CERTIFICA . IS dSIgUEd TE AS A MATTER OP INFOFtA$ggiC1N ONLY AND 0ONFERS NO RIGHTS UPON THE CERTIFICATE Sandpiper Ins Apcy Inc HOLDER,THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 12 Enterprise Road ALTINR THE COVERAGE AFFORDED BY THE POLICIES 13MOW Hyannis,MA 026D7 CDMPANIES AFFOR INStBFI;AhICE INSURED- COMPANY A 0R 179 STATE INSURANCE COMPANY BI MosherCon*txten Inc Pa Box 1131 South Dwn s,MA IX:660-0000 ?"S IS TO CERTIFY THAT THE FOLIC OF INSURANCE LISMO BEL.QW HAVE BEEN ISSUED CD THE INSURED NMED ABOVE FOR THE POLICY KRIOD INDICAT'ER,NOT WO'Td'iSTANDI O ANY REQUIREMW-TERM OR CONDITION OF ANY CONTRACT OR OTHER x OOCLIMENT WITH RESPECT TO WNION THIS CEiMFICATE M BEASSI"ED OR MAY PERTAIN,THC INSURAWA AFFO WI RDFD THS POLlcltrs DESCREM HEREIN IS SUO.IEOr TO rMBTERNlsa EXCWSIONS AND CONOIT1ONS OF SUCH P01.I0M.LBA.n SHOWN 14AY HAVE BEEN REDUCED BY PAID CLAIMS, a ' LTA rE 0 MO e! pip T80i10 ;RVn LIIArrS VOL 0 $737564 1 J2i3/2D06 3128P20Q7 +�Asvn�ir uwna i > ACOdQBN1' S 1,OR0,00 . .. .. rsasepOU'wN+�r $ 1,000,00 N O IO a RE CWnFICATE HOLDER EMCSIAATION LINEM CONSTRUCTION INC iNpt�a�rirornlc or orauraespac aapvR�r►� "NUTION DATI TF{�i1 .fk�JWGCQW*AWwLL6WXAvoR m M&LIQ PO BOX1737 oArawamEpNOMSIT*Tmlk.G% . UERN"AVToTKuser,stir B EWSTER,Mil02631 FA&UNTO"startHDft¢CSKML Won XgD9uAl"MNOpLM&&MGF AMp"D UPON TM C 0Pau+►,MS AGlh S OR aaa%S ,ATMiL AUTHORIZED REPRESENTAMVE . s t i �TNE � TOWN OF BARNSTABLE Building Application Ref: 20060787 • BARNSTABLE, * Issue Date: 05/24/06 Pe' l m it 9 MASS. �ArF0 339. A Applicant: B.L.MOSHER CONST.INC. Permit Number: B 20060221 Proposed Use: IND/COMM Expiration Date: Location °339 BARNSTABLE ROAD Zoning District HG Permit Type: ROOF/SIDING/WINDOW COMMERCIAL Map Parcel 310141 Permit Fee$ 150.00 Contractor B.L.MOSHER CONST.INC. Village HYANNIS App Fee$ License Num Est Construction Cost$ 0 Remarks APPROVED PLANS MUST BE RETAINED ON JOB AND RE-ROOF STRIPPING OLD THIS CARD MUST BE KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN MADE. WHERE A CERTIFICATE OF OCCUPANCY IS REQUIRED,SUCH Owner on Record: TRACY,AIDA BUILDING SHALL NOT BE OCCUPIED UNTIL A FINAL Address: 339 BARNSTABLE RD INSPECTION HAS BEEN MADE. HYANNIS,MA 02601 Application Entered by: SS Building Permit Issued By: THIS PERMIT CONVEYS NO RIGHT TO gCCUPX ANY STREET,AI<LX OR SII�FWKORNPART TIEREQF,EITHZR TEMPORARII l' RPERMANFNTLX; ENCROACHEMENTS QN PCJBLIC=PROPERTY NOT SPECIFICALLY PERMITTED UNDER`fHE�BCIILDING CxODE MUST BE APPROVED BY THEJLIRISDICT ON STREET ORALLY GLADES ASynWELUAS�DEPTH AID LOCATION�OF P�UI3LIG SEWERS MAY BE�OBTAINED FROM TIDE DEPARTMENT OF<PUB)•�fC WORKS X' THE ISSUANCIr>OF THIS PERMIT DOES NO3'RELEASE THE'APPLICANTFR.O�vI THE C®NDITIONS OF'ANY APPLICABLE SUBDIVISIC>N RESTRI TIONS` MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONTSTRUCTION WORK: 1.FOUNDATION OR FOOTINGS. . 2.ALL FIREPLACES MUST BE INSPECTED AT THE THROAT LEVEL BEFORE FIRST FLUE LINING IS INSTALLED. 3.WIRING&PLUMBING INSPECTIONS TO BE COMPLETED PRIOR TO FRAME INSPECTION. 4.PRIOR TO COVERING STRUCTURAL MEMBERS(READY TO LATH). 5.INSULATION. 6.FINAL INSPECTION BEFORE OCCUPANCY. WHERE APPLICABLE,SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL,PLUMBING AND MECHANICAL INSTALLATIONS. WORK SHALL NOT PROCEED UNTIL THE INSPECTOR HAS APPROVED THE VARIOUS STAGES.OF CONSTRUCTION. PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE PERMIT IS ISSUED AS NOTED ABOVE. PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO GUARANTY FUND(as set forth in MGL c.142A). BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 1 1 1 2 2 2 3 1 Heating Inspection Approvals Engineering Dept Fire Dept 2 Board of Health TO ALL E BiUSINESS OWNERS DATE: (O VY Fill in plea e: APPLICANT'S :; YOUR NAME: BUSINE R. YO R HOME ADDR S: 2�t 2 (no a- bilw TELEPHONE Tele hon Number Home NAME OF N. W BUSINESS TYPE OF BUSINESS 1. 43 A HOME iJCGUPATIQ,N YES NO Have yau� been given approval from he b � +diiN d�rr's ari'2 ESQ No . MAarAr�c �. Nunn�al*r7 ADnss C)F Bus�rlss When starting a new business there are several things you mus do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you.may need. Once you have obtained the required signatures, listed below, you may apply for a business certificate at the Town Clerk's Office (Ist floor-Town Hall) or if you get the business certificate first you MUST go to the following office to make sure you have all the required permits and licenses.. GO TO 200 Main St. — (corner of Yarmouth Rd. & Main Street) and you will find the following offices: 1. BUILDING COMMISSIO ER'S OFFICE This individual h bee i med y permit requirements that pertain to this type of business. Aut onzed Signature** COMMENTS: 2. BOARD OF HEALTH This individual has been informed of the permit requirements that pertain to this type of business. Authorized Signa re" COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature" COMMENTS: Business certificates (cost $30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in the town (which you must do by M.G.L. - it does not give you permission to operate -you must get that through completion of the processes from the various departments involved. "SIGNIFIES APPROVAL FOR A BUSINESS CERTIFICATE ONLY. ,i TOWN OF BARNSTABLE SIGN PERMIT PARCEL ID 310 141 GEOBASE ID 22710 ADDRESS 339 BARNSTABLE ROAD PHONE HYANNIS ZIP — LOT 7 BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT HY PERMIT 60999 DESCRIPTION SALON AIDA — 12 SQ FT PERMIT TYPE BSIGN TITLE SIGN PERMIT , N CONTRACTORS: Department of Health, Safety ARCHITECTS: and Environmental Services TOTAL FEES: $25.00 THE ' BOND .00 CONSTRUCTION COSTS $.007' 753 MISC. NOT CODED ELSEWHERE * BARNSTABLE, # MA83. f .i639. A�O� BUILDING DIVISION —7 s BX DATE ISSUED 05/09/2002 EXPIRATION DATE Town of Barnstable SABLE r yP� Regulatory i Yces. � �/ + Thomas F.Geiler,Di MSS.t s saRxsrna 9q� 16A39. �0� Building Onion A�Fo t�►a�° Peter F.DiMatteo, Building Commission_.: 200 Main Street, Hyanuiss.A — bld$d Office: 508-862-4038 Fax: 508-790-6230 Tax Collector , Treasurer Application for Sign Permit Applicant:_ C- Assessors No. pj Doing Business As: a la n (�� 1A Telephone No._S y`6 '7)ff 6 2--3 • Sign Location Street/Road: x-�Xr'e�' Zoning District:-�J — Old Kings Highway? Ye o H a '-s Historic District? Ye o r Property Owner Name: Iva C 4 R L1__Telephone: Address: b n n b �e �c� Village: t11'�\ 5 Sign Contractor Name:_ Telephone: .i�-o It 1 `� Address: 6 p f Yl-}-01'1 Y i Ve-- —village: Description Please draw a diagram of lot showing location of buildings and existing signs with dimensions,location and size of the new sign. This should be drawn on the reverse side of this application. Is the sign to be electrified? (5L/Nar (Note:If yes, a wiring permit is required) I hereby certify that I am the owner or that I have the authority of the owner to make this application,that the information is correct and that the use and construction shall conform to the provisions of Section 4-3 of the Town of Barnstable Zoning Ordinance. Signature of Owner%Authorized A ent-0/ ( Date - OZ Size: / Permit Fee: Sign Permit was approved: v Disapproved: Signature of.Building O icial: �• Gt� Date: `/ 7 r` Signl.doc rev.122801 D �n r '� z � �- D � .— �' �' o �Z m )D 3 a TOWN OF BARNSTABLE SIGN PERMIT PARCEL ID 310 141 GEOBASE ID 22710 ADDRESS 339 BARNSTABLE ROAD PHONE HYANNIS ZIP w LOT 7 BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT HY PERMIT 28888 DESCRIPTION DELLARIA SALONS (40"X60" ) PERMIT TYPE BSIGN TITLE SIGN PERMIT CONTRACTORS: Department of Health, Safety ARCHITECTS: ; . and Environmental Services TOTAL FEES: $25.00 THE BOND $.00 � Qi► CONSTRUCTION COSTS $.00 -153 MISC.. NOT CODED ELSEWHERE BAgNgrABLr, ; MASS. �FC . B LI DI G DIVA IO • x B � .rL DATE ISSUED 02/12/1998 EXPIRATION DATE The Town of Barnstable : Department of Health , Safety and Environmental Services rem Building Division 367 Main Strert,Hyannis MA 02601 L . Ralph Cmssen OffiC;e: 308-i 90-6u7 HuiIding Commissi Fax: 508-790-6Z30 on:: �89 Application for Sign Permit. - �� Assessors No. Applicant: — Doing Business As. �."\V �V: LcU Q �� Telephone No. Sign Location Street/Road: Zoning District Old Kings Highiiay? 1'es Property O Co O�`3 tiame: N-�1vp VAA2 Cc)`Z°Z� Telephone: Address• `�C��2�S —�tCA Village. tiiagnme ontracto � u � �`� Tel ephone:��_c Village: 5 c) -)CZZ_ vvv Address: Description Please draw a diagram of lot showing location of buildings and e:dsting signs pith dimensions, loczrion and size of the new sign. 'Ibis should be drawn on the reverse side of this applicarion. Is the sign to be electrified' 1' (iMotc.Yjw, a rkizi7gpctmitrsrrquirrag I hereby certify that I am the owner or that I have the authority of the owner to make this applicz�don, that the information is correct and that the use and construction shall conform to the provisions of Section _1-3 of the Town of Barnstable Zoning Ordinance. a Signature of Owner/Authorized Agent. Daze: Size: � 7L Permit Fee: Sign Permit Was approved: Disapproved: 1 ////� g� Signature of Btulauzg O ffici Z� Vlla-- Date: 6 W � V W s i f F TOWN OF BARNSTABLE B9BHSTOBfi$ • 3 YABs. OO1 am 3 Office of the Building Inspector April,30, 1984, Fee: $25.00 „ PERMIT TO ERECT SIGN IS HEREBY GRANTEDTO ........ ..t7e].l :.i ,...Ti►c.......................... ................................................... LOCATION .......3 .. 3� t7.e..�aac3P..giyatvii .............. ANY VIOLATION OF THE SIGN LAW WILL, CAUSE IMMEDIATE REVOCATION OF THIS PERMIT Building n eafor °•'" TOWN OF BA,RNSTABLE SIGN APPLICATION .Owner's Name Address Location 33t Vim' Y"47LJ2� VcL s Name of Builder 0 YM , Address !?6 f3eX 5-6 100 bul, iV-ej.CM'l, SPH 11-56—M _ 0-331 Type of Construction Diu 4�A,,,4 , n s �UbYI Free Standing or Attached 4:�c� Zoning District Fire District I hereby agree to conform to all Rules and Regulations of the Town of Barnstable regarding the above construction. All permits subject to approval of the Inspector of Wires. Name Diagram of Lot and Sign with Dimensions to be placed on revegesi e.`, r May 16, 1983 ARCHITECTURAL REVIEW SIGN APPLICATION P DATE TELEPHONE NUMBERS) l' `77 I lDl 3 �.Z 7• �'� ADDRESS OF PROPOSED PROJECT 339 �NYIS �+b OWNER wL „`�� 0 /��e <&54z,� MAILING ADDRESS 62� �», w SIGN REVIEW/NAME OF BUSINESS AGENT OR CONTRACTOR 0mn► 1 "� AND. ADDRESS �oQ �n� ��f. A-1 I S4M a2-17 q DESCRIPTION OF PROPOSED WORK(Use back of form if more space is needed) Please indicate dimensions, colors, lighting, site location, and if a sign methods of application. P"� `- FOR OFFICE USE ONLY PLEASE DO NOT WRITE BE')OW THIS LINE/CHECK EACH ITEM Sketch Attached Photographs Dimensions on Sketch Distance from ground Illumination Method of attaching Colors Number of signs Maximum of two a owa e Application Received on Action Taken _ Date of Hearing Building Inspector Notified - { OMNI SIGN �u�a iu�at�Ve S� Ana p� g g g LCOAAPANY INg. P.O. BOX , M 100 WINDOM ST., ALLSTON MA.02'1 34 C61 7] 787-1 1 01 0 787-1 1 02 April 11, 1984 Mr. Joseph BaLuz Town of Barnstable Building D"t. xyannis, MA 02641 RE: Sign Perini tfor John Dellaria, 339 Barnstable Rd. Dear Mr. DaLuz: As per our telephone conversation regarding the permit application for John Dellaria: We vill reduce the size of the sign proportionately from 4" x 61 to 3'1 4" x 5-1 0". Please find -enclosed the check for $25.00 to cover the permit fee. A copy of the permit should be sent to Omni Sign at the above address. Thank you for your assistance. Sincerely, OMNI SIGN COMPANY, INC. John Monahan fge Pc no. 3689 JM/ep P.S. Joe, since the plex -glass samples are difficult to replace, could you be so kind as to return them to me. Thanks. i 7t _ Pq MIN a 4• _ - OMNI SIGN P.O. BOX SO, 100 WINDOM ST., ALLSTON, MA. COMPANY, INC@ 021 61 7) 787 1 1 0130 787-1 1 02 r ARC (2� 5A� Le-v- (2) i 1 V -t- I ►kx- b ejjex-S4 , . -�,� i v eAA . , - J �QyofTHE.ro�o TOWN OF BAR.NSTABLE • ]IMSTADLE, i "6 9 BUILDING INSPECTOR , 11'•9 APPLICATION FOR PERMIT TO ..R.ensir...to...Bo.n.!-a..Bar-bes...S•hrap................................................... TYPE OF CONSTRUCTION ........v�.grad.:.sr1] �a �,e..w.ea.thex...frtan.t........................................................ September...... j 19...7f). TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .....3.39.... ...Rd.,................................................................................................................................... Proposed Use ...R.epa-Lr...ta...exi.sting...building.................................................................................................. ZoningDistrict .....................k...................................................Fire District .............................................................................. Name of Owner �d...Tv...Sem- h.............................Address 33.9...Bzr-nztgbl.e...Rd.... g Nameof Builder .-Nox-ma,n...Reke.r ex.................................. .................................................................................... Name of Architect Peter...Ecust.as...............................Address .................................................................................... Numberof Rooms ...1.............................................................Foundation .............................................................................. Exterior ..Br.i.Ck..&...camen.t...hl.oak............................Roofing ..` Ar...p?.p.e.r.......................................................... Floors .......Gpinan.t.... s-ph 1t....ti-le.................Interior .W.Q(ad,, rp:0.]�e1eidLe................................................ Heating ...Gas.......................................................................Plumbing .................................................................................. Fireplace ..................................................................................Approximate Cost ...... .�J..... ........................... Difinitive Plan Approved by Planning Board --------------------------------19--------. ��� C���� s�' G Diagram of Lot and Building with Dimensions Fe e— THE PROPOSED METHOD OF PR SANITARY WATER SUPPLY, SEWAGE FOR AND DRAT GE t 'HEREBY 4--A,PR GE DISPOSAL GG� PROVED row N OF BARNSTABLE, BOARD OF HEALTH A LICENSED INSTALLER PERMIT, AND INSTALL MUST SYSTEM; OBTAIN SEWAGE I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name 4�-zi. r ` { I i Smi th,. Donald T. @C r - 171 permit for alter commercial , No ...... ............................... buildin U Location ........... .39 3 „Barnstable Road .......................................... .........................Hyannis..................... ............. Owner ............. onald T. Smith .................... Type of Construction frame ..................,....................... ................................................................................ Plot ............................ Lot ................................ 't t Permit Granted ......September 28 19 70 Date of Inspection .....................................19 Completed ...............19`f` 8 ` c t r PERMIT REFUSED ................................................................ 19 ............................................................................... ................................................................................ I I ............................................................................... Approved ............................................................................... ............................................................................... %THE TOWN OF BARNSTABLE TO THE INSPECTOR OF BUILDINGS: The undersigned hereby ap lies ff r a permit according't the following information: Location .... ..........Rcir ...... .. ;41&. .-(.,,_71;�- —..... - - .. .. .1 Name of Owner Lo5�Vl�.tard. .............Address ....... 111-1&.4-1.............................Foundation .... ............... ........... ........... Number of Rooms .. Fireplace e-7 .............................................................Approximatt- Cost .........6/...... Diagram of Lot and Building with Dimensions THE PROPC'SLED METHOD OF PR)OWDIINIG FOR SANITARY WATER SUPPLY, SEW AGE DISPOSAL TOWN OF BARNSTABLE, A [J LICENSED INSTALLER �Uor [ PERMIT. AND -'~�^ VU[�UV | SYSTEM, --- ��'»=�� ^^~^^*�� ' | hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. mith, Donald l r�� 3147t 2.. Permit for model front 46 No ... .................................... of commercial building �F/o wet2 S�b� .................................................................. Location 3! Barnstable Road ........................................ Owner ..........Donald Smith .............................................. Type of Construction frame ..................................... 1 I - ' ................................................................................ w Plot ............................ Lot ................................ i r f Permit Granted .......October••.19...........19 70 r . Date of Inspection ........._ ............19 '7 � l Date Completed ..................19 1 PERMIT REFUSED . a ................................................................ 19 ............................................................................... .................................................. ........................ i r ..........................•.................................................... .......................................................................... 1 r Approved ................................................ 19 ............................................................................... .................... .......................................................... t ! t Assessor's map and -lot number ...... .' SEPTIC SYSTEM MUST BE �7 INSTALLED I,RI .COMPLIANCE Sewage Peimit,number � �... `. �? - r WITH ARTICLE •II STATE SANITARY COD °i�f© TOWN TOWN OF. B A R N S�T A RLT i `BAHH9TADLE;i t I '" r i ' "ASS. C D'IJ [L D 11:0 ft INSPECTOR' 0 ypY a' �} 1. APPLICATION FOR PERMIT TO ............ � j1Z U... . /........................................:......................................... c - �' ....... ... .. ••TYPE OF CONSTRUCTIONG.Q.... _ . , :. y`/........................19 i TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: 190� Location ........J. ..1....�c1. dGT�( ..............'....... .......... .... .... ............. Proposed Use ............... � �":.... P. ....................................................... ..................................... . Zoning District .........Fire District Name of Owner .. 0 �! .� ..... lM.� "i..................Address ...... 1�//. � ,5�`�J' Q!.'.,. Name of Builder ��We./1� ...b..:� J.'..� .........Address ./..`7.(/ 'L/............... ll�' �1. `Z fS Name of Architect .... /(z I........ ............ ....................Address (. .1.al"C....X�G.tkl Number of Rooms 4...:'.(�.�,�.�WplV ..Foundation ...�.�1.��/�.......... �. .... Exterior ...... ...........J�.. ... . ..................................Roofing ....... . . � ..,.... Floors Interior ............... ........................ A ....e���........................... .............. ... Heating ..... ................................................Plumbing ........................................................................... Fireplace U...................................................I.........Approximate' Cost o00 Definitive Plan Approved by Planning Board -------------------_-----------19________. Area '.......................................... Diagram of Lot and Building with Dimensions fee ........................... SUBJECT'TO APPROVAL OF BOARD OF HEALTH 33 � v -flaG • I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Nam i '.. : ................. .....��ry:...1f..J. 18278 Donald Smith , r ' � � 1 No 1R27.8........Permit for ...D,,.,Rem9del Comm Bldg .........�J�.:•y.yR-. ......' ..................................,............ Location ..............3 9:.Ba nstahle..Rd............ F E3;;a i s.:............................... Y .......... ................... Owner Donald...Smith......................... Type of,?Construction ......B r.a ......................... r ;, ........ ........................................ .........:........... Plot Lot E � Permit Granted ......Ap.1:i.1...I..............:.....19 76 " Date ofMlnspection ....................................19 `t Date Completed .... .... .,19 PERMIT REFUSED _ ^r .................. ...........r......................... '19 . C 11 A. ' . ................................. . ........~.................. ................. • - P ..... ............................ .. •............... ............... fA /... ................. .................... .......................... (........... .... .4' ........................... ....... .. . w. ♦. i , �Approvecl ................................................. .... ....... �C ' ` Sew6ge Permit' number V. TOWN OF BARNSTABLE 1639-AV BUILDINV INSPECTOR APPLICATION FOR PERMIT TO -_-..~�/���������!�------~--.---.---'^-.--------.— . ���E �� -------. /��,��---_---.--.-----_-----.--------. ~ ' ~' --.-.. -.---.—...l��'�� � ' ^ TO THE INSPECTOR OF BUILDINGS: . � . ' The -undersigned hereby applies for o permit according to the following information: Location --'~������� - Z� ���^ -.. ��/�- . .�_______.�_.���./�.��._.__-----. ' ProposedUse ................ .l.{..- �^� /H.���-------.-------.---.---..--.-----.--------- 'o � Zoning District ...........,-. .......................................................Fire District --- ........................................ / / Nome of Owner -��'/��/����{�-..L!�� /�^Y -----..A66,es --.�����r. .+-�r�v�. Name of 8vi|6e, ... .....-A66nss ............. ' Nome of Architect ... -Address �,� Number of Rooms -.Foon6otion .... Ex�e,io, -�/�/�^..-.�����. ---------.RooGng --. . .. '. .��'�..�.��---. . /�^�'/'�. Floors ---'-------------------------|nterior .............����-.���.��.��------_-.-----_. Heating -. �'�- ��.��--------.,------..�um6ng -------------.--.-------____ | Fireplace -----' --------------------..Approx|mote Cox -----.~~�.'�* ................................... Definitive Plan Approved by Planning Board l9-------- . Area -------------- .. Diagram of Lot and Building with Dimensions - Foe ...........................SUBJECT TO TO APPROVAL OF BOARD Of HEALTH ^ , � / ( . � ~ / --- V Ile, | / � . } | hereby agree to conform to all the Rules and Regulations of the Town of Barnstableregarding the above construction. . Nome_- -.-.�-/��[-.1/. _. / . _- . / 18278 Donald Smith No1&.2.7g....... Permit' l..�qM...J\l4- -.----.--.~---------.-.--.---.. � XJLy Location --339---Baroatoble-- ----{i-d..',��/o~,~� ............... 1a � --.------..^.---------------. � Owner -- ld...Bbu1.tb__.`_______.` � ^ Type of Construction .....F��za�'^ ------- � . --`--.----------------�-----. � . . } � / Plot ............................ Lot ..................... . ` . . � . � � ^y y �l � ' 76 � Permit Granted ..�F�--, - . - -]A ' Date of Inspection .............81.!.l._ lV � \ | ` - i Dote Completed ' � , / ^ . � lA ( � . , -... .^------------. � -''-'-~--^--'---`—~----------'' � . ................................... / . ----.~---.-------,-~.,...----.- ' � . ` � . Approved _-------------.. 9 � .......................................... � � - _ ---------- .----------'^-' � . . . ' � Roma, Paul From: Perry, Tom Sent: Tuesday, March 20, 2007 9:31 AM To: Roma, Paul Subject: FW: 399 Barnstable Rd Fyi;make sure that this is ok before the permit is released.thanks -----Original Message----- From: Lt. Don Chase (mailto:dchase@hyannisfire.org) Sent: Tuesday, March 20, 2007 9:02 AM To: Perry, Tom Subject: 399 Barnstable Rd Hi, Guy came in this AM for ok on renovation permit for a hair salon @ this address. He mentioned that the spiral stairs in the center of the room lead to a 2nd floor apartment. We just want to make sure that there is detection/ notification between the store and the apartment. Also, that the proper devices are in place and there is the proper separation (if needed) between dwelling and business. Thanks Don ps: say hi to Chris from BFD 1 _ � �1� �.� .. �� t 0 a,_ 3 a .. '' ;. .... _, ,. �z..:: '. ��` vo NOV %V 1 Q pe��' Q�P�a c���� � L C� "pl�l I ol% ott \� »� . . \�\�` �� . . ~�� � \ \ . >�E . ��} � � � : »2"f ^ � ���E� � ���`yt� � ��AYIK ��� � 1.�� � �� 1 �Z� X��� X`�P ���� t ��� ,�u� Ett ���� � �,�t P�Q. � - l _� f, u �;�- .+: 1 , I I 1R � i i �_� �_,� . . � � D� A � 9 !. ' .��':�. w rq ��VL X V X�¢� i 4 � 't J-`— ` v � o \\ � o V a r �, ����a �_a._— - —_ --— -- t � 1 e e �� i I O� F O O 4WIli,N O� 000 O O O O har, -- ac O O O O0' 0 OO O ;nY 100% Money Back Guarantee! O O 2 O O O DIGITAL O O O 000 O O O O O O O O O O O E)OO D O O O O O O O O O � O O .,.--.er.,,,yA. .. ._.�sz.�:v+r yw,^� ,�. .ar�:r_r -:�--t�•.�ia'1—�ja:..�:�,—,•.- �_� �ee�:��a"—`-".`—"� Date: MAhamacy- t READ THIS LIMIT OF LIABILITY AND REMEDY:Submitting any film,print,slide,negative or digital image to our company for processing,printing,storage transmission or other handling constitutes an AGREEMENT by you that any damage or loss by our company,subsidiaries or agents,even if caused by negligence or other fault will only entitle you to replacement with a like amount of unexposed film and processing.Except for the exclusive remedy or replacement,the handling of film,print, slide,negative or digital image is without warranty of liability and recovery for any incidental or consequential damages is excluded.NOT RESPONSIBLE FOR FILM,PRINTS OR DIGITAL MEDIA LEFT OVER 30 DAYS. 7 1 1 1• +`- .. 1 41771 53798 KodakI � F I�£ � I � t .fit � tl� 3�� yr + � i. 5 yore & hare Photos * 41- : , z f, i ""A at r rut # wwwA �, a{0 _7 , e n to r,co m 77 �� f AN j:3, x • 4 51A i-A A • •• 1,1 1 34575 • N v- f j FPrint v - 7 ry 1 g - 349479 r � 1 a TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map �. Parcel' ' Application # I o � Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Date Definitive Plan Approved by Planning Board Historic - OKH Preservation / Hyannis S E P 2 8 RECD Project Street Address Village •tti,s Owner ��) T&RCv Address UN01 L//t i, Pbxai; �i 2�Q„9 Il9 V Telephone Q�Q _ 2 Permit Request I e, S 6 w 147 C C et+L �r sue �rvd C kz CC.0 cart" aLAg PIZ Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation U 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 tll WkkOtthe Basement Finished Area(sq.ft.) sement Unfinished Area (sq.ft) Number of Baths: Full: existing Half: existing new Number of Bedrooms: a isTotal Room Count (not including aths xistw First Floor Room Count Heat Type and Fuel: ❑ Gas r' Oil ❑ Er Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing 0 new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board Zes' f eals Authorization ❑ Appeal # Recorded ❑ Commercial Q No If yes, site plan review#Current Use Proposed Use &A M 4�y APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number ',�-0 7_— "? ? d6�0 Address License # Ci�IT. o Z 6 Home Improvement Contractor# Worker's Compensation # LVCC 61 1 9 0 /Z o/0 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE (� FOR OFFICIAL USE ONLY t ` APPLICATION# c 2. DATE ISSUED ti MAR/PARCEL NO.a ADDRESS VILLAGE r OWNER a DATE OF INSPECTION: _ -'FOUNDATION,. 7 FRAME E' INSULATION x tr FIREPLACE a ELECTRICAL: ROUGH FINAL as - PLUMBING: ROUGH FINAL GAS ROUGH '" FINAL _ . . -a=FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. r . , f The Commanwealttz-ofAfassachusetts Department offizdustrial,4ccidents, Office of Investigations' 600 Wdshington.Street' Boston, M4 02111 �.•``� }vww.m ass.go v/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/EIectricians/Plumbers Applicant Iniorxnation Please Print Le ibl Name (Business/Organization/Individual)' Address: Ub olp7iv gr � n City/State/Z' f U 141 Phone:.#: ;S 6-. "(�C(� Are yo n employer? Check th�propriate bog: Type of project(required): 1. I asn a employer with 4. I am general contractor and I 6. ❑ New construction employees(full and/or part-time) *,. have hired.theshb contractors .2.0.I am a sole proprietor or.partnpr listed on the attached sheet T. Q Remodeling ship and have no employees These sub-contractors have g, 'Q Demolition workin for in an capacity. employees and fiave workers' g Y P n 9. ❑Building addition [No workers' comp.•insurance eom}i. insurance.$ required-] 5; ❑ We are a corporation•and•its I0.❑Electrical repairs or additions _ officers have exercised'their.. 11.❑Plumbing repairs or additions 3.❑ I am a homeowner doing all work r myself. [No workers' comp. right of exemption per MGL' 1:2.❑Roof repairs insurance required-] t c. 152, §1(4),.and we have no employees. [No workers' 1.3.[]Other comp. insurance required-] *Any applicant.that checks box#1 must also fin out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating theyare doing all work and then hire outside contractors must submit a new affida"vit 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 employccs,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. QQ Insurance Company Name; �V�V Hl a /� Ov Policy#or Self-ins. Lic. M W CC 06 ( qq® (Z.o) U Expiration Date: Job Site Address �: /CjPALe City/State/Zipy /y Attach a copy of the workers' comp ensation.policydeclaration page(showing the policy numb r 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 tip to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form.of a STOP WORK ORDER and a fine. of up to$250.00 a day against the violator. Be advised thata copy of this'statement may be forwarded to the Office of Invcsti atioas of the DIA.for ipfimanco coverage verification.: I do hereby certify under't pains and penalties of perjury that the information provided above is true and correct. Si ature:. Date: 27 (® Phone#: Official use only. Do not write in this area, 16 be completed by city or town officlal City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspector S. Plumbing Inspector 6. Other Cnntart PPr.cnn: Phone#: Information and. Instructions r Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their eniplo e Pursuant to this statute, an employee is defined as "...every person in.the service of another under any contract of hire,, express or implied, oral or written." An employer is defined as"an individual, partnership, association, corporation or other legal entity; or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer,or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant w.ho has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall . enter into any contract for,the performance of public work until'acceptable evidence of compliance Rzth the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractors)na.me(s),•addicss(cs)and.phone number(s) along with their certificate(s)of insurance. Limited Liability Companies'(LLC) or Limited Liability Partnerships (LLP)with no employees other than the members or partners, are not required to carry workers'compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit The affidavit should be returned to the city or town that the application for the permit or License is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' the Department at the number listed below. Self-insured companies should enter their compensation policy,please call self-insurance License number on the appropriate lino. City or Town Officials .Please be sure that the affidavit is complete'and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant- Please,be sure to flu in the pemut/license number,which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy.information(if necessary) and under`fob Site Address"•the applicant should write"all locations in (city or town).".A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year:Where a home owner or citizen is obtaining a license or permit not related fo any business or commercial venture (i.e. a dog license or permit to bu leaves etc.)said person is NOT required to complete this affidavit m The Office of Investigations would like to.thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone-and fax-number: net Commonwealth of Massachusel is Department of lndustrial Accidents --_ Office of Investigations. �- 6.00 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 11-22-06 www.mass.gov/dia oFY r ti Town of B arnstab-le Regulatory Services stixxsrAsr� Thomas F Geiler,Director - fo„q-���� Building Division Tom Ferry,Building Commissioner 200 Main Street, Hyannis, MA 02601 wnyw.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-62: Property Owner Must Complete_and Sign This Section, If Using A Builder as Owner of the subject.pzopetty hereb authorize S A) to act on mybehalf, Y �,�l f-eAJ �1/�/ in all matters relative to work authorized by this building perrutt application for. (Address:of rob) lgnature df er Date RdW . t Print Name If Property Owner is applying for permit please complete.the Homeowners License Exemption Form on the reverse side. Town of Barnstable Of THE r O T Regulatory Seirvices sAtsrAar� Thomas F. Geiler,Director W '6yq. Building Division ren" Tom Perry, Building Commissioner 200 Maid.Streei; Hyannis, MA 02601 www.town.barnstable.ma.us arnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230' HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number s trcet vi l l igc --"HOMEOWNER": - name home phone# work.pbone# CURRENT MAiUNG ADDRESS: city/town stato rip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow hQMr-owners to engage an individual for hire who does not possess a license,provided that the owner acts as superVlSOr. ' DEFINTITON OF HOMY-ONVNER Persons)who owns a parcel of land on which be/sbe 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 fazm 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 ja 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) T.h.c undersigned"homeowner" assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned "homeowner"certifies that_�Ushe understands the Town of Barnstable Building Department rninirnum inspection procedures and requirements and that he/sbc will comply wrth,said procedures and requirements. Signature of Homcowncr 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 homeowncrperforming work for which a building pcmrit is required shall be cxcmpt from the provisions of this scction.prction 1 D9.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a pason(s)for hire to do such work, that such Homeowner shall act as supcm.sar", Many homeowners who use this cxernption arc unaware that they are assuming the responsibilities of a supervisor(sec Appendix Q, Rulcs&Regulations for Licensing Construction Supervisors,Scction 2.15) This lack m of awareness bftcn rrsults 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 responsob)c. To ensure that the homeowner is fully aware of hisAc{respomnbilitics,many communities require,as part of the permit application, that the homcnwna certify that he/she understands the respansrbilitics of a Supervisor. On the last page of this issue is a,form currently used by several towns.'You may care t amend and adopt such a forrn)ccrtificalion for use in your community. lien*.3WO2CENTRALCA ACORN<:fCERT1FfCATE OF LIABILITY INSURANCE os 612010 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Dowling&O'Neil Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Agency ALTER THE COVERAGE AFFORDED BY THE POLICIES_ BELOW. 973 Iyannough Rd., PO Box 1990 Hyannis,MA 02601 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A- National Grange Mutual(nSuranc Central Cape Construction,Inc. assoRma Associated Employers Insurance 820 Main Street > C; ' Cotuit,MA 02635 INSURER O: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE O>INSURANCE POLICY NUIHM POLICY EFFECTIVE POLICY EJPIRA LWM A &ENERAI.LIABIRM UPM7640 11114/09 1Ut4HO EACH OCCURRENCE $1,000,000 GE RENTED X COMMERCIAL GENERAL LIABILITY $SOD 000 CLAM MADE Q OCCUR MED EXP(Any one pmm $1 O 000 PERSONAL&ADV INJURY $1 00O 000 GENERAL AGGREGATE s2.000.000 OEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGO OOO OOO POLICY JECT PRO LOC AUTOMOBILE LIABILITY COMBINED SINGLELIMIT $ANY AUTO ALL OWNED AUTOS (BODI �r P� SCHEDULED AUTOS $ 1NIREDAUTOS BODILYftecddwdINJURY CIO AUTOS $ PROPERTY DAMAGE $ (Per acddent) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO- OTHERTHAN EAACC $ AUTOONLY: AGG $ EXCESSIUMBRELLALIABWTY EACH OCCURRENCE $ OCCUR CLAiMBMADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ B WOIIRS COMPENSATION Arco WCCSMO9199012010 ON14110 06114111 WC STATU I 10�TH EMPLOYERS'LIABILITY El,EACH ACCIDENT $500 000 ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERtMEMBER EXCLUDED? YES E.L.DISEASE-EA EMPLOYEE MONO O es d under E.L.below DISEASE-POLICY LIA4R '$500 OOO OTHER DESCRIPTION OF OPERATIONS/LOCATIONS 1 VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT fSPECIAL PROVISIONS Steven Devtln Is excluded from the woriters compensation policy. Insurance coverage Is tirtdtad to On terms,conditions,exdusions,other Uniltations and endorsemmitso Nothing contained in the certificate if Insurance shall be deemed to have altered,waived,or extended the coverage provided by the policy provisions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIM POLICIES BE CANCELLED BEFORE THE EXPIRATION Town of Bourne DATE THEREOF,THE ISSUING INSURER WILL ENIWAYOR TO MAIL 10_ DAYS WWTTP.N Town Hall NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FANLM TO DO SO SHALL 24 Perry Avenue WpOSE No OBLIGATION OR LIABILITY OF ANY IOND UPON THE INSURER,ITS AGENTS OR Bourne,MA 02532-3441 REPRESENTATIVES. AUTHORIZED RESENTATIVE C. ACORD 25(2001f08)1 Of 2 #S70278/M70277 y LS7 O ACORD CORPORATION 1988 Massachusetts-bepartment of Public SafetN Board of Building Regulations and Standards Construction.Supervisor License License: CS 47993 Restricted to: 00 ; STEPHEN J DEVLIN 820 MAIN ST - COTU IT, MA 02635 Expiration: 21412012' ' ('irnunissiuirer Tr#a 15633 W Office of Consumer Affairs andVusiness.Regulation 10 Park Plaza- Suite 5170 c,M Boston, Massaclu`setts'02116 Home Improvement !It or.Registration Registration: 131841 : " Type: Private Corporation Expiration: 9f26/2012 Tr# 202911 CENTRAL CAPE CONSTRUCTIORY _. i #µa . STEPHEN DEVLINi 820 MAIN ST. COTUIT, MA 02635 Update Address and return card.Mark reason for change. Address n Renewat Emptoyment Lost Card r DPS-GA1 is SOM-04l04-6701216 0ft'ice�t�0fw^w WA 96"fi k c License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: �131841 Type:.: Office of Consumer Affairs and Business Regulation :. Expiration 91251�Q12 Private Corporation 10 Park Plaza Suite 5170 ,?` Boston,MA 02116 L CAPE QNSIICIOTiQNCO.INC. - h � STEPHEN DEVLIN r 820 MAIN ST CQTUIT,MA Q2635 m 'Undersecretary Zkot valid without signature TO ALL N W BUSINESS OWNERS DATE: S D Fill in please: APPLICANT'S a4'`, _ YOUR NAME: Uw#) - (y1Q1fKMWj BUSINESS ,' YOUR HOME ADDRESS: 513 A' 10 CI mtj a 50K-7-7/- a333 fa cts, illl�al TELEPHONE Telephone Number Home ! t tat- � NAMi� OF1W IEUSiNESc . s :.... "I"' P�. .:.. 15 THIS d HOIIIIE CUAq'ION ' Yip$ [O . :. i V b41[ :n �V : : cvt;frQrr�'tla i~►utNd#N tf "� 1fIS (7 y.: 1Ess ourEss . We When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. Once you have obtained the required signatures, listed below, you may apply for a business certificate at the Town Clerk's Office (Ist floor- Town Hall) or if you get the,business certificate first you MUST go to the following office to make sure you have all the required permits and licenses.. GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street) and you will find the following offices: 1. BUILDING COMMISSIONE 'S OFFICE This individual ha5.4een infor d of any permit requirements that pertain to this type of business. A o ized Sig nat e** COMMENTS: 2. BOARD OF HEEeinfor This individual has do he pe mit req ' ements that pertain to this type of business. A rized Signatu r COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual h een info ed of PV li si g requirements that pertain to this type of business. Au horized Sign ure** I ce QUX41�- VIC-&Ck& i5n COMMENTS: H-en Business certificates (cost $30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in the town (which you must do by M.G.L. - it does not give you permission to operate -you must get that through completion of the processes from the various departments involved. "SIGNIFIES APPROVAL FOR A BUSINESS CERTIFICATE ONLY. YOU WISH TO OPEN A BUSINESS? For Your Information: Business Certificates cost $30.00 for 4 years. A Business Certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L. - it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, 1st FL., 367 Main Street, Hyannis, MA 02601 (Town Hall). DATE: NOv_ Q2 , ao-0 S- Fill in please: APPLICANT'S YOUR NAME: KIT( �r-44 f_-T KA M p AN G- N BUSINESS YOUR HOME ADDRESS: A6 -TOW N k -o 0 &1- CT. N N f S �o � 771-2"s33 MA ©a 6o f TELEPHONE # Home Telephone Number: r7 5 NAME OF NEW BU5INESS (� 1c( " + TYPE OF BUSINESS n ru 7 IS THIS A H OO S Have you been given approval from the bundling d1vls►on YES NO / ADDRESS QI= BUSINESS 33;''�A (�°,��vST,���� �. tfiF1 aV N S r7 p a MAP/PARCEL NUMBER ��' L When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. — (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMISazed FICE This individual had of a y ermit requirements that pertain to this type of business. ture" COMMENTS: 2. BOARD OF HEALTH This individual has been informed of the permit requirements that pertain to this type of business. Authorized Signature" COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual been informed o le' M requirements that pertain to this type of business. ll ttAuthof ized Signature' COMMENTS: + fE; 010PIq TOr &-mmon Vtchy'.Vee bc&-vsz thaye, a11700-Inq J TOWN OF BARNSTABLE SIGN PERMIT PARCEL ID 310 381 GEOBASE ID 22926 ADDRESS BARNSTABLE ROAD PHONE (508)790-2432II �p Hyannis ZIP 02601- LOT 4 BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT HY PERMIT 13505 DESCRIPTION P.DEL THAI CUISINE (8.71 SQ.FT. ) PERMIT TYPE $SIGN TITLE SIGN PERMIT CONTRACTORS: Department of Health, Safety ARCHITECTS: and Environmental Services TOTAL FEES: $25.00, t DIME BOND $.00 ( CONSTRUCTION COSTS $.00 ' 753 MISC. NOT CODED ELSEWHERE ; BARN3TABLE, MASS. I 1639. OWNER FINLAYSON, SOMBOON A ADDRESS 9 JAMIE MARIE WAY CENTERVILLE, MA BVVILDI//N/G DIVISION / DATE ISSUED 02/28/1996 EXPIRATION DATE d The 'Fawn of Barnstable %i no �. Th Department of Health, Safety and Environmental Services w KMuildin Division date � 4� �, Building 367 Main Street,Hyannis MA 02601 Application for Sign Permit Applicant: "Richard K. Finlayson Assessor'sno. 3��' ��� Doing Business As: P.DEL Thai Cuisine Telephone (508) 790-2432 Sign Location Street/road: • 339A Barnstable Rd. Hyannis Ma. 02601 Zoning District Old King's Highway District? yes no x Property Owner Name: Somboon Finlayson Telephone (508) 771-3049 Address: 9 Jamie Marie way, Centerville Ma. 02632 Village Barnstablp Sign Contractor Name: C g age � d a r�s E I�, Tel 7 7 I Address: So 4v m t- Q4 Lantos Village s iJ S .—T Description Diagram of lot showing location of buildings and existing signs with dimensions, location and size of the new sigr to be drawn on the reverse side of this application. Is the sign to be electrified? yes x no (Note: if yes, a wiring permit is required) T h e:% - I S cx— S,5 rl po! 1 o v) 'V ra 1-ki �'' q M P -Q:QiovS owQ QfL-, I hereby certify that I am the owner or that I have the authority of the owner to make application, that the information is correct and that the use and construction shall conform to the provisions of Section 4-3 of the Town of Barnstable Zoning Ordinances. 26 February •1996 Date Signature of caner/Authorized Agent Size (sq. ft.) - f Permit Fee ems, c Sign Permit was approved: ✓ disapproved: Wlz 7/9� -L.�c-'. Date Signature dBuilding Official 'V a G r IL- t ' i tk; Richard& Somboon Finlayson 9 Jamie Marie Way Centerville Ma. 02632 Consumer Affairs Office Licensing Authority Attention: Ann C. Burlingome I am writing this letter in response to our opening of a take-out restaurant, at 33%- Barnstable Road Hyannis. Our restaurant will have no seating available for patrons to enjoy their meal. There will be a bench area for patrons to sit and wait,while we prepare their meal. If you have any questions, please do not hesitate to call me or ask my wife Somboon any questions you have. (508) 771-3049. 6PVL c K :}un tcv� Richard K. Finlayson TO ALL NEW BUSINESS OWNERS: Fill in below. NAME OF NEW BUSINESS: ` , l7 �— -TV4 ( -R ES-TL)2 A N / TYPE OF BUSINESS I H A IS THIS A HOME OCCUPATION? Q ADDRESS OF BUSINESS 3 q. �A 2 N; � i2 _ �VAVVNI S MAP/PARCEL NUM13ER If you are starting a new business there are quite a few things you need to do in order to be in compliance with all rules and retulations of the Town of Barnstable. Once you have been checked off on this sheet you may apply for a business certificate at the Town Clerk's office(Ist floor-Town Hall). 1. GO TO BU I I PECTOR'S OFFICE(4TH FLOOR TOWN HALL) This indi ' co Tian an has been explained the cedures needed to start a business uilding nspector's Sig ature f 2. GO TO BOARD OF HEALTH(3RD FLOOR TOWN HALL) This individual has been informed of any permit requirements that pertain to this type of business. � ,, �!J �� Health Inspector's Signature 3. GO TO CONSUMER AFFAIRS (LICENSING AUTHORITY)-(3RD FL SCHOOL ADMINISTRATION BUILDING This individual has been informed of any licensing requiremen that will pertain to this / type of business ensin Authority Si ature After being checked off by all of the above-remember to return to the Town Clerk's office to actually obtain your business certificate. • The Town of Barnstable ennxsrAM4 1�� Department of Health Safety and Environmental Services 039�-r� rA Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner July 16, 1998 Somak Sangworn 52 Hiramar Road Hyannis, MA 02601 Re: SPR-049-98 Bangkok Cuisine, 339 Barnstable Rd, HY (310/141) Proposal: New restaurant, seating for 8. Dear Mr. Sangworn, The above referenced proposal was reviewed at the Site Plan Review Meeting of July 16, 1998 and approved under Section 4-7.4 (2) of the Barnstable Zoning Ordinance with the following conditions: • Inspection of fire equipment over stove. • Construction of wall separating the kitchen area from the hallway where customers would be walking to the bathroom facilities. Please be informed that a Building Permit is necessary prior to any construction. Upon completion of all work, a letter of certification required by Section 4-7.8 (7) of the Town of Barnstable Zoning Ordinance must be submitted. Also, all signage must be discussed with Gloria Urenas of this Division. Should you have any questions, please feel free to call. Respectfully, Ralph Crossen Building Commissioner TOWN OF BARNSTABLE SIGN PERMIT PARCEL ID 310 141 GEOBASE ID 22710 ADDRESS 339 BARNSTABLE ROAD PHONE HYANNIS ZIP - LOT 7 BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT HY PERMIT 32299 DESCRIPTION BANGKOK CUSINE (16 SQ.FT. ) PERMIT TYPE BSIGN TITLE SIGN PERMIT CONTRACTORS:, Department of Health, Safety ARCHITECTS: and Environmental Services Bt)NDTOTAL FEES: $2�.0© �THE � CONSTRUCTION COSTS $.00 753 MISC. NOT CODED ELSEWHERE anitNsrAsi.E, MASS. 039.B ILDI DIVISION// DATE ISSUED 07/22/1998 EXPIRATION DATE . The Town of Barnstable • ; ,,,�,��8,•E, ; Department of Health, Safety and Environmental Services KAM �,� Building Division � 3 ��q� �� �9. 367 Main Street,Hyannis MA 02601 �a Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner Tax e ' j Application for Sign Permit Applicant: ✓ 54MAK. SAWIWKN Assessors No. MAP. �K CISIN� �og a Doing Business As:�✓ .��� Telephone Now Sign Location Street/Road: - 9 /�. �A t TA�1 PLAN 1 S N 6a 60 Zoning District: Old Kings Highway? Yes o)Hyannis Historic District? Yes -) Property Nam II " —Telep hone: Address: 1 COW ' Y'I G Village: itJIS Sign ConWactor Name: -,Ty Cs. N f/Li. __Telephone :.� � Address: - l a"�%'! Q �;t N ��Il/�I f, (92�_'`�Village• (A��►�-�,y,S OR be-I _ F---� Y-,� --� Description Please draw a diagram of lot showing location of buildings and existing signs with dimensions, location and size of the new sign. This should be drawn on the reverse side of this application. Is the sign to be electrified? Yes/No (Note.ff yes, a wiring permit is required) I hereby certify that I am the owner or that I have the authority of the owner to make this application, that the information is correct and that the use and construction shall conform to the provisions of Section 4-3 of the Town of B stable Zoning Ordinance. Signature of Owner/ Si Authorized Agent: " � UY� Date:Y,IJ �02 Size• f �� Permit Fee:ol ` Sign Permit was approved: Disapproved: r Signature of Building Offic'al: Date: Signl.doc i y, _ TOWN OF BARNSTABLE MASSACHUSETTS BUSINESS CERTIFICATE - DATE ISSUED: 7/17/98 DATE RENEWED: AL 17 0420 BOOK:183 RENEWAL BOOK: RENEWAL PAGE: PAGE 98-186 DATE DISCONTINUED: CERTIFICATE EXPIRES: 7/17/2002 DISCONTINUED BOOK: DISCONTINUED PAGE: "In conformity with the provisions of Chapter One Hundred and Ten(110), Section Five(5)of the General Laws, as amended, the undersigned hereby declare(s)that a business is conducted under the title below, located as shown,by the following named person,persons or corporation: BANGKOK CUISINE MAILING ADDRESS: 339A BARNSTABLE RD HYANNIS,MA 02601 SAMSAK SANGWORN 52 HIRAMAR RD HYANNIS,MA 02601 . i Signatures: I THE ABOVE NAMED PERSON(S)PERSONALLY APPEARED BEFORE,ME AND MADE OATH THAT THE FOREGOING STATEMENT IS TRUE. TITLE Identification Presented: DATE: July 17, 1998 CONDITIONS: BUILDING PERMIT&SIGN PERMITS REQUIRED In accordance with the provisions of Chapter 337 of the Acts of 1985 and Chapter 110, Section 5 of the Mass General Laws,Business Certificates shall be in effect for four years from the date of issue and shall be renewed each four years thereafter. A statement under oath must be filed with the city clerk upon discontinuing, retiring or withdrawing from such business or partnership. d Copies of such certificates shall be available at the address at which such business is conducted and shall be furnished on request during regular business hours to any person who has purchased goods or services from such business. Violations are subject to a fine of not more than three hundred dollars($300)for each month during which such violation continues. . ------------------------ CERTIFICATION CLAUSE I certify under the penalties of perjury that I,to the best of my knowledge and belief,have filed all state tax returns and paid all state taxe quired under�aw. * ignature of Individual or Corporate Name(Mandatory) By: Corporate Officer(Mandatory if applicable) ** or Federal ID Number * This license will not be issued unless this certification clause is signed by the applicant. ** Your social security number will be furnished to the Massachusetts Department of Revenue to determine whether you have met tax filing or tax payment obligations. Licensees who fail to correct their non-filing or delinquency will be subject to license suspension or revocation. This request is made under the authority of Mass:G.L. Cha 62C, S.49A. SI% :.,.a w � i r O 1 ' e / '98 7 18 ,r� "p V \ fl� -�.�\°�. \ pry INSTANT PRINTING•INSTANT SIGNS DESKTOP GRAPHICS HIGH SPEED&COLOR COPIES Trust Your Image To � /� TYPE, r i0© o Oc _ r •,� JJ r ry - , . The Printing Company PEG PESSA (508)771-8800 300 BARNSTABLE R FAX(508)771-1278 HYANNIS,MA 02601 YN& KOK CUI�OINE 4 CUISIM, 12 KO u r. EngiZ�ering Dept.(3rd floor) Map 0 Paicel ` �-t I - Permit#.. / 02 3 13,q a _ House# � ' Date Issued �- �'Board of Health(3rd floor)(8:15 -9:30/1:00- eF Se ` y 0v) �1p Q< :.: flo dg.) DIME 19 BARNSTABLE. TOWN OF BARNSTABLE; Building Permit Application 67 0 R-J�T Project Street Address r- , ' _ 3 3 Village Owner aul o Address �mb e�in A-1 Ai Telepho O !� 5 O zz-7s D.,.. /Permit Request = 411 W O {t/i�JB�LW G�l �y D G t i Li- � t✓ off+ �.B G i ��-►.�G Ka K First Floor b b - square feet Second Floor ' N �, square feet Construction Type Estimated Project Cost $ Zoning District -B f 6 P J y I Flood Plain Water Protection Lot Size C.bV Grandfathered ❑Yes ❑No t Dwelling Type: Single Family ❑i 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 )W Other i Basement Finished Area.(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half: Existing New No. of Bedrooms: Existing New Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: Gas ❑Oil ❑Electric ❑Other Central Air ,Yes ❑No Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial Qr�es ❑No IU`/e�site plan review# Current Use Proposed Use Builder Information 2, Name ( I, ��rpi�nn Telephone Number �'�' Address 1 C� License# (���y�¢ Home Improvement Contractor# I 16 9 Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEB R RE LT G FROM THIS PROJECT WILL BE TAKEN TO ,__N —� SIGNATUR ZV 'h ') Z BUILDING PERMIT D I T E FOLLOWING REASON(S) E _ Y Y w w I FOR OFFICIAL USE ONLYir - PERMIT NO. a , . DATE ISSUED. 4 + Se MAP/PARCEL NO. i r ••{ 4 `ADDRESS r ¢ 4 , - 'VILLAGE OWNER DATE OF INSPECTION: FOUNDATION; w" F F, _ '_f 3 FRAME _ { INSULATIONi FIREPLACE ELECTRICAL: , ROUGH FINAL" - c PLUMBING:' ROUGH ' FINAL' GAS: ROUGH FINA'L FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. i N , CONDITIONS This Company binds the kind(s) of insurance stipulated on the reverse side. The Insurance is subject to the terms, conditions and limitations of the policy(ies) in current use by the Company. This binder may be cancelled by the Insured by surrender of this binder or by written notice to the Company stating when cancellation will be effective. This binder may be cancelled by the Company by notice to the Insured in accordance with the policy conditions. This binder is cancelled when replaced by a policy. If this binder is not replaced by a policy, the Company is entitled to charge a premium for the binder according to the Rules and Rates in use by the Company. Applicable in California When this form is used to provide insurance in the amount of one million dollars ($1,000,000) or more, thetitle of the form is changed from "Insurance Binder" to "Cover Note". Applicable in Delaware The an ee or mortgagee 9 Ymortgage Obli ee of or other instrument given for the purpose of creating a lien on real property shall accept as evidence of insurance a written binder issued by an authorized insurer or its agent if the binder includes or is accompanied by: the name and address of the borrower; the name and address of the lender as loss payee; a description of the insured real property; a provision that the binder may not be canceled within the term of the binder unless the lender and the insured borrower receive written notice of the cancel- lation at least ten (10) days prior to the cancellation; except in the case of a renewal of a policy subsequent to the closing of the loan, a paid receipt of the full amount of the applicable premium, and the amount of insurance coverage. Chapter 21 Title 25 Paragraph 2119 Applicable in Nevada Any person who refuses to accept a binder which provides coverage of less than $1,000,000.00 when proof is required: (A) Shall be fined not more than $500.00, and (B) is liable to the party presenting the binder as proof of insurance for actual damages sustained therefrom. Adboo755.'14"1.:..)::::.::::::::::.:...:.......................................................................................................... ` The Commonwealth of Massachusetts . __ . :=_�. Department of Industrial Accidents Of>-ice of/nyestigatians , 600 Washington Street Boston,Mass. 02111 Workers' Compensation Insurance Affidavit name: .C70M,;A-k 906009,0 location: city �� �15 M� ' �02�1 phone#( ❑ I am a homeowner performing all work myself. ❑ I am a sole pro rietor and have no one working in an capacity %/%% %%%% /%%/ �/ //////%%%%%/% %%% O/%%%%%%/%%%/O%%%%%%%%�%%�%///%%//�//%i ❑ I am an employer providing workers' compensation for my employees working on this job. company name: KC IC CuT5;N address Agg Sl k Jll� ry city 1 i �.�('{(� yj:... ... hone#: .. insurance co. SUya- AO& lnC IuAG olicv# ❑ I am a sole proprietor, general contractor, or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: company name: No�hQWl �erl�� �/ ..(�� �Ne,,, address 1G 1 I 1.Y V0r , u phone insurance co. 01icv# _ company name. r� tfe g s�uicv� address: 'nnfig ctty — " �b5 1 i ' 0) phone#: J"� — b '�4 y��� _ otcv insnrance co: ; # Fafiure to secure coverage as required under Section 25A of NIGL 152 can lead to the imposition of criminal penalties of a tine 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$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. 1 do hereby certi nder the paiiLf—wc nalties of perjury that the information provided above it truo and correct �� Date ��—` —CIV Signature ,,I - Print name S 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 ❑Licensing Board ❑checklf immediate response is required ❑Selectmen's Office ❑Health Department contact person: phone t;; ❑Other (mvised 9/95 P1A) G Information and Instructions . Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their the "law" an em to ee is defined as eve person in the service of another under any contras employees. As quoted from p Y every 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 receiver 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 c, 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 renew of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who hay 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 returned fo 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 Me of Investlgatlons 600 Washington Street Boston, Ma. 02111 fax#: (617) 727-7749 phone #: (617) 727-4900 ext. 406, 409 or 375 Q g� W w fl CD _ a 0 PO _ f , `l^i l! ,- -`•` +�.:,-tit ',. P / - - • - I IJ 1 \ Y J I 91 J C KOK C_tS�N �CE T0l-i / L AO SQ , f I l `. �UO"tGN IK;.In � MEN zon \ bf A -:,.Frf--� �'' �� 3 �A% Sid•, r1k� �E e SANSwyc GGG.r�� a 3. WAIF% 6, :;c � G LL NGL F t� 1�' � rAN. �Ik wA\ W `111 N t;NC TOWN OF BARNSTABLE MASSACHUSETTS BUSINESS CERTIFICATE .` DATE ISSUED: 7/17/98 DATE RENEWED: JUL 17 p 4 .20 BOOK:183 RENEWAL BOOK: RENEWAL PAGE: PAGE 98-186 DATE DISCONTINUED: CERTIFICATE EXPIRES: 7/17/2002 DISCONTINUED BOOK: DISCONTINUED PAGE: In conformity with the provisions of Chapter One Hundred and Ten(110), Section Five(5)of the General Laws, as amended, the undersigned hereby declare(s)that a business is conducted under the title below, located as shown, by the following named person, persons or corporation: BANGKOK CUISINE MAILING ADDRESS: 339A BARNSTABLE RD HYANNIS,MA 02601 SAMSAK SANGWORN 52 HIRAMAR RD HYANNIS, MA 02601 Signatures: V-S THE ABOVE NAMED PERSON(S)PERSONALLY APPEARED BEFORE ME AND MADE OATH THAT THE FOREGOING STATEMENT IS TRUE. TITLE Identification Presented: DATE: July 17, 1998 CONDITIONS: BUILDING PERMIT&SIGN PERMITS REQUIRED In accordance with the provisions of Chapter 337 of the Acts of 1985 and Chapter 110, Section 5 of the Mass General Laws,Business Certificates shall be in effect for four years from the date of issue and shall be renewed each four years thereafter. A statement under oath must be filed with the city clerk upon discontinuing, retiring or withdrawing from such business or partnership. Copies of such certificates shall be available at the address at which such business is conducted and shall be furnished on request during regular business hours to any person who has purchased goods or services from such business. Violations are subject to a fine of not more than three hundred dollars($300)for each month during which such violation continues. --------------------------------------------------------------------------------------------------------------------------------------------- CERTIFICATION CLAUSE I certify under the penalties of perjury that I, to the best of my knowledge and belief,have filed all state tax returns and paid all state taxekliluired under aw. lit WC 411igna)tuareyo%ln�dividual or Corporate Name(Mandatory) By: Corporate Officer(Mandatory if applicable) ** or Federal ID Number * This license will not be issued unless this certification clause is signed by the applicant. ** Your social security number will be furnished to the Massachusetts Department of Revenue to determine whether you have met tax filing or tax payment obligations. Licensees who fail to correct their non-filing or delinquency will be subject to license suspension or revocation. This request is made under the authority of Mass. G.L. Cha 62C, S. 49A. i S f D r d r- rn O + �\01 30" MIN. I'-b U) a T I.. lJ 2 - I n y - m I 0 'Li?] MI 3- o r oIL -- -- I I � ;T BENGH \: 13 -5 /2" W ----------------- --------- - -------------------�'�� � ,a I I I I I I W I I W I I W I I = I I I I s I I • I I ' � o IO c I� } IW Iy I ---- ---- ------------------- ----------- PORIDUGT DISPLAY � 1 I I 1 I I I I I I q O J. 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