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0054 CEDAR STREET (7)
.�'� Ce�:c,r� �a is - - -- - - -- � _ - -- -J --- 1UWII Ul J3aJLWNLU131G mop Stte rp�y o Regulatory Services t Ra� .F Richard V. Scali,Director "ASS. Building Division RFD a Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 Office: 508-862-4038 Fax:!S08-790-6230 REQUEST FOR ELECTRICAL INSPECTION ELECTRICAL PERMIT NUMBER. Q I S U':* 3 �- (Permit required in order to.process inspection) cc =Today's ate_2-( Z` t { Requested.Date of Inspection Cn GI, �q :(3 f(��. hereby request an inspection under-Massachusetts, z General . (ElectziciaD) Law chapfer 143, section 3L and 237 CMR 4.02(3). . The installation will be ready for inspection at l fe-r � +�Glt�i C_ a3 (Property Location) Type of inspection requested: ❑ Temporary Service ❑ Service Re-inspection ❑ Excavation ❑ Rough Re-inspection ❑ Service Inspection ❑ Final Re-inspection ❑ Rough Inspection for ($100.00.Re-inspection Fee) ❑ Final Inspection for Other �e U� ae Owner or tenantc� Licensee's name, address, and.phoneC�v Z-:117v License number 13Zit-A Licensee's Signature This section to be completed by.Barnstable Inspector of:Mires Inspection date ❑Approved ❑Not Approved This work was:not approved for violation of the following Articles and Sections of.the MA Electrical Code: Q:WPFiles:forms:electrequest Rm04072014 elmmonwea&of Madeackmett6 Official Use Only cc�� cc77 Permit N mfJ�Part'nien�o��}ire�eruice3 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 1/071 pave blauk APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527(CMR 12.00 (PLEASE PRWT INMK OR TYPE ALL)NF'ORMATIOM Date: Z City or Town of- � �1n n _5 To the Inspector of`�Pires; By this application the undersigned giv s notice of his or her intention to perform the electrical work described below. Location(Street&Number) S 1-( Owner or Tenant p6 Telephone No. Owner's Address SIs this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Buildiug b0.Mo;e. Utility Authorization No. e1 . , q` Existing Service Amps / Volts, Overhead❑ Undgrd❑ No. of Meters New Service Amps / Volts Overhead❑ -Undgrd ❑ No.of Meters Number of Feeders and Ampacity \Location and Nature of Proposed Electrical Work: GE� Pe ,-� Completion ofthe follow, table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of Total. Transformers KVA, ' No.of Luminaire Outlets No.of Hot Tubs Generatom-' No.of Luminaires Swimming Pool Above ❑ Iu- ❑ o,o nck gency ig ri g nd. nd. Batte -U- i No.of Receptacle Outlets No.of Oil Burners FIRE A LDS No of Zo No.of Switches- No.of Gas Burners No.of Detection and Initiatin Devices? _ No.of Ranges No.of Aar Cond. Tonsl No.of Aler g Deviei% No.of Waste Disposers gear tamlp Number Tons KW.......... No.of Self- ontainedLJJ Detection/ erfing Devices rn No.of Dishwashers Space/Area Heating KW Local Municipal Connection Other. rs No.of Dryers Heating Appliances ISL4Y Security stems.** 19 m No.ofDevices o uiva e o.of to x E I nt ' N wHeaters No.of No.of Data Wiring: 'Signs Ballasts No.of Devices or E uivalent mile it No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiringg--. d No.of Devices or E uivalent m OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. N I Estimated Value of Electrical Work: (D U (When required by municipal policy.) 9 R Work to Start: -016111Y Inspections to be requested in accordance with MEC Rule 10,_and upon completion. o QD INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless a the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing oface. CHECK ONE: INSURANCE ❑- BOND ❑ OTEER ❑ (Specify:) Xcertify,under thepains andpenalties ofperjury,that the information on this application is true and complete. FIRM NAME: C'i/1. f t tC f�- LIC.NO.: Z,\k 70 Licensee: V Signature LIC,NO.: 3Z3`} Q (If applicable,enter "exemp "in Me license number line..) Bus.Tel.No.., S;-a ?G4 ®t3� Address: &Sk„n 5 }Cr 1hVIA,; Alt.Tel,No.: *Per M.G.L.c. 147,s.37- 1,security wor requires Department of Public Safety"S'. License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's a ent. Owner/Agent Signature Telephone No. PEAWT FEE:$ s�8n� + 3 b4� & plocrn!--wee� a str rn�� N-Y ,r Y IWL KAM ' Town of-B fristiW Zoning'Board of Appeals `-Decision and, ' once APpea12004-072-Koch APpeal'2004-073. Ferreira'; Appeal-2004.074=Scatambuli Appeal of the Building Commissioner Summary. . .:Upheld Commissioner's Didgon ;; Petitioners: Daniel:P.Koch, operty,.Owner Timothy J.Ferreira,Ferre�ra's Auto Repair&Ferreira'Landscapmg Roberto Scatambuli,Occupant ofPremises Property Address:: 54 Cedar St.,Hyannis,. MA Assessor's Map/Parcel: Map 343;Parce1;011, Zoning: Professional Residential;&Wellhead Protection Overlay Distracts Background&Relief Requested ;. f. i 'These three,appeals involve the. es located at 54 Cedar St.;Hyannis,MA.'The subject property is a.018 acre lot developed with.two structures: The:first is a.1;290 sq.;ft,two-story structure that dates to 1920. The-second is a'`newer 4988'one-story,2,400 sq.ft. industrial.type structure. On February 25 and26,2004.the Building Division issued cease and,desist orders to, Daniel P.Koch,as owner'of the property,Timothy J.Ferreira,as'owner of Ferreira's Auto Repair and Ferreira.Landscaping,and:Roberfo Scatambuh:as-occupant of.the premises; The'Building° . . division cited.several violations including violation of Seciion 3-2.1,Permitted uses in;the PRD . District,3-5.2(B)Wellhead Protection Overlay Distinct,4-3..3 Prohibited signs,2-6 1(3): Prohibited Uses,and violationof.the approved site-plan review number-'0167-98. On March 25,2004'Daniel P.};Koch,as owner of the property,and Timothy J.Ferreira-.•as owner of Ferreira's Auto Repair and Ferreira-Lands capin g :And Roberto.Scatambuli,as,-*:of the premises,;all appealed cease.and desist order issued by the'Building Division. The'appeals areE numbered 2004-72,73,and 74"respectfully. Procedural&IAearih Summary -This" was"''filed at'the Town Clerk's Office and at the'Office`of'the Zoning Board of Appeals on March 25,2004 A.'public,,hearing before the Zoning Board of Appeals was duly advertised;and nonce sent to all abutters in accordance with MGL Chapter 40A .The hearing was opened May.26;2004,:at which tim6 the Board found to reaffirm the Building Commissioner's , 'decision and uphold the,cease and desist orders issued. Board Members deciding this appeal `, ' =were Richard L::Boy,Jeremy'GilmoreGail Nightingale,'Ralph Copeland,and.Chairman Daniel M Creedon,III: The applicants represented themselves'at the hearing'and,it was.agreed,upon to hear the.three a eals together' It was clarified thatMr."Koch is ahe owner of the ro e PP g P P rty,and Mr'>s Ferreira and Scatambuli are tenants of the property. Mr.Koch.contended that it is a pre:=existing nonconforming use. He stated that.he.has been`there since 2002 and'cit&kiiit he has�;busuiess permit and sign permits from the Town He'stated that the.use complies.with zonwg,as thesite predates the creation of zoning., F 5, The Board questioned how long the site.ha.d been"dsed as;industriWdom ercial. It was;noted, that to substantiate a non-conforming use it would have to predatI .e:the original zoning of.the town. Prior to Mr.Koch's acquisition of the property,-it was usedby Bay;Side Auto:Sales It. appears the original use of the property dates to a,use by the`Hood milk company:. 1VIr:Tom Perry,Building Commissioner,stated neighborsIad"complained about;activities orillie site and the Building'Division inspectors investigated the,cgmplaint and dnoted half buried boats. on site and auto repair being performed'on the site. The prior Bay Side Auto didnot do repairs only retail sales. Mr.Peny cited that in the 1988 site plan approval for the new.building it was . approved for cold storage only., Mr.Perry submitted photos showing the`site apd`achvit es::be rig carried on at the site. Included in the:group was a photo showinga pile,of used batterieg that, were discarded in the snow. Mr.Ferreira stated that the batteries werethere when he moved to the siteand that he was takings them to the dump Public comment_was requested:and John Henderson:of 52 Cedar St:noted that this was;a milk` company dating to the.1900'.s. Margaret Sexton.a resident at.52 Cedar St.,stated-that the use has intensified and is disruptive to the neighborhood.There was no repair of autos,at his site before ,� Ann Johnson and husband Williarajohnson,;pwner4 of a neighboring business also testified expressing concerns for:the building permitted m,1988 Findings of Fact. At the:hearing of.May 26,.2004,the Board unanimously•made the'following findings of fact t 1. Mr.Koch as owner., Mr Ferreira Nand 5catambuli as.tenants under Appeals 2004=72,-73,:and' 74 have appealed 2�cease and desist ordrs,fr om the Building Commissioneron 2125/0,4;and, , 2/26/04 for-violation of zowng"ordmances.and WP.district violations; 2. The:property,is located as shown;on Assessor's;Map 343,.Parce1011, addressed as 54 Cedar 44 St, Hyan , MA in a Professional Residential Zoning District and a Wellhead`Protection nis Overlay District. ' 3_,.The roe consists of a sin le l utidin� that has a commercial steel structure with.3 bays.- P P rty: g 4_ �Th current`use made of the property, during Mr. Koch's ownership.:is that.of an auto repair,,:, auto-body repak and also;'landscaping businesses;.prior to thaf;'from testimony oaken, the. current structure was built,around 1988 with a building permtt< The building was used:for: ° storagge Prior to that there existed.a wooden or brick'barn used by Hood'as a milk storage r building for;dairy products dahngto 1940 1.5 ;The ro ert a ors to be located almost entire1 in a Wellhead Protection and PRD Zonin P P y PPe t. Y g District: Decision Based on the findings of fact,--a motion was.duly made and seconded td reaffirm.the decision iof the Building Commissioner and uphold..the,;issuance of he- Cease`and`,Desist orders dated February 25 and 26 of 2004 for the reasons stated. ' _ r The vote was as follows: . AYE: Richard L..Boy,'Jeremy.Gilmore,Gail Nightingale,Ra1ph;Copeland;.and-lb amel, ^ Creedon NAY: None Ordered: Appeals 2004-72„-73 and 74 have reaffirmed"the decision- -fahe Building Commissioner and uphold the issuance of the'Cease.and Desist order. This decision must be'recorded at the Registry of Deeds for;it to be m`effect. The relief authorized by-this decision must be exercised.. ... in one year. Appeals of this decision,if any;shall be madeypursuant to MGL Chapter 40A, Section 17,within twenty(20);days after the date.of the filin, of this decision,a copy of,which must' fil in the office of the Town,Clerk. ani Creedon,III,Acting Chairman` Date Signed I,Linda Hutchennder;Clerk ofthe Town of Barnstable,Barnstable County,Massachusetts, . hereby certify that twenty,(20).days have elapsed since the Zoning Board of Appeals filed this decision and that no appeal of,the decisi has been filed in the office of the Town Clerk. Signed and sealed this_ day v under the pains,and penalties of: perJm'y- z: , Linda Hutcheniider,Town Clerk3 *. cJ iz f ; a i. sc' f t74X i � � V �is T - Tr• - . Daniel P. Koch. { P.O. Box 416. TisburV. 114A r 02568 MARCH 24, 2004� t,..' zia TOVyTI OF BAR. ST,4BL)r -n h TOWN CLERK RE; NOTICE OF ZONING ORDINANCES'V1(?IT10N S-t Cedar Street,.H, q is DATED: February.26,2004 y. TO W14014i IT MAY CONCERN. Upon reception of said W tice,my,te ts,were informed of the,con�pSaint. The pro !we has been cleaned up as•was demanded.i~y your o8:ce,`This is.an�appeal tU to•remo�v1 the CEASE AND DESIST::Please; at your earliest co venience go and inspect the;: property,an 54 Cedar°Street,-Hyannis;MA. 1,v1ap 43a Parcel %1s owner and landlord of thr abcive rarned property.`I have been and will remain. willing and`able;to coinply kith suy zoning and safeiv regulaTions.issued by the Town Barnstable.;feniera X,andscaping and;BrazilaViotors'.my tenants,(%A, assured me thdt'. alltown-tamed legalities and lieensuig have txzxi met 1 have addressed these istiues,as well`'. and we three are in agreenienrto the appeal, Previously.tlns property has housed approved automotive rapair businesses These n. businesses had adtherzzation and,approval from vuur:to� .I;.have nog changed.the u.Sage` of said pro=-t which tojnv-`urxderstand nj is.IpWidfathered ( now•.employ a Property`lt4anager who oversees the conditions of the property ar�d I can guarantee that your tn�pectors.wll never agam`have ,o experience ttk &'Toss negligence andpotentially fkvardou °messJthat Was so clearly rapresented the pictures you serf i erelti, -, Daniel P, Koch i I i r: Town. of.BRrnstabYe -' Regulatory ServicE WE tow Thomas F .Geiler,Director- Toy " ARKS, ABLE AY, .Building:Division sa MASS. Tom Perry,:Budding Commis� Mass. � 200 Main Street, Hyannis;MA. �I �fD N1A'�A Office: 508-8624038 ..508 790-623.0: 'D .VISION' Notice of Zoning Ordinances Violations) and.Order to Cease, Desist and Abate: Daniel P.Koch and all persons having notice ofthis order. As owner/occupant of the,premises/structure located at 54 Cedar St.,Hyannis-Map 343.Parcel OM you aze hereby:notified that you are in violation of the Town of Barnstable Zoning Ordinances and are ORDERED-this date,February..26 2004;to: 1. CEASE ANDDESISTi IMMEDIATELY;`all functions connected Witkthis violation on.or:;at the above mentioned premises. SUMMARY OF V10LATION `.. . Violation of Town of Barnstable Zoning Ordinances: .3-2.1 PR Professional Residential District t 3-5.2(B)(MNR Well.Protection Overlay District : 4-3.3 Prohibited Signs 2-6.1(3)Prohibited Uses.Also in-violation of Site Plairkoe iew dec,W6n'SPR-016 98 2. COMMENCE immediately,;actiori;to abate;this viola ion SUMMARY OF ACTION TO A-$ATE,. j i . t .:And,if aggrieved by this notice!and order,to show cause as to why you should not be requued;to do so;by. filing an appeal with the Town.Clerk of Barnstable; .Notjce of,Appeal(specifying.the ground thereof] within thirty(30)days'of the receipt of this order(in accordance with Chapter 40A Secnon;l 5'of the Massachusetts General haws). If,at the expiration of the time allowed;action"to abato-this violation has nok' commence, further action as: the law requires will be.aaken { :By`order, c _ David Mattos . 4 `Local:Inspector,: CERTIFIED MAIL 7002.100070005 07$1 7488 Q/FORMS/viozonel: 1. I Parcel Detail '` Page a of 2 A t Logged In As: Wednesday,Ap= Margaret Rothman r �Pa re.e l Deta`i l Home Application Center Parcel Looku 3 ® Parcellnfo t �. P arcel ID343-011 y.Developer Lot; LOT D& Location ,54 CEDAR STREET Frontage ;Sec Road Frontage vivage: HYANN S Flre DistrictHYANNIS 77 Owner InfoT., Owner ;KOCH, DANIEL P ,.; Co owner Streetl 'P O.BOX 416 ; .= Streetz . City .TISBURY State A a zip `02568 Country US" Land Info Acres '0.28 � use. COMM WHSE� zornng PRD _ Nghbd CI02 Topography - -- - Road : Utilities Location o Construction Info I _ w _ _...v �uiId jn9,- a-12 rig: Year: - Roof�"`�F AC ¢ Built 11920 struct Gable/Hlp' Type°I,None Effect 1290 '� `Roof As h/F GIs/Cm Bed 2"Bedrooms _._V _. Area Cover T- Rooms rr Style Conventional `I"t Drywal Bath' 1 'Ba� hroom Wall Rooms! Total', Model Residential5 Roomsd Rooms€ r - Int ICaI Bath „ Grade Average TYP style ' t Floor �- Stories 2,StOf1eS Ki Style�"X ' ; ¢ ' Ex`t 'Wood Shin le Heat Gas ` Bath1 Full -- Wall 9 Fuel Split a Y :C, Heat 'Hot Found iPoured Conc.—; Type 'ation v in9 t®f.;Z Year 1988 Roof Gable/P Ac None.: f3Wlt Struct Type:.._ Effectt� * Roofp Be'. d , http//issgUlntranet/parceli<nfo/ParcelDetall aspx�ID=28449 4121/2004 g'e 2 of 2 Parcel Detail �~ �,; Pa Area 2400 cover MetallTl Rooms.Zero.Bedrooms t �E- -- -.. Int . Bath Style re- ng Wareh Wall Minimum Rooms n1 1/2 Bathrms .. - „ Model prldz6mm ROOMS _ Int _ Bath Grade-Average Floor,Concr Finished Style r'r Stories 1 Story Kitchen ;a w Style _ Ext : HeatBath Wan Pre-finch Metl Fuel ITYPlcal spot 0 Ful ..:+J v, Heat Found= T e Typical ationA Poured Conc. a Permit Hesto _ Issue Date Purpose Permit k . Amount Insp Date Comments 1988-05-01 631858 $0 - 1989 01-15' HY BLDG. 1988-05-01 B31859 $50;000 HY.COMM'L , Visit History Date Who Purpose Sales History Line Sale Date Owner . Book/Page ' a' Sale P 1 1/15/1992 KOCH,`DANIEL P C125429 . 2 12/15/1991 CAPE'COD BANK&TRUST CO C12519.7 3 5/15/1989 AITTANIEMI, G'RETCHEN TRS ,` C117439 4 1/15/1988 WHARTON, MARGO C113252 5 ' 9/15/1983 GREENE, PATRICIA A- C93369` , 6 ` GREENE, PH„IUP M-792 : :' C9336.977. o Assessment History 'Photos G ^ { r , a-0 , r ht_p//issgUintrariet/parcelinfo/ParcelDetail.aspx?TD=28449 4/21/2004 ....,., r C1 rr ♦,� .r � �... y e �s�^�+�'F "•" �i ' 3r * �`,d 3 �. t Ir" »��d�:e..}e'i}",i� t,�.�`��4�+.'�*a t_ i.0$�},'� ��r p,* �� rah �:,��*e'• �• w. ,� 3f�4 t aFa..m+.m+ _ .+ 1+:'s��,{� Ar' dr,..�'5.�1. ',��� �`.- � # •�` "� •'�,...«w�,:.:' '`� ="�" X`s ,..,�.': ;, '"t ,d. ji' ...,,., a "qi.,�+ ^�:,Fr,,a,;d4 NA'fa't.u�+.1,Y.� ,�,iy, ms..•. 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Cr� _ 's� c °,M1yiri ,h r` ', yt `s y ' +4..'b��g 'tjplhAw w�. t';, k -Tyyya�r INC e h ^+ kfl F3 �� ,c ,�k�4 '� ll� U �� d � h +r y.fi^ � d 'J` 3 '�•*'�. Ky r i J Ai dy r z c gyp', s le u'�.' +�' j„„ ,:S "p t tax,-" .s .�� a +ti• ���` ,9. y TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel I Application i-SIV 00� Health Division Date Issued 57`3-7 S Pie Conservation Division Application Fee '(J Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address 61ale_ S Village �� �a / Owner G�®� Seta /g Address Telephone 6-0 -7 4- "® L „y Permit Request O&I'L0✓ e X t s/7 5 i en Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 10 .57S-O Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existingnew Half: existing W new 9 Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count.-- oil � a� Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑Other ' 1 Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) C C3��'�/�i✓�d 3/S� y Name ���� ll� Telephone Number sad �h�� �`� Address License C-s Home Improvement Contractor# /6� !13 Email Worker's Compensation # ti✓C Z 3(s-3�B �S-©��i ALL CONSTRUCTION DEBRIS RESULTING FROM-THIS PROJECT WILL BE TAKEN TO !P&A4, 'S4,� 10" SIGNATURE rDATE FOR OFFICIAL USE ONLY APPLICATION# DATE-ISSUED 1 ' -MAP•/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: k FOUNDATION ' FRAME 4 INSULATION t G FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL t- FINAL B,UILDIN.G DATE-CLOSED OUT ASSOCIATION.PLAN NO. 1[w Cowman>;€wv h of-MassachusaYs Department of fard tr al Accidents r - Office of-&VEA oWions 600 Mwhingtom,5`reet Boston,,MA 02111 w -'� tvrttw trauss.go�dira Workers' CompensafioubmuranceAffdavit-.$uildersfCantractorslElectricians/Mumhers Applicant Information. Please Pant,Le?,ibly `Name(FBsmesgl�ationlf ffwidn4_ � �v /Yu(if-i? ke-r zc,t ff C- y Aci3re-sue �I'Ca (i✓.�Sk l h ci f tat z : 5: �, /W/, 6® ' Phpw e au an employer?Check the appropriate box: T of project r 4_ I arrx a confiactor aad I 3� ����� I. I am a employer with ❑ 6_ ❑New connsfruction employees(full andlorpart-time * havehiredthe su ctmtfactors. 7._ I am a sofe proptietor or partner- 9 listed on the attacked sheet 7- ❑Itrmtadeling shift astd hate no employees Xt/ These snb-contractors have g- ❑Demolition wodiag forme in any capcapacity. employees and have workers' 9_ ❑Building additionWa,Work:e1S' Comp:insurance comp.incmm2 , 5_❑ We area corporation and its 10_[]Electrical repairs or additions 1 officers ha"�e exercised fheir I1_. Plumbin airs or additions 3_❑ I am a htsmevu�ner doing all tivork ❑ g n.=p , myself. [No worlmrs'comp_ right ofe3cemption per MGL 12-.0 Roof c_152, 1 and we ba%m no �s rnmrrstnre requut;d_]i § (4k - employees_[No workers' 13_,EZ Other comp-insurance required- *Any sppEc of ff=t checks box N1 wmst also fill out the section below stacebxg fheir wa0ceis7 compenssfian pour'mR3rmatiaa_. T Homeowners who submit this affidnif i&cst Mg they are doing sll wc&sad them hire oU=&contractors mooed szabffirt a aetis ai�darit mdirs jog surer ri:ont mcmrs thst check ifiis box mast soothed as sdditiaosl sheet shouine the name of the Wb-0MIft3Ct0nand ststP cchedtEr arnmt th05e lilies Tim employees_ If the snhtontractm have employees,they must piuvide their warke€s'comp.policy number. lam an employer that is prm tr�orkers'corrgmnsalion inrttrtuzce for my e.mplayLvm BeIatc is thepoi cy anal job site iriforteratiotr_ - Insurance Company Dame: Policy 9orsel€irrs_Lic—& k/C2- 15- 3Vyts-©/Ii FxpisaliouDate: Job Site Addiess Citiv'Stati Zip: 0-2-6 O/ Attach a copy of the workers'compensation policy dediration page(showing the policy number and elation date). Failure to secure coverage as requireduuder Section 25A o€MGL c 152 can.lead to the imposititm ofcriminal penalties of a fine up to$1,500_dt}andlor one-year imprisonment,a's well as civil penalties in the fowl of a STOP WORK ORDER and a fine of up.trr$250_00 a.day against the violator_ Be advised that a copy of this statement maybe forwarded to the Office of In estigationss of the DIA for inamtnce coverage Verification- el ' I do hereby cerft Sall enahiss o penury that the infbrmtdian provided abtn a is true and correct Sit=_nattzi:e` Bate: . CPbgns#: 25-1-.32- t7 Off Edal use on[y, Do not write in this area,to be completed by cify or town of'ciaL City or Town: Pam tUcense# IS ui g Authority(circle one): 1.Hoard,of Health 2.Building Department I Cityl dwn Cleric 4.Electrical inspector S.Plumbing Inspector 6.Other Contact Person: Phone 9: — 6 1 Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant-to this statute,an ernzployee 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 IocaI 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 airy 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,,,rith the insurance requirements of this chapter have been presented to the contracting authority." Applicants — Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, necessary,supply sub-contractor(s)name(s), address(es)and phone number(s)along with their cert;.ncatc(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no emnployees 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 Depaitirent of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit_ '11e a,.adavit 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 obt;Hi,-i 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 lime. 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 ill out in the event the Office of Investigations has to contact you retarding the applicant_ Please be sure to fill in the permitilicense number which will be used as a reference number. In addition, an.applicant that must submit multiple permit1hoease applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is oa file for future permits or licenses. A new affidavit must be:51led out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e,a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: nt.CommonwWth of Massachus!�tls Department of InAustdal Accidents ogee of kvestigatiom 600 Wa,-,ngtan Street Boston,IAA G2111 T6L A 617-727-4900 W 406 or I-& MASSAFF, Fax 9 617-727-7-749 Revised 4-2447 www_rnassgav/dia - oFTMe� ti • •nxrrsr.�sr.E. • , ' ,� Town of Barnstable ArED��A Regulatory Services Richard V.Scali,Director Building Division Thomas Perry,CBO Building Commissioner - 200 Main Street, Hyannis,MA 02601 , www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize /"/(/ L(7"ke(U�t 4 ��Y��Gl�4' L- to act on my behalf, in all matters relative to work authorized by this building permit application for: r (Address of Job) Signature of Owner D e Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. QAWPHILESTORMS\building permit foims\EXPRESS.doc Revised 061313 . �e �(�aa��rrrner�ueci��a�C�/��z16�ic��r�te(lai Office of Consumer Affairs&Business Regulation I VOME IMPROVEMENT CONTRACTOR registration 167113 Type: i xpiration: 8/1 112 0 1 6r LLC MV CONSTRUCTION';SERVICES LLC. MAKSIMS VALAU *wF 235 GREAT WESTERN RD S.DENNIS, MA 02660 Undersecretary s j. • L .. Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supenisar License: CS 102857 MAKSIM S VALA1 J ` 68 Center St Ste if Hyannis MA 02601 ,.�.,. Expi ration ration Commissioner 11/30/2016 uVC 2 - 3{5 �,/ -_ oly License:or registration valid for individul use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Boston,MA 02116 f� Not valid wit ut signature Unrestricted-Buildings of any use group which contain less than 35,000 cubic feet(991M )of enclosed space. Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For DPS Licensing information visit: www.Mass.Gov/DPS Mass. Corporations, external master page Page 1 of 2 William Francis Galvin b a \ Secretaryof Commonwealth ofMassachusetts ss• 1� V'�O Corporations Division Business Entity Summary ID Number: 000561784 Request certificate New search Summary for: CAPITAL LEASING OF CAPE COD, INC. The exact name of the Domestic Profit Corporation: CAPITAL LEASING OF CAPE COD, INC. Entity type: Domestic Profit Corporation Identification Number: 000561784 Old ID Number: 000000000 ` Date of Organization in Massachusetts: 01-08-1997 Last date certain: s Current Fiscal Month/Day: 12/31 Previous Fiscal Month/Day: 00/00 The location of the Principal Office: Address: 1141 OLD STAGE RD. City or town, State, Zip code, CENTERVILLE, MA 02632 USA Country: The name and address of the Registered Agent: Name: CHARLES KIPNES Address: 1141 OLD STAGE ROAD City or town, State, Zip code, CENTERVILLE, MA 02632 USA Country: The Officers and Directors of the Corporation: Title Individual Name Address PRESIDENT ROBERT BELANGER 1141 OLD STAGE RD., CENTERVILLE, MA 02632 USA PRESIDENT ROBERT BELANGER 1141 OLD STAGE RD., CENTERVILLE, MA 02632 USA TREASURER. ROBERT BELANGER . 1141 OLD STAGE RD., CENTERVILLE, MA 02632 USA SECRETARY ROBERT BELANGER 1141 OLD STAGE RD., CENTERVILLE, MA 02632 USA DIRECTOR ROBERT BELANGER 1141 OLD STAGE RD., CENTERVILLE,'MA 02632 USA http://corp.sec.state.ma.us/CorpWeb/CorpSearch/CorpSummary.aspx?FEIN=000561784&... 5/22/2015 Mass. Corporations, external master page Page 2 of 2 Business entity stock is publicly traded r The total number of shares and the par value, if any, of each class of stock which this business entity is authorized to issue: Total Authorized Total issued and Class of Stock Par value per share outstanding No. of shares Total par No. of shares .value CNP $ 0.00 20,000 $ 0.00 1,000 r r Confidential E-1 Merger r Consent Data Allowed Manufacturing View filings for this business entity:. ;ALL FILINGS Administrative Dissolution �~ Annual Report Application For Revival Articles of Amendment 4` _I__ _L View filings Comments or notes associated with this business entity: 'x 1 1New search, http://cop.sec.state.ma.us/CorpWeb/CorpSearch/Corp$ummary.aspx?FEIN=000561784&... 5/22/2015 . Inspection Report — Building Department Date 14 — Address J Referred B i Purpose of Call/Inspection Reported to Site with Observations & Notes 1� - ' � } ��� � r � .' _ � �— L �° /. { s .. ` ✓ i . - � ' • r • � � _ � - � j - M � � � - � _