HomeMy WebLinkAbout0011 ENTERPRISE ROAD (10) 0
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
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Map Z17 J Parcel eO!q—JM Application #
Health Division Date Issued /-5--/(o
Conservation Division ZZ,..(�j&— CJ Application Fe{ OC)
Planning Dept. co
Permit Fee n
Date Definitive Plan Approved by Planning Board
Historic - OKH _ Preservation/ Hyannis
Project Street Address n'5c
Village pvb
Owner EM r� �� CorN ' Address (I F14PTi sC— -vzoo41_
Telephone 116 _ Cf 1 �)
Permit Request CNv e 1 a 6 e S+A t eLt k�(J Ig 1f Sq V+ 'Ib-4o41
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuation ` Z 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 95 Historic House: ❑Yes 5CNo On Old King's Highway: ❑Yes CENo
Basement Type:. &ull ❑ Crawl ❑ Walkout ❑ Other Q itt( Gar, U ,L
Basement Finished Area (sq.ft.) to 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
CD
L�(-Central Air: Yes ❑ No Fireplaces: Existing New Existing wood/coal stover]Yes ❑"No
Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑anew size
Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: 00z�a
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Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ '�
Commercial 3rYes ❑ No If yes, site plan review #
Current Use W A X L Proposed Use S P�m f
APPLICANT INFORMATION
(BUILDER OR HOMEOWNER)
Name T�+4�1 �7,e 1-0y-Me— Telephone Number �Sn S" T2 2-3 Z 3
Address 21,5 Le s l,�,6 rt z>r License #— C S`0(,3301
MAS 'A MA O?C,yq Home Improvement Contractor#
Email M i A Cal p_�0N v cx fh A i L o Ca rv% Worker's Compensation #
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
1J end CLS e, e nu L Le_s L ,grJAW
SIGNATURE DATE ZO f0t r ► S
AN
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FOR OFFICIAL USE ONLY
APPLICATION#
DATE ISSUED
MAP/PARCEL NO.
ADDRESS VILLAGE
OWNER
DATE OF INSPECTION:
FOUNDATION
FRAME
INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
FINAL BUILDING
DATE CLOSED OUT
t
ASSOCIATION PLAN NO.
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' 27m Comurarnvealth o:,jf-Maxyacli!�ells
DVarkrrelzt o►flnd sstrialAccidertirs
Owe o,f lmz t.gadons.
y 600 Was hzgtort Street
Baston,41A 172114'.
wFsnv ma-vmgovfilin
Workers' Compensat Gn Insurance Affidavit Bmlders/Cantracturs_/EIectricianslPlumhers
Applicant InfGn titian Please Print f e-,ib
Name�Basme�sfl�rganizatittafln�C�dual� �i! � Lc�urn f7
Address: Z 5 LeCc kore br;
City/S4- r . � � �o�-��(0-�3z
Are yo-u an emtloyer?Check the appropriate box: Type of project 4 ❑ (req i d),:
❑ I am a employer with. _ I ant a general contractor and I 6_ ❑I�Tew consirucfion
u.1
I.
/employees(fu11 and/or part-time).* have hired the sub-compactors
Z. I am a sale proprietor or partner- listed on the attached sheet 7- ❑Remodeling
slip and have no employees. These saib-contractors have 8_ ❑ Iitiau
wading RX Me in any capacity employees and have wodcers'
[No workers'camp.incur re comp_insuranti--I - ' 9. Building addition
required_] 5_ ❑ We are a corporation and its 16❑Electrical repairs,or additions
officers have exercised their
3111 am a homeou*ner doing all w 11_❑Plumbing repairs or additions
set€ o workers'comp- fit of exemption per MGL
c.1�Z, 14} and we have no 12_❑ ofrepairs
insurance required.]1 � ( h �
Io o workers 13_ 0ther
empyam. _&Uj&
camp_insurance mquired.j
'Any appNc 1%st checks box ffl mast also filloufthe secticabelowshmsing the¢woMere compensarioapoHU infoemsuan
Homemnters who submit Arts efiidaeu inrfmatMg they axe doing all waA ea4 then hiM GU de canttactoa mast submit a new affidavit indicating 5
fCantractorstfiat checY This box must attached as additinnil sheet showing themuue of the sub-ca atwi s and state whether ornottbase emidesha-e
employees.Ifthesab-contmaots have employees,they must provide.their workEn,camp.polky number.
lam air srripi �r tlarrtis pra�zding�vork¢rs'conrperrsrrfiurr irisurcurce f or anJ*¢nrplQ}'¢es ReI01v is tIt¢poticy Md jOh site
irtforrrta on i 1
Insurance CompanyName: ,
Policy 4i'or&K-ins.Lie. F—kpiaation Date: rt
Job Site Address: City/State/Zip:
Attach a copy of the workers"compensation policy declaration page(shotvisig the policy number and expiration date), • .
Failure:to secure coverage as required.under Section 25A o€MGL c 1572 can lead to the imposition of criminal penalties of a
fine up to$1500,OD and/or one-year imprisonment,as well as civil peaalt ies,m the form of a STOP STORY ORDER and a one
'of up to$250_00 a day against the violator. Be advised that.a.copy of this statement maybe forwarded to the Office of
ImVest gations of the DFA for iflsimance,coverage verifcation-
I do hemby ce&rof—
%th ' s and,perrahYzs vfper�tty Matdje irafbrmafiou prm ded abm a it tnre acid carrect
Sitmature: I3ate
: tr,, :no/
Phone b 7 t�9 "93Z
Ufj`a3cial use truly: ,Do not turtle itr thisarea,t�be cotrlpfete�d b}�t�arta}cn ojJiciat - ... .
City or Town.: Perndff kense#
Issuing 4ntlraritl*(circle one):
L Board of Hcdth 2.BuffTing Department 3.CityfPown Clerk 4 Electrical Inspector rr.Plu mbmg Inspector
6.Other
Contact Person: Phone 9:
haformation and structio ns
hfassachusett s Geheral Laws chapter 152 regarres all employers It[)provide workers'compensation fur their employees.
pursaaatto this Vie,au empLyne is defined as-"-.every person fn the service of another under any contract ofbite,
express or Implied,oral or writtcaf
An vnpTzye r is defined as"an indIvidnal,parfnershzp,assodafaon,corporation or other legal entity,or any two or more
of the foregoing engaged in a Joint ,and including the legal reTresentaiives of a deceased employer,or the
receiver or trustee of as iadividnal,parfneiship,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 ma;,,tmm ce,construction or repair work.on such dwelling house
or on the grounds or builcling appv�thereto shall not becanse of such employment be deemed to be an employer."
MGL chapter 152,§25C(6)also stgrs that"every sty or local ficeasm- agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct bindings in the commonwealth for any
applicanf who has not produced acceptable evidence of compliance with the insurance.coverage required_"
Additionally,MGL chapter 152, §2SC(7)states Neither fhe c•olhmcmweala nor ally ofifs political subdivisions shall
enter into any contract for the performance 0fpubho work-unt l acceptable evidence of compliance wiffi the iuscnance.
rcq�rrients of this chapter havre been presented to the contracting aufhomty."
Applicants
Please Ell oil the workers'compensation affidavit completely,by checking&e boxes that apply to your sitnafion anal,if
necessary,supply sub-contractors)nane.(s), address(es)and phone rinzaber(s) along with their certificafe(s)of
hisl==. Limited Liability Companies(TLC)or LimitedLiabl7ity Partnersbips.(LLP)with no employees other than the
members or partners,are not nqui e .to carry workers' compensation msa raaca If an LLC or LLP does have
employees,a policy is required. Be advised that this affidayit maybe submitted to the Department of industrial
Accidents for confinmaiion of insu ce coverage Also be sure to sign and date�he a flydavit. The affidavit should
be ret=i-_d to me city or town that the application for the permit or license is being requested,not the Department of
a1±sixial 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 con3panies should enter their
s elf-insvran.ce 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 in f M out in the event the Office of Investigations has to contact you regarding the applicant
Please b e sure to fill in the pen�it/license n=ber which will be used as a reference nnmber. la addition,an applicant
that must submit multiple pemlitllicense appht:ations many given year,need only submit one affidavt mdicaimg cusent
policy information(if necessary)and under"Job Site Address"the applicant should v;rite"all locations in---(city or
town)-"A copy of the affidavit that has been officially stamped or marked by the crfy or tows maybe provided to the
applicant as prooftbat a valid affidavit is on file for futar pemits or licenses_ A new affidavit must be filled Olt eiach
year.Whew 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 pemut to bum leaves etc.)said person is NOT reqairt--d to complete this affidavit
The Of of Iuvestigafions would like to thank you iu ativaace for your cooperafion and should you have any questions,
please do not hesitate to give us a call-
The Dep amtn fs a d&zss,telephone and fax number:
TI���a �alt]�Qf l�as�hu�tfs - -
D:eparEmmt of Iudufzzal AoVZeat%
Off lcze of kvestikatio=
Goo vlasbinza,,st=t
�osto-n�11�4 E�111
Tf,-1..4617 727-49W'�t4.06 car 1-977I& &SAFE
Fax 9 617-727 7M
Revised 4-24-07 f
r uGLVNML Vr IU:JL
140cOROY DATE(MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE 12/22/2015
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to
the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsements .
PRODUCER CONTACT John J. Lynch, IV
Paul Peters Insurance Agency NAME:PHONE 508-477-0021 FA11
680 Falmouth Rd. A/c No Ext: A/C,No):
Mashpee,MA 02649- E-MAIL DRESS:
John J.Lynch,IV
INSURERS AFFORDING COVERAGE NAIC#
INSURER A:SAFETY INSURANCE COMPANY
INSURED Carl Delorme INSURERB:
Box C-7 Seabrook Shores
Mashpee,MA 02649 INSURER C:
INSURER D:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTA
IN, THE INSURANCE AFFO
RDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR AUUL B
LTR TYPE OF INSURANCEINSO DI POLICY NUMBER MM/LDDNYYY MM/L DnYYY LIMITS
A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
CLAIMS-MADEAA TOKLINIIED
OCCUR BMA0024677 12/22/2015 12/22/2016 PREMISES Ea occurrence) $ 100,000
MED EXP(Any one person) $ 10,000
PERSONAL&ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
❑POLICY PRO-
JECT ❑LOC PRODUCTS-COMP/OPAGG $ 2,000,000
OTHER:
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
Ea accident
ANY AUTO BODILY INJURY(Per person) $
ALL OWNED SCHEDULED
AUTOS AUTOS BODILY INJURY(Per accident) $
HIRED AUTOS NON-OWNED PROPERTY DAMAGE
AUTOS Per accident $
$
,UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE
AGGREGATE $
DED RETENTION$ $
WORKERS COMPENSATION PER OTH-
AND EMPLOYERS'LIABILITY YIN STATUTE I I ER
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? ❑ N/A
(Mandatory in NH)
E.L.DISEASE-EA
If es describe u EMPLOYEE $
y under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
CERTIFICATE HOLDER CANCELLATION
BARN005
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
TOWN OF BARNSTABLE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
367 MAIN ST.
HYANNIS, MA02601- AUTHORIZED REPRESENTATIVE
John J.Lynch, IV
01988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
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t sARNbTABLE, • `
,�� Town of Barnstable
�EDMA't�
Regulatory Services
Richard V.Scali,Director
, n
Building Division
Thomas Perry,CBO
Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 5087790-6230
Property Owner Must
Complete and Sign This Section.
If Using A Builder
v / fit, /' i�-/ 0
I, C , g ,as Owner of the subject property
herebyauthorize � � �J_ C.: Z-0r-1 D� +' to act on m behalf,
� Y
in all matters relative to work authorized by this building pemsit application for:
(Address of Job)
r
Cerk�' zo ,15
Signature of Owner.' Date
�ALk � ��� � o
Print Name
If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the '
id reverse se.
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Revised 040215
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Mass. Corporations, external master page Page 1 of 2
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Corporations Division .
Business Entity Summary
ID Number: 454553553 ?Request certificate ;New search
Summary for: LILY A., LLC
The exact name of the Domestic Limited Liability Company (LLC): LILY A., LLC
Entity type: Domestic Limited Liability Company (LLC)
Identification Number: 454553553
Date of Organization in Massachusetts:
02-16-2012
z
Last date certain:
The location or address where the records are maintained (A PO box is not a valid
location or address):
Address: 11 ENTERPRISE ROAD STE 3
City or town, State, Zip code, HYANNIS, MA .02601 USA
Country:
The name and address of the Resident Agent:
Name: PAUL PALMARIELLO
Address: 11 ENTERPRISE ROAD STE 3
City or town, State, Zip code, HYANNIS, MA 02601 USA
Country:
The name and business address of each Manager:
Title Individual name Address
MANAGER PAUL PALMARIELLO 11 ENTERPRI_SE ROAD HYANNIS, MA 02601
USA
In addition to the manager(s), the name and business address of the persons)
authorized to execute documents to be filed with the Corporations Division:
Title Individual name Address
The name and business address of the person(s) authorized to execute,
acknowledge, deliver, and record any recordable instrument purporting to affect an
interest in real property:
Title Individual name Address
http://corp.sec.state.ma.us/CorpWeb/CorpSearch/CorpSummary.aspx?FEIN=454553553..., 12/23/2015
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TOWN OF BARNSTABLE
, SIGN PERMIT
PARCEL ID 293 004 10D GEOBASE ID 36926
ADDRESS 11 ENTERPRISE ROAD PHONE
HYANNIS ZIP —
LOT BLOCK LOT SIZE
DBA DEN $E�PMENT DISTRICT HY
PERMIT 83288 DESCRIPTION 2 @ 24 SQ CONSUMER NUTRITION
PERMIT TYPE BSIGN TITLE SIGN PERMIT
CONTRACTORS: Department of
ARCHITECTS: h
Regulatory Services
TOTAL FEES: $50.00
BOND �
CONSTRUCTION COSTS $.00 tf1E
4►
753 MISC. NOT CODED ELSEWHERE 1 PRIVATE '* �Ti •
INSTABLE,
Mass.
039.
RFD MP'�A
ti.
BBYILD)rG�DDIVISIO
DATE ISSUED 04/08/2005 EXPIRATION DATE �v
Town of Barnstable
Regulatory Services
o�
Thomas F.Geiler,Director
L& Building Division
Tom Perry, Building Commissioner
200 Main Street, Hyannis,MA 02601
Office: 508-862-4038 Fax: 508-790-6230
Tax Collector
Treasurer
Application for Sign Permit
yv
Applicant: ?O11 Q61- �fZ��'l/✓�a Zc�n�- �"/1 Assessors No.
Doing Business As:f�AO�� � —Telephone No.���-7-7 J�'—2cl o
Sign Location
Street/Road: t ZZ V-rz� P&c sir
Zoning District: Old Kings Highway? Yes/( Hyannis Historic District? YesA&
Property OwnerC lI�
Name: ! �'` �d R-P Telephone:
Address: RW -et/l?6 �6 1 eAco s at4. /M Village:
Sign Contractor 1. � � �
9-
Name S Gam` f'v� Telephone: J
Address: G(:�,S Ph`Pe Village: s � f ®va
Description
i
Please draw a diagram of lot showing location of buildings and existing signs with dimensions,location a'nd size of
the new sign. This should be drawn on the reverse side of this application.
Is the sign to be electrified? Yes (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.
l
Signature of Owner/Authorized Agent: Date: r(fib
if
Sl'ze: gl ;,y S f T / Y Y X ot.'/ii Permit Fee: SD O d
Sign Permit was approved: V 6S Disapproved:
Signature of Building Official: `✓'�"`' Date: Q`�
Signl.doc
�4 rev.122801
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CL
SIGN -A *RA MA Estimate No. 4491
OF CAPE COD,INC.
Estimate Printed On 3/16/2005
03:53:22PM
Consumer Products
Attn: Kadric Butt Acct#: 9259
11 Enterprise Rd. Terms: 50% Down/COD
Hyannis, MA 02631 Phone: (508)221-2540
Fax: (508)_-
Prepared For Kadric Butt,
Listed below is the quotation on the signage we discussed. This quote is good for 30 days from the date it was printed. If
ou have any questions, please do not hesitate to call.
Estimate Description
building sign
Item 1 Category Metals Product Code Aluminum.040
Quantity 2.00 Color White Size 24 Inch x 120 Inch Sides 1 Price @ $201.83
Description Aluminum I $403.65
6'
Notes:
Thanks for thinking of Sign*A*Rama for your sign needs. Sub-Total $403.65
All orders require a 50%down payment.
Master Card-VISA-American Express and Discover cards are always welcome! Sales Tax $20.18
Shipping $0.00
Total: $423.83
Yours Sincerely,
Jim McDermott
12-6 Whites Path South Yarmouth, MA 02664 Phone: 508-398-9100 Fax: 508-398-1760 (ccsar@capecod.net)
Page 1 of 1
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