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HomeMy WebLinkAbout0011 ENTERPRISE ROAD (6) �,..�" Jr Sign TOWN OF BARNSTABLE Permit . BARNSTABLE. ' 9 MASS 1639' �FG A Permit Number: Application Ref: 201105160 20070652 Issue Date: 09/22/11 Applicant: Proposed Use: RETAIL CONDO Permit Type: SIGN PERMIT Permit Fee $ ' 50.00 Location 11 ENTERPRISE ROAD Map Parcel 29300410C Town HYANNIS Zoning District B Contractor PROPERTY OWNER Remarks 17 SQ WINDOW GRAPHIC NATIONAL GUARD Owner: FJM CORP Address: 6 RYAN RD W TOWNSEND, MA 01474 Issued By: PC POST THIS C. RD SO THAN IS:VISIBLE FROM TIDE STREET r PERMIT PAYMENT RECEIPT TOWN OF BARNSTABLE BUILDING DEPARTMENT 200 MAIN STREET HYANNIS, MA 02601 DATE: 09/22/11 TIME: 10:39 ------------------TOTALS-- _...;__.__. PERMIT $ PAID 50.00 AMT TENDERED: 50.00 AMT APPLIED: 50.00 CHANGE: .00 APPLICATION NUMBER: PAYMENT METH: CHECK PAYMENT REF: 35874 Town of Barnstable Regulatory.Services Thomas F.Geiler,Director ELIMsTAB� em • p`� s. g Building Division \r U Thomas Perry,CBO Building Commissioner 200.Main Street, Hyannis,MA 02601 www.town.barnstable.ma:us ; Office: 508-862-4038 Fax: 508-790-6230 Permit# Application for Sign Permit ` Applicant: 3 j Q l O► Map&Parcel Doing Business As: Telephone No., Sign Location Street/Road: I �r .�P �dt�Q�.Y�i'U� rY) M4 © off�D W Zoning District: Old Kings Highway? Yes/N6 Hyannis Historic District? Yes/No Property Owner 1� Name: S'I L�.b Uy��r L((� Telephone: Address:_ Cl r) Gt✓ Village: Sign Contractor i i Name: Telephone: 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/No (Note:If yies,a wiring permit is required) Width of building face 1 3 ft.x 10= 3 (?-� x.10= 31,3 S+Ft.of proposed sign -9 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§240-59 through§240-49 of the Town of Barnstable Zoning Ordinance. y Signature of Owner/Authorized Agent:�r iC � 9 i a- , f Permit Fee: —a } Sign Permit was approved: Disapproved: a 'v Signature of Building Official- Date: In order to process application without delays all sections must be completed. M Rev. 9/12/06 i........_....._.._._....._... _.__._......_-----------_....................._.._.._ ------ ---------- ---�_— _ —_ — __ —_1 j Nindow Graphics Pill Quantity: �single-sided,1�q— I aa�rlaiaAt e�.^' — SIGNDESI91L I ,.r+. solo anU grlD;ac sc�W!c!a 1 Size: 70"x 30(< 17 sq ft total) I a 170 Liberty Street Material: perforated vinyl Brockton,MA 02301 i Graphics: digitally printed(latex) Finishing: curvalam lamination I 508.580-0094 Installation: onto windows as shown 1 � x I -- 70"- 70"— —►I la-- 70° Client: 1 CACI international,Inc. I Description: Hyannis I 89+ _._—..._..__ Date:05-06.11 .k;V.01. Project Number: 59337 NQTI MAI j iI Project Developer: C.Jones Designer Dt3 _....c i Design Scale: _i@t,K!�:,Itl);ki�dl^+10M ilp�i:yiu 11n�Y1�Mc�O n ?1y ?fti!y hf lt+h hilica!Tor'fy!N L0 I p i S r n h�.� `i i { rf8.4-I$v:i' 7 t P'JY:'N41N M It 7 re e�cn<I n i�xJ tt aav lm niittat wll�.��d 1 Illy taco W�MI.AMn D�.°Wn 11ae;?t ly i i>n:l i I bnlaA? d5 Yi Irby k: Y11A . � aid orauM re!U c.4cc4tl ai nuronvnU N Pip' wn bnU%%u�:ud4�:r.+.n+,!bnwIlh!IW![A 0 a dNN.l W! :ln fal>!5t�4.�aNpl hl�IbrgP�:iYflSu�t .l YY4Mni II � eekPq!41'�. JUN-22-2011 11:29 SIGN DESIGN 1508 Town of Barnstable Regulatory Services TOWN OF BARNSTABLE Thomas F.Geiler,Director Building Division -111 a111211 22 PH 10- 42 Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis, MA 02601 www.towmbarustable.ma.us Office: 508-$62-4038 Fax: SUS-790 6230 Permit# Application for Sign Permit Applicant: S�_4 eS 1._ o lam_ Map&Parcel# � 0 Doing Business As: Telephone No. Sign Location Street/Road: ►l �ll��r , 1`�� �� Gn,� r�l A' Zoning District: Old King ighway? Yes/No Hyannis Historic Dis 'et? Yes/No Property Owner r� Name: Telephone: '�� - Q-1 Address: Village: Sign Conti clot q Name: X'clephon 50 � 5�� Q� 1y Mailing Address: �► 0 Description Please draw a diagram of lot showing location of buildings and istin -igns with dimensions,location and size of the new sign. This should bedrawn on the reverse side of this pplica.io Is the sign to be electrified? Yes/No (Note,If yes,`a w' ing permit is req ect) Width of building face 31-3 ft.x 10= 3 .10= 31,3 Sq.F .of proposed sign 100 S� I hereby certify that I am the owner or that L have lh,authority of the owner to mlakc t .s application, that the information is correct and that the use and construe on Shall conform to the provisions o 240.59 through §240-89 r(�' of the Town of Barnstable Zoning Ordinance. �e Signature of Owner/Authorized Agent: � Date: 1\13 Permit Fee: Sign Permit was approved: Disapproved: Signature of Building Official: fate: In order to process application without delays all sections most be completed. Rev.9/12/06 Nil, . TOTAL`P.02 �\a `r s� S�. sb �'� °�°� � � � ���� Towm of Barnstable ; Regulatory Services Thomas F. Geiler,Director F STABLE, Mom. Building Division Fn nto+" Thomas Perry, CBO Building Commissioner 200 Main Street, ,Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Permit# Application for Sign Permit k Applicant: � QS Map&Parcel'# Doing Business As: Telephone.No.6o1 M -4 Sign Location r Street/Road: Ilk (1 tL (1'` ;� � 1\1Gnn; , rVlA Zoning District: Old Kings Highway? ' Yes/No Hyannis Historic District?.` Yes/No Property Owner Name: S -tA-bt)VVI Telephoner s Address:agq `�'Qn Village: Sign Contractor Name: tQ Y-% V{ Ct A/ l(r: TcliPhone J p — 5g0 Cj s Mailing Address: r IaQ�� S� r nGlc-ern rY1 0 � _ .-4 Description' CO Please draw a diagram of lot showing location of buildings and existing signs with dimensions, location nd size of'. the new sign. This should be drawn on the reverse side of this application. ' 0 Is the sign to be electrified'? _ Yes/No (Note:If yes, a wiring permit is required)h vJ - r Width of building face . f'.x 10= x.10= ': Sq.Ft.of proposed sign s Sit j I hereby certify that I am the owner or that I have the authority of the owner to make this application,that to information is correct and that the use and construction shall conform to the provisions of§240-59 through §240-89 v of the Town of Barnstable Zoning,Ordinance. Signature of Owner/Authorized Agent Date: Permit Fee: L r Sign Permit was approved:. Disapproved: Signature of Building Official:' Date: In order to process application without delays aff sections must be completed. Rev. 9/1.2/06 ' 1 Window Graphics -- — } — _ N LN Quantity: 3 single- SIGIdDESIgI�sided, 1 each � gAl1DM��1QT35''� == sign gr Size: as dimensioned - Lb ty Street stallions Material: perforated vinyl Brockton,i A 02301 Graphics: digitally printed(latex) 508-580-0094 Finishing: curvalam lamination Installation: onto windows as shown + 70" 70" 70" Client: CACI International,Inc. lni�Nr ",::tMASSACHUSETTS 29 1/4" Description: -- - _ r` , Hyannis 89'.' Date:05-06-11 Rev:01 a Project Number: 59337 Project Developer: t* C.Jones -_. Designer: DB Design Scale: 10% . C0004 This do—ru arid the deUpn lm2fn Ymm produced esprari for NR p Beet ono analn ft property or$gn Now,Ira. NY troy-+W mpmducod or Wad br any other propow,Wrial. do wdllen eo—trauuarlotbn of eon Deep, tn. . Th.coon fraud on I%pys.tre difotM mimeerds- _ solid old chide not W mpbd m nprod-d b nq - M,,A i used b aawdbn with oral prooct.Flat to cobr epee sm.,for promr romper much old rysun I • June 2, 2011 City of Barnstable Building Department - 200 Main Street Hyannis, MA 02601 , To Whom It May Concern: I authorize Sign Design, Inc. to act as our'agent for the enclosed sign permit application. Business Name: National Guard Property Location: I Enterprise Road, Hyannis, MA 02601. Building Owner: Stuborn, LLC Building Owner Address: 297 North Street, Hyannis, MA 02601 Phone: (508) 776-3104 Sincerely, Signature Title Date e _ � I The Commonwealth of 11lr�ssachu�etts , Depa;rtme #Qf Industrt+ l Aecidents - .Qf�ce of lnv�sh�ntions; 00 6DQ Wa�Xtfn���street A ✓ >�1;;tvrs o ens lion: sur } Ap�itit I>dformuaapt�ol�a, In ; Al'ft t n -Mnce exda� , � SlC ,� please Prot Legibly Natne(Busttiess/Osgat>azatton/irdividui}1) �'1 CAI�"1 � �,''�;�Ji��',,,_. Cit�ISte/ , . J�hone# e 'f Are,you an emplgyer�Check the apropriafe boar Type of p�ojeet(required)c 1.® I am a e to er with Q 4. ❑ I am:a general contractor a»d I y 6 [ New::construction employees;(full and/or part tune);* have hired the sub:contractors " 2.:❑ I am a sole<proprietor orpartnert one at#ached sheet: 7 ❑Remodeling ship and have no employees These sub contractors have g ❑Demohtioi workuig forme in any capacity. employees and Dave workers' [Ne workers' comp insurance r comp insurance 9. ❑Building addinon 10. Electrical r airs or additions required.] S• ❑ Weare a.corporation and its 0 eP:.,. officers have exercised their 3.❑ lam a homeowner doing.all work 11 ❑Plumbing'repairs or additions myself. [No workers'comp: right of exemphonper MG.i 12.❑Roof repairs insurance requiredj:t c 1152,§I(4),and we have no employees {No workers' 13 Other t >n comp insurance required:.] . .; .. . *Auy applicant that cheoks bow#1 must also fill out the section below showmg:then workers compensalion.pohcy information: t Homeowners wh. ibmit this affidavit ridicating they.are domg all work and then hire outside cofactors must submit a new'affidavit indicating such. tContractois that check this box must attached an'additional'sheet"showuig the:name o£the sub.contractors and state whetheror not#hose entities'have employees, If the sub-contractors have enipioyees,they must provide then workers'comp policy number. - I am an employer thaf is provi iing workers'compensation Insurance for my employees Below is the policy and job site information Insurance Company Name: o n n-I ft �!re, )A� ran C'p__l z . Policy#or Self-ins.Lic.#: W C, ( j , ' g 3- I(D 3 Expiration Date: Job Site Address: 1 �in A& Y-f't St✓ Oct� �� 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 imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up.to$250.0.0 a day against the violator. Be,advised.that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Si nature: 6 ' - Date: 10 1 Phone#: . CW�( Official use only. Do not write in this area,to 6e completed by city or town officiaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: �- m assadill tc= Dcltai tntcnt gat' Public �ztt'ct Berard of Building Regulations and Standard, Construction Supervisor License License .CS, 88112 y RALPH�R FERRIGNO,JR6 70 HEATHERTIILL D,4. & , BRIDGEWATER, MA 2324 Expiration: 8121/2012 Tr#: 644 -___ -- __: _. ..__._.-:.. wdv2010 16.3:9 ;FAZ 908. .586 3700 Bearce Brockton 110001/0001 Will NA7!DNA1r UN10N i*<! E 11SURAiCEOF1�AN1t �F P I TTSBURGH, PA 00772b 00 WC: 009 93 7163 . 77,7 ij13.$�=1110 `O0� er e e /r�` j��`r(F 17 7!LST�s?rdr�lll�y ���j 1 R ' /► 0z pi'l pc 0o a 0"�tertts 1Gesriltp �iy< �d G, �V>; SLE EXTI]�iS1417 OF ITEM 1 OF.THE itdFORMATION PAGE WC990610: ! $ tiatl 3tri;at 1 p# MA:aJ.I -tell . . TRi~IB1:R AEMC�' GRC11�P LLC 11Ydi��S COM L�LSN SATION A►�V D ;�NI P�.DYERS 377 CAK STRiiE1'. C5 Op l L��181LiTY POLICY IN�pF`tMA1"lQri iPAGE' GAR[�CN C1lY, WY 115,�0 0Q00 - ':INSuh D is .: ,:' PR��UF PiDLtCYNUPiI$E{1 o498bh. 8" 'O't'ItER 1NORKP,IAEES:NOT,S�GWN,11t30VE. ;::SEE E)CTENSION.OF ITEM. 1 O,F T'tiE INEOt2MATiON P/#'b`E W:C99061:0 , ,_.. . POUCY PERIOD t2 . A R1 elrindertl tiros ei thriesur.d s m.ni(iy5adree. FROM /0:1/10 TO 11/O1l11.. ITEM s`'A Workers Compensation Insurance: PartIme of he,policy appUes.to the Workers i ornpensation laiiv of the states'hsted.•. here. MA B Er»'ployers rLiability''lnsurartce Part:Two of he"policy apples to the work in each>state listetl In item 3 A: The limits of ourAiability under Part Two are ;Bodily Injury by Accident $ 1 .:�00,000 each accident. Bodily" Injury by-.Disea e ; 1 ,000 OOO ,policy limit- . E Bodily Injury by.Disetise, S 1 :000 000 each employee C Other State§ insurance Fait Three°of th'e policy applies to the states if any listed tiers: Alt AL AR AZ CA CO CT DC DE FL:GA N1:, I,A' I D I L. I N KS=`KY LIC MD, ME MI MN MO AS' M7 NC NE,NH NJ Nr� NV NY.OK OR`'PA RI Sc SQ TN UT VA ;vT wi ;WN o: This , policy includes.these endorsements end scheduie'si, SEE EXTENSION OF.ITEM 3.0.OF:THE INFORMATION PAGE.- WC990612. ITEM• The premium for this policy will'be determined by our Manuals of Rules, Classifications, Rates and Rating Plans: All Information required below Is subject to verifleation`and:change by audit. Remluni BasIs Rate Per Estimated pessificetions lode Number Total Remuneratlon $150 OF Re- Fremium RAnnual El 3 Year mue.retton Annual .a.3 Year SEE EXTENSION OF ITEM 4. OF THE INFORMATION PAGE - WC7754 TAXES/ASSESSMENTS/SURCHARGES $1 ,-193 EXPENSE CONSTANT(EXCEPT WHERE APPLICABLE;BY STATE) - $ . B MA MINIMUM PREMIUM -$Soo .,MA � � � TOTAL ESTIMATED.ANNUAL PREMIUM $19 ' 60 If indicated beio .Interim adjustments of premium shall be made: E] Semi-Annually 0jartariy Monthly - - DEPOSIT PREMIUM $3 09/14/10 PARS I PPANY 82 Idaue Date Issuing Office Authorized Representative WC 00 DO 01A 39967(fVV'd 04108) �y - � �- -� �� �g � Of � �� � z �' ���3�� -33 0�� �. TOWN OF BARNSTABLE, •. guildi n i g Application Ref: 200801823 * BARNSTABLE, Issue Date: 04/14/08 Permit 9 MASS. �p i639• �� Applicant: MULLIKIN DEREK Permit Number: B 20080711 Proposed Use: Expiration Date: 10/12/08 Location 11 ENTERPRISE ROAD Zoning District B Permit Type: COMMERCIAL ADDITION ALTERATION Map Parcel 29300410C Permit Fee$ 50.00 Contractor MULLIKIN,DEREK Village HYANNIS App Fee$ 100.00 License Num. 75863 Est Construction Cost$ 3,500 Sk Remarks APPROVED PINS ST BEpRETON JOB AND AINES 3 CUTS INTO EXISTING WALLS,INSULATION OF INTERIOR MAILBI XIS CARD MUST B PT POSTED UN 'IL FINAL 2 SMALL KNEE WALLS TO BE BUILT-WILL OCCUPY UNIT 4 AS WE L INSPECTION BEF� MADE. WHEREIA CERTIFICA E OF OCCUPANCY IS 4,,QUIRED,SUCH Owner on Record: FJM CORP BUILWG SHALL NOT BE OCCUPIED UNTIL A FINAL Address: 6 RYAN RD INSPECTION HAS BEEN , DE., W TOWNSEND, MA 01474 '(� Application Entered by: PR Building Permit Issued By: 11 THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET;ALLYOR SIDEVVaANYPARvT THEREOF,EITHER TEMPORARILY OR PERMANENTLY. ENCROACHEMENTS ON PUBLIC PROPERTY;NOT SPECIFICALLY PERMITTE. DER,'HE BUI , G CODE" USTB t APPROVED BY THE'JURISDICTION. STREET OR ALLY GRADES AS WELL AS DEPTH AND LOCATION OF,PUBLIC SEWERS;IvIAY BE OBT INED FROM THE DEPARTMENT"OF PUBLIC WORKS. a.r.. kl. ,. �....... THE ISSUANCE OF THIS PERMIT DOES NOT=RELEASE THE-APPLICANT FRQk ',THE CONDITIONS OF , 16'ABLE SUBDIVISION RESTRICTIONS. MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONTSTRUCTI ORK: 1.FOUNDATION OR FOOTINGS. y 2.ALL FIREPLACES MUST BE INSPECTED AT THE THROAT LEVEI('BEFORE FI4 T FLUE LINING IS INSTALLED. 3.WIRING&PLUMBING INSPECTIONS TO BE COMPLETED PRIOR TKO FRAME+ ION. 4.PRIOR TO COVERING STRUCTURAL MEMBER Em Y TO LATH'. : 5.INSULATION. 6.FINAL INSPECTION BEFORE OCCUPANC'. WHERE APPLICABLE,SEPARATE PERMIT ARE REQUIRED FOR ELECTRk AL,PLUMBING AND MECHANICAL INSTALLATIONS. WORK SHALL NOT PROCEED UNTIL TH' INSPECTO AS APPROVED TH�VARIOUS STAGES OF CONSTRUCTION. PERMIT WILL BECOME NULL AN� ID�F CONSTRUCTION WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE PERMIT IS ISS• D AS NOTE. ,`ABOVE. PERSONS CONTRACTING WITH a REGISTERED CO yMACTORS DO NOT HAVE ACCESS TO GUARANTY FUND(as set forth in MGL c.142A). D d 519 BUILDING�INSPECITN: PFRChA4^ PLUMBING INSPECTION AP PROVALS ELECTRICAL INSPECTION APPROVALS A 1 1 1 2 2 2 3 1 Heating Inspection Approvals Engineering Dept Fire Dept 2 Board of Health P oFIKE roy, Town of Barnstable Regulatory Services + BARNSTABLE. 9 MASS. Thomas F. Geiler, Director 039. �'A�ED r�►a.+"�� 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 Date: To: AL4 RE: Permit for property located at For project: t We have attempted to reach you by telephone on several occasions. Your permit is ready to be picked up at 200 Main Street, Hyannis in the Building Department. We are open Monday through Friday from 8:30 AM to 4:30 PM (excepting holidays.) L� The balance that is owed for this permit is $,0 and is payable by personal/business check or EXACT CASH. If you have any questions or wish to cancel this permit, please contact us at (508) 862 4038. Thank you. permitready TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION, 2 , Map—• / Parcel 66H b ' Application # 01 Health•Division Date Issued Conservation Division Application Fee �� • UV a OLIP Planning Dept. iJA• ,le t4�- 6(n t Permit Fee Date Definitive Plan Approved by Planning Board N A Historic - OKH tiN _ Preservation/Hyannis Project Street Address // E f <I Village W V,/-s Owner A~ OC-W JO-0 d.F-4AvF Address lo/ .�l�i.✓ sr ; Svc rE aiy ,yE4Fvao Telephone_ o Permit Request l'oWA"y '< r46 /,17"C`4/oR .04 fre-1-c Tia.+iS J nlxs lw ro x)ys 7i✓C �✓,t[�S /✓.f Z�it G.4 7�0•✓ i /X�•fiC �l.��G Q o X El e? S <c Gv,E.E�v.4l�S B�l� 7. r C-� IN /� Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation . 00 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new (� Total Room Count (not including baths): existing new First Floor Room Count ti Heat Type and Fuel: ❑ Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/8 oal sto`& ❑Yes ❑ No Detached garage: ❑existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑-existing O new size_ Attached garage: ❑existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: cap Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ fir' Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION . -(BUILDER OR HOMEOWNER) Name MV �-llc1Q Telephone Number S0� 3�ib 3 3 3 Address Z T rF-F(A, (2-t at e License # C5 -7 5 363 Nr Ry&T yko,- © �5 Home Improvement Contractor# 3 s Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO St-:r S . ftmk)Ls t-u-v SIGNATURE 4 1021DATE 7 i i FOR OFFICIAL USE ONLY a APPLICATION# DATISSUED r _ MAP PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION:,' r FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING t ` DATE CLOSED OUT ASSOCIATION PLAN NO. f The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensatio snrance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information �e*4t-k, VLjUu-(kt k-z Please Print Legibly Name(Business/Organization/Individual): M U Ll M 1 N3 G C Address: 2 t S 7'k-FT-1kW C-t 2 La - City/State/Zip: ZOGN�iSE2 -? V-W Phone.#: S08 3q S 7 Are you an employer? Check the appropriate bog: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(fiill and/or part-time).* have hired the sub-contractors 2.LLI am a sole proprietor or partner- meted on the attached sheet 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' 9 ❑Building addition [No workers' comp.insurance comp.msurance,t required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 1 LE]Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs 1§152 c. , 4 ,and we have no 13.[1 Other insurance Iequlred.]t ( ) employees. [No workers' comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating They are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the subcontractors 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.M 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 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 that a copy of this statement may be forwarded to the Office of Investigations of the WA for insurance coverage verification. I do hereby ce under the pains and penalties of perjury that the information provided above is true and correct. Si ature: (�1 Date: —f OFi en q Phone#- 8 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.CitylTown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions 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 representative's 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 fok 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-contractors)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 permittlicense 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 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 bdin 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. s� a The Commonwealth of Massachusetts Department of Industrial Accidents Mce of Investigations 600 Washington Street Boston,MA 02111 Tel. #617-727-4900 ext 406 or 1-977-MASSAFE Revised 11-22-06 Fax#617-727-7749 www.mass.gov/dia Apr 08 08 08: 24a CL 978-597-6133 p. 1 FROM NorthStar SG PHONE NO. 5085439527 Apr. 07 2008 07:53PM P3 Towny of Barnstable Regulatory Services s"KAM Thomss F.Geiler,Director �''►E610- ►'`� Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town:ba rnstable.ma.0 s 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 X �ly�C��kia /sUtt/,rr��iSETi< to act on my behalf, in all matters relative to work authorized by this building permit application for: 'eA17WRP'ffsy Ad. -gY4'V..1-1s, 1.44 (6/W.'rs 3 4.1) (Address of job) dZ4 L4e Signature of Owner Date Print Nance If Property Owner is applying for permit please complete the Homeoetmers License Exemption Form on the reverse side.` M Q:F0RMWWNF,RFERM1M0N a L 7-7 - .' !e {ponU.,wnureaLC/ �/ voac�udelta (Board of Building•Regulation and Standards Construction Supervisor License License: CS 75863 ,9 Birthdate�5/9/1968 E t 2b09 Tr# .13555 fa.r 2( i estncfio DEREK W MULLI�,q { F 21 STAFFORD CIRCE ! DENNISPORT,MA 0263 m Commissioner � oe� � o G �� ��3 6v� �. o� r i/ UTExisting Outlet Exisphone Existing Outlet "HYANNIS F RE E TIO BUREAU" HYA I FI E A l T 9 Gt H MA 02601 Thet�mt g ( Existin Outlet Existln OutletTO O 02� Existing Outlet Existing Outlet �I -UNIT-4, Existing Construction&Electrical Coastal Pack&Ship, LLC "dba"Qwik Pack&Ship Members: Jeff Anderson&Bill Fox 11 Enterprise Road Units 3&4 Hyannis, MA ? Existln 0utlet Existing Outlet Existin 0utlet I April 7,200 T Existing Outlet Existing Telephone uild knee wall ADD NEW DataiTel Existing Outlet uiIQ knee wal ADD NEW Datarrel,ADD NEW Outle 3' Wide _3' Wide 6' High 6' Hi h �g Build Table Top 8 Use 3/4"Plywood cover wl carpet) 6' Long 2.5' Wide High o� UNIT 3 Install Mailboxes Require: emove doorway 2x4 Cutout and 23 3/4".Wide open Lip wall Thermostat 60"Long 12"off the floor Change or ADD outlets to support a Blueprint& High Speed Copier. 120VAC . 15&16AMPS �m 60 Ha 8 g 1920 WATT Max Power Consum tiED on m � Existin Outlet ADD NEW Oudet Exlstin Outlet (� [Remove Wall L) L) o [� ^^••C*. Existing OWet Existing Outlet W� Cut into existing wall ake an opening for viewing out into the retail floor. UNIT 4 ut into existing wall Make opening Construction&Electrical 0 Coastal Pack&Ship, LLC �. "dba"Qwik Pack&Ship Members: Jeff Anderson &Bill Fox m 11 Enterprise Road Units 3&4 v AD NEW Outlet Hyannis, MA Exist' Outlet Ezlstin Outlet Existin Outlet Aril 7,2008 ADD EW DatalTete L 11 Enterprise Rd, Hyannis, MA 02601, USA - Google Maps Page 1 of 1 Address 11 Enterprise Rd Notes coastal Pack&Ship, LLC Hyannis, MA 02601 Unit. Q >4 Pack&Ship n { a 5C?i .3�y 4 ZY v f �. '�F: _ JZ -�: �QSYi�•� D � 1 � 7 i� 3 _ 93 ski t 77 .i 35 ., r r ry • +E'! .. } - i h E � 2 ? _ -- f 5�'J� i�N�Y }, ,.x k �1-,fT�{ � X �'' +�Y .y 4t r sc�T 4 r � .:: aIR f. � 7s, 3 t ro reA.} € ' i f R..: °ate 4_ 3 � { , ali4 et1tr3 a � � � � vrrJrtl >C l http://maps.google.com/maps?hl=en&safe=off&q=l I+Enterprise+Rd,+Hyannis,+MA+026... 4/7/2008 Massachusetts Department of Environmental Protection 0 Bureau of Waste Prevention -Air Quality 1100070358 B n.P Q Q w Decal Number Notification Prior to Construction or Demolition Important: A. Applicability When filling out forms on the computer,use only the tab key A Construction or Demolition operation of an industrial, commercial, or institutional building, or to move your residential building with 20 or more units is regulated by the Department of Environmental Protection cursor-do not use the return (DEP), Bureau of Waste Prevention-Air Quality Control Regulations 310 CMR 7.09. Notification of key. Construction or Demolition operations is required under 310 CMR 7.09 (2)ten (10)days prior to any work being performed. The following information is required pursuant to 310 CMR 7.09. . ` B. General Project Description 1. a. Is this facility fee exempt-cit ,town, district, municipal housing authority, owner-occupied Instructions residence of four units-or less? Yes. ?✓ No f 1.All sections of b.Provide blanket decal number if applicable:this form must be Blanket Decal Number ' completed in order 2 Facility Information: to comply with the y Department of Environmental ;COASTAL PACK&SHIP, LLC„DBA QWIK PACK&SHIP" Protection a.Name notification 11 ENTERPRISE ROAD(UNITS 3 S 4) requirements of b.Address 310 CM R 7.09 IBARNSTABLE q MA 1 02601 -Own, d.State egZip Code (508)778-0549 'foxcapecod@comcast.net f,_Telepha a Number(area wde and extension) q.E-mail Address(optional) �2,400 I 1 h.Size of Facility in Square Feet i.Number of Floors j. Was the facility built prior to 1980? Yes No k. Describe the current or prior use of the facility: ,VACANT i I. Is the facility a residential facility? Yes ✓ No m. If yes, how many units? I �o Number of Units ®0 3. Facility Owner: �N DARLENE L.COIT i �o a.Name �o 1101 MAIN STREET,SUITE 216 b.Address _ MEDFORD MA 02155 c0 cCitTown d.State e,.Zip Code �o (978)597-5650 i ® f.TTelephone Number(area code and extension)_ 4.E-mail Address(ontionah ?BILL FOX OR JEFF ANDERSON �Q h.Onsite Manager Name 13 ag06.doc-10/02 BWP AQ 06-Page 1 of 3 13 j Massachusetts Department of Environmental Protection i Bureau of Waste Prevention •Air Quality 1100070358 + Decal Number BWP AQ 06 Notification Prior to Construction or Demolition General Statement: If �B. General Project Description (cont. asbestos is found during a Construction or 4. General Contractor: Demolition 1DEREK MULLIKIN (MULLIKIN&RETIF) operation,all responsible parties a.Name must comply with 121 STAFFORD CIRCLE 310 CM R 7.00, b.Address Cha 7.15,and MA �� 02639 Chapter 21 E of the t g General Laws of ;cc.City/Town d.State e.Zip Code the commonwealth. (508)398-3339 This would include, f.Telephone Number(area code and extension) a.E-maiLAddress(optional) but would not be �•���� limited to,filing an JDEREK MULLIKIN asbestos removal h.On-site Manager Name notification with the Department and/or a notice of release/threatof C. General Construction or Demolition Description release of a hazardous substance to the 1. Construction or demolition contractor: Department,if applicable. IDEREK MULLIKIN (MULLIKIN&RETIF) a.Name 21 STAFFORD CIRCLE b.Address -..., -- DDENNISPORT MA i02639 c.City/Town d.State e.Zip Code (508)398-3339 _ - - f.Telephone Number(area code and extension) g.E-mail Address(optional) IDEREK MULLIKIN h.On-site Manager Name 2. On-Site Supervisor: 1DEREK MULLIKIN On-Site Supervisor Name 3. Is the entire facility to be demolished? Yes x No �N - �O 4. Describe the area(s)to be demolished: °CUT INTO WALLS IN 1 CLOSET&2 OFFICES i �N � � I �o h �° 5. If this is a construction project, describe the building(s)or addition(s)to be constructed: 'N/A o �Q 13 ag06.doc•10/02 BWP AQ 06•Page 2 of 3 13 Massachusetts Department of Environmental Protection 0 Bureau of Waste Prevention .Air Quality100 BWP Q Q 06 Decal Number Notification Prior to Construction or Demolition C. General Construction or Demolition Description (cont.) 6. a. If this is a demolition project,were the structure(s)surveyed for the presence of asbestos containing material(ACM)? Yes ✓ No If yes,who conducted the survey? ------------------- b$urvevo e c.Division of Occupational Safety Certification Number 7. Construction or Demolition: 04/10/2008 '04/18/2008 a.Start Date(mm/ddfyyyy) b.End Date(mmtdd/yyyy) 8. a. For demolition and construction projects, indicate dust suppression techniques to be used: 711 seeding 71 ,1 paving wetting b. If other, please specify: J shrouding covering other I 9. For Emergency Demolition Operations,who is the DEP official who evaluated the emergency? N/A a.Name of DEP Official IN/A - b.Title 04/08/2008 c.Date rrjT dA_/)r�yy)of Authorization IN/A .. d.DEP Waiver Number 1 D. Certification I certify that I have examined the (WILLIAM F.FOX �o above and that to the best of my a.Print Name O knowledge it is true and complete. WILLIAM F.FOX —� The signature below subjects the b.Authorized Signature signer to the general statutes ISIGNING AS MEMBER OF COASTAL PACK&SHIP, LLC o regarding a false and misleading c, osttion e �o statement(s). COASTAL PACK&:SHIP, LLC d.Representina ,04/08/2008 e.Date(mm/dd/yyyy) 13 o�Q aq 10/02 BWP AQ 06•Page 3 of 3 �IHE Sign TOWN OF BARNSTABLE Permit * BARNSTABLE, • MASS Permit Number. Application Ref: 200802281 20070167 Issue Date: •04/29/08 Applicant: FJM CORP Proposed Use: Permit Type: SIGN PERMIT Permit Fee $ 50.00 Location l I ENTERPRISE ROAD Map Parcel 2930041 OC, Town HYANNIS F; Zoning District "$ 4. Contractor PROPERTY OWNER Remarks NEW 24 SQ WALL SIGN - CAPE CURIOSITIES Owner: F]M CORP Address: 6 RYAN RD W TOWNSEND, MA 01474 a Issued By: PC POST THIS CARD SO<TI3AT IS,VISIBLE FROM TIE STREET Town of Barnstable Regulatory Services o� Thomas F. Geiler,Director BARNSTA13M Building Division Mnss. 25 9�A1 i639•�a��� Tom Perry,Building Commissioner �Z Fo�. b 200 Main Street,Hyannis,MA 02601 1� �( www.town.barnstable+ma.us (/ u Office: 508-862-403 8 Fax: 508-790-6230 Permit# Application for Sign Permit Applicant: � 1/�� �� Map &Parcel 9 c,�9D0`41/4 C ��/�� �UsO�s% Telephone Doing Business As: hone No.p Sign Location Street/Road: Zoning District:_Old Kings Highway? YesQNo) Hyannis Historic District? Yes& Property Owner ���---- Name: /G� C'O �f�� /(/ L'4 j Telephone: 5Vd* ` FSIZ —01'9? Address: Village: /� �; 1-214• 421-45 — Sign Contractor Name: 01VV Ve!5—G'O ) iM Telephone: S2D,F 2W,4L Mailing Address: a !g//� '/{oUS �.41*�E-3' I-LIlg B-2491 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® (Note:Ifyes, a wiring permit is required) Width of building face oZ S ft.x 10=a?$�® x.10 Sq.Ft. of proposed sign—Z�/ 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§240-59 through §240-89 of the Town of Barnstable Zoning Ordin e. Signature of Owner/Authorized Age Permit Fee: Sign Permit was approved: Disapproved: Signature of Building Official: Date: In order to process application without delays all sections must be completed. Q:I WPFILESISIGNSISIGNAPP.DOC Rev.9/12/06 y u fi t 41 sRif ' OPIES FAIL •CO - PASSP PHOT e -o �O A .V.13 mac\ .n to tr, p a _ A � A\ �O vqo ssa-7--z z � � �.TOYOTA = t Y ' , a •,,� a A A -A <n t� A A Y0 -.A rr. t^ A A y i T � A A a r''�• a `� r f -o W F rr` A A a � a i 1 - y � � •y WIT\ •; t� R\ A A TIN } %o A i i .r ••t\ TIN Pr A A TIM �O A � R A A 3 a + - x�. ,w� i� .Tx� a �, � ,d6, ^giyyi.: ,,. +tom Mai}• ,,a��'„ .'i. a�` � Y,� �''��� E� }t' ' �.. �,r r�t'�. Imo.]; � ti-r# �. xd� C � . via,` ;;;` g t ' dt... Ir J '8�h y �� aav�'� "0 v � z 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, 1' FL., 367 Main Street, Hyannis, MA 02601 (Town/Hall) and 200 Main Street Offices at the Licensing counter. 01 j DATE: S z; x r Fill in please: e' w APPLICANT'S YOUR NAME: r ' BUSINESS YOUR HOME ADDRESS: Fe .274_4Z./` •vi2 TELEPHONE # Home Telephone Number: a7,?GZ.s' 5Z NAME OF NEW BUSINESS CX-� C"v �C�S�lam= TYPE OF BUSINESS icf � IS THIS A HOME OCCUPATION? . YES NO Have you been given approval from the building divi ion? YES NO ADDRESS OF BUSINESS /'� -- 'fir "� lsvr�r�'_ MAP/PARCEL NUMBERS,93,�)� 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 I'M] IONER'S OFFICE This individ al h eeft--i e of any permit requirements that pertain to this type of business. A t orized ature COMMENTS: 2. BOARD OF HEALTH This individual h s b yen farmV the ermit re irenients that pertain to this type of business. Authorized Signature* COMMENTS:_ Arne AUK } —(- 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual h en inf ed of th PI e"Ig' uirements that pertain to this type of business. Authorized Signature** COMMENTS:. GL Cloya, Brr` CIO J r l)