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0076 FALMOUTH ROAD/RTE 28
1�p �A-,L-n\DLD--bA DA-D The Town of Barnstable Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 1 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner April 21, 2000 I Geferson Alves Post Office Box 902 Hyannis Port, MA 02647 Re: SPR 029-2000, Alves Landscaping, 76 Falmouth Rd., Hyannis, R311-076 Dear Mr. Alves; Please note that the site plan application submitted in regards to the above mentioned project was approved on March 9, 2000, with the following conditions: Applicant shall not stockpile mulch or other materials on this site. Applicant shall not use apartment as a public office. erely, Ro in Giangregorio Site Plan Coordinator q/bldg/wpfiles/siteplan/site00/alves Pi TO ALL NEW BUSINESS OWNERS Fill in please: APPLICANT'S YOUR NAME: BUSINESS ® ® ® �® YOUR HOME A d DRESS: `1 T G 06/& 76/-�) TELEPHONE Tele phone Number (Home)/9:--? K) '77501590 NAME OF NEW BUSINESS C.S 1-/W5 C22ZL G - TYPE OF BUSINESS l�sC IS THIS A HOME OCCUPATION? . S ADDRESS OF BUSINESS MAP/PARCEL NUMBER . s 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). 1. GO TO BUILDING INSPECTOR'S OFFICE (4TH FLOOR TOWN HALL) This individual has be i ed of y permit requirements that pertain to this type of business. orized Signature COMMENTS: 2. GO TO BOARD OF HEALTH (3RD FLOOR TOWN HALL) This individual has been informed of the permit requirements that pertain to this type of business. Authorized Signature COMMENTS: 3. GO TO CONSUMER AFFAIRS (LICENSING AUTHORITY) - (3RD FLOOR SCHOOL ADMI ISTRATION BUILDING) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature COMMENTS: After obtaining the required signatures you must return to the Town Clerk's Office to obtain your business certificate (cost$20.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME In the town (which you must do by M.G.L. - It does not give you permission to operate - you must get that through completion of the processes from the various departments involved. QUERY PROPERTY: QUERY END QUERY PROPERTY PENTAMATION----------------------------------------------------------- 02/17/00 PARCEL ID 311 005 GEO ID 23000 LOT/BLOCK 1A&2C DBA PROPERTY ADDRESS OWNER SULLIVAN 76 FALMOUTH ROAD (ROUTE RICHARD A HYANNIS 342 LONG POND DR S YARMOUTH MA 02664 PHONE DISTRICT HY DEVELOPMENT STATUS C ASSESSOR' S CODE CAPACITY (NOTES) ZONING DIST/ZO H�B SEWER SYSTEM FLOOD PLN/ELEV. WATER SYSTEM OKH? # BEDROOMS ZBA DECISION FAMILY APT LOT SIZE 9583 . 2 OPER/MGR NAME WET LANDS MULT ADDRESS USE 031 PROTECT DIST GP (N) EXT / (P) REVIOUS / NO (T) ES / PER (M) ITS / (V) IOLATIONS / (G) EOBASE / (E) XIT This value is not among the valid possibilities (73 � � P �s 508-�� I -��� IHE TOWN OF BARNSTABLE Buildirig ►�: 201404283( •* BARNSTABLE, Issue Date: 07/07/14 Permit y MASS. �p s639. Applicant: STEPHEN BOBOLA rFC MAC A Permit Number: B 20141.703 Proposed Use: MIXED USE OFFICE&RES Expiration Date: Location 76 FALMOUTH ROAD/RTE 28 Zoning District HB PermitType: ROOF/SIDING/WINDOW COMMERCIAL Map Parcel 311005 Permit Fee$ 160.00 Contractor STEPHEN BOBOLA Village HYANNIS App Fee$ License Num 058987 Est Construction Cost$ 8,000 Remarks, APPROVED PLANS MUST BE RETAINED ON JOB AND RE-SIDE WITH VINYL 16 SQUARE THIS CARD MUST BE KEPT POSTED UNTIL FINAL 76A INSPECTION HAS BEEN MADE. WHERE A CERTIFICATE OF OCCUPANCY IS REQUIRED,SUCH Owner on Record: BEGG,JOHN A TR BUILDING SHALL NOT BE OCCUPIED UNTIL A FINAL Adc'ress: 220 W MAIN ST INSPECTION HAS BEEN MADE. HYANNIS,MA 02601 Application Entered by: PF Building Permit Issued By: THIS PERMrr"CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALM dk SIDEWALK OR'ANY PART THEREOF,EITHER TEMPORARILY 0 ERMANENTLY. ENCROACHMENTS O LIC PROPERTYNO SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED,BY THE JURISDICTION.'.STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF R LIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS THE ISSUANCE OF;THIS PERMIT;DOES NOT'RELEASE THE APPLICANT PRONE THE CONDITIONS'OF ANY APPLICABLE SUBDIVISION.` RESTRICTIONS.';: MINIMUM OF FIVE CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: 1.FOUNDATION OR FOOTINGS. 2.SHEATHING INSPECTION 3.ALL FIREPLACES MUST BE INSPECTED AT THE THROAT LEVEL BEFORE FIRST FLUE LINING IS INSTALLED. 4.WIRING&PLUMBING INSPECTIONS TO BE COMPLETED PRIOR TO FRAME INSPECTION. 5.PRIOR TO COVERING STRUCTURAL MEMBERS(FRAME INSPECTION). 6.INSULATION. 7.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). f_ - — .. ,w 9 .:.,..aY. ....;: a.... :`• is'. 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 41 zP Map Parcel Permit# / 7 Date Issued k i4 7CBoard of Health(3rd floor)(8:15 -9:30[1:00-4:45). .' 4t,4v- .evL4e_ Fee- G' x, Engineering Dept. (3rd floor) House# ` � c , SEPTIC SY T BE 19 INSTALLED ANCE WITH TOWN OF BARNSTAB � ©NMENTAL C®®E AND C REGULATi O,M70, Building Permit Application / treet Address -��—�-Z Village 1 k Owner rc S�l�?l�Chh Address W� Telephone (Permi�tR�eue,st Al L460db (� Q First Floor square feet Second Floor square feet Estimated Project Cost $ CST , co-) Zoning District Flood Plain Water Protection Lot Size Grandfathered ? Zoning Board of Appeals Authorization Recorded Current Use _ �- f� Proposed Use SZ11 s1 Construction Type Commercial �� Residential Dwelling Type: Single Family Two Family Multi-Family Age of Existing Structure Basement Type: Finished Historic House Unfinished Old King's Highway Number of Baths No. of Bedrooms Total Room Count(not including baths) First Floor Heat Type and Fuel Central Air Fireplaces Garage: Detached Other Detached Structures: Pool Attached Barn None- Sheds Other Builder Information Name ��-�� `- � Telephone Number ( ('] 2�g Address 1 License# CC)qa!] _N, ¢•-A i6 0%-% �:I�S I r! Home Improvement Contractor# 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 DEBRIS RESULTING"F FR-0M THIS PROJECT WILL BE TAKEN TO y R'GNAT URE '' DATEUILDING PERK DENIED FOR THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY _ PERMIT NO. DATE ISSUED + MAP/PARCEL-NO. ADDRESS " VILLAGE _ OWNER - DATE OF INSPECTION: FOUNDATION -+ . t • ` � .� _ , FRAME INSULATION - FIREPLACE ELECTRICAL ROUGH FINAL - PLUMBING: f;'„ ROUGH = ,_ FINAL GAS: = R0 FINAL • i •gt FINAL BUILDINGS91 'r DATE CLOSED OU7f'2 t t ASSOCIATION PLAN-NO. r rT � - The Cuntnuonivealth Of Massachusetts '•+:I: �_=�;:�= Department of Industrial Accidents ;� iiw O1lfceol/otYest/gat/otts , .... 600 !1 asltinrtun Street Bonon.Mass. 02111 Workers' Compensation Insurance Affidavit p' n2MC: MCUL—v 010 citx k�u CTIA 0 X*__S�, Or 6one#;1 � ICun nuv.n v . i 1 t,• I am a ho6lowner performing all work myself. G3.�- sole proprietor and have no one working in any capacity , -. fir 19iNf� - 0 lam an employer providing workers' compensation for my employees working on this job. sump,nny name: address: --- city phnne#• :neu�w..ww wwpolicy# . 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: compam•name: atfdress• cetx. Rhone#: 1pcutancc co e�ii�g# 1 'e+ �.. •....�_.. _. .• rtn•yrr.�_:.•fpss-•?�?.'y?."Teets^sT'r5F`_:.i.�' !�- __ 'rJ4F.P3!P4S�1''�?-R7!!w --- -F`e..'4+"�'�9•'.�R4'3e3!s�'a=— �emRanv namC' - ^ddress• city phone#• insur•tnc�co �� policy# _ Atiach additional'sheet if necessa •ram - ',.�.;;; .:"` '� ' �� %� Failure,to secure coverage aas,required under Section A of 51GL 157,ean lead to the imposition of criminal penalties of a fine up to$1.500.00 and/or one.cars'imprisonment=as -�v I,as ciyii penalties°in t e form of a STOP11'ORI:ORDER and a fine of sI00.00 a day against me. 1 understand that a copy of this itatement�a rwardcd�t. =the Offic of lm �ao of the DIA for coverage verification. 1r ��� e�°o e, fll� I rlie n_ormatioa provided above is true and comet. !do erebt•cc�trf}• cr s'a�rd p j r/ury _f sit!patu ate Print name z Phone# y.. � 3�ta L/ official use only do not write in this area to be completed by city or town official city or to*wvn: permit/license g nliuilding Department Licensing[ioard'" " check if immediate response is required selectmen's Office (3Ilealth Department contact person: phone#;, nOther (revised i:95 P1A) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", an emplirnee is defined as every person in the service of another under an), contract of hire, express or implied, oral or written. An emplityer is defined as an individual, partnership, association. corporation or other ; gal entity, or anv two or more of tite fore=ping;engaged in a joint enterprise,and including the legal representatives of a deceased emplover, 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 T52 section 25 also states that even,state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally. neither the 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. :•—w+Y'!w�.r,!*.+�Y• I` :`f: :l:: 1. :f'�.1:. '�t J i ii.r�n{•:. ^�.: N:r:V�I:,�'bra.... �C, w'�� �'+�. .. Applicants V 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 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 affdayit. 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 for regarding the "law"or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. .-.w..�7 7 7 7 !..a7....,,.o„p�.w�r�..R ,.sw! Y •y„�.,_.'.,. •.r. 1r3. ..•...rwi r''�e `. 757 7.'•77 _. 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. Tile affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. Tile 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. r�.r,..•:s._-en.!svac _ -,,.,�;�..w T•ww!- ... ..� :.•u. .iw.wt•�Fr',-a..,v..•—..,.4'.,;..P..—wa.+.-n' , ��..�,�'..!�:• pis _ .y�:.,•.. •.s,.)Z.Ai, J�:T•..q :Y�...�.. 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 fax#: (617)727-7749 phone#: (617) 7274900 ext. 406, 409 or 375 .n �'J � Y-y J t J t axc 2K `� is co. 3 a t \t l � 4 I Oct COMMONWEALTH 'DEPARTMENT OF PUBLIC SAFETY IAjlyFotps�i;aRs�acurreet ONE ASHBORTON PLACE I ®�fllobu�64tse Stat�BMld3ng dais cause OF - cause for rasocatlon MASsdC 1iUSETTS 1,-,jjoST0N,MAb2108 _. . tAlsllotsss. L I C E N S E CAUTION nV4 ;`CONSTR. SUPERVISOR EXPIRATION DATE FOR PROTECTION AGAINST 05/2 0/199 6 EFFECTIVE DATE LIC-NO. THEFT, PUT RIGHT THUMB RESTRICTIONS :PRINT IN APPROPRIATE NONE 06/30/1993 0042-1 BOX ON LICENSE. MARK M SOBEL o p 0 BOX 1432 ' � BLASTING OPERATORS +� SS 034-32-0207 COTUIT MA 02635 b MUST INCLUDE PHOTO. PHOTO(BLASTING OPR ONLY) F p a C. OO NOT VALID UNTIL 4IGNEDBYLICETM EANDOFFICIALLY MISSIONER HEIGHT: STAMPED`-OR•SIGNATURE OF E cpM _ DOB: r i 05/20/1945 A E_r �� SIGN NAME IN FU[XjABOVE SIGNATURE LINE THIS DOCUMENT MUST BFCAR SIGNATURE OF UCENSEE •1. THE HOLDEREDON PERSON OF THE HOLDER WHEN EN MMISSIONER OTHERS-RIGHT THUMB PRINT GAGED INTHISOCCUPATION. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application 1�,Z J Health Division Date Issued 7-7 -IM P� Conservation Division Application Fee u Y) Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address Village ,may 4 h S Owner��9�,r, Sri ✓�'n Address Telephone_ 72�` :,Permit Request 4j e_ 16 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay (P-roject'Valaation 0 0 0 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family units) Age of Existing St ruc re 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 _newn=' Total Room Count (not incl ding baths): existing new First Floor Room Count Heat Type and Fuel: GYo ❑ Oil ❑ Electric ❑Other -�- E- r•b Central Air: ❑Yes F' aces: Existing New Existing wood/coal stove:y❑Yes No f Detache arage: ❑ existing ❑ new size_ ol: ❑ existing ❑ new size — : ❑ existing O�new ",*size A ch arage: ❑ existing ❑ new si _Shed: ❑ existing ❑ new size _ Other: Zoning Board of peals Authorization ❑ Appeal # Recorded ❑ Commercial es ❑ No If yes, site plan review# Current Use Proposed Use ---APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name �� 1���� Telephone Number SV O SS - 77 - 817 j Address ��a License # 9 Home Improvement Contractor# Email is- ad- C ah'i Worker's Compensation #l✓(Z_3 1 r3/7 7- ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATUR DATE 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, DATEXLOSED OUT ASSOCIATION PLAN NO. pry 4 The Commonwealth of Massackusetts Depart rent of'Iudus&ial Accidents Office o,f'Invesfigrrttans Boston,MA 02111 wwn:L maw av1d a Workers'.Compensation Insurance Affidavit: Blllilders/Contractors/Elertncians/Pbimbers Apphcant Information ,Please Print Lmbly 3iI �a1CRaP t7 anqudivi�ral}: G,5 �ti.� �� ���� s C Addis: CIS a /� arc eity{s ,tee : ph., �6' 7 J- 'K f 7 4j Are�Iallm an employer? eekthe appropriate box Type of project(required): a employer with 4. I ama, meral contractor and I 6. ❑New construction employees(full audlospart-time)-* have hired the sub-contraactads 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 far me in any capacity. employees and have workers' 9. ❑Building addition [No workers'camp.incarranree comp_insurance I rewired] 5. ❑ We are a corporation and its 10_❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I LE]Plumbing repairs or additions myself [No workers'comp. :right of exemption per MGL 12.❑hoof 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 mast also fill out the section below showing dL&workers'campessation.pol"acg infarmstim Homeowners who submit this of ulmit indicating they ire doing all work and then hre outside contractors mast submit a new affidavit indicating suc - =Coutractors fl=chock this box m=attached m additional sheet showing the aanbe of the sub-contrwAo¢s and state whetbet or not those entities have employees. Ifthe subcoattactors haste employees,they must provide their worken'ramp.policy number. lain an emptvyer that isprm d ag i4 orkers'compensation insurance for rtiy enrploywes. Below is thepolicy and jab site lnformat2om Insurance Cortlpany Name. Ll Policy#or Self-ins-Lie.4.-.AI 7�7 7 S :S,�:Z Z/ I 0!�3 Expiration Date: Job Site Address: 7 CitylStateiZip: 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 andlor 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 maybe forwarded to the Office of Investigations of the DIAL for insurance coverage verification. I do herebry cerhfy nnder 'n and penalties vfperjuty that the information provided abm a is true and correct Si Date: Phone#: 3-0 " 77 21 C?fficiat use only. Do not write in this area,to be completed by city or larva o ciat City or Town.: PermitUtense Issuing Authority(circle one):. 1.Board of health 2.Building Department 3.City./Tow€r Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Mane#: 6 oFt�rq�, 'H" Town of Barnstable AlFO MA'S 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: 508-8624038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder 'J e` , as Owner of the subject property hereby authorize �_ J2 .26-4<9 to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signature of Owner Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. Q:\WPFILESTORMS\building permit forms\EXPRESS.doc Revised 061313 v Massachusetts -Department of..public Safety d Bard of Building Regulations and Standar o s Construction Superdisor 87 License: CS-0589, s STUBEN E BOB 24 ST P'RANCIS ByANNIS IVIA 02601 Expiration —0' 02/0412016 Commissioner oaac/ccaed6 License or registration valid for individul use only Office of Consumer Affairs&Busi>ess Regulation before the expiration date. If found return to: ME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Regulation egistration: 158588 Type. 10 Park Plaza-Suite 5170 xpiration ,.2/11/2016: Partnership Boston,MA 02116 MASS UILDING SYSTEMS'' 1. STEPHEN BOBOLA 4` E' 24 CIRCL ST. FARNCIS g Not valid without signature HYANNIS,MA 02601 -�-- Undersecretary b/_5U/LU14 11:51:U5 AM YS'1' (liM'1'—tf) Pt(UM: JUUUUS--1'U: 15UtSEI1tUz1 Page.: Z of 2 CERTIFICATE OF LIABILITY INSURANCE DATE(Mht1DDlYY1Fi) 61301,20.-14 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(fes)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.carlificate does not conferrights to the certificate holder in lieu of such endorsemen s PRODUCER BRYDEN&SULLIVAN;INS CO EA T '88'FALMOUTH RD PHONE FAX HYANNIS,MA 02601' E xt):— (AIC ADDRESS:. INSURER(S)AFFORDING COVERAGE. NAIL.# �.INSURER:A.:. Lille.",Mutual Fire:Insurance 23035, INSURED INSURERS:: MASS BUILDING SYSTEMS:LLC 24 ST FRANCIS CIRCLE NSURER:C. HYANNIS MA 02601 INsuRERD:. INSURER.E::-. 6 URER:F:. COVERAGES CERTIFICATE NUMBER: 20737496 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. NOTWrrHSTANDING.ANY REQUIREMENT,TERM OR CONDITION,OF ANY CONTRACT OR.OTHER:.DOCUMENT WITH RESPECT TO WHICH:THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE:INSURANCE:AFFORDED BY THE POLICIES'DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,. EXCLUSIONS'AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE:BEEN REDUCED BY PAIDCLAIMS. INSR ADD BR `POIICY.EFF. POu Y EXP - LTR TYPE:OF INSURANCE. INSD POLICY NUMBER: MMID MMIDDIYYYY LIMITS' COMMERCIAL GENERAL LIABILITY .EACH'OCCURRENCE CLAIMS-MADE of OCCUR: $ MED EXP(Any one person) $: 'PERSONAL BAOV.INJURY $: GFUL AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ POLICY❑JPERc: �'LOC PRODUCTS.-COMPIOP AGG. $. OTHER: $ AUTOMOBILE LLRBdrrr .'COMBINED'SINGLE.LIMIT .$ Fe accident ANY AUTO BODILY INJURY(Per person). ,$ .ALL OWNED SCHEDULED' AUTOS AUTOS'. BODILY INJURY(Peracdiferd). $ NON-OWNED ARTY DAMAGE $ HIRED AUTOS AUTOS. UMBRELLA LIAR OCCUR EACH•OCCURRENCE' EXCESS LUU3. CLAIMS-MADE' ;AGGREGATE $'.. DED RETENTION $. A wOmmRs COMPENSATION WC2-31:S-31721.1:-044. W71201.4. 6/7/2015 PER OTH' :STATUTE ER AND EMPLOYERS*LIABILITY YIN.' ANY PRORRIETOR/PARTNERIEX€C117'NE 'El.EACH�ACCIDENT' -$ 500000 OFFICER/MEMBER.CXCLUDED? .NIA. (Mandatory in NII) -E-1.DISEASE-EA.EMPLOYEE 500000 If yes,desenbe under DESCRIPTION'OFOPERATIONSbebw E'.L..OISEASE-POLICYLIMIT' $ 500000 DESCRIPTION OF OPERATIONS/LOCATIONS!VEHICLES.(ACORD 101,AdditiunalRemaft Sdiedide;.mRYbeaRsehad'if mwe apace ie:requ red); Workers compensation insurance coverage applies only to the.workers compensation laws of the state ofTUTA.. This certificate cancer's and supersedes all:previously issued certificates,on(yas they relate to workers compensation coverage. CERTIFICATE HOLDER CANCELLJATION. TOWN OF BAF2NSTABLE SHOULD ANY OFTHEABOVE DESCRIBED POLICIES.BE CANCELLED BEFORE THE. EXPIRATION DATE THEREOF„ NOTICE VYILL BE DELIVERED IN 200 MAIN ST HYANNIS MA 02601 AGGDRDANCE'VitITt1 THE POLICY PROVISIONS. -AUTHORIZED REPRESENTATIVE Liberty Mutual'Fire Insurance 01988,2044 ACORD CORPORATION. All fights reserved. ACORD 25(2014101) The:ACORD name and logo are registered marks of ACORD CERT NO.: 2/1737496 CLIENT'CODE:. 1611184 Didi Dangas 6/30/2014 2.:49:.17 PM (EIT) Page 1 of 1 i Bk 26758 Pg 284 #59620 ACCEPTANCE OF TRUSTEE The undersigned, Kim M. Sullivan and Kelley A.Sullivan,having been appointed Trustees of the Falmouth Road Realty Trust,under Declaration of Trust dated May 7,. 2002,by the Trustee of said trust,John A.Begg,hereby accept the terms and conditions of the foregoing instrument and agrees to serve as Trustee of the Falmouth Road Realty Trust. i TNESS KIM M. SULLIVAN, WITNESS KELLEY A UL AN COMMONWEALTH OF.MASSACHUSETTS Barnstable, ss. On this y of kmt=7, 2012,before me, the undersigned notary public,personally appeared Kim M. . Sullivan and. proved to me through satisfactory evidence of identification, a Massachusetts driver's Iicense, to be the person whose name is signed on the preceding or attached document and acknowledged to me that she signed it L` voluntarily for its stated purpose. j [V,A..K H. Bo ROTn :' -: 3Ec� blic Ccmmoaws�l;h ct =�>4 My Comrnlssian Expires May 2, 2014 My commission expires: COMMONWEALTH OF MASSACHUSETTS Barnstable, ss. On this 46 day of Jeaueffy,2012, before me, the undersigned notary public,personally -appeared Kelly A. Sullivan and proved to me through satisfactory evidence of identification, a Massachusetts driver's license, to be the person whose name is signed on the preceding or attached document and. acknowledged to me that she signed it voluntarily for its stated purpose. Notary Public My commission expires: lvlAPK H 6 UD2EAU NO, at' PUBLIC vcrmr 0nrgal(h of 14assaftsells " MY Comm{sion Expires May 2, 2014 RAP.NSTARLE P.EGISTRY OF DEED -962 RESIGNATION OF.TRUSTEE OF FALMOUTH.ROAD REALTY TRUST I, John A.Begg, Trustee of Falmouth Road Realty Trust,under a Declaration of Trust dated.May 7.2002 and recorded with the Barnstable County Registry of Deeds in Book i resign as Trustee of said Trust, effective upon the acceptance 15155, Page 122; do hereby gn of Kim M. Sullivan and Kelley A. Sullivan as.Successor Trustees. Subscribed and sworn to under the pains and penalties of perjury this day of I II September, 2012. i f John A. g COMMONWEALTH OF MASSACHUSETTS ,II Barnstable, ss. On this�day of September, 2012,before me,the undersigned notary public, personally appeared John A. Begg,known to me personally to be the individual whose name is signed on the preceding or attached document and acknowledged to me that he signed it voluntarily for its stated purpose. Not Public My commission expires: 1 a all 1�- CHRISTOPt En tliURP 'b' Notary Public Commonwealth of Massachuset.'s My comm.Expires RE-ROOFING/RESIDING/WINDOWS (COMMERCIAL) ❑ If located in OKH or Hyannis Historic District- Certificate of Appropriateness required unless same color/same materials specified on application ❑ Map/parcel number Approval Sign-offs from: ❑ Tax Collector ❑ Treasurer ❑ # of squares of shingles or square footage of roof or sidewall to be shingled/sided ❑ Specify stripping old shingles or going over old roof. If going over ❑how many roof layers existing now ❑what size are rafters? What is span? ❑ Owner's name & address ❑ Project valuation must be entered ❑ Builders Information ❑ Signature ❑ Workman's Compensation Insurance Affidavit State form must be completed and.a copy of Insurance Compliance Certificate must be submitted. ❑ A copy of the Construction Supervisor license is required. Effective March 1, 2009 ❑ Check expiration date,no restrictions ❑ Permit fee-$160.00 ❑ Property Owner must sign Property Owner Letter of Permission. Projects requiring the use of a crane must complete the forms issued by the Aeronautics Commission q-forms/bldgpermits/permitchecklists rev.070610 OfIHE r Town of Barnstable Regulatory Services • BAiL14STABLE, MASS y Af.1S9. Thomas F. Geiler,Director ., a 0 Building Division Thomas Perry,Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 - SIGN PERMIT REQUIRENIENTS 1. A photograph showing the existing facade, on which has been indicated the proposed sign location..The photograph is to include a portion of adjoining stores or building. For a proposed building or new facade, an architect's elevation may be submitted in lieu of a photograph. 2. A scale drawing of the proposed sign. A scale drawing indicating: 1) The type of proposed sign (wall, hanging, free standing) 2) Dimensions of the proposed sign and any designs, logos, or lettering 3) A cross-section with dimensions showing edge detail. Minimum scale P 1 . Minimum sheet size, 8.5 x 1 i". 3. A scale drawing of the bracket, A scale drawing indicating dimensions, color, materials and method of affixing it to the sign and to the building. Minimum scale 17= 1'. Minimum sheet size, 8.5 x 11". 4. A completed Town of Barnstable Sign Application, including scaled diagram showing location of sign on building or location of free-standing sign. Show dimensions. 5. The width of the building face. NOTE: the map/parcel number is required on the application. 76aFalinouth Road d Deputy Tax Collector e n c h nm an Hearing, Services 778-1414 \ .r �r ` \J t`l 1 ti Sign TOWN OF BARNSTABLE Permit * BARNSTABLE, + MASS. 6 i 39�- A Permit Number: Application WE 200904245 20070368 Issue Date: 09/14/09 Applicant: BEGG, JOHN A TR Proposed Use: MIXED USE OFFICE &RES Permit Type: SIGN PERMIT Permit Fee $ 50.00 Location 76 FALMOUTH ROAD/RTE 28 Map Parcel 311005 Town HYANNIS Zoning District HB Contractor PROPERTY OWNER Remarks 5.4FX1.9P BOTTOM PIECE ONLY FOR BENCHMARK HEARING SERVICES TAX PART TO REMAIN Owner: BEGG, JOHN A TR Address: 220 W MAIN ST HYANNIS, MA 02601 Issued By: PC POST THIS CARD SO THAT IS VISIBLE FROM THE STREET �1. .s 1•' "�. 4,2 , -- ti 1 ;t t aaaa i. CV K.".F S >6 .91 Town of Barnstablelm, IHErO'yy Regulatory Services 2M9 SEp _q an IV. ( Thomas F. Geiler,Director \�)O + BAR,`JSTABLE, b SS. `�$ Building Division �r,�_ �a °TFp 9. A Tom Perry,Building Commissione - 200 Main Street,Hyannis,MA 02601 �--Q yyl�L;�) w-ww.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Permit# — OOC ()7 7Z—7 Application for Sign Permit Applicant: & �yZ L G L� �� Map & Parcel taza&71W Doing Business AsAA?toAt -,ccT �y� g ��/� Telephone No. ,(,. _,,�, Sign Location ,�• "' Street/Road:7(/ 1"AL-At,oy r tl tcv4 h "A TAIL> '"►'�l B�'� 1 Zoning District: Old Kings Highway? Yes/No Hyannis Historic District? Yes/No Property Owner �• _ Name:,'ue.u,/,A,t/ 2✓5 1 Telephone: Address Village: Sign Contractor Name: S I f N A- A4AAA TelephoneS09-3'W-41 0V Mailing Address: 5 PATtt S, YAfZW"'"_+ '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? YesA (Note:Ifyes, a wiring permit is required) A1 L (3 Width of buildingface 5 p / l 7 mot' ft.x 10= x .10= Sq.Ft. of proposed sign y 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§24M9 through §240-89 of the Town of Barnstable Zoning Ordinance. Signature of Owner/Authorized Agent: 1l ° �' ""d� Date:(9 ' 3-0of Permit Fee: Sign Permit was approved: Disapproved: Signature of Building Official: Date: In order-to process application without delays all sections must be completed. 0:11•YPFILESI SIGNnSIGA'APP.D0C PROOFDAT " • • CONTACT INFO 8/27/2009 COMPANY:7 PHONE: PROOF 1 Z 3 STOREET: FACUB HUNTER CONTACT PERSON: 1 11:53:04 AM CITY: STATE: ZIP: EMAIL: File Name:Nationwide_SU'eet_sign_Hyannis.fs Folder Name:\\DroboshareWrobo\FLECUBRiUB1M\BUTT a C�1(eC40 e c4?- 4v (Z-Q ✓r`�(�` DE2caumlr aulr-T�Eur-�2 11C Jewelry o Boutique Gifts 5 08- 778- 1000 65 In TO ASSURE SAFETY AND QUALITY OUR PRODUCT IS©LISTED ©COPYRIGHT 2009,SIGN*A*RAMA,Inc. THIS RENDERING IS INTENDED kS A SAMPLE ONLY.COLOR,TEXTURE,MEASUREMENTS,AND ACTUAL APPEARANCE MAY VERY SLIGHTLY FROM COMPLETED WORK AND IS CONSIDERED NORMAL&USUAL. Please check layout(artwork spelling,dimensions)and fax back with signature.Production I HAVE REVIEWED THE ABOVE SPECIFICATIONS&HEREBY FULLY UNDERSTAND THE cannot begin until written approval is Deceived.Additional charges will be applied for any changes 1 +` CONTENT OF WORK TO BE PERFORMED&APPROVE THIS PROJECT TO BEGIN: that are needed after approval is received.SIGN*A*RAMA is not responsible for any errors in CUSTOMER APPROVAL SIGNED BY: spelling,layout,or dimensions that have been approved by the customer.This proof is for listed PRINT. DATE: items only.Any changes or deletions by the customer not shown or,charged herein will be billed 12-6 White's Path,South Yarmouth,MA 02684 separately.5096 DEPOSIT DUE AT TIME OF ORDER(full amount if under$100),balance due Phone:508-398.9100 Fax:508-398.1760. LANDLORD APPROVAL SIGNED BY: upan time of installation.I HAVE READ AND AGREE TO ALL TERMS. UIRI IAL Email:ccsar@vekizon.net PRINT: DATE: www.signarama.com/096'4 x THIS ORIGINAL DESIGN AND ALL INFORMATION CONTAINED THEREIN IS THE PROPERTY OF SIGN%*RANA AND ITS USE IN ANY WAY OTHER THAN AS AUTHORIZED IS EXPRESSLY FORBIDDEN,THIS PROPERTY MAY NOT DE REPRODUCED OR DUPLICATED WITHOUT WRITTEN PERMISSION OF SIGN"A"RANA OR THROUGH PURCHASE. a, �L� DATE PROOF CUSTOMER INFO CONTACT INFO 9/8/2009 COMPANY: PHONE: A PROOF I 2 3 STREET: Rt.28 FAX. CONTACT PERSON: BUtt 9.44:59 AM cl-re: Hyannis STATE:MA ZIP: 7 EMAIL: File Name:Nationwide_Holf Circle_Awning.fs Folder Name:\\Droboshare\drobo\FLEXI_FILES\B\BUTT DESCRIPTION Half Circle Awining Lettering � � _ 47 in _I l y i. TO ASSURE SAFETY AND QUALITY OUR PRODUCT IS Q LISTED ©COPYRIGHT 2009,SIGN*A*RAMA,Inc. THIS RENDERING IS INTENDED AS A SAMPLE ONLY.COLOR,TEXTURE,MEASUREMENTS,AND ACTUAL APPEARANCE MAY VERY SLIGHTLY FROM COMPLETED WORK AND IS CONSIDERED NORMAL&USUAL. Pieesa check layout(artwork,spelling,dimensions)and fax back With signature.Production I HAVE REVIEWED THE ABOVE SPECIFICATIONS&HEREBY FULLY UNDERSTAND THE cannot begin until written approval is received.Additional charges Will be applied for any changes ;._ CONTENT OF WORK TO BE PERFORMED&APPROVE THIS PROJECT TO BEGIN: that are needed after approval is received.SIGN*A*RAMA is not responsible for any errors in CUSTOMER APPROVAL SIGNED BY: spelling,layout,or dimensions that have been approved by the customer.This proof is for listed PRINT: DATE: items only.Any changes or deletions by the customer not shown or charged herein will be billed 12-6 White's Path,South Yarmouth,MA 02684 separately,SD%DEPOSIT DUE AT TIME OF ORDER(full amount if under$100),balance due Phone:508-398-9100 Fax:508-398-1780 LANDLORD APPROVAL SIGNED BY: u on time of instafletion.I HAVE READ AND AGREE TO ALL TERMS. INITIAL Email:ccsar®verizon.nat PRINT: DATE: P www.signarams.com/02664 THIS ORIGINAL DESIGN AND ALL INFORMATION CONTAINED THEREIN ISTHE PROPERTY OF SIGNWRANAAND ITS USE IN ANY WAY OTHER THAN AS AUTHORIZED IS EXPRESSLY FORBIDDEN.THIS PROPERTY MAY NOT BE REPRODUCED OR DUPLICATED WITHOUT WRITTEN PERMISSION OF SIGWA-RAMA OR THROUGH PURCHASE. ' TOWN OF BARNSTABLE SIGN PERMIT PARCEL ID 311. 005 GEOBASE ID 23000 ADDRESS 76 ROUTE 132 PHONE Hyannis ZIP - LOT 1A&2C BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT HY PERMIT 15691 DESCRIPTION SEA WATCH REALTY (16SQ.1-1T.& 6 SQ_FT. ) PERMIT TYPE BSIGN TITLE SIGN PERMIT. CONTRACTORS: Department of Health, Safety ARCHITECTS;: and Environmental Services TOTAL FEE6: $25.00 THE BOND $.00 px CONSTRUCTION COSTS $.00 753 MISC. NOT CODED ELSEWHERE * BARNSTABLE, • MASS. OWNER SULLIVAN, RICHARD A i639. 68 ADDRESS 342 LONG POND DR EB BM, ILDI G DIVISION S YARMOUTH MA DATE ISSUED 08/07/1996 EXPIRATION DATE 1 a ownor arms a . pet no. Department of Health, Safety and Environmental Sernces /S69NAM / = Building Division Gate 4-9 s"¢ ,� 367 Main Street,Hyannis MA 02601 fee o2s` Application for Sign Permit Applicant: C � ,�,P Assessor's no. 311 - OMS Doing Business As: _ Q� � C �c�1,'F-� Telephone 4MCW-�s Sign Location street/road: i1 a� .� �G- el 2- Zoning District Old King's Highway District? yes no INJ 0 Prope Owner Name: �, "kktuc3myl�. Telephone�y��L1 3 4) �k Address: �� m� �dw Village �.t �, Sign Contractor 3 S Name: aaa-�,GQ5t60---\ Telephone_+4 . 42c� TC44 P W 00 ft, - W 111t 0 ` �ft O Address: Q Gees h � s (=>2G4L 'R' Village Description Diagram of lot showing location of buildings and existing signs with dimensions, location and size of the new sig. to be drawn on the reverse side of this application. Is the sign to be electrified? yes no ✓ (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 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. Date 4Signature of Owner/Authorized Agent (Av Y 16 � Size. (sq. ft.) ' a Permit Fee Sign Permit was approved: disapproved: 7-7 9� -a' Date Signature of g Official • •JI i. :, - � rr_ � `tl •1 i c 't•u "r .1 , � i�i}•9 .: i: ..m �J a 3. , v s • �'r `y f 4 � 5a. r �' +` . * •kR �,";�d.. S ��C <;+, fy /49.8 }�. 56 I W J i \509 . Q 5 8 2. j , r a , , \5 }�52.8 X 52.4 8 48.1 , 1 89 54.9 pA yEt? _ ------ -=---�== --k 5301 PARKIN r 'i � 5 7.0 6.3 �'•5 5 � r !` rP.r'' '' L � e✓a.C R C h. � �. ,ems a- •..erP w.+ � b�.t:� '' i: '_ �' ! jN ✓ - PAV r ' :-� r .}`52.3 E ARKI 1 NG �."MUr G�'il ?C`C*��.€y i� t�1. •Y y�p lA� � 1 ..' ' rn'vii L'�U e�jQ r•�yir C: LJ`S 7 1 .1 - ARE 0n 53.0 i f, 4 C, iC ; 48:3 1.3 t SBu . p !i�lJ i v 4 f n - �+'i k,'� ►r' > a:-S:} 's_ c"P1' * .er ""~.it `t "r�`> 44.9 f7 g, ss, a ISM j"� f p6 `j P -.e: t '�'� .,,.a. .p,t. �"A�•► tt • -3• J .'t 8�. f. � '?. . ar.;,a �'7LC. ,};,�.,.. n ♦,r. 3 �i.'iN„"4uofl r.�, ��,a,,�v. ✓ r� ' '.p:i <t.: ,,,,f.a �`'.` .r,,. i.' 1' �'y -. :''�+•�'• i'c�a/• ejt_ 2s7 _ 7 ;. DN� O -�• ' n ''r'ti +,1� �.rtY k ,�'n .•�"S'f' � hk�.. ? µt'r� 'r a ���' N'Ldsj jf'° ,"vi __ 46.5 + 09 4.5 Q + V N� r}�44 3 ��4 P ARKI }. i�' Ef 1.3 X 43: 46 AVER PARKiN ct Y E 1 i 2 % .4 7 rl' �46.7, Ia 7.' / �� i v c a 0 ' D r i l 11 / V ^. - �� � lu �,,,..n �::� 0 o �� �,I o '� D ;, o _ . a .� r 1 �_,-_� / // � 1 / V h TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel rr d Pppliocation # I �� Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _Preservation /Hyannis Project Street Address -7 Village_�.4H „ Owner Address Telephone .!rg 9' 7'7S M 7 3 1�- Permit Request _A�e, /[ �. / 2P , ,o 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 Historic House: ❑Yes ®'No On Old Kin 's Highway: ❑Y /No ges ® 9 g 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: El Gas ❑ Oil ❑ Electric ❑ OtherVIE a Central Air: ❑Yes Or No Fireplaces: Existing New Existing wood/coal s-t�ove:'Yes No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ LJ existing', ❑ow size_ Attache age: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of A eats Authorization ❑ Appeal # Recorded ❑ w Commercial Yes ❑ No If yes, site plan review # Current Use Proposed Use /j APPLICANT INFORMATION (BUILDER OR HOMEOWNER) l Name J ifs /�P e Telephone Number CO 2 i 7 Address G LQ- License# Xl,a. M 3 � d Home Improvement Contractor# Worker's Compensation # ��✓� Z i r 3 7 Z�� G �= ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 5 `lam SIGNATURE DATE f �a FOR OFFICIAL USE ONLY d APPLICATION# s DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE t OWNER DATE OF INSPECTION: FOUNDATION FRAME P INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING i DATE CLOSED OUT ASSOCIATION PLAN NO. y I - Die Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washh Wton Street Boston,'MA 02111 - www.mass gov/dia Workers' Compensation insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly NamO(Bnsmess%otganization/lndividnal): ��c,�. s�.� �'jl j',�l,�_ �s.�+» 5 • •��: e - Address: Ci /State/Zi ,� h H , s � UZ 0 5-0 1l Are you an employer?Check the appropriate bog: Type of project(required); 1.2] I am a employer with 4. ❑ I am a general contractor and I * have hired the sub-contractors" 6. ❑New construction employees (full and/or part-time). - 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling shipand have no employees These sub-contractors have �P Y S. ❑Demolition working for me in any capacity. employees and have workers' 9. Buildin addition [No workers'comp."inciTrance comp. insurance. _ ❑ g required.] 5. ❑ We area corporation and its • 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 1 a_ka oof repairs inctrrance required.]t. c. 152, §1(4), and.we have no �``�1` employees. No workers' 13.0 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 am doing all work and then hire outside contractors must submit a new affidavit indicating such, tContractms 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- ontractors have employees,they must provide their workers'comp,policy number. I run an employer that is,providing workers'compensation insurance for my employees-Below is the policy and job site informatian. ,( j Insurance Company Name: ' / �. V\j T Policy#or Self--ins. Lic.# /,/G Z ~ .�j S- ) Z I) a _ Expiration Date:_. 7�t . Job Site Address: r City/State/Zip: Z� h » 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 c. 152 can lead to the imposition of criminal penalties of a . fine up to$1,500.00 andlor 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 aa d penjalties of perjury that the information provided above is true and correcf- Si Date: Phone 4: S o . OffZcial use only. Do not write.in this area,to be completed by city or town offzciaL City or Town Permitll,icense# Issuing Aathori (circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector. 5.'Plumbing Inspector. 6.Other CQnntet Person= Phone#: x Regulatory Services Thomas F.Geiler,Director Building.Division Tom Perry,Building Commissioner. 200 Main Street,Hyannis,MA 02601 wW W.towvn.barnstable.ma_us Officer 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 l P Perty hereby authorize za to act on my behalf, in all matters relative to work authorized by this building permit (Address of Job) I Pool fences and alarms are the responsibility of the applicant. Pools are not to.be filled or utilized before fence is installed and.all final inspections are performed and accepted. Signature of Ow ex j Signature of Applicant Print Name Print Name ,3 ,3 Date i Q:F0RMS:0WNERPERMISS101e0OLS 62012 129/2012-5:25:11 AM-PST (GMT-8) FROM: 100005-T0: 150877111021 Page: 2 of z DATE p"Mu/YYYY) .. AC40R CERTIFICATE OF LIABILITY INSURANCE CERTIFICATE IS ISSUE AS A MATTE R OF INFORMATION ONLY AN END OR ALTER CONFERS NO RIGHTS COVERAGE AFFORDED N THE BYEPLTH THE DPOLIC EIS THIS CERTIF CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,. BELOW: THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A.CONTRACT BETWEEN THE ISSUING INSURER{S), AUTHORIZED ors REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.'thepoli�( } subject must be endors IMPORTANT: If the certificate holder is an.ADDITIONAL 1NSURED an endorsement. A statement on this certificate does not confer rights t the the terms and conditions of the policy,certain Policies maY require certificate'holder in lieu of such endorsements . coNracr NAME: PRODUCER gRYQEN 81 SULLIVAN TINS s 75-soso F C NO: 88 FALMOUTH RD PHONE HYANN I S, MA 02601 EMAIL ADDRESS: tAlc INSU AFFORDING COVERAGE NSURERA: MLIt NSURERB:' INSURED MASS BUILDING SYSTEMS LLC - 94SURMC: 24 ST FRANCIS CIRCLE NSURERD: HYANNIS MA 02601 NSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: 13480223 REVISION NUMBER: OVE FOR THIS IS TO CERTIFY THAT TDHE P REQUIREMEMTNTERM OR ISTEDGNITIONELOW HAVE OF E N ISSUED TO E INSURED NAMED ANYCONTRACT OR OTHER DOCUMENT�WITH RESPECT[HE TOPOLICY WHICH:THI PERIOD! INDICATED. NOTWITHSTANTHE POLICIES CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,.THE INSURANCE LIMITS SHOWN MAY AFFORDED BEEN REDUCED BY PAID SGL'AIMS.CRIBED HEREIN IS SUBJECT TO All THE TERMS, DCCLUSIONS AND CONDITIONS OF SUCH POLICIES POLICYEFF POLICY EXP LIMITS DL SUBR POLICY NUMBER M1DW MMIDD INSR TYPE OF INSURANCE IN SR WVD EACH OCCURRENCE $ LTR GENERAL LMILITY DAMAGE TO RENTED PREMISES a occurrence $ COMMERCIAL GENERAL LIABILITY MED $ CLAIMS-MADE OCCUR PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS-COMP/OP AGG $ GEN'L AGGREGATE LIMIT APPLIES PER: $ PRO- LOC COMBINE SINGLE LIMIT $ POLICY Ea Bu"�'t AUTOMOBILE LI LFrY BODILY INJURY(Per person) $ ANY AUTO BODILY INJURY(Per accident) $ ALL OWNED SCHEDULED PROPERTY DAMAGE $ AUTOS AUTOS (Pererxtiderd NON•SWNED $ HIRED AUTOS AUTOS EACH OCCURRENCE $ UMBRELLA LIAS OCCUR AGGREGATE $' EXCESS LIAB CLAIMS-MADE $ DED RETENTION$ $ $ WC STATU- FR yUC2-31 S-317211-042 6ITI2012 6(T12013 V TORY LIMITS A WORKERSYERS'LILrrCOMPENSATION, E.L.EACH ACCIDENT $ rn OO AND EMPL.OYERSt-IA80.fTY YIN ANY PROPRIETORIPARTNERIEXECU IVE� NIA - E.L.DISEASE-EA EMPI OYE $ 50000D OFFICERJMEMBER EXCLUDED? 6DODOD (Mandatory in NH) E.L.DISEASE-POLICY LIMIT $ Ifyes,descnbe under . DESCRIPTION OF OPERATIONS tlebw DESCRIPTION OF OP6t�4TiONS I LOCATIONS I VEHICLES(Altach.ACORD 101,Add{tlornt Rsmarkc S¢hedulo,N more cpa oa K raquked) ' lies Only to the workers Compensation laws of the state of MA. Workers compensation insurance coverage app GANCELLATIO N CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO ACCORDANCE WITH THE P N DATE O ICI`Pf20VIS10N3E WILL BE DELIVERED IN .. AUTHOR REPSENTATIVE ® RE Jeff Eldridge O 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05} The ACORD name and logo are registered marks of ACORD CERT NO.: 13480223 CLIENT com: 1611164 maria Ande-tsonusLy 6/2certi£icates?9/2012 2 Am Page 1 Of 1 This certificate cancels and supersedes ALL P Massaehus.etts Cie rgtment of public oaf Board ofEkqillll ns.a �I Licerrse CS"-058987 ; `STEPBEN E 24 ST FRANdS CIR HYANNIS Nkk 0260:1 Expiration Commissioner 02/04/2014 v .. �k- � d •—'4_4• e`- S 3 -_ 9 tom°— RESIGNATION OF TRUSTEE OF FALMOUTH ROAD REALTY TRUST I, John A.Begg, Trustee of Falmouth Road Realty Trust, under a Declaration of Trust dated May 7,2002 and recorded with the Barnstable County Registry of Deeds in Book 15155, Page 122, do hereby resign as Trustee of said Trust, effective upon the acceptance of Kim M. Sullivan and Kelley A. Sullivan as Successor Trustees. Subscribed and sworn to under the pains and penalties of perjury this day of September, 2012. 1-Z John A.yg COMMONWEALTH OF MASSACHUSETTS Barnstable, ss. On this day of September, 2012, before me, the undersigned notary public, personally appeared John A. Begg,known to me personally to be the individual whose name is signed on the preceding or attached document and acknowledged to me that he signed it voluntarily for its stated purpose. Not Public My commission expires: Notary Publlo commonwealth of Nlassachusat. Nly Comm.Expiresa- Bk 26758 Pg 284 #59620 i ACCEPTANCE OF TRUSTEE The undersigned, Kim M. Sullivan and Kelley A.Sullivan,having been appointed Trustees of the Falmouth Road Realty Trust,under Declaration of Trust dated May 7, 2002,by the Trustee of said trust,John A.Begg,hereby accept the terms and conditions of the foregoing instrument and agrees to serve as Trustee of the Falmouth Road Realty Trust. t ITNESS KIM M. SULLIVAN WITNESS KELLEY A UL AN COMMONWEALTH OF MASSACHUSETTS Barnstable, ss. M�P On this d y of kmnErq, 2012, before me, the undersigned notary public, personally appeared Kim M. Sullivan and. proved to me through satisfactory evidence of identification, a Massachusetts driver's license, to be the person whose name is signed on the preceding or attached document and acknowledged to me that she signed it voluntarily for its stated purpose. I,K H. B + NOTAR" blic COMMO.4.'Saith at. Xt? My Commission Expires May 2, 2014 My commission expires: COMMONWEALTH OF MASSACHUSETTS Barnstable, ss. On this 96 day ofJeReff r, 2012, before me, the undersigned notary public,personally appeared Kelly A. Sullivan and proved to me through satisfactory evidence of identification, a Massachusetts driver's license, to be the person whose name is signed on the preceding or attached document and acknowledged to me that she signed it voluntarily for its stated purpose. Notary Public M commission expires:y p 1vlAP{ ri.._ v BEAU NGri-Ail PUBLIC ^c aneonreaRF,of fG3S5achusBttS Comrt>Essioe Expires nay 2, 2014 SARNSTABLE REGISTRY OF DEED 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 the 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" FI., 367 Main St., Hyannis, MA 02601(Town Hall) and get the Business Certificate that is required by law. ' DATE: " .• Fill in please: v + t AR APPLICANT'S YOUR NAME: lG DRESS: BUSINESS YOUR HOME AD fH� I �� /VIITG�iG-�z5 IVA 1-�VA ,ems- MA 0 626 c TELEPHONE # Hom Telephone Number. NAME OF NEW BUSINESS 11/RTtl wtaG n vy ry;�v—c 5 US,d TYPE OF BUSINESS _A tL. 1S THIS A HOME OCCUPATION? YES NO y— Have you been given approval from the building divisi n? YES NO �*y�' ADDRESS OF BUSINESS MAP/PARCEL NUMBER 0V J 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 COMMISSIONER'S OFFICE This individual has been inform of any permit requirements that pertain to this type of business. Authorized Si nit COMMENTS: � 2. BOARD OF HEALTH This individual has be formed of t er equirements that pertain to this type of business. Authorized Signatur V1 p COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has 7n informpo 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 $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 first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1'' Fl., 367 Main St., Hyannis, MA 02601(Town Hall) and g.et the Business Certificate that is required by law. " DATE: Fill in please: ' APPLICANT'S YOUR NAME: tG -� w .< 2 8 h BUSINESS YOUR HOME ADDRESS. ti 4 i c-5 4 !7 fo O TELEPHONE # Hom Telephone Number. O —3l 7-;? NAME OF NEW BUSINESS_ Tn,rf wtd6 n 65c oy N i 60T aM5 03A TYPE OF BUSINESS_J r-7A tt. IS THIS A HOME OCCUPATION? YES NO Have you been given approval from the building divisi n? YES NO � ADDRESS OF BUSINESS .� MAP/PARCEL NUMBER 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 COMMISSIONER'S OFFICE This individual has been of any permit requirements that pertain to this type of business. COMMENTS: Authorized Signat � �.� `�-- 2. BOARD OF HEALTH This individual has been informed of the permit requirements that pertain to this type of business. COMMENTS: Authorized Signature" 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requ i rements.that pertain to this type of business. COMMENTS: Authorized Signature" _ TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map TJT -Parcel Cj �� Application# �6 V G Health Division Date Issued7f6- �2 Conservation Division Application Fee _ Tax Collector- Permit Fee Treasurer Planning Dept. Date Definitive Plan Approved by;Planning Board Historic-OKH Preservation/Hyannis Project Street Address F l m a Village /Y,. Owner. lor!y, Sn /I, y 0, h Address Z .9-7 Telephone 7 - e Z Permit Request W10A 61 06 Id Square feet: 1 st floor:existing 76 0° proposed e5:1dXisting proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation �?,Z ° Construction Type L✓ Lot Size Grandfathered: ❑Yes 44 No If yes, attach supporting documentation. Dwelling Type: Sing Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure V d Y d✓ Historic House: ❑Yes �No On Old King's Highway: ❑Yes No Basement Type: ❑ Full ❑Crawl ❑Walkout ❑Other 5-Al 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 Z 1 Heat Type and Fuel: AGas ❑Oil ❑Electric ❑Other Central Air: ❑Yes o Fireplaces: Existing -mew Existing wood/coal stove: �0 Yes` to Detache age:❑existing ❑new size existing ❑new size jexisting ti0 new,-size Attache ge:❑existing ❑new size ❑existing ❑new size Other: % __° a. ICD Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Ur Commercial ❑Yes ❑No If yes, site plan review# Current Use - . _ = Proposed Use _ BUILDER INFORMATION Name Lea t b e Telephone Number 50 $ r %7 2 - 2'Y- Address Z- y r� ,s C G 1 License# �'i'ell,_ UZ co ) Home Improvement Contractor# /3 0 6' Worker's Compensation# _1 i C Z,_ ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO T r m cu-� Ia v► �I� SIGNATURE DATE ! / /� FOR OFFICIAL USE ONLY ' APPLICATION# r DAIE ISSUED MAP/PARCEL NO. r ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION .y r Al FRAME A INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL ' GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. ,� ' The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111' wrdw.mass.gov/dia ' Workers"Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information / Please Print Leeibly Name(Business/Organization/Individual): •Address. / City/State/Zip: �� h f'7„ Phone.#: S C1 Sl— 7 >> S g 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 . loyees(full and/or part-time)-* • have hired the sub-contractors 2 I am a'sole proprietor or partner- listed on the sheet 7. ❑Remodeling ship and have no employees These sub-contractors have g, (]Demolition employee'$and have workers' working for me in any capacity. $. 9. ❑Building addition [No workers' comp.insurance comp.insurance. S. 10.❑Electrical repairs or additions . ❑ We are a corporation and its required.] officers have exercised their I L Plumbingairs or additions 3.❑ I am a homeowner doing ill-work : right of exemption per MGL ❑ repairs myself.[No workers comp. 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 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 ornot those entities have employees. Ifthe sub-contractors have employees,they must provide their workers'comp.policy number. I a n 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.#: / C Z /S ' 3 /7 j/-03 4 Expiration Date: �� 3 Job Site Address: -76 �a I�» B�: `�( City/State/Zip: /��'` h 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 lip 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 maybe forwarded to the Office of Inyestiaations of the bIA for insurance coverage verification. _ _ ---— I do hereby certi perjury that the information provided above is true and correct under the pains and penalties of Si afore / Date Phone#: —77 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): J.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: ,4OF1HETp + Town of Barnstable Regulatory Services BARNS'TABLE, v MASS. Thomas F. Geiler,Director �ArECMpva Building Division Tom Perry, 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 I, /"1 >"� III ✓ }1 , as Owner of the subject property hereby authorize Q s ry I z, !%�o b a �� to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signature of O fier Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FORMS:OWNERPERMISSION Town of Barnstable �Op THE Tp�� Regulatory Services S BARNWABLE, = Thomas F.Geiler,Director 9 MASS. q,A 1639. ,0 Building Division lEn �s Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER': name home phone# work phone# CURRENT MAILING ADDRESS: i city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor.. DEFINITION OF HOMEOWNER Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1,1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, - that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homeexempt, TOWN OF BARNSTABLE SIGN PERMIT . ` ? PARCEL ID 311 005 GEOBASE ID 23000 ADDRESS 76 FALMOUTH ROAD (ROUTE PHONE " HYANNIS ZIP - LOT IA&2C BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT HY PERMIT 53606 DESCRIPTION BENCHMARK HEARING SERVICE 17.6 SQ FT PERMIT TYPE BSIGN TITLE SIGN PERMIT CONTRACTORS: Department of Health, Safety ARCHITECTS: and Environmental Services TOTAL FEES: $25.00 BOND $.00 OxINE CONSTRUCTION COSTS $.00 753 MISC. NOT CODED ELSEWHERE # BARNSTABLE, ; MAS& 1639. " ED MA'S 'UILD NG DIVI IO DATE ISSUED 05/25/200.1 EXPIRATION DATE d� A Regulatory Services * $ Thomas F.Goner,Director Building Division � ►`°g Elbert C Ulshoeffer,Jr..Building Commissioner 367 Main Street, Hyannis,MA 02601 Fax: 508-790-6230 Office: 508-862-4038 /Old 1 Tax Collecto Treas r ` Application for Sign Permit Assessors No. Applicant: Doing Business ephone No. " Sign Location Street/Road: s Hi wa ? Y o Hyannis Historic District? Yes/c. Zoning District:Old King gh Y m Property Own Address: Telephone: Name: Village: Sign Contractor Telephone: Name: - Village: Address: Description Please draw a diagram of lot showing location of buildings and existing signs with dimensions,location a 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 yes, a wiring permit is required) I hereby cemfy that I am the owner or that I have the authority of the owner to make this application, that construction shall conform to the provisions of Section 4-3 the information is correct and that the use and of the Town of Barnstable Zoning Or Signature of Owner/Authorized Agent - ,Dates- = Perm it Fee Size: Sign Permit was approved: Disapproved: Date: Signature of Building Off. al: ^� Sign l.doc re►•.8131/98 (��.� ��5 76 Falm®ukh Road eltpSe Deputy Collector --Y-- VIdem n nn Hearin Services , 9 778 1414* t�:y s i ►� s _ 4ti ram, /o N S �eqV k- AFFt)< s C�J i E� s I I)E WW AsLk2 _�9 x 39rfT -,-,CO9.--��� ; OTTN �J j�jca,tiE�2�c� tJ�v� i3LuF wlw}� 3Auccgczo,..�.SID 76 Falmouth Road qu�A�o� Deputy CoRector 'j" ienc rn a r 0 0 Hearing Services L,)�4 ! A"A-*Q, 778= 14140""" -^' f w -• y- TOWN OF BARNSTABLE SIGN PERMIT PARCEL ID 311 005 GEOBASE` ID 23000 ADDRESS 76 ROUTE 132 PHONE Hyannis ZIP - LOT 1A&2C BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT HY .PERMIT 21673$� DESCRIPTION SEA WATCH REALTY (24 SQRS. ) PERMIT TYPE BSIGN TITLE SIGN PERMIT CONTRACTORS: , Department of Health, Safety ARCHITECTS: and Environmental Services 11 4 TOTAL . FEES: $25.00 BOND $.00 Ox THE CONSTRUCTION COSTS $.00 753 MISC. NOT CODED ELSEWHERE * BARN3TABLE. MASS. OWNER SULLIVAN, RICHARD A i639 -ADDRESS-- 342 LONG--POND- DR--- _ __ --- ED I�AI�► S YARMOUTH MA B+ILTILD �G DIVISIQJ N 1 B C DATE ISSUED. 03/12/1997 EXPIRATION` DATE `i i �, i �THE t d'`� `�► The Town of Barnstable - Department of Health Safety and Environmental Services KAM � Building Division fog 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner Application for Sign Permit Applicant: az Assessors No. "3 l t Do S Doing Business As: 0"? aA_1p _ Telephone No. 4 _ Sign Location Street/Road: G cu" t Zoning District: Old Kings Highmay? Yes�To Property Owner A/ Name: S'" Lk lv a,.•\ c e� ar a A Telephone: /V 4 Address: Village: V4�-o Sign Contractor Name: M 0."..� e� Telephone: S® 1� S W R' Lk b(2)b Address: ICIS QA" Village: Description Please draw a diagram of lot shoeing 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? Te i o (Yote.ffyes, a vwmgpermitisrequired) I hereby certify that I am the owner or that I have the authority ofthie o nR er to make this application, that the information is convect and, a Ehe use an'�o�trucdon shall conform to the provisions of Section 4-3 of the Town of arns666Z.ottii Ordinance. Signature of Owner Aorized en /'l/� gn Owner/Authorized ate: % / — j G .� C U j.,�jc Size: / g — / Permit Fee: 6W,3 Sign Permit was approved: Disapproved: Signature of Building Offici Y i Date: 4?— _ 7 / Af { i `t III r DEPUTY Talk COLLECTOR T. 1 . s of J sl- YO � r ✓ I L °f THE TOWN OF B :STABLE Q y 3 . s i HJHB9TABLB o° : �/.f� IA"I "T °moo 6p�a• ' Office of the Building Inspector June 20, 1984 No Fee: PERMIT TO ERECT SIGN IS HEREBY' GRANTEDTO ...............Its j&r4..Av..ns,,�1�,a, j..,F'a. •. i.�a •µc ............................................... -. LOCATION .................... fr r...Hyanzws....................................................... . . ............ ANY VIOLATION OF THE SIGN LAW WILL CAUSE IMMEDIATE REVOCATION OF THIS PERMIT = I B ddirw Inepecbr--- son son Our building. I r, ° °''""°• ' TOWN OF BARNSTABLE � ,n,r SIGN APPLICATION • H o. ° ever� — 19 g Owner's Name Address S$ F"A/�- u��<i 2� ,y .vv%s -a'. Location Name of Builder Address Type of Construction .( Free Standing or Attached 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 reverse side. ✓ iAck G � �AJ 3 F 1A)Cl Old f;art v V o At.,;TH E. f /o%•v,�.✓.'�N-N�%�.S � I I ^4 j R M y nrli �i�J`7�rU +C J� pM f i Cy aM + ne k C 7 L L 1 CoAV9'Plr✓G71;oAJ oFS;O^V :,t�. ,,r�,c-F:Xt v �0 6v:ice/;•vim w;�.y-N+%>S y bTHIL Dy..rA. _ �'"� 7��G ���J6,r. h j l fi- DG are; ;Services ;G9M s i ' t r tR� SUBMISSION REQUIREMENTS �1 for _. SIGN DESIGN REVIEW The Architectural Review 'Committee (ARC) requests that each business wishing to erect a sign, submit for review a photo- graph, scale drawings of the sign and bracket, and a Town of Barnstable Sign Application. Sign Applications may be ob- tained from the Building Commissioner ' s office, 4th floor, New Town Hall . A business may, at its option, submit addi- tional information which may assist the ARC in reviewing the sign design. A representative of the business making applica- tion is required to attend the ARC meeting at which its sign , will be discussed. Less than the minimum submission require- ments will delay action until they have been met. 1. PHOTOGRAPH A photograph showing the existing facade, on which has been indicated the proposed sign location . The photo- graph is to include a portion of adjoining stores or buildings . For a proposed building or new facade, an architect' s elevation may be submitlted in lieu of a photograph. c2 . SCALE DRAWING OF THE PROPOSED SIGN A scale drawing indicating 1 ) the type of proposed sign (wall, hanging, free standing) ; 2 ) dimensions of the proposed sign and any designs, logos, or let- tering; 3 ) colors; the drawing may,\be black and white; r but color chips must be attached fo colors other than black, pure white, or gold leaf; 4 ) materials ; what the proposed sign and letters are to�be constructed of ; and, S) a cross-section with dimensions showing edge detail . Minimum scale, 1 1 ' . Minimum sheet size, 81� x 11 . Two sets. c� 3. SCALE -DRAWING OF THE BRACKET A scale drawing, indicating dimensions, color, material, and' method of affixing it to the sign and to the build- ing. Minimum scale, 1" = 1 ' . Minimum sheet size, 83� x 11" . Two sets. 4 . TOWN OF BARNSTABLE SIGN APPLICATION A- completed Sign Application, including scaled diagram (� showing location of sign on building or location of free-standing sign. Show dimensions. May 1j�., jq�!83 ARCHITECTURAL REVIEW SIGN APPLICATION. o DATE S 3- y TELEPHONE NUMBER(S) ADDRESS OF PROPOSED PROJECT 76 f-A/''"'�"�'`'� �� 27 Zg >c'EAr N /-1i.�1vis' OWNER e:C,/--) �J• S� ii v�i./ MAILING ADDRESS Sg /,ov7`�`� SIGN REVIEW/NAME OF BUSINESS AGENT OR CONTRACTORAf y Co/�.�-,.�» • "' ' AND ADDRESS 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. IA.�f�;Xc�%� b oN-�� G.�vCcal�-tJ p��'�� S,�-�v 'c�S �+���`�S�vr-S���-,—�.C= ,�i%✓���,�.�.�� ,.��,��'D� by .,tl S`/ C a�-- �� ,� �-• Tom, J r`�`�t 1 (-✓i i> 6 L: 3 '� f ��' �'.l .�J T iv:�. -2- /✓i>J �oi.�J� 7�Oc.a�rc�S�lJ��Si J 7/C7 s/)Vr���ss�E / �• l��li�3h7 IS.9.�FiX�J�Q ��' FOR OFFICE USE ONLY PLEASE -DO NOT WRITE'BELOW"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 Parcel 4ermit# s Conservation Office(4th floor)(8:30-9:30/1:00-2:00) y Date Issued I6 J9 Board of Health(3rd floor)(8:15 -9:30/1:00-4:45) Fee K UEngineering Dept. (3rd floor) House# �.tME Planning Dept. (1st floor/School Admin. Bldg.) .' BARNSTABLE. MASS.. Yin Plan Approved by Planning Board 19 039.TOWN OF BARNSTABLEBuilding Permit Application ee Address Village t Owner Address Telephone 3 " - 1 Permit Request i First Floor square feet Second Floor square feet Estimated Project Cost $ Zoning District Flood Plain Water Protection Lot Size Grandfathered ? Zoning Board of Appeals Authorization Recorded Current Use Proposed Use Construction Type --Commercial Residential Dwelling Type: Single Family Two Family Multi-Family :y Age of Existing Structure Basement Type: Finished Historic House Unfinished Old King's Highway Number of Baths No. of Bedrooms Total Room Count(not including baths) First Floor Heat Type and Fuel Central Air Fireplaces Garage: Detached Other Detached Structures: Pool Attached Barn i None Sheds Other Builder Information Name 4 Telephone Number 3d Address' License# Home Improvement Contractor# 25d:Q U:;�l hQgz:���, D 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 DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DA A A�;,,--- BUILDING PERMIT DENIED OR THE FOLLOWING REASON(S) TOR OFFICIAL USE ONLY ` P) RMIT NO. DATE ISSUED 1 r MAP/PARCEL NO. " ADDRESS VILLAGE - OWNER , DATE OF INSPECTION: FOUNDATION FRAME INSULATION _ r t FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL #: GAS: _ ROUGH FINAL ? 1 '• , FINAL BUILDING ^ [ t I T # t t T � - •♦- 3 � t 't 1 1 t ' ' 7 t ' � ' ' 1 I DATE CLOSED OUT - t ASSOCIATION PLAN NO. t i "`i t { ► I 1 t � 1 � • 1 -� � } t � j � f t � t i 1 t � f � t- � - � ( 1 1 I 1 I ff • TileCunu1runl+•caltb of Atassaclnusetts '�•�1 '' ' Department tif Industrial Accidents 6011 fi<ashi,r.,7nn Street Bu%7aa.Mau. 02111 Workers' Compensation Insurance Affidavit F",�4locntio 2 O o�('o�oOtwhancly of�am homeowner performing all work myself. sole proprietor and have no one work-in_ in any capacity I am an emplover providing workers' compensation for my employees working on this Job. to-M- P.1fly slit nhone#• � # incur•ince co IZOUC • I am a sole proprietor.general contractor,or homeowner(circle one)and have hired the contractors listed below wr the following workers' compensation polices: nr n its nhone#• in—Surnnee Co. neiiev�! ••• m .Im•na e• 'Iddres-3- city, nhone#• - sumo a co ttoiirv!! :Attach addiHonai'she pen sides to secure cm erage as required under fieetion'3A of 1►1GL 1S2 na lad the imposition of erimia o the dHes ota fine up to SiS00.t10 i one.ears'imprisonment as well as cirii pensities in the form of a STOP WORT:ORDER and a Bite otStO0A0 a day aptiust mts 1 understand copy of this statement may be forwarded to the Me of Investigations of the D1A for contase*VAfiCuiom Z2 1 herchr carify unficr tilt pains and penaltl�t ofPerini that the infornmtion pry ded above isvine and comwL r — 8� Si_n tt n Print name Phone;# oRtcial use only do not write in this area to be compieted by city or town Diffe i pertnit4leense# ntluddiag Department cin•or town: pUcensiug Surd check if immediate response is required �Sdeetmen's Oliicr 13 �1;exub Department contact person• phone Ii• nUther� Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all emplovers to provide workers' compensation fc employees. As quoted from the "lay 7. an emplm►ee is defined as every person in the service of another under ar contract of hire, express or implied. oral or written. 'r An c nrph re►r is defined as an individual. partnership. association, corporation or other legal entity, or any two or the forcaoing engaged in a joint enterprise. and including* the legal represenmtivcs of a deceased employer. or tht recciver or trustee of an individual • partnership, association or other legal entity, employing employees. Howev oxvner of a dweiIinL 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 wort: on such dti;►elIin or on.the ;_rounds or building appurtenant thereto shall not because of such employment be deemed to be an emp MGL chapter 152 section 25 also states that ever}•state or local licensing agencl•shall withhold the issuance c renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally. neither the 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 char been presented to the contracting authority. .. � .1i !!�+�.:.. .,'• . .I•'.• ..:.mow•'!•.'y; r�.i. 'i.iY: ...'.i`{f::".. Applicants Please `ill in the workers' compensation affidavit completely, by checking the box that applies to your situation supplying company names, address and phone numbers 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. Tlie 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 regi to obtain a workers' compensation policy, please call the Department at the number listed below. �,���.. • ,.. .�. r-�..i„ew•sw...+�� - .v..1w..•�-_��. 7 :..•.i:;iL•tC... City or•towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottc the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be rerun 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 que: please do not,hesitate to ;_ive us a call. , The Departmenrs address. telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents .r Office of Investigations 600 Washington Street _ Boston,Ma. 02111 fax #_(617) 727-7749 ��ie �ammzaruuea/,l� a���cuauc«iccaeffa DEPARTUENT OF PUBLIC SAFETY CONS'T UCftON SUPERVISOR LICENSE H4.'irC'e�" � �0 RLSSsLL 4 Ap4L:�yY 5.`14 S'',ERRY RD "OH 818 S DENNIS, MA 02660 ` : .