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HomeMy WebLinkAbout0014 GUY LANE �4 Gk� bane j _ _ - - --� � _ �� � r' � `� � ' . , � j • � j � ° I, � �; " � �� 11 � i `�� j 1�� //.i:0�� .:. _ f 1� �� �� � �� �� � t► ti, ,I'y�•� �I � , I i �� A `f TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Q0 V Application # Health Division Date Issued q—7 Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address Village GV� . Owner Address Lim c.Y� Telephone � " Nnla4l, Ile (I(3A Permi Request Cl. C tIV LW115 - V&A, 6) Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation �e �� Construction Type --� a r� o Lot Size Grandfathered: ❑Yes ❑ No If yes, attach suporting cocumeu�tation. Dwelling Type: Single Family d'- Two Family ❑ Multi-Family (# units) s Age of Existing Structure Historic House: ❑Yes ❑ No On Old King'sHighway:0 Yeso❑ No Basement Type: UrlI ull ❑ Crawl ❑Walkout ❑ Other 2 Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft)t �+ Number of Baths: Full: existin new Half: existing new - Number of Bedrooms: existing _new Total Room Count (not inc ding baths): existing new First Floor Room Count Heat Type and Fuel: Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes U'Iqo` Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size — Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) 8� 778-01 Name C/1 �/) �'`� Telephone Number 1/ jam,, _ Address 7 /////> ( License# Home Improvement Contractor# Worker's Compensation # ['�V, �3'0/,7007 ALL CONSTRUCTION DEBRIS RE ULTING FROM THIS PROJECT WILL BE TAKEN TO 79 & /nl�) Do2� SIGNATURE DATE �J /� 7a7�' i" FOR OFFICIAL USE ONLY I' APPI!ICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FRAME a, -INSULATION. FIREPLACE 1. ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING.- DATE CLOSED OUT ASSOCIATION PLAN NO. i n The Commonwealth of massachusetts Department oflndustrialAecidents Office of Investigations ' d I Congress Street,Suite 100 Boston,MA 02114-201 Z S. www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organimflonandividual): Tupper Construction, Address:79B Mid Tech Dr City/State/Zip:west Yarmouth, MA 02673 Phone 4 508-778-0111 Are you an employer?Check the appropriate box: I am a employer:with 4. g a am I general contractor and.l Type of project(required): ❑ . employees(full and/or part-time).* have hired the sub-contractors 6• ❑New construction- 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling shipand.have no em to ees These sub-contractors have P y 8. n Demolition working.for me in any capacity. : employees and have workers' insurance.x 9 0 Building addition corn [No workers' comp. insurance P• required.] 5 ❑ We are a corporation and its 1.0.❑ Electrical repairs or additions 3 ❑ I am a homeowner doing all work. _ offcers have exercised their 1.1.❑Plumbing repairs or additions .myself [No workers'. comp. right of exemption per MGL: . 12.E]Roof repairs. insurance required.] t c. 152,§1(4),and we have no Insulation/ employees. [No workers' 1.3.D Other comp. insurance required:] Weatherization *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. 4 Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or.not those entities have employees. if the sub-contractors have employees,they must provide their workers'comp..policy number. lam an employer that isproviding workers'compensation insurance for my employees. Below is the .policy and job site information. . Insurance Company Name:AEIC Policy#or Self-ins..Lic.#:wC.C5005593012007 Expiration Date. 10/3/14 Job Site Address: 14 Guy Lane Hyannis MA 02601- H City/State/Zip: y 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$250.00 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' coverage verification. I do hereby.certify under ae pdi s d penalties of perjury that the information provided above is true and correct Signature.: Date: Phone#: 5087780111 . Official use only. Do.not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person:-- Phone#• j ACORL CERTIFICATE OF LIABILITY INSURANCE °Avc- m THIS CERTIFICATE IS AS q MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE ODES NOTOT AFFIRMATIVELY OR N EGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURRIM AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT. It the certillcate holder is an ADDITIONAL INSURED,the poilc ill I lixi must be endorsed. If.SUBROGATION IS WAIVED,subjectto the terms and conditions of the policy,certain ponc certificate holder in lieu of such endorsement(s). IDS may require an endoreoment.A statement on this certlticate does not confer rights to the PRODUCER AME: T Lora Lowe Southeastern Insurance Agency, Inc. , . (5Q8)gg7_6061 439 State Rd. No 000990-2731 P.O. Box 79398 tw e' N. Dartmouth, MA 02747 INSURED ;INSURE AFFORWNGCCIVHRAGIR NAIL# Tupper Construction Co LLC INSURERA; Arbella'Protect on Insurance IN R I AEIC 27 Roberta Drive INSURpRc: CNA Surety West Yarmouth, MA 02673. INsuR n: . . INSURER Ill - . . . . . . . . COVERAGES CERTIFICATE NUMBER:2013114 11NsuaERp; THIS IS 70 CERTIFY THAT THE POLICELOW HAVE BEEN ISSUED TO THE INSURES NMED AI ON N IES OF INSURANCE LISTED B BOVE FORT E POLICY PERIOD INDICATED.NONVITHSTANDINf3ANYREQUIREMENT,TERM OR A .GONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECTTO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERM EXCLUSIONS AND CONDITIONS OF.SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, S, TYPE OF INSURANCE q p POKY NUMBER EXP GENEItaL LIABILITY 850000874 11101/2013 11/01/2014 untlTb X COMMERCIAL GENERAL LIABILITY - - EACH OCCURRENCE - 8 1 000 000 - �6"Ti'RE' -----�.-- CIAIMS+MADE OCCUR PrtE u 6 100 , A MED EXP(Arty one person) S S 00 PERSONAL BADVINJURY 6 ..1 000.00 . . GEN'L AOOREQATE LIMIT APPLIES PER: GENERAL AGGREGATE g - z eta 0 POLICY WROgUCTS:DOMProPAr6f3 2�00�00 J LOC S AUYOMOALGWmLm 56 249000 1?10112l 12/0112 4 M INFO INGLEl I IT nNYnurD (66a aelu) ° 000 Q ALL OWNBO AUTOS 9001LY INJLrRV(Psrp@p 9 ix A X SDHLtDULUOALrr09 NODILY(NJIJRY JURY(Pat C X MIR@DAUTOS VtRCPEk-YYpp" OApE X NON,OWNED AUTOS {Fer axidenq. S: INC - Well US X OCCUR � 1 - BxcF UAB CLAI 46000583E 11101/2013 11101/2014 EhCMOCCURRENCt. b 1 000 00 A b1SMADE _ DEDUCTIBLE AGGREGATE S. 1,000.00 RETENTION B ID 0 .COMPENSATION AND eMPL01rERS•LIABILrTY YIN - .. WCCSOOS59301200 10/03/Z013 10/03/2014 X B o rcE�miP�a �CNE O?F.CUtfVEf"-� NSA RICHARD TUPPER I s (MAndHtory In NM) 4—J T 'ELIDED —R WC COVERAG E L.�nCr+AUDID vT- 1� 1�000�Q0 Bene-semB+Faa S �.L.DL9Ase.Fa Bunt ors s 1 OQO Op C.L.rnSFhse.POLICY LIMIT 6 . .'"1 000 QO PIS CRIpT1DNOF' tATIoNS1LOCATI6Nt3IVEHICl1G13 iAt►�chAGOADtOt,AddltlonelRlunaMs8cho8uk;IfmorotpMpigrGAylNq) CtvR711l fig HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE l'XPIRATION. OATS THEREOF, NOTICE WILL.BE' DELIVERED:IN 'ACCORDANCE WITH THE POLICY PROVISIONS: "Far Information-Purposes Only. . Tupper Construction Co LLC AUrnowzEDREPREmTArvE 27' Roberta Drive W Yarmouth, MA 02673 Lora Lowe ACORD 26(2009109) Th®ACORD name and logo are ®i SI B-2009 AGORO CORPORATION. All r ghtls reserved o9 registered marks Of ACORD f 'r3ifll,.tlLa F'�t41-ta3'SAPBs .:�f€9€{,?$i3�3�..di 4ay CeparFmgni of Pubfii:$jifety MY Sudding Ri,-gurak,ons and stanglama 4! t677,27,r td?a t•p,.tru,ti„n cur+rr"+.r License: CS-069W8 RICH.ARD S TVPPER 79 a NljD-TECH DR B WEST•YARIIQU"Ih7 ryg t TLOPW Via: 'mot' U:'"s4Fr 3Rt FX?t�tii t�f;. Carn.Fr�ssior,rr 12/31/2014 Peopte Helping Peoptle a iw a Safer World- <yrtKc of t'oAwr�r.oilain 4:ISt;iam Rt;uta#0 #TOME MPROVEMENT CONTRACTOR t Registration: itlt Fly. a ` rv1Eh18t li ' Expiration: eGQ 1g i tnawelualat RICHARDTUPPER ; Richard Tupper ? ,' � �r�• TUPPer Construction RICKARD TUPPER `9 Ra x rta Urine _.✓ i Building Safety Professional i-e -,J W Y;ARMOUTt-i,AAA 02613 - — Member#:8158119 t naerx:recer,y Exp:4f3012034 OWNER AUTHORIZATION FORM (Owner's Name) owner of the property located at P (P(operty Address) 707 Z dG (Property Address) hereby authorize_ U 6 G 1 an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my property. �—q 0ja ti Owner's Signature Date r 09 14 02:35p Tupper Co 15087785010 p.1 TU PRE R CONSTRUCTION CO_ LLc. 79B MID-TECH DRIVE,WEST YARMOUTH,MA 02673 PHONE: 508-778-0111 FAX: 508-778-5010 WNVW.TUPPERCO.COM Date: -�� c pw Town of Barnstable " =` Thomas Perry CBO Ka 200 Mai ri Street s::a Hyannis, Ma 02601 `�- (508) 7 0-6230 fax Re: Insulation Permits Dear Mr Perry This affidavit is.to certify that all work completed for per mit.appli,cation lssu d has been inspected by a certified Building Performance Institute (BPI) inspector. All work performed meets ore cee s Fed ral.and State requirements. Sinc arely, Permit / ; Ad d ress: `L y l Richard , upper . f Lice se; ' CS-6 058 , TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION OF BARNSTABLE Map Parcel �otn # Health Division 2013 €N 25 M 4' 4 S Date Issued Conservation Division Application Fee Planning Dept. Permit Fees D1VIS�t�;=! Date Definitive Plan Approved by Planning Board Historic - OKH _Preservation/ Hyannis Project Street Address I f`cvv z, Village —/Q K n t,5 Owner 1 e GIL, L LC Address ZID Telephone 6 0 S e` alb 3 nn Permit Request �►�V� LC �-C.�.� dVRd,4,► 2 ' t /o 4z:> Square feet: 1 st floor: existing 72-0proposed f 2nd floor: existing�Z� proposed " Total new Zoning District Flood Plain' Groundwater Overlay Project Valuation I QC>6 — 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 °Z. new Half: existing new Number of Bedrooms: H existing _new Total Room Count (not including baths): existing Q new First Floor Room Count Heat Type and Fuel: dGas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes U 0 Fireplaces: Existing : _-mew• Existing wood/coal stove: ❑Yes 0/No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name ����`', - 'v�o��1 0�� �`u Telephone Number —7 — L(Z A r S e # eq Address 16 (� G. &f Licens O 6 L °�-Lt/'c"l goa f / ASS Home Improvement Contractor# 6 —7 l� Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE G/ DATE Z. i'r - FOR OFFICIAL USE ONLY APPLICATION# R DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION - FRAME ' INSULATION FIREPLACE ELECTRICAL:, ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. • S III - The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' 600 Washington Street Boston,MA 02111 www.mass.gov/dia or c s'—Compensation Insurance Affidavit:.Builders/Contractors/Electricians/Plumbers Applicant Information PIease Print Le 'bl y. Name(Business/Organization/IndividuaI): G C,.VL �,� l3�� - l vv r(ti Address: . O (C-k C Our,G7 tt�G�L(svl c�► e(=�rt, City/State/Zip:.Act.S S D 2C((tin Phone#: Zy 7 — 4 �3^ 6'Z� S F1.Areyou an employer?Check the appropriate box: Type of project(required); I am a employer with �J 4. [] I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. .7. ❑Remodeling ship and have no employees These sub-contractors have g,.:Q Demolition working for me in any capacity. employees and have workers . coin insurance.$ 9. ❑Building addition [No workers' comp.insurance P required.] 5. ❑ We are a corporation and its 10:❑Electrical repairs or addition's 3.❑ 1 am a homeowner doingall work officers have exercised their 11.❑Plumbing repairs or.additions myself. [No workers' comp. right of exemption per MGL 12 ❑Roof repairs insurance required.]t c. 152,§1(4),and we have no employees. [No workers' HE 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 or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: C Q, --L i., S cG ,. Policy#or Self-ins.Lie.#: S (0 2 U t%S i.O C F t Expiration Date: Job Site Address:_ y y C2(� LQ"1 P, lfy 44c,c 5 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signafore: / Z / Date: Phone#: 3 Of use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): . 1.Board of health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Co.ntgct Person: Phone#• Office of Consumer Affairs,and Business Regulation t' 10 Park Plaza = Suite 5170 Boston, Massachusetts 02116 Home Improvement Co t actor Registration Registration: 167911 7r Type: Individual Expiration: 11/17/2014 Tr# 233993 ROBERT SABATINI is ROBERT SABATINI �. 16 OLD COUNTY RD HARWICHPORT, MA 02646 ;4 i e �Update Address and return card.Mark reason for change. SCA 1 Ca 20M-05/11 z- 'Address Renewal ❑ Employment ❑ Lost Card — --- ---------------- �f2P (QQ�IY//Ia2Q�/'EUf2CLGGIZ 6�C%(�GClQ6CGClZLGd8L�3 Office of Consumer Affairs&Business Regulation License or registration valid for individul use only rME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: gistration: 1,t7911 Type: Office of Consumer Affairs and Business Regulation piration: y.-AX17/2014 Individual 10 Park Plaza-Suite 5170 - Boston,MA 02116 ROBERT SABATINI IN ROBERT SABATINIF �I 16 OLD COUNTY RD t Y HARWICHPORT,MA 0264V Undersecret� ry Not valid without signature ' Nl,t�sa�huutts Dej�a tme'nt��f Puhlic SItEt� Board of BUiIdiiiii C�uliitir�n� d St.tril tr(1s?< t Construction Supervisor License i ��' *, License ROBERT SABATINI ' �1i3"CRANBERRY HARWICH MA 02645 9 µ r Expiration c5%17/2014 ( ,mtm. i n�ir y 4 Town of Barnstable ti Regulatory Services` 9$ IE� Thomas F.Geiler,Director 1639. ♦� A,Fo Building Division = Tom-P-er-r-y,-Build_ing-C-om miss ion er 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, O�i `� ��d��/ �- , as Owner of the subject ro e P p rty hereby authorize Zboar �tc.�l�/ �C'r�I�`�® �l%!do act on my behalf, in all matters relative to work authorized by this building permit. f r Address of Job) **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 Owner Signature of Applicant 670 Print Name Print Name Date Q:FORMS:OWNERPERMISSIONPOOLS 6/2012 w� !y • �tNE r , Town of Barnstable Regulatory Services 2, : Thomas F.Geiler,Director asnss. i6jg. ,�� Building Division rED MA't A 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: 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 i The Commonwealth of Massachusetts William Francis Galvin- Public Browse and Search Page 1 of 2 The Commonwealth of Massachusetts William Francis Galvin Secretary of the Commonwealth, Corporations Division di t One Ashburton Place, 17th floor Boston,MA 02108-1512 Telephone: (617)727-9640 HILLSEA ROAD, LLC Summary Screen J Help with this form R,equ�est a_uGertlfica"te F The exact name of the Domestic Limited Liability Company(LLC): HILLSEA ROAD,LLC Entity Type: Domestic Limited Liabili , Company(LLC) Identification Number: 001011871 Date of Organization in Massachusetts: 09/14/2009 The location of its principal office: No.and Street: 209 SO WESTGATE RD City or Town: HARWICH State:MA Zip`. 02645 Country: USA If the business entity is organized wholly to do business outside Massachusetts,the location of that office: No. and Street: City or Town: State: Zip: Country: The name and address of the Resident Agent: Name: TONI-ANN NARBONNE ' No. and Street: 209 SO WESTGATE RD City or Town: HARWICH State:MA Zip: 02645 Country: USA The name and business address of each manager: Title Individual Name Address (no PO Box) First,Middle,Last,Suffix Address,City or Town,State,Zip Code MANAGER TONI ANN NARBONNE 23 HILLSEA RD, . YARMOUTH PORT,MA 02675 USA The name and business address of the person in addition to the manager,who is authorized to execute documents to be filed with the Corporations Division. Title Individual Name Address (no PO Box) First,Middle,Last,Suffix Address,City or Town,State,Zip Code SOC SIGNATORY TONI ANN NARBONNE 23 HILLSEA RD, YARMOUTH PORT,MA 02675 USA The name and business address of the person(s)authorized to execute,acknowledge,deliver and record any recordable instrument purporting to affect an interest in real property Title Individual Name Address (no Po Box) First,Middle,Last,Suffix Address,City or Town,State,Zip Code REAL PROPERTY TONI ANN NARBONNE http://corp.sec.state.ma.us/corp/corpsearch/CorpSearchSummary.asp?ReadFromDB=True... 1/25/2013 i The Commonwealth of Massachusetts William Francis Galvin- Public Browse and Search Page 2 of 2 23 HILLSEA RD, I I I YARMOUTH PORT,MA 02675 USA I Consent _ Manufacturer _ Confidential Data _ Does Not Require Annual Report Partnership X Resident Agent. _ For Profit - Merger Allowed Select a type of filing from below to view this business entity filings: ALL FILINGS f € Annual Report i Annual Report-Professional Articles of Entity Conversion Certificate of Amendment (= s7 Vlew:'Flllrigs ; ]l ,r s;New S:ea"rch Comments O 2001-2013 Commonwealth of Massachusetts lr.J All Rights Reserved Help http://corp.sec.state.ma.us/corp/corpsearch/CorpSearchSummary.asp?ReadFromDB=True... 1/25/2013 3 J CD C> C � � N f I �r 'i t . 4 I o -... t r 1 i The Commonwealth of Massachusetts William Francis Galvin- Public Browse and Search Page 1 of 2 -41 ` The Commonwealth of Massachusetts William Francis Galvin Secretary of the Commonwealth,Corporations Division ". One Ashburton Place, 17th floor Boston,MA 02108-1512 req Telephone: (617)727-9640 HILLSEA ROAD, LLC Summary Screen , Help with this form Request a Certificate R The exact name of the Domestic Limited Liability Company(LLC): HILLSEA ROAD,LLC Entity Type: Domestic Limited Liability Company(LLC) Identification Number: 001011871 Date of Organization in Massachusetts: 09/14/2009 The location of its principal office: No. and Street: 23 HILLSEA RD. City or Town: YARMOUTH PORT State: MA. Zip: 02675 Country: USA If the business entity is organized wholly to do business outside Massachusetts,the location of that office: No.and Street: City or Town: State: Zip: Country: The name and address of the Resident Agent: Name: TONI-ANN NARBONNE No. and Street: 23 HILLSEA RD. , City or Town: YARMOUTH PORT State: MA Zip: 02675 Country: USA The name and business address of each manager: Title Individual Name Address(no PO Box) First,Middle,Last,Suffix Address,City or Town,State,Zip Code MANAGER TONI ANN NARBONNE 23 HILLSEA RD, YARMOUTH PORT,MA 02675 USA The name and business address of the person in addition to the manager,who is authorized to execute t documents to be filed with the Corporations Division. Title Individual Name Address (no PO Box) First,Middle,Last,Suffix Address,City or Town,State,Zip Code SOC SIGNATORY TONI ANN NARBONNE 23 HILLSEA RD, YARMOUTH PORT,MA 02675 USA The name and business address of the person(s)authorized to execute,acknowledge,deliver and record any recordable instrument purporting to affect an interest in real property Title Individual Name Address (no PO Box) First,Middle,Last,Suffix Address,City or Town,State,Zip Code REAL PROPERTY TONI ANN NARBONNE http://corp.sec.state.ma.us/corp/corpsearch/CorpSearchSummary.asp?ReadFromDB=True... 1/17/2013 The Commonwealth of Massachusetts William Francis Galvin - Public Browse and Search Page 2 of 2 23 HILLSEA RD, I I I YARMOUTH PORT,MA 02675 USA I Consent _ Manufacturer _ Confidential Data _ Does Not Require Annual Report Partnership X Resident Agent For Profit _ Merger Allowed Select a type of filing from below to view this business entity filings: ALL FILINGS j Annual Report i Annual Report-Professional h Articles of Entity Conversion4if Certificate of Amendment Comments ©2001-2013 Commonwealth of Massachusetts ..� All Rights Reserved Help http://corp.sec.state.ma.us/corp/corpsearch/CorpSearchSummary.asp?ReadFromDB=True... 1/17/2013 Parcel Detail Page 1 of 3 TA1311 IF Logged In As Parcel Detail Friday,January 11 2013 Parcel Lookup Parcel Info Parcel ID[271-004-005 I Developer LOTS Location 114 GUY LANE I Pri Frontage F- Sec Sec Road I Frontage village HYANNIS I Fire DistrictYANNIS Town sewer exists at this address YeS --I Road Index 2002m I Interactive Map V - S Owner Info Owner HILLSEA ROAD LLC I Co-Owner I Streetl 209 SOUTH WESTGATE ROAD Street2 � I City HARWICH I State jMA zip,02645 __ Country J Land Info Acres 10.42 Use :Single Fam MDL-01 �) zoning RC-1 Nghbd[0105 Topography C I Road I: Utilities( I Location I Construction Info Building 1 of 1 Year Roof _ ,._. Ext Built F89 I Struct Gable/Hip wall Wood Shingle , Living __ Roof ---- _- ACE Area 1152 CoverAsph/F GIs/Cmp Type INone Int Bed style Cape Cod T ) wall Drywall I Rooms 4 Bedrooms Bath Model Residential Floor Carpet Rooms 2 FUII - Heat _. Total Grade Average I Type 'Hot Air ' Rooms 6 Roomst, " n_ m Hat Stories Found .. . 1 1/2 Stories Fuel Gas �� ation[Poured e Conc. Gross 2334 Area Permit History rY ........ http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=20326 1/11/2013 . Parcel Detail Page 2 of 3 Issue Date Purpose Permit# Amount Insp Date Comments 8/1/1989 I IB33137 I$45,000 I 1/15/1990 12:00:00 AM 1HY 11/2 S Visit History Date Who Purpose 1/24/2012 12:00:00 AM Denise Radley Change of Address 10/5/2009 12:00:00 AM Denise Radley In Office Review . 7 9/1/2009 12:00:00 AM Michele Arigo Change of Address 6/12/2002 12:00:00 AM Paul Talbot Meas/Listed-Interior Access 5/15/1992 12:00:00 AM IML I Meas/Listed-Interior Access Sales History Line Sale Date Owner Book/Page Sale Price 1 9/23/2009 HILLSEA ROAD LLC 24048/230 $100 2 7/14/2005 NARBONNE,JENNIFER A TR 20044/245 $0 3 4/4/2001 NARBONNE, LEON D TRS 13698/41 $0 4 3/15/1990 SALZMAN, DAVID M TRS 7087/360 $100 5 3/15/1990 SALZMAN, DAVID M 7087/350 $137,500 6 6/15/1986 GREENBRIER CORP 5113/332 $1,735,000 7 7/15/1985 1 RIEDELL, CARL S ETAL 4629/083 1 $011 Assessment History Save# Year Building Value XF Value OB Value Land Value Total Parcel Value 1 2013 $102,100 $19,200 $0 $107,700 $229,000 2 2012 $104,400 $19,100 $0 $107,700 $231,200 3 2011 $130,100 $0 $0 $107,700 $237,800 4 2010 $129,700 $0 $0 $107,700 $237,400 5 2009 $129,200 $0 $0 $144,600 $273,800 6 2008 $134,300 $0 $0 $150,700 $285,000 8 2007 $157,000 $0 $0 $150,700 $307,700 9 2006 $136,900 $0 $0 $154,500 $291,400 10 2005 $129,500 $0 $0 $140,200 $269,700 11 2004 $103,300 $0 $0 $119,200 $222,500 12 2003 $91,700 $0 $0 $57,400 $149,100 13 2002 $91,700 $0 $0 $57,400 $149,100 14 2001 $91,700 $0 $0 $57,400 $149,100 15 2000 $73,400 $0 $0 $35,500 $108,900 16 1999 $73,400 $0 $0 $35,500 $108,900 17 1998 $73,400 $0 $0 $35,500 $108,900 18 1997 $63,200 $0 $0 $28,400 $91,600 19 1996 $63,200 $0 $0 $28,400 $91,600 20 1995 $63,200 $0 $0 $28,400 $91,600 21 1994 $64,200 $0 $0 $44,700 $108,900 22 1993 $64,200 $0 $0 $44,700 $108,900 23 1992 $63,000 $0 $0 $49,700 $112,700 24 1991 $68,800 $0 $0 $49,700 $118,500 25 1990 $0 $0 $0 $49,700 $49,700 26 1989 $0 $0 $0 $49,700 $49,700 http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=20326 1/11/2013 Parcel Detail Page 3 of 3 IL 27 I 1988 I $01 $01 $01 $19,4001 $19,40011 Photos is f 5 i p x I http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=20326 1/11/2013 Town of Barnstable -f t "c C THE Regulatory Services Thomas F.Geiler,Director 16 g' 59 BAMSM ` Building Division ASS' 9 MAM. �a 039. ♦� '°ifp MAC° Tom Perry Building Commissioner 200 Main Street, Hyannis,MA 026 p�d1S!© Office: 508-862-4038 Fax: 508-790-6230 COMPLAINVINQUIRY REPORT . Date: c 05 Rec'd by: G� ke Complaint Name: Map/Parcel Location c ,�( Address: `{ V Ln Lann , G Originator Name: r �j n� 00(��y t� Street: �Yt �."�\vim b� Village: State: Zip: Telephone: Complaint Description: 10,s �is do 6 S CQ o -FOR OFFICE USE ONLY Inspector's Action/Comments Date: Inspector: Additional Info.Attached Q:forms:complaint � 5 . � � � �� � � � �� ����� Assessor's office (1st floor): Assessor's map and lot number °iTNE r° Q Board of Health (3rd floor): Sewage Permit number .......................1 �:C,. ......�yr Z Basa9TABLe, ! Engineering Department (3rd floor): °0 163 9 0m� House number .................. . ✓.. ... ..! ........ '°'Fo gar 1, . .................. Definitive Plan Approved by Planning Board ---------9_-__l-------------19 APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO .......C'/w 5 TiZ L)C ij w C-C(-I/vc- .................................................................................................... TYPE OF CONSTRUCTION ......� F ��.................�? ............ .......... �(................. �l .............................................19........ f ' TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: o r 5- �U n✓6 �N/l/1S Location ...........�N......................... ................................................................................... Proposed Use .................-��I"�6- L 6 q l'� r f( L/ ....................................i. ...............I..........................................................................I......................... ZoningDistrict ..................C...................................................Fire District .............................................................................. Nameof Owner .......................... .............Address ...................................... ........... Name of Builder . prT Cl ......................Address ..< M (� . . ........................... ...................................................I............ Nameof Architect ..................................................................Address .........................................................::........................ Number of Rooms ..................................................................Foundation �UUIZL �........(q,,Vc 'l.t`1-( ........................................ Exlerior ...MCA, 1? .t...S/J �:w(rC(?'7 ' C eblo t-- ....Roofing ....... ....!451,21,110.'..................................................................... r Floors T�nc t(v tIvr Svt .. .... Iti ............................................... Heating ..... c y.A........8cf/ GR:5...............................Plumbing ........�... ..................................................................... Fireplace ............N.d .......................... Approximate Cost .... .tJ..6.'...................:...................... Area .......................................... Diagram of Lot and Building with Dimensions Fee ............................................. OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .. L�.! ...._ ........................................ -.. Construction Supervisor's License g` 3 ( /... ........................... I A=271-004-005 GREENBRIER CORP. �i " No ...33137 Permit for ...l z.. Story..........., Single Family„Dwelling,,.,...,.... Location Lot ,#5.......14„Guy„Lane .................Hyannis Owner ....Greenbrier, Corp,..................... Type of Construction ....Fr,ame......................... ............................................................................... Plot ............................ Lot ................................ III Permit Granted ......August...11..........19 89 Date of Inspection ....................................19 Date Completed ......................................19