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HomeMy WebLinkAbout0014 HARBOR ROAD __ /� �fa�o� ��-- 1 BUU " �, PdGE MG P � �DMQ IoE �638 1 M FRNS�Pg`� THE 14 HARBOR ROAD NOMINEE TRUST��N OF g DECLARATION OF TRUST The undersigned, Jaime Fornos, hereby declares and agrees for himself as original trustee, any additional trustees and all successors in office (hereafter the "Trustee") that One Dollar ($1) is held in trust hereunder and that any and all additional. property, real and personal, and interests in property, and any income therefrom, that may be .acquired hereunder (hereafter the "Trust Estate")shall .:be held�in-gust=fcr-t�z=sole�b_erief:it�uf� cthe beneficiaries from time to time hereunder upon the 'terms herein set forth. 1. This 'Trust may be referred to as "The 14 Harbor Road Nominee _Trust" =and is intended to be -a -nominee trust, ,so-called, ` for federal and state income tax purposes. The Trustee is intended to hold the record legal title to the Trust Estate and to perform such functions as are necessarily incidental thereto. The term "beneficiaries" wherever used herein shall mean the I beneficiary or beneficiaries listed in the Schedule of Beneficial i Interests this day executed by the Trustee. and all the beneficiaries and filed with an original counterpart of this instrument held by the Trustee, :as such Schedule may be revised from time to time hereafter. Any action by a beneficiary contemplated under this instrument may be taken on behalf of a: beneficiary who is a minor or otherwise incapacitated by the beneficiary's natural or legal guardian or by a conservator or custodian of the beneficiary, as the case may be. Any beneficiary may sell, assign, give, bequeath or otherwise transfer all or any part of his or her interest, during life .or t at death. Any such transfer during life shall be effected by a writing signed by the beneficiary and also by the. transferee to acknowledge the transferee's receipt and agreement to be bound by the terms of this Trust. The' Trustee'shall not be affected by i any transfer of a beneficial interest until he has received a copy of the instrument of transfer; and upon such receipt the Trustee shall execute a revised Schedule of Beneficial Interests reflecting such transfer, to be kept with an original counterpart of this instrument held by the Trustee. Any Trustee may be or become a beneficiary hereunder .And exercise all rights of :a j beneficiary with the same effect as though he or she were not a Trustee. 2. The Trustee shall hold the principal of this Trust and receive the income therefrom} for the. benefit of the beneficiaries,:. and :shall pay over the principal and income FGHTRUST AO BOOK7399PAGE 187 pursuant to:the-drect-io`o all:thebenefcaries_, and without - y such direction shall pay over the income when receveditoithel, beneficiaries in proportion to their respective iri€erests,t-„.. reserving therefrom such amounts as all the beneficiaries,may from time to time direct. Any :payments hereunder•or-,upon , termination of the trust to a beneficiary whois` a minors'+or otherwise incapacitated shall be made to, such beneficiary's he natural or legal guardian, ' conservator or custodian; 'and`A . receipt of the payee shall with respect to each1sucl payment be a j sufficient discharge to the Trustee so that lI. ie 'needf not,Fsee to-.. the further application thereof. 3. The;;Trustee shall have no-power_ to deal in or with the _ - fTr�ust Estate except�as- rected-byua?l e�aeriefi�cis-ties�,Wh__eI� . as and to the a.-tent specifically d.�rected by;all�the beneficiaries, the rustee sh 11buy, sell', convbi,aas16ss mortgage or otherwise dispose of, and as lessor' or�as• lessee execute and deliver leases and subleases of, 'all' or',any-part of the Trust Estate; borrow money and execute and1deliver','notes or other evidences of such borrowings; lend money and,execute,.,.and, deliver discharges or other evidences of satisfaction4ort, •,, I modification of such loan; grant and acquire rights ands-easements and enter into :agreements or arrangements with respect .to :the,,,,. , Trust Estate; invest and reinvest the Trust Estate,• or any-part or parts thereof and from time to time change investments; including the power to invest in all types of securities -.and other property, . of whatsoever nature and however''denomInated, even though such property or such inyes1m 1, ` shaTl� beiof ai : character or in an amount not customarily coisiddrediproper for the investment of trust funds or which does or maj"iiotiproduce, income; and sign checks, drafts, notes, bills' of exchange; , , •, acceptances, undertakings and other instrumentstor,%orders, for payment, transfer or withdrawal of money for�'wha`tevdr purpose and to whomever payable, including those drawn to 'the individual_ order of the signer, and sign all waivers of demand;� iprotest,. notice of protest or dishonor of any check, ' draft'; �note, ' bill or other instrument_.made.,,. drawn, or_ endorsed in 'the• name of,the Trust, and direct any person or 'persons to do 'the °same; acting singly or together with others, and whether 'ors not•'serving: as ,a Trustee. Without limiting the generality of' the foregoing,.,the Trustee shall also have full power and authority ,pursuant ;to, the d rect on_of�all the_b-enefic.iaries to execute ands=del- vet deeds, easements, leases and conservation restriat ons', orinominal, l.. consideration or as gifts, to any one or more`'individuals;;or entities including organizations or entities' exempt- from,.taxation. pursuant to Section 501(c) (3) of the Internal' RevenuesCode.,of, I 1986, as amended, or any successor provisions thereto. The Trustee shall have authority to maintain bank accounts ini,the name of the Trust or the Trustee as agent for the beneficiaries for the purpose of facilitating the transfer' ofe'funds- in connection with the Trust Estate. Any and all� nstruments -2- FGHTRUST.XO B-001 .399 PAGE 188 executed pursuant to'—the�direcf"ion of"all-the-beneficiaries may. create rights and obligations- extending over periods beyond the date of any possible termination of the Trust. All the Trustee's powers shall continue in full force and effect for a reasonable period of time after termination of the Trust to the extent necessary to wind up the affairs of the Trust. Notwithstanding any provisions contained herein, no Trustee shall be required to take any action which will, in the opinion of such Trustee; involve him or her in any personal liability unless first indemnified by the beneficiaries to his or her satisfaction. 4. T-he—T-rustmay be terminated at any time b-y any one or more of the beneficiaries, by notice in writing to the Trustee and all other beneficiaries, if. any;. and. upon receipt of such.. .., notice the Trustee bali cause a certificate of termination signed and acknowledged by the Trustee to be recorded with the Registry. Such termination shall be effective when such certificate is so recorded. If not sooner terminated as provided above, the Trust hereunder shall terminate twenty years after the . death of the said Trustee. In _case of any termination, the Trustee shall transfer and convey the Trust Estate, subject to any leases, mortgages, contracts or other encumbrances thereon, to the beneficiaries as tenants in common in proportion to their respective beneficial interests. 5. Any Trustee hereunder may resign by a writing signed and acknowledged by such 'Trustee and delivered to all the beneficiaries. Any Trustee may be removed by a writing signed by any one or more of the beneficiaries- and delivered to such Trustee. one or more additional Trustees may be appointed at any time or times, and in case of any vacancy in the office of Trustee, one or more successor Trustees may be appointed, in each case by a writing signed by all the beneficiaries and by each new Trustee signifying his or her acceptance of the office. No resignation, removal 'or appointment of a Trustee shall be effective. until the particular writing, or a certificate signed and£ acknowledged •by the ,successor. Trustee naming the one or more Trustees having resigned or having been �removed. .or appointed has been recorded with the Registry.. . Upon the appointment of one or .. more successor or additional Trustees, the legal title to. the Trust Estate shall thereupon and without the necessity of any conveyance be vested in. said successor or additional Trustees jointly with the remaining Trustee or Trustees, if any. Each successor 'or additional Trustee shall have all the. rights, powers, authority and privileges as if named as an original Trustee hereunder. No Trustee shall be required to furnish bond. 6. The provisions of this Declaration of. Trust other- than this paragraph .may be amended-by an instrument in writing signed W*;r_-by_a.J the benef:ici.aries _ by the' Trustee and acknowledged. by the. Trustee. or one or more of the beneficiaries. No such _3_ FGHTRUST:XO ao�K '39 p�� 189 amendment amendment shall be .effective until suchinbsttrieent of Trustee setting or a certificate signed and acknowledged Y forth the terms of such amendment has been recorded with the Registry. 7. No Trustee hereunder shall be liable for any error of judgment or for any loss arising out of any act .or omission in r own good faith, but shall be respinsii le ofe onlcourt shally for his rbeerequisite willful breach of trust. No the Trustee. I to the validity of any transaction entered into by transferee, pledgee, mortgagee or other lender need No purchaser, or property loaned or see to the application of any money delivered to any Trustee or ensure compliance with the terms and conditions of this Trust. g. Any person dealing with the TrusEstate certifirustee cateTsigned may always rely without further inquiry upon on a be a Trustee by any person appearing from the Registry hereunder as to .the identitit f fhtheTrustee Trusteerto the actbeneficiaries astothe hereunder, as to the author y existence or nonexiste acts by y the c Trustee factst or constitute or which arein any conditions precedent to Y provided, other manner germane to the affairs of rhrecording of such however, that the execution, delivery certificate shall not be a condition precedent to the validity of any transaction of the Trust. reement, lease, deed, mortgage, note or other 9. Every agreement, an person instrument or document executed todberaaTrusteection ahereunder shall be appearing from g thereon or conclusive evidence in eunder thataatr of the timeyofethendelivery thereof or claiming•ther of the taking of such action this Trust was in full force ofdsuch effect, that the execution and delivery thereof or taking other action was duly authorized, empowered and directed by all the beneficiaries, and that such .instrument or document or other d, binding, effective and legally action taken was vali enforceable. 10. if there are at any time more than one Trustee, the Tr`ustees sYiall act—by,_unan mou g eemen_t�; except that by a s any Trustee hereunder may delegate all or writing or writing_ , any of that Trustee's powers and disc rattime and amay revoke eoror a period. of not more than one y successively renew such delegation. Notwithstanding the foregoing, any action of the Trustees neYoethelTruste sy and signature and acknowledgement of any note or other instrument t every agreement, lease, deed, taken mortgage, an per-son appearing from or document executed or action taken by Y P the Registry to be a Trustee reunder rson relyingathereonll be oorlclaiming ever evidence in favor of Y P -4- FGHTRUST.XO BOOK7�PAGE �,90 thereunder that at the time of delivery thereof or of the taking of such action this Trust was in full force and effect, thet'the execution and delivery thereof or taking, of such other action was duly authorized, empowered and directed by all the Trustees I. all the beneficiaries, and that .such instrument or document ors other action taken was valid, binding, effective and legally ' enforceable. 11. The term "Registry" as used herein shall mean the Barnstable County Registry of Deeds; provided that if this Declaration of Trust is recorded or filed for registration in any other public office, within or without the Commonwealth of Massachusetts, any person dealing with portions or all Commonwealth, Trust Estate as to which documents or instruments are recorded or filed for registration in such other public office in order''to ` constitute notice to persons not parties thereto may rely upon the state of the record with respect to this Trust in such`'other public office, and with respect to such portions or all "o"f the' ` Trust ,Estate ,the term "Registry" as used herein shall mean such other public office. 12. This Declaration of Trust and the trust_ hereunder shall be construed and administered in accordance with the lawskof `The. Commonwealth of Massachusetts from time to time in force. Executed under seal in two original counterparts this day of December, 1990. - u tee -5- FGHTRUST.XO a0419 P46F 19l COMMONWEALTH OF MASSACHUSETTS Barnstable, ss. December /, 1990 .:. Then personally appeared the above-named Jaime Fornq$.oa;n4,-,, acknowledged the foregoing instrument to be his free- act"and , '' ; .deed, before me, Notary Public My Commission Expires: °+ ,rr�r�ti•' r I i FGHTOST.XO -6- RECOR�EU DEC 3190 14 Harbor Road. Nominee Trust REALTY TRUST Declaration of Trust Dated ptv. 3, 1990 121h SCHEDULE OF BENEFICIAL INTERESTS DATED: Sp_,1999 Beneficiaries Proportionate Interest ,Jaime Fornos and:Marlise:D. Hammond, Co-trustees,or their successors in trust, under"The Jaime Fornos Trust dated A ,1999 28.571438670% Marlise D. Hammond 71.428571330% We, the above-named trustees and beneficiaries of 14 Harbor Road Nominee Trust Realty Trust, do hereby approve the terms of said Trust, and agree for ourselves and our heirs, executors, administrators, successors.and assigns, both individually and as. trustees, to be bound by said Trust, to reimburse the Trustees for any expenses incurred in the performance of their duties, and to hold each of the Trustees and their successors harmless from any personal liability whatsoever, whether in.tort or in contract, for any error of judgment, or for any loss arising out of any act or.omission in the execution of the Trust so long as such Trustee acts in good faith, and we 'further agree that the Trustees may withhold.from any distribution, transfer or conveyance such amounts as they from time to time reasonably deem necessary to protect themselves from such liability, except that each Trustee shall be responsible for his or her own willful breach of trust,knowingly and intentionally committed but not for the breach of trust by any other Trustee. Page 1 RT lu EXECUTED under the seal as of this day of 11999. Jaime Fornos,Individually and as Trustee arlise D. Hammond,Trustee COMMONWEALTH OF MASSACHUSETTS Barnstable, ss. 1999 I Then personally appeared the above-named Jaime Fornos and Marlise D. Hammond, and acknowledged the foregoing to be their free act and deed,before me. Notary Public My Commission Expires: S'12p Z RT Page 2 - 9/3/2019 flexmis Web Residential Active MLS#:21900233 14 Harbor Road Hyannis MA 02601 LP:$549,000 " s Property Type: Residential Prop Subtype: Single Family Residence " v - County: Barnstable Village: Hyannis Town: Barnstable Beds: 5 _-�- Rooms: 10 Approx SgFt: 2,700 Baths F/H: 2/2 Lot Acres: 0.24 Year Built/Desc: 1953/Approximate DOM/CDOM: 230/230 - -, Tax ID: 306-179 Annual Taxes/yr: $4,851 /2019 Total Assessment: $510,700 Building Assessments: 180,800 Leased Land: No Land Assessments: 298,600 Other Assessments: 31,300 WF/WV: No/No Remarks:Charming Cape with private way to the beach and lots of possibilities.First floor of main house has 3 bedrooms,1 full and 1 half bath,a living room,and a kitchen with dining area(1,336 s.f.)second floor which is unheated has two-rooms plus a half bath(655 s.f.).Cottage has 2 bedrooms,a bath,a living room with kitchenette,and a loft(725 s.f.).Property has deeded rights to a private way that leads to a sandy beach.Property is on town sewer,so there is potential for expansion.15 Carl Ave.is the lot behind 14 Harbor Rd.It is for sale separately at$349,000(Listing number 21900235)but it will not be sold until a sale is made on 14 Harbor Rd.Taxes may vary due to owner use of property;buyer should confir Directions:Sea St.to Gosnold to Harbor,to#14 on the left. Listing Type: Exclusive Right To Owner Name: Madise D Hammond&James - Sell W TRS Listing Bernard W Klotz 508-737-5684 List Date: 01/14/2019 Buyer Agent 2.5% Agent: bernie@bkrealestate.com Fallthrough 06/22/2019 Comm: Listing Kinlin Grover BK Real 508-778-4005 Date: Facilitator 2.5% Office: Estate DOM/CDOM: 230/230 Comm: Original List $689,000 Dual Var Comm: No Price: Garage: No Zoning: RB Sub-Area: Hyannis Park Basement: Yes Lot Size SgFt: 10,454 Renovated: Yes Basement Bulkhead Access;Full;Interior Lot Size Source: Field Card SgFt Source: Estimated Description: Access Siding: Shingle School District: Barnstable Foundation Block Roof: Asphalt,Pitched Beach Ownership: Public Irregular: No Year Built: 1953 Miles to Beach: ' 0-.1 Year Round: Yes Beach Description: Nantucket Sound Special Listing None Flood Ins Required: Not Verified Cond: Lead Base Paint: Unknown Title Ref Book: 26853-340 Title Ref Page: 340 Interior Features: Hookup Washer. Exterior Features: Deck Street Description: Paved Convenient To: In Town Location;Medical Facility;Shopping Appliances: Dishwasher,Range-Electdc,Refrigerator,Washer Showing Instructions: Appointment Required;Call Listing Agent;Call Listing Office;Yard Sign Stories: 2 Heating: Forced Hot Water Pool: No Style: Cape Cooling: None Dock: No Floors: Tile,Vinyl,Wood Hot Water: Tank Living/Dining Combo: No Not Water Source: Natural Gas Kitchen/Dining Combo: Yes Water: Town Water Mass Use Code: 10-Multiple Use Property Sewer: Public Sewer Separate Living Qtrs: Attached Fuel: Natural Gas Room Name Room Level Length Width Features Room Name Room Level Length Width Features Master Master Bedroom Level:First 14 13 Closet;Private Half Laundry Room Level:Basement Bedroom Floor Bath; Living Room Living Room Level:First Floor 19 11 Flooring:Wood Flooring:Wood Bedroom 2 Bedroom 2 Level:First Floor 11 10 Closet; Flooring:Wood Bedroom 3 Bedroom 3 Level:First Floor 11 10 Closet; Flooring:Wood Bedroom 4 Bedroom 4 Level:First Floor 13 10 Kitchen Kitchen Level:First Floor. 18 11 Dining Area; Information is deemed to be reliable,but is not guaranteed.©2019 MLS and FBS.Prepared by Margo Pisacano on Tuesday,September 03,2019 1:38 AM.The information on this sheet has been made available by the MLS and may not be the listing of the provider. �Assec tce(1st floor) Map ( Lot Permit# Cc�servation Office(4th floor) - Date Issued ,wn ei /S _. Board of Health(3rd floor)(8:30-9:30/1:00-2:00) Fee. 0 • 0 d Engineering Dept.,.(3r&floor) House# I • Planning Dept. (1st floor/School Admin. Bldg.) RNSTABLE.�` �. MASS. Definitive Plan pproved by�Planning Board 19 r� TOWN OF BARNSTABLE U Building Pe it Application Project Street Ad ess Village �y Owner (� m _ c(Z- c) Address l � o tZ Telephone "(� ' 4 0 0 Permit Request �i e 4�zx Q-1c Total 1 Story Area(include 1 story garages&decks) \'\p 6 square feet Total 2 Story Area(total of 1st&2nd stories) square feet Estimated Project Cost $ (2� C) Zoning District Flood Plain Water Protection Lot Size Grandfathered ? Zoning Board of Appeals Authorization Recorded Current Use 9 S ��I-\ Proposed Use Construction Type v� �� a\•e S Commercial Residential S Dwelling Type: Single Family Two Family Multi-Family Age of Existing Structure \C S Basement Type: Finished Historic House Unfinished Old King's Highway Number of Baths No.of Bedrooms Total Room Count(not including bat ) First Floor Heat Type and Fuel VJ c> \ \ Central Air Fireplaces YP P Garage: Detached Other Detached Structures: Pool Attached Barn None Sheds Other Cd 1 Builder Information Name Ae I Telephone Number Address A�1\ Q� License# p Home Improvement Contractor# \ Ca `F> C.�-1 Worker's Compensation# \( /� Q�( I%\-a O a2 �S NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONS RUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO R SIGNATURE DATE °'t°1 BUILDING PERMIT DENIED FOR TIOOLLOWING REASON(S) FOR OFFICIAL USE ONLY MIT NO. #5787 DATE ISSUED June `15, 1995 MAP/PARCEL NO. 306. 179 l ADDRESS 14 Harbor Road VILLAGE Hyannia, MA 02601 OWNER +FoYnos, Jaime; Trs. *Dean F. Stanley (contractor) DATE OF INSPECTION: FOUNDATION x FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: - ROUGH FINAL FINAL BUILDING k li DATE CLOSED OUT ASSOCIATION PLAN NO. ,4. tt'94 17:02 V6177277122 DEPT IT'D ACCID Q 00 r fir. Cat;u"nitleaCtlL o Wa.JJac{zudetb ' aUa�oarfntenf o�.�nc�u�frr'a�✓�ccic�enf� 600 Wu4i j&.Srn�r James J.Campbell &ton, //(adda9WA 02f f f Commissioner Workers' Compensation Insurance Affidavit (Qodtscrlpamaree) with a principal place of business at: AR ^ � • (CccYlSrse�/Ziv) do hereby certify under the pains and penalties of perjury, that: () I am an employer providing workers' compensation coverage for my employees working on this job. Insurance Company Policy Humber () I am a sole proprietor and have no one working for me in any capacity. i am a sole proprietor, eneral contralto or homeowner (circle one) and have hired the contractors listed below w o ve the following workers' compensation policies: Contractor Insurance Company/Policy Number Contractor Insurance Company/Policy Number Contractor Insurance Company/Policy Number O I am a homeowner performing all the work myself. I u^d_:•star,d t t a copy of diiis stztement will be fone.zrded to the Office of Investigations of the OTA for coverage verification and that failure to secure ceVerage as rr;=ired under Section 25A of MGL 152 can lead to the Imposition of criminal penalties consisting of a fine of up to S 1,500.00 and/or cr. years' impri<crment as well as civil penalties in the for:of a STOP WORK ORDER and a flne of S 100.00 a day against me. S' this day of J 19 �— LiCensee/Permittee Building Department Licensing Board Selectmens Office Health Department TO VERIFY COVERAGE INFORMATION CALL: 617-727-4900 X403, 404, 405, 409, 375 TnT%TT nr RARN4T.ART F RTTTT.TITMC PFRMIT # a >+ E� The Town of Barnstable %RNVABLL Department of Health Safety and Environmental Services MAS& ,. lfcM>+►'° Building Division 367 Main Street,Hyannis,MA 02601 508-862-4038 508-790-6230 PLAN REVIEW Owner: u ,1 ` p ` n Map/Parcel: Project Address: '" i ttcur'DOr RA Builder: oAa©c-k The following items were noted on reviewing: Reviewed by: Date: I Asse`s'sor's map. and lot number ............. .•./:/�•��•••• ` 4 SEPTIC SYSTEM MUST BE / 'INSTALLED IN COMPLIANCE Sewage Permit number 'c-1 � WITH TITLE 5 F7RE TOWN O JJ.L- R" lm�E � ®E AND Z ]BARNSTABLE, i " "b BUILDING .- INSPECTOR, APPLICATION FOR PERMIT TO ...r.........................:.....................................:......................................................... TYPE OF CONSTRUCTION .................. ... ... ........ ........... ................. ............................................ ................................................19........ TO THE INSPECTOROF BUILDINGS: " The undersigned hereby applies for a permit according to the following information: Location ..... ! r.�a ....I� ......1.:{��J .......................................................... ................................... c/ ProposedUse ..... .............................................................................................................I......................... ZoningDistrict ........................................................................Fire District ..............................:............................................... Name of Owner jt4r .......F.O.& I.0 S. ....OI AI ........:.Address ....Ali...1.� .0......... Address �/ C .4.. /��%.���e...�1�....t`y ,P-f'1.t?.l.S�.s Name of Builder .`+�-4 ....Sl, .!?a v.P. �7 ....co...................... ,�. ..,�.. . /! Nameof Architect ..................................................................Address ...:................................................................................ Number of Rooms ...Foundation ..1=oo i.N��.�i.... q '..:P..5?5.B....................... . ............................................................... ..... Exlerior ....................................................................................Roofing —4..�O�ief. 7...........,................................................... Floors ......................................................................................Interior .................................................................................... Heating ..................................................................................Plumbing .................................................................................. Fireplace .........................................Approximate Cost ......Z.s16.c?pi...•.•............................ .. ........ Definitive Plan Approved by Planning Board -----------___-----------------19________ . Area . ....5. ... . ........ Diagram of Lot and Building with Dimensions Fee '— SUBJECT TO APPROVAL OF BOARD OF HEALTH s� EY15 1175 Hots 3'-A 'v AaI)#rion /3� q► L • 4, > I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ....... ....... ....'......... ..... .................................. l • c FORNOS, J. f Wo .A'12al... Permit for ............. t ...........:.......sari?Qx: ........................................ R Location ......1.4...H.d7rk?0J:..ZQAd......:.............. ..................... ........................................ Owner ... ......F.Q.rXIQ 5........................................ y � Type of Construction .Xr.aMe..........:...............: � ................. . ........................................................... Plot ................. Lot ................................ I t _ - Permit Granted June 24.r.........19 80 ............................ s Date of Inspection .................................... Date Completed ....:x�..^5�° .n........19 F PERMIT REFUSED ........... .... ......................................... 19 ..................................................... . .'. ::...................................................... .. ................................................... Approed. .......:....................................... 19 .............. ................................. ............................................................................... Assessor's map and lot number .............................. Sewce Perm.+. number ..!�../ fir ,}r *7HETO�y� TOWN OF BARNSTABLE Z BARISTADLE, ° .6 9 , BUILDING INSPECTOR O�U MPY h APPLICATION FOR PERMIT TO ............................................................................................................................. TYPEOF CONSTRUCTION ..................................................................................................................................... ................................................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ..........:...............................................................`` , . .......................................................... ................................... ' v� ProposedUse ...............:.......:.r:. .............................................................................................................................................. ZoningDistrict .........................................................................Fire District .............................................................................. ~ Name of Owner .....::. f'.....r-C,rr n n.L:...' -ro.g.�o.S......Address f...`. ....: is"l.n� .....r>,4� .1-/1. 4 ?.?....5 ���.......... •, •� Name of Builder „�...p r� ........................Address ��` � s.� ?�%aLs/ P l� s-�,.r..:.1 r r .. ........ ... ... ................. . Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ..................................................................Foundation .. ..!:.M ................. < .ar �. . Ts ........ .�. .... ................. Exterior Roofing ..�:. al Floors .........................................Interior ............................. ............................................. ....................................................... Heating ..................................................................................Plumbing ................................................................................... Fireplace ..................................................................................Approximate Cost /F., r7 c>. ., ............. ................................................... Definitive Plan Approved by Planning Board ________________________________19________. Area `��'1. .... .. ............. Diagram of Lot and Building with Dimensions Fee ..................." � i SUBJECT TO APPROVAL OF BOARD OF HEALTH [:.a!' I t{ I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. r: Name �......4.........................F........................................... . , ~ FERNDS. J _ . . . � . \ � JNo �Parm f�r , Carort ----............�.........—.. .................... ` ~ \J ' Location .l4.. ;�:..�lQ.ia.d.......................... ------ .......................................... J ` Type of ` Plot / ' O ` � ' 19 ' � � ~~.^ Completed � � ^ � PERMIT REFUIED ' . lA ' , � __,~,,,.,,J1—.---|. .---..~--...—.. l[' � � / ............................................ ................................... ' - � \ - ' / .—.---...,-.~--.—.—..—..~—..---~.`' ^ , � . Approved ---------------- lQ ! _________________.___~___._,. . -----------'^—^—^~^^^^'—^^^^^'^^— ~ �� Is r pF11 Town of Barnstable *Permit# a 201 p� Expires 6 months from issue date BAMST,BLE, : Regulatory Services Fee 9c� 0,19. `0�' Thomas F.Geiler,Director �/� Building Division Tom Perry, Building Commissioner ✓� �°°� �® 200 Main Street, Hyannis,MA 02601 T N 2 ��A® Office: 508-862-�4038 OP �200,� Fax: 508-790-6230 16-11j j,9r. A)` EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY qe4,rz Not Valid without Red X-Press Imprint Map/parcel Number 30 to Property Address I q 114^n Q ht_ R& N\$4&A/YUY A o I ( ,�Residential Value of Work 0,©De,) Owner's Name&Address (3'ln, € 6Y1 n o Q-),nm2,a ,nn1 Contractor's Name o n d( co Pc Telephone Number S DS • `f;t g-q 4,6SP Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) 0 4 f O t L ❑Workman's Compensation Insurance Check one: Q9 I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping..Going over existing layers of roof) ❑ Re-side [t Replacement Windows. U-Value An,1oG iQ SnA) (maximum.44) OOubtG Pub *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note Property Owner must sign Property Owner Letter of Permission. ome lmprovemen ontractors License is required. Signature ' Q:Forms:expmtrg Revise053003 r T'4-�+ Town of Barnstable Regulatory Services sa t E MASS. $' Thomas F.Geiler,Director .erF1639.MACa Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I '. [✓ , as Owner of the subject property hereby authorize U 04 PAM OC,C 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 Q:FORMS:OWNERPERMISSION Town of Barnstable ' `^• ' 200 Main Street, Hyannis MA. 02601 508-862-4038 Application for Building Permit Application No: TB-17-2044 Date Recieved: 6/29/2017 Job Location: 14 HARBOR ROAD,HYANNIS Permit For: Building-Insulation Residential Contractor's Name: Carl J Rebello State Lic. No: CS-084358 Address: Swansea, MA 02777 Applicant Phone: (508)567-4109 (Home)Owner's Name: HAMMOND,MARLISE D&JAMES W 'Phone: (603)387-1352 TRS (Home)Owner's Address: PO BOX 206, WATERVILLE VALLEY,NH 03215 Work Description: Insulation,Air Sealing&Door Weatherstrips 10 Total Value Of Work To Be Performed: $3,519.00 -ca • €ra Structure Size:' 0.00 0.00 0.0�0? Width , Depth Total lea I hereby swear and attest that I will require proof of workers'compensation insurance for every contractor,subcontractor,or other worker before - he/she engages in work on the above property in accordance with the Workers' Compensation Act(Chapter 568). I understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by filing a waiver with the appropriate District Office;and.that..a sole proprietor of business is not required to have coverage unless he files his intent to accept coverage. .. I hereby certify that I am the owner of the property which is the subject of this application or the authorized agent of the property owner and have ` been authorized to make this application. I understand that when a permit is issued,it is a permit to proceed and grants no right to violate the Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and specifications. All information contained within is true and accurate to the best of my knowledge apd belief. All permits approved are subject to inspections performed by a representative of this office. Requests for,inspections must be made at least 24 hours in advance. Signed: Carl Rebello 6/29/2011 (508)567-4109 Applicant Date Telephone No. Estimated Construction Costs/Permit Fees Total Project Cost ; $3,519.00 Date Paid Amount Paid Check N or CC# Pay Type Total Permit Fee: $85.00 6/29/2017 $85.00 Paypal Paypal Total Permit Fee Paid: $85.00 ` 1 a0, 3� Town of Barnstable *Permit# F.Vires 6 moontt hs from ir date �7 Regulatory Services Fee aARrtsrnai.e, % T— "M Richard V.Scali,Director Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us �oF �JP1�I� a Office: 508-862-4038 &;�: 508 790-6230 . EXPRESS PERMIT APPLICATION _. RESIDENTIAL ONL`' ST Not Valid without Red X-Press Imprint �e c Map/parcel Number 3 O Property Address 14 9Aar6or, �- , 0.lycanwis . 61iA 6 Z6o I [?Residential Value of Work$ i 3,$Gb Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address I 1 Ir ;St R%.mmenx `I 02.601 Contractor's Name (11 CNN-.e 1 Or"(-� , Telephone Number ..4-08- ys/- Home Improvement Contractor License#(if applicable) 0 SO Syq Email: eon. Construction Supervisor's License#(if applicable) GS s 07-7 L9 116 [?%Torkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner ER"I have Worker's Compensation Insurance Insurance Company Name / s Sae-u - ��+n12/oXer'-.% Gp ~ Workman's Comp.Policy# WC.0 5Ov SowR99 ZVI9 ,A Copy bf Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(riot stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders:U-Value . 31) (maximum:.32)#of windows �® #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red Sand inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: a. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 040215 The CommonweaM of Massadjusetts Deparhaent of Industricd Accideitrts QKwe ofInswfigtations 600 Wasliringtana,Street y Boston,CIA 02111 nwm massgovIdia Workers' Compensation Insurance Affidavit: Bunters/Contractors/Electricians/Plumbers Applicant Information Please Print I&m'bIy Name City/SU&2� p: Ce-gl erg,Ile- , ✓nA 6243Z Phone#: -6-08 P /st - 9&I'l,0 Are you an employer?Check the appropriate box: T of rei'ect 1.E?I arm a employer with 2— 4. ❑ I am a feral contractor and I Type p employees(fun andlor pact-b=)_s have hired the suer-contractors- 6 ❑New ] Remodeling 2.❑ I am a sole proprietor or partner- listed on.the attached sheet.. 7- ❑ ship and have a4 employees These sob-oarttractocs haxe g- ❑Demolcticri and have workers'woticing me in any capacity. employees 9. ❑Building addition [No workers'Comp.iaSMance comp.iUSUFI....m l , mod-] 5. ❑ We are a corporatim and its 10..❑Electrical repairs or additions 3.❑ I am a homeowner doing all work ofDs hale exercised their 11-❑Plumbing repairs or additions .myself.[No workers'comp_ ,x tip of exemption per MGL 12.❑Roof repairs ingtimnce require&]T c.152, §1(4X and we have no employees.[No wo 13.0 Other comp.insurance required.] *Any applicant that checks fox#1 tnasd also En out flee section bebw showing the wozkeWcompensation-policy ilarmffieon-. HomeowDers wbo submit this afidava m&mtLpg they we doing all Wal and then hire o coamictu s omit submit a new afdmit indicao ag such. ICon=cmn that check this boa must attached as additional sheet showamg the name of the and state Whedw ornot those entities hme employees. If the sab-caatrastorshave employee%ftey— prowde their workers'comp.pally member. I ant an omp€ay-er tliat is protzding x arkers'congwisoorc insurance for my ompIoy-ees. Bdow is the policy and job site isfmwatio& Insurance Company Name: eo• Ile t c— Policy#or Self ins.Lic-4: LVCG S'ooS'P7 9g9 20 t 5 A Expiration Date: 3 /6 D 16 Job Site Address: 14 Kbor- RCOL CityfStat&Zip: M fcw.,3 Attach a copy of thee workers'compensation policy declaration page(showing the policy number and ration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a Sue up to$000.00 andtar ante-year impri ,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a day against the'violator. Be.advised that a cop yy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage ve tion- I do hersby c a fy wl der the pains aitd pen ables ofpodWy-that the information prodded abmv is true and correct Siunatrtr�/'ll/ � Date:' 6/52/5� Phone#: SIC>a- 19.6,/ Official use only. Do not write in this area,to be completed by city or town official, City or Town: PermitUcense 9 Inning Authority(circle one): 1.Board of Health 2.Buidding Department 3.City/Town Clerk L Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone 9: 6 oftta ray, • . � t I '""1 Town of Barnstable Regulatory Services Richard V.Scali,Director Building Division Thomas Perry,CBO Building Commissioner , 200 Main Street, Hyannis,MA 02601 , . www.town.barnstable.ma.us Office: 508-862-4638 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder `�If S g' '�V %%Cm s O of th bect awner e suj ro eI, � �l, t(oil .. A . l property rty hereby authorize ftLw-c �TP�S�►rt' to act on my behalf, e in all matters relative to work authorized by-this building permit application for: (Address of Job) ' ? 14_.4AA&t4x � Signature of Owner bate V� Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. QAWPFILESTORIVL4\building permit forms\EXPRESS.doc Revised 040215 Town of Barnstable Regulatory Services . Richard V.Scali,Director Building Division * &UMST" • Tom T Per MASSry,Building Commissioner 1639. 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 containing35,000 cubic feet or larger will be required to comply g q with the State Building Code Section 127.0 Construction Control. PY g 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. p or. The homeowner actin as p g 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:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 040215 ent of Public MassachusettsSafety artm Standards 1� -R gulations and Board of Building Construction Supervisor g46 License: CS-0771 GA 356 BaY Ln . Centerv►l1e MA O'3632 ' Expiration i 0312312016 - Commissioner unr estricted-Buildings of any use group which 3 feet 991m of 5 00 0 cubic ) contain less than 3 � enclosed space.: Failure to possess a current edition of the Massachusetts, State Building Code is cause for revocation of this license. For'DPS Licensing information visit: %h".Mass.Gov/DP5 ✓/. � � ealt/ aryar�a l License or registration valid for individul use only Office of ConsumerTffa rs. Business egulahon HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: ;4>180849 Type: Office of Consumer Affairs and Business Regulation Expiration: -1J20L2017 LLC 10 Park Plaza-Suite 5170 Boston,MA 02116, MI EL GASPARDILC=. d MICHAEL GASPARD� 356 BAY LANE CENTERVILLE, MA 02632 Undersecretary Not valid without signature r._ MICHGAS-01 MVAUGHAN ACORO" DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 612►2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: ROgers&Gray Insurance Agency,Inc. PHONE FAX 434 Rte 134 A/c No Ext: AIC No): South Dennis,MA 02660 E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:NATIONAL GRANGE-MAIN STREET AMERICA INSURED INSURER B:Associated Employers Insurance Co. 11104 Michael Gaspard LLC INSURERC: dba Renovation Specialists 356 Bay Lane INSURERD: Centerville,MA 02632-3308 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY 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 PAID CLAIMS. INSR TYPE OF INSURANCE AD L UBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MMIDD MM/DD A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS-MADE N OCCUR MPP6672B 05117/2015 05/17/2016 PREMISES Ea occur re $ 500,000 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 RO X POLICYFI ECT LOC PRODUCTS-COMP/OP AGG $ 2,000,00 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accdent ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS PROPERTY DAMAGE NON-OWNED PROPERTYaccident) ccident $ HIRED AUTOS AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER B ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N WCC5005079992015A 03106/2015 03106/2016 E.L.EACH ACCIDENT $ 500,0000 OFFICER/MEMBER EXCLUDED? Y❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TOWN OF BARNSTABLE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200 MAIN ST. ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD