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HomeMy WebLinkAbout1220 IYANNOUGH ROAD/RTE132 (2) �.�.� �oD� �o�g it \� 1 S .��� . • Application numbe 6...... ............... .....- ate ssued.. ........✓............................................... . Q ', BA9D�$'�A,SI.E. %639� Building Inspectors Initials.......... .. . .................... F AUG 10201� Map/Parcel... .. ..... TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDO W S/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: =F,41VAI D 7_7 C" _" _ �IIJC ET VILLAGE �_' J /� 7— ���/ Owner's Name: ,� i� -r- , ,�. Phone Number -77 `� �An/® iA� Or Px,ov fay NC_i , C C Email Address: Cell Phone Number 7 7 y" 4�F 7" F/P Project cost 2,6w- d Check one }Residential Commercial , OWNER'S AUTHO ION ZAA 14 A' As owner of the abov p perty I here a tho ' e R-t moo r,v a rr Qom/ to make application o a,b ilding pe t ' a cor ce with 780 CMR /l G CAAL6s ate yl o Owner Siature: D . Typk.OF WORK 0 Siding 0 Windows (no header change) # 0 Insulation/Weatherization 0 Doors (no header change)# Commercial Doors require an inspector's review ,Roof(not applying more than l layer of shingles) Construction Debris will be going to JZb6� c ©r-, r ` CONTRACTOR'S INFORMATION Contractor's name ' P Lf� Home Improvement Contractors Registration(if applicable)# _S �2 (attach copy)+ , Construction Supervi'sor's License# I Q 1� « �1 (attach copy) Email of Contractor �'-i� 12 Z Phone number 3 �° ALL PROPERTIES THAT HA VEITRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE PERMIT CAN BE ISSUED. k . Sabatt Law Offices Charles 14.Sabatt 540 Main Street,Suite 8 Hyannis,MA 02601 i i Tel 508.775.5050 • Fax 508.778.4600 CMS@SabattLaw.com 1 SabattLaw.com ., Town of Barnstable Building " i .". a:. '€ - s.' "3.�v, Z.vR`.�aF a s..�,,� a` "4. ;:< 'z.T g •yaw+r-» .\_,.,.«x• yes e«,.�..y.» ,. POSt ThISBARIMA Card Sohat�itisV�sibieFrom,the Streets ApprovedPlanszMust be Retamed.on Job arid;this Gard Must be Ke„t Permit i6s� . Posted�UntilFina1 InspectionHas Been Made " Where a Cectificate.of Occupancy is Requ�red,suchg Bu�ldmg shall Not be Occupied unt�Ia;Final ln,spectiori has:been;made . .. �. ...�„�.�,.�,.ti Permit NO. B-18-2604 Applicant Name: C&F REMODELING INC Approvals Date Issued: 08/13/2018 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 02/13/2019 Foundation: Location: 1220 IYANNOUGH ROAD/RTE132, BARNSTABLE Map/Lot 274 007-B00 Zoning District: HB Sheathing: Owner on Record: P&LL INC CortractorName ~eC&F REMODELING INC Framing: 1 Address: PO BOX 1776 - Contractor;License 153792 2 HYANNIS, MA 02601 Est Project Cost: $12,000.00 Chimney: y: Description: Re-Roof rt - - rmnFee: , = $ 160.00 Insulation: `fee Paid $ 160.00 Project Review Req: Final: Date 8/13/2018 ` \ X Plumbing/Gas ( �r r Rough Plumbing: I Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. Rough Gas: �.Y ,t g All work authorized by this permit shall conform to the approved applic"ki6&and the'approved construction documentsxfor•which thi's permit has been granted. All construction,alterations and changes of use of any building and st$uctures shall be in compliance with the local zoning by laws and codes. Final Gas- This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for publi�spe idn for the entire duration of the work until the completion of the same. ' Electrical _ The Certificate of Occupancy will not be issued until all applicable signatures by the Bu ding and Fire Officials are pr8�u1d6d on this permit. Service: Minimum of Five Call Inspections Required for All Construction Work: & �� 1.Foundation or Footing Rough: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5,Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not'proceed until the Inspector has approved the various stages of construction... Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A).. Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT C i t COMMONWEALTH OF'MASSACHUSETTS' BARNSTABLE,ss SUPERIOR COURT C.A. NO. 1772CV6061.3 PAUL C.LORUSSO,as Trustee of theLyndon Paul Lorusso Charitable Foundation of 2002 vs. MARK THOMPSON,INDIVIDUALLY and as TRUSTEE of the Lyndon Paul Lorusso Charitable Foundation of 2002 et al ORDER This matter came on before the court,Honorable Comelius.J.Moriarty,11,presiding, upon plaintiff s motion to Appoint:a Special Fiduciary to the Lyndon Paul Lorusso Charitable Foundation of 2002,and upon consideration thereof,the court hereby appoints Charles A Sabatt,Esq., 540 Main Street,Barnstable,(Hyannis), MA, 02601,as Special Fiduciary,with the authority to: i 1_. Take possession of and safeguard the books,records and assets of the Foundation, including Independence Park, Inc.;'v 2. Take charge of the operations of Iiidependence'Park,Inc.,including the collection of rents and other obligations owed to the business,pay bills and expenses in the ordinary course of business, and prudently manage the;business for the benefit of the Foundation; 3 To investigate and prosecute reasonable claims on behalf of the Foundation or independence Park,.Inc. 4. Take all other reasonable measures to.prudently manage the Foundation in keeping with its private Foundation status and charitable mission: 5. Any,and all costs and expenses incurred in performance of his duties shall be paid:for by the Foundation. t Entered: December 28,2017 Justiee of Supe r Court A true copy, Attes Clerk �} t Application numbe .. / ® DateIssued..........................:...................................... KAM Building Inspectors Initials. Map/Parcel... ............ TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDO W S/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: 1 - -J ,'NAI D L/ ® °4 7-7 LJT )"t V,6 TNCF REET VILLAGE / /� 7- 0/,P/ Owner's Name: �d T � Phone Number / `� .Email Address: Cell Phone Number 7 y' �tf 7' Project cost $ J-2�8 d Check one Residential Commercial OWNER'S AUTHO ION y r As owner of the abov p perry I here a tho 'ze to make application o a b Ming pe t a cor ce with 780 CMR Owner Signature: Date: TYP -OF WORK 0 Siding E-1 Windows (no header change)# 0 Insulation/Weatherization Q Doors (no header change) # Commercial Doors require an inspectors review ;EI-Roof(not applying more than 1 layer of shingles) Construction Debris will be going to Rb6 Li k _ n, r CONTRACTOR'S INFORMATION Contractor's name C -? F Home Improvement Contractors Registration(if applicable) 1_S 3 cj (attach copy) Construction Supervisor's License# ' 0-1( t® (attach copy) Email of Contractor ( 2ne number ALL PROPERTIES THAT HAVEITRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS/N A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION NUMBER............................................................ *For Tents Only* Date Tent (s) will be erected Removed on number of tents total Does the tent have sides? Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent If food is being served at your event please obtain a Health Department approval between the hours . of 8:00am-9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval. *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I.understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures, specific inspections and documentation required by 780 CMRan d the Town of Barnstable. Signature Date APPLICANT'S SIGNATURE Signature Date 61 , All permit applications are subject to a building official's approval prior to issuance. r The Commonwealth of Massachusetts Department of Industrial Accidents - Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Indivi dual): Address: City/State/Zip: _ Phone#: � Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. New construction 22'] 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 workingfor me in an capacity. employees and have workers' Y P t)'• # 9. ❑Building addition [No workers' comp.insurance comp.insurance. required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 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' 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. :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. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: ca,-- - Policy#or Self-ins.Lic.#: Wcc_ Sid SG f�iS �• �� Expiration Date: 0 Y Job Site Address: aJ w 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 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 un-011hepains andpenalties ofperjury that the information provided above is true and correct. Sign eC Date: — I/ Phone#: 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#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." �' g PP . MOL 25C,152 chapter 6)also states that"every state or local licensing agency shall withhold the issuance or P § ( renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any" applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C( )states"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." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to cant'workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. .Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number; The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax#61.7-727-7749 Revised 4-24-07 www.mass.govldia F _ commonwealth of Massachusetts Division or Professional Licensure Board of Building Regulations and Standards ' ConstrguctibrllSupervisor CS-104107 ,� f Expires 08/25/2019 k •".CARLOS H FIGUEIROA 20 CAPTAIN NOYES RO D` .»s A SOUTH YARM61I ,H Commissioner cil, _� U/ze�p �oa»aoat.cueu�o`C��rddac/ucleia ' ., 'ot;ice.f Consumer Affairs&Business Regs0;410 HO":1E MIPROVEM.ENT CONTRACTOR . TYPE:Corporation F0 wtration Expiration 01/07/2019 C F.R,EMODE1 INJG::IR'G_ CarlosFigdelrOd +L�` 20 Captain Noyes Rd_ S.•Yarmeut5,MA 02604 Registration valid for individual use only b,afore the expiration date. If found return to: " fit-of Consumer AVair>an 3 5usiness R4gulatien - 10 Park Plaza-;Suite 5 i70 ` Boston,MBA 02113 — - -: Ot afl wif<@'-cu-t s!gna'ttfie 1 I ACORO®• DATE(MMIDD/YYYY) L...i CERTIFICATE OF LIABILITY INSURANCE 08/02/2018 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 have ADDITIONAL INSURED provisions or 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 CONAME:NTACT Larissa Camba Leonard Insurance Agency,Inc PHONE (508)428-6921 FAX (508)420-5406 A/C No. o El: A/C No): 683 Main Street ADDRESS: (arissa@leonardagency.Com Suite B - INSURER(S)AFFORDING COVERAGE NAIC# Osterville MA 02655 INSURERA: Atain Specialty Insurance INSURED - INSURER B: The Commerce Ins.Co. 34754 C&F Remodeling Inc. INSURER C: A.I.M Mutual Insurance Company INSURER D 20 Captain Noyes Road INSURER E: South Yarmouth MA 02664 INSURER F: COVERAGES CERTIFICATE NUMBER: Master 18-19 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 AUULIbUbRPOLICY EFF POLICY EXP LTR TYPEOFINSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE 7 OCCUR PREMISES Ea occurrence $ 100,000 MED EXP Any one person $ 5,000 A CIP353467 04/18/2018 04/18/2019 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY jRa LOC PRODUCTS-COMP/OPAGG. $ 2,000,000 OTHER: $ _ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANYAUTO BODILY INJURY(Per person) $ 250,000 B OWNED SCHEDULED RVM277 01/18/2018 01/18/2019 BODILY INJURY(Per accident) $ 500,000 AUTOS ONLY Ix AUTOS X _HIRED NON-OWNED i PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident s 250,000 $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ IEXCESS LIAB CLAIMS-MADE . AGGREGATE $ _ DED RETENTION$ r $ WORKERS COMPENSATION - - PER OTH- - AND EMPLOYERS'LIABILITY Y/N - STATUTE I X ER ANY PROPRIETOR/PARTNER/EXECUTIVE - E.L.EACH ACCIDENT $ 500,000 " C OFFICER/MEMBER EXCLUDED? - FR N/A WCC-5005018589-2018A 04/30/2018 04/30/2019 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below - E.L.DISEASE-POLICY LIMIT $ J. DESCRIPTION OF OPERATIONS I 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 THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Saltworks Village Condominiums ACCORDANCE WITH THE POLICY PROVISIONS. 174 Upper County AUTHORIZED REPRESENTATIVE Dennis _ MA 02639 �����,�j,-• cJ• .�,al/►f W`^' , ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD . TOWN OF BARNSTA BUILDING'PERMIT APPLICATION Map �-1` Parcel �y� ' fry Application # V / � . In Health Division Date Issued —o-�� Conservation Division �'�,p; ,,, Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board i Historic - OKH _ Preservation/ Hyannis ` Project Street Address 2 2 0 _-1 fl N ry Village N i5 / Owner tZ_K ►iam4 SyN Address Telephone S 056 - "7"1 S — 0 1(u Permit Request �� �r' t-P� f c)F bul ( ']a f4 OSYJ anf,0cP c ry wnq ��x �rg-,•,•,p r�7 ��eP Sad,n� .Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 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 X- � Historic House: ❑Yes f1 No On Old King's Highway: ❑Yes If No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other N6NQ 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: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No 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 W Yes ❑ No If yes, site plan review# _ � . . _ - - .---- -_ _ Current Use � W e55 Proposed Use ' ' " APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name �P f1r�aW) ' ovrl�5on Telephone Number S6 _ 3C�G - 3`/7 Address 9 k (2 License # \ UP O V�o Ny ry S 1 c,9O 1 Home Improvement Contractor# 17 S Worker's Compensation # - oo-SO J1 Zo I yq ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE -- —DATE 9 I I I I FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. • ADDRESS VILLAGE OWNER DATE OF INSPECTION: " FRAME �.. � . . ..� . INSULATION--, FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING; ' DATE CLOSED OUT ASSOCIATION PLAN NO. } Hie G'orr,marrmeaM of Vassathustfts . Department qf&dksftiid Accidents OfInvesagafiens 600 Waykington meet Bostax, MA 02M �vtt�rn�.rrrtrs�g��drr - ' ork-ers' C ampensat on Insurance davit:$u ldecslContractorsMecfricianMumbers AppEcant Information. Please Pant,Legibly Name(lhu�asl _n;��t;oel�+��,�i}__��C CJS urn C.iFl Gov i-4V �1 Address-- oz& 47 So',-360 -�S 5 L/7 GityfStafrlZip: r`)�'�"S � �'1� Phone Are you an employer?Check the appropriate bo= Type of project(rNui ed}: I_® I am a employer with 4. D I am a general contractor and Z 6_ New�n employees(full—Vorpart-#ime).* have hired the suli�trwtors. . ?_❑ I am a sole proprietor or partner- listed on the attached sheet y- ❑Remodeling ship and have no employees These sutf-contractors have g_ ❑Demolition worlsin:g for me in any capacity employees and have workers' 4_ ❑Building addition [No workers' coup:in¢atranre comp.,ns vauce 1 5-❑ We are a cotgoration=6 its 10_0 El�trical repairs or additions requrred-� 3_❑ I am a hsatneau�n�rifling all work officers Have exercised weir 1l_.Q Plug regains or additiams, right of eirmptioa per 1vfGL Myself [No workers'oonxp- C_152, §1(4},and we have no 12_.0 Roof repairs ' inmi anre required_]1 employees [NC)works' 13�,4tirer yJ d� comp insurance required.l *Amp appTiomt tlut checks boa tl mnst also U out the section below shooing iheir wooicersr rnmpensatioa poiit� l$nmeowuErs crhn submit tins afudsvrt i icsvag they arz tiaing sIl n�c an3 then hire oartride couttaetnrs must 5obm3t s neat algdsczt>0tiira n snrF lowtcacturs that rhxk this box m mt attached an atlditionSl sheet sbow-smog-the name ar the sat-{onft-2 YfTSs and State whether or not those mJmt es have employees- I€the employees,thgr ffirst pxvvide their workers'comp.policy aumber I am an employ"ihatis prmlid try workers'congm sac ion irmirance for my empLyerer Below is thepo cy arrd job site information lamrance CompanyMame: VY,ovt! r Policy 4 or Self-ins-Uc, :g- F ]ii3ti9i11 te: 0 2- /o I l'7 U Job Site Address: 12tLi T 48 r4"Wc, I- r d cityr'StatdZip: l}V ar\y)t S iV11� c7(oc7, Attach a copy of the-workers'compensation policy declaration page.(showing the policy number: and expiration date). Failure to secure covenge,as regairedunder Section 25A of MUL c. 152 can lead to the imposition ofcsimirnal penalties of a fine up to$1,500_OO andlor one-yearimpr saa ent,as wen as civil penalties in 1he famm of a STOP WORK ORDER and a fine ofup.to$250-00 a.day against the violator_ Be advised that a copy of this stint maybe forwarded to the Office of Im estigations of the DIft for insaiance coverage verification- . on prm dabaE is fna unf correct hcrebFc�r�fy tin, fTatfh in f f Sienature: Date: �S Phone#: Sob -3 G'o —ors 3 t-Y 7 CWrzFcial use only—I n.ot fvrit�to fliis urea,fa 5a cuxtpleted by nrYiarrn-of Seim---- —— - - City or Town: PermitUcense# F suing Anthority(circle one): 1.Board of Health 2.Building Department I Cit_frays Clerk 4.Electrical Inspector S.Plumbing fin4wctor .6.Other Contact Person. Phone#: 6 Information and Instructions ; Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant-to this statue,an employee is defined as"...every person in the service of another under any contract of hire, oral o express or implied, r written_" An empL9yer is defined as"an individual,partnership,association,corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer;or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,constriction or repair work on such dwelling house P P g or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shalt withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for Pay applicant who has not produced acceptable evidence of compliance with the insurance.coverage required.", Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdlvisions 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." Applicants — — Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s), address(es)and phone number(s)along with their c:erihificatc(s)of insurance. Limited Liabili'Ly Companies(I.LC) or Limited Liability Partnersh-�ps(LLP)with no e,-,�rloyees other than the members or partners, are not required to carry workers' compensation inmi-ance_ If an LLC or LL P does have employees, a policy is requimL Be advised that this affidavit maybe submitted to the Department of industrial Accidents for confirmation of incur:nce coverage. Also be sure to sign and date the 2i$d2vit 1lre a;fidavit should be returned to the city or town that the application for the permit or license is being requested;not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtail-i a workers' compensation policy,please call the Departmeat at the number listed below. Sell insured companies should enter their self-ins uranCe license number on the appropriate line. City or Town Officials PIease be sure that the affidavit is complete and printed legibly. The Deparbneat has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permit/license number which will be used as a reference number. In add tion,an.applicant that must submit multiple permitlEcense applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations is (city or town).-A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be El.led out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e, a dog license or permit to bum leaves etc.)said person is NTOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number Tho Commonwealth of Massachus4tts ` Departcaeut of Industrial Aacidtats Office Qi%Vesfigadoua 600 Washingtan St met Gaston,Iva G2I I I Tot-4 61 7-72 -49-GO W 406 or I-R -:NaSS-E Revised 4-24-07 Fax# 617--727-7-149 viww.nnas,5-go-.r/dia - TFiE r Town of Barnstable °* Regulatory Services + MRNST"LF Thomas.F.Geiler,Director y� Masis � � Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 , www.town.barnstable.ma.us I Office: 508-862-4038 Fax: 508-790-6230 A Property.-Owner Must Complete and Sign This Section 4 If Using A Builder I, Ma Teldetwed eA t e Fatf, as Owner of the subject property hereby authorize' s�C�-n CA e,,Ey i"C. to act on my behalf, in all matters relative to work authorized by this building permit . ILI (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. S' attire of Owner Signa of Applicant Print Name Print Name Date Q:F0RMS:0WNE"ERM S. SIONPOOLS 6/2012 THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR . QUALITY ORIGINAL(S)" IMF DATA, ISURED INSURER B:Associated tmpi0 ers Insurance Co. i 1'0 ,,• a ., t1J �a mil. B T Custom Carpentry,Inc. INSURER C: 999 Route 132 INSURER D. Hyannis,MA 02601 INSURER E INSURER F: - .Q - 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 E NDING ANY RE INDICATED. NOTWITHSTAQUIREMENT;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, e EXCLUSIONS AND CONDITIONS OF`SUCH 30LICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. c )- INSR - B 'r -'' POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE + POLICY NUMBER MMIDD/YYYY MMIDD ,.Q©C� - A X COMMERCIALGENERALLIABILITv ' -"; EACH OCCURRENCE $ 1,000,00 CLAIMS-MADE OCCUR, - { 08/29l2013 08/29/2014 PREMISES Ea occurrence $ 500,000 ❑X MPT6472F MEDEXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 le Faml� pe Sing GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 c' 0 2,000,000 "t PRO- i PRODUCTS-COMP/OP AGG $ ;n tUCe POLICY- JECT LOC tln StruC x OTHER- $ ry f 3 + - ©fEXIS ...'.- ,:.ull • AUTOMOBILE LIABILITY COMB e eaGtleDtSINGLE LIMIT $ - r T BODILY INJURY(Per person) $ Iy , ement PP'_' ; .ANYAUTO ALL OWNED SCHEDULED - - -. BODILY INJURY(Per accident) $ AUTOS - AUTOS,. - _ PROPERTY DAMAGE DAMAGE - 4 t Flnlsh NON OWNED 1 $ BaSemerl ;e HIRED AUTOS AUTOS" - Per accident Number of Baths ,Full e $ r UMBRELLA LIAB +' " EACH OCCURRENCE $ - OCCUR edrooms`— EXCESS LIAB CLAIMS MADE ex AGGREGATE . $ Number of Rf `rnQ . DED RETENTION$ $ nt l t 1g WORKERS COMPENSATION X PER . OTH- ; Total RQom Cou 2 1 STATUTE ER ANO EMPLOYERS'LIABILITY „- B ANY PROPRIETOR/PARTNER/EXECUTIVE Y� WCC50050117392014A_ - 02/01/ 014 02/01/20 5 E:L EACH ACCIDENT $ 500,000 e and Fuel OFFICER/MEMBER andatory In NH)EXCLUDED? N N/A 500,000 I� Heat Typ If yes,describe under E oucv`.L Mir $ 500,000 �+ E.L DISEAS ®Yes DESCRIPTION OF OPERATIONS below E L DISEAS . Central Air: x• Detached garage ® a D ❑E DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101 Addkional Remarks Schedule may be attached if more space Is required); 4 arage Attached g Y g and of AP. ZQn1ng ° Commercial Ye' p r nt USE) -i CANCELLATION- CUrre I CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Barnstable THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. { Building Division-Thomas Perry 200 Main Street ,a+'� AUTHORIZED REPRESENTATIVE'- Hyannis,MA 02601 . i ©.1988-2014 ACORD CORPORATION. All tights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Massachusetts Derai- ;er:* Ub c S ;fetl �d,�J.•�t t a;ldi, a r� r i ior:s and St incial.-!s '.Guns�ru�t Su. u� !cur �feEnse: CS-106046 .!.r.s BENJAI IN E-MOMPSON y_ 999IYANOLGHR6AD Hyannis MA';02601 Commissioner Expiration „ 02/09/2015 TOWN OF BARNSTABLE BUILIDING PERMIT APPLICATION Map C� Parcel V Application # 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 1�0 �j VOW , Village Owner "��® 50 Address Telephone J��- '_UPO 2s::�1/7 ,Permit Request R.e { Y?,�� `/��e��d�e`� •''���- / J`�`1 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation m 06 Construction Type °® -a Lot Size Grandfathered: �ies ❑ No If yes, attach;supporting documentation. Dwelling Type: Single Family ❑ Two ,Fy mily ❑ Multi-Family (# units) �-w � � rl Age of Existing Structure S 3 Historic House: ❑Yes ❑ No 1J On Old Kings kHighway` ❑Yews, ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Cl+/ 5Ab rt Rya Basement Finished Area (sq.ft.)_ Basement Unfinished Area(sq.ft) ° n 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: as 0 Oil ❑ Electric ��„,//❑ Other Central Air: Yes ❑ No 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 c� �(BUILIDER OR HOMEOWNER) Narre cDtak ��?�✓. `T�►iB�j�'o Telephone Number4 `" ' � Address g�� ry/44/0L/ �i - License # 6.5 Home Improvement Contractor# i Worker's Compensation # d °� j✓ ALL CONSTRUCTION DEBRIS RESUL ING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATEI FOR OFFICIAL USE ONLY 4 APPLICATION1 DATEISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION t FIREPLACE ELECTRICAL: ROUGH FINAL t PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 _ wmass.gov/diu ww. Workers' Compensation Insurance Aft davit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lezibly Name(Bvsmess/Org=zation/Individual): �5c_n l,�J V1'a Address:/ dl'JnLe!� City/State/Zip: QX61VN oS Phone-#: 6clS r Are you an employer? Check the appropriate box: Pepe of prof ect'(required): 1.❑ I am a employer with 4. I am a general contractor and I * Have hired the stab-contractors 6. ❑.New constractian Iopees(full and/or part-time).. - 2. _�a•sole proprietor or partner= listed on the-attached sheet modeling ship and have no employees These sub-contractors have 8.;Q Demolition working for me in any capacity. employees and have workers': ao insurance. 9. 0 Building addition [No workers comp.insurance. �• required] 5. We are a corporation'aad its 10.0 Electrical repairs or additions '3.❑ I am a homeowner doing all•work officers have exercised their 11.❑Plumbing repairs or additions myself: [No workers' comp. right of exemption per MGL 12.❑ repairs :c. 152, 1(4),and we have no wl -o`p,e+ ther JZ�� �%G''i f�` insurance required-]t § employees. [No workersf�� comp..insurance required.] 7� L &r*—Y *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 iE work and then hire outside contractors most 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 employers. If the sub--ontractors have employees,they must providb their workers'comp•policy number. Yam an employer that isproviding workers'compensation insurance for my employees. Below is thepolicy and job site information, Insurance Company Name: Policy#or Self-ins,Lic.# Expiration Date: r Job Site Address: City/State/Zip: Attach a copy of the workers'-compensation policy declaration p age'(showving the policy number and expiration date): Failure.to secure coverage as required under Section 25A ofMGL c. 152 can lead to the imposition of criminal penalties of 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$250M 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 u der thepains andpenalties of perjury that the information provided abov is fru an correct: Si atur . Date: Phone# IBD" Flo cial use only: Do not write in this area,to be completed by city or town offtciaL r Town: PermitlLicense# ng Authority(circle one): ard of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector heract Pelson: ,.Phone#: : The Commonwealth of Massachusetts William Francis Galvin- Public Browse and Search Page 1 of 2 �5 `* The Commonwealth of Massachusetts. William Francis Galvin `t' Secretary of the Commonwealth,Corporations Division e,r One Ashburton Place, 17th floor Boston,MA 02108-1512 Telephone: (617)727-9640 P & L L, INC. Summary Screen Help with this form ��-=Reiauest:a Certificates The exact name of the Domestic Profit Corporation: P&L L,INC. Entity Type: Domestic Profit Corporation Identification Number: 042973164 Old Federal Employer Identification Number(Old FEIN): 000259015 Date of Organization in Massachusetts: 07/17/1987 Date of Involuntary Dissolution by Court Order or by the SOC: 06/18/2012 Current Fiscal Month/Day: 12/31 Previous Fiscal Month 1 Day:00/00 The location of its principal office: No. and Street: P. O. BOX 1776 255 BREEDS HILL ROAD City or Town: HYANNIS State: MA Zip: 02601 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: Name and address of the Registered Agent: Name: MARK W. THOMPSON No. and Street: P.O. BOX 1776 255 BREEDS HILL ROAD City or Town: HYANNIS State: MA Zip: 02601 Country: USA The officers and all of the directors of the corporation: Title Individual Name Address(no PO Box) Expiration First,Middle,Last,Suffix Address,City or Town,State,zip code of Term PRESIDENT L.PAUL LORUSSO 15380 S.W.72 AVE.,MIAMI, FLA 15380 S.W.72 AVE.,MIAMI, FLA TREASURER L.PAUL LORUSSO 15380 S.W.72 AVE.,MIAMI, FLA 15380 S.W.72 AVE.,MIAMI, FLA SECRETARY MARK THOMPSON 999 RET 132 HYANNIS,MA USA 999 RET 132 HYANNIS,MA USA http://corp.sec.state.ma.us/corp/corpsearch/Corp SearchSummary.asp?ReadFromDB=True... 8/24/2012 The Commonwealth of Massachusetts William Francis Galvin- Public Browse and Search Page 2 of 2 business entity stock is publicly traded: The total number of shares and par value,if any,of each class of stock which the business entity is authorized to issue: Par Value Per Share Total Authorized by Articles Total Issued Class of Stock _ Enter 0 if no Par of Organization or Amendments and Outstanding Num of Shares Total Par Value Num of Shares No Stock Information available online. Prior to August 27, 2001, records can be obtained on microfilm. Consent _ Manufacturer _ Confidential Data _ Does Not Require Annual Report Partnership Resident Agent _ For Profit — Merger Allowed Note:There is additional information located in the cardfile that is not available on the system. Select a type of filing from below to view this business entity filings: ALL FILINGS I Administrative Dissolution l Annual Report 4 Application For Revival Articles of Amendment 77 N w Search '7 Comments O 2001-2012 commonwealth of Massachusetts All Rights Reserved Help http://corp.sec.state.ma.us/corp/corpsearch/CorpSearchSummary.asp?ReadFromDB=True... 8/24/2012 �'ME Town of Barnstable Regulatory Services ,Thomas F.Geiler,Director . '°lEn►na+" Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis-MA 02601 wwwAown.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize ����d►� sa to act on my behalf, in all matters relative to work authorized by this building permit: ( ddress,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. Sigj a'tute of Owner tore Applicant Print Narne Print Name . i . Is LI 1 Date QTORMS:OWNERPERMISSIONPOOLS 62012 Massachdsetfs'- Department of Public Safety Board of Bui,(ding Regulati.ons.and.Standards C•on,sth'uctiun Supcllisur License`. CS-106046 X BENJANHN EAIOWSON 999 IYANOUGH ROAD'"i Hyannis MA�—:02601 Commissioner Expiration 02/09/2015,