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0225 IYANNOUGH ROAD/RTE 28
��� —L cL l� �7 C� r � -_- - Town of Barnstable ,. Building Post This Car>d So That�t, s V�sibieF,rornthe Street Approved Plans Must be Retained on Job and this Card Must=be Kept • tAftHHS'fABLG .�,�, M" Posted UntilxFinal Inspection Has BeenxMade r Y s ° WF%ere a Certificate of Occupancy-s'Requred,such Building shall Not.,be Occu,p�edunt�l"a Finai Inspection hasbeen made Permit , ,u:,,.,..1tkn,i ,. ,:,�:z..,_ . '...H..K M;�`, ',.....,,:. �r.�,a F<. .,r�,, s.,>«e,.ro. � Sae,v,,,,k.u,...,. s...a.✓ .�,. ..ash' ,.a'o._- e....•{w.,+.'i�,.«rm....�...,:.,,., ,<_ew,...s?�,,..o :; ....w..,.. ".�..,k.,....,., Permit No. B-18-2732 Applicant Name: Notessa Brown Approvals Date issued: 08/22/2018 Current Use: Structure Permit Type: Building-Sign Expiration Date: 02/22/2019 Foundation: Location: 225 IYANNOUGH ROAD/RTE 28,HYANNIS Map/Lot: 328-205 Zoning District: HG Sheathing: x rName.. _ Framing: 1 Owner on Record: HYANNIS SERIES ONE LLC Contractor g: Address: PO BOX 342 Contractor License 2 HYANNIS, MA 02601 Est? Project Cost: $0.00 Chimney: E y: Permit Fee: $75.00 Description: Reface existing internal illuminated sign 32 sq-' g i Insulation: Fee Paid ' $75.00 Otaheite Restaurant ` Date 8/22/2018 Final: x 1 Project Review Req: ., Plumbing Gas P 77, Rough Plumbing: � .` Zoning Enforcement Officer Final Plumbing: Rough Gas: This permit shall be deemed abandoned and invalid unless the work auihoriied?by tfiis permit is commenced within siz onths'after.issuance. Final Gas: All work authorized by this permit shall conform to the approved application and4heYapproved construction documents for which tf is permit has been granted. '• All construction,alterations and changes of use of any building and structures�shall be in compliance with the local zoning by laws and codes. Electrical halm This permit shall be displayed in a location clearly visible from access street or road and Fbe aintained open for public inspection for the entire duration of the work until the completion of the same. Service: The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided`on this permit. Rough: Minimum of Five Call Inspections Required for All Construction Work: 'm 1.Foundation or Footing Final: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Low Voltage Rough: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Final: 6.Insulation 7.Final Inspection before Occupancy Health Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Fire Department "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: i$ 1 Town of Barnstable Building Department Services Brian Florence, Building Commissioner BARNSTABLE 200 Main Street Hyannis,MA 02601 ` www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Sign Permit Application Zoning District nL5 Permit # Historic District ❑ - �L or, Ann t S fo A CA b I Location by Street address and village Applicant Map & Parcel �'� o S Telephone Number �`�� f 3� Email �J(p yj IV- fytat � ° C A Wall ❑ ' i( Wall Freestanding Cam' �(P Freestanding ❑ Electrified* ❑ Electrified* Dimensions Sign #1 Dimensions Sign #2 Square feet Square feet Reface isting Sign 1 New/Replace Sign Width of Building Face ft. X 10 = X .10= Lighting Type A wiring permit is required if sign is electrified. � l 'from: Vision Art Graphics visionhyannis@gmaii.com Subject: Re: 2018_05 19 22-58-53.pdf Date: Aug 20, 2018 at 4:22:43 PM To: Conroy Johnson Iloyd1782@gmail.com o i Otahe& ILI- Rests�t�nt HIMAKFASM DINNEYt 96 BREAKFAST LUNCH DINNER 0 ) 9 �, 48 You need print this paper and go to the city hall to get the permit.._ ox m _P � . : If 23 62 s �� Ol Or A .. 1 ' 1J7 r o A o I- — I H •1 �- I "� V i ICE � = J� y _ � .r •�, I� � � , 11 •c r.; COUA J • � (� (�yhLl'Z t--39 d�;7d�—'G I �, C� � �4uY i� � F� V I ,1 V V y `{ rl\ lc L' Tj �-1 a �ACL` N '•` � nab /� wads ED] --- ° ' -ate � .�� ;' .• _3iR? -: ... t• � � .T. / cl `� t :NOTICE OF PUBLIC HEARING' ,, � NEW ANNUAL COMIufON �VICTUALLER ALLALCOHOL�. ' LICENSEAND NEW NON LIVE�� �'�.�'"t{ENTERTAINMENT LICENSE t``� ?In accordanceRE with s+Chapterty fi138 and ChapteQ140-afpe Genf':' =oral Lawslan;apphcation;of=Irie 'Eatsrinc�z�d/ti/a f0uta§Eaty 225`• Jpfinough Rd�Hyannist Marc,a Webster Man`a'ger for a,n`ew Ao'. nual,?�All E".glcohol,���Gommona Vcfualle�asgcense Houisaf oration will be 7 DO AM to'12 45 "AM daily, y rL 3R a Premise yDescnption ,iRestau - rant located ht,225 lya5nough Rtl with .dining area ;kitchen walk m cooleP storage',for fdry goods two�bathraoms;There: w,ll be„42"interior seats3�ap„? �pioved byrthe 8mldsng'Comms stoner on 328/18 No extenor �"�Non�Uve Entertalnmerd1is to: include irecoded Fmussc at�con� versationleveL�r �,� i 'Saidheanng2.'wdltbe he atld on fNanday°fMayi7 2018 y 9 30' am or as soon{following as"I practical in the Town Hall:Bwid;! ing 2nd Flour{rHeArmg?Room;? 367,MamStreet Hyanmsy' ��k! ;;;Martin E�Hdiue Chavperson r �}GeneBurmah Ron Sem..ri „Dawd Nunheimer�����,��c sin g Authordy . ,, Town of Barnstable Building e : . Post=This Card�So T.hai��t is=Visible,F..rom=; he Street A ,_,rav,,ed,Plans(Must,be;Retametl on Job�and this Card Mustbe Kept_ �._� MASBA91.C. • >�"^, ��y'"__ ,'r as�zT�:'� �-T 2'�' pP `m.� � rs � �' g�vs"..��%. }. 's �N �� .� ��:- .� a'�' rr� -..a��� • Permml lil � ;Where a Certffic�ite of Occ ;,pant, is Re wired,such Buildm shall Not be Occu red unt{I a F�na1 In�sp�ection hasbeen made t Permit No. B-18-3116 Applicant Name: STEPHEN W CRESWELL Approvals Date Issued: 09/19/2018 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 03/19/2019 Foundation: Location: 225 IYANNOUGH ROAD/RTE 28,HYANNIS Map/Lot 328 205 Zoning District: HG Sheathing: a T ~' k Owner on Record: HYANNIS SERIES ONE LLC ct Contraor Name "'�STEPHEN W CRESWELL Framing: 1 Address: PO BOX 342 Contractor L tense:, C5=076536 2 HYANNIS, MA 02601 F Est Project Cost: $6,750.00 Chimney: x� H .R Fee: Description: re-roof and siding �u ermit $370.00 Insulation: Project Review Req: FeePaid $370.00 e 9/19/2018 Final t x � Plumbing/Gas )y :, Rough Plumbing: Building 3 g Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authored by this permit is commenced within six,months a - issuance. Rough Gas: All work authorized by this permit shall conform to the approved appl catUon and theyapproved construction documents,for whichths permit has been granted. All construction,alterations and changes of use of an building and st uctutes shall be in compliance with the local zonin''b laws and codes. g Y g � ., P g Y Final Gas: This permit shall be displayed in a location clearly visible from access street orroad and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. 3 x 3 Electrical The Certificate of Occupancy will not be issued until all applicable si naiures b the Buildm Land Fire Officials are, rovided on this permit. P Y pP g 3 Y g �P P Service: Minimum of Five Call Inspections Required for All Construction Work N "N g F 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 App I' 'on tuber�..�.,......'�(`� Fee . 4. v, .... . . ..... ...... •nSi'8 SEP 19 2018 MAM / 6 P Building Inspectors Initials............................. ........ C�� /�RIB � R MA'S Date Issued................1......1...................................... Map/Parcel... .. .......�Q�..�..�...................... TOWN OF 1ARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: h C3 / h �� rl�ud ,9,4,,t, l NUMBER STRE VILLAGE Owner's Name: l / ae4 4. 4--1 lr( rIT ZLCPhone Number 00 Email Address:I 6elPS-04 e 1-1-6 Cell Phone Number Project cost$ (O ,0/ Check one Residential Commercial x OWNER'S AUTHORIZATION As owner of the above property I hereby authorize ,�j -,plr�( CrPS4/P to make application for a building permit in accordance with 780 CMR Owner Signature: Date: TYPE OF WORK B Siding Q Windows (no header change)# Q. Insulation/Weatherization 0 Doors (no header change)# Commercial Doors require an inspector's review Roof(not applying more than 1 layer of shingles) Construction Debris will be going to CONTRACTOR'S INFORMATION Contractor's names Home Improvement Contractors Registration (if applicable)# /S 7�91 (attach copy) Construction Supervisor's License# CS— ©7w/,5,3(,, (attach copy) Email of Contractor,�C eSa CoenogS Phone number,���'775-yr ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION NUMBER............................................................ *For Tents Only* 1 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. Purpose of Event 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 CMR and the Town of Barnstable. Signature Date APPLICANT'S SIGNATURE Signature Date All permit applications are subject to a building official's approval prior to issuance. , The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dhz Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organizationandividual): 1� C��s hC Address: ,Sr City/State/Zip: C4eiMly 1P /7,1 0oX3;, Phone#: 3"4R- 'I y7Fr Are you an employer?Check the appropriate box: Type of project(required): 1 ,K 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 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, ❑Demolition workingfor me capacity. employees and have workers' 'many p �'• 9. ❑Building addition [No workers' comp.insurance comp.insurance.: 10. Electrical repairs or additions required.] 5. ❑ We are a corporation and its ❑ p 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 12.3 Roof repairs _/ insurance required.]t c. 152,§1(4),and we have no 13.E&Other employees. [No workers comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :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: L `. P��� J I C/ T us,1 /'/re, 7iL S Policy#or Self-ins.Lic.#: WC 3yi �o/ Or2 a 1/6 Expiration Date: Job Site Address:C�35 Zyo /'C zo City/State/Zip: �y�,,tA� f ✓`�� '��66) �YA 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. Signature: Op�t'I ��f'-���'►< Date: IjI 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." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract 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 carry workers' compensation insurance. If an LLC or LLP does have employees,'a policy is required."Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple 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##617-727-7749 Revised 4-24-07 www,mass.gov/dia �I Mass. Corporations, external master page Page 1 of 2 1 R • R • s"rry�,.��1 Corporations Division Business Entity Summary ID Number: 000991233 1 Request certificate New search Summary for: HIBBARD LAND TRUST, LLC The exact name of the Domestic Limited Liability Company (LLC): HIBBARD LAND TRUST, LLC Entity type: Domestic Limited Liability Company (LLC) Identification Number: 000991233 Date of Organization in Massachusetts: 12-08-2008 Last date certain: The location or address where the records are maintained (A PO box is not a valid' location or address): Address: 247 IYANNOUGH ROAD City or town, State, Zip code, HYANNIS, .MA 02601 USA Country: The name and address of the Resident Agent: Name: ERROL M. THOMPSON - Address: 2 COVE ROAD City or town, State, Zip code, FORESTDALE, MA 02644 USA Country: The name and business address of each Manager: Title Individual name Address MANAGER ERROL M. THOMPSON 247 IYANNOUGH ROAD HYANNIS, MA 02601 USA In addition to the manager(s), the name and business address of the person(s) authorized to execute documents to be filed with the Corporations Division: Title Individual name Address 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 http://corp.sec.state.ma.us/Corp Web/CorpSearch/CorpSummary.aspx?FEIN=000991233&... 9/19/2018 Mass. Corporations, external master page Page 2 of 2 REAL PROPERTY I ERROL M. THOMPSON I USAIYANNOUGH ROAD HYANNIS, MA 02601 ❑ ❑Confidential ❑Merger ❑ Consent Data Allowed Manufacturing View filings for this business entity: ALL FILINGS Annual Report Annual Report - Professional Articles of Entity Conversion Certificate of Amendment View filings Comments or notes associated with this business entity: New search http://corp.sec.state.ma.us/CorpWeb/CorpSearch/CorpSummary.aspx?FEIN=000991233&... 9/19/2018 Commonw Ills of Massachusetts Divisio of fOSSional Licensure 9-F Board of Bui ing egulations And Standards Co1rtA lrfti.p rvisor �/?il.Ut�G�22iYli t'Jgi C9-076536 o- „f EKpir es: 08/27/2019 umer Affairs and Business Regulation 4 STEP EN W Eft.° F , 0 Park Plaza - Suite 5170 196 PINE STREET/! µ FF ston, Mas achusetts 02116 CENTERVILLE IVI�1 0263 '�" r orovement;G-ontractor Registration l./"� / m Type: Corporation Commissioner z W Registration: 187992 r 105 PINE ST. Expiration: 06/05/2019 � CENTERVILLE, MA 02632 n a a ti c SCA 1 Co 20M-05/11 Update Address and return card. Mark reason for change. ,q �(J0097D/!.N/I.CI�CCI,LC�O�V(/GCLOA2C�LlJBC�iJ _, . L. r LstMAdr!.--nt - nrd 921. . 4-� Office of Consumer Affairs&Business Regulation , HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only t� TYPE:Corporation before the expiration date. If found return to: i - =R®gfstration Expiration Office of Consumer Affairs and Business Regulation t879�2_ 06/05/2019 10 Park Plaza-Suite 5170 S CRIES INC. Boston,MA 02116 STEPHEN W.CRESUVELL 195 PINE ST. `` ',�i'! � C V CENTERVILLE,MA 02.32 Unders r i Not valid without signature ec etar .i , ® DATE(MMIDDIYYYY) ACORO CERTIFICATE OF LIABILITY INSURANCE �% , 1 08/20/201.8 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,subjedto 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: W Scott Kerry FAX KERRY INSURANCE AGENCY n/c"N E,t; (508)255-8000 No): E- ADMDRESS:AIL scoft@kerryinsurance.com ke insurance.com P O Box 1945 INSURER S)AFFORDING COVERAGE NAIC# N.EASTHAM MA 02651 INSURERA: LIBERTY MUTUAL FIRE INS CO 23035 INSURED INSURERS: S CRES INC INSURERC: INSURER D: 195 PINE STREET -INSURER E: CENTERVILLE MA 02632 INSURERF: COVERAGES CERTIFICATE NUMBER: 305112 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MMIDD MWDDIYYYY COMMERCIAL GENERAL LIABILITY EACHOCCURRENCE $ DA AGE TO RENTED CLAIMS-MADE OCCUR PREM SES Ea occurrence $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER- GENERAL AGGREGATE $ PRO POLICY❑JECT ❑ LOC I PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED N/A BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPER'accident PROPERTYDAMAGE HIRED AUTOS AUTOS (Par UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION X I STATUTE ER AND EMPLOYERS'LIABILITY ANYPROPRIETORIPARTNERIEXECUTIVE YIN E.L.EACH ACCIDENT $ 500,000 A OFFICERIMEMBEREXCLUDED? NIA NIA WA WC231S610224018 04/19/2018 04/19/2019 (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 N/A DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/Iwd/workers-compensationfinvestigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Lam . Daniel M.Cro y,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts, Department of IndustrialAccidents Office of Investigations 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual):Li nrn ,el Address: City/State/Zip: `e,7 e/di 1/e Aa Phone#: Jr��� 7 7_�-- Are you an employer?Check the appropriate box: Type of project(required): 1.0 I am a employer with 4. I am a general contractor and I 6. 0 New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. F1 Demolition working for me in any capacity. employees and have workers' 9. El Building addition [No workers'comp.insurance comp.insurance$ required.] S. F1 We are a corporation and its 10.❑Electrical repairs or additions 3.[1 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.[a Roof repairs insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 13.❑Other gfd 1" 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. tr—ontractors 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 thepolicy and job site information. Insurance Company Name:_i_ _ t � U�rJd,j rc �i(/�• �/� Policy#or Self-ins.Lie.#: G Expiration Date: Job Site Address: VC /1 o a City/State/Zip: f�v9 �S / 1n (0 Attach a copy of the workers'compensation po 'cy 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/penaldes of perjury that the information provided fabove is true and correct Sirmature � 96 zo Date: Phone#: �®9 " 775 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.EIectrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.] You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. ,. DATE:1 Fill in please: ^nlu. r,,�ey;;�s..��h,I„~f►1�°` APPLICANT'S YOUR NAME/ BUSINESS YOUR HOME ADDRESS: Scl L44 K Lei Me 31 TELEPHONE # Home Telephone Number - F' 19Y%1 Lk�d ts7 K!f� SOC I AL SECUR I TY OR E I N E-MAIL: NAME OF CORPORATION:•-'rkL NAME bF-NEW BUSINESSc--c ,- t- TYPE OF BUSINESS IS THIS A HOME OCCUPATION? ES NO ✓ ADDRESS OF BUSINES - -- MAP/PARCEL NUMBER 1: - (Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of r Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING CO ISSI ER'S OFF-ACE This individ I e n fb :, ell o y p mit requirements that pertain to this type of business. u orized Si COMMENTS: ' 2. BOARD OF HEALTH This individual has been informed of the permit requirements that pertain to this type of business. Authorized Signature** COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: � G Pa-y I .6�'-'�Er�-rl-on-s •pErKGa. I �, �-� _ W -- . \� • —TTI Dc G ot\ r IEI 3� . ! VLA ( gTir.v 3� I zrl Til �n�Do,R3�c> A N Ole, R,v►ups to PA,/�f ,P, P ,3 EVE Sign TOWN OF BARNSTABLE Permit * BARNSTABLE, MASS. 9�ArF6 :35 9. A Permit Number: Application Ref: 200700715 20070004 Issue Date: 02/12/07 Applicant: JOHNSON,NANCY L TR Proposed Use: RESTUARANT & CLUB Permit Type: SIGN PERMIT Permit Fee $ 50.00 Location 225 IYANNOUGH ROAD/RTE 28 Map Parcel 328205 Town HYANNIS Zoning District HG Contractor PROPERTY OWNER " Remarks REFACE EXIST 32 SQ SIGN WITH NEW BUSINESS NAME MITES PIZZA& SUSHI Owner: JOHNSON, NANCY L TR Address: P O BOX 342 HYANNIS, MA 02601 Issued By: p PAST THIS CARD,SO THAT IS VISIBLE FRAM THE STREET alp /�i Tan IJav 7 75- �� / / 60�- - -7 96 - a q �! r etjvu- CA SS RE-ROOFING/RESIDING C ❑ If located in OKH or Hyannis Historic District- C required unless same color/same materials specifie ❑ Map/parcel number Approval Sign-offs from: ❑ Tax Collector ❑ Treasurer ❑ # of squares of shingles or square footage of roof or si ❑ Specify stripping old shingles or going over old roof. If going over ❑how many roof layers existing now ❑what size are rafters? What is span? ❑ Owner's name & address ❑ Builders Information ❑ Signature ❑ Workman's Comp. Form. 'Copy of Insurance Compli ❑ No license is required for commercial work. �I Application.fee ❑ Permit fee S Can -1v Tg -Town.of Barnstable } '"E'gY,r Regulatory Services Q' Thomas F.Geiler,Director MAS9. Building Division 1 F;, r p j �66 7 7/S �p i639' s'0 Tom Perry, g Buildin Commissioner ' " T4 BL lfD MA'S 200 Main Street,Hyannis,MA 02601?°apt 6'JAN www.town.barnstable.ma.us �l:-3 p Office: 508-862-4038 �-- Fax: 508-790-6230 DIVI `-- Permit# Application for Sign Permit Applicant: LjLI PJ� SIR,6)10 1+ B f'M Map &Parcel# g 09,05 Doing Business As: AS S US l� 1 Ml Tl G 5Cg ��Ov'°2 4Tjlo - g95461�DUSE Telephone No. t Sign Location 1 A� (v"(� S M. A - 0260/ Street/Road: G Zoning District: Old Kings Highway? Yes T��o Hyannis Historic District? Yes& Property Owner _ t 5o3 qq I^ f 1q,0 Name: N A-N C I J0 N S0 i� Telephone: Address: 0 B0 x 34-�j Village: Sign Contractor S I C�W 508— 39 g— 9110 O Name: Telephone: Mailing Address: as 5 Zy A-l\) i\f 0 0 C)IJ R-D — �4 y P-N N I'S, Description Please draw a diagram of lot showing location of buildings and existing signs with dimensions,location and size of the new sign. This should be drawn on the reverse side of this application. Is the sign to be electrified? 'jVe No (Note:If yes, a wiring permit is required), Width of building face 4g ft.x to= 420 x.10= 0 Sq.Ft.of proposed sign I hereby certify that I am the owner or that I have the authority of the owner to make this application,that the information is correct and that the use and construction shall conform to the provisions of§240-59 through §240-89 of the Town of Barnstable Zoning Ordinance. Signature of Owner/Authorized Agent: Date: 01- r o Permit Fee: Sign Permit was approved: Disapproved: C 1,�� Signature of Building Official: Date: `` c U �J V In order to process application without delays all sections must be completed. Q:1 WPFILESISIGNDSIGNAPP.DOC ll� Rev.9/12/06 � dl w n ?�. ♦ .+..NKr— ,.,yy..tls.,.wtwa ... ety,'y 'A„�pysyr.WrinW+lriyav . S. r; ABM' fi : y 4fi , , a { y s �.:y � � °,,.+:�_„ �,::�'�..�..� 'a"""'..9,+ " `�"�n.w.• �+-'°�`�t.r''�_aye, , A • t � + yt pi C� UPe a f J°Cty' i 'r X ♦ R� F � ' { k 4 MM r � a i r r, a ' , ,,za�`"r^1.. )a 4.+ - '•4^wr� � :x e�'�^+y-...., F�� ,� - -n-w:.ar�.�` r �S' .�y.�„•�'X�""'a` _ >� x x ' y ..6 F `4 f x.• t ' •w5, q d a 12/28/2006 t 10:26:41AV 4 t -� 5816 Estimate No. Estimate Printed On 11080 Mities Pizza (508)775-4611 (508)_- Prepared For Lillian, , Listed below is the quotation on the signage we discussed. This quote is good for 30 days from the date it was printed. If you have any questions, please do not hesitate to call. Attn: Lillian Rt 28 Hyannis, MA 02601 Acct#: Terms: Phone: Fax: 50% Down/COD Changes to Light Box Face Estimate Description Product Code Quantity Vinyl Graphics Cust.Supplied Material 1 2.00 White 40 Inch x 46 Inch Customer Supplied the Substrate(Material)to make the Sign. Sign A Rama applies the vinyl. Remove faces and vinyl on top half of sign faces,apply.3 colors translucent vinyl,reinstall faces $604.91 $302.46 1 Item + Category Color Size Sides Price @ Description Sales Tax $604.91 $25.00 $629.91 Jim McDermott Thanks for thinking of Sign'A`Rama for your sign needs: All orders require minimum 50%down payment. Does not include any permits. $0.00 Notes: Sub-Total Shipping Total: Yours Sincerely, 12-6 Whites Path South Yarmouth, MA 02664 Phone: 508-398-9100 Fax: 508-398-1760 (ccsar@capecod.net) Page of 1 1 TOWN OF BARNSTABLE INSPECTION WORKSHEET Cl -1 CERTIFICATE NO: CANCELLED: MAP: 328 DBA: MITIE'S SUSHI HOUSE PARCEL: 205 NAME/MANAGER: ISERGIO&LILIAN HAIBARA STREET: 1225 IYANNOUGH ROAD(ROUTE 28) VILLAGE: JHYANNIS - � STATE: MA ZIP: 02601- SEQ NO: 1� BUSINESS TYPE: IRESTAURANT CONSTRUCTION TYPE: STORY1: CAPACITY: USE1: B Capacity Under 50: STORY2: CAPACITY: USE2: STORY3: CAPACITY: USE3: Outside Seating: ❑ BY PLACE OF ASSEMBY OR STRUCTURE CAP1: 42 LOC1: MAXIMUM SEATING CAPACITY CAPS: LOC8: CAP2: LOC2: CAP9: LOC9: CAP3: LOC3: CAP10: LOC10: CAP4: LOC4: CAP11: LOC11: CAPS: L005: CAP12: LOC12: CAP6: LOC6: CAP13: LOC13: CAP7: LOCI. CAP14: LOC14: INSPECTION: DATE ISSUED: EXPIRATION: -� 11/09/2011 COMMENTS: YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to'operate�)Yi3UTnust first obtain the necessary signatures on this format 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1.st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business.Certificate that is required by law. DATE: 1 1 Fill in please: tit* 00, � APPLICANT'S YOUR NAME/S: BUSINESS YOQR HOME A RESS: }3 ��Af YfA F F6°y:.y }ff �x � TELEPHONE # Home Telephone Number 1 U 011 NAME;OF CORPORATION � `- '° '' "m NAME OF NEW BUSINESS - .TYPE OF BUSINESS, TUTIMU IS THIS A HOME OCCUPATIONS YES NO M - QDDRE6S,OF BUSINESS MAP/ c (Assessing] When starting a new business there are several things you must do in order to.be in compliance with the rules and.regulations of the Town of. Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 2Q t. - (corner of Yarmouth Rd. &Main Street] to make sure you have the appropriate permits and licenses required to legally operat -your usiness in this town. L ' e. BUILDING COMMIS O ER'S OF ICE This individualihas tx n ir�for rflan., p rmit requ' ements that pertain to this type of business. I-P Aut orized-Signat�4r * r COMMENTS: i 2..BOARD OF HEALTH This individual has been informed of the permit requirements that pertain to this type of business. Authorized Signature* COMMENTS: S.,CONSUMER AFFAIRS (LICENSING AUTHORITY] This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature* COMMENTS: YOU•WISH TO OPFzN A 13USINESS? Fob Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME In town (which you must do by-M_G.L.-It does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis; MA 02601 (Town Nall) and get the Business Certificate that is required by law. E 03 O ❑AT Z� Fill In please: APPLICANT'S 'YOUR NAM E/S: . BUSINESS YOUR HQME ApQRESS. layLno ceoc� 4$ TELEPHONE # Home Telephone Number Sob) NAME OF CORPORATION: K 04 S l' UN b" NAME OF NEW BU5INESSO f3XtkS i Ww C4-iP r TYPE OF BUSINESS G5i179•u�g-r! IS THIS A HOME OCCUPATION?, YES . NO ADDRESS OF BUSINESS S ! Gi h Dtx MAP/PARCEL NUMBER 3A • [Assessing] When starting a new business there are 6evaral things you must do in order to be In compliance with the rules and regulations of the Town of Barnstable. This form Is intended to assist you In ❑btalning the,Information you may need. You MUST CEO TO 200'Main St. -"(corner-of Yarmouth Kid_ a Main Street) .to make sure you have the appropriate permits and licenses required to legally operate your business in this-4own. - i 9. 6UILDIN13 C❑VEER ❑ 1 � +� Thie Indlvld fr►fo of y armlt re irsmanta that pertain to this type of business. zed Slg a* COMMENTS. r VI •2. BOARD OF HEALTH This Individual.has,been informed of the permit requirements that pertain to this type of business, Authorized Signature** COMMENTS: 3. CONSUMER AFFAIRS [LICI=NSING AUTHORITY]. Thie Individual has been informed of.the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: NUMBER FEE ao2 THE COMMONWEALTH OF MASSACHUSETTS $100.00 TOWN OF BARNSTABLE onafini & Ristow Inc. d/b/a, A Brasileira Cafe Thisis to Certify that.................................................................................................................................................................................... 225..lyannough Rd.;.,Hyannis , Ma IS°:HEREB, RANTED A. COMMON..VICTUALLIE 'S'LICENSE Hyannis , Ma: ::':,.. s::: ,:i in said................................................:............................:..........:................ .......................::and•at that place only and expires December 31, 2015;.unless sooner'suspend:ed orxevoked'&o'violation of the laws of the Commonwealth respecting the licensing of common victuallers. This license-is issued In conformity:with the authority granted to the licensing r.: - authorities by General Laws,Chapter.140,and amen.d-Meuts thereto.' HOURS: Sunday to Saturday 6:00 am to 11:00 pm RESTRICTIONS: In Testimony Whereof'.fhe�uridersigned-,haye,hereunto.affixed their official signatures: NOT VALID .. unless issued in conjunction with a """" """""' """""""'"" Licensing Food Service Permit � , Authorities .......... Issue Date: June 19, 2015 THIS LICENSE MUST BE POSTED IN A CONSPICUOUS PLACE UPON THE PREMISES. i TOWN OF BARNSTABLE INSPECTION WORKSHEET s CERTIFICATE NO: CANCELLED: 0 MAP: 328 DBA: JABRASILEIRA CAFE PARCEL: 205 NAME%MANAGER: �( STREET: 1225 IYANNOUGH ROAD VILLAGE: JHYANNIS STATE: MA ZIP: 02601- SEQ NO: 1❑ BUSINESS TYPE: IRESTAURANT CONSTRUCTION TYPE: STORYI: CAPACITY: USE1: Capacity Under 50: STORY2: CAPACITY: USE2: Outside Seating: ❑ STORY3: CAPACITY: USE3: BY PLACE OF ASSEMBY OR STRUCTURE CAP1: LOCI: MAXIMUM CAPACITY CAPS: LOC8: CAP2: 42 LOC2: SEATS CAP9: LOC9: CAP3: 6 LOC3: STANDEES CAP10: LOC10: CAP4: 4 LOC4: EMPLOYEES CAP11: LOCI 1: CAP5: L005: CAP12: LOCI 2: CAP6: LOC6: CAP13: LOC13: CAP7: LOC7: CAP14: LOC14: INSPECTION: DATE ISSUED: EXPIRATION: INrufi; r 0 0 Ey_ COMMENTS: - CD i ,If . T. um 42' A BoAh +.:.. O y - v COUA - -� y (�1 flyh`IZ ;� 7 n n u, t 5,�t - I `► v y � ' ' ,�� II�•RNG try /� 67 :. - • I af _ •• ` a cl YOU WISH TO OPEN A BUSINESS? Fob Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by.M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St. Hyannis. Talc6 the completed form to the Town Clerk's Office., 1st Fl., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business.Certificate that is required by law. DATE: 03/0 Z-//6 �:. APPLICANT'S YOUR NAME Fill in please: BUSINESS YOUR HOME AO RESS. lay eaho seocze't. � t Cf�,<oi'� -e �lR oA63a y TELEPHONE # Home Telephone Number 5-OF NAME OF CORPORATION: b 44 S / /i' NAME OF NEW BUSINE5S�) TYPE OF �fiU '�1 IS THIS A HOME OCCUPATION? YES NO �C BUSINESS— ADDRESS OF BUSINESSro2�°M,gp/PARCEL NUMBER J�oZ 2 Aesessln When starting a new business there are several things you must do In order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the,Information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legaliy operate your business in this town. 1. BUILDING C❑ &En ER ❑ I ,n This indivld al o of y ermit re Irements that pertain to this type of businesa. ** Sig e _ ! COMMENTS. b 2. BOARD OF HEALTH This Individual has,been Informed of the'permit requirements that pertain to this type of business, Authorized Signature** COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This Individual her. been informed of.the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: NUMBER _ FEE 402 THE COMMONWEALTH OF MASSACHUSETTS $100.00 TOWN OF BARNSTABLE This is to Certify that...................... Bonafini& Ristow Inc. d/b/a, A Brasileira Caf6 .......................... ........................................................................................................................... 225,Iyannough Rd..,., Hyannis , Ma IS HEREBY GRAN, TED"A COMMON-VICTUALLER"S LICENSE in said......................................... Hyannis , Ma ...and'at that place only and expires December 31, 2015 'unless sooner suspended or revoked for violation of the laws of the Commonwea_lth respecting {1 ~ the licensing of common victuallers. This license is issued in i'conformity.with'the authority granted to the licensing :; authorities by General Laws,Chapter 140,and amendments thereto HOURS: Sunday to Saturday 6:00 am to 11:00 pm RESTRICTIONS: In Testimony Whereof,the undersigned have,hereunto.affixed their official signatures. NOT VALID .... . . unless issued in ....................... .. conjunction with a Licensing Food Service Permit d Authorities ...... ............. Issue Date: June 19, 2015 THIS LICENSE MUST BE POSTED IN A CONSPICUOUS PLACE UPON THE PREMISES. „ = l TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application # Health Division Date Issued Conservation Division Application Fee 160 Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis -Project Street Address xz- +�6 h \i r — 60 Village P KffAd Owner Ok -Sca Address Telephone OU aJ�— E Permit Request �)dmvhe Qb&Q6 dui FiCW1kk% i,2t oxjtv Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation ® gQ Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing woodlcoal stove,: ❑Eyes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ,❑ new size _ Barn: Q) 'xisting ..0 newp size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: , Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ rn Commercial ❑Yes ❑ No If yes, site plan.review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) --Name` �`=�IIG '`Telephone Number 806 ( --)` `�CLj�. �'' . License /0t��as Address tg— v )CNiv rS ,i Home Improvement Contractor# A 6 D� Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO aM(9 U 10 WA SIGNATURE DATE Da—Od' 15 . I i FOR OFFICIAL USE ONLY -APPLICATION# 7 'DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE w OWNER DATE OF INSPECTION: FRAME '....� t '! q I' INSULATION_. ._ FIREPLACE ELECTRICAL- ,ROUGH FINAL PLUMBING: ROUGH FINAL , GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. t Hie Co7nar yciteaUh of 41assachusetts Depurttrent of find Est,?ud Acadents ,olic--- - e,of In bons 600 Wash-Agton&reef Bostar4 MA 0211.E wtvn.mass�go Mia 'workers' Compensatianbsurance Affidavit:Biiilders/Couh acfarslElectri_ciansTlumbers Applicant Information L ] Please Pilaf Legibly Name{k jue IOj ani-zationlfndi dnat�: c� .V L (0 K nJ GityltaielZip: N/V Phone 47 Are you an employer?Cheep the app..ropriate box: Type of project r 1_�Za eaiplayer with 4- ❑ I ain a general contractor and I 6_ ❑��delin.g Ioyees Mull andlor part-ime)* have on t the to h ed she t 2_ a sore proprietor or partner- Thes]fisted on the attached sheep �- skits and have:no employees employees ees a sub-contractors have g- ❑Demolition 'Gtr far me in an capacity emp� and have wosdcers' oA=g y capa. � 4_ ❑Building addition [No�trQrlcP1S, Comp. +tranc to e comp-mcnrant�� 5_❑ We are a corporation and its 10_ ectrical repairs or additions requmed] 3_ officers El I am a homeou+ner doing all work: es haUe erased(heir 1 L.[(�lumbing repairs or additions myself [No worlr�'comp_ right of ems mgtian per n +2-�]Roof repairs rnmrrarnre required_]I C_152, §1(4},and we hH'L'e II{} 1 employees-[No words' 131-1 other comp_insurance reNuired_r *Auy apptit that checks box-nmst also fill out the section below showing their wa¢ rss'rnrepenss7iog pow i s t Eomerwners who submit dus a£davit in&cstar+•they ale doing BE Ira&and then hTE Mitade contra curs nmst 5ubua>t a new afdmat M rgtmQ such_" =Gontwcmrs tb�t check this box must attached au additional sheet shoumg the name of the saoh-o and state whether m nut these entifies have aVIayees_ Ifthe suB-contmctuis h=m empIoyees,they iffist pimnde their worlcrs'comp.policy aumber_ I am an Belau is the po&c}acid job site information_ Insurance Company Name: Policy 4..-or Self-ins-Lrc q Expiration Date: fob Site Address: a�� J �✓t J C�� �/�J Cifylstatelzip: /v . Attach A copy of the wGrkers'compensation policy declaration page(showing the policy nura er and expiration date). Failure to secure coverage as regdffeduader Section 25A of MUL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,5DO.OG andlor one-yearimprisoament,as well as civil penalties in the form of a STOP WORK ORDERand a ftae ofup to$250-DO a.day against the violator_ Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA far insurance coverage tierffi,cation- F dri here aerhfy rcarder the s andpenalties afperjurp thatthe informiation prm�rI ahime is fnta and correct Sianafnre: aa Date: l� �! i Phone#: 508 36na),m):�- — -- — - !�,jjZ— CO use on[y. Da n.of tvritgit�fills urea}fv bs w-mT zted by city or-town-a�icra — -- City or Town- PerraitUcense# Ensuing Authority(circle one): 1.Board of Health 2.Binding Department I Cit5frown Clerk d_Electrical Inspector S.Plumbing Ea-Tecfor .6.Other Contact Person: Phone ff: 6 Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuantto 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 tberein,or the occ,.rpant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152" §25C(6)also states th i"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commorz--�v_-alto.for=rzy applicant who has not produced acceptable evidence of compliance with the insurance.coverage requ.ired." Additionally,MGL chapter 152, §25C(7)states`Neither the commonwealth nor any of its political,ubdiv isions shall enter into any contract for the performance of public work until acceptable evidence of compli.arce the insurance requirements of this chapter have been presented to the contracting authority." Applicants —-- Please fill out the workers' compensation affidavit completely,by checking flit boxes that apply to yc-or situation and,i necessary,supply sub-contractors)name(s),addresses)and phone number(s)along with their c:er 1 ifie ft(s)of insurance. Limited Liability Companies(I LC) or Limited Liability Partnerships(LLP)with no e_.p.1 oyees other than the members or partners, are not required to carry workers' compensation insurance- If an LLC or LL P sloes have employees, a policy is required- Be advised that this affidavit may be submi�red to the Depatunent of indusir-i.al Accidents for confirmation ofi ar2nce coverage. Also be sure to sign and date the affidavit Tht a:�daNrit should be returned to the city or town that the application for the permit or license is being requested,not the De.par-mint of Industrial Accidents. Should you have any questions regarding the taw or i f you are regrrirtd to obt'in a worl.ers' compensation policy,please call the Department at the number listed below. Seii insured companies s1h.ould enter their self-insurance license number on the appropriate line. City or Town Officials PIease be sure that the affidavit is complete and printed legibly. The Department has provided a spar;ai the bottom of the affidavit for you to fill out in the event the Ofuce of Investigations has to contact you regardi-.2'che applicant Please be sure to,fill in the ptrmitdicense number which wit be used as a reference number. In ad.d ion, an applicant that must submit multiple permitllicease applications is any given year,need only submit one affidavit indicarng current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations In (city or town)."A ropy 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 co;rmercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this afndW,-%t_ 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 Commaaw,-an of Massachusc:�tts Department cif Industaak Accidents Qfxce oz favestiptFans 600 Wasbingtaa Stet Boston,MA G21II T61- 617-72 -49-GO W 4-06 or 1-977-MASSAFE Revised 4-24-07 Fax# 617-727--7-749 WWW.mass--ga vldia 1 Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor sr. License: CS-102905 CEZAR A LANW ' 37 Scallop Drive Dennis Port MA 0263 's Expiration OSN1/2015 Commissioner k' UU (YlbE,Q, fP la tip 1`f MA '� �,�a� � If2 �� S Le AR I �a�tilr j 1 ' G t _ cou fy m �ah`►Z r--�9� d�3� j_ . n -'teal L IE a �Pti 'l ' 1 Yee �-p pLo� 0 9 'I Alvry S 1 r I A' ()2-16®[ 1r ,n / Ill s _ \ _ of 6 •--it Ak JZ222W A/&L,Lj . VU J o� �-C- IYANNOUG}i RD (RT 26) 0,w� _ Es . PARKING PARKING PARKING PARKING 225 lyannough Rd {Route 2S) y �4-i Make Line r 0 OFFICE PARKING � 'OFFICE / N Jam. .. EXIT y�l= � � —� N KITCHEN t�l .8 �3u d 16 �til a PARKING BACK ROOM 1 or Dry storage d to Hand sin FRONT Make line si. 11 COUNTER { E E$ I 3 6 o o M1i Q I PARKING. Sink Area03 w. , x l' tt f (9 s N i —� �eCORRIDOR 3 Bleach dispenser ENTRANCE PARKING Dry storage Booth 4 �yh Table 4 I Booth 4 1 nn A `-- PARKING It�1� Booth �7atie4 Booth 4 , Booth 4 Table v Booth 4 PARKING Exrr MPSTER DU W PARKING HANDICAP PARKING PARKING �� r �. � E r Town of Barnstable Regulatory Services 9snxxsce� Richard V.Scali,Director . A,m Building Division Tom Perry,Building Commissioner 200-Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 T =-- --- -- - Fax: 508-790-6230 ^' Property Owner Must _ P Complete and Sign This Section If Using A Builder L4I, , as Owner of the subject property hereb authorize i- y � �14 1CA to act on my behalf, in all matters relative to work authorized by this building permit application for. aRs KVOU d is-/V\A 03rool 1. (Ad s 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 perfonned and accepted. C Sig a ignature of Applicant ZkO CA- Print Name Print Name 2 3 Date QTORMS:O WNERPERMISSIONPOOLS Town of Barnstable Regulatory Services THE T°� Richard V.Scali,Director ti Building Division f saxxsrasr 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. DEFINTI'ION 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 roc es and require is d that he/she w PY ill comply with said procedures and requirements. SignAffe of Horn er 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 persons)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 &ReguIations 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:\WPFILES\FORMS\building permit forms\E)PRESS.doc Revised 061313 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION OF �?a��RN,�aT��3t ZZ Map- Parcel Application # Health Division ` , ,". ,= Date Issued�� Conservation Division Application Fek& - k, Planning Dept. Permit Fee �D�• ©� Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/ Hyannis B Project Street Address �� ' �1 1 Village ( )" rS_ Owner A J L J eD Address Telephone Permit Request j U kw-- ^ Li (Od C\. U3/ �•c�C Z(� �' Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay w .ti Project Valuation,4 0'0V Construction Type Lot Size Grandfathered: ❑Yes ❑ No.,A/fyes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count 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 ❑ Appea'l # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) �a e ���j�c =( PA TelephoneWumkjer ) 0 Address License# Home Improvement Contractor# 6 3 Email Worker's Compensation # 6qu-8- S13 t�Z N 7-to-14 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ,SIGNATURE DATE- FOR OFFICIAL USE ONLY APPLICATION# e� DATE ISSUED MAP/PARCELNO. ' 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. vi 77ie CommrompeaM ojfMarsachusetts Deparaffenta,f'Industr atAcciden& ' Offl-ce of rmws4atiam. y 600 Washington&reef -- Boston,MA 0211I tVFV1# fliasmgOrldla Wcwkers' Campensation.Insurance Affidavit:B"niIder-jC,antractursMecfricians(Ph tubers Applicant Infarmatfant Please Print Address: l �('2�'Te9-•c-) L}:c�' City/State�:_- 4N e,e„0 D_ Phone 4"k Are J employer. Check the appropriate box: Type of project(reguireq: 1.12 I am a employer uith_"/L-t 4 ❑I am a general confractor and I • employees(felt arrd(or part-time)-* have hired the sub-coa4ractors 6. ❑Ides construction 2.❑ I am a sale preprietcm orpartner- listed om the attached sheet, 7_ ❑Remodeling. ship and have no employees. Theme sub-contractors have g. ❑Demolition w rt.:ina for me in any capacity euplcvees andhave wodcers' [No W06Mrs'camp.insurance comp.insurance i 9. El Budding addition required.] 5_ ❑ We are a-corporation and its 16-❑Electrical repairs cr additions 3.❑ I am a homeoumer doing all work officers have exercised their 1 L❑Plumbing repairs or additions myssod€[No workem' - tight of exemption per 1`t?fGL airs inmmnce required.]Y c.1 lry.❑Iloofr 52,§1(4}.and we have no , employees.(No worjcess' 13.❑Other cowp.insurance required.] J 1 •A.uy appEicxntdhat rbec sbax rl nnost also fill sectionbelowshnsing it wo&eW compersatiaapoHc in5rmsuam. #Sanx-owners who submit iNs.af6davu mating they aze doing RU wo&anti themhEm autsidecont-Rctors mast submit a new affidavit indieatin.sarlt fCoatLactos1bxt eher3[tWs boot mast attached=sdditiansl skeet showing the name of the sub-•contucfom and state whether or not tbmse enfities ham ewla3'en.Ifthe subtantactmshave empluees,theymmstpmtade their workers'-c=p.parky nun ber. I aa[ar[suipr that is prm-zdir[g yvarkers'con[peresairar[.u[sziraRce,�or�s[�*enrp�vy�es BaFa[v is iihepatiry aa,I jola s�e� • ixfarmrrtian • Insurance Company Name: 2 �ti S Policy or Self-irrs.Lie_ l )J �� Z l-kpiaationDate- l0 12-�e bz(f—, Job Site Address. citylstafe zip: ( Attach a copy of the workers'c ensaflonp.olicy declaration page(showing the policy number and expiration date). Fail=to secme coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1500 OO and,-'or one-year imprison,as well as civil penalties in the farm of a STOP WORK ORDER and a fine of up to M-00 a day against the violator. Be advised tint a copy of this statement maybe forwarded to the Office of Travesdgations ofthe DIAL for insurance coverage yzdfitaiion_ Ida herzby c fj rand tha pain at a �fF 'd attrio inforwa€ia[ipimi&rdabore is bars mid carrect - Siitaature= Phone i ;2-L( G ( Lk7'6 02kiduseatify. Do-tat write in this area,[a be cvinpTetiod by city ar tatr-n of)'idtat City or Town: PerrffitlLicense;9 Issuing AulhorFty(ci rle:one): L Board of Health r.BuffTmg Department 3.#Mervin,Clerk 4.Electrical bmpector S.Plumbing Inspector 5.Other Contact Person: Phone<;9- formation and Instrueflons q Mass aclrasetfs G&3 a Laws ahapt=M rega all employers`fn provide wormers'compensafton for their enPIoyees. Pmsamtfo this sib an MpIoyee is defined as¢.every person m.$ae service of another under ashy contract of hire, express or implied,oral orWlftb=" An err�Ioy�is defined as°Pail indiyidnal,partnmmbip,associafian,c�rporafion or other IegaI e�y,or a¢Y two or more of the foregoing engaged in aJoint e: tutp .andiacladmg the Iegal rep=seafafiives of a deceased employer,or the receiver or trastee of an individual,partnership,associai' or other Iegal entity,employing employees. However the ow,Tner of a.dvrellmg hDUSe having not more Haan three apart entity,- is and who resides therein,or the occapant of the . dwening house of another who employs persons to do mainienaam,construdd(M or rep air work.on sucli dwelling house: or on.the grounds or bmldmg appurteum¢$iereto shall not because of such employme be deemed tr be as employes." MGL chapter 152,§25C(6)also sues ffiA"every state or local licensing agency shall withhold$ie issuance or renewal of a license or permit to operate a business or to construct buildings za the commanwe alth for any applicantwho has not produced acceptable evidence of compliance with thre bigarance coverage required_" Additionally,MGL chaPt�x' 152, §25C(7)states-Weiiher the caimncmwealth nor nay ofits political subdivisions shalt enter into any contract for the performance ofpublic wont M acceptable evidence of coinpIiance the;,,ccrr�„ce. requirements of this chapter have been presented to the confractmg antho,*_" Applicants Please fU o� the wo&ess'compensation affidavit completely,by checl®g e boxes that apply to your sitaafion and,if necessary,supply anb-contactors)naa e*), addresses)andphpnenvmber(s) alongwiththeir certificate(s)of hem ance. Limited Liability Companies(LLC)or Limit LiahilityPartamships.(LLP)ylithno eauployees Other than the members or paafn=s�ate not required to casy wolkers' compensation iasaimc;e If an LLC or LLP does have =ptoyees,a policy is regnhed. Be advised the this a$dayitmaybe snbmiffied to the Department of Industrial. Accidents for confirmation of insurance coverage_ Also be sure to sign and date tithe zEIdavit Tho affidavit should be retvmesd to thee city or town that the application for the peanh or license is being requested,not the Deparmmenf of ; you my 4 the law or if u au e to obtain a workers' Ldestrial A_ccidenIs. Should * n have ons��g y° d antes should enter their compemsa�onpolicy,please colt the Depot nert at the nrmbea Listed below Self-instated camp s elf-;gin ce license nnmber on the appropriate Ime. City or Town Officials t Please be sore that the affidavit is complete and pri3±cdlegibly. 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 bo sure to fill in the pen�.it/licemse nninber which will be used as a referq_nce number. Ia-addition,an applicant that must sabn�nzvl4lo pennit/Iicense applications in any given year,need.only sabmit one affidavit indices: cent p olicy mfornaiion.(if necessary)and under"Job Sitz Address",the applicant shoud write"4 locations in (CiY Or- tawn).'A copy of the-affidavit that has be=officially stamped or maz}ced'17y the city or tov i may be provided to the applicant as proofthat a valid affidavit is on fire for f:ifni permits or licenses A nesw affidavitmust be fa -ci out eiarh year.-Where a bowie owner bi citizen is obtaining a.license or permit not=Iated to any business or commercial ve�� (i.e. a dog license or pew to bins leaves etc.)said person is NOT rcqtm ed to comple e fais affidavit The Of of Juvestigafions would Like to thank you m admce for your cooperation and should you have any questiow, please do not hesifatr to give us a caIL The Department's mess,telephone and fax number. - DeP33tamt of Iafts iek Accidents Off ce oflaveguratio= 6Q4 wQn t �ost�I�E�11� TeL4' 617- -4940'Q�t 4-06 or 14771LA GAF F Fax#617-727 7749 Revis_a4-24-07 V= s.,�.ODgfdia ..°F IKE • sAaxsrwsM • MASS. 16 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: 508-862-4038 Fax: 508-790-6230 F Property Owner Must - Complete and Sign This Section. If Using A Builder 1 ri ' I'_ �d �'`�®-�C1 ,as Owner of the subject property hereby authorize (2(Lc'—c-t7- to act on my behalf, . in all matters relative to work authorized by this building permit application for: (Address of Job) t c c Signatur of er ' Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side.. Q:\WPFU,ES\FORMS\building permit forms\EXPRESS.doc Revised 040215 J U OO-,(�, Ot?`�-Cl -t( i PLO el�- — V) lr' MA o Q Or EaA V �nr a CIO 1 p `�� S V• r '`~ YJ 1-3 ni I Y V L�Y H � n n Opt An YA �P . IS06 i cam' F mot , Sign TOWN OF BARNSTABLE Permit * BARNSTABLE. MASS. 6� 9.!•op� A Permit Number. Application Ref: 201500165 20671117 Issue Date: 06/10/15 Applicant: JOHNSON,NANCY L TR Proposed Use: RESTAURANT & CLUB Permit Type: SIGN PERMIT Permit Fee $ 75.00 Location 225 IYANNOUGH ROAD/RTE 28 Map Parcel 328205 Town HYANNIS Zoning District HG Contractor PROPERTY OWNER - - Remarks 32 SQ FT SIGN REFACE FOR A BRASILEIRA CAFE Owner: JOHNSON, NANCY L TR Address: P O BOX 342 HYANNIS, MA 02601 Issued By: PC POST THIS CARD'SO THAT YS vIIBLE FROM TIDE S REET d .. �TNE Town of Barnstable Regulatory Services7m,, r ; ST BL B" MAS&z� ' Richard V. Scali,Interim-Director SEA` Building Division j ,; � '� i ' Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.uT,j " Office: 508-862-4038 Fax: 508-790-6230 Permit# ( � Building Official approving-___________ Application for Sign Permit Applicant:_—��d-��� �-1 �Gk ----------Assessors N,o.---------------� Douig Business As:_ - j` Q Telephone No._r�C U0_I q3 5 Sign Location Street/Road: _ Q0 --- ------------------------------- Zoning District Old Kings Highway? Yes/No, Hyannis Historic District? Yes/No Property Ow1neer (� Name:__1JCAq� — S�!�_ �� ------------Telephone:_-5(-�/ � (� — 1- �- - J Address:_9-1 1_ yaL_r4 Village:,_ Sign Contra � A Name: - -- -- r`- iO-k C ----Telephone:-- Q(y) Mailing Address:__ Al oL i --_ --_- �40-. _1��} Description Please follow the cover directions.You must have an accurate rendition of sign with dimensions and location. Is the sign to be electrified? Yes/No (Note:If yes, a muvig permit is required) Width of building face tD_—ft.x 10=_ _x 10= Check one Reface existing sign or New_ Total Sq. Ft. of proposed sign (s) If you have additional signs please attach a Sheetlistlllg each one with dimensions If refacing an existing sign please provide a picture of the existing sign with dimensions. I hereby certify that I am die owner or that I have die audiority of die owner to make this application, that the information is correct mid that the use mud construction sliall conform to the provisions of §240-59 dirough§240-89 of die Town of B stable Z iing Ordii ice. Signature of Owner/Authorized Agent:- f �- Date 0 SIGNS/SIGNREQU revisedl 10413 a brasileira cafe.JP.9 1/12/15..2:12,PM � } ill � Cl. �i. � Y ., .; 96 y �-. r oll ti � . 48 about:blank Page 1.df'2 F � FF CAFE. � . CAFE AOL Y. 1 m ' .1N ice,•� �l .Y 4� �I�, :�' _ i� r / f �' , OP450 Coming Soon Y t Podera ser aplicado um y 1' adesivo impresso ou k-$A.0'. w i recorte em vinil sobre '•`"va'':`'; ' a Iona criada.No dia da inaugura4ao,basta tirar este adesivo.Como sao poucos dias,se o adesivo for de i q boa qualidade,nao deixara \ ` marcas ou sujeiras. �*p 7 U7 y� k ��• k �'' iDElAS/ J CAFE , CAFE 470=4945 e 5 �"•R�n r, xn t ����' r�. �� � � .alb .t tl W op�ao � _ Final t �� �' A r IDEIAS/ APRESENTA AO LONATOTEIVI 465x95 in RG7 IDEMS/ 1 YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, 1"FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) DATE: Fill in please: lltx r6 r w 3i'� :LLfi F fig iF ",emu B!7/� �/N/ r'�ryhda}r' `sr 6,��p �r" APPLICANT'S YOUR NAME/S: l��d/�Jf/4 di4 .T/L:IIA 1�7,racl/€ rs r'tf� �x� p {tF; BUSINESS YOUR HOME ADDRESS: 91S �7EWW- J'T UMIT t l=�'z YcS.�'.`Vjj��i�:il�i,r rfl[Fri• ;a�}'��`� 1._ /�/��.! i^ilA �[� —- 1d1Fi.rg'- J TELEPHONE # Home Telephone Number NAME OF CORPORATION: //V c NAME OF NEW BUSINESS JIL-1 iE TYPE OF BUSINESS IS THIS A HOME OCCUPATION? YES N �-7 <-- ADDRESS OF BUSINESS o2025 dirt-oG[CT�v. «h'7'd "14 MAP/PARCEL NUMBER ��i Z 0.5 (Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you.-may need. . You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMISSIONER'S FF. This individual has beba_mTorciked of any pe�i requirements that pertain to this type of business. uthorized Signature** - COMMENTS: 2. BOARD OF HEALTH This individual has been informed of the permit requirements that pertain to this type of business. Authorized Signature** COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: TO ALL NEW BUSINESS OWNERS DATE: :I Fill in please: , APPLICANT'S YOUR NAME: RALja z A 4ba EA Sow BUSINESS YOUR HOME ADDRESS: 2r D t i4NN,_&V •�14Q.M C50� 0� 39g . o LEPHONE Telephone Number Home `l — o x rr�m .... .. ........ .r.;: _ :t. r 4, Fr r WeU. : V�. ..L .,.u. r ... _... .a rr rr rr .., ,. r n. ._ �.''::.r' `-::r-� <ii+ I',�.E::� ..�• t C .�-...r... 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T .. .r = ..., 'k, ,: r 4 ..._r x,'!. .t ^ �'_$�(� � ; '.�'._ rl.0 - �''�'r�f.i. r9��r_::9t,�.r�. r..d:::.d:... a�'•' - !?, N �,. �`:�:tR�^:aJ.r I..,y r:•Jk.,:I .'fU'*t..r_ ��,r ...r•. ^... 4��•i' _.� .r� � .Il�i!T' t fi r When starting a new business there are several things you must do in rder to bean compliance ith the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you.may need. Once;you have obtained the required signatures, listed below, you may apply for a business certificate at the Town Clerk's Office (Ist floor-Town Hall) or if you get the business certificate first you MUST go to the following office to make sure you have all the required permits and licenses.. GO TO 200 Main St.— (corner of Yarmouth Rd. & Main Street) and you will find the following offices: 1. BUILDING COMMISSIONER' OFFICE This individual ha en inform9dpf any permit requirements that pertain to this type of business. Aut onzed Signature" COMMENTS: 2. BOARD OF HEALTH This individual has been informed of the permit requirements that pertain to this type of business. Authorized Signature" COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual nlbe= ope�g requirements that pertain to this type of business. Authorized S'MY' naturef"� COMMENTS: Al 0,✓74_v o F a V bcrose Business certificates (cost$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in the town (which you must do by M.G.L. - it does not give you permission to operate -you must get that through completion of the processes from the various departments involved. —SIGNIFIES APPROVAL FOR A BUSINESS CERTIFICATE ONLY. J v 4kN a � I i { 4.0 OF { ` 3P i 4Ar r��K � E � �`•� + ��PJ I Cab°� F } Assessor's map and lot number ... ..�.'. .. .. � „•u SEPTIC SYSTEM MUST" BE x Sewage Permit number GR:...' . ::� LE® IN COMPLIANCE INSTAL WITH ARTICLE.II STATE S v _, oE.TNEro ,f SANITARY 0 D TO 9 Wty w �Q� TOWN OF BAR NEST ' i BAHH9TADL8 • G; B U I�LD I-N G INSPECTOR OQ :1639,re� �.t • r. vv T • l� 2 APPLICATION FOR PERMIT TO ........../. ..4...G ...... .�4y(. �/.4'l1t! ........ TYPE OF CONSTRUCTION ...................... .................... ............ ....................... ................. G�►v�'� . ... ............19.../. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ...............i .......... J J................................................................... / Proposed Use .............. . 1�.1.t-e.....�'.`��C�:�:�:'-1............../.J.d.:.l`�....1. ..:q.........`�.!1 ...........-3........../...`.... ZoningDistrict ......... ......................... ...................... ....Fire District ............ .....................I............ Name of Owner . .. ti tix ...... ...... ... k0c'j............Address .................................................................................... Nameof Builder .....................................................................Address .................................................................................... Name of Architect ....Address �'— .............................................................. ..................................................................................... Numberof Rooms ....................................................................Foundation .............................................................................. Exterior .................... ...............................................Roofing ............C��� ... �.4:,.............. ..................................... .................. Floors ...............................Interior .................................................................................... Heating ...................................... :.... ....................................Plumbing .................................................................................. Fireplace Approximate Cost �G.. Definitive Plan Approved by Planning Board ------------____—-----------19_______. Area .../QC1............ ........S...., ......,...... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HE M j I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name . 771&��- ....... .. A7—. K2,4 .. ... Gerrior, Harry J. 4',d,19265 remodel & No ..................Permit for .................................... build 'overhang' - . ..................................:...........:................................... " '225 Iyanough Road Location ...............;......;..............................%........... Hyannis ................................................................................ H Owner ........... arry J. Gerrior........................................................ Type of Construction ....................f rame"...... ................................................................................ Plot ................. Lot ............. ............ ..................... t f. Permit Granted".. J.une...3...................ig 77 ,o Date of Inspection .......^r .....\..19 0- "d //* Date C mplete ............. .19 -PERMIT-REFUSED ........................................ ................. .... 19 ....................................... ...................................... ........................................................... .................... ............................ .............................. ........... ........................................................... .................. Approved ................................................ ig ................................................................... ....... ............................................................................... jq Asse.is o map and lot number ..A...........��...........�... THE �y ^- O O o�� /a_ 9_ 7 7 _ iyou� P F r Sewage Permit number l/l................................................... 306 & 3� 9 1 yrN BAHB9TADLE, House number ........................................................................� rues. TOWN OF BARNSTA ' ts� lsro, BUILDI �[,,NSPECTOR APPLICATIONFOR PERMIT TO ..................... .. ...... . ......... ................................................................................. TYPE OF CONSTRUCTION ...................................... Q..7 ...-'.................:............................................ .. ...................19. �q 1 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ................. ............ .... ................... 7G . .�ll.......`..1 <.................... ..... ............................................... ProposedUse .......................¢�� 4....... ...............................................................................................I......................... ZoningDistrict .......................... ........................................Fire District ........... ... . ........ .. Name of Owner W AA.Okksr...... .'....:....�.u Q�.'kt.0..Address .................................................................................. R1' Of Nameof Builder ....................................................................Address ......................................................................: .Name of Architect ..................................................................Address .................................................................................... Numberof Rooms ..................................................................Foundation .............................................................................. Exterior ....................................................................................Roofing ................... ........................................................ Floors .. .'. ....�.:.(....................................................Interior ............:........... ... . . Heating ..........t ..VA.Y............ .................................Plumbing .............. ... ....... ................................................. Fireplace .......................................................................Approximate Cost ..... .....................:.......... �. Definitive Plan Approved by Planning Board ---------------___-----------19--------. Area ................................... Diagram of Lot and Building with Dimensions Fee ers/ SUBJECT TO APPROVAL OF BOARD OF HEALTH i . I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ......... ................................... ....................... � � � ` � . . _ . . ' . ' . . . _ _ . - ' . - r . ' - l ' � ' - Tavano, Nicholas R. commercial building Hyannis Nicholas R. Tavano PERMIT REFUSED . . . ............................................... ................................................ ----. ~\ . � / ' ----- ^ < - lQ ' � ----~--^^^^^^^—~~—'--'' ' ,-----------~.---~.— . . NIiC���'� ��Nlu2le �lo � i W� �41zAn vv � Ma- DZ(o73 I , TOWN OF BARNSTABLE SIGN PERMIT PARCEL ID 328 205 GEOBASE ID 24578 ADDRESS 225 IYANNOUGH ROAD/RTE28 PHONE HYANNIS ZIP ( LOT BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT HY I PERMIT 46079 DESCRIPTION "PAPA BELLO" - 24 SQ. PERMIT TYPE BSIGN TITLE SIGN PERMIT CONTRACTORS: Department of Health, Safety ARCHITECTS: and Environmental Services TOTAL FEES: $25.00 NE BOND $.00 OxT CONSTRUCTION COSTS. $.00 753 MISC. NOT CODED ELSEWHERE 1 PRIVATE P:2(; ►ET"_ ; * ■ARN3TABLE, � y'7 MA83. 1639. BUILDINGG DIVTSIONW .BY DATE ISSUED 05/15/2000 EXPIRATION DATE �oF rOwti The Town of Barnstable ? DepArtment of Health, Safety and Environmental Services HG 'r Building Division :. . `m�' 367 Main Street,Hyannis MA 02601, QED MA'S� Ralph Crossen Office: 508-862-4038 Building Commissioner Fax: 508-790-6230 Tax Collector Treasurer.; Application for Sign Permit Applicant: Y iFN t U Zj e, Assessors Nod g Doin Business As: ��-��- B t;//c Telephone No. 7 Sign Location \ Ala j2 c� f - Z,g f �q,�'� 15 M 4- 0 2 G o Street/Road: '�2 5 Zoning District: Old Kings Highway? Yes/No Hyannis Historic District? Yes/No Property Owner 77 i• /� Name: /1/AAfC JokIVso%✓ Telephone:— Village' Address: k Sign Contractor Name: Oct-- I-KIZAJ 6S f F I �J G 516 46- Telephone: -7-2(—W9 Address: 3 Btu g Village: V nt N t S Description Please draw a diagram of lot showing location of buildings and misting signs with dimensions, location and size of the-new sign. This should be drawn on the reverse side of this application. Is the sign to be electrified? Y /No ote:If yes, a wiring permit is required) I hereby certify that I am the owner or eh`•att Ira have the.authority construction shallwner to conform reform . e this application, that the information is corn to the provisions of Section 44 of the Town of Barnst ble Zoning Ordinance. Signature of Owner/Authorized Agent Date: aQ-0 Permit Fee• Size: Sign Permit was approved: Disapproved: of Building 0 al: Date: Signature g Signl.doc rev.8/31/98 I 48 INCHES i P-DQpQ PIZ ZERIA RISTORANTE O�Qd0�1G�1 c� BRAZ§L§AH EAT=lN or TAKE OUT 06 'U77NELIVER 0 '4,,�N 775 .� 3q9 A� 0=0 d QB C& Q l�..l I b4 P. -___ a `� � � 1 - -�-�__ - TOWN OF BARNSTABLE 9' SIGN PERMIT PARCEL ID 328 205 GEOBASE ID 24578 ADDRESS 225 \IYANNdUGH ROAD/RTE28 PHONE HYANNIS ZIP LOT - y BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT HY PERMIT 32354 DESCRIPTION CHESTER FRIED CHICKEN PERMIT TYPE BSIGN TITLE SIGN PERMIT CONTRACTORS: Department.of Health, Safety ARCHITECTS: and Environmental Services TOTAL FEES: $50.00 THEBOND .00 I CONSTRUCTION COSTS $.00 d � I 753 MISC. NOT CODED ELSM ERE BARNSTABM # MASS. 1 039. UILDINjG DIVI ION DATE ISSUED 07/27/1998 EXPIRATION DATE BY p{ AA^^sr 5..> ,�+ Y �±�.RI .K..: ;D>3.�... 'k.� ��� 'cj 7 � Ha:urY2+1,116 0260, Jvtis-�0 r F!1 ccmt 11,-ppficaiian for Ss �Lff . �t^.� d ict: Old kdnp HIghvr&v r� `r`v s, Ii�anws Nfistor�c Disuict 5 � - rop 'Vivm° _u _ -Wy-- --- - t.:A�, Please di`avv a dia9ara of lot showil,'.1; locatmli of build-ngs auid exisoling signs crab &mensiom, + ego anti size of the new sign. T LiS shoWd be cLr�,,wjj o,=).the reverse side of this apphca tom 18 die sign to be ehcuifjedP (i� '.� O Ole: a r 6C"" rZ >+'U�.1?fj J?EtT'11t is R° ,?d1tfrCt',1 w heeeoy ceft,4 4, am th 31MIcr Gt that I have 1111� 3uthont-v 4f die owner to make td-us ap'spkakion, that il2w ir- orn:ation Is rot7e,:t ar d d:3: the c.tse azirl cOrssLIur.tas rs shall conform, to gilt'. Provisiot:z, of Section 4-8 of t:e Town ,,!'Bamstv:bIt ''.onmg Ordinance, Sig. = e�;:iit: aa� a9rczvd: v"Y1 ggam, . xattate of iaic'�i. il 'L. �7 Signl.doc r, a f=s e �C5 O r� %THE TOWN OF BARNSTABLE BARNSTLELE, MM& lei M A? B U ItI) I N G, INSPECTOR APPLICATION FOR PERMIT TO .................... .....V. .................................................................. TYPE OF CONSTRUCTION ............................... TO THE INSPECTOR OF- BUILDINGS:' The undersigned hereby applies for a p rmit accordin to following in rmation: pplies for a rmit accordin IL Location ................2..;L.5 ....................... ..... .............................. Proposed Use ............. .. .. . ... . . .............. .... ................. ad.q�k......... Zoning District ............................ 7......i��..........................................Fire District .......... AA Name of Owner .......T-a/1A.......AA/�...................Address .............�- .............................................. Nameof Builder ...................................................... .............Address .................................................................................... Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ..................... ................... Exierior .....W-0........ ..................................Roofing .................. ............................... Floors ..... ...................Interior ........ . . . . . . .. .......................................... Heating ................. ....................................Plumbing .................................................................................. 0---------- Fireplace ..................................................................................Approximatt- Cost ......... R�15-6.......................................... Difinitive Plan Approved by Planning Board --------------------------------19--------- -e ri e- Diagram of Lot and Building with Dimensions e- v�9 \5 I hereby agree to conform to till the Rules and Regulations of the Town of Barnstable regarding the above construction. NameA�� a_lt� ............. ....... .....I........................ � - � Garrior" Harry ' DEC 3 1 "Sp No -.ytO �—' Permit for ........ commercial�����mo���-------����v���----_____._______._ ` . . 2 Road u \ Location_ --.-- 2�-----.---^-------.—Hyannis � --.—..---..-".—.—..-----------.- � Gmrrior " Owner --.—..�����-----.-----.---. � �r�oa� � � Typo of Construction u ��n -------- � \ � ~^^^~^—^^--'—'-----^^'''~---~---- | Plot �� � —..~------. ----------.. ' ` 1 J,i�� �� » Permit Granted --^ lV 7I ' ^ ------------'— j | � . � Date of Inspection — ...... Dote Completed —.. ' \ ^ � PERMIT REFUSED ' � —..—.—.__.,—...------..-- lA ......---.—..-----.—.--._.--..—_.. | � | ` ..._....—.—._.--....—........—........,' ^ . � | ^--.~._.—~_.—^—.~.—'_..—.....^—,...— | —'—'----------`—^^^^^—^'`—'^^^'--^'' | ' � Approved .............................................. 19 ^ � .----------------------.—.... � ' � --------'------..--..,—.......... � � Q�Assessor's map and lot number ...........................................' f t �� � _ '7 c `-• , Sewage Permit number/"t/Xl. �....... i...� e�Q ♦°^ Z BAWSTABLE. i House number 9 ►Ines t 6 0� } �O 39• �0 o m A• TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATIONFOR PERMIT TO 'U d —.............................................................................................................................. TYPE OF CONSTRUCTION r .............!. \:.... ..................19. .� P' TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ......................-' ��........l- f✓1 C c;�>I t �l ��C.,...... ................... .............................................. ProposedUse .................... » ..... ................................................................................................... Zoning District .... .............. ............i..............................Fire District ,f �------ ....................................................... Name of Owner .� �..�.�. •01. ......!�... Address ........................1......................................................... - Name of Builder ....................................................................Address ................:................................................................... .Name of Architect ..................................................................Address .................................................................................... Number of Rooms ..................................................................Foundation ......................................:....................................... Exterior ....................................................................................Roofing ..................................................................................... Interior . ...................................... :.Floors .... .... ;. •� �........ ... . Heating ..............: ..... • .................................Plumbing ...� :1'`?•!!::✓.:a .. Fireplace ...........................�..-..........................................Approximate Cost .....�, f�. f)!)(1 7. Definitive Plan Approved by Planning Board -----------_------_-----------19________. Area .......................................... (---- Diagram of Lot and Building with Dimensions Fee ..... ................................ SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ...d...-:..:...... �' ! x.... Gc:: " ...--z-)... 0 Tavano, Nicholas R. A=328-205 21723 remodel No ................. Permit for .................................... commercial building ............................................................................... 225 Iyanough Road Location ................................................................ Hyannis ............................................................................... Owner ..............Nicholas. . ...R... ... Tavano. . ................. . .......... .. . ........ . Type of Construction .......f.;ame ..... ........................ Plot ........................ Lot ................................ October g Permit Granted ................19 79 .............. Date of Inspections ............................F19 Date/Completed. ......... ........... **..........19 U PERMIT REFUSED ..... ..... . ......... ....!*. ......... . 19 .. .................................. ................................................. ............................... .................................................... ..................... ............................................................................... �'�/� Approved ................................................ 19 -�� ^�� ell � �m 1 ..................... ......................................................... YV1 1 0 '{ Assessor's map and lot number ".....,,. \ Sewage Permit number A......:..........y✓ ,- y�F THE t0�4 TOWN ®Fr�1 1 R S 7I"�B L E ��?• ! O� �7 yT 33A" TOILE • / 039. It APPLICATION FOR PERMIT TO .........��: :v�„t r(!i.....................................^ / . (?1�rG t 4 Mtn ` TYPE OF CONSTRUCTION ................ `r R,r'ti.,�... -. Y....................4.........:........ 4 ................................................. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: i ^ Location _n (ja4l lProposed Use ......... .... /r w/a. e..... ..... ...........i.. .flf-P,d........ ;........................./\.... l ZoningDistrict ............................ .........................................Fire District .....................roA--. .................................. 1 �, Ia.�n._ � Y'I�P/vv��� Name of Owner Address Nameof Builder ....................................................................Address ...........................................:......................................... Name of Architect ............................Address Numberof Rooms ...................................................................Foundation ....................................:......................................... Exterior ........................�:.r........................................................Roofing ........... r ..0..................................................: Floors ...........................................................Interior Heating ........................................................................:.:.:.....Pluri'ibing' :.... ............ ........................... . ....:... Fireplace ............................................v ......Approximate pproximate Cost Definitive Plan Approved by Planning Board -------------------_-----------19--------• Area .... ........................................ Diagram of Lot and Building with Dimensions Fee .......... SUBJECT TO APPROVAL OF BOARD OF F HEALTH ._-.-- I hereby,agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. 2 Name . ... -, - ....,. ....:v....... a.. _�... i....- .-:.- ..d.'...-F..n. ..,..... .�,..t'-..� .::.... �...... ... � �._1 wf�r.vx..,x ...� �........ .. „_...... _....n •..`dr....r..e w,-. ....... .......... ... .. .. .. ... Gerrior, Harry J. A=328-205 T i 19265 remodel & No ................. Permit for .................................... build overhang ............................................................................... Location 225 Iyanough Road ................................................................ Hyannis ................................................................................ Owner Harry J. Gerrior ................................................................. Type of Construction ........frame .................................. ................................................................................ Plot ............................ Lot ................:............... Permit Granted ...........June,.3 (/,1,977 Date of Inspection ................... .... Date Completed ................. .... I ............19 PER REl SED ........ ........................./19 /7....�GiF�S��.1....... ..9.:...................... .�� �� r. ............................. ...... ... ............... .................................... i Approved ................................................ 19 ............................................................................... ............................................................................... i