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Home My WebLink About0259 MAIN STREET (HYANNIS) tea® s i 1� �k e e Tf4E Tp�� Sign HP a� oyq - BARNSTABLE BARNSTABLE. .TOF 9Q MASS. g 1639' p�� Permit Number: rF0 MA'S Application Ref: 200903913 20070359 Issue Date: 08/25/09 Applicant: DAALE & MARTINO INC Proposed Use: MOTELS Permit Type: SIGN PERMIT Permit Fee $ 200.00 Location 259 MAIN STREET (HYANNIS) Map Parcel 327127 Town HYANNIS Zoning District HVB Contractor PROPERTY OWNER Remarks 95 SQ FT TOTAL FOR 5 SIGNS FOR HERITAGE HOUSE AND CHAUNCY'S 1) 11 1/4 SQ FT 2) 21 SQFT 3)40 SQ FT 4)2 6/10 SF 5)21 SQ FT Owner: DAALE & MARTINO INC Address: 259 MAIN ST HYANNIS, MA 02601 Issued By: C . P®ST TINS CAIRI)S® IIAT' IS VISgBLE FROM TINE S'I'REE ' S`Gtn r Town of Barnstable a F'(HE Regulatory Services �Uf. � o Thomas F. Geiler,Director 2 aaR,NsTnsLE. Pt MASS. $ Building Division 6'� 019,q, °rFps a Tom Perry,Building Commissioner Z 200 Main Street,Hyannis,MA 02601 5 ww,w.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Permit#006V0ZC1 Application for Sign Permit Applicants I Map &Parcel# c>o�7 ,/027 Doing Business As: yalr&-& /76,Z 't 4!#9/O�elephone No. --5-0r--77S=7bo o Sign Location /� Street/RoadW')0/l�f/� W S . dGl� 6c- Kam Zoning District: Old Kings Highway? Yes Hyannis Historic District? &No Property Owner Name: Telephone: Sews Address: p?Jl9 9A//i) S� Ldty / Village: Sign Contrac Name: r LK S 14-IU Telephone: Mailing Address: 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? (Note:Ifyes, a wiring permit is required) Width of building faCe&GO- ft.x 10= x .10= Sq.Ft. of proposed sign i3 � �e�f'4n�rc.7 �roEl I hereby certify that I uz n 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- of the Town of Barnstable Zoning Ordina Signature of Owner/Authorized Age t: 1 Date: Permit Fee: Sign Permit was approved: Disapproved: Signature of Building Official: Date: In order to process application without delays all sections must be completed. 0:1TYPFILESISI GNSI SIGNAPP.D0C 1 - 3 r I _ Bk 23986 Ps1.03 _49067 pp IKE L —, n J cl �. eon AUG.9Q i6.39 `08' ArfD Mpy� Town of Barnstable Planning Board Decision and Notice Special Permit 2009-02 Superior Hotel Management Corp. d/b/a Heritage House Hotel Section 240-93.B Nonconforming Buildings or Structure To allow 95 sq.ft., of nonconforming signage. Summary: Granted with Conditions Petitioner: Superior Hotel Management Corp. d/b/a Heritage House Hotel Property Address: 259 Main Street.& 540 Old Colony Road, Hyannis, MA Assessor's Map/Parcel: Map 327, Parcels 127 & 128 Zoning: Hyannis Village Business District Deed Reference: Book 13248, Pg 344 Relief Requested and Background: The applicant is seeking to install 95 sq.ft. of signage when zoning only permits a total of 50-sq.ft. The request to the Planning Board is for a special permit pursuant to the structural nonconforming section of the ordinance (Section 240-93.13) and is based upon prior signage that totaled approximately 200 sq.ft. The subject property is that of the Heritage House Hotel: It consists of two lots totaling 3 acres located at the intersection of Main Street and Old Colony Road. The property is developed with three buildings totaling 78,751 sq.ft. The main section of the hotel dates to 1969 and the two "annex" buildings date to 1976/77. In addition to the hotel use, an accessory restaurant "Chauncy's, Bar & Grille" is located in the hotel. The applicant recently improved the facade of the building and is now considering new signage. The plans for the signs have been before the Hyannis Main Street Waterfront Historic District Commission on June 17, 2009 and the aesthetics of the signage was approved. Upon review of the plans by the Building Commissioner, it was determined that the area of the proposed four signs total 95 sq.ft. The applicant is seeking to install 4 areas of signage that consists of 5 separate signs: a 21 sq.ft. "Heritage House Hotel & Chauncy's." sign onto Old Colony Road; a second 5 sq.ft. free-standing "Heritage House Hotel & Chauncy's" sign onto Old Colony Road; two separate signs totaling 29 sq.ft. onto Main Street, one identifying "Chauncy's" and the other "The Heritage Hotel"; and a 40 sq.ft. "Heritage House Hotel" sign on the canopy situated at the main entrance from the parking lot. Procedural & HearinJ SU;nnn»r}: This application was filed at the Town (:Ir)rl-'s Office aI at the Office of ii�e Punning Board on July 9 public hearing befure the Plannino Board was duly advertised and notice sent to all abutters in accordance with /\/1GL Chapter !fr0f\. The 11earin •,vas opened July 27, 200ci at which time the ROarr! fC'rnCl t0 t'raili iilc- $ijF(,i 11 Pr.;fnj; SUJjeCt to Condli1011S. Board Members deciding this application were: Raymond Lang Dave ,\/lunsell, Patrick Princi, Paul Curley mitthev'/ Tea ue, and Chairperson, Felicia Penn. Peter Martino, President of Superior Hotel Management Corp. d/b/a Heritage House Hotel addressed the board. He stated that the siUna�P th at existed was approx. 20t� s f a hick was allowed under zoning Uy-lavv, at the time Of construction,1969. During the process of updating the entire prop he prOpOses to r<'place the existing signage with approximately 95 s.f. of signage which represents halfof the prior signage. The lighting and signage have received approval from the Hyannis Main Street Waterfront Historic District Commission. Public comment was requested and no. one spoke in favor or in opposition to the request. Findings of Fact. At the hearing of July 27, 2009, the Planning Board unanimously made the following findings� Of fact: -1 . Superior Hotel Management Corp. has petitioned for Special Permit pursuant to Section 240-93.B Alteration or Expansion of a Nonconforming Building or Structure Not Used as Single or Two- Family Dwellings. The petitioner seeks to allow replacement of existing 200 s.f. signage with 95 s.f. signage as a part of updating the entire structure, where the Hyannis Village Business District allows only a total of 50 s.f. of signage. >. Upon review of the application and relevant zoning history provided by Growth Management Department staff, the application falls within a category specifically excepted in the ordinance for a grant of a Special Permit. 3. After the evaluation of [lie proposed replacement signage; the square footage and location would not be substantially more detrimental to the surrounding the spirit and intent of the Zoning ol not r�eighbood and that the proposal fulfills the Public good or the neighborhood affected as onlyLrScadditiop I sq ftresent �facestontOl detriment.to ways• the public 4. Site Plan review approval for signage is not applicable in this case as the site is not being altered. b alt Decision: Based on the findings of fact, a motion was duly made by Raymond Lang and seconded by Paul Curley to grant Special Permit 2009-02 sub Ilowing conditions: 1. This permit is issued to ahOvlwfor a t f�95_s f �signage at the 3-acre subject property, addressed as 259 Main Street and 540 Old Colony Rd, Hyannis, MA, and now Occupied by the "Heritage House Hotel", and the hotel's accessory restaurant, "Chauncy's Bar & Grill". Of that 95 sq.ft- of signage, a maximum of 55 sq.ft. is permitted to face onto the public ways of Main Street 2 | . ` ` anU ()|h 0o(oov Road. Tk^ ^� [o�` Ue oar� i h a» ! no| un[u (ilepuoii( ~ m� �a� z� 2 shall be no more th oil t - -1 This pe/ .` �i w oe Property a~aod [Uhe-u,c o/ -= |c� owne�saote| should chane P_ � -\drcrbsio� tha:_ include� a//yuricm�. such as room n/ dinnrrpricos i� prnhibi�z o: a [ d s/X»a�e authorized hcrc/n� �« ny o �e 5. This permit is transferable to future owo�'� oi |he property provi�ed aU co��h, � adhered to, ' mns c/emaoe 6. This special permit must be recorded at th shall be Submitted to the Bui|d D� c negoi'yo[deeds. �\ copy o[the recorded decision � [ora si8n permit is submitted. mS w/smn and to'the Planning Board /i{c p/ior |o any application , The vote was: AYE:: Raymond Lang, David MpnseU, Patrick Princi Felicia Penn, pou| Curley, . at�hary Teague NAYNone Ordered: Given the 6 Positive votes of the 7-member Planning Board (the 7m memberwas absent) the votecarrSpecialco and Special Permit 2009()2 has been granted vvith . K r « ^ conditions. This decision must be recorded at o rd edo/ the Barnstable Registry of Deeds for it to be in effect and notice of that recording submitted to the of the Planning Board. The relief a h h ed by this decision must be exercised within b*oyears. Appeals of this decision., shall -be /mue pursuant to NCL Chapter 40A' SecUonviih . kwc" / (20) du te of the filing of this daris� O on. Copy o[which 'uS� be �ied in office . _ "^ Felicia Penn' Chairman Date Signed/ - |, Linda Uutchenrider, Clerk of the I. vvn of Barnstable, Barnstable [County, Massachusetts, he/ebvcertify that twenty (20) days have elapsed since the Planning Board filed hn iudcco/on and that noaPPca| of the decision has been filed in the office of theTovvn Clerk. Signed and sealed Mh d perjury. ' 3 ` o�� ' v � � Planning Boar(l SDec'�| �0 r r�j+ � }�O�h=� ! '�� -{�� {� ��C(�/�S) � '_� � � � � �' '- -- ^-' " ' ` `~ po,tic, o, interest�a,c those directly opposite the subject lot on nnv Public o, pr/vn�c '-, ,.d ~~~``".^ uaouccccswo street o.n3nn /re� ,ino ^r �uhjcctp,opc,tv. or 51 Total Count:� �� - Y�� Close �--- - ow:er» --- - ' -- � rcys �*u� -- - ' '--` -- zzaozr s�nwsrAuLE ._ i Hous;woxur�on� 14s SOUTH sT yYAmm/S' mx /-------------- -- - 02601 USA zz: / JzrD/o "^=°S' cnL'»S & x� ne�oYTeusT 8z w�/�owxvs *yAwwe;' MA — — ' ------------- '--- ' '- ---- - ' . - ozaoi USA cu | sz/o/z PLYMOUTH � anocxrowsrn�/� " ^n»uS/^mLPARK pL,nouTx m� ' - -------------_-_-_____ «o oz�eo ' usx ao' | s�a�� permourna �-------'--_-_-___ �- -�- eaocxTom o 'wousrn�� pxnx pL'wo�u m�Tx noxn ozsao ' USA 1e, /eocnArso ----'— --'--- '--'---___ 327074 CHURCH OF / zzn ��zwsTnscT *'xmmI� n� *,xmw/s ' us� �7\ ouaoz ^ comsrAmT/mc ��--------' -�-- -'-- - ---- --------_____ ~^'""� sowAxoA ' o1 BAY SHORE *vAwmr- mx __--- noAo 02601 - cz� reusT �v//= / uzaoz ' us� cz 3278e7 CAPE COD BANK m w" o*mxmox/n TRUST Co n^c�uT/esms�T c7ocon�'�ou�os omz [�m�� po*TLAwo' Ms � | ssx pnOpmsMT vLxzx 04101 USA ss( / a �zrSe8 s�r/ ' �x�*uu/ Mxxsrows asuzAesTn seocoru/r«o MILLS, MA USA Cl: nza*n � 3270e9 m)A REALTY u[ ---------------- 5e2 rLcAs»mTST wonwoOo' nx /----'------------ ____________ ozo«z zz( ' xzr�oz uAuwsrAeLr' ' TOWN or (wuw) 367 MAIN STREET *'xww|s' MA 02601 USA 131 zz7�oz onAwA' NEWSPAPERS INC z/e mmwsr nxAwmzs. NA ----------------'-------'--- -------------__- 02601 us� �w 327103 CAPE COD BANK m C/O FAC/BAnnmo«Tn LITIES MGMT C/O cons sOuLOs ONE CANAL ponTLxwo �c - / CO scn pnOpMoMT p�xzx n��0� ' »s� zz' PORTLAND, ME TRUST FACILITIES MGMT PROP MGMT 04101 PLAZAus� c4/ 3XO 5 CAPE COD BANK & C/O BANKNORTH C/O CBRE-BOULOS ONE CANAL FACILITIES MGMT TRUST PORTLAND ssR r^vpn��/ p��z� o*�n� � USA zz� +LA*EnTY' 327118 suzABernu ' 91wST«ne«zoos CHARLTON, MA cHRIslopHsn________ noAo 01507 zu uxxmSrxBLs ----------- ^ o n usImo 146SOoT* Ir U»^wwzs n� / AUTHORITYo2aoo�� ' 13. 327120 LYnw. cnAIGs w \ po BOX 4z1 n,AwwrSyoRT wx02672 ' �� | 327121 wcsvo,pAnx/wn | Assn[sxrc uc 53 pLsxsxnTsT Hvxwwzs, MA 02601 zz] . , . • l f T I \ ' T�`.' .._ .i `. -rn. ._ ter.... !-IVA�I nI?� t•.In _.._. 327 3 1GEV0'r REALTY `SSOr-iATES LLC ^4. PI ,Vr,,T cT HYANNIS, nqp. 327134 i`•10EVOY, NIAURICE ---- -- - r`1 P '?SE HIT T c HY��Nr,l!S, ^1A _: 07501 u5a 39bmt i,1Cr.VOI' REALTY -----..---__. 327135 56 PLEASANT ST HYANNIS, MA ASSOCIATES LLC Z178�>,r: — __•: 026G1 3 13 uARNSI Atilt HOUSING AUTHOR'Y i46 SOUTH ST HYAi\Jf1i5, P-1A 02601 USA 5532/1, -. -_— - -- -- GRIFFIN, DANIEL M 327155 1 a H Bon ,�6 rypp!n!OU'GH P, &TO BIT,,1, vLENN MIC REALTY __RUtif n HYANNIS MA t (R Rv 02601 USA C17473 32715600? MASSACHUSE l r S, C/O EXECUTIVE TRANSPORTATION - - & 10 PARK PLAZA BOS T Off, ILIA COMMONWEALTH OF OFFICE OF CONSTRU=O'N 3498/0(. -�`•--��-- SUITE 3170 OZll6 3 15600P I'IASSACHUSETTS C/O EXECUTIVE TRAM COMMONIN SPO,RTATION & 10 PART; PLAZA BOSTON., MA EA TH OI OFFICE OF CONSTRUCTION - SUITE 3170 02116 3498/0`MCEVOY �2 'i57 COMMERCIAL 56 PLEASANT ST HYANNIS, MA ASSOCIATES LLC 02601 21784/: CAPE COD 327158 REGIONAL TRANSIT P 0 BOX 2006 DENNIS, MA - _---� AUTHORITY 02638. USA 10968/( 327160 KURKER WAYNE 232-MAIN ST REALTY 21 ARI_INGTON Am HYANNIS, f 1A T TRS TRUST STREE USA 19343/: 02601 BURKE, JAMES M RENAISSANCE -� — �27242001 TRS DEVELOPMENT TR P 0 BOX 2127 HYANNIS, rlA USA 635612' -- __ 02601 327, 600A� HESTON R 247 MAIN STREET 43 BEDFORD NEWTON TRS i iIDDttovRO, REALTY TRUST / OZ REET f^..4 �46 ?Z7�5 724600E HESTON, R 247 MAIN STREET 43 BEDFORD M1D NEWTON, TRS MTD f f E(;F.O REALTY TRUST STREET MA 02346 22/25/ MENESALE, JAY & �a 3�724600C TAIJNYA PO BOX 2274 HYANNIS, P1111 02601 USA 22167/. FERREIRA GIr I lAR 2'u0u^D 251 MAIN ST, UP!IT HYANNIS, rJMA& P1ARIA C 3 02601 USA 22170/: 32724600E FRATAZZI KENNETH 247 MAIN ST UNIT 2 HYANNIS, i�IA _---- 02601 19822/: 4/oUS BANK NAT'L 4828 LOOP CENTRAL T 32724600E BLASER, NATHAN HOUSTON, TX ASSOC TRS DRIVE 77081 20065/( STEWART, SHELDON 3272 OG &VIOLA, ALLISON THE RYDER REALTY - CENTERVILLE,� TRS TRUST PO BOX 389 20101/( MA 02632 STEWART, SHELDON� 32724600H<r &VIOLA, ALLISON R`(DER REALTY TRS TRUST p0 BOX 389 CENTERVILLE, 20101/( MA 02632 AN JACK J & FIRST GUARDIAN 724/ FURM P 0 BOX 314 OSTERVILLE, MA SYLVIA M TRS REALTY TRUST 02655 USA 13506/: 327254 FAZIO, THOMAS E & EILEEN D 294 MAIN ST HYANNIS, MA 02601 USA C14739 CERICOLA, SARAH J _i 327255 & RAYMOND C 33 LORENA RD W YARMOUTH, MA 02673 C16342 327263 NEW ENGLAND TEL C/0 VERIZON &TEL CO PROPERTY TAX DEPT P 0 BOX 152206 IRVING, TX ......__._._._._.. USA 1831/2. 75015-2206 This list by itself does NOT constitute a certified list of abutters and is provided only as an aid to the determination of abutters. If,a certified list of abutters is required,contact the Assessing Division to have this list certified.The owner and address data on this list is hH11 / vwvv "vw im'vn harncfahla. ma nciar ,ram/� _._i.. ,__-.. 21o�� . . r � `� u /c �� z��n� s� �'»�zs *^ _ rss� ---' ----------- — -' ---- - ' — i 327123 EIsAoocx' s»: � �Sp' Sr u/ | ---------- ----------____ - — LAoEnGnsm' z^wss &SnAI�,A ' ! '^__---_-" �__________________. 13( i! 3z7[�6 nApp FAMILY LTD usTsnv —' -^` pAnr:nsnP 74e MAIN sTuEer I.uE, nx ozass n^wE n M^pTf�!o CORP - zsy w«'w sr *��*:z3' m� us� �z 02601 ' MA 02632 USA 327131 LLC USA is( .^ TOWN~~^^~`'-'—PLANNING-- wonccop PUBLIC xsAmxc ` wowo^xJUuz/ ^ ,°. ~.~^ ' NEW TOWN xxu SECOND "rumexExmxohbom367 MAIN STREET,HYANNIS, � � vm/` / `G�, ^��wc�"wom� m ~ General��^�^~`�' ' Town of um" ~�^."p=`~^fly'~--n—' yannis Village Zoning Distncts,you are hereby notified of Public Hearing.to be-held on'Aondav,July 27!2609 at 7:010 PM in the Hearing Room of the B4rnctable Town Hall,'167 Main.Street, to ","Sing~~.~.--.be __— excess of the 50 s in :Io�ation'is addressed�a��mmmBusines.s District. Applicant proposes to replace existing 200,s.f._, Copies of the applications and plans are vailablejorie*viia'��in t�e' i 6fficeof thePlanning Board,200 Main Street,Hyannis, be ieen the hours of 8:30 AM to 4:30'M, PlannInq Board Barnstable Patriot_ Patrick Princi,Charman | ' utout tiers 15 x 9 Sign 40.. x T2 i Chauncy's 4 " 3 y 4 s . w w HERITAGE HOUSE - � � : '•"t;"' .��:,�a ``# ,�t i �`{�` ��'= (' �#, '?C°��d� �� Fes.� �� +, o� +;� IJ umwm ,� . �a r� .r*, ,Per ;� •ar�.y ��' ��`. �y, �►�..,�" ,��#�-�zwn,. - r. c, r j'jjFF , f6i• o k , � � ur�y"„ ;�, ►��,...• �,^ d"'"�� f �+.�t�r.,I� � ��w7ari'�>h�"A7,�e�'.��,r4+'y� '.m"`� j' r NO e �� •�, _ t" i, 'a1. r - � *•.+e "� 'u�iF. ; '.''�T A' }.,- � •� �+s�r.�++�. .^a �°""+ma's * �4q• � �'� � �� r � r �� '""�'� :�''. s A t'^��,!'t f•� � y -�'« L.i `pia 4'{�'. ZI„�:', ' D ITAGE HOUSE HOIE - 13 X 144"' eChauncy s i6" x72" r _ .,.._ V,. Sa 1 �S6 r�,� i'�,. 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IT '{'t 'i t S •jY+�r K Y •�k"i�t � k t 'nYn. y a' �!•'�'G � �`'�t•' • 4; MENT :1 s FI "G d.fir b � � ka�� heir +r ay { Paz �Yk,,..,Wk �. [ MR !� I i y,. u� ? S �-L x re 41 7} `" �.3.7�� 'S G � !�;' � to✓,." �'v,�.�.*a'�"�°�o , N ' YS to XX iN qQ ' .k��i°� �� •'�� .1! k, � � § . ��tz,,"'�✓ ,f.r,�•�,'F)'�r�.� $ ;� ��°��` _ � ¢s�� SY"�'jdrld�lfiP�6i94p$}��g@F :.�B�ekg��4 "'y';r 1 a 7 -�.a r-r yyyy gj y i AF lh d £' Y a 'ff4'k PROJECT� ( c NAME: Q Caj� ADDRESS: PERMIT# PERMIT DATE: y( `i'. -� -�' MiP: LARGE.. DOLLED PLATS .III, s. SLOT C Data entered in M"s program on: ct'l 1 (5 t r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION a Map 3a.7 Parcel /A 7 Permit# Jl 6 Health Division Y sp,� &s Cie Date Issued ] Conservation Division Application Fed ` Tax Collector Permit Fee Treasurer U21— Planning Dept. Date Definitive Plan Approved by Planning Board A� Historic-OKH Preservation/Hyannisr7 xb 6& () Project Street Address / o�`.� /1/N -AL, Village k/YA Nil S Owner 5UVt;yax 91la- Abv146We--?4- L.P2ao Address 0 l Y�� .t)A 02-401 Telephone >°en-2 A-1AAT.,/D, rp�cs�xJ T fob'- 7'75=7o-a o / Permit Request >t�)2 ,� G.�Dr l�Pd,�.or�£' : lt/•r/,00aJ.�ta°� 9� 1", sb iPUV-1 A7-7—,ar1fI-� Square feet: 1st floor: existing proposed _ 2nd floor: exist'ng proposed _ Total new Zoning District HVf Flood Plain Groundwater Overlay AP Project Valuation $17S��0• Construction Type 5.4 Lot Size 2.01 A 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 UdrNo Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other MS M4A'3t- W ntsr CCMA o0 r 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:❑existingd ❑new size t ry Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: 2-111 a �v Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ < r �" Commercial W Yes ❑No If yes,site plan review# -� Current Use Proposed Use _ vT&rL. - �+ w BUILDER INFORMATION Name ��=�L'�°�Ls°� /�Z Telephone Numberd� Address 6rA r�A License# OS 5-/5 q Home Improvement Contractor# Worker's Compensation# IIJL'6�37��5�of ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO CA5,=21-4 k14 S,71F- SIGNATURE ATE A 60 FOR OFFICIAL USE ONLY PEJRMIT NO. DATE ISSUED - MAP/PARCEL NO. rR ADDRESS' VILLAGE OWNER # DATE OF`INSPECTION: ; FOUNDATION FEZ '2w zF / �"+` -' FRAME INSULATION FIREPLACE , ELECTRICAL: ROUGH FINAL " PLUMBING: ROUGH FINAL i GAS: ROUGH FINAL r FINAL BUILDING DATE CLOSED OUT ` - 1 ASSOCIATION PLAN NO. it T Commonwealth of Massachusetts I)e aF ttment of industrial Accidents ' .600 Washington Street Boston,Mass. 02111 Worke Cons ensatao n insurance Affidavit rs ITi7C�22��tI� /•�� name: Location: ' hone# city El I am a homeowner performing all work myself ® I am a sole proprietor and Dave no oneweLK3u in auo °" %%%% %%%%%%%%%%%%i� �%%/%%/�%///G/O � � workers' co ensation for my employees working .::. : .on this job. ::::: : ::::::::..::::::.:..::.....::.... LZ lam an employer providing:::.;::.;' eomoahv HHaYYic.. t �� r rg 1. add re ss i2�:�i: i:`i' ?">;> �'>� :::i:��:::'' .:: :i>';i: '';;: `isviir::4i:;�}is:i:}+:i'.••i.:i..:..........•' -.:.;J,,....yi:}};:n,.i}:.'....-..:.,...••.•:�{::?::..:'il.�': i:::i:..::..:::.....ID ii:i::i:::.:: :' :'::.:.:v: 'r': :. ... cHtw ....... ❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have workers easatlon polices: .. ::... ;;:<:,:....... ::::::.;;:: :::::;:>'. the following ......�°mP........::::.�:..::.:.::::::.�<:.:::::::.:_::.�-•.:::::::::::::.:::.::::.�:.:::...:.::.:.:.:::::.;'.:::.:::;.,:::. .::.:.,::::.:::::.�.<::<.::::::::::::::.:::::::.�:::::::::.::::.:.::::>_.:::. K. co �vn . ....:.....�:...::::.�::::::::•;:�:;:i::�;y:•::t;•:�JJ::::c•::•::.:-::::::::,..:..:::::•:•:•::::::.:JJ::•:y:>:�:a;y::'f•::;isi::y:;:;:;;;:;:::;<::::;:?"i:':>.::: address. :::.::.::::::.:.. ..:.,.....:.:.:::.,..:.... ...... ...........::..............:.:::.::::::::•J.y:r.JJ:.:r.::;:,.�.:a.:•}-J:;4>::•::.::::.:::::::::;.J:;.:«::}:J<-:;-::;;>::;::;.;:..:............... .:.::.:::....�:: bone :. :. ;:ir: ..::::::::::::::::::....:................::•:•r:::::.,r.•:::.�:::..;r..:t•J:•J:>:•:;•:•:;o:J>:-:;•J:...r.. - :..:t}::2:.;.:;:•:J•;;; •;4ri�•. Ht�Oi:}:•(v:^J:-.v�•:•::{::.•:�.:4••JJJJ:•JJiJJJ:4:•J:i«4•Yv4..-.n{...... ..vC«:;,y};v 6.4 :•:r:v.iJ::'::::•:::::: �. .. .. •.........:..{.i::.vv:•..}.�hSw.�7C:yy.{iR.i>S?:4:Sii•J:ti•::-Jivi+.::::::;:::::::.+.:-v.•ry. ::•v:::. .:.. Hnsncrince�ca�::;-,:�:::::,;:.>:�•-s;::.::: / ii/. ..;::.:. .... .. .......................:...::•.......... .. ........................ .::.:v:•.'fri:S•i?iiiJ::i::!:i%v:::•:J:?iiiTi}i:(:i:•:;J:i:$:;};:} $ii a�Danv n sore:..::.:;.;:::::.�:<.;:,::..........::. _. ... .:;: » »; ..:.....: :> ;;;.>:>;::�>:><:::;:::J.<:»r;}::�::>:<:::;;::::::::::..::;:...:::::..:;•;::>J;::::.;..:: add .......... . on �.JJ:•J:::.::• Failure to secure coverage as required order 6eetiest 25A of MQ.iSZ can lead to the imposition of criminal penalties of a one up to s1.s00.00 and/or one mean'imprisonment mo neat as wen as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement maybe forwarded to the OIDee of Iavesti�tlons of the DIA for coverage verification, that the in ormadon provided above is tru--and coned I do hereby ce • undgr the penalties of p f Date Z _ Signature Print name �OLAa/C� l�Gi��o�! Phone# �Y official use only do not write in this arse to be completed by city or town official city or town: permit/ficense# ❑Building Department ❑Licensing Board ❑Selectmen,s office ❑checkif Immediate rpponse is required ❑Heslth Department contact person: •phone#; - ❑Other UrAmd 9/95 PIA) ' r Information and Instructions ;Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for oe�� quoted from the"law", an employee is defined as every person in the service of anotherY emplo�•e.,s. As of hire, -,%press 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 trhe fcreaci_ng 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 dn•elling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of e ce, constr "1' or r 'atr work on such dwelling house or on the grounds or another whi o employs persons to do maint building appurtenant thereto shall not because of such employment be deemed to be an employer. , "vIGL chawaI pter 152 section 25 also states that every state or local lgcensing agency shall withhold the issu ance orwre elw� of a license or permit to operate a business or to construct buildings in the commonwealth for any pp cant red. Additionally, neither the not produced acceptable evidence of compliance with the insurance coverage requi commonwealth nor any of its political subdivisions shall,ei ter into any contract for the performance of public work until acceptable evidence of compliance wi the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. 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 Deparment at the number listed below. City or Towns Department has provided a space at the bottom of the Please be sure that the affidavit is complete and printed legibly. The P the applicant. Please affidavit for you to fill out in the event the Office of moons has to contact you regarding PP ennit/licease number which Will.be used as a reference number. The affidavits may be rettmted to be sure to fill in the p arrangements have been made. the Department by mail or FAX unless other like to thank you in advance for you cooperation and should you have any questions.'' The Office of Investigations would please do not hesitate to give us a call. The DeparEment's address,telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Imtesdgatlons 600 Washington Street Boston, Ma. 02111 fax#: (617) 727-7749 phone #: (617) 727-4900 ext. 406, 409 or 375 APR-01-2009 WED 05:27 PM MFT FAX N0, 7812612099 P. 02/03 C aM CERTIFICATE OF LIABILITY INSURANCE D0410112 0' PRODUCER (800)782-0251 FAX 781-261-2099 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Eastern Ynsurance Group LLC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 77 Accord Park Drive, Unit BI HOLDER,THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Norwe77, MA 02061 INSURERS AFFORDING COVERAGE NAIC 8 INSURED Consery Group Inc. INSURERA; Peerless Insurance Company P.o. Box 278 INSURERB: Hanover Insurance Co. 22292 Sagamore Beach, MA 02562 INSURER c: TPA Insurance Agency INSURER D; INSURER E: COVERAGES 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,AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN5R kOD'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY 8KO0953511978 0710712008 07/07/2009 EACH OCCURRENCE $ 10000001 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ro I0000 CLAIMS MADE M OCCUR NED EXF(Any one Pen) $ jOQO A PERSONAL B AOv INJURY $ loom GENERALAGGREGATE $ 200000 GEN'L AGGREGATE LIMIT APPLIES PER; PRODUCTS-COMPIOP AGG $ 200MO POLICY M JERCT LOC AUTOMOBILE LIABILITY ADN8411SO202 0812712008 0812712009 COMBINED SINGLE LIMIT ANY AUTO (Ea g'd�) $ 1000000 ALL OWNED AUTOS 800I4Y INJURY X SCHEDULEDAUTOS (PerPampn) $ S X HIREDAUTOS BODILY INJURY $ X NOWOWNEDAUTOS (Per accident) X Comp Ded $SOO PROPERTY DAMAGE X Co71 Ded $500 (Per acddent) $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY; AGG $ EXCESSIUMBRELLA LIABILITY US009S3511978 0710712008 0710712009 EACH OCCURRENCE $ 200000 OCCUR ❑CLAIMS MADE AGGREGATE $ A $ 200000 DEDUCTIBLE $ X RETENTION $ 1000 $ WORKERS COMPENSATION AND WC003730404 11/09/2009 1110912009 X WC STATU 2- EMPLOYERS'LIABILITY C' ANY PROPRIETORIPARTNERIEXECUTNE E EACH ACCIDENT $ j0000 OfFICERIMEMBER EXCLUDED? E.C.DISEASE-EA EMPLOYE $ 10000 If yes describ0 under SPECIAL PROVISIONS De10W E.L.DISEASE-POLICY LIMIT $ 500 OTHER BPP $126,000 A Property BKO09S3511978 0710712008 071071200-9 DESCRIPTION OF OPERaTIOr.SI LOCATIONS I VEHICLES I EXCVSIONS ADDED BY ENDORSEMENT I SPECIAL?ROVISIDNS E:Work performed for Superior Hotel Management Corp dba Heritage House Hotel 259 Main St. Hyannis,MA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE t EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL Town of Barnstable 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Building Division BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 200 Main Street OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES, Hyannis, MA 0260I AUTHORIZEDREPRESENTATIYE � L� Rona7d Cleaves REG ACORD 25(2001108) @ACORD CORPORATION 1988 t ✓�recvnvma .cx '4../vrr�vac/xuielCd Board dBuilding Regulati sand_Standards Construction up_ervisor License Lic se °>CS 5157� I Explratlon 5/23/2010 Ti'*;, 23121 gg gc R'est'ictton- 06 J.h 4 ROLANC B CATIGiVAIVI,� r a 60 GEMINI DR 4 W BARNSTABLE MA 02668 Commissioner f 4�a .. pp �. `p"E, Town of Barnstable 1 H o= Regulatory Services 'ilhomas F.GeUer,Director pjFO A� 130ding Division Tom Perry, )Building CGUIt 8Sioner 200 Main Street, Hyannis,MA 0250i Office: 508-8624038 v Fax: 5 C�8-79t 1-t23 0 Pr®perty Owner Must Complete and Sign This Sec ion If Using A Builder /+----- as Owner f the subject property hereby authorize O�r� ✓C�i@s✓ I WC to act on my behalf, in all=attets relative to work authorized by tKs building permit application for: (Address of Job) Ott=Lof Owner Z' 0&/ P Da Print Name • I Q:FORM&OWNWERMESION T 'd LLLT06LBOS 1310H 3snOH 39H1IN3H Wd90 :S 6002 10 add L7Massachusetts Department of Environmental Protection 646 Bureau of Waste Prevention • Air Quality Decal Number BWP A 06 Decal Number Notification Prior to Construction or Demolition Important` A. Applicability When filling out pp y forms on the computer,use only the tab key A Construction or Demolition operation of an industrial, commercial, or institutional building, or to move your residential building with 20 or more units is regulated by the Department of Environmental Protection cursor-do not use the return (DEP), Bureau of Waste Prevention -Air Quality Control Regulations 310 CMR 7.09. Notification of key. Construction or Demolition operations is required under 310 CMR 7.09 (2)ten (10) days prior to any work being performed. The following information is required pursuant to 310 CMR 7.09. B. General Project Description 1. a. Is this facility fee exempt-cit , town, district, municipal housing authority, owner-occupied Instructions residence of four units or less?[]Yes ❑✓ No 1.All sections of b. Provide blanket decal number if applicable: this form must be Blanket Decal Number completed in order to comply with the 2. Facility Information: Department of HERITAGE HOUSE HOTEL Environmental Protection a.Name notification 1259 MAIN STREET requirements of b.Address 310 CMR 7.09 H annis MA 02601 c.Ci /Town d.State .Zip o 5087757000 f.Tele hone Number area code and extension .E-mail Address(optional) 56147 3 h.Size of Facility in Square Feet i.Number of Floors j. Was the facility built prior to 1980? ❑✓ Yes ❑ No k. Describe the current or prior use of the facility: HOTEL I. Is the facility a residential facility? ❑✓ Yes ❑ No 93 �om. If yes, how many units? _ Number of Units -0 3. Facility Owner: �N SUPERIOR HOTEL MANAGEMENT CORP. Oo a.Name �0 1259 MAIN STREET b.Address � HYANNIS MA 02601 (D �0 15087757000 f.Tele hon Number(area code and extension) .E-mail Address i nal C PETER MARTINO &JAN DAALE �Q h.Onsite Manager Name ag06.doc•10/02 BWP AQ 06•Page 1 of 3 Massachusetts Department of Environmental Protection Bureau of Waste Prevention . Air Quality 1100086646 BWP AQ 06 Decal Number Notification Prior to Construction or Demolition General Statement: If B. General Project Description cont. asbestos is found during a 4. General Contractor: Construction or Demolition CONSERV GROUP, INC. operation,all responsible parties a.Name must comply with P.O. BOX 278 310 CMR 7.00, b.Address and Chapter 2 1 E of the SAGAMORE BEACH MA � 02601 Cha General Laws of c.Cit /Town d.State e.Zip Code the Commonwealth. 15083628903 1 lrcatignani@conservgroup.com This would include, f.Tele hone Number area code and extension .E-mail Address(optional) but would not be limited to,filing an IROY CATIGNANI asbestos removal h.On-site Manager Name notification with the Department and/or a notice of release/threat of release of a C. General Construction or Demolition Description hazardous substance to the 1. Construction or demolition contractor: Department,if applicable. ICONSERV GROUP, INC. a.Name P.O. BOX 278 b.Address SAGAMORE BEACH 1 102562 c.Cit /Town d.State e.Zip Code 5088886555 1 ircatignani@conservgroup.com f.Telephone Number area code and extension .E-mail Address(optional) ROY CATIGNANI h.On-site Manager Name 2. On-Site Supervisor: PETER SICILIANO On-Site Supervisor Name _ 3. Is the entire facility to be demolished? ❑ Yes ✓❑ No �N =0 4. Describe the area(s)to be demolished: �o EXTERIOR FRONT AND SIDE ENTRANCE CANOPIES. �N �O 0 5. If this is a construction project, describe the building(s)or addition(s)to be constructed: �0 NEW FACADE UPGRADES. �o �a �Q ag06.doc•10/02 BWP AQ 06•Page 2 of 3 Massachusetts Department of Environmental Protection ■ Bureau of Waste Prevention • Air Quality 1100086646 BWP AQ 06 Decal Number Notification Prior to Construction or Demolition C. General Construction or Demolition Description (coat.) 6. a. If this is a demolition project,were the structure(s) surveyed for the presence of asbestos containing material (ACM)? ❑ Yes ❑✓ No If yes, who conducted the survey? b.Survevor Name c.Division of Occupational Safety Certification Number 7. Construction or Demolition: 4/11/2009 6/15/2009 a.Start Date(mm/dd/yyyy) b.End Date(mm/dd/yyyy) 8. a. For demolition and construction projects, indicate dust suppression techniques to be used: ❑ seeding ❑ paving El wetting ❑ shrouding b. If other, please specify: ❑✓ covering ❑ other 9. For Emergency Demolition Operations, who is the DEP official who evaluated the emergency? NA a.Name of DEP Official NA b.Title 4/3/2009 c.Date mm/dd/ of Authorization NA d.DEP Waiver Number D. Certification I certify that I have examined the ROLAND B. CATIGNANI =o above and that to the best of my a.Print Name �o knowledge it is true and complete. IRoland B. Catignani The signature below subjects the b.Authorized Signature -N signer to the general statutes, PRESIDENT =o regarding a false and misleading c.Positioni I Me =o statement(s). CONSERV GROUP, INC. d.Representing 04/03/2009 -� e.Date(mm/dd/yyyy) �o �d �Q ■ ag06.doc•10/02 BWP AQ 06•Page 3 of 3■ C"Se v INCORPORATED tCONSTRUCTION'CONTROL AFFIDAVIT AT PRWkT.INCEPTION Parcel Number: Project.Name:. Project Owner Heritage House Hotel Project Location: 259Main Street Scope of Project:.;Exterior faQade renovation t In accordance with-paragraph 1.16.0'of 780 CMR,.the Massachusetts State Building ' Code; I, David 7 Vachon Massachusetts RegiStrat or Number 7471 being a Registered Professional Architect hereby.certify that all architectural plans,' computations, and specifications, and changes thereto,.involving the subject project will be prepared by or under.the direct supervision of a Massachusetts Registered Professional. Architect,and'bear his or her,original signature and seal-as defined by-Massachusetts General Law (M.G.L.) c 112, $81R. I further certify,that I.will be present on'the.construction site at intervals appropriate to ' the stage of.construction to become generally familiar with the.progress and:quality of the work to determine,:in general, if the architectural work is being performed in a manner consistent with the construction documents. 4!— Architect Ori inal signature,and Seal f' t g g ) a� G;"s ^a 4 Date r.J I ?lt! K . i � o0J7f 11 �S +' �tk Home-Office: Hedges Pond Crossing, 2277 State Rd., Suite H • PIymouth,.MA 02360 `Mailing Address: P.O. Box 278 •Sagamore' Beach, MA,02562 Phone: 508.S88.6555 •:Fax: 508.888.6566, TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION s Iflap Parcel I Permit# 9 �O Health Division Date Issued c� Conservation Division Fee so c b� Tax Collector Application Fee Treasurer (�JA Planning Dept. Checked in By Date Definitive Plan Approv by Pl91k ing Board Approved By Vk � Historic-OKH � PreseaN�tion/Hyannis Project Street Address ✓t'?A IN J Village YAtJ✓ J' Owner -PUPGZ-t02 A4"/C Am?fA6,L %9—yc" Coa.Q - Address 2�"4 M,41'v J' Telephone - �� °®d Permit Request 3ROVGt- 0'%14fL- 6,X(✓4_A1vG Z,&vF an/ ,FvO Ou'L0WC c��au ✓�� G�v+� AAra 01>L6A- .Juw41LAF_.!'. Square feet:,J11 st floor: existing proposed 4A 2nd floor: existing /J proposed Total new /11 14 Valuation 00 O . 60 Zoning District Flood Plain Groundwater"rlay---:, Construction Type co �t t Lot Size Grandfathered: ❑Yes ❑No If yes, attach supportings6omenta�'n. c-n -a Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) CD Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highw y: ❑le �lo 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:O existing ❑new size Pool:❑existing ❑new size Barn:O existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use BUILDER.INFOATION Name v yl� i�!� ` TI /�( ��Telephone Number �?S �7o00 Address o2S2/ � l/� Si'< /�'�1G��`1<,!` License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATU E DATE 0 r - x ' e r FOR OFFICIAL USE ONLY V PERMIT NO. t DATE.ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. r --- .The Commonwealth of Massachusetts + _ Department of Industrial Accidents • � Ol/Iceelle,vesU�s�lees � _ 600 Washington Street Boston,Mass. 02111 Workers' Compensation Insurance Affidavit nfuneP1a14. /"►/ 64'dt MEvIV� ccdrJ�i'�`37d location: eR M 14 r/V ST12 61y /_!-��yr{/r ..t ..... Phone# S®e-/ 7.-/00 d I.am a homeowner performing all work myself. 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I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do here2bZ certify under the airs and penalties of perjury that the information provided above is true an co cL O Si '� Print name �� ® Phone# S®f 77.T.700 0 official use only do not write in this area to be completed by city br town official city or town: permit/license# nBuilding Department oLicensing Board 0 check if immediate response is required ❑Selectmen's Office ❑Health Department r, contact person: phone#; nOther (revised 3/95 P1A) f Associated Industries of Massachusetts Mutual Insurance Company INSURANCE BINDER. This binder is a temporarY insurance contract sub'ect to the conditions spawn below. RODUCER ISSUE DATE(MM/DD/YY) 01/1 S/2005 ogers&Gray Insurance Agency EFFECTIVE EXPIRATION O Box 1601 DATE TIME DATE TIME oath Dennis,MA 02660 2:01 AM X 12 0!AM 04/01/2005 04/01/2006 No PM [ERITAGE 00000509 SUB CODE ESCRIPTION OF OPERA ONSN1 I.LESJPROPERlY(Including location) RIOR HOTEL.MANAGEMENT CORP. HOUSE HOTEL&RESTAURANT ain Streetis, MA 02601 INSURED G O Y B L L IT STATUTORY MA WORKERS COMPENSATION MASSACHUSETTS STATUTORY 500,000 —(EACH ACCIDENT) 500,000 ((DISEASE-POLICY L[Mrr WMZ 8003800 500,000 (DISEASE-EACH EMPLOYEE) PECIAL CONDITIONS/RESTRICTIONS/OTHER COVERAGES NAME&ADDRESS OUTVOMENRPRESENTATIVE CONDITIONS This company binds the kind(s)of insurance stipulated. The insurance is subjected to the terms,conditions, limitations of the policy in current use by the Company. This binder may be cancelled by the insured by surrender of this binder or by written notice to the Company stating when cancellation will be effective. This binder may be cancelled by the Company by notice to the insured in accordance with the policy conditions. This binder is cancelled when replaced by a policy. If this binder is not replaced by a policy,the Company is entitled to charge a premium for the binder in according to the Rules and Rates in use by the Company. TOWN OF BARNSTABLE BUILDING ERMIT APPLICATION_. 71, Map Parcel , Application # !� Health-Division Date Issued l� - - Conservation Division 'Application Fee Planning Dept. ,Permit Fee, Date Definitive Plan'Approved by Planning Board Historic - OKH Preservation/Hyannis Project Street Address! m Aatv �� l/ ��GA CC- U1if- r4-Fr_" C- Village rt't-YA Owner J'v.P 6A4 d s K4o tic- M �P 60" Address Telephone �-7��? oo Permit Request (,Al AZJ6A tM/N�, /_3U/4-A G✓llti4_l 7'� � ��- d-K r J 07'.49 ;A L-VM I s/V11, & Ci(AJj- WA C,4-- ,JY,Y .,• !3� BOG c_ A ✓lO l r 4&t_ �� !,[��a-"�" %�t'�- �!1!� !�C—OC�C (/}P :3 �,•/(^r/J®�'.J � NctTC� C�JrI✓� . _?j 6A 1,/ Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater.Overlay Project Valuation Construction Type ru Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. DwellingType: Single Family yp g y , 0 Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old Kings;Highway:' ❑199 P ❑ No Basement Type: ❑ Full ❑Crawl ❑Walkout ❑ Other NJ Basement Finished Area (sq.ft.) Basement Unfinished Area (sq: ) .c Number of Baths: Full: existing new Half: existing Pew — vo Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑ Oil ❑ Electric Iff Other VA c Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial XYes ❑ No If yes, site plan review# Current Use 0' -. Proposed Use H4 APPLICANT INFORMATION d (BUILDER OR HOMEOWNER) Name PA Gyzr�(JE�7 J_Y�- Telephone Number Address l__? N4 (u,J AVM License # CS 0-r:J- 02-0 W f-L(A�[:.�i% ,10A U 2 ( Home Improvement Contractor#Tr- Worker's Compensation # WC ?9 6T,?r.2- ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO WA At GM. SIGNATURE ��, DATE / a .3 'e FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION 3 FRAME INSULATION FIREPLACE _ :7 ELECTRICAL: ' .ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT IT ASSOCIATION PLAN NO. I` _ The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street I _ Boston, MA 02111 may` www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information �" Please Print Lefibly Name (Business/Organization/Indivi dual): {�r f. �l�ccy � . Address: /'1 1A-1AoGvj City/State/Zip: W f-4-v£J C!� ^4 o 2-V4 Phone M 2 4.1-2 2- Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I ,�mployees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.U I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g. ❑ Demolition workingfor me in an capacity. employees and have workers' y9. ❑Building addition [No workers' comp. insurance comp, insurance.$ required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp,policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic.M Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains nd penalties of perjicry that the information provided above is tree and correct. Signature: � Date: Phone M 7b t Z-3 �fL Z 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#: g Rgguhh fie an�nnan��rea .andSta/�cuaa�/ivaelta B,oa,rd ouldinoils ndards. C.onstr.uction 5uperuisor Lhcdnse UF#Fe CS 55020 1r an 6/2010 Tr# 16237 Qf UVALTER F GRE 17 M�4UGUS ALIEN WELLESLEY,MA 02481 ?' Coiiimissiorter f sTti Town of Barnstable Y Regulatory Services • Thomas F.Geiler,Director �o59LL. a Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.b arnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder 41t77,U®, , as Owner of the subject property hereby authorize 6r W o act on my behalf, m all matters relative to work authorized by this building permit application for: (Address of job) i Vignature of owner Date M/4L 77i0 O Print Name If Property Owner is applying for permit please complete.the Homeowners License Exemption Form on the reverse side. " n:cnn,.rc.nczn.r�nn�r?x.rccrn>,t Town of Barnstable P�pp'CHE TQ�y Regulatory Services • s.�xrrsn+sr.E, r Thomas F. Geiler,Director NUSI t � �bs� ,10 Building Division PrED '�A Tom Perry,Building Commissioner 200 Main.Street, Hyannis,MA.02601 www.town.barnstable.ma.us Office: 509-962-403 8 Fax: 508-790-6230 HOAEEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street villages "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: . city/town state rip 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. DEFINMON 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.L 1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that.he/she understands the Town of Barnstable Building Department minimum.inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signatiiro of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION .The Code states that "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 1 D9.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a parson(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware tha.tthey are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.1-5) 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 p licensed Supervisor: The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her respmm'bilitics,many communities require,as part of the permit application, that the homeowner certify that hrJshe understands the responsibilities of a Supervisor. On the last page of this issue is a.fmn cun-cnt]y used by several towns. You may care t amend and adopt such a form/certification for use in your corrariunity. Q:fb,:homccxcmpt 1 I I _.. — — 1 I 1 fuc tJ Cin� /j I I Pr �LaI Iry : I I r I i I ----- is n I I I , : - -. - - - - : I ' I ' �k t7 I i 7-7i: i I y t - _h I I �I I 6t, I i Ig0. - I- � I. i I s 1 ,S L ' yt 4 ' �;i{}n ':, if.:• y: i� :`L;y:H..l;!?:;i%;^'u'r';ii'd - _ � � � � � � � - � n ' {:[>; ;;i:'y'.�'i�••tk2=�7i�;•� ..irll�{'t�`!!�'^."ai3 72. ', �. .. - ��5 .....:i..:`...:�.•:t ...- .� .!n t`S 4 =�,.�+.+..��.+r-+sue®. y t \, a s'i'` aj t '` ` Jt«,�y. y✓A 1'`. k4 /V�}�AC� f y tJDS 20 GIq T . QF. �3Ulc;r h/.F 4,V dG, i�� r1 r(.4.C- W k ...... 2-1601 . • 3 �c tfQ--rd c A(?,V L w G-Y�1tJ;W ti�/q i-+-/3o;oit o_ �Isq a S y Giangregorio Robin From: Giangregorio Robin To: Ritchie Carol-Ann Subject: Heritage House Date: Friday, June 02, 2000 3:24PM It was determined that a Site Plan review hearing would not be necessary. The proposed entertainment did not cause any concern. There appears to be adequate parking (CCB&T, Colonial Candle offered as overflow within 300')therefore the issue is moot. Please accept the floor plan with Ralph's signature as approval. Thank-you. Page 1 Ef I -le7 L r FROM TEL: JUN. 1.2000 2:37 PM P 1 I 0 9feritage 9fouse 259 Main Sheet . Hyannl5 MA . 02601_4095 TO !,t?t;.7/!�.'/ODU 1.E►00.31s2.71g8 F;ax 5Uti.778.568? June 1,2000 Town Of Barnstable Licensing Authority. 230 South Street Hyannis, MA 02601 To Members of the Board, This letter is in response to our application for a live entertainment license of up to 8 pieces. We will specifically address the board's concern as far as adequate parking and overall noise control. RE: Parking The Heritage House currently has 138+marked parking spaces of which 72 are required for Hotel Guest parking and 50 would be required for a free standing Restaurant Parking.We feel this is more than sufficient to provide for all of our guests, and since our actual business is a crossover between the Hotel and the Restaurant and lounge,then there should be plenty of spaces allocated for both.. Also, because we always have at least two busses on the weekend nights when it would be utilized,we feel that would provide an additional 20-25 spaces that would be available. RE: Noise The entertainment(Dave Harris Band)is 4 pieces and scheduled from 9:00 P.M. to 12:30 P.M.on Both Friday and Saturday Night. We are scheduling a minimum of 4 noise checks each night during the middle of each set,where the owner, manager,or designated person will physically walk a circle from the interior of the restaurant out the main lobby entrance to the fence at the east end of the parking lot and along the fence northerly to Main Street, around the front of the building to the Old Colony Road side of the restaurant. If at any point In this walk,the noise level is observed to be too laud,then that person is instructed to go back to the band and lower their speakers. The desk clerks, night auditors and managers who work at the front desk(which is also adjacent to the entertainment)will monitor both the noise levels and any phone calls received from both inside the Hotel and any neighbors who may think the noise levels are too high_ Please let us know it there is anything else we can do to reassure the board that we want to fit into the neighborhood and the town as good neighbors who are responsible and cognizant of the people around them. Sincerely, Peter P. Martino, C.H.A. President Superior Hotel Management Corporation T Town of Barnstable Licensing Authority >�xtvsresta+, � . Mass. 9Q 1639. 230 South Street,Hyannis MA 02601 ED itAA't°i P.O Box 2430 TEL: 508-8624674 FAX: 508-778-2412 ENTERTAINMENT LICENSE APPLICATION NEW Dci LIy)�O NON-LIVE �O��p *RENEW [ NAME OF APPLICANT: (' '$ $ ,i� TELEPHONE 77S~-GIdD D.B.A./ORGIN t 2�!IZATION v W DDRESS o?J /1q fVA1.J J7;eba7, /)y STREET ADDRESS OF ENTERTAINMENT S � MANAGER Qa4 SIGNATURE OF APPLICAN - DESCRIBE ENTERTAINMENT: (X) DANCING BY PATRONS SIZE OF DANCE FLOOR ( ) DANCING BY ENTERTAINERS OR PERFORMERS STATE NUMBER* *Additional in formation may be required ( ) FLOOR SHOW: DESCRIBE ( ) RECORDED MUSIC: TYPE (X) LIVE MUSIC STATE NUMBER OF ENTERTAINERS (//p ( ) WILL THE MUSIC SYSTEM BE AMPLIFIED ( ) LIGHT SHOW DESCRIBE ( ) MOVING PICTURE SHOW DYNAMIC AUDIO SHOW ( ) POOL TABLES NUMBER OF TABLES ( ) COIN OPERATED NUMBER OF DEVICES ( ) VISUAL SHOW LIVE OR RECORDED DESCRIBE: ( ) OTHER DESCRIBE WILL AN ADMISSION FEE BE CHARGED? YES ) NO [ J HOURS&DATE OF ENTERTAINMENT: MONDAY_I!•60A 44, •- 'N TUESDAY l Z,-W yj H CI'C'-!1,,4 WEDNESDAY)24WWn6gg ft ZL-'cv,4w-(L:av,� THURSDAY FRIDAY Z �*,yCj SATURDAY //fin./ SUNDAY MID NIGHT SAT. 1:00 AM.SUN. SUNDAY 12:00 NOON—12:00 MIDNIGHT LIST OTHER LICENSES ASSOCIATED WITH ADDRESS OF PROPOSED ENTERTAINMENT LICENSE _1r_1fiil!!-MC10 Lf SMsle cjr *ALL CHANGES MUST BE APPROVED BY THE LICENSING AUTHORITY. If this is an annual event,please list on a separate sheet any changes(i.e.,location,time,event,etc.)_ pertinent to this application. Thank you. gAiscfbrni1entapfrm 'v C2 9v' � a n , 1'•s . z � X V r ( 1 h X x 1 I � �n 1® O � lk v i i .r._..r. �w h'�L:,a��' i�'t6'J•�t14RfCi` 1'.I�;c ••;,'�.v�• ;•`,s, CD _ ��•:: �' k X �► c r � dr NC:> CV- I �( F, ow N � r. _ •_... ...: .. ._ ti 17'fir 0,01 A6 _RIO 7.ccJ �' ti L 66 Al, 77 5 i� li i:: Alin 7�y- Z/11/&- �r f A16 / cu, Y��q S ria- auk V 75 7oy p r- LOU ZL sEs-sif I I G l `7S - 70y 0 ,a I I _ C II I (I 5 titA1,v 00 i a �� C'`�tlTh-�CT K�fIT' L��EsZIJ 6-r 0Z1111C« 64/1611 ,I EA A46-lno r/o i21 7��lcf 7/mil I, C�T� -e- I ` it i �i iI i ii� - //� �Orn cE�,� �� a9a � �s7 . ��"" �� THE COMMONWEAL W Department of I 600 Washingto Boston, Mass MITT ROMNEY Governor KERRY.HEALEY Lieutenant Governor ` Building Inspector Town of Barnstable . 367`Main Street Barnstable, MA 02601 a December 14, 2005 ` RE: Reminder-Workers' Compensation Affi Dear Sir�or Madam, I am writing to provide you with an ann any business or individual wishing to obtain a 1 must complete the appropriate Workers' Compen license or permit. No municipal authority may is a eA x, • en di Y^ �• _ `�' s to ,�• ' n;�-a.a� �A_ '� ��} }•r� w r .,b t� �� ,: • fir• 'y n :,.,> ".. y "III. • �qM' _'xo � ;� ' I.I � ! � {bb'' �'. }1,•»•, 4��ty !-;�� t t� / � �,4�'y�,� � �� . eTci9b+_:_V. �. �`, ��`.� � \. '�'"{:" ► .� '�a„� t .� ;'�+sA�Lj-_��1'`�,��}'• ^q�, '$'� . tie ' 1, F dt ! _r► . .� *rd� <.� 14 • "� ry"' rp.�'n s+ ! i :'s ."""'��- \ � + "'� er i � ;,A,�S 4 '�:. t y +tZ;A• ,n� �.+, �3� 'a.�. •�J � n ..': '�-t. zv .,•q,.\{t�'.�•f�, � �•.�" � �� f'�,.. � iW� �� §�5�:.v ,X �.� • "� 4 A �� 4�i� i!. a�s "n \ ,_m..=`*'"Y"+w•�r�.,.r,...�...:�; ''•�� sd . call w • y vv x • F °£ Alumni Job Posting Form The following information is required to post,jobs on alumni.jwu.edu. Please fill out the following information and send to careerpostings2jwu.edu. V Contact the Career Development,Office'at (401) 598 1070 if you have, any questions. k R- 1. Job Type - Hotel Management [Hotel Management, Accounting etc]. , 2. Job Title: Sales Coordinator. ; 3. Job Description (2000 Characters).- Organization and coordination , of groups, meetings, and functions. s 4. Company Name: The Heritage. House Hotel 5. City, State and Country: Hyannis, MA US. . Company Email(Required) in ajherita eh' h 1 m 6ouse ote .co g C g 7. Company URL: www.heritagelzousehotel.com 8. Additional.lnformation(Optional-255•Char.acters): Must.have SF CO iv11'YU^ coW cY1 oriey'ied PerroY1 organizational kills. �" .e`etztil X.'ii. AMM !� MA � r _ r ` � � ® dill , � do _ r - j ` AM � F ry i Alumni .Job Posting Form The following information is required to-post jobs on alumni.'wu.edu. Please fill out the following information and send to careerpostings(ccDjwu.edu. ° Contact the Career Development Office at (401) 598 1070 if you have any questions. 1. Job Type - Hotel Management ' ' [Hotel Management, Accounting etc] f ' 2.° Job Title: Housekeeping .Supervisor" 3. Job Descript-Ion (2000 Characters): Supervise housekeeping staff t„ a.I'Id•t.a.ke on :housekeeping responsibilities. 4'. Company Name: The Heritage House Hotel 5. :City; State and Country:•Hyannis; MA US. 6. Compariy Email(Required) : gm@heritagehousehotel.com 7. Company URL: www.heritagehousehoteLcom j 8' Adnditional'Iizformation(Optional-255 Characters)" Must be fluent in E. - Portuguese =(. %;��rh'(;%i}ttp�•Y,:,•t�y;`.h �%Yv�i�.e;";', f:•\:."•mot � , �� K,'i v+.`;T+.+c •iri{Y':> "}si�!:'�:�,�:i;t::,t,',c(F`�:"} s,^:. :;:y •!�,±s 3 f 4 t > \tt tit } •"vrv. �= '';Lei+w`:�u�,•'�:+ii t 1 i` ai " ii �:1:`y',j� i��':.�": ::i(`••it:iri:: •::P:i.Ra\'ii'••:.:Yt�jr :51:.:4•: n IC .. jr . .. �tt•. �1i:�..)i:;:��•!3y::.1t;v.�'i•.f\�:..Y3..,;^, 1'�i ,i: (XX�� ri��,:;��i ill� `•.r �1� '' .. ' •( •' yk 4 �}','••'•may i••Ylr'.}��1�a ' ,.t.f7.�;i7'�Ia � 1 i•' •ri:.t:�.,ri�:r�4 E: t e It ..�<��' "`spa"i.!1;:;•/ : :�'°lSe\';%!i� '. v„t•: :::t`�,?�:): ..1.^:)'i;�:'ii:iY%.:fit.+ L��; .. `.',''ys'>:ir:!<`.:^.J;.l":Y'u}Y-•;.�.9i�t,_}�^•c:: 1iAi'c;l�. , A-)' nl Fv.. Ooo.+e Pa m �G A 27214 t :-err a IS C/Jr1r/� :WaQL� 11 1 V/" v: ,.;yl Iry VrJ G - - �'1 Fl- y0of1 ' 'l � I � 0.21 vpoa- ____.- - -- ---- --- - ---- -- - - -- --- - -- ----- - 9> �� oZ .Tonal �U^A �w 8 rvn�I _ - _.._ i ✓j7 __ _.. -- �THEri TOWN OF BARNSTABLEBu..,�Jng Application Ref: 200904648 . BARNSTASLE. + Issue Date: 10/08/09 Permi t y MASS. 16 339. A Applicant: WALTER F GREELEY Permit Number: B 20091937 Proposed Use: MOTELS Expiration Date: 04/07/10 Location 259 MAIN STREET (HYANNIS) Zoning District HVB Permit Type: COMMERCIAL ADDITION ALTERATION Map Parcel 327127 Permit Fee$ 50.00 Contractor WALTER F GREELEY Village HYANNIS App Fee$ 100.00 License Num 055020 Est Construction Cost$ 4,500 Remarks APPROVED PLANS MUST BE RETAINED ON JOB AND IN REST,BUILD WALLS TO HIDE EXIST ALUM&GLASS WALL SYSSTENtHIS CARD MUST BE KEPT POSTED UNTIL FINAL BY POOL&HIDE BRICK WALL ON KIT SIDE-BLOCK 3 WIND TO KI C INSPECTION HAS BEEN MADE. WHERE A CERTIFICATE OF OCCUPANCY IS REQUIRED,SUCH Owner on Record: DAALE 8T MARTINO INC BUILDING SHALL NOT BE OCCUPIED UNTIL A FINAL Address: 259 MAIN ST INSPECTION HAS BEEN MADE. HYANNIS, MA 02601 Application Entered by: PR Building Permit Issued By: THIS PERMIT COIJVEYS NORIGHT-TO OCCUPY ANY STREET;ALLY QR.SIDEYJALK,ORRNY PART THEREOF EITHER TEMPORARILY OR- PERMANENTLY: ENCROACHEMENTS ON PUBLIC PROPERTY:NOT SPECIFICALLY PERIv1ITTED'UNDER THE BUILDING CODE,MUST BE APPROVED BY THE NRISDICTION' STREET ORALLY GRADES AS WELL AS DEPTH AND'LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF- PUBLIC WORKS '. THE ISSUANCE OF THIS PERMIT DOES NOTsRELEASE THE APPLICANT FROM,THE CONDITIONS OF.ANY APPLICABLE SUBDIVISION RESTRICTIONS MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONTSTRUCTION WORK: 1.FOUNDATION OR FOOTINGS. 2.ALL FIREPLACES MUST BE INSPECTED AT THE THROAT LEVEL BEFORE FIRST FLUE LINING IS INSTALLED. 3.WIRING&PLUMBING INSPECTIONS TO BE COMPLETED PRIOR TO FRAME INSPECTION. 4.PRIOR TO COVERING STRUCTURAL MEMBERS(READY TO LATH). 5.INSULATION. -6.FINAL INSPECTION BEFORE OCCUPANCY. WHERE APPLICABLE,SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL,PLUMBING AND MECHANICAL INSTALLATIONS. WORK SHALL NOT PROCEED UNTIL THE INSPECTOR HAS APPROVED THE VARIOUS STAGES OF CONSTRUCTION. PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE PERMIT IS ISSUED AS NOTED ABOVE. PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO GUARANTY FUND(as set forth in MGL c.142A). Pi IS BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSP>CTION APPROVALS 1 1 1 2 2 2 3 1 Heating Inspection Approvals Engineering Dept Fire Dept 2 Board of Health r 9 r `� z i 1 . TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION,, Map joS Parcel Application #-c�0 Health Division Date Issued 2: t Conservation Division Application Fee Planning Dept: Permit Fee" 6 Date Definitive Plan Approved by Planning Board Historic = OKH Preservation/Hyannis Project Street Address VillageO Owner A-lkf P HA2 1-7n/o iAJO . Address'� Telephone Permit Request SIf Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type FDA r n e/. Lot Size_(,p 1 F% Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family O Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑.Yes U o On Old King's Highway: ❑Yes 311;fo 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 (note including baths): existing new First Floor Room Count Heat Type and Fuel: U Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes W N0 Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑existing ❑ new size—Pool: arexisting U new size _ Barn: ❑existing ❑ new size_ Attached garage: ❑existing 0 new size _Shed: ❑existing ❑ new size _ Other: _ Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ ' Commercial ❑Yes ❑ No If yes, site plan review# - • Current Use 7FL /t'/D �`• Proposed Use APPLICANT INFORMATION o (BUILDER OR HOMEOWNER) - - -- - - -� �Y� U Namea u rn o ir,0w Telephone Number Address /VD%77- S7 License# S CP Z 'i 4,_c/4 !L-z� Home Improvement Contractor# Worker's Compensation # X .1 55190E �� 61 a a-/ d ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 01 SIGNATURE r'-t— DATE / / Z 1 / i r -- FOR OFFICIAL USE ONLY APPLICATION# Z DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit; Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ib Name (Business/Organization/Individual):6q-(/r-?��D - (//�I 6�d . 77/1/(?. Address: 0�00 City/State%Zip: IVA-, Br ,&."A-6z 74/DPhone# -5-0(? 996� / 7Q Are you an employer? Check the appropriate box: Type of project(required): 1.L�1 I am a employer with 4. ❑ I am a general contractor and I 6. ❑ New construction employees(full and/or part-time).* have hired the sub-contractors' T.2.El am a sole proprietor or partner- listed on the attached sheet $ ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers'comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work. right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers'. comp. c. 152,§1(4),and we have no 12.❑ Roof repairs insurance required.]t employees. [No workers' 13%Other Sic AG comp. insurance required.] *Any applicant that checks box#I 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 anew affidavit indicating such tContracton;that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:145SO f Ln lO gP/S Policy#or Self-ins. Lic. #: fie_5'6L3 ® A /D Expiration Date: `/� Job Site Address: i�/%✓ �7 City/State/Zip: LGO C � Attach a copy of the workers' compensation policy declaration page(showing the policy nu ber and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of crin}mnal 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 certi under the pains and penalties of perjury that the information provided above is true and correct. Signature: Dater Phone#: C C D 1 -74 l QS`rcial 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#: Client#: 142212 BEAUMONTSI ACORDr. CERTIFICATE OFLIABILITY INSURANCE 5DATE /10/2010nvvv) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION HUB International New England ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE ` 222 Milliken Blvd HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Fall River,MA 02722 508 235-2200 INSURERS AFFORDING COVERAGE NAIC# INSURED - INSURER A: Travelers Property Casualty Co 25674 Beaumont Sign Co. INSURER B: Associated Employers Ins Co Cavallo-Cavallo, Inc.dba INSURERC: 200 North Street INSURER D: New Bedford, MA 02745 INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR D' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR NSR DATE MM/DD/YYYY DATE MM/DD/YYYY A GENERAL LIABILITY 6804192N846 04/18/2010 04/18/2011 EACH OCCURRENCE $1 000 000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $30O OOO CLAIMS MADE 51 OCCUR MED EXP(Any one person)]s2 $5 OOO PERSONAL&ADV INJURY $1 000 000 GENERAL AGGREGATE OOO OOO ItOLICYF_X AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG s2,000,000 PRO- LOC JECT A AUTOMOBILE LIABILITY BA4447N13A 04/18/2010 04/18/2011 COMBINED SINGLE LIMIT OOO ANY AUTO (Ea accident) $1, ,000 ALL OWNED AUTOS BODILY INJURY X SCHEDULED AUTOS (Per person) $ X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ A EXCESS/UMBRELLA LIABILITY CUP004451 N60343 04/18/2010 04/18/2011 EACH OCCURRENCE s3,000,000 X OCCUR CLAIMS MADE AGGREGATE s3,000,000 DEDUCTIBLE $ X RETENTION $10 000 $ ORYB WORKERS COMPENSATION AND WCC5005726022010 04/18/2010 04/18/2011 )( WC STATT. OTHLIMI - ER EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1 000 000 MndtoryH)EXCLUDED? N aanN E.L.DISEASE-EA EMPLOYEE $1 000 000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS dba Beaumont Solar Certificate Holder,project owner and others,as additional insured with regards to general liability, where required by a written contract or agreement,according to policy terms and conditions. (See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION 10 Days for Non-Pa ment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Town of Barnstable DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 20_ DAYS WRITTEN 367 Main St. NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Hyannis, MA 02601 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHOR�RESENTATIV� ACORD 25(2009/01)1 of 3 #S382864/M372726 © 1988-20,09 ACORD CORPORATION. All rights reserved. The ACORD Dame and logo are registered marks of ACORD MA003 Town of Barnstable Regulatory Services y esB1'e M � Thomas F.Geiler,Director F16yq. . Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize P - to act on my behalf, in all matters relative to work authorized by this building permit application for as9 R V,1�7 .s�L. d Xoa h'n (Address of Job) ,P i I Signature of Owner Vate Print Name If Proper Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FORMS:OWNERPERMIS SION Town of Barnstable Regulatory Services BARN3rABLE, Thomas F.Geilerf Director • ♦ MAM RFD N1A'I a ,�� Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\VvrPFILES\FORMS\homeexempt.DOC Massachusetts- Department of Public Safe.t% Board.of Building Regulations and Standards i Construction_Supervisor License License: CS 21782 s Reti tricted.to:....QO ANT III REDER} E BEAUM Y. �142 NEW idi.OTON:FAD FAIRHAWEN19 ..<;. .. Expiration: 8/312011 Tr#: �1 conmiissioner I ILLIAM 0. BISHOP Structural Engineer 5263 WYLIE LANE PORT CHARLOTTE,FL 33981 TEL-508-328-5544 FAX 941-697-9867 January 16, 2011 Mr. Rick Beaumont Beaumont Solar Co. 200 North Street New Bedford, MA 02740 RE: Roof Mounted Solar Panels Heritage. House Hotel 259 Main Street Hyannis, MA Dear Mr. Beaumont; I. have reviewed the proposed placement and attachment of the solar panels at the existing building roof that you provided on Beaumont Solar Co. Sheets 1 through 2. I also reviewed the data on the building precast plank roof structure. I further understand that there are no evident deficiencies or damage to the existing roof structure, nor any existing additional roof loads in the affected areas. Based upon that information, and the weight and manifacturer substantiating data proposed solar panels, it is my opinion that the existing roof is capable of safely supporting the solar panels in the 120 mph Design Wind Speed requireq. The average superimposed dead load of the panels is less than 3 psf. All work shall be in strict accordance with the solar panel manufacturer's specifications and details and the Beaumont Solar Co. drawings. I hope tkthaddresses your inquiry. If you have any questi ncall me directly, very r Wil , PEF. 'SlwaLiAM o. Struct er o BISHOP G� a STRUCTURAL y solar2 Na.29488 • �o�FcrsT��°�� FFSS/ONAI �'`� j 1 2 r 3 AMri' ry BUILDING I SOLYNDRA 210 (131) 31.08 KW FLAT ROOF t DEGREE L a r+ r a�S V. ,a %c d:• BUILDINGS 2 3 SOLYNDRA 210 (321) 66.36 KW FLAt ROOF y . WI LIA 0 S`.�F■Tt' •yF 91SFi P S'TRUCTU 71 No,29496� ?p �C1STE�� 44tti. i ppi{nny Itln�� . t. �4 TOTAL SOLYNDRA 200 (464) '52.8 KW 255 MAIN STREET HERITAGE T I 1 AGE HYANNIS, MA 02601 200 Forth Street HO) t S ° New Bedford.MA02740 Vf Project number Project Number beau 508.990.1701 fax 5oe,993.323o ®SOt.AR CQ.mA-A.Deaumontsignscom HOTEL Date Issue Date Drawn by Andrew W Checked by Checker Scale 1"r 40'-0" 1/6/2011 5:03:01 PM E i I I 7 \ Oo oOoOoOo oO e.Oe .Oo oO.OoOe oOoOoo.oO. 1 . SOLYNDRA MODULE I , i SOLYNDRA ENGINEERED FOOT SYSTEM � I I ` EXISTING ROOF BALLAST TO BE REMOVED AND REPLACED WITH I" ADDITIONAL INSULATION ON , TOP OF EXISTING 2" INSULATION T AND COVERED WITH TPO MEMBRANE PRECAST 0 HOLLOW CORE LU M 0 SLAB 2' X 8" AISN �+ oc� STRUCTUm' NO.29488 0/3TEM- ; AL 1 25S MAIN STREET I HERITAGE HYANNIS, MA 02601 North Street New HOUSE L+E twwHedford,MA02%40 ��7 Project number Project Number beau 509.990.1701 fax 508.993,3230 www-beaumonEsions.com HOTEL Date Issue Date psoi.n�co. tL Drawn by Andrew W Checked by Checker Scale 1/2"=1'-0" 1/6/2011 5:05:16 PM 114E Hyannis Main Street Waterfront DF Tp� Historic District Commission UARNSTABL.E. Growth.Management - �� M S. � 200 Main ,Street °reo Hyannis, Massachusetts 02601 Phone: 508-862-4665 /Fay: 508-862-4784 CERTIFICATE OF NON APPLICABILITY Application is hereby made, in triplicate, for the issuance of a certificate of non applicability under M.G.L. Chapter 40C, The Historic Districts Act, for proposed work as described below and.on plans, drawings, or photographs accompanying this application. TYPE OR PRINT LEGIBLY DATE ADDRESS OR PROPOSED WORK r`I 'ji-o e t- � ASSESSORS MAP NO. tn ry ��! c� f >� if,�iiry�,. ynASSESSORS LOT NO. OWNER It, rlC f lYI v �G7� S HOME ADDRESS /I � r '%-r e TEL. NO. S ' s' - ` °7S 2 'c'�' AGENT OR CONTRACTOR L '. ✓ .w,, _ ell !/ f F "_ ADDRESS 2-120 /y ,1,7A f 2: /l� r i»'G 1 /'/ TEL. NO. L� G This application is for exemption of proposed exterior construction on the ground that: H112) 1) It will not be visible from any way or public place. It is within a category declared entitled to exemption by The Hyannis Main Street Waterfront Historic District Commission. (Check applicable box) PROPOSED WORK: Describe and furnish plan of proposed work, showing location on lot, and if an addition is involved, showing location of existing building. D � D . .• SIGNED !'��+ L -ze�9 owner-Contractor-AgentIV141. Up =Y . . .- f�. ived by H.D.C. Certificate is herebyti t t }- rime :TOWN OF BARNSTABLE y Da e_ . . N . Approved ❑ Disapproved ❑ Town of Barnstable Geographic Information System January 26, 2011 327063 327160 #30" 327155 .. 327069 #18 327156002 327158 #232 #206 #17 � 327073I'V #252327157 #242 11010 t�` 327156001� IF 252 #215,,,,n 327072 �. �-^�..•..: #10 27152 327070 d'� � „ #211 327075 9 82 - 327149 9 327151 327099 327130 327242001 #209 tr d #278 327126 ` #231 #225 #239 '. 327098 . 327097 #282 327150 #201 .327074 - #284 -, 327148 * ,.#320 #294 327255 #23 #292 327247 m_ #255 327078 327095 327246CND 327131 327245 a #296 � , d g #21 #24 # #28" 327147 #31 327094 <327079 #304 Cho- # 327080 ° r 327248 #20 �< _ 3#376 e � - @#20°' 327081 327124 327132 327243 #27 #30 #30 ' 327082 .., 327090 #20� � #334 327092- �''�< ® #326 * 41- 327127 327123 4259 #35 3270 327091 `�� 327133 i '#3 #330 :.. ".m . r 327257 #53 C 3271d3 C 327122 ' 10 b #307 `; e #43 q'P ^` 327144002CND 327106 �s e ^t 327134 #59 " C #56 #331 > :. . 327121 Q #53 �3 ,a.^ �+� 327107 R 1 327268 S 327143 #64r #67 327135 327138 327102w #76 27.11 #319 # 128 327120 #66 1s . r. 1. 327258 'k 1i #75 yN32711971 327136 �327137 327261 ® t#78. #86 327139 O #25G C 327101 326027 #72 V 1 p.p} 327109 #30 #500 J�2Tt1'9 #3 6 #77� tr27118 m #33 DISCLAIMERS:This map is for planning purposes only. It is not adequate for legal Map:327 Parcel:127 El iN boundary determination or regulatory interpretation. Owner:DAALE&MARTINO INC Total Assessed Value:$2443600 retation. Enlargements beyond a scale of Selected Parcel w 1"=100'may not meet established map accuracy standards. The parcel lines on this map are only graphic representations of Assessor's tax parcels. They are not true property Co-Owner:C/O SUPERIOR HOTEL MGT Acreage:2.01 acres Abutters i boundaries and do not represent accurate relationships to physical features on the map Location:259 MAIN STREET(HYANNIS) such as building locations. - _ Buffer �,r'✓i' r 1 2 -o o BUILDING I SOLYNDRA 210 (131) �:. 31.08 KW t FLAT ROOF 1� DE ME AZIMUT14 i M BUILDINGS 2 3 SOLYNDRA 210 (321) 6fo.3& KW iFLAT ROOF Oil .LIA 1 q < C31"�Ir ' C 'sJSr;. , 161 DEGREE t" o.2Ft488 A23MUTH N ` TOTAL SOLYNDRA 200 (4fo4) 92.8 KW I 259 MAIN HERITAGE MA 02 � HYANNIS, MA 02601 BorthSVice Ne HOU New Bedford.MAc2��o Project number Project Number beau a 508.990.1701 -,ax 5tk993323,j vnm.beaumontsignscom Date Issue Date *S(K R CC). HOTEL Drawn by Andrew W Checked by Checker Scale 1"=40'-0" 1/6/2011 5:03:01 PM rt , ZOO *g .t -4 � � -•� Y,. F » �. �, _'� ++`:•Y ,<e� �° �q. :� +.tom::::. k' d a Light Weight and Simple Ins tallation Means Fast Projects and Low Cost The 200 Series requires no tools for installation. The lightweight panels install without penetrations or array grounding, making this the easiest and fastest to install rooftop solar system yet. Ideal for older or "value engineered" buildings, the low distributed roof load is less than 3 lbs. per square foot. Snap together mounts dramatically lower labor costs and shorten project times for large rooftop solar installations. This minimizes business disruption and makes it a simple process should you need to move the system for future roofing, retrofit or ownership changes. Higher Power - Improved light collection makes the 200 Series our most powerful panel yet, especially when combined with a white, "cool roof". Individual panels are rated up to 220Wp. t Lower LCOE and Increased. ROI The ease of installation, low balance of system costs and higher power with n- the 200 Series provides significantly lower levelized cost of electricity and contributes to strong return on investment for the customer. Proven Solyndra Technology Direct Sunlight Solyndra panels capture direct, diffuse and reflected sunlight across a 360 degree oiffusesunii�g'�htJ photovoltaic surface. Solyndra panels can be placed in virtually any orientation and significantly closer together than conventional tilted panels. The unique cylindrical a design allows wind to flow through the panels and as a result no additional ballast or penetrations are required in winds up to 130 mph. Designed for maximum �Refleoted Ught performance in the rooftop environment, Solyndra panels offer superior wind, soiling and snow performance. TOWN OF BARNSTABLE,BUILDING PERMIT APPLICATION Ma Parcel A lication p Pp Health Division O 9S Date Issued Z .E 0 Conservation Division Application Fee U"r Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/Hyannis !7� Gum ` Project Street Address/ �G�' DL0L€ CZ Village Owner AQ*1V /ZdL /lc-*tir C Address. Telephone 3DY'7 Urz>o Permit Request POOL -07au ' Z /ee >N$1F#f4. Pie W 0, 38 r,swa-r 40cr- dy,_%. Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. welling 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 "CNIumber of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count r Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove ❑Yeas ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑,existing ❑=new=;size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: _r L i 2 Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ ; Commercial ❑Yes ❑ No If yes, site plan review# ' Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name off V/ ��Cq JA Telephone Number Address l 7 ffl � License # Cs ® S"ro Z �_S ZAI Home Improvement Contractor# e Q No ' /63�� Worker's Compensation # e- Iq S� ( L ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO SIGNATURES �Y o� /��-✓� DATES f i FOR OFFICIAL USE ONLY 'APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER i DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ,R ELECTRICAL: ROUGH FINAL P } PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT' ASSOCIATION PLAN NO. �Z W G� The Corn tnonivealth of Massachusetts Departtnent of Industrial Accidents Office of Investigations' 600 Washington Street gostDn, MA 02111 °••, •• www.tnass.gov/dia workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly_ Name (Business/Organization/Individual): A L 2 6Ll"Y ` Address: "? ✓41/a(.,lGV.I A V11'- City/State/Zip: �,✓F_( C�.l C�`7 MA 0 2- q Pr Phone.#: ?k? - Z 3J: 2— Are you an employer? Check the appropriate bog: Type of project(required): 1.❑ I am a employer with . . 4. ❑ 1 am a general contractor and 1 6- ❑New construction employees (full and/orpart.fime).* have hired the sib-contractors . 2.[rl am a sole proprietor or-partner-' listed on the-attached sheet. T. remodeling ship and have no employees These sub-contractors have 8. 'VDemolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'-comp.-insurance 'comp. insurance.$ required.] 5. ❑ %are a corporation and its J0.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11 ❑Plumbing repairs or additions myself. [No workers' camp. right of exemption per MGL 12.❑Roof repairs insurance required.] t G. 152, §l(4}, and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant.that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavitindicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. XContractors 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, tf the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer Chat is providing workers'compensation insurance far my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic. #: Expiration Date: Job Site Address: City/State 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 MGI.,c. 152 can lead to the imposition of crimin4l,penalties of a fine dp 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 statemcrit may be forwarded to the Office of Investigations of the MA for insurance cove,-rage verification. X do hereby certify under thepalns an.dpenalties ofperjury that t/re inrormation provided above is trueand correct Si ature V" l��"L //� Date Phone#: 7�( — Z 3 f C-'Z 2- 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 Infor aflon a"nd Inst ue ion 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 buster,of an individual,partnership, association or other legal entity, employing employees. I-Iowever 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 Iocal 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_t;ommonwealth nor any of its political subdivisions shall . enter into any contract for.the performance of public work until.acceptable evidence of compliance Rrith 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)names}, address(es) and phone numbers) 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-insuranGe 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 Ml1 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 fixture permits or licenses. A new affidavit must be 511ed out each year. Where a home owner or citizen is obtaining a license or permit not related fo any business or commercial venture (i.e. a dog license or permit to born 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 eornmonwealth of Massachusetts Departtuent of Industrial AGcidents. Office of YnvestigatiGus. 600 Washington Street -Boston, MA,02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-?749 Revised 11-22-06 _ www.mass,gov/din Town of Barn-stable Regulatory Services . Thomas F. Geiler,Director v Hues. g JX Building Azvision Tom Perry, Building Commissioner 200 Main Street, ffyanais, MA 02601 www.town.barnstable.rna.us Office: 508-862-4038 Fax: 508-790- Property OWher Must Complete and Sign 7C'Ms Section If Using .A.Builder ivVW1, , as.Owner of the subject.property hereby authorize �'� Iv� l tYL��1 to act on my behalf, m all matters relative to work-authorized. by this building permit application for: (Address of job) S o Date Print Naxne If Property Owner is applying for permit please complete.the Homeowners License. Exemption Form on the reverse side. Yt+r:.ram Town of Barnstable of , �0 Regulator Services y T g Y Thomas F. Geiler,Director "``R9. Building Division PrED '� Tom Perry, Building Commissioner 200 Mairi.Street•,,.-Hyannis, NfA.02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 fforIRDWT-,LR LICENSE EXEMPTION Pleace Print 'DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six Units or less and to allow homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. DEFINITION OF HOMEO";WER 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 thatbe/shc understands the'lbws of Barnstable Building Department minimum inspection.procedures and requirements and that be/sbe will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Contraction Control. HOMEOWNER'S FxRMT'7TON 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 1 D9.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hirc to do such work,that such Homeowncx shall act as supervisor." Many homeowners who use this exemption are unaware that they am assuming the responsibilities of a supervisor(scc Appendix Q. Rules&Regulations for Licensing Cons6vction Supervisors,Section 2.1 This lack of awareness bftcn 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 I licensed Supervisar. 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 prnnit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is s.fcrm currently used by several towns. You may care t amend and adopt such a fomr/ecrtification for use in your community. Q:forms:homcczcmpt - - t. i - _ f ��ie T�o7x7no��sUed� � �r � Board of Bwlding Regdlatio sand Standards e Construction Supeniisor License License: CS 55020 Expiration ti6/2010 Tr# 162V { estnp; R WALTtk F GREELEY JR 17 MAUGU$AVENUE , 6f WELLESLEY,MA 02481 Commissioner t -- L. F p/�� v1 � h1 fri i�ole�t d02 I - -- f . ._ ✓d'J I , r r , ... OW W } ; (/b� �IJ✓'�L`' �' , • 1 t2p tee 1 j ,( ' _.._.._. _. b`^v Fl..f i To i I r n. /j I ' I f i j �-Ia LVid�✓1/ j �Ir �i ; � i I . L I _I i I I 1 I I � ' I I + ' � f : r I I i ' � I ! I I I r I �1N�0�1.✓�i�l., I f I _ ___:I�. 1 -- - -- - - -- -- I I i I � PREVENTION- �� - G' -E_DEPAR$r� �� € --- --- - ;- I , i. ' I I I I !� Oft. q a-- I I /� �; A (Zf�4 ' 1 � f { I I I I : � i f ' r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel' l `Applicatioh # �6 (0 Health Division " Date Issued Conservation Division Application Fee Planning Dept. Permit Fee' Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/Hyannis Project Street Address �� Villag-ems---_'= Owne � � /%1A2?7_/AAddress, GTeI he one� 9',70 -3za n p C7_-Pormit=Request � 4 47 Square feet: 1 st floor: existing 'p pos d 2nd floor: existing proposed Total new Zoning District t Flood Plain Groundwater Overlay I roje_ ct-Valuat one- °&_O k 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 r, now Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name--�` � Tele hone Number, 4c 'T . p Address "� A,4neC6 cerise # '°` -• Home Improvement Contractor# �c ® f Worker's Compensation # -42&46 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO CS1.GNATURE FOR OFFICIAL USE ONLY APPLICATION# 3;"DATE ISSUED 1'730bf, . y,NMAP_1_PARCEL_NO+_ s :ADDRESS - VILLAGE OWNER s DATE OF INSPECTION: . - 4 1�4MUNDATION.. Dom#3 'i FRAME i • z FIREPLACE � s ELECTRICAL: ROUGH FINAL r . ;z PLUMBING: ROUGH FINAL GAS ; �ROUGH,UPl 15 FINAL i.LiFWANUBUILDING A DATE CLOSED.{OUT ASSOCIATION PLAN NO. The Commonwealth of Massachusetts Department of Industrial,4ccidents Office of Investigations 600 Washington Street Boston, MA 0211.1 lvt�%w.m ass.go v/dia UW. Workers' Compensation Insurance Affidavit: Builders/Contractors/Elee'tricians/PIumbers Applicant Information on = �g►y�.- f�Please Print Le ibl Name (Business/Organiza6on/Individual): 4t t Address: Afe� City/State/Zip: rAW Phone.#: �Oa 42 '4a VA� Are you an employer? Check the appropriate bog: Type of project(required): �I am 4. 1 s general contractor and[• '� am a employer with � 6. El New construction employees(full and/or part-;time),* have hired the sub-contractors .2.[l Lam a soleproprietor or'partfter-' listed on the attached sheet. 7.. E]Remodeling ship and have no employees These sub-contractors have g. 'Q Demolition . working for me in any capacity. employees and have workers' 9 .0 Building addition [No workers' comp.•insurance comp. insurance,[ required] 5. We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their. 11.❑Plumbing repairs or additions Myself [No workers' comp. right of exemption per MGL 12.2Roof repairs insurance required-] t c. 152, §1(4), and we have no employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant.thatchecks 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 subrnit a new alTdavit indicating such. xConbactors 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: Policy#or Self-iris.Lic. #: Expiration Date: p � Lob Site Address: E��/ � � 57 City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine. Of up to$250.00 a day agaimt.the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA.for insurance coverage verification I do hereby certify u gins and penalties of perjury that the info on nr,.gvided above is true and correct. Si afore: s Date: Phone #: Official use only. Do not write in this area, to be completed by city or town official 'City or Town: Pertnit/License # Issuing Authority(circle one): 1. Board of Health 2.Building Departrfient 3. City/Town Clerk 4.Electrical Inspector S. Plumbing Inspector 6. Other Information and Instructions loyers to provide workers'compensation for their.employees. Massachusetts General Laws chapter 152 requires all emp 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, associatioa, corporation or other legal entity; or any two or more -of the foregoing engaged in a jowf 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 tbereto�shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or lo'cal•licensing agencyshall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant wvho lias 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 unti.i acceptable evidence of compliance Rdth the in ur'nce 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, it necessary,supply sub-contiactor(s)n.ame(s),-address(es) and.phone number(s) along with their certificates)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-insurame license number on the appropriate lino. 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 permitllieense number which will•be used as a reference number. Iri addition, an applicant that must submit multiple permidlicense applications in any given year, need only submit one affidavit indicating current policy information(if necessary) and under`Job Site Address" fhe.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 maybe provided to the applicant as proof that a valid affidavit is•on file for future permits.or lie nses Anew affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related fo any business or commercial venture (Le. a dog license or permit to burn leaves etc.)said persou 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 Imdusbrial Acci&nts Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-IIASSAFE Fax # 617-727-7749 Revised 11 22-06 www.mass.gov/dia l F I LEPAAND-01 FRLI y'4f�°�®a CERTIFICATE OF LIABILITY INSURANCE -DATE 2ios/2� 010 ) PRODUCER (608)676-0309 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Viveiros Insurance Agency,Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 375 Airport Road ALLTER THE C�.OVERAGE AFFORDED NOT THE POLICIES BELOW Fall River,MA 02720 INSURERS AFFORDING COVERAGE NAIC# INSURED Lepage and Sons Roofing,LLC INSURER A:United States Fire Insurance 32 Pierce St INSURER a Applied Underwriters Rochester,MA 02770- INSURER C: INSURER D. INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD'L POLICY NUMBER POLICY EFFECTIVE PDATE IMMIDDIYYYYI OLICY EXPIRATION LIMITS GENERAL LIABRM EACH OCCURRENCE $ 1,000,000 A PCOM MERCIAL GENERAL LIABILITY CIP93389 10/16/2010 10/16/2011• ' PREMISES Me occurence $ 100,04 CLAIMS MADE a OCCUR MED EXP(Any one person) $ 5, PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,OW,OOC GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,00 X I POLICY PRO LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALLOWNEDAUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY $ NON-OW NED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY TORY LIMITS ER B ANY PROPRIETORMARTNERIEXECUTIVE Y-- 0830067 08/13/2010 08/13/2011 E.L.EACH ACCIDENT $ 100, OFFICERIMEMBER EXCLUDED? 100,0(Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yyes describe under 500,0 SPEGrIAL PROVISIONS below E.L DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Heritage Hotel 259 Main Street Hyannis Me. CERTIFICATE HOLDER CANCELLATION SHOULD ANYOF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Town of Barnstable DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN Building Detp NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Barnstable,MA- IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORRED REPRESENTATIVE ACORD 25(2009101) 0198S-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD - Massachusetts- Department of Public SufetN . Board of Buildi.n- Regulations and Standards Construction Supervisor Specialty License License: CS SL 99705 Restn'cted to: RF ?' HERBERT LEPAGE 32 PIERCE STREET ROCHESTER, MA 02770. Expiration: 1/6/2012 ('iimmissioner Tr#: 99705 r I tpo LePage & Sons Roofing Lic. 134094 608-295-6483 CS-SL 99706 Job name Beaumont Signs(Heritage Hotel) Job# gbeaumont010-0457 address 259 Main Street Town Hyanis State MA Zip cell 508-245-5952 Date 21-Nov work 508-990-3230 extended install mat'I/sq total/sq #squares total 30 year ART $ - 40 year ART $ - 30 year ART $ - special $ - second layer remove ballast 200.00 $ 8,000 $ 94,000 $ - TPO White 200.00 $ 86,000 extended additional charges: cost per qty: cost Dormer $ 70 dormer $ - Hip roof $ 10 sq $ - Pitch 7-10 $ 15 sq $ - Pitch >10 $ 25 sq $ - Valley $ 60 valley $ - Smart Vent $ 30 ea $ - soffit vents Tar paper 1 $ 128 roll $ - Ridge Vent $ 6 ft $ - optional Dumpster I per quote job Vent Boots $ 80 ea 23.00 $1,840.00 Units 1 $ 100 job $ 7.00 $ 700.00 Ice&Water Barrier $ 3 ft $ - optional $ 2,540 Description of work to be performed: Remove ballast (RJ Hydro Vac) quote is$40 per sq Fully adheared White TPO roof. Add 1"of ISO board to R24 building code. Terminate perimeter with 3 by 3 white angle. Payment terms: I T:� 50% Upon start to cover materials and initial labor $ 46,740 10% After ballast removed 1 1 $ 10,000 10% After first roof is insullated and covered $ 10,000 10% After second roof is insullated and covered $ 10,000 10% After Third roof is insullated and covered $ 10,000 10% Final payment after termination and walk thru $ 10,000 Signed: Herbert P. LePage total: $ 96,740 color: White TPO Total: $ 96,740 Deposit (50 % req'd before material delivery) Balance due upon completion requested start date BALANCE DUE 96,740 S ecial instructions Pagel I oFTHE Town of Barnstable ` Regulatory Services t uetasrAs[.� v Russ $ Thomas F. Geiler,Director 6196..196 Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 509-962-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using ABuilder as Owner of the subjectproperty , J . I hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of rob) Signature of Owner Date lam• 111,41Z171)G Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. I (1•Fl1R MC•f1 W1JFR PFR kf1CC1(1TJ Town of Barnstable apTFiE ram, „tip' do Regulatory Services saxrrsrwar e Thomas F. Geiler,Director Muss. t639. ,�� Building Division eo titan" Tom Perry, Building Commissioner 200 Mairi.Street, Hyannis,MA 02601 xrwv.town.b arnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HO1rEE0 LICENSE EXEMPTTON Please Print DATE: 2 -5 — ZD JOB LOCATION: number street village "HOMEOWNER": name ho hone# work phone# CURRENT MAILIN G 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. - r , DEFINrrION"'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 constrgcts 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 unde 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 Deparlment minimum inspection procedures and requirements and that be/she will comply with said procedures and requirements.. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 121.0 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,(Sectidn 109.1.1 -Licensing of eanstiuction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of s supervisor(sec Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicenscd person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsrb)c. To ensure that the homeowner is fully aware of his/her responsibilitics,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsrbilitics 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. r . Q:forms:homccxempt ��`�� `, � �'r�v� c�7�� c� � � �s_ , `� ---� �� i, • Asps _�v Parcel it# 13116 .1 Date Issued 13 1*�Board-of Health(3rd floor)(8:15 -9:30/1:00-4:45) Fee' D 00 494a�s Engineering Dept. (3rd flo Ouse# 92CONNNMON 3-Iv-9b 1� CON BI'RUCTIO�L ' D ammng oar 19 e 9. /� FD MPS t C/ TOWN OF.BARNSTABLE Building Permit Application Project Street Address !�Sj MA in 3TftF-r Village Owner l e a eLf- A• L C_)0'fF Address 1<0 E_ ►'m 1 c 4,rCt_' C d AMA 0,01D Oa631 Telephone ' '0L 275- -7000 r, Permit Request I dl L 5 1.D 1 Ao, 67 O First Floor square feet Second Floor square feet Estimated Project Cost $ .}o0o W Zoning District Flood Plain Water Protection Lot Size Grandfathered ? Zoning Board of Appeals Authorization Recorded Current Use Proposed Use Construction Type Commercial H'}o'(i:L Residential Dwelling Type: Single Family Two Family Multi-Family Age of Existing Structure Basement Type:'' Finished Historic House Unfinished Old King's Highway Number of Baths No.of Bedrooms Total Room Count(not including baths) First Floor Heat Type and Fuel Central Air Fireplaces Garage: Detached Other Detached Structures: Pool Attached Barn None Sheds Other Builder Information ��f o -TelephoneS0 Name `) � !� Vl1 F TT Number 0 0 Address 0 License# C S O C J mm A a o )_�o MA OA G 31 Home Improvement Contractor# Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT) SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. Q ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ► i SIGNATURE =_7F ("� ll ,t DATE 2�) aA-, BUILDING PER4T DENIED FOR THE FOLLOWING REASON(S) -, FOR OFFICIAL USE ONLY PE MIt NO. _ DATE ISSUED s ' P%PARCEL-NO. f ADDRESS `_ VILLAGE ; OWNER DATE OF INSPECTION: ' FOUNDATION FRAME f INSULATION = FIREPLACE f ELECTRICAL: e, GH ~FINAL y _ 1 PLUMBING: GH FINAL - GAS: M H FINAL J µ ' t ` FINAL BUILDIN r r DATE CLOSED ASSOCIATION PLAN NO. ' F s The Commonwealth of Afassachusetts Department of Indo-trial Accidents ofceof/oyes offs "60(J•11'ashitr,;;ton Street Boston.Alas. 02111 Workers' Compensation Insurance Affidavit — @pnIic—n nformation ase PRINT Ie�tbly a - name loc•,tion 01\5� rJly 14�A)1 S /T. d�W�� phone# � 78 04 1 am a homeowner performing all wort:myself. 0 1 am a sole proprietor and have no one working in any capacity z IF 1 am an employer providing workers' compensation for my employees working on this job. compmn3 name! PAT address• )5-1 City: r)A) is Dx�a phone 0, -7 Ooo incur•Jnce co P06CI C /YWT0AL D05 C•-O policy# 0 3"oZ 0 y$�S —`� 7- 31 I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: comriany rime: address: _ city: phone#• insurance co policy# �.. -.� ----;.�•._— �nra-•:�,,.iTcorerr•�^•-1+s1-nc1-+�.:ere .•..�-_-++y �`it,L3TII7°dy„g"•�t7'M'4r. -iII► ='9' _ - •-":-^fir om am•nain address: city rhon #• incur•rnce co policy# :Attach iddl_tionafsheei if'neeess �;:<..w, ., Failure to secure coverage as required under Section 25A of IitGL 152 can lead to the imposition of criminal penalties of a fine up to S1.500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP«'ORK ORDER and a fine of S100.00 a day against me. I understand that a copy of this statement may be forwarded to the Otricc of Investigations of the DIA for coverage verification. 1 do erebr certify uniler the pains and penalties of pcdun•that the information provided ab a is true and correct. OA i_na rez2L�a Date _ la tint name bon"' 7 7 ' 7Go0 official use only do not write in this area to be completed by city or town ofrrcial cih or town• permit/license# r'IQuilding Department Licensing Board check if immediate response is required OSelectmen's Office �11ealth Department .i contact person: phone#• riOther (revised V95 P1A1 1 J 4 s I. J•a• te-oa o r. 'e - i ��YII { to}_4 14•mBig Ilk o c�ru o 1. � m o e" CC H - i `TNEr�'`+ TOWN OF BARNSTABLE Z BAflB9TSIiLB, i 16 9•a BUILDING INSPECTOR �o war • APPLICATION FOR PERMIT TO addit,i,Qn„to„ h „ House,.,,,,,,, Motor Hotel TYPE OF CONSTRUCTION ...MA5.R=.y....An(A...h!Q..Qd...................................................................................... Februar ......................19.72 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ...r.QAr..... 9...MA-1,A Streets...HY.annis....................................................................................................... ProposedUse ....hOtel.........................................................................:.......................................................................... Zoning District .......Residence ....................................Fire District .....4yaapis....................................................... Name of Owner F'.urell„Realty,,,Trust,,,.,•,,,,,,,,.••._Address ...255„Main,,,Street, Hyannis „ Name of BuilderFurell Realty Trust Address 255 Main Street, Hyannis ..... .................................................................... Name of Architect .Robert E. Wilson, Jr •..........Address ...10 Clinton Avenue, Falmouth ................ .................................................................... Number of Rooms 60 Foundation ...,•concrete .................................................................. .................................................................... Exierior ....:masonry............................................................Roofing ...........tar and...gravel.................... ........... ......... Floors ........concrete.........................................................Interior ...........drywall„and masonry.................. Heating .klQ1;...AIr...4Ad..e ,r... ......Plumbing ......... opper„and...cast. . ...iron. . .................... .. .. ..... .... .. .. Fireplace ...............riQIXP.........................................................Approximate Cost ...a 25.4.1.000.00 Difinitive Plan Approved by Planning Board -----------_-------------------19 Diagram of Lot and Building with Dimensions r '7See g�apt(�t`'achepdy pplan SHE ANITARY WA TER Sd.P I- , SE'LV AGE DISP'OSAL AND DRAINA E IS �i..r �. i�'/1/" �' C Y�Acf'r u� "-.L d TOWN'F ARN STALE, BOARD OF HEALTH A L(CENSCL !NS iIU a FERNIiT, AND INSTALL 5 ,rErST DBTAII�I SEWAGZ YSTENIB b n I hereby agree to conform to all the Rules and Regulations of thd-Town of Barnstable re ng the above construction. Na ........ G:........................................................... - FR LL REALTY TRUST L Jack J. Furman, Treasurer Furrbll Realty Trust 14755 add to Motor No .... Permit for ................................... Hote*i**"(Appeal #1971-19) ............................................................................... Location .........re.a.r..259..Nain..Street.............. . .. ....... ......... ............. Hyannis ............................................................................. Owner ...........Furrel.l..Rea.ity..Trust.......... ............. .. ...... ...... frame & masonry Type of Construction ................................... ................................................................................ Plot ............................ Lot ................................ Permit Granted ......February 4 19', 72 Date of Inspection . ....40 ...... .......................19 Date Compl ed .......... . ........19 or PERMIT REFUSED ................................................................ 19 .........................................................i...................... ...........................................................I...................... +� i l ............................................................................... ............................................................................... A Approved .................................................. 19 ............................................................................... ............................................................................... n Crossen Ralph From: McKean Thomas To: Crossen Ralph `. Subject: Heritage House H tel/259 M n Street Hyannis Date: Friday, July 31, 19 10.24 Yesterday, we received a complaint about the indoor pool at the Heritage House Hotel. The complainant stated there was no fence around the pool. All the glass sliding doors were open and anyone including toddlers and street people could walk into the pool area and drown. I immediately went to the site and was able to verify the complainant's allegation. In addition there was no lifeguard in the indoor pool area. I issued a violation notice to the manager in regards to no lifeguard being present. Ralph -Will you or your staff address the issue regarding lack of fencing? If this violation reoccurs at some future date, I believe there is the potential of a drowning there. 1 /N �v V G c 0 q, A e,Q(Do0 �al �cJ 'o,� Page 1 °� �Olm biu 1 McKean Thomas From: McKean Thomas To: Crossen Ralph Subject: Heritage House Date: Tuesday, August 04, 1998 9:15AM Mrs Barbara Peterson called today at 9:00 a.m. (775-2721). The indoor pool at the-Heritage_Heus Motel is not fenced-in. The sliding doors were left wide open on Friday. Also,the outdoor pool gate was-left-open. It did not have an automatic closer. CDe:partment?'s etersn stated she originally called the Building Department and a woman told her that it is not the Building responsibility! She never her that response before from a Building Department. Building f ments in other towns always take action in this regard. Mrs. Peterson stated she lost a three year old grand-daughter due todrowning at the International Inn outdoor - - pool 21 years ago. The fence was broken at the International Inn outdoor pool at that time. t • t ;i' . .. �•� ;its 5t. a-'I�.. rK)i: I ` TD r� do `?� C✓v�L l2 3v _ Ate- ova cr. L Y" (A a, ` ° - ' Page 1 11 ��/�� / '��✓hi►+; I�►`aMa� a� ��o.�,�a� -�-� �a�-Q,.� �dP:�D-Q.J I,v-� G$� J c,,,, PAcy s �� e. r �, C on'sery GRO.uP,'INC6RPORATED CONSTRUCTION CONTROL AFFIDAVIT AT PROJECT-COMPLETION Parcel Number: Project Name: . . Proj ect Owner: Heritage.House Hotel Q Project LocationIC259 Main Street Scope of Project: Lobby toilets and upper evel guest room renovations M In accordance with paragraph;'116.0 of 780 CMR;the Massachusetts-State Building Code;I; David Vachon Massachusetts Re'gistration.Number '7471 being,a`Registered Profess16nal•Architect hereby certify that all architectural plans, computations, and specifications,-and'changes there'to,.involving'the subject proj ect have been prepared by or under the direct-supervision of;a Massachusetts Registered Professional Architect and bear his or her original signature and seal as define&by, Massachusetts-General Law (M.G.L) c 112,,$8IR: I certify that I have inspected;the'work'assoclate'd with Heritage House Hof el and.that,tQ the best of my knowledge, information, and belief the work has'been done in conformance with,the.permit and plans approved by theInspectional Services Department and with the provisions of the T%Iassacl�.�asetts State Building Code,and all other pertinent laws and ordinances.: _ fn• Architect,(Origi 1 signature and Se _ a�� Date VACHOIN Home Office: Hedges Pond`Crossing; 2277 State Rd., Suite H'!- Plymouth, MA 02360 - a Mailing Address; P.O. Box 278 •`Sagamore-Beach, MA 02562` Phone: 568.888.6555- Fax: 508.888.6566 dn's , v GROUP, INCORPORATED CONSTRUCTION CONTROL AFFIDAVIT AT PROJECT COMPLETION Parcel Number:. Project Name: _ Project Owner:' Heritage House Hotel. x Project'Location: 259 Main Street Scope of Project: Exterior Facade Renovation -In accordance with paragraph 116:0 of 780 CMR,the Massachusetts State Building Code; I,, David Vachon Massachusetts Registration Number '7471 . being a Registered Professional Architect hereby"certfy'that all architecturalplans, computations,, and specifications, and changes.thereto, involving the subject.projecthave been prepared by or under the direct supervision of a Massachusetts Registered -Professional Architect and'bear his onher original signature.and seal as,defined by Massachusetts General Law (M.G.L.) c,l l2, $81R. , I certify that I have inspected the work associated with'Heritage House Hotel and that to the best of my knowledge, information, and belief the work has been:done in conformance with the permit and plans approved by the Inspectional Services 'Department and with the provisions of the Massachusetts State Building Code and'all other pertinent laws and ordinances. 4",%ajx . L �sV 7.1 F 09y Architect (Origina ignature and Seal) '` MAIJ10 J. �` . Date Home Office: Hedges Pond Crossing, 2277 State Rd., Suite H •-Plymouth,.MA 02360 Mailing Address: P.O: Box 278 Sagamore Beach, MA02562 Phone: 508.888.6555 Fax: 508.88.8.65§6 r Parcel Lookup Page 1 of 1 ErgPj r , Logged In As: Parcel Lookup Wednesday, J Road Lookup Condo Lookup Multiple Address Lookup Reports Search Options Search By Street Street# 259 Street -' Name main Village JAII Villages Search <Prev Next> Page 1 of 1 Rows/Page Parcel Locati Owner Village Index IV 327-127 DAALE & MARTINO INC HY 0952 3; 134-013 259 MAIN ST./RTE 6A(W.BARN.) HAWLEY, JAMES E JR WB 0955 1: -7, http://issgl/intranet/propdata/lookup.aspx 7/8/2009 Map Page I of 1 Town of Barnstable Geographic Information System Parcel Viewer Custom Map Abutters 1 Map Size Zoom Out flUUDDfljUflIn 11 (ip ®= 3 P G Map: 327 \327165 - 327160 327161 J�—" Location: 4 18 327166002 327069�- 327073 327158 N 232 N 220 T NW' 1 262 327072 \13271�56001 3271167� � --327162 Owner: CN211("— N 104 ay215 J7 0 U P 262 V, #82 At, N 226 Location In 327099 327161 4278 327126 N 209 327160 Map & Parce #230, #201 32709 '327098 VN !1' Location 7 N282" 27240 CN D 327 N 28 327074 N294 11 1 Z Acreage N 320 327255 2724 N 21 2 096 N 292" 66 3 46 CN D 32 131 32720 ip 296 N 247 #24 icy I k 1�4,�"-' �A'3'709 N 28 Current 0% NJU4 327105 C Mailing Addi 307 N l!2 327132 327243 N 27 N 30 27092 -17"0271104 2"' '327127 71 3 1p, 5.77� 328 N 30 7 36 k- - A 3271461 CC N 269 �') 9� q�'2'�7'1 3 4A N 49 App raised L 32712? "1 #,43 Extra Featur ,X\� 1` 27103 327134 41 327138,,,�' Out Building 27100 N307 N 5!,Yru 331 27121 Land N63 327268 N 64 Buildings 3271 2 0 327136 - -t3 7128 3 2 7 1 Total Apprai N319 0 N 63 r ass V 327119 N 71 327130 327137 Extra Featur e t 26027 327118,Z� A� N 78— 1186 272 3 Out Building 25 500 N 77 #3 Land Buildings Set Scale 1" = 2p2 1 I iAerial Photos MAP DISCLAIMER Total Assess Copyright 2005-2009 Town of Barnstable,MA All rights reserved.Send questions or cornmt BarnstableMA v1.2.3435 [Production] http://www.town.bamstable.ma.us/arcims/appgeoapp/map.aspx?propertylD=327127 7/8/2009 12/23/2020 wr� .Wig Town of Barnstable Massachusetts ° Business Certificate TfO�RV i Permit Number: BL-308 Permit Issued: December 22,2020 Permit Expires: December 22,2024 In conformity with the provisions of Chapter One Hundred and Ten(110),Section Five(5)of the General Laws,as amended,the undersigned hereby declare(s)that a business Is conducted under the title below,located as shown,by the following named person,persons or corporation: Please Note:A Business Certificate Indicates that the named person(s)Is(are)doing business under a name different than his/her personal name(s). It does not Imply that the applicant(s)has(have)met all license,permit and other permissions required by the Town of Barnstable Building,Health,and Licensing Departments for the legal operation of this Business at the stated location. Granted To: 259 MAIN STREET(HYANNIS),Hyannis MA DBA: AARIA HOSPITALITY,LLC dba COMFORT INN-HERITAGE HOUSE INN Owner: AARIA HOSPITALITY,LLC 1661 WASHINGTON STREET PO BOX 6934,HOLLISTON MA 01746 Restrictions: In accordance with the provisions of Chapter 337 of the Acts of 1985 and Chapter 110,Section 5 of the Mass General Laws,Business Certificates shall be in effect for four years from the data of issue and shall be renewed each four years thereafter, A statement under oath must be filed with the city clerk upon discontinuing,retiring or withdrawing from such business or partnership. Copies of such certificates shall be available at the address at which such business Is conducted and shall be furnished on request during regular business hours to any person who has purchased goods or services from such business. Violations are subject to a fine of not more than three hundred dollars($300)for each month during which such violation continues. 1/1 r � - PRorl;T NAME: ) YGZ�Vv� ADDRESS: R(a t v) PERMIT# 0 Z) 0 0,-�--C) PERMIT DATE: . MiP: � LARGE ROLLED PLANS ARE IT: B® SLOT Data entered in MAPS program on: � a BY: � i Town of Barnstable Building Department Brian Florence, CBO Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Pre-application fo"r Business Certificate Date Map3; Parcel I Applicant Information Applicants Name 19y R J (l P xT Applicants Address S I J n C��— L� �0 Email Address Q 0\,G Gcr.\G` (�a� @ 9hn 0 1 Al" Telephone Number - 9 C(O 7 Listed ❑ Unlisted ❑ Business Information New Business? ------------------------------- --------- Yes No Business is a register ed corporation? -------------------------- Yes No If yes Name of Corporation ►'y Gt O� S 1�1�G� t�� L � T Does business operate under the registered corporate name? Yes No Is the business a sole proprietorship or home occupation? --------- Yes Ffo -- -------= -• If yes then a Home Occupation Registration is required—See Building Division Staff k Name of Business A(-,k( a �M5Q I�TAi.I-T`( 14- C O F3 OaCTA C-& 00JSF" O V� Business Address 2-1,S 9 Sj-V 'cT 0 Y 00 Q%S Type of Business l� Build' Commissioner Ofqce Use Only ,C Cond•tions i Building Commissi r i �'�" Date Clerk Office Use Only TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application #-6 I c Health Division Date Issued Conservation Division Application e /4 AA Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address A S9 MAID,) I AID,) Village T Owner )e,�V M 1� ,� 0 Address Telephone 50 o r))S D 0 0 6 Permit Request `@GiCk c + Po I I rl I tU ) wo 1 ki 11 �cuf Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 000 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 Unfi nishe6Area (sq.ft) Number of Baths: Full: existing new Half:fiexisting /)� new Number of Bedrooms: existing —new �NOP�yoo��J6' Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑Oil ❑ Electric ❑ Other 1'F Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size._Pool: ❑ existing ❑ new size _ Barn: ❑existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) U c� Name Telephone Number SO t � , S /�O0 Address Co License #Ili fV � � Home Improvement Contractor# Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO CAA SIGNATURE - DATE `,6 FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING- DATE CLOSED OUT ASSOCIATION PLAN.NO. Ct�z�xrrrtt�a�'3�r�sr�e�trfsr�s Depw tmwt ref f� Cr.kIAc der- - - �a� t�g�tiorrs 690 Wm*higfoa reef Bmtarj,HA Q? tvtt.�arrc�ga�dia Workere CompeisatiunInsu-aace Affidavit Euffde3rsfCcafz7actors/Mec dcianMumbers ApppI antlafarmatim Please Print on(hidb2id=0 � 6� 6,6 c fs _-- - � m �� g-237-��Gao r, rert-emu _-exagloy-er- riab�bo= _. -E ofprojmt(r�red�= I am'a e�player vtith 4. ❑I acaza cimiia aad I 6_ ❑New rrrr,�t,�v ,� €mPSoyees{full anVorpart-ime-* }save f e sub c�a�fofs 'Y.❑ I am a sole propv3dor orpartne r listed on the attached sheet 7- ❑R=odeliag ship and have na employees These snh-watactors h ve g- ❑71emo1itiv� °dcin ` anrtrar�� far me is ct employees d have woficers' Comp-r„ lL_ ElBvil�mg addition �NLi WQr�P:rS' Ci3n]{i:i'srerranc� c . S-❑ We are a corporaEien d ifs 10-0 Flecical repairs or adAitions ofirers h ati�zaercised(heir 3_❑ I am.a hr}niernvner doing all vaorli 1 L.❑Plumbmg repR1 fY or additions MYSCM [NO WO&Crs' right of eix fiici t per MGL 1 ❑Roof a i:n gnued_�1 c.15Z§1(4),awe have no nal 4 I n e-pl [No worms' -�.€�fher S 1 cep_==-nm � y�aysagli thztF�IPf�<bas'rlt�rttaIw ovttt SECttUnhE1A57ehrmi�ev 2aTLDmDe�iQgIWaT I S=emwnem Veho='bmaffi&Iffidnifi-fr= i gthey mm&ingsHimdcsad&eahiteData&couftz==r�sul:nx2aue�s�dsritT l�n, Coa�scmrs tbsf ci Jc d&box mgsc sttsched as aaa;n—�,sheQc sbcxing the nsme a£Sie s masrste Rhet�C oEnot H nsg r e¢�IQye�s Ifthe salr-co-nimdmsh�empI s,tht�Est provide tL�u•zra��s'comp.pa&cy avmbez •- .Lam are employer thati:spratmidirrg workers'conq7swsdi w irmtrartca f`ar rri}eugYL pem .ti`67tr is fhepaiicy arrdtob s&r irt�irmQtiarr- J �- lnsma aYrnce Coaip =a: l� Lei✓ e C 2- Polite 9 ce sel€ias-Lic-;-5�-_ (-U(!116 j y �fj �j FxpiratioaDate. / l i 1613Sib--Ad&esr Cifg/Swelzip_ 0,21,01 Ai#ach a wpg of the wurkers'compensation policy deciim6on page(showing the poHcg number and cq&-atiaa date). Failure to secum caverage as zegaimdnuder Sec(sosi.?5 A o€MM c. 152 can lead to the rmpesdim ofuiuimal patties of a free up fie S 1.501 Qa and/or one-year imp i as we-U as civil penalties in 13ie faun of a STOP W4RIK ORDER and a fw of up to,$250-DO a day against the violator_ Be advised that a copy of this sUda eutr maybe fxvarded to the Ot=of luriedE ptions of tiie DIA for imm—wce coverage;veEi;S ion- Ida hereby cer .fy clpsnah5ks afpedwy tlteffhe irzform�a n tWq avc fs h7m turf correct Phone 0 (3 cfaL irse only. Da teat trritg in ffsis area,to be camp&W by city or ariva afficiaL CRg or T'owm PereaLcense# Lwiing Au IN ariq(drde atxe),- L Board of Health I Builiffiag Depzrbneut I f ityf'Fawa(Qe rk 4.Electrical] ispector S.Piamhiug Im3pectter .6.Other Coact Persnsi: Phone#: 6 I - 0 • s t gAg2�`Z'ARI •R s 19. 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: 50 8-862-403 8 Fax: 508-790-623 0 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize G'q-r rQ4)lw to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address of Job) WiAgnatu=te Lofawner Da Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. A � Q:IWHFILESTORMSIbuilding permit formslEXTRESS.doc Revised 061313 Mass. Corporations, external master page Page 1 of 2 u .... v •y Corporations Division Business Entity Summary ID Number: 043149332 °Request certificate 3 New search Summary for: SUPERIOR HOTEL MANAGEMENT CORPORATION The exact name of the Foreign Corporation: SUPERIOR HOTEL MANAGEMENT CORPORATION Entity type: Foreign Corporation Identification Number: 043149332 Old ID Number: 000389413 Date of Registration in Massachusetts: 03-25-1992 Last date certain: Organized under the laws of: State: DE Country: USA on: 01-21-1992 Current Fiscal Month/Day: 12/31 Previous Fiscal Month/Day: 09/30 The location of the Principal Office: Address: 1209 ORANGE ST. City or town, State, Zip code, WILMINGTON, DE 19801 USA Country: The location of the Massachusetts office, if any: Address: City or town, State, Zip code, Country: The name and address of the Registered Agent: Name: KATHLEEN C. MARTINO Address: 259 MAIN ST., City or town, State, Zip code, HYANNIS, MA USA Country: The Officers and Directors of the Corporation: Title Individual Name Address PRESIDENT PETER F MARTINO HERITAGE HOUSE HOTEL, 259 MAIN ST. HYANNIS, MA 02601 USA TREASURER PETER F MARTINO HERITAGE HOUSE HOTEL, 259 MAIN ST. HYANNIS, MA 02601 USA SECRETARY KATHLEEN C MARTINO http://corp.sec.state.ma.us/CorpWeb/CorpSearch/CorpSummary.aspx?FEIN=043149332&S... 4/6/2016 Mass. Corporations, external master page Page 2 of 2 HERITAGE HOUSE HOTEL, 259 MAIN ST. HYANNIS, MA 02601 USA DIRECTOR PETER F MARTINO HERITAGE HOUSE HOTEL, 259 MAIN ST. HYANNIS, MA 02601 USA Business entity stock is publicly traded: ❑ The total number of shares and the par value, if any, of each class of stock which this business entity is authorized to issue: Total Authorized Total issued and Class of Stock Par value per share outstanding No. of shares Total par No.of shares value CNP $ 0.00 1,000 $ 0.00 1,000 ❑ ❑Confidential ❑Merger ❑ Consent Data Allowed Manufacturing View filings for this business entity: ALL FILINGS Amended Foreign Corporations Certificate ': Annual Report Annual Report - Professional < Application for Reinstatement v Vi 1.ew f 11 ilings Comments or notes associated with this business entity: i 1 i New search http://corp.sec.state.ma.us/CorpWeb/CorpSearch/CorpSummary.aspx?FEIN=043149332&S... 4/6/2016 Mass. Corporations,,external master page Page 1 of 2 h Corporations Division Business Entity Summary ID Number: 001086259 i Request certificate New search Summary for: GRAHAM, LLC The exact name of the Domestic Limited Liability Company (LLC): GRAHAM, LLC Entity type: Domestic Limited Liability Company (LLC) Identification Number: 001086259 Date of Organization in Massachusetts: 08-22-2012 Last-date certain: The location or address where the records are maintained (A PO box is not a valid location or address): Address: 66 BRANT WAY City or town, State, Zip code, HYANNIS, MA 02601 USA Country: The name and address of the Resident Agent: Name: GARY C. GRAHAM Address: 66 BRANT WAY City or town, State, Zip code, HYANNIS, MA 02601 USA Country: The name and business address of each Manager: Title Individual name Address MANAGER LAURA A. GRAHAM 66 BRANT WAY HYANNIS, MA 02601 USA MANAGER GARY C. GRAHAM 66 BRANT WAY 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/CorpWeb/CorpSearch/CorpSummary.aspx?FEIN=001086259&S... 4/6/2016 Mass. Corporations,.external master page Page 2 of 2 REAL PROPERTY JGARYC. GRAHAM 166 BRANT WAY HYANNIS, MA 02601 USA REAL PROPERTY I LAURA A. GRAHAM 66 BRANT WAY HYANNIS, MA 02601 USA ❑ ❑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 E View filings Comments or notes associated with this business entity: 1 New search i http://corp.sec.state.ma.us/Corp Web/CorpSearch/CorpSummary.aspx?FEIN=001086259&S... 4/6/2016 3/24/2016 07;07 TO: 15087756688 FROM:6174886501 Page: 2 AC RO v® CERTIFICATE OF LIABILITY INSURANCE °"TIEW""°°`""""' 03124=16 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 00391-001 i FRWCT ..p..N.._�N¢........._..._._........_._._.__----____._..._...----_._......._.._........_...--pp...........---._.--.....___..__..____....._—_..... Hargan Insurance Agency,tnc. PO Box 250 iVt:,•No;Exh...�548)775 5830 ................................!!� .. ........................ Hyannis,MA 026015 .............. ........ ............................................. ................RiSIrRERA.-Atlantic Charter Insurance Company VDAC 4432E INSURED Graham,LLC ..............._.............-._.._.............._._....._.........._._._.__.._....__..._.._.__...... ._............- ....... 66 Brant Way FlsuRFJf ^--------..............................._.._._.................._...._..-----.._.._ -._._....._.. ..............._._..._.__..._.`_. Hyannis,MA 02601 .(M URER.D:............................-..........................................................................:............................. INSUREg..E.:......_._.........._....._..............._._..--............._......_...........__..................._._.......... ._._.._..._._._........_...-.........___....--- COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. :............ TYPE OFINSUAANCE __ ......' .....__----._...POUCYNUh16ER...._--..,._,...__ l) LIMITS --.............._........._........_._._...---._._........_._......_._...._........_ ...... ....... . (M t.--............_......_- ........................ GENERAL LIABILITY I EACH OCCURRENCE S COMMERCIAL GENERAL LIABILITY D SAS ToENTED ._._. ___..._............_.....-_•--........_..--- P E _ } $ E t iCLAIMS-MADE ; :OCCUR .. ACCU 911Rd......;.............................__..__ __..._.._... MED EXP(Any one person) _$ -- __.........__....... ._._.....................__............_................... PERSONAL 8 ADV INJURY....- -- ....._ _......... PE �_..._. $ >.......I...._................................................_.._-.•-. GENERAL AGGREGATE...__.._.,_$_......-`_.---...........__........_ GEN'L AGGREGATE wry APPLIES PER: PRODUCTS-COMP/OP AGG 13 I'RO s POLICY i LOC - _................. ---._......_......... _ — .............:..............._---__.... _.... ......_......;----........_ AUTOMOBILE LIABILITY $_..............._..__.__......._ ............ :`-ANYALRO i Ea.4ccidanU.................................................................. ....._...; I BODILY INJURY Per person) '$ .ALLOWNEO 1 SCHEDULED ..............................._....__.....................=..._......._........._.___.__.._....___...... .. _.._.. AUTOS (.....---_t AUTOS BODILY INJURY(Per accident) S N040VVNEDP..._..._.._..._._._._._._._.._.._...._._.__....___................._..... HIRED AUTOS ....... AUTOS - ROPERIY DAMAGE .._............_............. _ i ..........._................ $ ....._. UMBRELLA JAB .._...................................................__............__ ... .. I OCCUR i EACH OCCURRENCE $ ...... .EXCESS LIAR...._.... ......t.CLAIMS MADE ? ........_._............__............... ..... --.... _._.__......----......._..... $ ' ........I i .................. AGGREGATE DEO RETENTION$ y�p�pg PT�p� X ......_.....-01-r......_._.._..........- .......... - AND EMPLO�tLttY I TQRY LIMITS YIN; .._........... gyy Py�pp(E7pp/P lEx�CurlvE WCV01069003 ; .__.._._........_.__..........._�._._..._._.. A OFFICEFLMEMBERp(CLUpE6T- y !N!A i 1/29/2016 1/29/2017 E.LEACHACCIDENT g 500,000.00 (Mandatory in NFQ E L DISEASE EA EMPLOYEE-$ - .. . _._._.,, pp 9�escr�a,�de� Policy Coverage State:MA ... _._._.....__ __..__........._. 500,00a00 P, ! ,OF OPERATIOhS below_......_...... ! ` P E.L.DISEASE-POLICY LIMIT S 500 000.00 -;- ........--.............-._._.. ----........_..__._...._.........._..' , Gary C Graham Is covered by the workers comPensation policy AND Laura A Graham Is not€covered by the workers compensatln policy. i i ........:........................................ ............................:.........:................................................................. ..........................,......................... .........................................................i.......................................... DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES(Attach ACO00101,Additional Rernarks Schad ute,It more space is required) CERTIFICATE HOLDER CANCELLATION Heritage House Hotel SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 259 Main Street BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY Hyannis,MA 02601 WILL ENDEAVOR TO MAIL NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVEAxd--L-9� 01 8-2014 ACORD CORPORATION.All rights reserved.. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD CERTIFICATE HOLDER COPY Z. Massachusetts Department of Public Safety ; f f Board of Building Regulations and Standards �VV License: CS-042246 Construction Supervisor •_ GARY C GRAHAM 66 BRANT WAY HYANNIS MA 02601 CA, Expiration: Commissioner 03120/2018 �pFTNE to Town of Barnstable RARNSTAE, _ MASS. a Regulatory Services p0 c 6 g q• Public Health Division 200 Main Street, Hyannis, MA 02601 Fax: 508-790-6304 Office: 508-862-4644 ! "MAIL TO: TOWN OF BARNSTABLE PUBLIC HEALTH DIVISION TT FF BB 200 MAIN STREET HYANNIS,MA 02601 DD GG LLPP PLEASE INCLUDE SIGNATURES On$50.00 FEE MADE AYABLEITOITOWN OF BARNSTABLE DEPARTMENTS AND THE REQUIRE APPLICATION FOR A. MOTEL LICENSE DATE Z -� �k NAME OF MOTEL T � . ADDRESS OF MOTEL tA NO. OF UNITS .VILLAGE OF MO TEL 4 Ll---- CAPACITY SWIMMING POOLS: INSIDE POOL OUTSIDE POOL CAPACITY pARTNERSHIP CORPORATION SOLE OWNER - ` �C; 2 j_A WA FEDERAL IDENTIFICATION NO STATE OF CORPORATION —f ` IF PARTNERSHIP: NAME AND HOME ADDRESS OF PARTNERS Tel.No. Tel.No. IF CORPORATION; NAME AND HOME ADDRESS OF CORPORATE OFFICERS ;12� ,,ruc Tel.No. President tW" Tel.No. Treasurer Tel.No. Clerk IF SOLE OWNER: NAME AND.HOME ADDRESS Tel.No. (SIGNATURE OF APPLICANT rNSPECTE DATE BUILDING DIVISION ` DATE FIRE DEPARTMENT r, / 0, v DATE O LTH DIVISION v r i _c., pRP1TF.T.DOC { TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel ' RI - Application # Mo S,�►c �L� he Health Divisio �/ 71w �w � l �,a p,,� 3�2��,� Date Issued Z— Conservation Division Application Fee 7� Planning Dept. Permit Fee Zc� Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address eV,41V 6r Village L4) .X ✓d✓/S Owner ` 7k Ltr Address X,f.W; ✓51' a/.r//S' Telephone iGm Permit Request AleAl XAddZ ;/ - ./ - �x fs� 94P?!V ff�7--vim✓ xu Square feet: 1 s floor: existing 6 -qr p sed d Total new Zoning District IAV6 Flood Plain Groundwater Overlay Project Valuation ` 7 -® Construction Type '39 AX41 6 Lot Size 2 of A Grandfathered: dYes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes 2'�o On Old King's Highway: ❑Yes & to Basement Type: UFull ❑ 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: a/Gas ❑ Oil ❑ Electric ❑ Other Central Air: G/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 _ Otlfe7(:1 ;" C) y Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial El"Yes ❑ No If yes, site plan review # LCurrent Use Proposed Use E'( APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Zl_� 3. (fXn6 4- Z1 or Telephone Number Address m1le License # CS' 6/S 7 P�4. Home Improvement Contractor# Worker's Compensation # l f6 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Clfi(.DS OA M1g SIGNATUR DATE a FOR OFFICIAL USE ONLY a APPLICATION# f DATE ISSUED MAP/PARCEL NO. , i ADDRESS VILLAGE OWNER ` DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL 4 FINAL BUILDING { t DATE CLOSED OUT" 4 ASSOCIATION PLAN NO. Ir The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston MA 02111 1� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): ,✓ ¢✓ ��t 1AIC Address: e•d o6m a?8' City/State/Zip: CX44AY� XrAla A0 Phone Are you an employer?Check the appropriate box: Type of project(required): 1.Ly'I am a employer with 10 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors [j44 2.El am a sole proprietor or partner- listed on the attached sheet. I Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We area corporation and its officers have exercised their 10.❑ Electrical repairs or additions required.] - 3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself. [No workers' comp, c. 152, §1(4), and we have no •12.❑ Roof repairs insurance required.] t employees. [No workers' 13.0 Other comp, insurance required.] Any applicant that checks box f#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 their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: c A-s /72-IW A*9,1CA Policy #or Self-ins. Lic. #: � �. �2 96 Expiration, Date: /' Job Site Address: aS ST g A4141 City/State/Zip: 14YA4141a,A4A 0 A60 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 ce nder the pains a pe flies of perjury t t the information provided above is tr a and correct. Signature: Date: 0 Phone.#: a b - � Official use only. Do not write in this area,to be completed by city or town offccial 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#: r 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 apWments.and who resides therein, or the occupant of the dwelling house of another who employs'perso"ns to do'main'tenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such emilloyment be deemed to be an employer." MGL chapter 152, §25C(6)alsostates that"every state or local licensin .agency shall withhold the issuance or renewal o.f a,`iie'ense�ot.PermAi(-to operate a business or to construct b"uildings i&ihe,edmnionwealth.for any applicant who has not produced acceptable evfd'en'ce-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 bf 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,.supplysub-contractor(s)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 maybe 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 hias 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 multi,plepermit/license applications in any given year, need onlydsubmi.t.one affidavif'in.dicating 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 burn 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, tel'ephone and fax number: { 1• .y «- ._•. ! Y i sR-Y+„J r•y��kj 1, s. . Y' -.. -•yR .+�� '•h y� J `S 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 Revised 5-26-05 Fax # 617-727-7749 www.mass.gov/dia r — A�RD® CERTIFICATE OF LIABILITY INSURANCE 2/22/2oi2Y' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT Norwell Construct South NAME: Eastern Insurance Group LLC AIC No, o Ell: (508)651-7700 A1C,No: 77 Accord Park Drive Unit B-1 E-MAIL ADDRESS: PRODUCER 00040172 CUSTOMER ID q: Norwell MA 02061 INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURERA:Ohlo Casualty Insurance Co INSURER B:Peerless Insurance Company ConSery Group Inc. - INSURER C:AmTruS t P.O. BOX 27$ -INSURER D:National Casualty Company INSURER E: Sagamore Beach MA 02562 INSURER F COVERAGES CERTIFICATE NUMBER:CL117104386 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. ILTR TYPE OF INSURANCE DDL SUBR POLICY EFF POLICY EXP INSR WVD POLICY NUMBER MMIDDIYYYY MMIDD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1000000 DAMAGE TO RENTEID— X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 100000 A CLAIMS-MADE Fx]OCCUR BKO1053511978 /1/2011 /1/2012 MED EXP(Any one person) $ 10000 PERSONAL&ADV INJURY $ 1000000 GENERAL AGGREGATE $ 2000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2000000 POLICY X PR� X LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 ANY AUTO BODILY INJURY(Per person) $ 20,000 B ALL OWNED AUTOS A6774745 /1/2011 /1/2012 BODILY INJURY(Per accident) $ 40,000 X SCHEDULEDAUTOS PROPERTY DAMAGE $ 1,000,000 X HIRED AUTOS (Per accident) X NON-OWNED AUTOS Medical payments $ 10,000 Underinsured motorist BI split $ 100,000 X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 4,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 4,000,000 DEDUCTIBLE $ A RETENTION $ 0 PS01053511978 /1/2011 /1/2012 $ L. WORKERS COMPENSATION X AC STAT OTH- AND EMPLOYERS'LIABILITY Y/N 0 Y ITU- ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100000 OFFICER/MEMBER EXCLUDED? NIA (Mandatory In NH) rWC3289196 /1/2011 /1/2012 E.L.DISEASE-EA EMPLOYE $ 100000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500000 D Architects & Engineers 00003843 /1/2011 /1/2012 Limi$5,000,0000 Professional Liability I I I I Deductible$10,000 Per Claim DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101.AddItional Remarks Schedule,If more space Is required) Heritage House Hotel — 259 Main Street in Hyannis CERTIFICATE HOLDER CANCELLATION Q a Q SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE! THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Dale & Martino Inc. ACCORDANCE WITH THE POLICY PROVISIONS. . 259 Main Street Hyannis, MA 02601 AUTHORIZED REPRESENTATIVE Ronald Cleaves/CG4 ,r��r� ACORD 25(2009109) ©1988-2009 ACORD CORPORATION. All rights reserved. INS025(200909) The ACORD name and logo are registered marks of ACORD o Sery GROUP, INCORPORATED ARCHITECT-CONSTRUCTION CONTROL AFFIDAVIT AT PROJECT INCEPTION , Parcel Number:. _ Project Name: ti 4ysr Arm Project-Owner: Heritage House Hotel Zed LE �' iAi2 ice+ �p/C.^ Project Location: 259 Main Street Scope of Project: New restaurant lobby.entrance and exercise room fit up in basement. In accordance with paragraph 107.6.2.1.Design & 107.6.2.2 Construction of 780.CMR; the Massachusetts State Building Code, Eighth Edition. I, David J Vachon , Massachusetts Registration Number 7471 being a Registered Professional Architect hereby certify that all plans, computations, and specifications,-and changes thereto, involving the subject project will be prepared by.or under the direct supervision of a - Massachusetts Registered Professional Architect and bear his or her original signature and seal as defined by Massachusetts General Law(M.G.L.) c 143, & 54A. ` I further certify that I will be Present on the construction.site at intervals appropriate to the stage of construction to become generally familiar with the progress and,quality of work and to determine if the work is being performed.in a manner consistent with the construction documents and this code. VAC HOJ.D Fehn+i ar��, 0 1 Architect(Origi al signature and Seal) No.7471 Date - Home Office: .Hedges Pond Crossing, 2277 State Rd., Suite H • Plymouth; MA 02360 Mailing Address: P:O. Box 278 • Sagamore Beach, MA 02562 Phone: 508.888.6555 •. Fax: 508.888.6566 e L7JMassachusetts Department of Environmental Protection __ Bureau of Waste Prevention . Air Quality 1100143106 BWP AQ 06 Decal Number Notification Prior to Construction or Demolition Important: A. Applicability When filling out pp `y forms on the computer,use only the tab key A Construction or Demolition operation of an industrial, commercial, or institutional building, or to move your residential building with 20 or more units is regulated by the Department of Environmental Protection cursor-do not use the return (DEP), Bureau of Waste Prevention -Air Quality Control Regulations 310 CMR 7.09. Notification of key. Construction or Demolition operations is required under 310 CMR 7.09 (2)ten (10)days prior to any work being performed. The following information is required pursuant to 310 CMR 7.09. reb B. General Project Description 1. a. Is this facility fee exempt-city,town, district, municipal housing authority, owner-occupied Instructions residence of four units or less?❑Yes FZ] No 1.All sections of b. Provide blanket decal number if applicable: this form must be Blanket Decal Number completed in order to comply with the 2. Facility Information: Department of HERITAGE HOUSE HOTEL Environmental Protection a.Name notification 1259 MAIN STREET requirements of b.Address 310 CMR 7.09 H annis MA 102601 c.Cit /Town d.State e.Zip Code 5087757000 f.Tele hone Number area code and extension E-mail Address(optional) 67758 3 h.Size of Facility in Square Feet i.Number of Floors j. Was the facility built prior to 1980? ❑✓ Yes ❑ No k. Describe the current or prior use of the facility: HOTEL I. Is the facility a residential facility? ❑ Yes FZ] No =o m. If yes, how'many units? Number of Units i -0 3. Facility Owner: _N DALE& MARTINO, INC. �o a.Name _0 1259 MAIN STREET b.Address HYANNIS MA 02601 �(D .Ci own d.State e Zio Code O 5087757000 f.Tele hone Number area code and extension .E-mail Address(optional) O PETER MARTINO �Q h.Onsite Manager Name ag06.doc•10/02 BWP AQ 06•Page 1 of 3 s x}• _ .1 Massachusetts Department of Environmental Protection 7LBureau of Waste Prevention • Air Quality 100143106 \ BWP06Decal Number ` Notification Prior to Construction or Demolition General Statement: If B. General Project Description (cont. asbestos is found during a 4. General Contractor: Construction or Demolition ICONSERV GROUP, INC. operation,all responsible parties a.Name must comply with P.O. BOX 278 310 CMR 7.00, b.Address and Chapter 21 E of the AGAMOR SE BEACH MA 02562 Cha General Laws of c.Ci /Town d.State e.Zip Code the Commonwealth. 15088886555 1 ircatignani@conservgroup.com This would include, f.Tele hone Number area code and extension .E-mail Address(optional) but would not be limited to,filing an IROLAND CATIGNANI asbestos removal h.On-site Manager Name notification with the Department and/or a notice of release/threat of C. General Construction or Demolition Description release of a hazardous substance to the 1. Construction or demolition contractor: Department,if applicable. CONSERV GROUP, INC. a.Name P.O. BOX 278 b.Address SAGAMORE BEACH MA 02562 c.Ci /Town d.State e.Zip Code 5088886555 f.Telephone Number area code and extension .E-mail Address(optional) ROLAND CATIGNANI h.On-site Manager Name 2. On-Site Supervisor: PIETER VAN SLYCK On-Site Supervisor Name 3. Is the entire facility to be demolished? ❑ Yes ✓❑ No �N =0 4. Describe the area(s)to be demolished: �o BASEMENT TO MAKE AN EXERCISE ROOM. �N �O _0 5. If this is a construction project, describe the building(s)or addition(s)to be constructed: � RENOVATION ONLY. 0 �o �Q �Q ag06.doc•10/02 BWP AQ 06•Page 2 of 3 r Massachusetts Department of Environmental Protection ■ Bureau of Waste Prevention . Air Quality 100143106 BWP AQ 06 Decal Number Notification Prior to Construction or Demolition C. General Construction or Demolition Description (cont.) 6. a. If this is a demolition project,were the structure(s)surveyed for the presence of asbestos. containing material (ACM)? ❑ Yes ❑✓ No If yes, who conducted the survey? b.Survevor Name c.Division of Occupational Safety Certification Number 7. Construction or Demolition: 3/5/2012 6/5/2012 a.Start Date(mm/dd/yyyy) b.End Date(mm/dd/yyyy) 8. a. For demolition and construction projects, indicate dust suppression techniques to be used: ❑ seeding ❑ paving ❑ wetting ❑ shrouding b. If other, please specify: ❑✓ covering ❑ other 9. For Emergency Demolition Operations,who is the DEP official who evaluated the emergency? a.Name of DEP Official b.Title c.Date mm/dd/ of Authorization d.DEP Waiver Number D. Certification co I certify that I have examined the IROLAND CATIGNANI =o above and that to the best of my a.Print Name �o knowledge it is true and complete. lRoland Catignani The signature below subjects the b.Authorized Signature -N signer to the general statutes PRESIDENT =o regarding a false and misleading c. Position/I Me o statement(s). JCONSERV GROUP, INC. d.Representing 2/22/2012 �(D e.Date(mm/dd/yyyy) �O �d �Q ■ ag06.doc•10/02 BWP AQ 06•Page 3 of 3■ �lussachusetts- Delfartment of Public SafetN Board of Building Regulations and Stan(lar(Is Construction Supervisor License License: CS 5157 Restricted to: 00 ,• r a $ ROLAND B CATIGNANI ' .s 60 GEMINI DR W BARNSTABLE, MA 02668 d- �"� Expiration: 5/23/2012 ('ununissi1O1'r Tr#: 24301 a I ow THETp�, Town Of Barnstable B sT��. Regulatory Services �►� M63: `�$` Thomas F. Geller' Director ArfO�,,,ya Building Division Tom]Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Oi cc: 5`Jo4o62-4035 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using.A. Builder . WA r1,10, t , as Owner of the subject property hereby authorize Cc�/ ,1/�2 rvo� lye to act on my behalf, in all matters relative to work authorized by.this building pertnit application for: VA-A/o✓f/WS -A **xog ir 4 4� z a,�'9 �9��✓�T' ,6l ,y�+/.✓/s �r9tt (Address of Job) y if Signature of Owner ate Print Name _ WORMS:O VI 1MRPERNM S ION t TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map o� 7 Parcel /oZ� �� Permit# Health Division cv S w�r� 3 2-3 0 �7�-0d- Date Issued �2 Conservation Division f / /ah *-), Application Fee aoz� Tax Collector 0 F _ �-� Permit Fee Treasurer o 1_ KA CAP NE CANT MPERMIFROM SEM Planning Dept. ENGINEERING DIMIoN pRIpR 1 Date Definitive Plan Approved by Planning Board CONSTRUCTION: TO Historic-OKH Preservation/Hyannis Project Street Address c�59 MAI Al S 1 Village gy/3Nmis Owner SUA!�o*o,_ 11ru- A G4Aow�urT d&woria,�.Address J;qE- Telephone 5_4- 975— 170vo *1� Permit Request o�7 &r&-Z- Roo InS / &7uode_ -er<s rvrrL Ao D maror. s7VDS t 4-111SR426- S'-IkG ZS uJ� AlelO /4M0&7{JoAJ I/^I-ye— J"��oerr Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Ove I N t1 rlayy �`�f 4O�D r 1 G- 13~1200 JW1 ." Boo {-� Z Project Valuation Construction Type AwrvK, 14&A10V10Wo 1J 7- Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. �67, 00 0 Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure © Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes Cl No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing 1� 7 new Half: existing new Number of Bedrooms: existing a 7 new Total Room Count(not including baths): existing o? 7 new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric AOther Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial Yes ❑No If yes,site plan review# Current Use 140-rI z, Proposed Use /40 BUILDER INFORMATION Name ��.Jfit' C-(ZEf Vf - TrZ-. Telephone Number Address i "2 MA J G-ti1 A te , License# G S 0S-s o 2 0 G _. J ,4 0 Z- `k k1 Home Improvement Contractor# r�_ ✓La: l 6 3 S13 Worker's Compensation# kimz 900 3 9000 18,00;, ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO (4A-j TE_ A1A iiAG,-_,, M�T- SIGNATURE Av DATE �� 6 2 ` f , FOR OFFICIAL USE ONLY PERMIT NO. s - DATE ISSUED MAP/PARCEL NO._- f � ADDRESS VILLAGE'' OWNER -,.DATE OF INSPECTION: r FOUNDATION `FRAME 31`31/ o l INSULATION FIREPLACE Y i ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL - Rr,-? 38Y- 3 FINAL BUILDING l�1/�3 ` GN .fl/r? Sd 7- 3A7 - DATE CLOSED OUT—) , ^J ) r ASSOCIATION PLAN NO. , t --- The Commonwealth of Massachusetts Department of Industrial Accidents 600 Washington Street Boston,Mass. 02111 Workers' Compensation Insurance davit i name: d� location city M V 26 a( phone tl ❑ I am a hoificowner performing all work myself. �'I am an employer providing workers' compensation for my employees•working,on this job.. .:. .::::..::.:::.::.: :::::::.:.:::::.::::.:::::.::.:::::::::::. rom sti >IIam �i gilre > < :.. ...... . .. :::: ::. .:::.............:..::.:.:::.:. murance olicv.# .... .......... ❑ I am a sole proprietor, general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices; :comoanv'name :.:::::.;;;::: X. >:::;::..:..:.:..: ad�ess . : .. ... :..ia:.;....••.;•.... ; :;:; •.. :•.r..,.:•::•:<•::::..:•.Wit.::;•:;::.;:.::::.:.�..;:.:;:::::::::.;•:.:;.;:•.;::::::.�:.�:.�.:: • <:• ;::.::.;�._::.................:.....:.. t•.; ::............................:...:........ ............:....:::::.::::..:.:...:�::::::::::::::::::..:...;.;;.;.:.;:.;;:.��.;:;.::;:.;:.::.::::.:;:.:::;;:::.::.:;:.;:.;:.:.:;: hone ?:. ....................................... X. an name:::;::;.;:>>;s>;<;•::;:::>:•:;;;:>::»>:::>:<:;.;:>:_:«:::>::::<;:.<:::;;•:::;.:.;:.;:;......... X. ;_• ttimo v :atliirESS :::::.;:..::....:......::::.::;:.;..:::. 2. eta.::: <.;:.::.:. ::.::;;.;; :.;:: e ..................................... Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of crinninal penalties of a fine up to S1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that s copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. 1 do hereby certify under the pains and penalties of perjury that the information provided above is truo.and correct Signature Date Print name Phone# official use only do not write in this area to be completed by city or town official city or town: permdttlicense# ❑Bullding Department ❑Licensinng Board ❑checkif immediate response is required ❑Selectmen's Office ❑Health Department contact person: phone#; ❑Other. Oe"ged 9195 PJA) , Information and Instructions �. Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", an 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 section 25 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,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 beenpresented to the contracting authority. Applicants Please fill in the workers compensation affidavit completely,by checking the box that applies to your situation and supplyingcorn an names, address and hone numbers along with a certificate of insurance as all affidavits maybe company P 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. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be retarned io the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any 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 Otlice of imlesugadons 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone #: (617) 727-4900 ext. 406, 409 or 375 C �t ',I I �. j i ' ✓�-(JOI77/I)t09tU/ O�i�I/CCZG6�LL/,JI,�6 I BOARD OF BUILDING REGULATIONS License-CONSTRUCTION SUPERVISOR N•umbe� 055020 f [ - f: rE Ef /Q 2t 04 Tr.nq: 16262 R�s�tr x' r WALTER F GREEL 17 MAUGUS AUEIN iWELLESLEY, MA i Administrator TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map3Q7 Parcel lc�! Permit# / ✓//lealth Division Date Issued 1 1 0 ` - VConservation Division CO2_ Fee 0 Tax�Collector Q0 Tre, tlrer 2 �s F nl,iC.11�x�.NfiNT fiSTA1N it �r try Plan I. '�(ON PERMIT FROM ng Dept. ,",I"RING 9IYISI6N?R cR - Date Nfinitive Plan Approved by Planning Board Historic-OKH , Preservation/Hyannis Project Street Address G `0 14 I V. 6AX11,7hr-g 4-excal 6 = Village 11 V11AW/S Owner LAEi<10(,P lLI V1 t (! ' Address S s ' � io !a= Telephone ��11 -��-7 7� � Permit Request ;2, i�d•'JyS_- �Dr� �f 1� �-+ � �ci�%Vic.% �`�rv�.2E'� �10� `0_ �('r �� ' �'�(/6�/ ✓i'✓G�l S Gl�.�� --� (1��j Square feet: st floor: existing proposed 2nd-floor: existing proposed Total new / f/ ';rvYl Valuation �D r-r Zoning District Flood Plain Groundwater Overlay �/ Construction Type Awa ©zw-q !> API"j("t `mk_` 300. �;1du - I Vex I_BAxT7,t1WM �_ AV4 A 6sr �,,00(p Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. ._...... Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structured 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 7 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 90ther A 1,4,(" Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool: ❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial 4 Yes ❑ No If yes, site plan review# `t Current Use ky;7, Proposed Use kk71- L BUILDER INFORMATION Name A tide, Tt), Telephone Number `7&1 _2-,3S E,.r2.2- Address 17 MA-iU 6-/J A\[f License# G S O d'S-02 0 A b Z`l8 1 Home Improvement Contractor# Worker's Compensation# We c/ 6S7 (s'2 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO MAS 6 MAA44 C* ME�✓� f SIGNATURE ' DATE F FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. ' ADDRESS 1 VILLAGE ` OWNER i S r DATE OF INSPECTION: FOUNDATION -7 3 2 7 FRAME iifirm a�a Qocv, I a a y , INSULATION - FIREPLACE ` ELECTRICAL: ROUGH FINAL , PLUMBING: ROUGH FINAL 3 GAS: ROUGH All? FINAL FINAL BUILDING J ' VOK) _dam. 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'.. � ., ko:: ;3a%)�w,;...;,.�:.<.... �?2;�;�>5:�<.o;i;,:.v?:�c;,�. ?':r: ��'K2�9Y:. .�o.•: ;:�� ..�>�aM.. rr . ,. .. ... .....' rmi Ir H ry 1. • _ l do notTiffte in this anst to becomplated r1r �l` � •r. 11 ■ ,li. cfty or town, Ouccusing Board 13sel9cmemOsOfmm ■ - ■ 1 Information and Instructions ,y Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for th=r emplovees. As quoted from the"law",an employee is defined as every person in the service of another under any cry of hire. express or implied, oral or written. An emplover 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 etc.-n e: trustee of as individual,partnership, association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartneats and who resides therein,orthe occupant of the dwelling house of another who employs persons to do maintPnance:, suction or repair work on such,dwelling house or on the grounds c: building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 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,neah'athe commonwealth nor any of its political subdivisions shall eater into any contract for the performance of public work until acceptable evidence of campiiauce with the insurance required of this chapter have been presented to the corara `Z authority.. - Applicants and Please fill in the workers' campeasatiaa affidavit completely,by checlmng the boat thus applies w yrnu stuati� address and hone mnabers along with a certificate of insurance as all aff davits tBaY be SUP1 .in8 y ms' P Also be sere to sign and submitted to the Department of Industrial Accid=js for c ofinsurance age• eimit or license is is date the affidavit, The affidavit should be returned to the chy arto 1f=the apPlicatioa for the p being requested,not the Department of Industrial Accidents- Shwld yQa have any gaesrz®s v'»°r u You are regtured to obtain a workers compensation policy,Please call the Department atthe number listed below. City or Towns Please be sure that the affidavit is complete and printed legmbly. 'Ihe Department has provided a space at the bat= of the affidavit for you to fill out in the event the Office of Iavestigatiaashas to contact you regarding appli== FI se be sore to fill in the permit/licease number which will be used as a rcfa=nmmber. The affidavits may be rcaanen TO the Departmeat by mail or FAX unless other anangmcats have been made. The Office of Investigations would hie to thank you in advance for you cooperation and should you have nay questions. plesse do not hesitate to give us a call. 15 TRUMP The Department's address,telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents Office of lavenwatioas 600 Washington street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 7274900 exL 406, 409 or 375 -'i'� t t �lze �o-�rrrzoauuQaalU o�../�aaocu•Ou�aelta - BOARD OF BUILDING=REGULATIONS License ONSTRUCTION SUPERVISOR Numle4 § 055020 epij 06�002 Tr.no: 16383 f Restricted Y Ob3� Y r I t -4r i WALTER F GREE4- 17 MAUGUS A./ENhI WELLESLEY, MA 02181 Administrator I THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I M / �C&E DATA TOWN OF BARNSTABLE.BUILDING PERMIT APPLICATION_ f:. Map Parcel= '/d 7 Application #. Health Division Date Issued . Conservation Division Application Fee 0 Planning'Dept: Permit Fee. 'AD Date Definitive,Plan Approved by Planning Board Historic - OKH Preservation / Hyannis Project Street Address MAIAd S &-&T Village Owner �2/d � ' C�YzP• Address i�f1R-ilk Telephone t _ � cC � fu� Tl-/ /Permit Reques � x o' Hal 9Of71" r <-&7-90C v- tea f j- ek Pe evk Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay `;i?Project Valuation 00 0 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) Age of Existing Structure 40 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.40 12 new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing /-2- new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric 3-Other Central Air: Mllees ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑existing ❑ new size — Barn: ❑existing ❑ new size_ Attached garage: ❑ existing ❑.new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board�of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial u�a'�Yes ❑ No If yes, site plan review# Current Use ttaIZz ��S774r�i�A�'t^ Proposed Use 14re-z- n APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name PA F• c 7 � Telephone Number Address '1 kA y&U s A\[,%I-' License# C'� O_s'!C(0 2 G I /qA 0 2-`( k i Home Improvement Contractor# �� ✓�o /G 3$3 Worker's Compensation # W AZ 9`O4 3*"41 aG l ZCOF ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Wbb A9X kaz,(air SIGNATURE DATE ti FOR OFFICIAL USE ONLY `` v APPLICATION# -1 DATE ISSUED MAP/PARCEL NO. t t. r ADDRESS VILLAGE OWNER- i ., DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. S t S The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information .. // Please Print Legibly Name (Business/Organizatiordlndividual): Address: 1 "? /L4 A yGu f A ✓� City/State/Zip: 6,- L-�J LL7 /t44 c7 �a'r Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.ta I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp.insurance.$ 9. ❑ Building addition required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.111 am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. ' right of exemption per MGL Y �o workers comp. 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they 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: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains andpenalties ofperjury that the information provided above is true and correct. Signature: `1 Date: Y 472( b v Phone#: D� '77�—Zopo 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#: r cJw 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-contractor(s)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 Revised 4-24-07 Fax# 617-727-7749 www.mass.gov/dia i Massachusetts Department of Environmental Protection Bureau of Waste Prevention .Air Quality 10008s837 Decal Number BWP AQ 06 Notification Prior to Construction or Demolition Important: A. Applicability When filling out pp `7 forms on the computer,use only the tab key A Construction or Demolition operation of an industrial, commercial, or institutional building, or to move your residential building with 20 or more units is regulated by the Department of Environmental Protection cursor-do not use the return (DEP), Bureau of Waste Prevention -Air Quality Control Regulations 310 CMR 7.09. Notification of key. Construction or Demolition operations is required under 310 CMR 7.09 (2)ten (10)days prior to any work being performed. The following information is required pursuant to 310 CMR 7.09. ,m B. General Project Description 1. a. Is this facility fee exempt-city, town, district, municipal housing authority, owner-occupied Instructions residence of four units or less?❑Yes ❑✓ No 1.All sections of b. Provide blanket decal number if applicable: this form must be Blanket Decal Number completed in order 2 Facilit Information: to comply with the Y Department of HERITAGE HOUSE HOTEL Environmental Protection a.Name notification 1259 MAIN STREET requirements of b.Address HYANNIS MA 310 CMR 7.09 .—._.____ 02601 c.Ci /Town d.State e.Zip Code 5087757000 1pmartino@heritagehousehotel.com f Tele hone Number area code and extension .E-mail Address(optional) 57000 3 h.Size of Facility in Square Feet i.Number of Floors j. Was the facility built prior to 1980? ❑✓ Yes ❑ No k. Describe the current or prior use of the facility: HOTEL& RESTAURANT I. Is the facility a residential facility? ❑✓ Yes ❑ No 143 o m. If yes, how many units? Number of Units -0 3. Facility Owner: _N SUPERIOR HOTEL MANAGEMENT CORPORATION �o a.Name �0 259 MAIN STREET b.Address HYANNIS MA � 02601 (D c.Citv/Town d.State %Zip, o 0 15087757000 pmartino@heritagehousehotel.com f.Tele hone Number area le and ex ensi n .E-m it A dr s o tional O JAN DAALE Q h.Onsite Manager Name ag06.doc•10/02 BWP AQ 06•Page 1 of 3 Massachusetts Department of Environmental Protection L7, Bureau of Waste Prevention . Air Quality 1100086837� BWP AQ 06 Decal Number Notification Prior to Construction or Demolition General Statement:If B. General Project Description Cont. asbestos is found during a 4. General Contractor: Construction or Demolition OWNER operation,all responsible parties a.Name must comply with SAME 310 CMR 7.00, b.Address and Chapter SAME i M� A y�-� 02601 Chapterer 21 E of the General Laws of c.Ci /Town d.State e.Zio Code the Commonwealth. This would include, f.Tele hone Number area code and extension .E-mail Address(optional) but would not be limited to,filing an IPETER F. MARTINO asbestos removal h.On-site Manager Name notification with the Department and/or a notice of release/threat of release of a C. General Construction or Demolition Description hazardous substance to the 1. Construction or demolition contractor: Department,if applicable. OWNER a.Name SAM E b.Address _ SAME 02601 c.Ci /Town d.State e.Zip Code f.Telephone Number area code and extension .E-mail Address(optional) PETER F. MARTINO h.On-site Manager Name 2. On-Site Supervisor: WALTER F. GREELEY JR. On-Site Supervisor Name 3. Is the entire facility to be demolished? ® Yes No �N -0 4. Describe the area(s)to be demolished: �o LOBBY, FRONT DESK, 12 ROOMS �N �O -0 5. If this is a construction project, describe the building(s)or addition(s)to be constructed: � REBUILD AS NEEDED. 0 a ag06.doc•10/02 BWP AQ 06•Page 2 of 3 Massachusetts Department of Environmental Protection __ ■ Bureau of Waste Prevention . Air Quality 1100086837 � Decal Number BWP AQ 06 Notification Prior to Construction or Demolition C. General Construction or Demolition Description (cont.) 6. a. If this is a demolition project,were the structure(s)surveyed for the presence of asbestos containing material (ACM)? (D Yes ❑ No If yes, who conducted the survey? AUGUST 2000-ATLANTIC ENVIRONMENTAL TECHNOLOGIES; b.Survevor Name TOIVO A. LAMMINEN c.Division of Occupational Safety Certification Number 4/18/2009 7. Construction or Demolition: _ __ 4/30/2009 a.Start Date(mm/ddiyyyy) b.End Date(mm/dd/yyyy)� 8. a. For demolition and construction projects, indicate dust suppression techniques to be used: ❑ seeding ❑ paving ❑ wetting ❑✓ shrouding b. If other, please specify: ❑ covering ❑ other 9. For Emergency Demolition Operations,who is the DEP official who evaluated the emergency? NA a.Name of DEP Official NA b.Title 4/8/2009 c.Date mm/dd/ of Authorization NA d.DEP Waiver Number _ D. Certification -CO I certify that I have examined the PETER F. MARTINO -o above and that to the best of my a.Print Name _o knowledge it is true and complete. The signature below subjects the b.Authorized Signature =N signer to the general statutes PRESIDENT =o regarding a false and misleading c.PositiontTitle =o statement(s). SUPERIOR HOTEL MANAGEMENT CORPORATION d.Re resentin e.Date(mm/dd/yyyy) �o -a -a ■ ag06.doc•10/02 BWP AQ 06•Page 3 of 3■ tr E Bard d of�l3uildin g Regulations and Stanaardds Construction Supervisor License y a License: CS 55020 Explration: .2/6/2010 Tr# 16237 z' Restriction: =00 WALTFR F GREELEY JR. 17 MAUGUS AVENUE r' WELLESLEY,MA 02481° Commissioner TT � Town of Barnstable Regulatory Services . Thomas F.Geiler,Director En,1 16 Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, d^°19TlevO matey , as Owner of the subject.property hereby authorize wjqjezz�� F. ��u`L1 , .Tiz.� to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signature of Owner Date Print Name If Property Owner is applying for permit please complete.the Homeowners License Exemption Form on the reverse side. Q:FORMS:O WNERPERMISSION L-- oFtt+e Town of Barnstable � rqs� o� Regulatory Services ? Thomas F.Geiler,Director � ' Building Division p1fD `� Tom Perry,Building Commissioner 200 Mairi.Street; Hyannis,MA.0.2601 Rww.to wn.b arnstabl e.ma.us Office: 508-862-403 8 Fax: 508-790-6230 HOl%1EOWNER 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. DEFINTPION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is, or is intended to be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that.he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption arc unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a.form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homcexempt on ery GROUP, INCORPORATED CONSTRUCTION CONTROL AFFIDAVIT-AT PROJECT INCEPTION Parcel Number: Project Name: Project Owner: Heritage House Hotel - Project Location:•259 Main Street $cope of,Project: Lobby and sleeping'room-renovations In accordance.with'paragraph 1,16.0 of780 Cmk,the,MassachusettsState-Building .'- Code, I, David 7 Vachbn'Massachusetts Registration Number, 7471 being a RegisteredTrofessiorial Architect hereby certify that all architectural.plans, computations; and°specifications, and-changes thereto, involving the subjectprojectwill: be prepared-byor under the direct supervisionof aMassachusetts Registered Professional Architect and bear his or her original signature and seal as defined by Massachusetts, General Law (M.G.L) c 112, $S 1 R. I further.certify that Twill be present on the construchori'site at,* tervals appropriate to' -the 'stage of construction to.become generally•familiar with the progress and.quality of the work to_determine, in ger`ieral,`if the"architectural work is-being performed in a manner ' consistent with'the construction documents. t2 5; 4-15=09 Architect (Original si ature:and Seal) Date WHO J htG 747' WFITAg4N a Home Office: Hedges Pond Crossing, 2277 State Rd.; Suite-H -.Plymouth, 'MA 02360 Mailing Address: P.O. Box 278 • Sagamo're Beach, MA 02562 Phone: 508:888.6555 Fax: 508.888.6566 t - a HERITAGE HOUSE •HYANW MAIN&=Wnnxorrr DWMCr- Peter E Martino, C.H.A. Owner/Manager �uA�JW`WINS o I pmartino@heritagehousehotel.com L i �� e A TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map�� a� Parcel /a� Application Y; ?n Health Division Date Issuedtq Conservation Division Application Fe Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/ Hyannis �&dz Project Street Address aS-9 M4 iN 577 Village P�tititS S'upeetwvL, jTEL rY1eNA6�deauvT Owner PEMI - ( AOLT.ayo rie,9 1IERiT4&_- /./dv54 Address ol Sl Mffilu 5 1-(YA1yv1 S Telephone S'0&- aso 3a 3 a- _ Permit Request _I&J- & ;a/ _ 3)c5yyLa L--7-tu fN of CAR.PLTc tv& L-ac.. e-r— ZKYws4 LLB _ m4uLAT,ori AS NEECa JyE 70 w,+T--/L _bAA4A E IiU FloT-ZL Roow►,5 rA,vc Flo re i- Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 1/5 Oo Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) 13 yryct'5 L'owerL Age of Existing Structure yp. IM5 Historic House: ❑Yes (�No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout )(Other cS`A 3 Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new _ Half: existing new Number of Bedrooms: �11(.0 existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: X Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use - - 'Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name WAP" RRe5r.YA4rQN Sfavv L4=3 Telephone Number !;:U�- n6 t9!/ Address asAYAfYjC4VN wP( License # IV fad S• Dwo�%`S to yA Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO •1'8w�1 011F -J Aa►nn.a j%-j-k 11\S Rs r4(, A2d1A SIGNATURE Lk) Le_� Li DATE 4, I FOR OFFICIAL USE ONLY APPLICATION# ' DATE ISSUED >_ s MAP/PARCEL NO. ADDRESS VILLAGE g OWNER r DATE OF INSPECTION: k � FOUNDATION - 'r FRAME 'INSULATION: t r FIREPLACE ELECTRICAL: ROUGH FINAL - PLUMBING: ROUGH FINAL GAS: ROUGH,-�_- r; FINAL FINAL BUILDING''._ � a DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 K%w massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electriciamffllumbers Aut)licant Information Please Print Legibly Name (Business/Organization%Indi�-idual): Whalen Restoration Services Address: 22 American Way City/State/Zip: South Dennis, MA 02660 _ Phone #: 508 760 1911 Are you an employer? Check the appropriate box: Type of project(required): 1.[3 1 am a employer with 4. ❑ I am a general contractor and I 6. ❑ New construction employees(full and/or pan-time).' have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. I Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance s. ❑ We are a corporation and its l0.❑ Electrical repairs or additions required.] officers have exercised their 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152.§1(4), and we have no 12.❑ Roof repairs insurance required.) ' employees !No workers' 13.❑ Other comp. insurance required.] -Any applicant that checks box#1 must also till out the section below showing their workers'conVensration policy information, Homeowners who submit this affidavit indicating they ate doing all work and then hire ou::�-de contractors must submit a new affidavit indicating such. iContractors that check this box must attached an additional sheet showing the name w the s-,; -contr*xz and their workers'camp:policy info riots 1 am an employer that is providing workers,compensation insurance f ur is ry employee& Below is the polity ead job site information. Insurance Com;)any Name: Arbella Protection Co. Policy#or Self-ins. Lic. #: 9091320408 Expiration Date: 4/1/12 a Job Site Address: S� MAIA) 5 — City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to S1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fin, of up to S250.00 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: dy `�` J ,�_.. - - �. ...—_ Date: 2- Phone#: `7�,C3 i (7 f Official use only. Do not write in this area,to be completed by city or town offtciai City or Town: Permit/License'O 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#: ,ate: 3/29/2012 Time: 11:40 AM To: Superior Hotel Management dba ® 1508.760-9995 Rogers 6 Gray Ins. Page: 001 Client#: 32193 W HALREES ACORD,. CERTIFICATE OF LIABILITY INSURANCE DAT 3/ 929120210112YYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement($). PRODUCER CONTACT Ann Pell NAME: Rogers&Gray Ins.-So. Dennis 508-398-7917FAX AIC No Ell: Arc,No): 508-256-2177 434 Route 134 - ellan ro ers ra com ADDRESS: p g g y P.O. Box 1601 CUSTOMER ID 9: South Dennis, MA 02660-1601 INSURER(S)AFFORDING COVERAGE NAIC r INSURED INSURERA:Arbella Protection CO 17000 Whalen Restoration Services Inc INSURER B: 22 American Way INSURER C South Dennis,MA 02660 INSURER 0 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NSR TYPE OF INSURANCE L SUBRI POLICY EFF POLICY EXP POLICY NUMBER MMIDDIYYYY MMIDDIYYYY LIMITS r--XPD GENERAL LIABILITY 8500040398 10112011 04/01/2012 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY - PREMISES Ea occurrence $100,000 CLAIMS-MADE �OCCUR MED E.XP(Any one person) $5,000 Ded:250 PERSONAL a ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY PRO- LOC $ A AUTOMOBILE LIABILITY 58243400004 1011201 1 04/01/2012 COMBINED SINGLE LIMIT (Ea accident) $1 000 000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ X SCHEDULED AUTOS PROPERTY DAMAGE $ X HIRED AUTOS (Per accident) X NON-OWNED AUTOS $ $ A UMBRELLA LIAB X OCCUR 4600021586 D410112011 04/01/2012 EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $1,000,000 DEDUCTIBLE $ X RETENTION $ 10000 $ A WORKERS COMPENSATION 9091320411 D410112011 04/01/2012 X I WC STATu-s ER oTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNERIEXECUTIVEYIN - E.L.EACH ACCIDENT s500,000 OFFICER0,1EMBER EXCLUDED? ❑N NIA (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 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space is required) Workers Comp Information Included Officers or Proprietors ProjectAddress:259 Main Street, Hyannis, MA 02601 CERTIFICATE HOLDER CANCELLATION Superior Hotel Management dba SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Heritage House - THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN g ACCORDANCE WITH THE POLICY PROVISIONS. Peter Martino 259 Main Street AUTHORIZED REPRESENTATIVE Hyannis,MA 02601 0198 -2009 ACORD CORPORATION.All rights reserved. ACORD 25(2009109) 1 Of 1 The ACORD name and logo are registered marks of ACORD #S79539IM691470 MEE Massachusetts Department of Environmental Protection Bureau of Waste Prevention • Air Quality 100146081 �, BWP AQ 06 Decal Number Notification Prior to Construction or Demolition r Men filling out A. Applicability forms on the computer,use only the tab key A Construction or Demolition operation of an industrial, commercial, or institutional building, or to move your residential building with 20 or more units is regulated by the Department of Environmental Protection cursor-do not use the return (DEP), Bureau of Waste Prevention-Air Quality Control Regulations 310 CMR 7.09. Notification of key. Construction or Demolition operations is required under 310 CMR 7.09(2)ten (10)days prior to any work being performed.The following information is required pursuant to 310 CMR 7.09. " B. General Project Description 1. a. is this facility fee exempt-city,town, district, municipal housing authority, owner-occupied Instructions residence of four units or less?❑Yes ❑✓ No 1.All sections of b. Provide blanket decal number if applicable: Blanket Decal Number this form must be completed in order to comply with the 2 Facility Information: Department of HERITAGE HOUSE HOTEL Environmental Protection a.Name notification 1259 MAIN STREET requirements of b.Address 310 CMR 7.09 MA 02601 H annis c.City/Town .Sae e.Zip Code (508)775-7000 f Tel hone Number area code and extension) E-mail Address(optional) 12,000 2 h.Size of Facility in Square Feet i.Number of Floors j. Was the facility built prior to 1980? ❑✓ Yes ❑ No k. Describe the current or prior use of the facility: HOTEL I. Is the facility a residential facility? ❑ Yes ❑✓ No i�_O m. If yes, how many units? Number of Units �° 3. Facility Owner: N DAALE AND MARTINO INC. �o a.Name �0 1259 MAIN STREET b.Address HYANNIS IMA 102601 �� o (508)775-7000 f.T le hone Number area code and extension .E-mail Address ional a MARK WALDRUFF �Q h.Onsite Manager Name ag06.doc-10/02 BWP AQ 06-Page 1 of 3 Massachusetts Department of Environmental Protection Bureau of Waste Prevention • Air Quality 1100146081 Decal Number BWP AQ 06 Notification Prior to Construction or Demolition General Statement:If B. General Project Description Cont. asbestos is found during a 4. General Contractor: Construction or Demolition 1WHALEN RESTORATION SERVICES INC. operation,all responsible parties a.Name must comply with 122 AMERICAN WAY 310 CMR 7.00, b.Address and Chapter SOUTH DENNIS MA 22660 Chapterer 21 E of the General Laws of c.Cit /Town d.State e.Zip Code the Commonwealth. (508)760-1911 1 Ijimellis@whalenrestorations.com This would include, f.Tele hone Number area code and extension Q.E-mail Address(optional) but would not be limited to,filing an JBILL WHALEN asbestos removal h.On-site Manager Name notification with the Department and/or a notice of release/threat of release of a C. General Construction or Demolition Description hazardous substance to the 1. Construction or demolition contractor: Department,if applicable. 1WHALEN RESTORATION SERVICES INC. a.Name 22 AMERICAN WAY b.Address SOUTH DENNIS MA 02660 c.Ci /Town d.State e.Zip Code (508)760-1911 1 ijimellis@whalenrestorations.com f.Telephone Number area code and extension .E-mail Address(optional) BILL WHALEN h.On-site Manager Name 2. On-Site Supervisor: JIM M. ELLIS On-Site Supervisor Name _ 3. Is the entire facility to be demolished? ❑ Yes ✓❑ No N =0 4. Describe the area(s)to be demolished: �o CARPET AND PAD REMOVAL.WET DRYWALL. �N �O -0 5. If this is a construction project, describe the building(s) or addition(s)to be constructed: NA 0 �o �O �Q aq 10/02 BWP AQ 06•Page 2 of 3 i Massachusetts Department of Environmental Protection Bureau of Waste Prevention • Air Quality 1oolasosl BWP AQ 06 Decal Number Notification Prior to Construction or Demolition C. General Construction or Demolition Description (cont.) 6. a. If this is a demolition project,were the structure(s)surveyed for the presence of asbestos containing material (ACM)? ❑ Yes ❑✓ No If yes,who conducted the survey? c.Division of Occupational Safety Certification Number 7. Construction or Demolition: 03/23/2012 04/02/2012 a.Start Date(mm/dd/yyyy) b.End Date(mm/dd/yyyy) 8. a. For demolition and construction projects, indicate dust suppression techniques to be used: ❑ seeding ❑ paving b. If other, please specify: ❑ wetting ❑ shrouding ❑ covering ❑✓ other 1AFFECTED AREAS WET DURING REMOVAL 9. For Emergency Demolition Operations,who is the DEP official who evaluated the emergency? NA a.Name of DEP Official NA b.Title 03/23/2012 c.Date mm/dd/ of Authorization NA d.DEP Waiver Number D. Certification I certify that I have examined the IJAMES M. ELLIS =o above and that to the best of my a.Print Name -o knowledge it is true and complete. IJIM M. ELLIS The signature below subjects the b.Authorized Signature _-N signer to the general statutes 1PROJECT MANAGER/ESTIMATOR =o regarding a false and misleading c. Position e _o statement(s). WHALEN RESTORATION SERVICES INC. d.Representing 04/11/2012 �CD e.Date(mm/dd/yyyy) �O �d �Q ■ aq 10/02 BWP AQ 06•Page 3 of 3■ I eDEP-MassDEP's Onlinefiling System https://edep.dep.mass.gov/Pages/PrintReceipt.aspx MassDEP Home I Contact I Feedback I Tour I Privacy Policy MassDEP's Online Filing System Usemame:ELLIS Nickname:BAYLIS My eDEP I Formsco My Profilec* Help LReceipt --- -ti Forms Signature Receipt Summary/Receipt pnnt receipt J Exit Your submission is complete. Thank you for using DEP's online reporting system. You can select"My eDEP" to see a list of your transactions. DEP Transaction ID: 464247 Date and Time Submitted: 4/11/2012 11:44:24 AM Other Email : Form Name:AQ 06- Construction/Demolition Notification Payment Information DEP code: 64652 Date: 4/11/2012 11:43:32 AM Amount ($): 85 Payment Detail: ELLIS JAMES --AccountType--AccountNumber****2004 Confirmation Number: Contractor Contractor Number Name Address, , Supervisor Project Monitor Lab My eDEP MassDEP Home I Contact I Feedback I Tour I Privacy Policy MassDEP's Online Filing System ver.11.5.7.0© 2011 MassDEP 1 of 1 4/11/2012 11:48 AM eDEP-MassDEP's OnljneFiling System https://edep.dep.mass.gov/Pages/Receipt.aspx MassDEP Home I Contact ] Feedback 1 Tour I Privacy Policy MassDEP's Online Filing System Usemame:ELLIS Nickname:BAYLIS My eDEP 1 Forms My Profiled Help Transaction OvervieW Trans#464247 ID#100146081 AQ 06-Construction/Demolition Notification Forms Signature Payment Submit Review and Submit your Transaction Exit Please review your transaction.If you are satisfied,scroll down and click submit. An email confirmation will be automatically sent to the owner of this account at jimellis@whalenrestorations.com If you would like to send this confirmation to others please enter their address below separated by a semicolon; accounting@whalenrestorabons.com DEP Transaction ID:464247 Date and Time Submitted:04/11/2012 11:43:45 Other Email Form Name:AQ 06-Construction/Demolition Notification Payment Information DEP code:64652 Date:4/11/2012 11:43:32 AM Amount($):85 Payment Detail:ELLIS JAMES--AccountType AccountNumber****2004 Confirmation Number: Contractor Contractor Number Name Address„ Supervisor Project Monitor Lab MassDEP Home I Contact I Feedback I Tour I Privacy Policy MassDEP's Online Filing System ver.11.5.7.0© 2011 MassDEP 1 of 1 4/11/2012 11:48 AM f eDEP-MassDEP's Onlinefiling System https://edep.dep.mass.gov/Pages/Payment/PaymentConfirmation.aspx MassDEP Home I Contact I Feedback I Tour I Privacy Policy MassDEP's Online Filing System Usemame:ELLIS Nickname:BAYLIS My eDEP I Forms®I My Profiled Help Transaction OvervieW Trans#464247 ID#100146081 AQ 06-Construction/Demolition Notification Forms Signature Payment Submit Payment print a, Exit € Payment Confirmation Thank you.Your payment has been received. Note:Payment received after 3:30pm will not be posted until the next business day. MassDEP Home I Contact I Feedback I Tour I Privacy Policy MassDEP's Online Filing System ver.11.5.7.0© 2011 MassDEP 1 of 1 4/11/2012 11:47 AM Restoration Services Inc. Fire,Smoke, Soot,Water Damage&Mold Remediation Services IvAdCleaning - Deodorization - Reconstruction Specializing in Fire Restoration - All Work Guaranteed Access, Authorization and Direct Payment Request Form I (we) authorize WHALEN RESTORATION SERVICES to perform work as per estimate at property located at 259 Main Street, Hyannis, MA 02601 to repair damage caused by arPr -on 3/23/12- As owner(s) of this property, I (we) understand that I (we) must authorize this work. I (we) hereby authorize WHALEN RESTORATION SERVICES to perform this work and accept responsibility for payment upon completion. I (we) authorize and direct my Insurance Company Arbella Policy No. 8500025379 to make payments directly to WHALEN RESTORATION SERVICES, Insurance Claim Specialists, for doing this work and to that extent I (we) assign the benefits applicable to this loss to WHALEN RESTORATION SERVICES. I (we) acknowledge receipt of a copy hereof: OWNER ` DATED SIGNED OWNER WHALEN RESTORATION REP. SIGNED 22 American Way, South Dennis,MA 02660 Phone: (508) 760-1911 - Fax: (508) 760-9995 - 1-800-244-2598 -E-Mail: restore@whalenrestorations.com Web Page: http://www.whalenrestorations.com OFFICE COPY NI a,1-aChu.Cit� t3Clr,sl'If nCr,t IIt PIJ1)1ii �aif+:i� Board o Buildili'_ Rl'-ulat!on, and �t�iit(I: rd, --- Constrli'ction .Supervisor License 6 icense: IS 74928 S, WILLIAM WHALEN 122 POND STREET BREWSTER, MA 02631 Expiration: 8/10/2012 �%fir�oori�raoa�men/(/n�C�r.rr.;nrfu:;r//i Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation y 0110egistration: 129244 Type: " kxpiration: 7/30/2013 Private Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 Whalen Restoration Services Inc. William Whalen 22 American Way South Dennis, MA 02660 Undersecretary Not valid without signature ILoop Up Print Page 1 of 3 foo Owner Information -Map/Block/Lot: 327/ 127/-Use Code: 3010 �i Owner Map/Block/Lot GIS MAPS 327/ 127/ Owner Name as of DAALE & MARTINO INC Property Address 1/1/12 259 MAIN ST HYANNIS, MA. 02601 259 MAIN STREET(HYANNIS) Co-Owner Name C/O SUPERIOR HOTEL MGT CORP Village: Hyannis Town Sewer At Address: Yes . Assessed Values 2012-Map/Block/Lot: 327/127/-Use Code: 3010 2012 Appraised Value 2012 Assessed Value Past Comparisons Building $ 1,793,700 $ 1,793,700 Year Total Assessed Value: Value Extra $ 0 $ 0 2011 - $2,443,600 Features: 2010 - $25.466,100 Outbuildings: $ 127,500 $ 127,500 2009 - $2,448,000 Land Value: $ 522,400 $ 522,400 2008 - $2,448,000 2007 - $2,448,000 2012 Totals $2,443,600 $2,443,600 2006 - $2,297,800 . Tax Information 2012-Map/Block/Lot: 327/127/-Use Code: 3010 Taxes Hyannis FD Tax $ 8,674.78 (Commercial) Community Preservation Act $ 556.41 Tax Town Tax(Commercial) $ 18,546.92 Fiscal Year 2012 TAX RATES HERE 27,778.11 . Sales History-Map/Block/Lot: 327/ 127/-Use Code: 3010 History: Owner: Sale Date Book/Page: Sale Price: DAALE&MARTINO INC 9/19/2000 13248/344 $1947712 ELLIOTT, JOHN H TR 11/19/1998 C150953 $1 ELLIOTT, JOHN H 11/19/1998 C150952 $1 ELLIOTT, JOHN H TR 11/19/1998 11853/098 $1 ELLIOTT, JOHN H 11/19/1998 11853/089 $1 http://www.town.bamstable.ma.us/Assessing/printl2.asp?searchparcel=327127 3/29/2012 Loop Up Print Page 2 of 3 ELLIOTT, JOHN H& FURMAN, JACK TRS 1404/114 $0 . Sketches-Map/Block/Lot: 327/127/-Use Code: 3010 ASJBMT[4142} U S NU S[17091.] AS(1298]" AS[130051. PT 0l��1 AsBuilt Card N/A . Constructions Details-Map/Block/Lot: 327/127/-Use Code: 3010 Building Details Land Building value $ 1,793,700 Bedrooms 01 USE CODE 301C Total Improvements Value $3,122,413 Bathrooms 0 Full Lot Size(Acres) 2.01 Model Commercial Total Rooms Appraised Value $ 522 Style Motel Heat Fuel Gas Assessed Value $ 52: Grade Below Average Heat Type Hot Air Year Built 1969 AC Type Unit/AC Effective depreciation 60 Interior Floors Carpet Stories 3 Interior Walls Drywall Living Area sq/ft 56,147 Exterior Walls Vinyl Siding Gross Area sq/ft 67,758 Roof Structure Flat Roof Cover Tar&Gravel . Outbuildings& Extra Features-Map/Block/Lot: 327/127/-Use Code: 3010 Code Description Units/SQ ft Appraised Value Assessed Value SPL7 Indoor Pool 800 $40,400 $40,400 PATI Patio-Average 7469 $ 11,300 $ 11,300 BMT Basement- 4142 $29,900 $ 29,900 Unfinished PAVING- http://www.town.bamstable.ma.us/Assessing/Printl2.asp?searchparcel=327127 3/29/2012 Loop Up Print Page 3 of 3 PAV I ASPHALT 30000 $27,400 $27,400 r SHED Shed 160 $ 1,500 $ 1,500 SPL1 Pool-Concrete 1252 $46,900 $46,900 . Sketch Legend Property Sketch Legend AOF Office, (Average) FTS Third Story Living Area SFB Base, Semi-Finished (Finished) BAS First Floor, Living Area FUS Second Story Living Area TQS Three Quarters Story (Finished) (Finished) BMT Basement Area GAR Garage UAT Attic Area (Unfinished) (Unfinished) CLP Loading Platform GRN Greenhouse UHS Half Story (Unfinished; CAN Canopy MZl Mezzanine, Unfinished UST Utility Area (Unfinishec FAT Attic Area (Finished) MZ2 Mezzanine, Semi-finished UTQ Three Quarters Story (Unfinished) FBM Finished Basement MZ3 Mezzanine, finished UUA Unfinished Utility Attic FCP Carport PAT Patio Outbuilding Listed UUS Full Upper 2nd Story (Unfinished) . FEP Enclosed Porch PTO Patio WOK Wood Deck FHS Half Story (Finished) REF Reference Only VVKO Wood Deck Outbuilding Listed FOP Open or Screened in SDA Store Display Area Porch http://www.town.bamstable.ma.us/Assessing/printl2.asp?searchparcel=327127 3/29/2012 WORKERS COMPENSATION. AND EMPLOYER'S LIABILITY INSURANCE POLICY ' PUBLIC SERVICE MUTUAL INSURANCE COMPANY,NEW YORK,N.Y NCC I COMPANY .NO: `16152 WC 4014 INFORMATION PAGE r POLICY NUMBER,, FROM POLICY PeRioo TO PREVIOUS POLICY OTHER COVERAGE=;` PRODUCER NUMBER r`''=# 03-254088-95 07 20/95 07/20/96 4--20--555-6216 1. THE INSURED MAILING ADDRESS: ' PRODUCER NAME AND ADDRESS HERITAGE PATRIOT INC E FUSHIA. MAHONEYEWRIAGHT ;INSURANCE REALTY TRUST AGENCY .INC :B©STCiN 46-`WASHINGTON ';ST :POB 746 259 MAIN ST NATICK MA 01760 HYANNIS MASS 02601 THE INSURED :CORPORATION FED ID NO. :04-3216692 OTHER WORKPLACES .NOT SHOWN ABOVE 259-263 "MA.IN ST -HYANNIS MA 2 ;THE POLICY PERIOD IS FROM 07/20/1995 TO 07/20/1996 12:01 AM STANDARD TIME AT THE INSUREDS MAILING ADDRESS. 3. A. WORKERS COMPENSATION INSURANCE: : PART ONE OF' THE POLICY APPLIES: TO . THE WORKERS COMPENSATION LADS OF THE STATES LISTED HERE: •' MASSACHUSETTS O. - EMPLOYERS LIABILITY INSURANCE: ` PART TWO OF THE POLICY ' APPLIES TO WORK IN EACH STATE LISTED 'IN ITEM 3.A. THE LIMITS OF OUR LIABILITY UNDER PART TWD ARE: BODILY INJURY BY ACCIDENT $500 000 EACH ACCIDENT BODILY INJURY SY � DISEASE $500v000 POLICY LIMIT BODILY INJURY BY DISEASE $5009000 EACH EMPLOYEE C. OTHER STATES INSURANCE: PART THREq. UF . THE POLICY APPLIES TO THE STATES* IF ANY, LISTED HERE: D. THIS POLICY : INCLUDES THESE ENDORSEMENTS BIND SCHEDULES WC131 WC242 WC332 WC000414 WC200303 WC200601 4 - THE PREMIUM FOR THIS POLICY WILL BE DETERMINED BY`.OUR MANUAL IMF ,RULES9 CLASSIFICATIONS• RATES AND RATING PLANS. ALL INFORMATION . REQUIRED BELOWIS SUBJECT TO VERIFICATION AND CHANGE :BY AUDIT. PREM BASIS RATE : EST CLASSIFICATIONS LOC CODE :TOTAL PER $100 ANNUAL ST NO NO ANN RERUN OF REMUN PREMIUM ( SEE SCHEDULE ) EXPENSE CONSTANT $160 $160 MIN PREM $328 DEPOSIT PREM $2s207 EST ANNUAL PREM $74941 PREMIUM ADJUSTMENT PERIOD:ANNUALLY f�,l e Cl3UNTERSIGNEO 08/09/1995 AT NEW YORKy N.Y. 8Y •,z„�`z) ..,. COPYRIGHT* 1987 NAT.COUNCIL ON COMP.INS. AUTHOI REPRESENTATIVE (urz��Wtd is 4--s-p- A-y " ) ring DeI3t.(3rei floor) Map a� Parcel Permit 'douse# � �-�' Jf Date Issued �� th 3rd floo�1-Ai 9:30/1:00-4:30 �j , rf a Fee 0s44V-41 Conservation Office(4th floor)(8:30-9:30/1:00-2:00) SINE rd 19 BARNMBLE. j � MASS. TOWN OF BARNSTAELE Building Permit Application Pr 'ect Street Ad ss Village Owner Address 2�,,C Telephon /` Permit Request y 7'c J" First Floor . square feet Second Floor square feet Construction Type Estimated Project Cost $ S� o Zoning.District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No 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 No. 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 Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use Builder Information Name Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE BUILDING PERMIT DENIEIJF, R THE FOLLOWING EAT(S) � �'.R Ay t FOR OFFICIAL USE ONLY ? z PERMIT NO. DATE ISSUED MAP/PARCEL NO. c ADDRESS ' VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME i INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING ! ! DATE CLOSED OUT ASSOCIATION PLAN NO. The Cununonl+•calrh of Afassachuscrrs Department of Industrial Accidents . - = '. � •• ,:..,.._r 600 11 ashuc„trrn Street e.•�`.�1;,, Bustnn.A1ws 02111. `- Workers' Compensation Insurance Affidavit gRnisant information• Please PRINT legthly_• _,� - - name - �� 615, phone# ��n1n1i5 �� ?®op i 1 am a homeowner performing all work myself. 0 1 am a sole proprietor and have no one working in any capacity •�� I am an employer providing workers' compensation for my employees working on this job. C� 4[4CrA&+ -PA T�Io1 TNC ct►mp�n� n�mc)) ,�y►� - address• JCS I Ur ( r1 5 city Rift /V I S ' phone# SO :70 Q 0 incurinceco P06CIC `jel'010 /1101 L)AL Otis C-0 policy 03'oZ fq r9 ga —91 — I am a sole proprietor, general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: m an •ra address: Sit) phone#• incurnnee co policy# j.. •fc ...----;�+.,_._• ven•a-• ...ee-ree-•r---�.�-nci-ns�ycW�'ZT�nvr-�e4OL.►—a+S.TJvrP7qre0"g''�►:�i'7:�Y:17 -.'i1�R'^'='�a_1�94i�'_a'-"'•"'P2 comnanv name- address: city phone#• -- insur•tnce co noiin# .Attach additionsi'sheeiifneeessa •::�+»: w�^ `+w^*r "e�:."`:. :"••'.� `�' " ^ »,�:�s% : Failur_e to secure coverage as required under Section 25A of I%IGL 152 can lead to the imposition of criminal penalties of a fine up to 51.500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of 5100.00 a day against me. 1 understand that a copy of this statement may be forwarded to the OMce of investigations of the DIA for coverage vwrifteatioo. I do erebr certify under the pains and penalties of peduty that the information pry id7abais true and correcti_n re ate - - Le - q� tint nameFILL LL hone# 7 7 - Woe Fcheck- nly do not write is this area to be completed by city or town official town: permitAicense# nBuiiding Department Duce Board mmediate response is required (3Selectmea'sOffice �11caltb Department on• phone#• r•iOther Irnised 3,9/ P1A1 DBPAITHIT Of PUBLIC SAYETY COISTIUCTI01 SUPERVISOR LICEISE lnt6erc Expires: itst icted`To: @0 BOX 316 CUWgUID, NA 62637 [ ] [R327 128 . ' ] LOC] 0000 OLD COLONY ROAD CTY] 07 TDS] 400 HY KEY] 242286 ----MAILING ADDRESS------- PCA13011 PCS100 YR100 PARENT] 0 ELLIOTT, JOHN H & MAP] AREA] HY08 JV] MTG] 0000 FURMAN, JACK, TRUSTEES SP1] SP21 SP31 FURELL REALTY TRUST UT11 UT21 . 99 SQ FT] 10956 259 MAIN ST AYB11976 EYB11976 OBS] 75 CONST] HYANNIS MA 02601 LAND 136600 IMP 711500 OTHER 5400 ----LEGAL DESCRIPTION---- TRUE MKT 853500 REA CLASSIFIED #LAND 3 136, 600 ASD LND 136600 ASD IMP 711500 ASD OTH 5400 #BLDG (S) -CARD-1 3 337, 600 DESCRIPTION TAX YR CURRENT EXEMPT TAXABLE #OTHER FEATURE 3 5, 400 TAX EXEMPT #BLDG (S) -CARD-2 3 373 , 900 RESIDENT'L #PL OLD COLONY RD OPEN SPACE #RR 1144 0166 COMMERCIAL 853500 853500 853500 *CH 11 JT PLAN OF REORG INDUSTRIAL *ORB 9347/307 EXEMPTIONS SALE] 00/00 PRICE] ORB] C44935 AFD] LAST ACTIVITY] 11/08/96 PCR] Y r s R327 128 . A P P R A I S A L D A T A KEY 242286 ELLIOTT, JOHN H & LAND BLD/FEATURES BUILDINGS NUMBER ZN/FL=RB- 1 136, 600 5, 400 711, 500 2 A-COST 853 , 500 B-MKT BY 00/ BY /00 C-INCOME PCA=3011 PCS=00 SIZE= 10956 A JUST-VAL 853 , 500 LEV=400 CONST-C 0 ----COMPARISON TO CONTROL AREA HY08 -- --MAY NOT BE COMPARABLE-- COMMERCIAL NBHD IN HYANNIS HY08 PARCEL CONTROL AREA TREND STANDARD 301 30 LAND-TYPE 1366001 LAND-MEAN +Oo 8535001 IMPROVED-MEAN +Oo 5001 ] FRONT-FT 31 100 DEPTH/ACRES TABLE 02 1000] LOCATION-ADJ APPLY-VAL-STAT 1 LNR] LAND LFT/IMP] ADJS/SB/FEAT STR] STRUCTURE ARR]AREA-MEASUREMENTS NOR] NOTES COM] MARKET INC] INCOME PMR] PERMITS GRR] GRAPHIC FUNCTION- [ ] STRUCTURE-CARD NO- [0 0 0] DATA- [ ] XMT [?] R327 128 . P E R M I T [PMT] ACTION [R] CARD [000] KEY 242286 000000001 PERMIT-NO MO YR TYPE VALUE CK-BY MO YR oCMP NEW/DEMO COMMENT [B18306] [04] [76] [NH] A ] [ ] [01] [77] [000] [NEW ] [HY MOTEL ] [B19005] [03] [77] [AH] A ] [ ] [01] [78] [000] [NEW ] [HY ADD'N ] E ;Aieering Dept. (3rd floor) Map Parcel 0 ��`)� Permit# .3 House# 2sl d`'��-. it Date Issued Board of Health( floor) 8:15.9.30/1.00-4,30) S�/ . �� Fee ,9"!r0, O 0 pl�lnfi7rrtrlrrlec 4 Admire Bldg.) �--�--r— -`�----�L A4PL1CANf A SEWER d 19 CONNECT ON THE INGINEE A OB TO MA85. `f lFD MAr a` • N OF BARNSTABLE� R Building Permit Application rProject dress �55 Yin A-1 K) S-F1'Z.CZ i 4 Villagex.� Owner C_#,S� J°hy H C Address qS }� TIN g Telephone 508- 7 77 7C, _Permit Request ti ePrtw .� 1N 1.!lt�l �' I�f�' First Floor square feet Second Floor square feet ,Construction Type ECO Wb t [®0 1 R E-ARP A—r JG_i 1 i s &' Estimated Project Cost $ 5 .00 Zoning District Flood Plain Water Protection S! Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) 0\ � Age of Existing Structure .31+ Historic House ❑Yes ❑No On Old King's Highway ❑Yes ❑No Basement Type: Er�ull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half: Existing New No. of Bedrooms: Existing New Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: OGas ❑Oil ❑Electric ❑Other Central Air.�Yes ❑No Fireplaces:Existing New Existing wood/coal stove ❑Yes ❑No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial Yes ❑No If yes, site plan review# Current Use - R1 j AV QP� O L-00 1146f_ Proposed Use SA Builder Information U*L7 7,' 7 7 7 Name 08 r T tea,,i—1c;�_V C-( 10/Q Telephone Number ,'j( - 7 2 1 5- Addresss Su 11 1 u Ph l d License# � 9 3 - Home Improvement Contractor# /6 w�17 14 WQ(1� ) �'+S S _ Worker's Compensation# C F NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTR ION D RI RE ULTING FROM THIS PROJECT WILL BE TAKEN TO SI NG'MATURE DATEzmiu BUILDING pm MIT DE , D: R -F WING ASON(S) 1 , l FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED, MAN/PARCEL NO. f - is .r, . .r f - a • + ADDRESS t ' VILLAGE OWNER , DATE OFINSPECTION: FOUNDATION FRAME' , - � ;. ; .` • r { - r :� A � I �. _ r -INSULATION FIREPLACE } z ELECTRICAL: ROUGH FINAL - PLUMBING: ROUGH s FINAL GAS: i ROiG�'H FINAL f FINAL BUILDING DATE CLOSED OLJzT��. n ASSOCIATION PLKA'NO. ! ' t F • _i _-__ The Commonwealth of Massachusetts n: _— �� Department of Industrial Accidents Office of/nsestigations _ I 600 Washington Street ��+/ 'Boston Mass. 02111 J• / porkers' C m ensation insurance Affidavit Mario Giannini name: location: 42 Sullivan Road West Yarmouth, Mass 771-0675 city phone# ❑ I am a homeowner performing all work myself. ❑ I am a sole r rietor and have no one working in any ca achy � �� ❑ I am an employer providing workers' compensation for my employees working on this job. comaanv name• ,.;.. .. address: city ,:.. Phone#: insuranc policv# ❑ I am a sole proprietor general contractor, or homeowner(circle one) and have hired the contractors listed below who have the following workers' compensation polices: M.G;,; Construction company name: 42 Sullivan `Road address: W Y; rmouth, Mass 5M 771 0675 dty 1 g no Gp�pmein '`l Group xn�. CEF 22.5�2 65't� M (:3SUa Co olicy# insurance co. com anv name: address: ctty- "phone#. -: olicv# Insurance co.: i xw Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a tine up to S1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a tine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the p d penalties of perjury that the information provided above is truo and correct Signs a Print name VVI(�} I(� i Y�n T1 l r):k Phone# -:d� -j 71 -b 4-),5 otIIcial use only do not write in this area to be.completed by city or town official city or town: permit/Hcense# ❑Building Department ❑Licensing Board ❑check if immediate response is required ❑Selectmen's Office ❑Health Department contact person: phone#; ❑Other (revised 9/95 P1A) r Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", an 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 o. 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 section 25 also states that every state or local licensing agency shall withhold the issuance or renews of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work-until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to yow-situation and supplying company names, address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. 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. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the peimittlicense number which will be used as a reference number. The affidavits may be returhR io the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any 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 Me of Investlgadons 600 Washington Street Boston; Ma. 02111 fax#: (617) 727-7749 phone #: (617) 727-4900 ext. 406, 409 or 375 N • ; . The Town of Barnstable • satv�r�at�-• 9� MASA Department of Health Safety and Environmental Services 'OrFo rao•�" Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner For office use only Permit no. ' Date AFFIDAVIT e ` HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors, with certain exceptions,along with other requirements. Type of Work Reconditioning and Rearrangist Cost $ 51000.00 Address of Work: 259 Main Street, Hyannis, Mass Owner's Name Angelo Di Censo 5-11-98 Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under$1,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGZAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY [hereby apply for a permit as the agent of the owner: M.G. Construction 106970 5-11-98 Mario Giannini Date ontr for Name Registration No. OR Date Owne ame . . . . . _ _ , . _ R .z - F . - r s _ . .. _ _ _. \ .". - -.. '' - - . i Y Y . .,. , ' .. .. - - - - - - . . _. _ C: - , 1. - . , .. - - -- Q,ye�C4,. R - - - t . . 1. . .. .T - . - ,:.: .. . _ _ - .. ,. '1 - _ ,_ .: _ -. r .. .. r - - C ,. - .. _ - ....e . . - -_ . _. .. ..- .. 'C.: .:' .. _ .. L ."'-v. . , .. ... _ . _ ..u.' - _ ,- -. _ .. Y .. �.. - _ t' �Y :t .. .. - - _ - . .. _ - , I. 1. I. ,. - _ .. `' - _ .-. .. �T .. - .. --,: ,. - - t ,t - i n . +I Wit` , Y _. - n . . . ._ :.. -. _ _ . H - .r - _ .. - , _ .- - .. ti .. _ _ _j� =•�d,.+�bN.:-'„�... „yp: -c"T(*oA'fl,.ar,.+Oli�'+�'' J' z • q s n. .N• k 1G _ . _ ` y '� yIM .i> _'11R• i..11t��.. ._. ( I: - ice. .Y T R,.'�, s�'4a` Y ,L 'I"..� , a,.�-- 1.�ip�,�`f'�fA fsreMl��, � ��' .C�v'��Q(�. _ "•� S ,". - .s .:ri. �..'`i -.tt4 t r"= .t; 3 :✓.1- ,tea " s a b ( �''II C L :X- t y r * ,; -- 9 - lL1 _ - �- , . r ,-r. _ �f v t.�, 1.. , —t .. p J -� �r T4� � �1 tl 1 . _ - - v • -. '._ .+. f ,. Ox "�'OM:a'i 41. K.;�pl�raygy,.r��+�rn�o..wrw� :a -+�'r..y,�v r 6-01-1�98 2:20PM FROM HYANNIS FIRE DEPT. 508 778 6448 P. 2 79 62 2 New Ap TOWN OF BARNSTABLE Q Renewalplication WAM [j Transfer LICENSE APPLICATION Other.................... Date. or type only (Please bear down hard) Name of Applicant. .............................................D/BiA- Corp.Name if Different.................................... ......... ........ .......................................FlD#.............................................. Permanent Address of Applicant.... ...Streeto....Ryann.i.w#—MA...02.601........................................... ..........I.... .. .. .... .... ...... x89 Local/Mailing Address..... iNairt...Street.,...'Hyami.z.s...MA..02601.......................................................I................. ........... .......................................................Place of .............I........................................................... ................................ Property OwnelfL"11-.R!ty Business Location.... !�!--MA Type of License... Victtsal®e............................................Status:Annual.......A.......................Seasonal................... .... ...........bect Name of Manager..Ro .................P. Ti1:1.......... .................... ......................I............ ............................... Permanent Address 1�.!�icdl Lane, Scuth Ta=xlth, MA 02664 ..............................I................................................................................................................................ Local Mailing Address.?S? ...........Place of Bitch.Jqdep C .......................................I............................................................................... Telepfi6ne#of Applicant:Home ..........).......77.5-713.1....................... -----------Bus 77-5-7131 .......................... Telephone#of Manager-Home(...... ..........)_.....39"227 ...I...I...................... ..............Bus .........7751-9wo".. Assessor's Map#(s)..3??...........................Parcel#(S)J?T.f...12-81-.1-.........Zoning District..'OL...-A.................. Any flammable substance or hawdous waste use in business(specify)...�..................................................................................... NO BUSINESS MAY OPERATE WITHOUT A VALID LICENSE ON 114E PREMISES 7yo Applicants must contact the Building Commissioner's Office, 790-6227; the Board of Health Office, 797,04245.and the appropriate Fire District Office to schedule inspections, Signature of Applicant.... .......By I........................................... .Previdqmt .................... .............................. ..........11,...... ....................... For,To*wn 11$9o»ty IS THIS USE FEMTED WITHIN THIS ZONING DISTRICT?.................................................................................................... Comments:.......................................................................................I..."....I.-.................................................................................... INSPECTORS APPROVAL....................... .....................................-........................ Building/Zoning.................................Date............ ..............................Board of Health.....................................Date................... Wire..................................Date.................Plumbing.............................Date.......................Gas............................ Date............. Fire Dist... .. Date ............ TAX OFFICE USE ONLY TAXES PAID IN FULL PAYMENT AGREEMENT IN EFFECT ON TAX COLLECTOR, White-LicemingAuthcrity Green-TaxOffice Canwy-ArvaldiDepartimnir Gold-Building Commissioner Pink-Fire Departimnt r 6-01-1998 2:20PM FROM HYANNIS FIRE DEPT. S08 778 6448 P_ 1 IIYANNIS FIRE DEPARTMENT v+w s 95 HIGH SCHOOL RD. EXT.HYANNIS, NIA.02601 HLM ICA% HAROLC S. BRUNELLE CHIEF T; FIA PREVENTION BUREAU BriIElNT•IWIRfNE88 Cf FIPI6011CAIICX BUSINESS PHONE.(508)775-1300 FACSIMILE PHONE:(508)778-6448 LT.DONALD H.CHASE,JR.,CFI LT.IEMC F.HUBLER,CFI FIRE PREVENTION OFFICER FEFtE PREVENYTON OFFICER FACSI11 LME TILINSINUITAL SHEET THIS FAX IS GOING TO: Louie THIS FAX IS BEING SENT BY: Fire Prevention Office SUBJECT OF THIS FAX: 259 Main St, ReSTAURANTE ABRUZZI FDATE: FAX NUMBER: NUMBER OF PAGES:. f9�3 790-6230 2.... .. ....................................... ....................................... (INCLUDES COVER) NOTES: ............................................................................................................................................. �, t�� ; � � °,, �J � z c-a s = r o ~ f� N rn to c ti �� .. � a a o o z a o ti. �o N o b �3 C � a m � a x c w i 6 V 1 O H \ !D -� �� N y t/'f o — a o �-r T Q a c-� rn �. m ---� �C S --c C. [ ] [R327 127 . J LOC] 0000 MAIN STREET CTY] 07 TDS] 400 HY KEY] 242277 ----MAILING ADDRESS------- PCA13011 PCS100 YR100 PARENT] 0 ELLIOTT, JOHN H & MAP] AREA] HY08 JV] MTG] 0000 FURMAN, JACK, TRUSTEES SPlJ SP21 SP31 FURELL RLTY TRUST UT11 UT21 2 . 01 SQ FT] 37324 259 MAIN ST AYBJ 1969 EYB] 1975 OBS] CONST] HYANNIS MA 02601 LAND 277400 IMP 1633500 OTHER ----LEGAL DESCRIPTION---- TRUE MKT 1910900 REA CLASSIFIED #BLDG (S) -CARD-1 3 1, 633 , 500 ASD LND 277400 ASD IMP 1633500 ASD OTH #LAND 3 277, 400 DESCRIPTION TAX YR CURRENT EXEMPT TAXABLE #PL 259 MAIN ST HY TAX EXEMPT #RR 0952 0069 1144 0440 RESIDENT'L #SR OLD COLONY ROAD OPEN SPACE *CH 11 JT PLAN OF REORG COMMERCIAL 1910900 1910900 1910900 *ORB 9347/307 INDUSTRIAL EXEMPTIONS SALE100/00 PRICE] ORB11404/114 AFD] LAST ACTIVITY] 11/08/96 PCR] Y R327 127 . A P P R A I S A L D A T A KEY 242277 ELLIOTT, JOHN H & LAND BLD/FEATURES BUILDINGS NUMBER ZN/FL=RB1 &B 277, 400 57, 000 1, 834, 800 1 A-COST 2, 169, 200 B-MKT BY 00/ BY /00 C-INCOME 1, 910, 900 PCA=3011 PCS=00 SIZE= 37324 C JUST-VAL 1, 910, 900 LEV=400 CONST-C 0 ----COMPARISON TO CONTROL AREA HY08 ----------------------------- COMMERCIAL NBHD IN HYANNIS HY08 PARCEL CONTROL AREA TREND STANDARD 301 30 LAND-TYPE 2774001 LAND-MEAN +Oo 21692001 IMPROVED-MEAN +Oo 500 ] FRONT-FT 31 100 DEPTH/ACRES TABLE 02 100°s] LOCATION-ADJ APPLY-VAL-STAT 1 LNR] LAND LFT/IMP] ADJS/SB/FEAT STR] STRUCTURE ARR]AREA-MEASUREMENTS NOR] NOTES COM] MARKET INC] INCOME PMR] PERMITS GRR] GRAPHIC FUNCTION- [ ] STRUCTURE-CARD NO- [0 0 0] DATA- [ ] XMT [?] R327 127 . P E R M I T [PMT] ACTION [R] CARD [000] KEY 242277 000000001 PERMIT-NO MO YR TYPE VALUE CK-BY MO YR %CMP NEW/DEMO COMMENT THE. TOWN OF BARNSTABLE $A"SMLE, o �6 9 BUILDING INSPECTOR APPLICATION FOR PERMIT TO TYPEOF CONSTRUCTION .. --...� 2� ... . . .. ............................................................................. TO THE INSPECTOR OF BUILDINGS:- They undersigned hereby applies for a permit according` to the following information: Location .......: ....... ....................................................... ProposedUse ......... ... . . .... . ........................................................................................................................................ ZoningDistrict .........................................................................Fire District .............................................................................. Name of OwnerG�r` 2 ". . .. . ..............AddreSS 7;3..,a`aa ....... ....y Name of Builder!...... .......................Address ... ..... . . . .. ............................................ Nameof Architect ..... ... .. . ... ..............................................Address .................................................................................... Numberof Rooms ..................................................................Foundation .............................................................................. Exterior ....................................................................................Roofing .................................................................................... Floors ......................................................................................Interior .................................................................................... Heating ................................................................................ Plumbing .................................................................................. Fireplace ..................................................................................Type of Chimney .................................................................... Diagram of Lot and Building with Dimensions o. LIZ:: J -- ------ _ _ ._ 7. I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Namefir.. t..... ..... ........... y�l�4� � ^ ~. No �� Permit for ---- --'--------- — ~~ ^om^ --��.��.�.��..�—..^��---.------.^—. . ^~^...~. ............... ' ,� � �� " . ---v«/��' '.�---------------'. Owner fn ' . . Type . ] of Construction ................... .................... Plot ---------. Lot ----------.. | / � > �� Permit Granted —',��'��--.,—�---]g ~ Date of Inspection .................................... / / ^ . Date Completed ------------'lg ^ � � / ' } ` \ PERMIT REFUSED ~ � | n lA ^ ` —.-------------------. f ' / ' .......... ................................................ -----. � , � ^ �-------''----------^--~----- ( ---.--..—.----...--._...--.--.--. 8 i / — \ ------------....---------.—~' � . / Approved ---------------- lV > -------.------..---.--..—........ i .............................. , ^ . ' l ° Assessor's map4 and lot number ..3��:...�� JS_ ► .�U l MUST - cow cj L,®vs� _ L/c�Qee QGCrJb�i� 'r ��U Sewage Permit number • rV � /� ,t'OG.........................f.....:�la:-�/U!!f!s'i�G �'I�IUl�"Gf • ��Q�OFTNETp�y a TOWN . OF BARN§TABL.,V �� vso4117 r _ S&TI i E,aBSTAnLE S':T BE ,o LIANC `' m IVILDING. INSPECTOR r - INSTALLSb P�;r DypY'° "FATE -, WITH A , SANITARY CODE AND TOWN- c REGULATIONS. .: ��*�• APPLICATION FOR PERMIT TO d�"•!�'11........ .. }.......................... ... .............. �i TYPEOF CONSTRUCTION ................. ............................................................. ..................................................... .........7))�ez....... .............19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby //applies for a permit accordingto the following information: Location ........ . (.. ?''... Q�..... ........ct'!' .:..................................................................................................... ProposedUse ...................................... 1 .................................................................................................:............. ZoningDistrict ....... ...... ..........................................Fire' District .............. ... ... ........:.................................... Nameof Owner /.. "' l.!......./. ....... ....�-0 �.5..�....Address .................................................................................... Name of Builder .. ;�2.... 1/..�f�. (......................Address ':................................................ Name of Architect. 0..J.0 �5...&/I•. A�.............Address ................. 1(... lj ........................... Number of Rooms .......................Foundatio,-.--&G.°!'�.1...... Exterior ....... ........................................................Roofing ....... ......... .. t ./7...............:............................. Floors ............��5.... ...�'.L................................................Interior ......................."��m-/................................... Heating1.��...................................................Plumbing ........ ..... ................................. Fireplace Approximate. Cost x./�U! ��'o• 6 ......................................................... ............. Definitive Plan Approved by Planning Board --------------------------------19________. Area ...0................ Dia ram of Lot and Building with Dimensions � 36 S� g g Fee .............................................. SUBJECT TO'APPROVAL OF BOARD OF HEALTH mow" 4 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ...: �....... ......... a • Furell Realty Trust r No . 8310.6......Perrriit for::..Mote1• - ........................... . ................ ........:...... ...................................... Old. Colony.Rd. Location ...:.......:............. _ ( _ '• ''' �'` _ r - - . - `e � '� 'r M1 .. /•�" � � i -. v•� '� - ,fit .............Hy�jall is................................................... ;f/' t Owner .,- .•« ,,, 7 t" r - F '-mast. ................ Frame S Type of Construction Plot 32.7. .....1.27..... .. lot ...... ........... Y +° R . . . ... . .... . Al -Permit Granted A.b 1..........Qt.....::1976 " ^ j , ' —,.19Date of Inspection ..........................^......Date Completed ....... ........:1974 PERMIT REFUSED t 1 'j r .::....... . ......................................, ..................... ........................f •.... . ...... ....................... ..................................7................... 71 ........................................................rf............... . .. Approved ............................................ 19 '� T t _ Assessor's •map, and lot mumber .�� ..../.'".....�. ...... QGGvG.y.�� i 4 !. A 7 7�'� ,�-=_ 1rid > COk-.tccr 1` O G/GC6-c,- _ 06aC w w-6E - u+ Sewage Permit number ................�........ ....u'� ......yC �/�� c o cd�/7/Uu.....f9/.nto Ue�F - GOT lop 2°*T"PTO = TOWN 'OF BARNSTABLE �y iii 8ABH9TAMLE,M69 . . � RUI-�! G-`t IN,SPECTOR j APPLICATION_FOR PERMIT TO ................... .. ti�....% `y.... c "`' ............. : TYPE OF CONSTRUCTION �N a)7I.'�� ' ..................................... .....19... TO THE INSPECTOR OF BUILDINGS: { The undersigned hereby applies for a permit according to the following information: Location ....0 .. !?"'..................:.............................................................................................. ProposedUse ( .................................................................................................. Zoning. District .......... ....................................................Fire District ........+.�.............................................................. Nameof Owner �7 ................................:................................................... Name of Builder l ;E.�..rl.. Al ..........................Address .....(1 .J.Y.. ...................... .................... Name of Architect . ...F.. .....W.. < ..............Address �........................................ Number of Rooms ....!�.q......... s.....................Foundation .... '► .... . ` ..�. 1 ... ........................................... Exterior ............1.f1.�. .................................................Roofing ........................... Floors ...........1.. . ................................................Interior ........... `��W . ..... ....... ....... .... .. ..................................... Heating ....... ....I...................................Plumbing .. ..._........ . Fireplace .......................................................................:..........Approximate Cost ....... ... i�t�........................................ Definitive Plan Approved by Planning Board ________________ „r7 --------------1 9--------. Area ew Diagram of Lot and Building with Dimensions Fee �� ....... ... ...... ..................... SUBJECT TO APPROVAL OF BOARD OF HEALTH ' 0-21 7.(- g� I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ....... .......... "✓. 1.............. Furell Realty Trust 4 4 No .....12.05. Permit for ...24„units w mat,r.1..- a, dition............................ Location ............................. ...........Hyamis..................................... .......... 1_ 1 .if - ,`;� k ,✓ Owner .....Fure.1.l...ReAlty,•,Trust Type of Construction £Xataa.......................... �- ,�. � • a !..: ..............................................................:............. Plot ............................. Lot .......... Permit Granted .......Xaxch..1.4.... ........1977 U v • ' Date of Inspection ...�.C.�.,,.........I o-7" 19 Date Completed ...... t C% 77 s` PERMIT .REFUS D,4 ► - .................................................... .:...:..... 19 - { r`'~• �,_, % a � �..�• s/? i. l� .......................... ......................y....:."...................... ............ .................................\: .. ......... .1r r' s Approved ............................................ 19 .................................. ............................................ , ..................... ..... ........................................ . ' Assessor's map and -lot number ..........................................T - �r.' :'�/ -C 3 Sewage Permit number " _ h of- yOFTNETQ�♦ TOWN OF BARNSTABLE b�Q �'� 7.'r.�l-��'S l� /" �'; /.:., � i�L�`t'' ' �✓��e'-/ �1J �l y�/�. - Z EARNSTO➢LE, i "6 BUILDING ' INSPECTOR ' ��-�-�� 1MPYp. - APPLICATION FOR PERMIT TYPEOF CONSTRUCTION .........� ........................................................................................................................ ............ ................................19 24 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a• permit according to the following information: Location ' ` ProposedUse .1 1 . ............................................:.................................................................. Zoning District ....... .................................................Fire District ............. ................................. ................... Ita?, .�......!( 4W ��5�7 Address Name of Owner ....:..........:..... ..............;. .......................................................................... Name of "Builder ....`..........................Address __7 e--............................... ......................... Name of Archite t ... XP;• �la t-S 6Y7 �fi�° ........ ........................Address ........................................,..:........................................ Number of Rooms rr,.�:......................Foundations!t�•,�L-Q'....... .....'.......................................... ..................... � 1 [ Exterior ........ .........................................................Roofing ....... rr " •a�17ew� ...........:..,..... ........................... Floors .................................. ...........................................Interior ..................... ... .. :...•..... ........................................ Heating :...................................................:.Plumbing .........:- / ,! ..........�.... �r.......`..................... Fireplace .............................................................Approximate. Cost .................................:.:................................ Definitive Plan Approved by Planning Board ________________________________19________. Area t- Diagram of Lot and Building witr Dimensions Fee3�:7.5� .......... . .................... SUBJECT TO APPROVAL OF BOARD OF HEALTH J M1 I hereby agree to conform to--all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ... ............ r � .� ..�v• sty' , 3z7-/zig �rell Realty Trust No ..... Permit for .........Mote!................ .................. ............................................... Location ...0.1.d..Co.l.ony..Ad................................ . ........ .............Hyinn.i.s.......................................... Owner .....Ftr.e.1.1.....R.eal.tv..TrAat................. ...... . . .. . ...... . Type of Construction Fra[T.e............................... ............... .......................... Plot .3.2.7.... t ................................ A Permit Granted ............pril 9............................1976 Date of Inspection .....................................19 Date Completed ......................................19 PERMIT REFUSED ............ 19 11-2 �,l .................................................... - -7;a ................. ...... . .0.. ....................... e ......................... •................ .............................. .......... ..... .\..... .............. ............. ... ..... ............... . ..... ..... ... zz Approved .......................................... ... 19 e jb .......................................kA...... Assessor's map and lot number )........1.a 1,7...... ter« G e f mug. . ., f F6-f= Sewage Permit number 's.............. ......................... rL FTNETp�y TOWN OF BARNSTABLE E9SHSTdDLE, • "6 q ,e0� BUILDING INSPECTOR ^ / PL APPLICATION FOR PERMIT TO ............................................................................................................................. TYPE OF CONSTRUCTION ................................'";"T.f',.....?a ,..;,...................................................................... ................................................19. I � . TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ..... ........!!�: ........... v..`.................................................................................................................. . �� ProposedUse .................................................................................:..................... .....,.1....................................,......................... ..Fire District ........:!..'"'� Zoning District ......... .. `........................................................ .............................................................. I Nameof Owner .".?'�...... ........... .....I/ C.a ...Address .................................................................................... Name of Builder ..........................Address .... ....................................:..:.......................................... Name of Architect `4-� ...T' �� >? ..............Address �T_!�-'�*-................... Number of Rooms .... ...............� !��+.....................Foundation .... !" '�t `�-� ............................................................... Exterior I.!� l Roofing .......... '?'1� !,.;�.�........................................ ........................................................ Floors1 qA,f AZ................................................Interior .......................... , Heating ............... .........................................Plumbing ..`- ...................:Itl.......... .................. Fireplace ..................................................................................Approximate Cost .l .................................................................... Definitive Plan Approved by Planning Board ________________________________19--------. Area ... ..... Diagram of Lot and Building with Dimensions Fee`.......... ........... .............r.......... t SUBJECT TO APPROVAL OF BOARD OF HEALTH 01 a a j F I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. (� �% Name ....•\.1 S-' .. .: �� .. z? � ............. Jarell Realty, Trust 327-1127 t .4 No ...1.9RQ,5.... Permit for ......2....4....units...................... ............. ... .d d 1 x1.Qn................................... Location yv.Q. .d..Gv. .4?�x..alya.,.:.................... ..................HYAJ=L s.............................................. Owner ...�1dlCe. �,..Rs�.ty. Trust..................... r Type of Construction .....f.xdW9.......................... . . • t ................................................................................ r - Ploti ............................ Lot ................................ • is _ - F r Permit Granted ....March..l4..................19 77 Date of Inspection ....................................19 ' Date Completed ........a.../....:....................19 t RMI �EF ED ......... ..................... ..\. ....................... 19 F, ....... _ ...... . ........................................... ;. ............................................................................... Approved ................................................ 19 ............................................................................... ..................... ......................................................... MEMO oa6WIKHERBERT D. STRINGER BUILDING INSPECTOR Telephone 775-1120 vJCp'✓G' e n 7 79e� TOWN OF BARNSTABLE INSPECTORS OFFICE 397 Main Street, Hyannis, Mass. MEMO/.*w %e -;KHERBERT D. STRINGER BUILDING INSPECTOR Telephone 775-1120 el TOWN OF BARNSTABLE INSPECTORS OFFICE t 397 Main Street, Hyannis, Mass. j f R' e�PyofTHE.r TOWN OF BARNSTABLE i EAHBSTAIILE, i 9� O�Ya`�� BUILDING INSPECTOR APPLICATION FOR PERMIT TO .... . .. .�::/. !.Tc`/.....�:�... ..�....... ............... TYPE OF CONSTRUCTION ............ .. ....KV.......... .�! J��... ��`. ........ :......................................... ................................................ ., TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ... �...�... ..../�?f9 r.nj.... ....... .......!` .:...................................................... ProposedUse ............ ........................................................................................................................................... Zoning Districtf'V Frl ��'��'��`� � .,..Fire District............................................ ;,. .............................................. Name of Owner , !.J. .7.......................Address .......�� iyl7��.�t'..�/�./ ............................. ............. ........ Name of n.c...........Addressri�'��✓6� ................ ...................a........ ./... Name of Architect .........................Address L/yj 76 i-t,q J-/, .............. .................................................................................... Number of Rooms .?/..................................................Foundation .....� ...................................................... Exterior ......`7A.. ..N/..Y.K,.!..uA .;L.j. sf..........................Roofing ....7!0�2...` ............................... Floors ..... ......................................................Interior ..... � 1 av c, 7Ff C `^ Heating �/d -71 l.. ....................................Plumbing dr/ ?�//` ✓/f�C ✓"C rl�J� ............I................... .................................................................................... ......................................Approximate Cost ........... - c3 Fireplace .....................!U.:J ti 1. ... `2 ) !..... .. ............................................ Difinitive Plan Approved by Planning Board ---------------_---------------19--------. Diagram of Lot and Building with Dimensions d I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ?.. ..........6 ."�j' .o................................... E Elliott. John No 11010 Permit for ... hotel ,. ;Location ..........261-267 Main Street � Hyannis Owner John Elliott Type of Construction ..... ................................................................................ Plot ............................ Lot ................................ February 16 67 Permit Granted ........................................19 Date of Inspection .... a`Z...Q...........19 8 Date Completed .........................19 PERMIT REFUSED ................................................................ 19 ............................................................................... ............................................................................... .................... ....................................................... Approved ................................................ 19 t .................... ......................................................... i r ly I � � 1 `�` { t � r' �} {, �� '�. � ��. � -- �, �I �� .�.• I, r� �, �° ��, � ; �,;;�� . _ �� . ��+. 1 77S-- 70-00 T r ffe4 �a t� 5 2 6 4 3 1 FOR SALE BEDROOM • C-P AFFOROASLE HOME, CORP. 508-420-1232 .� - 'i— n Py+ lS. �,: f` �t _ C� C r f3 C:f 0 (,41 1 5 2 FOR �-ALE BEDROOM • G-P AFFOR DABL E HOME, CORP. 508-420-1232 i _ r G' f '.a �. al � I ',' to Y p i �,.�_ 1y- �' f•a f, -- 5 2 6 4 3 1 FOR SALE fllolnm • • • G-P AFFORDABLE HOME, CORP. 508-420- 1232 �� :� ,� r� �, r w c r a LJ 5 2 6 4 3 1 FOR SALE wm"W.umj!TGT@Tiv"mrolm G-P AFFORDABLE HOME, CORK 508-420-1232 � M1i fV ' N E+� G`> a' C� C3 I N g' CrJ 1 1 .ti M - �O ea• �i to ,✓ �`��1 iry''�i Q I I i 1 ' 1- , _�.. .i - I ;- - -� - ` + ! t- t y i � I" �—�-'-.�_- I .� t- �_ �_ _ � � -{-• �- j�.... _.... --�- �---�- - "�'. �, _I 41 C3L 5, 7 --L- 4 ._.,_ 71 .�._ — - - -�- -' -.-..1-_ �._. - I--- '?-•-. I--..` - ri__� _ _ i i ._.1��. I i - - I _-'�_ I ! ,�, i I i I - �T ! _ .I_- , I ' r ,_ \ � � ' i —'i ��ra�.- ('��Ik`�d�1a� - I gPt•T1�'1�a�.:`. . 3A� +�a�+M.. �3l'�}Ev��UCsw�: �ia ��,.,. � - � f �� __ _ .1. _ _ _;-. _ _-� _ I � i I I t I I � � � � I 1-��-!1� � �I ► I � 1 i i I I � � . � � � � ! � � i ICI I I I , _... t . ---- _ awa w. .,. --- �3�s►� ;�.:.. - -3w cK Va w.�... - I - OA-i �luc►�.�.. I I _ I .,,_a._ I -i 1 I I t a R_ I- I f+-�� 11 � _� I j I I I � { I � i i I -1 I � - - t--- � —1L-- --�•---�--�---�-- - _—�_ , ..i _r.I�_.,r_...1._— -._.� ._ _...-.1. �.4 _...�.._-.�_... :._._�._.-.4._ ..}... .4._._.F_•.— w+..,.* i...«.4- _ ! , � - I -...�...aJ_.—,-.� ! _�/�' ,I I ' I I_ FYI � _� _ I � � L _ I I __� _ L_-_ _ I_ I _ _._ _ f. � _. i. !- t-' -f I - + t _,I _1. � _ � _ .._ + ! -- I -�- - +�^ -•' -�----�__ ---+ _ I ` _ I _-+--_+ -- ' - '- I _ � -. 1 L— . _ !— �� _ I _� _ I I I I I i 1 I f f r I i ` I I -- � ---f - � _ I ! ► � I I i � � .I I i I f I I � � � I � �t � � ! r L.l ; : r � . o oCD 3 sz ¢ ao GO o o aD p C3 0 �Lo o `o 8 E ' 1 1 ® tC )'fN (4W)" n R N N 65 k, ol UNIT 402 UNIT 404 UNIT 406 UNIT 408 UNIT 410 I 8 z 12'-10 7 8- 6. 13'-5 1 4' 6' 13'-5 1/4' 6 13'-5 1/4' 6' 14'—f0 7/8' O L z � Wwx UNIT 412 o 5 4 4 5 5 — 4 4 — q 5 5 — 4 1 O F" Q p z o 4-4 x d d a 9 0 0 9 9 0 0 9 9 00 w O O O 0 w � °' " 7 4 � z u O F� N Q a is 4 a 4 a 4 W N x x = � ^ F 4 4 4 4 4 4 9 O 0 .0 0 9 9 O O O O 9 r. 9 O O O 0 9 01101 REVISIONS 6 6 6 Issueu FOR vlsRnu'r 4-15-09 5 — 4 4 — 5 5 — 4 4 — 5�� 5 — 4 4 — 5 2 1 13'-1 1 4' 6' 6-13 13'-5 3 4' 6- 13'-5 3/4' 6' _ 6' 18'-0 1 4' 7 7 7 7 7 1 BATHROOMS TYPICAL: PROVIDE NEW WALLBOARD AND FINISHES AS SELECTED EXISITNG NB AND SURROUND TO UNIT 401 UNIT 403 UNIT 405 UNIT 407 UNIT 409 UNIT 411 REMAIN.PROVIDE NEW FIXTURES AND FITTINGS AS SELECTED BY OWNER.PROVIDE COAT POLE AND SHELF EACH ROOM. (WALLBOARD TO BE MOISTURE RESISTANT) DWG.INFO. DATE 4-15-09 i� SCALE 1/4"=1'-0" d DRAWN CADD CHKD X 1 X 1 1 1 r APPRVD ol 8 8 8 8 8 8 —7 —j NOTE: ALL DOORS AND FRAMES ON THIS FLOOR ARE / I \ EXISTING TO REMAIN.COMMUNICATING DOORS BETWEEN UNITS WALL MOTH SHALL BE REDUCED .� TYPE 7 WALL / a� \ TO 3 3/4-TO ACCOMMODATE EXISTING FRAME �`' AND DOORS; PAINT ALL FRAMES AND DOORS. :•'�9 2 1/2•METAL STUD / r 1•�t n 7 Q.1 SHEET TITLE: EXISTING COMMUNICATING DOOR / j \ 9 " - AND FRAME TO REMAIN / ;� ' FRAME DETAIL / � � �A P.a•' � PART PLAN UPPER LEVEL L - - - - - - - - - - - - - ----- - - SHEET&JOB#: Ira«9'st: A-2 .'J O f Q t• WALL TYPES: ] ° clii to EXISTING ALUMINUM&GLASS WALL SYSTEM PROVIDE NEW {E O ob PANELED BASE AND GRILLE VA 2 2'RRNG CHANNELS OVER.VAPOR MASONRY WALL 'A j Q 00 - PATTERN IN EACH WINDOW { O GYM Y RIGIDWAU INSULATION,4 ML VAPOR BARRIER,AND S/8' J O � CIPSIAI WALLB0ARD FINISH;EXTFTAI TO UNOER90E OF LL CONCRETE DECK C7 o y OD cc: � Lo 3 5/8'METAL STUDS 20 GA 0 IB-OC•/5/8-GYPSUM N 0 O ` WALLBOARD EACH SIDE EXTEND STUDS AND WALLBOARD TO E _LL t UNDERSIDE OF CONC DECK-PROVIDE ROL INSULATION FULL HEIGHT ® U) FILL DEPRESSED AREA VA1H 3 5/8'METAL STUDS 20 GA O IV OC�/5/8-GYPSUM NEW SELF LEVELING GYPCRETE O3 WAILBOAIID ONE SIDE ONLY:EXIEtID STUDS AND WALLBOARD OR EQUAL.PREPARE FOR TO CONCRETE DEC( N NEW FINISHES AS SELECTED ` BY OWNER �y' a'-10 1/a• s'-1 1/4' 0 S �s�1E�xTB�ro ura��aFSD�oNDECK;N�PRO� 1•-2 7/8• 3'SOUND BATE INSUAIION FULL HEIGHT O 2 O 2 O r , NOTE ONE HOUR RATING AT CORRIDOR WAUS TIP 2 I NEW WINDOW CUT I EXISTING 2 1/27 STUDWALL;PROVIDE 5/8'GYPSUM WALLBOARD INTO EXISTING WALL O EACH SIDE;EXTEND TO UNDERSDE OF CONCRETE DEC( NEW FIXTURES,FITTINGS AND - X I ACCESSORIES BY OWNER ALL 1 NEW FRONT DESK IbY I i DOSII G 2 I/P STUOWALU PROVIDE 1/2-SCUNDSOARDS AND 5/8' a y TO BE HANDICAP ACCESSIBLE I OWNER ( L I J — ] O GYPSUM WALLBOARD EACH SIDE PROVIDE J'SOUND BATE INSULATION z r 1 a i'AMEN MEN'S 4 T3 RILL HEIGHT Oi WALL F o 2 D�FlGE L 5 e 2 NEW B z 6 FT SOFFIT m DOUBLE ROW 3 S/8'SM15 STAGGERED NTH 5/8'GYPSUM WALIBOAHID AREA EXACT LOCATION OEACH SM n I TO BE FIELD DETERMINED 7 PROVIDE Y F.G.SOUND NN%4ARON Full WALL��4� W Fr Vl d \ ^ / 2 O \ I FRONT DESK LLLddLL..U111��. W cc 1 v I IDOSTING WOOD SDI:PROVIDE NEW Itt F.G.THERMAL INSIMTON,D EXIERIOR WALL NTH PLYWOOD AND4E'WI EXTERIOR O F' 2 L . .-OR SAMS AND 5/8 RRECOOE GYPSUM WALLBOARD FINISH, O EXISTING 2 TONE SIDE DAL STUD PROVIDE TE D GYPSUM I^ � � _ I' O � WALLBOARD ONE SIDE ONLY 10 CONCRETE DECO f., I\ Ir 1t lM1 C� cr ,.p. • EXISTING DUCTS FROM { \ N Z LOWER LEVEL: SEAL c OPENING AT FLOOR WITH I \ NOTES: FIRE SAFE INSUL&FIRE 1` 1. ALL WALLS WITH LINE HOUR RATING SHALL BE FIRE TAPED RESISTANT SEALANT ALL �' AND SEALED ALL PERIMETER EDGES (4)SIDES 2. WALLBOARD IN WET AREAS SHALL BF MOISTURE RESISTANT ( TYPE W 3. FINISHES: EXIT ACCESS CORRIDORS CLASS B / \ ROOMS CLASS C { L - - - - - - - - - - - - - - - - - - REVISIONS i ISSUED FOR PERM]"r 1 4-15-09 DOOR SCHEDULE DO '. DOOR FRAME HARDWARE NO. 'MOTH HEIGHT THICK TYPE MATER•L FINISH TYPE MAT FINISH THROAT OFFICE PASSAGE PRIVACY HINGES CLOSER STOPS RATING 1 3•-0- 6•-8• 1 3/4• FLUSH WOOD SEALER 1 HM PAINT 4 7/8- X 1 1/2 PR X 2 3'-0• 6•-8• 1 3/4- FLUSH WOOD SEALER 1 HM PAINT 4 7/8• X 1 1/2 PR X X P4 3 3'-0• 6•-W 1 3/C FLUSH WOOD SEALER 1 HM PAINT 4 7/8- X 1 1/2 PR X X 2'-e 8-8 1 3/ FLUSH WOOD SEALER 1 HM PAINT 4 7/8• X 1 1/2 PR X ams mn DWG.INFO. DATE 4-15-09 SCALE 1/4"=V-0"UNO DRAWN CADD CHKD GENERAL NOTES: APPRVD — — — — CONTRACTOR SHALL PERFORM ALL WORK SHOWN ON THESE i DRAWINGS OR AS OTHERWISE REOUIRED FOR A PROPER JOB. ALL FINISHES MUST BE CODE COMPLIANT SEE CLASS LISTING ON WALL SCHEDULE PLUMBING,MECHANICAL AND ELECTRICAL WORK SHALL BE BY DESIGN BUILD CONTRACTORS AND IS NOT A PART OF THESE c� - DRAWINGS. .,f' `Mi✓ ��.�rr•: s KEEP AREAS CLEAN DURING OPERATION FOR EGRESS OF HOTEL GUESTS. D4 ci , 21ul ,000 S:5 NON SPRINKLEREO; BUILDING FOOTPRINT APPROX USE GROUP FITFF yC r FIRST FLOOR PLAN MINIMUM CONSTRUCTION CLASSIFICATION TYPE 5A 'Y • PRESENTLY MIX OF TYPE 2C AND 5A Q, r, �l r:S SHEET TITLE: PART PLAN ENTRANCE LOBBY SHEET&JOB#: A-1 , ��Sl,a.l('� { �.UWc�.L•;: �.tt�it,�-- •i—�.a•----... . � t r �dsr-ate►�►�+.+. _ � 1 Ell f .I —.— _._. ... -• -- „�£'� �j �`j, �� ice/ r• [ F 11 X �{+' IRlSLE (O.+FGtCrCE r? !aue� 0}0 1' r ,g—lo 1 rrLerly S7c Z?rc L 1 tO +�� ; 11G• EY r 1 i iJ { op.ip - - - _ - - - - �- - j i tr 0 WoA i Dose C7) L JC �. x g � (665 x Ored- -7-71` 7060 ti. joii ; t r •, IN OL bL mj IV 3 - i a ` l..t �� i>�.�� :j.r �`'.� r+s-u.�,j�v .i�� i� �y��aq�� Afu�.,s}�S?•� :.,i� � _t �z � - .. � � � , - � �- � � � - �. '''�` ��S;"a�.�'-�3�9`3`�v+'y �c� r'z.'��tr'',�.s�`'��,�`�t',�'&� i i`t. �t•�...?�L.�w�3��.�-.H.�-: y-e .... _.� .. _.... .. ...... .._.. . �.. _. .__ .. .. - TOWN OF BARNSTA'BLE 2 ?9 OCT 14 Pil I: 17 D►`fi0 0 44 OL c T x � a ! •314 �� ,k tip ►. x `✓ �"'� i