Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0460 MAIN STREET (HYANNIS)
I - / � - 3c7� , �.. �?� - - ----.-- --- -- - i I kti �- ,,a,� i f f � _ Incl� E _ � • � :. P��ncea on 7�asr2aa� Co 1pla�nt CaII "N' 5 L&mffrABu?, • ,.:- 34 z €,n a a s.a� ,fl•z & _ .. 46�OMAIt�1 Case#: C-19-305 Address: 460 MAIN STREET(HYANNIS), Date: 5/6/2019 HYANNIS Owner info: Property Info: COURTYARD VACATION CLUB MBL: INC 125 NORTH STREET 309-225 HYANNIS MA 02601 Owner Notified?: Complaint Details: Type of Complaint Classification of Complaint Method of Complaint Building Code, Medium Priority Phone Complaint Summary: Inspection necessary to assess COI requirements. M&P 309-225 Please note that addresses are confusing. 460 Main is the restaurant(Fresh Ketch) and the Courtyard Resort uses 123 North ST, Hyannis although that is not actually a valid address. Must determine use of property-personal condos, time share or rentals or both. Action History: Action Taken Date Description Fee Inspector Close Case 7/15/2019 property is now in $0.00 bowerse system for COI Inspector Assigned to Complaint: bowerse Filed by: andersor Comments: Comment Date Commenter Comment ti OF,7HEl Town of Barnstable Inspectional Services I L4jW9TABLZ `; Brian Florence,CBO 1639• `0� Building Commissioner TEo MA'S s 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us INSPECTION REPORT Address : 460 MAIN STREET (HYANNIS), HYANNIS Case# C-19-305 Inspection Type : Violation Inspector: bowerse .. ....... ....... Description Date ]Unit Status Comment Violation 07/15/2019 PASS jApplicant has filed for COI .... __.._.._. .______..__ ___ .___�W_ .._... ....._._.. ..__.__ ._._. ._ ._.__._.� _. i___.__ .. . complaint resolved Inspection Type : Violation Inspector: bowerse .............................. ........................................................_..................................._..............................._................._............................__........................._........._._.................................................................................................................................................... ...................................................................................._............................._.._...................3 Description Date Unit Status l. ...... Comment Violation..._ 06/�25/2.a_�0.,,,19�.P PASS 'Spoke to manager He has been in contact with 'Brenda and is working on a Floor plan for the ;application. .. Should be .. .................. Inspection Type ; Violation Inspector: bowerse �._ .... _ ._. _..................._ ___ . . . ..... ._._...: ....... _ "... _._..__...... ._ . !,Description Date Unit iStatus Comment Violation 05/10/2019 PASS 'Spoke to manager president Ron Ranere He stated he will call Brenda and set up C01 inspection Intends to be compliant Ron Ranere Court, : • President Ron@cyrhyannis.com 125 North Street 617.818.4586 Hyannis MA 02601 www.cyrhyannis.com Permit Central Page 1 of 1 SEARCH p ovERviEw p Permit Central Barrows Debra 460 main Q 1 ....._.__ ..�...�._. . _� �® Excel ��_. ... ..__.�.Y__ . ._ 3 I f............ .......... Actions Permit Advanced 0 My Searches v v v Search Actions I View/Maintain Office .. __.. .._ ..__._<_..__M.__ _ .,_ .._.... _..._.,.. _......... ._..__...:._ Applications: 159 O Permits: 175 O J'A. Application Address Parcel Owner Description Status Received ....... . .................... ......... 1 .. 1 68188 O 460 WEST 269030 ASCLEPIUS 3 FIXTURES CC Complete 04/16/2003 MAIN CORPORATION HUMAN STREET SERVICES 78974 O 460 WEST 269030 ASCLEPIUS LAV/HOT WTR Complete, 08/31/2004 MAIN CORPORATION TANK/WTR ` STREET PIPING/WASTE " +. PIPING 79109 () 460 WEST 269030 ASCLEPIUS HOT WTR Complete 09/07/2004 MAIN CORPORATION TANK STREETq . f; j 82245 O 460 MAIN 309225 CONDO WORK REPLACE Complete 02/15/2005 �;h STREET WATER (HYANNIS) HEATER 82249 O 460 MAIN 309225 CONDO WORK REPLACE HOT Complete 02/15/2005 IOU,,- STREET WATER TANK (HYANNIS) 83183 O 460 MAIN 309225 CONDO WORK FRESH KETCH Complete 04/04/2006 111i STREET (HYANNIS) ...... .. ..... I << 0 < 01 30140 1 50 60 70 0 > 0 » 0 i https://munisweb.town.barnstable:ma.us/MunisProd/Appl4ost/PennitCentral/ 5/6/2019 Town of Barnstable Building Department Brian Florence, CB Building Commissioner 200 Main Street;Hyannis,MA 02601 www.town.barnstable.ma us Pre-application for Business Certificate A 09 � Date —z Z'J66 Map ' arcel Applicant Information A licants Name 144(M O W t� L `0 PP __. . —�. Applicants Address. MIS IARI'M S( ' t4l AiuAji S b 2A 01 Email Address ,�i t y h-e n f o j 1 1 ZD 0 g M A i L- C U Y✓I -Listed 0 Unlisted 0 Telephone Number S(24� -17 " S g05 Business Information New Busmess7 ----------------------------------------• Yes Business is a registered corporation? .---.---------------------. es No � ) If yes Name of Corporation 'CS S G�OU PA File, Does business operate under the registered corporate name? es No Is the business a sole proprietorship or home occupation? --------- Yes If yes then a Home Occupation Registration-is required—See Building Division Staff Name of Business 'r"Qesh 'e�c� Business Address Io,1 Vj \ �� ��I S rW"S 02'6U1 Type of Business ?tw;AYE Building mmissioner 0 ce Use Only Conditions I�LD 11I_ BuildingZ'r jw� - Commissioner_ Tat5 Clerk Office Use Only a; Ps 178 11—e-A-2012 �r i Courtyard Resort Condominium Trust CERTUICATION OF VOTE F We,the undersigned,hereby certify that at the Annual Meeting of the Unit Owners of the Courtyard Resort Condominium Trust held on November 5`h,2011 and with a quo present and voting in accordance with Section 5.10.3 id Trust,the f rum {Y elected Trustees of the Courtyard Resort Condominium Trust: ollowing were to � Anthony Lavina Jt! Robert AlIaire W.Jon Lemoine F Ralph Krau 11,3. We further acknowledge that by executing the within document we accept election and appointment as Trustees effective on the date of our election. �A4nthma Robert Allaire a.Jon e neRalph $ if COMMONWEALTH OF MASSACHUSETTS Barnstable Count Zgdayof,� Onthe 2012,before me,the undersigned not ary public, Personally appeared,Anthony Lavina,Robert Allaire, W.Jon Lemoine and Ralph Krau proved to me through satisfactory evidence of identification which was Drivers Licenses and Rhode Island Drivers Licenses,to be the persons whose name aere t� signed on the attached or preceding document and acknowledged voluntarily for its stated purpose. g to me that he signed it f. y 1 1. ♦ �•....... iL oP_,p��tis=T z otary Public . a x, My commission expires: OV12.712-01 wU� - � ; BARNSTABLE REGISTRY OF DEEDS I a . � sooK6dl�9c� 17� 78800 I .•Y " - t;, F DECLARATION 'OF TRUST + u ✓- ARD RESORTOCONDOMINIUM TRUST I COURTYARD •�, is - Table of Contents Name of Trust Ar 4$ 1 l j ticle I: , Trus The t Purposes I. :Article II: Unit Owner's Organization r 2.1 - 2.2 Not a Partnership . 2 r The Trustees i Article III: 2 3.1 Number - 2 4 3,2 Term ointment and 2 3.3 Vacancies; Appoint 3 Acceptance of 4 3.4 Trustee Action 4 35 Resignation; Removal 4 { 3:6 Compensation of Trustees . 4 § 3,7 No Personal Liability 5 3,8 Trustees Mof' T al rusteesWith Condominium . �. v 3.9 Indemnity . :. 5. # f Article IV: Beneficiaries and the Interest. in the Trust 5 4.1 Beneficial Interest 5 42 Each Unit to Vote by One Person . 6 . Article V:. By-Laws 6 4� 5.1 Powers of the Trustees s w 5.2 -Maintenance and Repair of Units 5.3 CommonnAcement Of teas andair a Facilaties1aAssessement .. 7 ' of Common Expenses Therefor g 4 < 5.4 Common Expense Funds ' - B 5.4.1 Condominium Dues or Charges 5.4.2 Reserve Funds 9 5.4.3 Estimates of Common Expenses• x and Assessments • • • 9 . . { Application of Common Fundss ees 9 o T 5.4.4 APP ' a 5.4.5 Notice. of Default to Mott9 9 e •gam - ,; - 9 . = - Rebuilding and Restoration, f f, 5.5 Improvements . 9 5.5.1 Determination of Scope of Loss 5.5.2 Submission to Unit Owners of 9 - Proposed improvements - • , MM 5.5.3 Arbitration of Disputed Trustees. 10 xx Action ' 3 7. ,a f ; • _ I .. • ' THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I M ^�C C DATA J a �! B k 26915 Rs 177 �b37'21 v 1 —�71-2 is 12 a rw I� Ove � 7777 Courtyard Resort Condominium Trust CERTIFICATION OF VOTE 1 a ► ' dersi ned hereby certify that at the Annual Meetin of the Unit Owners of the I,�the,un g Y Courtyard Resort Condominium Trust held on November 5 ,2011 and with a quorum resent and voting in accordance with Section 5.10.3 of said Trust,the following were rp =_elected Trustees of the Courtyard Resort Condominium Trust: David May Ifurther acknowledge that by executing the within document I accept election and appointment as Trustee effective on the date of our election. r i amz, C ` D d May R ; E "�` COMMONWEALTH OF MASSACHUSETTS "•AVAIABtE. na- OF •+ ,u Barnstable County, ss: Public, On the�day of ' Atia 2012,before me,the undersigned notary p , s•, personallyappeared,Da proved to me through satisfactory evidence of identification which was a Massachusetts Drivers License,to be the person whose name i �µ.. is signed on the attached or preceding document and acknowledged to me that he signed ua of uEAm == it voluntarily for its stated purpose. I ?YWN�LF_.D UFAO:. - 70.SE I�.OF r' �I im.p_ e _ Fred C.Bottomley of- Notary Public Notary - commonwealth of Massachusetts J. 1Q;201 My Commission Expires UTTv4 �P December27,20i3 G, B 0 fi my commission expires: IV, 4. Y xa I e�+q ls�V/L 4t�� c1_ a r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel_Q�O 5 too ). A Application # B Health Division 2 Date Issued Conservation Division 3 Application Fee , Planning Dept. Permit Fee %f Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/.Hyannis Project Street Address D / 2 PJd . Village 01V&0n 1 IS Owner_---,CO D Gal Address M3DIV Telephone C_�D'd 7 0-0 Permit Request _ eA PO'(L C`1!� P-M r~ v z- Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Silo Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) Age of Existing StructureJ�"� Historic House: ❑Yes )d No On Old King's Highway: ❑Yes/W No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑existing ❑ new size_ Attached garage: ❑ existing ❑ new size —Shed: ❑existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION - (BUILDER OR HOMEOWNER) Name � 'f><S /��/� �- Telephone Number '_5 U -7 2 1 Address 1SY License# S� :154AUJ 54M 9? lg f� CD Home Improvement Contractor# O'D Email J �1�1 � d L 0i� R Cc�, Worker's Compensation # ALL CONSTRUCTION DEBRIS RESU OM THIS PROJECT WILL BE TAKEN TO u SIGNATURE DATE 06'o z _ / 7 FOR OFFICIAL USE ONLY n P ' APPLICATION # DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH �J FINAL FINAL BUILDIN e 2 VD/ DATE CLOSED OUT ASSOCIATION PLAN NO. 17ke Colnno7r makk qfMassackusetts Office- 600 Washington Street Bastva,MA 02HI • k4'FVt'iLT71aS�g'QP�[�iLt Wmimrs' CampensafianLmu-nce Affidavit B•filer-dCuntracturgMect *rLans Plz tubers Applicant luffirmatian n ' Please Print Dame ��ionlln &a1 / 9 � L' bill � • .__. • 0 Are you an employer?Cheekthe appropriate bets T ofproject r .I.❑ I am a 1 Keith 4. ❑I am a general conf mctor and I P ( e4�d)•: �P employees(fu11 andl`oI r garb-lime * ?rage lvredfi$e sub-contractors 6. New constraicfi�� Z. ] I am a sole proprietor arpartaw listed onthe attffrhed sheet 7_ ❑RemodeHng // s and pageemployees. These soh-contractors have �P S_ E]Demolition: , wad-ing forme in,any capacity_ emF17�ees andhave WodMrs' c in Eance. 9. Svildsng adxiifioa INO�Lg'comp.in airanre gip- regaired 5. We are a torporatian and its 10:0 Elechcal repaifs or a,dc tuns 3_❑ lama homeo=er doitrg aII Work of cen have exercised their I❑Plumbingregairs or additions Myself[No woi,ers'comp- right of exemption per MGL L,. c.1.52 g (4h L ❑Roafrepairs +�+��n�e required,]i ' . 1 andwe FiaFvea:a . . employees.[No workers' I3.E•Other comp-msruance required_ #Aagsppficm &2tdMtI3F0s#lmastalsofiIloutthe—d-bgowskvvdagi pirvm e&lcompw=gdmpoyeyirff3rmsa= �E�nateovmetsuho submit r$is af5da�u iudicafiog theg are dome alF wa�Tc and tbeahtre outside car�cmrsamst submit a new a�daait india�ao ss�cEt ' FCanlxacfosfast t3 �this boa mast attchea as addi6nnal sheet shnnng the r—of the sub-contrscbo-is sad state Whether ar oat•those ertitieshaVe empio}ees.7€theSvIrtaatrad�ts e�gIoF�sidze}'mvstp—I&tbeir wurke,,Co'p.pau g—ban I am art ettip7r drat pra��tiircg te�rrkers'caurp�rrsaftrrrr i�rsruarrce for isr etrrpfes $aloiv is der puTiry arm jQIa azte ire,jarmcrliar� . - ' InsmmnceCompany Name : - PuIicy or pelf--izys_Li/c_ F—xpisstiouDate: tab Site Addy �6 IV14-IIJ citylStafel7.tp ; n9 p Atfach a copy of-the workers'compensationpolicy declaration page(showing the policy er and expo ation day Faiime to secure coverage as required under Se 63n 25A o€MGL c.157 can lead to the imposition of ccimi.�rtal penalties of a fine up to SL50lk OQ andf'or one-yearinVds=nank as well as ciO penalties in the form of a STOP WORK ORDERand a i W of up to SO.0a a day ag-ainst the violator. ed that a copy of this sbiftmmt may be forwarded fn five office of INVesEgadons of the DIA for ihs vetage�, ffi �t�0�LErBy GB17� ubr .- s ag fltatifia irrfarnxa#iar�ptmded above i�bzr8 aetd correct Siam Date ��0 � 1 OjgEdd ass roily. Do not write is dds area,fa be crrrripiete�d by city artolrri o,,�OL-Wl. City or Town: PermitUcenseff- ESUing AXOMrity(c-Ck Dne): L Berard of$•eaItb. 3.BuffZmg Departm,eat 3.#lWlrown Clerk 4.Electrical hmpector 5:Plumbing Inspector 6.Other Contact Person: Phone 9: ormatian and lastructiffias hassarlmcetts De al Laws chaps M requicPs all enTlDYcM'a ptuvida woe s'comPeasaiion for$leir employees. Pmsuaatto this sue: Iayee is defined M. .may person in the seaYice of another under any co w°fh�, CxPrMW or EMPHDC%oral or written" oration or other legal et±fy,or any two or more err�Ioyer is d�tmed as Sae,inMl,partoe=SbT,associaiion,carp of a deceased Ioyer,or the of t3ie foregoing is a1omt eoteapase,and mclndmg the legal Fegrese Ives .However the receiver or trustee of an in&vid�p ip,association or ocher legal entity,eanplopmg=P Yees. OW ner of a,dvveIhng how D�gnot more tba .tbree aparimeats andwho resides therein,Or occupant ofibe- dwelling house of moo ers r who employs persons to do maim,consUuctzon or reypa WO&0n such dv,*eIbng house tiier;b shaUnDtbmanse of sash em:IDYMED±bD d=me'dto be an employee" or on the grounds ar btIIZdmg agpvr�naz¢ . 1_�IGL cbapfnr ISZ,§25C(t7 also states that"everystafn or local li p�ageacyshallwithhold the issuance or renewal of a licease or permit to operate a business or to mnsirucE burgdin.gs za the commQnwe�th for any applicantwho has notproanced acceptable evidence of compiance with the Insurance coverage required" ter ISZ,§25C(T)status W6±1 er,the: nor jay ofits poItECal snbdiivi sions shall Addr(ionaIly.M rCtL chap o talce f comp a c line viith the ii ` C6. cotes into any ccontactfor the PM ofpublic vatic�accepbe eviden rtgaEm�me�s of tb.is chapter have been presen ted to the co�radmg anfhozify_" A.pplic=-& mp by�ecl�g ib a boxes that apply Yoe sitnafion anti,if Please fa 0i± the W011 ,compeusafion affidayit co y, s I withtheir ce cam(s)of n�ai:y Ply���°I(s)nm�s),aaft ssCes)andphsmernn M()along ano levees otiexi�the Dance Lmmite Uabi 4 Companies(ILC)orLi�dLiabMtyP p .(LU) members or parft s,are not required to Miry wormers'compensati°n iosor-ance. If an LLC or T T p does have employees,apolicy isregaued. Be advisedthAthis afddayitmaybe sabmftedto the De-pa-iment of Indtisfrial Accidents for confirmation of fimmaace coverage_ Also he sate to siga and dafx#_he affidavit The affidavit should be resumed to the city or town that the apPlicati°a for the pe Emiit or license is being regaest A not the Depa lment of ; T„ri, ,,-i.l,A c; dcata Shouldyou have any gnestions regardmg tb a IaFY or ifyoa are requnced to obfaia a worker' Mu2pens policy,please callthdDeparfineatattbenua berlistbdbelow Self-inssredcampames should��rt3leir ati s elf-m surancd liczaaSe nBmber on the appiupriatu line- City or Town Ofddals Please ore be s tbat she affidavit is camplebe and pri±xileg l - The Deparimeathas Provided a space at,the bottom of the affida�for youth fill out in.the eveuttbe Office oflnvmliga ons has to conactyoaregardmglbeepplicant ure to fill in the peunit/Iicense MMber WhicIL wM be used as a refore< m number. In-a ddition,an applicant ub Please b e s that must sure mvliple pennitjHmnse applications m aay givmyear.need.only submit one affidavit mdic?ting�t p olicy infosc.ation Ctf necessary)and undue`Job Situ-Q_tir =Se *tie applic,ant should wzt--Sall Iocativns p ( 3' town)"A copy of the-affidavit that has been officially sfamped or malted by the city or town maybe provided to the " applicant as proof that a valid affidavit is on file for 53±M .pew or licenses A new affidavit must be fMcd oi>t each o alicemse or permit not relafedto anybusin=or commercial vent` year.whexe a home owner or cozen.is btammg P Iete ties affidav�.t (i a Cl og ogliceoseorpeuarttnbumleavesetc.)saidperson.isNOTrMT ed�� The Office of Investing-�would lie to IhmkYott11Ladymm for your cooperafion and should you have any questions, please do not hesib�to give us a call The.Deq artmmf9addresstelephone and fax nIImbm-- T CU ttbE of Massarh I mMt c&IadsfiakAoc�dent-:z 4 �n St-C;d - �0�,11�4 E�IIF. • Fax 9 617 727 7M Revised4-24-47. w -gaZrfil Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-014501 Construction Supervisor STURGIS ST.PETER 1"� P.O.BOX 372 �. BARNSTABLE MA 02630• ;r ,,� l�r Expiration: L___�C20M_M1ss_ oner 08123/2017 ,_ ..., '✓�B YlYlir/I7r,P9'teOeC6C/�0/191,lchccsefl - office of Consumer Affairs&Business Regulation (• HOME IMPROVEMENT CONTRACTOR by _ Registration, -1,00390 Type: I N Expiration -�/}-6/2018 Individual '- �V 50 STURGIS Sl PETER C ,. Sturgis St.Peter 'I V..Z' 65 Cindy Lane/P.O.Box 372' Barnstable,MA 02630 —'m Undersecretary License or registration valid for individual use only before the expiration date. If found return to: € office of Consumer Affairs and Business Regulation ?' ' 10 Park Plaza-Suite:5170 Boston,MA 02116 f . t signature,with Not v 3{ I�, , „�..I..•r.v.•o�r.•'V gip•••_ , s ao�c6 :s� ILA 'a ar:: '76600 • r. ?•:� J,. y;<•.� DLCLARATION OF TRUST or RUST COURTYARD RESORT CONDOMINIUM T it ': Table of Contents ~• Name of Trust �•.; •',* g�.; Article I: ArtiCle II: The Trust PufPQG85q " owner's Organization 1 .. 2.1 Unit O i w ��. 2.2 Not a Partnership • • . • • . ' 1 !# 2 Si Article III: The Trustees . . . . • . • . 3.1 .Number . . . . . 2 3.2 Term .3 Vacancies; Appointment and 2 E•. 3 Acceptance of Trustees 3 t: 3.4 ' Trustee Action - 4 3.5 Resignation; Removal • • . 3,6' Compensation' of Trustees' . 4 . . .. 4 • No Personal Liability r�- ! 74 3,9 Trustees With.Conflomiaiu. 5 >r' 3,g Indemnity of Trustees •.fix` ZSrf .• Article IV, Beneficiaries and the Beneficial Inkarest 5 in the Trust . . .. . . . . . . . . . A.1 Beneficial Interest • V 5 y 4.2 Each Unit to Vote by One Person Y 6 ,c ACCicle V'. By—Laws 8 5.1 Powera of the Trustees 7 5.2 Maintenance and Repair of Units Y g.3 ,Maintenance, Repair and Replacement of Common Areas and g'aeilities, Assessement . 7 of Common Expenses Therefor B Common ExPease'•Funds .•, 8 • k 5,4.1 Condominium Dues or Charged e • 5.4.2 Reserve Funds ' 5:A.3 Estimated of Common Expenses 6 and %asessmente - 9 5.4.4 Application of Common Funds 5.4.5 Notice- Of Default to Mortgagees 9 c 3.5 Rebuilding and Restoration, 9 Improvements, . .y 5.5.1 Determination of Scapa of Lose 9 ?. •'5.5.2 Submission to Unit Oanere of g Proposed Improvements 5.5.3 Arbitration of Disputed Trdste6s. 10 a; 'Action �; _ j; • A 'lM'.1 •�. '.;;I- • .. . moo, .. :. , SSNAAI 1!11 '• r;l ;I Bk 2681-5 Ps 178 463722 A' hi i�, Courtyard Resort Condominium Trust �. C19RTMCATION OF VOTE We,the undersigned,hereby certify that at the Annual Meeting of the Unit Owners of the Courtyard Resort Condominium Trust held on November 5� 2011 and with a quonim present and voting in accordance with Section S.10.3 of said Trust,the following were y, elected Trustees of the Courtyard Rewit Condominium Trust: Anthony Lavina Robert.A.11airo W.Jon Leuoine Ralph Kraa III . i We further acknowledge that by executing the within document we accept election and appointment as Trustees effective on the date of our election. �Aathonyony vwa Robert Aare k. Vf Jon Lejuv Ralph COMMONWEALTH Of MASSACHUSETTS Barnstable County, ss: I� OntheZgf day of 2012,before me,the undersigned notary public, personally appeared, Anthony Lavina,Robert Allaire,W.Jon Lemoine and Ralph Krau �I proved'to me through satisfactory evidence of.identification which was a Massachusetts t Drivers Licenses and Rhode Island Drivers Licenses,to be the persons whose name are �Cl signed on the attached or preceding document and admowledged to me that he signed it .lE . IC voluntarily for its stated purpose. . 11 E �%., Notary Public F, i�fy,,jo1 My commission expires: 0�/2 7 F; . . S ARNSTABLF REGISTRY OF DADS OftFIE 1p Town of Barnstable Regulatory Services • r MASS Richard V.Scali,Director i63q. 10 . ► +' Building Division. Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office:: 508-862-4038 Fax: 50.8-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, Tony Lavina ,as Owner of the.subject property p ec�� }— 1 P �Y hereb authorize z t� 15 `tiY to act on mp behalf, in all matters relative to work authorized by this building permit application for. (Address:of Job) **Pool fences and alarms are the.responsibility of the applicant Pools are not.to be.filled or utilized.before fence is installed and all final inspections are performed.and accepted. Signa a:of Owner. S' ture App 'cant 0 .1 Tony Laving 5-rfJ ' Print Name Print.Name :Date QTORMS:OWNERPERMISSIONPOOLS r TOWN OR BARN'STABLE BUILDING PERMIT APPLICATION Map 309 /Z45 Parcel 30922.Sj Application Health Division Date Issued 1 L Conservation Division DUI G D�pr Applicationfj4- /V() V Planning Dept. Nov 02 Z® Permit Fee Date Definitive Plan Approved by Planning Board TOWS / - S Historic - OKH. _ Preservation / Hyannis ARNSTASCE Project Street Address 4160 JAAA9 STM ,T Village HyANN%S OwnercAntoAcC pomoS/9A,-TC„i.119R. -MQ5-r 11 Address 93 eta HUr RC),6,14-Kot`tT.r1A OZ178 Telephone �Gt7�-959-4`i65 Permit Request RamovAj OF F.acZt✓gUoR A*. D Root S►1lwusS \.y1ru REPLAr.,LKEtA-r Of JLP._W WINtJot/S EL.& �Mtk f.w1 XaCG S14caQI Ec Square feet: 1 st floor: existing�45proposed 6�",,5 2nd floor: existing WA_proposed "1A Total new O Zoning District H V J_Flood Plain M/p Groundwater Overlay M �A Project Valuation g �s�. Construction Type V 8 Lot Size 1.&1 AcGkES Grandfathered: 66 Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ N/A,Two Family ❑ N/A Multi-Family(# units) Age of Existing Structure 29 YEARS- Historic House: ❑Yes 0 No On Old King's Highway: ❑Yes 0 No Basement Type: ❑ Full XCrawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) N 1A Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new O Half: existing 141A, new N�A Number of Bedrooms: hl s existing —new Total Room Count (not including baths): existing 4 new 0 First Floor Room Count + Heat Type and Fuel: )(Gas ❑ Oil ❑ Electric ❑ Other Central Air: XYes ❑ No Fireplaces: Existing _New _ Existing wood/coal stove: ❑Yes )d 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 # NSA Recorded ❑ Commercial �d Yes ❑ No If yes, site plan review# tA hp. ` Current Use VF.5'VxU?U5.,yXT Proposed Use R1:STAQ7,b%t 1 APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name C.oRSER\1 CkQpgP tt4C - Telephone Number 50$ -88$•�555 Address 110 STATE Q om> gJ c'CE —1 License # G5-00 5IS 7 5 A, o 1yl 02 6 Home Improvement Contractor# Worker's Compensation # 6O L 4-?.L �o9L 4-?.L �09 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Row4AAESL, P.D. Box 11 43 T EST s ato4edk-rg&�MA SIGNATU DATE IFOR'OIFIFIICIIAL USE ONLY APPLICATION# DATE ISSUED M PARCEL NO.AP/P ADDRESS VILLAGE OWNER DATE OF INSPECTION: •FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL' FINAL BUILDING (-cr-)(,lL-6l/'7 V4 DATE CLOSED OUT ASSOCIATION PLAN NO. I r � Town of Barnstable Regulatory Services Building Division 'Tom Pam,9WvM coam"Wow Main Stutz.Hymn&MA 0201 mr+.rdnaa.t�asa�txbt�.r�.ps Office. 5 -14038 pax: 508- 0-b23 . Property. Owner Must Complete and Sign This Section U5 na.A. "Builder T 0Qr t EA TOk,Tic C nc:r of tit subi.cct property htitbv authorize ate ua 2cr an is behil� !n all amaers rebti .if)work audwazcd by ris buikfi g permit appFx ti for. � s of Job) *Pool fcncc s and a3 art the rcsWmibdity of the ipplkaj�L Pools arc not to be filled or acd dare fmxe is all inspections are performcd and,acccpm L S4�nituttof Owner 5i axse of Anl cavt Print N scat 4NL'W r I vtpv �Yarr" Initial Construction Control Document = W To be submitted with the building permit application by a Registered Design Professional for work per the 81" edition of the Massachusetts State Building Code, 780 CMR, Section 107 Project Title: Fresh Ketch Building Renovations Date:10/31/16 Property Address: 460 Main Street,Hyannis,MA 02601 Project: Check(x) one or both as applicable: New construction x Existing Construction Project description: Removal of exterior facade and windows with replacement of new windows and new panels and trim. I David Vachon MA Registration Number: 7471 Expiration date: 8-31-17 , am a registered design professional, and I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning': x Architectural Structural Mechanical Fire Protection Electrical Other: for the above named project and that to the best of my knowledge, information, and belief such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Code, (780 CMR),and accepted engineering practices for the proposed project. I understand and agree that I(or my designee) shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to: 1. Review, for conformance to this code and the design concept, shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Perform the duties for registered design professionals in 780 CMR Chapter 17, as applicable. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work is being-performed in a manner consistent with the approved construction documents and this code. Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107. When required by the building official, I shall submit field/progress reports(see item 3.)together with pertinent comments, in a form acceptable to the building official. Upon completion of the work, I shall submit to the buildi official a `Final Construction Control Document'. Enter in the space to the right a"wet"or oaw electronic signature and seal: vacs L• 4 Phone number: (508)-888-6555 Em conservgroup.com Building Official Use Only Building Official Name: Permit No.: Date: Note 1. Indicate with an`x'project design plans,computations and specifications that you prepared or directly supervised. If`other'is chosen, provide a description. Version 06 11 2013 ACC)RE® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDNYYY) `� 1 10/28/2016 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 Lynn Blanchard CIC CISR NAME: y FIAI/Cross Insurance PHONE (603)669-3218 No):(603)645-9331 1100 Elm Street E-MAIL ADDRESS: enc lblanchard@crossag y' m co INSURERS AFFORDING COVERAGE NAIC# Manchester NH 03101 INSURERANational Fire Ins Co of Hartford 20478 INSURED INSURER B ConSery Group, Inc. INSURERC: 110 State Road, Suite 7 INSURERD: INSURER E: Sagamore Beach MA 02562 INSURER F: COVERAGES CERTIFICATE NUMBER:16-17 WC REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DDIYYYY MMIDD/YYYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES Ea occurrence) ccurrence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY JECT PRO ❑ LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ WORKERS COMPENSATION 6014222869 X PER OTH-. AND EMPLOYERS'LIABILITY - STA PERT ER ANY PROPRIETOR/PARTNER/EXECUTIVE YIN N/A (3a.) MA & CT E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? A (Mandatory in NH) All officers included 7/1/2016 7/1/2017 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/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Barnstable, MA THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 367 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis, MA 02601 AUTHORIZED REPRESENTATIVE M Guarino/JSC ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025/201401) I The Commonwealth of Massachusetts , Department of Industrial Accidents ' VI Office of Investigations -` 600 Washington Street Z Boston, MA 02111 www.inass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Got-AsfifZ.1! G PCop . ►nl(l. Address: 11 O eSTAX 5 Roat Sv I'C E -T City/State/Zip: Phone #: GSos, S56-(o55S Are you an employer? Check the appropriate box: Type of project(required): 1. X I am a employer with 15 4. 1 am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. New construction 2. I am a sole proprietor or partner- listed on the attached sheet. 7. X Remodeling ship and have no employees These sub-contractors have g, X Demolition working for me in any capacity. employees and have workers' 9. Building addition [No workers' comp. insurance comp. insurance.+ required.] 5. We are a corporation and its 10. Electrical repairs or additions 3. 1 am a homeowner doing all work officers have exercised their 11. Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12. Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13. Other comp. insurance required.] *Any applicant that checks box#1 must also till 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: N AT tok At» FIRE 1 tyS co ' OF W A.&_r fo2.�1_> Policy#or Self-ins. Lic.#: &014 z2 Z S 69 Expiration Date: 7 11 1 Zp 17 Job Site Address:4(,O MAtt_ST. City/State/Zip:1i)%Ut41�MA 02610 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 $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby c under the pains d p nalties of perj y t t the information provided above is true and correct. Sianatur . ' Date: 1 2 Phone#: (Son S$a"(o S55 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#: Massachusetts Department.of Public Safety Board of Building Regulations and Standards License: CS-005157 Construction Supervisor ROLAND B CATIGNANI +• 60 GEMINI DR W BARNSTABLE MA a �-•�� Expiration: Commissioner 05/23/2018 s 4 L YOU WISH TO OPEN A BUSINESS? „ For Your Information: Business Certificates cost $40.00 for 4 years. A Business Certificate ONLY REGISTERS YOUR NAME in the Town (WHICH YOU MUST DO according to M.G.L. - it does not give you,permission to operate). You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1st FI., 367 Main St., Hyannis, MA 02601(Town Hall) and get the Business Certificate that is required by law. Fill in please: DATE APPLICANT'S YOUR NAME/CORPORATE AME ?616CAkrprlc��J INESS •TO'�� BUSIN $$.� � YOUR HO AD S Lo N �f�NPE. p TELEPHONE # Home ele hone b r NAME OF NEW BUSINESS OR EIN: Have you been given approv f m e buildi divis�Q YE NO ADDRESS 2F BUSINE . 1�. - y,( (� MAP/PARCEL L NUMBER —� L _ �� When starting a new business there are several things you must'do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. — (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMM SSIO ER'S OFFICE This individual h s n-infor d an per it requirements that pertain to this type of business. \ Au orized Sig atur COMMENTS• O �� ne 2. BOARD OF HEALTH This individual has been informed of the permit requirements that pertain to this type of business. Authorized Signature'* COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature" , COMMENTS: G Town of Barnstable NP�OFTHE Tp��o� Regulatory Services Director > BA U4STABLE, MASS. y-� Licensing Authority . '°Ten MPS° 200 Main Street Hyannis,MA 02601 www.town.barnstable.ma.us Fax: (508)778-2412 Telephone: (508) 862-4674 APPLICATION FOR NARR ATED TOUR ROUTE BUS 01 �22"� Name: Cc lJ V n �Z Address: Number of buses: Storage location tour buses: Hours of Operation: r J Tuesday Wednesdays S` Thursday Friday Monday -� Saturday -�= Sunday Specific Route(Identify each stop,th duration of the stop and if the stop is on a public or private property): j Please attach a map detailing the route(s)above. S Start,end location&location of ticket sales: �� M detailing experience and expertise in operating a tour bus. Y�L Attach a narrativeg {eMCIAttach a narrative explaini ng ywh it is in the interest of the public to grant this application A fy th t 's application is being submitted under oath: Date: The following must be presented with application:i Copy of Taxi Operator's License. List of proposed rates Drawings/photos of tour buns units in the amount of$1 million dollars Liability insurance certificate(or intent to provide insuranc ) i Fees: $100.00 filing fee&$50.00 Special Permit fee PER VEHICLE Permit expires 12/31 Town Manager Approval: Q:\WPFMESU.,ICENSING\Tour Bus(Trolley)\Tour Bus Application.DOC k TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Dr: RAJ Map 30 t Parcel aOS i� Application ."3 1 qo t-6 � 25' Health Division Zg1 11kY -7 tV' IDi atRsued 5-14" is 1 p C Conservation Division L Application Fee Planning Dept. �� ►�. �� -oS-�dL -- --Perfii it Fee . Date Definitive Plan Approved by Planning Board DIViwrF�� Historic - OKH P _ Preservation/ Hyannis a Project Str et Address M&A r 46O Village17 Owner f Address" Telephone Permit Request avi /wh)l 01 6al dil 4, Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) �, � y, / o - �1 Name f (iVli (� Telephone Number 026 l Address License #q 0 Home Improvement Contractor# n Email i�,� 7i�`t�/ �� �0/nn 4 ``� D ., CORI Worker's Compensation # C oq ( go�oI ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO �� r✓IX� SIGNATUR DATE /� FOR OFFICIAL USE ONLY t; �4 APPLICATION# DATE ISSUED MAP/PARCEL NO. { 4. ADDRESS VILLAGE s � s OWNER DATE OF INSPECTION: ` FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL r _ `. GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. X< The Commonwealth of Alassachlrsetts, --1 Department oflndzistrial.Aecidenis 016ce Of7Z� Vestioatio,zs -600 Washington Street Boston, MA 021.1.1 - W.T-).mass.govidiu Wor.kWs compensattiola Insurance Affidavit:Builders/ContractorsMectriciaus/pliitnbers . Applicant Tnfomatioln Please Print Legibly Name(Business/Organization/indi-vidual): Address: r - City/State/Zip: 7 1� ©� t!l J�5 Phone#: � XC/2 Are you an employer?Check the appropriate box: Type of project(required.): I. E3 .I am a.einployer witU__� 4•❑ I'am a general contractor and I have 6. New cc- employees(full and/or part-time).* „ � � euon P" . 1 hired tie sub-.,or,tractors lim-d on �, Remodeling 2, � the ^t�e6.siieety I am a sole proprietor or partnership These sub-contractors have 8, Demolition' and have no employees working for employees and have workers'comp. 9. Building addition me in any capacity.[No Iorkers' insuuance. comp insurance required.) 5. •We am a corporation and its 10. Electrical repairs or addition officers have exercised theaf ight of I L❑Plumbing repairs or additions 3 I am a homeowner doing all work exem Lion er'MOL c P .152' 4 l? and 3( 12. Roof airs myself.[tiro workers'camp, � we have no em Io ties. Q � ' P Y d.] workers' 13.❑Oth,—, insurance required.]i comp.insurance required.] 'A.nv applicant that checks box r1(rest also:au out the Secdtfn below snowing their wo:kers'.comper mrion policy iioraeadon t Homeowners who submit this affidavit induxting tluy ars doi:g all work and then hive o,:rsid contracwrs mua saga to new affidavit indicacn� $CoLtractars that check this box must attach an additional sheet snowing tlu name of the sub-aontntxc.s and state whether or not those trrti ies haveaployees If the sub rotors have cxaploYees they mast provide their;vorkers'comp,Policy number. I am an employer that is propiding workers,compensation insurance for ry employees.Below is the policy andjob site infomwdo& Insurance Cort paay Name: ���� y C, J'�CL �A � {' Policy r or Self--ins.Lic. W D 30(.9 0 l % 26 Expiration Dsrte: Job Site Address: 440rna, -ISWJ— Citylstate/zp: Attach a copy of the workers'compensation policy declaration page(shawbng the policy number and eo irziion date). rahure tc seonre coverago as required Lmder Section 25A of M(3L c.152 can lead to the i=osiE on of criminal one-year impti sonnleat,as weU as civil penalties is the fona of a STOP WORK ORrDER and a fine of uu to$250 Co �y of a rrAc np to$1,500.00 and%or that a copy of this starement may be forwarded to the Office o`Investigations of the DU for insurance coverage vex frcation�auts[ta�violator.Be advised c .16 hereby certif the erlalties of perjury•that the information d above is true and correct, Signature: Date: Phoonet a' j Official use only.Do not write in this are';to be completed by city or town offIciat I City or Town: Permit/License n Issuing Authority(circle one): - t I.Board of health 2.Building)Departutent 3.City1T01vn Clerk 4.Electrical Ia-peetor 5.Plumbing Inspector 1 6.Other Contact person: Phone#: -� FRASCON-01 PAAS - .- CERTIFICATE OF LIABILITY INSURANCE DATENMO""") 9/1912013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE ES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING NSURER($),ED BY TAUTHORZHE IED 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 Viveiros Insurance Agency,Inc. (508)676-0309 NAME: AshleyPaiva 375 Airport Road uc.N Exr• 508-676-0309 127 Ip (Afc,No): 508-324-9147 Fall River,MA 02720 ADDRESS:APaiva Viveirosinsurance.com INSURERS AFFORDING COVERAGE NAIC 8 INSURER A:Granite State Insurance Co INSURED Fraser Construction LLC INSURERS: PO Box 1845 INSURER C: Cotult,MA 02635 INSURER D: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPEOFINSURANCE IN SR WVD POLICYNUMSER MOD MMIDD P LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS MADE OCCUR MED EXP(Arryone person) $ PERSONAL&ADV N URY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIrAPPUESPER: PRODUCTS-COMP/OP.AGG $ POUCY D PRO- LOC $ AUTOMOBILE LIABILITY I SIN UM ANY AUTO Ea accident $ 13ODLY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS _ - BODLY INJURY(Per accident) s HIRED AUTOS NON-OWNED AUTOS Par accident A $ 4 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS L A6 CLAIMS-1v1ADE AGGREGATE DED RETENTION $ WORKERS COMPENSATION - $ AND EMPLOYERS'LIABILITY OC STATU OTF A ANY PROPRIETOFWARTIERIEXECUTIVE YIN W0009930601 TORY MITS ER OFFICER/MEMBEREXCLUDED? NIA' 9/26/2013 9/26/2014 E.L.EACH ACCIDENT $ 500,000 (Mandatory In NH) ". It yes,describe under E.L.DISEASE-EA EMPLOYEE $ 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(AttaellACORD101,Add&IonslRemarks Schedule,Ifmore space rsrequired) - - CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Barnstable Building Division THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN 200 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis,MA 02601- AUT1i0R1ZED REPRESENTATIVE O 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD 4 1 !r * Massachusetts -or2partment of Public Safety 801rd of Building Requiations and Standards I Construction supervisor License; CS-Oa7668 ` MAN C FRASER-` 1,a04 I'W�,RgN EAOA FAL OU 1 / Expiration Commissioner 06/07/2015 zs Fraser Construction, LLC 31 Bowdoin Rd. Mashpee, MA 02649 Email: info@fraserconstructioncapecod.com www.fraserconstructionca ecod.com FAX 1-508-428-0123/ PHONE 1-508-428-2292 HICL#112536 CS#97668 RE-ROOFING PROPOSAL t DATE: April 28, 2014 PHONE 508-775=8783 _ D NAME: Ed Tellier EMAIL: MAIL ADDRESS: .JOB ADDRESS: Fresh Ketch 460 Main St. Hyannis, MA 02601 FRASER CONSTRUCTION hereby proposes to perform the following services in a neat, professional like manner in accordance with the manufacturer's specifications and local building code. Job Description: - Remove and dispose of railing and existing roofing materials down to existing roof deck -Install Pressure Treated wood blocking on perimeter to accept new roofing system - Repair deteriorated roof deck with 3/4" plywood at an additional cost of$4/sq. ft - Mechanically fasten (2) layers of Isocyanurate Insulation to roof deck - Install .060 Black EPDM Membrane fully adhered to insulation - Tie new roofing into perimeter of elevated EPDM roof area - Remove and reinstall new,shingles to properly tie in new EPDM roof to shingle area - Fabricate and install .040 white aluminum termination with concealed hook strips and splice joints - Provide a Fifteen (15) year warranty Price: $38,980 Initial: ` PAYMENTS ARE DUE IMMEDIATELY AFTER JOB COMPLETION. 1/3 initial payment, remainder to be paid upon completion Payments accepted are: CASH — CHECK—MASTERCARD —VISA—AMERICAN EXPRESS *Any payments not immediately paid upon job completion will be charged 0.005%for every day after the given 5 day grace period upon day of job completion. Possible Extra-Any rotted or otherwise deteriorated trim boards, plywood sheathing, lead flashing, or other carpentry needing replacement will be done and charged for as an extra at the rate of$75.00 per hour, plus 20% mark-up materials. Any deviation or alteration from above specification will be executed upon written orders and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays are beyond our control. Owner should carry fire, tornado and other necessary insurance upon the above work. We, if not accepted within thirty days may withdraw this proposal. FRASER CONSTRUCTION, LLC: Carries Workman's Compensation and Public Liability Insurance on the above work, certificate available upon request. DATE OF ACCEPTANCE: e Homeowner Fraser Construction, LLC 460 Main St, Hyannis .. r. a. u - s T - . F KARAvaE riM 'T'ONIGH'T PRIVATEPARKIiVG „ . i FOR H RESORT&RESTAURANT SECURITY WILL HAVE All VIOLATORS TOWED ATTI-I E I R WNh _ - -^ - — 0. ;;(PF,NSE. y • F a e s 4^ �r„�r CF y ,.. _ ;� y� -Y.. a e�dysR•fr t. �r� j,� � u �, .- � •+7dc:`, a _ °4a±k;.�zy� a� r� .x f'•.,,. i . w M _ .., }. Y'•t c_w-n'R � ..h °'_3 d a:"' ti., .:�!"•� 1X.,.y,� S'� -e.f" 4` Y '`0 � b ._.. � � - -,..... � ?•-a-':. t`y',x ,,ti.iz. {` "�^�, - �"r^• ,ya•,..�•h'x*`�.';`+* =„s*"' Y •.�4 ? �'. - .+�,��. ';�`�'a� '#,`' ,a4'"' :.iA;.( - -.�:...:.--....- E � •,. :. .r 4�{<+ :: � „� ,yes, ,_ .,,•�+� .. ,,,, � �3'� ,x px.,:u.. �,`if�w,3 '.j"��`*�tw-+� ., .�+ �` r y._. '?. "4 � �' y Cc`°- k '�" � �q4. rr'. � �".�. ::x-* - ..t�,;, � _.� .>�y= .r,r,^'=+`�.�., �+",t n''-,�` -t �r'� +���➢' �'L.. n_;��y �� •�'""�'� :,w "3"�_ � 3,.� :r�`5? rtuc".i�s � � je ri :+ TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map s-' 1 Parcel Application # Z0 16 v 1 11 3 Health Division Date Issued -1+h I (c) Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/Hyannis Project Street Address � Village Q !A A010 Owner Address. mow Telephone _S` 8- �� T(-wot Permit Request Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuatio a 0`�$construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) v Age of Existing Structure g g Historic House: ❑Yes ❑ No On Old King s Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First FloorARd1om Cou`lt �- Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: 0 'es ❑ No Detached garage: ❑ existing ❑ new size Pool: ❑existing ❑ new size _ Barn: ❑ existing% new size_ 2 Attached garage: ❑existi.ng ❑ 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 Telephone Number Address !f e>.s1 ar ) License# Home Improvement Contractor# is I C RA Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 12,114 SIGNATURE DATE FOR OFFICIAL USE ONLY f APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: } FOUNDATION FRAME INSULATION FIREPLACE ' ELECTRICAL: ROUGH FINAL t%• 1 s PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. L z The Commonwealth of Massachusetts Departtnent of Industrial Accidents Office of Investigations + 600 Washington Street Boston, MA 02111. °� :�•�'� www.mass.gov/dia Workers' Compensation insurance Affidavit: Builders/Contractors/EIectricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):�� �rt�/ll�� /� U M 1 Q A'` S Address: City/State/Zip: � Phone.#: So. C1 Are you an employer? Check the appropriate bog: Type of project(required)`. 1.[1-I am a employer with . . 4• ❑ I am a general contractor and I employees(full and/or part-time): # have hired the stib-contractors 6. El New construction .2.❑ I am a soleproprietor ofpartiier=' listed on the attached sheet T. ❑ Re�iodeling, ship and have no employees `these sub-contractors have g. Demolition working for me in any capacity. employees and have workers'. 9 ❑Building addition [No workers' comp:•insurance comp. insurance.$ a corporation and its '10.❑Electrical repairs or additions required:] S. W e arerp 3.El am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12 ❑Roof repairs insurance required.],r c. 152, §1(4), and we have no employees. [No workers' 13.❑ Other comp.insurance required.] *Any applicant.that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who subn-t this affidavit indicating 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. 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 crimiri4l penalties of a fine tip 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 Investi ations of the DIA for insurance coverage verification. Ida hereby.cer*unde t e iv s and penalties.ofperjury that the information provided above is true and correct. Date: Phone#: Official use only. Do not write in this area, 10 be completed by city or town official City or Town: Pern-it/L.icense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6. Other C".nnfart PP.rsnn- Phone#: Information and Instructions. Massachusetts General Laws chapter 1S2 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 tiustee 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,�xzth 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-couti-actor(s)name(s), addiess(es)and phone numbers) 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-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 yo da it for u 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 maybe 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 btim 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 Departmamt of Inclustri.al Accidents Office of Investigations, 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-NIASSAFE Fax# 617-72777749 Revised 11-22-06 www.mass.gov/dia 04/06/2010 12:13 5088330680 PALUMBO PAGE 01/01 ,y DATE(MMlDDlYYYY) A`aRL> CERTIFICATE OF LIABILITY INSURANCE 4/6/2010 PROOUCER (508) 888-2244 FAX- (508)833-0680 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION William Palumbo Insurance Agency Bryden ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 125 Route 6A ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Sandwich MA D2563 INSURERS AFFORDING COVERAGE NAIL 4 INSURED INSURER A.Travelers insurance Company _:...... .......... ._. ._ _.- -......._... Michael Shastany DSA Bay Colony Aluminum s INSURER B_ 11 Winsome Road INSURER G. - INSURER D'..... _ S. Yarmouth MA 02664 INSURER C 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 OFEUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, POLICY EF EECTIVE POL CY EXPIRAl10N LIMITS TYE C POUCY NUMBER 6 (N1M Y Or; .NERALLIABIUTY - EACH OCCURRENCE --,• $•, _ _ , ..EACH TO-RF_RTED 6 -- I COMMF_RCIAL GENERAL LIABILITY -PREMISES CLAIMS MADE L.._.I OCCUR MED IXP(Arry ono person) -- PERSONAL R ADV INJURY GENERALAGGREGATE_ S G_EN L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP9P AGG S PRD.POLICY CJ LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea eccldert0 ANY AUTO ALL OWNED AUTOS BODILY INJURY ••••- g - - SCHkD,ULED AUTOS (Per person), ,- HIR aVTOS BODILY INJURY p (Per B=Mrit) .............. . NON OWNED AUTOS�;i PROPERTY DAMAGE 3 (Per pocldera) GARAGE{LIABILITY a AUTO ONLY-EA ACCIDENT- 5 @ A r OTHER THAN _EA ACC S - - AN17A_UTOa AUTO ONLY: AGG S � XCESSI UMBRELLq UA61LitY EACI OCCURRENCE nr AGGREGATE ..... I OCCUR I . ]CLAIMS MADE - - - _._.. .. ... S DEDUCTIBLE �_ ... RETENTION S. $ WCSTATU- OTH- WORKERSCOMPENSATION A solo proprietor. is not I TORY-LIMITS ER_;,, AND EMPLOYERS'LIABILITY �E L EACH ACCIDENT S 1001.000 ANY PROPRIET=PARTNER/EXECUTrVE Y 1 N naluded uAder woackOre —__._ r--0 -OFFICER/MEMBER EXCLUDED? - - (Men4atorylnNH) 7PJGS9054A03A-09 8/13/2009 S/x3/2010 •ELDISEASE EA EMPLOYE $ - ],OQ•,000 IrY9e,tlesodbeunder E,L.DISEASE-POLICY LIMIT R 500,D00 SPECIAL PROVISIONS below OTHER DESCRIPTIONOF OPERATIONS!LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT!SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION (508)790-6290 SHOULDANYOFTNE ABOVE DESCRIBED P000IESBECANCELLEDBEFORETMEEXPIRATION Town Of Barnstable DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN Bldg Department NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO 00 30 SMALL 200 Main St' IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON.THE INSURER,ITS AGENTS OR Hyannis, MA 02631 REPRESENTATIVES. AUTHORIZED REPRESENTATNE J LaRocca, Sr/MWOLI•' ACORD 25(2009/01) 01988-2009 ACORO CORPORATION. All rights reserved. INS02b(2ooso�) The ACORD name and logo are registered marks of ACORD Z 1 r. r � Town of B arnstab-Xe Regulatory Services M f Thomas F Geiler,Director noes. f� Building Division Tom Perry, Building Commissioner 200 Main Street,Hyannis,MA 02601 mvw.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using.A Builder j ✓•'/j / l , as Owner of the subject property hereby authorize C(y .chi U;,�,,,,vr�✓` to act on my behalf, in all matters relative to work authorized by this building permit application for. S4 (Ad ss of rob) 3 a - /Z2 signattre of Owner Date- Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. ^i* Town of Barnstable Hof its ray Regulatory SeIrvices t Thomas F. Geiler,Director HARNStABt-6. - . Building Division PrED µA't a Tom Perry, Building Commissioner 200 Maiu Street, Hyannis, MA 026.01 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICFNSE EXEMPTION Please Print DATE: JOB LOCATION: number street village _ ._-..HOMEOWNER": name home phone# work..pbone# CURRENT MAILING ADDRESS: city/town stato zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow hQmr-owners to engage an individual for hire who does not possess a-license,provided that the owner acts as supervisor. �DEFINTTION OFHOAEOWNER 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.hr-Abe understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signatiire 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 paTnit is required shall be exempt from the provisions of this scction.(Sccbon 109.1.1 -Licensing of canstruction Supervisors);provided that if the homeowner engages a po-son(s)for hire to do such work,that such Homeowner shall act as superosor." Many homcowncrs who use this exemption are unaware that they an:assuming the responsibilities of a supervisor(sce 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 homcowncr is fully aware of his/hQ rusponstbilitics,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsTbilitics 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 formlccrtification for use in your cornmunity. lei ,�aca�usettti Uipaitnunt it t7nslr3at.S 16ia B6attf trf Btirlxl►n� Rc<ulatal�ns'and Stand a d� n Construction Supervisor License Y License. CS 72755ft` r Restricted tc .00 a: MICHAEL.E SHASTANY'.' � 11 WINSOIt ME RD S YARMOUTH,'.MA 02664 . r Expirataan�61�1112010. - 11111116titi1.1i11'1' - -. ..a TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Application# Map Parcel" . Health Division Date Issued Conservation Division Application Fee If fflork Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/ Hyannis r Project Street Address q(o0 fOA n S�. Village t-114Goa 1:5 Owner 0 Address _ `4 D 1gp,', 'SA, dWnls Telephone oZ6o� Permit Request i✓lo v e - r,� ,Q cQ S h a •-oa-� Jr Square feet: 1 st floor: existing proposed 2nd floor: existing_ proposed Total new Zoning District Flood Plain Groundwater:Overlay r41ect Valuation 735 0 Construction Type Lot Size Grandfathere'd: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family O Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new a� Total Room Count (not including' baths): existing new First Floor Roo Cour 9 ) 9 � Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other cn Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wo�' coal stove: O) es ❑ No Detached garage: ❑ existing ❑ new size Pool: ❑ existing ❑ new size _ Barn: ❑existing ❑ n:.ew size_ Attached garage: ❑ existing 0 new size _Shed: ❑ existing ❑ new size _ Other: c o ,, 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 Leek S (YAC'ci- �eif Telephone Number (50RQ-9p l- (0 V,3 Address 7 7 CMedg/0( �� License# %z 6La!-L 1611 S O A Home Improvement Contractor# Ile Worker's Compensation # JVC CEO ALL CONSTRUCTION DEBRI ESULTING FROM THIS PROJECT WILL BETAKEN TO C4 S el1q r I� uJ i C. SIGNATURE DATE S /5 lo l Tom` s y/ FOR OFFICIAL USE ONLY �f 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 b ASSOCIATION PLAN NO. r ' The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 : www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): S Address: j 7 C41e4r_aId //1 City/State/Zip: Phone.#:(SGU - 63 Are ou an employer?Check the appropriate box: Type of project(required): 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 stab-contractors .2.❑ I am a sole proprietor or partner-' listed on the attached sheet. 7.. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition workingfor me in an capacity. employees and have workers' Y P tY• # 9. ❑Building addition [No workers'-comp.insurance comp. insurance. *10. Electrical repairs or additions required.] 5. ❑ We are a corporation and its ❑ P 3.❑ 1 am a homeowner doing all work officers have exercised their I l.❑Pltrep g repairs or additions myself. [No workers' comp. right of exemption per MGL 12. oairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.❑Other comp.insurance required.] *Any applicant.that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: A % ^A 5 U(c0.n C e__ Policy#or Self-ins.Lic.#: 0e n O S Z 05 Cl Expiration Date: 2-5 /D Job Site Address: b(o MQ /I ST City/State/ZipA4g_46yS 0.115 AN 026O 1 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure fo secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine tip to$1,500.00 and/or one- ell imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine. of up to MOM a day aga' a violator. Be advised that a copy of this statement may be forwarded to the Office of Investi ations of the D insurance Vera a verification. I do hereby certify,u e the pains d penalties of perjury that the information provided above is true and correct. Si afore: Date: 6. Phone#: SOF q - 6 3 63 Official use only. Do not write in this area,to be completed by city or town officiaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their.employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall . enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-conti-actor(s)name(s),-addresses)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 completeand 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 TO. #617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 11-22-06 , www.mass.gov/dia ' s► Tati Town of Barnstable Regulatory Services. HARMASS. Thomas F.Geiler,Director E16396 ' 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, V1 N '4 1 C C9 k R V as Owner of the subject property l l hereby authorize At e— 4f �k J1 to act on my behalf, in all matters relative to work authorized by this building permit application for. �JA 1A, (Address of Job) Signature of er D�a rffv/ti � Print Name If Property Owner is applying for permit please complete.the Homeowners License Exemption Form on the reverse side. Q:FORMS:O WNERPERM ISSION Town of Barnstable THE Regulatory Services swtuasrAsLF- : Thomas F.Geiler,Director MAss g . 16s� .• Building Division plf0 µA't A Tom Perry,Building Commissioner 200 Main.Street, Hyannis,MA_02601._ www.town.b arnstable.ma.us Office: 508-862-403 8 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;sixQ�,ihits 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 verformed undei 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. "��t Z \\,t S• '� ;V 3 Signature of Homeowner \ Approval of Building Official A\I 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 assurning 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 cart t amend and adopt such a form/certification for use in your community. Q:forms:homeexempt 07 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Old Cape Cod Insurance Agency Inc HOLDER. THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 296WInterStreet ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW Hyannis,MA 02601 COMPANIES AFFORDING INSURANCE COMPANY A GRANITE STATE INSURANCE COMPANY INSURED Michael Meagher 97 Emerald Street Marston Mills,MA 0264"000 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOT WITHSTANDING 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 THE POLICIES DESCRIBED HEREIN 18 SUBJECT TO ALLTHE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 00 LTR ME Or INWRANCE FOLIOY NUMBER FOLICYIPPEOM PAT! POLICY EXPIRA71ON DATE A WORKERECOPPENEUMIT— DEMPLOYERS'LIABILITY LIMITS E PROPRIETOR/ PARTNERSMECUTIVE OFFICERS ARE: uICL❑EXCL❑ 4520589 11/09/2008 11/09/2009 LATORYLIMITS THER CaerogoAppIIoB1oMAOpardonBONy. ACCIDENT S 100,00SE POLICY LIMIT S 800,00SE-EACH EMPLOYEE $ 100,00 DESCRIPTION OF OPERATIONSMEHICLESISPECIAL ITEMS RE:THE WORKERS COMPENSATION POLICY DOES NOT PROVIDE COVERAGE FOR MICHAEL MEAGHER. f CERTIFICATE HOLDER CANCELLATION TOWN OF BARNSTABLE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE BLDG DEPT EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL IQ 230 SOUTH ST DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT HYANNIS,MA 02BO1 FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Massachusetts- Department of Puhlic Safetj ' Board of Building Re-ulations and Standards Construction Supervisor License License: CS 102260 Restricted to: 00 cr" t MICHAEL MEAGHER JR 97 EMERALD LANE MARSTONS MILLS, MA 02648 °� ' Expiration: 11/5/2012 ('unun issio°er Tr#: 102260 t TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Ca Map6 Parcel 01 — 'Application # � } Health Division Date Issued Conservation Division Applicatiof Fee e'S Planning',Dept: Permit Fee Date Definitive'Plan Approved by Planning Board Historic - OKH Preservation Hyannis t Project Street Address �� ,ZPAut, r7 �a�S Village e-�,� ►g -t�t�S` _ Owner Coo, W .raR'v^C.- Address Telephone Permit Request OoT �' S���i g�: . 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: 0 Yes ❑ No If yes, attach,supporting documentation. DwellingType: Single Family ❑ Two Family ❑ Multi-Family # units Yp 9 Y ~ Y Y ( ) Age of Existing Structure Historic House: ❑Yes ❑ No ,On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Wa ut ❑ Other Basement Finished Area(sq.ft.) Basem rft 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 ❑ El e ric ❑Other Central Air: ❑Yes ❑ No Fireplac : Existing New ting wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ n size Pool: ❑ existing ❑ new size Zrn: ❑ existing ❑ new size_ 0 rAttached garage: ❑ existin new size _Shed: ❑ existing ❑ new size _ Othe : p Zoning Board of peals-Auther-ization--•-Ll-Appeal # bcorded Q "` ' Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use w ._ m APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name AC i&J Telephone Number 50g - Ooy Address Rlzxircr Ua€, License # ©J 0� A,Om , ASS OOVOJ Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Cogrewth a SIGNATURE DATE s u - FOR OFFICIAL USE ONLY ` APPLICATION# DATE ISSUED MAP/PARCEL NO. 'r ADDRESS VILLAGE OWNER r DATE OF INSPECTION: ,) FOUNDATION FRAME INSULATION I FIREPLACE ELECTRICAL: ROUGH FINAL `t . PLUMBING: ROUGH FINAL r GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT r ASSOCIATION PLAN NO. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.govldia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lefibly Name (Business/OrganizaEon/Inciividual): ;Ac k— t, Address: City/State/Zip: Phone.#: ®",®/ Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. I am a general contractor and I 6 0 New construction cmployees(full and/or part-time).* have hired the stab-contractors 2. ] I am a•sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. Q Demolition d have workers'an employee's working for me in any capacity. $ 9. ❑Building addition comp.insurance. [No workers' comb.insurance required-] S. We are a corporation and its 10.0 Electrical repairs or additions 3.El I 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.❑Roof repairs c. 152, 1(4),and we have no .0er Other incrrrance regtllICd]t � 13 . employees. [No workers' comp.insurance required] *Any applicant that checks box 01 must also fill out the section below showing their workers'compensation policy infannstion_ t liomcownet who submit this affidavit indicating they are doing all work and then hire outside eontractms must submit a new affidavit indicating Stich. YContractors that chock this box mist attached an additional sheet showing the name of the sub-contractors and state wbcther or not those entities have employees. If the sub�ontractois have employees,they must provide their workers'comp.policy number. I am-an employer that is providing workers'compensation insurance for my employees. S is the policy and job site information. Insuranee..Gompany Name: `-a Policy#or Self-ins.Lic.#: Expiration Date: fob Site Address: _ City/State/Zip: Attach a copy of the workers' compensati policy declaration pagM showing the policy number and expiration date). Failure to secure coverage as requir der Section 25A of MGL c. 152 can lea the imposition of crimirial penalties of a fine tip to$1,500.00 and/or ear imprisonment, as well as civil penalties in the f of a STOP WORK ORDER and a fine of up to$250.00 a day against the,violator. Be advised$iat a copy of thus statement y be forwarded to the Office of Investigations of the 1)[A for insurance coverage verification. I do hereby certify under the pain ndpenalties ofperjury that the information provided above is true and correct. Si enure: Date: '-OV Phone# Official use only. Do not write in this area, to be completed by city or town officiaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: Information and Instructions s r J 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." partnership, association, co oration or other legal entity,or any two or more ed as an individual, An employer is defin �P Rcorporation of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states`Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),addresses)and phone numbcr(s) along with their certificate(s)of insurance. Limited Liability Companies•(LLQ 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 D epartment 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 permittlicense number which will be used as a reference number. In addition, an applicant n that must submit multiple permitllicense 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 ctc.)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 4-06 4r 1-S77-MASSAFE Fax# 617-727-7749 Revised 11-22-06 . www.mass.g-ov/dia v �v �oFYKerO�ti Town of.Barnstable Regulatory Services �A HASSSBASTABTEB; Thomas F. Geiler,Director Cjo .i639 �� _. ' rEL639y1 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 to act on my behalf, in all matters relative to work authorized by this building permit application for: ano is) (Address of job) �() ° a- Si ature of Owner Date Print Name Tf.Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. +ry Town of Barnstable H� o Regulatory Services Thomas F.Geiler, Director sARNsrwarX, MASS. Building Division pTFO '�a Tom Perry,Building Commissioner. 200 Main Street, Hyannis,MA 02601 wyny.town.barnsiable.ma.us Office: 508-862-4038 Fax: 509-790-6230 ______-____--------- 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. r DEFINITION OFHOMEOWNER 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 allI suchwork performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other lations:d re' applicable codes, bylaws,rules and gu 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 7 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 oflcn 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 Mly 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 currcntly.uscd by several towns. You may care t amend and adopt such a fomi/certification for use in your community. . Ca T TOWN OF.BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel `Q.2s 405 y ApP lication# �oo.70Y880 Health Division Date Issued t 3 d 1 Conservation Division Application F,e Tax Collector Permit Fee 7 Treasurer Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address V(a 'I, s Village O!t/AJI jP Owner� .�r.���P� � '�C/�'/� Address Telephone Permit Request e 06, Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation ®L) 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 0ld King's Highway: ❑Yes O'No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) ,o Number of Baths: Full:existing new Half:existing new ' Number of Bedrooms: existing new Total Room Count(not including baths):existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name AICX�t U>� � ► ~ Telephone Number Address 9 A9-f0i- G�. License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE ���i d SR FOR OFFICIAL USE ONLY APPLICATION# x � DATE ISSUED `h y MAP_ /PARCEL NO. ADDRESS VILLAGE OWNER e DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL q,• GAS: ROUGH FINAL � FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. h C I The Commonwealth of Massachusetts Department of Industrial Accidents Office ��(•,ce of Investigations ^ q a' d 600 Washington Street Boston,MA 02111' www.mass.gov/dia ' Workers"Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Ledbly Name(Business/Organization/Individual): (, Address:,/ Cj�' ���� h 7�O/Y-,b-->a 1v 9 C j� Phone.#: 77 ' i /State/ %� ��7''� �� t3' Are y an employer? Check the appropriate box: [76. Type of project(required):. 1. I am a employer with 4• ❑ I am a general contractor and I ❑New construction . have hired the sub-contractors '•employees(full and/or part-time).* • listed on the'attached sheet. 7. ❑Remodeling 2.❑ I am a'sole proprietor or partner- These have ship and have no employees S. ❑Demolition employees and have workers' working for me in any capacity. 9. ❑Building addition • comp.insurance.$ ' [No workers comp.insurance 10.❑•Blectrical repairs or additions required.] 5. ❑ We are a corporation and its '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,❑Roof repairs insurance.required]t c. 152, §1(4),and we have no 13.❑ Other Lemployees. [No workers' - comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners.who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether ornot 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 insuranee for my employees. Below is.the policy and job site information. Insurance Company Name: Policy#or Self-inns.Lic,#: (�/ 02 $ l Expiration Date: l Job Site Address: y 1�l7 I s 7 City/State/Zip: S��� �is 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$250.00 a day against the violator. Be advised that a copy-of this statement maybe forwarded to the Office of Investigations of the CIA for insurance coverage verification. I do hereby certify under the ins and p allies of perjury that the information provided above is true and correct. aL�l:G Si afore: Date: _ Phone#: Official use only. Do not write in this area, tb be completed by,city or town official City or Town: . Permit/License# Issuing Authority(circle one): 2.Build ing Department 3. City/Town/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector f Health t3' .'1.Board o g P 6.Other Contact Person: Phone#: ,a Town of Barnstable, v Regulatory Services ` t "�I'E'Wca Thomas F.Geiler,Director Building Division rE0N1A'� TomTerry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable..ma.us arnstable.ma.us Office: 508-862-403 8 Fax: 5 08-790-62.3 0 Property Owner Must Complete and Sign This Section If Using A Builder L/i� ` , as Owner of the subject property hereb authorize ' y _�/���j' C G .3".�0 7'' to act on my behalf, in all matters relative to work authorized by this building permit application for; , (Address of job) O � Signature of Owner rate Print Name QIORMS:OwN —VERMISSION 08/07/2007 14:19 FAX 5087753821 OLDE CAPE COD INS AGENCY 001 07/16/07$'na DA MM/DD/YY f 1 i e �r,rr' i711y�I�ia��7�1711111� .yyr 1 w ODUCERm r THIS ff,CERTIFICATE*IS ISSUED.� AS A MATTER OF INFORMATION OLDS CAPE COD INS AGENCY INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 296 WINTER STREET COMPANIES AFFORDING COVERAGE HYANNI S MA 02601 COMPANY !^�� A SCOTTSDALE INSURANCE COMPANY INSURED COMPANY VILLANI CONSTRUCTION INC B SAFETY INSURANCE CO COMPANY P.O. BOX 692 C _ WEST HYANNISPORT MA 02672 COMPANY y Y D r;•r; a• •r;;?r�;ii�r? 'S'?p;o-li.a ;;r� •,'•••r'rr'i,•'•'r'i�i E;';;'��f"i'i%�i�rl��$�I!}jrl;r„rr,,,rra,,,,�,,,,,., THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE'INS URED 1.NAMED ABOVE FOR iTHE�POLICY••PE:RIODr 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. 00 TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION UMRB r L� DATE(MMMONY) DATE(MMIODM) GENERAL LIABILITY CLS 13 718 8 3 472 TO 7 4/12/0 8 GENERAL AGGREGATE s2, OOOfOOO COMMERCIAL GENERAL LIABILITY PRODUCTS•COMP/OP AGG $1, 0 0 0, 0 0 0 CLAIMS MADE 0 OCCUR PERSONAL$ADV INJURY $1, 000 , 000 OWNER'S&CONTRACTOR'S PROT EACH OCCURRENCE $1 0 0 0 0 0 0 w^ FIRE DAMAGE(Any One OM) $ 50, 000 . MED EXP(Any one person) $ 5, 0 0 0 AUTOMOBILE LIABILITY 315 0 2 7 5 8/0 9/0 7 8/0 9 0 8 ANY AUTO COMBINED SINGLE LIMIT 8 ALL OWNED AUTOS BODILY INJURY $ � SCHEDULED AUTOS IPer person) 250, 000 HIRED AUTOS BODILY INJURY $ i NON-OWNED AUTOS (Per 000ldenr) 500 , 000 PROPERTY DAMAGE 8 100, 000 GARAGE LIABILITY AUTO ONLY.EA ACCIDENT $ ANY AUTO OTHER THAN AUTO ONLY; u EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE OTHER THAN UMBRELLA FORM ^^` $ WORKERS COMPENSATION AND TWORY LIMIT ER EMPLOTERS'LIABILITY EL EACH ACCIDENT T^_$ THE PROPRIETOR/ INCL EL DISEASE-POLICY LIMIT S PARTNERS/EXIsCUTIVE OPPICERS ARE: EXCL EL DISEASE-EA EMPLOYEE OTHER DESCRDrTION OF OPERATIONSA.00ATIONBNEHICLF.SISPFCUIL ITEMS TM ^^�-'""'"."'. r" -71 . ,,'WORKERS' COMP";CERTIFICATE WILL BE SENT To-YOU DIRECTLY"FROM--GRAN ITE STATE i-Z,INS.URANCE CO 4/1/07 TO 4/1/08" #WC2358620 M!a!�I� �,V�y 4;1;Gi;;j!i¢4$¢$!:$G}¢;;S$!;�$;$rgr,i,f{d6?;4i'i i4?;'r;?��?%fii'r;?r�f;^'r'fr�i;i•Iti�iri}r?��rY :is% .FiM1YAr1,'iliilGA�lii`ii3:;r;x�'rr�riirir�r;�•r�r;�;'s;'r£;�i;'t;'°�i�;rr's;;'���;�f i;��rr•r. POP r� i'rc:n:n p„on,'. ............... rr�i ys:w•n:�yr•:CiiCtiiC{:+i:?'t.:..�...ii.r.,r,��i�i.�::. i.n'„•�..�.�..,.,..�i .........v....�:isn�::!w.v�::a:•,:era•rr.y:•o�inw:wwr:r�:tiu:�n:��w�vr�vi:wrn�w�:•ivrnrvyy:'�v�vywrnv:�•rvi' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE TOWN OF BARNSTABLE EXPIRATION DATE TMEREOP, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTTCE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, MAIN STREET RE TO MAIL SUCH NOTIC SMALL I E NO OBLIGATION OR UARt ITY HYANN I S, MA 02601 OP AN KIND PON C PANY AGB REPRESENTATIVES. A E Ju i h' D. u Ivan JS A t ':".. � n�,�,�i;Siir iiii;#1 �i�iiii;�iii;'r'r,'iii��'i' ;iiii!'R91......,.::.:...'.�'�"�.:..: .. .3!:' ' �ii:;s,: „r ,r,:' . . �I; qCj!�;. :.!�tptr.�'.F#?�':�`,.....:.:!.....o....; Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name Ob P,f2'� FAQR�-U( 0 Telephone Number SOg —3�5 MPS Address The K 1 CTs 3ft%m a, License# CS D 7 0%b �67hi Id l S [�A W 55• f7 Zl)kjo Home Improvement Contractor# C5 0 7oil Worker's Compensation# �s �-Twx ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE G 1 Y f, TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION r T z o Map 309 Parcely 0 Z� `�� Application# � 3 Health Division Conservation Division Permit# Tax Collector Date Issued Treasurer Application Fee l �- Planning Dept. Permit Fee L �' Date Definitive Plan Approved by Planning Board y�nT t-0 Historic-OKH Preservation/Hyannis Project Street Address 40 MA�� S� t(Ytq-A/AliS A4&-F Village ST Iq 15C L - Owner Address IVlJ S/ �`J�yJ�`�✓� A'ArC Telephone 50 71 ' 9_9-X5� Permit Request - .l A/.� LAleal ))009. Square feet: 1st floor:existing proposed '2nd floor:existing ' -proposed Total new Zoning District r Flood Plain Groundwater Overlay Project Valuation-2 _w 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 �Pf6 On Old King's Highway: ❑Yes tkWe— Basement Type: C-Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) 11t4_51_ 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: as ❑Oil ❑Electric ❑Other Central Air: Yes ❑No Fireplaces: Existing New - -Existing wood/coal stove: ❑Yes s-NT- 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-A-<S ❑No If yes, site plan review# r Current Use �,,j BusedVsY / BUILDER INFORMATION y �✓ /��Name � /�(,�f � ®(/� Telephone Number Address License# Home Improvement Contractor# 1 Worker's Compensation# q �'q ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE Az DATE Y FOR OFFICIAL USE ONLY 1 PERMIT NO. DATE ISSUED Nle MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: l711-� x FOUNDATION , FRAME i INSULATION - `i t FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING i DATE CLOSED OUT l ASSOCIATION PLAN NO. J f F• The Comnionwealth of Massachusetts ' Department o Industrial Accidents 0 ce of Investigations 600 Washington Street, Boston,M4 02111' www.mass.govldia ' Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant conformation Please Print Leeibly Name(Business/orgarn ation/Individual): •5` 1 6?_ Ad3ress:_ n> % Y VPws City/State/Zip: 1520J Phone.#: 7;1' Are you an employer?Check the appropriate bog: ' l contractor and I a am I enera ;Type of project(required):. 1.❑ I am a employer with 4. ❑ g , 'employees (full and/or part time). * , have hired the sub-contractors 6, ❑New construction . 2.❑ I am a'sole proprietor or partner- listed on the'attached sheet. 7. V<emodeling ship and have no employees These sub-contractors have g, ❑Demolition 'working fox me in any capacity.' employe'. and have workers' 9 °❑Building addition [No workers' comp,insurance comp,insurance.$' required.] 5, ❑ We are a corporation and its 10.❑Electricalrepairs or additions 3.U&I am a homeowner doing ill-work . officers have exercised their 11,7 Plumbing repairs or additions ' myself, [No workers'comp, right bf exemption per MGL ' c. 152 1(4), and we have no 12.❑Roof repairs , insurance.required.]fi ' § ( )° °. 13.[t��Other`� ,� tv1��,{. employees, [No workers comp,insurance required,] ------------- *Any applicant that checks boi#1 must also fill out the section below showing their workers'compensation policy information, f Homeowners,wbo submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the,sub-contractors and state whetber ornot those.entities have employees. Nthe sub-contractors have employees,they must provide their workers'comp,policy number. jam an employer that is providing workers'compensation insurance for my employees. Below is.the policy and job site' information, Insurance Company Name: Folic #or Self-ins.Lic.#: y Expiration Date: Job Site Address: City/Sta#e/Zip: - " Attach a copy of the workers' compensation policy.declaration p acre'(showiWg the policy number and eapirat1cm dite). Mluxe.to secure coverage as required under Section 25A of MGL c• 152 can lead to the imposition of crsninal penalties of a Ent up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP 71"ORK,ORDER a-ad a fine of up to$250.00 a day against the violator. Be advised that a copy of this"statemezit maybe forwarded to the Oface of Lvestizations.o for insurance coverage verification, Ida hereb certi t.thepa.,rs.andpen u that the in provided above is true an'd correct. Date; Si_naturz: V . • l F=•line IF: t 0fZcial use only. Do not write in this area, to.be completed by city or town afJicial City or Town: P ert/Licenser I Issuing Authority(circle one): .'1..Board ofHealth 2 Building Department 3, City/Town Clerk 4.Electrical Inspector 5,Plumbing Inspector 6.Other " Contact Person: Phone 4: imormanon ana in, s-cructi s ' Massachusetts General Laws chapter 152 requires all employers to pro�Hde workers'compensation--'or their employees. P.�rsuant to+ls statute, an employee is defined as".•.every person in the service of another under any contract of bile, 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 forego g engaged in a joint enterprise, and including the legal representatives of a-deceased employer, or the receiver or trustee-of an individual,pa,mership,association or other legal entity,employing employees. However the owner of a dweling house giving not more than three apartments and who resides therein,or the occupant of.the r dwelling house of ano laer 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." ,,,VfGL 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•conzpl me 7th'the u-aLance' requirements of this chapter have beenpresentedto 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-conti-actor(s)name(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-insurance license number on the appropriate`line. City or Towli 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 io 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 Deputment's address,telephone-and fax number% The CO-M .oDW t of Mas-whu.setts Dtpaztmeut of ladurtdal A.cddmts Office of In-Vestigattons 6.00 wawnatoii street BWon,.MA 0.111 - TO. 617-727-4900 ext 406 or 1-37 MASWE Fax#617-727-7749 Revised 11-22-06 • ��.mass.gav�dla . I 6/13/2007 10:49 f508-349-7894 Benson Young & Downs Kathy Jones4Ray Roy 2/3 ACORD DATE(MM/DDA`YYY) i TM. CERTIFICATE OF LIABILITY INSURANCE 06/13/2007 PR,,9DUCER , Phone.(508)432-1256 Faz(508)430-1532 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION BENSON YOUNG&DOWNS INSURANCE AGENCY INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 565A ROUTE 28 HOLDER. THIS CERTIFICATE DOES NOT AMEND,EXTEND OR P 0 BOX 158 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. HARWICH PORT MA 02646 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: NDRMand Insurance Company 24015 RCSJ GROUP INC INSURER B: DBA FRESH KETCH INSURER C: 540 MAIN STREET WEST YARMOUTH MA 02673 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 POLICES 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 ADD'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR INSRD DATE MWDD/Y DATE MMJDDIYY GENERAL LIABILITY CP50932202 03/29/07 03/29/08 EACH OCCURRENCE _$ 1,000,000 X COMMERCIAL GENERAL LIABLITY DAN+ncE TO RENTED $ 100 000 PREMISES(Ea occun"'ce) r CLAIMS MADE D OCCUR MED.EXP(Any one person) $ 5,000 A PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE S 21000,000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTSCOMPIOP AGG. $ 2,000,000 POLICY JPRO. LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANYAUTO (Ea accident) $ ALL OWNED AUTOS BODILYINJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY $ N09OWNED AUTOS (Per accident) PROPERTY DAMAGE g (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO - OTHER THAN. EA ACC $ AUTO ONLY. AGG $ EXCESS IUMBRELLALIABILITY EACHOCCURRENCE Y OCCUR FI CLAIMSMADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ - $ WORKERS COMPENSATION AND WC STAT TS ortlER EMPLOYERS'LIABILITY $ ANY PROPRIETOWPARTNERlEXECU E.L.EACH ACCIDENT TIVE - OFFICEWMERBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ It Ves,describe under SPECIAL PROVISIONS below - E.L.DISEASE-POLICY LIMIT $ OTHER: DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Seasonal Restaurant CERTIFICATE HOLDER CANCELLATION Town Of Barnstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 367 Main Street DATE THEREOF.THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.BUT FAILURE TO DO SO SHALL IMPOSE NO Hyannis,MA 02601 OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER.TPS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Attention: Fax:5085579820 RAP Paul R. Ilva ACORD 25(2001/08) Certificate# 6815 0 ACORD CORPORATION 1998 f 6/13/2007 10:49 f508-349-7894 Benson Young & Downs Kathy Jones-►Ray Roy 3/3 b IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies)must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 2"(2001/08) Certificate#6815 6/13/2007 10:40 C508-487-4135 Benson Young & Downs Kathy Jones-*Ray Roy 2/3 ACOkD BATE(MM/DDIYYY1) TM. CERTIFICATE OF LIABILITY INSURANCE 06/13/2007 PRODUCER Phone:(508)432-1256 Fas(508)430-1532 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION BENSON YOUNG&DOWNS INSURANCE AGENCY INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 565A ROUTE 28 HOLDER. THIS CERTIFICATE DOES NOT AMEND,EXTEND OR P O BOX 158 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. HARWICH PORT MA 02646 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Twin City Fire Insurance Company 29459 RCSJ GROUP INC INSURER B: D13A FRESH KETCH INSURER C: 540 MAIN STREET WEST YARMOUTH MA 02673 INSURER D: INSURER E: COVERAGES THE POLICES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICYPERIOD 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 POLICES 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 AOO'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION - LIMIT'S LTR INSRD DATE IMMIDDIYYkDATE MMIDDlYY GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RErvrt o $ PREMISES Es occurence CLAIMS MADE OCCUR - - MED.EXP(Any one person) $ PERSONAL&ADV INJURY S GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG. $ POLICY PEa LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS - BODILY INJURY SCHEDULED AUTOS - (Per person) $ HIRED AUTOS BODILY INJURY NON-OWNEDAUTOS (Per accident) $ PROPERTYDAMAGE g (Per accident) GARAGE LIABILITY g AUTO ONLY-EA ACCIDENT .. ANY AUTO - OTHER THAN EA ACC $_. AUTO ONLY. AGG S EXCESS T UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ WCIT WORKERS COMPENSATION AND OBWECNY3035 03/06/07 03/06/08 oRrLunTs OTHER EMPLOYERS'LIABILITY E.L.EACH ACCIDENT S 100,000 . A ANY PROPRIETOH/PAFTMEFVE%ECUTIVE ' OFFICERRAEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 100,000 H yos Asseribs unusr sPC&Z PROVISIONS bel*W E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER: DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Seasonal Restaurant CERTIFICATE HOLDER CANCELLATION Town Of Barnstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF.THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO 367 Main West OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,rPS AGENTS OR REPRESENTATIVES. Hyannis MA 02601 AUTHORIZED REPRESENTATIVE Attention: fax#508.778-4 2 12 Rokp FIRIIYa ACORD 25(2001/08) Certificate# 6814 0 ACORD CORPORATION 1999 if 6/13/2007 10:40 f508-487-4135 Benson Young & Downs Kathy Jones-*Ray Roy 3/3 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies)must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed.thereon. F ACORD 25-S(2001/08) Certificate#6814 aEAOEZ �e,nmERei Ai A' r Lj 111 i f 2 f I / . f/f 6 p v,n P LE7E Fp—A N►E '06/05/2007 11:17 9545454906 HUGH M BECKETTT PAGE 01/01 Jun 05 07 10:45a staphan 5087759920 p. 1 � ,►� Town of Barnstable. Regulatory Services r # >Mom$ Tbomm F.Geller,Director set Buildtug Db4sim Tom Perry, Building Comudselaner 200 Win 3tmet, Hysamis,NrA 02601 yppPw,to�vnbat�etable.tria.us • Moe: 509-9624038 Paac: 508-75042.30 Property Owner Must Complete.and Sign This Section If UsMi g A Builder . I�,• � l ;aS 4wuer of the subject property hereby authorize�, G.�U to act on my behalf, in,1,,,1' matte=relative to work authorized bythis to Ukg percnk application for. (Address of job $ipatum of 0.aer x}aY Pfi=Ni= BOARD OF BUILDING REGULATIONS c 1.�t7 License: CONSTRUCTIONS y � Number)QS 070961 r w1 � ` 6 z lEx�ires 10101%2007 ] Restricted 00 ,�. ROBERT E FARRELL�JR 168 KING JAMES DR,, ,;'' e.v SO DENNIS, MA 02660 Commissioner ru C� i "' ✓!e �onirnareusealC� o�/�aaaac�zuae�l6 '' !� •�: _ _ Board of Building Regulations and.Stancia +is y HOME liVIPROVEMENT CONTRA TOR Registration 141'236 l/Y Expiration 1/26/2008 Type Individual. ,, O �ROBERT E. FARRELL JR° j T. ROBERT, FARRELL ac _ f i -168 KING JAMES DR ®. Cal r S DENNIS MA 02660 ads msti iitor - 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 'bl Name(Business/Organization/Individual): . T FA Cer�(- Address City/State/Zip: S a QF(U IU I.5 Phone.#: 5 $ 3 — 65 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 6. ❑New construction . mployees(full and/or part-time).* have hired the sub-contractors t am a'sole proprietor or partner- listed on the-attached sheet. 7. ❑Remodeling ,, ship` and have no employees These sub-contractors have 8. Demolition workingfor me in an capacity. employees and have workers' Y P tY• #• 9. �Building addition comp.insurance. [No workers' 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 l l.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance,required.]t c. 152, §1(4),and we have no employees. [No workers' . 13.❑ Other comp.insurance required.] . *Any applicant that checks box#1 must also fin out the section below showing their workers'compensation policy infon-nation. 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. urance Company Name: Policy #or c.#: Expiration ate:D 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 MIA for insurance coverage verification. I do hereby certi a d he ains.and nal ' s of perjury that the information provided above is true and correct 7 S' afore: Date: L�P_�hone Official use only. Da not write in this area,to be completed by city or town officiat City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions - , Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two.or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee-of an individual,partnership, association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the' dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to bean 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 t6 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 fm 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-contiactor(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 permittlicense 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 Degarbment of Industrial Accidents Office of Investigations 600 Weshingt6 Street Boston,MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Revised 11-22-06 Fax#617-727-7749 www.mass.govldia SAT U .0 L;H. ,E] 0g C,I ay El EiJC) 1 I -PL M 1 tQ 6 _ 29 p RTMENt Aug �-r o k ,OFF t fV ) r .�. v TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 0 Map 3©Cj Parcel Z 21500-If Application# �o 0 y f Health Division Conservation Division Permit# Tax Collector Date Issued Treasurer Application Fee ; 00 Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address 1 0 afih �jf�, Village 1 ( 4A11V ( Owner cO U'r. dress Telephone Permit Request rcAk6a V�-66` roof r q0 Square feet: 1st floor:existing proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation .��44 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) _ C°r' m e SA cvre 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) a -z Number of Baths: Full:existing new Half:existing new Cz Number of Bedrooms: existing new. N Total Room Count(not including baths):existing new First Floor Room �Mint z M Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Otherrn p Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coals ve: ❑es 0 No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# -- - Current Use Proposed Use BUILDER INFORMATION Robes M /�Ae,/1 (Yoe) �6 9- 5-5-Al Namec� l A TelephoneNumberAddress �2 J � LA,,t License# C I Z- Ce 1 fe,— V(1� AAA- ® Z(� - � ` Home Improvement Contractor# 1100 Worker's Compensation# We a '.31 5"3237fq- tit& ALL CON TRUCTION DEBRIS ESULTING F OM THIS PROJECT WILL BETAKEN TO l SIGNATURE DATE A& 74Z7 FOR OFFICIAL USE ONLY ` PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION Z FRAME s _ i r INSULATION a FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ' r ASSOCIATION PLAN NO. l Town of Barnstable Regulatory Services ' t MAM a Thomas F.Geller,Director Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-8 62-403 8 Fax: 5 08-790-62.3 0 Property Oder Must Complete and Sign This Section If USm" g A Builder as Owner of the subject property hereby authorize 2n� J�G�PiG1 to act on my behalf, in all matters relative to work authorized.by this Building permit application for; , `lam Ait" (Address of Job) On 1�& 'A k-I S:::� l z czNt�f 07 nature o er Date Print Name QFOP MS:O v,�NFRPTrRviI55I0N i The Commonwealth of Massachusetts Department of Industrial Accidents W Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov%dia NVorkers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibly. Name(Business/Organization/Individual): Address: 2. re w r City/State/Zip: Ce44 k1,rV1�� , �ib�ls Phone]t:C 60 5�0 f— 55� Are 1 o n employer? Check the appropriate box: . :Type of project(required):. I. I am a employer with '2�,— 4. ❑ I am a general contractor 7andlees(full and/or pa -ti el.* have hired the sub-contra 6. ❑New construction listed on the attached sheet. Remodeling —_ ship and have no employees. These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.+ required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ officers have exercised their I am a homeowner doing all work 11.❑ Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12.��o`of repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. .Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing_workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: (�t"Lj �®/ik rt-,c Policy#or Self-ins. Lic. #: WCo? �� S' 3&Z3 /1FY 'alh Expiration Date: ?'2UP0 ' Job Site Address: I40 PI-4 5kelcly 6161—VNIs City/State/Zip: VZ(00 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 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 UA for insurance cove age verification. Idoherehycerti nde thep tnsandfp1ties of perjun-that the information provided above.is true and correct. Signature: Date: 2— J 14,Ve Z®Q 7 _ Phone#: 1 Official use only. Do not write in this area, to be completed by city or town official. City or Town: PerrrAt/License# Issuing Authority(circle one): 1.Board of health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instruction 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 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 permitllicense 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 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,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. #617-72.7-4900 ext 406 or 1-877-MASSAFE Revised 11-22-06 Fax# 617-727-7749 vN.-ANA,.rnass.gov/dia Liberty Mutual Group Liberty PO Box 7202 02 Mutual. Portsmouth, NH 03802-7202 Telephone(800)653-7893 Fax(603)431-5693 October 4. 2006 ` THE HOUSE COMPANY q� 7 �� l PO BOX 1166 BARNSTABLE, MA 02360- RE: Certificate of Workers Compensation Insurance Insured: ROBERT MITCH:ELL DBA PROFESSIONAL BUILDING AND REMODELING 452 STRAWBERRY HILL RD Policy Number: WC2-31S-32399=4-016 . Effective: 9/21/2006 Expiration: 9/21/2007 Coverage afforded under Workers Compensation Law of the following statc(s): MA Enlployers,Liability: Bodily hljury By Accident: $ 1O(U)00 Each Accident Bodily Injure by Disease: $ 100.000 Each Person Bodily Injury by Disease: $ 500.000 Policy Limits As of Ihis date, the above-referenced policyholder is insured by Liberty Mutual Fire Insurance Co under the polio- listed above. The insurance afforded by the listed policy is subject to all the terms, exclusions and conditions. and is not altered by anv requirement; terns or condition of anv or other doCLII11e111S lvith respect to which this certificate nlay be issued. This ;c!-!iliCate IS 1SSLled as a lnaticr Gf infor illation 0111V And COIIfCrS 110 I'Iglll LIP011 VOLT. the certificate holder. This certificate is not an insurance policy and does not amend. extend. or alter the coverage afforded by the policy listed above. If this policy is cancelled before the stated expiration date. Liberty Mutual 1vill endeavor to notify you of such cancellation. � I U1'n-fc.rR[zEi)REPRESENTATIVE, LI131:RTY MUTUAL INS URANCt GROUP Ihis Cell ili RC is e.Xecutcil hY LMER1Y NU'I'U:U,]IN tiU'RANl'1:GROLiP us respects such inzurnce:u is a0brdrd h.;those companies. cc: Insured: Producer of'Record:, ROBERT MITCHELL DBA PROFESSIONAL BUILDING FREDERICKS INSURANCE AGENCY INC AND REMODELING P 0 BOX 427 452 STRAWBERRY HILL RD OSTERVILLE. MA 02655 CENTERVILLE, MA 02632 10-I:2000 r i *.. n`'.i Cl a SC r—1 r .0 3 oX x 3 "T, z c� s L 1 S FIRE DEPARTMENT . J - Assessor's offioe (lst floor): _ pFTNEto J� i Assessors map and'lot number ...�.....Q�.....�.............. Q �. Board of Health (�rd floor): .Connected to Town Sower oQ 0 Sewage Permit number ........................................................ Gs�O' Z EAH39TADLE, Engineering Department (3rd floor): # /a Mb 9• House number .................................................................:...3;. �OYP�a' APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00.2:00 P.M. only r TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ........,,..Remodel TYPE OF CONSTRUCTION ....................2C ............................................ ................................................................... ..............June...17.1.................19.8 7.- 4 °! 0 TO-THE .INSPECTOR OF BUILDINGS: The undersigned hereb applies for a permit according to the following information: BuildZng known as Howard..Johnson Motor. Lodge4located at tie: corner of-Main �I Street and Winter Street H annis / 07CT?-� ST7Z `% Location ...... .........................................................a.....y..........................v..... ..................... .......... ..........I............................ Proposed Use .Upgrading facility and converting. Certain.adioining..�ooms to suites -.�Zoning District' .............. ....... B ..............................................Fire District .........................................................................: . :r .. Name of Owner ...Edward A. ,.,...•.••...Address Tellier 93 Birch Hill Road. BelmontP MA ................ -'Name of Builder Desmond Contract Design ,...Address .108 Union Wharf. Boston., MA 02109 ........ .. ...... Name of Architect Schofield Bros. , Tne......................Address .P.rO Box 101. Orleans MA 02653 Number of Rooms ..Same (78 rooms)..... . ...................•.Foundation ...y...`N/A ................................................................... Exterior ...........NIA.................................................................Roofing N/A .......................................................:.................... Floors .............N�A...................�:............................................Interior ..............NSA ............................... Heating Plumbing Self contained kitchen units. ........N/A.................................... ................ .. ............................................................. Fireplace ........ CIA. ....................... :.f.Approximate,C_ost .. L ,;©�d UU....... ................... . Definitive Plan.:Approved, by Pla.nning 'Bcard-_--- _ ______ _______1.9--'-----• Area ...... ............... Diagram of Lot "and Building with Dimensions Fee ../...So.............. . ......... ............. See plans (consisting of 4 sheets) submitted herewith. ' SUBJECT TO APPROVAL OF BOARD OF HEALTH • - r - o _ OCCUPANCY PERMITS. REQUIRED FOR NEW DWELLINGS 'S v I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .AP A. Construction Supervisor's License `.`..1\ -------. ---_-- A. — ~~. ^^~ nnh7 ~ �_/1 No —.30984— Permit --��l�� .�y Motel ............... ' _ Location -- ..................... .................................. ---------- . . O~,*, ............Edward_A.2\,_I�Ili��_____. ' - . ' Type of Construction ..........myo.t.e.l------- ^ --------------------------� - ^ . ` . . ' Plot ............................ Lot ................................ . ' � Permit Gronlexd ....... .Jj4lv—l4................ p 87 . . Date of | --------�---'lV ` . ^ Date Completed ...................................... ' ` , ^ ^ . . . . ' . . ^ ^ ^ ' . ` . - ' . . - ` ' . / � y ' Assessor's map and lot number ...�: ./... ... .�?.. Q�oFTHElo�i Sewage Permit number ......:...................I.............................: I r Z 33AR33TADLE, i House number .......................... 90 MA86 p t639. ♦� 0MOXa\ TOWN QF BARNSTABLE BUILDING ANSPECTOR ' APPLICATION FOR PERMIT TO ....... .��C�� .... .. ...... ..................................... TYPE OF.'CONSTRUCTION .......�N...qn�� ..................................................................................... ....... ....19. . TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .................... .......... ...................� .....a6.. W�� ProposedUse �.<.�..�r. ....fn.......................................................................................................................... Zoning District .............Fire District .......1�:�.r7,Ao.ev:S.../. Moss.......................... .......................... t/ ` n, 1 #0�V� at Hn56..S /die� LEo(c� G' Name of Owner ........��v -e�.............'" z�.�.�1. ..........Address ............................ .?�r!4?!Lt�...�/{!I�SS............... Name of Builder' .... .� I.............................................................Address 7 1. to cc/ram J��/.�nnaS /''1gSf � Nameof Architect .........4 .. ...............Address.... .................................................................................... Number of Rooms ..................Foundation Exterior ...............:.............................. Roofing .........:S 91f('.....:5 znyA .. .......................................... Floors ......................................................................................Interior .............. ................:................................................. Heating ..................................................................................Plumbing .............. . ... S�j-C� Fireplace --" Approximate Cost ' l Definitive Plan Approved by Planning Board -------------------_-----------19________. Area ..... "..................... Diagram of Lot and Building with Dimensions Fee 17,..G'` SUBJECT TO APPROVAL OF BOARD ,OF HEALTH .. s I r C. R Ww )I L � I . r I OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the, Rules and Regulations of the Town of Barnstable regarding the above construction. .Name ............... ........�. ................ ................................... TELLIER, EDWARD 23871 , Construct No ................. ........ Permit for .................................... Roof Facade .... ....... .We .................... Location inua:M�t Rear ............................................................ ... Hyannis ............................................................................... Owner ..Edward Tellier ..Edward.................................................. Type of Construction ....Concrete. . . ................... .. .. .... ................................................................................ Plot ............................ Lot ................................ Permit Granted ...... arch 15,. ..............................19 82 Date of inspection ....................................19 Date Completed ......................................19 b+rrr J o/J J.er rf I..l al[I uIK1 11101. s1w. tarot! u/OfI llM[I fl/0f1 4bf1 u/KI o4/Ot. u/K/ �• • . Yll Y.1/ ./I I r// W/I W/I `. J/1 JIJ JH .! !/! `•J/1 J// !01 Jpl YI !OJ . Jb f0..r6/t l.f Yfr ; y • I I lNfl 1J11/ JJ12I JlJI/ JJ•l/ lIII/ !)I tI = ; LI/I 111 11 JJ•f/ lJl if H•J a/nwe HNJ I'—o U c U./K Y/NJ 1,— 1/ 0 Z , ✓H./ rrN1 _ !A—w ` ..f. ..f, l.K. Mfw ..[. JKJ ..t. JKl JKJ I I wK. a..f. I I ..f. f / /!11 Illl /1/I I'll —am- Il/I 1101 a/I /1/I U/! I!// a4 y S 41N 1./w I.T. /,/w 4IN 4/N 41r 41w 1 4tf 4f 1 I I • 1 1 ' L 1 I C 1 1 1 1 1 1 t A 1 / 1 Or NON ..C. Ill `NJ IOr 41w YIN 4Ii YIN 4T. MIN 4/w 4tw 4/. 9 1 YOa /1. 4,e H / • UIO Y Q/ /1/1 ..e, "CA . II11I u/.I Jl1 to 111 tI llll! )J1lI ..so I $1, J/I JIe )/1 !I/ JI/ !,0 le• Je. Jei YI to Mal !t/Of• !t/It. 2a erl tl/If. fa/O[1 /l/KI laa[I IIKfI fl.tl 4efl tl/KI 11./ `\ Il/0f. I tier. 011.e• 1l.fl fIIKI aloe. IaY[I I I'm fame! nor /f // ./1 � I7JJ f/. •, /II //) /I/ HJ I// III IN • /01 I01 /eJ lJl 1! I y JIJ L! I11 tf JII IJ ul if ? � !!I l/ Illl/ )llt/ 1111./ ul t/ 1lJ tI I� YI2/ .If/ ' _ • �''.i l,K I I a,4 a.K. ' I t..f• it. I a..~ 1,wNQ I' /,...0 /w.t a/.Ne .c, If. .If. I I .K. I aH YU qY qa aq /U/ /J// /1/I Ur autil ..C.I/+ II41 411i 4z INI1 ` 1ll1 3 I41 I i. 1 1 i 1 1 .I J, 1 1 I 1 "• 11 t 1 ; l Jlo1.Q J.I. /,r. I•Iw 1 ! //1.It 7MJ.L.a/YLt r..D.CCU..rC1/ • , I /" I I I• ,Iw ' 4fw 4Iw /If. OC/ICrl r.(4IOYta0Gman.YNor..a0 N 1 I I I I olrtrJ/O.Je/l.(Y.Irt NYN/C.f0/a•f/I.t/.•/tl• a/1 /lr Y/0 /1II Y/! /1/I Y/e l /1/I /101•t/fJY•Jft4C1YJ/Y(IJJNO../at.r/. _ /!r /J./) •l/• a.// 1T0..Qt Ie(fI(GT/vf lut0/.OJ.fINLr e c a/ .Q 1 ���+Q �../-Q 1 1 :i..e a:�r I ���.f t! .%r. L. K. Z r. r. •4!2'I?.l!/l !�`jie. .ur Jn r! Yn! I ; Jn 1! o•u.' vJf! Jn I/ u•I✓ yr to Jn tf m t/ sn Lr a•1f [ o ?•• Fii I+,,,' . eI ni WACK•A •JACKS•f/ Ill Nr• ll.K. 4/KI 1lrK. u•K. la/K• 4me, la/K. O11Z ume.II U0 1MCQf/IcrarT,tN rrJNJf.LJNAVf r.u.•to/.eawroe.Ir/./r,r.r.Y1 rf..o THE COURTYARD RESORT CONDOM/N/UM .fcY1.IIe.Joer.t.roll Fe'sfrorrasoe FLOOR PLANS OF BUIL DINGS rNrce o..(.ar.or—sJ.I.YJerrf. THE MAIN RESORT' •ofr fe«�� HYANNIS •BARNSTABLE• MASS.• o.rt JCILr/.q rOV fN N.JJ • TOWN OF BARNSTABLE f SIGN PERMIT PARCEL ID 309 225 OBU GEOBASE ID 38773 . ' ADDRESS 460 MAIN STREET (HYANNIS PHONE HYANNIS ZIP LOT BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT HY PERMIT 83297 DESCRIPTION 30 SQ FRESH KETCH PERMIT TYPE BSIGN TITLE SIGN PERMIT CONTRACTORS: Department of ARCHITECTS: P TOTAL FEES: $50.00 Regulatory Services BOND � CONSTRUCTION COSTS $.00 ENE 753 MISC. NOT CODED ELSEWHERE 1 PRIVATE ° BUILDING D)IVISION BY ' DATE ISSUED 04/08/2005 EXPIRATION DATE Tow- i�of Barnstable Regulat6 Services�. Thomas F:Geiler,Director * BARNSPABLE, * a MASS. � Building:Division 'Oren nu•�° Peter F,DiMatteo;.Building Commissioner 200Main�Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Tax Collector Treasurer Application for Sign Permit �CZl3 t� o Applicant: .: . Assessors No:3y Ct- Z ZSp U Doing Business As: �`- S� \C� �G� I Telephone No. Sp --23 2 l S'�S Sign Location Street/Road: 41(00 � `-', k:-l—t 0 yMn�-S k. A&A , Zoning District: Old Kings Highway? Yes evyannis Historic District? Yes o Property Owner Name: '� �� �'?� Telephone: Address: LlQ)® \M 2c1- C Village: 1-4 Sign Contractor , �c�Name: ��� � � 5� C:� 1 � Telephone: Address: (0�-2j d c vJ vh :'U�' - Village: fx�> 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?. Ye!No Note:If yes, a wiring permit is required) I hereby certify that I am the owner or that I have the authority of the owner to.make this application,that the information is correct.and that the use and'construction shall conform to the provisions of Section 4-3 of the Town of Barnstable Zoning Ordinance. Signature of Owner/Authorized Agent: Date: 'j �'0-5`firr__ tt C� rt Size ��: —! V % �. Permit Sign Permit was approved: Vk S Disapproved: Signature of Building Official:— L Date: J" Signl.doc . rev.122801 l KE 0 -,-- or , Aw '9"'d ,^?� � Y�-a1.rWras;� R 4 si• A�.,�,t,E, v '� ' .�a� •+`_aw i -4�, :� -,k>�'� �,���-: w' � • `� �� � �„ �:,~- � � 3.�®L�MP:iN ST S�' �'Af31V101�)TI�� OREM "*�,-.:s`".� .`,.�:�li +�• �. :^��ar� r Y� -Illdll )1��41<�Il 0112�( al )C( ()(� 12` t g tr • Hyannis Main Street Waterfront ,a BAMST BM : Historic District Commission MAM 230 South Street . 1639• '°TEo MPS" Hyannis,Massachusetts 02601 TEL: 508-862-4665/FAX: 508-862-4725 � Application to t J Hyannis Main Street Waterfront-Historic District Commission in the Town of Barnstable for a CERTIFICATE OF APPROPRIATENESS �R Application is hereby made, in triplicate, for the issuance of a Certificate of Appropriateness ' 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 for: PLEASE CHECK ALL CATEGORIES THAT APPLY: 1. Exterior Building Construction: ❑ New Building ❑ Addition ❑ Alteration Indicate type of building: ❑ House ❑ Garage ❑ Commercial ❑ Other 2. Exterior Painting: ❑ 3. Signs or Billboards: ❑ New sign ❑ Existing sign Repainting existing sign 4. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Other 5. Parking Lot: ❑ New Building ❑ Addition ❑ Alteration (Please see the guidelines for explanation and requirements) C -�d TYPE OR PRINT LEGIBLY DATE off' + l7S e� C - ASSESSOR'S MAP NO. 30 9 ASSESSOR'S LOT NO. ZZS 00� C"a' rL� o R 10 t APPLICANT 12C 51 QtO 0•P_P rl RE SH k 01C TEL.NO. S Oig " �71-$LqZ— of APPLICANT MAILING ADDRESS 0 26 o I ADDRESS OF PROPOSED WORK &o l�Wtl►.Gi) 1�� S IvIKSS 0 Zb d I PROPERTY OWNER TEL. N0. D 7 !/ cl) OWNER MAILING ADDRESS 'A) C� yfi S lu if q FULL NAMES AND MAILING ADDRESSES OF ABUTTING OWNERS. Include name of adjacent c.M property owners across any public street or way. This information is best obtained at the Town Assessor's Office. (Attach additional sheet if necessary). AGENT OR CONTRACTOR_PL*A.DJr� 4-7 I b-N TEL.NO. ADDRESS b C DETAILED DESCRIPTION OF PROPOSED WORK: Give all particulars of work to be done, including detailed data on such architectural features as: foundation,chimney, siding, roofing,roof pitch, sash and doors,window and door frames,trim, gutters - leaders,roofing and paint color,including materials to be used, if specifications do not accompany plans. In the case of signs, give locations of existing signs and proposed locations of new signs. (Attach additional sheet,if necessary). Signed JOwner-Contractor Agent CD SPACE BELOW LINE FOR COMMISSION USE Received b+�((((HMS Date E "�� E � � D P Time FEB 14 2005 This Certificate is hereb V By NSTAgLE Date HISTORIC PRESAl 1UN IMPORTANT: If this Certificate is approved,approval is subject to th 0-day a eal erio d in the Ordinance. CONDITIONS OF APPROVAL: f r Hyannis Main Street Waterfront Historic District Co Al �o SPECIFICATION SHEET FOR SIGNAG y rod I isToRcopeq 00S Prior to filing your application for a Certificate of Appropriateness, please c 9 q 6 the Building Inspections office, at 862-4038 to discuss the amount of signage �gTipN allowed for your building, as well as any other Town Sign Code regulations which may affect the sign(s) you propose to install. Even if you are applying for the same amount of signage as previously existed on your building, the laws may have changed since that sign was installed. Once you have applied to the Hyannis Main Street Waterfront Historic District Commission for a Certificate of Appropriateness for signage, you may apply to the Building Department for a temporary sign permit. The Building Department can provide all information regarding the temporary sign permitting process. Please fill out all information requested below. BE SURE THAT YOU HAVE INCLUDED WITH YOUR APPLICATION: • a scale drawing of the proposed sign • color chips for all colors on your sign • a photo or scale drawing of the building on which the proposed sign location, as well as any light fixtures proposed to light the sign, are indicated • a scale cross-section of the sign, with dimensions, showing edge detail • specifications for any light fixtures proposed to light the sign • a scale drawing of the sign bracket, indicating dimensions, color, and material If you are applying for a Certificate of Appropriateness for more than one sign, please fill out ONE SPECIFICATION SHEET FOR EACH SIGN. Size of Sign 4 X —qy Material(s) of Sign Q411 l— AN Material of Lettering (if different) ✓� The Sign Will Be (circle one): carved wood / painted wood / vinyl lettering other (explain) OeA S4w �x6ST60 Locat'on In Which the Si n Will Han MSS 0 Z c) Will there be exterior light fixtures to light the sign?LV/ye )�5 C4'(V/46_ If so, what type of fixture? ftog #ecIc Where will the fixture(s) be located? 0y 1200V (Vmc- '45 �X151 iN� I The Town of Barnstable BABE. Department of Health Safety and Environmental Services MASS. a 9�A 1a79 �,�e rfo,r,or Building Division 367 Main Street,Hyannis, MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner Inspection Correction Notice Type of Inspection C/ C 11y S, c 71 o sl Location YG a Inn ,,v s 7� Permit Number OwnerW6XIVk' ('MASS °"I Builder One notice-to remain on jobsite, one notice on file in Building Department. The following items need correcting: t a i L O t� IVr4l0 02 X/i �S �y.✓S / S %.d� LLE' %Ro .vS %Q XrT C/n�/�6' ,Cw c y �9�i'FS �' CArtF aFi Please call: 508-862-4038 . for re-inspe 'on. Inspected by 1 Zd' Date 1�( l Town of Barnstable *Permit# w px Expires 6 months from issue date Fee d✓- 7 O ,BU& ; Regulatory Services BARM ems. g' Thomas F.Geiler,Director Eon Building Division X-PRESS PERMIT Elbert C-Ulshoeffer,Jr. Building Commissioner 367 Main Street, Hyannis,MA 02601w F E B 1 2 2001 Office: 508-862-4038 Fax: 508-790-6230 TOWN OF BARN STAB LEd,, EXPRESS PERNIIT APPLICATION � k Not Valid without Red X-Press Imprint Co1 � 3oG Map/parcel Number; _ _ — — Property Address �rno Mal r1 �� lQn n Is Residential OR Ptommercial Value of Work add Ow ner's Name&Address C0 Wf L SQt' 1 y coo ly(a QnA l.S NI A Telephone Number y Contractor's Name nn Home Improvement Contractor License#(if applicable) 3 D Construction Supervisor's License#(if applicable) OWorkman's Compensation Insurance Check one: .I am a sole proprietor I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Permit Request(check box) [] Re-roof(stripping old shingles) Re-roof(not stripping. Going over existing layers of roof) Re-side Replacement Windows. U-Value (maximum•44) Other(specify) rQ C S p Q *Where required: Issuance of this permit does not exempt compl iance with other town department regulations,i.e.Historic,Conservation,etc. Signature expmtrg 30922500C 0922500C 0225189 qll4l" I'll 111. Cie t NIT 103 COURTYARD VACATION CLUB INC IN&NORTH ST YANNIS MA 026 00000fGA COURTYARD RESORT 103 COURTYARD VACATION CLUB INC0000 000 0 MAIN STREET(HYANNIS) 0000 wv - \37 INC ,A1s The Town of Barnstable .." Inspection Department 91 . �0 Y&Y M' 367 Main Street, Hyannis, MA 02601 508-790-6227 Joseph D. DaLuz Building Commissioner November 12, 1993 Courtyard Resort 460 Main Street Hyannis, MA 02601 Gentlemen: You are hereby ORDERED TO CLOSE THE SWIMMING POOL IMMEDIATELY. The swimming pool and the swimming pool area must remain closed until a licensed electrician has corrected the electrical problems and an inspection has been made by this office. Very truly yours, �e ichard R. earse Building Inspector RRB/gr cc: Hyannis Fire Department i oF�YCTo Y The Town of Barnstable 4 : 1 )A))MAGI. r ). : Inspection Department � 367 Main Street, Hyannis, MA 02601 508-790-6227 Joseph D. DaLuz Building Commissioner November 12, 1993 Courtyard Resort 460 Main Street Hyannis, MA 02601 Gentlemen: You are hereby ORDERED TO CLOSE THE SWIMMING POOL IMMEDIATELY. The swimming pool and the swimming pool area must remain closed until a licensed electrician has corrected the electrical problems and an inspection has been made by this office. Very truly yours, ichard R. earse `-- Building Inspector RRB/gr cc: Hyannis Fire Department yofp,� n/�z/ya -�� � -� � � ��� Assese ssor's office(1st Floor): Assessor's map and lot number 9 02`S C� pi TN E Tp Conservation(4th Floor): Board of Health(3rd floor): • •7 • Sewage Permit number sy& �� ' Engineering Department(3rd floor): /` �J� i639' 4AA \O�° House number 6 y�� Definitive Plan Approved by Planning Board 19 APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO + TYPE OF CONSTRUCTION r-yr&?1j�LT 19 qq TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a, `permit according to the following information: Location rnAl N 5—r Proposed Use ����At,-k ft ' ` Zoning District Fire District c1le, X/,L/t� Name of Owner (t—C.L I C-P2 Address q70 M 4 IQ S 9 Y A-kMn;6 Name of Builder 1,1 &5 S C7 C4 A-S 5 6 Z Address -3 GzTG�6 P-- C--AJ IP- M A-261006 Name of Architect Address T n Number of Rooms ti�lq iC CSZ> Foundation 16// Exterior— ���� Roofing Floors �� Interior Heating Plumbing Fireplace Approximate Cost lDdC� Area Ale Diagram of Lot and Building with Dimensions Fee � ' (f OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I.hereby agree to conform to all the Rules and Regulations of the Town of Barnstable egarding the above coTZ4e./L Name Construction Supervisor's License ��66 TELLIER, ED No 36- 2 Permit For RESHINGLE ROOF Restaurant Location 462 Main Street Hyannis - Owner Ed Te,llier Type of Construction - Frame r• Plot Lot Permit Granted March 30 , 19 94 Date of Inspection: Frame 19 Insulation 19 - Fireplace 19 Date Completed 19 _ t - R o i r �V CO'W"ON W - OF EALTH DEPARTMENT OF PUBLIC SAFETY _ - MASSACHUSETTS 1010 COMMONWEALTH AVE. BOSTON,MA 02215 EXPIRATION DATE LICENSE 06/30/i994 CONSTR. SUPERVISOR RESTRI ONS CTI -� CAUTION NONE • EFFECTIVE DATE LIC-NO. FOR PROTECTION AGAINST 06/30/I 992 0454E6 THEFT, PUT RIGHT THUMB II PRINT I 93 EVERGREEN DR BOX ON LICENSE. PHOTO(BLASTING OPR ONLY) RS FEE: MAR S T ON S MILLS MA 0 2 h 4 BLASTING OPE iOUST INCLUDE�T�TO. 0.00 `�� E PHOTO. HEIGHT. NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY STAMPED-OR-SIGNATURE OF THE COMMISSIONER I THIS DOCUMENT MUST BE I CARRIEDON THE PERSON OF OTHERS-RIGHT THUMB PRIM THE HOLDER WHEN EN. GAG IN THIS y, SIGNATURE OF LICENSEE I « SIGN NAME IN FULL ABOVE SIGNATURE LINE OCCUPATION. /7 l p�,r�i.�`y COMMISSIONER' l L ...................................................I....................... ................................................................... . ................................................ ... ......... .............................................. ISSUE DATE(M M/D D/YY) ............... .............. ......................... ............. ................................ . .... ............................................................... X n03 30/94 ..... .. .. .. .. . .. ...... .... . . ..... .... ::X'X PRODUCER THI P41CATE 15 ISSUED AS*A"" MATTER OF INFORMATION ONLY AND Dowling & 0' Neil Insurance CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE Agency, Inc. POLICIES BELOW. 222 West Main St. PO Box 1990 Hyannis, MA 02601 COMPANIES AFFORDING COVERAGE COMPANYAU.S.F.& G. LETTER COMPANY INSURED LETTER Wayne Chasson, & Mark Chasson COMPANY C 470 Main St. LETTER Hyannis, MA 02601 COMPANY LETTER D COMPANY F: LETTER -------- ............................................................... .. ....................................................................... [00w9 . .. .. .................................. ........................I...... ......................................................................... ............ ................. ........ THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED 110 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. CO TYPE OF INSURANCE POLICYNUMBER POLICY EFFECTIVE POLICY EXPIRAT10N LIMITS LTR DATE(MM/DD/YY) DATE(MM/DD/YY) A GENERAL LIABILITY BINDER85136 03/30/94 03/30/95 GENERALAGGREGATE s600,OOO OMMERCIAL GENERAL LIABILIn PRODUCTS-COM P/OP AGG. $600,OOO FX_� LAIMS MADE OCCUR. PERSONAL&ADV.INJURY $300,OOO MM WNER'S&CONTRACTOR'S PROT. EACH OCCURRENCE 000,000 FIR E DAMAGE(Any one fire) $50,000 MED.B(PENSE(Anyone person) s5,000 AUTOMOBILE LIABILITY COMBINEDSINGLE $ ANYAUTO LIMIT ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (per person) HIREDAUTOS BODILYINJURY $ NON-OWNED AUTOS (Per accident) GARAGE LIABILITY PROPERTY DAMAGE $ EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ ............ .......... ... ....... .......... OTHER THAN UMBRELLA FORM . ........ WORKER'S COMPENSATION STATUTORY LIM ITS AND EACH ACCIDENT $ EMPLOYERS'LIABILITY DISEASE-POLICY LIMIT $ DISEASE-EACH EMPLOYEE,$ OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS Operations performed by the named insured as provided for by the terms & conditions in the policy ............................................................................. ................................................. -------- .... ... .... . ....... . . ..... ........ ......................... ....... ...... . ..................... .. ............................. LD ......... 4"A ... ......**......* i..... ....... .... ... ...... ...... ....... ............... ....... .. ..... ....... C : : --- ". ...................... . ......... ............... ........ .... ............... ON ........ ......X X. ..... -X....' .... ......... ............... ............... .T ... !R — .. :: : ...... ............. ........ ............. . ......... ..... SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO Town of Barnstable MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE Attn: Building Inspector < LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR South St. LIABILITY OF ANY KJNDUPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. Hyannis, MA 02601 AUTHORIZED," EIP!R!S�ENTAJWI� 7 ................... ........ ........ . ...oaib ............. . ............ ............... 51zi�tl :" ....... .... .......... ............. ................. ................ ..................... .. ............ i -t ad OEPARThENT OF PUBLIC SAFETY CONSTRUCTION SUPERVISOR LICENSE . Nuober : Expires: Restricted To: 00 NAYNEYN CHASSON ®OMMISSIONER P08% 373 ^(.p; t i The Town of BarnstableBARNSTABLL KASS. peg Department of Health Safety and Environmental Services ►aa. 16 Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-775-3344 Building Commissioner For office use only Permit no. Date AFFIDAVIT 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: �J Est. Cost 2�Z� Address of Work: �Z_ ln/1 F} f �1 ik-;W Owner Name: L; )��/��- VVI ( ' S (no Date of Permit Application: 1 -7 G 1 ` QC I hereby certify that: Registration is not required for the following reason(s): Work excluded by law �/ dbb under S1,000 Building not owner-occupied tier pulling own permit Notice is herebygiven that: � OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for,a permit as the agent of the owner: l 7.. 0 Date Contractor name Registration No. OR Date Owner's name 11/02 '94 17: 02 - Z 51;7277122 DEPT IT'D ACCID � /� l�0Ii2l Yl!)f1[UP.LZLr 1l of I/ l,24iachti�jetb lap artnwnl o�✓'liLill�LrL6L.J�cGLQ6Iu3 I 600 !/Va - tan stllaet James J.Campbell &ton, V".ckwutta 02f f Commissioner Workers' Compensation [ tsura>nce. davit IAI Yk/2 Alf eaomseerpvmara� with a principal place of business at: - do hereby certify under the pains and.penalties of perjury, that: (4-`�[ am an employer providing workers' Compensation coverage for my employees Working c this job. v (P 70 y'7 l Insurance Company Policy Number O I am a sole proprietor and have no one working for me in any capacity. ( a sole proprietor, general conuactor or homeowner (circle one) and have fired the contractors listed below who Rave the following workers' compensation policies: Contraaor Insurance Company/Policy Plumber Contractor Insurance Company/Policy Numbea Contractor Insurance Company/Policy .Numbei O I am a homeowner performing all the work myself. 1 uncersU : ac Z coz;y of c.s s=tement will be fom-zrced to d:e OMce cf investiE7,dons of d;e OTA for eoveragr verification and that failure tc E cc.e:ale s rEc_i.-ed urcer Sc-c*on 2�A of MGL 152 ua lead to the Jnpesition of criminal penalties eotnisane of a fine of up to S 1,500.00 anch years' imGriscnment;a well as Civil penalties in the torn.cf a STOP WORK ORDER and a fine of S 100.00 a day against M.C. day of Signe is Y ``� Licensee �rmitree Building Department Licensing Board Selectmens Office 5 7,(Fl Health Department TO VnrIFY COVERAGE INFORMATION CALL: 617-727-4900 X403, 404, 405, 4a9, :57- Assessor's Office(1st floor) Mao 3 o q Lot -v-2 SC' P rmit ., Date Issued S� S 3rd floor r' I En inecring Dept. Ord floor House � P t aARt+areetr, t Dcfinitivc Plan Approved by Planning Board "A"a 19 e» �� Ti0 A1R4� (Applications Processed 8:30-9:30 a.m. & 1:00-2:00 i TOWN OF BARNSTABLE D6'vJ� Building Permit Application Protect Street dress M A � i VillageFire District Ovncr ed:7� CfIN ) Address Telephone- `77/ Permit Rcc uest: Q-s — �� C� A✓PCL = 3B �C r; `` �ritLpe, Zoning District F12od Plain Water Protc.,tion Lot Size randfaihered Zoning Board of A Is Authorization Recorded Current Use Pro sed Use Constructign Tvpe EiistinQ Information Dwelling Type: Single Family Two family Multi-famil Age of structure Basement tune Historic House Finished Old Kin g's Hi hwai Unfinished Number of Baths Nf Bedrooms Total Room Count not includin baths) First Floor Heat Type and Fuel Central Air _fireplages Garage: Detached Other Detached Stnictures Pool Attached Barn None Sheds Other Builder Information Name Telephone number 7 _7/ 7 S,Y S- Address box 3-7 3 License# O q S y(o (P 5 dZ ( Home Improvement Contractor# Worker's Corn asa ion # NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN (AS BUILT) SHOWING EXISTING, AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUC i;CE: Dz L U,s ;'ESijLTYN FROM THIS PROJECT WILL BE TAKEN TO Pro• t Cos Fee SIGNATURE DATE BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) BPERM T Rio zi o 5/22/95 331t-r- 309.225 460 Main Street Hyannis Owner: Wayne M. Chasson y a � Assessor's Office(1st floor) Map .�� 1 4,ot-17.1 c; Permit# Conservation Office Oth floor Date Issued Board of Health Ord floor YK Engineering Dept. 6rd floor) House# "''�� Planning Dept. (1st floor/School Admin.Bldg.): 's aesnares It MAW .. Definitive Plan Approved by Planning Board 19 lb�a h�� — �O MKS II (Applications processed 8:30-9:30 a.m.& 1:00-2:00p.m.) TOWN OF BARNSTABLE Building Permit Application Project Street Address -Hto b HAI& S Sr. Village N g A M A J I'S , I Fire District N If A N AJ f S (honer COUP-7-1 A�A V AeATt N3 C�-U B I MC. Address Telcphone -I-Ufi -Bloc)() Permit Request: i�tvi t�" S'T R,OC T U eF— Zoning District Flood Plain Water Protection Lot Size Grandfathered Zoning Board of Appeals Authorization Recorded Current Use Proposed Use Construction Type Eaistim!Information Dwelling Type: Single Family Two family Multi-family Age of structure Basement type Historic House Finished Old King's Highway Unfinished 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 Name IsHtAf-- Telephone number Address License# Home Improvement Contractor# Worker's ComMusation # 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 Project Cost Fee SIGNATURE DATE BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) 1 BPERM T • �•8-cr�r'L 77,1 oG FOR OFFICE USE ONLY ADDRESS a /�IIiJ �� vII.LAGE f f � O_WNER 1 /� l (i '% ✓ •/ 6 � r DATE OF INSPECTION: FOUNDATION - 4 1 1 FRAME .INSULATION t FIREPLACE F ELECTRICAL: ROUGH FINAL ! PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING: DATE CLOSED OUT: ASSOCIATE PLAN NO. ' f 11/02/94 17:02 %T6177277122 DEPT IND ACCID Z 001 =(, Cotn4nonwP,aCt`2 0/ Maljaclzttdetb �Japartment o�,�'•nduatrial,�dcci�n,t3 600 gq1/��V��cr�Lyton St�ef James J.Campbell &Sto►t, 1'i'/aaachulrttt4 02//1 Commissioner Workers` Compensation Insurance Affidavit with a principal place of business at: 460 MA%t,3 ST N -4Ammks (cur/Stupi )— do hereby certify under the pains and penalties of perjury, that: ( I am an employer providing workers' compensation coverage for my employees working on this job. RMf�2.1CY�►tJ�c -1cl �lo�£�S W�C i�lIa1 `t Insurance Company Policy Number () I am a sole proprietor and have no one working for me in any capacity. () I am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed below who have the following workers' compensation policies: Contractor Insurance Company/Policy Number Contractor Insurance Company/Policy Number Contractor Insurance Company/Policy Number O I am a homeowner performing all the work myself. 1 understand that a copy of this statement will be forxarded to the Office of Investigations of the DIA for coverage verification and that failure to secure coverage as recroired under Section 25A of MGL 152 can lead ro the Imposition of criminal penalties consisting of a fine of up to S 1,500.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S 100.00 a day against me. Signed this J day of / f(o 19 915 UcenseelPermittee Building Department Licensing Board Selectmens Office Health Department TO VERIFY COVERAGE INFORMATION CALL: 617-727-4900 X403, 404, 405, 409, 375 TOWN OF BARNSTABLE BUILDING PERMIT # ,S Z L2-L Patent No. 4,425,742 and 4,501,103 H NDYrffi1HUT Wooden Storage Buildings / Sherwood & Seville / 8' x 8' Han;.ly C...,heCk11St' A ASsemblyIn'strubtions FIRST... ■ SQUARENESS MOST - ■ Read these instructions and watch the video IMPORTANT! thoroughly before beginning assembly. These Keeping all 900 comers and 900 perpendiculars instructions are easiest if you follow the steps in square throughout the assembly of this but will the order shown. You make a simple project make each succeeding step,easier and will make all much more difficult if you do not. . components fit together properly. In a drawing;-a dotted line represents a part - . hidden from view (like a part under a panel). 0 CHECK LOCAL ZONING ■ lumber is graded from only one side. Check the Before erecting any building on your property, you part for the most attractive face and make sure should check with your local government office to face it to the outside. regarding any local requirements. ■ CHECK ALL PARTS ■ TOOLS REQUIRED (Parts List on back page) ❑ Hammer ❑ Tape Measure If a part is missing, circle part in question on back ❑ Phillips Screwdriver ❑ Step Ladder page and call 1-800-221-1849. Ask for a customer service representative and they will assist you in E OPTIONAL TOOLS getting a replacement part. "❑ Cordless Electric Drill with Phillips Tip ■ ASSISTANCE REQUIRED We recommend that you assemble this Handy Hut un ievei grouna in the iocatiun it win oe useo. %yiv 1 r_N 1 rages Assistance is necessary to handle, fit and secure FLOOR KIT INSTRUCTIONS. . . . . . . . . . . . . .2-4 all components. HUT INSTRUCTIONS. . . . . . . . . . . . . . . . . .4-17 HUT EXTENDER INSTRUCTIONS. . . . . . . .18.19 If using 4'EXTENDER KIT to make Hut 8'wide x 12'deep, read EXTENDER KIT INSTRUCTIONS com- pletely before starting. 12'depth can be increased to 16'with another 4'Extender Kit. I , ASSEMBLY l i H�� g Video ❑ Included # I ;> with this kit UCTST. PROD [MHOME 6400 East 11 Mile Road Warren, MI 48091-4101 ��v - Toll Free 1-800-221-1849 U, 2 APPLICATION FOR PERMIT TO INSTALL AND REQUEST j0(�o't2 r Ogg FOR ELECTRICAL SERVICE �(o Zq Inspector of Wires (( Wiring Permit# COM/Electric# P 115 4 3 1 Town of )OA r,mod-k Massachusetts Building Permit# Date Customer: coati'[ Aa syzj on(Street#) Woo M4(( w Ct. Lot# in the village of Aw utility pole number or underground number Customer's billing address Temporary New installation Change of service Starting date — Job description 7;, Al e ty -. e •r Service entrance voltage Amperage Phase Wire size(cu.or al.) Conductor per phase. Number of meters Water heater Off peak: Yes_No_ Estimated load: Electric heat kw,lights kw,Range dryer Motors,H.P.&Phase Ready for first inspection_� Ready for final inspection Electrical Contractor ,'�.P F6.,4e Lic.# 1 ; 1� 11 Telephone* Address /10 F141—t 4-! Ot A,4 4— A,T, 4" e Additional Remarks: Do Not Write Below This Line ELECTRICAL WIRING INSPECTION CERTIFICATE INSPECTOR OF WIRES INSPECTIONS DATE FEE CHARGE Temporary Service Roughing in Service and Meter Off Peak Meter Final Approval la^- Disapproved* *For the following reasons CERTIFICATE OF INSPECTION Date To the COMMONWEALTH ELECTRIC COMPANY. The installation described above has been completed and has this day been inspected and approval granted for connection to your service. Inspector of Wires o WIRING INSPECTOR TO BE NOTIFIED WHEN WORK IS READY FOR INSPECTION Permit Good For One Year From Date Of Issue CA 46 INSPECTOR'S NOTICE (ov-3Y6 2S�' Y r _ l, 3; D�,1vrt-rcnc of PU��1� VCJcil/ fnl[ tll BOARD OF FIRE PREVEPIT]ON RECtJW71ONS 527 C},iR 12;C0 3/90 occupancy S rcc Chcckcd 043vc blank) APPLICATIONAL FOR PERMIT TO PER. ELECTRIC All 4ork to be periormcd In accordance with the ac Msachu:cru PJcctrical Codc. 527 CriR 12: WORK ' . (PLEASE PRINT 72t OR TYPE ALL x2tFOR2idTx02i) Dale . city or TO'.M of � ;f o To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below, Location (Street b Number) H(D C� e� :l4c Owner or Tenant 0.'ner's Address • Is this Permit. in conjunction with a building permit: yes ❑ 210 ® (Check Appropriate Box) Alrposc of Building ��( ( �d�p Utility Authorization NO. £.xisting Service Mps / Volts Overhead ❑ Undgrd No. of Meters New Sc;vicc 1�ps / Volts Overhead ❑ ' , Undgrd ❑ No. of Fe tcrs Ntrabcr of Fccdcrs and 'Ampacity Location and Nature of Proposed Electrical Work yrJ Y Aj e u-) (T-- r, No. of Lighting Outlets No. of Hot Tubs Total No. of Transformers No. of Lighting Fixtures ' Above In- KVA- Swimming Pool Frnd ❑ ❑grnd. Generators 1NA No, of Receptacle Outlets No. of Oil Burners` No. o£ Emergency Lighting Battery Units No.'of Switch Outlets No. of Gas Burners r ' FIR.. ALAR`iS No. of Zones No. of Ranges No. of Air Cond. Total tons No. of Detection and , No. of Disposals No, of I{cat Total Total Initiating Devices 1 Pum05 Ton!: KW No. of Sounding Devices No. of Dishwashers Space/Area Heating }1 ' No. of Self Contained Detection/Sounding Devices No. of Dryers Heating Device,- .. ' k'W. Local Municipal, No. of Water Beaters KW Noy of co. o>: Connection❑Other . Sirns `Ballasts Low Voltage Wirin No. Hydro Massage Tubs - No. of,Fotors. Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements I habe a current Liability Insurance Policy including Completed General Laws equivalent. YES NO p P Operations Coverage or its substantial ❑ ❑ I have submitted valid roof of same to this office. YES❑ NO ❑ If you have checked YES, please indicate the type of coverage by checking the appropriate box. , INSURANCE R BOW ❑ OTHER ❑ (Please Specify) Estimated Value of Electrical Work $ ,Dbd Expiration Dates Fork to Startl',��-i� Inspection Date Requested: Row h Final (p� J2—FS Signedundc he penalties of per FIRM NAPS 'Q G �v�- LIC. •Np, Licensee Signature Address LIC. NO.��± 3 Ol.'NER'S L`ISUF[ANC t,' I ,11t. Tcl. No. ��j -�g�c� I am aware that the Licensee does not have the insurance coverage or its sub- stantial cquivalcn .s uircd by MazsachuZCtts Cencral Li:+s application wai •cs t' i quircmcnt. O• ncr Agent and that my signature on this permit �_I� �J (c'lcasc Check one) Assessor's offioe•,(lst floor);, 4 �� a,c F i FfHET As map and Cot number ...... .... ... F ' A Qo o`` Board of Health'. floor): ` a l�. A_ — �— e • 4 ' fO� o" Sewage Permit. number {............ BARNSTABLE. i Engineering Department (3rd.floor): House number tt <-f APPLICATIONS PROCESSED 8:30,,7.9:30 A.M. and. 1:00'.2:00"P.M. only f '- TOWN. OF • BARNSTABLE RUILDING -IHS,PECTOR - APPLICATION FOR PERMIT TO fti r �! /a.S: �JC ! ........................... •••.•.....•••..... TYPE OF CONSTRUCTION ..*Cf?. ?........:. ... .....................................:.............................. .....�� ......:....l 19. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following info motion: Location ........ . ....../..:FR-.l. 1.......J`.f............... .!.Z . ��'!.+'1..1: ....... /.. �. Proposed Use .. � %.A U R A nip n/ i Al ....... Zoning District ................ :....Fire District ........ . , .......... ..... .............................. Name of Owner t k?c3< .. .(?.?....��=�/ice .... . ..Address /)..I.....6.!.. ..!'1.... Name of Builder .. '/ !Jl..e.L.Cr... .� . .. ,lt..Address �'` ... inJ...7�.. /' L 1,110 c3'%-/ f \. Name of Architect ..................................................................Address { Number of Rooms /t t LdrvC't.L�� F '' Exlerio.r ...1�`>.....t�.....`.... fr..L1 :5�. ..................... ..............Roofing 5��✓�z'1'" ✓> L .......... ...... . ..�.... .............. .t Floors �. .j. /. .....��i�G .S...................................Interior �L✓�5$"� f Heating /+ '�^.....-�....?� ..... .....�' ...-5................:............Plumbing ...� .... Fireplace ... .. i .........................Approximate Cost .�..l�.................................... w C7l� . Definitive Plan Approved, by` Planning Board -------------------------_ __ __ _ . Is.1 19 Area ............. Diagram of Lot,an-d'!Building with •Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH �o OCCUPANCY. PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and. Regulations of the Town of-Barnstable regarding the above construction. Name ... _ ............ .. .J J ...... r. r � � •,�� � • Construction Supervisor's License t,i.�..�,f•.�.�:`?�............... -� �!ELLIER, EDWARD A. No -30395 ADDITION ` s ...... .......: Permit, for .................................... ; M Commercial Bldg .. ................ ........ . ..... ........................ .......... ..... . -Main Street Locat n - , ......... 5............................................. Owner Edv#a d 'A. Tellier .................................................................. < � n c Frame , Type of Construction - I............................. -• _ i Plot ........... f ......... Lot ................................ • ' Permit Granted .:......J ndary'..2.3......19 87 ' Date of Inspection 19 r Date Completed .............. 19 a j T , r^ X 4 Assessor's offioe (1st floor): E FTNT Assessor's map and lot number................ �o Board-of Health (3rd floor): If) /l 7 /� - - Sewage Permit number ....................... .......................:..... • 1i BABd9TOBLE, Engineering Department (3rd floor): //_ r Sao MABI 0� I V 0 �✓ House number ......................................................................., - ''>F0MAI APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only TOWN OF BARNSTABL- E BUILDING INSPECTOR t1G105e - r 5Y l j �•- r 0 APPLICATION FOR PERMIT TO ............................................................................................................................. 1„ �' ' mot .s TYPE OF CONSTRUCTION ........... ..................................................................�..�.................................................. TO THE INSPECTOR OF BUILDINGS: , The undersigned hereby applies for a permit according to tH following information: Location .......7.•/,.� A .r v,......J`.(. / T..�l�.t'?.)g.t 5.......:......::.'...:'.!. f �.. �... .. ................. ProposedUse .................... ............................. .................................................................................. ............................... ZoningDistrict ........................................................................Fire District ...............//.,r... w. ..................................... Name of Owner .......W. m::Y':..... ......�, ....`�,/..�'.:`�.... ....Address ��1......(�':.Y.`'4--`'.�..... 1'!... SB Name of Builder /}r`.I.. .- �- �`/1l�/L�..Address C' LM0 ej7P /1'I .................................. ... ..................................................... Nameof Architect ..................................................................Address ............................ ....................................................... Numberof Rooms ...................../..............................:..............Foundation .............................................................................. Exterior ... � SArLF ...fi T ................................... C... t.... ...rI L . .................................Floors .. .. Interior ..�././.....`!".55 .R....O...�..�...-.�.,......................... g � �'� �' ; .Plumbing ��n/E Heatin ........:.................... ........... .. r' Cl Fireplace ... ...........................................................Approximate Cost .....Obl .............................................. Definitive Plan Approved by Planning Board ________________________________19-------- . Area Diagram of Lot and Building with Dimensions Fee / SUBJECT TO APPROVAL OF BOARD OF HEALTH 1, OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of thejown of Barnstable regarding the above construction. 1-7 w � Name .............. ../, A .................. hit-.%�t✓ --f �•-'C.t�•-��,,,�"""'��^ .............. Construction Supervisor's License a '. ..... r TELLIER, EDITARD A. A=309-2='5 No 30395 permit for .....ADDITION .............. Commercial Bldg.:........................ ... .. Main Street Location ..::. ........................................................... HYanni 5................. Owner ...Edward. ...A......Tellier. . . . .................... .. .. . .. .... .. .... .. Type of Construction ...Frame, ......................... Plot ............................ Lot ................................. I 3 Permit Granted ., January 23 , 19 87 ................... . Date of Inspection ....................................19 Date Completed ..............................:.......19 Assessor's map and lot number ... Sewage Permit number ........................................................ . 33A"ST&BLE, House number ................................................................. ...... ro NAG& 1639. up'l TOWN OF BARNSTABLE Arl- BUILDING INSPECTOR ........................ APPLICATION FOR PERMIT TO ......C ...................... TYPE OF CONSTRUCTION ....... ...... ..................................................................................... ...............19. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ....w................ ......... �i.T..................... . .. . ......P0 ...... ... .............. ...... ..... 0 e- 4YN Proposed Use ...............................0...............I................................................................................................................................ Zoning District ...........................`4.......................................Fire District ....... ................ Name of Owner ....... ........ ...... ...... .. ................ ...........Address ...................................V Name of Builder' ....���.A...4 ..................Address ..... ............... Nameof Architect ......... ..............Address .................................................................................... Number of Rooms .....................................Foundation ..........:7"" .......................................................... Exierior ....................................................................................Roofing ........... ...... ....................................... Floors ......................................................................................Interior ...................... ............................................................. Heating ....................................................................Plumbing .............. n.................................................. Fireplace ............................7..............................................Approximate Cost .................................................................... Definitive Plan Approved by Planning Board --------------------------------19--------- Area .....iR-Zl ........................... Diagram of Lot and Building with Dimensions Fee ........ ............ SUBJECT TO APPROVAL OF BOARD OF HEALTH C con C X C L 0 cl� OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ................ ................................................................. TELLIER, EDWARD A=309-225 86q-)016- 23871 Construct No ................. Permit for .................................... ................................................ wo Location ...No.r.tA...Street;,,, Rear) Hyannis .........................................................f................... Owner .....E.dwar.d...T.e 1.1.i e.j..................... .. .......... .. .. .... .. .... .. .. oncretil Type of Construction 9...............ol;...................... ............... ................. . ............................................... Plot .... . .................... Lot ................................. 'Ma rch 151, 82 Permit Granted ... .................... ..............19 Date of,Inspectional ...............19 Date Completed .................... ...........:..19 ,4 L 0141 R CLERK TOWN `OF BARNSTABL BEE. iASS. Zoriing Board of Appeals �Hi JUN. 10 AH 8 52 .........cdwaL°d A. Tellier ................ Deed duly recorded in the ................._. ....._................................_......................................._..._.................. . _._...... .... Property Owner County Registry of Deeds in Book ............_......._.... Candace I. Te Z Zier Registry ......................._.............................................. .........................................._.... Page .........._........_.., ......_........._........._ .._..._._.._ ._...... Petitioner v District of the Land Court Certificate No. ......................... ........................ Book ......._....._....... Page Appeal No. .:1988-42 ...... 19 FACTS and DECISION Petitioner Candace I. Tellier filed petition on .1' azJ_..2a... ... ._........__ 19 85 _........................_................._..........._.__..................... requesting a variance-permit for premises at _...._462.... ain..,St................................ in the village (Street) o1 ................Hyannis......._............................. ..............., adjoining premises of .................. (see attached list) _...._............. .... Locus under consideration: Barnstable Assessors Map no. ...............Z-0..0............................ lot no. ........2. ....._._. Petition for Special Permit: ❑ Application for Variance: ❑ made under Sec. I..... _..........—... of the Town of Barnstable Zoningby-laws and Sec. _....................._....................................................................._...................... Chapter 40A., Mass. Gen. Laws for the purpose of ._._.. f.raY.1 ... caXd._.abar creation of two gZassed-in dining area additions to the existing buiZding ......................._........._................................................................................................. Locus is presently zoned in..._........_...................... Notice of this hearing was given by mail, postage prepaid, to all persons deemed affected and by publishing in Barnstable Patriot newspaper published in Town of Barnstable a copy -of -.; iicii is attached to the record of these proceedi_f s filed , ith To,,vn Clerk. A public hearing by the Board of Appeals of the To«vn of Barnstable was held at the Town Office Building, Hyannis, Mass., at. ..8 .��._............. P.:II. ..._..........._..:_..May 16, 19 85 upon said petition under zoning by-laws. Present at the hearing were the following members: IA Richard L. Bob Luke P. Lallu ...._...GaiZ N2 htin aZe ..............._....................._........_........._..._.___ ._._ ....____......._.__................................. _.-..._ .... __.. _.._.__.._ . ........__.. ............_.._...._ Chairman Ronal Jan EZizabeth Horton At the conclusion of the hearing, the Board took said petition under advisement. A view of the locus was made by the Board. 1985-42 114_r / !, locus was No.........._............................................................ Page ......................... of ..................... On ........................................................................ 198..5.............. The Board of Appeals found Attorney. Richard C. Anderson represented the petitioner who is requesting relief 1! from the provisions of the zoning by-Zaw in a business. zone, which would require a 20 foot. frontyard setback., to allow the petitioner to instaZZ two glass enclosures to the front of the- existing Howard Johnson restaurant - to be a one-story addition and consist entirely of glass for a full-service fine-quaZity restaurant at Main St., Hyannis. These additions will not increase the capacity of the restaurant - seating of about 226 - no parking wiZZ. be eliminated. The addition to the west will seat about 50, while the addition to the east will accommodate about 36 patrons. The lot consists of 2.25 acres and contains the Howard Johnson Motor Lodge and also Wack A Jacks which is a separate building at the back of the Lot. The topo' is a cummulative collection of conditions of the area; almost all of the buildings violate the 20 foot setback requirement - this should not be closer to the sidewalk than many existing buildings along Main street. if the proposed additions are allowed, the westerly addition would intrude about three and a half feef(32)- the building is set back about 10 feet and the petitioner will come back another three and a half feet V21 - to 'b'e about 4;�, - 51 further towards main street than presently exists. To be a brick patiounder glass and continued brick inside. To be landscaped with shrubs in front of the building, etc. The petitioner does not intend to have any I dancing or entertainment ,*- would accept that as a restriction. The petitioner has submitted a.PZan which indicates the building in relationship to Main Street, Gail Nightingale made -a motion that we grant the relief requested with the restrictions that the addition never be solid enclosure (waZZs)., and that there be no dancing or entertainment - to be as per the Plan submitted at the filing - seconded by Ron Jansson, The Board voted unanimously (although absent., Mr. Boy 's vote. '.was recorded as in favor) to allow the petitioner the relief requested. .............. ................ Clerk of 'the Town of Barnstable, Barnstable County, lIassachusettls, hereby certify that twenty (20) days have elapsed since the Board of Appeals rendered its decision in the above entitled petition and that no appeal of said decision has been filed in the office of the Town Clerk. Signed and Sealed this ....... dad- of .............................T ....................... Ig fts� ............ under the pains and ..... penalties of perjury. Distribution:— PropertyOwner ......................................................................................................................................... Town Clerk Board of Appeals Applicant Town of Barnstable Persons interested Building Inspector Public Information 13Y ......... ------- --- ------------ ..................................... Board of Appeals Chairman - I I VI Al C x i _ I mill- r 'I 1 ' I ii ' ► J f LL ������i -`y..� t���.C.�.� *,x` ��N *'�'�"p� '�• Ey�,,�.,;`+., '4'E+?�.t '� +w�€ �+ .r�p rVa s ,.� 14t 7, , I II X • �Y/AG�LT� � LO��• oil ' LOCAY.O✓ ••• 1 .ol ls�.a rer✓el /�✓o � s••.r o(o /��' t � 1 of/�H . .. - opp /`r .cam .•.ri.al � 1 Q :x. • ..., , 1 it �00.Jp�. ' a.•ee 1 � ` Le 4 ,' �•'' 1, St ......fie.. �,-...__,r r�•wl.•r � o i - t coa+ps a.r.•. a�.r �— � y ' •" TOTAL AQBA• 11 w VV �9 1 c0T O'•�-'--- o i1 I ol;l oil mot' / y � a' � \ �~• -a.e...�wesa�� ! � L . iCna..f) \ 'w�• •� P y -i `Cw•r/a./ ^. eN`I rr 11 � ' ` '\ p•n�:, r `V, .�w �� •' ' ` ..•; �aL; wee �� ,,� j� '�t mil✓•* f r� .Ii1 ><a afar`�la.r rw✓r..lr� �a4 � �i ��'�.� . \ it p`o i r �.�./awo. i �q ••i t!� �� ar ' a...l ••• ✓l.r w•wa i . '::'.'o•.•:/..�oq./���� Off?t •o �,r-t oil' we,r'' - ssZJ[Yf21/�.�T ra O.ro.r •w 'I1Y `1� \yp en el (`�' •�r'rr 'ice:, aw..>.a✓�„o�o:a«��..%r � 1p� \\ !'�/ �' '\ .ri jO d�. er ay �pc "-AA P �! ro£YlvLvr�mJ � o/'. t — e y J THE Co 7,,,, BESO QT d'; :.a o o d ri,a• LO.CIDOM/Al/UM OcLao.tflry](.GO — ocA✓O.a.A L�...esa. - l.,l ..f Ocroell co,/flT 1 d M W M w i • n . - _� - _ ��''� � � , ✓, � , _�; �� t {w �. '1� y.. � i . i ,� _.� �� __ �� � �. �� 17 c?J (�y ���dl-SN�d9�o wol 't ROOF SIP .TO GLULAM RAFTER I—pia CONNECTION, SEE SCHEDULE >I x 2X8 SUB FASCIA CONNECTION, SEE DETAIL a-0 8-1/4" R38 SIP ON THIS PAGE SEE SCHEDULE ON P1. 2x8 SUB—FASCIA SIMPSON LSTA 30 AT EACH 0-0 SUB—FASCIA JOINT, 2X8 SUB FASCIA, B.O. ;t 8Ya' ROOF SIP ,S� ' SEE SCHEDULE ON P1 EXISTING GLULAM— RAFTER i '•, i EXISTING MASONRY WALL E VERIFY CONSTRUCTION I t tl a a SUB—FASCIA A CONNECTION i PANEL MASTIC EA. SIDE OF 2X z" FRAMING, TYP. 2x8 SPLINE, E.S. 8d NAILS 6" O.C., T&B, E.S. 8Ya" ROOF SIP (2) ROWS 16d NAILS @ 16- D.C. GABLE END DETAIL 120 NORTH STREET EXTERIOR HYANNIS, MA 02601 INTE OR IGA RISSAN 60 SIP TAPE11 s m. ROOF SIP SPLINE CONNECTION DRAWN BY:KD REMSION 3 DOUBLE 2X8 SPLINE CONNECTION, SIP TO RIDGE CONNECTION DOUBLE 2X8 SPLINE CONNECTION, SEE SCHEDULE SEE SCHEDULE SEE SCHEDULE ROOF SIP TO GLULAM CONNECTION, 2x RIDGE EMBEDDED IN SIP ROOF SIP TO EAVE WALL SEE SCHEDULE SEE CONNECTION SCHEDULE CONNECTION, SEE SCHEDULE SIGA RISSAN 60 8-1/4"ROOF SIP SIGA RISSAN 60 SIP TAPE Q SIP TAPE - SIP SCREW TO GLULAM GLULAM RAFTER SUB—FASCIA & TRIM B.O. —� SEE SCHEDULE BEYOND gRmk SUB—FASCIA & TRIM B.O. I _ EXISTING GLULAM RAFTER L.LJ GLULAM RAFTER-- EXISTING 2x KNEEWALL EXISTING MASONRY WALL L Q EXISTING MASONRY WALL O TYPICAL EXTERIOR WALL SECTION AT GLULAMS U RIDGE DETAIL , TYPICAL EXTERIOR WALL SECTION BETWEEN GLULAMS .DATE: 4/28/17 SCALE: r 3/4'=1'-0" SHEET: OF 3 P 3 - xxxx 339 I`�I 12, 9� 2IV- LULAM RAFTER BELOW, TYP �TTtUCTU AL INSULATED PANEL (SIP) NOTES: ' 1. THE POOL RESORT IS'ENCLOSED WITH ROOF SIPS, WHICH FORM THE HORIZONTAL DIAPHRAGMS OF THE MAIN WIND FORCE RESISTING SYSTEM (MWFRS). a. 2. ROOF SIPS SUPPORT BOTH GRAVITY AND LATERAL LOADS. " 3. IN ADDITION TO THE WEIGHT OF MATERIALS, SIPS WERE DESIGNED a 1 FOR THE FOLLOWING LOADS IN ACCORDANCE WTH 780—CMR: } GROUND SNOW LOAD = 30 PSF g BALANCED ROOF SNOW LOAD = 25 PSF F WIND SPEED = 115 MPH o EXPOSURE CATEGORY: C IMPORTANCE FACTOR:1 ; SEISMIC DESIGN CATEGORY: B (Ss=0.20:S1=0.054) 4. SIPS ARE FABRICATED IN ACCORDANCE TO THE NTA LISTING REPORT FLV012412-5 DATED JANUARY 20TH, 2014. i I 5. SIP DESIGN IS IN ACCORDANCE WITH NTA IM 14TIP 01: ENGINEERED UL DESIGN OF SIP PANELS USING NTA LISTING REPORT DATA, WHICH IS BASED ON THE APA SUPPLEMENT FOUR SPECIFICATION, 'DESIGN AND �. 43'-0" FABRICATION OF PLYWOOD SANDWICH PANELS'. 120 NORTH STREET HYANNIS, MA 02601 6. FOAM LAMINATES OF VERMONT IS NOT RESPONSIBLE FOR ANY GABLE END SECTION s STICK—BUILD OR FOUNDATION WORK. 7. THE PROPER INSTALLATION OF SIPS IS CRITICAL TO THEIR $ T PERFORMANCE. JOINTS BETWEEN PANELS MUST BE FULLY SEALED TO " e PREVENT TRAPPED MOISTURE WITHIN THE SIP. FOLLOW ALL FOAM sTE�o �o-a /�pCT LAMINATES INSTALLATION INSTRUCTIONS. DRAWN BY:KID REVISION 6P. 1 I ' fob ' yr L 1� .. / LJ V DATE: 4/25/17 SCALE: 1/4'=1'—O" SHEET: OF 3 P 2 . FILE: xxxx I OUBLE 2X SPLINES z ;.> J R-38 STRUCTURAL INSULATED ROOF PANEL 1� r 1IIIIIIIIIl 1IIIIIIIIIIIi ' OSBK— r — INS, B.S. -I --- S a o 7Y8 NEOPOR. FOAM CORE 'N SIP ROOF CONNECTION SCHEDULE CONNECTIOV FASTENER SPACING DOUBLE 2X8'S AT JDGE& 8d GAL 16' ! '1 6' 16' 16' 16' 1 INS' A IZED RINK oc.,B.Sh6' 16' 16' SPLINES TO SK VANLS 2X8 SUB-FASCIA 0 SKINS* 8d GALVANIZED RINK 67oc.,B.S. I SHAN NAILS 7.7 11Cc&.2IDAD&ITIONAL SIPS TO GLULAM SUPPORTS' 11"SIP SCREWS oEW R EAVE ND) eLULAM RAFTER BELOW, TYP (7 SCREWS/SIP -ROOF SIPS TO EAVE WALL BETWEEN GULAMS. FIELD 11"SIP SCREWS 8oc.• --_ --- VERIFY -.-I1 II >,SIMPSON LSTA 30 AT I I 11 I I I I I I I I I I I I I I I I SUB-FASCIA JOINTS 10D GALVANIZED NAILS 22 NAILS PER STRAP - II II II II I II I II II II I I ACCEPTABLE SIP SCREWS INCLUDE: II I I 'I II II I I II I I SIPTP BY TRUFAST; I II II II I II II 11 I II II I I SSUMED 2X WALL HEADLOK HEAVY DUTY FLATHEAD FASTENER BY FASTENMASTER; IIIIII IIIhII III II IIIIII IIIIII, II II II III , IIIII III I IIIIII IIiIIt I') OTHER SIP FASTENERS MAY BE SUBSTITUTED UPON APPROVAL ABOVE MASONRY. V NOTE: IF FASTENERS CANNOT E ATTACHED ALONG HE EA LINE,ERIFY IN FIELD. 4' 14 I 14' 14'' 14' 14' I 14' I 14' I 14' 14' 14' IL� INSERT(5)SCREWS AT THE BOTTOM OF EACH GLULAM AT EAVES.SEE II II II II II II II I II I I II - - ALTERNATE DETAIL II II II I II II I II I II I II II 120 NORTH STREET it II II I If II II II I II II REFER TO: HYANNIS, MA 02601 I II II II II II II II SHEET P2 FOR GABLE END SECTION II I I II II II II II II I y HEET P3 SIP DETAILS ` --- II II II II II II I II. II II II II H H II , u m II � II II � II I I II II II I II II I 38 ROOF SIPS, TYP All, I II II II I I II I II I II II II LIST OF DRAWINGS e1oe - I II II I I I II II II I II I II II II II 1 I I II II II I II I I P7 ROOF SIP LAYOUT DRA :KD' I I I I I I I I I I I I I I I I P2 GABLE END SECTIO I I I IN 5 ON t2 5 ON 17 P3 ROOF SIP DETAILS REVISION JF. 1 II II II II I II II I I I II II14' II 14' II 11 14' N 14' I 1 14' II 14' I 14' 1I 14' I 14' 11 1Q',I II II II H I II I II I H I II II II II II I II II I I II I H II NOTE: FIELD VERIFY ALL 11 N II II II II II I II I II II _ , " I N II II I II II II III II I II II DIMENSIONS OOF SIPS TO I I I I I I I I I III I I I I _ S GLULAM RAFTER CONNECTION, TYP I EE SCHEDULE L - II II II I I II II II II II I II II II - II II II I I I II II II I II II II O I 11 II II 11 1 II I 1 I II II II II II II II II I II II II I II II II II II II II ' II I II II I II I II I I, AVE FASTENERS' N I I I I I I I I I II I I I I I I SEE SCHEDULE . II II II II II I I II II � II II II II I II, II I II II II �I 4' I I . 14' 'I I I I I 14' 14' 1 I . 14' I I 14' I I. j 4' I I 14 14' 14' 14' II II II II I II II II I II II II I - Ln II II II II II II II II II II II II I � L II II II II II II II II 11 I II II II II II II II II II II II II II II II II Ir----I 1 --�r---If 1 ---1r--- ---- ---- II II II - II I II II II II H II II - O , II I II H II II II H II II II II I ry II II II II ' II II II II II II II II I _I 6' I I 16' I I 16' I I 16' 11 16' I '1,1 '16' I I . 16' I 16' 11 16' I 16' I 16' I 1,E�'I II I II II 1 I H I H II II II II II II II II II II IIII II. II II II II II II II II II II� II II II II II 11 '� 'll � II 11 II II II I II II 11 11 II II � �� II- _-I _- --- -- '--•'I - - - -1� - DATE: 4/28/17 SCALE: ROOF SIP LAYOUT 1/4=1'-O" SHEET: OF 3 FILE: xxxx a� � N so Q ^ N O - C Cn LQ CL -6 =ob 7 co ( t7p O O 00 O m tp O p E ♦— PROPOSED RENOVATIONSca for FRES H K E TCH RE S TA z z 460 MMN STREET HYANNI S MAS S A W F o � 8lJ1LOiiv . a NOV 022016TOWN x z OF BARNS-ABL - REVISIONS �- � - 1 ISSIiED FOR PERMI7' 11-1-16 460 li ED m PLO - - - - — - - _ - Seafood&Steak .Fresh Ketch DWG:INFO. DATE I0-3-16 SCALE NONE . - DRAWN CADD. MAIN STREET ELEVATION - "K° APPRVD !s ur r.srr•r � - V't �r�rr yt..�rr�w•.• - W�i.r� r1+�wrMr• it SHEET TITLE: 9 TITLE BLOCK - MA u. - SHEET&JOB#: T-1 a a� �E o a r N Coln �cfl � 2 2 d m CO � O65 E o H co 0 0 DINING ROOM BAR REMOVE 8' BRICK WALL TYPICAL 0 CONFIRM EXACT CONDITION O REMOVE EXISTING FACADE; LEAVE COLUMNS AND NOTIFY ARCHITECT FACADE AS SHOWNNG E PROVIDE NEW 0 0 0 O F REMOVE GREENHOUSE AND PROVIDE � F NEW FACADE AS SHOWN L H REMOVE FLOOR GRILLES O � a =c IF INACTIVE _ - ----=------z------== -- --------- — — --- — z a 'A ��f o z REMOVE'STO E VENEER Q V H _ _ x z _ - _ REVISIONS - 1 ISSUED FOR VEIL\II'f I I-1-16 EXISTING FLOOR PLAN _. TRIP EXISTING SHINGLES _ • __ ... ..-_- _ - ___.++-___.-. _.. —_�-� ._...-___.__.'-._--.-.-_._-.—_._._-_.�_._. __._.t__ .-__.� -'- —_ _.._—T— s^.fv.�a_=--_ __. ____....._.'., w-....tmT..z—r— __.-..wn..-.,r..4.-.._ rn.... -_ _..—�._ _..-�._.-...�._...•.. - iY�M•.. - REMOVE SKYLIGHTS (5) TOTAL — -- - -- DWG.INFO. REMOVE GREENHOUSE IN ITS ENTIRETY DATE 10-3-16 SCALE 1/4"=1'-0" BRAWN CADD APPRVD tEMOV (STING Wit 11OWS - TUFT REMOVE STUCCO REMOVE STONE VENEER "`:�'� _W.ur�ir.Tier�s.e vim+• REMOVE FABRIC CANOPY "' DAWD EXISTING MAIN STREET ELEVATION VAC �"�� 1^ En SHEET TITLE: 5 DEMOLITION PLAN q SHEET&JOB#: A-1 a� r N O to - 0 < Nn (O Q 0 t 00 OD �2 0 N O 00 b lDm - g o ® VAN"SCHEDULE ANDERSEN a EQUAL APPROVED BY ARCHITECT - U) O WI SIDING WINDOW 244GM15W6 R.O.S-O'a'r-r I l O O cis N F- -� W2 SLDG WIDOIN 244GW4W6 R.O.4•-O'a 4•-r r W3 PICTURE 24*A3W8 R.O.3'-O�a'r-w a PICTURE W4 PIC 244FX500 R.O.T-T a 4-r ' O NOTES: PROVIDE SCREENS ALL SLDOG WINDOWNO GRILLES WHITE FDM LOWBiSULAIID GLASSI DICATES.LOCA71ONS FOR DRACT RESISTANT CLA0=4 ROOM BARO 5 z = ® ® ® ® ® ® 1 p - � m U miiiiiiiii;i; lot . g' 1/4-v -4-r . 4-e 4'-4 V_r 11 3/4 IT- 8 E' 8'.. S' 8' 1'-O' 1'-O" it Ir C PROPOSED FLOORPLAN - REVISIONS _NEW ASPHALT SHINGLE ROOF I ISSUED FOR PE%NIIl' 11-1-16 GU FASCAI,SOFFIT - CE7tTAD11®LAFDANDYARK SAVER - -.- - -- AND OU .AND TIERS TO BE BOtCN - PAIFIED WHITE 460 - - - - = - Fresh Ketch Fresh T' 7 .� Seafood&Steak Ketch DWG.INFO. p I I 0 DATE 10-3-16 \ SCALE 1/4.._I._0.. DRAWN CADD NEW SLDDIO WINDOWS WITH EX!7N6 E7NTRANCE PVC PANEL TO NEW SLIDING WIDOWS WITH CHILD PVC SURROUND AND PANEL A4 - 10 REYAN NATCN PANEL,BELOW PVC SURROUND AND PANEL BELOW TYPICAL SEE ' MAIN STREET ELEVATION WINDOWS BELOW TYPICAL SEE LARGE APPRVD SCALE ELEVATION AND PLAN - _ __ NEW CANOPY ROOF. SCALE ELEVATION AND PLAN FASCIA AND SOFFIT TO MATCH EXISTING - tom' I W s. ..+..v..M+. VA r...e. N SHEET TITLE: VAPLAN& ELEVATION SHEET&JOB#: N A-2 a � O. N ,O. O U.) �� U) 2In O Q L Cb RIM ASPHALT SIMaE ROOF � O O N CO _ CWTA6fl®1M DMAIK SILVER cc: O 00 m O - ----- - ---PAINT CONCRETE PANELS N LO DELRAY GREY WIN 6L�RADI6 6.(IIERYAL 01EAR) � ♦- w MPACT RESISTANT T co Q7 0 .w. Fresh a Ketch LLI b PID RIGHT SIDE ELEVATION - ~ r, C -4-3'WHERE SHOWN _ - _ ASPHALTEm w�iowvnc � SERIES SAVER BIRCH �.•- _ - - - - ^-- -- PvD TM PTO MITE w == PVC TM PM GRAY _ - EY 1614 DELRAY GREY _ F7, Pvc.mN11 Pm e11rrE REVISIONS PM OREY - - 1 1 ISSfiED FOR YEILNI'1' II-t-I6 k .:...�_.(SL�Id11G TYPE)WMTELl -. .. . ANDERSEN OR EWAL _ ...Pvc.SILL _. LEFT SIDE ELEVATION EE PANB.S WITH TM AND AZEK MOULD040 ALL 164-JEW - YOORE 1814 DE1RAY GREY- - - DWG.INFO. DATE 10-3-16 .SCALE DRAWN CADD CHKD M40 J. MACH - SHEET TITLE: ELEVATIONS - SHEET&JOB#: A-3 a� cm CONFIRM EXACT CONDITION OF o In Ex1S INO HEADER AND NOTIFY d O REMAIN staul:TURE REMOVE E)051OG ASPHALT ARCHITECT PRIOR TO TE INS 00 Q SHINGLE ROOFING AM PROVIDE NEW ASPHALT NEW ASPHALT SHINGLES ON (O SHINGLES S/8'CDX PLYWOOD H1 L Op 00 NEW 2 x 8 RAFTERS O TB'D.C. O O c OD A/q)T1ER O037D10 FA�IA/GUT7ER ` Ir O '�. AND TF 70 REMAN AND SOFFIT TO RD" NEW 8/11'OWB ON SIRAPPINO N In p , PANT WIM PANT WHITE - O In O o O N F � NEW OITTER(WHITE) ccy NEW PVC TRIM BOARD NEW PVC TRW.BOARD L NEW FASCIA AND _ SOFFIT 7D MATCH - - cd NEW SLIDING WINDOWSNEW SLIDING Z ANDERSEN "ANDOWS.. _ ..�.,. ',RESIFT ESISTANTc01PWHACT 2 p F RESISTANT(NMI 1 1 Gzl = - NEW SUDING ANDERSEN IMPACTram" PVC PAID s RESISTANTp W a n NEW 2 x 6/2 x 4 STUD - " NEW 2 x 6/2 x 4 STUD - RALL WITH THERMAL GWB FINISH WALL WITH THOM&- R r GWB FINISH NSUL - O 00STNG MASONRY WALL _ _ / .,..n EWTIN GMASONRY WALL _ i O ARE70 REMAIN IMACTIVE. IF INACTIVE PVC PANEL AND TRIM / REMOVE A NO NFILL TO MATCH W z lV _ PVC PANEL AND 7RIM - -. PVC PANEL AND TRW p Hiy Z i • COSTING MASONRY E70S7NG MASONGTY PARR MASONRY BELOW / - - . PANT GRAY.70'"_� _ ._— PANT MAY 70 `-. f1Dgt GRAY TO MATCH - MATCH PANELS - - - con MATCH PANELS PANEL I I �„� y _ A WALL SECTION 9 WALL SECTION C WALL_SECTION_ - _ -- - REVISIONS I - 1 ISSUED FOR PERMIT 11-1-16 LIALT SHNOEB _ --__.. . FASCIA AND SOFFIT TO - - MATCH EX67NO - DWG.INFO. SIGN LIGHTDATE 10-3-16 SCALE 3/4"=1'-0" DRAWN CADD PVC SURROUND - CHICD %,kPPRVD - ®AWE VA 'H 1 L� SHEETTITLE: A ' WALL SECTIONS - SHEET&JOB#: ELEVATION A-4 � 'R N 1COLUMN I NLo y� yj O E OMO.SOFFITJ 2 x 8 WALL - SZ -p - aD NEW PVC 1WM /6'GWa FINISH O O co OP ORAINAM WRAP CC: () CO P YW 00 GItADE W%PLYWOOD FRIER Y m U') O65 O O E SLMING IAGT .WINDOW.. r ca ca In � WALL SECTION _ %6 0 Ile D.C. PVC SILL _ - PVC SILL _ PVC SHEETPVC F COO 1�RIM OVER 1N WIN OVER PVC Ow uv PVC COLUMN SUIlROUND SuNI tOUND b n LF. oas1ING Pw SEE Y E»IING Pasr SEE E'- -- l _ - PVC TRIM O%fR .. PVC TRIMOVER II 1/2'PLYWOOD T/2'PLYWQQD � L ola z It HEADER - � sDoow rONDOW z d - .. SLIDING WINDOW. U W How _= 2 WALL SECTION 5 WALL SECTION I• I EXISTINGEPfIRY 000R O W z r� Q 6x6WDPOSE _ SLIDING WINDOW WOOD SILL t/ �T SEAM PVC SILL 0 - 1 i/r HALF ROUND I x4PVC 2 x 6 WALL v/s M/r I PVC F.G.INSULATION TM�MOULDING 2x4 WALL./D1/2' I I e REVISIONS F.D.INSULATION PVC SIBLE `- LAB ON GRADE DRAKE Ir GM FINISH NEW S ' l ISSUED FOR PE2NIT 11-1-16 MASONRY WALL -1/2'EXT PLYWOOD-- - TO REYAIN 3 SLOPE WALL SECTION io - Ir.Ir FOOM./ BARS 3 - - T/2'ExT PL /3 flEs 0 .. - WALL�SE�CTION.. .. -S/6'GWB FINISFI .PVC SF$ET PVC YDULDINO 3 1//22''F.Q.INSUL - 'o - I x 4 PVC DWG.INFO. DATE 10-3-16 \. CRADE - .SCALE 11/2"=1'-O" 4 WALL SECTION DRAWN CADD CHKD APPRVD 11A%4 J. P VACF6 +q SHEET TITLE: r tl DETAILS SHEET&JOB#: A-5