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Home My WebLink About0572 MAIN STREET (HYANNIS) O w� \s```� `ICJ V� Via Town of Barnstable Bu11Cl1Ilg • , '.` ''4 - ate^,;: -", .„� �'' "�. xrlsrw `o s� ; PstTfiisCa d So That itis,Visible from .� the Street Approved Plans%Must be Retained onJob and this Card Must"be Kept M" PostedUn�til:final Inspection Has Been Madeh ,, 3 � ' F Permit �s Where a�Certificateoa,f O u�pancy is�Required,suchBu Id�ng shalt�Nbe O�ccupied�,unt�t a�F�,nal Inspector has been made �� Permit No. B-18-2571 Applicant Name: JASON R FREITAS Approvals Date Issued: 08/20/2018 Current Use: Structure Permit Type: Building-Addition/Alteration-Commercial Expiration Date: 02/20/2019 Foundation: Location: 572 MAIN STREET(HYANNIS), HYANNIS Map/Lot 308-278 Zoning District: HVB Sheathing: Owner on Record: KIMBALL GENE L TRH Contractor Name;;' ,JASON R FREITAS Framing: 1 Address: 508 RACE LANE �Corktractor; icense CS�103111 2 MARSTONS MILLS, MA 02648 " Est�*Oject Cost: $ 10,000.00 Chimney: Description: Repair/Replace front Facade of apartment wall,structual repairs as Permit Fee: $ 191.00 a result of a car hitting structure. , �� Insulation: Fee Paid: $ 191.00 Project Review Req: Dates 8/20/2018 Final: r - Plumbing/Gas Rough Plumbing: --..- -- BuildingOfficial Final Plumbing: Rough Gas: This permit shall be deemed abandoned and invalid unless the work authorizedby;this permit is commenced within six months afEer issuance. All work authorized by this permit shall conform to the approved appl cation and tthe,approved construction documents for which this permit has been granted. Final Gas: All construction,alterations and changes of use of any building and structuresshall be in compliance with the local zoning bylaws and codes. This permit shall be displayed in a location clearly visible from access street oi-road and shall be maintained open, public inspection for the entire duration ofthe work until the completion of the same. Electrical Service: The Certificate of Occupancy will not be issued until all applicable signaturesby the Build eing and Fire Officials ar providedon this permit. Minimum of Five Call Inspections Required for All Construction Work: � £' Rough: 1.Foundation or Footing �� '� 2.Sheathing Inspection Final: 3.All Fireplaces must be inspected at the throat level before finest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Final: Work shall not proceed until the Inspector has approved the various stages of construction. "Perso Tonkng with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Final: �� Building plans are to be available on site All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Applicationm z. - ................................ * BAMqSTABM ` v 4 � PCM h Fee........ ...............013�i rJF�ee.. ................... NAM MIS _ Total Fee Paid.... �- ...... .......... �.T.... 1,014 TOWNOF BARNS Permit Approval by.......................... roah�. •. ..............�. BUILDING PERMITf�BL� ...Pa=............._......_........... APPLICATION Section 1— Owner's Information and Project Location Prro � iv isi Own s�N me J� I�� c�w•b�i 1 Owners�Y egal�Address City State zip Owners Cell# E-mail Se, -tion 2=Useyof�StructMR Use Grroup ❑ Commercial Structure over 35,000 cubic feet E( Commercial Structure Tinder 35,000 cubic feet Single/Two Family Dwelling Secti'o,wl::�Type--of�Permi't, ❑ New Construction ❑ Move/Relocate ❑ Accessory Structure ❑ Change of use ❑ Demo/(entire structure) 0 Finish Basement ❑ Family/Amnesty ❑ Fire Alarm Rebuild ❑ Deck Apartment © Sprinkler System ❑ Addition ❑ R, fining wall ❑ Solar ❑ Renovation ❑ Pool ❑ Insulation Other—Specify ��412 `t'�n ov a A lNkV 11 Sechon4 �,W:orkpDescription, a. e�ri ��►c� �ro�►� ��erg ofi WJ A1oAr-r rAR^,7 W*110 i rZc,�T uv�-c� e p A firs s IA Re-s�)4 Q F A CA; h` iwu T Act undated•219=1 S e E Application Number.................................................... Section 5—Detail C�of Proposed Constr�lion /0'0 00 .00 Square Footage of Project Age of Structure Dig Safe Number # Of Bedrooms Existing Total#Of Bedrooms(proposed) 110 MPH Wind Zone Compliance Method ❑ MA Checklist ❑ WFCM Checklist ❑ Design Section 6—Project Specifics ❑ Wining ❑ Oil Tank Storage ❑ Smoke Detectors ❑ Plumbing ❑ Co ❑ Fire Suppression ❑ Heating System ❑ Masonry Chimney ❑Add/relocate bedroom Water Supply ❑ Public ❑ Private Sewage Disposal ❑ Municipal '❑ On Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: I am using a crane ❑ Yes ❑ No Section 7-Flood Zone Flood Zone Designation Within or adjacent to a wetland,coastal bank? Yes ❑ No ❑ Section S—Zoning Information 1 Zoning District Proposed Use Lot Area Sq.Ft. Total Frontage Percentage of Lot Coverage j i#of Dwelling Units (on site) Setbacks Front Yard Required Proposed Rear Yard, - Required Proposed _ V { `Side Yard Regiured Proposed 4 i Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No Last undated 1J92018 • Application Number........... t - Sech"an9ConsfractionSnperoisor Name-: S��j".e. rrA S Telephone Number Co13_ gRq- 763S" Address j M c l wro.)H Ott City Tig yr Rio N state M 4 Zip o z F 0 License Number CS^ 103 i 1 I License Type Uruvte sT Expiration Date 5-f l 312 0 Contractors Email_ - -Z5"fl y C, 4 rs5cx-v, co Wk Cell# I understand my responsibilities under the rules and regulations for Licensed Constrac.don Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and docimmentafion required by 780 CMR and the Town of Barnstable.Attach a copy.of your license. signature Date Section-10—Home Improvement Contractor Name A k S 5 erg s cc> mc-, - Telephone Number • Col '•-`l�'9 )t t t Address 38 CK,&j r'zs ST- City AjQ wop State tM A zip 6Z 4 S8 Registration Number t 6 *L43 8 Expiration Date 0'4I22 f 2 I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 CUR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and doctnnentation re • d the wn of Barnstable.Attach a copy of your HIC... Signature Date 7 if l S Section 11—Home Owners License Exemption Home Owners Name: Telephone Number Cell or Work Number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. signature Date LIz § S`I � NAT Signature Date 8lr€3 Print Name A �Frt tim 3 Telephone Number 617 41 Fr76T� E-mail permit to: J 41 @ A"SS-'K v s C oM _ T Section 12 —Department Sign-Offs Health Department ® Zoning Board(if required) + i Historic District ❑ Site Plan Review Cif required) Fire Department Conservations ; I t htA r J i For commercial work;please take your plans directly•to lke,fire department forlapproval = r.l Section 13—Owner's Authorization as Owner of the-subject property hereby j authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of j ob) Y date Signature of Owner r ` Print Name Last undated:2J92018 Firc . F.Iood , S.mo1: . M 1d eco tr coon r RES�"�T a�s�L1.�� REMEDIATION WORK AUTHORIZATION/CONTRACT AND DIRECTION OF PAYMENT The undersigned,as the owner/representative of the PROPERTY,hereby authorizes and instructs ARS Services,Inc.to perform work and services due to the loss s6bmitted on 07/23/18 JOB NUMBER: Y18-1516 CUSTOMER NAME: Julie Kimball STREET NAME: 572 Main St CITY: ..Hyannis STATE: MA ZIP CODE: 02601 INSURANCE COMPANY: INSURANCE ADJUSTER: CUSTOMER CLAIM#: DATE OF LOSS: 1.) I hereby authorize ARS Services,Inc.to perform the necessary work at the above property and I give the above Insurance Carrier permission to directly pay AILS Services,Inca for any&all work required to restore the structure within the premises to as near pre-loss condition. 2.) In the event that any part or whole of the authorized work is not covered by my property insurance,I accept full responsibility for payment.I understand that 1.5% interest per month will be charged on past due accounts over 30 days. Should collection proceedings!be instituted for payment,customer agrees to pay reasonable attorney fees,court costs,and other costs incurred.There will be a$25.00 charge for returned checks. 3.) The undersigned agrees to pay ARS Services,Inc.the deductible amount f t licy before the work begins unless it has been deferred to other areas of the policy for said cl ' by t e insurance adjuster. Name(Print) Aut rized Sign re Date a t ARS: Always Ready to Serve Throughout New England 24/7/365 Emergency Service 1-877-461-1111 www.arsserve.com i The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations• 600 Washington Street Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): ARS Restoration Specialists, INC Address: 38 Crafts St City/State/Zip: Newton, MA 02458 Phone #: 617-969-1119 Are you an employer?Check the appropriate bog: Type of project(required): 1. ✓ I am a employer with 150 4. I am a general contractor and I 6. New construction employees(full and/or part-time).* have hired the sub-contractors 2. I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have g. Demolition working for me in any capacity. employees and have workers' 9. Building addition [No workers' comp. insurance comp. insurance.$ required.] 5. We are a corporation and its 10. Electrical repairs or additions 3. I am a homeowner doing all work officers have exercised their 11. Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12. Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13. Other comp.insurance required.]' *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees Below is thepolicy and job site information. Insurance Company Name: Hartford Underwriters Ins Co. Policy#or Self-ins.Lic.#:6S60UB7H68400917 Expiration Date: 09/24/18 Job Site Address: 572 Main St City/State/Zip: Hyannis, MA 02601 J 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 unde' it �,d penalties of perjury that the information provided above is true and correct. Signature: Date: (1-4 - g q - (S 5- Phone Official use only. Do not write in this area,to be completed by city or town officiaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." .Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit'completely,by checking the boxes that apply to your situation and,if necessary,supply sub-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 aworkers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is.obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 4-24-07 www.mass.gov/dia i Commonwealth of Massachusetts 4 Division of Professional Licensure .Board of Building Regulations and Standards C on st rood6r[%upp ry i so r CS-103111 Ej ires: 05/13/2020 %. - x a i JASON R FREITAS, 5 MCI . # TAUNTON MA 02780 m .10 Commissioner l.IL � i' e olalawaclrcae16 Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:SuoDlement Card before the expiration date. If found return to: Reaistration Expiration Office of Consumer Affairs and Business Regulation -. 10643B 07/22/2020 1000 Washington Street-Suite 710 Boston,MA 02118 A R S SERVICES:INCc� DB/A ARS REST QRATION�SPECIALISTS r JAY FREITAS - R 38 CRAFT ST � y NEWTON,MA 02458' Undersecretary N valid without signature AGENCY CUSTOMER ID:ARSSERV-02 CWOODSIDE . ./� LOC#: 1 ACCOR U° ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY License#1780862 NAMED INSURED UB International New En land A.R.S.Services,Inc. g 38 Crafts Street POLICY NUMBER Newton,MA 02458 - EE PAGE 1 CARRIER NAIC CODE EE PAGE 1 SEE P 1 EFFECTA/E DATE:SEE PAGE 1 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance Description of Operations/Locations/Vehicles: Excess Liability$5mm Total Limits Policy#'s PGIXS00660-00 and DCEX00084-00 follow form Commercial General Liability, Contractors Pollution Liability,Professional Liability,and Employers Liability. Workers Compensation coverage noted above is for operations in Massachusetts only.Separate Workers Compensation policies in effect for states of Connecticut,Rhode Island,and New Hampshire. Fidelity Crime Bond $1,000,000 Limit w/5,000 retention through Twin City Fire Insurance, Pol#KB023651117-Term: 9-24-17-18. Linear Retail Harwich#1,LLC and KeyPoint Partners,LLC are additional insured per terms outlined above f ` r ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ARSSERV-02 CWOODSIDE CERTIFICATE OF LIABILITY INSURANCE DATE 03/20/2018Y) `-� 03/20/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER License#1780862 Co MTV T CT Gretchen Houghton NA HUB International New England PHONE FAX 600 Longwater Drive (A/C,No,Ext): (Arc,No): Norwell,MA 02061-9146 n DRESs:gretchen.houghton@hubinternational.com INSURERS AFFORDING COVERAGE NAIC# INSURER A:Lloyd's of London 15792 INSURED INSURER B':Commerce Insurance Company 34754 A.R.S.Services,Inc. INSURERC:Hartford Underwriters Insurance Company 30104 38 Crafts Street INSURER D:Hartford Fire Insurance Company 19682 Newton,MA 02458 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFFr0912412018 LIMITS L N D WVD MM/DD/ A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 CLAIMS-MADE ❑X OCCUR PGIARK07834-00 09/24/2017 DAMAGE TO RENTED 100,000 PREMISES Ea occurrence $ X Pollution/Profession . MED EXP(Any oneperson) $ 5,000 X $10,000 Ded PERSONAL&ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY�JECOT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 Ea accident $ X ANY AUTO 17MMCBGBJWM 09/24/2017 09/24/2018 BODILY INJURY Perperson) $ X OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ X HIRED X NON-OWNED P�20PERTYent DAMAGE AUTOS ONLY AUTOS ONLY er accd $ $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 4,000,000 EXCESS LIAB CLAIMS-MADE PGIXS00660-00 09/24/2017 09/24/2018 AGGREGATE $ 4,000,000 I_TDED I I RETENTION$ $ C WORKERS COMPENSATION X I PER OTH- AND EMPLOYERS'LIABILITY Y/N STATU E ER ANY PROPRIETOR/PARTNER/EXECUTIVE 6S60UB7H68400917 09/2412017 09/2412018 E.L.EACH ACCIDENT $ 1,000,000 Mandatory In NHR EXCLUDED? a NIA f 1,000,000 E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Excess Umbrella DCEXS00084-00 09/24/2017 09/2412018 1,000,000 D Bailment 08UUMR06539 09/24/2017 09/24/2018 Blanket 950,000 DESCRIPTION OF OPERATIONS r LOCATIONS I VEHICLES IACORD 101,Additional Remarks Schedule,ma be attached If more space is required) % Restoration Services Agreement. General Liability: Primary/Noncontributory#PGI 9L 020(2-10),Additional Insured ongoing operations CG2010(7-04), Additional Insured completed operations CG2037(7-04),Waiver of Subrogation CG2404(10-93). Contractors Pollution Liability Policy#PGIARK07834-00:Limits$3,000,000 Each Claim$3,000,000 Aggregate. Additional Insured PGI EL 018(2-10),Waiver of Subrogation PGI EL 019(2-10),Pollution Primary/Noncontributory PGI EL 020(2-10). Professional Liability Policy#PGIARK07834-00: Limits$2,000,000 Each Claim$2,000,000 Aggregate. Deductible General Liability,Contractors Pollution Liability,Professional Liability: $10,000. $15,000 Mold,Mildew and Fungus Deductible. Automobile Liability: Additional Insured and Waiver of Subrogation per Commerce Insurance form Vs C133 and CIC957. SEE ATTACHED ACORD 101 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Linear Retail Harwich#1,LLC THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN c/o KeyPoint Partners,LLC ACCORDANCE WITH THE POLICY PROVISIONS. ' 1 Burlington Woods Drive Burlington,MA 01803 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Town of Barnstable Building Department Services NAM Brian Florence,CBO 9. Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.maxs Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, &e NZ k I r%b*V I I ,as Owner of the subject property hereby authorize A RS Soz y t!s, u11.-.. to act on my behalf, in all matters relative to work authorized by this building permit application for: 5 72 = 1.9 fri s � 1414arV10 (kA7 i.e'r' [cE CCCAVV) (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. Signature of Owner _ Sign �eAppficant �ryt- Print Name Print Name ('ZI s Date Q:FORMS:OWNERPERMISSIONPOOLS Rev:08/16/17 "VI whc n r-r Vol (Cad _ s �` r �..� � � TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION G{ BUILDING DEpT Map Parcel �U Application # �l� ✓�! Health Division XT 8 2016' Date Issued Conservation Division TOWN OF SAR�'STAS Application Fee LE Planning Dept. Permit Fee d U 6 Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/ Hyannis Project_Str_eet_Address y- --,, S 7 J PW Village Owner l 2,�!� /ddress w a Telephone [Permit Reguesfl --� V_A Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay iProjecf'Valuation �C-CV 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) Name Telephone Number Address �$(P 'tiGS License # (.G /, 0�- c Home Improvement Contractor# T, Email C/ P ZC/d P Ch Worker's Compensation # 4wc.�Vb.a03-)VWOV(4 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATES l i FOR OFFICIAL USE ONLY + APPLICATION # DATE ISSUED MAP/ PARCEL NO. r ADDRESS VILLAGE s OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION ,r FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL + GAS: ROUGH FINAL FINAL BUILDING r s DATE CLOSED OUT ASSOCIATION PLAN NO. , . t3 , q- TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION t ; Map Parcel Application # !� Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee ll • 11 U Date Definitive Plan Approved by Planning Board M1 r r Historic - OKH _ Preservation/ Hyannis , Project Street Address ,� �� ^� . �i-� c4A4,-,,c_,,` Village Owner G)C Air T J�! D �1i.�.� 6,�Qddress S'G Telephone Permit Request; �VL-o V.9 c IC i Square feet: 1 st floor: existing f proposed. 1 2nd floor: existing proposed Total new r l Zoning District kFlood Plain r Groundwater Overlay Project Valuation ln. 6',CdV 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. j 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 i, 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 ❑ k Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION T_ �(BUILDER'OR HOMEOWNER) Name r"&1C." 1 , F"C, tc..P.f/L 6 G Telephone Number G Address 'CAI C-5 (P 16 License# lD Home Improvement Contractor# _- l U L1, IC).1 Email r a GW-i PGA Z�Jci27 (f��,hiy MA-��, (� Worker's Compensation # Awe .�06 .703)`�y�(�4 „ y c ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO I/Ai)nn-oW SIGNATURE DATE m r FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. 4.;il . lheCornrnornpealtlt,. f?fcissaclrusettr Depar&nent ofrrulrcsfrial Acciderrir - -- Q,f -ce of£rr tigadons. 600 Washington Street Y.. Boston,MA 02111 xaEvts na-mg4ov/dia �STnrk-ers'.Campensaf on Insurance Affidavit:Emlders/CoiLtradur--JEIectcicians]PhEmbers ApplicantTnfarm,afia r Please P>iut l r'IlI'y -- Na=(suss Cityftatel Phone l If ^ Are you an employer?.Che the appropriate box: Type of project(required}: I am a general contractor-and I I�I am:a employe with ❑ ° 6_ ❑New construction . employees(full andfor part-time).* have hiredthe sub-cositractm 2.El I am a sole proprietor orpartuer- Tinted ou the attached sheet I. ❑ modeling sbip and have no employees. These sub-contractors have g_ ❑Demolition wad.inb for xnP in any capacity employees andhave workers 9. .❑BIItltltng addifiazf [No wodoers' comp.insurance Comp-insurance.$ rexF&ed� S. ❑ We are a corporation and its 1 Q❑Electrical repairs or additions 3.❑ I an a homeowner doing all work , officers have;estscised their 1L❑Flumbingrepairs or additions' i£ [No workers'comp a of e$emgfiog per II�fGL 12-❑Roafrepairs incvrcanre reignited Y C.I521 §1(4},and we have no emp`logees.[No workers' 13.❑Other comp.insurance required.)` *way x"Hc=dmr checks box F1 most alai fM out the sEcdon below sh n-S ihea woken'capeasati npn&ep in5m=d=- �Snmeaaraees who submit this afiidariF ine�rsiiag they are dain�aIf waaY aid�hicE outside coatcactors Est submit a new'affida¢sTmdi�.tiae sacIi. ' fCan=z=xs ff=cherlr This box must attached as additiamal sheet showing the aaae of the nab-co=xcwrs and state whether.arnot f mse entities ham e iayen.Ifthesub-contactoshase employees;theyaautpnmi&thek worker'imp.paRcy number- IT arts all ellipfayer that isprfnzdiag it�arkers'compensation 1mvirancefor my employees $etoav is riT�Rpaficy curd job zits irtformrtlian - Insurance Company Nratne: Policy 4t or Self--ins_Jic. . - a dO 4 Expira onDafe: 0411 Job Site Address: Cft3d9tate ZipJer Attach aropy of warkers com .pensationpolic de ation page(showing the policy and respiration date). Failnre to seaura coverage as required under Section 25A of MGL c:157-can lead to the imposition of criminal penalti s of a fine up to$150D OG an1tor orie- y&irimprisDnmezd,as well as civil penalties in flee form of a STOP WORK ORDERand a fine of up to$250-Oa a day against the violator. Be adiised'that a copy of this statement maybe forwarded fn the Office of lavesfigations ofthe DIAL for insurance coverage verification. I rfa kgrcdry cRrirfje rdRr Sts pains andpsrta s af.perjuiy.Matthe irc;formtctiou prati&d ab lmi�s is burg and correct Siffiature_ Date- phone ik �-� Ofi7cial um drily: D&not avrrte rrt tlii�area,tfr 5e coinpletc�d by clip artat�n a,�`actQt City or Town: Perrmtlr icense# Issuing Authority(drele one): L Board of Health 2.Bud&ng Department 3.CityyTowa Clerk 4.Electrical Inspector S.Pl.ambiug Inspector 6.Other Contact Person: Phone-#: -- ---- -- - --- 6 Taformation. and Mstruct ons Massachusetf s Gf--neial Laws cS�apinr 152 regnhes all employers to provide wnrl�eas'compensation for theiF employees. pMM=t-tD this spa,an mVkyw is defined as."_,evmypeas6nin the service of another under any coilfxaat ofhire, express or iinplie d,oral or writ" An emplvyM_is defined as"an mdiyaA parta=Shzp,assoQahon,corporatttOn or other legal entity, or nay tFvn or more of the foregoing engMrd in aJo�e�pri=.and mcTn�the legal regreseatdVm of a deceased employer,or the . receiver or trustee of as individual,paltD=Shrp,association or other legal entity,employing employees. However the owner of a,dweiliiag house having not more than&ree apartments and who resides thercia,or the occapant of the- dwelling house of another who employs „persons tD do ma-infPna ce,construction or repair work.on such dwelling house or on the grounds or building appud=—t$hereto shall notbecause of snch employment be deemed to be an employer." MGL chapter r 152,§25C(6)also states that"every state or local licensing agency shall withhold fb,e issuance or renewal of a Ecen a or permit to operate a business or to construct bmldmgs in the commonwealth for any applicant:Who has not produced acceptable evidence of compliance,with the insurance.coverage regvire&' Additionally.MGZ chapter 152,§25C(7)stairs-Ncither the commonwealth nor any ofifs political subdivisions shall enter iab apy contract for the performances ofpnblic work until acceptable evidence of campliapace with the;n miraact6.. requ=mm is of this chapter have been presented to fhe contacting antb.outy." AppIicairfs , Please fill out the woikr_rs' compensation affaidavit completely,by dierlong ff,boxes that apply to your situation and,if necessary,sr" Ty sub�ontractor(s)name,(s), address(es)and phonennmber(s) along with.their certifrcate(s)of has man cB. Lnnitrd Liability Companies(LLC)or LmsitedLiabUAyParfnersbips(LI.P)withno employees other than the members or partners,are not mqumed to caayy woje& compensation instiranca If an LLC or LLP does have employees,apolicyisrequu-ed. Be advised that this affidayit maybe su_ itti--dtotheDepa-finentofIndustial Accidents for confnmation ofinsbrance coverage. Also be sure to sign and date the a:fiidavit--Thc affidavit should be rstinned to ffie city or town that the application for the permit or license is being requestr .not the Department of ; Ln&_gtri T Accidents. Should you have any gaestions regarding the law or ifyou are retj=6d to obtain a workers' compensationpclicy,pl=r,call the Department at then=brr1L-t:edbeIow. Self-fisLn companiesshouldenterth5ir self_fi s==c;e license number on the appropriate line. City or Town Of Eldals f . . Please be sure that the affidavit is completes and pried legibly. The Department has provided a space of tine bottom of the affidavit for you to fll out in the event the Office ofInvesti.gatioas has to couactyouregardiag the applicant- Please,be sure to till in the permit/liccnse number which w7.1 be used as a reference number. In addition,an applicant that must submit mvliiple pemrtllicense applications in any given year,need only submit one affidavit indicating=ent °° A dd*ess"the ' licant should route"all locations in (ciy or- n olicv in m a lion if neoess aiy)and under Job i ne_ app Cif - - fh „ da ' that has begin offici ed or maimed by the eery or town may be provided to e town)_ A copy of the,-affidavit �y applicant as-proofthat a valid affidavit is on file for futai-e peumits or licenses- Anew affidavit must be filled.out each bfaaihmg a license or p=it not related to any business or commercial ve at= year.Where a home owner or citizen is o (i e,. a dog license or peunit to bum leaves eta.)said person is NOT rec�to complete this affidavit The Office of Inves gations would film to tbaak you in.ddvaace for your to ration and should you have any g Pions, please do not hesifate to give us a call The I}epart nenfs address,telephone and fax number_ CGMMMwe�ajtij of MassarAnsztts Delta clmeut cif Rid del Aocidents am=ref)[ave&Vgkti0= -Tt�-L,4 6l7' -499 G Qmt 4-Q6 ar I-9"7-MAC E Fax 9 6.17 727 774 Revised 4-24-07 V_UIa_= .:. License or reg Stratton valid for•individul u` ^ . before the expiration date. if found retu►n t ' i , *. 6��r Vcrrtrn�iruu�nll�'.��/rl/lirf office of Consumer Affairs and:Business Reg '..• ytlice of C on_,umer Affairs&Busii(ess Rego r + w" ,UME IMPROVEMENT CONTRACTOR 1p.park Plazsi,-Suite 5170 \ i Boston,MA(`Zll�i'. 0gistration f53792 1 piration i/i3%201 i 'DBA Y ' 1(4 aDELING ' naturev GUEIROA Not valid with Sig �NOYES RD •H, N1A 02604 .; • Uude,rsccrc . a�ment of Public Safety e Massachusetts P tme ons and Standards. Board of Building Reg ullti License: C104107e sor Construction Sup ., � •y ,,� a . CARLOS H FIGUEIROA 20 CAPTAIN NOYES .� SOUTH YARMOUTH G A �` Expiration: 0812512017 Commissioner DATE(MWOD/YYYY) AC-ORO® CERTIFICATE OF LIABILITY INSURANCE `.� 09/14/2016 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 NAME: Rebecca Powers LEONARD INSURANCE AGENCY PHGNE 50s 428-6921 f No): E-MAIL ADDRESS: Rebecca@Leonardagency.com 683 MAIN STREET SUITE B INSURERS AFFORDING COVERAGE NAIC4 OSTERVILLE MA 02655 INSURER A: AIM MUTUAL INS CO 33758 INSURED INSURER B C & F REMODELING INC INSURERC: INSURER D: 20 CAPTAIN NOYES ROAD INSURER E: SOUTH YARMOUTH MA 02664 INSURERF: COVERAGES CERTIFICATE NUMBER: 84980 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. I�TR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MPMMtD EFF POLICYMMMIDDA ExP LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGES(TO RENTED PREMISES Ea occurrence) $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY JET LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident _ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS N/A BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per.accident $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X STATUTE ERH AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUIIVE E.L.EACH ACCIDENT $ 500,000 A OFFICER/MEMBEREXCLUDED? WA WA WA AWC40070324242016A 04/30/2016 04/30/2017 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 ff yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I$ 500,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/lwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town Hall of Provincetown ACCORDANCE WITH THE POLICY PROVISIONS. 260 Commercial St. AUTHORREDREPRESENTATIVE �_l rs f_ �•` Provincetown MA 02657 u°..-F Daniel M.Crow ey,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01, The ACORD name and logo are registered marks of ACORD Town of Barnstable Regulatory Services Richard V. Scali,Director 639. Building Division, Paul Roma,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 r , 3 I ,.as Owner of the subject property hereby authorize /ram ! to act on my 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. tare-of Owfier S' tune of Applicant Rz/aG / /l/ (/ 't LDS -� �✓ <►, t Name Print Name Date Q:FORMS:OWNERPERMISSIONPOOLS Town of Barnstable } Regulatory Services o4IMME nqy,� Richard V.Scali,Director Building Division sAuvsTnst.E Paul Roma,Building Commissioner 039. 200 Main Street, Hyannis,MA 02601 m HIED www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside;on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be resRonsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she.understands the Town of Barnstable Building Department minimum inspection procedures and requirements and,that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall-act as supervisor.'.' Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules &Regulations for Licensing.Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems, particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities, many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit formS\EXPRESS.doc 06/20/16 Sign OF WN T BARNSTABLE Permit O iARNSTABLE. • MASS. s639- � Permit Number: Application Ref: 201303407 20070867 Issue Date: 05/24/13 Applicant: Proposed Use: MIXED USE RETAIL &RES Permit Type: SIGN PERMIT Permit Fee $ 50.00 Location 572 MAIN STREET (HYANNIS) Map Parcel 308278 Town HYANNIS Zoning District HVB Contractor PROPERTY OWNER Remarks NEW 24 SQ WALL SIGN ELAINEA YONG'S PLACE Owner: MEDEIROS ESTATE PROPERTIES, LLC Address: 572 MAIN STREET HYANNIS, MA 02601 Issued By: _ pC PgST THIS CARD SO THAT IS VISIBLE FROM TIE S RLET 14 4 )� 20 10 Town of Barnstable Regulatory Services . , _. :.. Thomas F. Geiler,Director 'q o1 9 atwss ®l 639. Building Division 13 6 - Tom Perry, Building Commissioner ` 200 Main Street,.Hyannis,MA 02601 �O www.town.barnstable.maxs ,.Office: 508-862-4038 Fax 508-790-6230 Permit# Building Official approving i Application for Sign Permit �J Applicant Assessors No. DoingBusiness As:_Eia4 �r ��► J �� 319 Telephone No.S �� Sign Location �nn Street/Road: 571. N,A 6 V%_ Zoning District: Old Kings HighwayP Yes/No Hyannis Historic DistrictP ON. Prope� ` 1 Name Own(�P�y�F Va r dw lxik\ Telephoner 7 71 6,511 Address 6 c \ Pillage: ��y a�•�`� � Sig Na Can � � Co. I Name: n.�.- � Telephone:��7 7 7 I /Ile-5 Mailing Address: W - Description , -Please follow the cover directions.You must have an accurate rendition of sign with dimensions and location. Is the sign to be electrified? Y (Note.•Ifyes;.a Wi-Zi 2gpC222itis'required) Width of bmldmg face__ft x 10= 300 g..10 Check one Reface e.mstimg sign ✓or New V Total Sq.Ft of proposed sign(s) - Ifyou have additional srgas please aiiach a sheetliM4 each one Fvihb dimensions If refacing an, :Bditb ig sign please provide a picture of the with'. I hereby c x*—'that I,'am the owner or that I have the'authority of'the owner to make this application,. ' that the'informationds:correct and that the use andIdonstruction shall confonn� therprovisions of §240=59 through§24049 of,the Town,of Barnstable Zomng Ordinance ,.h 'iY.!`' ka�6(�, <A_�--`i.—y+,. ie .fie s „ux Q.,�.....t..a of VWller•/Y1.Lllll[)L1Ll� y /� !/ ° + 1 'ti „} n �i 'fir F ff"y SK ii� $ � LL.:IPGxt4c g+• iDatC:4L��oT/3' "' 4"' �* :v.{ ' a !,,-x:° t ,�.�X•. �(.. ,i i.`. - .;iK �,; e., +ni A e.: t ''F' •},d�' �� "%t¢-i .r.+e al.rr'-.a: } �� ,58 :.��. gp581 . wda" ^34: �y ,, d�. „ , .Ti` ix}� r`j # .t ".}`i e.ye- ''9;`X{, >(�t�E� �a' { {. ry � v.;»,!f r E +'' , a '�., � e �..s �,{._,. �� < ..�..k,� ,wt. u l r,} '5�.. P r 1 `�.�.., k '�A 6{ t S �'',?l}w•. � �:,`.'!�; � 5 k` jJ w 1 t.a {'z :& w i,., 1 W 6 g #, a•',r: ix 'iE `y� `�i:flr. A b dic4 w g ' �. , � kkit! .�'i �. ,. 't .;.��{ ..�,'� .Aat a-"'^'�,t � f .:t :'� ,! °�,` 1 .� } ,,,r;•.6 xk.b:-� .ak'�, ;k... rt;:, 4e�''`+ t :,•r� 'o+��',��t$'� }{' �}.,��. .� ° a 3".�'�D � ��- "� f�4'x''� �y ..;y�+'1 '��f j., '�> �t @ .p F �X l,} i�'.. �4 r .�. «�aN f a� ..ry " � �:,] #x .'.t }S:s',c ?E,.a k.: `t._pt �:4 q x (; !' i 1 .S Y➢ abl F , J.i}t, SIGNS/SIGlVREQITY . *! t } A, :;:•'y S r .y i!,"Y i,°F°,+�"ty�1<4� :.'�#' gy ,,:s! n �, ;�i a € £ ✓",' �'.�' ,'x.., } 1,S,revised12110.a,.K +.' ,,et 11F l',<.1�{ . .-�.A k. :9l-,,:k, t • ,� x do 4 s s Town of Barnstable Hyannis Main Street WAterfror t Historic. ®istriet Commission Application JCeA ficate of Appropreateness for S>tgnag;e Application is hereby made for the issuance of a Certificate.of Appropriateness uhde(MgL,Chapter 40C,The Historic Districts Act,for proposed signage as de-scnbed below and on drawings or photographs as ompanying this application: CHECK ALL THAT APPLY: 1. Business Sign =� 4 2. Open/Closed Sign 3. Trade Flag 4. Trade Figure or Symbol '�1a 5. Location Hartlship:Sign Assessor's Map No.,; .. - Parcel No ? r S u � A Address o � ti f Proposed Work r= Applicant" , G '^ # � . Applicant Mailing Address , Towh/statelZip 1 &S` ,`` licant E-Maiil Address =: e=; d�" Cca�, ARP. r Property Owner?-'"e- � r� C� t� Tel# . b 7 7 l Dwner Mailing Address 5 ? zu w : TownlStatelZip I 0-4,w Agent or Contractor. C_ ° tL i z �.0 Tel 9 ` Mailing.Address.: ate/Zip, J fit% ` adf _Agent.E Mail Address Signature,of ApplicantOde .,. : Date k � O For.Location Hardship Sigr s&freestanding Trade Figures or Symbols to be'JMated on private property: Check..boz if property owner has granted permission to locate Sign or Figure on their property abiatfing the_building front; Page o f a r i M � A G yyt t X 4 2 http:%/web.mail comcast net/sery celtiomeh/scan00118,jpg?auth=co&loc=en_US&id=4U0480&par:,. 4/30/2C Page 1 of 1 1 - it guk I e g • a r yol rfF v t. http://web:inail.comcast.net/se,rwpe/horne%/2013-0e,- 30 t8 22-15_584 jpg^auth—co&loc=... 4/30%2013 a✓ A O N CD , CD fD A . O i O �D r � F i A O D O O 4• Hyannis Wain Street Vi►ateifro_nt Historic'®istrct Commission DETAILED DESCRIPTION OF`PROPOSED WORK • Provide detailed specifications.of the proposal. • Include a detailed description of changes to existing conditions,if applicable, • Describe proposed materials to.be used,desired.colors,�manufactuter's specifications,W. • In the.case ofsigns give locations of existing signs. proposed locations of new signs, Attach an additional sheet,if necessary: t . t : 8igned Applicant Agent Date , I Page 3 of 3; t 't~ Page l o Breakfast Buffet 0 nd Lunch Specials of the Day p://web:mail.comcast.net/service/home/, /scan0031 j'?, uth—co&loc=en. US&id=408960&part=2; 5/19/2C Page I of:l A It 1�11 TiAr . 3 s, t � f Ni � ice: a LL Y •¢ � V V, e-40-1. AM ..3 ° QwA a: S -'rd'Ss fi NS - .Tj Al- C.....m....:..�..-,.:F�......,..«.,,...�..,..,.w«.n..,.:�.�-*�....� .�i. ..o-»�....«„s.�r..�-+�..»+�,.:;;.sw,.�...r��•,,.i,,.,;,..;�.'sw�,��i�is"., - . httpa/web.maiUomcast.net/service/home/ /2013-05=08 10-06-42_84.jpg?auth=co&loc—e : .5/19/20113: Page"I of 1. jjtt w � �« �� a ".r * ,� *� "�", `�` �, 'fir •vE' ��:�..,,,�� .- Ste° y"'' '�* s,:. gam' M��" � N z x ^ a } I 1S EC t htt //Web.mail comcast iiet/ ervice/ omh 5 8 0:7 1537_ c_e.ph_ o n US— 5pg 1;9/20I3:: i Urenas Gloria Subject: FW: Back Yard Buffet Signage From: Anderson Pat To: Urenas Gloria Subject: Back Yard Buffet Signage Date:Thursday, June 08, 2000 12:10PM Gloria--On Nov 19th the HDC approved three signs for the Back Yard Buffet submitted by Luiz&Valeria Medeiros#572 Main Street. The owner of the property is listed as Margaret Sweeney. All the signage was approved subject to the Town Sign Code. This language is added to all the HDC's sign approvals. One sign was to hang on the front of the building and read "Back Yard Buffet", 2nd sign on Bassett Lane on post to read "Back Yard Buffet, Dine In-Take Out, Brazilian American", 3rd sign on Main Street on post verbiage the same as sign #2 . Page 1 . < : TOWN OF BARNSTABLE SIGN PERMIT PARCEL ID 308 278 GEOBASE ID 22254 ADDRESS 570 MAIN STREET (HYANNIS PHONE HYANNIS ZIP LOT PARCEL BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT HY PERMIT 42136 DESCRIPTION "BACK YARD BUFFET w 12 SQ_FT. PERMIT TYPE BSIGN TITLE SIGN PERMIT CONTRACTORS Department of Health, Safety i ARCHITECTS: and Environmental Services TOTAL FEES: $25.00 BOND THE , CONSTRUCTION COSTS $.00 Qi► 753 MISC. NOT CODED ELSEWHERE 1 PRIVATE P * 1AItNSTABLE. • MASS. i639' A� ED NU'►l BU LDING DWISIO DATE ISSUED 11,/01,/1999 EXPIRATION DATE � ainy VE The Town of Barnstablez�3 (Department of Health, Safety and Environmental Services 1639. Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner Tax Collector Treasurer ornic �(/,1(qcr _ Application for Sign Permit Applicant ton M{h�1(4 Assessors No. f FS T,G Ufi Gl+� Doing Business As: � Telephone No. Sign Location Street/Road: M/Jl A) <j 0AA/N 15 p-A/ 7 9E 601L ClA14 Zoning District Old Kings Highway? Yes/No Hyannis Historic District? Yes/No Property Owner Name: 1 0�A) Sly:`6s !'�A'26A Telephone: Address- ST P k.4N N -If Village: Sign Contractor Name: � 1 i T Telephone: Address- 4",N 7 ST Village: ��'"� �s Description Please draw a diagram of lot showing location of buildings and existing signs with dimensions, location and size of die new sign. This should be drawn on the reverse side of this application. Is the sign to be electrified? Yes/No (Note.If yes, a whingpermitis required) I hereby certify that I am the owner or that I have the authority of the owner to make this application, that tine 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:. 't Date: Size• V Permit Fee: oZ Sign Permit was approved: Disapproved: � rf Signature of Building Of cial: /�'�% %7. G-- �� '`' Date: Signl.doc rev.8/31/98 F TOWN OF BARNSTABLE SIGN PERMIT PARCEL ID 308 278 GEOBASE ID - 22254 ADDRESS 570 MAIN STREET (HYANNISPHONE HYANNIS ZIP LOT PARCEL BLOCK LOT SIZE DBA DEVELOPMENT . DISTRICT HY PERMIT 43936 DESCRIPTION BACK YARD BUFFET - 2 SIGNS - 2, 8 SQ. PERMIT TYPE BSIGN TITLE SIGN PERMIT CONTRACTORS: Department of Health, Safety ARCHITECTS: and Environmental Services TOTAL FEES: $50.00 BOND $.00 Ox /. CONSTRUCTION COSTS . $.00 753 MISC.. NOT CODED ELSEWHERE 1 PRIVATE P: S1 * BARMABLE, MASS. 1639. MA'S 1 BirLD1 /O DIV'f$10N BU/J%1 i�� DATE ISSUED 02/02/2000 EXPIRATION DATE ,,� of r The Town of Barnstable �� :� , 3q 36 Department of Health, Safety and Environmental Services • BARMABM ' Building Division v `b$ 367 Main Street,Hyannis MA 02601 Office: 548-862-4438 Ralph Crossen Fax: 508-790-6234 Building Commissioner Tax Collector -- Treasurer Application for Sign Permit Applicant:- �/I Z �fQE�� Assessors No. 30-9 2�-g Doing Business As: '84C k bU026-T Telephone No.(5-01) S'02 S- Sign Location - Street/Road. Zoning District: Old Kings Highway? Yes/ Hyannis Historic District? Property Owner Name: hI A 26AR -(--( Telephone:- Address: Y9 sc-ro(Z ar 10b fJ(L Village: 0!40Z U)u6 h A Sign Contractor Name: Telephone: Address: Village: Description Pleas 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? Yes/@T (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 us'e and construction shall conform to the provisions of Section 4-3 of the Town of Barns,ab Zoning Ordinance. Signature of Owner/Authorized Agent: v Date: Size: ermit Fee: �� Sign Permit was approved: Disapproved: ZZSignature of Building Offici -�� Date:' `_;z n�� Signl.doc rev.W J198 ,Q FtHE r ° .� The Town of Barnstable - Department of Health, Safety and Environmental Services SM Building Division Mass. 059• 367 Main Street,Hyannis MA 02601 rED MA'S p . Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner a Tax Collector Treasurer Application for Sign Permit Applicant: LuIL MU(--1205 Assessors No. Doing Business As: I�y�K �� U f�ET Telephone No. Sign Location Street/Road: Zoning District: Old Kings Highway? Yes o Hyannis Historic District? s/No Property Owner Name: M A(L 6AOFj 5w6 F N E J Telephone: Address: I ST012(�21 pG� �2- Village: 0 STFRUI(� P�cQ Sign Contractor Name: Telephone: Address. Village: Description Pleas 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? Yes (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 B ble Zoning Ordinance. IoD Signature of Owner/Auth 'zed Agent t Date: z Z_ Size: Permit Fee: Sign Permit was approved: Disapproved: Signature of Building Offic c - Zkzol'eiz'Date: Signl.doc rev.8/31/98 �� ,�. �,y� TO ALL NEW BUSINESS OWNERS 4 DATE: `A t10 l O L— Fill in please: APPLICANT'S YOUR NAME: M\`�� YJV`n PJ • O ►J ��%C_ BUSINESS YOUR HOME ADDRESS: IiS i O STIR P-Vi �\ '�- ��a� O GSS TELEPHONE Tele phone Number Home NAME OF NEW BUSINESS V�! - 6' 11 TYPE OF BUSINESS 12E5TA0,9=%KT-. " IS THIS.A HOME OCCUPATION? YES NO . _ Have you been given approval from the building division? YES=NO '�D �..,r. •�� ADDRESS.OF BUSINESS- MP-_o2-Cp o 1 MAP/PARCEL NUMBER y 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 i4ormation you may need. Once you have obtained the required signatures, listed below, you may apply for a business certificate at the Town Clerk's Office (Ist floor-Town Hall) or if you get the business certificate first you MUST go to the following office to make sure you have all the required permits and licenses.. GO TO 200 Main St.— (cor r of Yarmouth Rd. Main Street) and you will find the following offices: 1. BUILDING C MI SIO. R'S This individual s e n inf ed r requi ements that pertain to this type of business. r on d Sign ur COMMENTS: 2. BOARD OF HEALTH f 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*" v COMMENTS: Business certificates (cost$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in the town (which you must do by M.G.L. - it does not give you permission to operate -you must get that through completion of the processes from the various departments involved. "SIGNIFIES APPROVAL FOR A BUSINESS CERTIFICATE ONLY. so Rj APPLICATION FOR SITE PLAN REVIEW ' ate: LOCATION Basiness Name: (i1 Q'� i 1•�.,=D � �"i Subdivision Plan Assessor's Map# v Parcel:#, ANR Plan Property Address: Fn Site Plan 10_zV OWNER OF PROPERTY APPLICANT ;' Name: 1y) _D i j3S Name: M Y �--� Address: b C Address:— "—F Low. c7 L 4 C,3 N N o - a O-L&0� - 1 Telephone: I. Tel*bone: o —O ZS� Fax Fax: Off- — 0 ARCHITECT/DEVELOPER/CONTRACTOR/ENGINEER AGENT/ATTORNEY Name: Name: Address: Address: Telephone: Telephone: Fax: Fax: STORAGE TANKSaLAZ MAT/FUEL OR WASTE OIL ZONING DISTRICT CLASSIFICATION Existing Proposed District Overlays) Number 'Z_ Number 's" Lot Area Sq.Ft. Ac. Size Size Fire District Above Ground L,,*"— Above Ground Underground Underground Setbacks ft. Contents — Contents "— Front: Side: Rear: Number of Buildines Existing Proposed UTILITIES Demolition Sewer �Pablic Elg Private Size al Water 4 " Public ❑ Private TOTAL FLOOR AREA BY USE Electric ]/Aerial ❑ Underground Gas [Natural El Propane Existing Proposed Grease Trap [I Size gal. (sq.ft s ' ft Basement Z) Sewage Daily Flow * gpd Residential a r_4 M ns *GP or WP areas restrict wastewater discharge to 330 gallons per Restaurant acre per day into on-site system. Retail Office PARMNG SPACES CURB CUTS Medical Office — Required Existing Commercial(specify) � . Provided Proposed Wholesale(specify) On-Site To Close Institutional(specify) Off-Site Totals Industrial(specify) — Handicapped All Other Uses On Site Estimated Project Cost: Fee: Gross Floor Area $ 30 $ SP-FORM-P1.DOC- 6 8 0 0 /1 /2 04 S fp rv. 1A (�T tZ_1 LA, b ��f�Z;C, — (Yj ) Yz;P ►3 S li, ►J , 5-�►-L MP , N Old King's Highway Regional Historic District File# Approved? ❑Yes ❑No Hyannis Main Street Waterfront Historic District File# Approved?[]Yes ❑No Listed in National and/or State Register of Historic Places? ❑Yes ❑No Previous Site Plan Review File# Approved? ❑Yes ❑No Previous Zoning Board of Appeals File# Approved? ❑Yes • ❑No Is the site located in a Flood Area(Section 3-5.1) ❑Yes ❑No In Area of Critical Environmental Concern? ❑Yes ❑No Is the Project within 100'of Wetland Resource Area? ❑Yes ❑No Site sketch-informal presentation Yes ❑No Site Plan prepared,wet stamped and signed by a Registered PE and/or PLS. Yes ❑No Parking and Traffic Circulation Plan ❑Yes ❑No Landscape Plan and Lighting Plan ❑Yes ❑No Drainage Plan with calculations and Utility Plan ❑Yes ❑No Building Plans, (all floor plans,elevations and cross sections) ❑Yes ❑No Note that all siznaze must be approved by Code Enforcement Officer at the Building Department Lot area in sq.ft. sq.ft Total Building(s)footprint sq. ft. Maximum Lot Coverage as%of Lot GROUND WATER PROTECTION OVERLAY DISTRICT REQUIREMENTS: OVERLAY DISTRICT(S): Lot Coverage (%) Required Proposed Site Clearing (%) Required Proposed PRINCIPAL BUILDING ACCESSORY BIM ING(Sl El Yes No Number of floors ` Height: fL Number of floors--ok.,—Height: ft. FLOOR AREA: FAR: FLOOR AREA: FAR: . Basement sq.ft.c-w Basement sq.ft. First o1 LIB sq.ft. First sq.fL Second sq.ft. Second sq.ft. Attic sq.fL Attic sq. ft Other(Specify) Cot sq.ft. Other(Specify) sq.ft. Please provide a brief narrative description of our proposed roj ect: -� INNOO L T Ue Oral JF_,X.I STi K 6- CN CL4L_)Se Ne r� N1 G— — _ oo Z- I assert that I have completed(or caused to be completed)this page and the Site Plan Review Application and that,to the best of my knowledge,the information submitted here is true. -I, I o ff Sigd&F a VW— Date Printed Name of Applicant SP-FORM-PIDOC-06/18/2004 e ` V"--F:GA mob. LAV S �- VAR 291 CM-1 A r Elk) 49 WOE IC its- -fv FAAJr e r-r-2"4------e'-� NF. --..-..- - - 44 -L�.11-1 i I �21 br FPRF F1 A C c L` 1 PATE 0 A y .,.ice � �. f � __:v ,, , r-o—�I• 22 YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.- it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, 1 FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) 3 DATE:M A G ZDd� > �f ` 'y Fill in please: �o(Z i i o� APPLICANT'S YOUR NAME: A'�R� �L A BUSINES . YOUR HOME ADDRESS: 40 &Lr 7 I /J AA)/v i S- In A 0 O 1 TELEPHONE # Home Telephone Number q4' .7F .. .r ! .�N � _. EW. BUSINESS AMA OF N i. :� � ...lk _ <i., 3 .i � ... �a::. fix.-. 4 � .=z �d °�, �..iK 'C---,^c § a•w4'x .�`. q .. ,_,.. ..'�.. . ,,,:,,:=.o'' ., ,:, �.. r:� n a , �"^� =e r 4, r. • . �", r�s "leg Have;; ou been.. even a houal.fr 4,t e..buildm ADDRE:, , .. 1 .. �: �...rk,. SS:.OF.B.USINES,S..�. :�� P..a_,�._�h..:�.<;� �,.,..:.w.,,... .>:.., .�-_..S 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 COM NER'S OFFICE This individ al h s er2..inf e o any permit requirem� that pertain to this type of business. horized S' ature** COMMENTS: 2. BOARD OF HEALTH This individual has been informed of the permit requirements that pertain to this type of business. Authorized.Signature COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY This individual ha ! en infor fl e licn r ' e ents that pertain to this type of business. uthorized S' * COMMENTS: � /a'� C !C� e 1 - TO ALL NEW BUSINESS OWN DATE: Fill in please: APPLICANT'S YOUR NAME: ' Y" So C.(Dj BUSINESS YOUR ,yHOME 1 ADDRESS: Co25 L A S i 6 y7n �t r' Z TELEPHONE at��r k Telephone Number Home (yAME OF NEW BUS ESS 1 t�:a� )r � TYPI= OF BUSttESS ', -"' IS THIS A;HQtllt C>+CG A7t0t? YE5 NO Have yotz been givesp vat fro the buldllg dtrrilsanS NQ aC 'DRESS OF lIStNSS 1R, s #� t cJ�: �-�-rt��a:�.��t: Mpt�1'1�A��.NUtVt��R 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. Once you have obtained the required signatures, listed below, you may apply for a business certificate at the Town Clerk's Office (Ist floor-Town Hall) or if you get the business certificate first you MUST go to the following office to make sure you have all the required permits and licenses.. GO TO 200 Main St. — (corner of Yarmouth Rd. & Main Street) and you will find the following offices: 1. BUILDING COMMISSIONE OFFICE This individual h en infor a of any permit requirements that pertain to this type of business. Aut orize Signature * COMMENTS: 2. BOARD OF HEALTH This individual has be forme oofoth ermit requirements that pertain to this type of business. Au rized_8 i cfna ure**, COMMENTS: 3. CONSUMER AFFAIRS (LICENSIN.Q AUTHORITY) This individuaM-e, of lic n i r quirements that pertain to this type of business. r re** V J COMMENTS: G� 6 a- Business certificates (cost $30A for 4 years). A business certificate ONLY REGISTERS YOUR NAME in the town (which you must do by M.G.L. - it does not give you permission to operate -you must get that through completion of the processes from the various departments involved. **SIGNIFIES APPROVAL FOR A BUSINESS CERTIFICATE ONLY. ack- Yard Buffet ke nn edv pr posed - touch 11t1 ��.ilinI1l of pe f0l -.a cod 0 � �. 101101 , , ©� W4,e- 0�� • . &Aa �_w_ .�_ -----�----__-� ---, 'I /� l { � �� ,, �� / � � i t } TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 30 Parcel Permit# .o�Health Division P Darn, Date Issued Fee l so,oj, --->Tax Collector - -';7 Treasurer 9- I IZ BIIZ, �1?7 jam"-ICANT}MUST OBTAIN A . R Planning Dept. ca,NNECTION PERMIT M THE BNGINEERIN(i D1VI81 PltI06t TA 1 � Date Definitive Plan Approved by Planning Board t[c'dl�N NV� j Historic-OKH Preservation/Hyannis �l�se i �I -71 Project Street Address Village Owner Address Telephone i (SOS) 1 S - 0 Z I Permit Request N STA lL A P A 1:3 S A R M6 -Q _ SET Square feet: 1 st floor: existing proposed 2nd floor: existing proposed..._.__..---- -Total new Valuation Zoning District ._.----Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes,attach--supporting documentation.• Dw4l+ g Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Exi Ming Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑ ZLJIN Basement Type: a Eull ❑Crawl . ❑Walkout ❑Other Basement Finished Area(sq:ft,� Basement Unfinished Areas . Number of Baths: Full: existing`�,.. new Half: existinq new Number of Bedrooms: existing new Total Room Count(not including baths): existing ``` new First Floor Room Count Heat Type and Fuel: as ❑Oil ❑ Ele ❑Other Central Air: ❑Yes t(No Fire la s: Existing New�_ Existing wood/coal stove: ❑Yes t No Detached garage:❑existing new size Pool:❑existing ❑new size , Barn:❑existing ❑new size Attached garage:❑e i�ing ❑new size Shed:❑existing ❑new size Other: Zonin and of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑ No If yes,site plan review# Current Use proposed Use BUILDER INFORMATION Name Q , Telephone Number r,. Address License# 3 "4 —Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO c _ . /J SIGNATURE DATE �� F _ FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS, -s _ VILLAGE y OWNER a .. DATE OF INSPECTION., t FOUNDATION FRAME INSULATION FIREPLACE • - F ELECTRICAL: ROUGH FINAL . PLUMBING: ROUGH FINAL GAS: .3 ROUGH ` r FINAL FINAL BUILDING-_, e-.a ^ DATE CLOSED OUT. F i �' ASSOCIATION PLAN NO: , fIK The Commonwealth of Massachusetts — '� — Department of Industrial Accidents t = = Office el/aYesaffatfeos t 600 Washington Street `4 Boston,Mass. 02111 -; Workers' Corn ensation Insurance davit . /�%%%%%%%�� name: Y AC K _ �/�n /1 -13V fF e I location Z V1,4 V S-T C CitV. b", A N J S MA O Z 60 Monet I am a homeowner performing all work myself. � I am a sole x rietor and have no one worl� in anv ca achy I am an employer providing workers' compensation for my employees working on this job. ::: ❑.. :::.:::::::::::::.ff...............:::::::::.::::::::::::.............:: ;:.::.;:..:::.:......:;;:.. comaanv name ::.: ......... ....... ...::........... aid ...... _ ,. city :.:.::. ....< alicv# insurance co :;:"..:. :' :. ..... ,:.:....:..... :<>:;::::.:::;;: .: »;::.:;:;;::.,:.;:: i ❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contactors listed below who have the following workers compensation polices:....... comoanvname :< address :.> ..................:. ...........................................-.... .. .::::... ....... ................ ............................................ #�,':'':?$;i,;:;i{{::%�j' XXX 5�;:;':;!}ji:i:;:`i�'}:;:v:;:?t�:! ........x.:}•.�.:}:iiiL•i:ii•i:4i::-i:i:i:w::::::v::::v:::::::•::•:::Y:::..............:.::.::::••::•:•:: ••:�::::::ps:;::::w:;:..................;.......::::.: none 1. -::::::::::•:::::•.�:::::.ii:h:i?ii}i:Jiiii:iC•:iiiiii:ii::::;::{ ^iiiiiiii}i::•:: i:-:iiii�>::.i:-isSin^:•iT:4i::i•::-:J:•iiii:•:4:!•i:i•i:i<•......•......•••.••.•.. rJx . :•v:.........:..:.i+"'::-::::iiiY*ii:i.i:•ii:':ii:•i•::::::::.�.�::.:::::••:::ii:.iiiii::'?ii:ii:•i} -iYSi•:{{i•i}X+'•:>''ik;}::{;i:5i;-ii:K::Y::<:i:•,. :: ::: ..:.. .::. ,.}:.;.;n::; sn .na ............._.._................ .....:... . ....... X. addesss cl w»' :.::.::.::::::.::.:.:::::::....................................:::::.:::.......:::............. . >:< ........................................................................................................... :...:-:.. :;:.:::.; Fw&ue to secure coverage as required under Section 25A of MGL 152 can lead to the Imposition of criminal pmalttes of a fine up to$1,500.00 and/or one years'imprisonment as well as civil pensides in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify t e pains and aloes of perjury that the information provided above is h w.and coned Signature Date 19 Print name Phone# r official use only do not write in this area to be completed by city or town official dty or town. peradt/license# ❑Building Department ❑Licensing Board ❑checkif immediate response is required ❑Selectmen's Office ❑Health Department contact person: phone#; ❑der. 0avued 9195 PW Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An employer is defined as an individual,partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the instwmce requirements of this chapter have been presented to the contracting authority. 1/11171%/, ' Applicants Please fill in the workers'compensation affidavit completely,by checking the box that applies to your situation and i supplying company names, address and phone numbers along with a certificate of insurance as all affidavits maybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be retmmed io the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. The Department's address,telephone and fax number- The Commonwealth Of Massachusetts Department of Industrial Accidents 8mc0 of Imlesugauons 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 l ✓fee �airvmon�ueai a� �u � BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number"C� 0203.04 Birthda�g':4T/D9l1540 ' Expires-OT/09/2001 Tr.no: 527 itestncted'' 00 JOHN B SWEENEY. 188 STURBRIDGE DR',-` ``' OSTERVILLE, MA 02655 Administrator l INSiO � -� t oo i 619 � 3 c pA e I j, J 9V I� 1�'0 0 f � � t I NS DE e e/ r n n . I 4a �b1 r � Ib INSIDE' Y t xm _4 _ era CHURRASQUEIRAS, ESPETOS E MISTURADORES Sema utilidades - CHIJRRASQUEIRA' GIRATORIA A CARVAO INFIRM ,ice��0�� ►� "1 I A Dimens6es da Churrasqueira. I Galeria `® .� (A)Altura = 0,25 m \11 (L) Largura = 0,67 m QI ` • k - (C) Comprimento =Ver tabela 2 Galerias I�. (A)Altura = 0,45 m . (L) LargUra = 0,67 m Compri- :ompri- �� (C)Comprimento =Ver tabela N° de memo N°de memo Espetos da boca Espetos da boca 45 do forno do Porno 9 � M 1,10 m � 9 0,70 m k ` s 10 1 1,20 m 11. 0,80 m 11 1,30 m 13 0,90 m 12 1,40 m 15 1,00 m 0 13 1,50 m 17 1,10 m C> 14 M 1,60 m 19 1,20 m C) 15 1,70 m 21 $ O 16 1,80 m 2r 1,40 m 17 1,90 m 25 1,50 m O 18 2,00 m 27 1,60 m 19 2,10 m 29 1,70 m 20 2,20 m 31 1,80 m ® 21 2,30 m M 33 M 1,90 m ` 22 2,40 m 35 2,00 m 23 2,50 m 37 2,10 m i --- 24 2,60 m 39 2,20 m r 25 M 2,70 m 41 2,30 m (L) 26 2,80 m 43 2,40 m I 27 2,90 m 1 1 45 1 12,50m I 28 3,00 m I 47 1 12,60 m l 440 (A) 29 3,10 m 49 2,70 m 30 3,20 m 51 2,80 m �31] 3,30 m_ 53 2,90 m f 150 55 3,00 m It 0O4 00 57 3,10 m M 59 3,20 m 61 3,30 m O 00 Posi4ao do Motor. ODireito OEsquerdo( Embaixo Serria ', J� I 9 Revendedor 9 � a " v v' 0 G b O , C 10 e" 0 0 E i I � O P P F Z r � l I I 1 1 a I m Sema utilidades k I �I , k �.i`• ,,�� fat� � I A qualidade do produto e nossa meta principal, com isso conseguimos uma durabilidade muito acima da media, exigindo menos manutenpao. . ¢ffi1 ti v 0 � I Miudos Churrasco i u — Cupim I Costeldo (3mm) IC Espetos em aqo inox,com cabo de madeira; Roldana de zamak fundido. Centro da roldana ate a ponta Tamanho=0,495 m �M A MISTURELA mistura e cozinha diversos tipos de massa,para qualquer finalidade. Ela e utilizada para produgdo de massa de cozinha, polenta, 4 risolis, marmeladas, doces (banana, abobora, cocada, ...) e, ate mesmo para a industria na produgao de colas a resinas. P E um equipamento para escala industrial,onde pode-se conciliar rapidez e criatividade para as suas receitas. .466 Ire- 4r; e 5 v A � t r - Yr N i I i P A a �i Especificagoes Tecnicas. Cozimento rapido e uniforme,com baixo Gusto; Estrutura tubular de ferro,com pintura epoxi; Revestimento em aqo inox, com forragao em la de vidro; Sistema giratbrio com engrenagens de.ferro; Embuxamento de bronze; Tanque de agua para recebimento de gordura,facilitando a limpeza; i Duas ou tres gelerias de espetos; Queimadores infra-vermelho,com funcionamento em grupos separa- dos; Possui rodas,facilitando deslocamentos; Motor: 1/4 HP(110v ou 220v); 2 Galerias de 9 a 53 espetos; 3 Galerias de 17 a 65 espetos. ® ® Dimensoes da Churrasqueira. °9 F e - 2 Galerias (A) t (A)Altura= 1,50 m y (L) Largura ='0,70 m (C) Comprimento =Ver tabela 3 Galerias (A)Altura = 1,60 m (L) L'argura='0,70 m (C) Comprimento =Ver tabela � J a v' .d4AIOR ESPACO MAIOR ESPACO PARA MANUTENC;AO PARA MANEJO DOS CONTEUDOS D SISTEMA DETRAVA k COM MAIOR FACILIDA_E I 1 I Obs.: Ns Opcionais j "Tubo Alongadores PAS ALONGADORES ® caso a pessoa desele SISTEMA PARA trabalhar cola a MOVIMENTACAO DO QUEIMADOR Misturella em nivel (DESLOCAMENTO FRONTAL) mars elevado. Capacidade em litros. , s 15,22,37e75' Estrutura. i Tubular Panela. Aluminio Fundido Motor.. i 1/4 HP (110/220v) e 1/3 HP(110/220v) r Fogareiro. . Duplo de alta pressao Obs.: Na Misturela 15 litros, o fogareiro e simples tambem de j alta pressao. Consumo de gas. �. Aprox. 750 gramas/hora Modelo` T:Rota5do p/o eixo das pas �� Motor M 015 18 voltas por minuto 1/4 HP F M 022 22 voltas por,minuto 1/3`HP. M 037 22 voltas por minuto 1/3 HP M 075: �c22 voltas por minuto. Vim, 1/3,,HPf Pas. Ik -04 revestidas com madeira de peroba(a madeira pode ser reti- 'F rada); =O eixo das pas gira no sentido horario; -A panela vira ate 90 graus para que a mistu_ra possa ser despeja- . da em vasilhas. Obs.. A Misturella M075 ndo e aconselhada Para a fabrica�do de massas com muita consistencia. r h N°de Compri- N°de Compri- 4 i Espetos mento Espetos mento m l 1 3 i M l 9 0,80 m 14* 0,80 m 11 0,90 m 17 0,90 m B 13 �1,00 m r 20* 1,00 m 15 1,10 m 23 1,10 in "i 17 1,20 m 26* �.1,20 m ki 19 1,30 m 29.* 1,30 m 21 1,40 m 32 1,40 m 23 1,50 m 35* 1,50 m 25 1,60 m 38 1,60 m 27* 1,70 m 41* 1,70 m 29* 1,80 m 44* 1,80 m 31 1,90 m 47* 1,90 m 33 2,00 m 50* 2,00 m 35 2,10 m 53 2,1O m 37 2,20 m 56* 2,20 m 39* 2,30 m M 59* 2,30 m M41 2,40 m M 62* 2,40 m i 43 N 2,50 m 65 2,50 m 45 M 2,60 m 47* 1 12,70 m 1 49* 2,80 m !, w 51* 2,90 m 53 3,00 m Obs.:(*)Sob consulta 1 Modelos I:a7-7 -� 71�t. dade M015 15 0,49 0,55 0,87 litros m m m M022 22 0,60 0,65 1.10 litros m m m M037 0 0,67 0,68 1.2037 ' litros m m m _ J1 M075 75 0,87 '0,86 1.33 E litros m m m I i a } Lf G7 YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates(cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office,,1 st Fl., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. DATE: 13 Fill in please: APPLICANT'S YOUR NAME/S: S BUSINESS YOUR HOME ADDRESS: I I I T��c TELEPHONE # Home Telephone Number _�W l 3 f2 2ll1 S NAME pF CORPORATION, 1 o ti. =- NAME OF VIEW 13USINE$SY + ;� S TYPE OF BUSINESS:(o-�w•� IS THIS A HOME OCCUPATIpN? YES ADDRESS OF BUSIIyESS' , [lu+l exu /7 MAp/PARCEL NUMBER (As$essing) --�— 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 CO *bn FFI This individ m a y it �rements that pertain to this type of business. 'iat ,s, !//�� COMMENTS: 2. BOARD OF HEALTH This individual has been informed of the permit requirements that pertain to this type of business. Authorized Signature** COMMENTS: 3. CONSUMER AFFAIRS(LICENSING AUTHORITY) This individual has been informed of the licensing requirements.that pertain to this type of business. Authorized Signature* COMMENTS: 46 -Sack-"o 99 s eat E� Uc `- �� ch'TRANEY CKIT __-�___ . . . _ t - F Fc T n M�tv " � � RAN 5 j UN GAR L� sLd TR• a i CE NTLAD �{Ot7 ao MAti S 3 < •� � Lo k-j --- c ®c L E R'S in W _ r 0 ENTRA EE �a ODFIRE Pins F \VK, /* 0 — OD CD m 2.aD Fig CXir m STOi C+E EW TRAM CE C�' S m Z� {- -r—i �T o 46 sew i5ack-o 99 s o ENTRANCE CKIT Cl 'BOFF ET r1 MA N r i n r1 r) n s ►c.E �AIC> `s LADE<, MAWS N)DER OV L L P, 5 1J i t K4TC1�F�.t > OFFICE L C N TRAN'C.E n � RRE PusF • K1TCHEW STORAGE ENTRANCE �/2� ( C%'FPA:TIQ` in 1 r pack-"o ag S ecv E ME <6c NJ( ® ENTRANCE ` -KIT ffiQ pTEV Qju n MAN' 1OFFcT Y. LAU } fc.E 's /�•� LADIES MAti'S Room �1 h Lo L n t<4TCU��1 (r\ (.4� OFFICE n I FIRE Pint F ID ! 11CY 2++a F'� F_ 9 KiTCNEN _STOR^GE ENTRAutiE - o TOWN OF BARNSTABLE In accordance with the Massachusetts State Building Code, Section 106.5, this CERTIFICATE OF INSIPECTION is issued to SAMBA GRILL OF BRAZIL X Certtfp that 1 have inspected the premises known as: SAMBA GRILL OF BRAZIL located at 570 MAIN STREET in the Village of HYANNIS County of Barnstable Commonwealth of Massachusetts. Construction Type: Use Group(s): A3 - The means of egress are si fficient for the following number of persons: Location Capacity Location Capacity v MAXIMUM INTERIOR CAPACITY 46 OUTSIDE SEATING SEASONAL PATIO 28 FRONT SIDEWALK SEATING 28 In case of inclement weather, patrons outside cannot be seated inside unless there is legal seating capacity for them. r^ Certificate Number: Date Certificate Issued: Date Certificate Expired: Map Parcel 200703144 6/27/2007 6/27/200.8 308 '278 The building official shall be notified within (10) days of any changes in the above information. Building Official d" BAcK- YARD E� C��Ncy q C�� T tf U FF n MAN< LA c ce ntTd )�' op LO k-1 r --- C oC L E P'5 7 j OFFic—r u RRE Fiat E D CxiT v � K1TE:HE STOKE TRAwtE 10 I - d YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office 1st Fl., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. F.: DATE: / 13 Fill in please: µ r Y APPLICANT'S YOUR NAME/S: S BUSINESS YOUR HOME ADDRESS: I 1 TELEPHONE # Home Telephone Number g5Ar2ll 2Z NAME OF.CORPORATION, v,w•n �'` wc�, e. S TH S A H M OCCUPATION.? � a � TYPE OF BUSINESS Goy r�1 ADDRESS.OF BUSINESS au r�.S�- �i:u Mr/7 MAP/PARCEL NUMBER Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING CO ISSIO R'S OFF[ This individ I h b e infer-m' a y. it raments that pertain to this type of business. Au orized Sifriat COMMENTS: 2. BOARD OF HEALTH This individual has been informed of the permit requirements that pertain to this type of business. Authorized Signature* COMMENTS: 3. CONSUMER AFFAIRS(LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature* COMMENTS: LAYOUT VARIES) _ g 14 s1 To N�DT p,i�/ M (1 N16 72,ET 73• f3A S 8p 2OGE OF CURS G_ DSGppED GA \\\ \\. a \\\ \.\\\,,• E ti \ o ' \ RA E� \, ep. .STp ��:\\ CE 34 � J N22.19 � 123.19 O W a