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HomeMy WebLinkAbout0599 MAIN STREET (HYANNIS) (10) TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application V�``f 0�> Jy Health Division Date Issued Conservation Division Application Fe Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/ Hyannis Project Street Address S Village F Owner ,.e- Address Telephone a 3� Permit Request C c- . .0 t1 „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 0 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' Highway,: ❑�(8"-s ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other __ : „ ." C Basemen`s; Finished Area (sq.ft.) Basement Unfinished Area (sq§ft) Number of Baths: Full: existing new Half: existing n9w Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Cour '�_ 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 C ( UILDER OR HOMEOWNER) Name ` " \ Telephone Number Address "l 2 l) License # n Home Improvement Contractor# ` of Email �(J �t� CA n GWorker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED may. MAP/PARCEL NO. �k ADDRESS VILLAGE ' OWNER i ti DATE OF INSPECTION: FOUNDATION FRAME INSULATION t' FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL ' GAS: ROUGH FINAL AI ri FINAL BUILDING DATECLOSED OUT -! a, I z ASSOCION PLAN NO. t f The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' 600 Washington Street Boston,MA 02111 www.mass.gov/din Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: City/State/Zip: ` 5 Phone#: �J C` - �j _ IT6C Are you an employer?Che-4 the appropriatePox: Type of project(required): L❑ I am a employer with 4. I am a general contractor and I 6. New construction employees(M 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' [No workers' comp.insurance comp.insurance.# 9. ❑Building addition 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.El.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. lContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Si ature: 1k V Date: r` 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, I xpress 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,orthe 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( )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 numbers)along with their certificate(s) of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance: If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit: The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-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 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 bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would hike to thank you in advance for yourcooperation 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 Westigations 600 Washington Street Boston,IAA 02111 Tcl.#617-727-4940 ext 446 or 1-977-MASSAFE Fax#617-727-7749 Revised 4-24-07 www,mass.gov/dia Town of Barnstable Regulatory Services t MASS � Thomas F.Geiler,Director 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 ' r f .. h - , as Owner of the subject property hereby authorize A`t; .I��P�I/\ �. )LI,LIl a n to act on mp behalf, in all raa.tters relative to work authorized by this building permit S • ( ddress of job) Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signature of Owner Signature of Applicant 1 '� • . PP 0 Tint Name Print Name IJLt -�'-.c Date Q:F0PM3:0WNERMERMBSI0NP00IS- 62012 Town of Barnstabl e Regulatory Services "'"" ASM « Thomas F.Geiler,Director w�6g Building Division Tom Perry,-Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstablema.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "IiOMEOWNER": 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. DEFINMON OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be, a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one I home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOwpmws EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a persons)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&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 world with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is My 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 Iast page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. C:1Usersldocollr'k1AppDaffi1LocaDMrcrosoRlwmdowslTempomTy Internet FrfleslContentoutlook\QREGZMN1EXPRESS.doc Revised 05301 2 14 AA AAAAAAAA♦AAAAAAAA1►AAAILLAAAAAAAAAAAAAA ►I►I►AAAAAr11Af A (9jertificate jaf Ntatur Rest-stance lip. '4 REGISTERED ISSUED BY DATE OF MANUFACTURE ► "4 /U'I'LfCjtTfDA1 CEAL TENT L ► ® NUMBER NORTH xor.,LYWOOn, CA FW9.Ot ► This Is to certify that the tnaterfais described have been flame retardant treated or lip.{ are inherently nonflammable). jib. � FOR� ► CITY: ADOitESS STATE : _ _ 4 Certification is hereby made that: The articles described on this certificate have been treated with a flame-retardant b' fabric. or material registered and approved by the State of California Fire Marshal. ► Trade name of ftane-ttsistant fabric or material used: I,AM-T£X Reg. F419.01 , ► d � ► co- The Flame RetaWa+nt Process Used will not Be ftermoved far Washing ► Type,Color ands wegnt of canvas&ww: �it� a'�"�. 1 %. � o ► G SOesrriptinn: 14 14 � ► Name of Applicator of Flame Resistant Finish Signature � ► CALIFORNIA COMBINING ► ►� Cena-a Tent mnufacum . of Nta �AF Tertiffitatte ,�e;�t����C�e ► REGISTERED . ISSUED BY DATE 4F MANUFACTURE � APPLICATION �` CENTRAL TENT z � NUMBER NORTH HOLLYWO01), CA , a F 7.9_.a1 ; This Is to certify that the materials described have been flame retardant treated or lip. - A are inherently nonflammable). � FOR ` CITY: STATE , ADDRESS : 1110. 4 Certification is hereby made that: � The articles described on this certificate have been treated with a flame-retardant fabric or material registered and approved by the State of California Fire Marshal, 00. 14 Trade wMe of�trsistant fabric or material used_ _ 6M-T C Reg. 4I9.01 ► Th Flame Retardant Process Used will not Be Removed RY Washing ® � 44 Type,color and weight of cwwumnyi: l Q x /0 o /1 / C= -T t0 . C . � Oesa�iption: ' . V Vi Name of Applicator of Flame Resistant Finish Signature Si ►v � CALWORNIA COMBINING /► t Certrsl Taft M=Ufkcww " � p0 UNDER-1 OP ID: DEB :4COROe CERTIFICATE OF LIABILITY INSURANCE DA05/211201TE Y) 05/21/2014 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 Debbie Sullivan DPS Insurance Group,Inc. NAME:PHONE FAX 500 Granite Ave.,Suite 3 A/c No Ell:617-479-5500 AIc No):617-479-8761 Milton,MA 02186 ADDRE Daniel P Sullivan SS:debsuilivan@berryinsurancesouth.com INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:St Paul Fire&Marine INSURED Undercover Tent&Party INSURER B:Quincy Mutual Tony Prizzi 31 American Way INSURER C:Travelers South Dennis,MA 02660 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. NSR ILTR TYPE OF INSURANCE DDL UBR POLICY NUMBER MM DDY/YYYY) (MMIDDIYYYY1 LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 �X ZPPISR357891347 11/21/2013 11/21/2014 DAMAGE TO RENTED 100000 CLAIMS-MADE OCCUR PREMISES Ea occurrence $ r MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PRO ❑LOC PRODUCTS-COMP/OP AGG $ 1,000,000 JECT OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident - B ANY AUTO AFV206208 11/21/2013 11/21/2014 BODILY INJURY(Per person) $ ALL OWNED rX SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIREDAUTOSAUTOS Per accident $ UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER C ANY PROPRIETOR/PARTNER/EXECUTIVE Y❑NIA XEUB1999T91213 11121/2013 11/21/2014 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 A Equipment Floater ZlMlSR482141347 11/21/2013 11/21/2014 Limit 600,000 Ded. 1,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Party Goods Rentals CERTIFICATE HOLDER CANCELLATION HYANNIS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Hyannis Main Street BUSIneSS THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ' y ACCORDANCE WITH THE POLICY PROVISIONS. District 599 Main St Hyannis, MA 02601 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD htt 66.203.95.236 n arcfms a eoa rna as x? r o pr ID 3U81188r ... 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(� water Bodies Tra �rtaFt eliao'n M1"y 1 �Jim, t,}a� MAIMS p MI t 15X30 10 100 HYANNIS MAIN STREET BUSINESS DISTRICTJUNE 26,2014 certificate Of Flame Resistance A zT REGISTERED ;ISSUED BY Date Work Per APPLICATION 1 CONCERN No. Glen Raven Custom Fabrics, LLC 1831 North Park Avenue 11/23/2011 T F-73101 Glen Raven, NC 27217-1100 This is to certify that the materials described at the bottom hereof have been flame-retardant treated(or are inherently nonflamable). FOR TRI VANTAGE®, LLC AT 2937 WEST 25th STREET CITY CLEVELAND STATE OHIO 44113 . Certification is hereby made that. (Check"a"or"b") ❑ (a) The articles described at the bottom of this Certificate have been treated`with a. flame-retardant chemical approved and registered by the State Fire Marshal and that the application of said chemical was done in conformance with the laws of the State of California and the Rules and Regulations of the State Fire Marshal Name of chemical used Chem.Reg.No. Method of application (b) The articles described at the bottom hereof are made from a flame-resistant fabric or material registered and approved by the State Fire Marshal-far such use. Trade name of flame-resistant fabric or material used Firesist Reg.No, F-73101 The Flame Retardant Process Used Will Not Be Removed By Washing (will or will not) Glen Raven Custom Fabrics, LLC By Wendy Miller,Customs Compliance Mgr. Name of Production Superintendent Title We hereby certify this to be a true copy of the original"CERTIFICATE OF FLAME RESISTANCE" r`/1 issued to us,"original copy"of which has been filed with the California State Fire Marshal J TRI VANTAGE, LLC BY Control/lot# Quantity 24 YDS Customer order#* 23169 Description FIRESIST 60"8.75OZ/SY 82003-0000 FOREST GRN Tri Vantage, LLC Invoice# 40132108 Product Code 888503 DURASOL AWNINGS-COMMERCIAL DIV 38 POIND LANE STE B MIDDLEBURY VT 05753 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application # Health Division Date Issued ` Conservation Division Application F6e Planning Dept. Permit Fee ��— Date Definitive Plan Approved by Planning Board Historic - OKH _Preservation/ Hyannis Proj treety d ss �Ell� r � ,� C f% - .K- ll c'�1h Ville ` `Owl n-erg Address Teleph'�one -z�-�Z�(33 Permit Request "i ot Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Tota(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 v � (BUILDER OR HOMEOWNER) ���. lam_ ��v�✓ � cName v, Telephone Number- SCE — 5 �� ,4ddress _c,: Lutl License # Home Improvement Contractor# Worker's Compensation # ` ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO h 1 SIGNATURE `�"��� rDATE" f aj v„ FOR OFFICIAL USE ONLY y 4APPLICATION# - - 'DATE ISSUED MAP/PARCEL NO. f ADDRESS VILLAGE OWNER R � 'E DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE t ELECTRICAL: ROUGH FINAL' PLUMBING: ROUGH FINAL�� M `' GAS: ROUGH FINAL", `4 FINAL BUILDING ' DATE CLOSED'OUT !� i ASSOCIATION PLAN-NO. f r, t t is • r e F .. -- 77' >. x`j http:J/66.203 95.236/arcims/_appcg?oapp/map aspx?proper�ID ,08118 - — " 'R�r x i b Bing _. ... _ �.r. � r -�.�� VOrtt . ��,tfeE ., ..� :• .,:-�<• ..,F- I ,:.�,.�, + �`� _. -r-:" �.� -bx,,. � �. `.�,.�-� � .ram x. :;�`a�- � .�;< K», ^' . _s� r -s...,,. ._a>••;-A���..,-_ w ... _. a-.a. .•s ��9 ...-._ �s �r�-� _ ....,.. z�. -a.. .�s;. ._�'"�,.xa .T�a`�.,.^ -��§"�"���,.... .�"'b.`�::. t.ag.��,.� r�-.e .s...� fl< .�R max°.,. .' a,b,,�..w,� � ��L�:��s ,..�-.�'s H. s .Favorrfes. ie �..... ���+:�C�h.aHe � ..;t%ue`3:w. 3., ..,. - ...ry� 4 .xv y,. :. 3%', ±'�'�� .;,.,: '�*.� �� -�$4,� ,'+�Fa''c').:. r.� r .•t..*�.oki �'S€:s Ri.f "`A�t S`+� �:-> ."fin. �:'.a ".'��. 'S: Map. ��.. ,�: . . ...• �, � ^. ..1 ,. fl:� �,���,�,�.�:..�� " . :.,� 4�� �s �g �_....��,.��;.:� . . w * Not for official flood hazard determrna . M AE(100 yr flood) ;. AO (100 yr flood) VE(100 yr flood w/suave action) a XSOO (500 yr floodM. ) r FEMA Preliminary Proposed Zones (subject z Summer 20 Expected opt . ion• S E cted Ad 13 ' SAE S00 year flood - ww AO- 100=yaar#}ood- � � < ' V9 AH- 100-year flood VE- Velocity Zone au 0,.2%Annual Chance Flood Neighboring Towns 3 . Water s (..I Streams : C Jetties Edge of Water { A a: $m Alit- marsh_ : i : ti ":9 � t nj ❑ Drainage Ditches c O T r Water Bodies, .2:? x M n rt r yyp. i3 Transportation ..-.._.._ fP .. �.,...i. -:.�„� .. roa..,-on, „v". y,;d,.` + op i4'"K _ _- -- . ( �InteFnet �_125/a _ x i n rr inter i y.. .M�. r �."a, u -Igo a m _ Start ' Parcel, Q ,, Main : �, at��+ .. �Icatio..., Ms . ,..Wrr,. . Ply Go p v ��r, 5 l�M, , Y f'I� �.. P P w. TM s � F Warfbain Event Main Street Hyannis The Beach Tree LEAVE KEEP PATH TO RIGHT SIDE ON LEF Tents are 50% cancellation SIDE Certiftcate of Flame Resistance REGISTERED ... . . .._ ...:.,. -- ._.. � .. FABRIC ISSUED BY pate of Manufacture NUMBER JOHNSON OUTDOORS INC. BINGHAMTON, NEW YORK 13902 JULY 2008 F-140.01 Manufacturers of the Finest Tent Products Described Herein This is to certify that the products herein have been manufactured from material inherently flame retardant ae here after specified by the material supplier. NAME: UNDERCOVER TENTS CITY: SOUTH DENNIS, MA Certification is hereby made that: The articles described on this eertlficate have been manufactured with an approved flame retardant chemical in compliance with California State Fire Marshal Code, NFPA-701', Underwriters Laboratory or Canada, and have been tested in accordance with the Federal Test Method Specifications and meet or exceed the Military Flame Specifications of MIL-C-43006G. i Type,color and welght of material 11 OZ WHITE Do"flotion of Item certified: PARTY CANOPY 2000 Flame Retardant Process Used Will Not Be Removed By Washing And Is Effective For The Life Of The Fabric Snyder Manufacturing,Inc. Manufacturer or Flame Retardant vinvl Laminates TENT 08PARTMENT,JOHNSON OUT RS IN . •Large Scal.......... ......... "'F LL V 1I®vV�tv TTV T®vv Iry I Le r-;�uan V1011I 00--5T `iCe Tn.� G�6G-O$6-$TAT _ m 1< IV ISSUED BY IDATE OF M"UFACTVRE � D REGISTERED APPLICATION � CENTRAL'T'ENT � NUMBER HOLLYWOOD. CA ®' F4f9Xf � -4 This Is to certify that the materials described have been flame (retardant treated (or n ® #re inherently nonflammable). ® FOR : ADDRESS 01. CITY : STATE : ^ . 10. � Certification is hereby made that: The articles described on this ce�iiaats have been treated with a flame-retardant ® e :State of California Fire Marshal- 1• approved b th 4 fabric or �rtaterial registered and PR y -4 Trado name of flame-resistant fabric or material used: A)4f EX Reg_F419.01 a ® � a The Flame Retardant Process Used will not Be Removed By ld4tAsM09 ® v c Type.eoW and wekjM of camrasNmyt: /)e�E_ l//,t/ 1l X 1�5' too. ® ces&ptkm . c t> Name of Applicator of Flame Resistant Finish Signature p► CALIFORNIA COMBINING Ccnaal'Ie�t glhhaut�eriatx l ��►A AAA1AAAAA►=6,.AAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA , IFF tamic T'& ® D ISSUED BY DATE OF MANUFACTURE ® REGISTERED APPLICATION � CENTRAL TENT � NUMBER NORTH HOLLYWOOD, CA ®, �1 F419.Of A This is to certify that the materials described have been Rame retardant treated (or are inherert#ly nonflammable). FOR ADDRESS : 101. ® CITY; STATE : Certification is hereby made that: The articles described on this certificate have been treated with a flame-retardant 100. ® fabric or material registered and approved.b the State of California Fire Marshal. � e9 DP Y � Trd&name of flame-misunt fabric orlmatuW used: 1 -7EX Reg,. FA -01 The Flame Retardant Process Used wilt Rot Be Removed BY Washing � Type,eaW and+might of oanvasNmyf_ Name of Applicator of Flame Resistant Finish Signature CAIJFoRrIA co NO tcaiunt Teas Mmuftcww UNDER-1 OP ID:AK IMMIDDIYYYYJ CERTIFICATE OF LIABILITY" INSURANCE 06/03112 THIS CERTIFICATE IS ISSUED AS A IMATTER 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 cortlflcate holder is an ADDITIONAL INSURED,tho policy(los)must be endorsed, If SUORQC+ATION IS WAIVED,subject to the terms and conditions of the policy,certain peftles may require an endorsement- A statement on this certificate does not confer rights to the Certificate holder in lieu of such endorsamen s). PRODUCER :CONTA CT B insurance Agency BOD-F + � NAME: PHONE 9 MaInStreet 508 20-6914H x_ Franklin,MA 02038 E.RtlAIL Daniel P.'Sullivan AnDREss: _ _ INSURERI5i AFFORDINOCOVERAGE NAIC s _ INsuRERA:St Paul Fire&Marine Ins.Co. ___ INSURED Undercover Tent&Pa - rtY InlsuRkRg:4uincy�Ilutual Fire Ins.Co. 15067 Toney Prizzi ' -- 31 American Way il�suREa .7he Travelers Insurannce Co. 19038 South Dennis,MA 02660 _— INSURER E: _ INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER; THIS 1S TO CCRTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED 1.0 THE INSURED NAMED ABOVE FOR THE POLICY PCRIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH kkSPECT 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 A Fed POLICY NUMBER IeParaolo yVY_..(MMILL)ONYYY LIMIT® OENERALLIABLITY EAOHOCCURRENCE $ 1,000,000 .,-A X COMMERCIAL GENERAL .: EMI' b cutQ+ca)...._ .._._LIABILITY CK002a3$92 05102112 05102113 100,000 CLAMS-MADEX OCCUR MED EXP(Any n.Doren $ 5,00 YERSONALBADVINJURY S 1,000,000 GENrdRALAGGREOA'rE GEN'L AGO REGAYELIL41T APPLIES PER: I PRODUCTS-COMFlOPAGG $ ^" 1,000,000 POLICY I I PRD 1-1 LOC AUTOMOBILE L"ILITY (. h1 I ent GLE LltlliT 1,000,00 B T ANY AUTO _ AFV205655 05102112 OW2M3 BODILY INJURY(Per person) s ALL OWNED SCHEDULED BODILY INJURY(Haracr4nn!) NON-0WNED AUTOS X ON-OUTOS �i PIiO TY DAMAGE X HIREDAUTOS X AUTOS 17arnccldoru) UMBRELLA LIAR _ OCCUR EACH OCCURRENCE 5 - _ EXCESS LAB CLAIM&MADE AGGREGATE_ $ DED Rr'.1'SNTION S $ WORKERS COMMNSAI ION X IL VVCY TAAT'q OTH- AND EMPLOYER$'LIABILITY IL C ANY PROPRIETOWPARTNERIEXECUTIVE Y N t A EU81999TS1211 11121111 11/21112 k,L.EACH ACCIDENT $ 1,000,00 OFFICERM49MBER EXCLUDE07 E.L.DISEASE•FiA SMPLOYEL- $ 1,000,00 (MnodgWry In NN) ,d V}yyea do F7IP99(kJ nON O d<a' DESG� OF OPERATIONS bolmre- E.L.DISEASE-POLICY LIMIT $ 11000,00 A Equipment Floater IM00201705 06102/12 05102113 Limit 600,00 Ded_ 5100 DESCRIPTION OP OPERATION5I I,OCAYIONS I VEHICLES(AtIwAi ACORD 101,AAtlltWol Rumarks Sehodulu,If morn apace Is Mquund) Party Goods Rentals CERTIFICATE HOLDER CANCELLATION .. - DbNALDC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES srz CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Don HQddeYig ACCORDANCE%qTH THE POLICY PROVISIONS, $99 Main Street' Hyannis,MA 02601 AYTHORIYI"UI EPRESENTAME @ 1988-2010 ACORD CORPORATION, All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD f Day at y.a nis Museu .. Date: Tuesday, April 17, 2012 - '' Time: 10)0&===*.offl pm ® lace: JFK Hyannis Museum 397 Main St. Hyannis, MA FREE Admission 'Face Painting Earth Friendly Crafts �a Uve ,Creatures *Popcorn 'rice Cream *Games *Obstacle Course *Whale Bones Have Fun while You Learn! 0 6 r ught o you t y by. HYANNIS NATIONAL ■ . �. M�, ARINE _ ,., LIFE CENTER CaringforStrandedMarineAnimals Hyccn & "alb' WDCS AMassAudubon p� � Whale and Dolphin Conservation Society I A�IN.i.YfdCl�tdS'' 3 Witcher � F Y The Commonwealth of Massachusetts Department of Industrial Accidents Office of fnvestigatiotrs ` = -6000 Washingtan Street _ Boston,MA 02111 www.massgav/dia ` Workers' .Compensation Iusuran:ce Affidavit:Builders/Contractors/FIecfricians/Plumhers A Reant Information Please Print & l ',NaIIle-p m ss/org=zatimY1ndividnai): ass: eCity/State/Zip: /��� �o Phone.#: Are you an employer? Check the appropriate bay Type afpTaject(require 1.❑ I am a employer with r[ am a general contractor and I ' employees(hill and/or part time). have hired fhe sub:contractors 6. ❑New construction. , 2.❑ I am a•sole proprietor or partneer- listEd on the'attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have . E. []Demolition working for me im any capacity, employees and have workers' [No workers' camp.insurance comp,invurancej' 9 ❑$reldmg addition required-] 5. 0 We are a corporation and its 10.[]Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 1L[]Plumbing repairs or additions myself [No workers' comp. right of exemption per MGI, 1�1]Roof repairs insurance required.]t c. 152, §1(4),and we have no . employees. [No workers' 13.❑ other comp.insurance re#rod *Any applicant that checks box A mmmt also fill out the section below showing their workers'compensation poficy iufatmation. t Homeowners who submit this affidavit indicating$ey are doing all work and Bien hire outside contractors must submit a new affidavit indicating such. tcont wt=d,at check tl&box umst ariached as additional sheet showing the n=of t hh sub-contractors and state whodus ornot those entities have employees. If the sub-conhmotors have employees,$ey raustpravick their workers'comp.pp1icynembcr. Iam an employer that isproviding,workers'compensation insurance for my employees. Below is the policy and job site in Insurance Company Name: Policy#or Self ins.Lie.#k ExpirafionDate Job Site Address: Ci{y/State/Zig: Attach a copy of the workers' compensation policy declaration p age'(sbowing the policy number and expiration date),' Failure•t o secure coverage as required m der Sectkm 25A of MGL c• 152 can lead to the 'mposition of cruel 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 viohLor• Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for incmanr"e coverage verification, I do-hereby c nder the pains-and penalties ofP�j�T that the information prqvid ed above is true and corr ; Phone-k .._.- Dfftcial use only. Do not write in this:ar!alb be completed by city or town official City or Town: PermitUcense# -Issuing Authority(circle axle): 1.Board of Health 2.Bmldiug Department 3.City/Town Clerk 4.Electrical InspE- 7g Inspector 6.Other - Contact Person: Phone#: ACC> CERTIFICATE DATE(MWDD,YYYY) .OF LIABILITY INSURANCE 6/19/2012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.TH15 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 13 WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this cer6if(cate does not confer rights to the certificate holder in lieu of such endorsements. PRODUCER CONTACT .: NAPE: Horgan Insurance Agency Inc . PHONE 508.775.5830 FAX 50e.973.663e 44 Barnstable Rd -MAIL ADD P O BOX 250 PRODUCER Hyannis MA 02601 INSU S AFFORDING COVERAGE NyCp INSURED - INSURERA;Zurich Insurance Company - INSURERS! - - - Hyannis Main Street Business` INSURFRcc Improvement Di.Strict INSURER0:' P.0- Box 547 INSURERE: Hyannis MA 02601 I RERF: COVERAGES CERTIFICATE NUMBERArannis Main Street. REVISION NUMBER: THIS 1S 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. �ITR TYPE OF INSURANCE IH wvD I - POLICY NUMBER Y DDY EFF OLIOYYn � LIMBS GENERAL LL461LrrY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PR occurrence $ ' CLAIMS-MADE DOCCUR MEDEXP(Any one on S PERSONAL 6 ADV INJURY $ GENERAL AGGREGATE $ GENL AGGREGATE LIMMAPPUESPER, PRODUCTS-OOMP10PAGG $ -1 7POLICY iE PRQ LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO $ (Es accident)ALL OWNED AlJr03 - BODILY INJURY(Per person) $ � SCHEDULED AUTOS BODILY INJURY(Per accident) $ ' PROPERTY DAMAGE $ HIRED AUMS (Per accident). NON-OWNED AUTOS $ $ UMBRELLA LIAB OCCUR - _ _ EACH OCCURRENCE - _$ EXCESS LUIB CLAIMS-MADE .AGGREGATE $ - DEDUCTIBLE $ RETENTION $ S. A WORKERS COMPENSATION 9001919101 - 1/02/2011 1/02/2012 y WCSTATU- I IOTH- AND EMPLOYERS'UABILnY Y/N ANY PROPRiETORIPARTNEA/EXECUTIVE E.L.EACH ACCENT $ V 100,000 OFFICERIMEMBER EXCLUDED? N I A (Mandatory in NH) E.L.DISEASE-EAEMP $ 100,000 If yes,DESCRIPTION OF $ 0 000 OE CSCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMB ............. DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Adfadt ACORD 101,Additional Remarks Schedule,it more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE. EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town Of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS. 200.Main St. Hyarmis r MA 02601 AUTHORIZED REPRESENTATIVE - - ACORD 25(2009/09) 01988-2009 ACORD CORPORATION. All rights reserved. INS025(20009) The ACORD name and logo are registered marks of ACORD Certificate of if tame 3ae!5u;tance REGISTERED Issued by Date Manufactured ♦5�-� sa, FQ FABRIC PLUMBER TOPTEC PRODUCTS, LLC � 04125/07 rt . 1073 Neely Ferry Road Laurens, SC 29360 REtp' This is to certify that the materials described are inherently flame retardant. UNDERCOVER TENTS Name Address 31 AMERICAN WAY . MA 02660 City S DENNIS State Zip r Certification is hereby made that: The articles described are flame-retardant, approved and registered by the State Fire Marshal and that the fabric is in conformance with the laws of the State of California and the Rules and Regulations of the State Fire Marshal. Fabric has been tested and passes NFPA701-99, ULC214, MVSS302. Method of Application: The Flame Retardency of this Fabric is Inherent and Permanent. Description of item certified: MARQUEE END CAP WHITE / 0 X 4�C The Flame Retardant Process Used WILL NOT Be Removed By Washing. TOPTEC PRODUCTS, LLC. MODEL T M2o0E SERIAL # 272906B Name of Production.superintendent a a BARNSTABLE, + ,� Town_ of Barnstable N1f�A 'Regulatory Services L Thomas F.Geiler,Director 4~ Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA:02601 www.town.barnstable.ma.us , Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must.. Complete and Sign This Section If Using A Builder I, as Owner of the subjectproperty P P rty ff hereby authorize I l' , r�j(r►r►n to.act on my behalf,. ,r in all matters relative to work authorized by this building permit application for: ' (Address of Job) Sign re of owner Date p �'LGr�� U? =—RVIC1 Phil Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side_ C:\Users\decollik\AppData\Local\Microsoft\Vb indows\Temporary Intemet Files\Content.Outlook\DDV87AAZ\EXPPESS.doc x Revised 072110 -' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map_:�A arcel 1 Application I,.—/V I Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board 77--1'13 ; P_ Historic - OKH _ Preservation / Hyannis Project Street Address Village Owner Address Telephone �za,�o�Fln ,r� c�i+n �t� <-O hr -vsra 2C Permit Request a -1�24Ak ila CDc -�i� �d �� 59gG.� ir' c��,� � S 1.3 Square feet: 1 st floor: existing proposed 2nd floor: existing propose D d ' otal new Zoning District Flood Plain Groundwater Overlay IN) .a Project Valuation Construction Type =: 4 .,. Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting^,docurpentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) ire 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-Pr-oposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER)o Name s l ( Telephone Number ;Sb - �-- Address 3�l`� � � License# f� Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 1 SIGNATURE �lJ`fl�a„� 1 DATE l UIll""L o z(A3 4. FOR OFFICIAL USE ONLY L APPLICATION# Ft DATE ISSUED IIf MAP/PARCEL NO. ADDRESS VILLAGE fr OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL { PLUMBING: ROUGH '`:fig FINAL r GAS: ROUGH FINAL { FINAL BUILDING DATE CLOSED OUT s ASSOCIATION PLAN NO. f The Commonwealth of Massachusetts William Francis Galvin -... Page 1 of 3 The Commonwealth of Massachusetts 6{� - William Francis Galvin Secretary of the Commonwealth, Corporations Division One Ashburton Place, 17th floor Boston, MA 02108-1512 Telephone: (617) 727-9640 BEECH TREE ALLEY, LLC Summary Screen a Help with this form Request. -C"76 i tic te,=_� The exact name of the Domestic Limited Liability Company (LLC): BEECH TREE ALLEY, LLC Entity Type: Domestic Limited Liability Company (LLC) Identification Number 001024072 Date of Organization in Massachusetts: 03/15/2010 The location of its principal office: No. and Street: 766 FALMOUTH RD., MADAKET PLACE #D-20 . City or Town: MASHPEE State: MA Zip: 02649 Country: USA If the business entity is organized wholly to do business outside Massachusetts, the location of that office: No. and Street: City or Town: Setate: Zip: Country: The name and address of the Resident Agent: Name: JAY R. PEABODY, ESQ. No. and Street: 128 UNION ST., SUITE 500 C/O PARTRIDGE SNOW & HAHN LLP City or Town: NEW BEDFORD State:.MA Zip: 02740 Country: USA The name and business address of each manager: Title Individual Name Address (no PO Box) First, Middle, Last, Suffix Address, City or Town, State, Zip Code MANAGER PHILIP M. MILLER JR. 766 FALMOUTH RD., MADAKET PLACE#D-20 MASHPEE, MA 02649 USA MANAGER WILLIAM D. PANE http://corp.sec.state.ma.us/corp/corpsearch/CorpSearchSummary.... 6/21/2013 f The Commonwealth of Massachusetts William Francis Galvin -... Page 2 of 3 2200 SO. OCEAN LN. APT. 1205 FT. LAUDERDALE, FL 33316 USA The name and business address of the person in addition to the manager, who is authorized to execute documents to be filed with the Corporations.Division. Title Individual Name Address (no PO Box) First, Middle, Last, Suffix Address, City or Town, State, Zip Code SOC PHILIP M. MILLER JR. 766 FALMOUTH RD., MADAKET PLACE#D-20 SIGNATORY MASHPEE, MA 02649 USA SOC WILLIAM D. PANE 2200'SO. OCEAN LN. APT. 1205 SIGNATORY FT. LAUDERDALE, FL 33316 USA The name and business address of the person(s) authorized to execute, acknowledge, deliver and record any recordable instrument purporting to affect an interest in real property Title Individual Name Address (no PO Box) First, Middle, Last, Suffix Address, City or Town, State, Zip Code REAL PHILIP M. MILLER JR. 766 FALMOUTH RD., MADAKET PLACE#D-20 PROPERTY MASHPEE, MA 02649 USA REAL WILLIAM D PANE 2200 S. OCEAN LN. APT. 1205 PROPERTY FT. LAUDERDALE, FL 33316 USA Consent Manufacturer — Confidential _ Does Not Require Data Annual.Report Resident Partnership Agent For Profit Merger Allowed Select a type of filing from below to view this business entity filings: ALL FILINGS 1� Annual Report ; Annual Report-Professional j Articles of Entity Conversion , Certificate of Amendment li Comments http://corp.sec.state.ma.us/corp/corpsearch/CorpSearchSummary.... 6/21/2013 The Commonwealth of Massachusetts William Francis Galvin -... Page 3 of 3 ©2001 - 2013 Commonwealth of Massachusetts ® All Rights Reserved Helg http://corp.sec.state.ma.us/corp/corpsearch/CorpSearchSummary.... 6/21/2013 "ME Town of Barnstable f t Regulatory Services t RARNtw'A Ri_,F i Thomas F. Geiler,Director �►r+a� Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable ma.us' . Office: 509-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section - If Using A Builder �, as Owner of the subject property hereby authorize. ;-iI of i,&c ,n to act on my behalf, in all matters relative.to work authoLized bythis building permit application for. (Address of job) S r ignature of Owner a UA6 K Print Name l— If_Property Owner is applying. for permit please com lete the Homeowners License Exemption Form on Elie reverse side. Q:FORMS:o WNERPERMISSIDN �e Tow' n of Barnstable "[KE ' o„ Regulatory Services t RISiTif PART^R « Thomas F. Geiler,Director, Mass. Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units-or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Persons)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 i09.1.1) 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 B arnstable 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 dwe-Iiings 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 bomeowner pmfbrming work for which a bui3ding 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,pamtculady 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 requirt,as part of the permit application, that the homeowner certify that helshe understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may cane t amend and adopt such a fnrm/catification for use in your community. QAWFILESIFORMSIhom' =xemptDOC . ' The commonwealth of Massachusetts Department of Industrial Accidents =. Office of InvesdgationV. 600 Washington Street Boston,MA OZrlr UV }vww.mass.gav/die _ � . Workers' Compensation Insurance Affidavit: Builders/Contractors/EIectricians&lumbers Applicant Information Please Print Letsibly Name(BusEn s/O`rganindon/FndividuaI): C`M5/State/Zip Are you an employer? Ch the appropriate b r. Type of project(required): 1.❑ I am a employer with4: I am a general contractor and I employees(full and/or part timcl. * have hired the stib-contractors 6. 0 New construction 2.0 I am a.sole proprietor ar'parh5er-' list!-,d on thee-atfached sheet. T. []Remodeling ship and have no employees These sub-contractors have g.'Q.Demolition working for me in any capacity. err�loyess and Have workers' . [No workers'•camp.•imrra rt nee comp.in� ranr:e,# 9. El Bu>7 dini addition • 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'camp. right of exemption per MGL_ 12 0 Roof repairs inmzance required] t c. 152, §1(4),°and we have no employees. [No workers,' 13.❑Otber corm,insurance required] *Any applicant,that chxks box#1 must also fill out the section below showing their workers'compensation policy,information t Homeowners who submit this affidavit indicating fbey ere doing aE work end then hire outside contractors must submit a new affidavit indicating Stich.$Contractors that cbeck this box must attached an additional sheet showing the name of the sub-contractors and stale whrtbcr or not those entitim have employees. if the sub-contractors have FnPloyces,they must providb their worker'comp.policy number. ram an employer thatisproviding workers'compensation insurance for my employees Beluip is thepoUcy andjob site information Insurance Company Name: Policy#or Self-ins.Lic.#: Y Expiration Date: Job Sit-Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy ntnnber and expiration date). Failure to secure coverage as required under.Section 25A of MGL c. 152 can lead to the imposition of crimin�I penalties of a free tip to 3'1,500.00 and/or one-year imprisoIIment as welI 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 chat a copy of this statement may be forwarded to the Office of Investiea.tions of the DIA for insurance coverage ycdacatian r do hereby under the pains•and penalties of perjury that the'information provided above is true and correct F6. 0ther only. Do not write in this area,tb be completed by city or town official Town: Permit/Licame# hority(circle one): Health'2.Building Department 3. City/Towu Cleric -4.Electrical Inspector S.Plumbing Inspector son: Phone#r Information and Ins fuctzons 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 j oiat enterprise,and including the legal representatives of a deceased employer,or the . receiver or triter.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 Di on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGrL 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 vgho has not Produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL ahapter 152, §25C(7) states"Neither the commonwealth nor,any of its political subdivisions shall . enter into any contract for.the perfo=annc 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-confi-actor(s)name(s),-addresses)andphone 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 Departmmi.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-i4surarpe license number on the appropriate Had. City or Towp Officials Please be sure that the affidavit is commplete'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 U in the permitllicense number which will be used as a reference number. In addition,an applicant that must submit multiple pmmit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary) and under"Job Site Address"the applicantt should write"all locations in (city ar 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 fo any business or commercial venture (i-c. a dog license.or permit in bum leaves etc.)said person is NOT required to complete this affidavit The Office of Iavesti.gations would like to.tbank 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 CvmmonwWth€}f MSssaGhu$r s Dq-psx umt of ladix Ed Acaulents Office of I>u�eigai ��s 600 Washings Strei t Boston,MA 02111 T4. #617-727-4900 ext 406 or 1-877-M.ASSAFF Fax# 617-727-774 i -vise, 11-22-06 i www.mass.gov(c a Client#:436885 UNDERTEN YYYY) I ACORD,. (MMDDI,, CERTIFICATE OF LIABILITY INSURANCE DATE 5/28/2013 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: USI Rental Specialties PHONE 800 854-3298 FAX A/C,No Ext: A/C,No: P.O.Box 53310 E-MAIL ADDRESS: Irvine,CA 92619 INSURER(S)AFFORDING COVERAGE NAIC# 800 854-3298 INSURER A:St Paul Fire&Marine Insurance 124767 INSURED INSURERB:Phoenix Insurance Company 125623 Undercover Tent&Party,Inc. INSURER C: j 31 American Way INSURER D: South Dennis,MA 02660 -- — 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 CONTRACTOR 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR.WVD POLICY NUMBER MM/DD/YYYY MMIDDIYYYY LIMITS A GENERAL LIABILITY ZPPlOP594591247 05/02/2012 05/02/2013 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES ERENTED cccc nce $100 000 CLAIMS-MADE I ^;OCCUR MED EXP(Any one person) s5,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $1,000,000 X POLICY PRO-F-IJECT v LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED —I SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED .• - PROPERTY DAMAGE $ HIRED AUTOS AUTOS Peraccident --- $------- ' UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DIED RETENTION$ $ B WORKERS COMPENSATION XNUB1999T91212 11/21/2012 11/21/201 X WC STATU- FIR !, AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE�Y/N E.L.EACH ACCIDENT $1,000,000 OFFICERIMEMBER EXCLUDED? IN 1 N/A _ (Mandatory in NH) - E.L..DISEASE-EA EMPLOYEE $1,000,000 . I If yes,describe under ' DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 t~` ,Equiprr cnt Floater ZIP!113"l253281247 05/02/2012 05/02/201 $&^0,000°Lir^°,'. ' Special Form ` $1,000 Deductible DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) This certificate is issued as a matter of proof only. CERTIFICATE HOLDER CANCELLATION Hyannis Main Street BUSIneSS District SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE y THE EXPIRATION„DATE THEREOF, NOTICE WILL BE DELIVERED IN Elizabeth Spilsbury ACCORDANCE WITH THE POLICY PROVISIONS. 599 Main St. _. Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S97794561M9510238 AXLJG 15X30 10X100 HYANNIS MAIN STREET BUSINESS DISTRICTJUNE 27, 2013 UNTIDE�C( PT S ?►, htt :/166.2O3 95.236/arcirns/aQPc�poapP/mad aspx�p#ahpltyID 308118 11 x kDBing .. :,r. . . ..._.:..._ e •.n-.:i9s�. ,}t:.l..- S" L.Fc �r i' s :i ,+-. K 'r E k ,td 'st -a :i.. z s �. ) ..,r, yN r, r�,�rFs:'t�'... .:� i , t«L 3 ... b - Fe` x'•. t' -:: C L 1- 4,, SC'1. h S.- E 'a}i .i. • .- .,� ,: � :r,tG�-�a �a 2: { ,.�, .�. ,.t i, �. 7Cr -rh i i � 'Fi §3 .,.,��.y-.y'}c s � '.. -;.- .. •',. .'Fi:°. �: r 4rn+k:..,.rF ,:'r^::'fi.r.. .,r. ,r i x'r� :::4N'F5[li �j; ,�+1''$,� .d.•.�w'1•x'�r 3y >}�: t.�,,'Sr #! wt i k..,...Sl '�Ei�r f:� i�..r[' �. xs �t�.:::^ dtr!,;{;:4+,,'3�`.�'F94,Frsw�r..n.c;Li. �, ..4i .'E :ti'ir ,A: 1: •'l"3' .ly. t1 .P:A-- - .,t f� ! 7 y. 4., 4 �, S! ,(' i'4 .r�: 5��4. 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"L�iAA2F�#, i. vLntk�.a.ai _ _- - - -- — ! —� - '�kr- {s�f'-0 m•: t } y 'Y r" u F yq-°' _ _ . - _ _ ��- - MUM, � ' .,: < i �. ~ = P' r r Certt�� c�.te of �c � me Rest ta re REGISTERED issued by Date Manufactured - ♦5 T� �•' "� C0 FABRIC NUMBER TOPTEC PRODUCTS, LLC • y � 04125107 rt ., 1073 Neely Ferry Road Laurens, SC 29360 PUT This is to certify that the materials described -t are inherently flame retardant. . g UNDERCOVER TENTS Name Address 31 AMERICAN WAY `— MA 02660 - City S DENNIS State Zip s _ A Certification is hereby made that: The articles described are flame-retardant, approved and registered by the State Fire Marshal and that the fabric is in conformance with the laws of the State of California and the Rules and Regulations of the State Fire Marshal. Fabric has been tested and passes NFPA701-99, ULC214, MVSS302. Method of Application: The Flame Retardency of this Fabric is Inherent and Permanent. Description of item certified: MARQUEE END CAP WHFrE l O - The Flame Retardant Process Used WILL NOT Be Removed By Washing. TOPTEC PRODUCTS, LLC. TTM200E 4 MODEL SERIAL # 272806B Name or Production.Superintendent THE FOLLOWING . - IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) -I M DATA . Certljwvste of Flame R"'esistance REGISTERED ISSUED BY Date of Manufacture FABRIC JOHNSON OUTDOORS INC, NUMBER BINGHAMTON, NEW YORK 13902 1(1LY 2008 F-140.01 Manufacturers of the Finest Tent Products Described Herein This is to certify that the products herein have been manufactured from material inherently flame retardant as here after specified by the material supplier. NAME: UNDERCOVER TENTS CITY; SOUTH DENNIS,MA Certification ie hereby made that: The articles described on this certificate have been manufactured with an approved Ilame retardant chemical in compliance with California State Fire Marshal Code, NFPA-701', Underwriters Laboratory of Canada, and have been tested in accordance with the Federal Tost Method Specifications and meet or exceed the Military Flame Specifications of MIL-C-43006G- i Type,color and weight of material 11 OZ WTI! Description of item certified: PARTY CANOPY 2Ox3O Flame Retardant Process Used Will Not Be Removed By Washing And Is Effective For The Life Of The IFabdc Snyder Manufacturing, Inc. Manufacturer or Flame Rataroant Vlnvi Laminates TENT DEPARTMENT,JOHN50N OU IRS IN , large Scale IIF ITY, �® � � �,ua,. L P.AaUan. VIO= T T 00--131 -,cam