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0631 MAIN STREET (HYANNIS)
w a 4 V v v ' V I I, W � � � 1� ,� � e �. h o � � � v � v v � 0 � � w °� 2 r � � � �� n �1 � � ``� 'I 3 i. .z( „_:+ - - - } V .F. BUILDING DEPT. NOV 2 2 2019 November 21,2019 TOWN OF BARNSTABLE Brian Florence Building Commissioner, Town of Barnstable 200 Main St Hyannis,MA 02601 Dear Mr. Florence, I applied for and received a building permit to replace damaged windows due to rot and age for building at 631-Main St,.Hyannis in February 2019. Unfortunately due to health issues I was unable to begin the project within the 6 month time limit. At this time I am ready to proceed and am requesting an extension on said permit. I am willing to pay the extension fee of$50.00 if approved the extension and ability to proceed. Thank you in advance for your consideration. f G a Michael T. Parece Finish First Construction �y� \P) V� i fin Application- Application number....for i-E8 0 6 Fee.............................................................. Building Inspectors Initials . .....Acl.I.i. ........... DateIssued................... :. ..................................... Map/Parcel.........3a,,g- 13 .©ate ................................... ................ TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION E PROPERTY INFORMATION Address of Project: ' NUMBER STREET KLXGE Owner's Name: ���� io� lD4cq!�_ Phone Number 5OF 125v�tc� Email Address:S/64,,,e_P r 6P 4f Cell Phone Number& �a Project cost$ Check one Residential Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize it E.:�!_5 to make application for a building permit in accordance with 780 CMR Owner Signature: Date: 02 1,d Z 5 TYPE OF WORK ❑ Siding Windows (no header change)# ❑ Insulation/Weatherization ❑ Doors(no header change)# Commercial Doors require an inspector's review ❑ Roof(not applying more than 1 layer of shingles) Construction Debris will be going to ���� CONTRACTOR'S INFORMATION Contractor's name , ��<Ss2g T ��.tS7`/der Home Improvement Contractors Registration(if applicable)#4" (attach copy) ,Construction Supervisor's License# D;V4��s� (attach copy) Email of Contractor 44ce t e 67 z�,&e;74' Phone number (5-4 66a /7a ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION NUMBER............................................................ *For Tents Only* ADate Tent(s)will be erected Removed on number of tents total Does the tent have sides? Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper.- Purpose of Event Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent Fuel source being used LP tank 20 lbs. or> Yes No , if yes, a gas permit is required. Natural Gas Yes No = , if yes,a gas permit is required. If food is being served at.your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3:30 pm-4.30pm. Commercial events may require Fire Department approval. *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLICANT'S SIGNATURE Signature `� y,� �ir-� Date All permit applications are subject to a building official's approval prior to issuance. ✓ate ��2�uL o�✓Ol�a,lJczc/uGseftJ ' office of Consumer Affairs&Business Regulation Registration valid for individual use only HOME IMPROVEMENT CONTRACTOR TYOE--Individual before the expiration date. If found return to: Reaisfration- Expiration Office of Consumer Affairs and Business Regulati• 72ar r 09119/2020 1000 Washington Street-Suite 710 . I A -1'I� Boston,MA 02118 MICHAEL PARED ill.; D/B/A FINISH FIFfSCOtJSTROCTION MICHAEL PARECE,`cJc'� �'' � 338 OLD PLYMOUTI =,RD: Not valid without signature SAGAMORE BEACH,MA 02562 Undersecretary u Q Commonwealth of Massachusetts 5 Division of Professional Licensure Board of Building Regulations and Standards Constrg6ti StS.E>?rvisor CS-042423 �tpires: 09116/2019 l MICHAEL' PARECE. , y - 338 OLD PLY►V�OUTH RED p ' 4 SAGAMORE BEACH,MA%`0256 BE J?> '�CISS33�� - lam""` Commissioner ----Construction Supervisor Unrestricted-Buildings of any use group which contain less than 35,000 cubic feet(991 cubic meters)of enclosed space. Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For information about this license Call(617)727-3200 or visit www.mass.gov/dp f, The Commonwealth of Massachusetts },r Department of Industrial Accidents l Office of Investigations v 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): �i ;�,� T -Zlh �iVk� in Address: City/State/Zip: ®I o Are you an employer?Ch ck the appropriate box: Type of project(required): 1.KI am a employer with_ l� 4. ❑ I am a general contractor and I employees(full and/or part-time . * have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7�Remodeling ship and have no employees These sub-contractors have g, ❑Demolition workingfor me'in an capacity. employees and have workers' Y P tY 9. .❑Building addition [No workers' comp.insurance comp.insurance.: 10.El Electrical repairs or additions required.] 5. ❑ We are a corporation and its P 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑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 the policy and job site information. Insurance Company Name:_ `�� Policy#or Self-ins.Lic.#: 9 S—O/ a 7 'Df�xpiration Date: Gi✓ Job Site Address: 3/ ✓Lim �s 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 cetWfy_under the pains and penalties of perjury that the information provided above is true and correct Signature: Date: a/ a /f 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 ,j Y Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. i Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also'states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificates)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit 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 burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington.Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax#617-727-7749 . www.mass.gov/dia I DAM(ufumrrYl : c#a CERTIFICATE OF Ll ILRY INSURANCE TH#S:CEitMCATE.#S.ISSUEQ;AS A:MATTER•:OF INFORMATION C?NLY<APID.CQhifERS`NO RIGHTS UPON TIIE;CERTTFICATE HOLDER.THIS CERTIFICATE DOES:NOT AFFIRMAT iMY Oft NEGATIVELY AMEND. EXTENC OR ALTER THE GOIIERAGE AFFORDED BY THE POL#CIES BELOW. THIS CERTIFICATE OF INSURANCE':DOES,NOT CONSTiTUT-E A CONTRACT:BETWEEN THE;ISSUING iN5URER(S}. AUTHORIZED REPRESENTATIVE OR PRODUCER.ANWME CERTIFHCA"i E OLDi 1It9P9RTAN'T:.:If the cerI ficate holder is an ADDITIONAL IN RED, golkKies)•must be endgrsaci tf SU8ROGATIflH IS 1NAIVED.subject'#o the:tarms and condifimt of the policy,cedatn pollide may requ re ail enrlorsernent, A statementon tfiis ccrt#ficate does:not'confe rights to the c+efuncew holler In lieu of such endwsinn s: : PRODUCER wcr _ Eastern .Insurance'Group LLC t80p}393-?23� ��aac 233 Wiest Central St �apsi�ra�easarrtiasurance coon _tettNzSsl��rnta�covERaGE .�. rt Natick Rgc _._.:is�eatcaT InsitranCe Cr? y 20230 Michael T Parece; DBA;: 8iaisb Fixat Cortstructicin [ c Associates 2=10vers._Insurancs , ._. 338 Old Pl ymouth Rd INSURER D. tNlRERE. __._. Sagamore.Beach >IA 025.62 1NSURMt COVERAGES, CERTIFICATE NUMtBEW.2018 19 .....: REVISION WIJMBER; THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTMBELOW HAVE BEEN:ISSUED..T"O THE::INSURED:NAMED:ABOVE.EOR 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_LIIMTTS SHOWN MAY HAVE:BEEN REDUCED SY PAIa;Gt AIMS. TNBR': POLICY EFF: POLICY EXP LTR :TYPE do ommmcE tmm MePOL Y#tlii>3FR. . :c3EItFRAL 11ABi6tiY : EACH OCCCURRENC �tf'0a,003.::: . 1 A CIAs :U.00CUR t3A6iA SES 50mu S ... 100,00i. ssa000boaa2i99r slls/xo a 9/13/2019 agoE cAa onaPmsari)— $__.... 5,04t -�- — — .. PFRSONAL&ADVJN1URY $>..... 1000,00`::`:..: � GENERAL.araATE � a 2,000,00a .. .ern AGGREGATE u ntWES aER tHCY L 2 000,aa P t OTHER:.:_ . AUT1DMO BILE LIABILF" tsaaide+AS $ t}0 00} ANY AttTO eCi}tLY�NJu3tr t�+o ^t s 1 oza,00+ u m. ALLORYF+Eo X' SCHEDULED : HAP'9?6Tflt18 2/912018 12!9/2019 8t7DILYtN,IURYtF ....::' js.; ... 4o,a4, : AUTOS:- AUTOS a�Earv:oeuaan€ NONOCWNED E Include; HQtEO:AUTOS 'AUTOS PIP UIISRELIA LIAR . OCCUR. EACH OCCURRENCE $ EXCESB:LtA$ CLIUMS AAAD: L+GfiREGATE .. _ ..................... ... WORKERS: DED RETE7+fTtOPi $ 001APENSATtOH I �t QTH- - AND t 'LOY�3'LlAleiiflTY _ MREXECU TIVF YIN EACH AGCtDt3dT QQpQQ; C t i tnNFt} T OT}50109F27-2418A d114l2itI8 4/10/2019 EL DLSEASE-T1#FA9PLtIY Y 1 4a,,tt, 00' PTIDN OFOPER/CRONS bteltsv EL.D�SI+SE=POLICY:i urt S l t)tt4 04 .'1 DEscrusrrtoN�oPERATtttfl8 i LOCAT(GN8 r VENfCtEB'�1M A#dttlanst Ti6fe�Nt�SuMs. �a�dt�ad M inwe m Lei - - - CERTiFiC ATE:NOLQER CANCELLATION SHQULD ANY:OF THE ABOVE DESCRIBED POLICIES.. CAldGE..... EFORE Town_.of HazriBtable tlt: ATION DATE THJ�EfiF: NQTICE:`ittEtLL BE,_D� tit 200.Main :Street AGGoRDAAtGI=•tAttili THE 0oucY'PROVisibNS. Barnst:abl�, DSA:.,':02630 '; _. J AUfHORTXED IMPRI S ATNE h t0 'KeyOr.:'.Kp-yin,AP 11,... C31988-2014 AGORD CORPORATION, Allghts t'esetvet AGO.RD 2S(2t)1jI 101}%: The i4CORD name.and ioga a t gistered marks of ACORD' IN4t1?5rsment� - _ r +i Application number 1 .6 ® Date Issued...................... 1 �. KP MA8�4M AUG 0 2 2018 Building Inspectors Initials........ ..... ... ............... � I� j o� Q nn `� TOWN 04� 8,AH 1 SIABLF Map/Parcel..'Jo.6.J.S ... .V� pt TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: VVN016AV {p� r STREET VILLAGE Owner's Name: f N=,) Low Phone Number_ ,—q o?4 �3 -O L�_utae Email Address: S 16 w e Q Q CiS 21'n ► Sy fG�r Cell Phone Number Project cost $ ���,dd Check one Residential Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize S�C,� to make application for a building permit in accordance with 780 CMR Owner.Signature: Q, 4dDate: -TYPE OF WORK ❑ Siding ❑ Windows (no header change)# ❑ Insulation/Weatherization ❑l Doors (no header change) # 1 Commercial Doors require an inspector's review L►Q Roof(not applying more than 1 layer of shingles) — a 56 Construction Debris will be going to ��n t� �2O ri CONTRACTOR'S INFORMATION Contractor's name S� - �p C' �4fi! V" y.Wt' C y Home Improvement Contractors Registration(if applicable)# (attach copy) Construction Supervisor's License# 6 _ (attach copy) Email of Contractor SotJ�2 �►aS hone number ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION NUMBER.................................................„......... *For Tents Only* Date Tent(s) will be erected Removed on number of tents total Does the tent have sides? Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent If food is being served at your event please obtain a Health Department approval between the hours . of 8:00am-9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval, *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing.Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION 4 Homeowner's Name: Telephone Number Cell or Work number I.understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLICANT'S SIGNATURE Signature Date b All permit applications are subject to a building official's approval prior to issuance. I u 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): 6 y `�M �CLg + ^ �.J U- Address: 6 J City/State/Zip: 1OA Phone#: �Q �` ? l LY Are you an employer?Check the appropriate box: Type of project(required): 1.ET I am a employer with P- 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑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.] S. ❑ 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#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. ( fl `�' Insurance Company Name: �'Pt/-° 1 IA S 0/0, c0 Policy#or Selfins.Lic.#: / 7 �� Expiration Date: Job Site Address: � co �� ���\✓1 S� �t������''� 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 an enaldes of perjury that the information provided�above is truce and correct Signature: Date: 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 a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington.Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Fax#617427-7749 Revised 4-24-07 www.mass.gov/dia Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Constrqhcti$riSapervisor F CS-054519 E' ires 12/11/2019 r STEPHEN B CLARK 1 f h 713 MILL STREET MARION MA 02738 X'; u Commissioner L � d/1 W— a 'paou'anes's oiegul office of Consumer Affal Business Regulation CONTRACTOR HOME IMPROVEMENT TYPE:_Comoration Reaistl�dn Eaim 10/24/2019 w SOUTH EASTERN BUILDING CORP.. STEPHEN C►ARK'i f 713 MILL ST MARION,MA 02738 w- ,. Undersecretary %..CR 1 1rit Al C ur LIADILI I T II IOUMAMPIM 0 5/1 712 0 1 8 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT. If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must 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 CONTACT Kristal Gouveia NAME: Southeastern Insurance Agency,Inc. PHONE (508)997-6061 FAX (508)990-2731 AIC No Ext: A/C No 439 State Rd. E-MAIL k ouveia southeastemins.com ADDRESS: g P.O.BOX 79398 INSURER(S)AFFORDING COVERAGE NAIC# North Dartmouth MA 02747 INSURERA: Central Insurance Companies 20230 INSURED INSURER B Southeastern Building Corp INSURERC: 713 MITI St INSURER D: INSURER E• Marion MA 02738-2201 INSURERF: COVERAGES CERTIFICATE NUMBER: 2017-2018 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE INSD WVD POLICY NUMBER Mao EFF POLICY D EXP LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE ©OCCUR PREMISES EaENTED occurrence $ 300,000 MED EXP(Any one person) $ 5,000 A CLP7940055 08/08/2017 08/08/2018 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY JECOT- LOC PRODUCTS-COMP10PAGG $ 2,000,000 OTHER: PDLDB $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANYAUTO BODILY INJURY(Per person) s 20,000 A OWNED SCHEDULED A BAP 8875389 08/14/2017 08/14/2018 BODILY INJURY(Per accident) $ 40,000 UTOS ONLY AUTOS X HIRED I X NON OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident PIP-Basic $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER ANY PROPRIETORIPARTNERIEXECUTIVE YIN 1,000,000 A OFFICERIMEMBER EXCLUDED? � N I A WC 7940056 08/08/2017 08/08/2018 E.L.EACH ACCIDENT $ (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. 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) DATE: (.Q 27- t7 Fill in please: APPLICANT'S YOUR NAME: 13 c tZ BUSINESS YOUR HOME ADDRESS: L . TELEFTHONE # Home Telephone Kumber s5 u -7 7 , 0 0 �r NAME OF PO/BUSINESS o TYPE OF BUSINESS IS THIS A HOME OCCUPATION? Y NO Have you been given approval from the buildin ivision? YES NO ADDRESS OF BUSINESS MAP/PARCEL NUMBER When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMISSIONER' OFFIC This individual has been i or f any pe r uirements that pertain to this type of business. ,� lAu d Signat re** ' COMMENTS: / W 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: TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Pp A lication # c>�D 15 / 2- S Health Division Date Issued "u— Conservation Division Application Fee planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address C`31 Aal� Village &ci nnn S Owner bcA' L4 W, e Address ro 3l 0 �_ ydn�iS a?& Telephone 5-o�, Permit Request mQAA. dig k ti 6'ti �6-+5 `� Dt ltr_ bv,t x w 1 A"d ( YI 54 11 18 e.J Ce(64e 01 Ln hA-,,[ rtc Na,,LY, Dcnh�Cl t AA \JS Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation lb �00 Construction Type EMA Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) ;u. r _; Age of Existing Structure Historic House: ❑Yes ❑ No On Old King•il;l-s:Highway:0 Yes, ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other ,7 Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft)l 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 Ar: ❑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 es, site plan review # Current Use 51&c e- � � G�'la Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name �a,}-CtC� C\S W4 Telephone Number 77� �22 OS 22 Address 15QW Witi1 rd ozaoSS License # )65 9S 1 10A 0 2(-�g Home Improvement Contractor# )7 3 19 Z Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Y4fw��w� �1 �u,ro►n SIGNATURE DATE �� FOR OFFICIAL USE ONLY y APPLICATION# DATE ISSUED MAP/PARCEL NO. �s ADDRESS VILLAGE r r OWNER s ti DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. i f COREY , COREY v CONSTRUCTION 12 Baldwin rd.Dennis,MA.0,2638 PHONE 1508 776,7I73 CERTAINTEED LANDMARK LIFETIME-ALGEA RESISTANT ARLHITEI✓TUAL STYLE.RE-ROOFING PROPOSAL. September 5,2015 Bradford W.Lowe DBA "Gov..Bradford Plaza" &Mail :slowe@southeasternins.comt 6.31 Main st. Phone: 509 2644 5333 Hyannis,MA. 02604 COREY&COREY hereby propose to perform the following services in a neat and professional manner and in accordance with the manufacturer's specifications and local building codes. Remove and Haul Away:all of the old asphalt shingles on the entire roof area of the building,tying in to the existing roof on the Dunkin Doughnuts portion of the building. Supply and Install:CERTAINTEED LANDMARK AR:30 YEAR"LIMITED LIFETIME"WARRANTY, 10 YEAR SURE START PROTECTION,CLASS A FIRE RATED,COPPER/CERAMIC STONES for a FULL 10 YEAR WARRANTY AGAINST ALGAE CONTAMINENT,240 POUND,HEAVY WEIGHT, 130 MPH WIND WARRANTY,CATEGORY II.HURRICANE,STORM/HURICANE NAILED(6 NAILS PER SHINGLE),MULTI- LAYERED,LAMINATED ARCHITECTURAL STYLE,FIBERGLASS BASED ASPHALT SHINGLES.COLOR:_ Moire Black Supply and Install% 8"White drip edge on the entire buildings eves. Supply and Install:-CERTAINTEED WINTER-GUARD(Ice&Water Shield)WATERPROOF UNDERLAYMENT SYSTEM on the entire buildings roof deck. Supply and Install:Shinglevent 1I ridge vent on the Entire Ridge area of the building using the 3"hand nailing method. Supply and Install:ALUMINUM&NEOPRENE SOIL PIPE FLASHINGS Remove and Re-Install: Bolts from 3 existing roof signs,as quickly as the area is stripped.and re-roofed.Not removing the signs from their current location if possible. Clean and Remove:Debris from work area after job is completed. Extras: There are some missing flashings on the.back left side of the windmill part of the building.We will need to take apart a small area of siding and the corner boards in a few spots and do some minor repair work to the flashings.This will be charged as extras at the end of the job,(materials+Labor at$80 per hour) POSSIBLE EXTRA CARPENTRY:Any Rotted or Otherwise Deteriorated Plywood Sheathing,Missing Metal Flashing, Side Walling or Any Other Carpentry or Masonry Needing Replacement❑ will be done and charged for as an Extra: Materials Plus Labor at the Rate of$80.00 per Hour. PAYMENT SCHEDULE:A Deposit of One Half is due at the Signing of this Roof Proposal and the Final Payment for the Balance is Due Immediately Upon Completion. All work is scheduled to begin within 30 days of the date of acceptance of this proposal COREY& COREY Warranties the Shingles and Labor for 10 years. CERTAINTEED Warranties the shingles and labor 100%for the First 10 Years and the Shingles your LIFETIME if the shingles becomes defective. CERTAINTEED Warrants the Shingles up to a CATEGORY it HURRICANE-130 MPH WIND WARRANTY.CERTAINTEED Warrants the Shingles to be Algae' Resistant for a Full 10 Years. COREY & COREY❑ Carries Workman's Compensation and Public Liability Insurance on the above work Total Investment: $16,500.00 Please make checks payable to PATRICK CLIFFO" DATE OF ACCEPT C << ©!`�❑ CCE D SUBMITT BY: JPR PER O ER COREY&COREY CONSTRUCTION d sr� xztt psri tay Ste,its >_' . tt}5951 r �k�k 42 AfLD�VIt`i R4U , . z: yz !ICCn-$C OF reciWit Lion t'itlid for individul use Onl. (�{ �oPt:nn<Ea�ner:,afta�rs S tlustneas ltegulatiG,n: before the el, tiara tl:tte, •If found re €urn to r .HUMS IMPROVEMENT CONTRAC70R Office of<onsa_mer.cffairs and Business Re elation a F egistrafion: 173192 TYPe:: to Par11 P(az`i-suite 5114 a„ ;Expiration: 91,11!241:6 !JBf1 B:6ston,11.�.0?liG GL? EY A.N{1 C�?RE f Ct?NS i RJC iON 1'ATRtGt�.CLiFPC�RsO ... GENI 'S.MAfa2o3$` Lndersceretar� )\otvalid�ritiout i?naiurc f: , Tfw Cow- ;mwmM gfHassacttu=Ys Deprartuu4wt gf1kd &TdAcciden tv 60 Washwgtda,reet Bosfaq,HA a2 - wnarv.rr�trs�go�drr� Workers' CompensatiouInsurauceAfdavit:Builders/Cantractors/Electncmns/Plumbers Aprplicat Information. PteaSe Print,Le-eibly -Name(R m fndividn&D: C�ff rd e y aN�I Dress Z ��,�r�a11�► citytst at&zip: Db4 Cgkl ; one 4-7 7'71 ?22 o!U2 Are you an employer?Check the appropriaie.box Type of project(req-iced): L❑ I am a employer with 4- ffIl arag general contractor and 1 6- ❑New omst� employees{€ult and/orpart-fine}* have hireathe,sub-co ors 2-❑ I am a sole proprietor or partner- listed on the attached sheet: 7- ❑Remodeling ship and have no employees These sub-contractors have g- ❑Demalitiou working for me in eery capacity employeess and have workers' 9_ ❑BuilF" g addition Wo workers' comp:inntranre comp-insuramr I recF ed 1 5_❑ We are a corporation and its 10-El Elechical repairs or additions 3.❑ I am a homeawner doing all wark officers have exercised their IL❑Plumbing repairs or addi#ions myself o work=' right of exemption per MGL I % ita required.]I c-15Z §1(4),and wehneare �pouf� 13_❑O.t$er eeugloyees-[No wox$rss' comp_in=ance rBg6red-j *Yap sopli�that checks boa W1 rsmst also sn o�tt �heiacQ cknai�n @ieit vvoritasT� F HnmenwuHs vrha submit this aff&V9 mf*Kr xg they are domg sHvro&sad iUn like oaiside cars nmst sty a mffw aSdsrit krUrstm mch kbnfmctcum that rT,xlr this bar mist sttadied sa addidarW sit shoicmg the nee a£the >nd sta3e whether ernoi thaw a ibes fLave am&DTes I€the snlrcoutmctms hTm empIayees,ffteg—1 pwvide th�Br warp'comp polwy amabes_ Iam an empJayer that ispmidAT workers'c-ongwm lan irm4rrutce for my cnrgTaycem Belau is thepolic}attd fob seta fnforrrralfa� Insazence Coenpazlyl�Zame: Policy 4 or Self irm Lic-i`- Fxpisati6uDate: Job Site Address: NV41& Cify�State/Zip: OZ6G Attach a copy of the workers compensation policy dedaration page(drawing the pohcy iramber and ergiratioEn date). Failure t o secure cm-erage as requimdunder Sectioa 25A o€MGL c. 152 can lead to the imposition ofcriminal petralties of a fine up to$I,5D0.00 and/or me-year imprisonment,ag wen as civil pis m the fuffi of a STOP WORK ORDER and a fine ofup to$250-0-0 a,day against the violator_ Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA far insax-mce carerage verification- Ida hereby aeriify carder dtepa:n andpenalties a. that if a in onrtadanprati&d ahart is true and c,arrect Si mature: -"A� ef—a— Phone 9: ?�'9 7712L QS t TWfat use anly. Do not write in this area,to be completed by dF or town offic&L City or Town- Permit cease ff Ensuing Au tharity(drele eae): L Board of HeaIth 2.Rug Ting Department I City1I'awn Clerk 4_Electrical Fnspector S.P%mbiag Inspector .6.Other Contact Person: Phone#: 6 Information and. THstfuctions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursnautto 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 Iegal 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 apar ments 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 staffs that"every state or IocaI 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 pe>iormance of public work until acceptable evidence of compli.arce with the insurance requirements of this chapter have been presented to the contracting authority_" Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s).along with their certaficate(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_ U 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 he sure to sign and date the affidavit. J-he affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Deparmrent 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. Sell 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 o f 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 perm h/licease 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 requited to complete this affidaY_t The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call- The Department's address,telephone and fax number. 'f c,CommnnwWth of Mmachusetts Degaztment Qf Ind a1 Aocidmts Office of kviasUntiom 600 Washin&ton Street Bos on-,MA 02111 TeL A. 617;727-49W W.406 or 1477 MASSAFE Revised 424-07 Fax#617-727-7749 - Fava�.rnas�go��da 1. %®1f 2f:2015 MON 13 5S FAX: 548'9923536' soLth'eastern Try ( ODL'f0}I ,gI. C R DAZE INfMIbDIYYY`ly E, .1F,t'CATE I— LIABILI`Y'Y INS�URAIU�E 1�12/2D15, , HIS CERTIFICATE IS ISSUED AS;A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS O'' THE CERTIFICATE.HOLD ' THIS CERTIFICATE DOES NOT.AFFIRNlAT1VELY,OR NEGATIVELY AMEND EXTEND OR ALTER Tt E COVERAGE AFFORDED'•"BY THE POLICIES BELOW; THIS CERTtFIC!#TE OF INSURANCE DOES NOT CONSTITUTE A CONTRAC BETWEEN THE;ISSUING INSURER{S},"AUTHORIZED REPRESENTATIVE OR?FtOdUCER AND THE CERTIFICATE( OLDER.':- IMPORTANT: I€the certlfi'cate h,. Is an RDdIT10NA4 INSUREt9, the policy'(I;es}tnust'be endbrso "If SUBROGATION IS.WAIVEd;subJect to the terms"and condltlons,bf the"policy,certain policies may requirs an endorsement. i4 statem`ent.on this certificate'does ticik confer rights tD the " �II ceitlficateholderin lieu-Df-_!such endorsement s}; PRODUCER':'. NAME: J,,*Bretton Southeaste. Insurance Agency; Inca arcr o xl t508)99776061 FAX Np tsoe>s90 z731 439 State W. MA€� .3hretton@sotii,theas'tarnins'.com ' P.O. SOX 79398 "'INSURER(s):AFFORDING covERAGe NAIC C' :.... North Dartisc►, LdA D2797. INsuRExA Arbella Protection insurance 41360 . _ —._ .. ,_. ._.— __..... MSURED, : 1NSURER6 AEIG. >. All Gage 'EXt2rlor `Remodeling 7aLG iSOtERC, 12 BalChain Itpad , INSURERD. II INSUREt:E D;ennss . M�, 02638 o; lNSURERF. .? COVERAGES CERTIPIC,TE tJUN1BER 21715 REVISION N;UNIBER: I. THIS IS T.I. CERTIFY THAT THE F0LlCIES QF INSURANCE LISTED BELOW HAVE BEEN:ISSUED i.0 THE INSURED;NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY:REOUIR£MENT,TERM OR CONDITION';OF AN,::. N, .CV:OR OT4ER.>D,1.�CI NT WITH RESPECT TO ti^MyCH THIS II CERTIFit>l+TE MAYBE ISSUED QR MAY PERTAIN THE INSURANCE AFFORDED BY. E P%ICIESFDESCRiBED HEREIN IS:SUBJECT::iO ALL TFE TERMS, EXCLUSIONS AND:GOND1T1 75 OF SUCH POLIC}ES LiM.[T.S SHOWN t�AY HAKE BEEN REbUCEd B-Y PAID CLAIMS, INSR - iA�ItC SCR 'POL CY f.F' PbLICY`EXP ' LTR TYPEOF'INSt1RANGE pOLICY',NUFABER ':MM1DD!YYYV�.MMtDDtYV I LIMITSmm -'' i GENERAL'LIABILITV tA2HvLi ,.:`thy_ S 1,000;000 TPI� I—q. _Y }'r 'n.kt4r-ri;-Ai e3JtR.L iA8( Ty ; .. �4 1At4 Y t;x€ i €S 1Ga GOG = _.___ 1. A AIN,r A i x'q U � 5f}0'0.$�933 119/2.. .. �11:111.11. i+A_., - A y<i e ar,. ; 5,O%G0 .._ E1. PSgva �A v �J r S 000 0a0 tvEPAL A : G E ¢C :2 000 600 1 d AGGREGATE IM o jt' a tt1. i 1. rc_6 v ...J�,4 Fr.'�RC.�is 2 Ooo 000 1. .. ....:. :: : . ... :..:..: :.. € _. [AUTOMOBILE LIABILITY -zs i �,� :. I t,rs G n I :_ 14 ALT I'lliT. Egbf1?/EAtu rat'( eis, t T c f" �w a r I cE € L_ ,I� `D s <R ;� LTc ,�'Tr o E I aI. ._ — N: UMEIRELLA tIJiB :'G J� ' :: " ' . 1 U u :: :: � :: . ;,RETEhT'O $! WDRKERSCOMPENSATION - v c A ,{ ANDEMPLOYERS Li481L,lTV YfN L ry xy t`' Al31'rigx vt�.(2'A'�t^E(4 r tR"ECt,TtbP : .. ..,:.n A,.,,,c:...�d' .._1 ooa 0 00 I R,� tt3FR£'Ct"tt rr N!A. : : _t ,..�� t Iq (MsndatoryinNH1 ' ` FdCC5 0=0 7 3 9 62 0-14A If;9f2015 ; f9f2Da:"6 :? c n _kESP Y a 3 oa0 .000 . °' ffiCR�T qIv O q? xAFi�ES;?�e w - _ �r,s iaoato`ao F i I t Df♦,9CPoPT70td9F OPERATIDNS I D AT3tlN31 VENIcLE3(AMitc 'ACOkD I AddiclonaF Remarks;5cttodula if morespace;ys requtredy,, . "... k 5. <. 4 .r„ y z .: :.-. .: :: .. : :— ,.....:: .. .. ., .. ,,:. CERTIFIGATE;HOLDER CANCELLOLO _. s HOULD ANY OF THE ABOVE DESCRISED POLICIES BE•CANCELLED BEFORE THE `EXPIRATIoN akfe LTHEREOF,ACfICE WILL t3£ DELIVERED iN. ACCORDANCE NhTH THE 60LICY PROVISIONS. H02[E AC�VISOr ': .'' 140r. Denver West Parkwa A(THORtZEO REPRESENTATIVE ., Joanne 'Bretton/JB �° � `"°" ACORQ 25(2010l05), Co}f 988,20f0 0.COitD GORPOf2ATION.`All rights reserve s: INS925 a7o n, T' ACORO riarils arir!logo ace registered marks of ACORD - . TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map V�arcel o G� Application #U �� Vo Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis 'Project t�et Address Village Owner ,S Gv -c�Wc� �124Qr ddress �R�►n �fi �°����'`S Telephone Per quest / So s. fi a ro gej 6.` �00 coo Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation � ' _Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑ Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION- (BUILDER OR HOMEOWNER) Name c U�C � "'j' ex,�phone Number ( o(M Address J l License # 0� �T 0� Home Improvement Contractor# 7a z C Email S ©y �'1 K ' �� I Worker's �P�S U` ��►r Worker's Compensation # t,J G 11,00 s� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT,WILL BE TAKEN TO ,.g SIGNATURE DATE P FOR OFFICIAL USE ONLY APPLICATION# 1 , DATE ISSUED MAR/PARCEL NO. i i i ADDRESS VILLAGE 4 OWNER DATE OF INSPECTION: FOUNDATION FRAME r INSULATION. FIREPLACE' ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL B.UILDING� D'ATE�':.CLOSED O,UT ASS.OrC I AT10N.PLAN N0. 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): 0 u� F e/ h Address: 7 1 City/State/Zip: `/ &ox o,,\ A A OV Sk Phone #: 5 D y a 7� �� 0 a Are you an employer?Check the appropriate box: Type of project(required):. 1.ERTam a employer with 2 4. ❑ I am a general contractor and I 6. El 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' [No workers' comp.insurance comp. insurance.: 9. ❑Building addition required:] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their I L❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no 13.0 Other Sc ', C Q a,a employees. [No workers comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. I Insurance Company Name: CeI,l.A—irax ` Ty S y rao Lf Q 11.Pq Yl 42 Policy#or Self-ins.Lic.#: W _ Z a 4 pQ'5 G Expiration Date: (� Job Site Address: 6 S ( iM a," S r' City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy num er 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. Sianature: P Date: z 02, — 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#: i Sep. 19. 2014 3:04PM No. 1182 P. 1/2 AC:uKus, CERTIFICATE OF LIABILITY INSURANCE DATE O 09/19/2014MIDD9/114 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 NAME CT Lora Lowe FitzGerald Southeastern Insurance Agency, Inc. AIC.No Ell: 508.997.6061 uc No: 508.990.2731 439 State Rd. E-MAIL ADDRESS: P.O. Box 79398 0 CUSTOMER ID 0: North Dartmouth, MA 02747 INSURER(S)AFFORDING COVERAGE NAIC0 INSURED INSURER A: Central Insurance Companies 20230 Southeastern Building Corp INSURERS: PO BOX 957 INSURERC: Mattapoisett, MA 02739 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 2014/15 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. LTR TYPEOFINSURANCE INSRSWVD POLICY NUMBER WDD MMILICYEXP DD LIMITS GENERAL LIABILITY CLP 794005 08/08/2014 08108/2015 EACH OCCURRENCE $ 1,000,00( X COMMERCIAL GENERAL LIABILITY PRE GET Ea E TO RENTED Cal $ 300,00( occu CLAIMS-MADE M OCCUR MED EXP(Any one person) $ 5,00( A PERSONAL&ADV INJURY $_ 1,000,00( GENERAL AGGREGATE $ 2,000,OO GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,060 POLICY SERCOT LOC $ AUTOMOBILE LIABILITY BAP887538 08114/2014 08/14/2015 COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO BODILY INJURY(Per person) $ 1,000,000 ALL OWNED AUTOS BODILY INJURY(Per accident) $ A X SCHEDULED AUTOS PROPERTY DAMAGE X HIRED AUTOS (Per accident) $ INC X NON-OWNED AUTOS $ UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS AND EMPLOY RT NUABILITY WC794005 08/08/2014 08/08/2015 X ORYSL M S X ER Y 1'N ANY PROPRIETORIPARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 A OFF ICERIMEMBER EXCLUDED? NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 1,000,000 DESCRscribe under IPTION OF OPERATIONS below NO OFFICER EXCLUSIONS E.L.DISEASE-POLICY LIMIT $ 1,000,000 1 717- -7- i i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if 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 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Lora FitzGerald ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD Southeastern Buildingcorp 713 Mill St Marion, MA 02738 508-274-4102 Southeastern Insurance 641 Main St Hyannis, MA Regarding - 631 Main St. Govenor Bradford Date- 12-11-2014 Repair gable on front of building - Repair upper roof on top - Building permit - Repair roof shingles on front entrance - Remove 10 clapboard over gable and around front entrance Install new flashing roof to wall - Install ice and water barrier - Install new clapboard - Paint the whole front clapboard to match existing. Total cost - 2500.00 Exceptance of proposal owner 4,0 �&�date I a I I j_WV UU date Contractor - J U/ze cPomvnuviac o� c�aclucaeCla Office of Consumer Affairs&Business Regulation ME IMPROVEMENT CONTRACTOR istration: 170463 Type: xpiration —1—_1_0125/2015, Corporation SOUTHEASTERN BUDDING CORP? Ilk I}i STEPHEN CLARK r sl 23 MATTAPOISETT RD'> t % ROCHESTER,MA 02770~ - Undersecretary I Massachusetts -Department of Public Safety 1IMSBoard of Building Regulations and Standards Construction Sup,,isor License: CS-OWig��' STEPHEN B CLAOI 713 NML ST MpRION NLA 021538 IC Expiration 12/1112015 Commissioner 631 Main St,:. Hy, annis /1 1 r v „v�+.•„aar y _ , y r , k 3Mw . r � i • o r , f r , 4j.a f e 1 " t Sign BARNSTABLE Permit BARNSTABLE. TOWN OF y MASS. $,e 1639. A� Permit Number. Application Ref: 201004503 20070507 Issue Date: 09/13/10 Applicant: LOWE, BRADFORD W 'Proposed Use: RETAIL& SERVICE,STORE SMALL Permit Type' SIGN PERMIT Permit Fee $ -50.00 Location 631 MAIN STREET (HYANNIS) Map Parcel 308131002 Town HYANNIS Zoning District HVB Contractor PROPERTY OWNER Remarks OPEN FLAG Owner: LOWE, BRADFORD W Address: 439 STATE RD NO DARTMOUTH, MA 02747 Issued By: p POST THIS CARD SO THAT IS VISIBLE FROM THE S REET 5 oF• �,,, Town of Barnstable Regulatory Services * BARNS 13M „AS& Thomas F. Geiler, Director 039.rFD3►.1A Building Division Thomas Perry, CBO �5 Building Commissioner 200 Main Street, Hyannis, MA 02601 406 O�� www.town.barnstable.ma.us ey 19'fee, Office: 508-862-4038 Fax. 8-790-6230/,' Application for: Open/Closed Signs, Business Trade Figure/Symbol/Flag,and Hardship. Location Signs in HVB Permit# V U Building Official approving Fee: $50.00(non refundable) Applicant: S-TA N 1-_� &LI'9J �l LM Assessors No. 3 - 0 0 2 Doing Business As: 5t .C_o ND Tom F. oWJ Q Telephone No. + 50 775-- If 4' Sign Location Street/Road: (�`3) � Zoning District: N.� Yes/No Hyannis Historic District? (Yes No Property Owner Name: L6 vi Telephone: Address: Village: ` I am applying for the following: (Please check all that apply) Trade Flag(not to be used in conjunction unctlon with open/closed sign or Business Trade Figure or Symbol) Business Trade figure or Symbol(not to be used in conjunction with an open/closed sign or trade flag). �,MJL Symbol) Sign (not to be used with a trade flag or Business Trade Figure or Symbol) Hardship Location Sign if this box is checked attach recorded planning board approval and �. letter from property owner giving expressed permission for the location proposed if not on applicant's 1v �S property. Please attach graphic or photo of proposed with dimensions and locations of each that are checked. I hereby certify that I am the owner or that I have the authority of the owner to make this application, that the information is correct and that the use and construction shall conform to the provisions of §240-59 through §240-89 of the Town of Barnstable Zoning Ordinance. 0Signature of Owner: 6U Date d-3640 Q:\WPFILES\FORMS\SignsinHyann is.DOC 6/24/2010 i Barnstable Hvannis Main Street Waterfront Historic District Commission pg pmicaQ 200 Main Street Hyannis,Massachusetts 02601 . - Phone: 508-862-4665 / Fax: 508.862-4784 A`0$Vl u-%Niv.to«n.bamstable.ma.us/arowthmanagement 2007 A.Jessop,Jr.AIA,Chair Marylou Fair,Administrative Aassi2mt CERTIFICATE OF APPROPRIATENESS FOR SIGNAGE Application is hereby made for the issuance of a Certificate of Appropriateness under MGL,Chapter 40C.The Historic Ds=icts Act,for proposed signage as described below and on drawings or photographs accompanying this application. CHECK ALL THAT APPLY* o" aUj 1. Open/Closed Sign *•_; 2. Trade Flag 3. Trade Figure or Symbol C71 =" 4. Location Hardship Sign tv 5. Business Sign *Application materials must be submitted for each sign requested w I Date ® f .ASSESSOR'S MAP# ASSESSOR'S PARCEL# APPLICANT Ste' /fiu-A 4 p8A 5&&3A►D TUB APU NJ) TEL# OS `77y- b ' APPLICANT MAILING ADDRESS 631 14 A-11s 5T HYAN=�J��M& 0 2-4 0 ! APPLICANT E-MAIL- ADDRESS. t4l' 1 a.CC°Fly ADDRESS OF PROPOSED WORK 6 z i N4w. .Sj- 4YAtJ u 19 MA 40-1-6 a 1 PROPERTY OWNER W r-- TEL# OWNER MAILING-ADDRESS \rOTIFICATION TO ABUTTERS: Please contact Growth Management Staff for abutters:list and assistance abutters. Applicants will be responsible for providing the postage stamps for abutter notification at the time of'_-. application. AGENT OR CONTRACTOR TEL# ADDRESS f }f SIGNTATURB of APPLICANT DATE 7jS/f� For Location Hardship Sign&freestanding Trade Figures.or.Symbols to be located on pr vz _ Check box if-property owner-h anted-permission-to locate S isign or Figure on their p zn building front. E E � 1Y/ J U L 0 6 ?A� R_..__.e-d.b: rI:iISWHDC: TOWN OF BARNSTABLE HISTORIC PRESERVATION_ Opeu losed Size of Open/Closed Sign: x Sign: Material of Open/Closed Sign: Color(circle one option)Red/Red&Blue s 3` L'rs'5 ra Trade Flag: Size of Trade Flag: `� x Material of Trade Flag: tj Y"N r{Z �Ai�}tTl �L-v Trade Figure Dimension of Trade Figure or Symbol: . x x Or Symbol: Material of Trade Figure or Symbol: Location Size of Hardship Sign: x Hardship Sign: Material of Hardship Sign: Lettering Color and Material: Business Sign: Size of Sign X. Material(s)of Sign Material of Lettering(if different) The Sign will be(circle one): Carved Wood/Painted Wood/Aluminum Other(explain) Exterior Light Fixtures(circle one)Yes/No If yes,what type of light fixture Location of Fixture D EC EHE ` Zo► - TOWN OF BARNSTABLE HISTORIO PRESERVATIONLj P4z=e_4 Hyannis Main Street-Waterfront Historic_Distri-ct Commission o IME r�,b 200 Main Street Barnstable Hyannis,Massachusetts 02601 Phone: 508-862-4665/Fax: 508-8624784 "eficaCily LE'$ www.town.barnstable.ma.us/growthmana eg ment �6N4P��10 2007 George A.Jessop,Jr.AIA,Chair Marylou Fair,Administrative Assistant Extension of Time To Hold the Public Hearing and File of Certificate of Appropriateness Under Section 112 Article III of the Code of the Town of Barnstable In the Matter of 5-7)pwY Applicant)the Applicant for a Certificate of Appropriateness and the Hyannis Main Street Waterfront.Historic District Commission agree to extend the time limits of Section 112-31.D and E for holding the public hearing and for the Commission to render a determination on the application,and issue a certificate or a disapproval for a period of days beyond that date the hearing was required to be opened and the determination of the Commission was to be made. In executing this Agreement,the Applicant hereto specifically waive any claim for a constructive grant of the application based upon time limits applicable prior to the execution of this Extension. Applicant: Hyannis Main Street Waterfront Historic District: Signature: 61 Signature: Applicant or A piicant's RepWesentative Chair or Acting Chair Date: 7/14I D Date: Address of Proposed Work.St. &No. 631 lit P W 5T-*-/ ��'�.�►N l5 i Vt 02 6 0 Assessor's Map#and Parcel Page 3 of 4 �ar��e• r.� S l - a J � w r ^. a ell r �4 l 1 i 7 f 1 i Barnstable Hyannis Main Street Waterfront okTME�►r�, Historic District Commission U4mMcaCfiy 200 Main Street 1 r saisrisrAs Hyannis,.Massachusetts 02601 M'S $ Phone: 508-8624665 / Fax: 508-862-4784 0gq. 2007 George A. Jessop,Jr. AIA, Chair Marylou Fair,Administrative Assistant Elizabeth Jenkins,Principal Planner Certificate of Appropriateness July 22, 2010 Linda Hutchenrider,Town Clerk Town Hall 367 Main Street Hyannis,MA 02601 Re: Certificate of Appropriateness for a Trade Flag,Stanley Allan Holmy dba Second Time Around The Hyannis Main Street Waterfront Historic District Commission,pursuant to the Code of the Town of Barnstable Chapter 112,Historic Properties,Article III,Hyannis Main Street Waterfront Historic District, hereby grants a Certificate of Appropriateness for the following property: . Property Address: 631 Main Street . Assessor's Map/Parcel: 308131-002 The Hyannis Main.Street Waterfront Historic District Commission considered the above referenced application on July 21, 2010. A public hearing before the Commission was duly posted and notice sent to all abutters and interested parties in accordance with MGL Chapter 40C. At the hearing, after consideration of the testimony given and materials submitted by the applicant and members of the public,the Commission found the proposed Trade Flag appropriately contributes to the historic character of the Hyannis Main Street Waterfront Historic District. The Commission considered the shape, material,color and texture of the Trade Flag and found it to be appropriate for the protection and preservation of the district. Based on these findings, the Commission voted to grant the certificate of appropriateness subject to the following conditions: 1. The trade flag displayed by the applicant shall be consistent in color, design,and material with the flag presented to the Commission in the application dated July 5, 2010(red, white and blue flag with black lettering). 2. A permit from the Building Division is required prior to displaying the Trade Flag. Present and voting in the affirmative to grant the certificate of appropriateness were: Barbara Flinn, Marina Atsalis,Joe Cotellessa,Meaghann Kenney,Paul Arnold Absent: George Jessop, Chairman,Dave Colombo,Dave Dumont,William Cronin Sincerely, F Barbara Flinn,Vice Chairman ZZ: C d £Z IN 01. Hyannis Main Street Waterfront Historic District Commission cc: �tanley Allan Holmy, Second Time Around j I Tom Perry,Building Commissioner V 0 File 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 ate. Business Certificates are available at the Town Clerk's Office, 1"FL., 367 M.G.L.-it does not give you permission to operate.)you must do b 9 Y v v Main Street, Hyannis, MA 02601 (Town Hall) DATE: 7 I D Fill in please: <-L L APPLICANT'S YOUR NAME/S: 7 , N lsv5 ass, t " ,x BUSINESS YOUR HOME ADDRESS: ` TELEPHONE # Home Telephone Number 0j�=77� NAME OF CORPORATION: NAME OF NEW BUSINESS `-i M u u� TYPE OF BUSINESS CUN S r GN Ml�l� IS THIS A HOME OCCUPATION. YES __NO -OD 2L(Assessi�ng]/,�I MAP/PARCEL NUMBER ADDRESS OF BUSINESS When starting a new business there are several things you must do in order to be incompliance 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 ISSIO ER'S OFF This individua ha e in ed f ny er requirem nts that pertain to this type of business. v horized Signatu COMMENTS: �, ra 2. BOARD OF HEAL This individual as.b6e--n i ,rmed f e e mi r rements that pertain to this type of business. Authorized S* ature* 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: - TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 30 Parcel Application# Z Health Division Conservation Division Permit# -117 Tax Collector - Date Issued �. Treasurer Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address 31 Vv\a Village -s Owner , - Address Telephone ®� '7 7� I1 Permit Request ke, f-5 of eq;,�l� Cb' 6esve5- - WISE rv/"L ct Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Vital ne" f Z_ Zoning District Flood Plain Groundwater Overlay � Qi 11 ! n-1 Project Valuation 30C) , OC) Construction Type -� Lot Size Grandfathered: ❑Yes ❑No If yes,attach suppor?in docume:atation; C.) Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) C, rn 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# _T Current Use Proposed Use 1 BUILDER INFORMATION q c� Name ' Telephone Number a•G Address !/'oA License# 674 S I ' 6090 U Home Improvement Contractor# 10 7- Jo Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO .IJQI/✓� nG / I SIGNATURE DATE «< pA? FOR OFFICIAL USE ONLY a` + I PERMIT NO. DATE ISSUED a MAP/PARCEL NO. ADDRESS VILLAGE rt , OWNER DATE OF INSPECTION: i FOUNDATION ti FRAME ` i r INSULATION FIREPLACE XI ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL 2 4 FINAL BUILDING t DATE CLOSED OUT ASSOCIATION PLAN NO. Y , The Commonwealth of Massachusetts Department of Industrial Accidents +, + Office of Investigations 600 Washington Street 11F;� jl o Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Ca 1� Ca C J k,r� 6,J \ S >f t Address: `]1 vvN City/State/Zip: �\�` O� , Qa `F Phone#: Are you an employer? Check the appropriate box: Type of project(required): 1.IJ 1 am a employer with / 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the'sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. t 7• ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. ❑Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions . myself, o workers' romp. c. 152, 1(4), and we have no Y � P § 12.N Roof repairs insurance required.]t 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 subcontractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: P_U1�+ T 1�1 S O '��t L� C.D,M 1�2 Policy#or Self-ins.Lie.#: W y190 6— 05 Expiration Date: Job Site Address:_ _���;(, VVI.O. - S�- City/State/Zip: 14 )4' 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 un er th ains and penalties of perjury that the information provided above is true and correct: Signature: Date: Phone#: �()� p ao ( [ 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): L.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector t 6.Other Contact Person: Phone#: 0 -Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity, or any,two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual;partnership, association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a.license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance, If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department.of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The.Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 6.00 Washington Street Boston, A.02111 Tel. ##617-7-27-49GQ e-xt 406 or 1-877-MASSAFE Revised 5-26-05 Fax 4 617-727-7749 www.rnass.g.ov/dia �afIKE'O�ti Town:of Barnstable Regulatory Services ' 3A1tY"Am.LE, " Thomas F.Geiler,Director 9 MASS' g �iOlEp 39, p Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I t , as Owner of the subject property hereby authorize sslz� ,ls e.`s�t►" to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job d pignaturqeoOwner Date Print Name Q:FORMS:OWNERPERMIS SION Town of Barnstable Regulatory Services STAB .Geller Director L% Thomas F , , 16.19. .19..N Building Division Tom'Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Fax: 508-790-6230 Office: 508-862-4038 Date ,o Address To Whom It May Concern: _ Our attention has been alerted to the fact that you are flying illegal ' contrary to the Town of B arnstable's Zoning Ordinances.The Town has a sign code which is explicit regarding flags. Section 4-3.3,Prohibited Signs(1)"Any eign�cial fla s o nations o or any portion of ar administrative och is set in �political n by ement; . including pennants,banners or flags,exc p g subdivisions thereof." Please contact me at 508-862-4033 when these flags have been that I can inspect the site.Thank removed so you for your anticipated cooperation. Sincerely, , David Mattos Building inspector r TO LL EW BUSINESS OWNERS DATE:A to ® � Fill in please: - MOIft � � e Q APPLICANT'S P YOUR NAME: f n wrg iC1�1 13440M BUSINESS '; �r ' � `� YOUR HOME ADDRESS: a'y'I Sc u,DDEA TELEPHONE NO. `r- ' Tele hone Number Home f;dk 711-//BS NAME OF NEW BUSINESS 5-47-eom b Tim. ou&I-b TYPE OF BUSINESS 0-6ns16-N m t w7" 546- IS THIS A HOME OCCUPATION? YES =_NO Have you been given approval from the building division? YES=NO ADDRESS OF BUSINESS 431 m AN Ajis m A 1,o MAP/PARCEL NUMBER 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, 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 listed below, y Y PP Y � you MUST go to the following office to make sure you have all the required permits and licenses. GO TO 200 Main St.-(cInn- of Yarmouth Rd. & Main Street) and you will find the following offices: 1. BUILDING C SI NER' This individual as i orm of 4rmit r quirements that pertain to this type of business. d ignature"* COMMENTS: I 2. BOARD OF HEALTH This individual has been informed of the permit requirements that pertain to this type of business. Authorized Signature" COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature" 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. QACONSUMER\Lois\CA Forms\newbusfrm.doc p`Of IKE T,,�� The Town of Barnstable ail O4 BABNSTASM Department of Health Safety and Environmental Services 9 MASS 0 �A f639•�� lfD MPy Building Division 367 Main Street,Hyannis,MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner Inspection Correction Notice ,6191071s T C/yo/t.aof Type of Inspection C 0 M/c / Nil/ �'2 �+r✓ v� ✓�^� Location 6 3/ /yi, /-IV S 7— Permit Number r ln&g ,¢c o,v e Builder One notice to remain on jobsite, one notice on file in Building Department. The following items need correcting: ,�v T fn c o✓7' �� f5d i e.o �•u In 'f /% !.✓C o C r, !3 C T-9 h &-Al 4 Please call: 508-862-4038 for re-inspectio . Inspected by 6 Z/� e '3 Of Date ti r v-5' 77 w " TOWN OF BARNSTABLE BAR—W 3644 Ordinance or Regulation WARNING NOTICE Name of Offender/Manager We Trle 1111 1A,'191 Address of Offender ' W#s?'7fe r ,r' :' ►..�,e01140 MV/MB Reg.# Village/State/Zip Business Name ,d 'Vt1 A' A11S' KI,Al a-o-, 4 " am/pm; on 51A 206-3 Business Address Signature of Enforcing Officer Village/State/Zip V'jj- ,,VA',` ylrl /e Location of Offense 1l / 7 �' �' Enforcing Dept/Division Offense "2oA/YA19 V- 7 a z, 4171,y �`� 5�/ a Facts 00'o ok 1' Ao� s-A" �F This will serve only as a warning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations. will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. f` ,y °F11KE►� Town.of,Barnstable y P Regulatory Services BAMSTABI EKAM Thomas F.Geiler,Director AjE1 9- Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 _ Fax: 508-790-6230 q 3 Date i �47 - /ap;'ds _ To Whom It May Concern: Our attention has been alerted to the fact that you are flying illegal contrary to ""the Town of Barnstable's Zoning Ordinances.The Town has a sign code which is explicit regarding flags. Section 4-3.3,Prohibited Signs(1)"Any sign,all or any portion of which is set in motion by movement, including pennants,banners or flags,except official flags of nations or administrative or political subdivisions thereof." Please contact me at 508-862-4033 when these flags have been removed so that I can inspect the site.Thank you for your anticipated cooperation. .Silrcerel David Mattos Building Inspector Q:\13LTIIAING\WPFRM\DMA7MS\IllegaI Flags.DOC NAME (LAST, FIRST, D. NOTE DETAILS OBSERVATIONS-ITEMIZE EVIDENC'�, SERIAL #S ETC. - NO W�"'Aj' J • o• �j ..� e = WINFv Ax NMI mll"AMM Ll 1 1 I � I, 7 ��..� •) J♦ • s_ r 1 � ..tee_ ra, � � 1 � P C. • ..1 ���� Our services include: • full range of landscape services, • Stone or asphalt driveways, �..:. • Bobcat services, 9 A • Electric Lines or trenches, 14 • All types of Drainage services. And lots more... -CONSIRUCIION*— (508)457-6288 _ Engineering Dept.(3rd floor) Map N3, Parcel_f�3��"" G® �- Permit# . House#. U� Date Issued -board of Health 3rd floor 8:15 9:30 1:00- Fee Conservation Office(4th floor)(8:30-9:30/1:00-.2:00) - v Planning Dept.(1st floor/School Admin. Bldg.) 1ME Definitive Plan Approved by Planning Bo d 19 • BARNSTABLE.�` MASS F A S�ABLEO r Building Permit Application 4 tre ddress 6a Village Owner - Address Telephone f ? , — S/$— - `Permit Request ] S .F st Fl l ` ` C�—squVre feet Second Floor square feet Construction Type Estimated Project Cost $ o:?-, Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Ty e: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Exis ' g Structure Historic House ❑Yes ❑No On Old King's Highway ❑Yes ❑No Basement Type: ull ❑Crawl ❑Walkout ❑Other Basement Finished Area(s Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half: Existing New No.of Bedrooms: Existing New Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other i Central Air ❑Yes ❑No Fireplaces: Existing New Existing wood/co tove ❑Yes ❑No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) J ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use Builder Information Name Telephone Number 7 5 — 17-1��� Address License# Home Improvement Contractor# Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO r SIGNATURE DATE \BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) ,r• • FOR OFFICIAL USE ONLY _ • _ � 4 . - ,t % - � .i= w•��7 � _ per; PERMIT NO. DATE ISSUED, MAP/PARCEL NO. ' ,• .. a. r' ' i , , � . rir t ' 4 - { ' t _ ,, - X.; ✓. y . +• : ` ` � � ` r S ,l n " ' r; ''�'.'4 ADDRESS � i VILLAGE OWNER ; ; , f ;„{ '! *• . DATE OF,INSPECTION. , FOUNDATION FRAME INSULATION _ ..jam'•, `� • ,. � _ '� •, -. ; C,. � , - FIREPLACE ELECTRICAL: ROUGH ' FINAL 4i - PLUMBING: ROUGH FINAL GAS:• ,': ROUGH ' ' FINAL FINAL BUILDING WX DATE CLOSED OUT ASSOCIATION-PLAN NO. _ The Commonwealth of Massachusetts Tj— tt,;l Department of Industrial Accidents Office 9f1aYestf9atfons --_-J 600 Washington Street Boston,Mass. 02111 Workers' Cotnjiensation Insurance Affidavit / ME - ocation city T��}NA/i phone# ❑ I am a homeowner performing all work myself. ISZ-i am a sole proprietor and have no one working in any capacity ❑ I am an employer providing workers' compensation for my employees working on this job. com nnv name: address: city phone# insurance co. oltcv# ///////////%///////%///%//%////%/////////////i/%///////////%////////////////%///.%///////////%%///////////////////%////////////////////////////%/////////////%///%i%%%//%/////%////////////////%//////////////%///////////%//,,;,, ❑ I am a sole proprietor, general contractor. or homeowner(circle one) and have hired the contractors listed below who have the following workers' compensation polices: . company name: address: ....: .... ..... phone#• dtv ...... ii//i/i0ii///////i/////////////%/��/////////////�/�///%/..�%//% cam anv name: XX address: .. . phone#: city: insurance co.. Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal Qenalt►n of a Me up to understand and/or one years'Imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of 5100.00 a day against ma I understand that a copy of this statement may be forwarded to the OMce of Investigations of the DIA for coverage verification. I do hereby certify under pains and penalties of perjury that the information provided above is true and correct Signature �' Date Print name Phone# Coontact se only do not write in this area to be completed by city or town otndal own permit/license is QBuilding Department city DLicensing Board pros is re aired ❑Selectmen's OtIIee kifLnmediatereap q QHexhhDepartittent person• phone#; ❑Other_�� lmmsw 9,95 P1A) 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 c 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 of repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renews of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you are required to obtain a workers' compensation policy,please call the 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 retired 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 081ce of Investigations 600 Washington Street i Boston,Ma. 02111 A: fax#: (617) 727-7749 : phone #: (617) 727-4900 eat. 406, 409 or 375 f . TOWN OF BARNSTABLE SIGN PERMIT • I PARCEL ID 308 131 002 GEOBASE ID 22100 ADDRESS 631 MAIN STREET (HYANNIS PHONE Hyannis + ZIP - LOT PARC B BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT HY PY MIT L.18636 DESCRIPTION JAVA & JOKE SHOP (6 SQ.FT. ) PERMIT TYPE ' BSIGN TITLE SIGN PERMIT CONTRACTORS: Department of Health, Safety ARCHITECTS: and Environmental Services TOTAL FEES: $25,00 'BOND $.00 0� CONSTRUCTION COSTS $.00 �753 MISC. NOT CODED ELSEWHERE BARNSI'ABLE. ,•' MA88. OWNER LOWE, BRADFORD W i639' ADDRESS 12., BARBARA COURT NII� NO DARTMOUTH MA ILDJNG DIVI5J OP41 DATE ISSUED 10/16/1996 EXPIRATION DATE ,� i ` /�, 16 The Town of Barnstable • • Services f an nvironmental Sern Department of Health, Safety d E /a � 1 p Building Division 367 Main Street,Hyannis MA 02601 Ralph Cmssen Office: 508-790-6227 Building Commissioner Fax: 508 790.6230 Application for Sign Permit / A licant Assessors No.a�1 `3` ` 0 0 °L pp �- Telephone No. �� Doing Business ps• j Sign Location _ p z a Street/Road: - &&,/,� I ///, _ • Old Kings Highway? Ye( /No Zoning District: Property Owner Name: S�� � Tel Address: Village: ------- —#-a4w� Sign Contractor Telephone: Name: — Address: Village: Description Please draw a diagram of lot showing lomdo== •�f buil4inv and existing signs with dimensions, location and size of the new sign. M is should be drawn on the reverse side of this application. �' errnit is required) • Is the sign to be electrified? Yes/ (Note:ffyes, a whiUffP I hereby certify that I am the owner or that I:lave 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 Barns le Zoning Ordinance. Signature of Owner/Authorized Agent Date:- Signature Permit Fee: Size: A) 3 - Sign Permit was approved: �/ Disapproved - � Signature of Building Offs 3 i f ASSESSOR'S MAP —6— -A,4*4 j t; Lgvouv. oc Ali✓;: ^- � zt I of I 1 i 907e0= I I I i o I fj I ! ,149 Wow +t ( I � ./019?O t� � 4• v � Q I vl I 1 oq sr a HoveoRT Lo d.Hrr�,y J,a NuMitr Old. j /R«iai�va Co.CoRir ` I i i � I I -o m-aw O.?9 A4ni No. 308' 1 all �'+ } � 7� _ � 'lac. �� l �'� a- . .�. t � -_ _1__. ._..T_._, - . _�. . __ � Date 7 Time !' WHILE YOU WERE OUT M of (p in,— In)6f-W 7 Phone / 7 2-t` Area Code Number Extension TELEPHONED PLEASE CALL CALLED TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU URGENT RETURNED YOUR CALL 1 Message C42 1-7` 41al '� C� Sly t2v�le,-si�( t Operator ' AMPAD 23-021-200 SETS �0 EFFICIENCY® 23-421-400SETS CARBONLESS lm®ST®W SARI® & GRAVEL CO. 227.9000 �i FAX (617) 523.7947 `7/� I DT i CT vo t z } i n� t y_ i 4 ; f1(. ._.0 � ' � � • 1 t t # , t E t ! f j t '� t ._. Gi � I 4 [ij 2 Y e e t "FIRST AND FINEST" ONE WORLDBIKE �d' 1 �i ri 57wa Val �a See Eve &d RENTAL QUALITY ONE WORLD BIKE PRECISIO USED BIKES �� REPAIRS 63�IssrRM n�' ON All FOR SALE MAKES LENGTH OF TIME 3I KINUk z ItOUi ...........-Sy0.00 SPECIAL,3 HOUQS........—$12.00 ADDITONAL HOURS..»..........$3.00 per ky. DAILY(24 HOURS) 20.00 VACATION SPECIAL! ?A�" ONLY $5.00tv For Each Days e '�) (After 1st 24 Hours)A4 LOCATED NEXT TO DUNKIN DONUT PARTS LOWEST AND PRICES ON ACCESSORIES THE CAPE i G� Assessor's map-and :lot number ..@.:1.�.. .... �.�. .� SEPTIC SYSTEM MUST BE a 1 INSTALLED IN COMPLIANCE 0Se age Permit number . .....:... . E.... V=`ITH ARTICLE II STATE QSANITARY CODE AND 'TOWN T"E T OWN OF BA IMSTAB L E $AHBS TAM E, �' o Ya DUI'LDING INSPECTOR- t 4t Ei aAPPLICATIONS FOR' PERMIT TO .. . ........:R.4'.AQd'el........... ........................ ...... ........................................ o . . TYPE OF :CONSTRUCTION .................... . W00A............. ............................................. : r a ...........Mcx-c.h...........1.9........19.?6.. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .....63i...Main... .t.....Hyannn s.............................................................................................:................................ ........ .. . ;Proposed Use ........retail„St.Ox'@...................................................................................................................................... Zoning District bUsl.......................................................Fire District ........HyElYixlis.................................................... Millard Stevens Address .63.1...F�s�*a..,S.t.......�yaxtYl7.s............................ Name of Owner............................... •Name of Builder ..Donald...FOrte --...•..•.............•..•Address .:.ShQO �,y�.21 ..H111..Kd......Cente .Ville Name of Architect Richard L1Undr ....•„•,-,,,•.............Address..... ...... . Number of Rooms ...tw.Q................................... ....................Foundation ...CQA1.Qr.eIkQ........................................................ Exterior .....}tiOldgla...sawn...pirie........................................Roofing ...s a91141 t............................................................... Floors ...............P1,yWOOd.....................................................Interior ....pane.lin.g............................................................ Heating ........F•Wt Ast...........gas....................:...................Plumbing ...:I...ba.th............................................................... Fireplace ........:.n0.....................I.............................................Approximate Cost ..... ...,,.OQO...QQ.......... .......................... Definitive Plan Approved by Planning Board --------------------------------19_____--• Area Ale ��� C,04,0rV C ...�.......................... Diagram of Lot and Building with Dimensions Fee /i SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. ll Name .. ,!.r.. Stevens, Millard . - ' 10206remodel store mo ------ permn r ----------- ...... ............................................... ' -------. ' 63l Ma1in .S' met Locotion —.---------..--..--...`---.. ^ Bymzuaio ----.-_--.-----------------.. . , - Millard Stevens" C�vvnar . '--------^—'---'^------ '� f ramme ^ Type of..Construction ------'`_�_.�,.--.. , ' ~ " �� ���----.^-------------,--. ---.. ' ' %��p�t �t —''�-------' . —'—'=-----''' P&rm� Grono�6 ........................................lq 76 ' - March ~~ - ~' �^ ` . .. . . ` , Ibteof Inspection ........................................ —.. . —.�_../�`g 7- Date Completed ./��<.��<<.����----..lg . . . . - . PERMIT REFUSED ^ ^ ` . �q —�---..--.� ---..��.��----- —. ,.—�—.----.----------------- ~.---.—.--.-------..~-----.--.. . . - . ^~,.--..--��—�--~—.~.~--... -----^. ' .... . ' ---------'—.—.-------..,--~—. � - T_ ' Approved ............................................ lA . . " ---------------.----..--.---. . . ' ` -----------------'---.----.— . ~ Assessor's map and lot number ......................................... Sewage Permit number .......................................................... y�FTHET��� TOWN OF BARNSTABLE t EAR3STLBLE. 1639. BUILDING I IS P E C.10111 /11 APPLICATION' FOR PERMIT TO ....... .......... ....... . .............. ............................................................. i # ... TYPE OF CONSTRUCTION .....................I.........11".....)3 . ................ .................................................................... ...... — .e�................-a r ........................ . TO THE INSPECTOR OF BUILDINGS: The undersigned hereby* applies for a* permit according to the following information: Location ..........-1 vanrli 3 ..................... ................................................... .................................................................................................. ProposedUse ..... .............................................................................................................I......................... Zoning District ..... bus-l-ness n 11 ...................................................................Fire District ............!.................................................................. 1,,1--l' ard Stevans Name of Owner .......it..;*........................................................Address S I-, TTV q n 1 j P-- .................... ................................ Name of Builder Donald -qr�-e ....................:q........:�.....................................Address e Name of Architect Aqhqrd T aundry ...................1!............. .............................Address .... tar........................ .. .....ari ............................... Numberof Rooms ........................................................Foundation ...C.. K,-.ne-!�e................;...................................... Exierior ..... .........................................Roofing ... ................................................................ Floors id-vviood ......................................................................................Interior ... ............................................................ Heating ........ 4... ,- -�h ...............................................................Plumbing h i t ...... ......................................................................... Fireplace ..........A D noo,w) ..............................................................!......Approximate Cost ..... .............. .......................................... Definitive Plan Approved by Planning Board --------------------------------19--------*. Area .....................................r Diagram of Lot and Building with Dimensions Fee ......................................... SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree. to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. 10 121-�4 1 D "t"Y NameA.,........... ...... .......................................... Stevens,18206 - euf»u.elcor- � �omo Perm/ .---..---------~—---- ~631 Maio StreetLocation ................................................... '' Hyannis ^' ' ' ----.-----------.—.--------.. . ` . . . . . Millard XXXMV Stevens ' ' Owner --------________._____.. ' frame ' Type of Construction .......................................... ' ` ................................................... . Plot ............................ Lot ................................ ` - - ' March l 76 ' Permit Granted -------------]g Date of Inspection ....................................lV � . - � Dote Completed ...................................... . - � . `PERMIT REFUSED ' . ------ .. ' �' 4 ^ —._.. �i --- . ' ............................... -'.—' —_ 8 �r _______. . ` �- ~--.. ----..':��.-----.-----.. . . . . ^ ` Approved ---------------.. 19 ' ' ' ` ^ . ---------------^—~'--------' ' --'-------.`-------------.—.. | |' P�oft�Erow� TOWN OF BARNSTABEE BMSTMM &asa r � Office of the Building Inspector �Op i63q. Date January 19, 1995 Fee $50.00 44 q 3 Permit No. 95-16 PERMIT TO ERECT SIGN IS HEREBY GRANTED TO Mary Kromb erg DIBIA Second Time Aroung LOCATION 631 Main Street, Hyannis, MA ANY VIOLATION OF THE SIGN LAW WILL CAUSE IMMEDIATE REVOCATION OF THIS PERMIT Building,lnspector The Town of Barnstable pert no. /16 Department of Health, Safety and Environmental Services ,►ems. Building Division date t 11L6�9 �`� 367 Main Street,Hyannis MA 02601 fee Application for Sign Permit Applicant: Assessor's no. '3 0,q . t 3 1 o �✓ Doing Business As: / Telephone Sign Location street/road:_ 6, -3 t Ma,,,) azrt.caC 9ul-i s Zoning District Old King's Highway District? yes no Property Owner Name: Telephone Address: Village � Sign Contract r Name: Telephone Cj 4 Andress:0 � Village Description Diagram of lot showing location of buildings and existing signs with dimensions, location and size of the new sign to be drawn on the reverse side of this application. Is the sign to be electrified? yes no (Note: if yes, a wiring permit is required) I hereby certify that I am the owner or that I have the authority of the owner to make application, that the information is correct and that the use and construction shall conform to the provisions of Section 4-3 of the Town of Barnstable Zoning Ordinances. Date tgn ure f Owner/ thorized Agent Size (sq. ft.) ` ,� Permit Fee \�_6 1� ISign Permit was approved: proved: Date �� ignature of But ding O c' d 7 �3� Maidn scime Around eet Hyannis, MA 02601 Tel: 775-1145 1 � Ladies Clothing & Accessories Open 7 days a week since 1966 Mary Kromberg C[oln j J SECOW.- '°4E AROUND Furniture ` )8447091029 p 0 L A R.D. � 2VV SECOND TIME AROUND j8447991029=- P .=R 0 D 2 VI 1 I r , L _ , r _ t r + r t I f r r 1 f r I r r f ' f lm rT fill ill Jill t'Li 17 i 11VV fi` -f rT ? I_ H w 1 - 1 t I I ' Fl ► T [ t I _11 I I I � I T�--? T -r -- 1-T- - - -�-- --�-y - 4-A. f - - - -I- - - - -f- I- - - i IL 7ZJ claf�;�►g 3 � T w,. 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A��. a:,:;� �, �. .. s all= aw ow � �l- o=:.1►' �.�; �'�++ ' � _ � Vie.J .:HANDf J PPED _?' � 3/ 7n� /� �� tk + . 0 Jim m L or \. l i 0 _ •.. .�� ....t. .:c -Lrf ',� _ _<� :ems:.-:..M;,.,s Sty ,. ti / �� \-y 4 �� `�, ��'' ��� �n Q C,,�va ro�� r. �� � / � � /� DUNKIN' DONUTS . w 23 SOUTH ROAD WEST YARMOUTH, MASS. 02673 000 MASSACHUSETTS ELECTRICAL � lo�—� CONTRACTORS ASSOCIATION MEMBER = i i i �._ : 1' ,- + t _ ppz.t., ; �. j�,:fit •.�' r >t N�' •' ,r� .. _ ,�;� _.. ., 1 ��" 1 r 3 '+ ,z y , el 41, i t e+ _ I f VIP