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0640 MAIN STREET (HYANNIS) (4)
i �� y� m��� ���.�� y s i �I - F 'N Z • 6, � C Z 1I 1 �Igo Sign TOWN OF BARNSTABLE Permit * BARNSTABLE, MASS. 9��F0 MAC A Permit Number. Application Ref: 20160063 20071171 Issue Date: 01/05/16 Applicant: Proposed Use: MIXED USE RETAIL & RES Permit Type: SIGN PERMIT Permit Fee $ 75.00 Location 640 MAIN STREET (HYANNIS) Map Parcel 308053 Town HYANNIS Zoning District HVB Contractor PROPERTY OWNER Remarks RREFACE 14 SQ FREESTND SIGN &NEW WALL SIGN 20 SQ KELLY'S ON MAIN Owner: PROPERTY OWNER Address: HYANNIS, MA 02601 Issued By: �---- POSTTHIS CARD SO THAT IS VISIBLE FROM THE STREET y R i� PERN(]:T PAYMENT RECEIPT TOWN OF BARNSTABI_E BUILDING DEPARTMENT 200 MAIN STREET HYANNIS, MA 02601 DATE: 01/05/16 TIME: 14:16 -------------------TOT.ALS----.._.------.--- _ PERMIT $ PAID 75.00 AMT TENDERED: 75.00 AMT APPLIED: 75.00 CHANGE: .00 APPLICATION NUMBER: PROPERTY OWNER PAYMENT METH: CHECK PAYMENT REF: 3018 TOWN OF BARNSTABLE oF�E taf, Town of Barnstable _ Regulatory Services '"R'W"U� " Richard V.Scali,Director MASS. 16g9• �0 Building Division D Tom Perry, Building Commissioner VA 200 Main Street, Hyannis,MA 02601 www,town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Permit# Building Official approving Application for Sign Permit Applicant &\Jy\j CQCACn�A Assessors No. Doing Business As: )r4AL.15 ("\A Telephone No.-S?f6- j' 1960 ' Sign Location Street/Road: ( 14q W,,,4 ``�� �' •-bra Zoning District Old Kings Highway? Yes�Hyannis Historic District? CYe)/No coo OwnerProperty Name: 0o �A UG �Q�� W' Su l lephone: ` - - Address• =5 _ - - - -- Village: Po Q>ox '-+2,\ Cuti�. Sign Contractor Name: Telephone: Mailing Address: l Description Please follow the cover directions.You must have an accurate rendition of sign with dimensions and location. Is the sign to be electrified? Yes .(]Vote:Ifyes, a wlnngpermitis required) Width of building face � ' ft x 10-%V x.10 Check one Reface existing sign or New Total Sq. Ft. of proposed sign (s)Co20 Ifyou have additional signs please attach a sheet listing each one with dimensions t If refacing an existing sign please provide a picture of the existing sign with dimensio�,—L 3`{ 'I herebyce that h rtify t I am the owner or that I have the authority of the owner to make this app cah�, 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. Signature of Owner/Authorized Agent Date 1 S SIGNS/SIGNREQU revised110413 RECEIVED iL= ,.s 1l,uv u 4 Z015 Town of Barnstable GROWTHMANAGEMEN'f Hyannis Main Street Waterfront Historic District Commission www.town.barnstable.ma.us/HyannisMainStreet CERTIFICATE OF' APPROPRIATENESS APPLICATION SUBMISSION REQUIREMENTS Application—3 Copies Complete all sections and provide a detailed description of the proposal. ❑ Supporting Materials--3 Copies Samples Material samples for all changes to exterior materials. Color samples(paint chips)for changes to exterior colors. Manufacturer's specification sheets for fixtures,furniture,fences, etc. (Note: If samples are too large to submit with the application,they may be brought to the hearing.) Photographs Include pictures of the affected area. For new construction, redevelopment, rehabilitations, or additions: ❑ Plot Plan/Site Plan A plan showing all structures on the lot and all additions or changes. ❑ Elevations Detailed elevations of all building facades, including dimensions and material specifications. ❑ Landscape Plan Detailed plan showing types, sizes, and quantities of plant material. $75 Filing Fee The$75 fee must be submitted with the application. Checks should be made payable to the Town of Barnstable.We are unable to accept credit/debit cards. Postage Stamps. Contact the Growth Management Department for the number of required stamps. Stamps are required for abutter notification. IMPORTANT INFORMATION All decisions of the Commission are subject to a 20 day appeal period. Approved applications may be picked up at 200 Main Street after the appeal period has ended. Please speak with staff for more information on the appeal period. • Review the Historic District guidelines for information on recommended designs, materials,colors,etc. • Providing all requested information with the application will prevent delays in processing and hearing your application. • The applicant or a representative must be present at the scheduled hearing;delays or a denial may otherwise result. • Approvals from the Historic Commission are required before you can apply to the Building Division for required,permits. If you have any questions, please call the Growth Management Department at (508) 862.4665 or contact Elizabeth Jenkins at elizabeth ienkins(@-town.barnstable.ma.us. Growth Management Department • 200 Main Street • Hyannis, MA • 02601 � a Town of Barnstable Hyannis Main Street Waterfront Historic District Commission Application Certificate of Appropriateness Application is hereby made for the issuance of a Certificate of Appropriateness under M.G.L.Chapter 40C,The Historic Districts Act for proposed work as described below and on plans,drawings or photographs accompanying y g this application for: r Assessor's Map No. Parcel No 0 Address of Proposed Work Applicant Name \k/\s Applicant Mailing Address Town/State/Zip -�.�atti��� Applicant Phone Number Applicant E-Mail Property Owner Name Owner Mailing Address ioLkc5 V'�tcl,� ` Town/State/Zip Owner Phone Agent or Contractor Name Agent or Contractor Address Town/State/Zip Agent or Contractor Phone Agent or Contractor E-Mail PROPOSED WORK Please check all categories that apply: Building Type: Eg Commercial ❑ Residential ❑Accessory ❑ Other Work Proposed: 1. Building Construction. ❑ New Building ❑Addition ❑ Alteration 2. Exterior Alteration: ❑ Windows ❑ Doors ❑ Siding ❑ Roof ❑ Other 3. Exterior Painting: 4. Signs: [ New sign ❑ Alteration to existing sign 5. Accessory Improvement: ❑ Fence ❑ Parking Lot ❑ Outdoor Dining ❑ Awning/Canopy 6. Other: Page 1 of 3 TOWN OF BARNSTABLE HYANNIS MAIN ST WATER=RONT HISTORIC DISTRICT COIL MiSSION s` Hyannis Main Street Waterfront Historic District Commission DETAILED DESCRIPTION OF PROPOSED WORK Provide detailed specifications of the proposal. • Include a detailed description of changes to existing conditions, if applicable. Describe proposed materials to be used, desired colors, manufacturer's specifications, etc. In the case of signs, give locations of existing signs and proposed locations of new signs. Attach an additional sheet, if necessary. c �G o� C^- u\z S:k<n r:vt ��rAczz.�� ok - l � \inn r, Signed G��t,�. Applicant-Agent Date APPROVED NOV 18 205 TOWN OF BARNSTABLE HYANNIS MAIN ST WATERFRONT HISTORIC DISTRICT COMMISSION Page 3 of 3 I Page I of 1 SUPEOt f HAND-CRAFTED FOOD � DDCKi'ATLS F r Owe/) oJ �- t. APPROVED � EVE® NOV 18 g.5 TOWN OF BARNSTABLE HYANNIS MAIN ST WAl-ERFRONT HISTORIC DISTRICT COMMISSION file:///C:/Users/herrandk/AppData/Local/Microsoft/Windows/Temporary%20Internet%20... 11/4/2015 k t . Neighborho odP � m a a ' >' de el 7v If- r lk HAND CRAFTEQ COCt(TAILs ' - '<"'' .,�"�•" +» �.:..,w � �;1� �� ,�a _. +�. ,�� �:sp mm„ a� �°ter .,�'�&r i''s",. i 4J c r o _ } - - .. � �"�nu, a.. y •� t,�� a .K_R .�' M ua, Afw NOV 20115 TOWN OF BARNSTABLEa HYANNIS MAIN ST WATERFRONT, HISTORIC DISTRICT COMMISSION , ... .-;•ems+Mm+...r•.:.�.:.. �,..w..._ en .:._... a. ..�..... _ ..... ... _ .. - - - y: i r p ( i AOM r ' 14 If ,k wl- w - '� � ,. 13' .-�+. � r � e av � -.wwk..�..J4•�'�.MsiyH.- b + R a€ ��p.� y^+,.x..wrw!�"�"w'e a'e� •t�s " ;��,�,,,`�.` �"' '�''fir .c'� s � � �' .',3 � r _..,..�. e , w 3 fill APPROVED TOWN OF BARNSTABLE HYANNIS MAIN ST WATERFRONT HISTORIC DISTRICT COMMISSION f BARMABUL Town of Barnstable Hyannis Main Street Waterfront Historic District Commission www.town.barnstable.ma.us/hyannismainstreet Decision—Certificate of Appropriateness Michael Gannon d/b/a Kelly's on Main—640 Main St. 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 approves a Certificate of Appropriateness for the following property: Property Address: 640 Main Street,Hyannis Assessor's Map/Parcel: 308/053 At the November 18, 2015 hearing, after consideration of the testimony given and materials submitted by the applicant and members of the public, the Commission found the proposed design for changes to the paint colors, installation and removal of awnings and new signage as outlined, will appropriately contribute to the historic character of the Hyannis Main Street Waterfront Historic District. The Commission considered the material, design, color, size, location, and context of the proposed signage and awning and found them to be appropriate for the protection and preservation of the district. Based on these fmdings, the Commission voted to grant the certificate of appropriateness subject to the following conditions: I. Existing hanging street sign installed on lamp post, as shown in the photograph submitted on November 4,2015,green and black lettering on white background with border is approved. 2. Second business sign not to exceed 3 ft. x 6 ft. as shown in the rendering submitted on November 4, 2015, green and black lettering on white background with border to be placed on the front of the building 3. Business sign on street-facing side of the awning above the ramp, as shown in photographs submitted November 4,2015,as permitted by Sign Code. 4. Removal of blue awning on the front (street-facing) side of building and reinstallation of lighting to illuminate sign 5. Blue awning over existing ramp to entrance is approved 6. Any and all neon signage shall be removed. Neon signage (with the exception of an open sign, as permitted by Code)is prohibited. 7. The current Irish Flag colors on front porch shall be removed and the porch shall be painted white or a light paint color 8. A Location hardship sign(A-frame sign)shall require additional approval by this Commission. 9. Sign permits from the Building Division are required. Present and voting in the affirmative to grant the certificate of appropriateness were: Vice Chair Paul Arnold, Bill Cronin,Bren avid olombo,John Alden,Taryn Thoman and Timothy Ferreira Opposed: eZ41, �^ Paul AYnold,Vice Chair D e Hyannis Main Street Wate ont Historic District Commission cc: Michael Gannon,Applicant Tom Perry,Building Commissioner File I,Amm Quirk,Clerk of the Town of Barnstable,Barnstable County,Massachusetts,hereby certify that twenty(20) days have elapsed since the Hyannis Main Street Waterfront Historic District Commission filed this decision and that no appeal of the decision has been filed in the office of the Town Clerk. Signed and sealed this day of under the pains and penalties of perjury. Ann Quirk,Town Clerk r 200 Main Street,Hyannis,MA 02601 367 Main Street,Hyannis,MA 02601 Town of Barnstable Growth Management Department Hyannis Main Street Waterfront Historic District Commission . www.town.barnstable.ma.us/Jiiiannismainstreet George A.Jessop,Jr.AIA,Chair Jo Anne Miller Buntich,Director Acknowledgment of Twenty Day Appeal Period Required by Section 112-33 of the Hyannis Main Street Waterfront Historic District Ordinance I; t �'C (;Xvw\,OXn ("Applicant"), acknowledge that the Certificate granted by the Hyannis Main Street Waterfront Historic District Commission is subject to a twenty (20) day appeal period, pursuant to Section 112-33.of the Code of the Town of Barnstable. Within 20 calendar days after the date of issuance of a Certificate, any person(s) aggrieved by the determination of the Commission may appeal the decision to the Historic District Appeals Committee. The Appeals Committee, after an evaluation of all pertinent evidence, may uphold, overturn, or remand a determination of the Hyannis Main Street Waterfront Historic District Commission. Decisions of the Historic_District Appeals Committee may be further appealed to Superior Court. Any subsequent permitting or licensure conducted in reliance of the Certificate granted by the Commission is contingent on the validity of said Certificate at the conclusion of any appeal. The Applicant shall be required to fully comply with any decision of the Historic District Appeals Committee or, upon remand, revised decision of the Hyannis Main Street Waterfront Historic District Commission. 1a I` Signature: Applicant Date Print Name Address of Proposed Work 200 Main Street,Hyannis,MA 02601 (o)508-862-4665(t)508-862-4784 - — TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application..t Health Division Date Issued Conservation Division Application Fee �S. Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis ®k ' T 'Project trCe2et,Address 644c���n Village - ��Vvs"V COwner-Db. \.A Address'4q; PayA Telephone I-Csi -d" - Olv fit{ Permit Request �C� Co�� ��er�- ti cc�-�-e �-� vt��rlCl M0 r yl 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:.Q Yeses ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other J j Basement Finished Area(sq.ft.) Basement Unfinished Area (sgft)' Number of Baths: Full: existing new Half: existing new,. cn Number of Bedrooms: existing _new ;z 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_ �oyr` 2J� Telephone Number 1� i Ad_dress.'-� SG--,Q� Sh-. License# i _ Qsi�aw . Home Improvement Contractor# I �� Email O\O"J I=.ke\fine (P- 4dAn >CC-A^ Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ,I ql ( � SIGNATURE ? FOR OFFICIAL USE ONLY _ APPLICATION # DATE ISSUED MAP/ PARCEL NO. j a ADDRESS VILLAGE OWNER i DATE OF INSPECTION: g FOUNDATION FRAME INSULATION i FIREPLACE , W ELECTRICAL: ROUGH FINAL 1 PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING t DATE CLOSED OUT ASSOCIATION PLAN NO. z z Town of Barnstable Building Department - 200 Main Street t MRNffABLE. t Hyannis, MA 02601 9 MASS q, 1639. . (508) 862-4038 Certificate of Occupancy Application Number: 201508497 CO Number: 20150235 Parcel ID: 308053 CO Issue Date: 12/11115 Location: 640 MAIN STREET (HYANNIS) Zoning Classification: HYANNIS VILLAGE BUSINESS DIST Proposed Use: MIXED USE RETAIL & RES Village:. HYANNIS Gen Contractor: PROPERTY OWNER Permit Type: CC00 CERTIFICATE OF OCCUPANCY COMM Comments: KELLY'S ON MAIN Building Department Signature Date Signed COMMERCIAL LEASE This Lease Agreement made this Is' day of March, 2013, by and between KELLY A. 'BORSATTO, Trustee of 640 MAIN STREET REALTY TRUST, of 680 Main Street, Hyannis, Massachusetts 02601 (the Landlord); and COUNTRY SALOON PRODUCTS, INC., of 455 Pond Street, Braintree, Massachusetts 02184 (the Tenant). WITNESSETH: In consideration of the mutual covenants and agreements hereinafter set forth, the parties hereto do 'hereby covenant and agree as follows: PREMISES AND IMPROVEMENTS A. Landlord hereby leases exclusively to Tenant, and Tenant hereby takes from Landlord, Units 1, 2 and 3 of a building located at 640 Main Street, Hyannis, MA 02601. B. So long as Tenant is not in default hereunder, Tenant shall have peaceful and quiet use and possession of the premises without hindrance on the part of Landlord. C. This Lease shall at the election of Landlord be subject and subordinate to all mortgages which may now or hereafter affect the real estate of which the premises form a part, and to ail renewals, modifications, consolidations, replacements and extension thereof. In confirmation of such subordination, Tenant agrees at the request of Landlord from time to time to enter into a subordination agreement with any holder of any such mortgage which shall bind and benefit the respective parties and their successors. D. Tenant is given the right of non-exclusive use, in common with others entitled thereto, of the sidewalks, parking area and loading area at the building. These common facilities shall at all times be subject to the exclusive control and management of the Landlord, which shall have the right to establish, modify and enforce reasonable rules and regulations with respect to the same. Tenant shall be responsible for removal of snow and ice from the sidewalks used to access the leased premises. Page I of l 1 TERM The term of this Lease shall be five (5) years, commencing at 12:00 Alva on March 1, 2013, and ending on February 28, 2018. If Tenant has not been in default hereunder, it shall have the option to extend the term of this Lease for two consecutive 5-year terms, Tenant may exercise each option by giving Landlord written notice thereof no less than 60 days before the expiration of the original and the first extension terms, respectively. BASE RENT AND RENTS PAYABLE Tenant covenants and agrees to pay to Landlord as base rental for the premises, in equal and consecutive monthly installments, on the first day of each month commencing March 1, 2013, the sum of $3,000.00 per month through and including February 1, 2014, then the sum of $3,200.00 per month through and including February 1, 2015, and then the sum of $3,500 per month through and including February 1, 2018. Landlord acknowledges that Tenant has paid $3,500.00 as a security deposit for Tenant's full and faithful performance of this Lease. An amount equal to said security deposit shall be returned to Tenant upon the termination of this Lease, subject to Tenant's satisfactory compliance with this Lease, less any amounts expended by Landlord pursuant to the terms of this Lease. Commencing on March 1, 2018 and on March I of every year thereafter, the annual base rent shall be subject to an adjustment for the following 12 months, consistent with the change in the cost of living as computed and set forth in the Consumer Price Index (CPI) for the City of Boston for all Urban Consumers published by the Bureau of Labor Statistics of the United States Department of!Labor for the next previous year. ADDITIONAL RENT As additional rent for the premises during the term, Tenant shall pay or reimburse to Landlord upon demand therefore an amount equal to 22% of all municipal real estate taxes, assessments and betterments assessed against the building at any time and being an encumbrance during the term of this Lease. Tenant shall also pay all municipal sewer rental charges for the leased premises as well as all Hyannis Main Street BID fees assessed against the building. In addition, Tenant shall pay or reimburse to Landlord upon demand therefore an amount equal to 50%Q of all expenditures incurred by Landlord in the maintenance of the common facilities of the property of which the premises Rage 2 of 1 l f are a part, including by way of example, trash removal, secu(ty, parking lot lighting, snow removal, and landscaping. USE OF THE PREMISES Tenant shall use the premises solely as a public restaurant and bar, and for no other purpose. FIXTURES All trade fixtures and trade apparatus (as distinguished from leasehold improvements) owned by Tenant and installed in the premises shall immediately become the property of Landlord and may be removed during the term only with Landlord's written assent, provided Tenant shall not then be in default of any terms or covenants of this Lease, and provided further that Tenant repairs any damage caused by such removal. OPERATION BY TENANT A. In regard to use and occupancy of the premises and common facilities, Tenant will at its expense: a) keep the inside of all glass in the doors and windows of the premises clean; b) replace promptly any cracked or broken glass of the premises with glass of like kind and quality and, to the extent required by Landlord, maintain plate glass insurance coverage; c) maintain the premises in a clean, orderly and sanitary condition and free of insects, rodents, vermin and other pests; d) keep any garbage, trash, rubbish or refuse in rat-proof containers within the interior of the premises until removed; e) have such internal building garbage, trash, rubbish and refuse removed on a daily basis; f) keep all mechanical apparatus free of vibrations and noise which may be transmitted beyond the premises; g) comply with all laws, ordinances, rules and regulations of governmental authorities and all recommendations of the Fire Underwriters Rating Bureau now or hereafter in effect; h) keep all sidewalks, steps and landing (front and rear) free of snow and ice; and i) have the premises treated regularly by a licensed professional to exterminate rodents, vermin and all other pests. Page 3 of I 1 B. In regard to use and occupancy of the premises and use of the common facilities, Tenant will not without the prior written consent of the Landlord: a) place or maintain any merchandise, trash, refuse or other articles in any vestibule or entry of the premises, on the sidewalks or steps adjacent thereto, or elsewhere on the exterior of the premises; b) use or permit the use of any advertising medium, such as, without limitations, loudspeakers, phonographs, public address systems, sound amplifiers, reception or radio or television broadcasts, which in any manner is audible or visible outside the premises; c) permit accumulations of garbage, trash, rubbish or other refuse within or without the premises; d) cause or permit objectionable odors to emanate or be dispelled from the premises; e) solicit business in the common facilities; f) permit the parking of trucks or delivery or other vehicles so as to interfere with the use of any driveway, footwalk or other common facility; g) use the sidewalks or any parking area adjacent to the premises for the sale or display of any merchandise or for any other business, occupation or undertaking; h) use or permit the use of any portion of the premises for any unlawful purpose; i) suffer or commit waste; or j) permit any mechanics liens or other lien to remain of record longer than five days after notice thereof to Tenant. STRUCTURAL REPAIRS Landlord will make all structural repairs to the premises and will keep the roof, foundation and exterior of the premises, except any doors, door frames, windows and glass, in repair, provided Tenant shall give Landlord written notice of the necessity for such repairs, and provided that the damage thereto shall not have been caused by negligence of or willful acts by Tenant, its patrons, visitors, invitees, employees, licensees or contractors, in which event Tenant shall be responsible therefore. Landlord shall be under no liability for repair, maintenance, replacement, alterations or any other action with respect to the premises or any part thereof, or any plumbing, HVAC, electrical, or other mechanical installations therein, or any of Tenant's improvements or fixtures except as may be expressly set out in this Lease. Page 4 of 1 I INTERIOR REPAIRS A. Tenant will keep all non-structural elements and the interior of the premises, together with all electrical, HVAC, plumbing and other mechanical systems and installations therein, including sprinklers, in good order and repair, and will make all replacements from time to time required thereto at its expense; and will surrender the premises at such time as it may vacate the premises in as good condition as when received, excepting depreciation caused by ordinary wear and tear, damage by fire, unavoidable accident or Act of Cod. Tenant will not overload the electrical wiring servicing the premises or within the premises, and will install at its expense any additional electrical wiring which may be required in connection with Tenant's apparatus. B. Any damage sustained by any person caused by mechanical, electrical, HVAC, plumbing or any other equipment or installations whose maintenance and repair is the responsibility of Tenant shall be paid by Tenant, and Tenant shall indemnity and hold Landlord harmless from and against all claims, actions, damages and liability in connection therewith, including, but not limited to, attorneys' and other professional fees, and any other cost which the Landlord might reasonably incur. DAMAGE TO THE PREMISES Tenant will repair, at its expense, any damage to the premises caused by Tenant or its customers, employees, invitees or guests, and upon demand shall reimburse Landlord for the cost of repair of any damage to the premises or the building caused by such persons or by bringing into the premises any property for Tenant's use, or by the installation or removal of such property, regardless of fault or by whom such damage shall be caused, unless caused by Landlord, its agents, employees, or contractors. In default of such repairs by Tenant, at the expiration of three (3) days after delivery of written notice to Tenant, Landlord may make the same and Tenant agrees to pay the cost thereof. ALTERATIONS BY TENANT A. Tenant will not alter the exterior of the premises (including but not limited to signs( and will not make any structural alterations or improvements to the premises or any part thereof without first obtaining Landlords written approval. Tenant agrees that in the absence of written agreement to the contrary, any leasehold improvements made by it shall immediately become the property of Landlord and shall remain upon the premises. Tenant further will not cut or drill into or secure any fixture, apparatus or equipment of any 'kind to any part of the premises without first obtaining Landlord's written consent. Page 5 of 1 I B. Any alterations, renovations, improvements, and other installations to be made in or on the premises, including, but not limited to, electricay, plumbing and mechanical installations, shall not be performed until plans and specifications therefore have been submitted to Landlord and Landlord has approved the some in writing. SIGNS AND ADVERTISING Tenant will not place or suffer to be placed or maintained any signs, advertising matter or any other thing of any kind, and will not place or maintain any decorating, lettering or advertising matter on the glass of any window or door of the premises without first obtaining Landlord's written approval, and Tenant will maintain such signs, decorations, lettering, advertising matter or other thing as may be approved in good condition and repair at all times. UTILITIES AND SERVICES Tenant shall maintain in its name and pay for all utilities and services such as gas, oil, telephone, television, electricity, air conditioning, water, and the like, serving the premises. Tenant will also pay, or reimburse Landlord for, any such expenses or utilities provided to the leased premises that are not separately metered, hereby indemnifying Landlord against all such expenses and costs. INSURANCE A. Tenant will keep in force at its expense as long as this Lease remains in effect and during such other time as Tenant occupies the premises or any part thereof: i) general public liability insurance in companies and in form acceptable to Landlord with minimum limits of One Million ($1,000,000,00) Dollars on account of bodily injuries to or death of one person, and One Million($1,000,000.00) Dollars on account of bodily injuries to or death of more than one person as the result of any one accident or disaster; ii) property damage with minimum limits of Five Hundred Thousand ($500,000.00) Dollars; and iii) fire and extended coverage insurance on Tenant's personal property including inventory, floor coverings, furniture and other property removable by Tenant. Page 6 of D l B. Tenant will deposit the policy or policies of such insurance or certificates thereof with Landlord, which policies shall have Landlord and its designee as additional named insureds, and shall also contain a provision stating that such policy or policies shall not be canceled except after ten j 10) days written notice to Landlord. If Tenant shall not comply with its covenants made in this section, Landlord may cause insurance as aforesaid to be issued: and in such event Tenant agrees to pay, as additional rent, the premium for such insurance upon Landlord's demand. C. Also, as additional rent, Tenant shall upon demand pay or reimburse Landlord for all premiums incurred by Landlord for all insurance coverage which Landlord shall elect or be required to place during the term, including public liability, property damage, fire and extended coverage, covering the leased premises. INDEMNITY A. Tenant indemnifies Landlord and saves it harmless from and against any and all claims, actions, damages, liability and expense, including attorney's and other professional fees, in connection with loss of life, personal injury and/or damage to property arising from or out of the occupancy or use by Tenant of the premises or the building occasioned wholly or in part by any act or omission of Tenant, its agents, licensees, invitees, customers, guests, contractors or employees. B. Landlord agrees to indemnify and save harmless Tenant from and against all claims of whatever nature arising from any act, omission or negligence of the Landlord, or Landlord's contractors, licensees, agents, servants or employees, or arising from any accident, injury or damage whatsoever caused to any person or to the property of any person occurring during the term hereof within the demised premises where such accident, damage or injury results from an act or omission on the part of Landlord or Landlord's agents or employees. FIRE AND OTHER CASUALTY A. If the remises or the building shall be damaged b fire the 'p 9 g Y elements, accident or other casualty, but the premises are not thereby rendered untenantable in whole or in part, Landlord shall promptly at its expense cause such damage to be repaired, without abatement of rent. If, as the result of casualty, the premises are rendered untenantable in part, subject to unavoidable delays due to labor disputes, Acts of God or the public enemy, governmental regulations or controls, or other conditions or causes beyond its reasonable control, Landlord shall at its expense cause such damage to be Page 7 of l 1 repaired within six (6) months of the date the damage occurred, and the rental and other charges shall be abated proportionately as to the portion of the premises rendered untenantable from the date of such casualty until the premises or portions thereof are rendered tenantable. If, as the result of casualty, the premises are rendered wholly untenantable, subject to the provisions listed below, Landlord shall at its expense cause such damage to be repaired and the rental and other charges shall be abated from the date of such casualty until the premises, or any portion thereof, have been rendered tenantable, in which case the proportionate abatement in the rental and other charges shall be made as determined above for partial damage. B. In no event shall Landlord be liable for interruption to Tenant's business or for damage to or replacement or repair of Tenant's personal property, including inventory, trade fixtures, floor coverings, furniture and other property removable by Tenant under the provisions of this 'Lease or to Tenant's leasehold improvements. C. If the premises are (a) rendered wholly untenantable, or (b) damaged as a result of any cause which is not covered 'by Landlord's,insurance, or if the building is damaged to the extent of fifty (50%) percent or more of the useable floor area, whether or not the premises are damaged, then in any such event, Landlord may terminate this Lease by giving to Tenant notice within ninety )90) days after the occurrence of such event. Rental and other charges shall be adjusted as of the date of such cancellation. INSPECTION BY LANDLORD Tenant will permit Landlord, its agents, employees and contractors, to enter all parts of the premises during Tenant's business hours to inspect the some and to enforce or carry out any provisions of this lease. In addition, 'Landlord and its agents may enter and show the premises to prospective purchasers and tenants during the last 90 days of the term hereof. Further, Landlord may enter and take appropriate protective action at any time during an emergency. NO ASSIGNMENT OR SUBLETTING A. Tenant will not assign this Lease, in whole or in part, nor sublet all or any part of the premises without first obtaining in each instance the written consent of Landlord. B. No assignment, subletting or licensing shall affect or reduce the liability of Tenant for the performance of the terms and provisions hereof during the term. RAINKRWPTCY If any sale of Tenant's interest in the premises created by this Lease shall be made under execution or similar legal process, or if a voluntary or involuntary petition or answer proposing the adjudication of Tenant as a bankrupt or the reorganization of Tenant pursuant to the Federal Bankruptcy Act or any similar Federal or State proceeding is filed against Tenant and such petition or answer is not discharged or denied within thirty (30) days of the date of the filing thereof, or if Tenant shall be adjudicated a bankrupt or insolvent and such adjudication is not vacated within ten (10) days, or if a receiver or trustee shall be appointed for its business or property and such appointment shall not be vacated within ten (10) days, or if a corporate reorganization of Tenant or any arrangement with its creditors shall !be approved by a court under the Federal Bankruptcy Act or any state bankruptcy law, or if Tenant shall make an assignment for the benefit of creditors, or if in any other manner Tenant's interest under this Lease shall pass to another by operation of law, Tenant shall be deemed to 'have breached a material covenant of this Lease and Landlord may re-enter the premises and/or declare this Lease and the tenancy hereby created terminated_ Notwithstanding such termination, Tenant shall remain liable for all rent and damages which may be due at the time of such termination and shall be liable for the damages set forth herein. DEFAULT: REMEDIES A. If the Tenant shall fail to pay any rental or other charges required to be paid by Tenant thereunder or shall fail to perform or comply with any of the other terms, covenants, agreements or conditions of this Lease, or if Tenant vacates or abandons the premises, such act or omission shall constitute a default under this Lease. In the event of a default by Tenant, Landlord may give written notice to Tenant, and if Tenant thereafter fails to cure any such default involving the payment of money within five (5) days after the date on which such notice was given, or if the default involves some act or omission other than the payment of money which cannot be cured within five (5) days after the date on which such notice was given and the cure thereof is not undertaken promptly wnthin such period and thereafter expeditiously completed, then in any such event, upon Landlord at its option serving a written notice of cancellation upon Tenant, specifying the nature of said default and the date of such cancellation, this Lease and term shall terminate and come to an end on the date specified in such notice of cancellation, and Tenant shall quit and surrender the premises to Landlord as if the term hereunder ended by the expiration of the time fixed herein, but Tenant shall remain liable as hereinafter provided. Page 9 of I B. Upon any such expiration or termination of this Lease, Tenant shall quit and peacefully surrender the premises to Landlord, and (Landlord, upon or at any such expiration or termination, may without further notice enter upon and re-enter the premises and possess and repossess itself thereof by summary proceedings, ejectment or otherwise, and may dispossess Tenant and remove Tenant and all other persons and property from the premises (and such property may be removed and stored in a public warehouse or elsewhere at the cost of and for the account of Tenant without resort to legal process and without being deemed guilty of trespass or becoming liable for any loss or damage which may be occasioned thereby) and may have, hold and enjoy the premises and the right to receive all rental income of and from the same. C. Tenant, for and on behalf of itself and all persons claiming through or under Tenant, also waives any and all right of redemption or re-entry or repossession in case Tenant shall be dispossessed by a judgment or by warrant of any court or judge or in case of re-entry or repossession or dispossession by Landlord or in case of any expiration or termination of this Lease. The terms "enter', "re-enter', "entry", "re-entry", "repossession', "dispossession", "possess", and "repossess", as used in this Lease are not restricted to their technical legal meanings. D. No failure by Landlord to insist upon the strict performance of any agreement, term, covenant or condition hereof or to exercise any right or remedy consequent upon a breach thereof, and no acceptance of full or partial rent during the continuance of any such breach, shall constitute a waiver of any such breach or of any such agreement, term, covenant or condition. No agreement, term, covenant or condition hereof to be performed or complied with by Tenant, and no breach thereof, shall be waived, altered or modified except by a written instrument executed by Landlord. No waiver of any breach shall affect or alter this Lease, but each and every agreement, term, covenant and condition hereof shall continue in full force and effect with respect to any other then existing or subsequent breach thereof. E. Should Tenant at any time fail to make any payment to Landlord or any other person under this Lease, Landlord may withdraw such amount from the security deposit. RECORDING Each party agrees on request of the other to execute a Notice of Lease in recordable form satisfactory to Landlord's attorney. In no event shall such Notice set forth the rental or other charges payable by Tenant hereunder. Page 10-of1] SUCCESSORS AND ASSIGNS This Lease and the covenants and conditions herein contained shall inure to the benefit of and be binding upon Landlord, its successors and assigns, and shall be binding upon Tenant, its successors and assigns, and shall inure to the benefit of Tenant and only such assigns of Tenant to whom the assignment of Tenant has been consented to in writing by Landlord, as herein provided. In witness whereof, the said parties hereunto set their hands and seals this 1 st day of March, 2013. 640 MAIN STREET REALTY TRUST, COUNTRY SALOON PRODUCTS, INC. by, b f! r K LLY A. ORSATTO, Trustee DAVID KEVILLE, President COMMONWEALTH OF MASSACHUSETTS Barnstable, ss. On this 1 st day of March, 2013, before me, the undersigned notary public, personally appeared COUNTRY SALOON PRODUCTS, INC. by DAVID KEVILLE, and proved to me through satisfactory evidence of identification, which was a Massachusetts driver's liceQ ��, person whose name is signed on the preceding or attached �., s acknowled to me that he/she signed it voluntarily for itspe pQ' t ;IA>rp �, • ( 1f�.v'cT44d, Notary Public 'i�8q"'EAtTMaF ,,..• My Clk � mission Expires: L1.el, q COMMONWEALTH OF MASSACHUSETfS Barnstable, ss. On this 151 day of March, 2013, before me, the undersigned notary public, personally appeared 640 MAIN STREET REALTY TRUST, by KELLY A. BORSATTO and proved to me through satisfactory evidence of identification, which was a Massachusetts driver's license, to be the person whose name is signed on the preceding or attached docu mq ut, and acknowledge me that she signed it voluntarily for its stated pu ,GeROC BYO, , �► : �► = Crai . Roc ood, Notary Public 3 My ommission Expires: 11/7/19 '•a�q oxwe� Sg,, An,Sgp�pfl'ttg`„�v, Page I 1 of 1 i YOU WISH TO OPEN A BUSINESS? For Your Information: Business Certificates cost $40.00 for 4 years. A Business Certificate ONLY REGISTERS YOUR NAME in the Town (WHICH YOU MUST DO according to M.G.L. - it does not give you permission to operate). You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1st FI., 367 Main St., Hyannis, MA 02601(Town Hall) and get the Business Certificate that is required by law. DATE Fill in please: _ APPLICANT'S YOUR NAME/CORPORATE NAMEC�-�k- ������ C cc BUSINESS TYPE: BUSINESS YOUR HOME ADDRESS: /4 SS sYt�L k- t O TELEPHONE # Home Telephone Number NAME OF NEW BUSINESS OR EIN 7 l Have you been°given approval fro the;buil jng divisions YES NO ADDRESS OF BUSIN,ES$ �u mat5 < MAP/PARCEL NUMSER I y� f© 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'S O _FICE This individual has been i f' ed of anyt mit requirements that pertain to this type of business. Authorize Signature" COMMENTS: 2. BOARD OF HEALTH This individual has been informed of the permit requirements that pertain to this type of business. Authorized Signature"* COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature*" COMMENTS: YOU WISH TO OPEN A BUSINESS? For Your Information: Business Certificates cost $40.00 for 4 years. A Business Certificate ONLY REGISTERS YOUR NAME in the Town (WHICH YOU MUST DO according to M.G.L. - it does not give you permission to operate). You must'first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1st Fl., 367 Main St., Hyannis, MA 02601(Town Hall) and get the Business Certificate that is required bylaw. DATE Fill in please: APPLICANT'S YOUR NAME/CORPORATE NAME J6 , ( &tA5,�C—BUSINESS TYPE: Ca44-u&eA Nf i BUSINESS YOUR HOME ADDRESS: y�j5 l CY1 1 5��S- `�7� ICJ c5b S I -,�5�l- c7 c o 1 Li- TELEPHONE # Home Telephone Number NAMEOF NEW;BUSINESS �� t`(1 S$N OR EIN �? cTi Have you been gwen approval from he building di ison� YES NO ADDRESS OF:;BUSINESS- �I�I 0. " iA a 1 MAP/PARCEL•NUMBER3 . When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St.-(corner of Yarmouth Rd. & Main Street),to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING CO MISSIO ER'S OFFICE This indivi ual hTAthorized en-info d a y per it requirements that pertain to this type of business. �gnatur COMMENTS: M! `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: ,r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map U Parcels Application #o?C� �O o 7 Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannisy�N�,�, Firms �,�� L r=t.r� �- Project Street Address eYl) Met i rl S f u nd 3 Village wwi 4, 0 40 Owner i Address X Telephone 6-OF ®1 V 9 Permit Request 3t r ®Q r WeOl n!�r Qe e�vA CxiS1�i'hu �o ®m /tone ge.cel,i'Pa Ix,all Square feet: 1 st floor: existing 0-1 0 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: E(Yes ❑ No Fireplaces: Existing New Existing wood/coal stove Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑-newc5ize_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: �^ Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ o Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use W APPLICANT INFORMATION /(BUILDER OR HOMEOWNER) Name 0/4'4 NTelephone Number a Address 4sd lou v: An u nd k Plicense# S 0 -7/6 2 U �®✓t l T �'� C�1� � CZ U4 Home Improvement Contractor# Email U i d,-10 Cz Hn r 0 4 &j/ Worker's Compensation # t ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO How&k G, 19 U o'L IQ SIGNATURE DATE 12,62 2- d FOR OFFICIAL USE ONLY APPLICATION# , DATE ISSUED 'MAP/PARCEL NO. <� ADDRESS VILLAGE OWNER i DATE OF INSPECTION: FOUNDATION i3 s FRAME INSULATION t FIREPLACE ' ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL k GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. i THE � 1MAM ,� Town of Barnstable �fD MA'S I► Regulatory Services Richard V.Scali,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 �Y ProP a Owner Must Complete and Sign This Section. If Using A Builder fl( I , as Owner of the subject property hereby authorize A FK 9Ui ld"vt a oEJ 1?em to&1t' t y to act on my behalf,. in all matters relative to work authorized by this building permit application for: (Address of Job) Signature oq Owner ' Date 1.4-0 t�A A - ` Prl'nt.Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. Q:\WPHLESTORMS\building permit forms\EXPRESS.doc Revised 040215 ?lie Commornvealtli of MMirssadinsetts D-eparkrrevito, rndushialAccide dg fire o,f lmwstfgadons y 600 Washurgton 19freet Barston,-41A a2111 k►�rvt�:atars�grrv�iiiri Workers' Cumpensaf GnInsurance davit:BmldersJC,untractnrsJMlect icians/Pkmhers �APPEcant InfGnuaf an Please Print f.eaib lr ame(BUSiUff F M3iZa iM d) 11 /�3 " /J Ui /,o 4 c,,2 City,/State Zip: dil.a-,t i a vo Phone Are you an employer?Checkthe a propriate bo=: Type of project(required).: 1.2'I am a employer with. 5 4. ❑I am a general confractor and I 6. ❑N. construe-tion employees(full andfor part-time)-* _ have hired:he sub-contractors 2.❑ I am a sole proprietor orpartner- listed on.the attached sheet, 7. ❑Remodeling slid and have no employees. ni ese sub-contractors have g_ ❑Demolition working forme in any capacity employees andhaire workers' [No workers'comp.insurance comp.insurauml - 9. ❑Building addition required-] 5- We are a-corporation and its 10-❑Electrical repaim or additions 3.❑ I am a homeowner doing all work officers have-exercised their 1 L❑Plumbing repairs or additions sel€ o workers' right of exemption per MGL �` � 'comF- 12.❑Roofrepairs im-ura cerequired-]o c.152,§1(4h and we have no employees.[No workers' 13-0.Other comp_insurance required-] *Any applicasrt&at checks box Fl nmst alsa fill out the sectizonb9 w--Bowing dbe r wa&eze campensatiau policy iaformadmL #S.ameovnmrs who submit rhis.affidaru nuffrating they are doing all wo*sad them hire outside contractors amst submit a new affidavit indicKdae sacs FCazrtractors*xt check this box roust attached an additional sheet showing the mane of the sub-cantractm3 and state whether or not those entities have employees.Ifthesub-coatractarshaceemplarpe,-%dLeynnrstpmvidetheir workers'camp.policy number- I am an ellrp1gvr Mat is prEniding irarkers congwisadan iiririranca jbr my emplay-ees Rel"ow is fire policy acid job site inforrnat om Insurance Company'Name: SS 2Y , TjmSU i-6V /g r P 'Ge ra y Pobcy;a,or self-ius.Lic. K/c c s'Ju—S—o/ 2 S i 3—z o lS-14 apiratiosDate: I G Job Sate Address: J!�yQ WI Q /a � � /1N a ffA/'s City/State/Zip: W y t;c�t n,' - 1104 016'f l Attach a copy of the workers'compensationp.olicy declaration page(showing the policy number and erpi ation date). Failure to secure coverage as required.under Section 25A of MGL c 1572 can lead to the imposition of criminal penalties of a fine up to$1,54a as andfor one-year imprisonment,as well as civil penalises in 1he farm of a STOP WORK ORDER and a fine of up to$250-00 a day against the violator. Be adidsed&.at a copy of this statement may.be forwarded to the Office of Investigations of the DIA€or insurance coverage verification.. I rho tierei�y certFfjr ri er Tie s arrd�perraffies a. Ire j ry .f prof'~ flratthe in atatBvr> itfed cbmv it Grrrg and correct t4, Suture= Date: 2 Z J Phone ik S 29-2,?y^ E91'3 Offirf d use anTy. Da not write in tfiis area,to be completed by city ortoorn afficiut City or Town: PermitUcense;g Issuing Anfltorfty(tdrde one): L Board of Maltfr 2.Building Department 3.Qtyffown Clerk 4 Electrical Inspector 5.Plumbing Inspector (.Other Contact Person: Phone#: laformation and Instructions Mas&a Irme#fs GehPaal Laws chapter 152 requires all employees Yo provide workers'compensation far their employees. pUrMI=t7-tD this Vie,an errmployMff is defined as-"_.every Person m the service of another under any contract of hire, express or implied oral or wifttmf An Moyer is defined as"an individual,pa ta=bip,association,corporation or other Legal a y,or any two or more of the foregoing engaged in a Joint enterprise,and including the Legal represenfafrves of a deceased employer,or the receiver or trustee of as individual,parhoersbsp,association or other legal entity,employing employees- However the owner of a.dwelling house having not more than three apartments and who resides therein,or the occupant of the - dwdIi g house of another who employs persaus to do mamma nce,construction or repair work.on such dweIEng house or on.the grounds or building app ►hereto shall notbecanse of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also sues that"every state or local Iicemdag agency shall withhold$he issuance or renewal of a Bcen a or permit to operate a business or to construct buildings in the commonwealflih for any applicant who has not produced acceptable evidence of compliance with the insurance.coverage required_ Additionally,MGI,chapter 152,§2SC(7)stains"Neither the commoavecalth nor aBy ofids political subdivisions shall enter into any contract for the performance 0fpublic work until acceptable evidence of compliance with the insM-aace.. re e�S of thiht s caper have been presented to the contracting aztho " �m , Applicants Please fia out the workers' compensation affidavit completely,by chwk g the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s), addresss(es)and phone numbers) alongwith their certdzcate(s)of ync�=. Limited Liability Companies(LLC)or Limited Liability Partnerships.(LLP)with no employees other than the merubers or partners,are not required to taffy workers' compensation msozance- If an LLC or LLP does have employees,a policy is required. Be advised that this affidaQrt may be submittr-d to the Department of Industrial Accidents for confirmation of insurance coverage Also be sure to sign and dateitidre affidavit. The affidavit should be retomed to the city or town that the application for the permit or license is being requested,not the Department of Li±nstiial Accidents, Should you have any questions regarding the law or if you are required to obtain a workers' compensation.policy,pinse call the Department at the nmnber listed below. Self-insurt d companies should enter their self-i sora„ce license number on the appropriate line. City or Town Officials Please be sure that the affidavit is comp Iete andprhted 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 coact you regarding the aPPv-cant- Please be sure to fill in the peunit/Iicrose number which will be used as a reference number. In addition,an applicant that must subm dt multiple penmit/Hcros5 applications in any given year,need only submit one affidavit indicating c=nt cc tt 0C3t1Cn II Or policy inl�irrnathon.(if necessary)and under lob Sue Address the applicant sho�d route all I ( _ 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 fbini ermits or licenses Anew affidavit must be filled Olt each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial vent urc (Le. 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 ut advance for your cooperation and should you have any questions, please do not hesitate to give us a caI L tel hone and fax number; The Department's address, ep - T�e wt3r of 11aachtts ' Depmtamt of lidustcial Accidents �c�r��t•�e�g�tiaA� - 604 woman Stcf�e_-t Bwtoaa,MA 0�11I Tf,-1..4 617727-49 0=t 406 or 14W-W M Fagg 617`27 7M Revised 4-24-07 .mass-gavIdia i CERTIFICATE OF LIABILITY INSURANCE 4izo�2 ) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDE . THIE TH CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY E P LICIEE BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTH RM 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,su !act to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer right I to the certificate holder in lieu of such endorsement(s). PAooucERNAME ACT Catherine Murray CSC The Oceanside Insurance Group PHONE (508)398-2282 Fax (308)760-2z 1 LAQ.4o. .catherine@oceaasideinsurance.com PO Box 38 INSURER S AFFORDING COVERAGE AIC P INSURED Hest Dennis MR 02670 INSURERA:Essex Insurance Company ,INSURER B;Associated Em lovers Ins CO A & A Building & Remodeling, Inc.APO Box 9.667 INSURER C$Vaastoa Insurance Co INSURER D: South Dennis MA 02660 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER-CL1531803690 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 THIE CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE rERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE POLICY NUMBER PODY EFF p EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 0,Oa Z COMMERCIAL GENERAL IJABILI7'Y PREMIs s Ea oewnertce $ 0,00 A CLAIMSMADE ®OCCUR DX9495 /9/2015 /9/2016 MED EXP(Any one person) $ 5,00 PERSONAL a ADV INJURY $ ILO 0,00 GENERAL AGGREGATE $ 2,10 0,00 GEN L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,0 DO,00 POLICY PRO- LOC AUTOMOBILE tJAB1UTY COMBINED SINGLE LIMIT ANY AUTO Ea accident) $ ALL OWNED SCHEDULED BODILY INJURY(Perperson) $ AUTOS AUTOS HIRED AUTOS NON-OWNED BODILY INJURY(Per accident) $ AUTOS PeOPERdTY DAMAGE $ $ UMBRELLA UAB OCCUR Fe V10L8100074 C X EXCESS LIAB CLAIMS-MADE EACH OCCURRENCE $ 2,000,001 DED RETENTIONS AGGREGATE $ E WORKERS COMPENSATION $ AND EMPLOYERS'LIABIuTy WC STATU OTH- ANY PROPRJETORIPARTNERlEXECUTIVE Y/N OFFICERIMEMBER EXCLUDED? N/A E.L.EACH ACCIDENT $ 1 O 0 O01 (Mandatory In NH) C-500-5012813-2015A /18/2015 /18/2016 ff yes descnbe under E.L.DISEASE-EA EMPLOYEE $ 1 0 0 0Oi DESCRIPTION OF OPERATIONS below E L.DISEASE-POLICY LIMIT $ 110(0.001 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,rf more apace is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BE FORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEUVERE 3 IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE C Murray CIC/MC ACORD 25(2010105) ©1988-2010 ACORD CORPORATION. All rights rued. INSI19R r?mnmi nm Th"Annan .,no ,e anA t-nn arc ro rl mnleforo arlicftf ar_nan 3 k. Massachusetts-Department of public Safety Board of Building Regulations and Standards Construction Supemim)r License:CS.071M GEORGE M SEL r� 54 LOCUST ST BERItLEY MA 0 ti It 146 t\ Expiration Commissioner 01/2012016 L �e�a.'titau�irrt�c+a+'l�c�'C��i!aauua/irraelts. fliee of Consumer Afairs&Badness Replation License or registration vaild for individal use only ME IMPROdEMEMP CONTRACTOR before,the expiration date. 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