Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0775 MAIN STREET (HYANNIS)
f _ f ._ _ _ _ __ 'i a8 - . A � -. . . ... 30 tF�E ~U °y Application Number..... . ..�.............. .... ......... • snxxsras>A • .a . MASS. m� a�� �� �� Permit Fee.......................................Other Fee........................ i a` 4 �O Total Fee Paid....... . I. ` .J. TOWN OF�ARNS BLE Permit Approval b &'?'� on�p y................................. � .... BUILDING PERMIT Map. .... ` ....................Parcel............................. ............ APPLICATION Section 1 — Owner's Information and Project Location Project Address %/G v11A-fib Village ►AV—iS�AQI G2 Owners Name Owners Legal Address 00 c �- city fJ �' v State _ Zip cal Owners Cell# E-mail Section 2 —Use of Structure Use Group ❑ Commercial Structure over 35,000 cubic feet ❑ Commercial Structure under 35,000 cubic feet ❑ Single/Two Family Dwelling Section 3 -Type of Permit ❑ New Construction ❑ Move/Relocate ❑ Accessory Structure ❑ Change of use ❑ Demo/(entire structure) ❑ Finish Basement ❑ Family/Amnesty ❑ Fire Alarm Rebuild ❑ Deck Apartment © Sprinkler System ❑ Addition ❑ Retaining wall ❑ . Solar renovation ❑ Pool ❑ Insulation Other—Specify. Section 4 - Work Description Last undated: 11/15/2018 ' Application Number................ Section 5—Detail Cost of Proposed Construction Square Footage of Project Age of Structure Dig Safe Number a� # Of Bedrooms Existing Total#Of Bedrooms (proposed) 110 MPH.Wind Zone Compliance Methods❑;MA Checklist ❑ WFCM Checklist ❑ Design I Section 6—Project Specifics • ❑ Wiring ❑ Oil Tank Storage ❑ Smoke Detectors ❑ Plumbing ❑ Gas ❑ Fire Suppression i ❑ Heating System ❑ Masonry Chimney �{ ❑Add/relocate bedroom Water Supply ❑ Public ❑ Private i Sewage Disposal ❑ Municipal ❑ On Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: I am using a crane ❑ Yes ❑ No Section 7—Flood Zone Flood Zone Designation, Within or adjacent to a wetland, coastal bank? Yes ❑ No ❑ Section 8—Zoning Information Zoning District Proposed Use Lot Area Sq. Ft. Total Frontage Percentage of Lot Coverage #of Dwelling Units (on site) Setbacks Front Yard Required . Proposed 1.y Rear Yard Required Proposed Side Yard Required Proposed Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No Last updated: 11/15/2018 Town of Barnstable Building Post his Card So That it.V Uis�bleFrom the Streetx ApprovedkPlans Mustbe ftetamed an Job and this Card Must be Kept 4 b' Post39. ed Until`'Final Inspection Has Been Made ' ;�Y _ ° Whe�ea C ertificate=of OCcu anc�-is Re used "such Bu�ldm °shall Not bye Occupied untila Filial Inspection hasb�een made Permit Permit No. B-19-1156 Applicant Name: RAYMOND WYATT Approvals Date Issued: 05/20/2019 Current Use: Structure Permit Type: Building-Alteration INTERIOR Work Only- Expiration Date: 11/20/2019 Foundation: Commercial Map/Lot: 290-099 Zoning District: SPLIT Sheathing: Location: 775 MAIN STREET(HYANNIS),HYANNIS Contractor,Name:°,RAYMOND WYATT Framing: 1 Owner on Record: ANK REALTY LLC Contractor License:- CS-083904 2 Address: 775 MAIN STREET Y Est Project Cost: $150,000.00 Chimney: HYANNIS, MA 02601 Permit Fee: . $ 1,465.00 Description: COMPLETE RENOVATION;NEW CEILINGS,WALLS, FLOORING, Insulation: Fee Paid $1,465.00 v , - INTERIOR FINISHES i , Final: Date: 5/20/2019 * �tg Project Review Req: �. Y a um / PI bing/Gas ew "> Rough Plumbing: y Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after;issuance. All work authorized by this permit shall conform to the approved application and the'approved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by la,Ws-and codes. This-permit shall be displayed in a location clearly visible from access streett or road and shall be maintained open for public_inspection for the entire duration of the Final Gas: work until the completion of the same. , Electrical The Certificate of Occupancy will not be issued until all applicable signatures'by the Building and,Fire Officials are provided on this.permit. Minimum of Five Call Inspections Required for All Construction Work.:• ",z Service: 1.Foundation or Footing Rough: 2.Sheathing Inspection , , g 3.All fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Final: 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "P ntracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Building plans are to be available on site Fire Department Final: <Z All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT R Michael J. Burke DBA Burke Engineering Services 299 Salisbury Street a Worcester MA 01609 Phone# (508) 450 3461 ` o Mikeburke7@aol.com z o D, X May 20, 2019 Mr. Robert Mckechinie Fr+ Building Inspector Tow of Barnstable 200 Main Street : Hyannis Ma 02661 Worcester Ma Re: 776 Main Street, Hyannis Ma Existing Building Checklist IEBC 2.015 WI MA Amendments Dear Mr. Mckechine, I performed an inspection on the above property on May 18, 2019 to determine that the proposed alterations would be in conformance with the provisions of the IBC, iEBC and CMR 780 the Massachusetts State Building Code. The existing building is a concrete block building with a truss roof measuring 74' by 46' 6".. The alteration will affect the interior only (with the exception of installing,:a handicap' ramp) and does not entail any changes to the structural systems or loading patterns building shell or the egress capacity. There are no known hazardous material s:.on site. The occupancy load is 57 and the maximum travel distance is less than 50 feet. Compliance method; The proposed alterations are evaluated under work,area level 1(section. 03).Level 1 compliance includes.chapter 7 of the IEBC', There is no change of use or occupancy classification and the work will comply with the provisions of Chapter7 alterations level.2. Chapter 7 Alterations — level 1 Section 702 Building Elements and Materials— Complies Section 703 Fire Protection —Complies Section 704 Means of egress - Complies Section :705 Accessibility-Complies Section 706 Re roofing Does not apply Section 707 Structural — Does not apply Section 708 Energy Conservation—Complies Page 2 The following codes will be adhered to: Plumbing will conform to 248 CMR Massachusetts Plumbing Code Fire Prevention 527 CMR Fire Prevention Regulations Electrical work will conform to 527 CMR 12.00 Massachusetts Electrical Mechanical will conform to the 2009 International Mechanical Code Accessibility will conform to 521 CMR Massachusetts Architectural Access Board Regulations. Scope of Work Remove two nonbearing walls Replace new wiring for cooler Check fire, smoke and:CO2,detectors Install new insulation, sheet rock, point, paint and finish Install new bathroom new interior trim Install Handicap ramp Three means of egress are providedand exit signs and emergency lights will be provided in accordance with the applicable,codes. If additional information is required please feel free to Contact my office. Yo y ' .... Mass. Corporations, external master page Page 1 of 2 fZ Corporations Division Business Entity Summary ID Number: 001338660 Request certificate New sea Summary for: EXPRESS MULTISERVICES LLC The exact name of the Domestic Limited Liability Company (LLC): EXPRESS MULTISERVICES LLC Entity type: Domestic Limited Liability Company (LLC) Identification Number: 001338660 Date of Organization in Massachusetts: 07-26-2018 Last date certain: The location or address where the records are maintained (A PO box is not a valid location or address): Address: 10 SPINWALL RD City or town, State, Zip code, WORCESTER, MA 01605 USA Country: The name and address of the Resident Agent: Name: PANY PHETDALINH Address: 10 ASPINWALL RD. City or town, State, Zip code, WORCESTER, MA 01605 USA Country: The name and business address of each Manager: Title Individual name Address MANAGER PANY PHETDALINH 10 SPINWALL RD WORCESTER, MA 01605 USA In addition to the manager(s), the name and business address of the person(s) authorized to execute documents to be filed with the Corporations Division: Title Individual name Address SOC SIGNATORY PANY PHETDALINH 10 SPINWALL RD WORCESTER, MA 01605 USA The name and business address of the person(s) authorized to execute, acknowledge, deliver, and record any recordable instrument purporting to affect an interest in real property: http://corp.sec.state.ma.us/CorpWeb/CorpSearch/CorpSummary.aspx?FEIN=0013 3 8660&... 4/18/2019 Mass. Corporations, external master page Page 2 of 2 Title Individual name Address REAL PROPERTY PANY PHETDALINH 10 SPINWALL RD WORCESTER, MA 01605 USA ❑ ❑Confidential ❑Merger ❑ Consent Data Allowed Manufacturing View filings for this business entity: ALL FILINGS Annual Report ^ Annual Report - Professional Articles of Entity Conversion Certificate of Amendment v' $View filings Comments or notes associated with this business entity: New search s http://corp.sec.state.ma.us/CorpWeb/CorpSearch/CorpSummary.aspx?FEIN=00 13 3 8660&... 4/18/2019 Mass. Corporations, external master page Page 1 of 2 • • • r ��s Jv`"3' c. Corporations -Division Business Entity Summary _....._.----------r_ ..... ___...._. ID Number: 001312286 Request c_e_"r't_"i_f'_ I New search Summary for: ANK REALTY LLC The exact name of the Domestic Limited Liability Company (LLC): ANK REALTY LLC Entity type: Domestic Limited Liability Company (LLC) Identification Number: 001312286 Date of Organization in Massachusetts: 02-09-2018 Last date certain: The location or address where the records are maintained (A PO box is not a valid location or address): Address: 775 MAIN ST City or town, State, Zip code, HYANNIS, MA 02601 USA Country: The name and address of the Resident Agent: Name: NILESH PATEL Address: 28 VILLAGE DRIVE City or town, State, Zip code, QUINCY, MA 02169 USA Country: The name and business address of each Manager: Title Individual name Address MANAGER NAVIN PATEL 10 JORDYN LANE ANDOVER, MA 01810 USA MANAGER NILESH PATEL 28 VILLAGE DRIVE QUINCY, MA 02169 USA MANAGER KAMLESHBHAI PATEL 2741 WHITE MOUNTAIN HWY, PO BOX 2125 NORTH CONWAY, NH 03860 USA In addition to the menager(s), the name and business address of the person(s) authorized to execute documents to be filed with the Corporations Division: Title Individual name Address SOC SIGNATORY NILESH PATEL 28 VILLAGE DRIVE QUINCY, MA 02169 USA The name and business address of the person(s) authorized to execute, acknowledge, deliver, and record any recordable instrument purporting to affect an interest in real property: http://corp.sec.state.ma.us/CorpWeb/CorpSearch/CorpSummary.aspx?FEIN=001312286&... 4/18/2019 Mass. Corporations, external master page Page 2 of 2 Title Individual name Address REAL PROPERTY NILESH PATEL 28 VILLAGE DRIVE QUINCY, MA 02169 USA ❑ ❑Confidential ❑Merger ❑ Consent Data Allowed Manufacturing View filings for this business entity: ALL FILINGS Annual Report > Annual Report - Professional Articles of Entity Conversion Certificate of Amendment v' View filings Comments or notes associated with this business entity: [New search 1 http://corp.sec.state.ma.us/CorpWeb/CorpSearch/CorpSummary.'aspx?FEIN=001312286&... 4/18/2019 Town of Barnstable' ° THE T0� Building Department Services Brian Florence,CBO s BARNSTABLE, • ^ 90 MA ' Building Commissioner 6�a°,0 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Construction Control Package Site Address: ,c/ S Arch itect/Engineer. /l�✓1� `. V, V���� - Name: Address: - Telephone: - Email: Contractor: Name: Address: Telephone: Email: Owner. Name: Address: Quincy , AIA 0Q161 Telephone: 'S Email: I - II Town of Barnstable IHE,O� Building Department Services Brian Florence,CBO a„a,,,sro Building Commissioner r, 9g, t�s' ,,�' 200 Main Street, Hyannis,MA 02601 gar A www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Massachusetts Existina Buildina Code Analysis Based on 2016 IEBC wl MA amendments Site Address: 7 �07 � Map: Parcel: Village: Applicant name: �"� P7v��i �9rvr'�e5 Phone: E-mail: Skca Risk Category: Use Group: Occupancy Limit: I.A.W. 780 CMR 2015 IEBC 301.1 -The permit application shall comply with one of the following methods: Choose One: ® Prescriptive method ❑ Work area method O Performance method Construction Control O Yes ONo If Yes Documents shall be in accordance with 780CMR 34.00 MA Amendment to 2015 IEBC.The building Owner shall cause the existing building (or portion thereof)to be investigated and evaluated.The investigation and evaluation shall include at least: structural,means of egress,fire protection,energy conservation, lighting,hazardous materials, accessibility, and ventilation for the space under consideration and,where necessary, the entire building or structure and foundation.The results of the investigation and evaluation shall be submitted in written report form. USE FILL IN FORM OR ATTACH DOCUMENTS AS NEEDED FOR EACH EVALUATION CATEGORY BE LOW: Structural,,,,,,,,,,,,,,,,,,,,, , woe /�A// Means of egress,,,,,,,,,,,: Fire protection.,____, Energy conservation Lighting....................... � // &�� /G�✓%f Hazardous Material..... > � Accessibility Ventilation w Description of Proposed work: x1P*1e�,o1,e Initial Construction Control Document To be submitted with the building permit application by a Registered Design Professional for work per the ninth edition of the Massachusetts State Building Code, 780 CAR, Section 107 Project Title: Date: Yot/4 Property Address: -7� Project: Check(x)one or both as applicable: New construction /Existing Construction Project description: I MA Regis adr2-L"Zber: Expiration date:���d� am a registered design professional,and I have prepared or directly supervised the preparation of all design plans,computations and specifications concerning': Architectural Structural Mechanical Fire Protection Electrical i//Other. l 1 dl- ;� for the above named project and that to the best of my knowledge, information, and belief such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Code, (780 CMR), and accepted engineering practices for the proposed project. I understand and agree that I (or my designee)shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to: , 1. Review, for conformance to this code and the design concept,-shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Perform the duties for registered design professionals in 780 CMR Chapter 17,as applicable. 3. Be present at intervals appropriate to the stage of construction.to become generally,familiar with the progress and quality of the work and to determine if the work is being performed in a manner consistent with the approved construction documents and this code. Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107. When required by the building official,I shall submit field/progress reports(see item 3.)together with pertinent comments,in a form acceptable.to the bu' ' qF Ai4Ss Upon completion of the work,I shall g official a'Final Construction Control Document'. F J. � y Enter in the space to the right a we BURKEE electronic signature and seal: No.23374 0 Gt5AL �S/CNAt- Phone number: Email: Building Official Use Only Building Official Name: Permit No.: Date. Note L Indicate with an'x'project design plans,computations and specifications that you prepared or directly supervised.If'other'is chosen,provide a description. Version 01 01 2018 ----------------- t Construction Control Progress Checklist = To be submitted at completion of required site reviews for construction progress per the ninth edition of the Massachusetts State Building Code, 780 CAIR,Section 107 Project Title: Date: Permit No. Property Address: H"`A--' 15 I, MA Registration Number: Expiration date: am a registered design professional and I or my designee have observed the following work, and to the best of my knowledge, information, and belief the construction work indicated below has been performed in a manner consistent with the approved plans and specifications: _.,. n'fiirPo `ons 1'lases ofConsiiiiction` = `entatio or 'd"Docaai ., to_.be= med`. the ro rIate. e 'teied Best' rofessional'oris er:cCesi ee or7V1 :L e`.112`:§BfR contracEor Site Review and Documentation 'X::,; Site Review and Documentation =X- Soil condition and analysis ' Ene rgy Efficiency Requirements Footing and Foundation,including Reinforcement and Fire Alarm Installation Foundation attachment Concrete Floor and Under Floor '. ::i Fire Su ression Installation Lowest Floor Flood Elevation :;'r" Field Re ortss Structural Frame-wall/floor/roof Carbon Monoxide Detection Systems =+! Lath and Plaster/Gypsum Seismic reinforcement Smoke Control Systems(Special inspection per Sections 909.3 Fire Resistant Wall/Partitions framing !_ and 90918.8 Fire Resistant Wall Partitions finish attachments '..... Smoke and Heat Vents Above Ceiling inspection ::'` Accessibility 521 CMR Fire Blocking/Stopping System Other: :r Emergency Li htin Exit Signage Means of Egress Com onenets Special Inspections(Section 1704): Roofing,coping/System _ Venting Systems(kitchen and cleanouts,chemical, Mechanical Systems 1.Indicate with an Y the work you reviewed for compliance with the approved plans and specifications and describe in detail below. _ 2.Include NFPA 72 test and acceptance documentation 3.Include applicable NFPA 13,13R,13D,14,15,17,20,241,etc.-test and acceptance documentation 4.Include NFPA 720 Record of Completion and Inspection and Test Form 5.Include field reports and related documentation 6.Nothing contained within construction control shall have the effect of waiving or limiting the building official's authority to enforce this code with respect to examination of the contract documents,including plans,computations and specifications,and field inspections. Description of Construction Work Observed': a. Describe in sufficient detail the work(i.e. foundation steel reinforcing,kitchen vent system,etc.) and the location on the project site,and list if applicable,the submittal documents that pertain to the work which was inspected. Enter in the space to the right a"wet"or electronic signature and seal: Phone number. Email: Building Official Ilse Only Building Official Name: Date: Version 01 01_2018 Final Construction Control Document To be submitted at completion of construction by a' Registered Design Professional f for work per the ninth,edition of the Massachusetts State Building Code, 780 CMR, Section 107 Project Title: Date: Permit No. Property Address: Project: Check(x)one or both as applicable: New construction Existing Construction Project description: I MA Registration Number: Expiration date: ,am a registered design professional,and I have prepared or directly supervised the preparation of all design plans,computations and specifications concerning: Architectural Structural Mechanical Fire Protection Electrical Other.Describe for the above named project. I, or my designee,have performed the necessary professional services and was present at the construction site on a regular and.periodic basis.To the best of my knowledge,information,and belief the work proceeded in accordance with the requirements of 780 CMR and the design documents approved as part of the building permit and that I or my designee: 1. Have reviewed,for conformance to this code and the design concept,shop drawings,samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Have performed the duties for registered design professionals in 780 CMR Chapter 17,as applicable. 3. Have been present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work was performed in a manner consistent with the construction documents and this code. Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107. Enter in the space to the right a"wet" or electronic signature and seal: Phone number: Email: Building Official Use Only Building Official Name: Permit No.: Date: Version 01 01 2018 Ninth Edition 780 CMR 107.6 Construction Control Document Construction Contractor-Services Certification Pursuant to Section 107.6.3 f Name of Contractor. If a Corporation,name of responsible Corporate Officer: If a DBA or Partnership,name of individual: I hereby certify that, to the best of my knowledge and belief, construction performed under permit number issued on has been completed in substantial accord with the approved construction documents, with all pertinent deviations specifically noted per Section 107.6.3 of the Massachusetts State Building Code(780 CMR),9w Edition Base Volume. Name of Project: Address of Project: List of Pertinent Deviations: Print Name: Signature: Date: Notarized by: Standard Notary Statement: This document shall be submitted to the Responsible Registered Design Professional (RDP) and, when requested,to the Building Official in accordance with 780 CMR section 107.6.3 (9th edition)at the completion of all construction projects performed pursuant to 780 CMR Section 107.6 Control Construction. Design Professional in Responsible Charge(RDP) Construction Control Roles and Responsibilities of Registered Design Professionals and Tradespeople With that said,there is a proper and reasonable methodology for construction control(780 CMR c.1§ 107.6)and for protecting yourselves... The answer lies in 780 CMR Chapter 1§107.6 Construction Control,M.G.L, 112§81R as it pertains to the practice of engineering(engineers=engineers and trades people)and M.G.L, 112§60A the practice of architecture(architects as coordinators for construction of buildings). [The practice of engineering] 112§81R.Nothing in said sections shall be construed to prevent or to affect:(a)the practice of any other legally recognized profession including the practice of architecture as defined in this chapter and the practice of any trade,including In connection with the practice of the electrical,plumbing,heating, ventilating air conditioning,refrigeration and all other trades, the preparation of plans,specifications or shop drawings by any person,firm,partnership,corporation or association practicing any such trade,for work to be Installed or being installed by the some person,firm,partnership, corporation or association preparing such plans,specifications or shop drawings; [The practice of Architecture] 112§60A Definitions: "Practice of architecture",performing or agreeing to perform or holding one's self out as able to perform professional services in connection with the design,construction,enlargement or alteration of a building Including consultations,Investigations,evaluations,preliminary studies,aesthetic design, the preparation of plans,specifications and contract documents, the co-ordination of structural and mechanical design and site development,administration of construction contracts and any other similar service or combination of services in connection with the design and construction of buildings- see below regardless of whether one or all of these services are being performed and regardless of whether these services are performed in person or as the directing head of an office or organization performing them;provided, that the practice of architecture shall not Include the practice of engineering as defined in this chapter,but a registered orchitectmay perform such engineering work as Is incidental to the practice of architecture. A licensed tradesperson engaged in design/build construction(example:an alarm system)can design, prepare plans and build their own system under the practice of engineering(112§81R)as long as that is the only trade being completed in a building. 1. They may not design a system for someone else to install. 2. And,if they install someone else's design an engineer is required (typical on larger projects). 3. As soon as any other trade(considered totbe the practice of engineering),is involved on a project then there needs to be a controlling entity who is a MA Registered Design Professional(architect or engineer)or RDP. Under Construction Control tradespeople can still design,prepare their own plans and build their system...but a review of the plans[for general conformance to the(RDP's overall)design concept—780 CMR c. 1 section 107.61 and coordination of the project needs to be completed by an RDP under Construction Control Construction control dots(initial,phased and final)do not make the RDP or person doing the"co- o'rdination" responsible for others work,they simply identify who is doing the administration of construction contracts and any other similar service or combination of services in connection with the design and construction of buildings(112§60A)-(see above). In other words,again the licensed tradesman can design,prepare plans and shop drawings for their own work,then they can perform that work. But in the end they need to demonstrate In writing to the RDP as the controlling entity that they have completed their work and that it complies.[for general conformance to the(RDP's overall)design concept]and In compliance with the regulations that they are constructing to. If a problem occurs you have written certification from the tradesperson attesting that they did their work in compliance with the RDP's overall design and their code. Initial and final construction control docs that you provide to the building department are not considered to be a statement by you that you are an expert in a particular trade(unless you specifically say so)and they are not considered documentation of an inspection and/or certification that work of a trade is correct...it simply says that you have reviewed their plans,have been on site and have or have observed general conformance to your design. Moreover,good construction control RDP's in my experience require that tradespeople provide them as the coordinator with written documentation certifying their work and conformance to the RDP's overall design...then they submit the tradespersons report with the construction control reports and/or final construction control dots. If you read the construction control documents themselves it never mentions RDP inspections.Under 780 CMR and MGL 112 the design professional has no role in completing Inspections...inspections are the responsibility of the municipality. Again the RDP's role during construction is to be"generally ; familiar"with progress and general design compliance so there should be no concern by your insurance company that you are performing inspections. For larger projects an RDP may insist that the owner retain engineering services for other trades due to the complexity of work or outside design. But every project in excess of 35,000 cubic feet is beyond the scope of a Licensed Construction Supervisor and requires construction control by an RDP(except as noted above and in M.G.L.112). Nevertheless,the building code and MGL 112 do not make it impossible for smaller projects to be completed under construction control by tradesmen without becoming federal projects or heaping liability on the RDP who is acting as the coordinator. 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): express multi services Iic Address: 10 aspinwall rd City/State/Zip: worcester ma 01605 Phone#: 508-969-6579 Are you an employer? Check the appropriate box: Type of project(required): I am a employer with 4. I am a general contractor and I Gemployees (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.] 5. We are a corporation and its 10. Electrical repairs or additions 3. I am a homeowner doing all work officers have exercised their 11. Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12. Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13. . Other . comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 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. Insurance Company Name: oxford insurance Policy#or Self-ins.Lic.#: CL2740207 Expiration Date: 11/28/2019 Job Site Address: 775 MAIN ST City/State/Zip: HYANNIS,MA 02601 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 certif and penalties of perjury that the information provided above is true and correct Signature: Date: 7" 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#: h/v /� ' �O _, �lcw-v �c� ..0..5�1 S:sa. . ��cTr�`CL � ,�,ogle r . -� rGf EE �AtlStlRl@C 3 CSIt@§`S R(3f�UI8fIQ(1 t ? M Ve,ME t ONfii�l9CT { fiYE 1n€�av�dua3 a £ 3CIply�t� �t i X fit !! h"�v - br" jx_ - LL Ol 3a M1 FiJ4YM7NAIMvy W YetT p a j 3't YCN LL TE OLLI cc CD } i 3s x:. Q � r3 U N r EXPRESS MULTI SERVICE LLC. 10 ASPINWALL RD.WORCESTER,MA 01605 TEL.508-96^-6570' EMAIL:SKSCONSTRUCTION@HOTMAIL.COM WHO IT MAY CONCERN, MR. RAYMOND WYATT IS EMPLOYEE OF EXPRESS MULTI SERVICE LOCATED AT 10 ASPINWALL RD.WORCESTER,MA 01605. HE WILL COVER BY WORKER COMPENSATION OF EXPRESS MULTI SERVICE LLC. THANK YOU PHETDALINH PANY MANAGER 1 i Application Number........................................... 4!!Zon 9- Construction Supervisor Names CV,4 J7 W\Lbir Telephone Number Address 5i" `�rcity tate M A Zip c916I D License NumberLS,o License Type C-?L Expiration Date Ca - Contractors Email M V` V0Ai1J o&Wn Cell # 1 I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachi�qtts'SPe Building Code. I unders construction inspection procedures,specific inspections and documentation require 15y 780 CMR and the wii of Barnstable.Attach a copy of your license. Signature f Date-- i, Section 10—Home Improvement Contractor r. Name Telephone Number Address City State Zip Registration Number Expiration Date I understand my responsibilities under the rules and regulations for Home Improvement Contractors 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.Attach a copy of your H.I.C... Signature Date F Section 11 —Home Owners License Exemption Home Owners Name: Telephone Number Cell or Work Number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CUR 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 "PLICAN�TSIGNATURE Prix Namesc` '► �"j T,�elephonerNumber - E-mail permit to: 1 U �x-4 �.d I awl Last updated. 11/15/2018 1 -- -- - --- - } Section 12 —Department Sign-Offs Health Department ❑ Zoning Board(if required) Historic District ❑ Site Plan Review(if required) ❑ - Fire Department ❑ Conservation ❑ - For commercial work,please take your plans directly to the fire department for approval Sectiqn13— Owners Authorization I, T_ S as Owner of the subject property hereby authorize E WLU ' '" off, W` to act on my behalf, in all matters relati e to work authorized by Lis building permit application for: - Address of job) A-k Sigdature of Owner date Print Name j I Last updated: 11/15/2018 i Town of Barnstable Building _ y Post This Card So£That rt is_1/is�ble.From the Stree# Approved Plans Must be Retained on 1oband this Card Must<be Kept anss �$ Post Until ed Final laspection Has Been Made = n a Permit f63P ♦ r a 2 y z Q Where a CertificateofOccupancy is Required,such{Bwldmg shall Not be Occu'pieduntil a Final Inspection has been mad"e Permit.No. B-19-3573 t Applicant Name: ROBERT D WOODBURY Approvals Date Issued: 10/24/2019 Current Use: Structure Permit Type: Building-Sheet Metal-Commercial Expiration Dater 04/24/2020 Foundation: Location: 775 MAIN STREET(HYANNIS), HYANNIS Map/Lot: , 290-099 . Zoning District: . SPLIT Sheathing: Owner on Record: ANK REALTY LLC Contractor Name ROBERT D WOODBURY Framing: 1 Address: 775 MAIN STREET Contractor License: 4323 2 HYANNIS, MA 02601 Est. Project Cost: . $0.00 Chimney: Description: (3)Zones Permit Fee: $ 160.00 (2)Yoprk Gas fired Furnaces ? Insulation: (2)York Condensing Units for Central Air Conditioning supplies and. Fee Paid:` $ 160.00 returns Date: 10/24/2019 Final Project Review Req: DUCT WORK ONLY. Plumbing/Gas Rough Plumbing: _, h<Building Official - Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authonzed`.by this permit is commenced within six months afte�'_issuance. All work authorized by this permit shall conform to the approved application and:the approved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures'shall be in compliance with the local zoning by laws and codes. This permit shall be displayed in a location clearly visible from access street mrba' and shall be maintained open for publicJnspection for the entire duration of the Final Gas: work until the completion of the same. Electrical The Certificate of Occupancy will not be issued until all applicable signatures byxthe Building and,Fire Officials are provided on, MID Minimum of Five Call Inspections Required for All Construction Work: �7i ,�, � � � �.'' � �` � � �� Service: 1.Foundation or Footing Rough: 2.Sheathing Inspection MJ, 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final' 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "-Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department +' Building plans are to be available on site Final. ' All Permit Cards are theof the APPLICANT-ISSUED RECIPIENT property f t *� Commonwealth of Massachusetts Sheet Metal Permit Date: 10/09/2019 Permit Estimated Job Cost: $44,477.00 Permit Fee: $ O '� Plans Submitted: YES NO Plans Reviewed: YES NO Business License# 801 Applicant License# 4323 Business Information: Property Owner/Job Location Information: Name: Coastal Mechanical Name: Ank Realty Street: 21 L Fruean Ave Street: 775 Main Street City/Town: South Yarmouth, MA 02664 City/Town: Hyannis, MA 02601 Telephone: 508-737-8747 Telephone: Photo I.D. required/Copy of Photo I.D. attached: YES V NO LW Staff Initial J-1 /M-1-unrestricted license J-2/M-2-restricted to dwellings 3-stories or less and commercial up to 10,000 sq. ft. /2-stories or less Residential: 1-2 family Multi-family Condo/Townhouses Other / Commercial: Office Retail V Industrial Educational Institutional Other Square Footage: under 10,000 sq. ft.V over 10,000 sq. ft. Number of Stories: 1 Sheet metal work to be completed: New Work: V Renovation: HVAC V Metal Watershed Roofing Kitchen Exhaust System Metal Chimney/Vents Air Balancing Provide detailed description of work to be done: 3- Zones 2 - York Gas Fired Furnaces 2 - York Condensing Units for Central Air Conditioning Supplies and Returns �� Sa �0c sht hC . CC�m a. 'RIGHT- SHORT FORM. ZMAMOL HVAC DESIGNS FL - May ' € _ " eae R • Q T L 1 AVANNIS PACKAM Ins"MMSYMET,HYAMNIS., A a Ckft ift db.(" cis. IiiriSiiti f � . i�sideYdb(' 1i� M y 70, n �ALEfiU11�N' ' `tea 'tde Tree aka She 0 #i + Or ii nll ring. 9 fah : ► w mr toil a Cep air i&taocw fl:EIQB e Q� f - LOW YrerwarwMl b" V7 #A tlW;t Ht�AVF tpAVF (0), P z s 1i NMI 9 iit � Ft+i i411 2104Y GEC i 04679 10370 � ..Nam ;1 � Low o x. 1i ll c � r A t fi' INSURANCE COVERAGE: I I have a current liabili insurance policy or its equivalent which meets the requirements of M.G.L.Ch.112 Yes® No❑ If you have checked Yes, indicate the type of coverage by checking the appropriate box below: A liability insurance policy ® Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 112 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this box[],I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Duct inspection required prior to insulation installation: YES NO Progress Inspections Date Comments Final Inspection Date Comments Type of License: By ® Master Title ❑ Master-Restricted City/Town ❑Journeyperson Signature of Licens Permit# ❑Journeyperson-Restricted License Number: 801 Fee$ ❑ Check at www.mass.-gov/dpl Inspector Signature of Permit Approval ._�v.... �� t ; t1• 4t' 7 d f a' ,�u��} '�y��,yt�; ,I x ' r ..�.«,�.•-.�� - a7;eaA NU6kpv � aAt ,�„ � 0 . FED SriIS , 1201 01 s964836 0 � y c �•"'. . 041 4- 1969- RuffaA Will We I 0 + f AAE r�,i1S' NDVII�CFlIIA023 ;�1r467, q y yeaF 'I8EM#BLU[, {'}tCt✓ �'�. ( +iJ `� ` a.• ,,, R"9 N,`' '' ll�:..��g3� +�1°t6.HCsTfJF 16',+ 1 11.61 ,��' _,� '�'��; �'S,�D4D O+Y?�►Z018"R�v021??YtD16 .e t +.�b�l'sfp.���`�.-.�r�':4•i>•x-..,�yr'.`i�77.+.��,•'��.'hr. tlh, Ommo , VEALTH .tJF A S SE TIME ;49411011M qM AA e rK�( y�C SHEE M TA�� ORK R Y J 4 . ISSUt THE I�OfL,O ' 1 .IIi r t y�wy,t F '�Yc�vf,w sk OID " S�j,t '•'K st t;I ' . •_ .`' '� 'i_w - v1 S r Mt k 1s c` i A 1 ��i.,,,s xyF"'h,mod,.au`"�r�f* � 1 Sf • •� d AZ J 1 11 �, ! �'j. 1.ti w• ,/ r // is .� .' �. # ;4i*y`, w'4, \•,�' "yam., '}. y.� v..i�: ( ( f Client#:764315 2COASTALPLI ' ACORDrM CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDNYYY) 01/07/2019 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Dowling&O'Neil Insurance Agy PHONE 508 775-1620 5087781218 A/C No Ext: A/C No 973 lyannough Road E-MAIL P.O.Box 1990 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Hyannis,MA 02601 INSURER A:Evanston Insurance Company 35378 INSURED INSURER B:Associated Employers Insurance Company 11104 Coastal Plumbing&Heating LLC INSURERC:Safety Insurance Company 39454 Dba Coastal Mechanical 299 Whites Path INSURER D: South Yarmouth,MA 02664 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE NSR WVD POLICY NUMBER ADDLSUBR MM/DDIM MM/DDY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY MKLV1 PBC000152 1/04/2019 01/04/2020 EACH OCCURRENCE $1 000 000 CLAIMS-MADE OCCUR PREMISES ��Ea ocounence $100 1 000 X BI/PD Ded:5,000 MED EXP Any one person) $5 000 PERSONAL&ADV INJURY $1,000,000 r,OTHER-. L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY❑JE� LOC PRODUCTS-COMPlOP AGG $2,000,000 $ C AUTOMOBILE LIABILITY BINDER459951 1/04/2019 01/04/2020 COMBINED SINGLE LIMIT Ee accident 1,000,000 ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY X AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE X AUTOS ONLY X AUTOS ONLY Per accident $ $ A X UMBRELLA LIAB X OCCUR MKLVIEUL101746 0110412019 01/04/2020 EACHOCCURRENCE $1 000000 EXCESS LIAB CLAIMS-MADE AGGREGATE $1 00O 000 DED I I RETENTION$ $ B WORKERS COMPENSATION WMZ80080074082019A 1/04/2019 01/04/202 X STATUT OTH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETORMARTNER/EXECUTIVE E.L.EACH ACCIDENT $1 00O 000 OFFICER/MEMBER EXCLUDED? 7 N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $I 000 000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived,or extended the coverage provided by the policy provisions. CERTIFICATE HOLDER CANCELLATION Town of Barnstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Dept. ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) .1 of 1 The ACORD name and logo are registered marks of ACORD #S227139/M227101 LS1 The Commonwealth of Massachusetts Department oflndustrialAccidents I Congress Street, Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/OrganizatiorYIndividual):Coastal Mechanical Address:21 L Fruean Ave City/State/Zip:South Yarmouth, MA 02664 Phone #:508-737-8747 Are you an employer?Check the appropriate box: Type of project(required): l.❑✓ I am a employer with 30 employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. [:]Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]? 10❑Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole I 1❑Electrical repairs or additions proprietors with no employees. 120Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.$ 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.00ther 152,§1(4),and we have no 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. :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:AIM Mutual Policy#or-Self-ins.Lic.#:MKLV1 PBC000152 Expiration Date: 1/04/2020 Job Site Address:775 Main Street City/State/zip: Hyannis, MA 02601 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: o Phone#:508-737-8747 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: f �THE Town of Barnstable Building Department Services ' f s sa[uvSTaBiE.� " Brian Florence,CBO Building Commissioner EQ MA'S 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder Pa,'f'C� , as Owner of the subject ro e P P rty hereby authorize Coastal Mechanical to act on my behalf, in all matters relative to work authorized by this building permit application for: 775 Main Street - Hyannis, MA 02601 (Address of Job) **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final _inspections are performed and accepted. e m, Sig ature Of Owner So ature of Applicant t {max — '-" James Nolan Print Name Print Name 23 Date I Q:FORMS:O WNERPERMISSIONPOOLS Rev:08/16/17 � r _ _Town of Barnstable �,a .� Building .s Post This,CarW That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept �$ (Posted Until Final Inspection Has Been Made Permit 2639. , A ' 1 Inspection h been made.. r �j #Where a Certificate of Occupancy�s Required,such Building shall Not be Occupied until a;Fina Spection as be 7 Permit NO. B-19-3176 Applicant Name: EXCEL BUILDING SYSTEMS COMPANY INC. Approvals Date Issued: 10/08/2019 Current Use: Structure Permit Type: Building-Addition/Alteration-Residential Expiration Date: 04/08/2020 Foundation: Location: 775 MAIN STREET(HYANNIS),HYANNIS Map/Lot: 290-099 Zoning District: SPLIT Sheathing: Owner on Record: ANK REALTY LLC Contractor.Name:. EXCEL BUILDING SYSTEMS Framing: 1 COMPANY INC. Address: 77S MAIN STREET 2 Contractor license: 182094 HYANNIS, MA 02601 Chimney: Description: REMOVAL OF EXISTING CHIMNEY,CLOSE HOLE AND ROOF SPOT Est. Project Cost: $ 1,500.00 Permit Fee: $85.00 Insulation: Project Review Req: Final: +• Fee Paid: $85.00 Date: 10/8/2019 Plumbing/Gas Rough Plumbing: I Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. Rough Gas: All work authorized by this permit shall conform to the approved application and the`approved construction documents forwhich this permit has been granted. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. Final Gas: i , i r h entire dur ation of the public ins ection for the e ' I from access street or road and shall be maintained open for ub c p This permit shall be displayed in a location clearly visible o P P , work until the completion of the same. l _ Electrical Service: The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work: `r Rough: - - g 1.Foundation or Footing _ -� -- - w•-- 2.Sheathing Inspection Final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Perso cting With unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department ` Final: Building plans are to be available on site� . All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Application Numb .v.......... ......... BUILDING DEPT, ....... • BARNSTABLF, • MASS. 1 SEP 2019 Permit Fee.......... .. ................ ............Mer Fee,....................... 639. 25 14'apj� Total Fee Paid................................................................. ....... TOWN OF BARNSTABLE Permit Approval by.................................on............... ..... 7 BUILDING PERMIT MV-1.......................................Parcel. .....6-5.J.................. APPLICATION Section I - Owner's Information and Project Location Project Address 4 :4_S t{ c, ,,n 9,9c 0�4 an W S4 Q'CnIS 0 .2) Village c Owners Name Owners Legal Address .3 A LL (r,01 d �c 01 ity-yuec State }A Azip 0 2 n.2 r, Owners Cell# -'S 2 06 , cLSO Q_E-mail Section 2 -Use of Structure Use Group_ ❑ Commercial Structure over 35,000 cubic feet ❑ Commercial Structure under 35,000 cubic feet ❑ Single Two Family Dwelling Section 3 -Type of Permit F1 New Construction ❑ Move/Relocate EJ Accessory Structure E:] Change of use El Demo/(entire structure) El Finish Basement El Family/Amnesty 0 Fire Alarm Rebuild El Deck Apartment El Sprinkler System ❑ Addition ❑ Retaining wall El . Solar a�Renovation D Pool El Insulation Other-Specify Section 4 - Work Description C-C-^0 C- 'n C-S4 e e),3 C— U LOOT_ 5 tQb iiI T..qqt imAnted- 11/11001 R a i • Application Number.................................................... Section 5— Detail Cost of Proposed Constructi o Square Footage of Project Age,of Structure , Safe Number # Of Bedrooms ExistingTotal# Of Bedrooms (proposed) (P P ) 110 MPH Wind Zone Compliance Method ❑" MA Checklist ❑ WFCM Checklist ❑ Design a { Vt O i Section 6-Project Specifics ❑ Wiring ❑ Oil Tank Storage ❑ Smoke Detectors ❑ Plumbing ❑ Gas ❑ Fire Suppression ElHeating System ❑ Masonry Chimney El Add/relocate bedroom Water Supply ❑ Public ❑ Private Sewage Disposal ❑ Municipal ❑ On Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: I am using a crane ❑ Yes ❑ No Section 7—Flood Zone i Flood Zone Designation Within or adjacent to a wetland, coastal bank? Yes ❑ No ❑ Section 8—Zoning Information Zoning District Proposed Use Lot Area Sq. Ft. Total Frontage Percentage of Lot Coverage #of Dwelling Units (on site) Setbacks Front Yard Required Proposed Rear Yard Required Proposed Side Yard Required Proposed Has this property had relief from the Zoning Board in the past?, ❑ Yes ❑ No Last updated: 11/15/2018 Client#:38860 2EXCELBLI ACORD. CERTIFICATE OF LIABILITY INSURANCE OATE(MwonryYYY) 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 i BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:Tf 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 any rights to the certificate holder in lieu of such endorsement(s). -PRODUCER CON ACT NAME: The Hilb Group of N.E.dba PHONE 508 775-1620 FAX 5087781218 A/C No Ext: A/C No Dowling&O'Neil Insurance Agy E-MAIL P.O.BOX 1990 ADDRESS: • INSURER(S)AFFORDING COVERAGE NgIC Y Hyannis,MA 02601 INSURER A:NGM Insurance Company 14788 INSURED Excel Building Systems Company,inc INSURER a:Associated Employers Insurance Company 11104 PO Box 436 INSURER C: -- - Forestdale,MA 02644 INSURER D:' INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTRR TYPED INSURANCE NSR WVO POLICYNUMBER MM/DO/VYYF MMMDD/VYYY LIMITS A X COMMERCIAL GENERAL LIABILITY X X MP02774T =2/2019 OM2/202C EACH�OECCTURRENCE $1 000 000 CLAIMS-MADE ❑X OCCUR PREMISES Eaxcu£rrance S500,000 MED EXP(Any one person) S10,000 PERSONAL&ADV INJURY $1 000 000 GEN'L AGGRE(GA;'T�E LIMIT APPLIES PER: GENERAL AGGREGATE s2,000,000 POLICY I xI JECOT I,�t LOC PRODUCTS-COMPIOP AGG $2,000,000 j OTHER: -.._.. -� ._ $ A AUTOM0131LE LIABILITY M102774T 2/09/2018 12/09/2019 COMBINED SINGLE LIMIT (Ea accieenn g1,000,000 ANY AUTO BODILY INJURY(Per person) $ AOWN UTOS ONLY JX UTOESULEDBODILY INJURY(Per accident) S HIRED NON-OWNED PROPERTY DAMAGEXAUTOS ONLY Per accdent S UMBRELLA LIAB j }OCCUR EACH OCCURRENCE $ _ EXCESS LIAB I CLAIMS-MADE AGGREGATE _ �ITT DED RETENTION$ S B WORKERS COMPENSATION WC C50050098182019A 3/05/2019 03/05/202 X RTUT, oTH- ANDEMPLOYERTLIABILrrY YIN ,TA ANY PROPRIETORIPARTNEREXECUTIVE-�1 NJ� E.L.EACH ACCIDENT 5500 OOO OFFICERIMEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE s500 OOO It yes describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT s500 ODO DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) - The following coverages applying in the favor of The Valle Group,Valle Redbrook,LLC,&John Parker Road, LLC:Additional insured status on the General Liability;Waiver of Subrogation on the General Liability,as well as other parties as required by contract.General Liability is Primary and Non-contributory for premises,products and completed operations. (See Attached Descriptions) 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 Cc31988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016tO3) 1 of 2 The ACORD name and logo are registered marks of ACORD #S230329/M230326 RPJX1 2. Commonwealth of Massachusetts � � Division oYPro€essional Licensure Building"Regulations arid`Standards t Gonstrr ctI nfSvpervisor r xf CS 098849 � plres 06120/2021 RENATO SILVA P O BOX'436'E FORESTDALEY,�AA 02� + $ .� Gomrnlssloner ^�..w���-� - a t Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR. Registration valid for mdrVidual use'only TYPE Corporation ore the expiration dat If found return to Reaistration> Exoir'ation bef e, Office'of Consumer Affai' and Business Regulation 18209 OS(25/2021 10001NaWri ton Stre uite 710r EXCEL BUILDING SYSTEfiA$COMPANY INC Boston MA 021;18 s �w m RENATO DA SIL�A 8JAN SEBASTIAN DR STE 9 a GG��Gfao�c SANDWICH MA Q2563 NOt>al OUt SIgtlBtUfe!; ,: Undersecretary; � ' � i l i G 17ze Cornmornvealth gfA&ssac asetts Department of Indusaial Accidents - Offwe of lnvestagadons 600 Washington Street Boston,AL4 02111 mmy massgvv1dia Workers' Campensatian Insu=ce Affidavit BuildersiCunt mzWrsMectdcians/Pkmbers AppHcmt Infw-matilxn Please Print Name(BusbzemXkganizationfIadividQal)_ u v S W d,^ z616�1' r) City/Statt:./ _ h p 9_ 9) ° p l 3 Are you an employer?Check the appropriate box: Type of project(retlairedy_ ' 1.Nr I am a employer with. 4. ❑ I am a general contractor and I 6_ El New motion employees(full an Vor part-time)-* bave h red.tbe sub-contactors 2.❑ I am a sole proprietor orpartner- listed on the attached sheet 7• ❑Remodeling - ship and have no.employees. These sub-mutractors have 8.-❑Demolition wotiong for me in any capacity. enTloyees ' [Notvarlaecs'comp.insurance iasuzau� a xvoslcess 9. El Building addition � 5. ❑ We are a corporation and its lO:El Electrical repairs or a ddstions �_❑ required-] officers have exercised flair I am a homeowner tieing all work 1L❑Plumbingrepairs or additions o wa'rlmrs' _ tight of exemptionlry❑Roof s per MGL rep fiwarance require&]; c.152,§1(4h andwe have no employees.(No workers' 13-❑Other off-insurance -1 'Any appli=ffiatcbettsbox9lmostalsofMcwihesmcdcmberpwshmingtheirwaskmecumpensa nperiyiaf3nnsdau- T homeowners Who submnt dais afiidnA i g they axe doing elf wa&=A them ham outside �rcM=— submit anew affidavit in dlCatino SIICFL fCanbxdgn tbat check this box must attache 3 sa additimal sheet showing thename of the sap-co�actess and state whethea ar not these entities heap employees.I€tbe 5ab-contactm Dace empIoyee.%they=istpsmuide their warken'ramp.policy number. I err[an erirplayer tiirrt is prarzding yvarkets'caa perzsrrhirtt instiranca for�y�enrpta}nees Below is riitepoticy and jab site information, a Insurance Companyy Name:I 6 ' 1 ( RW V(/I I raj ' n . Policy 4t or Self-ins.Lic.A X- j 500 a)Q !3 05 O Job Site llddress :4$ Cify/Stafel7.tp: 26 O l Attach a copy of the workers'compensationp cy declaration page(showing the policy nufa er and expiration date). Faihue to secure coverage as requireduuder SecEion 25A of MGL a 15 can lead to the imposition of criminal penalties of a flue up to$1,500OD anWor one-year imprismuneut,as well as cif penalties.in the form of a STOP WORIK ORDERand s fine' of up to WO-00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Imvestegafi=ofthe DIA for insurance coverage verificatim 140 hereby tzatder thepanrs andpenaMer afpedury thatthe infornzaffmprmri&dY rs abmw is ba and correct Dace Phone j�.7 ,5C)8) t7Okial um only. De ttat take in tkis area,fe be cainpieted by dry artoirn of j`icrat City or Tram• Pertaitffikense il Issuing Anthority(drde one): 1.Board of Health 2.Building Department 3.C Wrown Clerk 4.Electrical l nspector 5.Plumbing Inspector ' 6.Other Contact Person: Phone#: laformation and Instructions 7�Ijxccar_lmceflS C-,e =-g Laws chep�152 rmpirw all employers Yn provide WCaMS'compensation for then-employees_ pursam3tto this fie,an�Ivyw is defined as.":every person in the service of mother under�y confront of hire, express or implied,oral or written�" An empkyer is defined as"an mdxvidnA partam mNp.associab-om,corporation or other legal entty,or any two or more of the faregomg engagedin aJoi33t MtZjMiSC,and including the legal mpresea atives of a deceased employes,or the recei4er or trastee of as individual,partnership,association or other Iegal entity,employing employers. However fhe owner of a dwelling house having not more than tbree apartmeah-,and who resides therein,or the octet of the - dw ni g house of another who employs perms to do mamtenimce,caas t uc i pn or repair woik an such dweIl ng house or on the grotmds or building appurieuanttherein shannot because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that¢every sfafe or local licensing agency shall withhold$e issuance or renewal of a license or permit to operate a business or to construct buildings is the commonwealth for any applicant who has not produced acceptable evidence of compliance W th the insurance.coverage required." Addit onaIIy,MQ,chaptmr 152.§25C{7)states¢Neither the commaxweahh.nor;iny ofifs political subdivisions shall enter mio any contract for the perfanznance'of2uh1ic work unbl acceptable,evidence of compliancewith the msm-ancce.. r5]i ents of bits chapter havo been P==±arted to the=&acting auihoi*. APplican is Please fill ofit the wo&eas'compensation affidavit completely,by rheckbg the boxes that apply to your situation and,if necessazy,supply sob-conk-dL (s)nam e(s). addresses)and phone numbers)along with their cerli aMte(s)of msarance. Limitrd Liability Companies(LLC)or Limited LmbslityParhmml rps(LLP)withno eaployees other.than the members or partners,are not required to ca ry wtrarlreas'compensation msarance- 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 conffimation of bsmmnce coverages Also be sure to sign and date the affidavit. The affidavit should berstumed to the city or town that the application for file permit or license is being requested,not the Department of . „ A od ents_ Should you have any questions regaidmg the law or ifyou.are required to obtain a workers' T rh�.sf,-raT yo compensation policy,please call ibe Department at the nnmbea listed below. Self-insured townies should ear their self-i err ce,license number on the appropriate line. City or Town Officials f - Please be stn a that the affidavit is complete and primed legibly. The Department has provided a space of the bottom of the affidavit for you to fill out in the event the Office of Invesfigati om has to contact you regarding the applicant: Pleas a be mn a to fll in the permYt/licrose mmaber which wM be use e as a reference number. In addition,an applicant mat mnst submit Multiple permit/license,applizmdws is any given year,need only submit one affidavit indicating eument policy mnfiirnatian Cif Lece-sir )and under"Job She 1A_ddress"tie applicant should Write"all locations in (may or town)_'A copy of the-affidavit that has been.officially stamped or madced by the city or town may be provided to the applicant as proof that a valid affidavit is on file for fuime'permits or licenses- Anew affidavit must be f cd out each year.Where a home owner or citizen is obtaining a license or permit not relafrd to any business or commm vial venture (i_e_ a dog license or permit to bum leaves etc_)said person is NOT to complete this affidavit The Office of Investigation would lik-In thank you k advance for your cooperation and should you have any questions, please do not hesitate to give us a caIL The Department's address,telephone and fax rmmber: Thu CGMMMW21-ffiE Of Massachusetts , Depaitnent of lidushiat Acident% �it�e of�t�,�e�figa<ttop.� 6w V7ashzan Stf,-t t . Boman..MA 0�11F T(,-L46177 -49WVYt406QrI� Fax 9 617` 27 774 Revised 4-24-07 w w -m -gPvldiEL I . WE Town of Barnstable Building Department Services Brian Florence,CBO 1"9. ►``� Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I. ! V M L.ESH P ftT<c-L'L. ,as Owner of the subject property hereby authorize (fx ('F- An^5,q sl Co-, to act on my behalf in all matters relative to work authorized by this building permit application for: (Address of Job) **Pool fences and alarms are the responsibility of the applicant Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. �l • Signature of Owner S of Applicant Print Name Print Name 912 Date } Q:FORMS:OWNERPERMISSIONPOOLS Rev:08/16/17 Town of Barnstable Building Department Services Brian Florence,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 aAYNNUEM Muse. www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MARJNG ADDRESS: cityAD" state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which`there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval ofBuilding Official Note: Three-family dwellings containing 35,000 cubic feet or larger will.be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION t The Code,states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. QAWPFl1M\FORMS\building permit 1hrms\EXPRESS.doc ar 08/16/17 Application Number.... ...................................... Section 9- Construction Supervisor t Name x -- ,J i C . L2nraelephone Number C C)g )_�©1 - 0 Address R ion _S lcY:c a n C1ty SCnd c.� State zip 0 a Sc2 Jeense Number_'S v Qy g 5 License Type 1-e ,,,�o,_ Expiration Date n-�-J p 8/o t Antractors Email V-),SS4S QMia L 'yt ens,., Cell # Csoa) no I - o t43 IIderstand 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 If required by 780 CMR and the Town of Barnstable.Attach a copy of your license. Signature Date 10 1,2S/;J_q Section 10-Home Improvement Contractor xI a0Name C . ay jelephone Number C.S O'R ) _9 O 1- 0('�-1 Address6 A on F�c_c a n City S c.r, w.c 1-) State ,tA A Zip n 2_S 6 f Registration Number $ D O cf y Expiration Date 0 S/2 S�� � I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 I. 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.Attach a copy of your H.I.C... Signature Date I Section 11 -Home Owners License Exemption Home Owners Name: Telephone Number Cell or Work Number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLICANT SIGNATURE r �s6nature FDate 1 o a Print Name , ncT'elephone Number 143 Emailpermit to: o P —�� rcr�, S _, v�. � (--, Last updated: 11/15/2018 Section 12 —Department Sign-Offs ' Health Department ❑ Zoning Board(if required) ❑ Historic District ❑ Site Plan Review(if required) ❑ a Fire Department ❑ Conservation ❑ For commercial work,please take your plans directly to the fire department for approval, Section 13— Owner's Authoriza ' n S�� a i as Owner of the subject property hereby authorize to act on my behalf,in all matters relative to work authorized by this building permit application for: (Address of job) Signature of Owner date Print Name Last updated: 11/15/2018 L u �~II NOTE: ' CERAMIC TILES ARE PROPOSEND ON ALL FLOORS,INCLUDING WALK IN REFRIGERATOR AND ALL STORAGE AREAS.ALL FLOORS MUST BE SEALED,IMPERVIOUS TO WATER, EASILY CLEANABLE AND NON-SLIP. RMV :n .................-_..__................... ......... W.LLwN CottEM BnsEUEM n -........._.... - eEEP••_ az[Ru9E i v. 5 - . ....._...............__..._:._....._racn. ] 1............... I _ m FLOOR PLAN LOCATED ON 775 /``I��7ln�►^ ril�f�S e�C� 17 c'"`-! {-�'�9.('� �� G'/�'1` MAIN STREET r PREPARED FOR NILESHPATEL 775 MAIN STREETA (` `7G 4- HYANNIS, MA 02801 04/17/2019 DATE: ��(�/� � � �4`a �✓` `����J ,//��� � S'G� � N�- /F Bo w M MICHACL J.BURNE P.E.123374 Jam,` 6 ESN®BNY;VEYOk l I ! • '/�j//\�\ CIVIL[YLIN[GRi.LAND 511R VEYORS GRAPHIC SCALE 4 ENVIRONMENTALta'OPSULTANTS tIs• o I. ttr 508-SLS-9551 WWW.ALPHAOMEGAEN C.NET INFOOALPHAOMEGAENC.NET . (IN FEET) Hsov as/rs/Tors --_ _ R( i ST �^1�1 Y►Y►t 5; ry l )9 - ci 2 Ga 1 The Commonwealth of Massachusetts ABCC Commission Decision Alcoholic Beverages Control Commission r r. Application Summary Review APPROVED Municipality: BARNSTABLE Date of Commission Decision:08/28/2018 License Information: Applicant Name/DBA: ANK Liquor,Inc./Hyannis Package Store Date Filed: 08/28/2018 Premises Address: 775 Main Street Barnstable MA 02601 License Number(if applicable): 89292-PK-0070 Manager Name: Nilesh Patel Record Number: 2018-000937-RT-AMEND Class: Annual Granted Under Special Legislation? Yes O No O Category: All Alcoholic Beverages On/Off Premises: Off-Premises Consumption Chapter: Year: Type: Package Store Application Contact: Name John Mooradian Title: Attorney Phone: 7815953311 Email: jmooradian@demakislaw.com Amendment Options: Change of Pledge of License Financial Information: Total Cost of Transaction: 2050000 Seeking a Pledge: Yes O No O Application Contribution: 856125 Pledging to: Leader Bank,N.A. Lender Contribution: 856125 Amount of Loan: Ownership Interests: Contact Type Name Type of Interest %of int ��_Email Beneficial Interest-Individual Nilesh Patel Director,Officer,Other,StockhoIder 45'" nilesh@emphotels.com Beneficial Interest-Individual Navin Patel Officer,Stockholder 10 npatel@ihmus.com Beneficial Interest-Individual Kamleshbhai Patel Officer,Stockholder 45 kamlespatel@gmail.com Manager Nilesh Patel Director,Officer,Other,Stockholder 45 nilesh@emphotels.com License Period: Q lam : ❑New Application [Z Renewal Date: 00 iianx; l::l;3LSC,'` `,� Li N ❑Transfer S� ❑Amend The undersigned hereby applies for a License to conduct'business in the Town of Barnstable in accordance with the Statues of the Commonwealth of Massachusetts and subject to the Ordinances of the License Authorities. NO BUSINESS MAY OPERATE WITHOUT A VALID LICENSE ON THE PREMISES Name of Applicant/Corporation: �� L-I&V vR Business phone Address of Applicant/Corporation: Cell Pho en# -20 Email Address:I Wt 2'} Q "1hC41• Federal ID# g2-h J21MZ last 4 digits only D/B/A: cArri S S40A-qrc- —jMap/Parcel #. bmlvql _ Business Address: ►'Y1C_",Y1 S f a pd Village Business Mailing Address: 5eATy-v- Property Owner Name of Manager: P e—L Length of Lease License Type:1 ptl I A F Go ho 1] Manager's Email Hours of Operation: Annual Seasonal Entertainment: Yes❑ No 17F/I TV's and Recorded Music is considered Non-Live Entertainment and renuires a license If yes, the Entertainment License Application Form is required. NOTICE:Any misstatement in this application or violation of the applicable town ordinances, bylaws or regulations shall be considered sufficient cause for refusal,suspension,or revocation of any and all licenses. I warrant the truth of the forgoing statem nt under the penalty of perjury: Signature of applicant: 1 For Town use only Tax Collector Town Clerk Grease Trap Approval USE PERMITTED WITHIN THIS ZONE? YES❑ NO ❑ NO❑ R.E. Tax Paid Business Cert Filed Yes❑No❑ Special Permit Granted YEYES[] Yes ❑No❑ Yes[]No❑ Initials❑Date El If yes,include with application G. Mgmt Approval Police Dept Approval Cons Com Approval Approved Floor Plan on File YES❑ NO [] Yes❑No❑ Yes❑No❑ Yes[:] No Occupancy Initials Date❑ Initials❑ Date❑ Initials❑Date❑ Number of Units or Rooms Building Approval Health Approval Fire District Approval Seating Capacity Yes[:] No ❑ Yes❑No ❑ Yes No❑ Initials❑ Date❑ Initials❑ Date❑ Initials❑Date u` FIME �' r e°.,Prin'teii On 6%2 /2019 �C`om.p.ilaint All Report', ST"M �pr ,,0�q 775 MAIN STREET (HYANNIS) HYANNIS EOM WIN Cast Case#: C-19-523 Address: 775 MAIN STREET(HYANNIS), Date: 6/27/2019 HYANNIS Owner Info: Property Info: ANK REALTY LLC MBL: 775 MAIN STREET 290-099 HYANNIS MA 02601 Owner Notified?: Complaint Details: Type of Complaint Classification of Complaint Method of Complaint Electrical, NB Sweep Sweep Complaint Summary: Case created to add additional photos Action History: Action Taken Date Description Fee Inspector Inspector Assigned to Complaint: fourniee Filed by fourniee Comments: Comment Date Commenter Comment d `�i" Dade 6i27f2019 ' � , tWAN, d ToyinafBrns�ab)e Printed On 6/27/201'9 +,", wT Ow ° �k a: C�Q p � ■��p�■ <a i� + ?�aBl io^�P P ,i��i NSni 7tiPo,r�`.�"l nwb..... ,. 4r e M pTf^;ffi,,0�p 775 MAIN STREET (HYANNIS), HYANNIS I Case# C-19-522 Case#: C-19-522 Address: 775 MAIN STREET(HYANNIS), Date: 6/27/2019 HYANNIS Owner Info: Property Info: ANK REALTY LLC MBL: 775 MAIN STREET 290-099 HYANNIS MA 02601 Owner Notified?: Complaint Details: Type of Complaint Classification of Complaint Method of Complaint Electrical, NB Sweep Sweep Complaint Summary: Running wires observed hanging no covers on boxes wires not properly secured. plumbing inspector posted stop work order building inspector called to site Action History: Action Taken Date Description Fee - Inspector Inspector Assigned to Complaint: fourniee Filed by: Journiee Comments: Comment Date Commenter Comment s,� mA♦i t fi%37120<19 Tnmrq OW of Barnstable w Date. r< e p1HEIOky Complaint Call Re.;port ,r. Printed On 6/27/2019 �E " raaa Wawa '3 e � t,,, +.•„m.i Eis' f„ a at: tirt?s 6aPir w, r a r ,aP s a:. . ,.,✓s vh!?a"SAP, ',` „ AKAM ( 775 MAIN STREET (HYANNIS), HYANNIS a rfoMA+° Case# C-19-521' Case#: C-19-521 Address: 775 MAIN STREET(HYANNIS), Date: 6/27/2019 HYANNIS Owner Info: Property Info: ANK REALTY LLC MBL: 775 MAIN STREET 290-099 HYANNIS MA 02601 Owner Notified?: Complaint Details: Type of Complaint Classification of Complaint Method of Complaint Plumbing, Electrical High Priority Phone Complaint Summary: Plumbing Inspector called to say he posted the property, due to open pipes,with sewer gas flowing thru building. Action History: Action Taken Date Description Fee Inspector Inspector Assigned to Complaint: andersor Filed by: barrowsd " Comments: Comment Date Commenter Comment 41 Da#e 6/27/201„9' y Town of Barnstable ,„ rm tJ 7r F�He Panted On'6/2�12019 Complaint CaII'Report t avwsmsm � ,0�a �k 775 MAIN STREET (HYANNIS) HYANNIS /+ �TED MPyd �` +%� '"4 i> ..i� �.tii 4^ "l✓aSQ. Case#: C-19-456 Address: 775 MAIN STREET(HYANNIS), Date: 5/24/2019 HYANNIS Owner Info: Property Info: ANK REALTY LLC MBL: 775 MAIN STREET 290-099 HYANNIS MA 02601 Owner Notified?: Complaint Details: Type of Complaint 1 yp p Cassi fication of Complaint Method of Complaint Plumbing, High Priority Dept Referral Complaint Summary: Un-permitted plumbing performed at package store left no working bathrooms, no running water and employees and workers using buckets for toilets. Action History: Action Taken Date Description Fee Inspector Close Case 6/27/2019 $0.00 andersor Inspector Assigned to Complaint: duffyr Filed by: andersor Comments: Comment Date Commenter Comment 5/29/2019 duffyr 05/29/2019-Update: After my initial inspection of the work being conducted at this address, the sanitary standards were so deplorable that a "Stop Work Order"was issued on this property. Upon further review of the address records, NO Plumbing permits had been applied for at the time of inspection (05/24/2019). The Plumbing Contractor contacted me directly and i explained the Penalty for starting the work unpermitted and explained the Stop Work Order. The Permit WAS applied for and PAID IN FULL along withe Penalties. They MAY resume working on the property now that a proper Sanitary"Porta John" is on site for the employees to use.All remaining issues have been forwarded to Licencing to review the case. Date 6/ 7I01x9 Town of Barnstable f., oFVE ! Pnnt4tl O 2712019 Complaint Call Report p .,. • u,p fnE^xaDs Mr"AlM 6 d� ' 77 Y ANNIS), ,HYAN NIS5 AIN ST REET (H3q. 't C'a"s,'��e # C-19-456 6/25/2019 duffyr 06/25/2019-UPDATE-On 06/23/20 our office was informed by Auditing that the permit fee that was applied for and PAID was returned for insufficient funds.The previously approved permit was then made inactive.They currently have no permit to conduct work. I contacted the plumber and the general contractor and notified them of the issues, the GC response was "He would be in to pay the fees". I explained the amount of time to act (installing sanitary bathroom facilities for the employees. I will follow up with the contractor on Thursday 6/27/2019 andersor As immediate conditions were satisfied (temporarily meeting the minimum standards) pertaining on the conditions cited on this RFS the store was allowed to re-open. Allowing for this RFS to be closed. See C-19-521 for subsequent work, requirements and existing conditions/violations noted. Date 6/27/2019 Town of Barnstable a kcal as inn �f TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION { Map Parcel, Application # 4(0 Health Division ':`Date Issued o Conservation Division ,Application Fee Planning Dept. Permit Fee`, Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address 995 Village 141 l./G� any 1� Owner 2nmjnj R(J rC-,h —'%,rfX_9Address.-77� Telephone Perm' Request at l Y Yl A//6 14 GCS Square feet: 1 st floor: existing/2proposed 2nd floor: existing �� proposed A4 Total new Zoning District Flood Plain Groundwater Overlay Project Valuationw- ate Construction Type Lot Size Grandfathered: 0 Yes ❑ No If yes, attach supporting documentation. C�A4 �.� / Dwelling Type-Single Family ❑ Two Family ❑ _Witi-Family(# units) Age of Existing Structure ly'71� Historic House: ❑Yes ANo On Old King's Highway: ❑Yes �W-No Basement Type: LXFull ❑ Crawl ❑Walkout ❑ Other S r0e-C,, Basement Finished Area(sq.ft.) 0 Basement Unfinished Area (sq.ft) 3-f o� Number of Baths: Full: existing new Half: existing new Number of Bedrooms: ® existing .L.,�ewO Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: )fGas ❑ Oil ❑ Electric ❑ Other F4L Central Air: ❑Yes No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑existing ❑ rNw/4size_Pool: ❑existing e4w_ size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new Size _Shed: ❑ existing YAe size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ w Commercial KYes ❑ No If yes, site plan review # No Current Use Lt Proposed Use T 1J APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Rtcho,9 ) Telephone Number Address 7" ZqL114 i ense n�j 3 / Home Improvement Contractor# Worker's Compensation # �16 25zLtlol� ALL CO TRUCTION DEBRIS RESULTING FROM IHIS PROJECT WILL BE TAKEN TO SIGNATURE - DATE 9 ` 0 I ' I y. > FOR OFFICIAL USE ONLY - APPLICATION# DATE ISSUED MAP/PARCEL-NO, - ADDRESS VILLAGE OWNER S ' t DATE OF INSPECTION: FOUNDATION= - FRAME r . f :..INSULATION+6 - F _ FIREPLACE — - w — `a s ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL - • ,4 GAS ROUGHS = FINAL FINAL BUILDING t - rite 4 f r. DATE CLOSED OUT- ASSOCIATION PLAN NO. 4 s • ' The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 go www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers . Applicant Information Please Print Legibly Name(Business/Organization/Individual):'FC—N 66&), `,NHS& WcSAS`ZR Address: 7-0 130,< 980/ Iq "�F�l� i�g i 1 A74I Doi City/State/Zip: 7")21\/bc OK A, MA 01 Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1. I am a employer with 090 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors ? ❑Remodeling 2.El am a sole proprietor or partner- listed on the attached sheet. 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 g p right of exemption per MGL 11.❑Plumbing repairs or additions myself.[No workers'comp. c. 152,§1(4),and we have no 12.❑Roof repairs .. insurance required.]t employees.[No workers' 13.5d Other comp.insurance required.] v,"e� *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 anew affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors 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: 8 R EAE LLA REGIZZCT/OT/ Policy#or Self-ins.Lic.#: Expiration Date: oC d Job Site Address: `775 rr)5 l n ireC f- City/State/Zip: a nO 1� � Attach a co of the workers'compensation policy declaration page(showing the policy number and ex iration date). PY P P Y P g ( g P Y P 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 certi under t ains and penalties of perjury that the information provided above is true and correct. Si ature: J't Date: 0 3 Janin Phone#: 5's�33 /HS Official use only. Do not write in this area,to be completed by city or town offwiaL City or Town: PermitlLicense# Issuing Authority(circle one): L1.Board of Health 2.Building'Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: ACC)RE) CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 12/30/2009 PRODUCER (508)775-0500 FAX: (508)790-7955 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Oceanside Insurance Group ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Oceanside Insurance Agency Inc ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 52 West Main Street Hyannis MA 02601 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA:Arbella Protection Insurance Benabby, Inc. , DBA: Disaster Specialists INSURER B:American Zurich Insurance P. 0. Box 480 INSURERC:Rockhill Insurance INSURER D: Sandwic MA 02563 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OISUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. rA DD' C POLICYNUMBER POLICYEFFECTIVE POLICY EXPIDRATION fYYYYI LIMITS NRR� TYPE OF INSURANDATE IMMIDDIYYYYI DATE GENERALLIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE ToRENTED X COMMERCIAL GENERAL LIABILITY PREM SES Ea occurrence) $ 100,000 X CLAIMS MADE ❑X OCCUR 8500038944 1/1/2010 1/l/2011 MEDEXP Anyoneperson) $ 10,000 PERSONAL 8 ADV INJURY $ 1,000,000 X Bailment Coverage GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 PRO Bailment Coverage POLICY LOC 250 000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ 1,000,000 A X ALL OWNED AUTOS 47018400003 1/l/2010 1/l/2011 BODILY INJURY X SCHEDULED AUTOS (Per person) $ X HIRED AUTOS BODILY INJURY X NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 3,000,000 OCCUR ❑X CLAIMS MADE AGGREGATE $ 3,000,000 $ A DEDUCTIBLE 4600038945 1/1/2010 1/1/2011 $ RX RETENTION $ 10,00 $ B WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE� E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) LETTER ID#3222138 1/1/2010 1/1/2011 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 11000,000 OTHERContractorS R CPLE002420-00 11/22/09 11/22/2010 Each occurence 1,000,000 C Pollution Liability Aggregate 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS 1 VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE.HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2009/01) ©1988-2009 ACORD CORPORATION. All rights reserved. I NS025(200901) The ACORD name and logo are registered marks of ACORD �Oovi�/2O" `�•` License or registration valid for individul use only Office of Consumer Affairs&Business Regulation before the expiration date. If found Yeturq t "o:,,,>.. , HOME IMPROVEMENT CONTRACTOR . Registration: ;Q8642 Type: Office of Consumer Affairs and Business Regulation -• 10 Park Plaza'-Suite 5170 Expiration:: 720/2012 Private Corporation _�_=�� Bostonx MA 02116 , BENABBY INC/D,IS' "ST--R,SPECIA; IST RICHARD LENNO+ 9 Jari-Sebastian Wa = Sandwich,.MA 02563H Undersecretary No valid without signature t - i i r f Muss I J cllusetts- Veparunent ul Public aICIN IFailure to possess a current edition of the Board of Building Regulations and Standards Massachusetts State Building Code is License is cause for revocation of this license: t 6i r n License: CS 55731 Refer to: WWW.Mass.Gov/DPS 4tu, � Ii µRICNARD;Ii `L'ENNOX i i,PO B ,8�q a rig# SANDWICH, MA0256�3 `F Expiration: 11/7/2012 C'onuni�siuncr? + °' Tr#: 5340 i i ' 11/04/2010 14:39 5087751253 HYANNIS PACKAGE PAGE 01/01 9OV/04/2010/THU 10:31 AM Diaster Specialist PAX No. 5088882951 P, 001/001 Town of Barnstable Regulatory S erviices Thomas 17,CaUer,Drrector 46 �� Building Division Tom Perry,BaUdiuX Commissioner 200 Main Street,Hyannis,UA 02601 yrYrvr.Eowrin.�arngtable,ma.us . Office: 508-862-4038 Fax: 508-790-623 Property Owner Must Complete and Sign This Section If Using:A�uxlder - _.__._........,. . as Owner of the subject property hereby aixrharize �� Sd e 1 i -s to act oa my behalf, in all matters reLati've to work authorized byt •bitg&g permit application for, ain { (Addxrss of foby ao Signature of Ovtmr ate Name If Pr_o er permit Owner is applying for please complete the. Homeowners License Exemption Form on the reverse side. Q;FORMs:01A"NERPERMis SION Main Level r zs e �' zs• I I I I ll 7" 11'T - offi. m s� 10�3„ Main Level HYANNIS-PACKAGE-R 1/31/2010 Page: 6 Main Level t 28'e 28' IVY i0'3" - M3in Level HYANNIS-PACKAGE-R 1/31/2010 Page:6 Main Level 7s'8' 28' 117' - IVT �m !�U d0'3" Main Level HYANMS-PACKAGE-R 1/31/2010 Page: 6 Main Level ` 7e e mom zs• m �t•z•• 1TY m m C.T Main level HYANMS-PACKAGE-R 1/31/2010 Page:6 Main Level 28' . - - _ - IT F - Main4evel HYANNIS-PACKAGE-R 1/31/2010 Page: 6 / 9A -�� Assessor's map and lot number .:..'. ...............:........::..... vZ0 SINE �j Sewage Permit number Z E9H$9TA LE, i 3 House number ..........700�........�/�. �, 'ao N & e0� TOWN OF BARNSTABLE Y' BUILDING INSPECTOR PERMIT TO ..eol.��) L .........................................................APPLICATION ....... ..................o IT(v A) w R MPS S TYPE OF CONSTRUCTION' ....... ......�..`.,. o...... . .�CA� 1. L- IE�- Co9)C(t .... ..........3 .................................................... ........................... :.�..I. ...19..�' TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: 7 0 s. Location ....... Proposed Use ........ ..........�.P....., !�.t.�..�.7—. . �. 1 ................................................................. ZoningDistrict ...........................................�.............................Fire District ................................ ......... . ............................. Name of Owner ...U...................�)................... . ...........Address .....77-S.— �. Name of Builder ...... ®..�.!�.....� A.Q.VS.............Address l'3 l 1-�'v� t�LlZa4&E .... . ....................... ................ ............. ............. R.1cl l 6-l) I L L -/ IA,i Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ........................ ..Foundation ...I'.x� � 106UI. Avb— I. ..................................... ............. ...............................ep.....^...........00Te........ Exterior 40 iti C PF—'T� (3 L 1< ��� t?-1�Roofing ..$..�b CLIIF, ' P/`0.�....PAMPz Ls ...................................................................... ...................a..... ............... ` o R.c��'.`T" ZC U ............Interior C©1�.��� .G Floors � .... (�.P Ai Heating /�. .....................................Plumbing c� ol/ ............. ............. ......................... r� Fireplace .................w.....v............&................................................Approximate. Cost .......... ..S *. ........................... Definitive Plan Approved by Planning Board ________________________________19________ . Area .... ............ Diagram of Lot and Building with Dimensions Fee 4� ( .G1 ............... ..................... SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of th ow of Barnstable regarding the above construction. Na e ... ..�� ..... Construction Supervisor's License .................................... Itk,BIRCH, DONALD < No ..28294.... Permit for Bu.i.ld Addition ........... .... . .... .. . ...... . . .. HYAN IS PACKAGE STORE. ........... ..... ............................................ Location Main Street.......................................................... ' '� Hyannis ........... .. ................................................................ Donald Birch -',-Owner ..... Type of Cohstruction .....Frame..................................... . ................................................................................ Plot ............................ Lot ................. Permit Granted ....Augu.-,t...6...... ...........19 85 Date of Inspection 19 Date Completed ...... ... ...........................19 Assessor's map and lot number,............................................. QyWHE toy♦ -3 Sewage Permit dumber alcll .,.#�w...��� f t •/ . r- b ;. .; / Z EJHH9TSDLE, i House number ................,.....,.. rasa ;.:.. ..°.... r 00s�t639. `00 CFO NOR d' TOWN OF BAR.NSTABLE r BUILDING INSPECTOR r APPLICATION FOR PERMIT TO .. - 1.. . !... .. ..1 � - . �?1 f.�...... .. �'�i...... Phi r � .............. TYPE OF CONSTRUCTION ........K�..I.A.A C......�- f . �..�.....Q ..<' ..........CC) ' C ..d * ......................... .. .. .c, 19..�. 4 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ........ i..t:.l: .t �.�> � tt� � ? ... .. .. ... Q i,„t +� ............ Proposed �,se .......f� .R .IF ........... ....... .F .. �.. ` S.:.........../. ................................................ l� ZoningDistrict .....................................................�...................Fire District ..............................�..................M. �................. Name of Owner .. . .......:?........BA..t CAA.......Address ...... ?................. ..�. ..Name of Builder .... AAN.....O.I�e:.f a� .........Address ...R.�s, 4 �V1Z lZ Ll7 Ate i� ......�.� .......................................... Name of Architect � � �� � � � �i .................................................................Address ..................................................................................... Number of Rooms ............Foundation .......... F . Exierior ...... ...... ............................ .Roofing ......... t Floors � .tU ��.t -VC - Interior Q l ixt ............. . .................. ..................... ................... ....................... µ Heating ........... .4Z.j. =...................................... ........:Plumbing .....................................e............................................. Fireplacew.1 A)..................................................................................Approximate Cost .................................................................... Definitive Plan Approved by Planning Board ________________________________19________. Area ... - . '. F.`1. �� ..:....... Diagram of Lot and Building with Dimensions Fee ... , SUBJECT TO APPROVAL OF BOARD OF HEALTH j OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS f, r I hereby agree to conform to all the Rules and Regulations of the,Town of Barnstable regarding the above construction. ,r Name . .......:.............:.. r�.. .:' "�... . .....:`. ..:.. ......: r Construction Supervisor's License .................................... c BIRCH, DONALD A=290-99 No .18294 Permit for '..Bui ,i Addition. . . .. ......... . . .... ........Hyannis Package Store ��5 ........................ Location .fig Main Street ................................................ .................Hyannis........................................... .. Owner ....Donald Birch. .......................... ............... ....... Type of Construction .......Frame Plot ............................ Lot .......... . ................... Permit Granted ..... August 6, 85 ........................l 9 Date of Inspection ....................................19 Date Completed ......................................19 �L 2 .. .. ,. . .., .... .. •�. ,. .: •..x��._s .,w,r'rnYar�n.,rrn�q.�!ay'm..rr,r, . �r*' Is+a��ga+raF!e. �' s"a�»7`� '�1�'i"�"}"4 ��ur� ... IZ 1 F�13EQC,lASy "1A100 1 0 A) , S�D� of oatL r(:pk y To GoeFS._Fawry fly.� U—Q n — � �^.Y q C74Q 4Gti9ooQ� Y • 6 .1 I y' i r — K ` r 14 $ ! .. !d •C`s Y f�f 7 �1di- Jie? d � �-' ��P'1.:,�" .�Yw"_ S i� � �� l�.. P y f YOU WISH TO OPEN A BUSINESS? For Your Information: Business Certificates cost $40.00 for 4 years. A Business Certificate ONLY R d) lMQ6j E in the Town (WHICH YOU MUST DO according to M.G.L. - it does not give you permission to operate). You mush f�i tain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town %IPTW?Office, 5t Fl., 367 Main St., Hyannis, MA 02601(Town Hall) and get the Business Certificate that is required by law. 10; 2. I DATE Fill in please: APPLICANT'S YOUR NAME/CORPORATE NAME JANK Liquor, Inc. BUSINESS T�- BUSINESS YOUR HOME ADDRESS: 775 Main Street, Hyannis, MA (508)775-1205 TELEPHONE # Home Telephone Number (857)206-9500 mail Address nilesh@emphotels.com NAME OF NEW BUSINESS jHyannis Package Store OR EIN: 82-4126822 Have you been given app 290099 ADDRESS OF BUSINESS 775 Main Stret, Hyannis, MA 02601 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 COMMISSION E OF I This individual has been nfor a of any per 't r rements that pertain to this type of business. AtftKo—rizd ignat e** VS S COMMENTS: 2. BOARD OF HEALTH This individual has been informed of the permit requirements that pertain to this type of business. Authorized Signature** COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: uv W C40 rD-t7L n LLJ M l i cadK rc CAM re co s 6411 ate— � UntrG.nu � co , a + up � t CQDI•lir" W 1. 9woi nA L, u 1 \rlr r , �urfra.n GL I,ou,r��n� aD�k pl��otm z3� TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel" Application# � (� Health Division S Z ©� Date Issued Conservation Division `,:Application Fee Planning,Dept! 'Permit Fee: 7 7 Date Definitive Plan Approved by Planning Board f 1 Historic - OKH _ Preservation/ Hyannis Project Street Address �� MeLln az2al, a 9 Village n Owner s�� , ur cA Address 775 /147 Telephones ® 77S 0)0S Permit Request fieor✓s' ` Pv,,vV,9,v,5- �i✓r�v�� � � �w'slJ� . �/� �E/���Q ',�.c+�:� �c��v�D�v� v�oL��>�-'t��", �f'�r��vul6r✓T �'�r� Square feet: 1 st floor: existingMproposed2nd floor: existing proposed IO&TOtal new 7 Zoning District Flood Plain. GroundwaterOverlay Project Valuation v Construction Type ' ; Lot Size i 7(P qe_i'�i Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single F .�mrn�rcf� Age of Existing Structure l Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: X'Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Q56/ Number of Baths: Full: existing' new _ Half: existing / new Number of Bedrooms: existing _newA Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: XGas ❑Oil ❑ Electric ❑ Other Central Air: ❑Yes �(No Fireplaces: Existing New "` Existing wood/coal stove: ❑Yes �TNo Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: 4 h , ...9 Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ , `I _a Commercial )4 Yes ❑ No If yes, site plan review# Current Use Proposed Use .k+a Gi APPLICANT INFORMATION " (BUILDER OR HOMEOWNER) Name Telephone Number 6�12 66 Address g 60,0 7 az, .P� License # O / 7Ea Home Improvement Contractor# t cS' nn 1)" Worker's Compensation # 909�l-ga .V ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO cvn - la4ar� SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. 5 " 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):'rC—N Address: EC) 130x 4480/9 •\n1Q -Z)F21 V E' City/State/Zip: ','�21\/L IC_M, MA 0 Phone#: 8s,13 — () �3 Are you an employer?Check the appropriate box: Type of project(required): 1.EN I am a employer with cQQ 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 7. ❑Remodeling 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 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 ME]Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL I LEJ Plumbing repairs or additions myself.[No workers'comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees.[No workers' 13'EZ Other comp.insurance required.] i I *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 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: i9)Q 6F LLA PEOTEJCDON Policy#or Self-ins.Lic.#: Expiration Date: / �0 Job Site Address: 77_ /�/O�i/� ��• City/State/Zip: 4/ � Attach a copy of the workers'compensation policy declaration page(showing the policy num r and expiration date). -Zl 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 certi under t ains and penalties of perjury that the information provided above is rue and correct Si, / Z Phone# Official use only. Do not write in this area,to be completed by city or town of wiaL 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#: CORD. CERTIFICATE OF LIABILITY' INSURANCE a r4 z7iao 0 PRODUCER (508)775-0500 FAX: (508)790-7955 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Oceanside Tasurance Group ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Oceanside Insurance Agency Inc ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 52 West Main Street Hyannis MA 02601 INSURERS AFFORDING COVERAGE NAIC# INSURED BENABBY, INC. DHA INsuRER A:Arbella Protection DzBaster Specialists INSURERB., P. O. Box 480 INSURERC: INSURE D• 3andwirh MA 02563 INSURERE: OVERAGEt— THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTVATHSTANDING 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 POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. �t kTU LIMITS O�I�+ MAY d&%X C III AOIrL P��EFFEMUSICTIVE POLICY O EXPI p TON LIMITS OF INSURANCE POLICY NUMBER GENERAL LIABILITY OCCURRENCE 0 1000000 COMMERCIAL GENERALUABILRY DAMAGE TO RENTED A 100000 CLAIMS MADE ❑OCCUR B500038944 l/l/2009 1/l/2010 p 8 5000 V INJURY 1000000 MNERALAQGREGATE 2000000 GEM AGGREGATE LIMIT APPLIES PEFt PRQ9 2000000 u Pa PRO- - AUTOMOBILEUA81WTy COMBINED SINGLE LIMIT ANY AUTO (Eaoaldanl) a 1000000 ALL OVVNED AUTOS 47018400003 i/l/2009 l/l/2010 BODILY INJURY X SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY X NDMOWNEDAUTOs (Para-unnl) 9 PROPERTY DAMAGE 9 (Per eo:iftnl) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT 8 ANY AUTO OTHER T14AN EA aC AUTO ONLY: EXCESSIUNBRSLLA LIABILITY F 1000000 OCCUR CLAIMS MADE -AMREGATE a 1000000 oEDUCTIBLE Rr+.MML OF 460003B945 1/l/2009 1/l/2010 c X ON S 10000 WORKERS COMPENSATION AND STA OTH EMPLOYERS'LIABILITYER ANY PROPRIETORIPARTNER/EXECUT(VQ E.L.EACH ACCID N G 500000 OPMcERtmEmaEREXCLUDEDT 9098140109 l/X/ZOOS 1/1/20X0 If YW.aesama Under DISEASE-EA EMPLOYEC 500000 c C ay L.DISEASE.PO I IM 500000 oTT1fiR rz CRIPTION OF OPERATIDNM(LOCATIOMaMHICLE$=CW8ION8 ADDED 6Y@7DORSEMENT/BPEC(AL PROVISIONS ITIF1CATE HOLDER CANCELLATION IH)228-7.249 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED B6FORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR Lwe1UTY OF ANY IOND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVE$, AUTHORIZED REPREBENTATIVE RD 26(2001/08) !S(o�0e).ose 0 ACORD PORATION 4988 P8Ae 1 of2 er fai s an usiness e u anon JXe O lce o onsum _ g i 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement.Contractor Registration Reqistration: 108642 Type: Supplement Card sa,r Expiration: 8/20/2010 BENABBY INC/ DISASTER SPECLALIST JASON CULLITY - 'a 9 Jan-Sebastian Way j Sandwich MA 02563 = _ Update Address and return card.Mark reason for change. Address Renewal Employment Lost Card DPS-CA1 0 SOM-04/04-GIO1216 72 ��// . &."'./DL a�✓l�GctddCLc/t[td6 6 Office of Consumer Affairs&Business Regulation License or registration valid for individuI use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation Registration;,::,;;108642 10 Park Plaza-Suite 5170 Expiration�8/2012010 Boston,MA 02116 „Type;Supplement Card BENABBY INC[DISASTEWSRECIALIST JASON CULLITY Box 480 _ Sandwich,MA 02563 T Undersecretary of valid witho signature 0'-f 7E-f, COPY Massachusetts- Department of Puhlic Safe£ Board of Buildinldy Regulations and Standarlis Construction Supervisor License License: CS 81782 Restricted to: 00 JASON M HOLT-CULLITY ry 9 BUNKER CIRCLE SANDWICH, MA 02563 Expiration: 7/21/2010 ('nnuuisiunci Tr#: 236 i Restricted to: 00 00- Unrestricted 1G-1 2 Family Homes Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. Refer to: WWW.Mass.Gov/DPS BIKE Town of Barnstable Regulatory Services If f * HAi NffrABLE, Thomas F. GeUer,Director 0.19. �`�� Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Itsing 'A Bu;tlder T, ���� , as Owner of the subject property herebyauthorize ,21sasl-er j,a� ��� to act on'mybehalf, in all matters relative to work authorized bythis building permit application for, �;A 51rlz6 A.Xff (Address of b) Signature of.Owner ate Print Name If Property Owner is applying for permit please complete the . Homeowners License Exemption Form on the reverse side. Q:FORMS:0NVNERPERMISSION Town of Barnstable - o Regulatory Services T sAxxsrAsr.E, ' Thomas F. Geiler,Director KA-9& 9�A 039. A,m� Building Division rFD MAy Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508462-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCAT N: number street village _"_HOMEO_WNER": na e - -------home phone# -- - - - - - - - work phone CURRENT MAILING ADD S: city/town state zip code The current exemption for"homeo rs"was extended to elude owner-occupied dwellings of six units or less and to allow homeowners to engage an in di 'dual for hire who does not possess a license,provided that the owner acts as supervisor. D INITIO OF HOMEOWNER Person(s)who owns a parcel of land on which /sh resides'or intends to reside, on which there is, or is intended to be,a one or two-family dwelling,attached or deta ed structures accessory to such use and/or farm structures. A person who constructs more than one home in a o ear period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Off ial on form acceptable to the Building Official, that he/she shall be res onsible for all such work performed and r the build ermit. (Section 109.1.1) The undersigned"homeowner"assumes esponsibility for co pliance with the State Building Code and other applicable codes,bylaws,rules and re lations. The undersigned"homeowner"cc lfies that he/she understands the own of Barnstable Building Department minimum inspection procedures d requirements and that he/she wit omply with said procedures and requirements. Signature of Homeowner Approval of Building Offi al Note: Tl ee-family dwellings containing 35,000-cubic feet or larger will be re wired to comply with the State Building C de Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The ode states that: "Any homeowner performing work for which a building permit is required shall b exempt from the provisions of this section ection 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a pe on(s)for hire to do such work,that s h Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a- pervt t�(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it wound with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a forrn/certification for use in your community. Q:\WPFILES\FORMS\homeexempt.DOC M A> '23 ti - 3 L6 • y � s � I � Z _1 Z �c��uT TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Ma Z�I C� Parcel lica ioinV_ p `� � Health Division Date Issued `{-23 - {'� 7� Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address ihos i f\ _ Village 6q n to t Owner 1 s I Ck �UY C Address ��� In V� Telephone fib% , -7 -7:5-, l SOS Permit Request t o Sfa ous Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District M Flood Plain Groundwater Overlay Project Valuation l `1 b Construction Type M6\0_V-C(CAA 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 JdNo On Old King's Highway: ❑Yes ENO N -1 Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑Other S2 C> Basement Finished Area(sq.ft.) Basement Unfinished Area (sqt Number of Baths: Full: existing new Half: existing nem Co Number of Bedrooms: existing —new z Total Room Count (not including baths): existing new First Floor Roo gn Countq9 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 U4es ❑ No If yes, site plan review# Current Use CP)MnNav-QCd Proposed Use - _ APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number- ({ai)l Address . CQ-7_eel�_ 'F c ,�nC_ License # L®-1 fy-&kn sk, �C* I Home Improvement Contractor# 10-�>7 Worker's Compensation # WC`5 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE �I I� raa' 3 i t FOR OFFICIAL USE ONLY APPLICATION# _DATE:ISSUED MAP/PARCEL NO. E ADDRESS VILLAGE F kk OWNER F DATE OF INSPECTION: r; ,> FOUIVDATIQN�!. 1= �iuft,; Eff FRAME _ INSULATIONjL s FIREPLACE 4 6 ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING y i T DATE CLOSED OUT- ASSOCIATION PLAN NO. t i The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name(Business/Organization/Individual): LT r 50N-�, Address: /6 3! Mrn/ Sl City/State/Zip:&r&VI44E if OlG55_Phone#: (faV fW—1/TZ Are u an employer?Check the appropriate box: Type of project(required): 1. , I am a employer withl'GLL TlYrl� 4. ❑ I am a general contractor and I employees(full and/or part-time).s 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. 10. 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 I L[J 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��-tither �s cotter.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 state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. lam an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: U46IVC70- ( Cleho Policy#or Self-ins.Lic.#: 1/V06'3 f 5 ��f�p(a/����� Expiration Date: Job Site Address: �'9 ^� ST 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 hereb under t ain and penalties of perjury that the information provided above is true and correct signafore: Date: Phone#: 'cl-2W' 11 V7 Official use only. Do not write in this area,to be completed by city'or town officiaL City or Town: PeradtlLicense# Issuing Authority(circle one): I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: /lb/LU1.5 tf:UO:Uy API L'J'1' (hM•1'-t!) rKUr•1: 1V0000-'1'U: 1)Va46V4000 cayc. c va E ® DATE(PdMIDD1YYYY) CERTIFICATE OF LIABILITY INSURANCE 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 endorsements. PRODUCER DOWLING &O'NEIL INSURANCE AGENCY INC C ONTACT NAME: 973 IYANNOUGH RD E E • ac NoPO BOX 1990HYANNIS, MA02601 MAILAI Ess: INSURERS AFFORDING COVERAGE NAIC 9 INS URER A INSURED PISURER B PAUL J CAZEAULT&SONS ROOFING INC 1031 MAIN STREET msuaeac: OSTERVILLE MA 02655 PISURERD: INSURER E• INSURER F COVERAGES CERTIFICATE NUMBER: 17327850 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. TYPE OF WSURANCE ADDL SUBR POLICYEFF POLICY EXP LLNriS IITR NS VWD. POLICY NUMBER MM1DD MMIDDIYYYY GENERALLIABILr1Y EACH OCCURRENCE S COMMERCIAL GENERAL LIABILITY D//��,MIS S t RENTED PREAIISES Ea occurrence S CLAIMS-MADE DOCCUIR MED EXP(Anyoneparson) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS•CCMPIOP AGG S POLICY PRO JFCT tOC $ AUTOMOBILE LWBO RY COfgBc1NEMDISI GLE I fIT $ ANY AUTO BODILY INJURY(Per person) $ ALLOWNED FIAUTOS SCHEDULED BODILYINJURY(Peraccident) $ AUTOSAUTOSNOWO"NEDHIRED AUTOS $ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DEb Li RETENTIONS $ $ $ A WORKERS COMPENSATION WC5.31S-386670-013 8/10/2013 8/10/2014 TRY TA AND EMPLOYERS'LUIBILITY YIN ANY FROPRIE-To PARTNEWEXECUTIVE Q NIA A E.L.EACH ACCIDENT $ 1000000 OFFICER/h4EMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1000000 If yes,deserbe under DESCRIPTION OF OPERATIONS below E.L.DISEASE•POLICY LIMIT $ 1000000 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Workers compensation insurance coverage applies orgy to the workers compensation laws of the state of MA. 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 UCLA J- Jeff Eldridge ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD RT NO.: 1112 850 CLIENT C OE: 1614182 Anne Chandl 8/16/2013 8:03:3,3 AN P ge 1 of,l Fhzs certificate cances and supersedes AL previously issue certificates. Property Owner Must Complete & Sign This Form If lasing a Roofer 1 Builder. I (print) 06,a fttrc� , as Owner / Agent of the subject property hereby authorizes Paul J. Cazeault & Sons Roofin_g-Inc. to act on my behalf, in all matters relative to work authorized by this building permit application for. Address of Job g a ire�' 01,6LAs Signature of Owner Mailing Address of O ner 7r7S a,� S Q Telephone# Date 61 A (Please return this form to Cazeault roofing along with your signed contract; It is needed for us to obtain the building permit required.by your town, to complete your roofing project, thank you) fax#508-420-4555 Massachusetts -Department of Public Safety Board of Building Regulations and Standards ,�� ,tom Ulae cpomvnarnuuea z% as zcu�eCt� , Rice of Consumer Affairs&.Business Regulation Construction Supervisor License: CS-098595 d° IMPROVEMENT CONTRACTOR ME IMPRO , . Registration. i03714 Type JAMS L CAZEAAT Expiratidn 7/g/2014, Supplement 63 CAPT ALDEX9 ! OSTERVILLE MA 02' PAUL J.CAZEAULf&=SONS INC JAMES CAZEAULT I .�r�+�`` Expiration 1031 MAIN ST " 02/2412016 Commissioner OSTERVILLE, MA 02658 Undersecretary R t License or registration valid for individul use only before the expiration date. If found return.to: . J Office of Consumer Affairs and Business Regulation. 10 Park Plaza-Suite 5170 s.:ard Boston,MA 02116 iNot valid it out signature I a TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map t O Parcel O -r 9 .Application# /� � ' 1 Health Division'' Date Issued'. I d Conservation Division Application Fee f W Tax Collector Permit Fee Treasurer Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address 5 n(�)n i 1 Village flil cLn n i s Owner d Address �J ff'�6n e-t Telephone v _1 10 — 0 Permit Request � a_nd re- -W �V 111� Ies �1 J Y 1 Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuatiok / Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Y 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 -f Appeals Authorization❑ Appeal# -Recorded❑ — Commercial ❑Yes ❑No If yes, site plan review# r r Current Use Proposed Use BUILDER INFORMATION ' . Name- Telephone Number. f� Address C). X License# d T OIA W�) O1qt.O0 1 Home Improvement Contractor# Lut, Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO "� SIGNATUR DATE 9151 fl— a FOR OFFICIAL USE ONLY ,. APPLICATION# DATE ISSUED MAP/PARCEL NO. ' ADDRESS VILLAGE I ' OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL +' PLUMBING: ROUGH FINAL •„ GAS: ROUGH FINAL FINAL BUILDING � DATE CLOSED OUT s=. ASSOCIATION PLAN NO. i The Commonwealth of Massachusetts Department of Industrial.4ccidents Offzce of Investigations µ d 600 Washington Street Boston,M.4 02111 www.m ass.gov/dia Workers"Compensation Insurgnce.Affidavit;.Buqders/Contractors/Electricians/Plumbers Applicant Information /e n ( Please Print Le 'bI Name (Business/Organization/Individual):. J�Y s- l Address: City/State/Zip: � - � i 1' f� NtAhone.#: 0 - Are you an employer? Check the appropriate bog: Type of project(required):, 1.❑ I am a employer with 4. (] I am a general contractor and I �mployees(full and/or part.time).* have hired the stib-contractors 6. ❑New construction . 2.!J 1 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 0 Building addition [No workers'comp.insurance comp.insurance.#• required.] 5. F1 We are a corporation and its 10.]Electrical repairs or additions , '3.❑ officers have exercised their I am a homeowner doing all work 11.[1 Plumbing repairs or additions myself [No workers' comp. right of exemption per MG 12.DZoof repairs insurance required.] t c. 152, §1(4),and we have no employees..[No* workers' .•13.❑ Other comp. insurance required.] . *Amy applicant that checks box#T 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. tL6ntractors 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. Tf the sub-contractors have employees,they must providb their workers'comp.policy number. , lam an employer that is providing workers'compensation insurance for my employees Below islhe policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date),. Failure.to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Lcetlio and epa ..aId her b penalties of perjury that the information provided bov is true and correct: Sienature: Date- O� _ Phone #: 1 O - `T 0* Official use only. Do not write in this area,Y5 be completed by city or town of ciaL City or Town: PermitUcense# 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#: ` t w • -�� Town of Barnstable. °* Regulatory Services Thomas F.Geller,Director �ATEa �b,� Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstabie.ma.us Office: 5 06-8 62-403 8 Fax: 5 08-790-62 3 0 Property Owner Must Complete and Sign This Section If Using A.Builder as Owner of the subject property hereby authorize -s to act on my behalf, in all matters relative to work authorized by bi ilding permit application for; . man �Lt aRAIA. (Address of tature of Owner Date DW(d 6 ku t Print Name Q TO R M S:01W N E.RP HRM IS S I ON t.� '.._W:p q M 7/5/02 Hyannis Package +o. +^s- 1 Hyannis Package WEST END ROTARY g r y NOTE: CERAMIC TILES ARE PROPOSEND ON ALL FLOORS, INCLUDING WALK IN REFRIGERATOR AND ALL STORAGE AREAS, ALL FLOORS MUST BE SEALED, IMPERVIOUS TO WATER, EASILY CLEANABLE AND NON-SLIP. 74' BEER CASE DOWN TO 1BASEMENT RAMP WALK-IN COOLER Lo BEER CASE ILA C11 C> CZ) BEER CASE I RAMP Ln rn 21' G) ?r m 0 LIQUOR LIQUOR 0 ;o LIQUOR LIQUOR 6' 01 51-61' LIQUOR - —LIQUOR - Zq IT! LIQUOR - —LIQUOR - LIQUOR LIQUOR LIQUOR —LIQUOR 81 t9 in MOP HANGER LIQUOR SINK 20' % - GUM &CANDY- —LIQUOR GUM &CANDY- bo BATHROOM 331-311 LOTTERY& LIQUOR - TOBACCO FLOOR PLAN LOCATED ON -,V OF 144S W01AE L 775 MAIN STREET HYANNIS, MA BURKE 'U No 23374 10 rns PREPARED FOR Ba .table Bldg- NILESH PATEL � °� � � T� Av ed bY• Ppro ff 775 MAIN STREET HYANNIS, MA 02601 04/17/2019 DATE., MICHAEL J. BURKE P.E. #23374 DESIGNED 8 Y- R. M. DRAWN BY R. M. DESIGN DATE: 04-17-2019 SCALE, 114- = I' SHEET- I OF I 4 a&INS-laff" j I k Palo rqw&= 4ft CIVIL ENGINEERS*LAND SURVEYORS ENVIRONMENTAL CONSULTANTS GRAPHIC SCALE 25 HIGHLAND VIEW DR SUTTON,MA 01590 1/4 0 1/411 1/2 WWW.ALPHAOMEGAENG.NET 508-865-9551 :INFO@ALPHAOMEGAENG.NET ( IN FEET ) REWSION: 0511612019 1/4 inch = 1 ft. PLAN NO.: 19-0391 ----------- 1 w y�c�SETTS 0 ccN W m Z 14 .,� W mom.' rn A 72'-9" V' c c, Z 00 W o 19'-0" C) 00 om «, TILITIES ROOM C 0STORAGE TORAG STORAGE CHIME -] o as U p w Up 11'-8" - 12'-0" 11'-10" E-+ �.t.] tp P� 00 L 6'-10" 0 C) 2 X 12 FRAMING 0 16" o.c. , STORAGE 4 w I a � - 90-410 c� I ,_0" I U 13 I a 2 X 12 FRAMING 0 16" O.C.STORAGE f �, STORAGE W U 04— — — — — — — — — — — — — — — — —' — — — — 11���._ylll !� W cmN O r� i i I I a U I I I Up O C I U w "-I I I I I I I i z PARTIAL EXISTING BASEMENT FLOOR PLAN 11309 S.F. .. o o U w z � DATE* 04-02-2019 SHEET NO. c,4SETTS j, a Y ` M V" W ol 72 „,-9 i 22_ — — --9" 30'-0' C7 u � o ca CN � N 19'-0" BATHROOM 00 «I — ATHRO w z �+ N r 0 � + "c ► ton Tsa co o a STORAGE26 o p as R C IMN M 04 «I CV M DN CLOSET «I H f M r \ �1 M OrlELEVATOR « � U N GT1 DN U.) 000 o cc CIS WALK IN COOLER • `� « 60 -0�if t - - - - - - - - - - -I � 19'-5" 25 —2 WALK IN COOLER LOADING DOOR r V �- 16'-7`0 � ice• It I U «I Tllll �- 27'-2" —- I c W LIQUOR STORE H CV DNF119 ON s'-0" 6'-0" 20--° - �' v O � 000 U te) 6MM0 `o p PARTIAL EXISTING FIRST FLOOR PLAN 11309 S.F. H 1/4" l'-0" C4n .z H C) U � H O � W � z oDATE: 04-022019 w SHEET NO. r