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Home My WebLink About0111 OCEAN STREET (5) � � s 3 I dt Zt li i i �S o I { 1 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application # loin 00419 r Health Division Date Issued Conservation Division Application Fee / S Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/Hyannis Project Street Address Village �Na Y)n`S ti Owner Address Telephone 11 Permit Request e "rim Q Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type ; Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting dc��mentation. Dwelling Type: Single Family. ❑ Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ; ,Yes ❑ No LO Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑Other Basement Finished Area (sq.ft.) Basement Unfinished Area ( ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION -(BUILDER OR HOMEOWNER) Name Le (Atl � 61 � d� Telephone Number �� E3 t Address G ? la ccvrC�_ r"/I License # 1_6 0 G l C, A Home Improvement Contractor# Worker's Compensation # V- - e-- ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO DATE SIGNATURE/`"�---- FOR OFFICIAL USE ONLY F 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. The Commonwealth of Ma Department of Industrial Accidents 1 Office of Investigations c 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): " /<_e Address: /- (mot •P'rl ,�j�:�'s.�-t_ City/State/Zip: j ( Z -Y2 1k c; 7cn 6 q Phone #: Are you an employer?Check the appropriate box: 4. I am a general contractor and I ' Type of project(required): 1.❑ I arri a employer with employees(full and/or part-time):* have hired the sub-contractors 6. 0 New construction 2.❑ 1 am a sole proprietor.or partner- listed,on the attached sheet. .7. "[�Remodeling ship and have no employees These sub-contractors have g• 0 Demolition. working for mein any.capacity. employees and have workers' .[No workers' comp, insurance comp. insurance.$ 9•. [ Building"addition required.] S. [� We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doingall work officers have exercised their , 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL t, c. 152`. O 12.0 Roof repairs insurance required.] , §1 4 ,and we have no - zrnployees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#1 must also fill but 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. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those cntities have employees. If the sub-contractors have employees,theymust:provide their workers'comp,policy number. I am an employer that is providing'workers'compensation insurance for my employees. Below is thepolicyand job site information' Insurance Company Name: ,r1 1� U l Policy#or Self ms. Lic. #: off-zoo St,0&$b/_l Expiration Date: 1� "`Z Z to Job Site Address: City/State/Zip: 1! 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$250,OO.a day against the violator: Be advised that a,copy of.this statement may be forwarded to the'Office of Investigations.of the DIA for insurance coverage verification: a I do hereby certify under the.patns and penalties of perjury. that the information provided above is true-and correct Signature: Date: 2 — 7- Phone —1 a #: �31 "FS-ff Official use only. Do not write"in this area, to lie completed by city or town official _ City or Town: Perm it/License# L uing Authority(circle one): Board of Health .2. Building Department .3..City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector Other ntact Person: Phone#: °fTHE ram, Town of Barnstable Regulatory Services 9$ STAB '�" Thomas F. Geiler,Director A,Eo 39. � Building Division Tom Perry,Building Commissioner 200:Main Street,Hyannis,MA 02601 Office: 50&862-4038 Fax: 508-790-6230 NOTICE TO THE BUILDING DIVISION OF LICENSED CONSTRUCTION SUPERVISOR ASSUMPTION OF RESPONSIBILITY I, 1`eN Uw—�k :� c� 'r` , Construction Supervisor License. # —, hereby certify that I have assumed responsibility for the project under. construction, as authorized by building permit# _ issued to (property address) +j�;. on � i , 2046 «o z Z<-:4DIre o j o y The following documents are attached: ��©l 7 copy of my Massachusetts State Construction Supervisor's license or Homeowner's License Exemption form (if applicable) copy of my Home Improvement Contractor registration(if applicable) Commonwealth of Massachusetts Workers' Compensation Insurance Affidavit. Road Bond (if applicable) 01 Z LICENSE HOLDER DATE r °pIHE roy� Town of Barnstable °» Regulatory Services 9 B"NSMner�'�a Thomas F.Geiler,Director MASS059. y 6. Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 Office:'508-862-4038 Fax: 508-790-6230 NOTICE TO THE BUILDING DIVISION OF WITHDRAWAL OF LICENSED CONSTRUCTION SUPERVISOR FROM.PROJECT I, Construction.Supervisor License #GG T - ,hereby certify that I am no longer the Construction Supervisor listed on the application for the project under construction as authorized by building permit # ,issued to (property address) lD " 1 rC_ocM-�S' j , on , 200a.. I also certify that on 1 , 204 b I notified the.property owner, that the project under construction must cease until a successor licensed Construction Supervisor, is submitted on the records of the Building Division. r I ao6 Z .2, . t D LICENSE OLDER DATE ao b o b D gdorms/newconh rrfrrnnrr.R-5 7Rn r..MR .._.� ...• ice. 1 �Z d. - - Page: 002 ��ORav CERTIFICATE OF LIABILITY INSURANCE DATE(MM-DD:YYYY1 PRODUCER 2 2 J2010 (781)681-6656 FAX: (781)681-6686 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION The Driscoll Agency, Inc. ONLY AND. CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER- THIS CERTIFICATE DOES NOT AMEND, EXTEND OR- ALTER THE COVERAGE AFFORDED'BY THE POLICIES BELOW; P.O. Box 9120 Norwell MA 02061 v. INSURED IPISURERS AFFORDING COVERAGE NAIC# rJSI;h::F: at I Fire Ins Co,of 20478 Acella Construction Corp. iva;,.ER Trans ortation insurance 20494 ; 62 Accord Park Drive ----- _--�-- :Js+,a:-l;c:North River Insurance Jau F C.:_Norwell MA :02061 - - _ - ............---- ------. -- . .------ INSUR_r._. THE POI ICIES OF 1N.SI FRANCF LISTED BEL OJV HAVE BEEN ISSUED TO THE INRI IRED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTVVITI-ISTANDING MJY' RFt U11iEW1Rd(,TERM OR CONDITION OF ANY GCYdTF1.AC T Oh OTHER DOC;iN1ENT WI1.H(I'SPFCT TO l^MIi;H THIS OFATIFICA,TE r0 Y UE 1591!E> OH t lAY f F.IiTAIN, THE INSUA/�NCF AFFORDED SY.THE. POLICIES DESCRIBED HFREIN IS SUBJECT TO All THE TERMS, E.XCLUSICM3 AND CWDITIONS OF SUGH POI_ICIFS. A`G�:; Il'c....... .....I{a : >;::P4I I ... ,..PSI. � INSR 0.00'L POLICY EFFECTIVE POLICYEXPIRATION _ S TYPE QF INSURANCE POLICY NUMBER DATE A1M DD/YY DATE(MMIDD=YY) LIMITS , GENERAL LIABILITY EA N E b 1,000,00 0 'u� °. �J �Al 1 A:il r rA�rP F FE�T , ; lea- ooe A. �' I- w r� •+I, .}A^ 1 X 1 "r, .-:F: C2083108786 9/22/2009 9/22/2010 -- - I7 rrsr- 5 .�. 6 15,000. FE3,ONIAL B.A-DV AJl,31 ` :, 1,000,000 (I> i:l:_arr„r,.41:E 6 - 21 000,000 ------------- AUTOMOSILE LIABILITY 4:`JY.d:1:' Ci'NEI`iEC. IV iE L1%1; c .� . $ 1;000,Doo, B A. _OWNECAU-GS 2063108741 4/22/9009 9/22/2010. X RE:) _TUS 3 e Y ,,.r , . lax c,^7; .. -. '_ _ .•� GARAGE LIABILITY AMA'A:I'i:. J � .... EXCESS-'UMBRELLA LIABILITY 10,0*00.000 10,000,000 c - c 9iC? E 5530922963 9J22/2009 9/22J2010 X B WORKERS COM➢ENS0.TION AND X EMPLOYERS'LIAEILITY VY P3nFFl-rP!cf T'J -d=x C.T:Vc .. -- ------ -- : C �1000;000 WC2083108.884 =]/22/2009: 4/22/2010 - 1 Ala.L , '_s 110a0,000 t.:.L::Jr.aS` (.LEI:�L NI.. i' :-1.,aaa aaa - A OTHER Leased/Rented C2083108786 4/22/2009. -4/22/2010.: : Equipmsnt Prom. a25,coo any one itern others ° DESCRIPTION QFOPERATIONS/LOCATIONCvYEFIICLES£XCLUSIONS ADDED BY ENDORSEMENTiSPECIAL PROVISIONS r,E:: Hostel Intercational; 1.01-111,Ocean Straet, Kpanni.a NA. renovation of two 1 ui l.ii.nga, ircJ.uding demolit.icn of.. ethers. PleaSL- refer to attached adlendui" Notice,of cancellation provision is 30 days, except. Y0'`daye el•g•lies for npn payment of piemium: CERTIFICATE HOLDER CANCELLATION { SHOULD ANYOF THE ADOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Eastern New England Council of EXPIRATION DATE ?HEREOF, THE ISSUING INSURER WILL fNGEAVOR TO MAIL Hostelling International, 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLGER NAMED TO THE LEFT.BUT American Youth Hostels,Inc, 218 Holland Street _ FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE ScMerville, MA 02144 INSURER.ITS AGFNTSORREPRESENTATI'VES. AUTHORIZED REPRESENTATIVE ACORD 25(2601J0e) AGORD CORPORATION 1988. . ' - public S.tt�t) . pepartmu't of ft►one .end Reau r Stuncl►rds �1�,�uchutictt� ,f .. License goaa d.ot guildin.� evaisor Construction Sup. _ 00619 jicense: CS 1 Restricted to' 00 KENNETH CALDER ,RCH STREET' 40 CH . 021g6 MILTON,MA I2012 Expiration: 7126 T ; 100619 , ti r. THE rp� Town of Barnstable Regulatory Services �� F3AR'rSfABL£, l •' \ MAnss �,/ Thomas F. C;eiler, Director 1639. \�AlF0µp�a Buildln(j Division 'rom Perry,Building Commissioner ?UO Maim Street,Hyannis.MA 02601 iviviy.town.harnst able.ma.us Office: 508-S62.403 Fax: 505=790-6230 P rope rt-y Owner Must Complete and Sign This Section If_Using A.'Builder,' John Yonce,for.Eastern New England Council of 1, Hostelling International-American Youth — , as 0vvner of the subject propemr hereby authorize Acella Construction Corporation to aet on nivBehalf, in all matters relative to work authorized hyih.is building permit application for 111 & 105 Ocean St, Hyannis (Address of Job) 2/2/10, Signattir .of Owner Tate John Yonce feint Name If PropertOwner is applying for-permit please complete the Homeowners License,Exeinption Nonni on the reverse side. Q:FORhtS:o1\�tiEltl'F.It141tiSIG ACELLA , Construction Corporation To Whom It May Concern: Acella Construction Corporation is a General Contractor that hiressub=contractors:Acella has been selected to manage the Hyannis Hostel at 111 Ocean St.Attached to this letter is a list of our sub- contractors and their workers' compensation policy numbers. The hiring of all sub-contractors has not been completed yet.As we continue to do so we will provide the Barnstable Building Department with any necessary information regarding their workers compensation insurance. Thank you, David Dirubbo 62 Accord.Park Drive •__Norwell,- A 02061 Tel. 781-681 9240� Fax 781-681-9241 w,vw.acellaconstruction.com f Construction Corporation Subs List with Workers Compensation policy numbers Hinkley Electric Company,Inc. 108 Parker Road Osterville, MA 02655 Policy#::08WECTJ0977 Effective:05/19/09—05/19/10 'Asbestos Man Removal Co.,Inc. 929 State Road Plymouth,MA 02360 Policy#: 5091807 Effective: 10-3-09 to 10-3-10 Diaz Construction Co.,Inc. 190 Bodwell Street Avon, MA 02322 Policy#: WC8332378 Effective: 7-1-09 to 7-1-10 y 62 Accord Park Drive Norwell,MA 02061 • Tel 781 681 9240 Fax 781 681 9241 www.acellaconstruction.com CEdLLA Construction Corporation To Whom It May Concern: Kenneth.Calder is an employee of Acella construction and will be representing the company as the Superintendent at The Hyannis Hostel on Ocean St. in Hyannis Massachusetts. Sin r ly David Dirubbo 62 Accord Park Drive Norwell-, MA 02061 a� Tel. 781-681�;9240 Fax 781-681-9241 www.acellaconstruction.com �� . 1 �t Demo TOWN OF BARNSTABLE Permit * SARNnABLE, MASS. i6 9�ArF�39�- a�� Permit Number: Application Ref: 200900678 20091611 Issue Date: 09/03/09 Applicant: ROBERT, EVANS D Proposed Use: MULTIPLE HOUSES ONE PARCEL Permit Type: ACCESSORY BLDG DEMO Permit Fee $ 50.00 Location I I I OCEAN STREET Map Parcel 326045 Town HYANNIS Zoning District HD Contractor ROBERT, EVANS D Remarks DEMO EXISTING GARAGE (400 SQUARE FEET) Owner: TUBMAN,.SANDRA L Address: 462 TU BMAN RD BREWSTER, MA 02631 Issued By: SS POST THIS CARI) SO THAT IS vTSIBLE FROM THE STREET �IKETn. TOWN OF BARNSTABLE :A1 9 Application Ref: 200903053 — • BARNSTABLE, Issue Date: 09/03/09` Permit ' 9 MASS. �A 039. �� Applicant: ROBERT EVANS D rFG MAC A Permit Number: B 20091608 Proposed Use: MULTIPLE HOUSES ONE PARCEL Expiration Date: 03/03/10 Location 111 OCEAN STREET Zoning District HD Permit Type: RES.BLDG MOVE/FOUNDATION Map Parcel 326045 Permit Fee$ 250.00 Contractor ROBERT,EVANS D Village HYANNIS App Fee$ License Num. 77751 Est Construction Cost$ 5,000 Remarks APPROVED PLANS MUST BE RETAINED ON JOB AND RELOCATE BLDG C COTTAGE THIS CARD MUST BE KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN MADE. WHERE A CERTIFICATE OF OCCUPANCY IS REQUIRED,SUCH Owner on Record: TUBMAN, SANDRA L BUILDING SHALL NOT BE OCCUPIED UNTIL A FINAL Address: 462 TUBMAN RD INSPECTION HAS:BEEN A BREWSTER, MA 02631 Application Entered by; SS Building Permit Issued By: -— THIS PERMIT CONVEYS NO:RIGHT TO OCCUPY'ANY STREET;�ALLY OR SIDEWALK OR ANY PARTTHEREOF,EITHER TEMPORARIL-Y:0 ERMANENTLY. ENCROACHEMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED;UNDER;;THE BUILDING CODE;MUST,BE APPROVED BY'. E JURISDICTION. STREET.OR ALLY;GRADES AS WELL AS DEPTH,AND LOCATION OF PUBLIC-SEWERS;IvIAY BE;OBTAINED FROM THE,DEPARTMENT'0 PUBLICgWORKS:- THE ISSUANCE,OF.THIS PERMIT DOES.NOT RELEASE THE APPLICANT FROIvITHE CONDITIONS OF ANY`APPLICABLE;SUBDIVISION RESTRICTIONS MINIMUM OF FOUR CALL INSPECTIONS REQUIRED-FOR ALL CONTSTRUCTION WORK: 1.FOUNDATION OR FOOTINGS. 2.ALL FIREPLACES MUST BE INSPECTED AT THE THROAT LEVEL BEFORE FIRST FLUE LINING IS INSTALLED. 3,WIRING&PLUMBING INSPECTIONS TO BE COMPLETED PRIOR TO FRAME INSPECTION. 4.PRIOR TO COVERING STRUCTURAL MEMBERS(READY TO LATH). 5.INSULATION. 6.FINAL INSPECTION BEFORE OCCUPANCY. 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. PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE PERMIT IS ISSUED AS NOTED ABOVE. PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO GUARANTY FUND(as set forth in MGL c.142A). 79 .-'. $9: y.ut �sa Ew .<✓ •. BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 2 2 2 3 1 Heating Inspection Approvals Engineering Dept Fire Dept 2 Board of Health r Oil � �� : ,TOWN OF BARNSTABLE ��E�ti _ Building - Application Ref: 200903054 • Permit* BARNSTASLE, * Issue Date: 09/03/09 y MASS, �ArFG N319. AN� Applicant: ROBERT,EVANS D Permit Number: B 20091619 Proposed Use: MULTIPLE HOUSES ONE PARCEL Expiration Date: 03/03/10 Location 111 OCEAN STREET Zoning District HD Permit Type: COMMERCIAL ADDITION ALTERATION Map Parcel 326045 Permit Fee$ 25.50 Contractor CALDER,KENNETH Village HYANNIS App Fee$ 100.00 License Num Est Construction Cost$ 5,000 Remarks APPROVED PLANS MUST BE RETAINED ON JOB AND REBUILD BLDG C-COTTAGE AS NECESSARY THIS CARD MUST BE KEPT POSTED UNTIL FINAL CHANGE OF CONTRACTOR 2/2010 1ST EXTENSION EXPIRES 9/3/1.0 INSPECTION HAS BEEN MADE. WHERE A CERTIFICATE OF OCCUPANCY IS REQUIRED,SUCH Owner on Record: TUBMAN, SANDRA L BUILDING SHALL NOT BE OCCUPIED UNTIL A FINAL Address: 462 TUBMAN RD INSPECTION HAS BEEN MADE. BREWSTER, MA 02631 Application Entered by: SS Building Permit Issued By: THIS PERMIT CONVEYS,NO,RIGHT TO OCCUPY ANY STREET;AILY'QR SIDEWALIC'OR"ANY PARTT;HEREOF;EITHER TEMPORARILY OR PERMANENTLY'. ENCROACHEMENTS ON PUBLIC PROPERTY;NOT SPECIFICALLY*P-ERMITTED"UNDER THE BUILDING`CODE,MUST BE A,PROVED-'BY THE JURISDICTION. STREET OR-ALL>Y GRADES-AS WELL, DEPTH AND LOCATION OF PUBLiC;,SEWERS MAY BE OBTAINED FROM THE'DEPARTIv1ENT OF PUBLIC WORKS: THE ISSUANCE OFTHIS P$R]vIIT DOES"NOT%RELEASE THE"APPLICANT FROM THE CONDITIONS OF ANY AP PLICABLE SUBDIVISION RES..T.RICTIgNS MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONTTTRUCTION WORK: 1.FOUNDATION OR FOOTINGS. 2.ALL FIREPLACES MUST BE INSPECTED AT THE THROAT LEVEL BEFORE FIRST FLUE LINING IS INSTALLED. 3.WIRING&PLUMBING INSPECTIONS TO BE COMPLETED PRIOR TO FRAME INSPECTION. 4.PRIOR TO COVERING STRUCTURAL MEMBERS(READY TO LATH). 5..INSULATION. 6.FINAL INSPECTION BEFORE OCCUPANCY. 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. PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE PERMIT IS ISSUED AS NOTED ABOVE. PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO GUARANTY FUND(as set forth in MGL c.142A). NX t ,h .A�; 8 Fe &n '"✓,x'•, a BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 2 2 2 3 1 Heating Inspection Approvals Engineering Dept Fire Dept 2 Board of Health Message Page 1 of 1 Barrows, Debi From: Perry, Tom _ Sent: Tuesday, August 31, 2010 4:06 PM To: Barrows, Debi Subject: FW: Hyannis Hostel - 111 Ocean St. Importance: High This is ok.Thanks -----Original Message----- ° From: Sean P. Smiley [mailto:smiley@acellaconstruction.com] Sent: Monday, August 30, 2010 4:00 PM . To: Perry, Tom Subject: Hyannis Hostel - 111 Ocean St. Importance: High Good afternoon Mr. Perry, Please find attached our formal request for permit extension for permit numbers B 200900679 & B 200903054. Please let me know if you have any-questions or comments that need tobe. addressed. We have placed an original copy of.this letter in the mail addressed to your attention. Thank you in advance for your anticipated,cooperation. ACELLA Construction Corporation Scan Smiley Project Manager AcELLA Construction 62 Accord Park Drive Norwell, MA 02061 Office (781) 681-9240 Fax (781) 681-9241 Cell (781)424-6633 m wwwA CELLAconstraction.conr Click here to see our Spring/SummeY Newsletter , �#Please consider the environment before printing;thine-nail 9/1/2010 ACELLA Construction Corporation August 30, 2010 Thomas Perry Building Commissioner Town of Barnstable 200 Main St. Hyannis, MA 02601 RE: Hyannis Hostel — Permits B 200900679 & B 200903054 111 Ocean St. Mr. Perry: As you may know the above permitted projects have not begun construction. The permits are slated to expire on.September 3, 2010 and we would like to extend it for an additional 8 months if possible. There are a couple of reasons we are not able to begin construction sooner. The Owner was not able to proceed until recently due to internal issue. The resolution has allowed the team to be released to finalize the documents which have been issued'for pricing.'In addition to this ' the Owner is unable to begin until after the.season has ended on.Columbus Day weekend. For these reasons we wish to get permission to extend the permit and begin construction this fall. Thank you in advance for your anticipated cooperation. Regards, Sean Smiley . Project Manager Cc: file, Rick Fenuccio fi? Acc.or,d Pa,rk,I}Hyv.._'..Nor.wel.l , ►I. _02061.. - ei 781 t f3l 1240.� 41. N ww.ace]laconstruction.corn h:t7- ��v.;4{ ►,, ". �h W ,�d �. �� ' ,� 4 d +4 , F 4 , r >k c� ym a „x "z mk rrx a § � �, :. dhi; ,+ ✓.3x ,' 'Yc' i .e .•.. -^.tj. Y t a e AIR OV r�,� #' _ ,✓ t �� la ,��' � »3a R' a� ti��4�-� ,.,�g �, �„ca� a* S� £,� � � ;, h. ..�. �.. [ �CC"� � '•.° �- .{"* ,Y-�Y ��m ffi � � ��wu�"� � � A ,sf'��'t� , � � ��-+>'.� r�&� "�° p �ta,.,.. r to omion" AKE 3, t" �`' r � �✓ 1 � �� k �+;� � a fib � ,,,: c a � .:�`a �" "��i �^r ;� xn, �'"ui x t ,ffor �.At- 4M, a r r ��` wa t a r " Fq c, Y 6 +�'t, � �� >�. ��°"` ,✓ r�' <`"' � v� F< t " �" w 2,;# a � � �.f:Y a y $�..°S � *� t i"4zM" �+� R ,�t a r I ,w ''I G SY art y;w a h ' ' mot �� e "$✓ d' �y�'s t "`: wN+ �„� „✓ .., $n � �, 3 .,„�_ �v aT� s� , ' t lw µ r 3 �4W r'w, da "" �4 .��-,�„.,,, d h� dx*r" +„a%tr.r •� 1 a ,,`�� _� a _ i i r it TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION ° Map Parcel 6q5 Application Health Division "I Date Issued Conservation Division Application Fee S Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board �� Historic - OKH _ Preservation/Hyannis �Pro� t S�freet-,4 d11`r ss= 'Village ` V'��rti%it S wrier-' i F�iJ�e CS[I O Addr sw 4 Z Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay 1 Project Valu tia on �_ Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) 8 °a cn Age of Existing Structure Historic House: ❑Yes ❑ No On Old Kirk ' HighwQ ❑ s ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other w °D Basement Finished Area (sq.ft.) Basement Unfinished Area (sq ft) can Number of Baths: Full: existing new Half: existing ew rn Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use i APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name'r - i At�1 1 Telephone Number�` �. t1 ��-D05j Lb 05 Address � A lklA License# C5 -7 7 9 0 Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO �IGATURE ..DATE' -� FOR OFFICIAL USE ONLY iA'PPLICATION# DATEISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER ` DATE OF INSPECTION: FOUNDATION FRAME INSULATION r FIREPLACE ELECTRICAL: ROUGH FINAL" PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. a The Commonwealth of Massachusetts Department of Industrial Accidents R . 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 NNa Bus mess/Organization/Individual): 1 "" t �Ad'dress:— 2-3 0 4 A tv in 5 r.City/State/-Z-ip- 1/ �` 1•' M 0201 Phone #: ��b 0�.� �00 51 `Ar —e you—an employer?.Check the appropriate box: Type of project(required): 1.❑ 1 am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑ New construction 2:L am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees' These sub-contractors have g. demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance. 9. ❑ Building addition required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I I.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp.insurance required.] '*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: *s C� �1 5 Policy#or Self-ins. Lic.#: 1'QJ IGIG+�7'� � WC M I g600) Expiration Date: 1 7 Job Site Address: _ ((P� � City/State/Zip: . MA o D) Attach a copy of the workers' compensation policy declaration page(showing the policy num er and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do her and r t ains and penalties of perjury that the information provided above is true and correct. t �Snature:' fDate 6��„ t LI/p Phone#: Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License.# Issuing Authority(circle one): 1.Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.'Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association, corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7) states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractors)name(s), address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships (LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any'given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write-"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax # 617-727-7749 www.mass.gov/dia Town of Barnstable Regulatory Services BMMSTAB ' ` Thomas F.Geiler,Director ;pr p 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 i Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize ,EQ� ��5 &-t-EApz�. (-��st��act on my behalf, in all matters relative to work authorized by this building permit application for. i 110c 5 (Address of Job) a']' /Zi A 'Signature of Owner ' Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FORMS:O WNERPERMIS SION i Town of Barnstable `' Y` OF THE Regulatory Services snRrrsTnet.e Thomas F.Geiler,Director MASS. .��A Building Division rF0 N1p� Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: ` city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER 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 of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Constriction 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 of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\homeexempt.DOC BIKE TOWN OF BARNSTABLE .' Building . Application Ref: 200903054*. BARNSTABLE, Issue Date: 09/03/09 Permit y MASS. �ArFG �A� Applicant: ROBERT,EVANS D Permit Number: B 20091619 Proposed Use: MULTIPLE HOUSES ONE PARCEL Expiration Date: 03/03/10 Location I I I OCEAN STREET Zoning District HD Permit Type: COMMERCIAL ADDITION ALTERATION Map Parcel 326045 Permit Fee$ 25.50 Contractor ROBERT,EVANS D Village HYANNIS App Fee$ 100.00 License Num 77751 Est Construction Cost$ 5,000 Remarks APPROVED PLANS MUST BE RETAINED ON JOB AND REBUILD,BLDG C-COTTAGE AS NECESSARY THIS CARD MUST BE KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN MADE. WHERE A CERTIFICATE OF OCCUPANCY IS REQUIRED,SUCH Owner on Record: TUBMAN, SANDRA L BUILDING SHALL NOT BE OCCUPIED UNTIL A FINAL Address: 462 TUBMAN RD INSPECTION HAS BEEN DE. BREWSTER,MA 02631 Application Entered by: SS Building Permit Issued By: THIS PERMIT CONVEYS NO RI6HT.`TO'000UPY ANY STREET;ALLY OR SIDEWALK OR ANY,PART THEREOF;EITHER TEMPORARILY ORP ANENTLY: ENCROACHEMENTSON,PUBLIC PROPERTY NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY TH URISDICTION. STREET ORALLY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS,MAY BE,OBTAINED FROM THE.DEPARTIVIENT OF P LIC WORKS..:: :a THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS< OF.ANY APPLICABLE,SUBDIVISION'RESTRICTIONS .", MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONTSTRUCTION WORK: 1.FOUNDATION OR FOOTINGS. 2.ALL FIREPLACES MUST BE INSPECTED AT THE THROAT LEVEL BEFORE FIRST FLUE LINING IS INSTALLED. 3.WIRING&PLUMBING INSPECTIONS.TO BE COMPLETED PRIOR TO FRAME INSPECTION. 4.PRIOR TO COVERING STRUCTURAL MEMBERS(READY TO LATH). 5.INSULATION. 6.FINAL INSPECTION BEFORE OCCUPANCY. 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. PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION.WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE PERMIT IS ISSUED AS NOTED ABOVE. PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO GUARANTY FUND(as set forth in MGL c.142A). ffi NFRAW JW f - „� •;., . :W, <a#. 'Y Spa r r S"c +ram BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 1 1 1 I 2 - 2 2 3 1 Heating Inspection Approvals Engineering Dept Fire Dept 2 Board of Health r Fd9e O/po b 0/0 PL 397/1 O/O E /� � ..,� ea,ob a O 7 a <�9 I ASSESSORS REF.: �J (� Mop 326, Porcels 45 Z ( � OVERLAY DISTRICT: N m I AP — Aquifer Protection District o C m 16.3' ZONE: $ I BL—B Area (min.) 7,500 SF Fronta e (minn) 20' Width min) 75 0 Setbacks: 3 10.1' Front 20' I - � Side 7 5' New Concrete w� z Rear 7.5' z �o Foundations NI o 3 m d 0°m o o n ........... O O N v?� flat l I certify that the �°d eF!°°1td foundations shown hereon W°owellm9 oaN conform to the setback requirements of the Zoning oaN ; �3 Bylaws of the town of a I Barnstable. b r � 0 30.00 CD M- .� - ' RICHARD R. o 9 ;o Bd Sidewalk C�c Curb uR�V , �a V14F 75.00 140. 34312 m Edge Pave o 01 YO 6 5 13'56 p0 E e "e1a�• stre can Edge OG of PLOT PLAN On Ocean Street. BARNSTABLE. (Hyannis) NOTES: MASS. DATE: 17/DEC110 SCALE: 1"--30' 1.) The structures shown were located on the ground 0 15 30 45 60 FEET by conventional survey methods on (or between) 08/OCT/03 and 05/DEC/10. PREPARED FOR: Hostelling International, Inc. 2.) The property line information shown hereon was 111 Ocean Street compiled from available record information. Hyannis MA 023601 3.) This plan is not for recording and is not to be PREPARED BY: used for construction layout or deed description purposes. 7 Parker Road Osterville MA 02655 DWG #: C600.1 g1 CPP1 FIELD BY: RRL/MLL (508) 420-3994 / 420-3995fox TOWN OF BARNSTABLE BUILDING.PERMIT,APPLICATION'). } A Map Parcel A p ica i Health Division - � p Conservation Division {Appbcatiorr Fee Pd� Planning Dept: Permit Fee Date Definitive Plan Approved by Planning Board Historic - OW Preservation/Hyannis bid a i Project Stre t Address _ } Village Owner - 'F Address TU bmia* 50 m Telephone Permit Request P, AAP' _Z�, e 4 r- and cex)faru Square feet: 1 st floor: existing.380 proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater,Overlay Project Valuatio Construction Type Lot:Size . I Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(# units) Age of Existing Structure To t Historic House: ❑Yes ;Q No On Old King's Highway: ❑Yes ?(No Basement Type: ❑ Full ❑ Crawl ❑Walkout Other �- Basement Finished Area(sq.ft.) Pr r� Basement Unfinished Area(sq.ft) I 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 kin-i Central Air: ❑Yes ANo 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 ❑ = C> Commercial ' Yes ❑ No If yes, site plan review# 6 Current Use �� Proposed Use _ a APPLICANT INFORMATION it (BUILDER OR HOMEOWNER) Name �� Telephone Number Address ��0 Mq1-1 `7T► License# C5 1 Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ,SIGNATURE - DATE -'2-0 --D J FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. - ' ADDRESS VILLAGE ; OWNER z - ,.. . DATE OF INSPECTION: `=. , •� ,-rT r FOUNDATION !. FRAME ,• -� INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL- PLUMBING: - ROUGH FINAL OAS: ROUGH 'FINAL FINAL BUILDING R DATE CLOSED OUT. ASSOCIATION PLAN NO. j Join, p sTy Town of Barnstable Regulatory Services . g Y 9="u' "BI E$ Thomas F Geiler,Director Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject ro e J P P rty hereby authorize A+F Aiz :ti i-etc.; to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address of jot) Signature of Danner Date riot Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. . Q:FORMS:O WNERPERMISSION The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations a 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Eleetricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): A ad,i-W_c �e) Address: 7--3 e4 A Nl^in : City/State/Zip: L,5i-e ,rVt� , 02� i. Phone.#: Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with . 4. I am a general contractor and I 6. ❑New construction employees(full and/or part-tim.e).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner-' listed on the attached sheet. T. rM Remodeling ship and have no employees These sub-contractors have 8. [g Demolition workingfor me in an capacity. employees and have workers' Y P tY• t 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. xContractors 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:. i iJ) U�J Policy#or Self-ins.Lic.#: VICOX F 9 S Q 9 Q i Expiration Date: Job Site Address: OUMI City/State/Zip:T\OV111i 02�0' 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 tip 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 the pains andpenalties ofperjury that the information provided above is true and correct � Si afore: C t tti` Date: _ Phone#: 5P 0( l r 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#: Client#:21966 2AEAR ACORU. CERTIFICATE OF 'LIABILITY INSURANCE 0DATE 2/18/09D ) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Dowling&O'Neil Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Agency HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 973 lyannough Rd., PO Box 1990 Hyannis,MA 02601 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA: Zurich U.S. A&E Architects,Inc. INSURER B: 2384A Main Street INSURER C: Brewster,MA 02631 INSURER D: 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 OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L POLICY EFFECTIVE POLICY EXPIRATION . LTR INSRE TYPE OF INSURANCE POLICY NUMBER DATE MMIDD/YY DATE(MM/DDIYYI LIMITS A GENERAL LIABILITY PAS02667337 10/17/08 10/17/09 EACH OCCURRENCE $2 000 000 N COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED a occurrence) $2 000 000 CLAIMS MADE 51 OCCUR MED EXP(Any one person) $1 O 000 PERSONAL&ADV INJURY s2,000,000 GENERAL AGGREGATE s4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG s4,000,000 POLICY JEQ LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY 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 $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKERS COMPENSATION AND WCO261980901 10/17/08 10/17/09 X WC STATUS CETR EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $SOO,000. OFFICERWEMBER EXCLUDED? NO E.L.DISEASE-EA EMPLOYEE s500,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS 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. (See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Town of Barnstable-Bldg. Dept. DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL I O_ DAYS WRITTEN 200 Main Street NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Hyannis,MA 02601 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. - AUTHORIZED REPRESENTATIVE ACORD 25(2001/08)1 of 3 ' #55549 LS1 0 ACORD CORPORATION 1988 /J�)9�)'fi///9.(/./� �'C'Vd/�Q Boai of Bw ding Regu atiom and Standards ` Construction Supernsor License �It'Yk a" a 1 License ;CS 7775:1 F z ' Expiration "__1012912009" -'TV �9256 r Restriction 00 ROBERTD EVANS" 21 GOVERNOR BRADFORD RC � -- BREWSTER,.MA 02631 C t ommissioner Town of Barnstable IKE Tp 200 Main.Street, Hyannis, Massachusetts 02601 9B^BM�BLE•0 Growth Management Department JoAnne Buntich, Interim Director %639. p�0 367 Main Street, Hyannis, Massachusetts 02601 ED MA'S Phone(508)862-4785 Fax(508)862-4725 www.town.barnstable.ma.us February 26, 2009 Ruth M. Rusher Trust c/o Attorney Michael D. Ford P. O. Box 665 West Harwich, MA 02671 Reference: Site Plan Review # 043-07 Ruth M. Rusher Trust Informal Review,Regulatory Agreement III & 115B Ocean, Hyannis, MA Map 326, Parcel 045 & Map 266, Parcel 006001 Proposal: Change of use of the site to a hostel with 47 beds. Remodeling and updating of three existing residential buildings on the site with the addition of approximately 950 s.f. to one existing structure; conversion of an existing 400 s.f. garage to a 2-bedroom cottage; and construction of a 10-space parking area. Dear Sir/Madam: Please be advised that subsequent to the informal site plan review committee meeting of September 5, 2007 the above Regulatory Agreement received an administrative approval. Said regulatory.agreement however, contains Condition#37 which requires the Developer to submit revised plans addressing comments submitted by the Site Plan Review Committee in report dated September 5, 2007 to the extent applicable, which plans are be reviewed and approved administratively by the Building Commissioner. This approval is issued for the purpose of allowing the applicant to move forward with the building permit application and is subject to the following: • Approval is based upon plans entitled, "Proposed Site Plan" Sheet S-1 dated 02/26/07, and Proposed Plans A-2, A-3, A-4, A-5 and A-6 dated 06/02/07 prepared by A&E Architects, 15 Cape Lane, Brewster, MA. • Additional or revised approvable plans if not already provided and approved, may be required which depict the following for permitting purposes: Paved parking lot with drainage and calculations Utility plan including the depiction of the tie-in of structures Easing of the turn radius off Ocean Street onto the property for fire equipment. Lighting plan for evening hours. Fire Department access of gate at the Old Colony Road driveway to be provided. Compliance with conditions of Hyannis Main Street Waterfront Historic District Commission approval. • Applicant must obtain all other applicable permits, licenses and approvals required. • Upon completion of all work, a registered engineer or land surveyor shall submit a letter of certification, made upon knowledge and belief in accordance with professional standards that all work has been done in substantial compliance with the approved site plan (Zoning Section 240-104 (G). This document shall be submitted prior to the issuance of the final certificate of occupancy. Sincerely, r Ellen M. Swiniarski, SPR Coordinator CC: Tom Perry,Building Commissioner SPR File Planning Board Rusher RA File Hyannis Main Street Historic =+ ARCHITECTS BrewserMA0263, (Pt 6A) Residential Commercial 508.896.0051 phone 508.896.6199 fax Sustainable Design www.capecoddesigner.com February 25, 2009 Thomas Perry Building Division of the Regulatory Services Department Town of Barnstable 200 Main Street Hyannis,MA 02601 RE: Hostel, Ill Ocean Street Shut off letters for permit applications Dear Mr. Perry: The schedule for utility shutoffs will be as follows: May 1 Electric Disconnect Bldgs. A, B, C Reconnect Temporary Construction service May 15 Gas Disconnect Bldg. B Reconnect after rough-in inspection May 15 Sewer Disconnect Bldgs. A,B, C Reconnect in October June 1 Water Disconnect Bldgs I've also enclosed my contacts with the appropriate departments and utility companies. If and when any of these schedules change I will notify you in writing. Thanks for your help in this matter Sincerely, Robert D. Evans Principal - Project Construction Manager " f '+ ARCHITECTS BrewserMA02631 `R` fi", Residential Commercial 508.896.0051 phone 508.896.6199 fax Sustainable Design www.capecoddesigner.com February 25, 2009 Hyannis Hostel Utility shutoff schedule Electr_ie NStar Hyannis Engineer-Justin Reihl 781-441-3334 Work Orders: Bldg. A. 1703476 Bldg. B. 1703483 Water Barnstable Water Supply Division R.W. "Bud"Breault;Asst. Director Lines must be cut and capped Fax schedule to 508-790-1313 U_ as National Grid Construction Manager Steve Eber (732)584-0631 fax: (732)764-6609 Sewer Barnstable Engineering Division Town Engineer: Bob Burgmann 508-862-4070 Utility Contractor to pull Trenching permit Disconnect permit Connection permit Dave Andersen Inspector Coordinate with Hyannis Traffic Police Sgt Andrew McKenna 508-778-3847 If there is an existing septic—will need a Title V Abandoning permit Board of Health r n + ARCHITECTS B3ewserMA02631 (Rf. 6A) Residential Commercial 508.896.0051 phone 508.896.6199 fax Sustainable Design www.capecoddesigner.com February 26,2009 Thomas Perry - Building Division of the Regulatory Services Department Town of Barnstable 200 Main Street , Hyannis, MA 02601 RE: Hostel, 111 Ocean Street List of Sub contractors Dear Mr. Perry: This is a preliminary list of subcontractors for the above referenced project. Framing, Exterior& Interior Finish Brennick Building Systems,Inc 80 Mattakeese Road-Unit 2 W. Yarmouth, MA 02673 Plumbing&Heating Jared's Plumbing& Heating Jared Wilber License#PL1519-M Fire Protection FSS Automatic Sprinkler Corporation P.O. Box 3116 Plymouth,MA 02360 Electrical + Bayside Electrical Contractors Inc. License#A17197 372 Yarmouth Road Hyannis, MA 0260.1-2043 Sincerely; Robert D. Evans Principal Project Construction Manager F-eb 2b U9 U2:J4p Brennan ISSUE DATE 1210312008 rl"I 5, g1l RODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND linuteman Insurance Agency CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE 6 Blanchard Road POLICIES BELOW. iurlington,MA 01803 COMPANIES AFFORDING COVERAGE 4SURED ,enesis Consolidared Services Inc 6 Blanchard Rd,fl 2 COMPANY A A.I.M.Mutual Insurance Co LETTER wrlington,MA 01803 P y ........... I I ems-A A-1[I 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. co TYPE OPJNSURANCE POLICYNUMBER POLICYEFFEMVE FOLICYTXPIIIATI�[ LIMITS LTR DATE(MWDDqY) DATE(MMIDD1YY) GENERAL A GGREGATE GENERAL LIABILITY PRO0UC7rS-00mp/OpAGG- r--jC0.%IMERCL',L GENERAL LIABILITY PERSONAL&AD V.INJURY F-1=CLAPAS MADE=OCCUR. EACH OCCURRENCE =OWNEPS&CONTRAMORS PPOT. FIRE DAMAGE(Anyone Cvc) MED.EXPFhSEjA.y-CFerswj AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO BODILY INJURY ALL OWNED AUTOS 'Pa percn) SCHEDULED AUTOS HIRED AUTOS BODILY INJURY NON-OWNED AUTOS ;Per mcident) GARAGE LIABILITY PROPERTY DAMAGE EXCESS LIABILITY EACH OCCURRENCE UMBRELLA FORK AGGREGATE mw: �:7. w OTHER THAN UMBILELLA FORM WORKERS COMPENSATION AND STAT LIMITS STATE OTHER EMPLOYERS LIABILITY x MA THE PROPRJETORr EL EACH ACCIDENT $ 1,000,000 A PARNERVIXECUTIVE OFTICIERS ARE. 7015863012009 01/01/2009 01101/2010 EL DISEASE--POLICY LIMIT S 1,000,0010 34 INCL EXCL EL DISEASE—EACH mlip]r)vpp 3 1,000,000 COMMENTS1 DESCRIPTION OF OPERATIONS OR LOCATIONS: :'OVEYZA:GE'IS RESTRICTED TOEMPLOYEES LEASED TO:BRENNICK BUILDING SYSTEMS,LLC. 411 HOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE HEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL MWR17TEN NOTICE TO THE CERT!FICATE IRENNICK BUILDING SYSTEMS,LLC HOLDER NAMED TO THE LEFT,BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO 03 LIGATION P LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. 10 MATTAIKEESE RD. JNIT 2 NEST YARMOUTH,MA 02673 AUTHORIZED REPRESENTATIVE FtEi-�b-�bdy 14:48 I-rom:HNUEKSUN-LUIJbH1NU 1Nb 5Ud'J4(blde Io:"15VJdb1Jbb'lyy ragecefl,3 • DATE(MWDDIYYYY) ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID U-1 02/26/09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Anderson Cushing Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 148 West Grove St HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR PO Box 549 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Middleboro MA 02346 Phono: 508-947-3036 Fax:508-947-6182 INSURERS AFFORDING COVERAGE NAICIk QWURED IN$URFRA: First Mercury In8 Co INSUMEM B: Inrua•dn 2a Co of Stale of PA FSS Automatiq Sprinkler Co Inc INSURERC: Travelers Insurance Co. 225 Water St/ Ste B110 PO Box 3116 INSURER 0. Plymouth MA 02360 INSURER F• 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORD'EU UY THE POLICIC3 DCSCIIIDED HEITEIN IS SUBJECT TO A11. 1 HE TERMS,EXCLUSIONS AND CONDITIONS Or SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Nwwo-LPO .. - LI CY F --•- ... .._..._. LTR N6R TYPE OF INSURANCE POLICY NUMBER DATE MM/DD/v DATE MMVDD LIMITS GENERAL LIABILITY EACHOCCUHRHNCE S 1000000 A x COMMERCIAL GENERAL LIA6111TY FMM1010262-3 04/13/08 04/13/09 PREMISES Faoacurence $50000 CLAIMS MADE I X i,OCCUR MCD CXP(Any one pereon) _ $5000 PkRSONAL a ADV INJURY $1000000 GI=N6HALAGVAEGATE $2000000 GEN'L AGGREGATE LIMIT APPLIES PER- PRODUCTS-COMP/OP AGG $ 1000000 X7 POLICY F JFCT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1000000 C ANY AUTO BA4015C863 04/21/08 04/21/09 (Enncudenll) ALL OWNED AIJTOS Nnlm Y IMIURV x (Per person) 3 - SCHEDULED AlfI05 x HIRED AUTOS DODILY INJUIIY $ x NON-OWNED AUTOS (Par accident) PROPERTY DAMAGE $ (Pbr accldeo) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ - AUTO ONLY' AGG S . EXCESSNMBRELLALIABILITY EACH OCCURRbNCb $ OCCUR EJ CLAIMS MADE AGGREGATE _ S $ DEDUCTIBLI $ RETENTION $ $ WORKERS COMPENSATION AND x JTORYLMTS AR EMPLOYERS LIABILITY g WC2930063 06/21/08 06/21/09 E.L.EACEIACCIDENT $ 1000000 ANY YHUPHIETOR/PARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? E L.DISEASE-EA EMPLOY[[ $ 1000000 11 Vee,describe under - E.L.DISEASE-POLICY LIMIT $1000000 SPECIAL NNOvISIONS below OTHER DESCRIPTION OF OPERATIONe/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Automatic Sprinkler System Contractor CERTIFICATE HOLDER CANCELLATION BARNST 1 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 OH1- ION OR LIABILITY OF ANY KIND O HE INSURER,ITS AGENTS OR Town of Barnstable 367 Main street REPRESENTA S, Hyannis MA 02601 AUTHORgp�EPM-SIWTATIVE Bonni e u ACORD 25(2001/08) Q ArORDIGQRPFRATION 1980 rod Barnstable The Town of Barnstable > AS& ` Growth Management Department � 367 Main Street,Hyannis,NIA 02601 Office: 508-8624678 Patty Daley 7-007 Fax: 508-862-4782 Interim Director REGULATORY AGREEMENT Rusher Trust Hostel 1'11 OCEAN STREET, HYANNIS This regulatory agreement("AgreemenY')is entered by and between the applicant, Ruth M. Rusher Trust, ("Applicant"and" eloper°)and the Town of Barnstable("Town"),a municipal corporation,on this day off c TO08 pursuant to Section 240-24.1 of the Barnstable Zoning Ordinance and Section 168 of the Barnstable Code; WITNESS: WHEREAS, the Applicant under this Agreement will contribute public capital facilities to serve the proposed development and the municipality or both; WHEREAS, this Agreement shall establish the permitted uses, densities, and traffic within the Development, the duration of the agreement, and any other terms or conditions mutually agreed upon between the Applicant and the Town. WHEREAS, this Agreement shall vest land use development rights in the property for the duration of the Agreement,and such rights shall not be subject to subsequent changes in local development ordinances, with the exception of changes necessary to protect the public health, safety or welfare. WHEREAS, the Town is authorized to enter into this Agreement pursuant to Chapters 168 and 240 of the Barnstable Code WHEREAS, the Applicant is the legal owner of the property("Property")at 111 and 105 Ocean Street, Hyannis, consisting of approximately.45 acres,shown on Barnstable Assessor's Map 326 as Parcel 045, title to which is recorded in Barnstable County Registry of Deeds Book 18564 Page 234, and desires to develop the Property pursuant to a Regulatory Agreement; WHEREAS, it is anticipated that ownership of the Property will be transferred from the Ruth Rusher Trust to the Cape Cod Foundation once building permits are issued for the Project and as such the Cape Cod Foundation shall also be a signatory to this Agreement and when the term"Developer"is used herein it shall include the Cape Cod Foundation; WHEREAS,.the Applicant is willing to commit itself to the development of the project substantially in accordance with this Agreement and desires to have a reasonable amount of flexibility to carry out the Development and therefore considers this Agreement to be in its best interests;and WHEREAS, the Town and Applicant desire to set forth in this Agreement their respective understandings and agreements with regard to development of the Property; WHEREAS, the Development will not require regulatory review under the Massachusetts Environmental Policy Act(MEPA)or the Cape Cod Commission Act; WHEREAS,the Applicant has made application to the Planning Board pursuant to Section 168 of the Barnstable Code; Regulatory Agreement Rusher Trust Hostel 1 105 and 111 Ocean street,Hyannis October 2,2008 Bk 23298 Pg 208 #61260 WHEREAS, the Development is located in the Hyannis Growth Incentive Zone("Hyannis GIZ")as approved by the Cape Cod Commission by decision dated April 6, 2006, as authorized by Barnstable County Ordinance 2005-13,Chapter G, Growth Incentive Zone Regulations of the Cape Cod Commission Regulations of General Application; WHEREAS,the Development is not subject to review by the Cape Cod Commission as a Development of Regional Impact due to its location in the GIZ and due to the adoption of Barnstable County Ordinance 2006-06 establishing a cumulative development threshold within the GIZ, under which this development may proceed and the Applicant has submitted a Jurisdictional Determination to the Town of Bamstable Building Department to confirm the same; WHEREAS, the Applicant has undergone informal review by the Hyannis Main Street Waterfront Historic District on August 15 and September 19,2007; WHEREAS, the Applicant has undergone informal site plan review on September 5,2007; WHEREAS,the Development is serviced by municipal sewer and does not impact resources protected by the Barnstable Conservation Commission; WHEREAS, the Applicant will require zoning relief from the use regulation schedule in the HD zoning district, more specifically referred to in Paragraph 36, below; WHEREAS, the Applicant has undergone at least two public hearings on the Agreement application and received a majority vote from the Planning Board approving the application on January 28, 2008; WHEREAS, the Applicant has undergone a public meeting on the Agreement application before the Town Council and received a 213rds vote approving the application on October 2, 2008; NOW,THEREFORE, in consideration of the agreements and covenants hereinafter set forth, and other good and valuable consideration,the receipt and sufficiency of which each of the parties hereto hereby acknowledge to the other, the Applicant and the Town do enter into this Agreement, and hereby agree and covenant as follows; 1, The Applicant agrees to construct the Project in accordance with the plans and specifications submitted to and approved by the Town, listed as follows and made part of this Agreement by reference: a. Plans entitled°Proposed Site Plan"Sheet S-1 dated 02.26.2007, and Proposed Plans A-2,A- 3,A-4,A-5, and A-6 dated 06.26.2007 prepared byA+E Architects, 15 Cape Lane, Brewster, MA. b. Such other plans and plan revisions as may be required by the terms and conditions of this Agreement. 2. The Developer proposes to renovate four existing buildings to develop the Property as a Hostel. For the purposes of this Agreement, a Hostel is defined as a facility which provides inexpensive, overnight accommodations for travelers in down-style rooms with male,female, coed and family rooms. The hostel is designed to bring people together through the use of shared kitchens;bathrooms, and common areas. The four existing buildings at the Property shall be remodeled and updated to comply with applicable building and health codes. 3. A new 16 car parking area is also proposed to service the hostel(the"Development"),with 13 spaces of pervious parking and an additional three lined and available if the need arises. 4. As shown on the plans entitled, proposed Plans A-2,A-3,A-4,A-5,and A-6 dated 06.26.2007 prepared by A+E Architects, 15 Cape Lane, Brewster, MA Hostel shall have a maximum of 13 rooms Regulatory Agreement Rusher Trust Hostel 2 105 and 111 Ocean Street,Hyannis October 2,20DO B}� 23298 Pg 209 #61260 with a maximum of 47 occupants, including Hostel staff and children under 18.The maximum number of occupants shall be posted in the area of the premises where guests register. 5. When open,the Hostel shall have a minimum number of one Hostel staff.on the premises on a 24 hour basis. S. Hostel visits shall be limited in duration. Each individual Hostel visitor shall be limited to not more than fourteen (14) aggregate nights in a one year period. The Hostel management shall keep a log containing the names of visitors or groups of visitors occupying the Hostel. The log shall be made available for inspection by the Town Board of Health and/or the Town Manager's office upon request, but in no case shall such log be made available later than five(5) business days after receipt of a written request by the Town. 7. The Hostel shall operate on a seasonal basis and shall not receive visitors between!November 16'" through April 14'"of each year, but may be open at its option seven(7)days a week from April 15'h through November 15"in any one year. 8. Separate sleeping accommodations shall be provided for visiting boys and girls under the age of 18. This shall not apply to a family sharing a discrete room. 9. The preparation of food shall be restricted to the kitchen and a designated area for outdoor grilling and dining.The management shall ensure that food preparation does not occur in sleeping rooms. 10. The Hostel management shall clearly post and shall enforce a quiet time between 11 pm and 7 am. 11. Smoking shall not be allowed. Outdoor smoking on the premises shall only be permitted in designated areas with proper receptacles. 12. The possession and/or consumption of alcoholic beverages or illegal substances shall be prohibited. The management shall take steps to remove anyone from the premises who has had too much to drink or is disruptive. 13. Animals,with the exception of service animals assisting persons with disabilities, shall be prohibited. 14, The four-habitable buildings shall include a full emergency sprinkler system as approved by the Hyannis Fire District. 15. The curb cut on Ocean Street shall be configured on Ocean Street so it only allows for"right turn in, right turn out"and Developer shall install a"No Left Turn'sign. 16. Developer shall construct a Passive Stormwater Maintenance and Infiltration System to service the Development 17. Developer will provide a bicycle rack at the Property. 18.`Developer and its,successor(s)shall maintain all landscaping and drainage facilities during the term of this agreement for the period for which the development rights granted hereunder continue to be exercised. 19. Upon completion of all work, a registered engineer or land surveyor shall submit a letter of certification, made upon knowledge and belief in accordance with professional standards that all work has been done in substantial compliance with the approved site plan(Barnstable Code Section 240- 104(G). This document shall be submitted before the issuance of the final certificate of occupancy. 20. Prior to the issuance of any building permit, the Developer shall submit a landscape plan which shall be reviewed and approved by the Planning Board. Regulatory Agreement Rusher Trust Hostel 3 105 and 111 Ocean Street,Hyannis r October 2,2008 Bk 23298 Pg 210 #61260 21. The Developer shall apply or cause its approved operator to apply for and receive a yearly license for the operation of the Hostel from the Town Manager or his designee, unless the Town Manager determines that there is an alternative adequate licensing procedure.The Developer agrees that for the first year the fee for said license shall be$1,000 per year. Thereafter,the fee shall be determined pursuant to the Town's fee-setting procedures.A denial,suspension or revocation of a license by the Town Manager or his designee shall result in the closure of Hostel operation on the premises,subject to all rights of appeal. No occupancy permit shall be issued until the Developer demonstrates that the premises are duly licensed. 22. Developer shall permit or cause its approved operator to permit the inspection of the premises by town staff, includingbut limited t not m ted to health building and fire safe personnel. 9 safety 23. Upon notice and hearing,the Town Manager reserves the right to terminate Hostel operations if necessary to protect the public health, safety or welfare.. 24. No change in the licensed operator of the.premises shall be permitted without the prior written approval of the Town Manager or his designee. 25. Any reconfiguration of the interior of the premises which alters the number of rooms available for - guests shall receive the prior written approval of the Planning Board,who may approve such change administratively. 26. The development rights granted hereunder shall be exercised and development permits may be obtained hereunder for a period of two years from the effective date of the Agreement, provided, however,that prior to the expiration of said one year period the Applicant may request one six month extension to obtain development permits. Upon receipt of necessary development permits, construction shall proceed continuously and expeditiously, but in no case shall construction exceed 2 years from receipt of necessary development permits. The Applicant estimates that construction will commence on or about November, 2008 and will be completed on or about November,2009. 27. Commencing in the third year of operation,the Developer has agreed to contribute to public capital facilities to serve the proposed development and the Town by making a yearly payment in lieu of taxes.The initial payment shall be$5,355.40,which amount shall be increased by 2%Z per cent per year. No license(permit)shall issue for the third year of operation until the initial payment constituting a contribution to public capital facilities has been received by the Town. The Town Manager shall make provision for a proportionate share of said payment to be paid to the Hyannis Fire District 28. Any lighting for the development shall be contained on-site,shall be down cast and shall not contribute to light pollution of the area. 29. All landscaping within the Development shall be low water use and shall minimize the use of fertilizers and pesticides in keeping with the Hyannis Village Zoning Districts Design and Infrastructure Plan. 30. All plumbing fixtures shall be low water use fixtures and other water conservation measures are. encouraged in the design and development of the project. 31. Constructon and demolition debris from the Development shall be removed and reused or recycled to the maximum extent possible. 32. Developer is responsible for obtaining all applicable permits and licenses, including but not limited to the following: foundation permit, building permit,street excavation permit(necessary for work in all public spaces)sewer permits and water permits. 33. Exterior construction impacts shall be minimized and construction shall be limited to the hours of 7:30 a.m. to 6:00 p.m. weekdays, and 8:30 a.m.to 2:00 p.m. Saturdays. No exterior construction shall occur on Sundays. The Building Commissioner shall establish protocols to minimize the location of staging, noise, dust,and vibration. Regulatory Agreement Rusher Trust Hostel 4 106 and 111 Ocean Street,Hyannis October 2,2008 Bk 23298 Pg 211 #61260 34. To the extent that the referenced plans do not depict all of the findings and conditions as set forth in this Agreement, revised plans and/or notations shall be provided. In addition to permits, plans and approvals listed above, any and all permits and Iicenses required shall be obtained. 35. Developer has represented to the Board that it intends to enter into contract with the Easter New England Council Hostelling international—American Youth Hostel, Inc. to operate the Hostel. Prior to the issuance of any occupancy permit for the premises,Developer shall submit a copy of said contract to the Planning Board for their determination that the contract incorporates the terms and conditions of this regulatory agreement.All operators shall be bound by the terms and conditions of this Agreement and the Developer shall incorporate this Agreement by reference into any contract it enters into for the operation of the premises and said contract shall require that the operator comply with the terms of this Agreement. 36. Town hereby grants a waiver from the following zoning restrictions: permitted or conditional use in the HD zoning district(Hostel), Section 240-24.1.7 of the Barnstable Code and reduction in onsite parking requirements, Section 240-24.1.10 (4)(b) 37. The Developer shall submit revised plans which address the comments submitted by the Site Plan Review Committee dated September 5,2007,to the extent applicable,which plans shall be reviewed and approved administratively by the Building Commissioner. IN WITNESS WHEREOF,the parties have hereunto caused this Agreement to be executed,on the day and year first above written. Dated this day of �� 2008. Town of,Barnstable Developer By: By: c� Cape Cod Foun'dat-iron By 7 Developer Regulatory Agreement Rusher Trust Hostel, 5 105 and 111 Ocean Street,Hyannis October 2,2008 BARNSTABLE REGISTRY OF DEEDS ' zae<G 1Az�n svxxt(Rt.SA) R— ARCHITECTS e�x,�=�x«��02651 WE.8g6.0051 v0onx Residential Commercial soe.eeeslssr:� Sustainable Design www.cavxcca O.Mg—.— CODE ANALYSIS REVIEW Ruth M.Rusher Trust Proposed Hostel I i I Ocean Street Hyannis,Kk (Building A BUILDING CODES Sixth Edition 780 CMR Massachusetts State Building Code GENERAL BUILDING LMIATIONS (Table 503) Proposed Use Group: Residential:R-1 Boarding House Change of Use: Existing Use Group: Residential R-3 Single Family B1 DING AREAS First Floor: Second Floor: Attic Floor: 1115 SF 1115 SF 300 SF Total: 2530 SF BUILDING AREA USE GROUP 4800 SF SPRINKLER INCREASE 4800 SF PERIMETER INCREASE 768 SF TOTAL ALLOWABLE AREA INCREASE PER FLOOR 5568 SF BUILDING HEIGHT MAXIlv1UM BUILDING HGT:2 Stories/35 FT. MAXIMUM NUMBER OF FLRS:1+1 ACTUAL:2'1/ Stories/29 FT. CONSTRUCTION TYPE(Table 602) CONSTRUCTION TYPE 5B—COMBUSTIBLE NMED USES(Table 31312) A 3 Common Dining/Kitchen R-1 Boarding House Separation Method: 2-Hour Rated Fire Separation Assembly Exception:Automatic Sprinkler System—reduce one hour Building Volume: 19,940 CUFT Section 116.0 is NOT applicable. FIRE SEPARATION(Table 602.0) Fire Area Separation Section 709.2 EXTERIOR WALLS(Table 705.2) North 65'+South 5 + East 17'+ West 120'+ PERRy4ETER CALCULATIONS TOTAL PERIIv ETER 157 LF PERIMETER OF FRONTAGE 25 LF PERIMETER OF FRONTAGE TO TOTAL 16.0% PERCENT OVER 25% REQUIRED 8% FLOOR LOADING (Table 1606.1) First: 40 PSF Second:40 PSF Attic:40 PSF OCCUPANCY LOAD(Sec. 1008.1) First Floor: Second Floor: Total Area: Actual: 2 2 4 Total: 12 Required EXIT Signs(Section 1023.0) YES Required Egress Lighting(Section 1024.0) YES Is Sprinkler System Required? YES Fire Protective Signaling System(Section 917.0) NO Automatic Fire Detection Systems(Section 919.3.2) YES Is the Building required to be Accessible(521 CMR AAB)? YES ARCHITECTS Brewterrain Street MA02631(Rt.6A) Residential Commercial 506.696.0051 phone 606.E96.6 i99 fax Sustainable Design wwml.capecoddesigner.com Town of Barnstable Building Department RE: Ruth M. Rusher Trust Proposed Hostel 111 Ocean Street Hyannis, MA 02601 Response to site plan review comments dated 09/05/07: 1. Access/egress stairs are as remote as possible between 15t and 2nd floor. We can rebuild stairs from 2nd floor to attic to make them more remote.The entire building will be sprinkled?Tradeoff? 2. Why do we need to have paved parking?Where is that required by Zoning?We are concerned about the ecological impact on Hyannis Harbor and want to handle all stormwater on-site by utilizing pervious paving. Passive stormwater plan with calculations is required by the Regulatory Agreement and will be prepared by Eastcape Engineering. 3. Utility plan will completed by Eastcape Engineering.. 4. All buildings will be sprinkled 13R. 5. The extra garage (not Building D)will be for Hostel storage ie furniture, etc. 6. Board of Health variance received at 12/09/2008 meeting. 7. Walkway and ramp coincide. See updated drawings. 8. Beds will be relocated. See updated drawings. 9. Yes, commercial kitchen will be properly vented. 10. Not sure? 11. We will change this radius upon meeting with Hyannis Fire Department. 12. The gate Will be removed. 13. Lighting plan forthcoming. 14. According to Regulatory Review process Main Street Waterfront Historic District and DIP review has been conducted. We have presented the project to the Historic and worked extensively with Growth Management staff in preparing the Regulatory Agreement. 1 �ppTHE Pp�� Town of Barnstable Regulatory Services vsrBLE,$ Thomas F. Geiler,Director Building Division Thomas Perry, CBO Building Commissioner. 200 Main Street, Hyannis,MA 02601 wim.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 February 3, 2009 A &E Architects Mr. Robert Evans 2384 A Main Street Brewster, MA 02631 Re: 111 Ocean St., Hyannis,MA Dear Mr. Evans, his letter will c-nfirm-our-re-cent-conversation-regard;'ng the-above-refe-r-enced property. As long as the application is clocked into our office by February 27, 2009, the project will be able to proceed under the 6th edition of the building code and the existing stairs (item 4 of your letter)will be able to remain as long as your P.E. determines they are safe.As is standard practice, the issuance of the permit requires all necessary supporting documentation (e.g. Board of Health decision, etc.) and conformance with the 6th edition (e.g. item 5 .of your letter and table 705.2 for all buildings on site, etc). If you have any questions,please do not hesitate to call. Sincerely, (fi\ Ct Paul Roma Local Inspector Massachusetts Department of Environmental Protection Bureau of Waste Prevention ® Air Quality I1oo©84540 WDecal Number Notification Prior to Construction or Demolition Important: When filling out A. Applicability forms on the computer,use only the tab key A Construction or Demolition operation of an industrial, commercial, or institutional building, or to move your residential building with 20 or more units is regulated by the Department of Environmental Protection cursor do not return use the return (DEP), Bureau of Waste Prevention -Air Quality Control Regulations 310 CMR 7.09. Notification of key. Construction or Demolition operations is required under 310 CMR 7.09 (2)ten (10) days prior to any work being performed. The following information is required pursuant to 310 CMR 7.09. B. General Project Description 1. a. Is this facility fee exempt-city,town, district, municipal housing authority, owner-occupied Instructions residence of four units or less?ID Yes [✓!No 1.All sections of b. Provide blanket decal number if applicable: Blanket Decal Number this form must be completed in order 2 FacilityInformation: to comply with the Department of I'RUSHER HOSTEL Environmental Protection a.Name notification 105 111 OCEAN STREET requirements of b.Address 310 CMR 7.09. (�A '02601 Brewster c.Ci /Town e e.Zip Code 5088960051 f.Telep-hone Number area code and extension) E mail Address o tional 4185 — � 3 h.Size of Facility in Squar e Feet I.Number of Floors j.Was the facility built prior to 1980? ✓1 Yes r—I No k. Describe the current or prior use of the facility: CURRENT: UNUSED,VACANT PROPOSED:3 BLDG HOSTEL I.Is the facility a residential facility? EO] Yes h No 1 o m. If yes, how many units? Number of units 0 3. Facility Owner: . N CAPE COD FOUNDATION o a.Name i 0 259 WILLOW STREET b.Address r------ -----— -- l ;YARMOUTHPORT IMR ( o:2 75 I (0 c.Citv/Town r—d.state eMZip Code 1 f.Teleohone_Number(arEa_code and extension) _� __o E-mail Address(opticoal) d JDEBORAH RUH_E Q b.onsite Manager Name agO6.doc•1 D/02 BWP AQ 06•Page 1 of 3 ,;. Massachusetts Department of Environmental Protection y 100084540 Bureau of Waste Prevention ® Air Quality Decal Number Notification Prior to Construction or Demolition General B. General Project Description (cont.) Statement: If J asbestos is found during a 4. General Contractor: Construction or �i Demolition A+E ARCHITECTS BUILDERS operation,all a.Name - -—— responsible parties must comply with 2384 A MAIN STREET 310 CMR 7.00, b.Address 7:09,7.15,and II 02631 Chapter 21 E of the 1BRE WSTER ! IMA General Laws of C.City/Town d.State e.ZiQ Code the Commonwealth. 15088960051 ,bob@capecoddesigner.com I This would include, f.Telephone Number(area code and extension) q E-mail Address(optionaD but would not be — limited to,filing an ROBERT EVANS asbestos removal h.On-site Manager Name notification with the Department and/or a notice of release/threat of C. General Construction or Demolition Description release of a hazardous substance to the 1. Construction or demolition contractor: Department,if applicable. A+E ARCHITECTS BUILDERS i a.Name i 2384 A MAIN STREET b.Address BREWSTER 1MA 02631 c.City/Town d.State e.Zip Code 5088960051 (bob@capecoddesigner.com f.Telephone Number(area code and extension) g.E-mail Address(optional) ROBERTEVANS I h.On-site Manager Name 2. On-Site Supervisor. F ROBERT EVANS i On-Site Supervisor Name 3. Is the entire facility to be demolished? F1 Yes C No N 0 4. Describe the area(s)to be demolished: o INTERIOR GUT OF BUILDING A, BLDG D DEMO N ®p 5. If this is a construction project, describe the building(s) or addition(s)to be constructed: !ADDITION TO BLDG A, NEW BUILDING AT BLDG D FOUND o i d ag06.doc-10/02 BWP AQ 06•Page 2 of 3 WE r Massachusetts Department of Environmental Protection ' = '�100084540 Bureau of Waste Prevention ® Air Quality Decal Number Notification Prior to Construction or Demolition C. General Construction or Demolition Description (cont.) 6. a. If this is a demolition project,were the structure(s) surveyed for the presence of asbestos containing material (ACM)? El Yes No If yes,who conducted the survey? b.Survevor Name c.Division of occupational Safety Certification Number 6/1/2009 5/1/2010 7. Construction or Demolition: a.Start Date(mmlddlyyyy) b.End Date(mm/ddiyyyy) 8. a. For demolition and construction projects, indicate dust suppression techniques to be used: seeding ❑ paving b. If other,please specify: wetting ❑ shrouding covering ❑ other 9 For Emergency Demolition Operations,who is the DEP official who evaluated the emergency? i. a.Name of DEP Official 3 b.Title c.Date mm/dd/ )of Authorization i d.DEP Waiver Number D. Certification m l certify that 1 have examined the ROBERT EVANS o above and that to the best of my a.Print Name o knowledge it,is true and complete. IlRobert Evans The signature below subjects the b Authorized Signature N signer to the general statutes CONSTRUCTION SUPERVISOR o regarding a false and misleading c. ositionlTitle €€ statement(s). IA+E ARCHITECTS BUILDERS I L esenting 2009(mmlddlyyyy) o d Q BINP AQ 06•Page 3 of 3 ag06.doc•10/02 f 1 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION o �Map 2L Parcel Application # #20 Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/Hyannis Project Street Address C ea n a. Village�nn6 Owner Address Telephone o � Permit Request . Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type 2 Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting docurn ation. Jp- F"1-1 6r"M1!;' � O Dwelling Type: Single Family '❑ Two Family ❑ Multi-Family (# units) .<. -n 10 Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Fuld ❑ Crawl ❑Walkout ❑ Other "'aa Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑existing ❑ new size_ Attached garage: ❑existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number Address Z- Acc c,-L P.,ck- le j_ License# Home Improvement Contractor# Worker's Compensation # WCZ0 8-31 08-S-SS'-1( ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE l (c) FOR OFFICIAL USE ONLY APPLICATION# DATEISSUED s ` MAP PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: - FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL ` PLUMBING: ROUGH FINAL r GAS: ROUGH FINAL FINAL BUILDING = DATE CLOSED OUT I` ASSOCIATION PLAN NO. 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 i Please Print Legibly Name (Business/Organization/Individual): ALYL 0< 1 t�cY..-1.4,_%.fC1- ru-__ Address: 6,'2- Ace_c__,c-4_. MA City/State/Zip: j Y^,( u Phone #: 7Z 9Z`/0 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4:_KI am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. [ Remodeling ship and have no employees These sub-contractors have g, 0 Demolition . working for me in any capacity. employees and have workers'comp. 'Building addition [No workers' comp. insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 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: :P^<=. CV1V Policy#or Self-ins. Lic.#: ��' �13�d��Ll Expiration Date: l� Job Site Address: 105-- 1(t City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00.a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains andpenalties ofperjury that the information provided above is true and correct. Signature f` — Date: Phone# Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: - Phone#: FTC Town of Barnstable ti . Regulatory Services ► BAMSMELEr ` MASS. a Thomas F.Geller,Director 9�°Or16 ,39.y a � Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis;MA 02601 Office:'508-862-4038 Fax: 508-790-6230 NOTICE TO THE BUILDING DIVISION OF WITHDRAWAL OF LICENSED CONSTRUCTION SUPERVISOR FROM PROJECT I, GtY1`� , Construction.Supervisor License #C51 T7 51 ,hereby.certify that I am no longer the Construction Supervisor listed on the application for the project under construction as authorized by building permit # Cry_,issued to (property address) 1 on 200-�'. I also certify that on 1 , 204 b , I notified the property owner, that the project under construction must cease until a successor licensed Construction Supervisor, is submitted on the records of the Building Division. r 1 D ao6 2 .2, : b 20b`� 1102.�� 6��1 �-a�-- LICENSE OLDER DATE bb� oc oy a5 ,> 2009036 � 2oogoa�� : q/forms/newcontr , rrfrrrnrr.R-5 7 R 0('MR te: 2/4/2010 Time: 8:21 AM To: 1-508-790-6230 1-508-790-6230 Page: 002 ACORD', CERTIFICATE CF LIABILITY INSURANCE 2/2/2010 PRODUCER (781)681-6656 FAX. (781)681-6686 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION i, The Driscoll Agency, Inc. ONLY AND. CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER- .THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 93 Longwater Circle ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. , P.O_ Box 9120 Norwell MA. .02061 INSURERS AFFORDING COVERAGE NAIC# INSURED i%)i,.;:I::A.Nat I 1 Fire Ins Co of 20478 Acella Construction Corp_ u:L;F?FRFTransportation Insurance 20494 62 Accord Park Drive Iu;u;;;'P:c:Nort.h River Insurance ..... .............._...........__....................______•_----__.-._..__.__-..............,_. Norwell MA 02061 1VSURE,_COVERAGES THE POUCIES OF INSI TRANCE 1_ISTED BEI.-GO HALE BEEN ISSLIED TO THE INSIIRED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOWATIiSTANDNG ANY AFQLRREMRTI`,TFRP1 OR CONDITION OF ANY C.C?FJTRACT OR OTHER DOCYI111ENT W[T11 RESPECT T-0 WHICH THIS CERTIFICATE IAAY BE BSLIED OR MAY PPRTAIN; THE INILIRANCF AFFORDED BY THE ?CkJCIES DESCRIBED HEREIN IS S1JRJFCT TO ALL THE TERMS, EXCL.LISIONS AND CONDITIONS OF SUCH POIACIES. A`fi{ %" IAI'c c Ic MA•'F{p : :::J I I UE ,„PAID � INSR ADD'L POLICY EFFECTIVE POLICY EXPIRATION TYPE OF INSURANCE POLICY NUMBER DATE MM1DD.'YY DATE(MM.-DD,YY) LIMITS GENERAL LIABILITY rP^ !J''e 5 1,000,000 X :% ;i CC:):J°RkL I Oi:l-: ( I;O.§'p.. 100,000 F v F.c: G)�_ A C2083108786 4/22/2009 4/22/2010 I,, r car :� r� s 15,000 FE1Sb�A', ArNr:NJURY , 1,000,000 FII::`d'c iAL ,G<>GPi;el':_ 6 2,000,000 A - . 2,000,000I r: 'i" AUTOMOBILE LIABILITY: C:P!Ei:'icl":`aI V E fit�9 i J 1,000,Q00'j B AL_04VNECAUG5 2063108741 4/22/2009 4/22/2010 1 ti VNEDkLI"u9 GARAGE LIABILITY ;.UTCCNLY-EAAC:;IL'=\' �J AL,70 ONLY EXCESS;UMSRELLA LIABILITY'. F• :;,q S 10,000.000 10,000;o00 Ii C EuU -IcLE 5530922883 4/22/2009 '4/22/2010 h $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY NYPROPPFIE:CFfFV.;;TN=_:V=XP:CI-T:VE EL a HACCIJ_N: 1,000,000 wC21)83108884 11/22/2009 4/22/2010 E.;,D�_:�a :�.�.�,�ra.�L l'��5 1,000,000 �i=CL4 : V E.L. :ScAS -POLICY LiA-. V.." f - 1,000,000 A OTHER Leased/Rented C2083108786 4/22/2009 4/22/2010 $25,000 any iteni Equipment from others DESCRIPTION OFOPERATION5/LOCATIONyVENICLES.EXCLUSiONS ADDED B`1 ENDORSEMENT/SPECIAL PROVISIONS RE., Hostel International, 1.01-111 Ocean Street;, Hyannis; MA renovation of two buildings, including demolition of. ethers. Please refer to attached adlendum. Notice of cancellation provision is 30 days, except 10 days applies for non-payment of premium. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Eastern New England Council -of EXPIRATION DATE THEREOF. THE ISSUING INSURER V(ILL ENDEAVOR T0`MAIL Hostelling International, 30 DAYS.l+1RITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.BUT --AJneriCan Youth Ii03tels,Inc. FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE - 218 Holland Street Somerville, MA 02144. INSURER.ITSAGENTSORREPRESENTATIVES. AUTHORIZED REPRESENTATIVE - - �CLr:= L'r3_soil/.._,_ ••'?,!•..<:r.;G/i5 rii:� r—�'e''y .. ACORD 25(2001;oe) s'ACORD CORPORATION 1988 ACELLA Construction-Corporation To Whom It May Concern: r I Kenneth Calder is an employee of Acella construction and will be representing the company as the Superintendent at The Hyannis Hostel on Ocean St. in Hyannis Massachusetts. Sin r ly David Dirubbo 62 Accord Park Drive Norwell.MA 02061 Tel. 781-681-9240--- Fax 781-681 9241 w vw.acellaconstruction.com I ELL Construction Corporation To Whom It May Concern: Acella Construction Corporation is a General Contractor that hires sub-contractors.Acella has been selected to manage the Hyannis Hostel at Ill Ocean St. Attached to this letter is a list of our sub- contractors and their workers' compensation policy numbers. The hiring of all sub-contractors has not been completed yet.As we continue to do so we will provide the Barnstable Building Department with any necessary information regarding their workers compensation insurance. Thank you, David Dirubbo 62 Accord Park Drive Norwell, MA 02061 Tel. 781-681-9240 Fax 781-681-9241 www.aceHaconstruction.com AC' ELLA - Construction Corporation Subs List with Workers Compensation policy numbers Hinkley Electric Company,Inc. 108 Parker Road Osterville,MA 02655 Policy#::08WECTJ0977 Effective: 05/19/09—05/19/10 Asbestos Man Removal Co.,Inc. 929 State Road Plymouth, MA 02360 Policy#: 5091807 Effective: 10-3-09 to 10-3-10 Diaz Construction Co.,Inc. 190 Bodwell Street ` Avon,MA 02322 Policy#: WC8332378 3 Effective: 7-1-09 to 7-140 a 62 Accord Park Drive Norwell,MA 02061 Tel. 781-681-9240 Fax 781-681-9241 _ - www.acellaconstruction.com. . r THE r� Town of Barnstable Regulatory Services '. f3AftNSfAiILE, Musa �,�f `Phomas '. (:eiler, Director \�Al i639 Q�0 F0Mpy Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,Mid 02601 �r•��•��.tow:n.barnstable:ma.us Orrice: 508-862.4035 Fax: 508-7190-6230 Property Owner Dust Complete and Sign This Section If L7sirg A Builder John Yonce,for Eastern New England Council of 1. Hostelling International-American Youth as (?tier of the subject propemT hereby authorize Acella Construction Corporation to act on ii v behalf,- in lall matters relative to work autho iznd by this btidding permit application for: 111&105 Ocean St, Hyannis (Address of job) 2/2/10 Sign ature:of.Owner. Tate ~ John Yonce ` Print Name If Tropez-ty Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side: Q rORMS o��'rzf Ftr Fiz�nss�o� nt i►t t►nd t►(Is plt)i►►tm� S , • u vats- n, a,ut � t t i � t . �a u �1.«. �t R4- License Board of Buil(hn-Sup tion ervisor . �., Construc . 100619 License Cs d to .00 'Restricte i, KENNETH CAtDER 40 CHURCH STREET MILTON,MA02186 Expirat wn 712612012 100619 ,ioncr � � y S C�� o The Commonwealth of Massach usetts Department of Industrial Accidents Office of Investigations 600 Washington Street s � Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): ACA-1 G, Cow _,-4-, Address: /// - //.5— oc-- ,, 1S4- City/State/Zip: Phone #: Are you an employer?Check the appropriatx: . Type of project(required): 1.❑ I am a employer with 4. t I am a general contractor and I 6. ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. emodeling 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 sta4whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp,policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the:workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cert' der a pains and penalties of perjury that the information provided above is true and correct. Signature: Date: Phone#: Official use only. Do not write in this area, to be completed by city or town offciaL City or Town: Permit/License# Issuing Authority (circle one): 1.Board of Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: s' i Clientif:52743 DIAZCON ACORD- CERTIFICATE OF LIABILITY INSURANCE DATE PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Rogers$Gray Ins. Plymouth ) ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 34i Court Street HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.0.Box 3700 Plymouth,MA 02361-3700 INSURERS AFFORDING COVERAGE NAIC III INSURED DNSuRERA. Peerless Insurance Diaz Constriction Co Inc , PER f1 Excelsior insurance Company 314 Howard Street INSURER C: Brockton,MA 02302 INSURER D: 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 OF SUCH POLICES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE POLICY NUMBER LIMITS A GENEALLIABILITY CSP8334279 10/18/09 10/18/10 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABRITY DAMAGE TO RENTED '9ES IEa omunano $100 000 CLAIMS MADE Q OCCUR MED EXP are amm $5 000 PERSONAL a ADV UWRY S1,000,000 GENERAL AGGREGATE $2 000 000 GENL AGGREGATE LOOT APPLIES PER: PRODUCTS-COMPJOP AGG s2.000.000 x ICY X jEcTPRO- x LOC B AUTOMOBILE LIABwm BA8334576 10118/09 10/18/10 COMBINED SINGLE LIMIT ANY AUTO (Eaacddmrt) $1,000,000 ALL OWNED AUTOS BODY INJURY X SCHEDULED ALITOS (per P—) $ X HIRED AUTOS BODILY INJURY $ X NON-OWNEDAUTOS (P- ) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EAACCIDENr $ ANYAUO 07HERTHAN EAACC $ AUTO ONLY: AGG $ - A EXCESSIU B;RELLA LIABILITY CUB334176 10118/09 10/18/10 EACH OCCURRENCE $5 000 000 X1 OCCUR CLAIMS MADE AGGREGATE $ HDEDUCTIBLE $ X RETENTION $10 000 $ B wommt8 COMPENSATION AND WC8332378 07/01/09 07/01/10 x Y STA EMPAW PR PRI UABITORIP TY E.L.EACH ACCIDENT $500 000 ANr PROPRKErowPnJRTnesr�curlvE-. , OFFICERIMEMBER EXCLUDED? E.L.DISEASE-EA EMPL $5OO IfM gibe wWar SPECIAL PROVISIONS balm E.L.DISEASE-POLICY LIMIT $500 000 OTHER DESCRIPTION OF OPERATION I LOCATIONS I VEHICLES I rz=LUSMM ADDED BY ENDORSEMENT I SPECIAL PROVISIONS - Project 111 Ocean St„Hyannis Hotel,Hyannis MA Acella Construction Corp.is acknowledged as additional Insured with respects to general liability coverage per signed written contract 10 days notice for non payment cancellations.30 days notice for all other cancellations. I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EVIRATION � Acella Construction Corp. DATE IMEREW.WE ISSUING INSURER WILL ENDEAVOR TO MAIL -M DAYS WRTI TEN ) 62 Accord Park Drive NOTICE TO THE CERTIRCATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO Do 80 SHALL Norwell,MA 02061 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE ENSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESONTATM ACORD 25(2M=)1 of 2 #S491631M46475 JB ®ACORD CORPORATION 1988 `, 4. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel3'zko l/ Application # _r:�_O(qn 3o Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/Hyannis Project�Street Address Villa"— e " Vc;� O��.p� GTelep`--hone=� Permit-Request � Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) ' Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's--Highway: UYes,°© No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area(sq.ft)I E3 k Number of Baths: Full: existing new Half: existing new. b` Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name4-0 l YJ � '�' phone_Number�S� � '�C 7 .1pAddress { / ( , � - iL-cens'e-i# -G'_S —�� ' Jl✓'x//Lf , (� �Y� Home I provement:C tractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE_"' FOR OFFICIAL USE ONLY 1 APPLICATION# s DATE ISSUED ,FLAP/PARCEL NO. ADDRESS VILLAGE OWNER r - DATE OF INSPECTION: 'FOUNDATION,' - J FRAME INSULATION t FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL SAS ROUGH . �u;.,-� FINAL WIVAL BUILDINGt 4, ;DATE CLOSED_OUT ASSOCIATION PLAN NO. 7 ° I i `�.;,•'` a .tk {'x"� ..h3i�gi� 5 / �r+;'�_1k'� <".n r"T3+z .s �' �i y 14`,4 9••.e.F�:,.'t'' rj '`a iE A� T...K .a7_ 'r}-ys>:ri 4V, v-�1aC-t'�,st` 1�-,' x'P i r u y A/e.-} a-14{"�ma's �.#�'.;`:. t ISSUE DATE(MM/DDY-Y)t Q 0 Riz" , w$ns {1 , 5 , .6/4/2010 ON -MEGA PROPERTY & CASUALTY GROUP INC. UPON THEICERTIFICATE HOLDER MA CERTIFIICATE DOEIS NOT ANDLAMEND.EXTEND OR AL ERS .THE COVERAGE AFFORDED BY THE AGREEMENTS BELOW. Go Cannon Cochran Management Services, Inc. COVERAGE PROVIDED BY 100 Quannapowitt Parkway COVERAGE A- MEGA PROPERTY &CASUALTY GROUP INC. . Suite 201 PROVIDER Wakefield,MA 01880 COVERAGE B PROVIDER - COVERED MEMBER - COVERAGE - - PROVIDER _ CAPE COD RTHS COVERAGE .•D 351 PLEASANT LAKE AVENUE PROVIDER HARWICH MA 02645 COVERAGE E • PROVIDER - COVERAGES s.: r °T� -Kin sty s•a-fir ) j,r k; Wr: r dry 4:- iy.y�4n st�.w +.v 'K s:.k fir• 1 Fr r } •# 3- �x �� -i.s .. to ..`L,� . vim. . •: x.�,..,: ?^, �.k � :<r,.::: �.%k« ''E_ �...'r..,n�, 4 3! 1' n: THIS IS TO CERTIFY THAT COVERAGES LISTED BELOW HAVE BEEN ISSUED TO THE MEMBER NAMED ABOVE FOR THE COVERAGE 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 COVERAGE AFFORDED BY THE AGREMENTS DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH AGREEMENTS. f,. PR TYPE OF COVERAGE AGREEMENT NUMBER EFFECTIVE DATE EXPIRATION DATE - — LTR (MMIDD/YYYY) (MMIDD/YYYY) ALL LIMITS- GENERAL LIABILITY GENERAL AGGREGATE COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG. & CLAIMS MADE F__] OCCUR. PERSONAL&ADV.INJURY- s - OWNERS&CONTRACTOR'S PROT, - EACH OCCURENCE "- $ FIRE DAMAGE(Any one fire) ,. & MED.EXPENSE(A.y one person) $ AUTOMOTIVE LIABILITY - - COMBINED SINGLE ANY AUTO - .LIMIT f ALL OWNED AUTOS - - - BODILY INJURY - SCHEDULED AUTOS - - (Per person) f HIRED AUTOS BODILY INJURY NON-OWNED AUTOS Per accidenl & GARAGE LIABILITY PROPERTY DAMAGE & EXCESS LIABILITY r EACH OCCURENCE S UMBRELLAFORM AGGREGATE _ $ OTHER THAN UMBRELLA FORM - - - .k-'7( � s+y- r c4-r w_:. <{ :iga,:3 WORKER'S COMPENSATION 7 STATUTORY LIMITS X A & WCX3401520010 7/1/20.10 /I1I2O11 EACH ACCIDENT $ SOO,000 EMPLOYERS LIABILITY DISEASE-POLICY LIMIT s 500,000 DISEASE-EACH EMPLOYEE S �jQQ�Q00 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES/SPECIAL ITEMS a Sz ELL'gT�ON, ! SHOULD ANY OF THE ABOVE DESCRIBED AGREEMENTS BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING PROVIDER WILL ENDEAVOR TO MAIL DAYS WRITTEN NOTICE TO CAPE COD RTHS THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO.MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE PROVIDER,ITS AGENTS OR 315 PLEASANT-LAKE AVENUE ;.REPRESENTATIVES. HARWICH MA 02645 t-2,h sxg"-�} Insured',COpY.! '-' r; 1 s. x v a fis, r t F?Ir Est x a Yxr r s 64 ,r na,P-nFinaon I n I The Commonwealth of Massachusetts I I 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): Address: 7mr Le- _� Q City/State/Zip: 'r c"► / c Phone #: —�3 Z t- f-f'� � Are you an employer?Check the appropriate box: Type of project(required): 1.El am a employer with 4. ❑ I am a general contractor and I 6.,®New construction employees(full and/or part-time).* have hired the'sub-contractors' listed on the attached sheet. # El Remodeling 2.❑ I am a sole proprietor or partner- r 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 required.] officers have exercised their, 10.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doing all work 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.❑ Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractors that check this box must attached an additional sheet showing the name of the sub-contractors and 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. � j� Insurance Company Name: e.6.e-1 ��" /if� �, 6�L' �► Policy#or Self-ins. Lic. D S Z-0 Q/ Expiration Date. 7 Job Site Address: . P I ` ' `r City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.-Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi y'"?n er the pains and f pury that the information provided above is true and correct. Signature: Date: 114e) .. Phone#: de— Lf-S-00 t 7 Official use only. Do not write in this area,to be completed by city or town official , City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association, corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more ihan three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractor(s)name(s), address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no'employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials y , y Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: , The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax # 617-727-7749 www.mass.gov/dia I Telephone: To r.0 Robert P.Sanborn,III (508)432-4500 r-g Superintendent-Director (508)771-2600 Cape Cod Regional Technical High School ErinOreutt Fax Number: 351 Pleasant Lake Avenue, Harwich, MA 02645-1813 Business Administrator ................................................................................ (508)432 7916 Cape Cod Regional Technical High School will provide an opportunity to acquire high qualihj technical,academic,and social skills which prepare our students for success in our changing world. To Whom it May Concern, Roy Colby is a full-time employee of Cape Cod Regional Technical High School. Roy Colyby is a Carpentry instructor for our school. Furthermore, Roy is covered under the school's workman's compensation coverage and he is authorized by our school to pull building permits. Any questions and/or concerns, please do not hesitate to contact me at the school (Extension 214). Sincerely, Robert P. Sanborn III Superintendent/Director M Barnstable•Brewster • Chatham •Dennis• Eastham•Harwich•Mashpee • Orleans•Provincetown•Truro •Wellfleet •Yarmouth s �"�rorti Town of Barnstable. ` Regulatory Services uRrrsr�st.E, r , v MAss. Thomas F. Geiler,Director '`�� Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862--4038 . Fax: 508-790-6230 ti R _Property Owner Must Complete and Sign This Section If Usina A Builder 1A ,as (,Owner of the subject.property hereby authorize C nZ. C J -':e ccLv to act on my behalf,' in all matters relative to work authorized by this building permit application for: (Address of Job) v5 I Sig e of Owner r Date (an6-e M Print Name If Property Owner,is applying for permit please eomplete'the, Homeowners License Exemption Form.on.the reverse side: Q:FORMS:O WNERPERMISSION L �oF icy Town of Barnstable tt+e o Regulatory Services BARNS.,BLF- Thomas F. Geiler,Director it.tss . Building Division PrEo►�.�" . Tom Perry, Building Commissioner 200 Main.Street,_Hyannis,MA 02601 www.to wn.b arnstab l e.ma.us Office: 508-862-403 8 Fax: 508-790-6230 i HON E0V1 NER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER" name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Persons)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a bomeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that.he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION .The Code states that "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this scction_(Section ID9.1.1 -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 bft=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 homcowncr 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 form/certification for use in your community. Q:forrru:homeexempt �TME r Town of Barnstable 0 Regulatory Services * snxxsTna[.E. MASS. �, Thomas F.Geiler,Director 1639. rFn,,,►+° Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 Office: 508-862-4038 Fax: 508-790-6230 NOTICE TO THE BUILDING DIVISION OF CHANGE OF LICENSED CONSTRUCTION SUPERVISOR owner of property located at J J � r�� ,v yGn I l L d- lv. r S"- - ; hereby certify that is no longer Construction Supervisor listed on the application for the project under construction as authorized by building permit # )Qoc1 0?(a S c J , issued on cl/� 2010 I understand that the project under construction must cease until a successor licensed Construction Supervisor, is submitted on the records of the Building Division. l PR PERTY ER DATE r q/forms/newcontr reference R-5 780 CMR rev:110410 ' [Massachusetts- Department of Public SafcIN Board of Buildino, Re„mlations aml Standard, Construction Supervisor License License: CS 73550 Restricted}p 00 " . ROY D COLBY JR .; 678 DEPOT'ST HARWICH, MA 02645 Expiration: 2/6/2012 Commissioner Tr#: 15484 f TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Yy, Map Parcel_ J Application # Health Division Date Issuedf��lL� Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis cProject St er et=Ad'd-ress--4 IAl 0cQCal^ Village �Owner� Address jelephone- - Permit Request Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑ Oil ❑ Electric ❑Other Central Air: ❑Yes ❑! No Fireplaces: Existing New Existing wood-76oal stovea ❑Yes ❑ No `ter - Detached garage: ❑existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: .L?existing �J never size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other. Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # cam ' Current Use ____ Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name /�.e�� -r�iv�r�r� �`TelephoneNamber ��/ `� z:� �,� •, Add�ressi�� CdyJj_ /License•:#�f �3�/2-. Zc cow fir ' �vz Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 1-9� Sir SIGNATURErt "." "" / D. E_-,;.: A� / FOR OFFICIAL USE ONLY ,f APPLICATION# DATE ISSUED i MAP/PARCEL NO. ADDRESS VILLAGE OWNER i t DATE OF INSPECTION: i FOUNDATION FRAME INSULATION f FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING i DATE CLOSED OUT ASSOCIATION PLAN NO. e �s The Commonwealth of Massachusetts ' ,► .w Department of Industrial Accidents Office of Investigations 600 Washington Street t wii h Boston, AM 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit; Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: City/State/Zip: -0747 Phone #: 4:;�3 4�d. Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. I am a general contractor and I 6. $4New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner listed on the attached sheet. 1 7• ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. EJ Building addition [No workers'.comp. insurance 5. ❑ We are a corporation and its .s officers have exercised their 10.❑ Electrical repairs or additions required.] : , . 3.❑ I am a homeowner doing all work right of exemption per MGL 1 l..❑ 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.❑ Other comp. insurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. xContractors 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: 7� Policy#or Self-ins. Lic. #: C 2-4j9;1 3/C.)e 2b a Expiration Date: / Job Site Address: City/State/Zip: J- Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of.a Fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verificatio I do hereby certify un a pains and penalties of ufy that the infortnation provided above is true and correct. Signature: Date- Phone.#: LOther only. 'Do not write in this area,to be completed by city or town official n: Permit/License# hority(circle one): Health 2. Building Department 3. City/Town Clerk 4, Electrical Inspector 5. Plumbing Inspector . son: Phone#: r r j Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual, partnership,association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable,evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s)name(s),address(es)and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. [f an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information(if necessary) and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. Anew affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Dapartment of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. # 617-727-4900 ext 406 or 1-8.77-MASSAFE Fax # 617-727-7749 Revised 5-26-05 w�w.mass..gov/dia y, of Yt r Town of Barrista.ble . . ... Regulatory Services t s.txxsrABt.E, ass $ Thomas F:Geiler,Director :659- tea' '°rEnr " Building Division . Tom Perry,Building Commissioner 260 Main Sheet,-Hyannis,MA 02601 www.town;barnstable.ma.us Office: 508-862-4038 Fax: 508-740-6230' Property Owner Must` Complete and Sign This Section If Using A-Builder �J0VI~`'`k e I, , as Owner of the subject.property a hereby authorize to act on my behalf, in all'matters relative to work authorized by this building permit application for (Address of job) r tore of F ate Print Name If Property Owner is applying:for permit please complete the 4 F Homeowners License Exemption Form onahe reverse side. Q:FORMS:O WNERP ERMISSION � y 1 �oF Y�ray Town of Barnstable o Regulatory Services BARrrsrAsr.F Thomas F. Geiler,Director Mnss. Building Division Prfp�� Tom Perry,Building Commissioner 200 Main.Street,.Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 509-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code i 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. DEFT MON OF HOMEOWNER Persons) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constrmcts 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.be/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. } , Signature of Homeowner Approval of Building Official t Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that "Any homeowner performing work for which a building p=Tnit is required shall be exempt from the provisions of this section.(Section ID9.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a parson(s)for him to do such work,that sujch Homeowner shall act as supervisor." }vlany homeowncts who use this exemption am unaware that they am assuming the responsibilities of a supervisor(set Appendix Q. Rules&Rcgvlations for Licensing Construction Sup nrisors,Section 2.15) This lack of awareness often results in scrious 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 inquire,as part of the permit application, that the homeowner certify that bc/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 fom>/ccrtification for use in your corrununity. Q:forms:homocxcmpt ACELLA Construction Corporation Town of Barnstable Building Department RE: Hyannis Hostel 490 Ocean Ave Building Permit To whom it may concern, Acella Construction Corporation authorizes Bob Hanley to act on our behalf as it relates to managing construction projects and assuming permits in our name. Regards, Anthony Dirubbo VP Operation Acella Construction Corporation r 62 Accord Park Drive Norwell, MA 02061 Tel. 781-681-9240 Fax 781-681-9241 www.acellaconstruction.com . ,AcoRV CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 6/1/2011 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 endomement(s). PRODUCER - NTA NAME: The Driscoll Agency, Inc. PHONE FAX 93 Longwater Circle A/C No Ext: - - A/C No):781-681-6686 P.O. Box 9120 -ADDRESS: Norwell MA 02061 - PRODUCER CUSTOMER ID#: INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURERA:Nat'1 Fire Ins Co of Hartford 20478 Acella Construction Corp. INSURERB:NOrth River Insurance Company 62 Accord Park Drive Norwell MA 02061 INSURER C:Transportation Insurance Co. 20494 INSURER D:Illinois Union Insurance Com a 1178978 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER:1082309503 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE IN SR WV POLICY NUMBER MM/DDYNYYY MM/DDNYYY LIMITS A GENERAL LIABILITY C2083108786 4/22/2011 8/31/2011 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE PREMISESS(RENTED 100,000 Ea occurrence $ CLAIMS-MADE IT]OCCUR MED EXP(Any one person) $5,000 PERSONAL 8 ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GENI AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $2,000,000 POLICY X PRO- LOC $ C AUTOMOBILE LIABILITY 4020035368 4/22/2011 8/31/2011 COMBINED SINGLE LIMIT $1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS - BODILY INJURY(Per accident) $ X SCHEDULED AUTOS PROPERTY DAMAGE $ X HIRED AUTOS (Per accident) X NON-OWNED AUTOS $ $ B X UMBRELLA LIAR X OCCUR 5530933125 4/22/2010 8/31/2011 EACH OCCURRENCE $10,000,000 EXCESS LIAR CLAIMS-MADE AGGREGATE $20,000,000 DEDUCTIBLE $ X RETENTION $0 - $ C WORKERS COMPENSATION WC2083108884 4/22/2011 8/31/2011 X WCSTATU- OTH- AND EMPLOYERS'LIABILITY Y/N - ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $1,000,000 If,yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$1,000,000 D Contractors Pollution CEOG23879876003 4/22/2010 8/31/2011 Pollution Aggregate $2,000,000 Pollution per claim $1,000,000 Contractors Equipment Leased Rented Equip $25,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) Hostel International is included as Additional Insureds for General Liability and Excess (Umbrella) Liability as required by a signed written contract or agreement with the Named Insured. 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. Hostel International 290 Ocean Street Hyannis MA 02601 AUTHORIZED REPRESENTATIVE ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD z �jmssacnusetks° kqe -irtment of Pub(ic $bard of Bundin2 Re4sitl tt ion s an, S hard . Construction Supervisor License �i nje CS 73412 _ .ROBERT P HQNLEY " _ AMEND? PLY MOUTH MA 02WO ��- Expiration: I V30AD12 commissioner Tw 527 i June 21,2011 Town of Barnstable, Building Division 200 Main St Hyannis MA 02601 RE: Permits and Inspections, ill Ocean St, Hyannis 02601 To Whom it May Concern, Please note that the Eastern New England Council of Hostelling International-American Youth Hostels Inc., has retained Acella Construction and its subcontractors to complete construction of two buildings - at 105 and ill Ocean St in Hyannis. Please allow the transfer of permits from Cape Cod Technical High School to Acella and its subcontractors, and please also conduct the inspections they require. If you have any questions, please call myself at 508-775-7990,or John Yonce at 617-922-0076. Thank you. Sincerely, F � . Jamie Lombardo Manager, HI-Hyannis. Y ac_jz- C .. I ; 45 UIYVU do'- C�i June 21, 2011 Town of Barnstable, Building Division 200 Main St Hyannis MA 02601 RE: Permits and Inspections, 111 Ocean St, Hyannis 02601 To Whom it May Concern, Please note that the Eastern New England Council of Hostelling International-American Youth Hostels Inc., has retained Acella Construction and its subcontractors to complete construction of two buildings at 105 and 111 Ocean St in Hyannis. r Please allow the transfer of permits from Cape Cod Technical High School to Boston Air Mechanical Systems for Plumbing and Charles Perfettuo Electric to finish Electrical work and please also conduct the inspections they require.; If you have any questions, please call myself at 508-775-7990, or John Yonce at 617-922-0076. Thank you. Sincerely, Jamie Lombardo Manager, HI-Hyannis. ACELLA Construction Corporation June 27, 2011 Town of Barnstable Building Department 7at 230 Re: 490 Ocean Ave, Hyannis Transfer of Building Permit To whom it may concern: Bob Hanley is a full time employee of Acella Construction and is authorize to apply, pull, and transfer permits on our behalf. —.a Regards—. EE Anthony . Dirubbo XP _. ZM VP Operations M Acella Construction Corporation � ti 62 Accord Park Drive Norwell, MA 02061 Tel. 781-681-9240 Fax 781-681-9241 www.acellaconstruction.com Town of Barnstable Building Department - 200 Main Street t STAMLE. * Hyannis, MA 02601 1639. a.�AN& ' (50$) 862-4038 O MP icate of OccupancCertify Application Number:-200903054 CO Number: 20110095 Parcel ID: 326045 CO Issue Dater 06/30111 Location: 111 OCEAN STREET Zoning Classification: HARBOR DISTRICT Proposed Use: CHARITABLE HOUSING OTHER Village: HYANNIS Gen Contractor: HANLEY, ROBERT;P Permit Type: RC00 CERTIFICATE OF OCCUPANCY RES Comments: Building Department Signature Date Signed TOWN OF BARNSTABLE B.UrfaingET ti �► Application Ref: 200903054* aaRlvsrnBl.E, Issue Date: 09/03/09 Perm it y MASS. �ArFG 39.�a�� Applicant: ROBERT,EVANS D Permit Number: B 20091619 Proposed Use: MULTIPLE HOUSES ONE PARCEL Expiration Date: 03/03/10 Location 111 OCEAN STREET Zoning District HD Permit Type: COMMERCIAL ADDITION ALTERATION Map Parcel 326045 Permit Fee$ 25.50 Contractor COLBY D.ROY JR Village HYANNIS App Fee$ 100.00 License Num Est Construction Cost$ 5,000 Remarks APPROVED PLANS MUST BE RETAINED ON JOB AND REBUILD BLDG C-COTTAGE AS NECESSARY THIS CARD MUST BE KEPT POSTED UNTIL FINAL CHANGE OF CONTRACTOR 2/2010 1ST EXTENSION EXPIRES 3/3/11 INSPECTION HAS BEEN MADE. WHERE A CERTIFICATE OF OCCUPANCY IS REQUIRED,SUCH Owner on Record: TUBMAN, SANDRA L BUILDING SHALL NOT BE OCCUPIED UNTIL A FINAL Address: 462 TUBMAN RD INSPECTION HAS BEEN MAKE. BREWSTER, MA 02631 Application Entered by: SS Building Permit Issued By: ' �� THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY.STREET;ALLY OR SIDEWALK OR ANY;PART THEREOF,EITHER.TEMPORA11 RILY OR PERMANENTLY . ENCROACHEMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED-UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION. STREET'ORALLY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS IMAYBE OBTAINED'FROM THE DEPARTMENT OF PUBLIC WORKS. THE•ISSUANCE OF,THIS PERMIT.DOES NOT RELEASE THE APPLICANT FROM THE`CONDITIONS OF ANY APPLICABLE 11 SUBDIVISION RESTRICTIONS:".' MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONTSTRUCTION WORK: 1.FOUNDATION OR FOOTINGS. 2.ALL FIREPLACES MUST BE INSPECTED AT THE THROAT LEVEL BEFORE FIRST FLUE LINING IS INSTALLED. 3.WIRING&PLUMBING INSPECTIONS TO BE COMPLETED PRIOR TO FRAME INSPECTION. 4.PRIOR TO COVERING STRUCTURAL MEMBERS(READY TO LATH). 5.INSULATION. 6.FINAL INSPECTION BEFORE OCCUPANCY. c 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. PERMIT WILL BECOME NULL- AND VOID W CONSTRUCTION WORK IS.NOT STARTED WITHIN SIX MONTHS OF DATE THE PERMIT IS ISSIJED~AS NOTEDABOVE: PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOTHAVE ACCESS TO GUARANTY FUND(as set forth in MGL c.142A). 191M'1110 M' 11 W. , tea' G33.. BUILDING INSPECTION APPROVALS ` -PLUMB-1NC,INSPE:C`I'ION APPROVALS =iEEECTRICAL INSPECTION APPROVALS 1 ��j_ � �L.",/. F - � ",-`- `. I•�� L92/f��,��J�/�-/�+ ,*' '� 1 �'j ., of 3 l '` i t.re atspecti n,Apg rovak = Engit.�r: Dept, B d f H l h { J r 00 00 Z r. s T , vOi M' 00 r oo 70 FU] 2500 � Zmo i` "'00000°c �r 7 "R p� Z G es y� C10 � �r �rfr m Z f ti290 p M D .'n� �mn to 0 • m mGO D $ ° '9 =1 RENOVATIONS FOR: ' A 7� 2384 A Main Street(Rte.8A) AR Brewster,MA 02631 �� CAPE COD FOUNDATION/ Residential Commercial i 508.896.0051 phone -O Z TRUSTEES OF IL RUSHER ESTATE \ 5068966199fas Sustainable Design www.copecoddesigner.com z 111 OCEAN STREET Go HYANNIS,MA 02601 �00 � m J b X Ca' m co J. { IF 0o z CO) N " F} r m A%,1� E O 17, it m I s � C « F s my" z Z r� 6'-6Y2• 6'-6Y2" T_2" d c r nl j N O a b0 00 40 b0 O � row• O O V D I CO) Rt (f) p p v n N ? 0 rn p0 IS 0 ❑❑ z 0o m O m O N ;0 0 00 r Q ° m = X r m _ - M__ M I TE 11 —Di D z .� , O O O z o 5'nz• 5'4° 3'-0Y2 z 6'.6Y2• 6'-6Yz' T-2" C. � € ; C bo 1 . 1 O'M n O zz m° IU lu S, A RE m . xz , o III ': III N OmmA Opsc o CO) m z M ' " 8888WT D c m N OO O O m C '� mggvv0 � I I. I " I = � � � � oZ o I ` L - - - - - - - - - -`J I m n x Z Omg G') r O ;0 � IT7 0 0 Z rn n �d DicD n 0 t=i G) Z z z m lr � � � p � � 20,-3" o Z z � T > - m �] RENOVATIONS FOR: � 0 3 w v m 0 90 m 0 T < p Fn N /�n l�L7T CTS Brew t Main Street(Rte.6A) 0 D N Lyjtt.jZj j t. 1 Brewster,MA 02631 rn "� CAPE COD FOUNDATION/ Residential Commercial 508.896.0051 phone � O TRUSTEES OF R.RUSHER ESTATE N 508.896.6199 fax z ■ w o Sustainable Design www.capecoddeslgner.com (Dz 111 OCEAN STREET `° m rt.. ,.. ,., M on„ A �° HYANNIS,MA 02601 N • t O z� X c";- WG)C 1 r 00 1 z 0 nQ ♦ T - O <o �M0, m*oc pm� zm 41 DNA -1, N rn.ZD 4, �1G) �N OND Or �m { mX 0 mmm 4 G) 3 _► A d M 09 m § < n m D . N D T v C T + 0 - nm ANT 1N m X;0p • - �m r �71p t m a) OO nP m =� �A Z �T r ?O .T `2 D O �D O rw 5 _ -40 y X X� - A 0 5 G) 1 O <� Zr m0 m N .Zl pZ " m s �N C T MD C) m� D - m DT D y tCD °°_ X a m p o c z N , i to p r m O N p O - m s'-5" .. - 4-0" M 1pm lP7 @ mad o'11 11 Jilli n s N O 0 C w A l� z N D O . b 0 II z //Z�� r - CA o A II G) DOS ND o zz M �°„N 0 x<v -0- 0 II m II M A3o ° �zm T oo Oro Z p-4 ' ;cz w yOno C C 0 X o �. U.) m N yp n II °mm A mmr j T N Z cop(n o mP °o oA a 2•x 10 RAFTERS Q 16"O.0 z m m y" m z z Q X n II m� C) ° t n Z � Z 7-4° w H D Zt7 � N D fn C.) M �7 wgoD Z yr v r y m Na 8M�� m X0 X � � p°ANo 'I x AM mo =O ^ _D DDT mD lO' - Cn N O z 6 Co Ny rn b D �(n cn m rn rA • y Cn -n RENOVATIONS FOR: 00 0Kz m ( '�'C 1'T' 2384 A Main Street(Rte.6A) D Z v L-1RCf 1 S Brewster,MA 02631 n p G) > CAPE COD FOUNDATION/ 0 Residential Commercial 508.896.0051 phone z - TRUSTEES OF R.RUSHER ESTATE ■ i j www.c6.6199 fax w 1 z 111 OCEAN STREET Sustainable DesignW�»n wwwcapecoddeslgner.com_ 1P z A R' HYANNIS,MA 02601 N BUILDING C: FAMILY COTTAGE BEDROOMS: 1 F' TOTAL BEDS: 4 . . W TOTAL TOILETS: 1 TOTAL SINKS: 1 O 0 OLIL 0 TOTAL SHWRS: 1 SIZE: 350 SF W ff!" I a O U y � w�/ -, a 16 ran" LL 1 w� TITLE: 1 ST FLR. PLAN MAP&PARCEL: 326-045 m ` C� c; c rn m N _0 � o a -a co o r ` O . R cqq cq co L- oo (Vm ►oL i E E L1OR ZT T U :2 W cl) U Ll\ COMMON/ — — KITCHEN FAMILY BEDROOM O 0 0 0 u BATH Date: 12/15/2008 (D 00 (D00 Sheet: 1 EX. 1 ST FLR PLAN 2 PROPOSED 1 ST FLR PLAN 1.1 114*=1'4r BUILDING C: Aml m0 111 OCEAN STREET - C/O TTAr-� . PERMIT SET A I 1 1. 1 1 1 IT] _ H III I I I I I I I I I A I t .1 1 .1 1 1 z z a 1111111 L L 111 O z 1.1 1. -1 L I I I I Hill lill O � u "owe. u PROPOSED NORTH ELEVATION 7 PROPOSED SOUTH ELEVATI N > o w Ai w 114"=1'-0" .�I 1/4"=1'-0" O w 0 z LU d n M sa - .. TITLE' w _ - 4 FLOOR PLAN & ELEVATIONS . p ❑oo MAP & PARCEL: 326-045 ,, xK , I o ai c - -- CD N -C X 3Y2"CONCRETE SLAB I I o Q a W16X6X1.0WWF c o - o F ON 6 MIL VAPOR BARRIER o co O CD t 4 EXISTING WEST ELEVATION 5 PROPOSED WEST ELEVATION ON 4"CRUSHED STONE N (I (o I - -- - 0� CC) " 14'-11Y2" L_ °° C° C 3 N m in ) Lo i 6'-2Y" 2'-7Y2" 3 - --CONC. TG. ca LL O O _ _ 8" � ( III CONC. ND.WALL - \ E � N v CO 0 E N -- ------------ — — c0 F r PROPOSED FOUNDATION PLAN o FAMILY BEDROOM o �.� 1(4"=1'-o" BATH 275 SF : 6 BEDS o E o � N ED F in b ° C� !0O(:l) 0001 o o R_ -tL aF� Y� El `° BUILDING C: FAMILY COTTAGE `� Date: 2/20/2009 BEDROOMS: 1 TOTAL BEDS: 4 Sheet: o O TOTAL TOILETS: 1 TOTAL SINKS: 1 EXIST. 1ST FLOOR PLAN 4 ' �`4�-0" TOTAL SHWRS: 1 �•� ,(4"=''-0" 2 PROPOSED 1ST FLR PLAN SIZE: 350 SF BUILDING C: 111 OCEAN STREET - COTTAGE PERMIT SET ENVIRO-SHAKES CELL OSE IN IN TYPICAL ROOF ASSEMBLY CELLULOSE INSUL. ` ARCH.COMP.SHINGLES �! 12 3 2 / Y2"CDX PLYWOOD ROOF -7.z 15#FELT PAPERCX _ W 70 9 SHEATHING 2„X 10"RAFT/EORS @ 16-O.C. Z 7 ICE AND WATER SHIELD O F4 / @ALL EAVES 8/12 4 U_ E� CONT.SOFFIT VENT -- -- 3f12 ~ a-1 U) Q w 1 x SOFFIT Z O AL.GUTTER, half round,WHITE 24'.6" OILQ Q /� NEW PLATE HGT. \ TYPICAL WALL ASSEN O WHITE CEDAR 5"T.W.zo z W FASCIA 1x8 PINE WOOD FLOORING TYVEK WRAP Uj O 3/4 ADVANTECH SUBFLOOR z CDX PLYWOOD P.T.2 X 4 WOOD SLEEPERS 2"X 4"WALL STUDS @ 16"0.( 2"USG FIBEROCK AQUA 1x8 FRIEZE BD 3 TOUGH INTERIOR PANELS of55 ON 1 X 3 STRAPPING 16"O.C. .-.... :; , TITLE: 3. 3 ` °'"s°""°""°"¢ 1"RIGID INSUL.24"OUT&DOWN 724" N ur°H L 8"CONC.FOUNDATION WALL ON/6' CONCRETE SLAB MIL VAPOR BARRIER FOUNDATION & " AND 4"CRUSHED STONE FRAMING PLAN 2 x 6 & SECTION WALL ASSEMBLY 2 BUILDING SECTION MAP & PARCEL: 326-045 1.2 1/4"=1'-0" of 4 EAVE DETAIL N x (n Q LO (D n d 00 00 � M - 0 0 c N m Lo Lo z CONTINUOUS RIDGE BOARD RIDGE VENT CAP BY REF.STRUCT.DRAWINGS _ _ — �-�I L c ENVIROSHAKE 1 1 -1 3/4"X11 1/4"(2 X 10 RAFTERS) — — — r 1 'N 32" 1 -1 4"X 9 4"LVL(2 X 8 RAFTERS) O L/ Q AT BUILT-UP RIDGE BEAM RAFTERS, REF. Co CONDITIONS INSTALL BEAM STRUCT.DRAWINGS V 1"LOWER THAN RAFTER TOP AT PEAK. w C 12 - 1 4' 11 "LVI RID EBE NM >� CV LL 5 11 �\ 8"RAFTERS @ 16"O.0 r i y 2" 10"F OOF AF RS 16 O.0 ='J 2 Date: 2/20/2009 Sheet: II PROPOSED ROOF FRAMING PLAN 3 RIDGE DETAIL BUILDING C: � 111 OCEAN STREET - COTTAGE Al m2