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/-y �: - _ `� R E /1'iaTa2 I�oDGC Co��a 7ku-s7 '� �. ----- - - -----_--_ - - -------- ---- - �'' '� I • TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION .1 Map < Parcel _ Application(ii:�X)fOy 1) .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 Village Ownerea:rendmAddress ©Ct'6Y ST Telephone 'f3 L Permit Request _ C�&L L%Ji'IlicJw u .3 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation t� 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 4. Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other i Basement Finished Area (sq.ft.) Basement Unfinished Area (sgft)�: , e "1 Number of Baths: Full: existing new Half: existing °' new:T Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor RoomCount 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 �-ri` IeL Telephone Number Address �13 ZS- /4 fr0,%e,t le 7 License # (S — 4f "2 AA-A 02700 Home Improvement Contractor# qVO Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO Aif'&L SIGNATURE DATE p IS FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. I ?lie Comurarnrealth of Massachusetts Deparment cr,f industrial Acciderds - f ie oflmwtigadons. 600 Washington Street n , Barstwill?CIA 02111 wYwrmas&gov1dia Workers' Compensation Insurance Affidavit:BuiIder-s/CuniractarsiElecfricians/Phumbers Applicant InfarmafiQn Please Print LeggiU Name(Husiwm'Yrgan±mfionaffy daal): Address: Z j _City/statef t=i tJ�!' Phoneme Are you an employer?Check the a ropriate box: Type of project(reguiredy I-L] 1 am a employer with 4 ❑I am a general contractor and I employees(full arldfor pant-time). * liave l3ired the sub-contractors 6 ❑New construction 2.❑ I am a sole proprietor orpartuer- listed on the attached sheet. 7. RemodeHng slip and have no employees These sub-contractors have g_ ❑Demolition Working forme in any capacity- employees and have worlcers'[No lT orke-M'comp.issuance comp. 9. ❑Building addition required.] 5. ❑ We are a corporation and its 10-0 Electrical repairs or additions officers have exercised their 3.El am a homeoumer doing all work 11_❑Plumbing repairs or additions ' myself.[No workers'comp- t of exemption per MGL 17.0 g,00frepairs fimmance required]i c.152,§1(4h and we have no employees.[No workers' 1I.❑'other comp.insurance required_] •dory appffcantdhatcfierksbox#1 mnst also,filloutthe sectioabelowsbawing their wo&els'camipensafioupolicyinfannxioL 1 HameDwners who submit this of idatiu ing5cating they are doing all weak sad,then brae outside cone actors nmst submit anew affidavit i"a'mfing suct_ ZCantractorstbztcheck this box mustattachedanadditianal sheetstot mgflrenameofthesnb-cc trzcADrsandstatewhetherornotlhoseerrritiesh_av employees.7fthe5nGtaatactarshaceempIoye2stbeymustpmvidetheir workes'comp.policy number. Ian[all irmiranceformyeHipLalves. SeToav is tihapoticy and f obi site ir�orrnrrtiarL Insurance company Name: Policy 4"or Self--ins.Lic. Expiration Date: Job Site Address: citylstatelzip- _ Attach a copy of the workers'compensationpolicy declaration page(showing the policy number and expiration date). Failure to secure coverage as requireduuder Section 25A of MGL c 152 can lead to the imposition of criminal penalties of a fine up to$15.0aOD andbr one-year imprisonment as we=l as civil penalties.in the form of a STOP WORK ORDER and a fine of up to 0- y against the-violator. Be adsdsed that a copy of this statement maybe forwarded toile Office of Isrrvest gat{ons f fe DIA.for insurance coverage verificadon- I Ufa hereby ardor t andpsnahies ofpetlacry that the informatimi protzrled a 'a r 8 and correct Sitntature: U"— Bate: O Ll Phone ik 0jokial use anTy. Do not write in tuts area;to be caainpleted by city artoirn of)rciaL City or Town- PernatUcense# Ensuing kuthority(circle one): L Board of Health 2.Buff&ng Department 3.#ftytPmen clerk 4.Electrical Inspector S.Flantbing Inspector b.Other Contact Person- Phone#- Wormation �xzd Instruefions Mass r-hasctts General Laws chapter 152 rtaoirm all employers to pravide workers'compensation for fheir employees. PMM=tto this sty,an m playme is defined as-"_.every person in ffie sm-vice of another under any contract of hire, express or impliecA oral orwritte . An er,Plvy�is defined as"an individual,parinemsh�,association,corporation or other legal entity,or any tFvo or mom Of the foregoing engaged m a joint mtmpase,and inclnding the legal m epresentatives of a deceased employer,or the m eceiver or trustee of an individual,pa>.toersh ,association or other Iegal entity,employing employees. However the owner of a.dwelling house having not more than tbrea apartments and who resides therein,or the occupant of the - dwelling house of another who employs persons to do maintnan c�,construction or repair work on such dweIling house or on the grounds or bruldmg appurte -ffiemto shaIl not becanse of such employment be deemed to be an employer." MGL chapter 152,§25g6)also sees fh2t"every state or local Licensing agency Shan withhold fhe issuance or to construct bufld� in the commonwealth for any renewal of a Iicease or permit to operate a business or � applicantwho has not produced.acceptable evidence of compliance wih the hLS-Ii ce coverage regnked"Additionally,ML chapter 152,§25C(�sus"Neither fle co�gnvtPaT nor iay ofits political subdivisions shall enter mto any contract for the performance ofpublic work nni11 acceptable evidence of compliance with the insr„-a„ce._ rcq�ents of this chapter have been presented to the contracting ar>thoxity_" , APplicants Please fill oil the workers'compensation affidavit completely,by che6kiag the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s), address(es)and phone,number(s) alongwifhthen-certtfrcate(s)of ;T,s, a ce. LbmiteciLiabffity Companies(LLC)or LimitedLiabERyPertaershi s.(LLP)withno employees other tbanthe members or partners,are not rbquimd to carry workers' compensation insurance- If an LLC or LLP does have employees,a policy is regn:red. Be advised that this affidayk may be submitf_-d to the Department of Industrial Accidents for confamatsoa of ins'u ancc-c coverage Also be sure to sign and date fine affiftylt The affidavit should be net=r d to ffie city or town that the application for the permit or license is being request 4 not the Department of Indastrial Accidm s. Shouldy�ou have any questions regarding the law or ifyou are req (—,d to obtain a workers' compensation.p olicy,please call tune Department at the number listed below. Self-insured companies should enter their s e1f-mmnau ce license number on the appropriate line. City or Town Officials T _ Please be sure that the affidavit is complete andprmted.IegRiIy. The Department has provided a space at the bottom t you the applicant ' for you to tiIl out m the event the Office of Investigations has fn contact y regarding aFP e affidavit . . or th Y applicant Please be sure TD fll m the pemlitlIicense ntYmber which wr7l be used as a reference number. In a.ddrhon,an that must submit m_ubi ple pemsitllicense applications in any given year,need only submit one affidavit indicating current policy info]nation t`if nere - )and undue"Job Site Address"the applicant shoTsd v rite"aIl locat es>im (cTY or town)-"A copy of the-affidavit fiat has been officially stamped or marked by the city or town may b e provided to the applicant as proofthat a valid affidavit is on fdc for fctm permits or licenses A new affi davit must be filled oirt each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venue (ie. a dog license or permit to bum leaves etc.)said person is NOT required to complete$ris.affidavit The Office of Investigations would Imke to thank you is advance for your cooperation and should you have any questions, please do not hesitate to give us a call tel hone and fax number: The,Department's address, ep s tin of Massachusetts , Department of Iadustdal Agents , fie r�.f�esfig�tio� - 6Q�� Qn Stet Badon,lA()�111 Tel..'617'27-4900'eat 406 nr 1-`-MA�4 Fax#617` 27 774 Revised 4-24-07 mas, gQgf dia I - I oFTME MAM 1619. Town of Barnstable QED MA't D Regulatory Services Richard V.Scali,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section. If Using A Builder I, �PQ , as Owner of the subject property hereby authorize �'L� �/" 1&Q(AJ to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) to I2. 2) Signature of Owner ' Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. QA)ATFILES\FORMS\building permit forms\EXPRESS.doc Revised 040215 0/16/2015 FRI 14:06 FAX 508 676 6823 Pella windows fall river 001/001 Pelic-P Windows & Doors 1325 Airport Road Fall River, MA 02720 ® Phone; 508.676.6820 Fax: 508.676.6823 www.gopella.com October 1VI, 2015 Town of Barnstable RE: Raj Patel Steve Dickinson is an employee of Pella Windows&Doors and is covered under Pella's workers compensation insurance. Regards ,J4 Steve Dickinson Pella Windows&Doors VIEWED TO BE THE BEsr I Client#:73461 PFRACQ ACORD. CERTIFICATE OF LIABILITY INSURANCE DAT 4/28120158/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Melissa Tanguay Starkweather&Shepley PHONE 401 435-3600 FA 401 431-9658 PO Box 549 MAILo Ext: AIC,No Providence,RI 02901-0649 ADDRESS: mtanguay@starshep.com 401 435-3600 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Utica Nat'l Assurance Co. INSURED INSURER B: PFR Acquisition LLC DBA: Pella Windows&Doors INSURER C: INSURER D: 1325 Airport Rd INSURER E Fall River, MA 02720 INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTRR ADDLSUBR TYPE OF INSURANCE NSR WVD POLICY NUMBER MM/DD�YY MM/DD�YY LIMITS A GENERAL LIABILITY CG4759537 05/01/2015 05/01/2016 EACH OCCURRENCE $1 000 000 N MERCIAL GENERAL LIABILITY DAMA E O RENTED PREMI E Ea occurrence $100 000 CLAIMS-MADE I OCCUR MED EXP(Any one person) $5 000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY PRO JECT LOC $ A AUTOMOBILE LIABILITY BAC4761327 05/01/2015 05/01/201 COMBINED Ea ccident SINGLE LIMIT $ e �1 000 000 a ANY AUTO BODILY INJURY(Per person) $NED ALL OW X SCHEDULED UTOS AUTOS BODILY INJURY(Per accident) $ A X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident $ A X UMBRELLA LIAB X OCCUR CULP4761538 5/01/2015 05/01/201 EACH OCCURRENCE $10 000 000 EXCESS LIAB CLAIMS-MADE AGGREGATE $10 000 000 DED I X RETENTION$O $ A WORKERS COMPENSATION B614932 05/01/2016 05/01/201 X TO Y LIMIT OTH- AND EMPLOYERS'LIABILITY Y/NIER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1 00O 000 OFFICER/MEMBER EXCLUDED' N N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1 000 000 I ,describe under DESCRIPT ON OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) Proof of Insurance Only. CERTIFICATE HOLDER CANCELLATION PFR Acquisition LLC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN DBA: Pella Windows&Doors ACCORDANCE WITH THE POLICY PROVISIONS. 1325 Airport Road Fall River, MA 02720 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD #S686772/M682889 PAT2 Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor M '. License: CS-081843 STEPHEN T DICIT '• .. Y, (y 12 BURNSIDE L�tE MERRIMAC MAr Ol Expiration Commissioner 02/06/2016 � � �e�avr�mo�rcuse�i;�Cf a�C�/�lauac�uaeCL, �, 1,I f�9ee;of Ceasamer Affairs&Baeiuea Re;olatiou t ME IMPFt01kENiENT CON7RACtOR' Regstratloti:� 984 Type Expiratkr 6- Supplement PELL%A WIWDOWS;IA t325 AiRP©RT Ro�� .. eau:RIVEit;+MA tt0 >Jaeter aertry . I - Town of Barnstable °^ Regulatory Services ► BMMSTM Richard V. Scali,Director �EDM�.Ip, Building Division Thomas Perry,Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Building Permit Procedure for Commercial Additions/Alterations ❑ Map and Parcel number ❑ Letter of Approval from Site Plan Review(if applicable). ❑ Site Plan must also be submitted showing the location and setbacks of existing/proposed structures, septic,parking, etc. ❑ Historic District at 200 Main Street: Certificate of Appropriateness is required. Old Kings Highway Historic District(north of the Mid Cape Highway) Hyannis Main Street Waterfront Historic District(See map for boundaries) Historic Preservation(if applicable). ❑ Construction plans-one complete set of full sized plans and one complete set reduced to 11"xl7and fully dimensionalized must be submitted with the building permit application. Both sets must have an original architect or engineer's stamp. Note: The applicant must also submit a set of plans to the appropriate Fire Department for review. The application package will not be accepted without prior approval from the Fire Department. ❑Approval from the following departments, located at 200 Main Street,must be obtained ❑Health Department Hours(8:00-9:30 AM or 3:30-4:30 PM) ❑Conservation Department Hours(8:00-9:30 AM or 3:30-4:30 PM) ❑Tax Collector ❑Treasurer ❑ Permit must contain full description of the project, correct square footage,valuation of project(do not include hvac)owner's name,address and telephone number,contractors information and signature and dated ❑ Workers Compensation Insurance Affidavit State form must be completed and a copy of Insurance Compliance Certificate must be on file. ❑ A copy of the Construction Supervisor license is required. Note: Construction Supervisor's license holders are not entitled to supervise construction of a building or an addition (regardless of size)to a building with a total cubic volume greater than 35,000 cubic feet. In that case, the application must be accompanied by controlled . construction documents as indicated in 780 CMR sections 116& 1705. ❑ Check expirations date, no restrictions ❑ Controlled,Construction ❑ If sprinkler or fire alarm system is required, do not accept application package without prior approval from Fire Department(phone call or in writing) ❑ Have you submitted the AQ 06 form with the State?www.mass.gov/dep Any question on completing form call Caroline McFadden 617-292-5766 ❑' A NON-REFUNDABLE Application Fee of$100 must be paid upon receipt of application number,check made payable to the Town of Barnstable. Permits are$9.10 per$1000 of value of work.Minimum permit fee$66.00 Property owner must sign Property Owner Letter of Permission. Projects requiring the use of a crane must complete the forms issued by the Federal Aviation Administration(FAA)(Form 7460)AND the MassDOT Aeronautics Division(Form E-10).Forms and procedures may be obtained from the FAA and MassDOT websites. Note: No wall is to be covered before wiring,plumbing and frame inspections. Q:forms/bldg/permits/CADDALT Revised 02/27/15 t YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates(cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town(which you must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St.,, Hyannis. Take the completed form to the Town Clerk's'Office, 1st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate tliat is required by law. DATE: )0_C_ ZCr 1 Fill in please: APPLICANT'S YOUR NAME/S: Rf BUSINESS YOUR HOME ADDRESS: rat s r H`tq►��ns ►K� y.2xo/ �$3 ,} 't'c f FiE ^ �wFFFZ �li'D -71 - ' TELEPHONE # Home Telephone Number NAME OFCOR NEW Busl NAME OF NEW BUSIN N. Sffir bKviu "'ji�fC ESS kt&P op kpu(G 1 N/mil TYPE OF BUSINESS /jai IS THIS A HOME OCCUPATION? YES NO ADDRESS OF BUSINESS iR o c C-Ow S M R'.!Vlz low MAP/PARCEL NUMBER c�.o u 014`I (Assessing) 'When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. — (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally'operate your business in this town. 1, BUILDING COM ISSIO ER'S OFF[ This individua has ee i orm d c�f ny !er it eire •ents that p stain to this type of business. rV IV Aut Piz d Signat rem COMMENTS: .2. BOARD OF HEALTH This individual has been informed of the permit requirements that pertain to this type of business. Authorized Signature* COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) business. individual has been informed of the licensing requirements that pertain to this type of bu i This ind i g q Authorized Signature* COMMENTS: Town of Barnstable u7 BARNSTABLE. Regulatory Services 9 MASS. 0 =6 M a Building Division prEO Py . 200 Main Street,Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Inspection Correction Notice Type of Inspection r'e}kYy�E Location `� y C EA-?J -ST Permit Number Owner Builder One notice to remain on job site, one notice on file in Building Department. The following items need correcting: 4)FFDED ovEK LALA,-�); /e-4� 12Z Please call: 508-862-4038 for re-inspection. Inspected by -PZ J � ' Date ��L� 13 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION TOWN OF BARNST ELE Map 3 Z 6 Parcel �� QUA Application b Health Division I'll ICT 15 P Rhss ed Conservation Division Application Fee 411 Planning Dept. DIVISIO.�,�, --Permir t+ee 16 �-�-1�� Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address 0(eA� 5�ree f Village 14 v &.1 o^f/ss Owner Address 1��1 oc ec,, SiPft 14 r,".11 S Telephone Permit Request Reimo(-t cuA cnejAte 6 Lj,I,, OWa A1.1 i e,,W re 6.+(d, �emod c t,,A&f&,tr5 6,p,hArovm (em13de e 1s A V C_L1h.n�C.P Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 2 4 I Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name �_'1�G�1 F�T&5 r Telephone Number 50 Z" yZ 5 q� 7 Address U`� ���� V` W License # nq 7�� Home Improvement Contractor# j 2 5;0!5 Worker's Compensation # WC.00 � ml�0so ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TOL`i SIGNATURE _ DATE G l S FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ' ADDRESS VILLAGE { OWNER � t } DATE OF INSPECTION: i FOUNDATION ! FRAME INSULATION ? FIREPLACE c- x ELECTRICAL: ROUGH FINAL 'r PLUMBING: ROUGH FINAL 4 9 GAS: ROUGH FINAL i . FINAL BUILDING r ' DATE CLOSED OUT �r ASSOCIATION PLAN NO. _ The C'gmm"Onwealth of Massachzlsetts —I Department of Industrial Accidents Olice o Invesrigarimu A _ ;1 600 Washingron Street Boston, A! 11. J 0� . - _ tivww.mass.govldia WorkWs compensation,Insurance Affidavit:Builder•s/Contracto.,s/Mectrieiaus/p]mubers Applicant Tnfomatio3n Please Print:Legibly- Name(,Business/Organization/individual): f L -71 Address: r City/State/dip: �� Mlq �� J�� .Are you an employer?Check the appropriate box: Type of project(required): 1. !J .t am a employer witlt � 4•❑ I a~a general conir2ctor and I have F. • employees(full and/or Part-time).* New ccrsCttetion P' 1 hired the sub-co,:rractors listed on .T �•--� the 4ed7sheety Remodeling 2. t—1 1 am a soleP-nl etar or partnership These sub-contractors have $• ❑Demolition' and have no employees working for mein any capacity.[No vfoiorkers' employees and have workers'comp. 9. Building addition rs insurance.]: comp insurance required.] 5. •we are a corporation and its 10.❑Electrical repairs or additions officers have exercised their right of l 1 plumbing repairs or additions 3 ❑ I am a homeowner doing all work exemption per MGL c.152§(4),and 12.Q Roof repairs insurance r myself e workers'camp, we have no employees.[No workers,equired]'I we insurance requited.] 13 Oche *Any applicant that checks bcx rl anst also yil out me see tipn beloN showisg their 1+xlsers'.comperrdonpoiicy Ltiossttiou t Homeowners who submit;his affidavit indicating dhcy are doh g all work and then hire o xsid--contactors must submit a new affidavit indicating saeh #Coznac�rs that check this o must mrst aupl'dd eirh�'workers' mp policy nub onmaors and state Nvl:cther or not those amines have aploy�s.;f the sub-con=tors have employees, I ant an employer that is providing Workers'compensation buur•ance for my employees.Belo,,is the Policy and job site injornwtion. ,�iD Insurance Compaay Name; Policy r or Self-ins.Lic.;h `�V 0 3 f , f F.zpk-•ation D•ate: Job Site.Addr ss: C A, S <Qe City/StateYLtp: H /c-hnt S ,/A �Z�j•(J �&ttach a copy of the wnrlters'compensation policy declaration page(showing the policy.number and exprrabon date). r'all='to.secure coverages as required ander Section 25A of MGL a.152 can lead to the imDositi.on of criminal penalties of a fine up to$15�?0.00 and'or one-y Ar mprisonment as well�s Civil penalties in the form of a STOP WORK ORDER snd a fine of up to$250.0o a exy against the v$1,50r.D advised that a copy of dlzis stat�rnent maybe forwarded to the Office n:Investigations of the DTA for insurmce cov ge v tification 16 hereby curt}/ the , enallies of perjury that the information rye idzd above is true and correct. Signature: G�/X13 Date: Phoonet 02 3FI.rBoard nly.Do not write in this aea,to be completed by city or town offcipl I Town- Permit(License n ority(circle one): lealth 2.Building Department 3.City/Town Clerk 4.Electrical I.a� 1 6.Other pector 5.Plumbing Inspector Contact Dema: Phone??: NCO FRASCON-01 PAAS �- CERTIFICATE OF LIABILITY INSURANCE DATE(MWDONYYY) 19 THIS CERTIFICATE 1S ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED 13Y THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s), PRODUCER CONTACT Viveiros Insurance Agency,Inc. (50$)676-0309 NAME: Ashle Paiva 375 Airport Road AiC.No Ext': 508-676-0309 127 (Art,No): 508-324-9147 Fall River,MA 02720 ADDRESS:APaiva@Viveirosinsurance.com INSURER(S)AFFORDING COVERAGE NAIC 0 INSURED Fraser Construction LLC INSURERA:Granite State Insurance CO INSURERS: PO Box 1845 INSURERC: Cotuit,MA 02635 INSURERD: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN )$SUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOM11THSTANDING 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. I SUBR LTR TYPEOFINSURANCE IN SIR WVD POLICY NUMBER POLICYEFF MML EKP LIMITS GENERAL LIABILITY EACHOCCURRENCE $ COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS.MADE OCCUR NED EXP(Anyone person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP.AGG $ POLICY I PRO- PR _ LOC $ AUTOMOBILE LIABILITY E ALITO e a cident) L'MI $ ALL SCHEDULED BODILY INJURY(Per person) $ AUTOS SCHEDULED HIRED AUTOS NON-OWNED AUTOS BODILY INJURY(Per acddent) $ AUTOS Peracclderi)A a $ UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LLAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ WORKERS COMPENSATION $ AND EMPLOYERS'LIABILrIY WC SLIMIT OTH- A ANY PROPRiETORIPAR TNERtXECLITIVE YIN WC009930601 TORYLIMIT ER OFFICERMEM9ER EXCLUDED? NIA 9/26/2013 9/2612014 E.L.EACH ACCIDENT $ 500,000 (Mandatory In NH) It yes,descibeunder E.L.DISEASE-EA EMPLOYEE $ 500.000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks schedule,If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Barnstable Building Division THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN 200 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis,MA 02601- AUTHOR2ED REPRESENTATIVE O 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD t Massachusetts -IJepartrrtent of fiut)IIC Safety Ir Board of Building Requla[Inns anct Stflnclards Cnnstrurtlun SaiTcrstsne _ I License; C"97688 s DYAN C FRASER 104 TWAVN VMW LA1 EAST FALtVIOTJA;,j? t i •T:1:11 r Expiration � 1 Cummissiater 06/07/2015 r Office of Consumer Affairs and Business Regulation y•-��� • � 10.P _ ark Plaza.- Suite 5170 Boston,Massachusetts 02116 Nome Improvement Contractor Registration Registration: 112536 Type: DBA FRASER CONSTRUCTION CO. Expiration: 3123l2015 Tr' 237059 DEAN FRASER P.O. BOX 1845 COTU IT, MA 02635 YJpdateAddress and return card_Mark reason for change. sr,:4 a Address ❑ Renewal ❑ Employment P ymenE ❑ Lost Card w ;. Office of Consumer Affairs&$ n�RcSulation License or registration valid for individul use only '.__XOME IMPROVEMENT CONTRACTOR before the expiration date, dffound return to: e9istration_ 1 Type_ Office of Cousumer Affairs and Business Regulation p Pir*'Uoo: U=015 DBA 10 Park Pla=-Suite 5170 FRASER CONSTRUCTION CO. Boston,MA 02116 DEAN FRASER 104 TVVINN VIEW LANE 1 E FALMOUTH,MA 02536 Undersecretary Not valid without signature Mass. Corporations, external master page Page 1 of 2 William Francis Galvin j h t ySecretaryof Commonwealth ofMassachusetts HOME DIRECTIONS CONTACT US Search sec state.ma us SeafCh Corporations Division Business Entity Summary ID Number:001108279 Request certificate � New search Summary for: SAI PRABHU,LLC The exact name of the Domestic Limited Liability Company(LLC): SAI PRABHU, LLC Entity type: Domestic Limited Liability Company(LLC) Identification Number: 001108279 Date of Organization in Massachusetts: 05-30-2013 Last date certain: The location or address where the records are maintained(A PO box is not a valid location or address): Address: 119 OCEAN STREET City or town,State, Zip code,Country: HYANNIS, MA 02601 USA The name and address of the Resident Agent: Name: STEVEN J. PIZZUTI ESQ Address: 336 SOUTH STREET City or town,State, Zip code,Country: HYANNIS, MA 02601 USA The name and business address of each Manager: Title Individual name Address MANAGER NAYANA R PATEL 119 OCEAN STREET HYANNIS, MA 02601 USA MANAGER RAJENDRA P PATEL 119 OCEAN STREET HYANNIS, MA 02601 USA In addition to the manager(s),the name and business address of the person(s)authorized to execute documents to be filed with the Corporations Division: Title IIndividual name Address SOC SIGNATORY STEVEN J PIZZUTI 336 SOUTH STREET HYANNIS, MA 02601 USA The name and business address of the person(s)authorized to execute,acknowledge,deliver,and record any recordable instrument purporting to affect an interest in real property: Title Individual name Address REAL PROPERTY NAYANA R. PATEL 119 OCEAN STREET HYANNIS, MA 02601 USA REAL PROPERTY RAJENDRA P PATEL 119 OCEAN STREET HYANNIS, MA 02601 USA r Consent r Confidential Data r Merger Allowed r Manufacturing View filings for this business entity: ALL FILINGS Annual Report Annual Report-Professional Articles of Entity Conversion Certificate of Amendment ) I View filin gs Comments or notes associated with this business entity: http://corp.sec.state.ma.us/CorpWeb/CorpSearch/CorpSummary.aspx?FEIN=001108279... 10/15/2013 f IFELORM Fraser Construction, LLC CONSTRUCTION P.O. Box 1845, Cotuit MA. 02635 0:41111 ,' ' Email: info(@,fraserconstructioncapecod.com com 5�8-42$-2292 www.fraserconstructioncapecod.com FAX 1-508-428-0123 HICL#112536 CS#97668 WORK PROPOSAL DATE: September 5, 2013 PHONE: 617-852-1868 NAME: Raj Patel EMAIL: pate11961@hotmail.com MAIL ADDRESS: JOB ADDRESS: 119 Ocean St. Hyannis, MA 02601 FRASER CONSTRUCTION hereby proposes to perform the following services in a neat, professional like manner in accordance with the manufacturer's specifications and local building code. Windows 1) Remove and replace (6) windows with Replacement Style windows. Remove and replace interior casing. Windows to be true divided, grilles outside and between windows. a) Windows: $2,378.50 b) Interior Trim: $750 c) Labor for 2 men: $2,700 Total Investment: $5 828.50 Initial: N ' i Fraser Construction LL CONSTRUCTION P.O. Box 1845, Cotuit MA. 02635 abdLILMM Email: info fraserconstructioncapecod com 508-428-2292 w ww.fraserconstructioncapecod com FAX 1-508-428-0123 HICL#112536 CS#97668 WORK PROPOSAL DATE: September 9, 2013 PHONE: 617-852-1868 NAME: Raj Patel EMAIL: pate11961@hotmail.com MAIL ADDRESS: JOB ADDRESS: 119 Ocean Ave. Hyannis, MA 02601 FRASER CONSTRUCTION hereby proposes to perform the following services in a neat, professional like manner in accordance with the manufacturer's specifications and local building code. Downstairs Bathroom - Install new replacement window - Remove old shelves and install Wainscot with chair rail to match remainder of office - Install new Toilet and new 24" Vanity - Install new light with fan - Re-sheetrock on (3) walls and ceiling Allowance: 3 750 � Initial: Bathroom Allowance - Supply and install new 30" X 36" Standup Shower. Remove old shower. Install new floor and sink. Set-up plumbing for washer and dryer. Plumbing and wiring included. Allowance: $10,000 Initial:— Exterior Carpentry - Remove and replace rotted Rake, Soffit and other existing trim in need of replacement before start of painting. Price: $3,500 Initial: Kitchen Allowance - Remove wall, install Beam to carry load of second floor. Install new flooring and interior trim. Stove, Hood and cabinets to be decided by owner. Allowance: $10,000 Initial:_ Painting - Remove old paint as needed on interior. Apply one coat of primer and one coat of paint. Paint color decided by owner. - Prep and Paint siding T1-11 Gables on Motel Building. - On front of building remove old paint, sand and apply one coat of primer and one coat of paint on Clapboard, shingles and trim. Price: $19,415 Initial• PAYMENTS ARE DUE IMMEDIATELY AFTER JOB COMPLETION. 1/3 initial payment, remainder to be paid upon completion Payments accepted are: I I 1 CASH - CHECK - MASTERCARD -VISA-AMERICAN EXPRESS *Any payments not immediately paid upon job completion will be charged 0.005%for every day after the given 5 day grace period upon day of job completion. Possible Extra -Any rotted or otherwise deteriorated trim boards, plywood sheathing, lead flashing, or other carpentry needing replacement will be done and charged for as an extra at the rate of$75.00 per hour, plus 20% mark-up materials. Any deviation or alteration from above specification will be executed upon written orders and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays are beyond our control. .Owner should carry fire, tornado and other necessary insurance upon the above work. We, if not accepted within thirty days may withdraw this proposal. FRASER CONSTRUCTION, LLC: Carries Workman's Compensation and Public Liability Insurance on the above work, certificate available upon request. DATE OF ACCEPTANCE: �S Homeowner Fraser Construction, LLC Page 1 of 3 ®p HARVEY Manufacturing • r f3U1LDfNm PRODUCTS ORDER Harvey Industries,Inc. 1400 Main Street.Waltham,MA 02451-1689 (781)899-3500 harveybp.com Hyannis BILL TO: SHIP TO: 186 Breeds Hill Road HYANNIS, MA 02601-1186 Phone:(508)775-7788 Fax:(508)771-3217 FRASER CONSTRUCTION FRASER CONSTRUCTION IIII'I�IIII'lllll'IIIIII�III��IIIII�I�I PO BOX 1845 PO BOX 1845 PO BOX 1845 MP30190398599900 COTUIT MA 02635-0000 Phone 508-428 2292 Fax 5084280123 Phone 508-428 2292 Fax (508)428-0123 � iQtA�"?ECh� tai � ?? xoQF a poi' r ERall, 3485999 1005444 0 9/26/2013 9/26/2013 7 32:21 AM Charge a r t ,GURU + n + BY 1r� r kk} � '�,,.5�.f+����� tit+'1'3r'b,�.r�:�„�ti�f.�+„��'�i� �i��d fi� it- rf, •.'i�Fr r II]�I�1�`+' �A{I2EaA~��3�°,T`���'�ir fi��`I DEAN }�} I Ordered Whse Pickup HYANMS WAREHOUSE •t.:� .,� :��+�' ��� �t.'tl;f!Nrr�.�`..#..IY;.! �r. .>#�� �i 111:�1 I ���-�� e.'� �� i.�ut}F ?E. r�+::='� i',.::k` "r� . r a �' ;","+ hl ?.= '? mind -Mike Denwood HARBOR HOUSE �t�::,1.G,1fl7I�T�i,�'r IfIlV L�4, { M k#" a ti IOI 'rTIONi p;"f}k�r�}i{;j{ ;""{• i}�{Ji{ F (,l.lt'JFI t�'QT�Y"I;�r4 , iI'I2TGt�,{7{Erb iET T ND�YI 10000-1 Classic DH,Unit Size 30.75 x 64.5,RO 31 x 65 5 $310.90 $1 554.50 Half Screen,Fiberglass Mesh i . .- Double .... Double Glazed,Low E,Argon Filled i � 1; l' Double Locks, Sash Limit Devices=Night Latch ry u Energy Star Unit 1:U-Factor='0.3, SHGC=0.27, VT=0.49,AL-,NFRC CPD it it Number=BH M 31 00423 00002,Replacement,Fully Welded Unit 1 Lower Glass, 1 Upper Glass:NFRC CPD Number=BE M 31 00423 00002 i Base Color=White --"",-- Sill rise extender =No Exterior&Contour In-Glass, Colonial,3W2H Overall Rough Opening Width 131,Overall Rough Opening Height =65 Head Expander=Yes Room Location: None Assigned Pricing Details Lower Glass Grid Add-On $59.75 Upper Glass Grid Add-On $59.75 Lower Glass Low-E Add-On $9.00 Upper Glass Low-E Add-On $9.00 Lower Glass Argon Add-On $3.00 Upper Glass Argon Add-On $3.00 Classic Fully Welded DH Base Charge $167.40 Page I Of 3 ` Page 2 of 3 1T TI3$ , IM::Oka ri l* �RE4TED D IT OO RDaER1ED f ," aORDERg I'IFE u. P 3485999 „.,. , 1005444 0 3 7 32:21 AMU- Charge 9L26/2013 9/26/201 .i.l}1��34�7Y'1�'{���LI�� `G�J1 Il.IL111:�L�.LLIlI I 1 W.IIIILI lil IJI I^lli:ll WI ""' II �:LL1111IfYL141:1I I. L I W1L'..'4LI II.I...111 1 ' ' " V IP+ .,.,...�_..,.,..:.1'hihhi�.h�'?k}1�3C ;;S�Ti,4TI75�'kx�,�;t1411!l:l�€�i{�]E3It'�t�,,�i,,.T�1�lituil.�t���iEG1€(}Ali€1'r�'-ilr?��►:EL`IyS,?ERSc�'_�RE�� `��-��a�=.�.���1 DEAN Ordered Whse Pickup �k;l HYANNIS WAREHOUSE I,If,1111'�1 �rQ . I,ii�lai'�clr Bjtr l aoQroNi 1�!I� 1L l.lft _wa�I mmd -Mike Denwood HARBOR HOUSE 11000-1 Classic DH,Unit Size 30.75 x 56.5,RO 31 x 57 1 $310.90 $310.90 Half Screen,Fiberglass Mesh Double Glazed,Low E,Argon Filled Double Locks, Sash Limit Devices=Night LatchEnergy Star Star a I Li c i Unit 1:U-Factor=0.3, SHGC=0.27, VT=0.49,AL-,NFRC CPD j Number=HIE M 31 00423 00002,Replacement,Fully Welded Unit 1 Lower Glass, 1 Upper Glass:NFRC CPD Number=BE M 31 00423 00002 Base Color=White Sill rise extender =No Exterior&Contour In-Glass,Colonial,3W2H Overall Rough Opening Width=31,Overall Rough Opening Height =57 Head Expander=Yes Room Location: None Assigned Pricing Details Lower Glass Grid Add-On $59.75 Upper Glass Grid Add-On $59.75 Lower Glass Low-E Add-On $9.00 Upper Glass Low-E Add-On $9.00 Lower Glass Argon Add-On $3.00 Upper Glass Argon Add-On $3.00 Classic Fully Welded DH Base Charge $167.40 .:c.. �10�01 � ..1.„ .; P I , , ENDED, 12000-1 Classic DH,Unit Size 27.5 x 34.5,RO 27.75 x 35 1 $191.40 $191.40 Half Screen,Fiberglass Mesh r ............................. Double Glazed,Low E,Argon Filled Double Locks, Sash Limit Devices=Night Latch j Energy Star I I L Unit 1:U-Factor=0.3, SHGC=0.3,VT=0.55,AL-,NFRC CPD `........................... Number=HII M 31 00423 00001,Replacement,Fully Welded Unit 1 Lower Glass, 1 Upper Glass:NFRC CPD Number=HII M 31 j 00423 00001 € Base Color=White Sill rise extender =No Overall Rough Opening Width=27.75,Overall Rough Opening Height=35 Head Expander=Yes Room Location: None Assigned Pricing Details Lower Glass Low-E Add-On $9.00 Upper Glass Low-E Add-On $9.00 Lower Glass Argon Add-On $3.00 Upper Glass Argon Add-On $3.00 Classic Fully Welded DH Base Charge $167.40 Page 2 Of 3 p 3q �43 7 � � add S 6l � � Standards Standards ents ly 1, 2013 or later will requirement has been irements and the DPS and COURSES of k then click on 'CSL x)-12 CEU's x)-10 CEU's x)-6 CEU's molition;Solid Fuel; proximately 60 days ended you complete �Yje �G�omcrrYor�i�e�cYtYj of AaMMOUOM6 TOWN OF BARNSTABLE In accordance with the Massachusetts State Building Code, Section 106.5, this CERTIFICATE OF. INSPECTION is issued to HARBOR HOUSE MOTOR LODGE INN `t. f QCertlfp that I have inspected the premises known as: HARBOR HOUSE INN located at 119 OCEAN STREET in the village of HYANNIS .<.t . County of Barnstable Commonwealth of Massachusetts. ' Construction'Type: 5 B Use Group(s): RI The means of egress are sufficient for the following number of persons: Location Capacity Location Capacity MOTEL ROOMS 19 Certificate Number: Date Certificate Issued: Date Certificate Expired:. Map Parcel 201303691 7/29/2013 7/29/2014 326 044 red within 10 days o any The building official shall be notified ( ) ay .f changes in the above information. Building Official Parcel Detail Page 1 of 2 1 i r°�s 'MASS Cir/fJ1 tiF: ri�iirr'��az f/[/ .- aF.v:. . Logged In As: Parcel Del I Thursday,June 6 2013 Parcel Lo u 7 c el Info _ LNIT Parcel ID i326-044-OOS Con U it 21 &22 1 Condo(----- _R-HOUSE MOTOR LODGE Building,BLD� G 2 — — � Com Location i 119 OCEAN STREET — _ Pri Frontage - - ___-...._ -----------.� --------------------- ---__.._------•--.--.._._.__._ _ Sec i Sec Road: Frontage i villageHYANNIS — — — —! Fire District'HYANNIS' — Town sewer exists at this address!Yes �—�— � � I Road Index j 1133 Interactive Map Owner Info Owner I'DUQUETTE, DONALD ET AL TRS Co-Owner(HARBOR HOUSE MOTOR LODGE COND Streets PO BOX 1401 Street2 I r — city';.SOUTH DENNIS — State[MA zip 02660 Country j Land Info --- — Acres Use 12FF CONDO MDL-06 zoning�HD Nghbd 10003 _J Topography i 1 Road F Utilities! Location A Construction Info _ ---- --- Building 1 of 1 Year$$0 Roof( Ext Built Struct Wall' Living j 1467 Roof r AC None Area Cover i Type Non Bed Style;Condo Office — wall(Drywall Rooms 12 Bedrooms Model iCom Condo Int ardwood Bath 2 Full � Floor H Rooms! Total Grade I Type Hot Water Rooms!6 Rooms 1 Heat— ation Found- stories 1/2 Stories Fuel I Oil Poured Conc. Gross(2570 Area http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=27337 6/6/2013 Y_^rcel Detail Page 2 of 2 History_. _ -- --- - - Issue Date Purpose . ~Permit# Amount Insp Date Comments 5/1/1993 Commercial B35846 1$9,000 HY REMODE Visit - Date Who Purpose 12/26/2012 12:00:00 AM Tony Podlesney In Office Review 8/6/2012 12:00:00 AM Denise Radley Change of Address 7/31/2012 12:00:00 AM Denise Radley In Office Review Sales_ History - Line Sale Date Owner - Book/Page Sale Price 1 9/19/1997 DUQUETTE, DONALD ET AL TRS 10960/087 $1 2 2/13/1992 LONG,JAMES J JR&LILLIAN F 7876/051 $30,000 3 2/15/1990 SENTRY FEDERAL SAVINGS BANK 7077/116 $97,500 4 5/15/1985 KOMENDA,JEFFREY F& 4522/265 $465,000 Assessment History _ _ -_ Save# Year Building Value XF Value OB Value - Land Value Total Parcel Value 1 2013 $179,300 $0 $0 $0 $179,300 2 2012 $198,000 $0 $0 $0 $198,000 3 2011 $198,000 $0 $0 $0 $198,000 4 2010 $211,200 $0 $0 $0 $211,200 5 2009 $194,800 $0 $0 $0 $194,800 6 2008 $194,800 $0 $0 $0 $194,800 8 2007 $194,800 $0 $0 $0 $194,800 9 2006 $200,600 $0 $0 $0 $200,600 10 2005 $165,900 $0 $0 $0 $165,900 11 2004 $83,800 $0 $0 $0 $83,800 12 2003 $61,300 $0 $0 $0 $61,300 13 2002 $61,300 $0 $0 $0 $61,300 14 2001 $61,300 $0 $0 $0 $61,300 15 2000 $60,400 $0 $0 $0 $60,400 16 1999 $60,400 $0 $0 $0 $60,400 17 1998 $60,400 $0 $0 $0 $60,400 18 1997 $75,000 $0 $0 $0 $75,000 19 1996 $75,000 $0 $0 $0 $75,000 20 1995 $75,000 $0 $0 $0 $75,000 21 1994 $91,700 $0 $0 $0 $91,700 22 1993 $91,700 $0 $0 $0 $91,700 23 1992 $104,500 $0 $0 $0 $104,500 24 1991 $274,600 $0 $0 $0 $274,600 25 1990 $78,500 $0 $0 $14,000 $92,500. 26 1989 $78,500 $0 $0 $14,000 $92,500 27 1988 $59,500 $0 $0 $7,000 $66,500 28 1987 $59,500 $0 $0 $7,0001 $66,500 / Photos http'://issg12/intranet/propdata/ParcelDetail.aspx?ID=27337 6/6/2013 �orivo uM fP ECKME AND SAU AGUMF rr 1) PARTIES This_,,,,!day of April,2013. Kenneth H.Foster&Carolyn L.Foster of 161 Main Street,South Dennis,Massachusetts; Elsie S.Hudson of29 Wcst Main St.#l210,Hyatmis,.Massaehusetts; James&Lillian F.Long 25A Toftm Drive,Wobuhn,Massachusetts;Mid Mm Jeffrey Komenda of P.O.Box 160,Centerville,Massachusetts; Ken Komeoda of-.-; RobatB.Ryder of 85-175 Farrington Highway,Apt C223,Waianee,Hawaii; Dr.,Robert F.Rowe.of48i Lakeside Drive West,Centerville,Massachusetts; Brian C.&Judith S.Badrigian of I I Loring Street,Newton,Massachusetta; Mr.and Mrs.Morton Sped of 50 Waltham Street,Unit 105,Lmngtott,Massachusetts; Daiva R.Kle inas of 3 Vista bate,-East Sandwich,Massachusetts; John C.&Maxine 7arterim of 56 Sean aw .Brewster Mamebusetts• Mr.John Villa of P.O.Box 1760,Cotuit,Massochuactts; Robert K.&Patricia C.Johnson of 1163 Orkmns Road,'Harwich,Massachusetts; Donald D.&-V-ugWa R.Duquette of4l Overlook Drive,.Centerville,.MassMdxMwtts; Martha D.Milos of.45 Stafford Circle,Dennispon,Massachusetts; and Bertrarn..A&=of P.O.Box 103;Cbeg=Bill,Mass{erddhuseus; haeuudter collectively called the SELLER, agrees to SELL, and.Raj=h PraMWN Patel and Nayana RejaWn Patel, or nominee !hereinafter called the BUYER or PURCHASER, aghee(s) to BUY, upon the terms bexethtafter set forth, the following described practises: 2) DF,SCRIPTLON Units :I through 20 of the Harbor House Moor Lodge Condominium located at 119 Oceim Street,Hyatm Masseohuw*as mods partKvlady described in the Master Deed .0-_, of the Harbor House Motor ': Lodge Co>rdomigtum neard3ed witb�the Barnstable county of DOW$in.Boole 4514, �' ' RAY . Page f 37 as amended in Boole 10960 P 61 with the percM9W Wterest in the common facilities and arm all as set forth aster ia- ; amended m deeed (the "Condominium"). It is intended that all property of thi Condominium shawa.on site plea recorded in.said.Registry in Plan Book 397,Page d', Included in the sale.shall be all furniture,fixhnw and equipment a dsdng on the• ses , on the date of Buyer's structural Wspection and unlined in the iarroeat motel bushhesj ` ("Business'), including but not limited to all motet mom flunishings and elactro - office equipment, thous koq tug equipment,shgihage.as wcH as•all iom'ble assets of they::: - =4 motel business,such as trade-names,logos,telephone numbers,wt bsitasand 1P addreAssesu, as well as all other Wand rdated grvperty utila=d in the Business.and goodwill-of the;'. d -a Busine ssAli asse:ts.rpal and bee and.in personal,tangy tangible arc hereinafter referred to as Property l 3) PURCHASE PRICE The agreed purchase price for said premiss is NINE HUNDRED ONE THOUSAND and 00/160($901,000.00)DOLLARS of which: S 5,000.00 have previously been paid as a binder; S 7W.00 to be paid as an additional deposit upon delivery of fatly executed Purchase AVeemeW to the Buyers and Buyers attonrT,, S 926,000.00 To be paid in cash,certified check or bank-draft or IOLTA account check upon uw afw and recording of the deed made payable to "David V. Lawler, attaey for Sellers" or such other attorney representing Sellers should David Lawler no longer re pr+aswt the Sellem at closing S 901;000.00 TOTAL PURCHASE-PRICE 4) TITLE. DEED Said premises are to be:conveyed by good and sufficient quitclaim tieed(as)running to the BUYER,or to the nominee designated.by the.BUYERby written ttiodce to.the SELLER at least seven(7)days before the deed is to be delivered as herein provided,and said deed shall convey a good and clear record and marketable title tbescto, fine from enanabrances, except as aforesaid and (a)provisions of existing building and zoning laws;(b)such taxes for the then:curmit year as are not due and payable of dw due.of the delivery of such deed;(c)any liars for municipal.oetternserits assessed before and after the dare of this agreement;(d)Easo rents,Restrictions and Reservations of r ecard,if any, so long as the same do not prohibit or materially hamfere with the.cturent:use of said premises as a motel wi -mattager's residential aparbnent;and(e)Conditions,covenants, restrictions, easements, liautatio , reservations, tam, lien.rights and provisions and charges set forth in the sfoam wdoned.Master Deed as amended and.Decla v4on of TnW of Harbor House Motor Lodge CondaminhMms recorded in Bdok 4514,Page 158, as well as all related condominium docuioents'(hatinafter,"Condominium Domtmeats"). 5) TlM)r kOR PERFORMANCE•RELIVER:Y OF DEED Such deal is to be delivered at 2,00 pxL on or before the l5th'day of May;2013,at the Barnstable County Registry of Deeds, unless.othemse agreed upon in writing. It is agreed that time.is of the essence of this agreement At the Buyer's election with written notice to the Scutt,the closing may take-pime at the office of die-Buyers lender/attorney so long as said office is within the Town of Barnstable. 2 Y 6 USE OF PURCHASE MONEY TQ CLEAR TITLE To ehhable the SELLER to make conveyance as herein provided,the SELLER or BUYER may,at the time of delivery of the deed,ase the purchase money or any portion thereof to clear the title of any or all encumbm=or interests. 7) POSSESSION AND CQ[lRMON OF PREMISES Full possession of said premises free of all tenants and occupants, except as herein. provided, is to be delivered at the time of the delivery of the deed,said premises to be then(a)in the some condition as they now are,reasonable use and wea thereof excepted, and.(b)-trot in vidlation of said building andzDning laws,and(c)in compliance with.the provisions of any instrument referred to in clause 4-hereof. The BUYER shall be entitled to an inspection of the.Unit prior to the delivery of the deed in order to determine whether the condition thereof complies wit)r the terms of this clause. 8) ACCEUMCE OF DM The acceptance of a deed by the BUYER or his nominee as the case may be, shall be deemed to be a full performance and discharge of every. agreement mhd.obligation herein contained or expressed,except such as arc,by the.terms thereof;to be performed after the delivery-of said deed. 9) ADJU� Taxes for the there errant year, and condommium common area charges and advance deposits,shall be apportioned and fuel value shell be adjusted,if applicable,as of the date of closing and the net amount thereof shalt be added"to or deducted from,as the case may be,the Purchase price payable by to BUYER at the time.of delivery of the deed. There shall be no adjustment for the SELLER'S allocable share of any capital reserve, 10) ADJUSTMENT OF UNASSESS,�►ID.ABA D TAXES If the amount of said.taxes is.not known at the time of the delivery of the deed,.they shall be apportioned on the basis of the taxes.assened for the preceding year, with a reappoilionment as soon as the new tax rate need valuation can be ascertained;and,if the taxes which are to be apportioned shall thereafter be reduced by abatement,the amount of suck abatement, less the resaonable cost of obtaining tbo' same, shall be apportioned between the parfim,provided that neither party shell be obligded to institute or prosecute Proceedings for an abatement unless herein odretwiw agreed. it, INSURANt The SELLER repremb that at time of-the execution of the aft,the OVOL,26on Of unit Ownets.makWw ithsurunce withsespect to the Condominium as follows: As is presently insured. 3 v 12, INSURANCE EYIDSNCI At the time of the delivery of the deed, the SELLER shall deliver to the BUYER a certificate of the Cmdominium insures referred to in clm=11 as then in effizt. The procuring of any rupplemeaW bwmartce shell be at the option and sole expense of the BUYER: 13. MMSION To EEIRFEa CE 'REMISES CONFORM If the SELLER shall -be unable to give We or to make conveyance, or to deliver possession Of-the premises„all 83 herein stipulated,or if at the time of the delivery of the deed the premises do not conform with the provisions hereof, the.SELLER shall use r=sonable efforts to remove any defects in title, or to deliver possession as provided herein,or to make the:said premises conform to the-prevWons hamof,as.the case may be, 3n which event the time for performance beteof shall be extended for a period of thirty (30) days, unless such extension shall result in an increase in Buyer's mortgage loan interest rate, in which event at Auyt es election this agreement may be terminated and any payments made under this agreement shall be forthwith mftdod and all other obligations of all parties.hereto shell cease and this agreeartent shall be void without recourse to the patties hereto. Reasonable efforts slued not require the SELLER to spend greater than$5000.00 exclusive of voluntary liens and encumbrances so as to make the .premises conform. 14. FAILURE IQ Pam.�FFM TITLE OR MAKE PRE14tISES CpNFORM If at the expiration of the extended time the SELLER shall have failed to so mm. ve any defects in title,deliver possession,or make the pre,.mises conform,as the case may be,all as herein agreed.then,at the BUYER'S optioa,.any payments made under this agreement shall be forthwith.ref oiled and all other obligations bf-all parties hereto shall cease and this agrecment shall be void without recourse to the.parties hereto, 15. $TTM S ELECTION To ACCEDE i The BUYER shall have-the election, at either the original or any wended time for performance,to accept such title as the SELLER can deliver to the said ptemiaes in their then condition sad to pay therefore the purchase prim without deduction; in which case the SELLER shall convey such title, accept that in the levent of such conveyance in accord with the provisions of this claus4 if the said premises shall.have been.damaged by fire or casualty ins u ed against, then the SELLER shall, unless the SELLER has previously restored the pretamccs to than faairrer condition,eWm (a) pay over or assign to the BUYER, on delivery of the deal, all amounts recovered or roeoven ble on account of such insurance, less any amounts.reasotrably expended by the SELLER for any partial restoradvrt,or 4 i (b) if a holder of it Mortgage on said premises .shad not permit the insruanoo PMMC&Of a Pert tbomf to be used to restore the said Premises to tint' former corli� tiotr or to be so paid over or assigmd, give to the BUYER a credit against the purdmise price, on.delive y of the deed, equal to said moms so mcovered or roeoverable and retained by the holder of the said mortgage less any amounts Masonably expended by the SELLER for any Partial restoration. Notwithstanding the provisions of this Paragraph (15), BUYER may terminate this Agteernont in the event that the Premises is partially or completely destroyed by fire or Other casualty and The SELLER fails to gore said Premises prior to closing to substantially the seater condition as the Premises was prior to.sarid fire,or other casualty lb. BUYER'S DEFAULT:DAMAM If tba BUYER shall fail to .fulfill the BUYER'S agreemerds berein, all deposits made hereunder by the BUYER shall be retained by the SELLER as liquidated damages, and Shall.be the Seller's sole.aW exclusive remedy. The parties acknowledge Ne difficulty of ascertaining exact damages in the event of a default and agree-that the terms herein for liquidated damages are reasonable and fair to both parties. 17. DEPOS All deposits shade hereunder shall be held by John E.Ciluzzi of Premier Commercial,as agent for the SELLER subject to the terms of this agreement and shell he duly accormted for at the time for performs=of this"agreement T6c Escrow Agent shall only release escrow monies upass written itnsCntcdm of both patties or by a final order of a court of c�tnPetent,jtuisdictian. IS. BROW AS ItTY The B;vkzrs,John E. Ciluai &Wa PreMer Commercial and ERA Cape Real Estate named herein joins in Ibis agreement and becomes a Katy hereto, insofar as any provisiow of this agreement expressly apply to him, mid to any amiendments or modifications of such provisions to which it agrees in writing. 19. BR4il ES FEE The SELLER and.BUYER aclarov4edge that a foe of.six. (6%)pendent of the purchase Price fur professional seryi es shall be paid by the SELLER to Premier Commercial when and if title m5fen and the full p mbme pda is paid, and not otherwise. The BUYER and SELLER understaW that ERA Cape Real Estote, the buyer's real estate 5 agency,is seeking half of the total fee'f era Premier Commercial,the listing real estate agency, for services rendered as a buyees agent, The BUYER fiuther represents and wanfants that then is no other broker with whom BUYER has dealt.in connection with the.purchase ofikPremism. 20. )�Rd1i;ER'S WARRANTY The pokers named herein warrants that it is duly licensed by the Conunonwealth of Massachusetts. 21, WARRANTY OF REP MEIdTATlOId A&TO PRESI3NCFJ ABSENCE OF LEAD PAINT The BUYER acknowledges that SELLER has represented that SELLER has disclosed any and.all information known to SELLER about the actual or-potcatial lead hazards in the property which is the subject of this Agreement. The BUYER acknowledges that he or his agents h$ve-been given an opportunity to examine the premises and that any obligations arising under Massachusetts General laws,Chapter I H, Section 197, shall be borne by the BUYER in accordance with the terms thereof. 22. NOTICE OF I:EEAD PAINT OBLIGATIONS Wbenevea a child under six years of age resides in any residential premises in which any paint,plaster or other accessible material contains dangerous levels of lead,the owner is required by law,to remove or cover said paint,plaster or other material so as to make it inaccessible to a child under six years of age. Consu Mvion of leaxl.is poisonous and may caiuse serious personal injury,whenever such residential premises containing,dangerous levels of lead undergoes a change of ownership,and as a result,.a child under six years of age will become as resident,the.new owner is required by law to remove.or cover said paint,Plaster or other materials so as to makeit iiutecessible to such child. The promulgation of this.ckm Would not be cmideWto impose an.obligation on any hm*er to undertake an.-inspection for lead paint. The BUYERS should rt ttkin a qualified person to conduct an invesdgtdion. For Mmes of'Webag firms bpaWng in this area, contact the MuNdusetts As CMan of Lead 'festers at (617) 337-5546 or Massachusetts Childhood Lead Poisoning Prevention Program (State lead Lab)at(617) 522-3700. BUYERS acknowledge that they have received from the Broker and signed the Property Transfer Notification-Certniicatioa of the Depwtutent of Public Health,Commonwealth Of Massechusens, pwsuant-to Massachusetts General Laws Chapter I I I, Section 197 through'199A,as amended by Chapter-773 of.tbe Ants..of-1.-987. BUYERS further acknowledge that the Massachusetts. Department of Public Health's notification was provided to therm; and that Buyers were verbally.informed about the availability ofinspections for dangerous levels of lead. 6 23. SMOKE DETECTOR AND CARBON MONOXIDE DETECTOR The SELLER shall,at the time of the delivery of the deed,deliver a certificate from the fie depmtmmt of the city or town in which the promises am located stating that said premises have been equipped with approved smoke detectors and can monoxide detectors in conformity with applicable law for the residential manag+er.'s unit. SELLER. shall produce a certificate from the governing authorities} within the Town for -amble evidencing that Premises has passed the necessary inspections.for the-motel operation.Oniy to the extent that said certificate is required for the operation of the motel 24. WARRANTIES AND REPRESENTATIONS The BUYER acknowledges that.the BUYER has.not been influenced to enter into this transaction nor,has he relied upon any warranties or representations not.set forth or incorporated in this agreement or previously made in.writing, except for the following additional warranties and representations,if any,.made by the SELLER: None 25. LIABILITY OF TRUSTEE,SKAREHOLI}ER BENEFICIARY.ETC. If the SELLER or BUYER executes this agreerneat.in-a representative or fiduciary capacity, only the principal or the estate represented shall be.bour4 and neither the SELLER or.BUYER so executing,nor any.shareholder or beneficiary of any.trust, shall be personally liable for any obligation,eycp=or ilnpli4 hereunder. 26. CaNSTI unON OF AaR This instrument is to be.construed as a Massachusetts contact, is to take eEfeci as ai sealed inswument;, sets forth the entire contract between the pasrdes,is bring upon and inures to the bemlit of the parties hereto and their respective heirs,devisees,execrators, administrators,successors and assigas,gad may be cancelled,modified or amended only 'by a written insttument-executod by both the SELLER and the BUYER If two or more persons are named herein as BUYER, their oNigaadons hetntmder shalt be joint and several. 27. CERTIFICATE.OT NO ASSESSMENT At the time of the delivery, of the deed,lbe SELLER shall deliver to the BUYER a statement from the organization of unit owners in recordable form and setting forth, in acrurdame with.Section 6(d)of the Act,that dune are no outstanding common expan.Cs assessed against all Units as of the said closing date. 28, NO WARRAN TES OR REPRESENTATFONS All real and personal.property " be tnwsfettred to BUYER in an"AS IS"condition without waananties or iepnselttations;however, said Premises and all personal property shall be in substantially the stone condition as on the elate of Buyer's structure inspection, 7 � N reasonable wear and tear, excepted, Buyer represents that it has.had the opportunity to conduct a thorough property inspection and has conducted said inspection, receiving a reduction in the purchase price as detailed in Paragraph#36 of this Agreement. 29. SWUMACEN—ASTE DjUOAL RYSMM. The Seller warrants and represents to the best of Seller's knowledge that all habitable portions of the Premises is serviced by municipal sevw. 30. IOTICB All notices required or permitted to be given hereunder shall be in writing and delivered by hand or mailed postage prepaid, by.registered or certified.mail,or by facsimile email to the stated representative: David V.Lawler 540 Main.Street,Suite 8 Hyannis,MA 02601 TEL:: 508-7711-0303 FAX 508-778-46Q0 EMAIL: lavvler arty V �1Jfl�nflt Buyer: Steven J.Pizzuti,Esquire 336 South Street Ryann*MA 02601 TEL!(500)771-1911 FAX:(509)790-0$00 EMAIL:ciosi izzatilaw cot or is the case of either party to such other addresses as shall be designated by written notice given in such manner to the.other patty. Notice•shall be deemed effectuated(a) upon mccipt if mailed via United States Postal SaTice.(USPS} or(b)on the date and time said notice is.smt via.facsimile to the party with a delivery.receipt as evidence of same, or (c) sew by electronic email to the email address of the. party, or if(d) by delivery in hand. Notice to a party may be effecdmted by gmug notice to party's counsel and in the case of the Buyer, if Buyer has nm designated eouuwl, to Buyer's lender's counsel. Each party hereby appoints their counsel(and in the caw of the Buyer, if Buyer has not designated counsel,Buyer's lender's eounseOlo be the;patty's lawful attomey-its-fact for the limited purpose of the execution of extensions to time limitations set forth in obis Agreement. 8 r 1 y 31. CONDITIONS PRECEDEiVT The SELLER shall ensure that the air conditioning system is fiantioning at the time of closing. 32, MORTGAGE FINANCING The BUYER'S obliption .to purchase is conditioned upon obtaining a written oomnutment for mortgage financing in the amount of$720,800.00 at prevailing rates, terms and conditions by May 1, 2013. SELLER is to provide BUYERS, for mortgage aPPmval PmPOses, business federal.tax returns for the years 2008,2009 and 2010(2012 -if completed and available,otherwise fmal P&L statement for 2012).The BUYER,shall have an obligation to act reasonably diligently to satisfy any conditions within BUYER'S co=L If~ despite such diligent efforts,-the BUYER has been unable to.obtain such written commitment the BUYER may terminate this Agre=mt by giving written notice that is received by SELLERS or SELLER'S agent by.�-QOPM on.the calendar day after the date set for*above. In the event that written notice has not been received by said time and date. then this condition is deemed waived. In dw.event that due:notice has been tceeived, all. monies deposited or paid by the BUYER.shall be returned and all obligations of the BUYER and SELLM pursuant to the Agreenverit.shall cease anal'this Agreement shall become void. In the event. that the lender for any reason needs additional time to process Buyer's application, then the commitment contingency date shall be extended up to fttreeatt(IS)days and at the election of the Buyer,the closing date may also be extended up to fifteen(IS)days, 33 ADDITIONAL PROVISIONS This Agreement is.fiuther contingent upon the following: a This agreement is cmrdugead upon rho Buyer obtaining at.Buyer's eatgeM a Hamrdous Material Phase I Study and inspection of the property (cominordy referred to as a "21-E study")on or before May 1,2013. In the event that the 9L* indicates tbrr probability of the ptesence of.hmgdous materials, then the Buyer shad].have the option to either,(1)terminate this ageemeut and in such case all deposits shall be forthwith m Tundcd, without recoum to either patty, or (ii) conduct such hither studia and tuts to determine the existence of said dials and in such case the contingency date sent forth herein shall be extended thirty (30) days. In the event that ttx results of the studies andlor tests indicate fire presence of hazwdous materials,.then the-Buyer shall have the option to teeminme this apmement and in such case all deposits shell be forthwith refiatded,without recourse to citber panty. b. Buyer and the Buyer's agent shall have: rights of reasonable access to the Premises during the contract period aind:prior to tb c time specified for delivery of the Sellers deed for the Purposes of inspecting the-coalition of said Pminisers and 9 conAwt ng necessary tests and .evalwbons, but said rights of access shell be exercised only after reasonable notice thereof to Seller and when reasonably convenient for Seller. Said right of ec ccss shall be exercised in the presence of an employer or agent of Seller. Brayer shall indemnify Seller for-any damage to the Premises-arising-during any such inspection-if caused by Buyer or Buyer's agents or invitees. C. Any title or praefice urns«arising under.or relating to this Agreement which is the subject of a title or practice standard of the Real Estate Bar Association of Massachusetts ("REBA") at the time of delivery of the deed contemplated hereunder shall be govancd by such title or practice standard,as tk case may be, to the extent applicable. d. As part of and along with the real property refereed in or described in this Purchase and Sale Agreement,the Sellers also-agree to transfer and assign the following property interests included in the purchase price: (i) all plans relating to the lot conveyed and any subdivision thereof, all construction andlor renovation plans and spedftcations, if any, relating to the land, structure and all guarantees and warranties, if Puy, by and rights against, third parties with mpxt to any and all borings, soil.tots, percolation tests and other teats and upsets with respect to the Premises,and. (ii) all parmits, certificate% variances, cm=M and appmvals, if any, pertaining to the land,structure,-or any personal property thereon. The items set forth in(i)and(it)shall be deerned for all purposes of this AVeement,to be an a=nW part of the Premises. S. This We is contingent tyro ihe-Buyer receiving att aecmuy transfers,approvals and permits(hereinaft collectively,-the.Parnits7),to operate theP'r raises as a motel %ilh the current same number of units with the manager's residential apartr>=L Into event that Buyer is unable to obtain-the Permits on or before by closing,then the Bayer may extend this contingency for'thirty(30)days with the closing date alw extended for the thirty(30)days, if after'the.extMded period, Buyer is still ratable to obtain said Permits, then Buyer may terminate this Agreement and all deposits.$hail be fordrwith tefmided without recuurrse against either party. Sella shall open and conduct busum no later than May 1, 2013 and such operation shall be eoodu csod in substantially the manner (or,better) including.maittenanc a operations as in 2012. h. It is understood mud aged by the parties.that the Premises shall not be in conformity with the title provision of this Agreement unless: (i) all buildings,structures and impioveinants, including, but not Urnited to, any driveways, parking areas, landscape areas and garages, and all means of access to the premises,shall be located completely within the boundary liras of 10 "s y said Premises and shall not encroach upon or under the pmperty of any other person or entity;and (ii) . No building,structure or improvement of any kind belonging to any other person or entity shall encroach upon or under said Premises;and (iir7 The premises abut a public way duly laid out or abut a private way with access to such a public way accepted as such by the town or city within which the Premises is located. i. To the best of Seller's knowledge and belief Seller nepre.=ts and agrees with Buyers as follows: (1) Seller have the legal right, power and authority to enter into this Agreement and to perform all of its obligations hereunder, (ii) 'There are no tenancies,occupancies,or linen in or to the Premises; (ii) To the-best of Seller's knowledge, Sellers hoe not.comrne;nced nor have Sellers ro wed notice of the commencement of any proceeding that would affect the present wing classification.of the Premises.. Sellers will not initiate any such pnoceedinp and will promptly notify Buyers if Sellers receive notice of any such proceeding commenced by third parties; (iv) No work-htas been done on the Premises which could give rise to any liens under Massachusetts tare wral LAws,Chester 254 and no contracts are outstanding or in effect with respect to the doing of any such work; (v). To the best of Seller's knowledge,there is no notice,suit, order,d=cc, claim, writ, injunction or judgment relating to materiah violatiaos of any laws, ordinaries;codes,regulations or other requirements with respect to the Premises (err any portion themf)in,of or by any court or govexamental authority having jurisdiction over the Promises; (vi) -To the best of Seller's kmowledge, there is no oil or other hazardous material a9 dcfuaed.in M.G.L.Chapter 2E on or about the.Premiseg (viai) To the best of Seller's knowledge,there are no utoe rground.storages tanks on the Premises. Sellers' made in sub-peragraphs (h){vii) above shall be a condition of.Buyers' obligatkm to.close under this Agreement that all of said wanmuties and oprnsentadons are tame,both as of ttte,date hereof and as of the Closing, Il I i i j. The Seller agrees to provide consulting services on-site upon request for a period of seven(7)after closing to ensure a smooth transition. 34.ASSIGNMENT The Seller acknowledges that Buyer intends to assign this contract or otherwise accept title to the Property in a related company to Buyer. Notwithstanding anything contained in the Agreement to the contrary,.Buyer may assign this Agreement to an entity in which Buyer has a financial or otherwise tangible interest. 35. CLOSING DOCUMENTS AND ELECTRONIC MAIL The Seller shall execute at closing all documents reasonably required by the Buyer's lender, if applicable, or customarily executed at residential closings in the Commonwealth of Massachusetts,if no lender. A document delivered by electronic mai l or facsimile shall have the same force and effect as the original and the copy of a signature of any party on a document so delivered shall. have the same effect as an original signature. 36. CREDIT TO 13UYER'` The Seller shalt provide Buyer with a credit at closing in the amount of$3S4000ip In consideration thereof, the Premises shall be transferred in an "AS IS" condition but in substantially the same condition nonetheless as on the date of Buyer's structural inspection. EXECUTED this the 0 day of 2 O/3. Elsie S..Hudson,SELLER — Rajendra Prabhudas Patel,BUYER /V.if,Par 1. Robert B.Ryder,SELLER Nayana Rajendra Patel,BUYER Kenneth.H.Foster,SELLER Carolyn l,. foster,SELLER James Long,SELLER Lillian Long,SELLER 12 y I j. The Seller agrees to provide consulting services on-site upon request for a.period of seven(7)after closing to ensure a smooth transition, 34.ASSIGNMENT The Seller acknowledges that Buyer intends to assign this contract or otherwise accept title to the Property in a related company to.Buyer. Notwithstanding anything contained in the Agreement to the contrary,Buyer may assign this Agreement to an entity in which Buyer has a financial or otherwise tangible interest. 35.CLOSING DOCUMENTS AND ELECTRONIC MAIL The Seller shall execute 'at closing all documents reasonably required by the Buyer's lender, .if applicable, or customarily executed at residential closings in the Commonwealth of Massachusetts,if no lender. A document delivered by electronic mail or facsimile shall have the same force and effect as the original and the copy of a signature of any party on a document so,delivered shall have the same effect as an original signature. 36. CREDIT TO BUYER The Seller shall provide Buyer with a credit at closing in the amount of S 3S,000*00 In consideration thereof, the Premises shall be transferred in an"AS 1S" condition but in substantially the saute condition. nonetheless as on the date of Buyer's structural inspection. EXECUTED this the 61' day of A PRI L a,o ti3 46- Elsie S.Hudson,SELLER Rajendra Prabhudas Pagel,BUYER IV.tf-Pa re 1. Robert B.Ryder,SELLEA Nayana Rajendra Patel,BUYER Kenneth H.Foster,SELLER Carolyn L.Foster,SELLER James Long,SELLER Lillian Long,SELLER 12 a cy j. The 6,eUa up=to provide corn hang.mvk=on-aim�mq�t for a*Od of seven(7)4or closing to ensure a wmtb uvuaidw 34.ASSIGNMENT rk sailer acknoww46e3 drat Btgrer wwn& to assign twa,conuact or odi$rwi� �oca. titbc i bl w Pmpeny In is xb o d company to Bayer. N,otwubs waK an-Wing WntmnW in the Ag m=wt to the coa=y,Buycr may assigp this Agreement to aL eadt.y in which Buyer tm a financial or otbeerwiso tartgtble ir)*Srest. 35.CLOSING DOCUMENTS AND ELECTRONIC MAIL 1br.Seller shall.executo at closing all doowtterrts reasonably mqubW;by elm Buyer's leader, if amhgable, or customarily e=uWd at raddent al c sings in the Commonwealtb ofNbssa*$3M,if no k*r, A docwrreat delivered bye aloorowc mail or facsimile sW1 bava the same force and c&ct as ilia vPiOW and; der vopy Of a si a are of any lam' oa a docurrrent so delivered shall have ft =0 %�ftt as an otigiaa)sig�u►e- 36. CREDIT TO BUYER The Seiler alien provide-Buyer withA at closing in rho am mutof 5 3�A_ In consideration liana$ the Peenrtses shad be tr$nslxtred in an "AS W mditum but in sabstaatially the soma condition nonetbolom as an tits darn* of B yae's strudoml hVectiom MCUTgD"ti the say of 131sic S.Via,SELLER Rajeadca Prt+Mbtulas Patti,WYER Robert B.Ryder;SELLER Naywta P4=bv'Pw4 BUvf R Kamedt X Foyter.SELLER, f wWyn L.FwtMSELLER` Lames Long,98LIAR Lillian Tong,BELLED. 12 FRQJ1 :Longs Property Mgmt+Rentals FAX NO. :7819355653 Apr. 22 2013 10:34AM P15 soE> � e Gn moatueaub of Aaiil;acbttfiLb / 8 STAMDARD MRTuaCATE OF VEATN {p (1 REGMW OF VITAL AECORDSAND STATIM3 REGISTERED NUMaER STATE VSE ONLY EE ODeM.Uwe FIRST MIDDLE LAST S OA a ar DEA7N(PEp„DW rq James J. Long, Jr. Male February 27 2009 PA,Cx 0.DEATH CWhITY OF A H NOePrtµ o7HER w3 I .N,R+P{Ir Aol n AATgr,P'.t,RFs(ud n.Tlsa/ Winchester Middlesex Winchester Hospital � OWN (C7AM p,i,•on,)• OTNCA 144! NVI®EA IF.V3 W O�K»i•KY9Lworoee.A OnoA 0"-WjholN 0PW dNe, 0Q@w(Spa7� 027-28-2020 �qffftnam $W OECfpENT Of HISPANIC IN7 AAOE b,P.WIft.9IAGA noon,FIG) EDENT•t EOVCA {�]r o' vE9P.*AMA.Dbril u.cw.r..a) rS.aY) White Immm" Nei,. AGE.LW%M"y I OATEr OF MATH f►w.,0".rrj "T WvzE(C.q W 9YN a o(r4(I Cove). (rq,) 040E. I DAYS NOVAS i InINE ,a 71 . I Dec. 17, 1937 . Woburn, MA MARME R MARAWO WT SPOUSE 1P ws.0"'Wid"rift) GOUPJLTION KIND OF INEHb OR INDUSTRY WIDOWED OR DIVORCEDIA ryAer.Y A.irO) Married Lillian F. Pittman Attorney Law ,e RESIDENCE•NO.i ST.,QTYITOWN,COUNTl,gG7WCOVNTRY LP CODE I 25A T c n Drive Woburn' 1"fidd esex MA 01801 i►T l(41,{.„E $TA (I=AT Us. 1"OT"IR-16"IlE rq 11"DFN) STATE W Ao(A,Per James J. Long APM0° nry)MA Florence Carroll ftft -wMA 17 I lit 04,0111610(m HAA(a MAILNiO AODRE3a•N0. aT„CITT(ROWN,STATE.I*CODE REtA Lillian F. Long, 25A Totmau It Drive, Woburn, MA 01801 Wife ATe DIMM PUREPAL-SMICE" LICENSQ. aDAW g OREWU ON PE01EMOvALiAOMSTATs IM Edward J. Cantillon III 955 Psr9 OF o ITIM INW*a ow-my. Ivq d oFwr) ,.e&U. Calvary Cemete Woburn, MA DATE OF OLIP OKFION .""It He Of FACILRY(1l10 A OEHAawEE I+11:2731h 3, 2009 Z�ynch—Cantilloa 'Fun Home, 263 Main St., Woburn, ]!PAA7 I•taw e.OimIi i,i -1-W fr d.,m,Do"Vie a4 h a"ft Arm AI Wff=d miohx IY AREA,M.a v I.i(I%kn. AP(rprn.y"= UN""GkM a,.PIA 1rn IF PI,WIp,d)PR,NT OR TT►E tEOIDLT, BFtw.ir Ct.AT yI,p,y( 4111114011174 CAM IFAW i,O M7I/ 04 To IOA.n•CO-WO.04CM 9FYYY.YFY M+OO/W.b,.,7 ,. .Iq,WJ.q Io�,In+dpa a.To IW AS Am.uaui+cF 09 owAl+•6+�VNDWT416 CAUU(40iiwPW►11r,MAI T. MAW opwa W"v M M To As A,A C*W"N%"Or) aPru LAP PART n•Oe+I(yOdlyy WAabarP QX*1 Ar4 I,a,p(W M(FWWO R u.5rTT"CUM OW in P1II I. WA8 AVIOPHY WERE AIT MV PPd*M PERFOAIAED7 AVAaAW RPM TO n•.dAI,1 COMPLETION OF CAM oT DEATH?(Yaw A" 50.olAK EA a�QEATN Dr, T NOTI A1107 wATVAAI LJ�DIrICIDE 0 COULD NOT ee DETI A WD � YES ACtID[NT OHUCIDE ❑aENOM6 WVE9TIDATtoN Y 36t '.YrKM occuitAto MACE OF#WRY(,1(Wn, LOCATIM(r10.i o'•R SYIy .rd so** me ifA aq V.n ti To o oowd ry I, =*. al r,p Y el.im,.sae,,AIId p+,d,ab dw u e•r 476 O 0 Mrs a aN,i.,gn b aCnm+anT ampler p PP Pi.. 3 ra A(..F b . DIF Pam W Or o ar aIMO1 AIY16, (S♦quo. (S471KW F'jog am DATE awNM(Aft,D.r.Yr,) A of DEATH a Pe.,D+r W) DEATH NO, February 27, 2009 P. 12:52 p. M 1 T>e 77F _ NAVE OF Art PNYMCLM IF AOT czFjiviF.q VRONOUWAD DEAD MAa• r.Yc) PIVNOUNICED F F 7A A,A ADDAE99 OF A PHY9IOLW Oa M AL EIUMINER(T)ye a P(IP1 •, y� hes a MA 01890 ill- No OF s< Harisa Kearney, M, Winchester Hospital, 41 H Ig�ilana Rive. 219358 WAS TXERE A 1i S. ATE IF'T P Ptlowol»,c gw IFOAM7 PRONOUK90 PROKOJ14 Eo no ❑A.M.0 P.A.C]N.v. .i-oo Y DA RECOf�' MAR.0 2 2009 Town of1,the undersigned,hereby certify tha(1 hold the Ogee of Town Clerk of Me Town W T LN Ci ETER ominehater is the Cavity orMlddlesei,and the Commoowcalth atUmtsehwcits; Cominon►v ealth of that the Records of 01rthe,Marriage Aad Deaths are la my custody and that the following Massachusetts is s true copy from the records,as ccrtUlcd by me. f M .' sti of flit,Teiivn(%F IV; -liectol ttttess m�•hand anti the e. rX-m A-� V-Qft DAA-L I Jeffrey Komenda,.SELLER Riiy K SELLER B.tian'C,Bodrigisw,SELLER Judith S.BWgia%SELLER Mm Morton Spook,SELLER Mort0i Speck,SELLER Kan Komend%SELLER Daivak.IQeinas,SELLER Jahn C.Zattmian,.SELLER Maxine Zartariau,SELLER Robert K.Johnson,SELLER Patricia C.Jolmson,SELLER Donald D.Duquette,SELLER Virginia R.Duquette,SELLER Beftm Allwa,SELLER Mard a D.Miles,SELLER. John Vl*SELLER PREMIER COMMERCIAL ERA Cape Real Estate sy, By: John Cihtzzi,Broker ,Stoker 13 4eBiey1 .S.ELLER Nwcy Konranda,SELLER Brian C.Badrigian,SELLER Judith S.Badrlgian,SELLER Mrs.Morton Speck,SELLER Morten Speck,SELLER Ken Komenda,SELLER Daiva.R.KlaWs,SELLER John C.Zartarian,SELLER Maxine Zartarian,SELLER Robert K.Johnson;SELLER Patricia C.Johnson,SELLER Donald D.Duquette,SELLER Virginia R.Duquette,SELLER Bertram Alba,SELLER Martha D.Miles,SELLER John Vita.,SELLER PREMIER COMMERCIAL ERA Cape Real Estate By: By. John CAuai,Broker Broker 13 i APR-18-2013 07:54A FROM:MOUNT AUBURN PROPERT 617-926-0600 T0:15087784600 P.1 Jefty Kowncr,4 SELLER Nancy Komenda,SELLER Brian C.Badrigiao,SELLERdtigtan,S Mo.Morwn Speck,SELLER MoMn Speck,SELLER Ken Komenda,SELLER Daiva.R.Uehmm SELLER John C.7.amirianAELLER Maxine ZmmrkA Smug Robert K.J6hwn,SELLER Patricia C.Joluaon,SELLER Donald D.Duquette,SELLER Virginia R.Duquette,SELLER Bantam Allow,SELLER Martha D.Mile$,SELLER. John Vila.,SELLER PREMIER COMMERCIAL ERA Cape Rae!EsU to By: 13y: Jobh Cituai,Breyer ,&nkar 13 ' Thursday,April 18,2013 9:12:39 AM Eastern Daylight Time Subject: Re: Purchase and Sales Agreement Date: Wednesday,April 17, 2013 3:24:34 PM Eastern Daylight Time From: gayle speck To: David Lawler JefFivy KwRadIOSELLER *:.S i . Brien C. Bsrigi; lr> SELLER MM maim S ;Ohn C,Z Vxi&%. LER RObW K. IWIM , MLL.ER id D.moo, Lit V.1 .. Bawl"i ew Aticon, SM.UR �, D6:111. Page 1 of 3 Jeffrey Komenda,.SELLER Nancy Kommnda,SELLER Brian C.Badrigisn,SELLER Judith:S.Bafrigian,SELLER i Mrs.Morton S k,SFUER go-riQii Speck,SELLER Ken omenda, LER Daiva L Kleinas,SELLER John C.Zx adM.SELLER Maxine Zattarian,SELLER, .Robert K.Johnson,SEI:LER Patricia C.Jonson,SELLER Donald D.Duquette,SELLER Virginia R.Duquette,SELLER Bertram Alkon,SELLER Martha D.Miles,SELLER John.Vila,SELLER PREMM COMMERCIAL ERA Cape Rai Estate By: By. John Glum,Broker ,Broker 13 Jeffrey Komenda,-SELLER Nancy Komenda,SELLER Brian C.Ba"giaa,SELLER Judith S.BWgima,SELLER Mtn.Morton Spook,SELLER Mortga Speck,SELLER Ken Komenda,SELLER a JL Kloinas,SELLER John C.7.artarian,SELLER Maxine Zsrtarian,SELLER Robert K.Joheson,SELLER Patricia C.Johnson,SELLER Donald D.Du Wft,SELLER Virginia R.Duquette,SELLER Bertram Alkon,SELLER Martha D.Milos,SELLER John Vila,SELLER PREMIER COMMERCIAL ERA Cage Rol Estate By: 'By: John CHUM,Broker ,Broker 13 f r tl JaffieY Kane0dI6 SELLER.... Nancy Kamm*SELLER Brien C.BadiOw,SELLER Judith S.BoMgiaa,SELLER ice► tvtortan Speck,SELLER Mottgit Spk;SELLER Kan Komenda,SELLER Dsiva.R.Kleinas,SELLER n �SEUERMsfm ZNU25XLLER Robeat K.Johncoa,SELLER Patricia C.Johagon,SELLER Donald D.Duquotto,SELLER Vi%inia'R.Duqueft,SELLER Bft m AUwn,S.ELt R Muft D.MUMs,SELLER Jolni Vila,SELLER PREM>FR CQMME XIAL ERA Gape Rawl fismte Bar 'By: John Cilurzi,Bioipsr Bivket 13 1efey Komenda,SELLER Nancy Komenda,SELLER Brun C.BaMgiaa,SELLER Judith S.Ba ftian,SELLER Mrs.Morton Speck,SELLER Morton Speck,SELLER Ken.Kommde,SELLER Dsiva.R.IQdmaa,SELLER John G Zattarian,SELLER Maxine Zartanan,SELLER Robert K.John ,S LER - atric C.olmson,SELLER ,J Donald D.'Daquctto,SELLER Virginia R-Duquette,SELLER Bctirem Alknn,SELLER Martha D.Miles,SELLER John Vila,SELLER PREMIER COMMERCIAL ERA Cape Rnal Estate By: By: John Cilmi,Broker >Bmkcr 13 i y Jeffrey Kornenda,_SELLER Nancy Komenda,SELLER Brian C.Badrigian,SELLER Judith S.Badrigian,SELLER Mrs.Morton Speck,SELLER Mortga Speck,SELLER Ken Komenda,SELLER Daiva R.Kloiaas,SELLER John C.Z,attariM.SELLER Maxine Z %ria%SELLER Robot K.Johnson,SELLER Patricia C.Johnwmq SELLER Donald D.DKwtte,SELUb Virginia R.Dvqueft,SELLE Bertram Alkan,SELLER Martha D.NOm SELLER John Vila,,SELLER PREMIER COMMERCIAL ERA Cape Real Estate By By: John Cilum i,Broiter ,Broker I3 I lcffroy ER N�7 Kacrmnda,SELLER ; Htaen G�edtiSian,SELL Rsdith S.Badti�+SELLER ER Mtn.Marta►spec);,SELLER Mottal Spo*SEL'LM Kco ICadreada.SELLER Deitvn R.' ei ,SELLER 3abt<C.ZsWidn' LLBR Maxine zmtfs jw� SELLER Robert K•Jobtsm►�SE1:1-ER Patricia C.Jolir)n,"� R DoWd D.5;—" te►S£L ER V• R..Duqucan,SELLER Htttrsrn A1loass 8£LLER D MattaD.Miks,SELLER i Jobn Vila.SELLER COMMERCIAL ERA Ceps R29 E sbe PRF.A+i� By, By: Jam Cihizzi,Btolper �Broker 13 Blew C_Bs&iOm SEIZE JAB. SELLEt ... mm bfiwtm Speck SELLER madqu S ,SELLER Kean Kam,SELLER Dflirra lL xwnw ]f� Jot C bmvfim,SELLER, mlafm zaftdsf,DER Bobrett X Joi n,Sa L EK Pdrecia C.Johmm.SELLER DoosW D.D%uctW SELS,E,R V'Vgma R MquaDp SELLE4,t Baetram A1koe.3EE.LER D MiM SE y JJvbn Vtl%SELLER. PREMIER COMMERCIAL EPA Coix Real Booft BY John CSWr-d,01*w ,8tol�et Z3 i Jeff my Komenda,,SELLER Nancy Konwnda,SELLER Brien C.Badtigian,SELLER Judith S.Badrigian,SELLER Mrs.Morton Speck,SELLER Mortqn,Speck,SELLER Ken Komenda,SELLER Drive.R.Kteinas,SELLER John C.ZsrWaa,.SELLER Maxine Z&rWrian,SELLER Robert K.Jolmsori,SELLER Patricia C.Johnson,SELLER Donald D.Duquette,SELLER Virgin R.Duquette,SELLER Bertram Alknn,SELLER Martha D.Miles,SELLER J Vila,SELLER PREMIER CONhMCIAL ERA.Caps Real Estate By: 'By: John Cihi zi,Bra*er ,Broker 13 f9 25 2OX3 1E: 15 MAIL PACK CENTER OF SIES1 �41-5'46�3886 p,� 00 y Oft ]�►1C t ►; Mgr ,� - e.faddo L, a ems. ,ems, I 4 ,�alqu C.Za�ioh,, aa�, K,JN ,SBLt.eR pu"m c ,S$5m Deneltl D.. i��dab�t; @it M R Dugp9�y B$nL� 8ael�h�116me, NOMA W41M Dr Ro4r� �4ze—rte #*kW t CM60CIAL BtI�,Orpe 8�I Beta�e R. �. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel I ®� �0 5 Permit# � t Health Division �O�nnf Date Issuedd d Conservation Division Fee T Tax Collector / r Treasurer �5 Planning Dept. Date Definitive PI ed by Planning Board c. Historic-OKH Preservation/Hyannis J' Project Street Address \e� © f:e_G`,k3 S Village ( Jo tz `� t Owner �(�1 I' 1 S Pam\ Address ��CL D cle . JIN S� Telephone �� �-j Permit Request e O �,► LP c%� Cn �'C 1\ CA Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Valuation Zoning District _Flood Plain Groundwater Overlay 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 �� 1 Historic++.am-a: ese O No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑existing ❑new size Pool:❑existing Cl 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 BUILDER INFORMATION Name Telephone Number bo Address License# CS Z�-T 3> Home Improvement Contractor# G( cz y Worker's Compensation# o D ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO SIGNATURE DATE t FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED i MAP/PARCEL NO. r` ADDRESS VILLAGE - ' OWNER f t� DATE OF INSPECTION: FOUNDATION FRAME k INSULATIONr FIREPLACE '.f ELECTRICAL: ROUGH FINAL r PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING I , Y � DATE CLOSED OUT R ASSOCIATION PLAN NO. k t w Z t The Commonwealth of Massachusetts Department of Industrial Accidents 600 Washington Street Boston,Mass. 02111 Workers' Com ensation Insurance Affidavit name: location: city phone# ❑ I am a homeowner performing all work myself. ❑ I am a sole etor and have no one work in in ca achy %/%/%%��%%/%///////��%%%%%///%/G%%/// / %/%%%//%%%%/%%%%%%%%//////G��%%%%/%%///%%//////%�/�%%�%�%------ I am an employer raviding workers' compensation for my employees working.on this job. : :::: ::::::::::::::::::::::::: ::::::: ::: : P .P.......................................:.:: ::. : :::,.:.:.:.:........:::::::::.:::,::::::::::.:::::,.......:.::::.:.::::::::.:::.::::.:::.:............:.:;.:::::::::::::,::::::::::.........::::::::::::...... ................ ................ ::::. .::::. :....................:::...::::::::::....... :. coma :.name................. :::ii' ":yi:;:; �•��.�rCS 9tl .r ::::.. :::..:. ....::.:.::.:::.:::::.: .. .:... ...:.:. ...:... :: ,:::.:::::::.::.:..... ....:..:::.:..:. ........._::::::::::::. .::. :.:..... ..... .... .. hop e# C1 D ❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have e following workers' compensation polices: cum an ::name :::.:.:.:....:...: ...... are <� `on..D h ............ .. ;;:........................................................................... <.. <.. lhsnranc :::>: ob cv c as n ....... ..... address• :.<. > bII h :..... K. .............. ..................................... ........................................................................................................................................... .........::.:v:::v.::::........::v..::........................:.......... :...:...3iiiii::Lii.�:.:, .... ::::::::v::::::::::::::::::::. .... !•: :;}.::.ii:;:;i::�ii:�:{ ipi;:::�>.`ii2:y<;:v:;:;:;i:;jki:!��;::;:;':�::ii:i:::!i�+;`:;:';i';•'� :{:; i:;:i i '•�:.. iriarance Failure to secure coverage as required under Section 25A of MGI.152 can lead to the imposition,of criminal penalties of a fine to S1,S00.00 and/or one years'imprisonment as well as duff penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this may be forwarded to the Office of Investigations of the DIA for coverage vetiffcation I do here c fy and penalties ofpedury that the information provided above is true and rred Date Signature Phone# Print name J official use only do not write in this area to be completed by city or town official city or town: permiUllcense# L ❑Building Department ❑Licensing Board ❑check if immediate response Is required ❑Selectmen's Office _ ❑Health Department contact person: phone#; ❑fie! Barred 9195 PJA) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An employer is defined as an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver 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 section 25 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,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and supplying company names, address and phone numbers along with a.certificate of insurance as all affidavits may be submitted to the Department.of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the'law"or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the.applicant. Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returh d to the Department by mail or FAX unless other arrangements have been made-.-- The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of InsestigauOus 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 hone#: 617 727-4900 eat. 406, 409 or 375 � <`-�ti" fir,• ,.. '< Limppa��rs� +.,i'w...:� •�1 w a .. _a..ve'� IF OPEN OFF S . RATES �r�® KITCHENETTE-+ AIR CONDITIONED COLOR TV I�� VACANCY k" ; fit '.�wf Ar ��.i.>t�.Y � `�.w•'l:. ..... - �. M .e'•^ y F�`� .yam f � '}�. - ` .. x .w.. .may �_ t.., .,•., ,.. - s,ar'�.�'^n��t.�y �i � "fyM'+>., « -^� �e+Mrw, '" !1 Y• �` wF'9�'�"'"�'1'''430. � .•++� �"w�L..'..w+-_ !s�!'�'�2 }��-yW.. °dy4+ '::�h.^a•i�r' . i C Y►t� - ter' y r T. 8 Assessor's map and lot number sTNE Sewage Permit number ........................................................ EAMSTABLE, House number ....................... ................. 14AS& ........................ 039. 0 MA Ar TOWN OF BARNSTABLE BUILDING INSPECTOR 0M APPLICATION FOR PERMIT TOc �� ..........0..................................................... .... ........ ..... TYPE OF CONSTRUCTION .......... ...........................................................e...................................I......... ..al .............19. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ...... .........0-c-e:a�?....�-t....... . ...........4.................... tylvif... ................................... ProposedUse ....0.q- ......................................................................................................................................................... ZoningDistrict ........b.L9....................................................Fire District ........ MA................................................ Name of Owner ......�ki+i................Address ..... ..................X....6.�az..wz/:�2...................... ........ ... ................................. Name of Builder lkc.cy.....0111.ts.:...........................Address .....6.&.... y. q Name of Architect ..................................................................Address ... lvo.(+ ......... Numberof Rooms ..................................................................Foundation ... ............................................................ Exierior ................... ..................................................Roofing .......................................................;............................. Floors ......................................................................................Interior .................................................................................... Heating ..................................................................................Plumbing .................................................................................. Fireplace ..................................................................................Approximate Cost ....... 5....0..0.............................................. .. ... .. Definitive Plan Approved by Planning Board -------------------------------19--------- Area ........ 0.................. Diagram of Lot and Building with Dimensions Fee ...471.6................................ SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ..... ................................. ......................... Construction Supervisor's License ... ......... HARBOR HOUSE REALTY No .27.7.6.9. Permit for ADD DECK Commercial ............................................................................... Location ...119 Ocean Street ............................................... .....................Hyannis....................:. t. Owner ..... ..Y. Harbor House Realt ........................................................ Type of Construction ....Frame ............................ ....................... .... .................................................. - Plot ............................ Lot ................................ t .. Permit Granted •„•Apri 1 18. 19 85 t ......^..... Date of Inspection ..................................:19 Date Completed .. .�;, /................... 19 � fi ' r Assessor's map and lot number . ......................................... THE �oF toy Sewage Permit number ........................................................ . 19 t BJHH9TADLE. i Housenumber ...........I ........... ............................................ 11AG& 1639. TOWN OF BARNSTABLE BUILDING INSPECTOR C ..�.............Ievgy ft5-to APPLICATION FOR PERMIT TO ......A-4.4..... �NJ+) ................................................................................... TYPE OF CONSTRUCTION ........ ...........I.......................................................................................... ... .a.! .............. J�'.. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ..... .......&&(A!y................................. ....... g�p.......... ........................................... ProposedUse ... ....................................................................................................I....................................................... Zoning District ........(�LB....................................................Fire District ........Q,�qNwl ................................................................. Name of Owner il.(6(.....O.s:s .................Address ..... 0 X ........�) Name of Builder ......10-01t.c..............................Address ................ ..................... Name of Architect ..Address ...�.l.....fvq.(+�.....SJ.)...... .......... Numberof Rooms ..................................................................Foundation ...6....Or.............................................................. Exterior ....................................................................................Roofing .................................................................................... Floors ......................................................................................Interior .................................................................................... Heating ..................................................................................Plumbing .................................................................................. Fireplace ..................................................................................Approximate Cost .................................................................... Definitive Plan Approved by Planning Board --------------------------------19--------- Area ....................I..................... Diagram of Lot and Building with Dimensions Fee .... .......................... SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules. and Regulations of the Town of Barnstable regarding the above construction. Name ....4��.................................................. \j Construction' Supervisor's License ...0.1)1. ......... ... ....... ... HARBOR HOUSE REALTY . A=326-4.4 No .2.7.769... Permit for AW...P.E.CK............. ..........q9mmer i.q 00 . 1......................��') ...........9... . . ... ...... Location ...1.19....Qc.eaa...,9:trP-e.t................... ....................... ...................................... Owner ..........Harbor. . . . ...House se....Re.a.lt.y...... .. .. .... .. .. ....... .... .... .. .... .. Type of Construction .................Frame......................... ............................................................................... Plot ............................ Lot ................................ Permit Granted ...Al?r.i.1...18. ................19 85 Date of Inspection ....................................19 Date Completed ......................................19 Town of Barnstable Current Certificates of Inspection for Selected Type 08-Mar-13 Pagel DBA CERT# DATE ISSUED MANAGER ADDRESS Type Use INSP DATE CAPACITY LOC DATE EXPIRE AMERICA'S BEST VALUE INN 206 MAIN STREET HOTEL/MOTEL RI 201202845 84 MOTEL ROOMS 6/9/2012 AMERICA'S BEST VALUE INN HYANNIS 5/21/2012 6/9/2013 ANCHOR-IN MOTEL 1 SOUTH STREET HOTEL/MOTEL RI 201206692 42 MOTEL ROOMS 11/25/2012 HYANNIS BUILDING&DEV. HYANNIS 10/30/2012 11/25/2013 CAPE COD HARBOR HOUSE INN 119 OCEAN STREET HOTEL/MOTEL Rl 201205108 19 MOTEL ROOMS 7/29/2012 HARBOR HOUSE MOTOR LODGE HYANNIS 8/22/2012 7/29/2011 CAPE COD INN 447 MAIN STREET HOTEL/MOTEL RI 201204255 39 MOTEL ROOMS 8/20/2012 CAPE COD INN HYANNIS 7/17/2012 8/20/2013 CAPE CODDER RESORT 1225 IYANNOUGH RD/RTE 13 HOTEL/MOTEL A2 201201725 LOWER LEVEL 4/24/2012 HEARTHN KETTLE OF HYANNIS,IN HYANNIS 3/27/2012 232 EMERALD ROOM 4/24/2013 52 NANTUCKET ROOM (CHAIRS ONLY 111) . 56 BARNSTABLE ROOM (CHAIRS ONLY 121) 58 SANDWICH ROOM (CHAIRS ONLY 126 CAPE CODDER RESORT 1225 IYANNOUGH RD/RTE 13 HOTEL/MOTEL RI 201201725 261 HOTEL ROOMS 4/24/2012 HEARTHN KETTLE OF HYANNIS,IN HYANNIS A2 3/24/2011 4/24/2013 H&K RESTAURANT .166 DINING ROOM 49 TAVERN(31 & 18 STOOLS) 170 JFK#I (CHAIRS ONLY 364) 170 JFK#2(CHAIRS ONLY 364) 130 JFK#3 (CHAIRS ONLY 278) Db PROJECT NAME: ADDRESS: PERMIT# PERMIT DATE: r � M/P: ' / lam► "` D `f LARGE ROLLED PLANS ARE IN: BOX SLOT Data entered in MAPS program on: �l D BY: [/ q/wpfiles/archive Map - Parcel y�_ ' {Y/ !!Permit#- conservation Office(4th floor)(8:3R 9:30/1:00-2:00) S q ate Issued `DPW Six-- �lceov�- ofHea1A f 3rd-ftaorj-(8- -5-9-30-/1:00-4:45) p`Z (4 30 �FJS Fee f,5 U �110, (D�ngineering Dept..(3rd floor) House# ] C FJJ, oFI"E' Planning Dept. (1st floor/School Admin. Bldg.) ee, RNSTABLE,�` Definitive oved by Planning Board 19 e 9. Eo ram+& TOWN OF BARNSTABLE Build' Permit Application Project St ress / I Village ded,�, .Owner Address Telephone , Permit Request t r 'First Floor square feet Second Floor square feet Estimated Project Cost $ eq 0 Zoning District Flood Plain Water Protection „Lot Size Grandfathered ? Zoning Board of Appeals Authorization Recorded 'Current Use Proposed Use Construction Type Commercial Residential Dwelling Type: Single Family Two Family Multi-Family Age of Existing Structure Basement Type: Finished Historic House Unfinished Old King's Highway Number of Baths No.of Bedrooms Total Room Count(not including baths) First Floor Heat Type and Fuel Central Air Fireplaces Garage: Detached Other Detached Structures: Pool Attached Barn None Sheds Other Builder Information Name A Telephone Num'.berp 721 6 32_9 1730 Addre s — aix�2� License# 6X-0 Z —/9te— O a (o O Home Improvement Contractor# Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE Z�� BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) -! Y, FOR OFFICIAL USE ONLY PERMIT NO. - DATE ISSUED ' MAP I PARCEL NO. a t ADDRESS ' x` - VILLAGE OWNER DATE OF INSPECTION: + . t , + + �- FOUNDATION _1 t FRAME 1 - INSULATION FIREPLACE t ` ELECTRICAL: ROUGH ? FINAL PLUMBING: ROUGH FINAL v _ GAS: ROUGH FINAL FINAL BUILDING { •� ? DATE CLOSED OUT - + }ASSOCIATION PLAN NO. + ; ; ' ' ' i s .-='ti. 1 ""`•'�' Tile Cunn»nunH•CaMI of Massachusetts Department of Industrial Accidents 60f1 if axbitnPon'Street yr•. .: Bawatr:Maim 02111 a Workers' Compensation Insurance Afridavit A •—,-• — -..-�.-'-- Please i'R1NT1e ly• - ---- �Rhc-�nt��n��nna••••••- . Anne IN City ❑ I am a homeowner performing,all work myself. i ; ❑ I am a sole proprietor and have no one work-in, in any opacity ❑ I am an employer providing workers' compensation for my employees working on this job. nddre` . ' • volley# aurance co C.... ❑ 1 am a sole propriet enerai contractor r homeowner((circle one)and have hired the contractors listed below wh the following workers' compensation polices: comiliny n Address! 2 . � 3 .. f /—,3/a-aR �� =oi3 ,-. `urnnee Co. ., --- r�...:n•.reses, -rya- - m env name- Rhone �.. inprance co. offer a — Attach additidnai•sheei inii tin of a titre u .00 a Failure to secure coverage as required under Station 3A of 111GL 152 an lad to the imposition of erimtaal ltetud P to 51300 une years'imprisonment as well as civil penalties in the form of a STOP 1V ORK ORDER and a fine of SI00.00 a day against ma I understand t copy of this statement mad be forwarded to the Otltce of Investigations of the DIA for coverage YM(leadoa. do/rerrhr cerri •utrrlcr die pal nd penalties of pedurr that the infornmtion pro►z�bove is true and COMM Stenaturc one# 7 7/ ofliciai•use only do not write in this area to be completed by city or town amcial Y pertni01 ense# nt3ttildlttg Department city or town:, C3Ltaasing Board OSelectmen's OBicc I1 check if immediate response is required Otieaith Department phone#: slOther�� COMM person: Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation fo employcrs. As quoted from the"law". an enrphtilee is defined as every person in the service of another under ar contract of hire, express or implied. oral or written. An rmpinrer is defined as an individual• partnership. association. corporation or other legal entity or any two or the foregoing; ctignued in a joint enterprise, and including the legal representath-cs of a deceased employer, or thf receiver or trustee of an individual , partnership. association or other legal entity, employing employees. Howe., owner of a dwelling, house haying not more than three apartments and who resides therein, or the occupant of the dwclling house of another who employs persons to do maintenance, construction or repair wort: on such dwcllin or on the grounds or building appurtenant thereto shall not because of such employment be deemed to bean emp MGL chapter 152 _;action :5 also states that every state or local licensing agene}•shall withhold the issuance c reneival of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally. neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chaF been presented to the contracting authority. —.. �-.w..�.r—. ...—��..aw..-��. .. '?..t::!..: • .�:_ .:: .y.«a.`tir';Itt�.JpC,�V ... �:t..a:.i.•Yt},ii�4�.�°—%7�'T`•c.•ay .-•�. Applicants Please `;II in the workers' compensation affidavit completely, by checking the box that applies to your situation r supplying company names. address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested. not the Department of Industrial Accidents. Should you have any questions regarding the "law"or if you are regt to obtain a workers' compensation policy, please call the Department at the number listed below. F.�x .�.`:xs�-•.:=is-%~•'.. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottc the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be retur- the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any que, please do not hesitate toLive us a call. F!•1W� 1wr w..�-�.r .�.•. M��:I:mow r�•r-r•=.s W atr'r The Department's address. telephone and fax number. The Commonwealth Of Massachusetts `' Department of Industrial Accidents Y Office of investigations " 600 Washington Street Boston,Ma. 02111 fax #: (617) 727-7749 nhone 9: (617) 727-4900 ext. 406. 409 or 375 I: _..•.,�_ _...._ --"�lie'�arrhrconufeall! o�t/�aaaacfucae%�i � DEPARTMENT OF PUBLIC SAFETY CONSTRUCTION SUPERVISOR LICENSE Na�ber, Expires: Restricted To: 00 =R08ERT E RYAN 15 ORCHARD NAY ` SANDNICH MA 0256 -----_ I -- dab -- --------_-- - -- - --- _ . ._- - , j n..� {r7"'_•+- 1'. / � -rft - ;f � t"/, r � T:1 t� .���i �`�' � ..t sr��s F'��,�a +�+� ��.�. � � �;f- �l:% 1 -r. t.-.t. � - rr (-- .tl _ J + .\. .,-i� .1 \ �_�_ Z•t ___``t (,,.. �1,K,1�t-vz...��'�iro�°., „ti•Y\-•S i.�,.h2�.4.��`a�•.�z#���"��1a:�,4t�.��. Assessor's office(1st Floor): Assessor's map and lot nu(tuber ^ l� Q Y 41, r� _ *TM t r r Conservation Board Health floor): m • Sewage Permit number a` ,� S DAfil7TLDLr: i 7 YYl Engineering Department(3rd floor): �J oo ,a3q. House number ! ( ��VA*4 Definitive Plan Approved by Planning Board 19 APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO 'r f-Vv%o8,-1 dc� �'h,►t+• r�L ydpo.f l a-f- Sfz}w•y oo Sceoml Aw-r TYPE OF CONSTRUCTION tv c 19 9 3 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location 19 OCu� Proposed Use d 4C-rc•C, cM (s►- ���r ' rtk�( v���' o� �"``� �I„ov Zoning District Fire District Name of Owner Address 5 �x�,n, lMcsS Name of Builder ���� �L outj Address v (0C W- Name of Architect Address Number of Rooms C sC5 f%"!i n i� Foundation Exterior ( s �-c^ *- o0 CL-y ss�•e`r,✓ey Roofing /\y tx5.zth-, Floors Interior 4id J I"n u,r° roves, Heating 4 S`3� Plumbing {+k;s N1,c Fireplace �`� Approximate Cost 9,000 Area r Diagram of Lot and Building with Dimensions Fee Q OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name Construction Supervisor's License /oaeao i FOSTER, KEN i i No 35846 permit For REMODEL OFF SCE Motel Location 119 ' Ocean Street R Hyannis Owner Ken Foster Type of Construction Framei r Plot Lot Permit Granted May 7 , 19 93 Date of Inspection / 19 Date Com let d f D! �'��9.3 19 d k ' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map '3 N M9 7 Parcel `ALE} Permit# TOWN 9 BARNSTABLE Health Division Date Issued Conservation Division ND FEB -3 AM B: 50 Application Fee Tax Collector o�/3�/.� ( Permit Fee Treasurer '3 Planning Dept. Date Definitive Plan Approved by Planning Board n Historic-OKH Preservation/Hyannis Project Street Address \\ Ct?(�f� 5� �A�' � A-5,0`b LTI n Village 1�;1 q 4 15 Owner h L Address Telephone -ZV7 Permit Request T' C- vov� 'o 19 Yt e ' Square feet: 1st 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) 9 a 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 Cl 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 1 BUILDER INFORMATION Name 01 e Cb'S 1, Telephone Number Ll A b 13) to i Address IS- Ve� \6 0-\,� -CA License# 0 y 9 Sti 6 A Home Improvement Contractor# k at H? Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULT G FRO THIS PROJECT WILL BE TAKEN TO ���nSA S I� SIGNATURE DATE D� FOR OFFICIAL USE ONLY ERMIT NO. DATE ISSUED y ` ' MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION 1 FIREPLACE ELECTRICAL: ROUGH FINAL r , PLUMBING: ROUGH FINAL ' GAS: ROUGH 'FINAL FINAL BUILDING DATE CLOSED OUT, i ASSOCIATION PLAN NO. • i ' "-,A'` The Commonwealth of Massachusetts - =— Department of Lndustrial Accidents ` Office 011llyesl%981%OOs t 600 Washington Street — " Boston,Mass. 02111 Workers' Com ensation Insurance davit name: i Flo y b �Yt YI location. \(4 e city Y1Y11 phone# ❑ I am a h eowner performing all work myself. ❑ I am a tor and have no one world sole ri%%es m ay ca ch ��%%%/D/%%��/G�/%%%/%%/G%%/�%��%/�%/G%%�%%%%�/%�/G%�%%%iiii%��/�/%%�/�%/�/ I am an em 1 er rovidin workers' compensation for my employees working.on this job.:::::::::::?::::::::{::::::: :::,: ::::: ::::::} :,:::: ::: P o3' P g............................:::::::::.::.::::::::::..:...........::. ......::::::::::::..:.........:::.:::::::.:::.:::.::::::::::..:.::..:........::::::::::::::,........:.::.:::::::::::::.:::::::::::: ...............................: :: :.::.::::.: ..............:::.::::::::::..............:::...::::::::::.::.::::::::::.::::::..........:::::::::::...........:::.::::;:::::::::::.: ffl-i om an v neat e � U 4 <: i i ii?i >`<i?>+?'•{>%`; `?''' >i?`3?•`. ii>..`c r, :.%! i? `gtl re .. ' # :ta k:;:`•:s:::;;:;::;:;:;:::;:i;:;:;:;: :;::::::�;:�;::::;i::::::t�::;::;;:::%•<::�:is;;:2:£i::::.:;;::i:;:::';x.;:: T..•�:'::::::::�::::};::r::i;:;:>:Y::::r:::i':;G:::::::;::i'::?::s::::::::::::;:i:::;::r>:?::i:::;:>:::::::>:%;:::i:::::::i:::::::::Y: a tY'.. . .......shone#. ...�..:. :<:<;:::�-�: .> � M. tisuratrce:ca<><... .::::::.: ......::; :.., :..: .:,::::....... ............ olicv# ❑ I am a sole proprietor, general contractor, or homeowner(circle one)and have hired the contractors listed below who have the foll'aomw in compensation polices:. . . ... : .:....:.....:: ...: . :. . ....................:.......::...........:............ :.... :com an� n >'s }::n2 istiC?::•:":{"?•:tiv'-i''•?S:��Tijiiii r.:f��::�:�:'•:` ::: is�ti:� :;:�:::%;:::�::�:�:��:•`:�:?�:?���:���::�:.`�>:?:�i;fi�:;:�::�;:;;:•i:;;;::�}:�:::?:•:;r::<•isi?:?:{;•isi:::::::::::.�:::::•:::::.........::..,..�:•:�::;.;:.�;....{:..... y.,,? 9..r .............:............................rr.. ..n..............r..r..:............................:::.::.. } �:::::•:{::•�:i:::ti$::;^i??i: y �.#::i:.:isi{:v:;ii:i?}{isv:?.?iY<}:;i?is�^y.::::'•:<i:}ri:}{:><4i;}:;: h�t1#:'8itCC::CO::;';<:�i:;:::;i::;:;:;:{::s:>^::}}:;::;•}:!:.}: :{.% ?: }.::.;':;::•:.?>:::..;.};.:.;:.:..:•.:...........:..::...:..::.... .... .. .. OII Roffimm :}i:j;:;:?;i:j;ii:;:i:ji:i;}iiii:j:'isii:v:J:i-'ii':i;:<v';:;r:'i:;isy;Y>: ::i:;'Y;:;T:tii::ii::::;:^iil:ii:i:iiii:�ii:'ii^iiii:::sr?{:::}i:;::}vvv:;:;:$j{:::�}i::vi}:i•':^}}:•:>{SLv: :71aRI :...... .... .>}. adslr }:?;:}v;::S:;:;i:+!iv ii`:�f ii tiv::iiii�ii::' i:ii`iii rii......iiii}ii}:{•i:{•i:{{{•i:<.i•}:4:�:{{:{•::::n:::::::•::.:::...r................:.. :::::::.::.:.:...................... ::::.:::{?:{{•}:ti•:4i}i}:!i.{•::vi;':;ii}i}:::::�:.�.�.�::•:r.: Y!{ti•i}}i}i}:•: i:{:•}:;:.{•}}i}:•}:•?ii:i•?}:;:.{::: {•X '':91•.<:+r`:4�?;'j'�:;:Sr;:?;,;:Y:;j,;;}� r:;i L:;::•i?i:{.:>:vS?T}:.??:::Ni:::. Fanure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to S1,500.00 and/or one yam'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that s copy of this statement may be forwarded the Office of Investigations of the DIA for coverage verification. 1 do hereby certify under t e pains a es of perjury that the information provided above is true and correct Signature Date t>?`�2—d Print name Av K L\e F��y� Phone# official use only do not write in this area to be completed by city or town official city or town: perudt/license# ❑Building Department ❑Licensing Board ❑checkif immediate response is required ❑Selectmen's Office ❑Health Department contact person: phone#; _ f-10th°r Onimed 9195 PJ� Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An employer is defined as an individual,partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or hi association or other legal entity, employing employees. However the owner of a i e of as individual,partners p, . trustee not more than three apartments and who resides therein, or the occupant of the dwelling house of e ha P dwelling hour wing the grounds or house or on another who employs persons to do maintenance, construction or repair work on such dwelling gr building appurtenant thereto shall not because of such employment be deemed to be an employer. also states that eve state or local licensing agency sh all withhold the issuance or renewal MGL chapter 152 section 25 every of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has P either the not produced acceptable evidence of compliance with the insurance coverage required. Additionally,n 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 and Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation supplyingcompanynames, address and phone numbers along with a certificate of insurance as all affidavits maybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and t- date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is "law"or if you being requested, not the Department of Industrial Accidents. Should you have any questions regarding the are required to obtain a workers' compensation policy,please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be rettmmed t" the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. ////%//////%%%%%%O//////%%%%///%�O%//////%%%�%%%%�'''%%' The Department's address,telephone and.fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Me of Invesilgadons 600 Washington Street Boston, Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375