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HomeMy WebLinkAbout0213 OCEAN STREET (17) nCjc�r) i SENDER::COMPLETE THIS SECTION • ON DELIVERY I ■ Complete items 1,2,and 3.Also complete A. Sign e I item 4 if Restricted Delivery is desired. ❑Agent 6 ■ Print your name and address on the reverse_ ❑Addressee so that we can return the card to you. eceived by(Printed Name) to of 14 eli ery ■ Attach this card to the back of the mailpiece, M i�i R U t or on the front if space permits. U D. Is delivery address different from ite 1. Article Addressed to: If YES,enter delivery address belo ❑No I 01,36�cvn 3. Service Type 13 Certified Mail® ❑Priority Mail Express' ❑Registered ❑Return Receipt for Merchandise D Z!o ❑Insured Mail ❑Collect on Delivery 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number (transfer from service label) 7 012 '1010 0000 2 8 4 7 7523 I PS Form 3811,July 2013 Domestic Return Receipt i UNITED STATES POSTAL SERVICE First-Class Mail � Postage&Fees Paid LISPS Permit No.G-10 Sender: Please print your name, address, and ZIP+4®in this box• I TOWN OF BARN-STABLE N BUILDING DIVISION 200 MAIN ST. I HYANNIS, MA 02601 I �°F I 4 m .. OFFICIAL cp Postage $ HI N Certified Fee (� O Pos rk t!� 0 Retum.Receipt Fee C He$ p (Endorsement Required) to PO C3 Restricted Delivery Fee O (Endorsement Required) Q p Total Postage&Fees $ rq Sent T N OY1�ra .......................� ------------------- -- M or Street, t ---------------- City,State,ZIP+4 Certified Mail Provides: o A mailing receipt ' a A unique identifier for your mailpiece o A record of delivery kept by the Postal Service for two years Important Reminders: o Certified Mail may ONLY be combined with First-Class Maile or Priority Maile o Certified Mail is not available for any class of international mail. e NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. e For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required. a For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the'! endorsement"Restricted Delivery". o If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 iXV Environmental M Partners A partnership for engineering solutions. _ August 30,2012 Mr. Hans Keij ser DdHyannis Water System 47 Old Yarmouth Road Hyannis,Massachusetts 02601 RE: Water System Evaluation Hyannis Harbor Suites—213 Ocean Street Dear Mr.Keij ser: At the request of the Hyannis Water System, Environmental Partners Group, Inc. (EPG) has completed a hydraulic assessment of the water system in the area of the proposed Hyannis Harbor Suites hotel. The hotel is proposed to be located next to the existing Hyannis Harbor Hotel on Ocean Street. The existing main on Ocean Street is an unlined 8-inch cast iron pipe installed in the early 1900's. Due to the age and condition of this main the system is limited to an available fire flow of 1,300 gpm during a maximum day demand condition. This was calculated using the Town's distribution system model developed in H2O Map software, calibrated 2011.. ISO has assigned a needed fire flow at the Hyannis Harbor Hotel of 5,000 gpm. According to ISO, forty percent of a community's Public Protection Classification(PPC) grading is based on your water supply's ability to meet needed fire flow. For purposes of calculating your community's PPC, ISO does not normally consider the needed fire flow at properties with a needed fire flow in excess of 3,500 gpm. These buildings get an individual grade,which can differ from that of the community.This means that the fire protection requirements in excess of 3,500 gpm becomes the responsibility of the property owner and impacts their insurance rates not the Town's. The fire flow demand of the proposed Hyannis Harbor Suites was provided by the Architect's Fire Protection Engineer, Energy Economics. In accordance with NFPA 13, the total building demand for a fully sprinklered system is the greater of the sprinkler system demand or the standpipe demand,which for this building will be 750 gpm. It is not recommended that a new fire demand be added to this area until the existing deficiency is corrected. A hydraulic evaluation of the area using the Town's calibrated water distribution system model was completed to identify the improvements needed to address the existing fire flow deficiency. Based on the results of the evaluation, it is recommended that approximately 1,100 feet of existing 8-inch main on Ocean Street (from South Street to Channel Point Road) be replaced with a new 12-inch main. This improvement will allow for a fire flow of 3,500 gpm. If you require additional information or have any questions,please contact me at(61`7)657-0255. Very truly yours, Environme artn rs Group,Inc. p en C. Olson,P.E. Senior Project Manager Hyannis: Headquarters: Woburn: 297 North Street,Suite 311,Hyannis,MA 02601 1900 Crown Colony Drive,Suite 402,Quincy,MA 02169 18 Commerce Way,Suite 2000,Woburn,MA 01801 TL 508.568.5103•FX 508.568.5125 TL 617.657.0200•FX 617.657.0201 TL 781.281.2542•FX 781.281.2543 www.envpartners.com Sign BARNSTABLE. TOWN BARNSTABLE Permit* MASS. 9�Ar16 39. a Permit Number: Application Ref: 201203081 20070750 Issue Date: 05/21/12 Applicant: Proposed Use: Permit Type: SIGN PERMIT Permit Fee $ 200.00 Location 213 OCEAN STREET Map Parcel 326035 Town HYANNIS Zoning District Contractor PROPERTY OWNER Remarks REPL EXIST SIGNS W/LIKE 126.25 HYANNIS HARBOR HOTEL Owner: CONDO WORK Address: HYANNIS, MA 02601 Cc #A A Issued By: POST THIS CARD SO TI3AT IS VISIBLE FROM:THE STREET Town of Barnstable Regulatory Servicesy�� II II ="RNMARIA ' Thomas F.Geiler,Director vLA� NAM & Building Division- S . 1,4 l� Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Permit# Building Official approving Ap lication for Sign Permit Khe /44,7-,e Applicant��a.2 N7 �Assessois No. .(6 Doing Btccincss As• Av el --TelcpLauc No. yd,7 yao aC Sign Location _ Street/Road: _ 2 /3_Q Zoning District; _Old Kings Highway? Yes/No Hyannis Historic District? Yes,/No Property Owner Name: W1fe✓oo/T T /OcJD Telephone:—_ei/a/ t! �OQ� X �l 3 Address: o4d, lT rat l dAj _Viflage:- g� z'��✓ /e'r 7 0. ee3 A Sign Contractor Name: dome , L Telephone:_ Mailing Address: 6AIC- T C•� o Qi v L_�i �,1/fr �jG? �6 Description Please follow die cover directions.You must have an accurate rendition of sign wide dimensions wid location. Is de�rr�ssi I to be electrified? Ye o (Note:if yes,a wiring permit is required) °'e— (�'G�u�✓� rS/-L3 02 9 cy.?� aces `�- wdof 6ds � �r Check one Reface existing sign or New !/ Total Sq.Ft of pro sign{s) If you have additional signs please attach a sheet listing each one with dimensions If refacing an existing sign please provide a picture of the existing sign with dimensions. I hereby certify that I am the owner or drat I have the authority of die owner to make this applic.Won, 75 that die information is correct and that die use and construction shall conform to die provisions of §240-559 through§240-89 of the Town of Barnstable Zoning Ordinance. o, Signature of Owner/Authorized Agent. e Date l ) RTrWq/fiTr;NRR(N T rp-likPrl t)11 A F LAU ETANO S t a N V t3 to C7 LJ P W O R L [D W 1 E:) E Quote Number: 25226 ! page 7 of 7 Quote To: Ship To: Newport Hotel Group Hyannis Harbor Hotel 28 Jacorne Way 213 Ocean Street Middletown,RI 02842 Hyannis,MA 02601 Doug Cohen Doug Cohen Ph:401-862-5755 Ph:401-862-5755 Fx:401-849-3721 Fx:401-849-3721 Project Type;Open/Needc new sign Sales Person:Andy Ciaburri Approximate Install Date: 4/20/2012 Date:3/612012 _ Date Printed:4/16/2012 AUTHORIZATION TO INSTALL SIGNAGE Fill out form and return to Lauretano for any projects involving municipal permits I/WE GIVE LAURETANO SIGN GROUP AND OR THEIR AGENTS PERMISSION TO SIGN THE BUILDING PERMIT APPLICATION AS MY AGENT, AND TO FURNISH AND/OR"INSTALL SIGN(S) AT: .S SIGNATURE OF O REPRESENTATIVE NAME- _ {Signature) NAME: bU he ki (Pleasq Prin " ADDRESS: t ! G� _ e W 0 � }� � W TELEPH�jNE: Alm TITLE: t'✓1'r)GAM A i DATE: 7 21 Please fax tMs form back to 860-S834%9 One Tremco Drive Terryville,CT 06786 Ph.860582.0233•Fx.860.583.0949 www.lauretano.com c Hyann "' is 3l111111111111H N .. Harbor i ! e • Hotel F —r , o. - n � a • S NEW Left Sign NEW Right Sign s o� - I. r.. a" IIT�RI 5'6n ,. Y 6n A .� 4 6 -- CLIENT APPROVAL fisting eft Sign istin Right Sign AUTHORIZED SIGNATURE DATE Print History Date Description Title Hyannis Harbor Hotel Sign Type Pylon Sign City/State Hyannis,MA Location As Illustrated LAUOIRhETANO 673 -2 3 19 12 Customer H annis Harbor Hotel Size S'6"x 8'0" 44 s ft 10'0"OAH IL G Fi p !J P 6732BR-3 4/10/12 Al Exec. AC Description Replace 2 existing Ion si ns 6786 6732BE-4 4/15/12 Quote 25226 with new Ion signs. t Tone:8 Drive. Terryville,CT .S83. phone:860.582.0233 tax:860.583.0949 Line 1 signs@lauretano.eom www.laumtano.eom This drawing contains original elements c reared by Wuretano Sign Group,Inc.,and is subject to all applicable copyright laws:It is also the property of Lauretano Sign Group,Inc.,and it is intended for your review and approval purposes ony.This drawing is not to be reproduced,copied,transmitted by electronic 1'Of 2 media,or exhibited in any fashion or shown to anyone outs We your organization without the expressed written consent ofLauretal Sign Group,Inc.TNs design remains the property ofLauretano Sign Group,Inc.and may not be used in anyway until full payment is received byLauretano Sign Group,Inc. `t 8'Orr PMS 280 Blue background and edges w/gold leafed faces. Fit White cladding. V 0.375" Hyannis (2)Layers of 1"thk.sign foam panels w/aluminum core per side. 5'6" Routed background w/raised copy&"rope"border with applied gold leaf. Hbor. New Alum,clad supports. Decorative alum.baseplate cover at foot of posts. 4"x 4"Steel posts,8"x 8"x.75"baseplates. 4'6"x4' x 2'3"x 43"x 4'0"deep concrete footings. Hotel Excavation&removal of existing footings required. 44 10,0" 9 Decorative HP fluting 3M HP Sapphire Blue •-J------- 5'A"Cto-C I 8„ 4"x 4"steel posts 4'6" 2'6" 11. k12rr Concrete footings. 8.0" A; Scale:3/8"_t, 1 4'On PROCEED TO PRODUCTION 2'6" 2'6" 4'6" i AUTHORIZED SIGNATURE DATE `t FOOTING SIDE VIEW:3/8"= 1' LAUtETANO E. 1 L3 N G Fi O U P TECHNICAL PAGE UL FILE NO.E70436 t Tremco Drive. Te"Ale,CT 06786 Print 6 326E-4 Quote 25226 Installation Method Base ate Amps P.W.-.60.582.0233 fax:860.583.0949 Date 4 12 Line 1 volts slgn:@lauretano.eom www.lauretano.com �f This drawing contains original elements created by Lauretano Sign Group,Inc,,and is subject to all applicable copyright laws.It is also the property of Lauretano Sign Group,Inc.,and It is intended for your review and approval purposes only.This drawing is not to be reproduced,copied,transmitted by electronic 2of 2 media,or exhibited in any fashion or shown to anyone outside your organization without the expressed written consent of Lau retano Sign Group,Inc.This design remains the property of Lauretano Sign Group,Inc,and may not be used in anyway until full payment is received by Lauretano Sign Group,Inc. -- 72 aAaajaysl Eyehooks(painted blue) - 5'0" 1"routed SignFoam painted PMS 280 Blue g° 3.75" w/white text and border Raised edge w/routed reveal between white and blue Scale: 1"=1' Qty:2 Countersunk screws painted blue (screw into cladding) .063"aluminum painted PM5 280 Blue 9rr e 0 3e375" w/applied HP PSV J� IF A Scale: 1 rr=1 Qty:2 PMS 280 Blue background and outer edge w/white copy&border 1"thk.sign foam w/.125"aluminum backer painted PMS 280 Blue.. Sandblasted background w/raised painted graphics painted. PROCEED TO PRODUCTION AUTHORIZED SIGNATURE DATE LAU ETANO t� 1 G " G Fi M tJ F° d Installation Method Install on existing posts Amps HNICBAL,'PAGE:- Quote 25226 UL FILE NO. E70436 Tremcoorive. TerryvHle,t:To6786 phone:860.582.0233 fax: 860.583.0949 5 12 Line 15 with angle brackets:" Volts signs�lauretano.com www.lauretano.com 1this drawing contains original elements created byLauretano Sign Groupinc.,and is subject to all applicable copyright laws.Itis also the property ofLauretano Sign Group,Inc.,and it is intended for your review and approval purposes o nly.This drawing is not to be re produced,copied,transmitted try electronic edia,or exhibited in any fashion or shown to anyone outside your organiWiDn without the expressed written consent of I-Duretano Sign Group,Inc.Th1s design remains the property of I-DUretano Sign Group,Inc.and may not be used in anyway until full payment Is received byl.auretano Sign Group,Inc. 5'0 n ® ® INSTALL ON EAST SIDE OF 9 ® ® 3.75 LEFT SIGN& RIGHT SIGN. - )-.? LINE 2: 1"=1' Qty:2 9 ® 3.375" INSTALL ON WEST SIDE OF RIGHT SIGN. All LINE LINE 3: 1"=1' Qty:1 9° ® ® ® MW3.375" INSTALL ON WEST SIDE OF LEFT SIGN. S/G•✓Ali LINE 5: 1"=1' Qty: 1 PMS 280 Blue background and edges w/white copy&border r (2)Layers of 1"thk.sign foam panels w/aluminum core. .Sandblasted background w/raised graphics painted white. (2)layers of 1"thk.sign foam per sign panel. PROCEED TO PRODUCTION (4)sign panels required. Install new panels on existing posts. AUTHORIZED SIGNATURE DATE ®AU tETANO G Fi O lJ P MN CALPAGE'tl Quote 25226 Installation Met UI:FILE N�.E70436 t Tremco Crive. Terryville,CT06786 Method Install On existing posts gmps phone:860.582.0233 fax:860.583.0949 slgns@lauretanocom www.lauretano.com 3/16/12 1 Line 2 3 5 with an le brackets. volts This drawing contains original.elements created by Laureta no Sign Group,Inc.,and is subject to all a pplica all copyright laws,It is also the property of Lauretano Sign Gro u p,Inc.,and it is intended for your review and approval purposes only.This drawing is not to be reproduced,copied,transmitted by electronic 3' media,or exhibited in any fashion or shown to anyone outside your organization without the expressed written consent ofLauretano Sign Group,Inc.This design remains the property ofLauretano Sign Group,Inc.and may not be used in anyway until full payment is received byWuretano Sign Group,Inc. l AZ73 10'3" RM ® — RrrFrr ta w 4. 7 Orr w- Icia j A. 3r w rc Existing Condition Proposed Condition Reduce sign height by 2'0': Remove existing sign panel and post caps from existing posts. Remove 2'0"in length from top of posts Reinstall sign panel and post caps. CLIENT APPROVAL AUTHORIZED SIGNATURE DATE Print History Date Description Title Hyannis Harbor Hotel Sign Type Reduce Sicin Heicaht City/State Hyannis,MA Location As Illustrated Customer Hyannis Harbor Hotel Size 3'0"x 10'3"30.75 sq ft 5'0"OAH S I G N IL G Ft t:) U P Acct Exec. AC Description Reduce si n heiciht by 2'0" Quote 25226 from T D"to 5'0° 1 Tremoo Drive. Terryville,eTo6786 Line 7 phone:860.5B2.0233 fax:860.583.0949 signs@laumtano.com www.louretano.com This drawing contains original elements created by Lauretano Sign Group,Inc.,and is subject to all applicable copyright laws.lt is also the property of Lauretano Sign Group,Inc.,and it is intended foryour review and approval purposes only.This draw!ng is not to be reproduced,copied,transmitted by electronic -1-of 1 media,or exhibited in any fashion or shown to anyone outside your organization without the expressed written consent of Lauretano Sign Group,Inc.This design remains the property of Lauretano Sign Group,Inc.and may not be used in anyway until full payment is receivedby Lauretano Sign Group,Inc. LAU ETANO s i C ry EM R o u P W O. R L 1:3 W ! E3 E May 14, 2012 Town of Barnstable Building Division 200 Main Street Hyannis, MA 02601 Reference: Hyannis Harbor Hotel—Signage, Attention: Building Official To whom it may concern, This letter is in regards to the Hyannis Harbor Hotel located at 213 Ocean Street, Hyannis, MA 02601. There are 2 existing signs that will have permanent panels below the sign; the left sign will have a panel.reading Hotel' Lobby and on the opposite side a panel reading Vacancy (No Vacancy sign panel made to be attached over the Vacancy sign with eyehooks). The right sign (by road) will have a permanent panel reading Hotel Parking Only, and a panel on opposite side reading Vacancy (No Vacancy sign panel made to be attached over the Vacancy sign with eyehooks). The AAA Sign will be removed permanently. Please reference Print#6987BE-2 _ If you have any further questions or require any additional information please feel free to contact me. 4Thank y , AI on o browski One Tremco Drive,Terryville,CT 06786 Voice: 860.582.0233 x 155/Fax: 860.583.0949 alysondombrowski@lauretano.com www.lauretano.com t 10'Y C1tT• �► ♦ .�x Ir®. �' ,aRpp� n�� ` Y� s d 1 ?� � ,� _�+�y 71 OII A „/!" �� � +. � ate.�, x.;:.. w • w D O • • i .,.. .>.�.• -+? � " r '�a �Ptah �*+� ,,r � �., .-.. id'" Y"~..! ,�, .:fi:' � x -;.+ae�. 4�5 t'# �s:� `',.' ��1'�j;'" s � >;+ .t` �,5. s K4' �Y, �, •Y,+:a t21w •� d o `�� Y Existing Condition Proposed Condition • Reduce sign height by 2'0". Remove existing sign panel and post caps from existing posts. Remove 2'0"in length from top of posts Reinstall sign panel and post caps. CLIENT APPROVAL AUTHORIZED SIGNATURE DATE Print History Date Description Title Hyannis Harbor Hotel Sign Type Reduce Sign Height ��� tETANO 6734JK 3 16 12 City/State Hyannis,MA Location As Illustrated Customer Hyannis Harbor Hotel Size TO"x 10'3" 30.75 sq ft 5'0"OAH cct Exec: AC Reduce sign height b 2'0" s I G ^' G Ft o u P A Description Quote 25226 from 7'0"t0 5'0" 1 Tremco Drive. Terryville,CT 06786 phone:860.582.0233 fax:860.583.0949 Line 7 signs@lauretano.com www.lauretano.com This drawing contains original elements created by Lauretano Sign Group,Inc.,and is subject to all applicable copyright laws.It is also the property of Lauretano Sign Group,Inc.,and it is intended for your review and approval purposes only.This drawing is not to be reproduced,copied,transmitted by electronic 1 of 1 media,or exhibited in any fashion or shown to anyone outside your organization without the expressed written consent of Lauretano Sign Group,Inc.This design remains the property of Lauretano Sign Group,Inc.and may not be used in anyway until full payment is received by Lauretano Sign Group,Inc- c z s� .fit_. .: �� .. *� „?. ''• " t 9.. �2"` t'� a � '...^""_!Sk �. �'„+�'� y j,,,i�{ �4;vim-NIL M, a,l -�.*� �"•,��. ""' �,� � ;.� - Gc�1.,a .k, fit!i�t•�4 a.�'Ir -.. .... ..».. Ca� e_�1 ���"t '"•'"%: ', � I ,{ � ®T]aa�•'•'�'�,�1- fir.�� �'� t �'-+ �s,ty''� `�4RAyi�. �Yy '" .ram•.f.�:. -, _.<, S r;-r+, .,�.o i. -® I •k _ ,, L....-„no•t r:t,i,oisnr r-..?•. r �♦ r''� tit t�'a't�� d�!`�'� '� -'�� -►`.<, `Y 1 1 � .^t� till:� � J •�.fYj4--yl' �#'�A`i7il(}T eta` y 3 u F- •, .r°y' °_ �* ' ,�"'k ^r +<y•2,A4� ,�,w �F�' 14i�c •yr ..wf t•�r / I°• i CF. Irl f Y ',. ^ tank !, 'r.w_i s„sn a J q ♦L n . • t �:,� Take Plide m�tour.•Ueer.° . � J j LQ .fi �. �. TOWN OF BARNSTABLE BAR-W 9736 Ordinance or Regulation WARNING NOTICE Name of Offender/Manager Address of Offender MV/MB Reg.# Village/State/Zip Business Name 4 VAN 0 1-5 NAAAA 007E /:- /1 �l rpm, on b~�3 20 /6 r r Business Address f+l Signature of Enforcing Officer Village/State/Zip 000,41C &A � y Location of Offense SA &4 04'10-- '�-� Enforcing Dept/Division Offense U Nw-:rk < A ACN S' /t H Facts This will serve only as a warning. At this time no legal action has been taken. It is the goal ' of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. . 77 r a $ '� •xX4, y.y , t m. r • x s� Y 5 • �rss A9 x� r` �,,;� !^,7..'"'� ,ems• - a ' . V a e, , a , PTU .�u.F 1 �n •yq ;ay 4 1 w , 1,41 , IN i *r.�'�,,,y„ * . .. g � � y d•�* .,,«'.gip .�,� . ' e �'�f� ,7r�' '" "Ft � •: � t,Q � `�.��'�+��+ OF� .q. �' � *,r,� ,+ � �, ... y� °' .l+.. `t y'( x '� },.,k+�i, s• Te'!,hy +!Mw �'.t ; '�a Mf"`.,71 T .� ), .+,!'-r B'^,T.:�" • `iK , + w �� :+r ♦, ':�'r �*', < gy •r�'�x wt`,;w� �, '' .•. �t *,r 3.. v,cR. r"x „+ � 'Ww` '+4 "' Q.: a .a ,.. , y . K.q a , }r' i � tut,. , F ti !! Ve �y� ■ r "�'` ^,`. ,��"""^ 'y a,,".�fY� i�1'�! ,.a' •'�"! "+i r,.,►yr w•.S•,^ L ` ,!' •'r:'i ti:c 6 ..'..b- N., �:. t �'^ 1. .k,. vx �� X1 yyyy.i� .. -.> t-}�` a `,�6: .iw;*t c�,, 3 „r}•, `..,.,�,:,� C,�`• '^r,o w T �.. •3 a� ."k* y .t«r +.� �..�{'. �yy !, f - = xa „ ..,.. fe'v�Y� �, fi� �` .,s+•x t--a.ix�.. 'lSy"+� s �'y' .y .fiy '`� TOWN OF BARNSTABLE BAR-W � Ordinance or Regulation WARNING NOTICE Name of Offender/Manager Address of Offender MV/MB Reg.# Village/State/Zip Business Name !� +`�` '�`- am/pm, on -7 20f Business Address 0 Signature .of Enforcing Officer Village/State/Zip Location of Offense m Enforcing Dept/Division Offense Facts This will serve only as a warning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. �J �-,vw- Adr f a"r� r 4 �rf.y} `r 3t .` y. "�# •maw gyp ' M� r/ R Jam Y •i-� ` M, AM t-" •♦ 'PRV �' �� c.-. 7-4 TW d b r n M d k ..a e Hf i w,,fir-•i X .... ,x•� ":a f1 �ti.-.^.. _ r t 1 1 gyp• 1 ,+. T � 1 � � � �` •`�� �� � �'� s P�, , r - �e Ey '4 -M firTr Iola, ` i�1'ake pride iu ruw ber`J 4'Uk x n �p JJy �: �' ,t w� •s �,� rr-. Fi K� a'��+s �'��si'� � .F�•�< het�r.'y,.F�°T+,c �� ,� � `,'� �� �^ +e { �.�`�rai't*G�'`�'SS�i',FSs•^y.', �'F�r t .T T .�.r..�.,.aw ,a,,,,,'ti�•�,. ^S.;� >f �e;��`ss•E���`�� �f* ;1 t< r .\ A • ,;,y.� ,ys a: '�?��e3�.�J9 �'�: •�•� R�i(•�'s^"-)�t fi K'h:�t°� ` x rf,k !}- l '��� 1 y n-.S �, .j'r�+ ,y,�.FJ'rf 1.,�,i�'M• � C�S�t''..A Yi'�� iV �" -� ... � t 5-1 ,�t� 1..,,•�v..,�,,r•'hzol* i'1j� {��^�+f'�''o,.� ..t� sd,�� ;, 7 !, � � „y...i y.�t..rys•'' �•� ,�, r_`,jY� 3'�1 i y SI' "y','4,�F Z �'y ��':, . a �V 1 G d Yk - .'^'" 1 ,l '+2 Y 't�5.�i • .fe �?'S V:1 , ••-T.. TP J �„�,.ems �l��F",%y `viF'.., mac�' -,... > t wr �� ; A e« �� ao .�' td4:•b + ry A s y; �� .♦ "6"'"�+vi�i?� �"S i'P' .sa. �[�`Si''°�^• s 'YF'-,,,r±*slr ►'�' :,,.P".,'�.7�_'rj �,,rf�0n��'14�g} "�fiY�'iC,�i ��;.y a�i �`�'�: + k4 f*�5�-f yPrtyy{9F' � �S p.�• TfF 4i 'P�n.�e�• s �;'1 N!`,... • r p r �r����.'�#.�^�i� ��°0'��xj ,J' . '§`.tom �i.,'�'� �w�r.;�� s-;..��,''"� �.'`••.rt�S='�}i"„.' �1�� �: .�r��'�� `n+�S'R'�'`��'� L'"�,(%,y�.s �'� 1, � .� f.. w.... �s,�} ...a +�* w �,,,yp, �� .a� ��P&+ f�7 �; .•.r s�'Yr� �- J �,� � �"•�r t +� .�.. :hr�-. -",rt. 1 z "r.. s+'t �w •�•''�!�^^[• lq�.Y�r../�"a "^ rir" tir `�r'" } i'1' � -v 4. t�. � y,,,tM�'7 a�i; � � t��� dtt ..�_�y ,,r ,�� !°• AU Pl '�?• -IE'F '' t 4 : �•+ ', " ,�r t p,TriAf ,�V '.1-'a r 4,' �.kn `'+'[�,. ems. arr,.��1��c�fO �,+�..�'FR.'_;a• ^�„�t?'!�64at,..µ•�/��'!3t`�r'�.�v�'��.i+."u�,'%t.F_"!.X w,�\.it `t;��d�k��iw"1'' ��. i ��:X: "Wla�zil"; ♦-',:���`�tiC' ��ti'�s"$.M,f.,.. ��!�1��^`a1. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map ` ' Parcel 03 dr Application #e:�� .. Health Division Date Issued 7i Z Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board P 1 Historic - OKH _ Preservation/Hyannis Project Street Address 2-1-3 O cE 5 a eai t­-► r-fl-)P, Village Owner N-o-r - Leo P Address Z$ Pt-c-orn t .u_�,innn m to 0L= Telephone 4D I - 846- O0i 00 Permit Request C--P L,(Irc C 2N-W,3Tf t a Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's HighwgW, ❑Yes ❑ No C=:l C> Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑Other °r Basement Finished Area (sq.ft.) Basement Unfinished Area (sgft) a Number of Baths: Full: existing new Half: existing new --o n Number of Bedrooms: existing _new v Total Room Count (not including baths): existing new First Floor Room Count-- c a 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: 2 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 r o� 17�1 '-r�2� Telephone Number 210 1— 2-toS`7 Address j 1��-�tJvc��L �T License # d t U3 r F> a 2 Z=2Z±n Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN Tb SIGNATURE o. DATE I � i d FOR OFFICIAL USE ONLY APPLICATION# DATE-ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER " DATE OF:INSPECTION: t Z . FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL ` PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. v r The Corn trt onivealth of3fassachusetts Department of.ludustrial Accidents Office of Investigations' 600 Washington Street Boston, MA 02111 �., www.to ass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information n Please Print Le>sibly_ Name (Business/Organization/Individual): No nu ftT-%V,';; on Address: SAS rY, go City/State/Zip: 9-\ fU-LbZ?' Phone.#: +Ol- (07A'e'1505 Are you an employer? Check the appropriate bog: Type of project(required): 1.[ 1 am a employer with 1 Q 4. 0 I am a general contractor and I 6. ❑New construction employees (full and/or part-tirn.e).* have hired the sab-contractors 2. listed. � I am a sole proprietor or'partr]er-' d on the attached sheet T. Remodeling These sub-contractors have g. 'Q Demolition ship and have no employees and have workers' working forme in any capacity. employees9. ❑Building addition . [No workers'•comp..insurance comp• insurance.$ required.] 5. We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.El Plumbing repairs or additions myself. [No workers' comp. right 6f exemption per MGL 12.❑Roof repairs insurance required_] t C. 152, §1(4), and we have no 13.❑Other employees. [No workers' comp. insurance required] *Any applicant.that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Xcontractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have employees. 1f the subcontractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:R a G'S- C)Ze Policy#or Self-ins. Lic.#: ( (A-2 C. 0+ S Z to 09 Expiration Date: _ 10 Job Site Address: 213 Q U-5 � <� _City/State/Zip: -1 INN"��S Attach a copy of the workers' compensation policy declaration page (showing the policy number,and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of crimiri41 penalties of a fine tip to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine. of up to$250.00 a day against the violator. Be advised that a copy of this statemcrit may be forwarded to the'Office of Investigations of the DIA for insurance cove-rage verification. I do hereby certify under the pains andpenalties ofperjury that the infortnatlon provided above is true and correct Si ature: Date: ZIt b I LZO(t) — ' Phone# �t I ' (o?--,P 4So5 Official use.only. Do not write in this area, tb be completed by city or town offlciaL .'City or Town: Permit/License # Issuing Authority(circle one): 1.Board of Health "2.Building Department 3. City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6. Other Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in,the service of another under any contract of hire, express-or implied, oral or written." An employer is defined as"an individual,partnership,association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or tfustee of an individual,partnership, association or other legal entity, employing employees. I3owever the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every stale or Iocal licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable.evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the Commonwealth nor any of its political subdivisions shall . enter into any contract for,the performance of public work until acceptable evidence of compliance Rzth the insur?13ce requirements of this chapter have been presented to the contracting authority.' Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary, supply sub-contiactor(s)name(s),.address(es)and.phone number(s) along with their certificates) of insurance. Limited Liability Companies.(LLC) or Limited Liability Partnerships(LLP)with no employees other than the members or partners, ate not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete'and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address" the applicant should write"all locations is (city or town).".A copy of the affidavit that has been officially'stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be 611ed out each year.Where a home owner or citizen is obtaining a license or permit not related fo any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to.thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone•and fax number: The Commonwealth of Massachusetts Department of Industrial Acciclents Office of ruvestigati.ons 600 Washington Street Boston, MA 02111 Tet, # 617-727-4900 ext 406 ar 1-877-MASSAFE Fax# 617-727-7749 Revised I1-22.06, www.mass.gov/di a Massachusetts Department of Environmental Protection Bureau of Waste Prevention •Air Quality. 1100101572 BWP ACC 06 Decal Number Notification Prior to Construction or Demolition Whenrfilling out A. Applicability forms on the computer,use only the tab key A Construction or Demolition operation of an industrial, commercial, or institutional building, or to move your residential building with 20 or more units is regulated by the Department of Environmental Protection cursor-do not use the return (DEP), Bureau of Waste Prevention-Air Quality Control Regulations 310 CMR 7.09. Notification of key. Construction or Demolition operations is required under 310 CMR 7.09 (2)ten(10)days prior to any work being performed. The following information is required pursuant to 310 CMR 7.09. B. General Project Description 1. a. Is this facility fee exempt-city,town, district, municipal housing authority,owner-occupied Instructions residence of four units or less?❑Yes ❑✓ No 1.All sections of b. Provide blanket decal number if applicable, Blanket Decal Number this form must be completed in order to comply with the 2. Facility Information: Department of Hyannis Harbor Hotel Environmental Protection a.Name notification 213 Ocean Street requirements of b.Address 310 CMR 7.09 H annis MA 02601 c.Citvrrown d.State e.Zip Code (401)624-4505 1 Irgifford@iciofamerica.com f.Tele hone Number area code and extension .E-mail Address(optional) 72,000 h.Size of Facility in Square Feet i.Number of Floors j. Was the facility built prior to 1980? ❑✓ Yes ❑ No k. Describe the current or prior use of the facility: Hotel I. Is the facility a residential facility? ❑ Yes ❑✓ No -0 m. If yes, how many units? Number of units �—O 3. Facility Owner: �N Newport Hotel Group �o a.Name ®o 28 Jacome Way b.Address Middletown RI 02842 ®(O c.City/Town d.State e.Zip Code ®o (401)845-0900 fchaves@newporthotelgroup.com , ® f.Tele hone Number area code and extension .E-mail Address(optional) d Fran Chaves ®Q h.Onsite Manager Name ® ag06.doc•-10102 BWP AQ 06•Page 1 of 3 =' Massachusetts Department of Environmental Protection Bureau of Waste Prevention •Air Quality 1100101572 BWP AQ ®p Decal Number Notification Prior to Construction or Demolition General Statement:If Bo General Project Description coot. asbestos is found during a Construction or 4. General Contractor: Demolition Innovative Construction Inc. operation,all responsible parties a.Name must comply with 295 Main Road 310 CMR 7.00, b.Address and Chapter Tiverton RI 1 02878 Chapterer 21 E of the General Laws of c.City/Town d.State e.Zip Code the Commonwealth. (401)624-4505 1 irgifford@iciofamerica.com This would include, f.Tele hone Number area code and extension .E-mail Address(optional) but would not be limited to,filing an Randy Gifford asbestos removal h.On-site Manager Name notification with the Department and/or a notice of release/threat of release of a C. General Construction or Demolition Description hazardous substance to the 1. Construction or demolition contractor: Department,if applicable. Innovative Construction Inc. a.Name 295 Main Road b.Address Tiverton IRI 02878 c.CitvrFown d.State e.Zip Code (401)624-4505 1 irgifford@iciofamerica.com f.Telephone Number(area code and extension) g.E-mail Address(optional) Randy Gifford h.On-site Manager Name 2. On-Site Supervisor: Glenn Hathaway On-Site Supervisor Name 3. Is the entire facility to be demolished? ® Yes ✓1 No �N -0 4. Describe the area(s)to be demolished: 0 _o Removal of structural beam at second floor deck. N ®o ®0 5. If this is a construction project, describe the building(s)or addition(s)to be constructed: ® Replace structural beam at second floor deck. �0 ®o e� s �Q ® ag06.doc•10/02 BWP AQ 06•Page 2 of 3 Massachusetts Department of Environmental Protection Bureau of Waste Prevention .Air Quality 100101572 BWP ACC 06 Decal Number Notification Prior to Construction or Demolition C. General Construction or Demolition Description (cont.) 6. a. If this is a demolition project,were the structure(s)surveyed for the presence of asbestos containing material (ACM)? ❑ Yes ❑✓ No If yes,who conducted the survey? b.Survevor Name c.Division of Occupational Safety Certification Number 7. Construction or Demolition: 02/22/2010 1 02/25/2010 a.Start Date(mm/dd/yyyy) b.End bate(mm/ddlyyyy) 8. a. For demolition and construction projects, indicate dust suppression techniques to be used: ❑ seeding ❑ paving ❑ wetting ❑✓ shrouding b. If other, please specify: ❑ covering ❑ other 9. For Emergency Demolition Operations,who is the DEP official who evaluated the emergency? a.Name of DEP Official b.Title c.Date mm/dd/ of Authorization d.DEP Waiver Number D. Certification I certify that I have examined the Randy Gifford �o above and that to the best of my a.Print Name o knowledge it is true and complete. -� The signature below subjects the b.Authorized Signature �N signer to the general statutes JVice President ®o regarding a false and misleading c.Positioni I Itle ®o statement(s). 11nnovative Construction Inc. ® d.Representing s Z �� e.Date(mm/dd/yyyy) e O e� ®d s�Q ® ag06.doc•10/02 BWP AQ 06•Page 3 of 3 �► r� Town of Barastable �^ Regulatory Services . ="xNSTAxte Thomas F. Geiler,Director Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790 Property Ovvter Must Complete and Sign This Section IfUsing .A wilder � �►�, otL C�t^sj as Hof the subject property. �-hereby autho � e C� o act on mybehaf, in all matters relative to work authorized by this building permit application for. Zl7 a c�1v� S� OZICc h4 (Address of job) Signature Date :r Print Name If Property Owner is applying for permit please complete.the Homeowners License Exemption. Form on the reverse side. Town of Barnstable pp YIiE Regulatory Services Thomas F. Geiler,Director Building Division �PrED '� Tom Perry,Building Commissioner 200 Maid.Str(_— Hyannis, NIA,02601 www.town.barnsbble.ma.us Office: 508-862-403 8 Fax: 508-790-6230 90MEOWNER LICENSE EXEM-PTTON Pieace Print DATE: JOB LOCATION: number street village "HOMEO VIN ER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"h°meowners"was extended to include owncr-occupied dwellings of six units or less and to allow hDnleowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. DEFINNON OF HOMEOWNER Person(s)who owns a parcel of land on which be/she resides or intends to reside,on which there is, or is intended to- be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner, Such "homeowner" shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner" certifies that.be/she understands the Town of Barnstable Building Depa.rnnent rrrinimum inspection procedures and requirements and that he/she will comply with said proceduzes and requirements. Signal#rc of Homcowncr Approval of Building Official Note_ Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Constriction Control. aomEovwEws rxE?e ON .The Code states that "Any homeowner prrfosming work for which a building pemvt is required shall be exempt from the provisions of this section(Section I o9.1.1 -Licensing of construction Supervisors):provided that if the homeowner mgagcs a person(s)for hirr:to do such work,that such Homeowner shall act as supervisar." Many homeowners who use this cxcmptian arc unaware that they arc assuming the responnbilitics of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction SuperYisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hirrs unlicensed persons. In this ease,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisar. The homcowncr•acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of hiv'hcr respmuibilitirs,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a,farm currently used by several towns. You may care t amend and adopt such a form/certification for use in your convnunity. Q:fonns:homcczcmpt S '1 c' ,' ', If 7 Massachusetts- Department of Public SafetN Board of Building Regulations and Standards, g Construction Supervisor License License: CS 80103 �® - �,�arn•r�Krnn am Restricted,to; OOst+gtx i. -6 t�. ifi ICtvs S� _� • • ,;.RANDY E GIFFORD F' 17 PENNACOOK ST; NEWPORT;'RI 02840 Expiration: 11/16/2011 Commissioner Tr#: 16907 r eb 18 10 08:47a Innovative Construction 401-624-4506 p,1 DATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 2/18/2010 - PRODUCER (508) 699-7511 FAX: (508)695-3957 THIS CERTIFICATE'IS ISSUED AS A MATTER OF INFORMATION R.S. Gilmore Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR '27 Elm St. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P. O_ Box 126 I N. Attleboro MA 02761 _ _ _ INSURERS AFFORDING COVERAGE NAIC11 - - ---- - ---.............. INSURED INSURERA:ACadia Insurance Company 31325 - Innovative Construction, Inc. INSURERB:Star Insurance Company 295 Main Road INSURERC: INSURER D: Tivertog RI 02878 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OFSUCH POLICIES-AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD I POUCYNUMBER ,POUCYEFFECTIVE ;POUCYIbik ATION - LIMITS GENERAL LIABILITY - EACH OCCURRENCE ;S 1/DOO,000 J X. COMMERCIAL GENERALU DAMAGE TO RENTED ABILITY, PREM_SES�Ee_oawrrenceL__5 1WL-000 A I CLAIMS MADE $ OCCUR CPA0300579-10 7/8/2009 7/8/2010 MEO EXP(Anyone person)_- S _ - PERSONAL B-ADV INJURY 1 S 1 OOO OOO GENERALAGGREGATE I S _2 OG0 000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPJOP-AGG I S__—2,.000,000 X POLICY PRO- LOC ._.....------------- ---- -- FCT I AUTOILLOBILEUABIIJTY - I COMBINED SINGLE LIMIT S 1,000,000 ANY AUTO (Ea wadenq A ALL OWNED AUTOS 0301723-10 7/6/2009 7/6/2010 BODILY INJURY X SCHEDULED AUTOS (Per person)) S S HIRED AUTOS BODILY INJURY S X NON-OWNED AUTOS (Perac6cent) PROPERTY DAMAGE_ S (Per acacent) i GARAGELIABILITY -AUTO ONLY-EAACCIDENT S ANY.AUTO OTHER THAN EAACC S . . --' -- i - AUTO ONLY: ACC S EXCESS I UMBRELLA LIABILITY F11CH OC W RRENCE S 2,0 0 0,000 hXRETENTION OCCUR 71 CLAIMS MADE AGGREGATE $ A DEDUCTIBLE CUA03D0560-10 7/8/2009" 7/B/2010 S 10,000 S " 13 WORKERS COMPENSATION WC STATU- OTH-; AND EMPLOYERS'LUU31L1TY —_ TORKLIMITS 1 ER.: ANY PROPFj)E'TORIPARTNEPJEXECUTNE Y/N - E_�FACH ACCIDENT i S 50O OOO OFF CE ER EXCLUD ---- - (1da datoryJA"NH) NC0452609 10/1/2009 10/1/2010 E.L.- DISEASE-EA EMPLOYE$ __ 500,000 Wdescribe under. AL PPaOSIONS below E.L.DISEASE-POLICY LIMB $ 500,000 CPCR DESCRIPMNOFON TIONSIL064'116NSlVEHICLESIEXCLUSIONSADDEDBYENDORSEMENT1SPECIALPROVISIONS iI I6... U- , n e4 Co L'j CERTIFICATE HOLDER CANCELLATION SHOULD ANYOF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION - Town Of Hyannis DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN Hyannis, MA 02601 NOTICETO THE CERTIFICATE HOLDER NAMED7O THE LEFrBUT FAILURE TODOSOSHALL IMPOSE NO ODUGAT10N OR LLAEML17Y OF ANY KIND UPON.THE INSURER,ITS AGENTS OR REPRESENTATIVES. - - AUTHOR¢FDREPRESENTATNE Tim Gilmore/RTUCKE ACORD 25(20091011 (go1988-2009 ACORD CORPORATION. All rights reserved. INS026(2DDeot) The ACORD name and logo are registered marks of ACORD ' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map � � Parcel D�J pp A lication # ;26 ! o 6 D Health Division Date Issued ► d Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board o_ Historic - OKH Preservation/ Hyannis Project Street Address I ` 0 C p, t S Village _ �(A���t AAA--- Owner Address Telephone Permit Request (2- /v l/�-� V6 Ice--. 4UV14 A10o v..l V A./ Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation �b 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 � On Old King's Highway: ❑Yes ❑ No Basement Type: U ull ❑ 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 ® ®_ o Total Room Count (not including baths): existing new First Floor Rg;i i County►- o Heat Type and Fuel: ❑ Gas .®'Oil ❑ Electric ❑Other Central Air: Q-Y6s ❑ No Fireplaces: Existing New Existing wood/c Dal stove❑YL5 ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing WewW ize_ Attached garage: ❑existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: � M Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION _ (BUILDER OR HOMEOWNER) �^ S .()C eel �] Name ()k-�_� STAPL�—W_10 Telephone Number TT91—� '' nn 1 Address [��V�� (_ C l l� License# kf& �L 5 I11 q. f �= Home Improvement Contractor# ` Worker's Compensation # . 1 1 - ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE ATE G R ` FOR OFFICIAL USE ONLY i APPLICATION# DATE ISSUED MAP/PARCEL NO. I. • r k , ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME s r INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL ` PLUMBING: ROUGH FINAL GAS: ROUGH FINAL. L FINAL BUILDING DATE CLOSED OUT f" ASSOCIATION PLAN NO. i' The Corninonwealth ofAfassachusetts Departrrient of Industrial Accidents Office of Investigations' 600 Washington Street Boston, MA 02111 .:• www.rnass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information A, Please Print Le 'bl Name (Business/Organ ization/Individual): Address: 9 U G City/State/Zip.:. �iS14A / ne.#: ®�Are�yon employer? Check the appropriateo Type of project(required):employer with P 4. t e al contractor and I 6. Now construction employees (full:and/or part-tiin.e).* have hired the shb-contractors 2.r] I am a sole proprietor or'partner-' listed on the attached sheet 7.. .. Remodeling ship and have no employees These sub-contractors have 8. 'Fl Demolition working for me in any capacity. employees and have workers' 9 Building addition [No workers'-comp.-insurance comp. insurance.# required.] S. We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I L El Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required_] t c. 152, §1(4), and we have no employees. [No workers' 13. Other comp. insurance required..] *Any applicant.thatchccks box#1 must also fill out the section below showing their workers'compcnsation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whethcr or not those entities have employecs. If the sub-contractors have employces,they must provide their workers'comp.policy number. 1"am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. 11VSvqA&e-S Insurance Company Name: y �((���/f _� l Policy#or Self-iris. Lic.#: {,/fJ � � Expiration Date: 51+ Job Site Address: �` ©C`eo yf 4��W)s 6(l) City/StatdZip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of crimiii4l penalties of a fine tip to$1,500,00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the MA for insurance coverage verification. I do hereby certi nder tls ns a rr.altie of perjury that the information provided above is true and correct Si ature: �i Date: C �U Phone Official use.only. Do not write in this area, to be completed by city or town offtciat .City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.ElectricaI Inspector S.Plumbing Inspector 6. Other 0—farf Phone #: _ Information and In t�' efio ns Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as "...every person in.the service of another under any contract of hire, express or implied,oral or written." An employer is defined as "an individual, partnership,association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or tiustee 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 of on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." . 1 . MGL chapter 152, §25C(6) also states that"every stale or local licensing agency shall withhold the issuance or renewal of a license or permit.to operate,a�business or io onstruct buildings in the4commonwealth for any applicant who has not produced"acceptable.evidence T of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7) states"Neither the Commonwealth nor any of its political subdivisions shall . enter into any contract for,the performance of public work until acceptable evidence of compliance Frith the insurance requirements of this chapter have beeapresented to the contracting authority.' Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes.that apply to your situation and, if necessary, supply sub-contractor(s)name(s), address(es)and phone numbers) along with their certificate(s) of. insurance. Limited Liability Companies(LLC) or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers'compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete'and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permitflicense number which,�srill be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year,need only'submit one affidavit indicating current policy information(if necessary) and under"Job Site Address" (.he.applicant should write"all locations in (city or town).".A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is onifile fork pen-nits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related Eo any business or commercial venture (i.e. a dog license of permit to bum leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to.thank you in advance for your cooperation and should you have any questions, please do not hesitate to give as a call. The Department's address,telephone-and fax number: _The Commonwealth of Massachusetts Depaz went of Industrial Accidents Office of Investiga.0.0ns. 600 Washington Street Boston, MA 02111 Tct. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-?749 Revised 11-22-06 www,mass.gov/dia Town of Barnstable n . Regulatory Services . Ns-`An Haas. Thomas F. Geiler,Director y • g 65 Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis, MA 02601 Yn".town.b arnstab le.ma.us Office: SOS-862-4038 Fax: 509-790-62 Property ow.her M st Complete and Sign This Section If Using A wilder eng vim,el^ of the subject property v� hereby audiorize�yi/�GVt � �N to 1.act on my behalf, m all matters relative to work authorized by this building pernvt application for. M4lid (Address of fog) � Signature o Date Print Name If Property Owner is applying for permit please complete.the Homeowners License Exemption Form on the reverse side. Town of Barnstable ��op Yt�row o Regulatory Services Thomas F. Geiier,Director WW ib q, Building Division ��� �PrfD 'y Tom Perry, Building Commissioner 200 Main-Street, Hyannis, MA.02601 Rvww.town.barnstable.ma.us Office: S08-862-4038 Fax: 509-790-6230 ETOMEOWKER LICENSE EXEMTTTON Pleacc Print DATE: JOB LOCATION: number street village "HOMEOWNER!': name home phone# work phone# CURRENT MAILING ADDRESS: city/tovm state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. ' DEFINMON OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is, or is intended to' be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner, Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the Stater Building Code and other applicable codes, bylaws,rules and regulations, The undersigned"homeowner"certifies that.he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official t 1 Note: Three-family dwellings containing 35,000 cubic feet or larger will be regwred_to comply with the State Building Code Section 127.0 Construction Control. r - t HOMEO'WNER'S EXEn=ON The Code states that "Any homwer eon performing work for which a building pcmvt is required shall be exempt from the provisions of this section(Scotion 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner cngagcs a person(s)far hire to do such work,that such Homeowner shall act as supervisor." Many homcowncre who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appcndiz Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness bftcn results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it wDuld with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible, To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a.form currently used by several towns. You may care t amend and adopt such a forn/ecrtification for use in your community. Q:forms:homcnxrmpt - Mussachusetts-Dehartment_of Public Safety Board of Building Regulations,and Standard~ t Construction Supervisor License. «License: CS 59182 Ri:i ricted to OP LA.UREN F -STAPLETON 1,LAUREL CIR FCRESTDALE; MA 02644 Expiration: 6/3/2010 Conmissioner Tr#: 27639 / U d f\IVI l DATE ARM\DD\YY 10-23-09 D. CERTIFICATE 4F INSURANCE f i THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION PRODUCER ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND,EXTEND OR MURRAY&MACDONALD INS S 550 MACARTHUR BLVD ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE BOURNE,MA 02532 COMPANY 75NHN A TRAVELERS DIRECT ASSIGNMENT INSURED COMPANY B STAPLETON LAUREN COMPANY , 1 LAUREL CIRCLE C " FORESTDALE,MA 02644 COMPANY a .. - 4. j N COVERAGE ¢ w THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, �D NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUER MAY PERTAIN.THE INSURANCE AFFORDED_BY THE POLICIES DESCRIBED HEREINIS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF S66H POLICIES Z LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. - 1-0 CO, POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER' DATE(MM=O YY) DATE LIMITS -_ �- — GENERALLIABILITY GENERAL AGGREGATE B57 COMMERCIAL GENERAL PRODUCTS-COMP/OP AGG. $ CLAIMS MADE OCCUR. PERSONAL&&ADV.INJURY $ OWNER'S&&CONTRACTOR'S PROT. EACH OCCURRENCE $ FIRE DAMAGE(Any one fire) $ MED.EXPENSE(Any one person) $ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ ALL OWNED AUTOS BODILY INJURY(Per Person) $ SCHEDULE AUTOS -BODILY INJURY(Per Accident) $ HIRED AUTOS PROPERTY DAMAGE NON-OW NED AUTOS GARAGE LIABILITY 1 ANY AUTOS AUTO'ONLY-EA ACCIDENT $ OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGREGATE $ EXCESS LIABILITY UMBRELLA FORM EACH OCCURRENCE $ OTHER THAN UMBRELLA FORM AGGREGATE $ WORKER'S COMPENSATION AND A EMPOLYER'S LIABILITY UB-0475NO19-09 05-09-09 05-09-10 STATUTORY LIMITS X100,000 !. EACH ACCIDENT $ THE PROPRIETOR!. DISEASE PARTNERS/EXECUTIVE INCL. DISEASE-POLICY LIMIT $ 500,000 OFFICERS ARE: X EXCL DISEASE EACH EMPLOYEE $ 100,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS(SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. THE WORKERS'COMPENSATION POLICY DOES NOT PROVIDE COVERAGE FOR STAPLETON LAUREN. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE TOWN OF BARNSTABLE BUILDING DEPT. -EXPIRATION DATE THEREOF,-THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TOTHE CERTIFICATE HOLDER NAMED TOTHE-LEFT,BUT ZOO MAIN STREET FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF A14Y KIND UPON.THE COMPANY,ITS AGENTS OR REPRESENTATIVES. HYANNIS,MA 02601 AUTHORIZED REPRESENTATIVE AcoRo-zs s(s/ss) Charles J Clark - i i , ��.,, �rrf_ , �.�Illll�f(IIIIII=��I ? "'�Illllll��,,a � _ � ��. ���- r , 1 u�� � -� _ f�l��iat„� �� ill'�II IIIIIII !� �` = _ t „ e �� ,'aq.1.tiu�Y'_tit+:. � Y n A .r�y Y III all 07 ----------------------------- IIIfIIililUfl i xa f i A9P ie �''niJ�, "v- r 1tC