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0286 SOUTH STREET
2 S to �©u�� ��R a.r�i Sign -' TOWN OF BARNSTABLE Permit BARNSTABLE, • MASS. 9�Ar��N9. p Permit Number: Application Ref: 201502513 20071101 Issue Date: 05/04/15 Applicant: HILL, JOAN B &DAVID B TRS Proposed Use: GENERAL OFFICE BUILDING Permit Type: SIGN PERMIT Permit Fee $ 50.00 Location 286 SOUTH STREET 'Map Parcel 308087 Town HYANNIS Zoning District SF Contractor PROPERTY OWNER Remarks 1 TEMP FUNDRAISING GOAL SIGN RED CROSS INSTALL 5/15/15 REMOVAL 12/15/15 Owner: HILL, JOAN B 8t DAVID B TRS Address: 575 AMALFI,DRIVE PACIFIC PALISADES, CA 90272 Issued By: PC . DUST THIS CARD SO THAT IS VISIBLE FROM THE STREET PERMIT• PAYMENT RECEIPT TOWN OF B4NSTABLE BUILDING DEPARTMENT 200 MAIN STREET HYANNIS, MA 02601 DATE; 05/04/15 TIME: , 15:49 --_ -,-----------TOTALS-- --- -- - ----- PERMIT $PAID 50.00 , MT TENDERED: �50%00 AMT ;APPLIED: 50.00 '00 APPL.�ICATION NUMBER: PAYMENT METH: CHECK AYMENT REF:�� 3460 t;;^�' f - -------- IL Town of Barnstable 2-6 Regulatory Services * '"�'„.` � ., Richard V. Scali,Director (/4M(�0 a__ 059. � Building Division Tom Perry, Building CommissionerQlLk 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us b b\�7 Office: 508-862-4038 Fax: 508-790-6230 Permit# Building Official approving Application for Sign Permit ..APP._licant. �Mm'l La A- CSC y�31 Assessors No.3L�_. �U Doing Business As: (OA Telephone No., 509 "7 C-1 S Llo Sign Location Street/Road: O �(��J�. l w.d oil 6i'm dl Zoning District: Old Kings`Highway? YesA�o Hyannis Historic District? Yes/(S Property Owner Q y Name: bGl'V tA_.A �O a.r' I/I Telephone:__ Address rD bA S r g oil z Sign Contractor p i[ g Name:_ J Gt.( l VW Telephone:_5� ,` 7�� 0 Mailing Address: 4 S ,C Q 1�Q , QY)�ls _�z�0' 1 Description Please follow the cover,directions.You must have an accurate rendition of sign with dimensions and location. . a . Is the sign to be electrified? Ye /No (Note:Ifyes, a wiring permit is required) Width of building face fL x 10 Q x.10 Check one Reface existing sign or New Total Sq. Ft. of proposed sign(s) Ifyou 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 that I have the authority of the owner to make this application, that the information is correct and that the use and construction shall conform to the provisions of §240-59 through§240-89 of the Town of B stable Zoning Ordinance. Signature of Owner/Authorized Agent: VKiOL—e- Date . 1 SIGNS/SIGNREQU revised 110413 oFTHE rqy, Town of Barnstable } Regulatory Services * anxxszesr.E. MASS Richard V. Scali,Director E16,19. � 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 SIGN PERMIT REQUIREMENTS 1. A photograph showing the existing facade, on which has been indicated the proposed sign location. The photograph is to include a portion of adjoining stores or building. For a proposed building or new facade, an architect's elevation may be submitted in lieu of a photograph. 2. A scale drawing of the proposed sign. A scale drawing indicating: 1) The type of proposed sign(wall, hanging, free standing) 2) Dimensions of the proposed sign and any designs, logos, or lettering 3) A cross-section with dimensions showing edge detail. Minimum scale 1"= 1'. Minimum sheet size, 8.5 x 11". 3. A scale drawing of the bracket. A colored scale graphic indicating dimensions, showing colors, materials and method of affixing it to the sign and to the building. Minimum scale 1 '= 1'. Minimum sheet size, 8.5 x 11". 4. A completed Town of Barnstable Sign Application, including scaled diagram showing location of sign on building or location of free-standing sign. Show dimensions. 5. The width of the building face or the leased area. sj NOTE: the map/parcel number is required on the application. SIGNS/SIGNREQU revised110413 1 I�jAmerican A Century ofd Red Cross Serving Cape Cod �. � ,. .. aiummiirtiiy H k H Sim�r.1843� t l 4 $1001000 5 : . C $901000 ' $80,000 70 0 , 00` - $60,QOO $50,000 $40,000 � , $30,000 . - 01000 . A s� R $10,000 g�. ' Products - Specific sign or banner with custom options for size, material, wording or grap... Page 1 of 2 • - � ------------------------ Same Day Sign search Shopping Cart reachus@samedaysign.it Qry 0 888-322.7448 ` "Advanced Search ^�� Tota1 _$0_00 —� e a/J - ---------' - - --- � - left)Ode_. ------------- - -- ------------------------------- Home•.Contact Us �' Affiliate+Account+Cart w Checkout Navig — ----._--. atio___n _..� V �� �, • ' About Products/Production Outdoor/Indo r oal Thermometer Banners(00002 08 .. ` Ready To Order? Easy Proof/Quote Forms Product Order Form Upload Files - Custom Info/Wording Categories —`— Outdoor � W Goal Thermometer Banner(Required) equired) Acrylic-Laser Cut I Goal Banner, 0GT Banner 2'x 8'($128.50) Arrow Signs Auto Dealer Signs �GT Banner 2.5'xBuilding Numbers/Letters CharitiesGT Banner 3'x 12'($177.00) Checks(Big)For Awards With hems and grommets • Q GT Banner 3'x 6'($129.50) Church Signs&Banners _ 0 GT Banner 4'x 16' 2 Closing and Liquidations pe/� + ` a p�{ I p ,..,_,f ($ 99.00 Contractor Signs Great Outside.and Inside ��� t C, GT Banner 4'x 8'($168.00)) Dry Erase Products -` Event Signs „rk Favorites V Your. Usl01n tlr0id111��080;^ S - m: _^Your _ Optional Extra Fill Vinyl For Sale By Owner <2�rrf(t!Ill Your Benchmarks Or,We Fd(tl"t-' �. •,.r„d; i ,p,oy, I CUstoln l7 N/A For Sale,For Lease ( . Goal Thermometers3 ,CgmeS with Red Yiny4To h�l In-..h.*��,` 4YOrding Extra Set of Red Vinyl Fill($11.00) 1 Grand Opening Coming Soon Hiring Banners&Signs T * etRleter. a y . i ' &Logo, Percentage Mark Choice(Required) Hotels&Motels i Metal Signs j 0 Include Percentage Marks($0.00) No SmokingDecals ""' ""'' �` i we 1 ( 0 NO Percentage Marks($0.00) Race Signs,Even[Signs Renting,Leasing&Building Safety Signs Sale Banners&Signs 1 7 Schools,Daycare a.C.A 3 Oar.* I 1 Custom -----.--_I } Sign Frames toaK saw Ii t i s•a Benchmarks ! Tournament Brackets-Pools Wedding-Reception Signs i j —.--_.._..t +ow •p9i i(*)Mandatory Option i aCr�S •ou 5a. I 'C es - Related Products: love i With � ( �� � tow � I � � RedVinyl� � • Ell>Goal Thermometers To Fill In • BU>Charities I ! TflefmOtrleler •• AU>Church Signs&Banners j -'• All>Outdoor Fundraising ® L.. . ......... - Thermometers • Search Related Product< 2.5'x 51,Xx 'and 4'x 8' 2'x 8',Xx 12'and 41x 16' A gr t ind r or outdoor fundraising thermometer banner that you can roll! They are made on a durable 13 ounce banner material with hems lJ� and grommets. It comes with red vinyl to fill in the thermometer as you work towards your goal.The special"red fill"is in handy widths to apply as you go toward your goal.You can buy additional sets of the fill. For the gradations along the side of the thermometer, simply fill in your custom,information with a permanent marker or we can print them permanently. We can also change the heading and add logos for you at no additional charge. If your goal thermometer is custom you will get a proof to approve prior to production.. Production usually takes 1-2 working days for the thermometer.As a note,your"fill"and goal thermometer typically come in separate packages. �. We can customize it for you!Contact us if you have special needs: � .era'-", � Qrder onitne'or�� rR` �SEOV., FAX, �ORdER��FORM _ tglcli"Product Order form"UndarTfia, tiavlgatlonBarTo- Left ` Miscellaneous: t I I http:/Lwww.sam6daysignstore:net/store/scripts/prodView.asp?idproduct--1029 4/22/2015 .,..«. "�".t'', Y,°-,TS.y,-_ ice..,a ae:++rya ""F". Tyr.`"-', t F w°a,;i.: •. -' -•v:- .; =a �'"'+rR�,J�*'.,:t 'is"''yak ".`.:'�"-?fi` .` o-. ".4•"`x, "S r:. .Gr �r v - {X °t"y,*;""'^y i 4'!c•' • --,.. 4} R C .2 1"'kd%'_'r 'i?ir.��St , i" ... :us.. k .;.st: 44 ` .: +as ,3..'_. `' f r 7'°a A.iA.O'k��-a�`^i€✓ S i 1 a?t`+,.: t 1 -hY r t :=Wtii'^ t "f `.�':_� �>a YV;s•. •;R r� ;_. � v .�: s`� d- 'S _ r -}�.s,r• ^ � !< - a '� A �•:,.I ..:.�,.1w°'�..,....n�.,w'$us�^. IA\Jh �O � -D FKNTS American Red Cross 16, Alyw Cape,Islands and Southeast Massachusetts SPONSORSHIP AGREEMENT ❑ Yes, I would like to join the American.Red Cross in honoring local heroes at the.13th Annual Heroes Breakfast event on Friday, April 10, 2015. Please accept my gift of: 0 Sustaining Sponsor-$7,500 0 Supporting Sponsor-$5,000 0 Community Sponsor-$2,500 0 Hero Sponsor-$1,000 0 Table Sponsor-$500 0 Full-page Program Book Ad -$400 0 Half-page Program Book Ad -$300 0 Quarter-page Program Book Ad -$200 0 Congratulate a Hero-$100 All print amenities are subject to print deadlines. 0 Individual Breakfast Tickets-$50 (Please indicate number of tickets) 0 Ticket to VIP Reception on April 9 -$50 (Please indicate number of tickets) 0 1 would like to make a general donation of$ Contact Information Organization Contact Address City State Zip Phone Alt Phone Fax Email Payment Information 0 Credit Card 0 Check(payable to the American Red Cross) 0 Send Invoice Card Type(Circle One) Visa MasterCard American Express Discover Card Number Expiration / / CSV/CID/CVV Name Signature Date Please send completed Sponsorship Agreements and Payment to: American Red Cross of the Cape, Islands and Southeast Massachusetts Attn: Hi;ary Greene 286 South Street HyanGis, MA 02601 t i t Y , s y � r u �r ' r a , v � , • yL o. � rn7A'«4 w. }" " Uh wx oil 14 -r! m x xrevA _ � a 1p - a _,so q, i a..a.@^„ .�• �era .•�„ � � •w^- �w, .*,,,, :,.:.,,„� - �. y ' �. .�'�.. e„a +.,a m«�_ � "� �.:a - � ,""�Ra",w:�.- "'° ,� ,wre,^"^gg?-a°aa°P,ate'r ±«.a -�'^1w. y r ,:'�� w�:« « n s ,. - •7t: ,�`,. - s acgpk. +am*... 4 r«r w"- ayz'y,y�, «a w5.y°x' � '�. .. w V�y_ a ,.a^ _ .a,�.. . � m .Baw�.. � , ..•„ .w��- " �� � .�{c'.aver+- P* " '""' . 4 v " n a e .+r 'k.. 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Ni•!h ..c�,...r�-�^°d","�'"` 'w�,,;,„��;., � �� ,M ,�,,,�v, �i ka2 �� .'�w"gr� ="�� a^�y cy'',`:'> .W e *'� �� •e�� ` aYr"*^-*� � ,^ "�' _ r� r ^�•u ,r e.ws •..,ram" �� �� '� ,�" 4 �` - r` " -� ,., » -`� "' �'✓t °5. 3,��aa ,r.X �.' `s���r;�� ,� 1. . v� r L, � . artr •• n5�y,.aWIN Al #I- !�w•"_'*�d�fi��� �`f "y o'er� �k+�� ��r Ir .:'�+ci; h`.. Y TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION DO501 Map. Q)' 05]LRParcel � � Application 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 syv Village `` n Owner�J a Address -'S t - Z Telephone qOZiI Permit Request `1 i s d t AAh �(�f V 2-D ,'A 61.e srn�P12M h Square feet: 1 st floor: existing proposed 2nd floor: e isting proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation , Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/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 I (BUILDER OR HOMEOWNER)Name l � Telephone Number 4— -] so o e Nu be 3 p Address JDv License # AM 01601 Home Improvement Contractor# Email a !�6"A.(ILO GIPP9. 61R Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE V DATE ?a S I FOR OFFICIAL U$E ONLY -APPLICATION# DATEISSUED MAP/PARCEL NO. ;F ADDRESS VILLAGE ` OWNER 3 F DATE OF INSPECTION: r k FOUNDATION g� FRAME ' INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DAcTECLOSED OUT AS;5nWATION PLAN NO. t TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION r Map Parcel ,�Obo aJp� Application #�6 z 0 ?R! OF B RNSTABLE Health Division '' Date Issued mj 1 PI{j. 2: 5 r Application Conservation Division Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board b ia, Historic - OKH _ Preservation/Hyannis Project Street Address Mn Om2C:�- Village Na n` b Owner -AOCM 2)A- �)aQld �p %N\ � Address � �NC�o wee\ C�(11r115 cr c , Telephone noY)- D] Permit Request2R new Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay .Project Valuation Construction Type. 110W. 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 C a new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor om Cour 173 Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other ' Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing woo coal st6Ye: des ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing `-0 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 ��Q �0 &NSIUL/6110 (Q Telephone Number "�_o Address �7�P d`'�a�►N S-� License #SG,f, C/0 e `0V_S�? I �f� '�`�' Home Improvement Contractor# A0,9 Worker's Compensation # � Z9fZS �' ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 1 S SIGNATURE / DATE FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: ,t (-FOUNDATION. FRAME r INSULATION C FIREPLACE_. ELECTRICAL: ROUGH t FINAL fy i y ` PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING - -- -- DATE CLOSED OUT ASSOCIATION PLAN NO. I ' commonwealth of ealth Massachusetts i The Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 �;91 www,mass.gov/dia Affidavit:Builders/Cont ractors/Electricians/P1uLe bl bers Workers' Compensation InsurancePlease Print A licant Information Name(Business/organization/Individual): Address: ,t �� Phone#: City/StatelZip: �-�- Type of project(required): Are you an employer?Check the appropriate box: yp 4. [] I am a general contractor and 1. 6 []New: construction. 1.M I am a employer with _ have hired the sub-contractors �: Remodeling employees(full and/or part-tune).* listed on the attached sheet. 2,❑ I am a sole proprietor or partner- These Sub-contractors have 8. ![]Demolition ship and have no employees employees and have workers' 9 , Building addition " working for me in any capacity. comp.insuraneeJ Electrical repairs or additions [No workers' comp.insurance l0.❑ 5. �] We are a corporation and its � airs or additions required.] officers have exercised their t 1 I.❑Plumbing rep 3.❑ I am a homeowner doing all work right of exemption per MGL 12,E Roof repairs I 0 • myself.[No workers'comp. c. 152,§1(4),and we have no , 13.0 Other - insurance required]t employees.[No workers' comp.insurance required.] ion Policy n. T Ho applicant that checks box#1 must also fi trot the sect doingon low showing their workers,all work and then hire outside contractors must submit new affidavit indicating such. l Homeowners who submit this affidavit indicating Y xContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. + I am an employer that is providing workers'compensation insurance for my employees- Below is the policy and job site information. Insurance Company Name: �FtPolicy#or Self-ins.Lic.#: Expiration Date: Job Site Address: - ��\ �� city/State/Zip: V /l( I\ Attach a copy of the workers'compensation policyeclaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to S1,500.00 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 of1he DIA for insurance coverage verification. I do herebyIfyUrer a pains and penalties of perjury that the information provided a ve • true and correct Si afore. Date: - Phone#: d ca"L�21Sb Official use only. Do not.write in this area,to be completed by city or town official t City or Town: PermittLicense# Issuing Authority(circle one): L Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector. 5.Plumbing Inspector 6.Other Contact Person: Phone#: Assessor's office(1 st Floor): Q 7 ,(Y7 �� . / p r 0 V•E D Assessor's map and lot number U Barnsi. o�` " �> ♦:^ission Board of Health(3rd floor): ! d ` Sewage Permit number �. �" <� '. i • . . Engineering Department(3rd floor): INSTALL19" iN9 to House number C E Definitive Plan Approved by,Planning Board 19 WITN TIT ILY APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only ENVIRONMENTAL CODE AND ° '" ���"LAT'®�s TOWN OF . BARNSTAB BUILDING INSPECTOR APPLICATION FOR PERMIT TO ' W &4kda TYPE OF CONSTRUCTION 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to t e following information: Location 1 Proposed Use S Zoning District A6 I Fire District Name of Owne AIJ � � �- � Address C? Name of Builder c� Address ® y Name of Architect J,�14 �/�77if�A ' Address/ /A"alow / S Number of Rooms Foundation s ,! s Exterior le,3 Roofing Ag Floors e- Interior Heating Plumbing dew en Fireplace Approximate Cost .1<1.-. A Area Diagram of Lot nd Building with Dimensions Fee • 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 zmlaye -AN RED CROSS. P,NiERI i ADD TO CHAPTER No 34538 Permit For HOUSE Chapter House Location Ff'86 South Street Hyannis ! _ Owner�American :Red Cross - ~ Type of Construction Wood f rame f ` r"" Plot Lot { Permit Granted August 30 -19 9�1 Date of Inspection s r Date Completed 19 , ;.�'}�"s� ems.-' �g :+' � , 1' � , ` •� � .' '••-••""� ••••„"''•-'�`• •+ "�++�+�...++..�-..- . . .''yr.n.rv,lV.•V.•�a'/1nu'VV.•.'GnJ nV nlvl"r1�TVt•Vl• l'17CVCn'.rfl4N7CfiVL'OCn.'1'(11'J- CERTIFlCATE 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 Dowling&O'Neil AHCONN A/C Ext:508 775-1620 IC,No 5087781218 Insurance Agency E-MAIL 973 lyannough Rd., PO BOX 1990 ADDRESS: Hyannis,MA 02601 INSURER(S)AFFORDING COVERAGE NAIC& INSURER`A-.National-Grange Mutual-Insuranc INSURED INSURER B:Associated Employers Insurance Meagher Construction Inc. Timothy Meagher ' INSURER C: 772 Main Street INSURER D: INSURER E: Osterville,MA 02655 INSURERF: 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. INSTpR TYPE OF INSURANCE ADDL UBR POLICY EFF POLICY EXP INS WVD POLICY NUMBER MM/D MM/D LIMITS A GENERAL LIABILITY MPT125OG 0/16/2014 10/16/2015 EACH OCCURRENCE $1 000 000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Eao«x,rrence $500,000 CLAIMS MADE I Al OCCUR MED EXP(Any one person) .. $1 O 000 PERSONAL BADVINJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY[71 JECOT- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident AUTOS AUTOS ( ) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED I I RETENTIONS ' $ B WORKERS COMPENSATION WCC50050054422014A 6/23/2014 06/23/201 X WC STATU- OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNERIEXECUTIVE Y/N OFFICER/MEMBER EXCLUDED? N NIA E.L.EACH ACCIDENT - $100 000 Mandatory in NH) (f yes,describe under E.L DISEASE-EA EMPLOYEE $100,000 I ° DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived,or extended the coverage provided by the policy provisions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE.DELIVERED IN ACCORDANCE WITH THE _POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 01988-2010 ACORD CORPO RATION. I N.All rights reserved. ACORD 25 2010/05 Th e ACORD name ( ) 1 Of 1 a e and logo are registered marks of ACORD #S140580/M140561 CBD , 79 Massachusetts -`Department of Public Safiet , i y . ' Board of Building g Regulations and Standards Construction Supervisor , .License: CS-102260 ,r•.T,r.v NIICHAEL S NIEA�6HERJR 9 EMERALD LAVE 0248 . Expiration . Commisssio'nne'r`, - 11/05/2016 .y - Office of UJae 1pam��za�rraP.rc�a�UUGaQAaClat6e�� � � . Consumer Affairs&Business Regulation = ME IMPROVEMENT CONTRACTOR' egistration 1t2938 Type; Expiration. 4PLZ12015 DBA a MEAGHER BROTHERS CONSTRUCTION f � a MICHAEL MEAGHER JR i 97 EMERALD LN - MARSTONSMILL,MA 02648 ;Undersecretary c . , y. I _ , Unrestricted-Buildings of any use group which contain less than 35,000 cubic feet(9911n3)of enclosed space. , �1 Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license: For DPS Licensing information visit: www.Mass.Gov/DPS License or registration valid for individul use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Su i!Y5170 Boston,MA 021l No alid ithout signature I t . . T own of Barnstable ', s, •`� Regulatory Seances Richard V.Scab,Interim Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Sitreet, Hyannis;MA 02601 www.town.barnstable,ma.us Fax: 508-790-6230 Office: 508-862-4038 Properiy Owner Must Complete and Sign This.Section If Using A Builder as Owner of the subject property to act on my behalf, hereby authorize in all matters relative to work authorized by this building permit application for: DRU (Address of Job) c e of Owner D to �c �� \� Print Name If Property Owner is applying'for permit,please complete the Homeowners License Exemption Form on the R reverse side. T:\KEVIN_MRuilding Changes\EXPRESS PERNGIMXPRESSAOC Revised 061313 . .. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION y Map � Permit# " � Parcel � � 7 Health Division S E F 7 2001 Date Issued a C Conservation Division f b ' Fee _�91 �D Tax Collector ] Treasurer Z� )0 Pei< Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH I Preservation/Hyannis Project Street Address 12TC® 1 S () • si__. Village 14 M AY M I S Owner CO • C� O A&4"w'" Address S 0. 57 • y�� I Telephone 6"55 Permit RequestkanC5 Xopf 0 Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Valuation )/ Zoning District Flood Plain Groundwater Overlay Construction Type , f reume Lot Size Grandfathered: ❑Yes ❑No If es attach y supporting documentation. r 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: 0 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 dYes ❑ No If yes, site plan review# Current-Use—- - - - Proposed Use - - — -- - BUILDER INFORMATION Name rd 5S A4 J? E7 Telephone Number 5V7-X96 W3d-2% Address E& License# ®®U f�7 V r�' ,s t -� ( Home Improvement Contractor# Worker's Compensation# Gf1 $� - ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO Y&A4 6117-/�% SIGNATUI���� � C � � DATE p P' _ FOR OFFICIAL USE ONLY r �► Cr PERMIT NO. DATE ISSUED jy MAP/PARCEL NO. ` ,T ADDRESS - VILLAGE r OWNER r _ DATE OF INSPECTION: } R. FOUNDATION FRAME INSULATION t FIREPLACE 'ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING • t DATE-CLOSED OUT ASSOCIATION PLAN NO. . ' 1 ' Y 1 1 The Commonweaun o =�•z Department of Industrial Accidents R ,� °=�'� . 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As quoted from the"law", an employee is defined as every person in the service of another under any come p lied, oral or written. of hire, express or imp association, corporation or other legal entity, or any two or more c An employer is defined as an individual, partnership, nP deceased the foregoing engaged in a joint enterprise. and including the legal representatives of However the or Cher receive i e trustee of an individual,partnership, association or other legal entity,employing employees. dwelling house "' not more than three aparunerrts and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance, ca asttuctiau or repair work on,such dwelling house or on the grounds 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 ren( of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who o the not produced acceptable evidence of compliance with the insurance coverage r the performance eer foAdditionally,cbliic work u= P of ill political subdivisions shall enter into any contract for the p commonwealth nor any P of this.chapter have been presented to the contras in ' acceptable evidence of compliance with the insurance requirements authority. / / Applicants ' compensation affidav�t completely,by checking the box that applies to your siuratzoa�d Please fill in the workers p with a certificate of insurance as all affidavits may be supplying company names,address and phone m=bids=for aiaag Also be sure to sign an. submitted to the Department of Indusaial�ccidents�c of insurance coverage• or town that the application for the permit or license is date the affidavit. The affidavit should be rettuned to the nould y ou have�Y regards the��w„or if. being requested,not the Departatent of Industrial Acid�e�the Department at the number listed below. are required to obtain a workers'compensatioa policy,p City or Towns legibly. The Department has provided a space at the bottom of Please be sure that the affidavit is complete and printed egi y. the apph�• please affidavit for you to fill out in the event the Office of hvesdgations has to contact you regardinga zetume a tc emus in e e e member which will be used as a reference number. The affidavits may be sure to fill in the p have been made. the Department by mail or FAX unless other arm gations would like to thank you in advance for you cooperation and should you have any question The Office of Investi ' please do not hesitate to give us a ca. The Department's address.telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents olflce of invesduadons 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 eat. 406, 409 or 375 • it ,( �12C �VNI97//77.O��LCl/BCLGLI2yOl l//�(p4i3�CiLI/aGGl4 - t BOARD OF BUiLDi G REGULATIONS License: CONSTRUCTION SUPERVISOR , Number. CS 000674 " f 04/09/2002 Tr.no: 21378 Restricted To RUSSELLM BASSETT 2351 MAIN ST/PO BOX396 BREWSTER, MA 02631 Administrator f-r 'it;Z °tr+;r �° .4°°ys�y��,eyx " � 4<a y �4��r-y b'�n��,��# > d���y*��'i 3"•f `-t�'itwY�. . �,r7 � '� �, ✓,+�by��nano�ugeall�� � +OMEI p OVEMENCOHTtAC# x Regis ra � tio A41 i15j5 tl� au UBt'' in rah i s� z,t,Ezpxra'ti � ��M = ems• Y�r}li yF �: 0.c'kr � t1§'! .•,, t'� + i ff - ptIIJSSELV#.,$R9��ET��,�`���� `` pX 396/33i51��1AINST� WSTERl1A' 02631 A '�; DM AllSj `` � �TlO"R ,.^'=•+a n0. . (,�C .°a oS�S3� 8d 7/3/vo 7 7t -i��0 special permit uses Permit is first obta A) Open Spdce Resid provisions of Se ' 5) Bulk Regulations:_ ZONING MIN.LOT MIN.LOT DISTS . AREA FRONTAGE SQ. FT. IN FT: RC-2 43560 20 * * Or two and one-half # L00 Ft. along Route; Department ofHealth, SRfdy a' • Building Division 367 Main Street,HYannis MA 02601 Ralph Crossen Office: 508-862-4038 ��"'!' 6�4� Building Commissioner Fax: 508-790-6230 44 Tax Collector Treasurer application for Saga Permit rZ Assessors No. Applicant: Doing Business As: ,� �2� Telephone No. Sign Location - Street/Road. Zoning District:_— Old Highw � ��NogY�sboric District? �� a9 Yes/No property owner Telephone: Name: - Address: Sign Contractor Telephone: Name: e ze g,I L4 V Address: Descripth= signs with and e�sting of lot showing location of building Please draw a diagram This should be drawn on the reverse side of dimensions,location and size of the new sign this application. ed? . Ye (Note:If yes, a wiring Permit is required) Is the sign to be electrifi of the owner to make this I hereby certify that I am the owner or that I havea��0�construction shall conform application, that the information is correct and Zoning Ordinance to the provisions of Section 4-3 of the Town of Barnstable Signature of Owner/Authorized Agent: ate: permit Fee: Size: Disapproved: — Sign Permit was approved: Date:---------- Signature of Building Official: Sign i.doc c-4. ngineen o Map 30 Parcel OF Permit# �_ House#. lao l0 S��w !e,P� Date Issued �- - aFrn Board of Health(3rd floor)(8:15 -9:30/1:00-4434) Fee. Conservation Office(4th floor)(8:30- 9:30/1:00-•2:00) Planning Dept.(1st floor/School Admin. Bldg.) �tNE APPLICANT Definitive Plan Approved by Planning Board 19 CONNECTIO c e WER FiNGINEERITHE l�00�15TRUCTI0 +bsa R TO TOWN OF BARNSTABLE Building Permit Application ' Project Street Address Gj Spy a Village 4,tom yt t' Owner 661 1 eft 11.C MLeaAddress :.Telephone 'Perre- it Request r \ ®. X -PTo , ' L, .er Lx a TOAr CL First Floor square feet Second Floor square feet •.Construction Type Estimated Project Cost $ Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No 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 No. 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 Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use Builder Information Name Telephone Number Address License# Home Improvement Contractor# 6�5�3 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 �V BUILDING PERMIT DEN4D FOR HE OLLOWING REASON(S) i FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE' OWNER DATE OF INSPECTION: FOUNDATION { FRAME f +INSULATION FIREPLACE ELECTRICAL- ROUGH FINAL PLUMBING:• ROUGH - FINAL - GAS: f ROUGH' FINAL r - FINAL BUILDING s - F DATE CLOSED OUT x ` ASSOCIATION PLAN sN0 t r r �r�tft<r of U5 a e Mal Wtance ts r REGISTERED ISSUED BY �;- �er6'"'�i�p FABRIC Dote NUMBER TOPTEC, INC. manufactured 4. . ~ 1905 N.E. MAIN ST. �i.� M��s•` SIMPSONVILLE, SX 29661 31 . 02 6J3/96 This is to certify that the materials described on the obverse side hereof have been Q ir.. flame-retardant treated (or are inherently nonflammable). FCttt TAYLOR RENTAL CENTER ADORESS__ 681 TEATIGKET HWY _ CITY E FALMOUTH STATE 02536 i Certification is hereby made that: (Check "a" or "b") ` El (a) The articles described on the obverse side of this Certificate hove been treated with:Q floe e-retardant -- chemical approved and registered by the Stale Fire Marshal and that the application of $aid chemical was done in conformance with the laws of the State of California and the Rules and Regulations of the Slate Fire Marshal. Name of chemical used-----------------------.._..._.---------..........................Chem. Reg. No........___......... _. e Method of application................................................................................................................... .._.... CD from o flame-resistont fabric or moteriat -�•• (ba The articles described on the obverse side hereof ore mode o registered and approved by the State Fire Marshal for such use. the flame Retardant Process Used WILL NOT Be Removed By Washin4 CD TOPTEC, INC. MODEL 30 X 30 EXF FRAME WRITE l SERIAL# 96I594FD- . 13 P Name of Predudron Superintendent 06/12/1998 11:43 5085632074 TAYLOR RENTAL,N.7AL. PAGE 02 JUX. -08' 98(W,A) 10:5 FiRST r,ARDIN•AL TEL:518 464 c1510 P. 002 Massachusetts Retail Merchants Workers' Compensation Group, Inc. 190 Forbes Road, Suite 237 Braintree, MA 02184-2613 Certificate Holder: _ Date: _ Town of Falmouth WSW Attention: Jean -Policy'Number: 59 Town Hall Square 161502 Falmouth MA 02540 Effective Date: 111/98 Expiration Date; Plan Participanl:,�-��----- 111/99 Capewide Rental, Inc. 5tatuto Limits: Taylor Rental Center - -rX--- - 432 N. Falmouth Highway Each Accidsnl: $100,000 i North Falmouth, MA 02556 Disease-Policy Limit $500,000 i Disease-Each Emplayea E140,400 This is to certify that the Plan participant named above Is insured with the Massachusetts Retail Merchants Workers' Compensation Croup, Inc, udder the policy number and for the period indicated above, This policy covers the entire obligation of this policyholder for Workers' Compensation under the Commonwealth of Massachusetts Workers' Compensation Act with respect to all operations in the Commonwealth of Massachusetts, and with respect to operations outside Massachusetts, to the policyholder's regular Massachusetts employees only. If said policy is cancelled, or changed prior to the expiration date indicated above, in such a manner as to affect this certificate, thirty days written notice of such cancellation will be given to the certificate holder above. Notice by regular mail so addressed shall be sufflciant compliance with this provision. No liability is assumed in the event of failure to give such notice. MassachusQttt$Retail Merchants Workers'Compensation Group, Inc. g Administrator, First Cardinal Corporation 1 A Pine West Plaza Albany NY 12205 06/12/1998 11:43 5085632074 TA'YLOR RENTAL,N.FAL. PAGE 01 0 CIA . ary .. .. ..tin l c v Assess cw•1 / Parcel eimit# 0 t.. Conservation Office(4th floor)(8:30-9:30/1:00- 2:040) �� t�b (�c,J� Date Issued X,4 Board of Healtli(3rd floor)(8:15 -9:30/1:00-4:45) (- Fee Engineering Dept.(3rd floor) House# 14 7�r6z5w �� FA . . dg. � SA�� �'"� n LE oar 19 T- f E TOWN OF BARNSTABLE Building P rmit Application , L'� CO 7ctStr ddress Village -.-Owner C.,«� Address .-Telephone 2 2S_— /,S—`7` d Permit Request e A•-) t 60 x7 First Floor ZA 660 Si/. �.4j-L4 square feet f Second Floor , 'GGG 1.51,12®p cz o 47 square feet Estimated Project Cost $ ����f 0'2 ?_, Zoning District a 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 Telephone Number61� Address C !� License# ^` • 3 3 Home Improvement Contractor# Worker's Compensation# o< tiOR 52 66,Y tcSfi�G NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. a ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ,5-4 -4r 116 7 121f-c;� SIGNATURE . D j� BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) T- • ' FOR OFFICIAL USE ONLY PERMIT NO: ' DA`I`E ISSUED MT/:PARCEL NO. t �RESS VILLAGE I } � _ �• . � � ' ADD OWNER r DATE OF INSPECTION: ` FOUNDATION - t FRAME'. • _ INSULATION f FIREPLACE ' y ELECTRICAL: s ROUGH FINAL tIz PLUMBING: #OUGH i FINAL - • a GAS: FINAL _ FINAL BUILDIR � A , DATE CLOSED OUT ASSOCIATION PLAN NO. r - The Commonwealth of 4fassacbusctt ;I ._ _ ...�y Department ojludustriafAccidents 600 11•asbinl ton Street Boston,111ass 02 11 `- Workers' Compensation Insurance Affidavit nnlica—n nformation - Please PRINT le�tbl�s, � , Sit) tihone# I am a homeowner performing all work myself.. 0 1 am a sole proprietor and have no one working in any capacity -..,tt�•n••^•rr'�^,"'P.!t!�'.lTd"tt..:.. ._ ,. ..:! .:.-.__ �..... _ ., !..s�..Ar. I am an employer providing workers compensation for my employees working on this job p name- address: Sit) r phone#: insurance co policy# I am a sole proprieto era ontractor, r homeowner(circle one)and have hired the contractors listed below who have the following workers compensa ion po icee�s: comijan •name: � m�vG/77 m ��� rnnce co �/ A -� . -- wen.a-. .nere•rr�•s'_-,.�Mcers�.--�F'--+na ?�tr�rel�4•' '' '7'+r: =^-'�sr,.� 'sv"`?"''?�r lien am•na c• , address: phone#• s r•tnce co policy# s .Attach additioiial'sheet if aecessa Failure to secure coverage as required under Section 25A of 111CL 152 can lead to the imposition of criminal penalties of a fine up to S1.500.00 and/or one years'imprisonment as well as civil penalties in the form of s STOP WORK ORDER and a fine of S100.00 a day against mto I understand that a copy of this statement may be forwarded to the Office of lnvestigntions of the DIA for coverage vMfieation. !do hereby ceruff}•u cr the p ins and petit• -or ` uy that the information prodded above is true and come � u t/Signature .Print Warne S Pl� `7(U �Phone } 4 official-use only do not write in this area to be completed by city or town official city of town: permit/license 0 rlBuilding Department oLicensing Board C3 check if immediate response is required (]Selectmen's,Offic ;P F 5 �Heallb Department contact person: phone N: pother Imased 3:75 P1A1 Sod • . 39 40 PAffrmw,.OF(PUBIJC:S 0 COWAWW TH A phi,MI1SS�.•02210t r tirt"t��*� irT �' PERVESA s Y �rX Al, STERF EVI 74 ;:Od YARM9UTK R,QiW N 94 Y-ARMGU MR 026l-' 1� N OVA IJNR'L°'BRiNEW, kF,LICENSEE ANO OFFIMLL-, , Y r4TAMVE0'.01b SIGNATURE OF4TNE COMMISSIONER : E r�x � . SIGNATU ` NSEE S: r C NIISSIONER I 1 % 1 xk-- , Parcel tr ` Permit# 5-1(�S Date Issued t Fee' /Engineering Dept.'(3rd floor) House# ' BARNSTABLE. 19 MASB. `J 16,39 rE0 MP'�A TOWN OF BARNSTABLE Building Permit Application Projiec Address Village Owner ,z�zaq.C,�./ �� Address Telephone j a Permit Request 4 First Floor square feet � -0 U Second Floor square feet Estimated Project Cost $ 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 /J/,/> Telephone Number 77 elz,9 Address !/2�� s ,� �j / �,/�,�icense# Home Improvement Contractor# %a�Z9--Z Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRErASITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. 1 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE /!) 9 BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY PItMI NO. - �i D�TEISS D M P/ AR EL NO. ADDRSS f VILLAGE OWNBR DATE F I PECTION: FOUN ATION FRAME' u INSULATION z FIREPLACE } ` r ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ! ROUGH FINAL FINAL BUILDING DATE CLOSED OUT , t ASSOCIATION PLAN NO. } { }^ The Commo"Wealth of Massachusetts 7 f' •+rij -=f;.� Department of Industrial Accidents �»1 60# li ashington Street x� Boston.Mass 02111 Workers' Compensation Insurance AlMdavit AR 1• ton• n ts•.nt mformat � �„__,� ,; name* locition• city phone# 1 am a homeowner performing all work myself. 1 am a sole proprietor and have no one working in any capacity 1 '1 am an employer providing workers' compensation for my employees working on this job. asldrets• �/1//./JiC/f��� l� phone I rzIF-�7S ' sup , .# I am a sole proprietor,general contractor, or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: company name! - address: Slh' Rhone#: iA lltM.wn wn ppluh•# • +.i1.� ..N.._�.�. � .. Kl[t.7.—r•4,.:.71�'=`�•"�%'=�•�R+^ '•��.� _ _—_ ____ "77CF/�TRIiR'•;l_iJ=A:�•:fitR�.e�i"^��Su�-'_'��TIS!�T=�.'r'7S c6mpany name! address: - ... city: phone#• insurance co i •' politry# :Attach additiona!'sheet if tieeessa Y" -f �••� Yw Y� •' ,A•� 477C L .'�.o. Failure to secure coverace as required under Section SA of 51GL 152 can lead to the imposition of criminal penalties of a fine up to 51.500.00 and/or one years'imprisonment as well as civil penalties in the form of STOP WORK ORDER and a fine of S100.00 a day against me. 1 understand that a copy of this statement may be forwarded to the Office of investigations of the D1A for coyeMge verification. I do hereby cert fj•under the pains and penalties of pei jury that the infontwtion prm7ded above is trite and correa 'Signature ate Print name - ' Phone# 5���7� 7iS� official use only do not write in this area to be completed by city or town official city or town: permit/license# rritluiiding Department •. (3Ircensing Board:: C3 check if immediate response is required . OSelectmen's Office (3I1ealth Department contact person: phone it; rJOther --[—Wed 3;9i PJAL . Information and Instructions s General Laws chapter 152 section 25 requires all em lovers to provide workers' compensation for their acltusctt.Massachusetts ,pP employees: As quoted from the"law",an emphtree is defined as every person in the service of another under any contract ofhire, express or implied, oral or written. An enrplaver is defined as an individual, partnership,association,corporation or other isgal entity, or any two or more o the fore�soing 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 1'52 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 itas not produced acceptable evidence of compliance with the insurance coverage required. Additionaliv. 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. 777 .p..:i+;'r;+� •i }, '�,,:s,.Try:.'-1;i •�•.� .�' •+•;.',:. 1 �•r. .sit It •n"!�ti r'•T��•"'t �. 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 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. �_ ''- rY: �A.iL".'.+µvt'iJ�:A i'•♦ (ij.:. .i+77 `v T'. ..~ •'� \!4. 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 permittlicense number which will be used as a reference number. The affidavits may be returned 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. • w4. �- -•w•� v.:-•,..,..ems.!'• :.i _• '•.r.. 77.:.r-Z;77.wa<.w; .Nf.iei:.w�i►•..w .,e.—:.: '�.i?�►., :w,�':• :�. The Department's address, telephone and fax number The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street -- Boston,Ma. 02111 ' a fax#: (617) 727-7749 phone#: (617) 7274900 ext. 406, 409 or 375 f . ISSUE DA TE /DD :::::::.::::::::::::::::: 1� +�:: , .::+ � I�f4 ak . :.:::::::::::::::::::::::::::::::::::::::::::::: .::.::::::::::::::::::::::::::::................................................::::::::.:::::::::::::::::::::::::::::::::::::::::..................................................:.::::::. .::::::. ........... 0 6 0 4 9 6 PP4))UCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE W.H. ESHBAUGH INS. AGCY. INC. DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 805 WEST MAIN STREET HYANNIS, MA 02.601 COMPANIES AFFORDING COVERAGE CODE SUB-CODE COMPAN LETTER Y A EASTERN CASUALTY ' COMPANY B INSURED LETTER DAVID R. COX DBA COMPANY LETTER C DAVID COX REMODELING P.O. BOX 401 COMPANY D LETTER SOUTH YARMOUTH, MA 02664 COMPANY E LETTER THISI .............................:::::::::::>:o::»;;;:»::::•;:•:;::;:•;:;:;:;;>;»;;:;:::<;;•:;:;:;;::;::•::•::•::•;:;:;:;;::;>:^:a>:::::•:::::•;::•::•::;•:;;:::•::a:»::: S S TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH_RESPECT TO WHICH THIS } CERTIFICATE MAY BE'SSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO POLICY EFFECTIVE POLICY EXPIRATIO TR TYPE OF INSURANCE POLICY NUMBER LQyII7'S DATE pNM/DD/YY) DATE(MM/DD/YY) GENERAL LIABILITY GENERAL AGGREGATE $ COMMERCIAL GEN.LIABILITY PRODUCTS-COMP/OP AGG. $ CLAIMS MADE D OCCUR. PERSONAL&ADV.INJURY $ OWNER'S&CONTRACTOR'S PROT. EACH OCCURRENCE $ FIRE DAMAGE(Any one fire) $ MED.EXPENSE(Any one person) $ AUTOMOBILE LIABILITY COMBINED SINGLE ANY AUTO LIMIT $ ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS r= (Per person) $ HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per Accident) $ GARAGE LIABILITY PROPERTY DAMAGE $ EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM STATUTORY LIMITS WORKER'S COMPENSATION WCVO 019 5 3 9 0 4-14-9 6 0 4-14-.7 / EACH ACCIDENT $'. 1•. 10000 O AND EMPLOYERS'LIABILITY DISEASE-POLICY LIMIT $ 500, O O DISEASE-EACH EMPLOYEE $ 100, 0 O OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE AMERI CAN RED CROSS '`:` EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO ROBERT GRUENWALD `' MAIL10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE PO BOX 428 » LEFT,BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. OS TERV I LLE MA. 02655 AUTHORIZED REPRESENTATIVE #10497-3* .: .. .: :::::::::::::::::::::::.:::::::::::::::::::::::::::::::....::::::•r n•.•::•. :::::::::::::::::::::: :.: :::::::::: .. .. ::. ,.rr:::::....., 4 \ }fix Y- ♦ ADM r 4 I hr �. �� 1DdII7/IILIYItIIICOA.[2 O�i/ �6Q�6 �\-�. OEPRTMENT OF PUBLIC SAFETY , . CONSTRUt! SUPERVISOR LICENSE. T -Expires' - `�09T1ID:R COX 401 6 S YRRNOUIN, NA 0264 •'' L y ,*THETO�y TOWN OF BAR.NSTABLE i • i 33AUSTAXt i 9� a�Y�,e�� BUILDING INSPECTOR s �[ �^ APPLICATION FOR PERMIT TO /7 �.1. // TYPE OF CONSTRUCTION .....t7t.a .''! �............................................................................ ................................................ 9. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: s l 1� f Location ......02-5 .�...�...........�!��..LC. !�......... . ... ..........!�.y.. .�/�. .....✓....:..�.�.5,. ................................. ProposedUse ....... ....... 1^4 ....... . .......................................................... ZoningDistrict �.. J`� C.......... ..................................................Fire District ....... ....�J......!�.�1..<.�°........................................... Name of Owner `. r....�, � ✓ �� Wit( l`F ?...n................ ress ....................,yam y.ss��C........................... .�.......... j /41I�� �itt�iP,o. Name of Builder / / ... ....., f 4'41P!?.4..`.! ..Address ..............1 .....!i!/€°./...P ....................... XN3..... Name of Architect 6! ..........f....!.e,....'.`..l. .h.�. Addresses {'f L'j,. .... .... .........�(`...�... .....................� Number. of Rooms ..................................................................Foundation ........ .............c..V. C..i...... Exterior ..... ........`.�d� .......�„?.. `7. 'tw.Roofing ...� �....... .......`. ......... Floors ./..�l..d..14.'��5..�'-� .....Interior ....�! ....`e�;�/'®•� �` .. ........................... ........... o � Heating ! `'ef ............ Qyr . Plumbing ....... .! :............... Fireplace .............../ .. ..........................................................Approximate CosY.:....1.�.� ,�„d-+�....................... �,/ Difinitive Plan Approved by Planning Board __�QE_"_e_T______19 Diagram of Lot and Building with Dimensions I 71 3 °7 • —�+I n i I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the.1albov). ti construction. a Name ..... Cape Cod Chapter American Red Cross No .1�769.... Permit for ....,,,,,add to Red Cross building ............................................................................... Location ......286..South..St................................ .....................Hyanni s........................................... Owner ....•.Cape Cod Chapter American Red Cross Type of Construction frame .......................................... ................................................................................ Plot ............................ Lot ................................ June 12 68 Permit Granted ........................................19 Date of Inspection ..✓.. 7..... .!?........19 Date Completed 19 i k l . r PERMIT REFUSED ................... .................................... 19 ............ ............................................................... t ................................................................................ I ............................................................................... ............................................................................... t. Approved .,.............................................. 19 ............................................................................... ...............................................................................